American Journal of Ophthalmology最新文献

Objective: To compare costs between enucleation and plaque brachytherapy procedures for the treatment of intraocular malignancies.

Design: Retrospective economic analysis using a time-driven activity-based costing (TDABC) methodology.

Subjects: Patients undergoing plaque brachytherapy and enucleation procedures for the treatment of intraocular malignancy performed at the University of Michigan Kellogg Eye Center from 2021-2022.

Methods: Data inputs were obtained from the Electronic Health Record (EHR) and prior literature. Associated expenses were determined using TDABC, a method for cost calculation that correlates the cost rate of each resource used in a procedure with the amount of time that the resource is used.

Main outcome measures: The primary outcome was the difference in total cost associated with enucleation versus plaque brachytherapy procedures. Secondary outcomes included length of surgery (in minutes), total day-of-surgery costs, and number of follow-up visits.

Results: 145 cases were included, with 41 enucleations and 104 courses of plaque brachytherapy. Between all enucleation and plaque brachytherapy procedures, plaque brachytherapy was significantly more costly ($10,140.95 versus $6,127.70, P < .01), with total difference in cost of $4013 (95% confidence interval $3352.02 to $4674.47). There was no significant difference in OR time between enucleation and plaque brachytherapy. Plaque brachytherapy required significantly more follow-up visits than enucleation (1.02 visits versus 0.59 visits, P < .01).

Conclusions: Through TDABC cost analysis, we determined that the surgical course of plaque brachytherapy is more costly than enucleation, with the primary cost drivers being cost of the radiotherapy plaque and radiation oncology-related expenses.

Purpose: To develop and validate a pachymetry-based machine learning (ML) index for differentiating keratoconus, keratoconus suspect, and normal corneas.

Design: Development and validation of an ML diagnostic algorithm.

Methods: This retrospective study included 349 eyes of 349 patients with normal, frank keratoconus (KC), and KC suspect (KCS) corneas. KCS corneas included topographically/tomographically normal (TNF) and borderline fellow eyes (TBF) of patients with asymmetric KC. Six parameters were derived from the corneal thickness progression map on the Galilei Dual Scheimpflug-Placido system and fed into a machine-learning algorithm to create the Thickness Speed Progression Index. The model was trained with 5-fold cross-validation using a random search over 7 different ML algorithms, and the best model and hyperparameters were selected.

Results: A total of 133 normal eyes, 141 KC eyes, and 75 KCS eyes, subdivided into 34 TNF and 41 TBF eyes, were included. In experiment 1 (normal and KC), the best model (Random Forest) achieved an accuracy of 100% and area under the receiver operating characteristic (AUROC) of 1.00 for both normal and KC groups. In experiment 2 (normal, KCS, and KC), the model achieved an overall accuracy of 91%, and AUROC curves of 0.93, 0.83, and 0.99 in detecting normal, KCS, and KC corneas respectively. In experiment 3 (normal, TNF, TBF, and KC), the model achieved an accuracy of 87% with AUROC curves of 0.91, 0.60, 0.77, and 0.94 for normal, TNF, TBF, and KC corneas, respectively.

Conclusions: Using data solely based on pachymetry, ML algorithms such as the Thickness Speed Progression Index are able to discriminate normal corneas from KC and KCSs corneas with reasonable accuracy.

Purpose: Most patients with retinal vascular disease require chronic, regular treatments to maximize visual potential. This places a challenging burden on the patient and is one reason why real-world visual outcomes often lag the results seen in clinical trials.

Review: Sustained drug delivery devices have long been considered one way to alleviate this difficulty. In particular, devices with refillable reservoirs aim to take advantage of existing drugs to improve their pharmacokinetics and reduce treatment frequency. Very few devices utilizing a refillable reservoir have reached human clinical trials, however. Only one, the Port Delivery System (PDS) with ranibizumab, has received FDA approval. Despite this milestone, the PDS was voluntarily withdrawn one year after its introduction due to product quality challenges related to the septum of the device. The PDS was recently returned to the market following modifications to the implant as well as the refill-exchange needle.

Conclusion: Although devices with refillable reservoirs have increased challenges related to their inherent complexity, the potential for improved patient outcomes merit further development of this technology.

Purpose: Establishing associations between structure, function, and clinical outcomes in intermediate age-related macular degeneration (iAMD) remains an unmet need. This study aims to (1) cross-sectionally investigate the relationships between optical coherence tomography (OCT) biomarkers and quantitative contrast sensitivity function (qCSF)-measured contrast sensitivity (CS), and (2) longitudinally assess their relationship with progression from iAMD to late stages of the disease.

Design: Cross-sectional and cohort study.

Methods: Our study was conducted at Massachusetts Eye and Ear (Boston, MA, USA) and included eyes with (1) baseline diagnosis of iAMD, (2) same-day OCT and qCSF test, (3) visual acuity ≥20/200 Snellen, and (4) 24+ months of follow-up. qCSF metrics included the area under the logCSF curve, contrast acuity, and CS thresholds at 1- to 18-cycle-per-degree (cpd). Two independent graders reviewed macular OCT scans for various biomarkers, and outer nuclear layer (ONL) thickness and retinal pigment epithelium (RPE) volume were measured. Progression to wet AMD or geographic atrophy (GA) was confirmed using imaging studies. Generalized linear mixed-effects models assessed associations between qCSF and OCT biomarkers, while Cox regression models evaluated their association with progression to late AMD.

Results: We included 205 iAMD eyes from 134 patients (age: 73 [69-78] years; 63% female). Higher RPE volume in the central subfield and a greater number of intraretinal hyperreflective foci were associated with reduced area under the logCSF curve, contrast acuity, and CS at 6 to 12 cpd (P < .05). ONL thinning in the inner ring and a greater number of intraretinal hyperreflective foci were associated with reduced CS at 1 and 3 cpd (P < .05). During follow-up, 35 eyes developed wet AMD (17%) and 53 progressed to GA (26%). subretinal drusenoid deposit, ONL thinning in the inner ring, and reduced CS at 1.5 cpd were associated with wet AMD (P < .05). Higher RPE volume in the inner ring, hyporeflective drusen cores, subretinal drusenoid deposit, higher HRF count, and reduced CS at 1 cpd were associated with GA (P < .05).

Conclusions: Our study reveals significant structure-function relationships between OCT biomarkers and qCSF-measured CS in iAMD. These findings highlight the impact of AMD alterations on CS function and offer valuable insights for patient stratification and prognostication in research and clinical settings.

Purpose: To investigate the comparative efficacy and safety of half-dose photodynamic therapy (PDT) and half-fluence PDT in the management of chronic central serous chorioretinopathy.

Design: Systematic review and meta-analysis.

Methods: A comprehensive literature search was conducted on Ovid MEDLINE, Embase, and the Cochrane Library, covering publications from January 2000 to March 2024. The review focused on studies reporting the efficacy and safety of half-dose PDT compared to half-fluence PDT in treating chronic central serous chorioretinopathy. The primary outcome was the best-corrected visual acuity (BCVA) at the last study observation. Secondary outcomes included retinal thickness (RT), the presence of subretinal fluid (SRF), and SRF recurrence across follow-up visits. Random effects meta-analysis was performed using RevMan 5.4.

Results: A total of 10 studies (eight observational and two randomized controlled trials) were included in the analysis. The results indicated that half-dose PDT and half-fluence PDT achieved similar BCVA at 1 month (P = .24), 3 months (P = .40), and 6 months (P = .16). Similarly, there were no significant differences in RT at 1 month (P = .23), 3 months (P = .99), and at 6 months (P = .54) between the two treatment protocols. Both treatment protocols were associated with minor complications, indicating similar safety profiles in patients with CSCR.

Conclusions: The findings suggest that both half-dose and half-fluence PDT are effective and safe for treating CSCR, with no significant differences in BCVA, RT, or SRF resolution between the two modalities. These results support flexibility in selecting treatment based on individual patient needs. Further research with larger sample sizes and longer follow-up is required to optimize these protocols and confirm these results.

Purpose: To examine the cross-sectional and longitudinal associations between visual impairment (VI) and falls in United States older adults.

Design: Retrospective cross-sectional and cohort study.

Methods: This study utilized data from the National Health and Aging Trends Study 2021 and 2022. Participants were Medicare beneficiaries ≥71 years. Exposures were any VI - defined as distance or near VI (>0.3 logMAR), or contrast sensitivity (CS) impairment (<1.55 logCS) -and changes in distance visual acuity ([DVA], logMAR/y), near visual acuity ([NVA], logMAR/y), or CS (logCS/y). Outcomes were self-reported falls in the past 12 months.

Results: 2822 participants were included in the analysis. At baseline, adults with any VI had greater rates of falls (rate ratio = 1.16, 95% CI = 1.04-1.30) and multiple falls (rate ratio = 1.23, 95% CI = 1.01-1.49) than peers without VI. In longitudinal analysis, adults with any VI at baseline did not have a greater risk of falls or multiple falls in the following year compared to peers without VI; only worse CS (hazard ratio [HR] = 1.03, 95% CI = 1.01-1.06, per 0.1 logCS worse) and DVA (HR = 1.11, 95% CI = 1.04-1.18, per 0.1 logMAR worse) were associated with a greater risk of falls and multiple falls, respectively. However, in other models, change in NVA (HR = 1.04, 95% CI = 1.01-1.08, per 0.1 logMAR worse/y) was associated with greater fall risk over the follow-up period. Further, change in CS (HR = 1.11, 95% CI = 1.05-1.18, per 0.1 logCS worse/y) was associated with a greater risk of multiple falls, while changes in DVA and NVA were not.

Conclusions: Older United States adults with VI are more likely to experience a fall, with various components of their vision influencing the fall risk.

Purpose: Sex bias remains a pervasive reality in academic medicine, often reflected in subtle linguistic choices, which can skew perceptions of competence and perpetuate workplace inequity. This study aims to investigate the relationship between host sex, speaker sex, and speaker introduction practices in ophthalmology grand rounds events.

Design: Cross-sectional study.

Methods: Publicly accessible videos of English-language ophthalmology grand rounds and other teaching events uploaded by academic institutions in the United States and Canada from January 2019 to June 2024 were analyzed by two independent reviewers. The primary outcome was the proportion of male and female speakers introduced with the formal title "Dr." by the event host. Secondary outcomes included the proportion of male and female speakers introduced with their academic degrees, current academic appointments, awards or achievements, and research interests. Univariable and multivariable logistic regressions adjusted for the speaker's degree type(s), academic appointment, and affiliation were performed using Stata v17.0.

Results: Of 1,450 videos screened, 399 speaker introductions across 298 ophthalmology teaching sessions were analyzed. The formal title "Dr." was employed by the event host in 75.2% (n = 300/399) of speaker introductions. In multivariable analysis, female speakers were significantly less likely to be introduced by their formal title (OR = 0.55, 95% CI: 0.25-0.78, P < .001), academic degrees (OR = 0.61, 95% CI: 0.35-0.97, P = .03) and their awards or achievements (OR = 0.62, 95% CI: 0.35-0.95, P = .04) compared to male speakers. Interaction terms between speaker and host sex were significant for formal title use (P = .03) and academic degrees (P = .04), prompting subgroup analyses by host sex. Findings were consistent when stratified by male hosts, while there was no difference in the likelihood of introducing male or female speakers with their formal titles, academic degrees, or awards/achievements when introduced by female hosts. Female speakers were significantly more likely to present on nonclinical topics compared to male speakers (OR = 2.39, 95% CI: 1.36-4.79, P < .001).

Conclusions: When introduced by male hosts, female speakers were less likely to be addressed using a formal title compared with male speakers, while no significant differences were observed when female hosts introduced speakers of either sex. A standardized approach to introducing speakers may be beneficial in mitigating sex biases during grand rounds and other academic events.

Purpose: To gauge the efficacy and safety of performing a one-stage endoscopic orbital decompression procedure combined with the intraoperative relaxed medial rectus muscle (MR) positioning technique as a means of treating esotropia associated with thyroid-associated ophthalmopathy (TAO).

Design: Prospective, single-blind, randomized controlled trial.

Setting: Eye Hospital of Wenzhou Medical University.

Methods: 38 TAO patients fulfilled the study requirements. The patients in Group A (n=19; mean age 52.32 ± 9.90 years; 12 males, 7 females) underwent a one-stage surgical procedure, whereas the patients in Group B (n=19; mean age 52.53 ± 8.49 years; 9 males, 10 females) underwent staged surgery. Preoperative and postoperative best-corrected visual acuity (BCVA), visual field mean deviation (MD), Hertel exophthalmometry, intraocular pressure (IOP), deviation, ocular motility, and diplopia were compared between these two groups.

Results: Of the patients in Group A, 8 (42.11%) underwent unilateral orbital decompression and 11 underwent bilateral decompression, while all 19 patients in Group B underwent bilateral decompression. Both groups exhibited significant improvements in postoperative BCVA (Group A 0.09 ± 0.15 logMAR, Group B 0.04 ± 0.08 logMAR), MD of visual field (Group A -2.73 ± 3.36 dB, Group B -1.82 ± 3.75 dB), proptosis (Group A 16.23 ± 2.58 mm, Group B 17.04 ± 2.70 mm), and IOP (Group A 16.23 ± 4.49 mmHg, Group B 17.24 ± 4.14 mmHg) when comparing postoperative values to preoperative levels, while there were no significant differences between these groups. In each group, 8 patients (42.11%) underwent surgical procedures targeting one single MR, whereas the remaining 11 in each group underwent surgery on two MRs. The respective primary motor and sensory success rates in Group A were 68.40% (13/19) and 78.95% (15/19), whereas those in Group B were 73.70% (14/19) and 84.21% (16/19), with no significant differences between these groups in terms of postoperative residual strabismus, stereoscopic vision improvements, or success rates.

Conclusion: These results demonstrate that a one-stage surgical procedure can simultaneously alleviate proptosis and diplopia while achieving outcomes comparable to those achieved through staged surgery. This treatment strategy can thus provide patients with greater therapeutic convenience, decreasing the overall number of surgical procedures and their attendant risks.

Purpose: This study aimed to investigate the relationship between sociodemographic and healthcare access factors with self-reported diabetic retinopathy (DR) prevalence in a nationally representative sample of the United States.

Design: This is a population based, cross-sectional analysis.

Methods: Data from those who answered the question, "Have you ever been told by a doctor or other health professional that you had diabetic retinopathy?" from the 2017 National Health Interview Survey (NHIS) was analyzed through logistic regression to examine the association between DR prevalence and social determinants of health (SDH).

Results: Of 26,966 eligible NHIS respondents (81.4%), 26,699 participants answered the DR question, of whom 266 (1.0%) self-reported a DR diagnosis. Multivariable analysis found a significant association between DR prevalence and the following social determinants of health:, poorer health status (OR = 5.9; 95% CI = 3.6-9.7; P < .001), disability (OR 2.1; 95% CI 1.3-3.2; P = .001), no employment status (OR = 1.8; 95% CI = 1.2-2.9; P = .009), and living in Southern regions of the US (OR = 1.9; 95% CI = 1.1-3.3; P = .020). Not having a usual place for healthcare (OR 0.3; 95% CI 0.1-0.7; P = .006) and female sex (OR = 0.6; 95% CI = 0.4-0.8; P = .002) were negatively associated with self-reported DR prevalence.

Conclusion: Multiple sociodemographic factors are associated with self-reported DR prevalence. Health care providers and policymakers should tailor future interventions to address SDH in a holistic model of DR screening and care.