Ophthalmology Patient Perceptions of Open Payments Information.

Importance: Since 2014, medical industry payment data to physicians have been public via the Open Payments database. Patient opinions regarding these data help us to understand concerns and policymakers to improve reporting mechanisms for such payments. Objective: To assess patient perceptions of Open Payments information. Design, Setting, and Participants: This cross-sectional, questionnaire-based study was conducted in 3 ophthalmology clinic sites of an academic institution in Manhattan, New York City, New York. All patients older than 18 years who were waiting for appointments were eligible. Data were collected from January to June 2016 and analyzed from June to September 2016. Exposures: Participants answered 27 questions about the Open Payments database in English or Spanish. Demographic information was also collected. Main Outcomes and Measures: Key questionnaire results included patient awareness of the Open Payments database and perceptions of physicians' financial relationships. Cronbach α validation of the survey was performed, and Poisson multivariable regression analysis was performed to evaluate the association between patient characteristics and responses. Results: A total of 407 individuals participated. The mean (SD) age of study participants was 58.8 (17.9) years, and 220 (54.2%) were women. Of these, 30 (7.3% [95% CI, 5.1%-19.4%]) were aware of the Open Payments database, and 109 (26.8% [95% CI, 24.8%-34.0%]) planned to access it. More than half (n = 212; 53.5% [95% CI, 48.6%-58.5%]) wanted to know if their physician receives industry payments. Regarding payments of any kind valuing $100, 161 (41.9% [95% CI, 37.0%-46.9%]) disapproved. Similarly, 178 (45.8% [95% CI, 40.8%-50.7%]) disapproved of $500 payments, and 221 (57.0% [95% CI, 52.0%-61.9%]) disapproved of $25 000 payments. Poisson multivariable regression analysis demonstrated that participants who took the survey in Spanish were 38% more likely to approve of physicians receiving payments than were those who took the survey in English (incidence rate ratio [IRR], 1.38 [95% CI, 1.19-1.59]; P < .001). For every 1 year of age, the likelihood of approval for a physician receiving payments decreased by 1% (IRR, 0.995 [95% CI, 0.99-1.00]; P = .007). Participants with graduate degrees were 20% less likely to approve of physicians receiving payments, compared with those with less than a high school degree (IRR, 0.80 [95% CI, 0.66-0.97]; P = .02). Conclusions and Relevance: If the survey is validated, and if these results are generalizable outside of the 3 academic centers in ophthalmology surveyed, the findings suggest that many patients disapprove of physicians receiving payments from industry. However, few patients had accessed the Open Payments database or planned to access it. Further investigation is required to determine if these results can be generalized for other settings.

SURGICAL TREATMENT OF A MACULAR HOLE IN X-LINKED RETINOSCHISIS.

PURPOSE: To report a case of full-thickness macular hole in a patient with X-linked retinoschisis and the outcome after surgical repair. METHODS: A 15-year-old boy with a history of X-linked retinoschisis presented to his ophthalmologist for routine follow-up and was found to have a Stage-3 macular hole in his left eye. His vision was 20/200. The patient underwent pars plana vitrectomy and internal limiting membrane peeling, and he received long-acting gas. Color fundus photography and spectral domain optical coherence tomography (Cirrus; Carl Zeiss Meditech Inc, Dublin, CA) recorded images at office visits, before and after surgical repair. RESULTS: The initial spectral domain optical coherence tomography of the left eye showed a full-thickness macular hole of 1,370 µm in diameter as well as schisis cavities in the macula. After pars plana vitrectomy and repeat fluid-gas exchange, the hole was closed at the sixth-week follow-up visit. The patient noted a subjective decrease in the size of a central scotoma. Best-corrected visual acuity returned to the baseline of 20/80. CONCLUSION: A large full-thickness macular hole can develop in X-linked retinoschisis, and pars plana vitrectomy with internal limiting membrane peeling may be helpful for successful surgical closure.

Vitrectomy for macular hole following Nd:YAG laser injury.

The Q-switched Nd:YAG laser can cause significant ocular injury, because it can emit an invisible and powerful load of energy in a short period of time. One of these injuries is macular hole formation. We report the case of a 21-year-old woman who presented with acute floaters in her left eye after exposure to a Q-switched Nd:YAG laser. Her initial best-corrected visual acuity (BCVA) in the left eye was 20/80. Examination demonstrated an acute vitreous hemorrhage, and spectral-domain optical coherence tomography (SD-OCT) confirmed a full-thickness macular hole (FTMH). Four months after her injury, her BCVA deteriorated to 20/400, and she underwent vitrectomy, internal limiting membrane peeling, and gas injection. Three weeks following the procedure, her FTMH was closed, however, her BCVA remained 20/150. At her last office visit, 19 months after the surgery, the examination was unchanged. There are few reports of vitrectomy to close an FTMH after Nd:YAG laser exposure, and the factors that contribute to visual recovery remain unclear. The aim of this case report is to emphasize the importance of early diagnosis and surgical repair, and to review the literature and surgical outcomes of cases of Nd:YAG laser-induced macular holes. Imaging with SD-OCT was essential in evaluating the visual outcome, as it was dependent on the degree of photoreceptor and retinal pigment epithelium injury.

Quantitative Fundus Autofluorescence and Optical Coherence Tomography in ABCA4 Carriers.

PURPOSE: To assess whether carriers of ABCA4 mutations have increased RPE lipofuscin levels based on quantitative fundus autofluorescence (qAF) and whether spectral-domain optical coherence tomography (SD-OCT) reveals structural abnormalities in this cohort. METHODS: Seventy-five individuals who are heterozygous for ABCA4 mutations (mean age, 47.3 years; range, 9-82 years) were recruited as family members of affected patients from 46 unrelated families. For comparison, 57 affected family members with biallelic ABCA4 mutations (mean age, 23.4 years; range, 6-67 years) and two noncarrier siblings were also enrolled. Autofluorescence images (30°, 488-nm excitation) were acquired with a confocal scanning laser ophthalmoscope equipped with an internal fluorescent reference. The gray levels (GLs) of each image were calibrated to the reference, zero GL, magnification, and normative optical media density to yield qAF. Horizontal SD-OCT scans through the fovea were obtained and the thicknesses of the outer retinal layers were measured. RESULTS: In 60 of 65 carriers of ABCA4 mutations (age range, 9-60), qAF levels were within normal limits (95% confidence level) observed for healthy noncarrier subjects, while qAF levels of affected family members were significantly increased. Perifoveal fleck-like abnormalities were observed in fundus AF images in four carriers, and corresponding changes were detected in the outer retinal layers in SD-OCT scans. Thicknesses of the outer retinal layers were within the normal range. CONCLUSIONS: With few exceptions, individuals heterozygous for ABCA4 mutations and between the ages of 9 and 60 years do not present with elevated qAF. In a small number of carriers, perifoveal fleck-like changes were visible.

Muscle and nerve biopsies: techniques for the neurologist and neurosurgeon.

OBJECTIVE: Muscle and nerve biopsies are commonly performed procedures for the diagnosis of neuromuscular disorders. Neurologists and neurosurgeons are often consulted to perform these procedures in clinical practice. We provide guidelines in the performance of muscle and nerve biopsies. METHODS: We describe the technique for performance of muscle and nerve biopsy, and review the relevant literature. RESULTS: The quadriceps muscle is the most typical biopsy site for most myopathies, whereas the sural nerve is the most common nerve biopsy site for most peripheral neuropathies. Other sites may be utilized depending upon the pattern of symptoms or the differential diagnosis. Motor nerves may be sampled in the setting of motor neuron disease, for example. We advocate the use of conduit repair to allow for sensory or motor recovery to occur following nerve biopsy. CONCLUSION: The muscle biopsy and nerve biopsy may be performed with high yield, low morbidity, and rare complications.