Pub Date : 2024-09-19DOI: 10.1001/jamaophthalmol.2024.3779
Byron L Lam
{"title":"Detection and Referral of Depression in Patients With Visual Impairment: A Call for Practical Training and Methods.","authors":"Byron L Lam","doi":"10.1001/jamaophthalmol.2024.3779","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2024.3779","url":null,"abstract":"","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":" ","pages":""},"PeriodicalIF":7.8,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142287374","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}
ImportanceFederally qualified health centers (FQHCs) are federally funded community health clinics that provide comprehensive care to underserved populations, making them potential opportunities to offer eye care and address unmet health care needs. Evaluating the presence of eye care services at FQHCs in Florida is important in understanding and addressing possible gaps in care for the state’s large uninsured and underserved populations.ObjectiveTo determine whether FQHCs in Florida are currently offering eye care services, where they are available, what services are being offered, and who provides them.Design, Setting, and ParticipantsThis study used a cross-sectional design conducted within 1 year (from November 2023 to February 2024). FQHCs listed in the US Health Resources and Services Administration database were contacted by telephone to inquire about the presence of eye care services. The FQHCs were located in both urban and rural areas in Florida to assess accessibility of eye care services in the state. School-based health centers and nonophthalmic specialty care health centers were excluded. A total of 437 FQHCs were included.Main Outcomes and MeasuresPrimary outcomes included the presence of eye care services, types of services offered, clinician type (optometrists or ophthalmologists), frequency of services, and availability of pediatric services.ResultsAmong 437 FQHCs contacted, only 39 (8.9%) reported offering eye care services. These services primarily included vision examinations, glasses prescriptions, and dilated eye examinations. Optometrists were the primary providers of services at all clinics, with no clinics reporting care by ophthalmologists. The frequency of services varied considerably, ranging from daily to bimonthly. Thirty-seven (94.9%) of the 39 clinics offered pediatric eye care services.Conclusions and RelevanceThe low prevalence of FQHCs with eye care services and the absence of ophthalmologist-provided care highlight a gap in access to eye care for underserved populations in Florida. These findings support investigations into implementing eye care services and interventions at FQHCs that might enhance access and equity in eye care.
{"title":"Potential Gaps in Eye Care Based on Evaluation of Federally Qualified Health Centers","authors":"Nikhita Yadlapalli, Ruby Hollinger, Shannan Berzack, Daniela Spies, Annika Patel, Jayanth Sridhar","doi":"10.1001/jamaophthalmol.2024.3569","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2024.3569","url":null,"abstract":"ImportanceFederally qualified health centers (FQHCs) are federally funded community health clinics that provide comprehensive care to underserved populations, making them potential opportunities to offer eye care and address unmet health care needs. Evaluating the presence of eye care services at FQHCs in Florida is important in understanding and addressing possible gaps in care for the state’s large uninsured and underserved populations.ObjectiveTo determine whether FQHCs in Florida are currently offering eye care services, where they are available, what services are being offered, and who provides them.Design, Setting, and ParticipantsThis study used a cross-sectional design conducted within 1 year (from November 2023 to February 2024). FQHCs listed in the US Health Resources and Services Administration database were contacted by telephone to inquire about the presence of eye care services. The FQHCs were located in both urban and rural areas in Florida to assess accessibility of eye care services in the state. School-based health centers and nonophthalmic specialty care health centers were excluded. A total of 437 FQHCs were included.Main Outcomes and MeasuresPrimary outcomes included the presence of eye care services, types of services offered, clinician type (optometrists or ophthalmologists), frequency of services, and availability of pediatric services.ResultsAmong 437 FQHCs contacted, only 39 (8.9%) reported offering eye care services. These services primarily included vision examinations, glasses prescriptions, and dilated eye examinations. Optometrists were the primary providers of services at all clinics, with no clinics reporting care by ophthalmologists. The frequency of services varied considerably, ranging from daily to bimonthly. Thirty-seven (94.9%) of the 39 clinics offered pediatric eye care services.Conclusions and RelevanceThe low prevalence of FQHCs with eye care services and the absence of ophthalmologist-provided care highlight a gap in access to eye care for underserved populations in Florida. These findings support investigations into implementing eye care services and interventions at FQHCs that might enhance access and equity in eye care.","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":"1 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142275624","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}
Pub Date : 2024-09-19DOI: 10.1001/jamaophthalmol.2024.2945
Zuyi Yang,Youxin Chen,Xinyu Zhao
{"title":"Synchysis Scintillans After Long-Standing History of Retinal Detachment.","authors":"Zuyi Yang,Youxin Chen,Xinyu Zhao","doi":"10.1001/jamaophthalmol.2024.2945","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2024.2945","url":null,"abstract":"","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":"35 1","pages":"e242945"},"PeriodicalIF":8.1,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142273377","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}
Pub Date : 2024-09-19DOI: 10.1001/jamaophthalmol.2024.3641
Hae Rang Kim, Nang Kyeong Lee, Youngsong Suh, Christopher Seungkyu Lee, Suk Ho Byeon, Sung Soo Kim, Seung Won Lee, Yong Joon Kim
ImportanceThere is a lack of large-scale clinical studies exploring mental health among patients with retinitis pigmentosa (RP). Additionally, few studies have evaluated the associations of visual impairment with mental health in young patients.ObjectiveTo investigate the association between depressive disorder and RP.Design, Setting, and ParticipantsThis was a retrospective, nationwide, population-based cohort study using data obtained from the Health Insurance Review and Assessment service in Korea between 2008 and 2022. A total of 10 879 individuals who were newly diagnosed with RP between January 2011 and December 2021, as verified by both the RP registration code (National Registry of Rare and Intractable Disease in Korea code V209) and diagnostic code (<jats:italic>International Statistical Classification of Diseases, 10th Revision</jats:italic> code H35.51), were included. Data analysis was performed from October 2023 to January 2024.ExposureDiagnosis of RP.Main Outcomes and MeasuresParticipants were categorized into 3 groups based on age at diagnosis (&lt;20, 20-39, and ≥40 years). The incidence of depressive disorder in RP was determined after excluding those diagnosed with depressive disorder prior to RP diagnosis. Age- and sex-adjusted standardized incidence ratios (SIRs) of depressive disorder in patients with RP compared with the general population were calculated. Subgroup analyses by sex and age group were conducted.ResultsA total of 10 879 patients (638 aged &lt;20 years, 2233 aged 20-39 years, and 8008 aged ≥40 years; 5710 [52.5%] female) newly diagnosed with RP between 2011 and 2021 were included. The 10-year cumulative incidence of depressive disorder was 17.67% (95% CI, 16.57%-18.84%) in patients with RP. Subgroup analysis showed higher incidence of depressive disorder in female patients (hazard ratio [HR], 1.46; 95% CI, 1.29-1.65; <jats:italic>P</jats:italic> &lt; .001) and those aged 40 years or older (HR, 1.93; 95% CI, 1.63-2.29; <jats:italic>P</jats:italic> &lt; .001). The overall SIR of depressive disorder in patients with RP was 1.19 (95% CI, 1.12-1.27; <jats:italic>P</jats:italic> &lt; .001), indicating a higher risk of depressive disorder compared with that in the general population. Both male and female patients with RP showed increased incidence rates of depressive disorder (17.53 [95% CI, 15.91-19.27] and 25.57 [95% CI, 23.58-27.67] per 1000 person-years, respectively) and increased SIRs of depressive disorder (1.21 [95% CI, 1.10-1.33] and 1.18 [95% CI, 1.09-1.28], respectively) (all <jats:italic>P</jats:italic> &lt; .001) compared with the general population. Subgroup analysis by age group showed that the SIR peaked in patients in their 20s (1.50; 95% CI, 1.17-1.90; <jats:italic>P</jats:italic> = .006) and aged 60 years or older (1.25; 95% CI, 1.14-1.37; <jats:italic>P</jats:italic> &lt; .001).Conclusions and RelevanceIndividuals diagnosed with RP had a higher
{"title":"Incidence and Risk of Depressive Disorder in Patients With Retinitis Pigmentosa","authors":"Hae Rang Kim, Nang Kyeong Lee, Youngsong Suh, Christopher Seungkyu Lee, Suk Ho Byeon, Sung Soo Kim, Seung Won Lee, Yong Joon Kim","doi":"10.1001/jamaophthalmol.2024.3641","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2024.3641","url":null,"abstract":"ImportanceThere is a lack of large-scale clinical studies exploring mental health among patients with retinitis pigmentosa (RP). Additionally, few studies have evaluated the associations of visual impairment with mental health in young patients.ObjectiveTo investigate the association between depressive disorder and RP.Design, Setting, and ParticipantsThis was a retrospective, nationwide, population-based cohort study using data obtained from the Health Insurance Review and Assessment service in Korea between 2008 and 2022. A total of 10 879 individuals who were newly diagnosed with RP between January 2011 and December 2021, as verified by both the RP registration code (National Registry of Rare and Intractable Disease in Korea code V209) and diagnostic code (<jats:italic>International Statistical Classification of Diseases, 10th Revision</jats:italic> code H35.51), were included. Data analysis was performed from October 2023 to January 2024.ExposureDiagnosis of RP.Main Outcomes and MeasuresParticipants were categorized into 3 groups based on age at diagnosis (&amp;lt;20, 20-39, and ≥40 years). The incidence of depressive disorder in RP was determined after excluding those diagnosed with depressive disorder prior to RP diagnosis. Age- and sex-adjusted standardized incidence ratios (SIRs) of depressive disorder in patients with RP compared with the general population were calculated. Subgroup analyses by sex and age group were conducted.ResultsA total of 10 879 patients (638 aged &amp;lt;20 years, 2233 aged 20-39 years, and 8008 aged ≥40 years; 5710 [52.5%] female) newly diagnosed with RP between 2011 and 2021 were included. The 10-year cumulative incidence of depressive disorder was 17.67% (95% CI, 16.57%-18.84%) in patients with RP. Subgroup analysis showed higher incidence of depressive disorder in female patients (hazard ratio [HR], 1.46; 95% CI, 1.29-1.65; <jats:italic>P</jats:italic> &amp;lt; .001) and those aged 40 years or older (HR, 1.93; 95% CI, 1.63-2.29; <jats:italic>P</jats:italic> &amp;lt; .001). The overall SIR of depressive disorder in patients with RP was 1.19 (95% CI, 1.12-1.27; <jats:italic>P</jats:italic> &amp;lt; .001), indicating a higher risk of depressive disorder compared with that in the general population. Both male and female patients with RP showed increased incidence rates of depressive disorder (17.53 [95% CI, 15.91-19.27] and 25.57 [95% CI, 23.58-27.67] per 1000 person-years, respectively) and increased SIRs of depressive disorder (1.21 [95% CI, 1.10-1.33] and 1.18 [95% CI, 1.09-1.28], respectively) (all <jats:italic>P</jats:italic> &amp;lt; .001) compared with the general population. Subgroup analysis by age group showed that the SIR peaked in patients in their 20s (1.50; 95% CI, 1.17-1.90; <jats:italic>P</jats:italic> = .006) and aged 60 years or older (1.25; 95% CI, 1.14-1.37; <jats:italic>P</jats:italic> &amp;lt; .001).Conclusions and RelevanceIndividuals diagnosed with RP had a higher","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":"23 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142275594","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}
Pub Date : 2024-09-12DOI: 10.1001/jamaophthalmol.2024.3458
Susan B Bressler,Abhijit Barve,Prasanna C Ganapathi,Katrin Beckmann,Rajendra S Apte,Dennis M Marcus,Kristine Baumane,Somesh Agarwal,Piotr Oleksy,David A Reichstein,Sunil S Patel,Jan Ernest,Rozsa Dégi,Vishali Gupta,Genichiro Kishino,Motohiro Kamei,Subramanian Loganathan,
ImportanceBiosimilars may be lower-cost alternatives to originator biologic products, potentially offering expanded access or reduced economic burden, but have not been evaluated with aflibercept in diabetic macular edema (DME).ObjectiveTo compare efficacy and safety of MYL-1701P, an aflibercept biosimilar, with reference aflibercept (Eylea [Regeneron]) in DME.Design, Setting, and ParticipantsThis was a double-masked, randomized clinical trial that included participants at 77 centers across the US, Europe, Japan, and India. Included in the analysis were individuals 18 years and older with type 1 or type 2 diabetes with central DME and best-corrected visual acuity (BCVA) letter score of 73 to 38 in the study eye using an Early Treatment Diabetic Retinopathy Study (ETDRS) chart. Study data were analyzed from October to December 2021.InterventionsFormulations of MYL-1701P (0.5-mg vial) or reference aflibercept every 4 weeks for 5 consecutive intravitreal injections, followed by every 8 weeks through week 52.Main Outcomes and MeasuresThe primary outcome was the adjusted difference in least squares mean (SE) change from baseline BCVA letter score at week 8 with an equivalence margin of -3 to +3 letters. Secondary outcomes included change in central subfield thickness (CST), BCVA, number of injections over 52 weeks, incidence of adverse events (AEs), and antidrug antibodies (ADAs).ResultsA total of 355 participants (mean [SD] age, 62.2 [9.2] years; 216 male [60.8%]) were randomized to MYL-1701P (179 participants [50.4%]) and aflibercept (176 participants [49.6%]). At week 8, mean (SE) change in BCVA was 6.60 (0.55) letters vs 6.56 (0.55) letters in the MYL-1701P vs aflibercept groups. The adjusted mean difference of 0.04 letters (90% CI, -1.16 to 1.24 letters) met the primary outcome. At week 8, mean (SE) change in CST was -112 (7) μm vs -124 (7) μm in the MYL-1701P vs aflibercept groups (adjusted mean difference, 12 μm; 90% CI, -3 to 26 μm). The incidence of treatment-emergent AEs in the MYL-1701P and aflibercept arms were ocular (30.9% [55 of 178] vs 29.5% [52 of 176]), serious ocular (0.6% [1 of 178] vs 1.1% [2 of 176]), nonocular (65.2% [116 of 178] vs 65.3% [115 of 176]), and serious nonocular (16.9% [30 of 178] vs 11.9% [21 of 176]). The mean (SD) total number of injections was 8.4 (2.1) vs 8.7 (1.8) in the MYL-1701P vs aflibercept groups. The incidence of treatment-induced or treatment-boosted ADAs was 2.8% (5 of 177) vs 5.7% (10 of 176) in the MYL-1701P vs aflibercept arms.Conclusions and RelevanceMYL-1701P demonstrated clinical equivalence in regard to efficacy, with comparable safety and immunogenicity, to reference aflibercept. These findings support use of MLY-1701P as an alternative to reference aflibercept.Trial RegistrationClinicalTrials.gov Identifier: NCT03610646.
重要性生物仿制药可能是原研生物制品的低成本替代品，有可能扩大使用范围或减轻经济负担，但尚未对阿弗利百普治疗糖尿病性黄斑水肿（DME）进行评估。目的比较阿弗利贝西普生物仿制药MYL-1701P与阿弗利贝西普参考药（Eylea [Regeneron]）在DME中的疗效和安全性。分析对象包括18岁及以上、患有中心性DME的1型或2型糖尿病患者，使用早期治疗糖尿病视网膜病变研究（ETDRS）图表对研究眼进行最佳矫正视力（BCVA）字母评分，结果为73至38分。主要结果和测量指标主要结果是第8周时与基线BCVA字母评分的最小二乘法均值（SE）变化的调整差值，等值线为-3到+3个字母。次要结果包括中央子场厚度（CST）变化、BCVA、52周内注射次数、不良事件（AE）发生率和抗药抗体（ADA）。结果共有355名参与者（平均[标码]年龄为62.2[9.2]岁；216名男性[60.8%]）随机接受了MYL-1701P（179名参与者[50.4%]）和aflibercept（176名参与者[49.6%]）治疗。第8周时，MYL-1701P组和aflibercept组BCVA的平均（SE）变化分别为6.60（0.55）个字母和6.56（0.55）个字母。调整后的平均差异为0.04个字母（90% CI，-1.16至1.24个字母），达到了主要结果。第8周时，MYL-1701P组与aflibercept组的CST平均（SE）变化为-112（7）μm，而MYL-1701P组为-124（7）μm（调整后的平均差异为12μm；90% CI为-3至26μm）。MYL-1701P组和aflibercept组的治疗突发AE发生率分别为眼部（30.9% [178例中的55例] vs 29.5% [176例中的52例]）、严重眼部（0.6% [178例中的1例] vs 1.1% [176例中的2例]）、非眼部（65.2% [178例中的116例] vs 65.3% [176例中的115例]）和严重非眼部（16.9% [178例中的30例] vs 11.9% [176例中的21例]）。MYL-1701P组与aflibercept组的平均（标度）总注射次数为8.4（2.1）次 vs 8.7（1.8）次。MYL-1701P组与aflibercept组的治疗诱导或治疗增强型ADA发生率为2.8%（177例中有5例），而MYL-1701P组为5.7%（176例中有10例）。这些研究结果支持使用MLY-1701P替代阿弗利百普：NCT03610646。
{"title":"Aflibercept Biosimilar MYL-1701P vs Reference Aflibercept in Diabetic Macular Edema: The INSIGHT Randomized Clinical Trial.","authors":"Susan B Bressler,Abhijit Barve,Prasanna C Ganapathi,Katrin Beckmann,Rajendra S Apte,Dennis M Marcus,Kristine Baumane,Somesh Agarwal,Piotr Oleksy,David A Reichstein,Sunil S Patel,Jan Ernest,Rozsa Dégi,Vishali Gupta,Genichiro Kishino,Motohiro Kamei,Subramanian Loganathan,","doi":"10.1001/jamaophthalmol.2024.3458","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2024.3458","url":null,"abstract":"ImportanceBiosimilars may be lower-cost alternatives to originator biologic products, potentially offering expanded access or reduced economic burden, but have not been evaluated with aflibercept in diabetic macular edema (DME).ObjectiveTo compare efficacy and safety of MYL-1701P, an aflibercept biosimilar, with reference aflibercept (Eylea [Regeneron]) in DME.Design, Setting, and ParticipantsThis was a double-masked, randomized clinical trial that included participants at 77 centers across the US, Europe, Japan, and India. Included in the analysis were individuals 18 years and older with type 1 or type 2 diabetes with central DME and best-corrected visual acuity (BCVA) letter score of 73 to 38 in the study eye using an Early Treatment Diabetic Retinopathy Study (ETDRS) chart. Study data were analyzed from October to December 2021.InterventionsFormulations of MYL-1701P (0.5-mg vial) or reference aflibercept every 4 weeks for 5 consecutive intravitreal injections, followed by every 8 weeks through week 52.Main Outcomes and MeasuresThe primary outcome was the adjusted difference in least squares mean (SE) change from baseline BCVA letter score at week 8 with an equivalence margin of -3 to +3 letters. Secondary outcomes included change in central subfield thickness (CST), BCVA, number of injections over 52 weeks, incidence of adverse events (AEs), and antidrug antibodies (ADAs).ResultsA total of 355 participants (mean [SD] age, 62.2 [9.2] years; 216 male [60.8%]) were randomized to MYL-1701P (179 participants [50.4%]) and aflibercept (176 participants [49.6%]). At week 8, mean (SE) change in BCVA was 6.60 (0.55) letters vs 6.56 (0.55) letters in the MYL-1701P vs aflibercept groups. The adjusted mean difference of 0.04 letters (90% CI, -1.16 to 1.24 letters) met the primary outcome. At week 8, mean (SE) change in CST was -112 (7) μm vs -124 (7) μm in the MYL-1701P vs aflibercept groups (adjusted mean difference, 12 μm; 90% CI, -3 to 26 μm). The incidence of treatment-emergent AEs in the MYL-1701P and aflibercept arms were ocular (30.9% [55 of 178] vs 29.5% [52 of 176]), serious ocular (0.6% [1 of 178] vs 1.1% [2 of 176]), nonocular (65.2% [116 of 178] vs 65.3% [115 of 176]), and serious nonocular (16.9% [30 of 178] vs 11.9% [21 of 176]). The mean (SD) total number of injections was 8.4 (2.1) vs 8.7 (1.8) in the MYL-1701P vs aflibercept groups. The incidence of treatment-induced or treatment-boosted ADAs was 2.8% (5 of 177) vs 5.7% (10 of 176) in the MYL-1701P vs aflibercept arms.Conclusions and RelevanceMYL-1701P demonstrated clinical equivalence in regard to efficacy, with comparable safety and immunogenicity, to reference aflibercept. These findings support use of MLY-1701P as an alternative to reference aflibercept.Trial RegistrationClinicalTrials.gov Identifier: NCT03610646.","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":"13 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142174623","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}
Pub Date : 2024-09-12DOI: 10.1001/jamaophthalmol.2024.3528
Azraa S Chaudhury,Maryam Ige,Shikha Marwah,Xueqing Zhou,Chris A Andrews,Kunal Kanwar,Charlesnika T Evans,Abel N Kho,Joshua D Stein,Paul J Bryar,Dustin D French,
ImportanceBesides race, little is known about how other social determinants of health (SDOH) affect quality of diabetic eye care.ObjectiveTo evaluate the association between multiple SDOH and monitoring for diabetic retinopathy (DR) in accordance with clinical practice guidelines (CPGs).Design, Setting, and ParticipantsThis cohort study was conducted in 11 US medical centers and included adult patients (18-75 years old) with diabetes. Patients received care from 2012 to 2023 and had 18 months or more of follow-up.ExposuresMultiple SDOH and associated factors, including ethnicity, urbanicity of residence, health insurance type, and diabetes type.Main Outcomes and MeasuresAdjusted odds ratio (aOR) of receiving 1 or more eye-care visits and 1 or more dilated fundus examinations in accordance with CPGs.ResultsThe study cohort included 37 397 adults with diabetes: 10 157 Black patients and 27 240 White patients. The mean (SD) age was 58 (11) years for Black patients and 59 (11) years for White patients. Of the Black patients, 6422 (63.2%) were female and 3735 (36.8%) male; of the White patients, 13 120 (48.1) were female and 14 120 (51.8) were male. Compared with those of the same race in urban communities, Black patients (aOR, 0.12; 95% CI, 0.04-0.31) and White patients (aOR, 0.75; 95% CI, 0.62-0.91) with diabetes living in rural communities had 88% and 25% lower odds of having eye-care visits, respectively. Sicker Black and White patients, defined by the Charlson Comorbidity Index, had 4% (aOR, 1.04; 95% CI, 1.02-1.06) and 5% (aOR, 1.05, CI 1.04-1.06) higher odds of having an eye-care visit, respectively. Black patients with preexisting DR had 15% lower odds of visits (aOR, 0.85, CI 0.73-0.99) compared with those without preexisting DR while White patients with preexisting DR had 16% higher odds of eye-care visits (aOR, 1.16; 95% CI, 1.05-1.28). White patients with Medicare (aOR, 0.85; 95% CI, 0.80-0.91) and Medicaid (aOR, 0.81; 95% CI, 0.68-0.96) had lower odds of eye-care visits vs patients with commercial health insurance. Hispanic White patients had 15% lower odds of eye-care visits (aOR, 0.85; 95% CI, 0.74-0.98) vs non-Hispanic White patients. White patients with type 1 diabetes had 17% lower odds of eye-care visits (aOR, 0.83; 95% CI, 0.76-0.90) vs those with type 2 diabetes. Among patients who had eye-care visits, those with preexisting DR (Black: aOR, 1.68; 95% CI, 1.11-2.53; White: aOR, 1.51; 95% CI, 1.16-1.96) were more likely to undergo dilated fundus examinations.Conclusions and RelevanceThis study found that certain SDOH affected monitoring for DR similarly for Black and White patients with diabetes while others affected them differently. Patients living in rural communities, Black patients with preexisting DR, and Hispanic White patients were not receiving eye care in accordance with CPGs, which may contribute to worse outcomes.
{"title":"Race, Social Determinants of Health, and the Quality of Diabetic Eye Care.","authors":"Azraa S Chaudhury,Maryam Ige,Shikha Marwah,Xueqing Zhou,Chris A Andrews,Kunal Kanwar,Charlesnika T Evans,Abel N Kho,Joshua D Stein,Paul J Bryar,Dustin D French,","doi":"10.1001/jamaophthalmol.2024.3528","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2024.3528","url":null,"abstract":"ImportanceBesides race, little is known about how other social determinants of health (SDOH) affect quality of diabetic eye care.ObjectiveTo evaluate the association between multiple SDOH and monitoring for diabetic retinopathy (DR) in accordance with clinical practice guidelines (CPGs).Design, Setting, and ParticipantsThis cohort study was conducted in 11 US medical centers and included adult patients (18-75 years old) with diabetes. Patients received care from 2012 to 2023 and had 18 months or more of follow-up.ExposuresMultiple SDOH and associated factors, including ethnicity, urbanicity of residence, health insurance type, and diabetes type.Main Outcomes and MeasuresAdjusted odds ratio (aOR) of receiving 1 or more eye-care visits and 1 or more dilated fundus examinations in accordance with CPGs.ResultsThe study cohort included 37 397 adults with diabetes: 10 157 Black patients and 27 240 White patients. The mean (SD) age was 58 (11) years for Black patients and 59 (11) years for White patients. Of the Black patients, 6422 (63.2%) were female and 3735 (36.8%) male; of the White patients, 13 120 (48.1) were female and 14 120 (51.8) were male. Compared with those of the same race in urban communities, Black patients (aOR, 0.12; 95% CI, 0.04-0.31) and White patients (aOR, 0.75; 95% CI, 0.62-0.91) with diabetes living in rural communities had 88% and 25% lower odds of having eye-care visits, respectively. Sicker Black and White patients, defined by the Charlson Comorbidity Index, had 4% (aOR, 1.04; 95% CI, 1.02-1.06) and 5% (aOR, 1.05, CI 1.04-1.06) higher odds of having an eye-care visit, respectively. Black patients with preexisting DR had 15% lower odds of visits (aOR, 0.85, CI 0.73-0.99) compared with those without preexisting DR while White patients with preexisting DR had 16% higher odds of eye-care visits (aOR, 1.16; 95% CI, 1.05-1.28). White patients with Medicare (aOR, 0.85; 95% CI, 0.80-0.91) and Medicaid (aOR, 0.81; 95% CI, 0.68-0.96) had lower odds of eye-care visits vs patients with commercial health insurance. Hispanic White patients had 15% lower odds of eye-care visits (aOR, 0.85; 95% CI, 0.74-0.98) vs non-Hispanic White patients. White patients with type 1 diabetes had 17% lower odds of eye-care visits (aOR, 0.83; 95% CI, 0.76-0.90) vs those with type 2 diabetes. Among patients who had eye-care visits, those with preexisting DR (Black: aOR, 1.68; 95% CI, 1.11-2.53; White: aOR, 1.51; 95% CI, 1.16-1.96) were more likely to undergo dilated fundus examinations.Conclusions and RelevanceThis study found that certain SDOH affected monitoring for DR similarly for Black and White patients with diabetes while others affected them differently. Patients living in rural communities, Black patients with preexisting DR, and Hispanic White patients were not receiving eye care in accordance with CPGs, which may contribute to worse outcomes.","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":"21 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142174622","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}
Pub Date : 2024-09-12DOI: 10.1001/jamaophthalmol.2024.3453
Nicolas Chirpaz, Marion Bricout, Sandra Elbany, Olivier Loria, Antonin Rocher, Carole Burillon, Corinne Dot
This case report describes a woman who presented with bilateral blurry vision a few days after dyeing her hair with hair dye containing aromatic amines.
本病例报告描述了一名妇女在使用含有芳香胺的染发剂染发几天后出现双侧视力模糊。
{"title":"Retinopathy Associated With Hair Dye","authors":"Nicolas Chirpaz, Marion Bricout, Sandra Elbany, Olivier Loria, Antonin Rocher, Carole Burillon, Corinne Dot","doi":"10.1001/jamaophthalmol.2024.3453","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2024.3453","url":null,"abstract":"This case report describes a woman who presented with bilateral blurry vision a few days after dyeing her hair with hair dye containing aromatic amines.","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":"105 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142174959","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}
Importance: Although augmenting large language models (LLMs) with knowledge bases may improve medical domain-specific performance, practical methods are needed for local implementation of LLMs that address privacy concerns and enhance accessibility for health care professionals.
Objective: To develop an accurate, cost-effective local implementation of an LLM to mitigate privacy concerns and support their practical deployment in health care settings.
Design, setting, and participants: ChatZOC (Sun Yat-Sen University Zhongshan Ophthalmology Center), a retrieval-augmented LLM framework, was developed by enhancing a baseline LLM with a comprehensive ophthalmic dataset and evaluation framework (CODE), which includes over 30 000 pieces of ophthalmic knowledge. This LLM was benchmarked against 10 representative LLMs, including GPT-4 and GPT-3.5 Turbo (OpenAI), across 300 clinical questions in ophthalmology. The evaluation, involving a panel of medical experts and biomedical researchers, focused on accuracy, utility, and safety. A double-masked approach was used to try to minimize bias assessment across all models. The study used a comprehensive knowledge base derived from ophthalmic clinical practice, without directly involving clinical patients.
Exposures: LLM response to clinical questions.
Main outcomes and measures: Accuracy, utility, and safety of LLMs in responding to clinical questions.
Results: The baseline model achieved a human ranking score of 0.48. The retrieval-augmented LLM had a score of 0.60, a difference of 0.12 (95% CI, 0.02-0.22; P = .02) from baseline and not different from GPT-4 with a score of 0.61 (difference = 0.01; 95% CI, -0.11 to 0.13; P = .89). For scientific consensus, the retrieval-augmented LLM was 84.0% compared with the baseline model of 46.5% (difference = 37.5%; 95% CI, 29.0%-46.0%; P < .001) and not different from GPT-4 with a value of 79.2% (difference = 4.8%; 95% CI, -0.3% to 10.0%; P = .06).
Conclusions and relevance: Results of this quality improvement study suggest that the integration of high-quality knowledge bases improved the LLM's performance in medical domains. This study highlights the transformative potential of augmented LLMs in clinical practice by providing reliable, safe, and practical clinical information. Further research is needed to explore the broader application of such frameworks in the real world.
{"title":"Development and Evaluation of a Retrieval-Augmented Large Language Model Framework for Ophthalmology.","authors":"Ming-Jie Luo, Jianyu Pang, Shaowei Bi, Yunxi Lai, Jiaman Zhao, Yuanrui Shang, Tingxin Cui, Yahan Yang, Zhenzhe Lin, Lanqin Zhao, Xiaohang Wu, Duoru Lin, Jingjing Chen, Haotian Lin","doi":"10.1001/jamaophthalmol.2024.2513","DOIUrl":"10.1001/jamaophthalmol.2024.2513","url":null,"abstract":"<p><strong>Importance: </strong>Although augmenting large language models (LLMs) with knowledge bases may improve medical domain-specific performance, practical methods are needed for local implementation of LLMs that address privacy concerns and enhance accessibility for health care professionals.</p><p><strong>Objective: </strong>To develop an accurate, cost-effective local implementation of an LLM to mitigate privacy concerns and support their practical deployment in health care settings.</p><p><strong>Design, setting, and participants: </strong>ChatZOC (Sun Yat-Sen University Zhongshan Ophthalmology Center), a retrieval-augmented LLM framework, was developed by enhancing a baseline LLM with a comprehensive ophthalmic dataset and evaluation framework (CODE), which includes over 30 000 pieces of ophthalmic knowledge. This LLM was benchmarked against 10 representative LLMs, including GPT-4 and GPT-3.5 Turbo (OpenAI), across 300 clinical questions in ophthalmology. The evaluation, involving a panel of medical experts and biomedical researchers, focused on accuracy, utility, and safety. A double-masked approach was used to try to minimize bias assessment across all models. The study used a comprehensive knowledge base derived from ophthalmic clinical practice, without directly involving clinical patients.</p><p><strong>Exposures: </strong>LLM response to clinical questions.</p><p><strong>Main outcomes and measures: </strong>Accuracy, utility, and safety of LLMs in responding to clinical questions.</p><p><strong>Results: </strong>The baseline model achieved a human ranking score of 0.48. The retrieval-augmented LLM had a score of 0.60, a difference of 0.12 (95% CI, 0.02-0.22; P = .02) from baseline and not different from GPT-4 with a score of 0.61 (difference = 0.01; 95% CI, -0.11 to 0.13; P = .89). For scientific consensus, the retrieval-augmented LLM was 84.0% compared with the baseline model of 46.5% (difference = 37.5%; 95% CI, 29.0%-46.0%; P < .001) and not different from GPT-4 with a value of 79.2% (difference = 4.8%; 95% CI, -0.3% to 10.0%; P = .06).</p><p><strong>Conclusions and relevance: </strong>Results of this quality improvement study suggest that the integration of high-quality knowledge bases improved the LLM's performance in medical domains. This study highlights the transformative potential of augmented LLMs in clinical practice by providing reliable, safe, and practical clinical information. Further research is needed to explore the broader application of such frameworks in the real world.</p>","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":" ","pages":"798-805"},"PeriodicalIF":7.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11258636/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141633476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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