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Abstract
A 44-year-old male patient developed proptosis, edema, and erythema progressing to complete ptosis and supraduction deficit 2 days after positive COVID-19 test. He failed to improve on systemic antibiotics. MRI showed thickening and T2 enhancement of the superior rectus/levator complex consistent with orbital myositis. He improved on intravenous corticosteroids and experienced continued gradual improvement on oral steroids.
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Affiliation(s)
- Blair K Armstrong
- Oculoplastic and Orbital Surgery Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Ann P Murchison
- Oculoplastic and Orbital Surgery Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Jurij R Bilyk
- Oculoplastic and Orbital Surgery Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
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Abstract
PURPOSE To assess the epidemiology of pediatric ocular conditions presenting to an ophthalmic emergency department and analyze the incidence of ocular trauma and other ophthalmic diagnoses. METHODS A retrospective review was performed of all patients seen in an urban eye emergency department over a 1-year period. The following variables were examined: visit date, demographics, diagnosis, mechanism of injury, and level of patient care. RESULTS Analysis was performed on 1,136 pediatric visits spanning 1 year. Trauma was the most common etiology, seen in 44.4% of patients, followed by infection in 19.3%. The largest volume of pediatric use was in the spring and early summer, with the peak of trauma in the spring. Most admissions of pediatric patients were due to trauma (76.4%), of which the most common diagnoses were ruptured globe (27.3%), eyelid laceration (18.2%), and orbital fracture (10.9%). Sporting activities were the most frequent broad cause of trauma seen in pediatric patients, accounting for 30.9% of all trauma, whereas the highest singular cause of trauma was injury by air guns (9.5%). CONCLUSIONS Pediatric ophthalmic emergency department visits in this urban setting are most often due to trauma, with increased use in the spring and early summer. A majority of the more serious conditions leading to admission can be attributed to trauma, which is often preventable. Knowledge of patterns of visits could improve planning of ophthalmology physician coverage. [J Pediatr Ophthalmol Strabismus. 2021;58(2):84-92.].
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Pizzi LT, Leiby B, Chu DS, Gower EW, Ailani H, Shovlin J, Prioli KM, Shukla S, Patterson BJ, Rausch DA, Buck PO, Murchison AP. 1716. Prospective Multicenter Observational Cohort Study to Assess the Burden of Herpes Zoster Disease in the Eye: Baseline Results of Initial Patients. Open Forum Infect Dis 2020. [PMCID: PMC7777780 DOI: 10.1093/ofid/ofaa439.1894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Herpes Zoster Ophthalmicus (HZO) affects 10-20% of adults with herpes zoster; ≥ 50% of these cases manifest as serious ocular diseases. This 1-year prospective observational cohort study aims to determine patient-reported HZO symptoms as well as economic and quality of life burden among 300 HZO patients from 6 major US ophthalmology practices. Here, we report baseline data from 13 initial enrollees.
Methods
Inclusion criteria were: participants ≥ 18 years, diagnosis of clinically active HZO, English or Spanish speaking, be willing and able to respond to study assessments, not be enrolled in a concurrent interventional HZO trial. Information are collected via 1) a clinical assessment form completed by the practice (baseline) and 2) patient questionnaires (baseline, 3, 6, and 12 months) on symptoms, medications, healthcare use, vision function, depression, and work productivity impact. Baseline results are presented for patients recruited during the first 6 months of enrollment from the first 4 sites to go live: diagnoses, and patient-reported symptoms and outcomes (eight-item Patient Health Questionnaire [PHQ-8] for depressive symptoms, National Eye Institute 25-item Visual Function Questionnaire [NEI-VFQ-25] for vision-related quality of life, and Zoster Brief Pain Inventory [ZBPI] for pain).
Results
The mean age of participants is 71 years; 11 are female and 9 are retired. Seven participants are college graduates or hold other degrees. All have health insurance coverage, with most (10) having primary insurance through Medicare. HZO diagnoses (Table 1) were: keratitis (4), iridocyclitis (4), conjunctivitis (1), other HZO diagnosis (3), other ocular diagnosis (6). Patient-reported symptoms (Table 2) were: pain above the eye, sensitivity to light, redness, feeling of sand/grit in the eye (9 each). The mean overall PHQ-8 and NEI-VFQ-25 scores were 5.9 (Standard Deviation [SD]:4.5) and 74.6 (SD:13.9), respectively; the mean ZBPI score for worst pain severity was 3.3 (SD:3.8) (Table 3).
Table 1. HZO Diagnosis at Baseline based on Clinical Assessment Form (N=13)
Table 2. Patient-reported Symptoms in the HZO-Affected Eye at Baseline (N=13)
Table 3. Patient-reported Outcomes: Depressive Symptoms, Vision-Related Quality of Life, and Herpes Zoster Pain at Baseline (N=13)
Conclusion
This study represents the first large scale effort to quantify HZO burden. Findings will inform development of a formal patient-reported symptom scale for use in research and clinical practice.
Funding
GlaxoSmithKline Biologicals SA (GSK study identifiers: 209235/HO-17-17967)
Disclosures
Laura T. Pizzi, PharmD, MPH, ORCID: 0000-0002-7366-7661, GlaxoSmithKline (Research Grant or Support) Soham Shukla, PharmD, ORCID: 0000-0002-4139-0856, GSK (Employee)Rutgers University (Employee) Brandon J. Patterson, PharmD, PhD, GSK (Employee, Shareholder) Debora A. Rausch, MD, ORCID: 0000-0001-9759-2687, GSK (Employee) Philip O. Buck, PhD, MPH, ORCID: 0000-0002-3898-3669, GSK (Employee, Shareholder) Ann P. Murchison, MD, MPH, GSK (Grant/Research Support)
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Affiliation(s)
| | | | - David S Chu
- Metropolitan Eye Research and Surgery Institute, Palisades Park, New Jersey
| | | | - Haresh Ailani
- Eye Consultants of Northern Virginia, Springfield, Virginia
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Murchison AP, Sweid A, Dharia R, Theofanis TN, Tjoumakaris SI, Jabbour PM, Bilyk JR. Monocular visual loss as the presenting symptom of COVID-19 infection. Clin Neurol Neurosurg 2020; 201:106440. [PMID: 33383464 PMCID: PMC7831816 DOI: 10.1016/j.clineuro.2020.106440] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 12/06/2020] [Accepted: 12/10/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND IMPORTANCE Additional time is needed to determine the exact impact of COVID-19 on acute cerebrovascular disease incidence, but recently published data has correlated COVID-19 to large vessel occlusion strokes. CLINICAL PRESENTATION We report the first case of central retinal artery occlusion (CRAO) as the initial manifestation of COVID-19 infection. Subsequent neuroimaging revealed a large thrombus extending into the internal carotid artery. CONCLUSION This case illustrates the need to suspect COVID-19 infection in patients presenting with retinal arterial occlusion, including individuals who are asymptomatic or minimally symptomatic for COVID-19 infection.
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Affiliation(s)
- Ann P Murchison
- Eye Emergency Room, Wills Eye Hospital & Associate Professor, Department of Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, United States; Oculoplastic and Orbital Surgery Service, Wills Eye Hospital, Philadelphia, PA, United States.
| | - Ahmad Sweid
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, United States.
| | - Robin Dharia
- Department of Neurology, Thomas Jefferson University Hospital, Philadelphia, PA, United States.
| | - Thana N Theofanis
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, United States.
| | - Stavropoula I Tjoumakaris
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, United States.
| | - Pascal M Jabbour
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, United States.
| | - Jurij R Bilyk
- Oculoplastic and Orbital Surgery Service, Wills Eye Hospital, Philadelphia, PA, United States.
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Mayro EL, Murchison AP, Hark LA, Silverstein M, Wang OY, Gilligan JP, Leiby BE, Pizzi LT, Casten RJ, Rovner BW, Haller JA. Prevalence of depressive symptoms and associated factors in an urban, ophthalmic population. Eur J Ophthalmol 2020; 31:740-747. [PMID: 31983234 DOI: 10.1177/1120672120901701] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine the prevalence of depressive symptoms in an adult ophthalmic patient population and to delineate correlates. DESIGN Cross-sectional study. PARTICIPANTS Adult patients (⩾18 years) were approached in general and sub-specialty cornea, retina, and glaucoma ophthalmic clinics. A total of 367 patients from the four clinics were enrolled. METHODS Depressive symptoms were assessed using the Patient Health Questionnaire-9. A cut-off score of ⩾10 was used to indicate clinically significant depressive symptoms. Patient Health Questionnaire-9 scores were used to evaluate bivariate relationships between depressive symptoms and distance visual acuity, ocular diagnosis, diabetes status, smoking status, demographic information, and medications. RESULTS The majority of patients were female (52.9%) and Caucasian (48.6%). The mean age was 52.0 years (standard deviation: 16.7). Clinically significant depressive symptoms were present in 19.9% of patients overall; this rate varied slightly by clinic. Patients with low vision and blindness (visual acuity worse than 20/60) were more likely to have depressive symptoms (odds ratio = 2.82; 95% confidence interval: 1.90-4.21). Smoking and diabetes were also associated with depressive symptoms (odds ratio = 3.11 (2.66-3.64) and 3.42 (1.90-6.16), respectively). CONCLUSION In a sample of urban ophthalmic adult patients, depressive symptoms were highly associated with low vision, smoking, and diabetes. This information can be used to target interventions to those at greatest risk of depressive symptoms.
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Affiliation(s)
- Eileen L Mayro
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Ann P Murchison
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.,Wills Eye Hospital, Philadelphia, PA, USA
| | - Lisa A Hark
- Wills Eye Hospital, Philadelphia, PA, USA.,Department of Ophthalmology, Columbia University Irving Medical Center, New York, NY, USA.,Vagelos College of Physicians and Surgeons and Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Marlee Silverstein
- Department of Ophthalmology, The Ohio State University, Columbus, OH, USA
| | - Olivia Y Wang
- Department of Surgery, Lankenau Medical Center, Wynnewood, PA, USA
| | - John P Gilligan
- Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | - Benjamin E Leiby
- Department of Pharmacology & Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA, USA
| | - Laura T Pizzi
- Center for Health Outcomes, Policy, and Economics, Rutgers University, Piscataway, NJ, USA
| | - Robin J Casten
- Department of Psychiatry & Human Behavior, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Barry W Rovner
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.,Department of Psychiatry & Human Behavior, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.,Department of Neurology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Julia A Haller
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.,Wills Eye Hospital, Philadelphia, PA, USA
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Abstract
A 71-year-old woman with a history of acute lymphoblastic leukemia presented with unilateral optic disc edema. Laboratory evaluations for infectious, inflammatory, and neoplastic etiologies were negative. Magnetic resonance imaging of the orbits with and without contrast demonstrated enhancement and thickening of the right optic nerve with mild stranding of the intraconal fat. She underwent three large-volume lumbar punctures, all of which were negative for malignancy. An optic nerve biopsy was ultimately performed, demonstrating malignant cells on immunohistochemical staining. This case illustrates a rare case of biopsy-proven leukemic infiltration of the optic nerve head as the presenting sign of leukemic relapse despite a negative systemic workup. Leukemic infiltration should be considered in the differential diagnosis for cases of acquired disc edema, especially in patients with a past medical history of leukemia.
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Affiliation(s)
- Faith A Birnbaum
- Department of Ophthalmology, Duke Eye Center, Durham, North Carolina, USA
| | - Landon C Meekins
- Department of Ophthalmology, Duke Eye Center, Durham, North Carolina, USA.
| | - Archana Srinivasan
- Skull Base Division, Neuro-ophthalmology Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Ann P Murchison
- Skull Base Division, Neuro-ophthalmology Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA; Director, Wills Eye Emergency Department, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
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Hark LA, Myers JS, Ines A, Jiang A, Rahmatnejad K, Zhan T, Leiby BE, Hegarty S, Fudemberg SJ, Mantravadi AV, Waisbourd M, Henderer JD, Burns C, Divers M, Molineaux J, Pizzi LT, Murchison AP, Saaddine J, Pasquale LR, Haller JA, Katz LJ. Philadelphia Telemedicine Glaucoma Detection and Follow-up Study: confirmation between eye screening and comprehensive eye examination diagnoses. Br J Ophthalmol 2019; 103:1820-1826. [PMID: 30770354 DOI: 10.1136/bjophthalmol-2018-313451] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 01/09/2019] [Accepted: 01/16/2019] [Indexed: 11/03/2022]
Abstract
AIMS To evaluate agreement between ocular findings of a telemedicine eye screening (visit 1) with diagnoses of a comprehensive eye examination (visit 2). METHODS A primary care practice (PCP)-based telemedicine screening programme incorporating fundus photography, intraocular pressure (IOP) and clinical information was conducted. Eligible individuals were African American, Hispanic/Latino or Asian over the age of 40; Caucasian individuals over age 65; and adults of any ethnicity over age 40 with a family history of glaucoma or diabetes. Participants with abnormal images or elevated IOP were invited back for a complete eye examination. Both visit 1 and visit 2 were conducted at participants' local PCP. Ocular findings at visit 1 and eye examination diagnoses at visit 2 are presented, including a cost analysis. RESULTS Of 906 participants who attended visit 1, 536 were invited to visit 2 due to ocular findings or unreadable images. Among the 347 (64.9%) who attended visit 2, 280 (80.7%) were diagnosed with at least one ocular condition. Participants were predominately women (59.9%) and African American (65.6%), with a mean age (±SD) of 60.6±11.0 years. A high diagnostic confirmation rate (86.0%) was found between visit 1 and visit 2 for any ocular finding. Of 183 with suspicious nerves at visit 1, 143 (78.1%) were diagnosed as glaucoma or glaucoma suspects at visit 2. CONCLUSIONS This screening model may be adapted and scaled nationally and internationally. Referral to an ophthalmologist is warranted if abnormal or unreadable fundus images are detected or IOP is >21 mm Hg. TRIAL REGISTRATION NUMBER NCT02390245.
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Affiliation(s)
- Lisa A Hark
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania, USA .,Ophthalmology, Columbia University Irving Medical Center, New York, New York, USA
| | - Jonathan S Myers
- Glaucoma Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA.,Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Andrew Ines
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Alicia Jiang
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Kamran Rahmatnejad
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Tingting Zhan
- Division of Biostatistics, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Benjamin E Leiby
- Division of Biostatistics, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Sarah Hegarty
- Division of Biostatistics, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Scott J Fudemberg
- Glaucoma Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA.,Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Anand V Mantravadi
- Glaucoma Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA.,Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | - Jeffrey D Henderer
- Ophthalmology, Temple University Hospital, Philadelphia, Pennsylvania, USA
| | - Christine Burns
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Meskerem Divers
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Jeanne Molineaux
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Laura T Pizzi
- School of Pharmacy, Rutgers University, Piscataway, New Jersey, USA
| | - Ann P Murchison
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Emergency Department, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Jinan Saaddine
- Centers for Disease Control and Prevention, Division of Diabetes Translation, Vision Health Initiative, Atlanta, Georgia, USA
| | - Louis R Pasquale
- Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Julia A Haller
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Wills Eye Hospital, Ophthalmologist-in-Chief, Philadelphia, Pennsylvania, USA
| | - L Jay Katz
- Glaucoma Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA.,Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Mayro EL, Pizzi LT, Hark LA, Murchison AP, Wisner D, Koka A, Leiby BE, Dabbish N, Okulate A, Dessy A, Green C, Bailey R. A Proposed Intervention to Decrease Resident-Performed Cataract Surgery Cancellation in a Tertiary Eye Care Center. Am Health Drug Benefits 2018; 11:480-487. [PMID: 30746019 PMCID: PMC6322594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 06/15/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Cataracts are the leading cause of preventable blindness globally. As a result, competence in cataract surgery is an important component of ophthalmology residency training. Residency programs must optimize the number of cataract surgery cases to train proficient physicians. However, the rate of cataract surgery cancellations is high, and some are canceled because of preventable causes. OBJECTIVE To evaluate the effect of mandatory on-site preadmission testing, including having a physical examination, on resident-performed cataract surgery cancellation rates. METHODS For this study, patients scheduled for cataract surgery at the Wills Eye Hospital resident cataract clinic between January 2015 and November 2015 were enrolled and randomized into 2 groups: usual care or intervention. The patients randomized to the usual care group were instructed to complete preadmission testing and to have a physical examination with their primary care physician. The patients randomized to the intervention group were escorted to a Wills Eye Hospital-affiliated cardiologist to complete preadmission testing and to have a physical examination. Patients in both groups received a reminder call before the cataract surgery. RESULTS A total of 441 patients were included in the study-240 patients in the usual care group and 201 patients in the intervention group. The overall cataract surgery cancellation rate was 14.5%; the rate was 12.4% in the intervention group and 16.3% in the usual care group (P = .28). The patients receiving the intervention were more likely to have preadmission testing and a physical examination than the patients in the usual care arm (P <.001). CONCLUSIONS Facilitating the completion of preadmission testing for patients decreased the rates of resident-performed cataract surgery cancellation at a Wills Eye Hospital resident clinic and has the potential to improve patient outcomes and prevent blindness.
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Affiliation(s)
- Eileen L Mayro
- Research Coordinator, Department of Research, Wills Eye Hospital, Philadelphia, PA, and Student, Sidney Kimmel Medical College, Thomas Jefferson University (TJU), Philadelphia
| | - Laura T Pizzi
- Professor and Director, Center for Health Outcomes, Policy, and Economics, Rutgers University, Piscataway, NJ
| | - Lisa A Hark
- Director, Department of Research, Wills Eye Hospital, and Professor of Ophthalmic Sciences (Ophthalmology), Columbia University Vegalos College of Physicians and Surgeons, New York, NY
| | - Ann P Murchison
- Attending Surgeon and Director, Emergency Department, Wills Eye Hospital, and Associate Professor of Ophthalmology, Sidney Kimmel Medical College, TJU
| | - Douglas Wisner
- Attending Surgeon, Cataract and Primary Eye Care Service, Wills Eye Hospital
| | - Anish Koka
- Attending Physician, Koka Cardiology, TJU
| | - Benjamin E Leiby
- Associate Professor and Director, Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, TJU
| | - Nooreen Dabbish
- Biostatistician, Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, TJU
| | | | - Alexa Dessy
- Students, all at Sidney Kimmel Medical College, TJU
| | | | - Robert Bailey
- Attending Surgeon and Director, Cataract and Primary Eye Care Service, Wills Eye Hospital and Professor of Ophthalmology, Sidney Kimmel Medical College, TJU
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Mayro EL, Hark LA, Shiuey E, Pond M, Siam L, Hill-Bennett T, Tran J, Khanna N, Silverstein M, Donaghy J, Zhan T, Murchison AP, Levin AV. Prevalence of uncorrected refractive errors among school-age children in the School District of Philadelphia. J AAPOS 2018; 22:214-217.e2. [PMID: 29660392 DOI: 10.1016/j.jaapos.2018.01.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Revised: 01/17/2018] [Accepted: 01/18/2018] [Indexed: 11/16/2022]
Abstract
PURPOSE To determine the prevalence and severity of uncorrected refractive errors in school-age children attending Philadelphia public schools. METHODS The Wills Eye Vision Screening Program for Children is a community-based pediatric vision screening program designed to detect and correct refractive errors and refer those with nonrefractive eye diseases for examination by a pediatric ophthalmologist. Between January 2014 and June 2016 the program screened 18,974 children in grades K-5 in Philadelphia public schools. Children who failed the vision screening were further examined by an on-site ophthalmologist or optometrist; children whose decreased visual acuity was not amenable to spectacle correction were referred to a pediatric ophthalmologist. RESULTS Of the 18,974 children screened, 2,492 (13.1%) exhibited uncorrected refractive errors: 1,776 (9.4%) children had myopia, 459 (2.4%) had hyperopia, 1,484 (7.8%) had astigmatism, and 846 (4.5%) had anisometropia. Of the 2,492 with uncorrected refractive error, 368 children (14.8%) had more than one refractive error diagnosis. In stratifying refractive error diagnoses by severity, mild myopia (spherical equivalent of -0.50 D to < -3.00 D) was the most common diagnosis, present in 1,573 (8.3%) children. CONCLUSIONS In this urban population 13.1% of school-age children exhibited uncorrected refractive errors. Blurred vision may create challenges for students in the classroom; school-based vision screening programs can provide an avenue to identify and correct refractive errors.
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Affiliation(s)
- Eileen L Mayro
- Department of Research, Wills Eye Hospital, Philadelphia, Pennsylvania; Sidney Kimmel Medical College of Thomas Jefferson University, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Lisa A Hark
- Department of Research, Wills Eye Hospital, Philadelphia, Pennsylvania; Department of Ophthalmology, Columbia University Medical Center, New York
| | - Eric Shiuey
- Department of Research, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Michael Pond
- Department of Research, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Linda Siam
- Department of Research, Wills Eye Hospital, Philadelphia, Pennsylvania
| | | | - Judie Tran
- Department of Research, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Nitasha Khanna
- Division of Ophthalmology, Brown University, Providence, Rhode Island
| | - Marlee Silverstein
- Sidney Kimmel Medical College of Thomas Jefferson University, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - James Donaghy
- Department of Research, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Tingting Zhan
- Department of Pharmacology and Experimental Therapeutics, Division of Biostatistics, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Ann P Murchison
- Department of Research, Wills Eye Hospital, Philadelphia, Pennsylvania; Sidney Kimmel Medical College of Thomas Jefferson University, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Alex V Levin
- Sidney Kimmel Medical College of Thomas Jefferson University, Wills Eye Hospital, Philadelphia, Pennsylvania; Pediatric Ophthalmology and Ocular Genetics, Wills Eye Hospital, Philadelphia, Pennsylvania; Department of Pediatrics, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania.
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10
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Savino, MD G, Campana, MD A, Petrone, MD G, Grimaldi, MD G, Murchison AP. In search of a disease. Surv Ophthalmol 2017; 62:716-721. [DOI: 10.1016/j.survophthal.2016.12.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 12/14/2016] [Indexed: 01/13/2023]
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11
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Hark LA, Katz LJ, Myers JS, Waisbourd M, Johnson D, Pizzi LT, Leiby BE, Fudemberg SJ, Mantravadi AV, Henderer JD, Zhan T, Molineaux J, Doyle V, Divers M, Burns C, Murchison AP, Reber S, Resende A, Bui TDV, Lee J, Crews JE, Saaddine JB, Lee PP, Pasquale LR, Haller JA. Philadelphia Telemedicine Glaucoma Detection and Follow-up Study: Methods and Screening Results. Am J Ophthalmol 2017; 181:114-124. [PMID: 28673747 DOI: 10.1016/j.ajo.2017.06.024] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 06/22/2017] [Accepted: 06/23/2017] [Indexed: 12/13/2022]
Abstract
PURPOSE To describe methodology and screening results from the Philadelphia Telemedicine Glaucoma Detection and Follow-up Study. DESIGN Screening program results for a prospective randomized clinical trial. METHODS Individuals were recruited who were African-American, Hispanic/Latino, or Asian over age 40 years; white individuals over age 65 years; and any ethnicity over age 40 years with a family history of glaucoma or diabetes. Primary care offices and Federally Qualified Health Centers were used for telemedicine (Visit 1). Two posterior fundus photographs and 1 anterior segment photograph were captured per eye in each participant, using a nonmydriatic, autofocus, hand-held fundus camera (Volk Optical, Mentor, Ohio, USA). Medical and ocular history, family history of glaucoma, visual acuity, and intraocular pressure measurements using the ICare rebound tonometer (ICare, Helsinki, Finland) were obtained. Images were read remotely by a trained retina reader and a glaucoma specialist. RESULTS From April 1, 2015, to February 6, 2017, 906 individuals consented and attended Visit 1. Of these, 553 participants were female (61.0%) and 550 were African-American (60.7%), with a mean age of 58.7 years. A total of 532 (58.7%) participants had diabetes, and 616 (68%) had a history of hypertension. During Visit 1, 356 (39.3%) participants were graded with a normal image. Using image data from the worse eye, 333 (36.8%) were abnormal and 155 (17.1%) were unreadable. A total of 258 (28.5%) had a suspicious nerve, 62 (6.8%) had ocular hypertension, 102 (11.3%) had diabetic retinopathy, and 68 (7.5%) had other retinal abnormalities. CONCLUSION An integrated telemedicine screening intervention in primary care offices and Federally Qualified Health Centers detected high rate of suspicious optic nerves, ocular hypertension, and retinal pathology.
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12
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Bilyk JR, Murchison AP, Leiby BT, Sergott RC, Eagle RC, Needleman L, Savino PJ. The Utility of Color Duplex Ultrasonography in the Diagnosis of Giant Cell Arteritis: A Prospective, Masked Study. (An American Ophthalmological Society Thesis). Trans Am Ophthalmol Soc 2017; 115:T9. [PMID: 29967570 PMCID: PMC6021029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE To evaluate the diagnostic yield and concordance of color duplex ultrasound (CDU) of the superficial temporal artery (STA), temporal artery biopsy (TAB), and American College of Rheumatology (ACR) criteria in the diagnosis of giant cell arteritis (GCA). METHODS Prospective, masked study of all patients evaluated in one institution suspected of having GCA. All patients with a suspected diagnosis of GCA were admitted for pulsed intravenous corticosteroids. Patients underwent serologic work-up and ACR criteria were documented. All patients had a CDU and TAB performed within 3 days of initiation of systemic corticosteroid therapy. Main outcome measure: Concordance of CDU and TAB. Secondary outcome measures: Concordance between unilateral and bilateral CDU and TAB by side and segment, concordance between TAB and ACR criteria, and statistical analysis of serologic markers for GCA. RESULTS The diagnosis of biopsy-proven GCA was found in 14 of 71 (19.7%) patients. The sensitivity of CDU compared to the reference standard of TAB ranged between 5.1% and 30.8% depending on the signs studied on CDU and correlation of specific TAB parameters. Of the serologic studies, a platelet count threshold of 400,000μL had the highest positive (18.32) and lowest negative (0.37) likelihood ratios for a diagnosis of GCA. CONCLUSIONS In this study, CDU showed minimal value in diagnosing GCA compared to TAB. There was poor correlation between CDU results and ACR criteria for GCA. The threshold platelet count had higher positive and negative predictive values for GCA than CDU and is a useful serologic marker for GCA.
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Affiliation(s)
- Jurij R Bilyk
- Oculoplartic and Orbital Surgery Service, Wills Eye Hospital, Philadelphia PA (Drs. Bilyk, Murchison), Department of Pharmacology & Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA (Dr. Leiby), Neuro-Ophthalmology Service, Wills Eye Hospital, Philadelphia PA (Dr. Sergott), Ocular Pathology Service, Wills Eye Hospital, Philadelphia PA (Dr. Eagle), Department of Radiology, Thomas Jefferson University, Philadelphia, PA (Dr. Needleman), Shiley Eye Institute, University of California, San Diego, La Jolla, CA (Dr. Savino)
| | - Ann P Murchison
- Oculoplartic and Orbital Surgery Service, Wills Eye Hospital, Philadelphia PA (Drs. Bilyk, Murchison), Department of Pharmacology & Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA (Dr. Leiby), Neuro-Ophthalmology Service, Wills Eye Hospital, Philadelphia PA (Dr. Sergott), Ocular Pathology Service, Wills Eye Hospital, Philadelphia PA (Dr. Eagle), Department of Radiology, Thomas Jefferson University, Philadelphia, PA (Dr. Needleman), Shiley Eye Institute, University of California, San Diego, La Jolla, CA (Dr. Savino)
| | - Benjamin T Leiby
- Oculoplartic and Orbital Surgery Service, Wills Eye Hospital, Philadelphia PA (Drs. Bilyk, Murchison), Department of Pharmacology & Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA (Dr. Leiby), Neuro-Ophthalmology Service, Wills Eye Hospital, Philadelphia PA (Dr. Sergott), Ocular Pathology Service, Wills Eye Hospital, Philadelphia PA (Dr. Eagle), Department of Radiology, Thomas Jefferson University, Philadelphia, PA (Dr. Needleman), Shiley Eye Institute, University of California, San Diego, La Jolla, CA (Dr. Savino)
| | - Robert C Sergott
- Oculoplartic and Orbital Surgery Service, Wills Eye Hospital, Philadelphia PA (Drs. Bilyk, Murchison), Department of Pharmacology & Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA (Dr. Leiby), Neuro-Ophthalmology Service, Wills Eye Hospital, Philadelphia PA (Dr. Sergott), Ocular Pathology Service, Wills Eye Hospital, Philadelphia PA (Dr. Eagle), Department of Radiology, Thomas Jefferson University, Philadelphia, PA (Dr. Needleman), Shiley Eye Institute, University of California, San Diego, La Jolla, CA (Dr. Savino)
| | - Ralph C Eagle
- Oculoplartic and Orbital Surgery Service, Wills Eye Hospital, Philadelphia PA (Drs. Bilyk, Murchison), Department of Pharmacology & Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA (Dr. Leiby), Neuro-Ophthalmology Service, Wills Eye Hospital, Philadelphia PA (Dr. Sergott), Ocular Pathology Service, Wills Eye Hospital, Philadelphia PA (Dr. Eagle), Department of Radiology, Thomas Jefferson University, Philadelphia, PA (Dr. Needleman), Shiley Eye Institute, University of California, San Diego, La Jolla, CA (Dr. Savino)
| | - Laurence Needleman
- Oculoplartic and Orbital Surgery Service, Wills Eye Hospital, Philadelphia PA (Drs. Bilyk, Murchison), Department of Pharmacology & Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA (Dr. Leiby), Neuro-Ophthalmology Service, Wills Eye Hospital, Philadelphia PA (Dr. Sergott), Ocular Pathology Service, Wills Eye Hospital, Philadelphia PA (Dr. Eagle), Department of Radiology, Thomas Jefferson University, Philadelphia, PA (Dr. Needleman), Shiley Eye Institute, University of California, San Diego, La Jolla, CA (Dr. Savino)
| | - Peter J Savino
- Oculoplartic and Orbital Surgery Service, Wills Eye Hospital, Philadelphia PA (Drs. Bilyk, Murchison), Department of Pharmacology & Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA (Dr. Leiby), Neuro-Ophthalmology Service, Wills Eye Hospital, Philadelphia PA (Dr. Sergott), Ocular Pathology Service, Wills Eye Hospital, Philadelphia PA (Dr. Eagle), Department of Radiology, Thomas Jefferson University, Philadelphia, PA (Dr. Needleman), Shiley Eye Institute, University of California, San Diego, La Jolla, CA (Dr. Savino)
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Asfar T, Lee DJ, Lam BL, Murchison AP, Mayro EL, Owsley C, McGwin G, Gower EW, Friedman DS, Saaddine J. Evaluation of a Web-Based Training in Smoking Cessation Counseling Targeting U.S. Eye-Care Professionals. Health Educ Behav 2017; 45:181-189. [DOI: 10.1177/1090198117709883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. Smoking causes blindness-related diseases. Eye-care providers are uniquely positioned to help their patients quit smoking. Aims. Using a pre-/postevaluation design, this study evaluated a web-based training in smoking cessation counseling targeting eye-care providers. Method. The training was developed based on the 3A1R protocol: “Ask about smoking, Advise to quit, Assess willingness to quit, and Refer to tobacco quitlines,” and made available in the form of a web-based video presentation. Providers ( n = 654) at four academic centers were invited to participate. Participants completed pretraining, posttraining, and 3-month follow-up surveys. Main outcomes were self-reported improvement in their motivation, confidence, and counseling practices at 3-month follow-up. Generalized linear mixed models for two time-points (pretraining and 3-month) were conducted for these outcomes. Results. A total of 113 providers (54.0% males) participated in the study (17.7% response rate). At the 3-month evaluation, 9.8% of participants reported improvement in their motivation. With respect to the 3A1R, 8% reported improvement in their confidence for Ask, 15.5% for Advise, 28.6% for Assess, and 37.8% for Refer. Similarly, 25.5% reported improvement in their practices for Ask, 25.5% for Advise, 37.2% for Assess, and 39.4% for Refer to tobacco quitlines ( p < .001 for all except for Refer confidence p = .05). Discussion. Although participation rate was low, the program effectively improved providers’ smoking cessation counseling practices. Conclusions. Including training in smoking cessation counseling in ophthalmology curriculums, and integrating the 3A1R protocol into the electronic medical records systems in eye-care settings, might promote smoking cessation practices in these settings.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Jinan Saaddine
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA, USA
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14
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Murchison AP, Haller JA, Mayro E, Hark L, Gower E, Huisingh C, Rhodes L, Friedman DS, Lee DJ, Lam BL. Reaching the Unreachable: Novel Approaches to Telemedicine Screening of Underserved Populations for Vitreoretinal Disease. Curr Eye Res 2017; 42:963-970. [PMID: 28506091 DOI: 10.1080/02713683.2017.1297463] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Telemedicine involves electronic communication between a physician in one location and a patient in another location to provide remote medical care. Ophthalmologists are increasingly employing telemedicine, particularly in retinal disease screening and monitoring. Telemedicine has been utilized to decrease barriers to care and yield greater patient satisfaction and lower costs, while maintaining high sensitivity and specificity. This review discusses common patient barriers to eye care, innovative approaches to retinal disease screening and monitoring using telemedicine, and eye care policy initiatives needed to enact large-scale telemedicine eye disease screening programs.
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Affiliation(s)
- Ann P Murchison
- a Wills Eye Hospital , Thomas Jefferson University , Philadelphia , PA , USA
| | - Julia A Haller
- a Wills Eye Hospital , Thomas Jefferson University , Philadelphia , PA , USA
| | - Eileen Mayro
- a Wills Eye Hospital , Thomas Jefferson University , Philadelphia , PA , USA
| | - Lisa Hark
- a Wills Eye Hospital , Thomas Jefferson University , Philadelphia , PA , USA
| | - Emily Gower
- b Wilmer Eye Institute , Dana Center for Preventive Ophthalmology, The Johns Hopkins School of Medicine , Baltimore , MD , USA.,c Department of Epidemiology , Wake Forest School of Medicine , Winston-Salem , NC , USA.,d Department of Ophthalmology , Wake Forest School of Medicine , Winston-Salem , NC , USA
| | - Carrie Huisingh
- e Department of Ophthalmology , School of Medicine, University of Alabama at Birmingham , Birmingham , AL , USA
| | - Lindsay Rhodes
- e Department of Ophthalmology , School of Medicine, University of Alabama at Birmingham , Birmingham , AL , USA
| | - David S Friedman
- b Wilmer Eye Institute , Dana Center for Preventive Ophthalmology, The Johns Hopkins School of Medicine , Baltimore , MD , USA.,d Department of Ophthalmology , Wake Forest School of Medicine , Winston-Salem , NC , USA
| | - David J Lee
- f Departments of Public Health Sciences and Ophthalmology , Miller School of Medicine, University of Miami , Miami , FL , USA
| | - Byron L Lam
- f Departments of Public Health Sciences and Ophthalmology , Miller School of Medicine, University of Miami , Miami , FL , USA
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Srinivasan A, Kleinberg TT, Murchison AP, Bilyk JR. Laboratory Investigations for Diagnosis of Autoimmune and Inflammatory Periocular Disease: Part II. Ophthalmic Plast Reconstr Surg 2017; 33:1-8. [PMID: 27115208 DOI: 10.1097/iop.0000000000000701] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE To review the important laboratory serological investigations routinely performed for the diagnosis of autoimmune and inflammatory diseases of the orbit and ocular adnexa. METHODS Review of the literature as well as personal clinical experience of the authors. Due to the extensive nature of the topic, the review has been split into 2 parts. Part I covers thyroid eye disease, IgG4-related disease, and myasthenia gravis. In part II of the review, sarcoidosis, vasculitis, Sjögren syndrome, and giant cell arteritis will be discussed. RESULTS Several relatively specific serologic tests are available for the diagnosis of a variety of inflammatory and serologic diseases of the orbit. CONCLUSION In cases of limited orbital or sino-orbital disease, serologic testing may be negative in a significant number of patients. Specifically, the clinician should be wary of ruling out limited orbital sarcoid or sinoorbital granulomatosis with polyangiitis based on serologic testing alone. Part I of this review has covered serologic testing for thyroid eye disease, IgG4-related disease, and myasthenia gravis. In part II, the authors discuss serologic testing for sarcoidosis, vasculitis, Sjögren syndrome (SS), and giant cell arteritis (GCA).
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Affiliation(s)
- Archana Srinivasan
- *Research Department, Wills Eye Hospital, Philadelphia, Pennsylvania, †Worcester Ophthalmology Associates, Worcester, Massachusetts, and ‡Skull Base Division, Neuro-Ophthalmology Service, Wills Eye Hospital, Philadelphia, Pennsylvania, U.S.A
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Murchison AP, Hark L, Pizzi LT, Dai Y, Mayro EL, Storey PP, Leiby BE, Haller JA. Non-adherence to eye care in people with diabetes. BMJ Open Diabetes Res Care 2017; 5:e000333. [PMID: 28878930 PMCID: PMC5574424 DOI: 10.1136/bmjdrc-2016-000333] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 05/31/2017] [Accepted: 06/05/2017] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE Evaluate individual factors that impact adherence to eye care follow-up in patients with diabetes. DESIGN AND METHODS A 4-year retrospective chart review was conducted for 1968 patients with diabetes over age 40 from an urban academic center. Data collected included demographics, insurance, visual acuity, smoking status, medications, dates of dilated fundus examinations (DFE), and reported hemoglobin A1C and blood glucose levels. The primary outcome was timely DFE follow-up adherence following the initial eye exam visit. RESULTS Overall, 41.6% of patients adhered to initial follow-up eye care recommendations. Multivariable analysis demonstrated that patients with severe diabetic retinopathy (DR) were more adherent than patients with mild DR (OR 1.86). Other variables associated with increased adherence were visual impairment and reported A1C or blood glucose. Smoking was associated with decreased adherence. Ethnicity and insurance were also significantly associated with adherence. Longitudinal follow-up rates were influenced by additional factors, including ethnicity and neighborhood deprivation index. CONCLUSIONS Patients with moderate to severe DR and/or visual impairment were more likely to adhere to timely DFE follow-up. This could relate to the presence of visual symptoms and/or other systemic manifestations of diabetes. Smokers were less likely to adhere to timely DFE follow-up. One hypothesis is patients who smoke have other symptomatic health problems which patients prioritize over asymptomatic ocular disorders. In order to reduce vision loss from DR, practitioners should be aware that patients with mild and moderate DR, patients with normal vision, and smokers are at greater risk for poor follow-up eye care adherence.
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Affiliation(s)
- Ann P Murchison
- Department of Research, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
- Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Lisa Hark
- Department of Research, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
- Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Laura T Pizzi
- Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Yang Dai
- Department of Research, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Eileen L Mayro
- Department of Research, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Philip P Storey
- Department of Research, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | | | - Julia A Haller
- Department of Research, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
- Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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17
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Wilson ME, Thornton S, Murchison AP, Bilyk JR. Clinical challenge: An orbital Hickam's dictum. Surv Ophthalmol 2016; 61:799-805. [DOI: 10.1016/j.survophthal.2016.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 03/10/2016] [Accepted: 03/10/2016] [Indexed: 10/22/2022]
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Gill KS, Hsu D, Tassone P, Pluta J, Nyquist G, Krein H, Bilyk J, Murchison AP, Iloreta A, Evans JJ, Heffelfinger RN, Curry JM. Postoperative cerebrospinal fluid leak after microvascular reconstruction of craniofacial defects with orbital exenteration. Laryngoscope 2016; 127:835-841. [DOI: 10.1002/lary.26137] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 03/20/2016] [Accepted: 05/17/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Kurren S. Gill
- Department of Otolaryngology-Head and Neck Surgery; Thomas Jefferson University; Philadelphia Pennsylvania U.S.A
| | - David Hsu
- Department of Otolaryngology-Head and Neck Surgery; Thomas Jefferson University; Philadelphia Pennsylvania U.S.A
| | - Patrick Tassone
- Department of Otolaryngology-Head and Neck Surgery; Thomas Jefferson University; Philadelphia Pennsylvania U.S.A
| | - John Pluta
- Department of Radiology; University of Pennsylvania; Philadelphia Pennsylvania U.S.A
| | - Gurston Nyquist
- Department of Otolaryngology-Head and Neck Surgery; Thomas Jefferson University; Philadelphia Pennsylvania U.S.A
| | - Howard Krein
- Department of Otolaryngology-Head and Neck Surgery; Thomas Jefferson University; Philadelphia Pennsylvania U.S.A
| | - Jurij Bilyk
- Department of Ophthalmology, Oculoplastics and Orbital Surgery Service; Thomas Jefferson University Hospital and Wills Eye Institute; Philadelphia Pennsylvania U.S.A
| | - Ann P. Murchison
- Department of Ophthalmology, Oculoplastics and Orbital Surgery Service; Thomas Jefferson University Hospital and Wills Eye Institute; Philadelphia Pennsylvania U.S.A
| | - Alfred Iloreta
- Department of Otolaryngology-Head and Neck Surgery; Thomas Jefferson University; Philadelphia Pennsylvania U.S.A
| | - James J. Evans
- Department of Neurological Surgery, Division of Neuro-Oncologic Neurosurgery; Thomas Jefferson University; Philadelphia Pennsylvania U.S.A
| | - Ryan N. Heffelfinger
- Department of Otolaryngology-Head and Neck Surgery; Thomas Jefferson University; Philadelphia Pennsylvania U.S.A
| | - Joseph M. Curry
- Department of Otolaryngology-Head and Neck Surgery; Thomas Jefferson University; Philadelphia Pennsylvania U.S.A
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Callinan CE, Kenney B, Hark LA, Murchison AP, Dai Y, Leiby BE, Mayro EL, Bilson J, Haller JA. Improving Follow-Up Adherence in a Primary Eye Care Setting. Am J Med Qual 2016; 32:73-79. [PMID: 26656245 DOI: 10.1177/1062860615616860] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Lack of patient adherence with eye appointments can decrease ocular outcomes. This prospective, randomized, single-blinded controlled study assessed the effectiveness of multiple interventions in improving follow-up adherence to recommended eye appointments. Patients due for follow-up appointments were randomly assigned to usual care, automated intervention, or personal intervention. Automated-intervention patients and personal-intervention patients received a call one month prior to the recommended follow-up date, and a mailed appointment reminder letter. The call was automated for automated-intervention patients and personalized for personal-intervention patients. The primary outcome was adherence to the follow-up appointment. The secondary outcome was rate of appointment scheduling. Patients in the personal-intervention group had greater adherence to follow-up recommendations (38%) than patients in the usual care group (28%) and the automated-intervention group (30%). Personal intervention significantly increased appointment scheduling (51%) over usual care (32%) and automated intervention (36%). These results support systems-level changes to improve patient follow-up adherence in urban primary eye care settings.
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Affiliation(s)
| | | | - Lisa A Hark
- 1 Wills Eye Hospital, Philadelphia, PA.,2 Thomas Jefferson University, Philadelphia, PA
| | - Ann P Murchison
- 1 Wills Eye Hospital, Philadelphia, PA.,2 Thomas Jefferson University, Philadelphia, PA
| | - Yang Dai
- 1 Wills Eye Hospital, Philadelphia, PA
| | | | | | | | - Julia A Haller
- 1 Wills Eye Hospital, Philadelphia, PA.,2 Thomas Jefferson University, Philadelphia, PA
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Rovner BW, Haller JA, Casten RJ, Murchison AP, Hark LA. Cultural and Cognitive Determinants of Personal Control in Older African Americans with Diabetes. J Natl Med Assoc 2016; 107:25-31. [PMID: 27269487 DOI: 10.1016/s0027-9684(15)30021-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
ACKNOWLEDGEMENTS The study was funded by Pennsylvania Department of Health's Commonwealth Universal Research Enhancement (CURE) Program (SAP#4100051727). OBJECTIVE To describe the determinants of personal control over diabetes complications in older African Americans (N=123) with type 2 diabetes. METHODS We administered structured instruments to assess perceptions of personal control, time orientation, religiosity, depression, and cognition in this cross-sectional study. RESULTS More years of education (p ≤ .001), better Clock Drawing (p ≤ .001), higher levels of Religiosity (p ≤ .04), and lower Present Time Orientation (p ≤ .01 ) were independent predictors of higher levels of Personal Control. DISCUSSION Risk perceptions of control over diabetes complications vary among older African Americans according to cultural constructs, executive function, and education. This finding highlights the cultural diversity in this population and the potential impact of culturally-determined views and cognitive function on health behaviors. Cognitive screening of older persons with diabetes and interventions that incorporate perceptions of time and religion to increase rates of eye examinations are needed.
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Affiliation(s)
- Barry W Rovner
- Departments of Psychiatry and Neurology, Jefferson Hospital for Neuroscience.
| | | | - Robin J Casten
- Department of Psychiatry and Human Behavior; Jefferson Hospital for Neuroscience
| | | | - Lisa A Hark
- Department of Ophthalmology, Wills Eye Institute
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21
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Pizzi LT, Tran J, Shafa A, Waisbourd M, Hark L, Murchison AP, Dai Y, Mayro EL, Haller JA. Effectiveness and Cost of a Personalized Reminder Intervention to Improve Adherence to Glaucoma Care. Appl Health Econ Health Policy 2016; 14:229-40. [PMID: 26924099 DOI: 10.1007/s40258-016-0231-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
BACKGROUND Glaucoma is the leadi ng cause of irreversible blindness in the USA. Glaucomatous vision loss is preventable with proper eye care, including appointment adherence. Therefore, interventions that improve appointment adherence can reduce the number of patients with more severe glaucoma. OBJECTIVES The primary study aim was to determine the efficacy and cost-effectiveness of a multifaceted personal reminder intervention, which included a customized letter and personal telephone outreach, in improving appointment adherence of patients with glaucoma. A secondary study aim was to identify patient characteristics that were associated with non-adherence. METHODS This prospective, randomized, controlled study included a cost-effectiveness analysis completed using a decision analytic model. The subjects included 256 patients with glaucoma. Study measures included appointment adherence and incremental cost effectiveness ratios. RESULTS Patients in the intervention group were more likely to adhere to appointments (82.31 vs. 69.05 %; RR 1.23; 95 % CI 1.04-1.37, p < 0.012) than patients in the usual care group. Patients in the intervention group were 23 % more likely to adhere to appointments (RR 1.23; 95 % CI 1.08-1.41, p < 0.0021) than patients in the usual care group, when adjusting for age, secondary insurance, primary open angle glaucoma diagnosis, number of previous visits at Wills Eye Hospital, and follow-up recommendation using Poisson regression. Per-patient cost of the program was US$11.32, and cost per follow-up attended within the adherence window was US$73.56. CONCLUSIONS A low cost reminder intervention consisting of a personalized letter and telephone outreach significantly improved appointment adherence of patients with glaucoma.
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Affiliation(s)
- Laura T Pizzi
- Thomas Jefferson University, 901 Walnut Street, Room 911, Philadelphia, PA, 19107, USA.
| | - Judie Tran
- Wills Eye Hospital Glaucoma Research Center, 840 Walnut Street Suite 1140, Philadelphia, PA, USA
| | - Anousheh Shafa
- Wills Eye Hospital Glaucoma Research Center, 840 Walnut Street Suite 1140, Philadelphia, PA, USA
| | - Michael Waisbourd
- Wills Eye Hospital Glaucoma Research Center, 840 Walnut Street Suite 1140, Philadelphia, PA, USA
| | - Lisa Hark
- Wills Eye Hospital Glaucoma Research Center, 840 Walnut Street Suite 1140, Philadelphia, PA, USA
| | - Ann P Murchison
- Wills Eye Hospital Glaucoma Research Center, 840 Walnut Street Suite 1140, Philadelphia, PA, USA
| | - Yang Dai
- Wills Eye Hospital Glaucoma Research Center, 840 Walnut Street Suite 1140, Philadelphia, PA, USA
| | - Eileen L Mayro
- Wills Eye Hospital Glaucoma Research Center, 840 Walnut Street Suite 1140, Philadelphia, PA, USA
| | - Julia A Haller
- Wills Eye Hospital, 840 Walnut Street Suite 1500, Philadelphia, PA, USA
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Murchison AP, Friedman DS, Gower EW, Haller JA, Lam BL, Lee DJ, McGwin G, Owsley C, Saaddine J, Insight Study Group. A Multi-Center Diabetes Eye Screening Study in Community Settings: Study Design and Methodology. Ophthalmic Epidemiol 2016; 23:109-15. [PMID: 26949832 DOI: 10.3109/09286586.2015.1099682] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Diabetes is the leading cause of new cases of blindness among adults aged 20-74 years within the United States. The Innovative Network for Sight Research group (INSIGHT) designed the Diabetic Eye Screening Study (DESS) to examine the feasibility and short-term effectiveness of non-mydriatic diabetic retinopathy (DR) screening for adults with diabetes in community-based settings. METHODS Study enrollment began in December 2011 at four sites: an internal medicine clinic at a county hospital in Birmingham, Alabama; a Federally-qualified community healthcare center in Miami-Dade County, Florida; a university-affiliated outpatient pharmacy in Philadelphia, Pennsylvania; and a medical home in Winston-Salem, North Carolina. People 18 years or older with previously diagnosed diabetes were offered free DR screening using non-mydriatic retinal photography that was preceded by a brief questionnaire addressing demographic information and previous eye care use. Visual acuity was also measured for each eye. Images were evaluated at a telemedicine reading center by trained evaluators using the National Health System DR grading classification. Participants and their physicians were sent screening report results and telephoned for a follow-up survey 3 months post-screening to determine whether participants had sought follow-up comprehensive eye care and their experiences with the screening process. RESULTS Target enrollment at each site was a minimum of 500 persons. Three of the four sites met this enrollment goal. CONCLUSION The INSIGHT/DESS is intended to establish the feasibility and short-term effectiveness of DR screening using non-mydriatic retinal photography in persons with diabetes who seek services in community-based clinic and pharmacy settings.
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Affiliation(s)
- Ann P Murchison
- a Wills Eye Hospital , Thomas Jefferson University , Philadelphia , PA , USA
| | - David S Friedman
- b Dana Center for Preventive Ophthalmology , Johns Hopkins Hospital , Baltimore , MD , USA
| | - Emily W Gower
- b Dana Center for Preventive Ophthalmology , Johns Hopkins Hospital , Baltimore , MD , USA.,c Departments of Epidemiology and Prevention, and Ophthalmology , Wake Forest School of Medicine , Winston-Salem , NC , USA
| | - Julia A Haller
- a Wills Eye Hospital , Thomas Jefferson University , Philadelphia , PA , USA
| | - Byron L Lam
- d Department of Public Health Sciences , University of Miami Miller School of Medicine , Miami , FL , USA
| | - David J Lee
- d Department of Public Health Sciences , University of Miami Miller School of Medicine , Miami , FL , USA
| | - Gerald McGwin
- e Department of Ophthalmology , University of Alabama at Birmingham , Birmingham , AL , USA.,f Department of Epidemiology , University of Alabama at Birmingham , Birmingham , AL , USA
| | - Cynthia Owsley
- e Department of Ophthalmology , University of Alabama at Birmingham , Birmingham , AL , USA
| | - Jinan Saaddine
- g Division of Diabetes Translation , Centers for Disease Control and Prevention , Atlanta , GA , USA
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Weiss DM, Casten RJ, Leiby BE, Hark LA, Murchison AP, Johnson D, Stratford S, Henderer J, Rovner BW, Haller JA. Effect of Behavioral Intervention on Dilated Fundus Examination Rates in Older African American Individuals With Diabetes Mellitus. JAMA Ophthalmol 2015; 133:1005-12. [DOI: 10.1001/jamaophthalmol.2015.1760] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- David M. Weiss
- Department of Research, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Robin J. Casten
- Department of Psychiatry and Human Behavior, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Benjamin E. Leiby
- Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Lisa A. Hark
- Department of Research, Wills Eye Hospital, Philadelphia, Pennsylvania4Department of Ophthalmology, Thomas Jefferson University, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Ann P. Murchison
- Department of Research, Wills Eye Hospital, Philadelphia, Pennsylvania4Department of Ophthalmology, Thomas Jefferson University, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Deiana Johnson
- Department of Research, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Shayla Stratford
- Department of Research, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Jeffrey Henderer
- Department of Ophthalmology, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Barry W. Rovner
- Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Julia A. Haller
- Department of Ophthalmology, Thomas Jefferson University, Wills Eye Hospital, Philadelphia, Pennsylvania
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Aleo CL, Murchison AP, Dai Y, Hark LA, Mayro EL, Collymore B, Haller JA. Improving eye care follow-up adherence in diabetic patients with ocular abnormalities: the effectiveness of patient contracts in a free, pharmacy-based eye screening. Public Health 2015; 129:996-9. [PMID: 26119987 DOI: 10.1016/j.puhe.2015.05.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 03/04/2015] [Accepted: 05/13/2015] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Patient contracts are increasingly utilized in medical practice and have the potential to improve health outcomes in high-risk populations. However, as a relatively new tool, there has been limited research regarding the efficacy of patient contracts. Diabetic retinopathy (DR) is one of the leading causes of vision impairment in adults in the US and only 50-60% of adults with diabetes adhere to annual dilated fundus exam recommendations. This study aimed to evaluate the impact of patient contracts on follow-up adherence in diabetic patients with ocular abnormalities after a free, pharmacy-based eye screening. STUDY DESIGN This prospective study implemented a non-invasive, non-mydriatic fundus camera in an urban, community-based pharmacy setting to screen for ocular diseases in patients with diabetes. Patients were assigned to the contract or non-contract group. Patients who signed a contract agreed to: 1) review their results with their primary care doctor, 2) follow-up with an ophthalmologist if their results were abnormal, and 3) inform research staff if/when they completed an eye care appointment. All study participants and their primary care doctors were notified of their results via mail. Follow-up questionnaires were administered to all patients by telephone three months after the screening results. RESULTS 500 patients were screened and 113 (22.6%) had abnormal results. Of the patients who had abnormal results, 83 (74.3%) were able to be contacted. Of the 83 patients who were able to be contacted, the majority of patients were African American (73.5%) and female (56.6%). The mean age was 54.7 years. Of those, 34 (41.0%) adhered to follow-up recommendations. There was no significant difference in follow-up adherence between the contract (38.1%) and non-contract group (43.9%) (P = 0.59). In addition, 70.4% of patients did not comply with at least one measure of the contract agreement. CONCLUSION Contracts did not increase follow-up adherence to eye appointments in diabetic patients with ocular abnormalities. The majority of patients did not comply with their contract and follow-up adherence was low in both groups. Most research has yielded mixed results regarding the efficacy of contracts in improving health outcomes. Therefore, different types of contracts or other patient-centered tools should be evaluated in order to increase follow-up adherence in patients at high risk for DR.
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Affiliation(s)
- C L Aleo
- Wills Eye Hospital, Research, 840 Walnut Street, Suite 802, Philadelphia, PA 19107, USA.
| | - A P Murchison
- Wills Eye Hospital, Emergency Department, 840 Walnut Street, Suite 802, Philadelphia, PA 19107, USA
| | - Y Dai
- Wills Eye Hospital, Research, 840 Walnut Street, Suite 802, Philadelphia, PA 19107, USA
| | - L A Hark
- Research Department and Glaucoma, Research Center, Wills Eye Hospital, 840 Walnut Street, Suite 802, Philadelphia, PA 19107, USA
| | - E L Mayro
- Wills Eye Hospital, Research, 840 Walnut Street, Suite 802, Philadelphia, PA 19107, USA
| | - B Collymore
- Wills Eye Hospital, Research, 840 Walnut Street, Suite 802, Philadelphia, PA 19107, USA
| | - J A Haller
- Wills Eye Hospital, 840 Walnut Street 1510, Philadelphia, PA 19107, USA
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Rovner BW, Casten RJ, Murchison AP, Ho AC, Henderer J, Haller JA. Depression and Memory Loss in African Americans with Diabetic Retinopathy. J Am Geriatr Soc 2015; 63:1249-51. [DOI: 10.1111/jgs.13470] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Barry W. Rovner
- Department of Psychiatry; Department of Neurology; Sidney Kimmel Medical College; Thomas Jefferson University; Philadelphia Pennsylvania
| | - Robin J. Casten
- Department of Psychiatry; Department of Neurology; Sidney Kimmel Medical College; Thomas Jefferson University; Philadelphia Pennsylvania
| | - Ann P. Murchison
- Department of Ophthalmology; Wills Eye Hospital; Philadelphia Pennsylvania
| | - Allen C. Ho
- Department of Ophthalmology; Wills Eye Hospital; Philadelphia Pennsylvania
| | - Jeffrey Henderer
- Department of Ophthalmology; School of Medicine; Temple University; Philadelphia Pennsylvania
| | - Julia A. Haller
- Department of Ophthalmology; Wills Eye Hospital; Philadelphia Pennsylvania
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Adam MK, Brady CJ, Flowers AM, Juhn AT, Hsu J, Garg SJ, Murchison AP, Spirn MJ. Quality and Diagnostic Utility of Mydriatic Smartphone Photography: The Smartphone Ophthalmoscopy Reliability Trial. Ophthalmic Surg Lasers Imaging Retina 2015; 46:631-7. [DOI: 10.3928/23258160-20150610-06] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Accepted: 03/26/2015] [Indexed: 11/20/2022]
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Pizzi LT, Zangalli CS, Murchison AP, Hale N, Hark L, Dai Y, Leiby BE, Haller JA. Prospective randomized controlled trial comparing the outcomes and costs of two eyecare adherence interventions in diabetes patients. Appl Health Econ Health Policy 2015; 13:253-63. [PMID: 25786858 DOI: 10.1007/s40258-015-0159-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
OBJECTIVE Diabetic retinopathy is one of the leading causes of vision impairment among adults in the USA. While it is suggested that diabetics receive annual dilated fundus examinations (DFE), many patients do not adhere to these recommendations. This paper investigates the outcomes and costs of an educational and telephone intervention on DFE follow-up adherence in patients with diabetes. METHODS In a prospective trial, 356 diabetic patients due for a DFE at an urban eye clinic were randomly assigned to usual care (UC; reference case), mailed intervention (MI), or telephone intervention (TI). UC patients (n = 119) received a standard form letter. MI patients (n = 117) received a personalized letter encouraging scheduling of an eye examination with an educational brochure about diabetic eye disease. TI patients (n = 120) received personal calls (up to three attempts) to schedule a follow-up with standard form letter. The primary outcome was obtaining a DFE within 90 days of suggested return. Costs (US$ 2013) included time costs for staff, phone charges, supplies, and postage. Since TI involved greater cost components compared to MI, univariate sensitivity analysis examined the impact of reducing phone costs. RESULTS Patients were mostly female (66 %) and African American (70 %) with a mean age of 61 years. TI patients were more likely to schedule DFE [65 vs. 42 %; relative risk (RR) 1.54; CI 1.20-1.96; P < 0.001] versus UC patients. Obtaining a DFE within 90 days of suggested return was also significantly higher among TI patients compared to UC patients (51 vs. 36 %, RR 1.41; CI 1.05-1.89; P = 0.024). MI patients were slightly less likely to schedule DFE versus UC patients (38 vs. 42 %, RR 0.90; CI 0.66-1.22; P = NSS) and obtain a DFE (32 vs. 36 %; RR 0.90; CI 0.63-1.28; P = NSS). The total cost of TI was US$798.28 or US$6.65/patient and the cost/follow-up DFE was US$26.05. Sensitivity analyses revealed that the cost/follow-up can be greatly reduced but remains greater compared to UC (US$2.76 if US$0.25/call, US$11.13 if $1/call; US$22.29 if US$2/call). CONCLUSIONS Personal phone assistance in scheduling DFE follow-up is more effective but also more costly. Follow-up research has been initiated to determine whether automated phone reminders can achieve similar effectiveness at a lower cost.
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Affiliation(s)
- Laura T Pizzi
- Jefferson School of Pharmacy, Thomas Jefferson University, 901 Walnut Street, Suite 911, Philadelphia, PA, 19107, USA,
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Abstract
A 30-year-old man presented with painless total visual loss in the right eye. Fundus exam and imaging was consistent with total internal carotid artery occlusion and hemispheric stroke. The presentation and management options of retinal vascular occlusive disease in association with asymptomatic stroke are discussed.
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Affiliation(s)
| | - Scott Uretsky
- Division of Neuro-Ophthalmology, Neurological Surgery P.C., Lake Success, NY, USA
| | - Adam E Flanders
- Division of Neuroradiology, Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Jurij R Bilyk
- Skull Base Division, Neuro-Ophthalmology Service, Wills Eye Hospital, Philadelphia, PA, USA
| | - Ann P Murchison
- Skull Base Division, Neuro-Ophthalmology Service, Wills Eye Hospital, Philadelphia, PA, USA
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Aleo CL, Hark L, Leiby B, Dai Y, Murchison AP, Martinez P, Haller JA. Ophthalmic Patients' Utilization of Technology and Social Media: An Assessment to Improve Quality of Care. Telemed J E Health 2014; 20:887-92. [DOI: 10.1089/tmj.2013.0365] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
| | - Lisa Hark
- Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Benjamin Leiby
- Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Yang Dai
- Wills Eye Hospital, Philadelphia, Pennsylvania
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Zangalli CS, Murchison AP, Hale N, Hark LA, Pizzi LT, Dai Y, Leiby BE, Haller JA. An Education- and Telephone-Based Intervention to Improve Follow-up to Vision Care in Patients With Diabetes. Am J Med Qual 2014; 31:156-61. [DOI: 10.1177/1062860614552670] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
| | | | | | | | | | - Yang Dai
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Benjamin E. Leiby
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
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Murchison AP, Bilyk JR. Pediatric canalicular lacerations: epidemiology and variables affecting repair success. J Pediatr Ophthalmol Strabismus 2014; 51:242-8. [PMID: 25062138 DOI: 10.3928/01913913-20140604-05] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 03/13/2014] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the epidemiology and outcomes of all pediatric canalicular lacerations at a high-volume urban tertiary eye care center. Variables of repair were evaluated in relation to age and success of repair. METHODS A retrospective review over a 10-year span of all primary pediatric canalicular laceration repairs was performed. Variables included patient demographics, repair setting, mechanism of injury, associated injuries, type of stent used, and success of repair. RESULTS Of 137 canalicular lacerations evaluated, 27.7% occurred in patients younger than 18 years. The majority of the children were male (73.7%) and white (68.4%), with a mean age of 10.8 years (range: 1.1 to 17.9 years). The mechanism of injury was significantly more likely to be due to dog bites in children when compared to adults (P < .0001), particularly those younger than 10 years (P = .0068). Repair was significantly more successful in the operating room than the minor procedure room, regardless of type of stent used (P = .0247). The majority of children did not have other injuries (60.5%). However, of the other injuries sustained, 52.6% required further monitoring or repair. CONCLUSIONS Pediatric canalicular lacerations are most common in young boys and dog bites are the most common etiology. Although many children may not have other injuries, full examination is warranted because other injuries may require intervention or more frequent monitoring.
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Abstract
Objective. The purpose of this study is to describe the impact of depression on perceptions of risks to health, diabetes self-management practices, and glycemic control in older African Americans with type 2 diabetes. Methods. The authors analyzed data on depression, risk perceptions, diabetes self-management, and A1C in African Americans with type 2 diabetes. T-tests, χ(2), and multivariate regression were used to analyze the data. Results. The sample included 177 African Americans (68% women) whose average age was 72.8 years. Thirty-four participants (19.2%) met criteria for depression. Compared to nondepressed participants, depressed participants scored significantly higher on Personal Disease Risk (the perception of being at increased risk for various medical problems), Environmental Risk (i.e., increased risk for environmental hazards), and Composite Risk Perception (i.e., overall perceptions of increased risk); adhered less to diabetes self-management practices; and had marginally worse glycemic control. Depression and fewer years of education were independent predictors of overall perception of increased health risks. Conclusion. Almost 20% of older African Americans with type 2 diabetes in this study were depressed. Compared to nondepressed participants, they tended to have fewer years of education, perceived themselves to be at higher risk for multiple health problems, and adhered less to diabetes self-management practices. It is important for diabetes educators to recognize the impact of low education and the fatalistic perceptions that depression engenders in this population.
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Storey P, Murchison AP, Dai Y, Hark L, Pizzi LT, Leiby BE, Haller JA. Comparing methodologies for imputing ethnicity in an urban ophthalmology clinic. Ophthalmic Epidemiol 2014; 21:106-10. [PMID: 24568574 DOI: 10.3109/09286586.2014.884603] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE To compare methodologies for imputing ethnicity in an urban ophthalmology clinic. METHODS Using data from 19,165 patients with self-reported ethnicity, surname, and home address, we compared the accuracy of three methodologies for imputing ethnicity: (1) a surname method based on tabulation from the 2000 US Census; (2) a geocoding method based on tract data from the 2010 US Census; and (3) a combined surname geocoding method using Bayes' theorem. RESULTS The combined surname geocoding model had the highest accuracy of the three methodologies, imputing black ethnicity with a sensitivity of 84% and positive predictive value (PPV) of 94%, white ethnicity with a sensitivity of 92% and PPV of 82%, Hispanic ethnicity with a sensitivity of 77% and PPV of 71%, and Asian ethnicity with a sensitivity of 83% and PPV of 79%. Overall agreement of imputed and self-reported ethnicity was fair for the surname method (κ 0.23), moderate for the geocoding method (κ 0.58), and strong for the combined method (κ 0.76). CONCLUSION A methodology combining surname analysis and Census tract data using Bayes' theorem to determine ethnicity is superior to other methods tested and is ideally suited for research purposes of clinical and administrative data.
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Casten RJ, Brawer R, Haller JA, Hark LA, Henderer J, Leiby B, Murchison AP, Plumb J, Rovner BW, Weiss DM. Trial of a behavioral intervention to increase dilated fundus examinations in African–Americans aged over 65 years with diabetes. Expert Review of Ophthalmology 2014. [DOI: 10.1586/eop.11.69] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Bshouti E, Hoban K, Affel E, Bourbonniere M, Line C, Murchison AP. Ocular emergencies in an ophthalmic emergency room. Insight 2014; 39:18-21. [PMID: 25195337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Law MG, Komura S, Murchison AP, Pizzi LT. Pharmacy staff opinions regarding diabetic retinopathy screenings in the community setting: findings from a brief survey. Am Health Drug Benefits 2013; 6:548-552. [PMID: 24991381 PMCID: PMC4031736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Diabetic retinopathy is a retinal vascular disorder that affects more than 4.1 million people in the United States. New methods of detecting and ensuring adequate follow-up of this life-altering disease are vital to improving patient outcomes. Wills Eye Hospital and the Centers for Disease Control and Prevention are conducting a collaborative study to initiate a novel diabetic retinopathy screening in the community setting. OBJECTIVE To evaluate the feasibility of a more widespread, large-scale implementation of this novel model of care for diabetic retinopathy screening in the community setting. METHODS A simple, self-administered survey was distributed to pharmacists, pharmacy technicians, student pharmacists, and Wills Eye Hospital interns. The survey consisted of open-ended questions and responders were given 1 week to respond. A total of 22 surveys were distributed and 16 were completed. The responses were culled and analyzed to assess the feasibility of implementing this novel screening model in the pharmacy. RESULTS The response rate to this pilot survey was 72%. The majority of the responding pharmacy staff members indicated that diabetic retinopathy screening in community pharmacies would greatly benefit patients and could improve patient care. However, they also noted barriers to implementing the screening, such as concerns about the cost of carrying out the screenings, the cost of the equipment needed to be purchased, and the lack of time and shortage of pharmacy staff. CONCLUSION The potential exists for pharmacists to positively influence diabetes care by implementing retinopathy care through the early detection of the disease and reinforcement of the need for follow-up; however, real-world barriers must be addressed before widespread adoption of such a novel model of care becomes feasible.
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Affiliation(s)
- Miranda G Law
- Jefferson School of Pharmacy, Thomas Jefferson University, Philadelphia, PA
| | - Stephanie Komura
- Jefferson School of Pharmacy, Thomas Jefferson University, Philadelphia, PA
| | - Ann P Murchison
- Codirector, Emergency Department, and Associate Professor of Ophthalmology, Wills Eye Hospital, Philadelphia, PA
| | - Laura T Pizzi
- Associate Professor, Department of Pharmacy Practice, Jefferson School of Pharmacy, Thomas Jefferson University
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Abstract
PURPOSE To examine the etiology, surgical extent and techniques, complications, and outcomes of microvascular free flaps (MFF) in the reconstruction of orbitocraniofacial defects. DESIGN A retrospective, institutional review board approved study was performed of all patients undergoing MFF to repair orbitocraniofacial defects over 51 months. PARTICIPANTS Fifty-eight patients undergoing MFF to repair orbitocraniofacial defects were included. MATERIAL AND METHODS Variables analyzed included demographics, etiology, resection area(s), donor site, flap size, duration of surgery, complications, length of hospital stay, flap survival, and mortality. RESULTS Fifty-eight patients underwent 61 MFFs from June 2007 to September 2011. The majority of patients were white (79.3%) and male (72.4%). The mean age was 64.1 years. The most common etiology was intraorbital and skull base extension of cutaneous squamous cell carcinoma (29.3%) followed by sinonasal squamous cell carcinoma (13.8%). Dura and/or brain were exposed in 44.8% of cases. MFFs were harvested from the anteriolateral thigh in 71.4% of cases with a 180.9 cm(2) mean flap area. The mean length of hospital stay was 15.3 days and mean length of surgical time was 11 h and 17 min. CONCLUSIONS Complex orbitocraniofacial defects require a multi-disciplinary team skilled in surgical extirpation and advanced reconstructive techniques. MFF should be considered in the management of large defects, especially when there is dura or brain exposure. Intensive postoperative monitoring is indicated for both systemic and flap-related complications. MMFs provide excellent coverage of large areas of exposed critical skull base structures, including dura and brain, and may allow for earlier adjuvant treatment.
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Affiliation(s)
- Ryan Heffelfinger
- Department of Otolaryngology-Head & Neck Surgery, Jefferson Medical College, Philadelphia, Pennsylvania, USA
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Kisza K, Murchison AP, Dai Y, Bilyk JR, Eagle RC, Sergott R, Savino PJ. Giant cell arteritis incidence: analysis by season and year in mid-Atlantic United States. Clin Exp Ophthalmol 2013; 41:577-81. [DOI: 10.1111/ceo.12069] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Accepted: 12/22/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Krystian Kisza
- Department of Ophthalmology; Wroclaw Medical University; Wroclaw; Poland
| | - Ann P Murchison
- Wills Eye Emergency Room; Thomas Jefferson University; Philadelphia; Pennsylvania; USA
| | - Yang Dai
- Department of Pharmacology and Experimental Therapeutics; Thomas Jefferson University; Philadelphia; Pennsylvania; USA
| | - Jurij R Bilyk
- Oculoplastic and Orbital Surgery Service; Thomas Jefferson University; Philadelphia; Pennsylvania; USA
| | - Ralph C Eagle
- Ocular Pathology Department; Thomas Jefferson University; Philadelphia; Pennsylvania; USA
| | - Robert Sergott
- Neuro-Ophthalmology; Wills Eye Institute; Thomas Jefferson University; Philadelphia; Pennsylvania; USA
| | - Peter J Savino
- Shiley Eye Center; University of California; San Diego; California; USA
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Murchison AP, Bilyk JR. Brow Ptosis after Temporal Artery Biopsy. Ophthalmology 2012; 119:2637-42. [DOI: 10.1016/j.ophtha.2012.07.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Revised: 07/09/2012] [Accepted: 07/10/2012] [Indexed: 10/27/2022] Open
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Abstract
Idiopathic orbital inflammatory syndrome (IOIS) is a nonspecific inflammation of orbital tissue. As it is a diagnosis of exclusion, systemic testing and, at times biopsy, is utilized to rule out other inflammatory etiologies. Since some inflammatory etiologies that masquerade as typical IOIS can be vision or life threatening, it is important to consider these diagnoses. Systemic lupus erythematosus (SLE) is a chronic systemic autoimmune process that can affect the eye and visual system in 20% of individuals. In this idiopathic process, the deposition of pathogenic autoantibodies and immune complexes damage tissues and cells. Some common ocular manifestations of SLE include keratoconjunctivitis sicca, periocular skin lesions, orbital inflammation, retinal hemorrhages and vasculitis, retinal vaso-occlusive disease, iritis, scleritis, optic neuritis and optic neuropathy. One rare clinical entity in the SLE spectrum is panniculitis, also known as lupus erythematosus profundus (LEP), which is a nodular inflammation of adipose tissue. Panniculitis involving orbital structures as the primary presenting symptom of SLE is quite unusual and has only rarely been previously reported in the literature and has not been reported presenting as IOIS. This uncommon presentation can make the diagnosis more difficult. We describe a patient who had presented with ptosis evolving to orbital inflammation, which was consistent with IOIS by laboratory and histologic examinations. The patient later developed extensive panniculitis and a final diagnosis of LEP was made.
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Affiliation(s)
- Linda H Ohsie
- Neuro-Ophthalmology Service, Wills Eye Institute, Philadelphia, PA, USA
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Abstract
Early diagnosis of optic nerve head (ONH) avulsion may be difficult due to an obscured fundus view. Although B-scan ultrasonography is more useful than MRI and CT imaging, it has limited sensitivity and specificity. Optical coherence tomography (OCT) can be used to identify optic nerve pathology. Utilization of OCT has not been widely reported in the diagnosis of ONH avulsion. Two cases OCT use in ONH avulsion are reported. The utility of OCT in the diagnosis of ONH avulsion is of limited value.
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Affiliation(s)
- Ann P Murchison
- Oculoplastic and Orbital Surgery Service, Wills Eye Institute, Philadelphia, PA 19107, USA
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Abstract
A 71-year-old female with a history of thyroid eye disease (TED) presented for evaluation of a skull base mass noted on neuroimaging. She had previously undergone bilateral orbital decompressions and strabismus surgery and had no neurologic symptoms. Successful resection of the menigoencephalocele and repair of the skull base defect was performed through a combined transnasal endoscopic and transorbital approach, obviating the need for craniotomy.
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Affiliation(s)
- Madeleine Schaberg
- Department of Otolaryngology/Head Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
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Abstract
OBJECTIVE To evaluate the necessity of neuroimaging in patients with acute, isolated ocular motor mononeuropathies. METHODS A prospective case series evaluating diagnostic technology results in 93 patients older than 50 years with acute isolated mononeuropathies was performed. Patients were included in the study if they had new-onset diplopia with an isolated cranial neuropathy (cranial nerve III, IV, or VI palsy) and no other signs of neurologic dysfunction. All patients had gadolinium-enhanced magnetic resonance imaging (MRI). The number of patients with lesions noted on MRI and the overall cost of imaging the patients were determined. Cost analysis of the MRI was conducted using Current Procedural Terminology codes and Medicare costs in 2010 dollars. Cost utility was estimated using cost data as well as published utility values for adults with diplopia and sex-specific life tables for life expectancy in the United States. RESULTS Four of 93 patients had lesions on MRI; however, only 1 of the 93 patients had a lesion related to the cranial mononeuropathy. The total modeled cost of imaging for these 93 patients was $131,688 to determine an underlying cause in 1 patient with no change in treatment. The estimated cost utility for the patient with a causative lesion found by MRI was $90.19 for diagnosis alone. CONCLUSIONS It may not be medically necessary to perform MRI scanning on every patient with an isolated cranial nerve III, IV, or VI palsy. In adults older than 50 years with an isolated mononeuropathy, physicians should carefully review the patients' history and findings to determine which patients to image at the initial evaluation.
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Affiliation(s)
- Ann P Murchison
- Oculoplastic and Orbital Surgery Service, Wills Eye Institute, Thomas Jefferson University, Philadelphia, PA 19107, USA.
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Campbell PG, Yadla S, Rosen M, Bilyk JR, Murchison AP, Evans JJ. Endoscopic transnasal cryo-assisted removal of an orbital cavernous hemangioma: a technical note. ACTA ACUST UNITED AC 2011; 54:41-3. [PMID: 21509724 DOI: 10.1055/s-0030-1270465] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The cryoprobe device is commonly used by orbital surgeons for the extraction of intraorbital lesions. Cryoprobes provide a safe mechanism to manipulate fluid-filled tumors. Such lesions can present in locations in which intraoperative neurosurgical assistance is essential. The authors describe a technique whereby removal of an orbital hemangioma was facilitated by the aid of an endoscopic, transnasal cryoprobe while standard microsurgical dissection was performed concurrently via a transconjunctival approach.
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Affiliation(s)
- P G Campbell
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA 19107, USA.
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Abstract
The diagnosis and management of periocular cutaneous malignancies are essential components of an ophthalmologist's practice. Skin cancers comprise nearly one-third of newly diagnosed malignancies. Furthermore, the incidence of skin cancer appears to be increasing. Multiple treatment modalities exist for periocular cutaneous malignancy. Surgical extirpation, often with the combined expertise of a Mohs micrographic surgeon, is typically the first line therapy and is often curative in the periocular region, depending on a variety of factors, including tumour histology, specific location, depth of invasion and surgical technique. However, there are instances where a less invasive, non-surgical treatment option is warranted, including patients who are poor surgical risks or those with diffuse disease. The purpose of this article is to review the literature and describe the non-surgical treatment options, indications and efficacies for non-melanoma primary eyelid malignancies.
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Affiliation(s)
- Ann P Murchison
- Oculoplastic and Orbital Surgery Service, Wills Eye Institute, Philadelphia, Pennsylvania 19107, USA.
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Murchison AP, Rosen MR, Evans JJ, Bilyk JR. Endoscopic approach to the orbital apex and periorbital skull base. Laryngoscope 2011; 121:463-7. [PMID: 21344420 DOI: 10.1002/lary.21357] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Revised: 08/30/2010] [Accepted: 09/01/2010] [Indexed: 01/24/2023]
Abstract
OBJECTIVES/HYPOTHESIS To review cases of endoscopic orbital apex and periorbital skull base surgery and stratify the pathology and lesion location. Variations in surgical technique and the outcomes are reviewed. We report the results of all cases of endoscopic orbital apex surgery over a 40-month period. Eighteen cases with a variety of pathology, location in the orbital apex, and surgical technique are reviewed. STUDY DESIGN Retrospective chart review. METHODS All cases of endoscopic orbital apex and periorbital skull base surgery over a 40-month period were reviewed. Lesion location, surgical approach, pathology, and postoperative complications are summarized. The details of the technique as well as limitations and advantages of this approach are summarized. RESULTS Eighteen patients who underwent endoscopic orbital apex surgery were identified. Eleven (61%) of the patients were men, and the average age was 51 years. The majority of lesions, 12 (67%), were located in the medial orbit and/or optic canal, two (11%) in the cavernous sinus and/or superior orbital fissure, and four (22%) in the inferior orbit and/or pterygopalatine fossa. The etiologies were diverse, including benign (44%), malignant (28%), infectious (11%), and inflammatory (17%). The majority of cases, 67%, were approached by the transnasal endoscopic technique followed by 28% with a combined transnasal and transcaruncular approach, and 6% by the sublabial approach. Complications occurred in 22% of cases. CONCLUSIONS Conventional orbitotomy techniques and craniotomy are frequently used to access lesions in the orbital apex. The more recently described endoscopic technique with intraoperative image guidance can provide access to a subset orbital apical and periorbital skull base lesions. In carefully selected cases, this technique provides excellent visualization and access to the orbital apex and avoids larger craniofacial surgeries.
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Affiliation(s)
- Ann P Murchison
- Oculoplastic and Orbital Surgery Service, Wills Eye Institute, Philadelphia, Pennsylvania, USA.
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Abstract
We report a case of orbital sarcoidosis with extraocular muscle and orbital fat involvement that did not respond to oral corticosteroid treatment, but was successfully treated with oral hydroxychloroquine. There were no side effects or disease recurrence. To our knowledge, anti-malarial therapy for isolated orbital sarcoidosis has not been reported in the literature.
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Abstract
Injuries to the eyelids mandate a systematic evaluation of the eye and ocular adnexa. Anatomic knowledge and an understanding of the etiology of periocular injuries are required for evaluation, optimal patient care, and to aid in prevention of globe dysfunction. This article also reviews the medical and surgical treatments and potential complications of eyelid injuries.
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Affiliation(s)
- Ann P Murchison
- Oculoplastic and Orbital Surgery Service, Wills Eye Institute, Philadelphia, PA, USA.
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Abstract
A 37-year-old man presented with a facial abscess that progressed to external ophthalmoplegia and proptosis. Neuroimaging was consistent with cavernous sinus thrombosis. The diagnosis, management options, and management controversies of septic cavernous sinus thrombosis are discussed, including neuroimaging, antibiotic choice, and the role of corticosteroids and anticoagulation.
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Affiliation(s)
- Behin Barahimi
- Wills Eye Institute, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA
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