ABSTRACT
PURPOSE: To ensure optimal care of patients, cornea specialists measure corneal features, including epithelial defects (ED), with slit-lamp calipers. However, caliper measurements are subject to interphysician variability. We examined the extent of variability in ED measurements between cornea specialists and discuss the potential clinical impact. METHODS: A total of 48 variably sized EDs were created in pig eyes. Three cornea specialists measured the maximum vertical and horizontal ED lengths to the nearest 10th of a millimeter using slit-lamp microscopy. An absolute difference in ED measurement between cornea specialists of 0.5 mm was chosen to be the a priori threshold for clinical significance and was evaluated by the Wilcoxon signed-rank test. Interrater reliability was assessed by intraclass correlation coefficients. RESULTS: The average absolute difference in the vertical ED length between pairs of examiners ranged from 0.54 to 0.63 mm, and that of the horizontal ED length ranged from 0.44 to 0.46 mm. These differences in ED measurement were not significantly different from 0.5 mm (all P > 0.06). However, pairs of examiners differed in vertical ED length measurements by >0.5 mm in 44% to 52% of EDs and by >1.0 mm in 13% to 17% of EDs. Pairs of examiners differed in horizontal ED length measurements by >0.5 mm in 31% to 40% of EDs and by >1.0 mm in 10% to 15% of EDs. The intraclass correlation coefficient was 0.85 (95% confidence interval, 0.77-0.91) for vertical and 0.84 (95% confidence interval, 0.74-0.90) for horizontal ED measurements. CONCLUSIONS: Cornea specialists showed good reliability in the measured EDs; however, depending on the threshold for clinical significance, a nontrivial percentage of cases have high interexaminer clinical variability.
Subject(s)
Corneal Diseases/diagnosis , Diagnostic Techniques, Ophthalmological/standards , Epithelium, Corneal/pathology , Animals , Disease Models, Animal , Observer Variation , Ophthalmologists/standards , Reproducibility of Results , SwineABSTRACT
PURPOSE: To evaluate how the monitoring and treatment for diabetic macular edema (DME) has changed in a national sample. DESIGN: Retrospective cohort study. SETTING: Administrative medical claims data from a large, national U.S. insurer. STUDY POPULATION: Beneficiaries of a U.S. insurance company. OBSERVATION PROCEDURES: All incident cases of DME were found. Those in years 2002/3, 2006 and 2010 were followed for a 2-year observation period and those from 2009, 2010 and 2011 for a 1-year observation period. MAIN OUTCOME MEASURES: Types and frequencies of treatment were tallied and compared over each of the cohorts. RESULTS: Two-year cohorts had 233, 251 and 756 patients in 2002/3, 2006 and 2010 respectively. One-year cohorts had 1002, 1119 and 1382 patients in 2009, 2010 and 2011, respectively. Both percentage of patients receiving therapy and number of treatments given increased across the 2-year cohorts for both focal laser and anti-vascular endothelial growth factor (anti-VEGF) (p<0.001). The highest use of anti-VEGF agents in any of the cohorts was in the 2011 1-year group that only averaged 3.78 injections. Focal laser was used 2.5x as frequently as anti-VEGF injections in the most recent cohorts with only a high of 14.0% of DME patients receiving anti-VEGF therapy in any of the cohorts. CONCLUSION: Regardless of treatment modality (laser or injection) DME patients received vastly fewer treatments than patients in randomized control trials. Despite the proven superior visual outcomes of anti-VEGF agents over focal laser in DME, focal laser was still used more frequently.
Subject(s)
Diabetes Complications/therapy , Macular Edema/therapy , Bevacizumab/therapeutic use , Cohort Studies , Diabetes Complications/epidemiology , Female , Follow-Up Studies , Humans , Laser Therapy , Macular Edema/epidemiology , Macular Edema/etiology , Male , Middle Aged , Retrospective Studies , United States , Vascular Endothelial Growth Factor A/antagonists & inhibitors , Vascular Endothelial Growth Factor A/immunologySubject(s)
Cat-Scratch Disease/diagnosis , Eye Infections, Bacterial/diagnosis , Retinitis/diagnosis , Adult , Anti-Bacterial Agents/therapeutic use , Bartonella/isolation & purification , Cat-Scratch Disease/drug therapy , Cat-Scratch Disease/microbiology , Doxycycline/therapeutic use , Drug Combinations , Eye Infections, Bacterial/drug therapy , Eye Infections, Bacterial/microbiology , Female , Humans , Papilledema/diagnosis , Papilledema/drug therapy , Papilledema/microbiology , Retinitis/drug therapy , Retinitis/microbiology , Rifampin/therapeutic use , Tomography, Optical CoherenceABSTRACT
We know little about the processes by which we evaluate the opportunity to look at another person. We propose that behavioural economics provides a powerful approach to understanding this basic aspect of social attention. We hypothesized that the decision process culminating in attention to another person follows the same economic principles that govern choices about rewards such as food, drinks and money. Specifically, such rewards are discounted as a function of time, are tradable for other rewards, and reinforce work. Behavioural and neurobiological evidence suggests that looking at other people can also be described as rewarding, but to what extent these economic principles apply to social orienting remains unknown. Here, we show that the opportunity to view pictures of the opposite sex is discounted by delay to viewing, substitutes for money and reinforces work. The reward value of photos of the opposite sex varied with physical attractiveness and was greater in men, suggesting differential utility of acquiring visual information about the opposite sex in men and women. Together, these results demonstrate that choosing whom to look at follows a general set of economic principles, implicating shared neural mechanisms in both social and non-social decision making.
