Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 9 de 9
Filter
1.
Ophthalmic Surg Lasers Imaging Retina ; 53(6): 310-316, 2022 06.
Article in English | MEDLINE | ID: covidwho-1903577

ABSTRACT

BACKGROUND AND OBJECTIVE: The purpose of this study was to implement a clinical decision support tool (CDS) and assess its impact on adherence to 2016 American Academy of Ophthalmology (AAO) hydroxychloroquine dosing recommendations. PATIENTS AND METHODS: This retrospective, interventional study implemented an automated alert to calculate maximum daily hydroxychloroquine dose based on 2016 AAO recommendations and flag noncompliant orders. Prevalence of excessive dosing after CDS implementation was assessed. RESULTS: A total of 7,417 patients met inclusion criteria. After intervention, prevalence of excessive dosing decreased from 27.4% to 21.1% (P < .001) among all prescriptions and from 26.8% to 16.2% (P < .001) among new prescriptions. Daily doses exceeding 400 mg decreased from 0.8% to 0.02% (P < .001). Risk factors for excessive dosing included low weight (odds ratio, 75.6 [95% CI, 54.0 to 105.8]) and nonrheumatologist prescriber (odds ratio, 1.60 to 3.63; all P < .005). CONCLUSIONS: This study highlights the efficacy of a CDS in reducing excessive hydroxychloroquine dosing and improving adherence to AAO ophthalmic safety guidelines. [Ophthalmic Surg Lasers Imaging 2022;53:310-316.].


Subject(s)
Antirheumatic Agents , Ophthalmology , Antirheumatic Agents/adverse effects , Decision Making , Electronics , Humans , Hydroxychloroquine/adverse effects , Retrospective Studies , United States
2.
J Clin Med ; 10(7)2021 Mar 25.
Article in English | MEDLINE | ID: covidwho-1753619

ABSTRACT

The real-world performance of a home telemonitoring strategy (ForeseeHome AMD Monitoring System®, Notal Vision, Inc.,Manassas VA, USA) was evaluated and compared to the device arm of the AREDS2-HOME study among patients with intermediate AMD (iAMD) who converted to neovascular AMD (nAMD). All patients with confirmed conversion to nAMD who used the home monitoring system from 10/2009 through 9/2018 were identified by Notal Vision Diagnostic Clinic's medical records. Selected outcome variables were evaluated, including visual acuity (VA) at baseline and at conversion, and change in visual acuity (VA) from baseline to time of conversion. In total, 8991 patients performed 3,200,999 tests at a frequency of 5.6 ± 3.2 times/week. The 306 eyes that converted from iAMD to nAMD over the study period (a 2.7% annual rate) were included in the analyses. There was a median (interquartile range) change of -3.0 (0.0-(-10.0)) letters among converted eyes, 81% [95% confidence interval (72-88%)] maintained a VA ≥ 20/40 at the time of conversion, while 69% of the conversion detections were triggered by system alerts. The real-world performance of an at-home testing strategy was similar to that reported for the device arm of the AREDS2-HOME study. The home telemonitoring system can markedly increase early detection of conversion to nAMD.

3.
Optom Vis Sci ; 99(2): 190-194, 2022 02 01.
Article in English | MEDLINE | ID: covidwho-1672427

ABSTRACT

SIGNIFICANCE: Teleophthalmology became widely used during the coronavirus 2019 pandemic; however, the quality of this care remains to be understood. PURPOSE: This study aimed to compare patient satisfaction levels from virtual and in-person visits based on post-visit surveys, as well as investigate demographic characteristics that may predict patient satisfaction with virtual visits. METHODS: Virtual (n = 2943) and in-person (n = 56,175) visits from March 19, 2020, to July 31, 2020, were identified using the electronic health record system. For in-person visits, a random subset of 3000 visits was acquired using a random number generator. Of these, 2266 virtual and 2590 in-person visits met the inclusion criteria. Patients who completed the Telemedicine for Medical Practice Survey and Medical Practice Survey were analyzed in this report. Nonparametric Mann-Whitney test was used to compare scores between groups. RESULTS: Two hundred eleven virtual patients (9.31%; 82 phone, 115 video, 14 hybrid) and 307 in-person patients (11.85%) completed the Telemedicine for Medical Practice Survey and Medical Practice Survey, respectively. Satisfaction scores were similar and high in both groups-virtual visit satisfaction scores averaged 4.82, whereas in-person visit satisfaction averaged 4.85 (P = .80, θ = 0.501 [0.493 to 0.509]). Only one question yielded significantly different satisfaction scores, and no demographic variables were significant predictors of satisfaction scores. CONCLUSIONS: Patient satisfaction is comparable between virtual and in-person visits, validating the continued usage of telemedicine for eye care visits.


Subject(s)
COVID-19 , Ophthalmology , Telemedicine , Humans , Patient Satisfaction , Personal Satisfaction , SARS-CoV-2
4.
Eye (Lond) ; 2022 Jan 28.
Article in English | MEDLINE | ID: covidwho-1655566

ABSTRACT

OBJECTIVES: To characterize the use of virtual visits, as well as compare the characteristics to in-person visits during the pandemic period. METHODS: This retrospective study included patients who had virtual and in-person ophthalmology visits from March 19, 2020, to July 31, 2020, in a large multispecialty ophthalmic center. Exclusion criteria included patients aged less than 18 years old; canceled, incomplete, mislabelled, and duplicated visits. 2943 virtual and 56,174 in-person visits were identified. A random sample of 3000 in-person visits was created. Each visit was analyzed as an individual data point. RESULTS: 2,266 virtual visits (2,049 patients, 64.3% female, mean [SD] age 64.3 [16.6] years old) and 2590 in-person visits (2509 patients, 59.5% female, 65.9 [15.8] years old) were included. Most virtual visits were classified as comprehensive ophthalmology (34.6%), optometry-related (19.5%), and oculoplastics (13.0%). For in-person visits, the most common specialties were optometry (29.8%), comprehensive ophthalmology (23.9%), and retina and uveitis (17.3%). The most common diagnoses in the virtual group were from the eyelids, lacrimal system, and orbits group (26.9%), while in the in-person groups were choroid and retina conditions (19.3%). CONCLUSIONS: Numerous ocular conditions were evaluated and managed through virtual visits, and external complaints and oculoplastic consults appear to be well-suited to the virtual format. Further studies focusing on visual outcomes and patient experience will be beneficial.

5.
Ophthalmic Surg Lasers Imaging Retina ; 52(10): 556-559, 2021 10.
Article in English | MEDLINE | ID: covidwho-1478171

ABSTRACT

BACKGROUND AND OBJECTIVE: To evaluate coronavirus disease 2019 (COVID-19) cases as of February 1, 2021 and the proportion of ophthalmologists in the United States older than age 60 years to provide a framework for successful vaccine distribution for the ophthalmology workforce. PATIENTS AND METHODS: The Association of American Medical Colleges ophthalmologist workforce dataset (from 2019) for each state was combined with John Hopkins University's COVID-19 tracking data to determine exposure risk for ophthalmologists, especially those older than age 60 years. RESULTS: Of the 18,915 practicing ophthalmologists in the US, 37.6% are older than age 60 years. North Dakota (48.4%), Connecticut (46.8%), and Maine (46.7%) have the highest percentages. South Dakota (9,567), Utah (7,559), and Idaho (7,411) currently have the highest COVID-19 exposure burden per ophthalmologist older than age 60 years as of February 1, 2021. CONCLUSION: Care must be taken to distribute the COVID-19 vaccine in a safe and proactive manner to ophthalmologists that face high exposure risk, both to ensure physician safety and ensure adequate care for the population they serve. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:556-559.].


Subject(s)
COVID-19 , Ophthalmologists , Ophthalmology , COVID-19 Vaccines , Humans , Middle Aged , Prevalence , SARS-CoV-2 , United States/epidemiology
6.
Ophthalmic Surg Lasers Imaging Retina ; 52(9): 513-518, 2021 09.
Article in English | MEDLINE | ID: covidwho-1403928

ABSTRACT

BACKGROUND AND OBJECTIVES: This study aimed to evaluate the necessity of the postoperative day-1 (POD1) review after pars plana vitrectomy. PATIENTS AND METHODS: The analysis included available literature that documented medical and surgical interventions performed on POD1 review after pars plana vitrectomy. A meta-analysis of proportions was conducted using a binomial-normal model to analyze three data sets consisting of all interventions, medical interventions, and surgical interventions. Heterogeneity and publication bias analyses were performed. RESULTS: POD1 reviews of 2,262 patients across 14 studies were examined to yield a total POD1 intervention rate estimate of 4.7% (95% confidence interval [CI], 3.0-13.9). When stratified by medical or surgical intervention, the intervention rate estimates were 4.1% (95% CI, 1.4-11.6) and 0.7% (95% CI, 0.3-1.3), respectively. The most common complication requiring postoperative intervention was elevated intraocular pressure. CONCLUSION: Given the wide confidence intervals of the estimated intervention rates, variability in postoperative practices, and range of interventions performed, the POD1 review cannot be discarded in its entirety. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:513-518.].


Subject(s)
Eye Diseases , Vitrectomy , Humans , Intraocular Pressure , Postoperative Complications , Postoperative Period , Retrospective Studies , Tonometry, Ocular
7.
Ophthalmic Surg Lasers Imaging Retina ; 52(S1): 996, 2021 07.
Article in English | MEDLINE | ID: covidwho-1325832
8.
JAMA Ophthalmol ; 139(4): 456-463, 2021 04 01.
Article in English | MEDLINE | ID: covidwho-1116915

ABSTRACT

Importance: The American Academy of Ophthalmology (AAO) indicated that urgent or emergent vitreoretinal surgical procedures should continue during the coronavirus disease 2019 (COVID-19) pandemic. Although decreases in the frequency of critical procedures have been reported outside the field of ophthalmology, analyses are limited by volume, geography, and time. Objective: To evaluate whether the frequency of ophthalmic surgical procedures deemed urgent or emergent by the AAO changed across the United States during the COVID-19 pandemic. Design, Setting, and Participants: Vitreoretinal practices from 17 institutions throughout the US participated in this multicenter cross-sectional study. The frequency of 11 billed vitreoretinal Current Procedural Terminology (CPT) codes across respective weeks was obtained from each practice between January 1, 2019, and May 31, 2020. Data were clustered into intravitreal injections (code 67028), lasers and cryotherapy (codes 67141, 67145, and 67228), retinal detachment (RD) repairs (codes 67107, 67108, 67110, and 67113), and other vitrectomies (codes 67036, 67039, and 67040). Institutions were categorized by region (Northeast, Midwest, South, and West Coast), practice setting (academic [tax-exempt] or private [non-tax-exempt]), and date of respective statewide stay-at-home orders. Main Outcomes and Measures: Nationwide changes in the frequency of billing for urgent or emergent vitreoretinal surgical procedures during the COVID-19 pandemic. Results: A total of 526 536 CPT codes were ascertained: 483 313 injections, 19 257 lasers or cryotherapy, 14 949 RD repairs, and 9017 other vitrectomies. Relative to 2019, a weekly institutional decrease in injections was observed from March 30 to May 2, 2020, with a maximal 38.6% decrease (from a mean [SD] of 437.8 [436.3] to 273.8 [269.0] injections) from April 6 to 12, 2020 (95% CI, -259 to -69 injections; P = .002). A weekly decrease was also identified that spanned a longer interval, at least until study conclusion (March 16 to May 31, 2020), for lasers and cryotherapy, with a maximal 79.6% decrease (from a mean [SD] of 6.6 [7.7] to 1.5 [2.0] procedures) from April 6 to 12, 2020 (95% CI, -6.8 to -3.3 procedures; P < .001), for RD repairs, with a maximal 59.4% decrease (from a mean [SD] of 3.5 [4.0] to 1.6 [2.2] repairs) from April 13 to 19, 2020 (95% CI, -2.7 to -1.4 repairs; P < .001), and for other vitrectomies, with a maximal 84.3% decrease (from a mean [SD] of 3.0 [3.1] to 0.4 [0.8] other vitrectomies) from April 6 to 12, 2020 (95% CI, -3.3 to -1.8 other vitrectomies; P < .001). No differences were identified by region, setting, or state-level stay-at-home order adjustment. Conclusions and Relevance: Although the AAO endorsed the continued performance of urgent or emergent vitreoretinal surgical procedures, the frequency of such procedures throughout the country experienced a substantial decrease that may persist after the COVID-19 pandemic's initial exponential growth phase. This decrease appears independent of region, setting, and state-level stay-at-home orders. It is unknown to what extent vitreoretinal intervention would have decreased without AAO recommendations, and how the decrease is associated with outcomes. Although safety is paramount during the COVID-19 pandemic, practices should consider prioritizing availability for managing high-acuity conditions until underlying reasons for the reduction are fully appreciated.


Subject(s)
COVID-19/epidemiology , SARS-CoV-2 , Vitreoretinal Surgery/statistics & numerical data , Cross-Sectional Studies , Emergency Medical Services , Humans , Vitrectomy/statistics & numerical data
9.
Ophthalmol Retina ; 5(10): 975-980, 2021 10.
Article in English | MEDLINE | ID: covidwho-1002942

ABSTRACT

PURPOSE: To examine the effect of delay in care on visual acuity (VA) in patients requiring intravitreal injections (IVIs). DESIGN: Retrospective cohort study. PARTICIPANTS: Patients 18 years of age or older with diabetic macular edema (DME), proliferative diabetic retinopathy (PDR), or both; neovascular age-related macular degeneration (nAMD); or retinal vein occlusion (RVO) scheduled to see a retina specialist during the mandated lockdown period (March 14 - May 4, 2020 [the coronavirus disease 2019 period]) and who had received an IVI in the 12 weeks prior. METHODS: Chart review was performed and demographics, diagnoses, procedures, and VA were recorded. MAIN OUTCOME MEASURES: VA in patients who completed, canceled, and no-showed for the scheduled visit. RESULTS: Of the 1041 total patients, 620 (60%) completed the scheduled visit, whereas 376 (36%) canceled and 45 (4%) no-showed. In patients who missed the visit, the average delay in care was 5.34 weeks. In those who missed a visit, VA was assessed at the subsequent visit. Patients who canceled a visit were older, and patients who no-showed had lower baseline vision (mean Early Treatment Diabetic Retinopathy Study letters ± standard error [SE]: no-show, 53.27 ± 3.21 letters; canceled, 60.79 ± 1.11 letters; and completed, 62.81 ± 0.84 letters; P = 0.0101) and were more likely to have DME, PDR, or both (no-show, 13 patients [29%]; canceled, 56 patients [16%]; completed, 81 patients [13%]; P = 0.0456). Patients who missed a visit lost vision as compared with the patients who completed one (no-show, -5.024 ± 1.88 letters; canceled, -1.633 ± 0.65 letters; completed, 0.373 ± 0.50 letters; P = 0.0028). Patients with DME, PDR, or both (-3.48 ± 1.95 letters vs. 2.71 ± 1.75 letters; P = 0.0203), with RVO (-3.22 ± 1.41 letters vs. 0.95 ± 1.23 letters; P = 0.0230), and, to lesser degree, with nAMD (-1.23 ± 0.70 letters vs. -0.24 ± 0.56 letters; P = 0.2679) lost vision compared with patients with same diagnoses who completed the scheduled visit. CONCLUSIONS: In patients requiring IVIs, a delay in care of 5.34 weeks resulted in vision loss. It was seen in all patients, but was more prominent in patients with DME, PDR or both and RVO. Further studies are necessary to examine whether these vision changes persist over a longer duration.


Subject(s)
COVID-19/epidemiology , Diabetic Retinopathy/drug therapy , Macular Edema/drug therapy , Ranibizumab/administration & dosage , SARS-CoV-2 , Time-to-Treatment/trends , Visual Acuity , Aged , Aged, 80 and over , Angiogenesis Inhibitors/administration & dosage , Comorbidity , Diabetic Retinopathy/complications , Diabetic Retinopathy/epidemiology , Female , Follow-Up Studies , Humans , Intravitreal Injections , Macula Lutea/pathology , Macular Edema/epidemiology , Macular Edema/etiology , Male , Middle Aged , Ohio/epidemiology , Retrospective Studies , Time Factors , Tomography, Optical Coherence , Vascular Endothelial Growth Factor A/antagonists & inhibitors
SELECTION OF CITATIONS
SEARCH DETAIL