Oral Corticosteroids for Teprotumumab-Related Hearing Loss: A Case Report.

Teprotumumab is a novel insulin-like growth factor-1 receptor inhibitor approved for the treatment of thyroid eye disease, but growing reports of hearing loss require further investigation. To date, an effective protocol for managing hearing loss in this setting has not been determined. Here, we present the first report of the resolution of teprotumumab-related hearing loss with prompt oral prednisone. A 70-year-old woman on teprotumumab experienced sudden hearing loss and tinnitus after her first infusion. An audiogram demonstrated a mild down-sloping to moderately severe mixed conductive and sensorineural hearing loss that was promptly treated with prednisone 60 mg for 6 days with a 1-week gradual taper. An audiogram 3 weeks later demonstrated return of hearing to normal thresholds, and the whole teprotumumab treatment course was completed without further issue. This case highlights the importance of audiometric monitoring, prompt identification of hearing symptoms, and the potential for oral steroids to reverse teprotumumab-related hearing loss.

Advances in the Treatment of Thyroid Eye Disease Associated Extraocular Muscle Myopathy and Optic Neuropathy.

PURPOSE OF REVIEW: To review emerging treatments for thyroid eye disease (TED) associated extraocular muscle myopathy and dysthyroid optic neuropathy (DON). RECENT FINDINGS: Emerging targeted biologic therapies may alter the disease course in TED. Teprotumumab, a type I insulin-like growth factor receptor inhibitor, is the most recent addition to the treatments available for TED-associated extraocular muscle myopathy causing diplopia. Small studies also suggest a potential therapeutic benefit for DON. Various recent studies have also expanded our knowledge on conventional TED therapies. The therapeutic landscape of TED and its sequelae has evolved in recent years. New targeted therapies have the potential to reduce the extraocular muscle and orbital volume expansion which can lead to diplopia and vision loss from optic nerve compression. Longer term efficacy and durability data is needed to determine the role biologics, such as teprotumumab, should play in the treatment of TED patients compared to the current standard of care.

Sentiment Analysis Surrounding Blepharoplasty in Online Health Forums.

Background: Upper and lower blepharoplasty are among the most common procedures in aesthetic surgery and are often emotionally laden due to the subjective nature of outcomes and implications with beauty and self-identity. This article capitalizes on the increasing wealth of patient-provided health information online and is the first to analyze the emotions surrounding blepharoplasty discussions in an open internet health forum, MedHelp. Methods: We used Python to scrape MedHelp for threads that contained "blepharoplasty" and then used IBM Watson Natural Language Understanding to perform sentiment analyses, calculating a general sentiment score (-1 to +1) as well as emotion scores for anger, sadness, joy, fear, and disgust (0 to 1) for posts and keywords contained within the posts. Keywords were then manually grouped into five distinct clinical categories: symptoms, doctor, treatment, medication, and body. Results: We collected 52 threads containing "blepharoplasty," yielding 154 posts and 1365 keywords. The average sentiment score was negative among all posts (-0.15) and keywords (-0.30). Among all posts and keywords, sadness had the highest score and disgust had the lowest score. Conclusions: Fear and sadness are the predominant emotions for blepharoplasty patients online, and the most negative symptoms cited are not ones that surgeons typically expect.

Reactivation of Herpes Zoster Keratitis Following Shingrix Vaccine.

We present a case of herpes zoster keratitis reactivation shortly following the Shingrix vaccine. In our patient, reactivation of herpes zoster keratitis occurred a few weeks following the herpes zoster subunit (HZ/su) vaccine. The development of herpes zoster ophthalmicus following HZ/su is exceedingly rare, with only one prior reported case found in the literature. Reporting of this potential correlation is important in understanding the full risks of vaccines and can help elucidate the etiology of such responses.

Imaging in neuro-ophthalmology in the context of value-based care.

PURPOSE OF REVIEW: Neuro-ophthalmic imaging is an invaluable tool for clinical decision-making and has evolved rapidly. At the same time, both imaging utilization and healthcare costs have skyrocketed, and concern for imaging overuse has become a salient topic. This article gives an overview of the current state of neuro-ophthalmic imaging from a value-based medicine lens and discusses recent neuro-ophthalmic advancements in OCT with these considerations in mind. RECENT FINDINGS: Neuro-ophthalmology is not immune to the waste prevalent in medical imaging. Recent guidelines recommend against routine imaging for ophthalmic conditions without the presence of symptoms. Although neuro-ophthalmic specialty consults and imaging compare favorably against other specialties, the diagnostic yield depending on imaging indication can vary dramatically. For newer developments such as in OCT, it is particularly difficult to assess cost-effectiveness despite the technology's exciting diagnostic potential. SUMMARY: Familiarity with guidelines to counter misuse, the diagnostic yield of imaging in particular situations, and the limitations of new technology can all help neuro-ophthalmologists make educated tradeoffs and adapt to the new landscape of cost-effective medicine. By helping to decrease costs and efficiently utilize limited resources, the end benefactors will be the increased number of patients who have greater access to affordable care.

Homebound patients' perspectives on technology and telemedicine: A qualitative analysis.

Telemedicine holds promise in bridging the gap between homebound patients and high quality health care, but uptake of such technology remains limited. Qualitative interviews conducted with 17 homebound patients found two major barriers to telemedicine. First, participants who lack familiarity with technology are hesitant about telemedicine, as baseline use of technology in the home is limited, participants did not feel capable of learning, and the advantages of telemedicine were unclear. Second, homebound patients place a high value on in-office visits due to therapeutic benefit, face-to-face communication, and the social aspect of medical appointments.