PURPOSE:Patients with noninfectious uveitis (NIU) may be more susceptible to complications of COVID-19, including long COVID, yet limited research has evaluated this outcome in NIU populations. This study aimed to assess the prevalence and risk factors of long COVID among individuals with NIU in the United States. METHODS:A retrospective cohort analysis was conducted using de-identified data from a large healthcare claims database. A time-varying Cox proportional hazard regression analysis was performed to estimate the effects of various risk factors on the development of long COVID. Models were adjusted for use of systemic corticosteroids and other immunosuppressive medications, comorbidities, COVID-19 vaccination status, and demographic variables. RESULTS:The study population consisted of 63 220 individuals with NIU (mean age (SD) = 62.9 (17.4) years, 60.7% female). There were 621 (0.096%) documented cases of long COVID across 100 105.6 person-years, representing an incidence rate of 6.2 cases of long COVID per 1000 person-years. Exposure to systemic corticosteroids was associated with an average increased risk of long COVID (hazard ratio (HR) = 3.45, 95% CI: 2.68-4.46, p < 0.001). Additionally, COVID-19-related hospitalizations, increased healthcare utilization, and having baseline asthma and mental health disorders were also associated with an average increased risk of long COVID (all p < 0.003). Male sex, topical or local corticosteroid exposure, and COVID-19 vaccination were associated with an average decreased risk of long COVID (all p < 0.001). CONCLUSION:This large population-based study identified key risk and protective factors for long COVID among patients with NIU. Findings suggest that systemic corticosteroid-induced immune dysregulation may increase vulnerability to long COVID in individuals with severe uveitis.

PURPOSE:To evaluate the effect of a digital mindfulness-based program (Calm Health) on mental health outcomes in adults with noninfectious uveitis (NIU). DESIGN:Single-center, single-masked, waitlist-controlled, randomized clinical trial. PARTICIPANTS:One hundred adults aged ≥18 years with active or inactive NIU and baseline mild or greater anxiety or depression were randomized 1:1 to immediate access to a mindfulness application (app) (Calm Health) or to a waitlist control group. METHODS:Participants in the intervention group were instructed to use the Calm Health mobile app for ≥10 minutes daily for 8 weeks. Controls received no new mindfulness intervention during this period. Outcomes were assessed at baseline and 8 weeks using validated surveys. MAIN OUTCOME MEASURES:The primary outcome was the mean difference in the anxiety symptom severity score measured by the Generalized Anxiety Disorder-7 (GAD-7) at 8 weeks. Secondary outcomes included changes in depression (Patient Health Questionnaire-9 [PHQ-9]), perceived stress (Perceived Stress Scale-10 [PSS-10]), and vision-related quality of life (National Eye Institute Visual Function Questionnaire-25 [NEI VFQ-25]). Outcomes were analyzed using linear analysis of covariance (ANCOVA) models, adjusting for baseline scores. RESULTS:Of 100 randomized participants (median age 43.5 years; 75% female), 70 completed the primary endpoint assessment. Median [Q1, Q3] total app use among intervention participants was 578.62 [397.79, 923.00] minutes over 8 weeks. After adjustment for baseline scores, the intervention group had a significantly lower GAD-7 score at 8 weeks compared with controls (mean difference -1.7 points; 95% CI, -3.17 to -0.23, P = 0.02). Secondary analyses showed significantly greater reductions in PHQ-9 scores (-1.90 points; 95% CI, -3.04 to -0.76, P = 0.001) and PSS-10 scores (-3.69 points; 95% CI, -6.00 to -1.37, P = 0.002) in the intervention group. Changes in NEI VFQ-25 scores were not statistically significant between groups (mean difference 1.98 points; 95% CI, -0.90 to 4.86, P = 0.18). Sensitivity analyses accounting for missing data and clinical covariates yielded similar results. CONCLUSIONS:A digital mindfulness-based intervention (Calm Health) significantly reduced anxiety, depression, and perceived stress in adults with NIU. Digital mindfulness tools may serve as a feasible, scalable adjunct to uveitis care, particularly in settings with limited access to traditional mental health services. FINANCIAL DISCLOSURE(S):Proprietary or commercial disclosure may be found after the references.

Purpose Initial studies during the COVID-19 pandemic demonstrated a possible increased risk of COVID-19 infection and severe outcomes with prior or concurrent immunomodulatory therapy. The purpose of this study was to determine the impact of the COVID-19 pandemic on treatment patterns for non-infectious uveitis (NIU). Design Retrospective interrupted time series analysis using Optum Labs Data Warehouse (OLDW), a national de-identified healthcare database in the United States with administrative claims and electronic health record data. Participants Individuals with a new diagnosis of NIU from December 1st, 2017 to December 31st, 2020 with continuous enrollment ≥1 year prior to this diagnosis. Methods This study was divided into three time periods: pre-pandemic (12/1/17 to 11/30/19), early pandemic (3/1/20 to 12/31/20) and post-vaccine period (1/1/21-9/30/21) corresponding to time prior to the pandemic, during the pandemic when no COVID-19 vaccine was available and after widespread utilization of the vaccine began. Normalized prescription rates of uveitis therapies were modeled as an interrupted time series. In time to treatment analysis, Cox proportional hazard models were used to determine differences in likelihood of different modalities between time periods. Main Outcome Measures Temporal trends in the initial therapeutic choice for non-infectious uveitis. Results This study included 22,444 patients with a new NIU diagnosis. The average age was 61.9 (SD 17.5) years and 59.3% were female. There were no significant temporal breaks in prescribing trends for topical, local, and systemic corticosteroids or immunosuppressive therapy (disease-modifying anti-rheumatic drugs and biologics) between pandemic periods (all p>0.05) in interrupted time series analysis. Overall, topical steroids were more likely to be prescribed in the early versus pre-pandemic period (HR 1.10; 95% CI 1.06-1.15; p<0.001). Intraocular steroids also saw greater relative use during the early (HR 1.29; 95% CI 1.13-1.46; p<0.001) and post-vaccine (HR 1.29; 95% CI 1.14-1.46; p<0.001) period. Use of immunomodulatory therapies increased in the post-vaccine as compared to pre-pandemic period (HR 1.25; 95% CI 1.07 to 1.46; p<0.001). Conclusions No significant differences in prescribing patterns for NIU were observed between pandemic periods. However, utilization of topical and local steroids for NIU was, overall, increased in the early compared to pre-pandemic period.

Purpose: To evaluate the diagnostic performance of a sinusoidal flicker stimulus test at various frequencies using a handheld electroretinography (ERG) device in glaucoma versus control participants. Design: A cross-sectional study conducted between June 2019 and October 2022 at the University of California, San Francisco. Participants: Participants with glaucoma were recruited from glaucoma clinics if they had a diagnosis of open-angle glaucoma, as demonstrated by optic nerve damage or reproducible visual field defects. Control participants had normal optic nerves and intraocular pressures of <21 mmHg and were recruited from optometry clinics. Methods: The RETeval device (LKC Technologies), a handheld ERG recording system, was used to administer a sinusoidal flicker stimulus modulated at 14 frequencies from 1 to 50 Hz, and the first harmonic frequency response amplitudes were collected. Logistic regression models with glaucoma diagnosis as the outcome were trained using data from 67% of participants; models were then tested on the remaining 33%. Main Outcome Measures: Receiver operating characteristic curves demonstrating model performance on the testing set were generated, and area under the receiver operating characteristic curve (AUC) was calculated. The improved DeLong algorithm was used to compare diagnostic performance of the models and differences in performance in dilated versus nondilated eyes. Results: The study included 117 eyes from 72 participants (18 control, 54 glaucoma; mean age [standard deviation {SD}]- 70.4 [12.2] years; 51.4% female). Among glaucomatous eyes, average (SD) mean deviation was-4.61 (5.55) decibels. In a model assessing the combined effects of amplitude responses across all frequencies, the AUC was 0.57 (95% confidence interval [CI]: 0.37-0.78). However, in a model focusing on frequencies of >= 30 Hz, where the OFF pathway may be more affected, the AUC improved to 0.81 (95% CI: 0.66-0.97). In this higher frequency model, sensitivity was 80% and specificity was 74% at the Youden J cutoff. Conclusions: These findings provide evidence of the potential use of handheld ERG in diagnosing glaucoma by assessing retinal amplitude responses to sinusoidal flicker stimuli at frequencies between 30 and 50 Hz. This supports the hypothesis that the OFF pathway may be more vulnerable in glaucoma. Financial Disclosure(s):Proprietary or commercial disclosure may be found in the Footnotes and Disclosures atthe end of this article.Ophthalmology Science 2025;5:100739 (c) 2025 by the American Academy of Ophthalmology. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Purpose:Initial studies during the coronavirus disease 2019 (COVID-19) pandemic demonstrated a possible increased risk of COVID-19 infection and severe outcomes with prior or concurrent immunomodulatory therapy (IMT). The purpose of this study was to determine the impact of the COVID-19 pandemic on treatment patterns for noninfectious uveitis (NIU). Design:Retrospective interrupted time series (ITS) analysis using Optum Labs Data Warehouse, a national deidentified health care database in the United States with administrative claims and electronic health record data. Participants:Individuals with a new diagnosis of NIU from December 1, 2017, to December 31, 2020, with continuous enrollment ≥1 year before this diagnosis. Methods:This study was divided into 3 time periods: prepandemic (December 1, 2017-November 30, 2019), early pandemic (March 1, 2020-December 31, 2020), and postvaccine period (January 1, 2021-September 30, 2021) corresponding to time before the pandemic, during the pandemic when no COVID-19 vaccine was available, and after widespread utilization of the vaccine began. Normalized prescription rates of uveitis therapies were modeled as an ITS. In the time-to-treatment analysis, Cox proportional hazard models were used to determine differences in likelihood of different modalities between time periods. Main Outcome Measures:Temporal trends in the initial therapeutic choice for NIU. Results:This study included 22 444 patients with a new NIU diagnosis. The average age was 61.9 (standard deviation 17.5) years, and 59.3% were female. There were no significant temporal breaks in prescribing trends for topical, local, and systemic corticosteroids or immunosuppressive therapy (disease-modifying antirheumatic drugs and biologics) between pandemic periods (all P > 0.05) in ITS analysis. Overall, topical steroids were more likely to be prescribed in the early versus prepandemic period (hazard ratio [HR] 1.10; 95% confidence interval [CI] 1.06-1.15; P < 0.001). Intraocular steroids also saw greater relative use during the early (HR 1.29; 95% CI 1.13-1.46; P < 0.001) and postvaccine (HR 1.29; 95% CI 1.14-1.46; P < 0.001) period. Use of IMTs increased in the postvaccine period compared with that in the prepandemic period (HR 1.25; 95% CI 1.07-1.46; P < 0.001). Conclusions:No significant differences in prescribing patterns for NIU were observed between pandemic periods. However, utilization of topical and local steroids for NIU was, overall, increased in the early compared with the prepandemic period. Financial Disclosures:The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Précis: Children with glaucoma had an average of 1.3 visual field tests per year. Self-reported black and multiracial patients had lower visual field testing rates, whereas older children with better visual acuity had more frequent testing. Purpose: To evaluate frequency of visual field (VF) testing in children with glaucoma and identify characteristics associated with VF frequency. Methods: A retrospective cohort study of 82 children 6–18 years of age with glaucoma seen between August 2018 and May 2023. Patients were divided into those who had ≥1 VF test (303 VF tests of 61 children) and 0 VFs (21 children). Eyes were excluded if best corrected visual acuity (BCVA) was counting fingers or worse. Characteristics obtained included age, self-reported race and ethnicity, sex, primary language, glaucoma diagnosis, distance to provider, office visit frequency, follow-up compliance, insurance type, and BCVA. The main outcome measure was VF testing frequency. Results: Among children with ≥1 VF test, mean age at first VF was 11.8±2.8 years, mean number of VF/year was 1.3±0.8, and 44.9% of all VFs were reliable. Thirty nine percent of patients underwent <1 VF/year, 45.9% ≥1 to <2 VFs/year, and 14.8% ≥2 VF/year. Children who were black or multiracial had significantly lower VF testing frequency [estimated difference (ED) −1.2 (95% CI, −2.0 to −0.4, P=0.002) and ED −1.3 (95% CI, −2.2 to −0.3, P=0.008), respectively]. Better visual acuity and greater office visit frequency were significantly associated with higher VF testing frequency [ED 0.052 (95% CI, 0.001–0.103, P=0.045) and ED 0.2 (95% CI, 0.1–0.3, P<0.001), respectively]. Conclusions: Most children had between 1 and 2 VF/year, although less than half of all VFs were reliable. Ophthalmologists should consider barriers to care in glaucoma monitoring.

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Many forms of childhood glaucoma have been associated with underlying genetic changes, and variants in many genes have been described. Currently, testing is variable as there are no widely accepted guidelines for testing. This systematic review aimed to summarize the literature describing genetic changes and testing practices in childhood glaucoma. This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic review and Meta-Analyses (PRISMA) 2020 guidelines and registered with Prospero (ID CRD42023400467). A comprehensive review of Pubmed, Embase, and Cochrane databases was performed from inception through March 2, 2023 using the search terms: (glaucoma) AND (pediatric OR childhood OR congenital OR child OR infant OR infantile) AND (gene OR genetic OR genotype OR locus OR genomic OR mutation OR variant OR test OR screen OR panel). Information was extracted regarding genetic variants including genotype-phenotype correlation. Risk of bias was assessed using the Newcastle-Ottawa Scale. Of 1,916 records screened, 196 studies met inclusion criteria and 53 genes were discussed. Among study populations, mean age±SD at glaucoma diagnosis was 8.94±9.54 years and 50.4% were male. The most common gene discussed was CYP1B1, evaluated in 109 (55.6%) studies. CYP1B1 variants were associated with region and population-specific prevalence ranging from 5% to 86% among those with primary congenital glaucoma. MYOC variants were discussed in 31 (15.8%) studies with prevalence up to 36% among patients with juvenile open angle glaucoma. FOXC1 variants were discussed in 25 (12.8%) studies, which demonstrated phenotypic severity dependent on degree of gene expression and type of mutation. Overall risk of bias was low; the most common domains of bias were selection and comparability. Numerous genes and genetic changes have been associated with childhood glaucoma. Understanding the most common genes as well as potential genotype-phenotype correlation has the potential to improve diagnostic and prognostic outcomes for children with glaucoma.

PurposeTo date, many case reports have detailed the recurrence of non-infectious uveitis (NIU) following COVID-19 vaccinations, contributing to vaccine hesitancy in patients with a history of NIU. This study aimed to evaluate the association between COVID-19 vaccination and risk of recurrent NIU in those with a prior history of the disease between December 11, 2020 and January 31, 2022.DesignSelf-controlled case series (SCCS) analysis using Optum Labs Data Warehouse (OLDW), a national de-identified healthcare claims database in the United States with administrative claims and electronic health record data.ParticipantsPatients continuously enrolled in OLDW at least 730 days prior to December 11, 2020 who received a COVID-19 vaccination and experienced a NIU event within the study period. Enrollees without a NIU event before the study period were excluded.MethodsIncidence rate ratios (IRR) comparing NIU incidence in exposed post-vaccine risk periods and unexposed control periods within an individual were calculated using conditional Poisson regression models. Subgroup analyses were conducted by vaccination type, age group, and use of immunomodulatory therapy.Main Outcome MeasuresRates of NIU identified with International Classification of Disease 10th (ICD-10) revision codes.Results412 patients were included in the SCCS analysis (mean age [SD] = 51.5 [15.1] years, 60.7% female). 209 NIU outcomes were identified in post-vaccine risk intervals spanning 111 cumulative person-years; 203 NIU outcomes were identified in unexposed control intervals, which spanned 184 person-years cumulatively. The IRR comparing post-vaccine risk to risk in the control intervals adjusted for time since NIU flare was 1.29 (95% CI: 1.02-1.62, p = 0.03).ConclusionsThere was an increased risk of NIU post-vaccination in patients with a prior history of the disease, which may be due to immune activation from vaccination. This finding merits further study and may have clinical implications for this population, including the need for post-vaccination monitoring.

Older adults with cancer are at increased risk for financial toxicity given high rates of polypharmacy, out-of-pocket costs, fixed incomes, and financial management challenges [1]. Furthermore, older adults with cancer who experience financial toxicity are at increased risk for depression, anxiety, and decreased quality of life (QOL) [1,2]. Oral targeted therapies may compound financial toxicity due to high cost-sharing requirements under Medicare Part D, the prescription drug benefit that insures most older adults [3].

PurposeTo evaluate Humphrey Visual Field (HVF) test reliability and its associated risk factors in children with glaucoma or glaucoma suspect.DesignRetrospective cohort study.MethodsNoneSettingSingle-center childhood glaucoma clinic.Patient Population136 patients aged ≤18 years with glaucoma/glaucoma suspect, and least 1 completed 24-2 HVF test between 2018 and 2023.Observation ProcedureDemographic and clinical characteristics including age, primary language, visual acuity (VA), and glaucoma diagnosis were extracted from electronic health records.Main Outcome MeasuresHVF 24-2 testing metrics, including FP, FN, and FL. Tests were defined as reliable using manufacturer guidelines of ≤33% FP, ≤33% FN, and ≤20% FL. For each patient, a reliability score was calculated as the percentage of reliable tests among all tests completed. A multivariable logistic regression model was used to determine factors associated with test-level reliability (yes/no). A multivariable linear regression model was used to determine factors associated with patient-level reliability score.ResultsAmong 634 HVFs from 136 patients (Mean±SD age at first test 12.0±3.2 years, 47.8% female), 51.3% were reliable. Older age, better baseline VA, and English as primary language were associated with greater odds of test-level reliability (p<0.04). Mean±SD patient-level reliability score was 51.7±38.1%. Older age at first clinic visit, better baseline VA, and English as primary language were associated with higher reliability scores (all p<0.02), and number of prior VF tests was not (p=0.56).ConclusionsYounger age, worse visual acuity, and non-English as primary language were associated with decreased reliability and should be considered when interpreting VF testing in children. A significant learning effect was not observed with repeated testing.

PurposeCytomegalovirus (CMV) retinitis can have debilitating impacts on quality of life (QOL), but few contemporary studies have characterized these ramifications. This study assessed the impact of CMV retinitis on vision-related QOL for those living with HIV/AIDS in Thailand.MethodsQOL was assessed as part of a prospective interventional cohort study of patients referred to a tertiary hospital in Thailand for CMV retinitis screening. A validated vision-related QOL questionnaire was administered at the baseline screening visit and at the 6-month study visit. Multivariable linear regression models were performed to determine the effect of CMV retinitis diagnosis on QOL score.ResultsA total of 152 participants completed the QOL questionnaire at their initial clinic visit. At baseline, a diagnosis of CMV retinitis diagnosis was significantly associated with decreased QOL score: unilateral retinitis was associated with a 0.11 (95% CI: -0.26-0.03) decrement in QOL, and bilateral retinitis was associated with a 0.33 (95% CI: -0.51-0.16) decrement (joint P-value = 0.0009). For the 78 participants with a 6-month visit, changes in QOL from baseline were small and not significant. A diagnosis of CMV retinitis was still associated with decreased QOL score at 6 months (joint P-value = 0.03).ConclusionsThis study found that vision-related QOL was lower in those with CMV retinitis, especially with bilateral involvement, and did not improve after treatment among those with follow-up. These findings reinforce the debilitating clinical manifestations of this disease, and support efforts for earlier screening to detect CMV retinitis before impacts on QOL have occurred.

Little is known about the evidence to support prescription digital therapeutics, which are digital tools that rely primarily on software for diagnosis or treatment that have indications for use regulated by the Food and Drug Administration (FDA) and require a clinician's prescription. We conducted the first retrospective crosssectional analysis of clinical studies of twenty prescription digital therapeutics authorized by the FDA and available on the market as of November 2022. Our analysis found that just two prescription digital therapeutics had been evaluated in at least one study that was randomized and blinded and that used other rigorous standards of evidence. Two-thirds of clinical studies of prescription digital therapeutics were conducted on a postmarket basis, with less rigorous standards of evidence than the standards used in premarket studies. More than half of studies did not report data on participants' race, and more than 80 percent did not report their ethnicity. More than one-third required English proficiency, and nearly half of nonpediatric studies had an upper age limit. These results suggest the need for a more rigorous and inclusive approach to clinical research supporting FDA-authorized prescription digital therapeutics. A stronger evidence base would increase confidence in these technologies' effectiveness and would enable more informed decision making about their clinical use and coverage.

PURPOSE:To assess noninfectious uveitis (NIU) risk after coronavirus disease 2019 (COVID-19) vaccination in patients without a history of uveitis. DESIGN:A retrospective matched cohort study and self-controlled case series (SCCS) analysis using a longitudinal data asset with claims data from the OptumLabs Data Warehouse from December 11, 2020, through November 30, 2021. PARTICIPANTS:The matched cohort analysis included patients continuously enrolled for 730 days before December 11, 2020, who received a COVID-19 vaccination during the study period. This COVID-19-vaccinated group was matched to a COVID-19-unvaccinated historical cohort enrolled in 2018 and 2019. The SCCS design included individuals from the vaccinated cohort who experienced an NIU event during the study period. Enrollees with a history of uveitis were excluded. METHODS:Hazard ratios (HRs) were calculated using Cox proportional hazards models in the matched cohort design. Incidence rate ratios (IRRs) comparing NIU incidence in exposed risk periods after vaccination and unexposed control periods within individuals were calculated using conditional Poisson regression models in the SCCS design. Models were adjusted for age, recent receipt of non-COVID-19 vaccinations, corticosteroid or immunosuppressive use, and smoking history. Subgroup analyses were conducted by vaccination type and age group. MAIN OUTCOME MEASURES:Rates of NIU identified with International Classification of Diseases, Tenth Revision, codes. RESULTS:The matched cohort analysis included 4 611 378 patients, with 2 305 689 per cohort. The adjusted HR comparing NIU incidence in the COVID-19-vaccinated and unvaccinated cohort was 0.91 (95% confidence interval [CI], 0.75-1.10; P = 0.33). The SCCS analysis included 686 patients. The IRR comparing NIU risk after vaccination with risk during control intervals was 1.05 (95% CI, 0.89-1.23; P = 0.57). An increased risk was found in the subgroup aged 5 to 44 years (IRR, 1.40; 95% CI, 1.04-1.87; P = 0.024). CONCLUSIONS:The matched cohort and SCCS analyses did not detect increased NIU risk after COVID-19 vaccination overall in individuals without history of uveitis, providing reassurance about the vaccine's safety. The finding of increased risk in the youngest subgroup suggests heightened immune responses in younger individuals, warranting further investigation. FINANCIAL DISCLOSURE(S):Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

e18916 Background: Financial drug assistance programs are a critical resource to mitigate financial toxicity for oral targeted therapy but can be challenging to access and navigate. Older adults with cancer frequently face high copayments for oral targeted therapy, yet they may be less able to navigate assistance programs due to functional and cognitive impairments. To identify potential barriers to receipt of assistance among older adults with advanced NSCLC, we evaluated associations between demographic, clinical, and geriatric assessment characteristics and receipt of financial drug assistance. Methods: We conducted a prospective cohort study at a Comprehensive Cancer Center where thoracic oncology nurses and pharmacists are available to help patients navigate financial drug assistance applications. We enrolled adults age > 65 with advanced NSCLC starting a new chemotherapy, immunotherapy, and/or oral targeted therapy regimen with non-curative intent. For this analysis, we included only older adults who received oral targeted therapy. Patients completed a pretreatment geriatric assessment to evaluate function, cognition, social support, comorbidities, mood, and nutrition. Receipt of financial drug assistance was abstracted from the medical record. We used Fisher’s exact tests to evaluate for differences in demographic, clinical, and geriatric assessment characteristics between those who did and did not receive financial drug assistance. Results: Of the 168 older adults with advanced NSCLC in the parent cohort study, 45 received oral targeted therapy and were included in this analysis. Median age was 74 (range 65-94); 56% were White, 40% Asian, 2% Black, and 2% Hispanic. The majority had Medicare (76%) followed by private insurance (18%), Medicare and Medicaid (4%), and Medicaid alone (2%). On the geriatric assessment, 60% were dependent in instrumental activities of daily living, 20% were dependent in basic activities of daily living, 51% had an abnormal Montreal Cognitive Assessment, and 42% had poor tangible social support. Overall, 9 older adults (20%) received financial drug assistance for their oral targeted therapy. Older adults with a lower household income were more likely to receive financial drug assistance (p = 0.007). There were no statistically significant differences in receipt of financial drug assistance according to other demographic, clinical, or geriatric assessment characteristics including function, cognition, and social support. Conclusions: Older adults with advanced NSCLC on oral targeted therapy with lower household incomes were appropriately more likely to receive financial drug assistance. The lack of associations between receipt of financial drug assistance and function, cognition, and social support suggests that thoracic oncology staff are successfully helping older adults navigate financial drug assistance programs.

Purpose Clinical management of disc degeneration in patients with chronic low back pain (cLBP) is hampered by the challenge of distinguishing pathologic changes relating to pain from physiologic changes related to aging. The goal of this study was to use imaging biomarkers of disc biochemical composition to distinguish degenerative changes associated with cLBP from normal aging. Methods T1ρ MRI data were acquired from 133 prospectively enrolled subjects for this observational study (80 cLBP, 53 controls; mean ± SD age = 43.9 ± 13.4 years; 61 females, 72 males). The mean T1ρ relaxation time in the nucleus pulposus (NP-T1ρ; n = 650 discs) was used as a quantitative biomarker of disc biochemical composition. Linear regression was used to assess associations between NP-T1ρ and age, sex, spinal level, and study group, and their interactions. Results NP-T1ρ values were lower in cLBP patients than controls (70.8 ± 22.8 vs. 76.4 ± 22.2 ms, p = 0.009). Group differences were largest at L5–S1 (ΔT1ρ cLBP-control = −11.3 ms, p < 0.0001), representing biochemical deterioration typically observed over a 9–12 year period (NP-T1ρ declined by 0.8–1.1 ms per year [95% CI]). Group differences were large in younger patients and diminished with age. Finally, the age-dependence of disc degeneration was stronger in controls than cLBP patients. Conclusion Aging effects on the biochemical composition of the L5–S1 disc may involve a relatively uniform set of factors from which many cLBP patients deviate. NP-T1ρ values at L5–S1 may be highly relevant to clinical phenotyping, particularly in younger individuals.

Current glaucoma management centres on intraocular pressure (IOP) reduction through pharmacological and surgical therapy. Despite broad interest in active management of glaucoma through lifestyle modifications, such recommendations have yet to be incorporated into standards of treatment. In this review, noteworthy preclinical studies and their translations in clinical populations are discussed to evaluate the roles of lifestyle factors in lowering IOP, offering neuroprotection, and/or slowing disease progression in those with open-angle glaucoma. Current literature suggests that aerobic exercise may be associated with neuroprotection and decreased disease progression. Mindfulness is associated with IOP reductions and neuroprotection. Caffeine is associated with mild, transient IOP elevations of uncertain significance. Nicotinamide supplementation is associated with neuroprotection and short-term visual function improvement. This review also highlights knowledge gaps regarding these factors and opportunities to strengthen our understanding of their role in glaucoma, including future preclinical studies that elucidate underlying mechanisms and clinical studies with additional functional endpoints and longer follow-up.

BACKGROUND:Circulating tumor DNA (ctDNA) is used to select initial targeted therapy, identify mechanisms of therapeutic resistance, and measure minimal residual disease (MRD) after treatment. Our objective was to review private and Medicare coverage policies for ctDNA testing.METHODS:Policy Reporter was used to identify coverage policies (as of February 2022) from private payers and Medicare Local Coverage Determinations (LCDs) for ctDNA tests. We abstracted data regarding policy existence, ctDNA test coverage, cancer types covered, and clinical indications. Descriptive analyses were performed by payer, clinical indication, and cancer type.RESULTS:A total of 71 of 1,066 total policies met study inclusion criteria, of which 57 were private policies and 14 were Medicare LCDs; 70% of private policies and 100% of Medicare LCDs covered at least one indication. Among 57 private policies, 89% specified a policy for at least 1 clinical indication, with coverage for ctDNA for initial treatment selection most common (69%). Of 40 policies addressing progression, coverage was provided 28% of the time, and of 20 policies addressing MRD, coverage was provided 65% of the time. Non-small cell lung cancer (NSCLC) was the cancer type most frequently covered for initial treatment (47%) and progression (60%). Among policies with ctDNA coverage, coverage was restricted to patients without available tissue or in whom biopsy was contraindicated in 91% of policies. MRD was commonly covered for hematologic malignancies (30%) and NSCLC (25%). Of the 14 Medicare LCD policies, 64% provided coverage for initial treatment selection and progression, and 36% for MRD.CONCLUSIONS:Some private payers and Medicare LCDs provide coverage for ctDNA testing. Private payers frequently cover testing for initial treatment, especially for NSCLC, when tissue is insufficient or biopsy is contraindicated. Coverage remains variable across payers, clinical indications, and cancer types despite inclusion in clinical guidelines, which could impact delivery of effective cancer care.