Clinical Characteristics of Idiopathic Intracranial Hypertension in Older Adults.

BACKGROUND: Idiopathic intracranial hypertension (IIH) is a condition that classically affects obese women of child-bearing age. However, it is sometimes encountered in older patients. The purpose of this study was to help clinicians better understand how this disease can present differently in these age groups. METHODS: This is a retrospective chart review from a single academic center of baseline characteristics of adult patients diagnosed with IIH based on the modified Dandy criteria. The patients were divided into 2 groups: (1) those 18-44 years old and (2) those older than 45 years at diagnosis. RESULTS: One hundred sixty-seven patients were identified; 135 in the younger group and 32 in the older group. The younger group had a higher rate of headaches (90% vs 63%, P = 0.0004), higher body mass index (38.9 vs 36.1, P = 0.046), higher opening pressure (38 vs 31 cm H2O, P = 0.005), and thicker peripapillary retinal nerve fiber layer average thickness (right eye 178 vs 131 µm, P = 0.02; left eye 184 vs 136 µm, P = 0.045). The older group had higher rates of empty sella (90% vs 62%, P = 0.0039). In addition in the younger group, there was a trend toward higher rates of pulsatile tinnitus (63% vs 45%, P = 0.08), transient visual obscurations (50% vs 32%, P = 0.07), and lower rates of spontaneous cerebrospinal fluid leak (4% vs 13%, P = 0.08). Sex, rates of obesity, other MRI findings typical of elevated intracranial pressure, frequency and Frisen grading of papilledema, and visual field loss were not statistically different between the groups. CONCLUSIONS: The older age group had milder signs and symptoms of IIH and a higher prevalence of empty sella than the younger group, but otherwise had typical characteristics. These findings suggest that IIH in the older age group may represent milder chronic disease that was previously undiagnosed.

Global Trends in Blindness and Vision Impairment Resulting from Corneal Opacity 1984-2020: A Meta-analysis.

TOPIC: We provide global estimates of the prevalence of corneal blindness and vision impairment in adults 40 years of age and older and examine the burden by age, sex, and geographic region from 1984 through 2020. CLINICAL RELEVANCE: Corneal opacities (COs) are among the top 5 causes of blindness worldwide, yet the global prevalence, regional differences, and risk factors are unclear. METHODS: Abstracted data from the published literature and surveys were obtained from the Global Burden of Disease Vision Loss Expert Group. We supplemented this by an independent systematic literature search of several databases. Studies that provided CO vision impairment data based on population-based surveys for those 40 years of age or older were included, for a total of 244. For each of the 4 outcomes of blindness and moderate to severe vision impairment (MSVI) caused by trachomatous and nontrachomatous CO (NTCO), time trends and differences in prevalence by region, age, and sex were evaluated using a Poisson log-linear model with a generalized estimating equation method. Age-standardized estimates of global prevalence of blindness and MSVI were calculated using the 2015 United Nations standard populations. RESULTS: The global prevalence of blindness resulting from NTCO in those 40 years and older was 0.081% (95% confidence interval [CI], 0.049%-0.315%); that of MSVI was 0.130% (95% CI, 0.087%-0.372%). A significant increase with age was found (prevalence rate ratio, 2.15; 95% CI, 1.99-2.32). Latin America and Europe showed the lowest rates, with 2- to 8-fold higher rates of blindness or MSVI in other regions. The global prevalence of blindness resulting from trachomatous CO in those 50 years and older was 0.0094% (95% CI, 0%-0.0693%); that from MSVI was 0.012% (95% CI, 0%-0.0761%). Blindness resulting from trachomatous CO and MSVI increased with age and female sex, and rates were significantly higher in the African regions. A decrease in trachomatous blindness rates over time was found (prevalence rate ratio, 0.91; 95% CI, 0.86-0.96). DISCUSSION: An estimated 5.5 million people worldwide are bilaterally blind or have MSVI resulting from CO, with an additional 6.2 million unilaterally blind. Blindness resulting from trachomatous CO is declining over time, likely because of the massive scaleup of the global trachoma elimination program and overall socioeconomic development. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Effect of Provider Specialty on Medical Resource Utilization and Costs in Chronic Spinal-Pain Management.

BACKGROUND: Poorly managed chronic spinal pain encumbers medical resources and drives healthcare costs, suggesting a target for improvement. OBJECTIVES: To determine how specialist-care pathways influence healthcare costs in the first year after a referral for chronic spine pain. STUDY DESIGN: This was a retrospective cohort analysis of administrative claims from a large commercial health insurance provider, analyzing a 6-month baseline, a variable "pre-referral period," and a one-year period of specialist care. SETTING: US patients covered by private commercial insurers. METHODS: Adult patients diagnosed with chronic, spine-related pain between July 2016 and February 2018 and under the active care of a specialist were eligible. Patients with neurological deficits or cancer-related pain were excluded. Patients were categorized based on sequence-dependent exposure to a pain specialist, a surgeon, or both specialties. Key measures were pain-related and all-cause medical resource use and costs and opioid prescription fills. RESULTS: Of 306,080 eligible patients (mean age 61.6; 61.5% women), 13% saw a pain specialist, 71% a surgeon, 7% a pain specialist then a surgeon, and 9% a surgeon then a pain specialist. Referral to a pain specialist alone was associated with lower resource use and per-patient adjusted cost savings of $3,311 (pain-related) and $6,447 (all-cause) compared to patients referred to a surgeon alone. The pain specialist pathway was associated with increased indicators of prescription opioid use. LIMITATIONS: Cohort design constraints temper the results' generalizability, given the need to simultaneously examine specialty pathway and medical resource incurred over the same time period. CONCLUSIONS: We observed meaningful savings in cost and resource use when chronic spine-pain patients were managed by pain specialists. Pain-management referrals should be an element of a thoughtfully designed care pathway.

Electronic Cigarette Harm and Benefit Perceptions and Use Among Youth.

INTRODUCTION: The purpose of this study is to examine adolescent perceptions of harms and benefits associated with electronic cigarettes (e-cigarettes) and their associations with use. METHODS: Data from the 2016 Florida Youth Tobacco Survey were analyzed in 2017. Participants who were in high school aged 14-17 years were included (n=22,884). Logistic regression analyses were used to compare e-cigarette use groups on perceived harms and benefits of e-cigarettes. RESULTS: Less than one half of the sample reported that e-cigarettes are harmful to their health and less than two thirds reported that individuals can get addicted to e-cigarettes. Compared with committed never users, susceptible never users and all e-cigarette use groups were less likely to report that e-cigarettes were harmful to their health, people can get addicted to e-cigarettes, and that smoke from others' e-cigarettes were harmful. Furthermore, susceptible never users and all use groups were more likely to report that it would be easy to quit using e-cigarettes than committed never users. Susceptible never users and all use groups were also more likely to perceive benefits of e-cigarette use including having more friends, looking cool or fitting in, feeling more comfortable in social situations, and stress relief compared with committed never users. CONCLUSIONS: Youth who are susceptible to use, currently use, or have used e-cigarettes are less likely to report harms and more likely to perceive benefits associated with e-cigarette use compared with committed never users. Addressing harm and benefit perceptions may be important for interventions designed to reduce e-cigarette use among adolescents.