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Expanding Vision Services at Federally Qualified Health Centers.
IF 7.8 1区 医学 Q1 OPHTHALMOLOGY Pub Date : 2025-02-13 DOI: 10.1001/jamaophthalmol.2025.0003
Sally S Ong
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引用次数: 0
Pixel Intensity to Estimate Choroidal Tumor Thickness Using 2-Dimensional Ultra-Widefield Images
IF 8.1 1区 医学 Q1 OPHTHALMOLOGY Pub Date : 2025-02-06 DOI: 10.1001/jamaophthalmol.2024.6064
Michael D. Yu, Michael Heiferman, Edward Korot, Aneesha Ahluwalia, Gina Yu, Prithvi Mruthyunjaya
ImportanceTumor thickness is a well-established risk factor for malignant transformation of choroidal nevus into melanoma. To date, reliable evaluation of tumor thickness relies on B-scan ultrasonography, which is frequently unavailable at nonsubspecialty clinics where most melanocytic choroidal lesions (MCLs) are first diagnosed.ObjectiveTo describe a technique for potential rapid and reliable estimation of MCL thickness using only Optomap ultra-widefield (UWF) images without B-scan ultrasonography.Design, Setting, and ParticipantsThis retrospective, exploratory, cross-sectional analysis of consecutive MCLs diagnosed at Byers Eye Institute, Stanford University, Palo Alto, California, investigates the quantitative correlation between B-scan ultrasonographic thickness of MCLs with the relative pixel intensity of MCLs on green-channel (GC) Optomap UWF images. Pixel intensity overlying the lesion was standardized to the pixel intensity surrounding the lesion (pixel intensity difference [PID]), which was then correlated with ultrasonographic tumor thickness in all study lesions using linear regression analysis. Data were collected from January 1, 2019, to July 1, 2021.Main Outcomes and MeasuresThe correlation between ultrasonographic tumor thickness and PID was measured. Performance (sensitivity and specificity) of the regression analysis trendline in estimating tumor thickness was also determined.ResultsA total of 138 MCLs from 138 patients (mean age, 57.0 years; 51% female) were included, comprising 125 that were nevi and 13 that were melanoma. The mean ultrasonographic tumor thickness was 1.1 mm (median, 0.8 mm; range, 0.2-5.5 mm), with a mean PID of 2.13. Stratifying lesions by ultrasonographic thickness (<1.0 mm vs 1.0-2.0 mm vs >2.0 mm), the mean PID increased (−1.95 vs 3.72 vs 17.62; P < .001) as mean thickness increased (0.5 mm vs 1.4 mm vs 3.3 mm; P < .001). PID was correlated with tumor thickness (R2 = 0.823; 95% CI, 0.770-0.875; P < .001) across lesions of all sizes.Conclusions and RelevanceIn this proof-of-principle study, GC-derived lesion intensity correlated well with ultrasonographic tumor thickness. Leveraging this correlation, this study demonstrates a technique for potentially reliable and rapid estimation of tumor thickness using UWF Optomap images without the use of B-scan ultrasonography.
{"title":"Pixel Intensity to Estimate Choroidal Tumor Thickness Using 2-Dimensional Ultra-Widefield Images","authors":"Michael D. Yu, Michael Heiferman, Edward Korot, Aneesha Ahluwalia, Gina Yu, Prithvi Mruthyunjaya","doi":"10.1001/jamaophthalmol.2024.6064","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2024.6064","url":null,"abstract":"ImportanceTumor thickness is a well-established risk factor for malignant transformation of choroidal nevus into melanoma. To date, reliable evaluation of tumor thickness relies on B-scan ultrasonography, which is frequently unavailable at nonsubspecialty clinics where most melanocytic choroidal lesions (MCLs) are first diagnosed.ObjectiveTo describe a technique for potential rapid and reliable estimation of MCL thickness using only Optomap ultra-widefield (UWF) images without B-scan ultrasonography.Design, Setting, and ParticipantsThis retrospective, exploratory, cross-sectional analysis of consecutive MCLs diagnosed at Byers Eye Institute, Stanford University, Palo Alto, California, investigates the quantitative correlation between B-scan ultrasonographic thickness of MCLs with the relative pixel intensity of MCLs on green-channel (GC) Optomap UWF images. Pixel intensity overlying the lesion was standardized to the pixel intensity surrounding the lesion (pixel intensity difference [PID]), which was then correlated with ultrasonographic tumor thickness in all study lesions using linear regression analysis. Data were collected from January 1, 2019, to July 1, 2021.Main Outcomes and MeasuresThe correlation between ultrasonographic tumor thickness and PID was measured. Performance (sensitivity and specificity) of the regression analysis trendline in estimating tumor thickness was also determined.ResultsA total of 138 MCLs from 138 patients (mean age, 57.0 years; 51% female) were included, comprising 125 that were nevi and 13 that were melanoma. The mean ultrasonographic tumor thickness was 1.1 mm (median, 0.8 mm; range, 0.2-5.5 mm), with a mean PID of 2.13. Stratifying lesions by ultrasonographic thickness (&amp;amp;lt;1.0 mm vs 1.0-2.0 mm vs &amp;amp;gt;2.0 mm), the mean PID increased (−1.95 vs 3.72 vs 17.62; <jats:italic>P</jats:italic> &amp;amp;lt; .001) as mean thickness increased (0.5 mm vs 1.4 mm vs 3.3 mm; <jats:italic>P</jats:italic> &amp;amp;lt; .001). PID was correlated with tumor thickness (<jats:italic>R</jats:italic><jats:sup>2</jats:sup> = 0.823; 95% CI, 0.770-0.875; <jats:italic>P</jats:italic> &amp;amp;lt; .001) across lesions of all sizes.Conclusions and RelevanceIn this proof-of-principle study, GC-derived lesion intensity correlated well with ultrasonographic tumor thickness. Leveraging this correlation, this study demonstrates a technique for potentially reliable and rapid estimation of tumor thickness using UWF Optomap images without the use of B-scan ultrasonography.","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":"9 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143191968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
COVID-19 Pandemic and Rates of Common Ophthalmic Procedures Among Medicare Beneficiaries
IF 8.1 1区 医学 Q1 OPHTHALMOLOGY Pub Date : 2025-02-06 DOI: 10.1001/jamaophthalmol.2024.6065
Raziyeh Mahmoudzadeh, Mariam Samuel, Sydney Wheeler, Mirataollah Salabati, Christopher T. Leffler, Jessica D. Randolph
ImportanceThe COVID-19 pandemic has altered health care delivery, including ophthalmic care. Understanding how the pandemic has changed the rates of commonly performed ophthalmic procedures is crucial for assessing the broader implications for patient care and resource allocation.ObjectiveTo estimate the changes in the rates of the 10 most prevalent ophthalmic procedures among Medicare beneficiaries during the COVID-19 pandemic and to explore the geographic disparities in these shifts.DesignThis retrospective US cross-sectional study compared data from Medicare Part B National Summary Data Files for the calendar years 2019 and 2020. Participants included Medicare beneficiaries undergoing the 10 most common ophthalmic procedures. Data included a total of 3 879 533 procedure entries in 2019 and 3 181 439 entries in 2020. Data were analyzed from January 1, 2019, to December 31, 2020.ExposureCOVID-19 pandemic.Main Outcomes and MeasuresThe primary outcome was the percentage change in the number of beneficiaries for each of the 10 most common ophthalmic procedures in each state.ResultsThere was an overall decrease of −17.9% in the rates of the 10 ophthalmic procedures from 2019 to 2020 (99% CI, −24.8% to −11.3%). The largest reduction was observed in laser peripheral iridotomy (−43.6%; 99% CI, −51.7% to −31.9%), while eye drug injections saw the smallest decrease (−1.5%; 99% CI, −3.3% to 0.3%). Cataract surgery also saw a reduction of −23.0% (99% CI, −28.8% to −18.7%). Regionally, the Northeast experienced the greatest reductions in cataract surgery (−27.9%; 99% CI, −32.8% to −22.3%).Conclusions and RelevanceThese results show that the COVID-19 pandemic caused a notable drop in the number of common ophthalmic procedures among Medicare beneficiaries, especially in laser peripheral iridotomy, while eye drug injections saw minimal changes. The Northeast experienced the largest reductions, highlighting the pandemic’s association with changes in eye care and indicating a need for focused recovery efforts in the hardest hit areas.
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引用次数: 0
Error in Methods and eTable 1.
IF 7.8 1区 医学 Q1 OPHTHALMOLOGY Pub Date : 2025-02-06 DOI: 10.1001/jamaophthalmol.2025.0060
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引用次数: 0
Can Medicare Data Describe COVID-19 Practice Pattern Changes?
IF 7.8 1区 医学 Q1 OPHTHALMOLOGY Pub Date : 2025-02-06 DOI: 10.1001/jamaophthalmol.2024.6183
Sean T Berkowitz, Avni P Finn
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引用次数: 0
Importance of Thickness When Evaluating Choroidal Tumors.
IF 7.8 1区 医学 Q1 OPHTHALMOLOGY Pub Date : 2025-02-06 DOI: 10.1001/jamaophthalmol.2024.6182
Carol L Shields
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引用次数: 0
Primary Conjunctival Rhabdomyosarcoma Presenting as an Enlarging Papillomatous Lesion in a 3-Year-Old
IF 8.1 1区 医学 Q1 OPHTHALMOLOGY Pub Date : 2025-02-06 DOI: 10.1001/jamaophthalmol.2024.6228
Zara Saleem, Alan D. Proia, Lars M. Wagner, Olivia J. Killeen, Sharon F. Freedman
This case report describes a rapidly growing conjunctival lesion in a 3-year-old patient, which was incompletely resected and diagnosed as rhabdomyosarcoma.
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引用次数: 0
Progressive Eyelid Lesions in a Woman With Essential Thrombocythemia. 原发性血小板增多症女性进行性眼睑病变。
IF 7.8 1区 医学 Q1 OPHTHALMOLOGY Pub Date : 2025-02-01 DOI: 10.1001/jamaophthalmol.2024.5304
Akshara R Legala, Marissa K Shoji, Don O Kikkawa
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引用次数: 0
Five-Year Outcomes of Lenadogene Nolparvovec Gene Therapy in Leber Hereditary Optic Neuropathy. Lenadogene Nolparvovec基因治疗Leber遗传性视神经病变的5年疗效。
IF 7.8 1区 医学 Q1 OPHTHALMOLOGY Pub Date : 2025-02-01 DOI: 10.1001/jamaophthalmol.2024.5375
Patrick Yu-Wai-Man, Nancy J Newman, Valérie Biousse, Valerio Carelli, Mark L Moster, Catherine Vignal-Clermont, Thomas Klopstock, Alfredo A Sadun, Robert C Sergott, Rabih Hage, Simona Degli Esposti, Chiara La Morgia, Claudia Priglinger, Rustum Karanja, Magali Taiel, José-Alain Sahel
<p><strong>Importance: </strong>Limited studies have assessed the long-term benefit/risk of gene therapy for Leber hereditary optic neuropathy (LHON).</p><p><strong>Objective: </strong>To determine the safety and efficacy of lenadogene nolparvovec in patients with LHON due to the MT-ND4 gene variant for up to 5 years after administration.</p><p><strong>Design, setting, and participants: </strong>The RESCUE and REVERSE Long-Term Follow-up Study (RESTORE), conducted from 2018 to 2022, is the 5-year follow-up study of the 2 phase 3 clinical studies RESCUE (Efficacy Study of Lenadogene Nolparvovec for the Treatment of Vision Loss Up to 6 Months From Onset in LHON Due to the MT-ND4 Mutation) and REVERSE (Efficacy Study of Lenadogene Nolparvovec for the Treatment of Vision Loss From 7 Months to 1 Year From Onset in LHON Due to the MT-ND4 Mutation). At the end of each study, ie, 2 years after gene therapy administration, patients were offered enrollment in the RESTORE trial, a multinational, multicenter, prospective study, for an additional 3 years of follow-up. Patients with LHON due to the MT-ND4 gene variant received lenadogene nolparvovec in 1 eye and a sham injection in the other eye.</p><p><strong>Intervention: </strong>Lenadogene nolparvovec was administered as a single intravitreal injection in the RESCUE/REVERSE studies.</p><p><strong>Main outcomes and measures: </strong>Measures included best-corrected visual acuity (BCVA), quality of life using the National Eye Institute visual functioning questionnaire 25 (NEI VFQ-25), and adverse events.</p><p><strong>Results: </strong>Among the 76 patients who received gene therapy in the RESCUE (n = 39) and REVERSE (n = 37) studies, 72 (94.7%) completed these studies; 62 patients (81.6%) participated in the RESTORE trial, and 55 patients (72.4%) completed the 5-year follow-up. Participants were mostly male (49 [79.0%]) with a mean (SD) age of 35.9 (15.3) years at treatment. At baseline, the mean (SD) BCVA was 1.5 (0.5) logMAR (20/600 Snellen) in eyes to be treated with lenadogene nolparvovec and 1.4 (0.5) logMAR (20/500) in sham eyes. At the end of the RESCUE/REVERSE trials, ie, 2 years after treatment, eyes treated with lenadogene nolparvovec and eyes treated with sham reached a mean BCVA value of 1.4 (0.6) logMAR (20/500). The mean (SD) change from baseline to year 2 was -0.05 (0.6) logMAR (+1 line) and 0.01 (0.6) logMAR (-0 line) in gene therapy-treated and sham eyes, respectively (difference, -0.03; 95% CI, -0.16 to 0.09; P = .60). Five years after treatment, the bilateral improvement from nadir was similar to that observed at 2 years, with a mean (SD) change in BCVA of -0.4 (0.5) logMAR (more than +4 lines) for eyes treated with lenadogene nolparvovec and -0.4 (0.4) logMAR (+4 lines) for eyes treated with sham (difference, -0.05; 95% CI, -0.15 to 0.04; P = .27). An improvement of at least -0.3 logMAR (+3 lines) from the nadir in at least 1 eye was observed in 66.1% of participants (41 of 62). Between
重要性:有限的研究评估了基因治疗Leber遗传性视神经病变(LHON)的长期获益/风险。目的:确定lenadogene nolparvovec在MT-ND4基因变异的LHON患者用药后长达5年的安全性和有效性。设计、设置和参与者:救援和扭转长期随访研究(恢复),进行了从2018年到2022年,5年的随访研究2 3期临床研究救援(功效研究Lenadogene Nolparvovec治疗视力丧失从发病6个月LHON由于MT-ND4突变)和反向(功效研究Lenadogene Nolparvovec治疗视力丧失从7个月到1年从发病LHON由于MT-ND4突变)。在每项研究结束时,即基因治疗后2年,患者被纳入RESTORE试验,这是一项多国、多中心、前瞻性研究,并进行额外3年的随访。MT-ND4基因变异导致的LHON患者在一只眼接受lenadogene nolparvovec治疗,另一只眼接受假注射。干预:Lenadogene nolparvovec在RESCUE/REVERSE研究中作为单次玻璃体内注射。主要结果和测量:测量包括最佳矫正视力(BCVA)、使用美国国家眼科研究所视力功能问卷25 (NEI VFQ-25)的生活质量和不良事件。结果:在RESCUE (n = 39)和REVERSE (n = 37)研究中接受基因治疗的76例患者中,72例(94.7%)完成了这些研究;62例患者(81.6%)参加了RESTORE试验,55例患者(72.4%)完成了5年随访。参与者大多为男性(49岁[79.0%]),治疗时平均(SD)年龄为35.9(15.3)岁。基线时,lenadogene nolparvovec治疗眼的平均(SD) BCVA为1.5 (0.5)logMAR (20/600 Snellen),假眼的平均(SD) BCVA为1.4 (0.5)logMAR(20/500)。在RESCUE/REVERSE试验结束时,即治疗后2年,lenadogene nolparvovec治疗和sham治疗的眼睛的平均BCVA值达到1.4 (0.6)logMAR(20/500)。基因治疗组和假眼组从基线到第2年的平均(SD)变化分别为-0.05 (0.6)logMAR(+1线)和0.01 (0.6)logMAR(-0线)(差异为-0.03;95% CI, -0.16 ~ 0.09;p = .60)。治疗5年后,双侧从最低点的改善与2年时相似,lenadogene nolparvovec治疗组的BCVA平均(SD)变化为-0.4 (0.5)logMAR(超过+4线),sham治疗组的BCVA平均(SD)变化为-0.4 (0.4)logMAR(+4线)(差异为-0.05;95% CI, -0.15 ~ 0.04;p = .27)。66.1%的参与者(62人中有41人)至少有一只眼睛从最低点至少改善了-0.3 logMAR(+3线)。在2至5年间,4名参与者出现眼内炎症,其中lenadogene nolparvovec治疗的眼睛有8例,sham治疗的眼睛有1例。结论和相关性:在这项RESTORE试验的分析中,对单方lenadogene nolparvovec治疗的MT-ND4基因变异导致的LHON患者的随访显示,BCVA的持续双侧改善以及治疗后长达5年的良好安全性。随着时间的推移,这种持续获益的证据为在这些患者中使用基因治疗提供了希望。试验注册:ClinicalTrials.gov标识符:NCT03406104。
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引用次数: 0
Risk Factors for Retinopathy in Young Adults With Type 1 Diabetes. 1型糖尿病青年视网膜病变的危险因素
IF 7.8 1区 医学 Q1 OPHTHALMOLOGY Pub Date : 2025-02-01 DOI: 10.1001/jamaophthalmol.2024.5274
Shilan Seyed Ahmadi, Johnny Ludvigsson, Henrik Imberg, Thomas Nyström, Marcus Lind
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引用次数: 0
期刊
JAMA ophthalmology
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