Publications by authors named "Ingrid U Scott"

252 Publications

COVID-19 and Public Interest in Ophthalmic Services and Conditions.

R I Med J (2013) 2021 Feb 1;104(1):61-64. Epub 2021 Feb 1.

Division of Ophthalmology, Alpert Medical School, Brown University; Section of Ophthalmology, Providence VA Medical Center, Providence, Rhode Island; Office of Academic Affiliations, US Department of Veterans Affairs, Washington DC.

Objective: To assess the impact of the COVID-19 pandemic and associated lockdowns on public interest in ophthalmology.

Methods: Search interest data for ophthalmic services and conditions were collected from January 1, 2019 to June 21, 2020. Temporal statistical analysis was used to identify significant trends. Weekly data on ophthalmic services and conditions search interest obtained from Google Trends were analyzed with analysis of variance testing and the generalized linear model based on dates.

Results: Ophthalmic services searches decreased after the first COVID-19 case in the country (p<0.001); ophthalmic services and conditions search interest also declined after the first COVID-19 case and lockdown orders in each state (p<0.001). Following the first in-state COVID-19 case, search interest in ophthalmic services fell more than for ophthalmic conditions (p=0.0088). Lockdown and COVID-19 had similar effects on ophthalmic services search interest (p=0.2246), but interest in ophthalmic conditions decreased more after lockdown than after the first in-state case (p<0.0001).

Conclusions: Most of the decrease in search interest in ophthalmic services was associated with COVID-19 rather than lockdown orders, suggesting that public interest in ophthalmic care may be more sensitive to changes in the COVID-19 pandemic than lockdown orders.
View Article and Find Full Text PDF

Download full-text PDF

Source
February 2021

ETDRS panretinal photocoagulation combined with intravitreal ranibizumab versus PASCAL panretinal photocoagulation with intravitreal ranibizumab versus intravitreal ranibizumab alone for the treatment of proliferative diabetic retinopathy.

Arq Bras Oftalmol 2020 Nov-Dec;83(6):526-534

Department of Ophthalmology, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil.

Purpose: To compare visual acuity, macular thickness, and the area of active neovascularization based on fluorescein angiography outcomes associated with standard single-spot panretinal photocoagulation in the Early Treatment Diabetic Retinopathy Study (ETDRS) pattern combined with intravitreal ranibizumab injection versus multiple-spot full scatter (PASCAL) panretinal photocoagulation combined with intravitreal ranibizumab injection versus intravitreal injection alone in patients with proliferative diabetic retinopathy.

Methods: Patients with proliferative diabetic retinopathy and no prior laser treatment were randomly assigned to receive three different types of treatment. Panretinal photocoagulation in the ETDRS group was administered in two sessions (weeks 0 and 2), and panretinal photocoagulation in the PASCAL group was administered in one session (week 0). Intravitreal injection of ranibizumab was administered at the end of the first laser session in both the ETDRS and PASCAL groups and at week 0 in the intravitreal injection group. Comprehensive ophthalmic evaluations were performed at baseline and every 4 weeks through week 48.

Results: Thirty patients (n=40 eyes) completed the 48-week study period. After treatment, best-corrected visual acuity was significantly (p<0.05) improved at all follow-up visits in the group receiving intravitreal injection alone, at all but week 4 in the ETDRS group, and at all but weeks 4 and 8 for the PASCAL group. A significant decrease in central subfield macular thickness was observed in the PASCAL group at weeks 4, 8, and 48; only at week 48 in the intravitreal injection group; and never in the ETDRS group. There was no significant difference among the three treatment groups with respect to change from baseline to week 48 in best-corrected visual acuity, central subfield macular thickness, or fluorescein leakage from active neovascularization in best-corrected visual acuity, central subfield macular thickness, or fluorescein leakage from active neovascularization.

Conclusions: Intravitreal injection alone or combined with single- or multiple-spot panretinal photocoagulation yielded similar outcomes with respect to mean change in best-corrected visual acuity, central subfield macular thickness, and fluorescein leakage from active neovascularization at up to one-year of follow-up. All subjects provided written informed consent to participate (NCT02005432 in clinicaltrials.gov).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5935/0004-2749.20200096DOI Listing
February 2021

Association between early and late response in eyes with central or hemiretinal vein occlusion treated with anti-VEGF agents : SCORE2 report 12: secondary analysis of the SCORE2 clinical trial.

Graefes Arch Clin Exp Ophthalmol 2021 Jan 7. Epub 2021 Jan 7.

Doheny Eye Institute, University of California, Los Angeles, CA, USA.

Purpose: To assess whether early visual acuity letter score change from baseline (ΔVALS) and early spectral domain optical coherence tomography (SD-OCT) measures of center point thickness (CPT) are associated with later ΔVALS in eyes with macular edema due to central or hemiretinal vein occlusion treated with intravitreal aflibercept or bevacizumab.

Methods: Secondary analysis of a randomized clinical trial of 362 participants.

Results: Considered separately at month 3, CPT (categorized as ≤ 300 μm, > 300 μm) and ΔVALS (categorized as < 5, 5-9, ≥ 10) are predictive of ΔVALS at month 6 (aflibercept: P = 0.02 for CPT and P < 0.0001 for ΔVALS; bevacizumab: P = 0.007 for CPT and P < 0.0001 for ΔVALS) and, except for CPT in the bevacizumab arm, also predictive of ΔVALS at month 12 (aflibercept: P = 0.03 for CPT and P < 0.0001 for ΔVALS; bevacizumab: P = 0.18 for CPT and P < 0.0001 for ΔVALS). Month 3 predictors are also associated with average ΔVALS from months 4 to 12 (CPT P = 0.01 in the aflibercept arm, P = 0.02 in the bevacizumab arm; ΔVALS > 10 versus < 5; P < 0.001 for both aflibercept and bevacizumab). When month 3 measures are considered jointly, ΔVALS effect remains significant for average ΔVALS from months 4 to 12 (aflibercept: P = 0.002; bevacizumab: P < 0.0001) but not CPT (aflibercept: P = 0.18; bevacizumab: P = 0.22).

Conclusion: While both month 3 ΔVALS and CPT are predictive of ΔVALS after month 3 through month 12, early ΔVALS has a stronger relationship than CPT with later ΔVALS. SCORE2 registration number is NCT01969708.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00417-020-05018-7DOI Listing
January 2021

Spectral Domain OCT Predictors of Visual Acuity in the Study of COmparative Treatments for REtinal Vein Occlusion 2: SCORE 2 Report 15.

Ophthalmol Retina 2020 Dec 26. Epub 2020 Dec 26.

Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin. Electronic address:

Purpose: To evaluate the association between baseline demographic and spectral domain OCT (SD-OCT) features with visual acuity (VA) in the Study of COmparative Treatments for REtinal Vein Occlusion 2 (SCORE2) over 2 years.

Design: Post hoc analysis of prospective clinical trial data.

Participants: A total of 362 SCORE2 participants with macular edema secondary to central retinal (CRVO) or hemiretinal vein occlusion (HRVO).

Methods: Spectral domain OCT volume scans were assessed at the SCORE2 reading center at baseline, month 01 (M01), month 06 (M06), month 12 (M12), and month 24 (M24) for central subfield thickness (CST), subretinal fluid, intraretinal fluid, vitreoretinal interface abnormalities, disorganization of retinal inner layers (DRIL), and ellipsoid zone (EZ) within the central subfield (CSF).

Main Outcome Measures: Visual acuity at M06, M12, and M24.

Results: Mean baseline age was 68.9 years. Mean VA at M01 was 63.2 letters, and CST was 299.7 μm. At M01, subretinal fluid was seen in 28.5% intraretinal fluid in 67.2%, DRIL was seen in 73.8%, mostly within the CSF, and the EZ was absent in 9.8 and patchy in 31.7%. In multivariate analysis including all M01 demographics and SD-OCT parameters and their association with VA at M06, M12, and M24, VA at M01 remained significant across all time points up to M24 (P < 0.001).

Conclusions: In this 2-year follow-up of eyes that were treated with both per protocol and off protocol for RVO, VA at M01 was an important predictor of long-term vision and change in vision. Establishing predictors of visual recovery helps identify causes for poor responders to treatment in patients with RVO.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.oret.2020.12.016DOI Listing
December 2020

Video-Conference Interviewing for the Ophthalmology Residency Match.

JAMA Ophthalmol 2021 Feb;139(2):249

Department of Ophthalmology, Pennsylvania State College of Medicine, Hershey.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1001/jamaophthalmol.2020.5759DOI Listing
February 2021

Retinal vascular occlusions.

Lancet 2020 12;396(10266):1927-1940

Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, USA; Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA. Electronic address:

Acute retinal vascular occlusions are common causes of visual impairment. Although both retinal artery occlusions and retinal vein occlusions are associated with increased age and cardiovascular risk factors, their pathophysiology, systemic implications, and management differ substantially. Acute management of retinal artery occlusions involves a multidisciplinary approach including neurologists with stroke expertise, whereas treatment of retinal vein occlusions is provided by ophthalmologists. Optimisation of systemic risk factors by patients' primary care providers is an important component of the management of these two disorders.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/S0140-6736(20)31559-2DOI Listing
December 2020

The Pediatric Examination Assessment Rubric (PEAR) toolkit: reliability study.

J AAPOS 2020 12 2;24(6):365.e1-365.e4. Epub 2020 Dec 2.

Department of Ophthalmology, Penn State College of Medicine, Hershey, Pennsylvania.

Background: The Pediatric Examination Assessment Rubric (PEAR) toolkit consists of an examination sheet and rubric designed to assess ophthalmology residents' performance on the pediatric eye examination. The purpose of this study was to evaluate the reliability of the PEAR toolkit.

Methods: Six ophthalmology residents (2 PGY-2, 4 PGY-3) at a single ACGME-accredited US program participated in 11 video-recorded pediatric ophthalmology patient encounters. Two pediatric ophthalmologists reviewed the videos and the residents' examination sheets to complete a PEAR evaluation. The inter-rater reliability of the rating for each of the 12 examination skills evaluated using PEAR was determined using kappa statistics, and reliability strength was categorized based on published guidelines (≤0, poor; 0-0.20, slight; 0.21-0.40, fair; 0.41-0.60, moderate; 0.41-0.60, substantial; 0.81-1.00, almost perfect).

Results: Eleven video encounters were completed. Of the 12 examination skills evaluated using PEAR, 9 had kappa scores with strengths of moderate to almost perfect reliability. Two examination skills, Worth 4-Dot and alignment, showed fair reliability. A kappa score could not be calculated for stereoacuity because of the lack of variability among the evaluators' raw scores.

Conclusions: In our small sample of residents from a single institution, the PEAR toolkit showed inter-rater reliability.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jaapos.2020.08.012DOI Listing
December 2020

Gender disparities among United States academic pediatric ophthalmologists: an analysis of publication productivity, academic rank, and NIH funding.

J AAPOS 2020 12 10;24(6):337.e1-337.e6. Epub 2020 Oct 10.

Department of Ophthalmology, Penn State College of Medicine, Hershey, Pennsylvania. Electronic address:

Purpose: To investigate gender disparitie among pediatric ophthalmologists in academic rank, publication productivity, and National Institutes of Health (NIH) funding.

Methods: In this cross-sectional analysis of pediatric ophthalmologists at 113 US academic programs, data on gender, residency graduation year, and academic rank were obtained from institutional websites between January 2019 and March 2019. The Scopus database was used to calculate h-indices and m-quotients. The NIH Research Portfolio Online Reporting Tool was used to determine NIH funding.

Results: We identified 389 pediatric ophthalmologists: 194 women (49.9%) and 195 men (50.1%). A binomial logistic regression model, which included career length as an independent variable, showed proportions of women to men were similar across all academic ranks (assistant professor, 64.4% vs 46.2% [P = 0.738]; associate professor, 21.7% vs 19.0% [P = 0.357]; full professor, 13.9 vs 34.9% [P = 0.119]). Women had a lower median h-index (5.0 vs 8.0 [P = 0.008]) and a shorter median career duration (12.5 vs 25.0 years [P < 0.001]), but a similar median m-quotient (0.5 vs. 0.5; P = 0.525). Among pediatric ophthalmologists who received NIH funding (20 women vs. 27 men; P = 0.826), the overall median grant-funding total for women was $804K (interquartile range (IQR) 5.0M, mean $3.8M) compared to men, $2.2M (IQR, 4.0M; mean, $3.7M; P = 0.328).

Conclusions: The shorter career duration for women likely contributes to the difference in overall h-indices between genders, as m-quotients were similar. The m-quotient should be used over the h-index when comparing academic productivity across genders when disparities in career length exist.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jaapos.2020.06.013DOI Listing
December 2020

SCORE2 Report 13: Intraretinal Hemorrhage Changes in Eyes With Central or Hemiretinal Vein Occlusion Managed With Aflibercept, Bevacizumab or Observation. Secondary Analysis of the SCORE and SCORE2 Clinical Trials.

Am J Ophthalmol 2021 02 20;222:185-193. Epub 2020 Aug 20.

The Emmes Company, LLC, Rockville, Maryland, USA.

Purpose: To investigate the relationship between intraretinal macular hemorrhage and visual acuity outcomes in eyes with central retinal vein occlusion or hemiretinal vein occlusion managed with aflibercept, bevacizumab, or observation.

Design: Retrospective analysis of data from 2 randomized clinical trials.

Methods: A total of 362 participants were randomized in the Study of Comparative Treatments for Retinal Vein Occlusion 2, and 88 participants randomized to observation in the Standard Care vs Corticosteroid in Retinal Vein Occlusion Study. Participants received monthly intravitreal aflibercept or bevacizumab through month 6 or observation through month 8. The main outcome was visual acuity letter score (VALS).

Results: Reduced area of hemorrhage by month 6 was observed in 70.7% (116 of 164) of aflibercept-treated eyes, 63.8% (104 of 163) of bevacizumab-treated eyes, and 42.2% (27 of 64) of observation eyes by month 8 (P < .01). Relative to eyes with hemorrhage during follow-up, aflibercept-treated eyes without hemorrhage at month 6 had a mean VALS improvement of 8.0 (99% confidence interval [CI]: 1.9, 14.2); bevacizumab-treated eyes without hemorrhage at month 6 had a mean VALS improvement of 3.2 (99% CI: -4.6, 11.0); and observation eyes without hemorrhage at month 8 had a mean VALS improvement of 13.5 (99% CI: 0.4, 26.5). At month 6, the presence of hemorrhage and the change in central subfield thickness (CST) were significantly associated with the change in VALS; however, CST was a more important predictor.

Conclusion: Improvement in hemorrhage during follow-up was associated with visual acuity improvements and predicted visual acuity changes beyond what was explained by CST. These findings suggest that intraretinal macular hemorrhage is an important indicator of disease severity in retinal vein occlusion.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ajo.2020.08.030DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7895852PMC
February 2021

Repeatability and comparability of keratometry measurements obtained with swept-source optical coherence and combined dual Scheimpflug-Placido disk-based tomography.

J Cataract Refract Surg 2020 Dec;46(12):1637-1643

From the Department of Ophthalmology (Lu, Poulsen, Scott, Pantanelli), and the Department of Public Health Sciences (Lehman, Scott), Penn State College of Medicine (Cui, Seeger), Hershey, Pennsylvania, USA.

Purpose: To assess the repeatability of keratometric measurements obtained using a reflectance and swept-source optical coherence tomography (SS-OCT) based biometer and to compare these values with those obtained with a dual Scheimpflug-Placido (S-P) disk-based tomographer/topographer.

Setting: Department of Ophthalmology, Penn State College of Medicine, Hershey, Pennsylvania, USA.

Design: Prospective consecutive case series.

Methods: Patients undergoing cataract evaluation were prospectively enrolled. Surgery-naive eyes without corneal pathology were measured 3 times with the reflectance/SS-OCT biometer and once with the dual S-P disk tomographer/topographer. Intradevice repeatability for anterior (K), posterior (PK), and total corneal keratometry (TK) readings were evaluated using within-eye SDs, test-retest repeatability (TRT), coefficients of variance, and intraclass correlation coefficients (ICCs). Bland-Altman analysis was used to assess agreement between devices.

Results: Eighty-two eyes from 48 patients met inclusion criteria. The TRT for the anterior, posterior, and total corneal powers were 0.33, 0.08, and 0.36 diopter (D), respectively. TRT for the anterior, posterior, and total keratometric astigmatism were 0.58, 0.14, and 0.64 D, respectively. Anterior keratometric indices had higher ICCs than posterior indices. Bland-Altman analysis revealed that the SS-OCT consistently reported flatter posterior corneal curvatures than the S-P.

Conclusions: The SS-OCT posterior keratometric measurements contain more noise (lower ICCs), but still have lower within-eye SDs and TRTs than that of anterior measurements. This may be due to the small index of refraction change at the cornea-aqueous interface. Although keratometric indices from the 2 devices are highly correlated, measurements taken using SS-OCT and S-P devices were not interchangeable.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/j.jcrs.0000000000000346DOI Listing
December 2020

Anterior, Posterior, and Non-Keratometric Contributions to Refractive Astigmatism in Pseudophakes.

J Cataract Refract Surg 2020 Aug 14. Epub 2020 Aug 14.

From the Department of Ophthalmology, Penn State College of Medicine (Kansara, Scott, Pantanelli).

Purpose: To investigate the relationship between measured anterior (ACA) and posterior (PCA) keratometric astigmatism and post-operative refractive astigmatism (RA) and to quantify non-corneal astigmatism (NCA) contributions to RA.

Setting: Penn State College of Medicine, Hershey, Pennyslvania, USA.

Design: Retrospective consecutive case series.

Methods: Consecutive eyes underwent preoperative biometry (IOLMaster 700) and tomography/topography using a dual-Scheimpflug placido disc-based device (Galilei G4), cataract surgery with implantation of a monofocal intraocular lens (IOL), and postoperative manifest refractions. RA was compared to keratometric astigmatism using the following methods: IOLMaster, SimK, CorT, SimK + measured PCA, total corneal power at the corneal plane (TCP2), and CorT(Total). An ocular residual astigmatism (ORA) vector was calculated between RA and each measured astigmatism.

Results: Analysis was based on 296 eyes. ORA centroids were 0.28 @ 179, 0.45 @ 001, 0.37 @ 001, 0.19 @ 003, 0.19 @ 001, and 0.23 @ 178 D for the 6 aforementioned methods, respectively (P < .000001 [ORAx, ORAy]). Based upon TCP2 measurements, eyes with against-the-rule ACA and with-the-rule (WTR) ACA had ORA centroids of 0.09 @ 082 and 0.58 @ 001 D (P < .000001 [ORAx, ORAy]), respectively. ORA was non-zero and not entirely explained by the cornea, especially in those with WTR ACA.

Conclusions: Total keratometric astigmatism did not explain all ocular astigmatism. Non-corneal contributions were significant, especially in eyes with WTR ACA.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/j.jcrs.0000000000000390DOI Listing
August 2020

Combined pars plana vitrectomy (PPV) and phacoemulsification (phaco) versus PPV and deferred phaco for phakic patients with full-thickness macular hole (FTMH) and no significant cataract at baseline: 1-year outcomes of a randomized trial combined PPV/phaco vs PPV/deferred phaco for MH.

Graefes Arch Clin Exp Ophthalmol 2021 Jan 6;259(1):29-36. Epub 2020 Aug 6.

Ophthalmology, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil.

Purpose: To compare functional and anatomic outcomes of combined pars plana vitrectomy (PPV) and phacoemulsification (phaco) versus PPV and deferred phaco in patients with full-thickness macular hole (FTMH) and no significant cataract.

Methods: Thirty-four patients were randomized to group 1 (combined PPV/phaco) and 34 to group 2 (PPV/deferred phaco). Group 2 patients could undergo phaco any time after FTMH surgery if significant cataract developed.

Results: Sixty-five patients (33 group 1 and 32 group 2) completed the 12-month visit. Mean ± SEM logMAR best-corrected visual acuity (BCVA) was 0.92 ± 0.04 and 0.90 ± 0.04 at baseline and improved significantly to 0.60 ± 0.05 and 0.58 ± 0.05 at month 12 (p < 0.0001) in groups 1 and 2, respectively. There was no significant difference between the groups in mean BCVA at baseline or at month 12. Mean macular sensitivity (dB) was 18.22 ± 0.93 and 16.72 ± 0.93 at baseline and increased to 21.13 ± 0.86 and 21.07 ± 0.85 in groups 1 and 2, respectively (p < 0.05) with no significant difference between the groups (p = 0.449) at month 12. FTMH closure rate was 73% and 75% in groups 1 and 2, respectively (p = 0.834).

Conclusion: Among patients with FTMH and no significant cataract at baseline, combined PPV/phaco was associated with similar BCVA, microperimetry, and FTMH closure outcomes at 1-year compared with PPV/deferred phaco.

Trial Registration: ( clinicaltrials.gov.br ): Ensaios clínicos brasileiros: RBR-3wmd9s; UTN number: U1111-1190-5013; Plataforma Brasil CAAE number: 50455415.3.0000.5440; IRB number: 1.433.000.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00417-020-04731-7DOI Listing
January 2021

Pain during pars plana vitrectomy following sub-Tenon versus peribulbar anesthesia: A randomized trial.

PLoS One 2020 6;15(8):e0236624. Epub 2020 Aug 6.

Department of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil.

Purpose: To compare pain during pars plana vitrectomy (PPV) following topical lidocaine jelly and sub-Tenon anesthesia versus peribulbar anesthesia.

Methods: Prospective, single-center, randomized study. Patients scheduled for PPV for macular hole (MH) or epiretinal membrane (ERM) at the Retina and Vitreous Section of the Department of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo were randomly assigned to one of two groups in a 1:1 allocation ratio. Patients assigned to Group ST received topical anesthesia with 2% lidocaine jelly followed by sub-Tenon anesthesia with 2-4 ml of 1% ropivacaine. Patients assigned to PB received peribulbar anesthesia with 4-6 ml of 1% ropivacaine. After PPV, patients in both groups were asked to rate the level of pain they felt during the entire procedure (including anesthesia administration and PPV) by pointing at a 0-100 Visual Analogue Pain Scale (VAS). Data regarding demographics, patient characteristics and surgical features were also collected.

Results: Fifty-four patients were enrolled in the study (26 in Group ST and 28 in Group PB). Baseline characteristics, including age, gender, and presence of comorbidities, were similar in both groups. The surgery performed was PPV alone in 10 and 14 patients in the ST and PB groups, respectively, and combined phacoemulsification and PPV in 16 and 14 patients in the ST and PB groups, respectively (p = 0.39, Pearson). Surgery duration (mean ± SD minutes) was similar in the two groups (62 ± 12 for ST and 70 ± 20 for PB, p = 0.09, t-Test). No patients needed supplemental topical or intravenous anesthesia during surgery. No sight- or life-threatening complication was observed in either group. VAS score was significantly lower in the ST compared to the PB group (median (interquartile range) was 1 (2.25-0) in the ST group compared to 11.5 (29.75-5) in the PB group, p< 0.0001, Wilcoxon).

Conclusion: In this study of patients who underwent PPV for MH or ERM, topical followed by sub-Tenon anesthesia was more effective in controlling pain during the whole vitrectomy procedure than peribulbar anesthesia. Compared to peribulbar anesthesia which is administered with a sharp needle, sub-Tenon anesthesia administered with a blunt cannula may be associated with a reduced risk of such adverse events as globe perforation, retrobulbar hemorrhage, and inadvertent injection of anesthesia into the optic nerve sheath.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0236624PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7410239PMC
October 2020

Multiple Bilateral Retinal Breaks as a Long-Term Complication of Retinopathy of Prematurity Treated with Intravitreal Bevacizumab.

Retin Cases Brief Rep 2020 Jul 15. Epub 2020 Jul 15.

Department of Ophthalmology, Ribeirão Preto School of Medicine, University of São Paulo, Brazil.

Purpose: To report the occurrence of multiple bilateral retinal breaks 11 years after bevacizumab treatment for retinopathy of prematurity (ROP).

Methods: Case report.

Results: An 11-year-old girl developed multiple bilateral retinal breaks in areas of vitreous condensation 11 years after treatment for ROP with intravitreal bevacizumab at 4 months of age. The retinal breaks were treated with laser retinopexy as prophylaxis for retinal detachment.

Discussion: Patients with a history of ROP have a lifelong increased risk of retinal tears, and the long-term effects of intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy for ROP are not well understood or documented. It is unknown whether there are differences in the rates of long-term ocular complications of ROP following anti-VEGF versus laser treatment of ROP. Studies are needed to compare the long-term benefits and risks associated with both approaches.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/ICB.0000000000001035DOI Listing
July 2020

A semi-automated machine-learning based workflow for ellipsoid zone analysis in eyes with macular edema: SCORE2 pilot study.

PLoS One 2020 30;15(4):e0232494. Epub 2020 Apr 30.

Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America.

Background And Objective: To develop a semi-automated, machine-learning based workflow to evaluate the ellipsoid zone (EZ) assessed by spectral domain optical coherence tomography (SD-OCT) in eyes with macular edema secondary to central retinal or hemi-retinal vein occlusion in SCORE2 treated with anti-vascular endothelial growth factor agents.

Methods: SD-OCT macular volume scans of a randomly selected subset of 75 SCORE2 study eyes were converted to the Digital Imaging and Communications in Medicine (DICOM) format, and the EZ layer was segmented using nonproprietary software. Segmented layer coordinates were exported and used to generate en face EZ thickness maps. Within the central subfield, the area of EZ defect was measured using manual and semi-automated approaches via a customized workflow in the open-source data analytics platform, Konstanz Information Miner (KNIME).

Results: A total of 184 volume scans from 74 study eyes were analyzed. The mean±SD area of EZ defect was similar between manual (0.19±0.22 mm2) and semi-automated measurements (0.19±0.21 mm2, p = 0.93; intra-class correlation coefficient = 0.90; average bias = 0.01, 95% confidence interval of limits of agreement -0.18-0.20).

Conclusions: A customized workflow generated via an open-source data analytics platform that applied machine-learning methods demonstrated reliable measurements of EZ area defect from en face thickness maps. The result of our semi-automated approach were comparable to manual measurements.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0232494PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7192485PMC
July 2020

Assessing the Quality of Published Surveys in Ophthalmology.

Ophthalmic Epidemiol 2020 10 6;27(5):339-343. Epub 2020 Apr 6.

Division of Ophthalmology, Warren Alpert Medical School, Brown University , Providence, Rhode Island, USA.

Purpose: Surveys are an important research modality in ophthalmology, but their quality has not been rigorously assessed. This study evaluated the quality of published ophthalmic surveys.

Methods: Three survey methodologists, three senior ophthalmologists, and two research assistants developed a survey evaluation instrument focused on survey development and testing; sampling frame; response bias; results reporting; and ethics. Two investigators used the instrument to assess the quality of all ophthalmic surveys that were published between January 1, 2018 and December 31, 2018; indexed in MEDLINE/PubMed, Embase, and/or Web of Science; contained the search terms "ophthalmology" and "survey" or "questionnaire" in the title and/or abstract; and were available in English.

Results: The search identified 626 articles; 60 met the eligibility criteria and were assessed with the survey evaluation instrument. Most surveys (93%; 56/60) defined the study population; 48% (29/60) described how question items were chosen; 30% (18/60) provided the survey for review or described the questions in sufficient detail; 30% (18/60) were pre-tested or piloted; 25% (15/60) reported validity/clinical sensibility testing; 15% (9/60) described techniques used to assess non-response bias; and 63% (38/60) documented review by an institutional review board (IRB).

Conclusion: The quality of published ophthalmic surveys can be improved by focusing on survey development, pilot testing, non-response bias and institutional review board review. The survey evaluation instrument can help guide researchers in conducting quality ophthalmic surveys and assist journal editors in evaluating surveys submitted for publication.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/09286586.2020.1746359DOI Listing
October 2020

Association Between Sex Composition and Publication Productivity of Journal Editorial and Professional Society Board Members in Ophthalmology.

JAMA Ophthalmol 2020 05;138(5):451-458

Department of Ophthalmology, Penn State College of Medicine, Hershey, Pennsylvania.

Importance: Because women remain underrepresented in leadership positions in medicine, including ophthalmology, knowledge of sex composition of ophthalmic journal editorial and professional society boards seems warranted.

Objectives: To investigate the sex composition of ophthalmic journal editorial and professional society boards and compare the publication productivity and number of citations of male vs female board members.

Design, Setting, And Participants: In this cross-sectional study, the SCImago Journal Rank indicator was used to identify the 20 highest-ranked ophthalmology journals. Faculty members from each ophthalmic subspecialty were surveyed within a US academic ophthalmology department to identify 15 influential ophthalmology societies. The 2018 board members of each journal and society were identified from the journals' and societies' official websites, and the sex of each individual was recorded. Information regarding journals and societies was collected from October 1 to December 31, 2018. The Scopus database was accessed in January 2019 and then used to find each member's h-index and m-quotient.

Main Outcomes And Measures: The h-index, defined as the highest number of an author's publications that received at least h number of citations, was calculated for each board member. The m-quotient, which accounts for varying lengths of academic careers, was calculated by dividing the h-index by the number of years since first publication.

Results: Of the 1077 members of ophthalmic journal editorial and society leadership boards, 797 (74.0%) were men and 280 (26.0%) were women. Among the 24 editors in chief of the 20 journals investigated, 23 (95.8%) were male. Thirteen of the 15 professional society presidents (86.7%) were men. Male board members had significantly higher median h-indexes (male vs female journals: 34 [interquartile range {IQR}, 23-47] vs 28 [IQR, 19-40], P < .001; male vs female societies: 27 [IQR, 15-41] vs 17 [IQR, 8-32], P = .006), median publication numbers (male vs female journal board members: 157 [IQR, 88-254] vs 109 [IQR, 66-188], P < .001; male vs female society board members: 109 [IQR, 57-190] vs 58 [IQR, 28-139, P = .001), and median citations (male vs female journal board members: 4027 [IQR, 1897-8005] vs 2871 [IQR, 1344-5852], P < .001; male vs female society board members: 2228 [IQR, 1005-5069] vs 1090 [IQR, 410-2527], P = .003). However, the median m-quotients for male and female board members were comparable (male vs female journal board members: 1.2 [IQR, 0.8-1.6] vs 1.1 [IQR, 0.8-1.5], P = .54; male vs female society board members: 1.0 [IQR, 0.7-1.4] vs 0.9 [IQR, 0.6-1.3], P = .32).

Conclusions And Relevance: The findings suggest that the sex composition on journal editorial and professional society boards in ophthalmology is consistent with the sex composition of ophthalmologists in the US, as reported by the Association of American Colleges, but that editor in chief and society president positions are male dominated despite the apparent equality in academic productivity.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1001/jamaophthalmol.2020.0164DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7099467PMC
May 2020

Bevacizumab versus triamcinolone for persistent diabetic macular edema: a randomized clinical trial.

Graefes Arch Clin Exp Ophthalmol 2020 Mar 23;258(3):479-490. Epub 2019 Dec 23.

Department of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo, Brazil, 3900, Bandeirantes av., Campus, 12fl., Ribeirão Preto, São Paulo, 14048-900, Brazil.

Purpose: To evaluate 24-week visual acuity and anatomic outcomes of two "pro re nata" (prn) treatment strategies (intravitreal bevacizumab [IVB] prn versus intravitreal triamcinolone acetonide [IVT] prn) in patients with persistent diabetic macular edema (pDME) after 24 weeks of prn-IVB.

Methods: One hundred eyes with center-involving DME were enrolled and treated with prn-IVB for 24 weeks; at week 24, eyes with pDME (central subfield thickness [CST] on spectral domain optical coherence tomography > 300 μm) were randomized to IVB monthly prn (group I; prn-IVB) or IVT every 3 months prn (group II; prn-IVT) and eyes in which the CST was ≤ 300 μm were assigned to continue prn-IVB (group III).

Results: Seventy-four eyes completed a 48-week study period. At week 24, 65 (79.3%) eyes still had DME with CST > 300 μm and, therefore, were randomized to prn-IVB (group I, n = 33) or prn-IVT (group II, n = 32); the remaining 17 (20.7%) eyes had CST ≤ 300 μm and were assigned to continued treatment with prn-IVB (group III). At baseline, mean CST (μm) ± standard error of the mean (SEM) was 447.2 ± 24.4, 478.0 ± 19.7, and 386.0 ± 21.0 in groups I, II, and III, respectively (p > 0.05). At week 48, there was no significant difference in mean CST between groups I and II (369.9 ± 23.3 and 426.0 ± 26.1, respectively; p = 0.9995). A significant reduction in mean CST, compared with baseline, was noted at weeks 28 (p = 0.0002) and 44 (p = 0.0002) in group II. Group I did not show a significant reduction in mean CST compared with baseline at any study visit. There were no significant differences in mean CST between groups I and II at any study visit. At baseline, mean ± SEM best-corrected visual acuity (BCVA) (logMAR) was 0.50 ± 0.00, 0.60 ± 0.10, and 0.50 ± 0.10 in groups I, II, and III, respectively (p > 0.05). At week 48, there was no statistically significant difference in mean BCVA between groups I and II (0.50 ± 0.10 and 0.80 ± 0.10, respectively; p = 0.4473). There was no significant improvement in mean BCVA, as compared with baseline, at any study follow-up visit in any of the groups. Group II demonstrated significantly lower BCVA after 24 weeks of IVT (at week 48) compared with baseline (p = 0.0435). There was no significant difference in mean BCVA between groups I and II at any time-point.

Conclusion: In eyes with pDME after 24 weeks of treatment with prn-IVB, there was no difference between continued treatment with prn-IVB versus a treatment switch to prn-IVT with respect to mean BCVA or mean CST at week 48. However, BCVA was stable in the prn-IVB group, while prn-IVT was associated with BCVA reduction from baseline and a higher risk of IOP elevation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00417-019-04564-zDOI Listing
March 2020

Transzonular Triamcinolone-Moxifloxacin Versus Topical Drops for the Prophylaxis of Postoperative Inflammation After Cataract Surgery.

J Ocul Pharmacol Ther 2019 12 15;35(10):565-570. Epub 2019 Oct 15.

Department of Ophthalmology and Penn State College of Medicine, Hershey, Pennsylvania.

To compare the safety and efficacy of an intraoperative transzonular injection of triamcinolone-moxifloxacin (Imprimis' Tri-Moxi 15 mg/1 mg/mL) to topical drops in patients undergoing cataract surgery. Between January 2017 and October 2017, patients undergoing phacoemulsification cataract surgery by a single surgeon at the Penn State Eye Center were offered a single intraoperative injection of transzonular triamcinolone-moxifloxacin in lieu of perioperative drops. Between November 2017 and July 2018, the transzonular injection was not offered, and all patients who underwent surgery by the same surgeon received a drop regimen consisting of polymyxin b/trimethoprim and prednisolone acetate 1%. Patients were seen 1 day, 1 week, and 6-9 weeks postoperatively. Outcome measures included incidence of intraoperative complications, postoperative breakthrough inflammation, cystoid macular edema, and infectious sequela. Of the 198 eyes, 99 from 73 patients received the injection and 99 from 82 patients received topical drops. One (1%) intraoperative posterior capsule tear occurred in each group. Eleven (11.1%) eyes in the injection group and 3 (3%) in the drop group experienced symptomatic breakthrough inflammation necessitating treatment ( = 0.0488). One (1%) eye in the injection group and zero (0%) in the drop group developed clinically significant macular edema ( = 1.0). No instances of elevated intraocular pressure or infectious sequela occurred in either group ( = 1.0). Transzonular injection of triamcinolone-moxifloxacin may be associated with an increased incidence of breakthrough inflammation compared to topical drops.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1089/jop.2019.0097DOI Listing
December 2019

Month 24 Outcomes After Treatment Initiation With Anti-Vascular Endothelial Growth Factor Therapy for Macular Edema Due to Central Retinal or Hemiretinal Vein Occlusion: SCORE2 Report 10: A Secondary Analysis of the SCORE2 Randomized Clinical Trial.

JAMA Ophthalmol 2019 Oct 10. Epub 2019 Oct 10.

Southern California Desert Retina, Palm Desert.

Importance: Two-year outcomes are reported comparing eyes originally assigned to aflibercept or bevacizumab to assess the need for continued anti-vascular endothelial growth factor (VEGF) therapy for macular edema due to central retinal vein occlusion (CRVO) or hemiretinal vein occlusion (HRVO) from participants in the Study of Comparative Treatments for Retinal Vein Occlusion 2 (SCORE2) trial.

Objective: To investigate outcomes 1 year after cessation of the SCORE2 treatment schedule.

Design, Setting, And Participants: In this secondary analysis of the SCORE2 randomized clinical trial, follow-up included 117 participants originally randomized to aflibercept and 119 participants originally randomized to bevacizumab between September 17, 2014, and November 18, 2015. Data for the analyses were frozen on September 13, 2018.

Interventions: SCORE2 participants completed the treatment protocol at month 12, were subsequently treated at investigator discretion, and underwent assessment at month 24.

Main Outcomes And Measures: Visual acuity letter score (VALS) and central subfield thickness (CST) on spectral-domain optical coherence tomography.

Results: Among 362 participants randomized to aflibercept or bevacizumab, 65.2% (236 of 362) completed a protocol visit at month 24 (mean [SD] age, 68.5 (12.0) years; 53.8% male). The mean (SD) VALS improved from baseline to 12 months by 21.6 (14.5) in the aflibercept group compared with 21.9 (16.6) in the bevacizumab group (difference, -0.3; 99% CI, -5.6 to 4.9), then worsened from those values by a mean (SD) VALS of 7.6 (17.5) in the aflibercept group and 7.5 (14.5) in the bevacizumab group (difference, -0.1; 99% CI, -5.6 to 5.3) at month 24. The mean (SD) CST improved from baseline to 12 months by 394 (231) μm in the aflibercept group compared with 420 (274) μm in the bevacizumab group (difference, 26 μm; 99% CI, -62 to 114 μm), then worsened from those values by a mean (SD) of 58 (192) μm in the aflibercept group compared with 48 (186) μm in the bevacizumab group (difference, 10 μm; 99% CI, -58 to 78 μm) at month 24.

Conclusions And Relevance: No differences in VALS or CST outcomes at month 24 were identified when participants originally assigned to aflibercept were compared with those assigned to bevacizumab. Caution in interpretation is needed because of loss to follow-up. In both groups, VALS and CST improved through month 12 and then worsened somewhat during the second year, when treatment was at investigator discretion. This analysis suggests that CRVO and HRVO warrant close monitoring and treatment as needed over at least 2 years to optimize outcomes in eyes treated with anti-VEGF therapy.

Trial Registration: ClinicalTrials.gov identifier: NCT01969708.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1001/jamaophthalmol.2019.3947DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6802250PMC
October 2019

Patient-Reported Visual Function Outcomes After Anti-Vascular Endothelial Growth Factor Therapy for Macular Edema Due to Central Retinal or Hemiretinal Vein Occlusion: Preplanned Secondary Analysis of a Randomized Clinical Trial.

JAMA Ophthalmol 2019 Jun 6. Epub 2019 Jun 6.

Texas Retina Associates, Dallas.

Importance: Anti-vascular endothelial growth factor (anti-VEGF) therapy is the standard-of-care first-line treatment for macular edema associated with central retinal vein occlusion (CRVO) or hemiretinal vein occlusion (HRVO), and information is needed to assess the effect of anti-VEGF therapy on patient-reported visual function.

Objective: To investigate the effect of intravitreal aflibercept or bevacizumab on patient-reported visual function in patients with macular edema secondary to CRVO or HRVO.

Design, Setting, And Participants: This preplanned secondary analysis of the Study of Comparative Treatments for Retinal Vein Occlusion 2, a randomized clinical trial, included 346 participants from 66 private practice or academic centers in the United States. Participants had CRVO- or HRVO-associated macular edema and month 6 outcome information. Data were collected from September 17, 2014, through November 18, 2015, and analyzed from February 7, 2018, through February 26, 2019.

Interventions: Eyes were randomly assigned to receive an intravitreal injection of bevacizumab (1.25 mg) or aflibercept (2.0 mg) at baseline and every 4 weeks through month 5.

Main Outcomes And Measures: Difference between treatment arms at month 6 in the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) composite and subscale scores.

Results: Among the 346 participants (56.1% men; mean [SD] age, 69 [12] years), significant improvements occurred from baseline to month 6 in the NEI VFQ-25 composite score in the aflibercept (mean [SE] change, 7.5 [0.9]; P < .001) and bevacizumab (mean [SE], 6.1 [0.9]; P < .001) arms and in 10 of 12 subscale scores after multiplicity adjustment. No differences were observed at month 6 in NEI VFQ-25 composite or subscale scores between participants randomized to aflibercept or bevacizumab treatment. Weak positive correlations were seen between the change in the study eyes' visual acuity and the changes in the NEI VFQ-25 composite score (r = 0.22; P < .001) and the Distance Activities (r = 0.24; P < .001) and Driving (r = 0.19; P = .03) subscale scores.

Conclusions And Relevance: Significant improvement occurred from baseline to month 6 in patient-reported visual function as assessed by the NEI VFQ-25. The lack of difference in NEI VFQ-25 scores between study participants treated with monthly intravitreal aflibercept and bevacizumab for macular edema due to CRVO or HRVO at month 6 is consistent with the primary outcome finding that showed bevacizumab was noninferior to aflibercept with respect to visual acuity improvement from baseline to month 6.

Trial Registration: ClinicalTrials.gov identifier: NCT01969708.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1001/jamaophthalmol.2019.1519DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6555474PMC
June 2019

Intraoperative aberrometry versus preoperative biometry for intraocular lens power selection in short eyes.

J Cataract Refract Surg 2019 06 8;45(6):719-724. Epub 2019 Mar 8.

Department of Ophthalmology, the Penn State College of Medicine, Hershey, Pennsylvania, USA. Electronic address:

Purpose: To compare the accuracy of preoperative biometry-based formulas to intraoperative aberrometry (IA) with respect to predicting refractive outcomes after cataract surgery in short eyes.

Setting: Private practice and community-based ambulatory surgery center.

Design: Retrospective consecutive case series.

Methods: Eyes with an axial length (AL) shorter than 22.1 mm underwent cataract extraction and intraocular lens (IOL) implantation. The predicted residual refractive error was calculated preoperatively using Hoffer Q, Holladay 2, Haigis, Barrett Universal II, and Hill-RBF formulas and intraoperatively using IA. The postoperative spherical equivalent (SE) was compared with the predicted SE to evaluate the accuracy of each aforementioned method.

Results: Fifty-one eyes from 38 patients met criteria to be included in the analysis. Without optimizing the formulas specifically for short eyes, the mean numerical errors (MNEs) associated with Hoffer Q, Holladay 2, Haigis, Barrett Universal II, Hill-RBF, and IA were -0.08 (95% confidence interval [CI], -0.30 to 0.13), -0.14 (95% CI, -0.35 to 0.07), +0.26 (95% CI, 0.05 to 0.47), +0.11 (95% CI, -0.10 to 0.32), +0.07 (95% CI, -0.14 to 0.28), and +0.00 (95% CI, -0.21 to 0.21), respectively (P < .001). The proportion of eyes within ±0.5 diopter (D) of the predicted SE were 49.0%, 43.1%, 52.9%, 52.9%, 60.8%, and 58.8%, respectively (P = .06). The prediction outcomes from IA were statistically better than Haigis, but not other formulas. When formula and IA predictions differed by 0.5 D or more, IA's ability to recommend a more emmetropic outcome was no better than chance (50%).

Conclusions: Intraoperative aberrometry is not significantly different from the best preoperative biometry-based methods available for IOL power selection in short eyes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jcrs.2018.12.016DOI Listing
June 2019

Month 12 Outcomes After Treatment Change at Month 6 Among Poor Responders to Aflibercept or Bevacizumab in Eyes With Macular Edema Secondary to Central or Hemiretinal Vein Occlusion: A Secondary Analysis of the SCORE2 Study.

JAMA Ophthalmol 2019 03;137(3):281-287

Paducah Retinal Center, Paducah, Kentucky.

Importance: Information is needed to assess switching treatment in eyes with a poor response to 6 months of monthly administration of aflibercept or bevacizumab for macular edema from central retinal vein occlusion (CRVO) or hemiretinal vein occlusion (HRVO).

Objective: To investigate visual acuity letter score (VALS) and central subfield thickness (CST) changes from month 6 to 12 among eyes with a poor response at month 6 to monthly dosing of aflibercept or bevacizumab in the Study of Comparative Treatments for Retinal Vein Occlusion 2.

Design, Setting, And Participants: This secondary analysis of the Study of Comparative Treatments for Retinal Vein Occlusion 2 (SCORE2) was conducted at 66 private practice or academic centers in the United States. Participants included 49 patients (1 eye from each patient evaluated) with CRVO- or HRVO-associated macular edema and a protocol-defined poor response to aflibercept or bevacizumab treatment at month 6. The first month 6 visit occurred on September 8, 2015, and the last month 12 visit occurred on October 24, 2016.

Interventions: Treatment in eyes receiving monthly aflibercept was switched to a dexamethasone implant at month 6 and, if needed, at months 9, 10, or 11. Treatment in eyes receiving monthly bevacizumab was switched to aflibercept at months 6, 7, and 8, and then to a treat-and-extend aflibercept regimen until month 12.

Main Outcomes And Measures: Change from month 6 to 12 in VALS and CST.

Results: Of the 49 participants at month 6, aflibercept treatment had failed in 14 (6 [43%] women; mean [SD] age, 70.4 [13.0] years). Bevacizumab treatment had failed in 35 patients (16 [46%] women; mean age, 70.0 [13.2] years). In 14 eyes with treatment switched from aflibercept to dexamethasone, the estimated mean change from month 6 to 12 in VALS was 2.63 (95% CI, -3.29 to 8.56; P = .37) and 46.0 μm (95% CI, -80.9 to 172.9 μm; P = .46) for CST. In 35 eyes with treatment switched from bevacizumab to aflibercept, the estimated mean change from month 6 to 12 in VALS was 10.27 (95% CI, 6.05-14.49; P < .001) and -125.4 μm (95% CI, -180.9 to -69.9 μm; P < .001) for CST.

Conclusions And Relevance: Eyes treated with aflibercept after a poor response to bevacizumab had improvement in VALS and CST. Few eyes had a poor response to aflibercept, and therefore, few eyes were switched to dexamethasone. Caution is warranted in interpreting these results owing to the small number of eyes and lack of comparison groups. These factors preclude definitive assessment of whether the switching strategy is superior to maintaining treatment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1001/jamaophthalmol.2018.6111DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6439712PMC
March 2019

Virtual eye surgery training in ophthalmic graduate medical education.

Can J Ophthalmol 2018 12 18;53(6):e218-e220. Epub 2018 May 18.

Division of Ophthalmology, Alpert Medical School, Brown University, Providence, RI; Section of Ophthalmology, Providence Veterans Affairs Medical Center, Providence, RI. Electronic address:

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jcjo.2018.03.018DOI Listing
December 2018

Reducing the Disclosure Effect in the Vitreoretinal Fellowship Match.

JAMA Ophthalmol 2019 01;137(1):119-120

Roger Williams Medical Center, Department of Medicine, Boston University, Providence, Rhode Island.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1001/jamaophthalmol.2018.4990DOI Listing
January 2019

Low vision services: a practical guide for the clinician.

Ther Adv Ophthalmol 2018 Jan-Dec;10:2515841418776264. Epub 2018 Jun 11.

Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA.

Low vision has been defined by best-corrected visual acuity worse than 20/40 in the better eye, substantial visual field loss, or substantial loss of contrast sensitivity that cannot be corrected by refraction, medical treatment, or surgery. In the United States, low vision is most commonly caused by age-related macular degeneration, glaucoma, and diabetic retinopathy. Most patients with low vision are elderly, although patients of all ages - including pediatric patients - may be affected. Low vision may decrease a patient's quality of life substantially, leading to emotional distress and possibly depression. Low vision specialists aim to maximize the remaining vision of a patient by providing optical aids, orientation and mobility training, psychosocial support, and other methods of rehabilitation. Innovations in technology and devices offer additional options in low vision rehabilitation. Clinicians should consider referral to low vision specialists when a patient has difficulty with reading, mobility, driving, recognizing faces, or suffers from emotional distress due to low vision. Early referral may lead to improved outcomes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/2515841418776264DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6024512PMC
June 2018

Optical Coherence Tomography Angiography.

Case Rep Ophthalmol Med 2018 6;2018:7140164. Epub 2018 Jun 6.

Department of Ophthalmology, Penn State College of Medicine, Hershey, PA, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1155/2018/7140164DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6011171PMC
June 2018

Resident Wellness in US Ophthalmic Graduate Medical Education: The Resident Perspective.

JAMA Ophthalmol 2018 06;136(6):695-701

Division of Ophthalmology, Warren Alpert Medical School, Brown University, Providence, Rhode Island.

Importance: Wellness programs have become important strategies to combat burnout and depression among residents. However, the resident perspective on wellness in ophthalmic graduate medical education has not been solicited on a national level.

Objectives: To report on residents' views of wellness initiatives in ophthalmic graduate medical education and identify potential strategies for promoting resident wellness.

Design, Setting, And Participants: In this national survey of ophthalmology residents in the United States, conducted from September 21 to November 3, 2017, all 1048 ophthalmology residents listed on the websites of ophthalmology residency programs accredited by the Accreditation Council for Graduate Medical Education were emailed an anonymous online survey consisting of 12 multiple-choice questions with options for free-text answers. Residents also received a mailed letter with a survey link and a $1 incentive, as well as 2 reminder emails. Survey responses were analyzed using descriptive statistics, and the free-text answers were categorized.

Main Outcomes And Measures: Main outcomes include residents' reports regarding their personal experiences with wellness during residency, support systems provided by their programs, and opportunities for improving wellness in ophthalmic graduate medical education.

Results: Of 1048 residents, 241 (23.0%) responded to the survey. Most respondents (121 of 177 [68.4%]) reported that their programs faced an issue involving depression, burnout, or suicide among residents within the past year; 26.3% of respondents (61 of 232) reported being involved in a case when resident fatigue, burnout, or depression adversely affected a medical outcome or judgment. Fewer than half of the respondents (110 of 241 [45.6%]) reported that their residency programs placed moderate or major emphasis on promoting a culture of resident wellness, and only 26.7% (63 of 236) reported that their department had a formal resident wellness program. The most commonly cited barrier to resident wellness (59 of 236 [25.0%]) was a lack of time to attend wellness programs.

Conclusions And Relevance: These results suggest that there is a substantial burden of burnout and depression among US ophthalmology residents and that there are opportunities to boost wellness in ophthalmic graduate medical education by making wellness curricula more accessible to residents and ensuring that residents have time to attend wellness programs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1001/jamaophthalmol.2018.1383DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6145770PMC
June 2018

LONG-TERM PHYSICAL STABILITY, STERILITY, AND ANTI-VEGF BIOACTIVITY OF REPACKAGED BEVACIZUMAB IN 2-ML GLASS VIALS.

Retina 2019 Sep;39(9):1802-1809

Fundus Photograph Reading Center, University of Wisconsin, Madison, Wisconsin.

Purpose: Repackaged bevacizumab in single-dose, prefilled syringes for intravitreal injection is available, but with shelf life limited from 60 days to 90 days. For the Study of COmparative Treatments for REtinal Vein Occlusion 2 (SCORE2), 2-mL sterile glass vials were used rather than prefilled syringes to provide a longer shelf life for study supplies.

Methods: Repackaged bevacizumab in glass vials was tested at release and, for 1 lot, after 1, 3, 6, and 12 months for physical stability, including concentration, purity and appearance, and for sterility and endotoxins. Vials from 2 lots were tested at release and after 20 months and 21 months, respectively. One lot was tested at 21 months for anti-VEGF bioactivity compared with a fresh supply of commercial bevacizumab.

Results: Repackaged bevacizumab in 2-mL glass vials continued to meet all quality release specifications and remain sterile for up to 21 months. In addition, no degradation in anti-VEGF bioactivity was observed at 21 months compared with a fresh bevacizumab control.

Conclusion: Bevacizumab can be repackaged into small, single-dose glass vials for intravitreal injection and the qualities of the commercial product maintained, including anti-VEGF bioactivity, for up to 21 months in refrigerated storage. Consideration should be given to repackaging bevacizumab for ophthalmic use in small glass vials as opposed to plastic syringes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/IAE.0000000000002212DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6226382PMC
September 2019

Comparison of Monthly vs Treat-and-Extend Regimens for Individuals With Macular Edema Who Respond Well to Anti-Vascular Endothelial Growth Factor Medications: Secondary Outcomes From the SCORE2 Randomized Clinical Trial.

JAMA Ophthalmol 2018 04;136(4):337-345

The Retina Group of Washington, Fairfax, Virginia.

Importance: Comparisons of monthly vs treat-and-extend anti-vascular endothelial growth factor (anti-VEGF) regimens for macular edema from central retinal vein occlusion or hemiretinal vein occlusion is needed.

Objective: To compare visual acuity letter score and central subfield thickness outcomes of participants in the Study of Comparative Treatments for Retinal Vein Occlusion 2 (SCORE2) trial who then received either monthly injections or treat-and-extend (TAE) regimens of aflibercept or bevacizumab after a good response at month 6.

Design, Setting, And Participants: This randomized clinical trial enrolled participants from 66 private practice or academic centers in the United States. All participants had macular edema associated with central retinal vein occlusion or hemiretinal vein occlusion, had enrolled in the SCORE2 trial, and had a protocol-defined good response to monthly injections in the first 6 months of the trial. Participants initially assigned to receive monthly aflibercept were randomized to aflibercept on a monthly or TAE schedule, and participants initially assigned to receive monthly injections of bevacizumab were randomized to receive bevacizumab on a monthly or TAE schedule. The first participant was randomized in the SCORE2 trial on September 17, 2014, and the last month 12 visit occurred on October 24, 2016.

Main Outcomes And Measures: Change from month 6 to month 12 in best-corrected electronic visual acuity letter score (per the Early Treatment Diabetic Retinopathy Study).

Results: The 293 participants had a mean (SD) age of 68.9 (11.9) years; 127 (43.3%) were female. Of these, 79 were randomized to aflibercept on a monthly schedule, 80 to aflibercept on a TAE schedule, 67 to monthly bevacizumab, and 67 to bevacizumab on a TAE schedule. Mean treatment group difference (the change in visual acuity letter score in the monthly group minus the change in the TAE group) from month 6 to month 12 was 1.88 (97.5% CI, -1.07 to 4.83; P = .15) for aflibercept and 1.98 (97.5% CI, -1.08 to 5.03; P = .15) for bevacizumab. In the aflibercept arm, the mean number of injections between months 6 and 11 was 5.8 in the monthly injection group (95% CI, 5.6 to 5.9) and 3.8 in the TAE group (95% CI, 3.5 to 4.1; P < .001); in the bevacizumab arm, the mean number of injections was 5.8 (95% CI, 5.6 to 5.9) in the monthly group and 4.5 in the TAE group (95% CI, 4.2 to 4.8; P < .001).

Conclusions And Relevance: One to 2 fewer injections of aflibercept or bevacizumab were given to the TAE groups than the monthly groups in months 6 to 12 for macular edema associated with central retinal or hemiretinal vein occlusion. Because of wide confidence intervals on the differences between the groups, caution is warranted before concluding that the regimens are associated with similar vision outcomes.

Trial Registration: www.clinicaltrials.gov identifier: NCT01969708.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1001/jamaophthalmol.2017.6843DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5876862PMC
April 2018