Evidence-Based Ophthalmology: January 2005 - Volume 6 - Issue 1 - p 36-37 doi: 10.1097/01.ieb.0000150380.89047.89
Evidence-Based Ophthalmology: January 2005 - Volume 6 - Issue 1 - p 48-49 doi: 10.1097/01.ieb.0000150381.96671.6b
Evidence-Based Ophthalmology: January 2005 - Volume 6 - Issue 1 - p 28-29 doi: 10.1097/01.ieb.0000150382.73800.67
OBJECTIVE:To evaluate the 5-year safety and efficacy of adjunctive 0.005% latanoprost once daily.METHODS:Patients with primary open-angle or exfoliation glaucoma who completed a 3-year, open-label, uncontrolled, prospective trial could enter a 2-year extension phase. High-resolution color photographs of irides were taken at baseline and at 14 subsequent visits. Photographs were assessed for change in iris pigmentation compared with baseline. Intraocular pressures and adverse events were recorded.MAIN OUTCOME MEASURE:Development and progression of increased iris pigmentation over 5 years.RESULTS:Of the 519 original patients, 380 enrolled in the extension phase with approximately 89% having an eye color known to be susceptible to color change. After 5 years, most patients had no increase in iris pigmentation, but certain colored irides exhibited notably greater susceptibility than others. For those whose irides did change, onset occurred during the first 8 months in 74% and during the first 24 months in 94%. No patient developed an increase in pigmentation after month 36; the rate of progression decreased over time. Adverse event profiles were similar for patients with and without increased pigmentation. The overall mean intraocular pressure reduction from baseline of 25% was sustained with no need for change in intraocular pressure-lowering treatment in 70% of the eyes.CONCLUSION:Latanoprost therapy is safe and well tolerated for long-term treatment of open-angle glaucoma.
Evidence-Based Ophthalmology: January 2005 - Volume 6 - Issue 1 - p 18-19 doi: 10.1097/01.ieb.0000150293.42389.ea
Evidence-Based Ophthalmology: January 2005 - Volume 6 - Issue 1 - p 24-25 doi: 10.1097//01.0000150295.24620.ae
Starting with the January issue, this journal will have a new name. Evidence-Based Eye Care will proudly become Evidence-Based Ophthalmology. The editors have made this decision after examining our core constituency, the ophthalmologist community. We are most pleased that both ophthalmologists in the academic arena and the private practice clinician arena alike find the journal both informative and useful. We are confident that the journal will continue to appeal to all who are involved with care of the visual system. First, let us thank all of the talented reviewers on the Editorial Board who have provided superb reviews that greatly enhance the value of the journal. While most peer-reviewed medical journals do not have experts comment on the articles contained therein, the expert critique remains a central part of our journal. We believe that the insight of talented practitioners commenting on articles within their area(s) of expertise gives the reader an insight into clinical usefulness that is often not otherwise clear or apparent. The articles selected for review are those that we believe best demonstrate the finest evidence-based principles in the recently published literature. Even these are critiqued by our reviewers, often with the result of enhancing the overall value of the article to the reader. One thing that we know is that if the reviewers also agree that the articles are good, they are publications that the readership should keep in their disease-fighting armamentarium. Since the journal was initiated in 1999, value-based medicine has become a term more familiar to many physicians. With the advent of the Medicare Prescription Drug, Improvement and Modernization Act of 2003,1 the terms used in Evidence-Based Ophthalmology will become even more familiar to the readership. Why? Because the bill mandates a $50 million expenditure for the study of the cost-effectiveness of pharmaceuticals. While the exact method of analysis is not specified, there is every reason to believe that it will take the form of cost-utility analysis. Thus, we firmly believe value-based medicine and cost utility should and will become integral parts of the health care equation within the decade. Over the past two decades, reimbursement for ophthalmologic interventions has dramatically decreased. In the early 1980s, the Medicare reimbursement for cataract removal and intraocular lens implantation was in the range of $2000, while the national average in 2004 is $684.2 Thus, in 2004, reimbursement for cataract surgery, adjusted for inflation,3 is 17% of what is was in the early 1980s. Cost-utility analysis, the form of health care economic analysis that provides the information necessary to create value-based medicine standards, has been performed for the intervention of cataract surgery with intraocular lens implantation. For cataract surgery in the first eye, the cost utility is $2182/QALY4 (quality-adjusted life-year) in 2004 dollars, while that for the second eye is $2890/QALY5 in 2004 dollars. Cataract surgery in the second eye is similar to the first eye in conferred value and cost-effectiveness because people with one eye generally have considerable worry about the fate of that eye. Having two eyes with good vision confers peace of mind and thus is associated with better quality of life than having good vision in one eye.6This is an important concept that applies to other ocular interventions as well as to people with only one good organ in what is normally a two-organ system (ears, lungs, kidneys). Considering that the most common upper limit of cost-effectiveness for cost-utility analysis is $100,000,7 cataract surgery in both the first eye and the second eye delivers among the greatest value of the common major interventions in health care. Additionally, this surgery is among the most cost-effective, common, major interventions in health care. Had this information been available 20 years earlier, it is likely that the current Medicare reimbursement for cataract surgery would not have experienced such a draconian cut, especially considering the great value that cataract surgery in either eye confers to the average patient. Looking to the future, the superior value and great cost-effectiveness of cataract surgery in the second eye will be powerful deterrents to those who might say second-eye surgery is not of sufficient benefit to merit reimbursement. This applies to other ophthalmic interventions as well, which as a group remain among the most cost-effective in medicine.8 In the journal, we will attempt to continue to highlight relevant articles that represent the best of evidence-based medicine. In this regard, we attempt to choose articles that are relevant to the practicing clinician. At times, the balance is difficult since articles that demonstrate good evidence-based principles may have nominal clinical importance. On occasion, we will include nonophthalmologic evidence-based studies that we believe provide basic knowledge relevant and important to all who practice medicine. We thank the readership for support of the journal and welcome suggestions for improvement at any time to Editors, Evidence-Based Ophthalmology, Center for Value-Based Medicine, 1107 Bethlehem Pike, Suite 210, Flourtown, PA 19031. We hope that you have as much enjoyment reading the journal as we have in working with our talented colleagues in editing it.
Evidence-Based Ophthalmology 10(4):p 179-180, October 2009. | DOI: 10.1097/01.IEB.0000361664.37801.41
Evidence-Based Ophthalmology: January 2005 - Volume 6 - Issue 1 - p 30-31 doi: 10.1097/01.ieb.0000150397.83885.e5
Objective: To determine the prevalence and causes of low vision in a large sample of nursing home residents.Methods: Twenty-eight nursing homes on the Eastern Shore of Maryland and Delaware were enrolled in a clinical trial to assess the impact of vision restoration/rehabilitation on nursing home residents. Visual acuity was measured using both recognition charts and preferential looking techniques. An ophthalmologist examined all residents with visual acuity worse than 20/40 in the better-seeing eye and determined the primary cause for decreased vision. Results are reported for the better-seeing eye.Results: Of 2544 eligible residents, 1591 (63%) participated, but 286 residents were unable to respond to visual acuity testing. Of the remaining 1307 residents, 496 (37%) had best-corrected visual acuity worse than 20/40 in the better-seeing eye. Causes were ascribed for 412 subjects. Rates of low vision were similar between African American subjects and white subjects (39% and 38%, respectively; age-adjusted P = .18). Cataract was the leading cause of low vision, responsible for 37% of low vision among white subjects and 54% of low vision among African American subjects. Macular degeneration was responsible for 29% of low vision among white subjects but only 7% among African American subjects. Glaucoma caused low vision in 4% of white subjects and 10% of African American subjects. Refractive error was not a frequent cause of low vision in nursing home residents.Conclusions: Low vision is highly prevalent among nursing home residents, with 37% having visual acuity worse than 20/40 in the better-seeing eye. Differences in causes of low vision between African American subjects and white subjects were noted, with African American subjects more likely to have vision loss on the basis of cataract, a readily treated condition. Appropriate interventions for nursing home residents, who face significant obstacles in accessing eye care services, have the potential to improve the quality of life of this at-risk older population.
PURPOSE:To evaluate the association between intracranial hypertension (IH) and isotretinoin use.DESIGN:Observational case series.METHODS:In this retrospective study, approximately 1950 case reports of adverse ocular side effects related to isotretinoin were received from spontaneous reporting systems. Reports were evaluated as to the occurrence of IH with isotretinoin use. A survey was mailed to all members of the North American Neuro-ophthalmology Society soliciting their opinions on whether isotretinoin caused IH.RESULTS:One hundred seventy-nine reports of IH were associated with isotretinoin use. The mean time from drug exposure to IH diagnosis was 2.3 months. There were 6 cases of positive rechallenge; 5 new cases are reported here, along with 1 previously published report. Of neuro-ophthalmologists surveyed (62% response rate), 6% believed an association between IH and isotretinoin use was certain; 32%, probable; 52%, possible; and 10%, unlikely. Twelve respondents (4%) had personally seen one or more cases of positive rechallenge with isotretinoin causing IH.CONCLUSIONS:Based on the number and pattern of rapid IH onsets after isotretinoin exposure and the 6 cases of positive rechallenge, along with the probable similarity in metabolic pathways of this agent and vitamin A (a known cause of IH), it seems certain that there is a direct correlation between IH and isotretinoin use.
BACKGROUND/AIMS:Not much is known about the relative importance of different determinants of anxiety in cataract patients. This study analysed the predictive value of factors related to surgery induced anxiety. METHODS:In 128 cataract patients, recruited from two hospitals (Medical Centre Maastricht Annadal (MCMA) and Rotterdam Eye Hospital (REH)), state anxiety was assessed at four different time points using the State-Trait Anxiety Inventory (STAI). The following predictive factors of anxiety were measured: trait anxiety, outcome expectancies, doctor-patient relationship, coping strategy, social support, information supply, sociodemographic variables, and previous cataract surgery. Repeated measures ANOVA, t tests, multiple regression analysis, and correlations were used to analyse data. RESULTS:In general patients reported little anxiety. The level of anxiety (scale 1-4) was the highest before surgery, decreased immediately after surgery, and increased again after the postoperative visit. Patients with higher trait anxiety levels (r = 0.41; p<0.01), and women (r = 0.30; p<0.01) reported more anxiety. The REH patients showed lower anxiety scores than the MCMA patients. CONCLUSION:Women and patients with higher trait anxiety were more likely to experience higher levels of state anxiety. Positive outcome expectancies and social support may decrease anxiety.
BACKGROUNDThe prevalence of glaucoma is higher in African American individuals than in white individuals.OBJECTIVETo report the safety and efficacy of topical ocular hypotensive medication in delaying or preventing the onset of primary open-angle glaucoma (POAG) among African American participants in the Ocular Hypertension Treatment Study.METHODSEligibility criteria included age between 40 and 80 years, intraocular pressure between 24 and 32 mm Hg in one eye and between 21 and 32 mm Hg in the other eye, and no evidence of glaucomatous structural or functional damage by standard clinical measures. Participants were randomized to either the observation group or medication group. Of the 1636 participants randomized, 408 were self-identified as African American.MAIN OUTCOME MEASUREThe primary outcome was the development of reproducible visual field abnormality and/or reproducible optic disc deterioration attributed to POAG.RESULTSAmong African American participants, 17 (8.4%) of 203 in the medication group developed POAG during the study (median follow-up, 78 months) compared with 33 (16.1%) of 205 participants in the observation group (hazard ratio, 0.50; 95% confidence interval, 0.28-0.90; P =.02).CONCLUSIONTopical ocular hypotensive therapy is effective in delaying or preventing the onset of POAG in African American individuals who have ocular hypertension.
Evidence-Based Ophthalmology: January 2005 - Volume 6 - Issue 1 - p 34-35 doi: 10.1097/01.ieb.0000150379.89047.ef
Evidence-Based Ophthalmology: January 2005 - Volume 6 - Issue 1 - p 44-45 doi: 10.1097/01.ieb.0000150398.65959.82
Evidence-Based Ophthalmology: January 2005 - Volume 6 - Issue 1 - p 38-40 doi: 10.1097/01.ieb.0000150394.99132.71
Evidence-Based Ophthalmology: January 2005 - Volume 6 - Issue 1 - p 22-23 doi: 10.1097/01.ieb.0000150385.83209.3f
