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Felfeli T, Eshtiaghi A, Rhee J, Balas M, Tai F, Kaplan AJ, Christakis PG, Dzulynsky K, Monson H, Mandelcorn ED, Rubin LA, Bakshi NK, Derzko-Dzulynsky LA. Clinical characteristics of non-infectious uveitis treated with and without systemic immunomodulatory therapy. CANADIAN JOURNAL OF OPHTHALMOLOGY 2023:S0008-4182(23)00308-3. [PMID: 37972648 DOI: 10.1016/j.jcjo.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/28/2023] [Accepted: 10/04/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVE To compare the patient characteristics and long-term outcomes for those treated with and without systemic immunomodulatory therapy (IMT) for non-infectious uveitis (NIU). DESIGN Retrospective cohort study. PARTICIPANTS All consecutive adults with NIU receiving care at 5 uveitis subspecialty tertiary care clinics between 2010 and 2021. METHODS Clinical outcomes were evaluated on initial presentation and at the last available follow-up. The main outcome measures were baseline characteristics and final visual acuity. RESULTS A total of 914 NIU patients (418 IMT, 496 non-IMT) with a median age of 51.0 years and 57.4% female were identified. Over half the patients had bilateral disease, with a significantly higher proportion of bilateral cases in the IMT group compared with the non-IMT group (p < 0.001). The IMT group was more likely to have chronic uveitis (p < 0.001), with a higher proportion of patients experiencing cataracts and cystoid macular edema (p < 0.001 for both). A significantly higher proportion of non-IMT patients had anterior uveitis and an idiopathic etiology (p < 0.001). Overall, visual acuity improved significantly from baseline to last follow-up in the entire cohort (p < 0.001), with a slightly better improvement in the IMT group. Multivariable linear regression analysis suggested that baseline visual acuity and panuveitis were significant predictors of final visual acuity (p < 0.001 for both). CONCLUSIONS NIU patients on IMT are often younger, suffer from bilateral and chronic uveitis, and are more likely to have ocular complications. Those in the non-IMT group are more likely to have anterior idiopathic NIU. Baseline visual acuity and panuveitis are the main predictors of final vision outcomes among patients with NIU.
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Affiliation(s)
- Tina Felfeli
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON; Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, ON; Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, ON.
| | - Arshia Eshtiaghi
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON
| | - Jess Rhee
- Faculty of Medicine, Schulich School of Medicine and Dentistry, London, ON
| | - Michael Balas
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON
| | - Felicia Tai
- Division of Ophthalmology, McMaster University, Hamilton, ON
| | - Alexander J Kaplan
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON; Department of Ophthalmology, Toronto Western Hospital, University Health Network, Toronto, ON; Kensington Vision and Research Centre, Kensington Health Institute, Toronto, ON
| | - Panos G Christakis
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON; Kensington Vision and Research Centre, Kensington Health Institute, Toronto, ON
| | - Kira Dzulynsky
- Faculty of Engineering, McGill University, Montreal, Que
| | - Hayley Monson
- Faculty of Mathematics, McMaster University, Hamilton, ON
| | - Efrem D Mandelcorn
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON; Department of Ophthalmology, Toronto Western Hospital, University Health Network, Toronto, ON; Kensington Vision and Research Centre, Kensington Health Institute, Toronto, ON
| | - Laurence A Rubin
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON; Division of Rheumatology, St. Michael's Hospital, Unity Health Toronto, Toronto, ON
| | - Nupura K Bakshi
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON; Kensington Vision and Research Centre, Kensington Health Institute, Toronto, ON; Department of Ophthalmology, St. Michael's Hospital, Unity Health Toronto, Toronto, ON; Department of Ophthalmology, Mount Sinai Hospital, Toronto, ON
| | - Larissa A Derzko-Dzulynsky
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON; Kensington Vision and Research Centre, Kensington Health Institute, Toronto, ON; Department of Ophthalmology, St. Michael's Hospital, Unity Health Toronto, Toronto, ON
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Traitement des uvéites intermédiaires, postérieures et panuvéites non infectieuses. J Fr Ophtalmol 2020; 43:341-361. [DOI: 10.1016/j.jfo.2019.03.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 03/02/2019] [Accepted: 03/28/2019] [Indexed: 01/01/2023]
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de Parisot A, Jamilloux Y, Kodjikian L, Errera MH, Sedira N, Heron E, Pérard L, Cornut PL, Schneider C, Rivière S, Ollé P, Pugnet G, Cathébras P, Manoli P, Bodaghi B, Saadoun D, Baillif S, Tieulie N, André M, Chiambaretta F, Bonin N, Bielefeld P, Bron A, Mouriaux F, Bienvenu B, Amamra N, Guerre P, Decullier E, Sève P. Evaluating the cost-consequence of a standardized strategy for the etiological diagnosis of uveitis (ULISSE study). PLoS One 2020; 15:e0228918. [PMID: 32059021 PMCID: PMC7021300 DOI: 10.1371/journal.pone.0228918] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 01/25/2020] [Indexed: 12/02/2022] Open
Abstract
MAIN OBJECTIVE To prospectively assess the cost-consequence of a standardized diagnostic strategy as to compared to an open one for the etiological diagnosis of uveitis. DESIGN This was a prospective, non-inferiority, multicentre, randomized controlled trial. METHODS We included all consecutive patients with uveitis who had visited at least one of the Departments of Ophthalmology. In the standardized group, patients had a minimal work-up regardless of the type of uveitis (including evaluation of the CBC, ESR, C-reactive protein, tuberculin skin test, syphilis serology and chest X-ray). Depending on ophthalmological findings, further investigations could be performed. In the open strategy, ophthalmologists were free to order any kind of investigation. The main outcome was the mean cost per patient of each strategy. RESULTS 903 uveitis patients were included from January, 2010 to May, 2013. The mean cost per patient of the standardized strategy was 182.97 euros [CI 95% (173.14; 192.80)], and the mean cost per patient of the open strategy was 251.75 euros [CI 95% (229.24; 274.25)]. Therefore, the mean cost per patient of the standardized strategy was significantly lower than the mean cost per patient of the open strategy (p<0.001). There were significantly fewer visits (p<0.001), fewer radiological procedures (p<0.004) and fewer laboratory investigations (p<0.001) in the standardized group. CONCLUSION A standardized strategy is a cost-saving approach for the etiological diagnosis of uveitis.
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Affiliation(s)
- Audrey de Parisot
- Department of Internal Medicine, Hospices Civils de Lyon, Croix-Rousse Hospital, Lyon, France
| | - Yvan Jamilloux
- Department of Internal Medicine, Hospices Civils de Lyon, Croix-Rousse Hospital, Lyon, France
| | - Laurent Kodjikian
- Department of Ophthalmology, Hospices Civils de Lyon, Croix-Rousse Hospital, Lyon, France
| | | | - Neila Sedira
- Department of Internal Medicine, Quinze-Vingts Hospital, Paris, France
| | - Emmanuel Heron
- Department of Internal Medicine, Quinze-Vingts Hospital, Paris, France
| | - Laurent Pérard
- Department of Internal Medicine, Edouard-Herriot Hospital, Lyon, France
| | | | - Christelle Schneider
- Department of Ophthalmology, Centre Hospitalier Regional Universitaire de Montpellier, Montpellier, France
| | - Sophie Rivière
- Department of Internal Medicine, Centre Hospitalier Regional Universitaire de Montpellier, Montpellier, France
| | - Priscille Ollé
- Department of Ophthalmology, Pierre-Paul Riquet Hospital, Toulouse, France
| | - Grégory Pugnet
- Department of Internal Medicine, Purpan University Hospital, Toulouse, France
| | - Pascal Cathébras
- Department of Internal Medicine, Centre Hospitalier Universitaire de Saint-Etienne, Saint-Étienne, France
| | - Pierre Manoli
- Department of Ophthalmology, Centre Hospitalier Universitaire de Saint-Etienne, Saint-Étienne, France
| | - Bahram Bodaghi
- Department of Ophthalmology, Pitié-Salpêtrière Hospital, Paris, France
| | - David Saadoun
- Department of Internal Medicine, Pitié-Salpêtrière Hospital, Paris, France
| | - Stéphanie Baillif
- Department of Ophthalmology, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Nathalie Tieulie
- Department of Internal Medicine, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Marc André
- Department of Internal Medicine, Gabriel-Montpied Hospital, Clermont-Ferrand, France
| | | | - Nicolas Bonin
- Department of Ophthalmology, Gabriel-Montpied Hospital, Clermont-Ferrand, France
| | - Philip Bielefeld
- Department of Internal Medicine, Centre Hospitalier Universitaire de Dijon, Dijon, France
| | - Alain Bron
- Department of Ophthalmology, Centre Hospitalier Universitaire de Dijon, Dijon, France
| | - Frédéric Mouriaux
- Department of Ophthalmology, Centre Hospitalier Universitaire de Caen, Caen, France
| | - Boris Bienvenu
- Department of Internal Medicine, Centre Hospitalier Universitaire de Caen, Caen, France
| | | | | | | | - Pascal Sève
- Department of Internal Medicine, Hospices Civils de Lyon, Croix-Rousse Hospital, Lyon, France
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Roy M, Roy AK, Farrell JJ. Ocular syphilis in an immunocompetent host. IDCases 2019; 19:e00684. [PMID: 32099808 PMCID: PMC7030984 DOI: 10.1016/j.idcr.2019.e00684] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 12/11/2019] [Accepted: 12/11/2019] [Indexed: 10/26/2022] Open
Abstract
Syphilis is an old disease that experienced a resurgence with the emergence of HIV/AIDS. Syphilis is a reportable infection that is monitored by the Centers for disease Control (CDC) in the U.S. and rates have been rising since 2000. Although ocular syphilis is a well known consequence of syphilis infection it continues to be less frequently diagnosed, partially because ocular manifestations are not reportable to CDC. While the majority of recent cases in the U.S. have been reported in men who have sex with men (MSM) population, 50 % of these cases are HIV negative. We present a case of acute iridocyclitis and ocular hypertension due to syphilis infection. This case reiterates the need to increase healthcare workers' awareness of the importance of timely recognition of potential ocular syphilis to prevent visual sequelae from the infection. Ocular syphilis should be kept in the differential diagnosis in immunocompetent/HIV negative patients, and the importance of obtaining a detailed sexual history should not be forgotten.
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Affiliation(s)
- Moni Roy
- OSF Saint Francis Medical Center, Peoria, IL, USA.,University Of Illinois College of Medicine, Department of Medicine, Peoria, IL, USA
| | - Ashish K Roy
- OSF Saint Francis Medical Center, Peoria, IL, USA
| | - John J Farrell
- University Of Illinois College of Medicine, Department of Medicine, Peoria, IL, USA.,OSF System Laboratory, Peoria, IL, USA
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Groen-Hakan F, Eurelings L, ten Berge JC, van Laar J, Ramakers CRB, Dik WA, Rothova A. Diagnostic Value of Serum-Soluble Interleukin 2 Receptor Levels vs Angiotensin-Converting Enzyme in Patients With Sarcoidosis-Associated Uveitis. JAMA Ophthalmol 2019; 135:1352-1358. [PMID: 29121154 DOI: 10.1001/jamaophthalmol.2017.4771] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Importance New and improved diagnostic tests for sarcoidosis-associated uveitis are needed because the currently available laboratory diagnostic biomarkers (eg, lysozyme and angiotensin-converting enzyme [ACE]) are lacking in high sensitivity and specificity. Objective To compare the value of soluble interleukin 2 receptor (sIL-2R) with ACE as diagnostic biomarkers of sarcoidosis in patients with uveitis. Design, Setting, and Participants A cross-sectional retrospective study was conducted using data collected from 249 consecutive patients with uveitis at the Erasmus University Medical Center uveitis outpatient clinic, Rotterdam, the Netherlands, from April 3, 2013, through November 25, 2015. Measurements of sIL-2R and ACE in serum samples and data extraction from patient files were conducted from December 2016 through February 2017, and analysis from April to May 2017. Main Outcomes and Measures Serum levels of sIL-2R and ACE and chest radiographic findings were assessed. Receiver operating characteristics analysis was used to determine the probability that individual tests correctly identified patients with sarcoidosis. The Youden Index was used to determine the optimal cutoff points for serum sIL-2R and ACE levels to define sarcoidosis in patients with uveitis. Results Data were analyzed from 249 patients with uveitis who had their serum sIL-2R and ACE levels determined and underwent chest radiography. Mean (SD) age at the time of sampling was 51 (16) years, 161 patients (64.7%) were women, and 191 (76.7%) were white. Although patients with sarcoidosis-associated uveitis had the highest mean (SD) serum sIL-2R (6047 [2533] pg/mL) and ACE (61 [38] U/L) levels, elevated serum sIL-2R levels were also found in patients with HLA-B27–associated (4460 [2465] pg/mL) and varicella-zoster virus–associated (5386 [1778] pg/mL) uveitis. Serum sIL-2R and ACE levels were significantly correlated (Pearson correlation coefficient, 0.205; P = .001, 2-sided), but no association was found between uveitis activity and sIL-2R (Spearman rank correlation coefficient [ρ], 0.070, P = .27) nor uveitis activity and ACE (ρ, −0.071; P = .27). The highest Youden index for sIL-2R alone was 0.45, corresponding to an optimal cutoff of 4000 pg/mL and providing 81% (95% CI, 74%-89%) sensitivity and 64% (95% CI, 56%-72%) specificity alone but combined with chest radiography yielded 92% sensitivity and 58% specificity. Chest radiography combined with sIL-2R at a cutoff of 6000 pg/mL resulted in 77% sensitivity and 73% specificity. Combined chest radiography and serum ACE levels at the standard cutoff of 68 U/L resulted in 70% sensitivity and 79% specificity. Conclusions and Relevance This cross-sectional study demonstrates that sIL-2R is a useful marker for diagnosing sarcoidosis in patients with uveitis and has slightly better diagnostic value than ACE.
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Affiliation(s)
- Fahriye Groen-Hakan
- Department of Ophthalmology, Erasmus University Medical Center, Erasmus University, Rotterdam, the Netherlands
| | - Laura Eurelings
- Department of Internal Medicine, Section of Clinical Immunology, Erasmus University Medical Center, Erasmus University, Rotterdam, the Netherlands
| | - Josianne C ten Berge
- Department of Ophthalmology, Erasmus University Medical Center, Erasmus University, Rotterdam, the Netherlands
| | - Jan van Laar
- Department of Internal Medicine, Section of Clinical Immunology, Erasmus University Medical Center, Erasmus University, Rotterdam, the Netherlands,Department of Immunology, Erasmus University Medical Center, Erasmus University, Rotterdam, the Netherlands
| | - Christian R B Ramakers
- Department of Clinical Chemistry, Erasmus University Medical Center, Erasmus University, Rotterdam, the Netherlands
| | - Willem A Dik
- Department of Immunology, Erasmus University Medical Center, Erasmus University, Rotterdam, the Netherlands,Laboratory Medical Immunology, Erasmus University Medical Center, Erasmus University, Rotterdam, the Netherlands
| | - Aniki Rothova
- Department of Ophthalmology, Erasmus University Medical Center, Erasmus University, Rotterdam, the Netherlands
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Referral characteristics and wait times for uveitis consultation at academic tertiary care centres in Toronto. Can J Ophthalmol 2018; 53:639-645. [PMID: 30502992 DOI: 10.1016/j.jcjo.2018.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 03/11/2018] [Accepted: 03/13/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To assess the characteristics of referrals to academic uveitis tertiary care centres in Toronto and identify determinants of wait time for consultation. DESIGN Retrospective case series. METHODS Consecutive new uveitis referrals received at 5 University of Toronto-affiliated uveitis tertiary care centres, between February 2016 and November 2016, were included. RESULTS A total of 159 new uveitis referrals were received from academic (69%) and community (31%) providers. A large proportion of referrals were sent by comprehensive ophthalmologists (33%) and retina specialists (38%). Disease was bilateral in 46% of cases, had an acute onset in 43% of cases, and was classified as posterior uveitis in 38% of cases. Disease etiology at the time of referral was unknown in 55% of cases. Only 43% of all referrals included a basic uveitis workup, and patients who had undergone diagnostic testing had a shorter wait time for consultation (41 ± 43 vs. 59 ± 54 days, p = 0.033). Acute uveitis had a shorter wait time compared with recurrent and chronic uveitis (33 ± 42 vs. 66 ± 44 and 59 ± 58 days, p < 0.001). Referrals triaged as urgent had significantly shorter wait times compared with referrals triaged as semiurgent or elective (7 ± 10 vs. 54 ± 43 and 88 ± 59, p < 0.001). CONCLUSIONS Referrals to academic uveitis tertiary care centres in Toronto are often acute, bilateral cases affecting the posterior segment without a known etiology. Approximately half of referrals include no diagnostic workup, which may delay diagnosis for patients and lengthen wait times for consultation. We provide a set of recommendations for investigations that should be included in uveitis referrals.
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Chest Radiographic Screening for Sarcoidosis in the Diagnosis of Patients with Active Uveitis. Ann Am Thorac Soc 2017; 14:912-918. [DOI: 10.1513/annalsats.201611-888oc] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Cheung CSY, Noordeh N, Gottlieb CC. A national survey of Canadian ophthalmologists to determine awareness of published guidelines for the management of uveitis. J Ophthalmic Inflamm Infect 2016; 6:38. [PMID: 27757929 PMCID: PMC5069221 DOI: 10.1186/s12348-016-0102-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 08/22/2016] [Indexed: 02/05/2023] Open
Abstract
Background The objectives of this study are to assess Canadian ophthalmologists’ awareness of established uveitis treatment guidelines and clinical management of uveitis and to assess the frequency of government applications for immunomodulatory therapy (IMT) and identify primary prescribers. A 25-item questionnaire was sent to 759 practicing Canadian ophthalmologists. Six questions assessed demographics including the year of residency completion, training by uveitis specialists during residency, and fellowship training. Five questions assessed application of guidelines to clinical scenarios, and 12 questions assessed referral patterns and success of obtaining coverage for IMT. Results Of 144 respondents, 12 (8.3 %) were uveitis specialists; 45.1 % of respondents had uveitis training during residency by a uveitis specialist. Sixty-one percent reported awareness of management guidelines. Recent graduates (2001–2012) referred patients to uveitis specialists (55.3 %) less frequently than earlier graduates. Recent graduates also managed uveitis patients more frequently with corticosteroid injections (15.6 %) than those who graduated before 1980 (9.75 %). The majority (93.6 %) of respondents submitted less than six IMT funding applications for provincial drug coverage yearly, and 5.5 % reported prescribing IMT themselves, rather than referring to other specialists. Conclusions Although greater than half of respondents reported awareness of uveitis treatment guidelines, Canadian ophthalmologists’ awareness of uveitis treatment guidelines and application of the guidelines to patient care could be improved. Few applications are made for IMT, and the majority of applications are sent by non-ophthalmologists. This suggests the need for further education of ophthalmologist about uveitis treatment guidelines and for more ophthalmologists trained to manage uveitis with IMT. Electronic supplementary material The online version of this article (doi:10.1186/s12348-016-0102-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Crystal S Y Cheung
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada. .,Department of Ophthalmology, Kensington Eye Institute, 340 College Street, Suite 600, Toronto, ON, M5T 3A9, Canada.
| | - Nima Noordeh
- University of Ottawa Eye Institute, Ottawa, Ontario, Canada
| | - Chloe C Gottlieb
- University of Ottawa Eye Institute, Ottawa, Ontario, Canada.,Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Patterns of Laboratory Testing Utilization Among Uveitis Specialists. Am J Ophthalmol 2016; 170:161-167. [PMID: 27521608 DOI: 10.1016/j.ajo.2016.08.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 07/29/2016] [Accepted: 08/03/2016] [Indexed: 11/23/2022]
Abstract
PURPOSE To examine the range of practice in laboratory testing utilization among a subset of uveitis specialists using a scenario-based survey. DESIGN Cross-sectional survey. METHODS A web-based survey consisting of 13 patient scenarios was presented to the Executive Committee and Trustees of the American Uveitis Society. The participants were allowed to choose preferred testing in a free-form manner. The patterns of test utilization were studied and the cost of the testing was calculated based on Noridian Medicare reimbursal rates for Seattle, Washington. RESULTS Nearly all providers recommended some testing for all scenarios. Forty-five different tests, including laboratory investigations and imaging and diagnostic procedures, were ordered. The mean number of tests ordered per scenario per provider was 5.47 ± 2.71. There was limited consensus among providers in test selection, with most tests in each scenario ordered by fewer than half of the providers. Average cost of testing per scenario per provider was $282.80, with 4 imaging tests (fluorescein angiography, magnetic resonance imaging, chest radiograph, and chest computed tomography) together contributing 59.9% of the total testing costs. CONCLUSIONS Uveitis specialists have a high rate of laboratory testing utilization in their evaluation of new patients. There is substantial variability in the evaluations obtained between providers. Imaging tests account for the majority of evaluation cost. The low agreement on specific testing plans suggests need for evidence-based practice guidelines for the evaluation of uveitis patients.
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Shen K, Smith SV, Lee AG. Acute myelogenous leukemia presenting with uveitis, optic disc edema, and granuloma annulare: Case report. Can J Ophthalmol 2016; 51:e153-e155. [PMID: 27769343 DOI: 10.1016/j.jcjo.2016.05.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Revised: 05/07/2016] [Accepted: 05/17/2016] [Indexed: 11/18/2022]
Affiliation(s)
- Kevin Shen
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX; Baylor College of Medicine, Houston, TX; Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medical College, New York, NY; Department of Ophthalmology, The University of Texas Medical Branch, Galveston, TX; Department of Ophthalmology, The University of Iowa Hospitals and Clinics, Iowa City, IA; UT MD Anderson Cancer Center
| | - Stacy V Smith
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX; Baylor College of Medicine, Houston, TX; Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medical College, New York, NY; Department of Ophthalmology, The University of Texas Medical Branch, Galveston, TX; Department of Ophthalmology, The University of Iowa Hospitals and Clinics, Iowa City, IA; UT MD Anderson Cancer Center
| | - Andrew G Lee
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX; Baylor College of Medicine, Houston, TX; Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medical College, New York, NY; Department of Ophthalmology, The University of Texas Medical Branch, Galveston, TX; Department of Ophthalmology, The University of Iowa Hospitals and Clinics, Iowa City, IA; UT MD Anderson Cancer Center.
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Teoh SC, Dick AD. Diagnostic techniques for inflammatory eye disease: past, present and future: a review. BMC Ophthalmol 2013; 13:41. [PMID: 23926885 PMCID: PMC3750647 DOI: 10.1186/1471-2415-13-41] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 08/01/2013] [Indexed: 12/14/2022] Open
Abstract
Investigations used to aid diagnosis and prognosticate outcomes in ocular inflammatory disorders are based on techniques that have evolved over the last two centuries have dramatically evolved with the advances in molecular biological and imaging technology. Our improved understanding of basic biological processes of infective drives of innate immunity bridging the engagement of adaptive immunity have formed techniques to tailor and develop assays, and deliver targeted treatment options. Diagnostic techniques are paramount to distinguish infective from non-infective intraocular inflammatory disease, particularly in atypical cases. The advances have enabled our ability to multiplex assay small amount of specimen quantities of intraocular samples including aqueous, vitreous or small tissue samples. Nevertheless to achieve diagnosis, techniques often require a range of assays from traditional hypersensitivity reactions and microbe specific immunoglobulin analysis to modern molecular techniques and cytokine analysis. Such approaches capitalise on the advantages of each technique, thereby improving the sensitivity and specificity of diagnoses. This review article highlights the development of laboratory diagnostic techniques for intraocular inflammatory disorders now readily available to assist in accurate identification of infective agents and appropriation of appropriate therapies as well as formulating patient stratification alongside clinical diagnoses into disease groups for clinical trials.
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Affiliation(s)
- Stephen C Teoh
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore.
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Wakefield D, Chang JH, Amjadi S, Maconochie Z, el-Asrar AA, McCluskey P. What Is New HLA-B27 Acute Anterior Uveitis? Ocul Immunol Inflamm 2011; 19:139-44. [DOI: 10.3109/09273948.2010.542269] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Noble J, Hollands H, Forooghian F, Yazdani A, Sharma S, Wong DT, Derzko-Dzulynsky L. Evaluating the cost-effectiveness of anterior uveitis investigation by Canadian ophthalmologists. Can J Ophthalmol 2008; 43:652-7. [DOI: 10.3129/i08-147] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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