1
|
Killeen OJ, Gonzalez LA, Rothberg AE, Khanna S, Cornblath WT, Deveney T, Wong SH, De Lott LB. Facilitators and Barriers to Weight Loss Among Patients With Idiopathic Intracranial Hypertension. J Neuroophthalmol 2024:00041327-990000000-00622. [PMID: 38608181 DOI: 10.1097/wno.0000000000002133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
BACKGROUND Little is known about motivation for weight loss and barriers to weight loss among patients with idiopathic intracranial hypertension (IIH). Such information is crucial for developing tailored weight management recommendations and novel interventions. METHODS We administered a survey to patients with IIH presenting to neuro-ophthalmology clinics at The University of Michigan Kellogg Eye Center (Michigan, USA) and St. Thomas' Hospital (London, England). Participants rated importance and motivation to lose weight (1-10 scale; 10 = extremely important/motivated). Facilitators and barriers to weight loss were assessed using open-ended survey questions informed by motivational interviewing methodology. Open-ended responses were coded by 2 team members independently using a modified grounded theory approach. Demographic data were extracted from medical records. Descriptive statistics were used to analyze quantitative responses. RESULTS Of the 221 (43 Michigan and 178 London) patients with IIH (Table 1), most were female (n = 40 [93.0%] Michigan and n = 167 [94.9%] London). The majority of patients in the United States were White (n = 35 [81.4%] Michigan), and the plurality were Black in the United Kingdom (n = 67 [37.6%] London]) with a mean (SD) BMI of 38.9 kg/m2 (10.6 kg/m2) Michigan and 37.5 kg/m2 (7.7 kg/m2) London. Participants' mean (SD) level of importance to lose weight was 8.5 (2.2) (8.1 [2.3] Michigan and 8.8 [2.1] London), but their mean (SD) level of motivation to lose weight was 7.2 (2.2) (6.8 [2.4] Michigan and 7.4 [2.1] London). Nine themes emerged from the 992 open-ended coded survey responses grouped into 3 actionable categories: self-efficacy, professional resources (weight loss tools, diet, physical activity level, mental health, and physical health), and external factors (physical/environmental conditions, social influences, and time constraints). Most responses (55.6%; n = 551) were about barriers to weight loss. Lack of self-efficacy was the most discussed single barrier (N = 126; 22.9% total, 28.9% Michigan, and 20.4% London) and facilitator (N = 77; 17.5% total, 15.9% Michigan, and 18.7% London) to weight loss. Other common barriers were related to physical activity level (N = 79; 14.3% total, 13.2% Michigan, and 14.8% London) and diet (N = 79; 14.3% total, 9.4% Michigan, and 16.3% London). Commonly reported facilitators included improvements in physical activity level (N = 73; 16.6% total, 18.5% Michigan, and 15.1% London) and dietary changes (N = 76; 17.2% total, 16.4% Michigan, and 17.9% London). CONCLUSIONS Patients with IIH believe weight loss is important. Self-efficacy was the single most mentioned important patient-identified barrier or facilitator of weight loss, but professional resource needs and external factors vary widely at the individual level. These factors should be assessed to guide selection of weight loss interventions that are tailored to individual patients with IIH.
Collapse
Affiliation(s)
- Olivia J Killeen
- Department of Ophthalmology (OJK), Duke University, Durham, North Carolina; Department of Ophthalmology & Visual Sciences (LAG, SK, WTC, TD, LBDL), University of Michigan, Ann Arbor, Michigan; The Ohio State University College of Medicine (LAG), Columbus, Ohio; Department of Internal Medicine (AER), The University of Michigan, Ann Arbor, Michigan; School of Public Health (AER), The University of Michigan, Ann Arbor, Michigan; Weight Management Program & Rewind (AER), The University of Michigan, Ann Arbor, Michigan; Department of Neurology (WTC, LBDL), University of Michigan, Ann Arbor, Michigan; Department of Neuro-Ophthalmology (SHW), Moorfields Eye Hospital, London, United Kingdom; Eye Department (SHW), St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Institute of Neurology (SHW), University College London, London, United Kingdom; and Faculty of Life Sciences & Medicine (SHW), King's College London, London, United Kingdom
| | | | | | | | | | | | | | | |
Collapse
|
2
|
Jarocki A, Benard-Seguin E, Gonzalez LA, Costello F, Andrews CA, Kerber K, De Lott LB. Predictors of Long-Term Visual Acuity in a Modern Cohort of Patients With Acute Idiopathic and Multiple Sclerosis-Associated Optic Neuritis. J Neuroophthalmol 2023; 43:475-480. [PMID: 37200095 PMCID: PMC10656360 DOI: 10.1097/wno.0000000000001870] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
BACKGROUND For patients with idiopathic or multiple sclerosis (MS)-associated optic neuritis (ON), the largest multicenter clinical trial (Optic Neuritis Treatment Trial [ONTT]) showed excellent visual outcomes and baseline high-contrast visual acuity (HCVA) was the only predictor of HCVA at 1 year. We aimed to evaluate predictors of long-term HCVA in a modern, real-world population of patients with ON and compare with previously published ONTT models. METHODS We performed a retrospective, longitudinal, observational study at the University of Michigan and the University of Calgary evaluating 135 episodes of idiopathic or MS-associated ON in 118 patients diagnosed by a neuro-ophthalmologist within 30 days of onset (January 2011-June 2021). Primary outcome measured was HCVA (Snellen equivalents) at 6-18 months. Multiple linear regression models of 107 episodes from 93 patients assessed the association between HCVA at 6-18 months and age, sex, race, pain, optic disc swelling, symptoms (days), viral illness prodrome, MS status, high-dose glucocorticoid treatment, and baseline HCVA. RESULTS Of the 135 acute episodes (109 Michigan and 26 Calgary), median age at presentation was 39 years (interquartile range [IQR], 31-49 years), 91 (67.4%) were women, 112 (83.0%) were non-Hispanic Caucasians, 101 (75.9%) had pain, 33 (24.4%) had disc edema, 8 (5.9%) had a viral prodrome, 66 (48.9%) had MS, and 62 (46.6%) were treated with glucocorticoids. The median (IQR) time between symptom onset and diagnosis was 6 days (range, 4-11 days). The median (IQR) HCVA at baseline and at 6-18 months were 20/50 (20/22, 20/200) and 20/20 (20/20, 20/27), respectively; 62 (45.9%) had better than 20/40 at baseline and 117 (86.7%) had better than 20/40 at 6-18 months. In linear regression models (n = 107 episodes in 93 patients with baseline HCVA better than CF), only baseline HCVA (β = 0.076; P = 0.027) was associated with long-term HCVA. Regression coefficients were similar and within the 95% confidence interval of coefficients from published ONTT models. CONCLUSIONS In a modern cohort of patients with idiopathic or MS-associated ON with baseline HCVA better than CF, long-term outcomes were good, and the only predictor was baseline HCVA. These findings were similar to prior analyses of ONTT data, and as a result, these are validated for use in conveying prognostic information about long-term HCVA outcomes.
Collapse
Affiliation(s)
- Adrienne Jarocki
- University of Michigan Medical School (AJ), Ann Arbor, Michigan; Department of Surgery (EB-S, FC) and Clinical Neurosciences (FC), University of Calgary, Calgary, Canada ; Department of Ophthalmology and Visual Sciences (LAG, CAA, LBDL) and Neurology (LBDL), University of Michigan, Ann Arbor, Michigan; Department of Neurology (KK), Ohio State University, Columbus, Ohio
| | | | | | | | | | | | | |
Collapse
|
3
|
De Lott LB, Ehrlich JR. Patient-Reported Outcomes for Ocular Myasthenia Gravis: Response. J Neuroophthalmol 2023; 43:e357. [PMID: 35421027 PMCID: PMC9500114 DOI: 10.1097/wno.0000000000001512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Lindsey B. De Lott
- Department of Ophthalmology and Visual Sciences, Michigan
Medicine, Ann Arbor, Michigan, USA
- Institute for Healthcare Policy and Innovation, Michigan
Medicine, Ann Arbor, Michigan, USA
| | - Joshua R. Ehrlich
- Department of Ophthalmology and Visual Sciences, Michigan
Medicine, Ann Arbor, Michigan, USA
- Institute for Healthcare Policy and Innovation, Michigan
Medicine, Ann Arbor, Michigan, USA
| |
Collapse
|
4
|
Halawa A, De Lott LB, Trobe JD. Lyme Disease Presenting With Orbital Myositis. J Neuroophthalmol 2023; 43:e352-e354. [PMID: 36730967 DOI: 10.1097/wno.0000000000001721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Ahmad Halawa
- Department of Ophthalmology and Visual Sciences (AH, LBDL, JDT), Kellogg Eye Center, Ann Arbor, Michigan; and Department of Neurology (LBDL, JDT), University of Michigan, Ann Arbor, Michigan
| | | | | |
Collapse
|
5
|
Lin CC, Hill CE, Kerber KA, Burke JF, Skolarus LE, Esper GJ, de Havenon A, De Lott LB, Callaghan BC. Patient Travel Distance to Neurologist Visits. Neurology 2023; 101:e1807-e1820. [PMID: 37704403 PMCID: PMC10634641 DOI: 10.1212/wnl.0000000000207810] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 07/10/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The density of neurologists within a given geographic region varies greatly across the United States. We aimed to measure patient travel distance and travel time to neurologist visits, across neurologic conditions and subspecialties. Our secondary goal was to identify factors associated with long-distance travel for neurologic care. METHODS We performed a cross-sectional analysis using a 2018 Medicare sample of patients with at least 1 outpatient neurologist visit. Long-distance travel was defined as driving distance ≥50 miles 1-way to the visit. Travel time was measured as driving time in minutes. Multilevel generalized linear mixed models with logistic link function, which accounted for clustering of patients within hospital referral region and allowed modeling of region-specific random effects, were used to determine the association of patient and regional characteristics with long-distance travel. RESULTS We identified 563,216 Medicare beneficiaries with a neurologist visit in 2018. Of them, 96,213 (17%) traveled long distance for care. The median driving distance and time were 81.3 (interquartile range [IQR]: 59.9-144.2) miles and 90 (IQR: 69-149) minutes for patients with long-distance travel compared with 13.2 (IQR: 6.5-23) miles and 22 (IQR: 14-33) minutes for patients without long-distance travel. Comparing across neurologic conditions, long-distance travel was most common for nervous system cancer care (39.6%), amyotrophic lateral sclerosis [ALS] (32.1%), and MS (22.8%). Many factors were associated with long-distance travel, most notably low neurologist density (first quintile: OR 3.04 [95% CI 2.41-3.83] vs fifth quintile), rural setting (4.89 [4.79-4.99]), long-distance travel to primary care physician visit (3.6 [3.51-3.69]), and visits for ALS and nervous system cancer care (3.41 [3.14-3.69] and 5.27 [4.72-5.89], respectively). Nearly one-third of patients bypassed the nearest neurologist by 20+ miles, and 7.3% of patients crossed state lines for neurologist care. DISCUSSION We found that nearly 1 in 5 Medicare beneficiaries who saw a neurologist traveled ≥50 miles 1-way for care, and travel burden was most common for lower-prevalence neurologic conditions that required coordinated multidisciplinary care. Important potentially addressable predictors of long-distance travel were low neurologist density and rural location, suggesting interventions to improve access to care such as telemedicine or neurologic subspecialist support to local neurologists. Future work should evaluate differences in clinical outcomes between patients with long-distance travel and those without.
Collapse
Affiliation(s)
- Chun Chieh Lin
- From the Department of Neurology (C.C.L., C.E.H., L.B.D.L., B.C.C.), University of Michigan, Ann Arbor; Department of Neurology (C.C.L., K.A.K., J.F.B.), the Ohio State University, Columbus; Department of Neurology (L.E.S.), Northwestern University, Chicago, IL; Department of Neurology (G.J.E.), Emory University, Atlanta, GA; and Department of Neurology (A.H.), Yale University, New Haven, CT.
| | - Chloe E Hill
- From the Department of Neurology (C.C.L., C.E.H., L.B.D.L., B.C.C.), University of Michigan, Ann Arbor; Department of Neurology (C.C.L., K.A.K., J.F.B.), the Ohio State University, Columbus; Department of Neurology (L.E.S.), Northwestern University, Chicago, IL; Department of Neurology (G.J.E.), Emory University, Atlanta, GA; and Department of Neurology (A.H.), Yale University, New Haven, CT
| | - Kevin A Kerber
- From the Department of Neurology (C.C.L., C.E.H., L.B.D.L., B.C.C.), University of Michigan, Ann Arbor; Department of Neurology (C.C.L., K.A.K., J.F.B.), the Ohio State University, Columbus; Department of Neurology (L.E.S.), Northwestern University, Chicago, IL; Department of Neurology (G.J.E.), Emory University, Atlanta, GA; and Department of Neurology (A.H.), Yale University, New Haven, CT
| | - James F Burke
- From the Department of Neurology (C.C.L., C.E.H., L.B.D.L., B.C.C.), University of Michigan, Ann Arbor; Department of Neurology (C.C.L., K.A.K., J.F.B.), the Ohio State University, Columbus; Department of Neurology (L.E.S.), Northwestern University, Chicago, IL; Department of Neurology (G.J.E.), Emory University, Atlanta, GA; and Department of Neurology (A.H.), Yale University, New Haven, CT
| | - Lesli E Skolarus
- From the Department of Neurology (C.C.L., C.E.H., L.B.D.L., B.C.C.), University of Michigan, Ann Arbor; Department of Neurology (C.C.L., K.A.K., J.F.B.), the Ohio State University, Columbus; Department of Neurology (L.E.S.), Northwestern University, Chicago, IL; Department of Neurology (G.J.E.), Emory University, Atlanta, GA; and Department of Neurology (A.H.), Yale University, New Haven, CT
| | - Gregory J Esper
- From the Department of Neurology (C.C.L., C.E.H., L.B.D.L., B.C.C.), University of Michigan, Ann Arbor; Department of Neurology (C.C.L., K.A.K., J.F.B.), the Ohio State University, Columbus; Department of Neurology (L.E.S.), Northwestern University, Chicago, IL; Department of Neurology (G.J.E.), Emory University, Atlanta, GA; and Department of Neurology (A.H.), Yale University, New Haven, CT
| | - Adam de Havenon
- From the Department of Neurology (C.C.L., C.E.H., L.B.D.L., B.C.C.), University of Michigan, Ann Arbor; Department of Neurology (C.C.L., K.A.K., J.F.B.), the Ohio State University, Columbus; Department of Neurology (L.E.S.), Northwestern University, Chicago, IL; Department of Neurology (G.J.E.), Emory University, Atlanta, GA; and Department of Neurology (A.H.), Yale University, New Haven, CT
| | - Lindsey B De Lott
- From the Department of Neurology (C.C.L., C.E.H., L.B.D.L., B.C.C.), University of Michigan, Ann Arbor; Department of Neurology (C.C.L., K.A.K., J.F.B.), the Ohio State University, Columbus; Department of Neurology (L.E.S.), Northwestern University, Chicago, IL; Department of Neurology (G.J.E.), Emory University, Atlanta, GA; and Department of Neurology (A.H.), Yale University, New Haven, CT
| | - Brian C Callaghan
- From the Department of Neurology (C.C.L., C.E.H., L.B.D.L., B.C.C.), University of Michigan, Ann Arbor; Department of Neurology (C.C.L., K.A.K., J.F.B.), the Ohio State University, Columbus; Department of Neurology (L.E.S.), Northwestern University, Chicago, IL; Department of Neurology (G.J.E.), Emory University, Atlanta, GA; and Department of Neurology (A.H.), Yale University, New Haven, CT
| |
Collapse
|
6
|
Hamedani AG, De Lott LB, Willis AW. Nationwide trends in emergency department utilisation for acute retinal ischaemia in the USA, 2011-2018. Br J Ophthalmol 2023; 107:1490-1495. [PMID: 35760457 PMCID: PMC10196936 DOI: 10.1136/bjo-2022-321418] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 06/14/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Guidelines recommend urgent evaluation for transient monocular vision loss (TMVL) and retinal artery occlusion (RAO), but emergency department (ED) utilisation for these conditions is unknown. METHODS We performed a retrospective longitudinal cross-sectional analysis of the Nationwide Emergency Department Sample (2011-2018), a database of all ED visits from a representative 20% sample of US hospital-based EDs. We identified patients aged 40 and older with a primary diagnosis of TMVL or RAO and calculated the weighted number of total visits and admission rate by year. We used joinpoint regression to analyse time trends and logistic regression to measure differences according to demographic characteristics and comorbidities. RESULTS There were an estimated 2451 ED visits for TMVL and 2472 for RAO annually in the USA from 2011 to 2018. Approximately 36% of TMVL and 51% of RAO patients were admitted. The admission rate decreased by an average of 4.9% per year for TMVL (95% CI -7.5% to -2.3%) and 2.2% per year for RAO (95% CI -4.1% to -0.4%), but the total number of ED visits did not change significantly over time. Elixhauser Comorbidity Index and hyperlipidaemia were associated with increased odds of hospital admission for both TMVL and RAO. There were also differences in admission rate by insurance payer and hospital region. CONCLUSION Of the estimated 48 000 patients with TMVL or RAO annually in the USA, few are evaluated in the ED, and admission rates are less than for transient ischaemic attack or ischaemic stroke and are decreasing over time.
Collapse
Affiliation(s)
- Ali G Hamedani
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, PA, USA
- Translational Center of Excellence for Neuroepidemiology and Neurology Outcomes Research, University of Pennsylvania, Philadelphia, PA, USA
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Allison W Willis
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Translational Center of Excellence for Neuroepidemiology and Neurology Outcomes Research, University of Pennsylvania, Philadelphia, PA, USA
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA, USA
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
7
|
De Lott LB, Moniz MH, Niziol LM, Khanna S, Musch DC, Cornblath WT. Levonorgestrel intrauterine device use and incident idiopathic intracranial hypertension among commercially insured women. Contraception 2023; 125:110089. [PMID: 37331461 PMCID: PMC10870341 DOI: 10.1016/j.contraception.2023.110089] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 06/08/2023] [Accepted: 06/09/2023] [Indexed: 06/20/2023]
Abstract
OBJECTIVES To estimate the hazard of incident idiopathic intracranial hypertension, a potentially blinding condition, among women using levonorgestrel intrauterine devices (LNG-IUD) compared to copper IUD, as conflicting associations have been reported. STUDY DESIGN This retrospective, longitudinal cohort study identified women ages 18-45 years in a large care network (January 1, 2001, to December 31, 2015) using LNG-IUD, subcutaneous etonogestrel implant, copper IUD, tubal device/surgery, or hysterectomy. Incident idiopathic intracranial hypertension was defined as the first diagnosis code for after 1 year without any codes and following brain imaging or lumbar puncture. Kaplan-Meier analysis estimated time-dependent probabilities of idiopathic intracranial hypertension at 1 and 5 years after incident contraception use, stratified by type. Cox regression estimated the hazard of idiopathic intracranial hypertension associated with LNG-IUD use compared to copper IUD (primary comparison) after adjusting for sociodemographics and factors associated with idiopathic intracranial hypertension (e.g., obesity) or contraception selection. A sensitivity analysis with propensity score-adjusted models was performed. RESULTS Of 268,280 women, 78,175 (29%) used LNG-IUD, 8715 (3%) etonogestrel implant, 20,275 (8%) copper IUD, 108,216 (40%) hysterectomy, 52,899 (20%) tubal device/surgery, and 208 (0.08%) developed idiopathic intracranial hypertension over a mean follow-up of 2.4 ± 2.4 years. Also, 1-/5-year Kaplan-Meier idiopathic intracranial hypertension probabilities were 0.0004/0.0021 for LNG-IUD and 0.0005/0.0006 for copper IUD users. LNG-IUD use did not show significantly different hazard of idiopathic intracranial hypertension compared to copper IUD (adjusted hazard ratio 1.84 [95% CI 0.88, 3.85]). Sensitivity analyses were similar. CONCLUSIONS We did not observe a significantly increased hazard of idiopathic intracranial hypertension among women using LNG-IUD compared to copper IUDs. IMPLICATIONS The lack of an association between LNG-IUD use and idiopathic intracranial hypertension in this large observational study provides reassurance to women considering initiation or continued use of this highly effective contraceptive method.
Collapse
Affiliation(s)
- Lindsey B De Lott
- Department of Ophthalmology and Visual Sciences, University of Michigan Kellogg Eye Center, Ann Arbor, Michigan, United States; Institute of Health Policy and Innovation, University of Michigan, Ann Arbor, Michigan, United States.
| | - Michelle H Moniz
- Institute of Health Policy and Innovation, University of Michigan, Ann Arbor, Michigan, United States; Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, United States
| | - Leslie M Niziol
- Department of Ophthalmology and Visual Sciences, University of Michigan Kellogg Eye Center, Ann Arbor, Michigan, United States
| | - Sangeeta Khanna
- Department of Ophthalmology and Visual Sciences, University of Michigan Kellogg Eye Center, Ann Arbor, Michigan, United States
| | - David C Musch
- Department of Ophthalmology and Visual Sciences, University of Michigan Kellogg Eye Center, Ann Arbor, Michigan, United States; Institute of Health Policy and Innovation, University of Michigan, Ann Arbor, Michigan, United States; School of Public Health, Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, United States
| | - Wayne T Cornblath
- Department of Ophthalmology and Visual Sciences, University of Michigan Kellogg Eye Center, Ann Arbor, Michigan, United States
| |
Collapse
|
8
|
Xue K, Feng Y, Tam V, Lin CC, De Lott LB, Hamedani AG. Sociodemographic and Geographic Variation in Access to Neuro-Ophthalmologists in the United States. J Neuroophthalmol 2023; 43:149-152. [PMID: 36857136 DOI: 10.1097/wno.0000000000001821] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
BACKGROUND Neuro-ophthalmologists have expertise in rare and complex disorders, but the ability of patients to access neuro-ophthalmic care has not been examined at a nationwide level. METHODS Using the 2020 directory of all 502 members of the North American Neuro-Ophthalmology Society as a reference, we found the practice locations of 461 confirmed practicing members and converted each street address to latitude and longitude coordinates. We calculated the travel distance and time from each census tract to the nearest practice location and calculated population-weighted averages by state, region, and other prespecified factors. Choropleth maps were used to visualize the distribution of travel distances and times across the United States. RESULTS California had the most practicing neuro-ophthalmologists out of any state (50), whereas 4 states (DE, MT, SD, and WY) had none. Washington, DC and MA had the most neuro-ophthalmologists per capita. The average travel distance and time to the nearest neuro-ophthalmologists were found to be 40.90 miles and 46.50 minutes, respectively, although a large portion of western plains and mountain regions had travel times of over 120 minutes. Patients in rural areas had longer travel times than those in urban areas, and Native American patients had the longest travel times of any racial or ethnic group. CONCLUSION The travel time to see a neuro-ophthalmologist varies widely by state, region, and rurality, with Native American patients and rural patients being disproportionately affected. By identifying the areas with the greatest travel burdens, future policies can work to alleviate these potential barriers to care.
Collapse
Affiliation(s)
- Katie Xue
- Departments of Neurology and Ophthalmology (KX, AGH), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Ophthalmology (YF), Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts; Department of Biomedical and Health Informatics (VT), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Neurology (CCL, LBDL), University of Michigan Medical School, Ann Arbor, Michigan; Department of Ophthalmology and Visual Sciences (LBDL), Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan; Leonard Davis Institute for Health Economics (AGH), University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | | | | | | |
Collapse
|
9
|
Feng Y, Lin CC, Hamedani AG, De Lott LB. A Validated Method to Identify Neuro-Ophthalmologists in a Large Administrative Claims Database. J Neuroophthalmol 2023; 43:153-158. [PMID: 36633356 PMCID: PMC10191877 DOI: 10.1097/wno.0000000000001794] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Validated methods to identify neuro-ophthalmologists in administrative data do not exist. The development of such method will facilitate research on the quality of neuro-ophthalmic care and health care utilization for patients with neuro-ophthalmic conditions in the United States. METHODS Using nationally representative, 20% sample from Medicare carrier files from 2018, we identified all neurologists and ophthalmologists billing at least 1 office-based evaluation and management (E/M) outpatient visit claim in 2018. To isolate neuro-ophthalmologists, the National Provider Identifier numbers of neuro-ophthalmologists in the North American Neuro-Ophthalmology Society (NANOS) directory were collected and linked to Medicare files. The proportion of E/M visits with International Classification of Diseases-10 diagnosis codes that best distinguished neuro-ophthalmic care ("neuro-ophthalmology-specific codes" or NSC) was calculated for each physician. Multiple logistic regression models assessed predictors of neuro-ophthalmology specialty designation after accounting for proportion of ophthalmology, neurology, and NSC claims and primary specialty designation. Sensitivity, specificity, and positive predictive value (PPV) for varying proportions of E/M visits with NSC were calculated. RESULTS We identified 32,293 neurologists and ophthalmologists who billed at least 1 outpatient E/M visit claim in 2018 in Medicare. Of the 472 NANOS members with a valid individual National Provider Identifier, 399 (84.5%) had a Medicare outpatient E/M visit in 2018. The model containing only the proportion of E/M visits with NSC best predicted neuro-ophthalmology specialty designation (odds ratio 1.05 [95% confidence interval 1.04, 1.05]; P < 0.001; area under the receiver operating characteristic [AUROC] = 0.91). Model predictiveness for neuro-ophthalmology designation was maximized when 6% of all billed claims were for NSC (AUROC = 0.89; sensitivity: 84.0%; specificity: 93.9%), but PPV was low (14.9%). The threshold was unchanged when limited only to neurologists billing ≥1% ophthalmology claims or ophthalmologists billing ≥1% neurology claims, but PPV increased (33.3%). CONCLUSIONS Our study provides a validated method to identify neuro-ophthalmologists who can be further adapted for use in other administrative databases to facilitate future research of neuro-ophthalmic care delivery in the United States.
Collapse
Affiliation(s)
- Yilin Feng
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Chun Chieh Lin
- Department of Neurology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Ali G. Hamedani
- Departments of Neurology and Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Lindsey B. De Lott
- Department of Neurology, University of Michigan Medical School, Ann Arbor, MI, USA
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
10
|
Killeen OJ, De Lott LB, Zhou Y, Hu M, Rein D, Reed N, Swenor BK, Ehrlich JR. Population Prevalence of Vision Impairment in US Adults 71 Years and Older: The National Health and Aging Trends Study. JAMA Ophthalmol 2023; 141:197-204. [PMID: 36633858 PMCID: PMC9857701 DOI: 10.1001/jamaophthalmol.2022.5840] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 11/08/2022] [Indexed: 01/13/2023]
Abstract
Importance Existing estimates of the prevalence of vision impairment (VI) in the United States are based on self-reported survey data or measures of visual function that are at least 14 years old. Older adults are at high risk for VI and blindness. There is a need for up-to-date, objectively measured, national epidemiological estimates. Objective To present updated national epidemiological estimates of VI and blindness in older US adults based on objective visual function testing. Design, Setting, and Participants This survey study presents a secondary data analysis of the 2021 National Health and Aging Trends Study (NHATS), a population-based, nationally representative panel study of Medicare beneficiaries 65 years and older. NHATS includes community-dwelling older adults or their proxies who complete in-person interviews; annual follow-up interviews are conducted regardless of residential status. Round 11 NHATS data were collected from June to November 2021, and data were analyzed in August 2022. Interventions In 2021, NHATS incorporated tablet-based tests of distance and near visual acuity and contrast sensitivity with habitual correction. Main Outcomes and Measures National prevalence of impairment in presenting distance visual acuity (>0.30 logMAR, Snellen equivalent worse than 20/40), presenting near visual acuity (>0.30 logMAR, Snellen equivalent worse than 20/40), and contrast sensitivity (>1 SD below the sample mean). Prevalence estimates stratified by age and socioeconomic and demographic data were calculated. Results In the 2021 round 11 NHATS sample, there were 3817 respondents. After excluding respondents who did not complete the sample person interview (n = 429) and those with missing vision data (n = 362), there were 3026 participants. Of these, 29.5% (95% CI, 27.3%-31.8%) were 71 to 74 years old, and 55.2% (95% CI, 52.8%-57.6%) were female respondents. The prevalence of VI in US adults 71 years and older was 27.8% (95% CI, 25.5%-30.1%). Distance and near visual acuity and contrast sensitivity impairments were prevalent in 10.3% (95% CI, 8.9%-11.7%), 22.3% (95% CI, 20.3%-24.3%), and 10.0% (95% CI, 8.5%-11.4%), respectively. Older age, less education, and lower income were associated with all types of VI. A higher prevalence of near visual acuity and contrast sensitivity impairments was associated with non-White race and Hispanic ethnicity. Conclusions and Relevance More than 1 in 4 US adults 71 years and older had VI in 2021, higher than prior estimates. Differences in the prevalence of VI by socioeconomic and demographic factors were observed. These data could inform public health planning.
Collapse
Affiliation(s)
- Olivia J. Killeen
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Lindsey B. De Lott
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Yunshu Zhou
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor
| | - Mengyao Hu
- Institute for Social Research, University of Michigan, Ann Arbor
| | - David Rein
- National Opinion Research Center, University of Chicago, Chicago, Illinois
| | - Nicholas Reed
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Bonnielin K. Swenor
- Johns Hopkins University School of Nursing, Baltimore, Maryland
- Johns Hopkins Disability Health Research Center, Johns Hopkins University, Baltimore, Maryland
| | - Joshua R. Ehrlich
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Institute for Social Research, University of Michigan, Ann Arbor
| |
Collapse
|
11
|
De Lott LB, Lin CC, Burke JF, Wallace B, Saukkonen D, Waljee AK, Kerber KA. Predictors of Glucocorticoid Use for Acute Optic Neuritis in the United States, 2005-2019. Ophthalmic Epidemiol 2023; 30:88-94. [PMID: 35168450 PMCID: PMC9378755 DOI: 10.1080/09286586.2022.2034167] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 01/10/2022] [Accepted: 01/21/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE Acute optic neuritis (ON) is variably treated with glucocorticoids. We aimed to describe factors associated with glucocorticoid use. METHODS In this retrospective, longitudinal cohort study of insured patients in the United States (2005-2019), adults 18-50 years old with one inpatient or ≥2 outpatient diagnoses of ON within 90 days were included. Glucocorticoid use was classified as none, any dose, and high-dose (>100 mg prednisone equivalent ≥1 days). The primary outcome was glucocorticoid receipt within 90 days of the first ON diagnosis. Multivariable logistic regression models assessed the relationship between glucocorticoid use and sociodemographics, comorbidities, clinician specialty, visit number, and year. RESULTS Of 3026 people with ON, 65.8% were women (n = 1991), median age (interquartile range) was 38 years (31,44), and 68.6% were white (n = 2075). Glucocorticoids were received by 46% (n = 1385); 54.6% (n = 760/1385) of whom received high-dose. The odds of receiving glucocorticoids were higher among patients with multiple sclerosis (OR 1.61 [95%CI 1.28-2.04]; P < .001), MRI (OR 1.75 [95%CI 1.09-2.80]; P = .02), 3 (OR 1.80 [95%CI 1.46-2.22]; P < .001) or more (OR 4.08 [95%CI 3.37-4.95]; P < .001) outpatient ON visits, and in certain regions. Compared to ophthalmologists, patients diagnosed by neurologists (OR 1.36 [95%CI: 1.10-1.69], p = .005), emergency medicine (OR 3.97 [95%CI: 2.66-5.94]; P < .001) or inpatient clinicians (OR 2.94 [95%CI: 2.22-3.90]; P < .001) had higher odds of receiving glucocorticoids. Use increased 1.1% annually (P < .001). CONCLUSIONS Demyelinating disease, care intensity, setting, region, and clinician type were associated with glucocorticoid use for ON. To optimize care, future studies should explore reasons for ON care variation, and patient/clinician preferences.
Collapse
Affiliation(s)
- Lindsey B. De Lott
- Department of Neurology, Michigan Medicine, Ann Arbor, Michigan
- Institute for Healthcare Policy and Innovation, Michigan Medicine, Ann Arbor Michigan
| | - Chun Chieh Lin
- Department of Neurology, Michigan Medicine, Ann Arbor, Michigan
- Institute for Healthcare Policy and Innovation, Michigan Medicine, Ann Arbor Michigan
| | - James F. Burke
- Department of Neurology, Michigan Medicine, Ann Arbor, Michigan
- Institute for Healthcare Policy and Innovation, Michigan Medicine, Ann Arbor Michigan
| | - Beth Wallace
- Institute for Healthcare Policy and Innovation, Michigan Medicine, Ann Arbor Michigan
- Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | | | - Akbar K. Waljee
- Institute for Healthcare Policy and Innovation, Michigan Medicine, Ann Arbor Michigan
- Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Kevin A. Kerber
- Department of Neurology, Michigan Medicine, Ann Arbor, Michigan
- Institute for Healthcare Policy and Innovation, Michigan Medicine, Ann Arbor Michigan
| |
Collapse
|
12
|
Feng Y, Commiskey PW, Deveney TK, De Lott LB, Trobe JD. Evaluation of Diplopia by Emergency Medicine Physicians and Consulting Neurologists. J Neuroophthalmol 2022; 42:e230-e239. [PMID: 35500240 DOI: 10.1097/wno.0000000000001247] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Appropriate evaluation of diplopia requires separating serious from benign causes. If providers are not adept in this task, diagnosis of critical conditions may be delayed and unnecessary testing may result. METHODS We studied the records of 100 consecutive patients who presented to an emergency department between 2010 and 2020 with diplopia as a prominent symptom. We rated the performance of emergency medicine physicians (EMPs) and consulting neurologists (CNs) in the examination, diagnosis, and ordering of diagnostic tests according to standards based on neuro-ophthalmologic consultation and the neuro-ophthalmologic literature. RESULTS EMPs made no diagnosis or an incorrect diagnosis in 88 (88%) of 100 encounters. They ordered 14 unindicated and 12 incorrect studies, mostly noncontrast computed tomography scans. CNs made an incorrect diagnosis in 13 (31%) encounters. They ordered 6 unindicated and 2 incorrect studies. The total charge for unindicated and incorrect studies ordered by EMPs and CNs was $119,950. CONCLUSIONS EMPs and CNs made frequent errors in the examination, diagnosis, and ordering of diagnostic studies, leading to inefficient care and unnecessary testing. EMPs largely delegated the evaluation of diplopia to their consultants. If such consultative support were not available, the care of diplopic patients would be delayed. CNs performed more complete examinations, but rarely enough to allow appreciation of the pattern of ocular misalignment, contributing to misdiagnoses and ordering errors. The identification of these provider errors allows for more targeted teaching in the evaluation of diplopia.
Collapse
Affiliation(s)
- Yilin Feng
- Department of Ophthalmology and Visual Sciences (YF, PC, TD, LBDL, JDT), Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan; and Department of Neurology (LBDL, JDT), University of Michigan, Ann Arbor, Michigan
| | | | | | | | | |
Collapse
|
13
|
Kolli A, Seiler K, Kamdar N, De Lott LB, Peterson MD, Meade MA, Ehrlich JR. Longitudinal Associations Between Vision Impairment and the Incidence of Neuropsychiatric, Musculoskeletal, and Cardiometabolic Chronic Diseases. Am J Ophthalmol 2022; 235:163-171. [PMID: 34543661 PMCID: PMC8863581 DOI: 10.1016/j.ajo.2021.09.004] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 09/07/2021] [Accepted: 09/07/2021] [Indexed: 11/01/2022]
Abstract
PURPOSE To compare the incidence and hazard of neuropsychiatric, musculoskeletal, and cardiometabolic conditions among adults with and without vision impairment (VI). DESIGN Retrospective cohort study. METHODS The sample comprised enrollees in a large private health insurance provider in the United States, including 24 657 adults aged ≥18 years with VI and age- and sex-matched controls. The exposure variable, VI, was based on low vision and blindness International Classification of Diseases, Ninth and Tenth Revision, Clinical Modification (ICD-9-CM and ICD-10-CM), diagnosis codes. Physician-diagnosed incident neuropsychiatric, musculoskeletal, and cardiometabolic diseases were identified using ICD codes. Separate Cox proportional hazards regression models were used to assess the association of VI with incidence of 30 chronic conditions, adjusting for Elixhauser Comorbidity Index. Analyses were stratified by age 18-64 years and ≥65 years. RESULTS In individuals with VI aged 18-64 years (n=7478), the adjusted hazard of neuropsychiatric (HR 2.1, 95% CI 1.9, 2.4), musculoskeletal (HR 1.8, 95% CI 1.7, 2.0), and cardiometabolic (HR 1.8, 95% CI 1.7, 2.0) diseases was significantly greater than in matched controls (mean 5.5 years follow-up). Similar associations were seen between patients with VI aged ≥65 years (n=17 179) for neuropsychiatric (HR 2.4, 95% CI 2.1, 2.7), musculoskeletal (HR 1.8, 95% CI 1.6, 1.9), and cardiometabolic (HR 1.7, 95% CI 1.4, 2.0) diseases. VI was associated with a higher hazard of each of the 30 conditions we assessed, with similar results in both age cohorts. CONCLUSION Across the life span, adults with VI had an approximately 2-fold greater adjusted hazard for common neuropsychiatric, musculoskeletal, and cardiometabolic disorders compared with matched controls without VI.
Collapse
Affiliation(s)
- Ajay Kolli
- University of Michigan Medical School, University of Michigan, Ann Arbor, MI,Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA
| | - Kristian Seiler
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
| | - Neil Kamdar
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI,University of Michigan Center for Disability Health and Wellness. University of Michigan, Ann Arbor, MI,Department of Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI,Department of Obstetrics and Gynecology, Michigan Medicine, University of Michigan, Ann Arbor, MI
| | - Lindsey B. De Lott
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI,University of Michigan Center for Disability Health and Wellness. University of Michigan, Ann Arbor, MI,Department of Ophthalmology & Visual Sciences, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Mark D. Peterson
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI,University of Michigan Center for Disability Health and Wellness. University of Michigan, Ann Arbor, MI,Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI
| | - Michelle A. Meade
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI,University of Michigan Center for Disability Health and Wellness. University of Michigan, Ann Arbor, MI,Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI
| | - Joshua R. Ehrlich
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI,University of Michigan Center for Disability Health and Wellness. University of Michigan, Ann Arbor, MI,Department of Ophthalmology & Visual Sciences, Michigan Medicine, Ann Arbor, Michigan, USA,Institute for Social Research, University of Michigan, Ann Arbor, MI USA
| |
Collapse
|
14
|
Ehrlich JR, Hu M, Zhou Y, Kai R, De Lott LB. Visual Difficulty, Race and Ethnicity, and Activity Limitation Trajectories Among Older Adults in the United States: Findings From the National Health and Aging Trends Study. J Gerontol B Psychol Sci Soc Sci 2022; 77:S39-S50. [PMID: 35034111 PMCID: PMC9122656 DOI: 10.1093/geronb/gbab238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 07/13/2021] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVES To characterize the influence of visual difficulty on activity limitation trajectories in older U.S. adults and investigate whether this varied across racial/ethnic groups. METHODS We used data from 8,077 participants in the nationally representative National Health and Aging Trends Study from 2011 to 2019. Using mixed-effects regression models, we investigated the association of self-reported visual difficulty and race/ethnicity with activity limitation trajectories. RESULTS Higher levels of visual difficulty and belonging to a minority racial/ethnic group were associated with greater mobility, self-care, and household activity limitations. Visual difficulty was associated with mobility and self-care activity limitation trajectories, and race/ethnicity was significantly associated with mobility and household activity limitation trajectories. Among those with the highest levels of visual difficulty, non-Hispanic Black participants experienced a faster rate of decline in self-care activities compared to non-Hispanic White participants. DISCUSSION Promoting optimal aging for all requires an understanding of the factors that influence disparities in key outcomes. Our study provides evidence from a diverse national sample that visual difficulty appears to disproportionately affect activity limitation trajectories among older adults from minority racial/ethnic groups and particularly among non-Hispanic "Black individuals." Further research is needed to determine whether interventions to promote healthy vision may positively affect overall activity and independence and ameliorate disparities in late-life activity limitation trajectories.
Collapse
Affiliation(s)
- Joshua R Ehrlich
- Address correspondence to: Joshua R. Ehrlich, MD, MPH, Institute for Social Research, University of Michigan, 426 Thompson Street, Ann Arbor, MI 48104, USA. E-mail:
| | - Mengyao Hu
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Yunshu Zhou
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, USA
| | - Rohan Kai
- College of Literature, Science, and the Arts, University of Michigan, Ann Arbor, Michigan, USA
| | - Lindsey B De Lott
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, USA
| |
Collapse
|
15
|
De Lott LB, Bennett JL, Costello F. The changing landscape of optic neuritis: a narrative review. J Neurol 2022; 269:111-124. [PMID: 33389032 PMCID: PMC8253868 DOI: 10.1007/s00415-020-10352-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [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: 09/10/2020] [Revised: 12/02/2020] [Accepted: 12/04/2020] [Indexed: 01/03/2023]
Abstract
Optic neuritis (ON) is an inflammatory optic neuropathy that is often a harbinger of central nervous system (CNS) demyelinating disorders. ON is frequently misdiagnosed in the clinical arena, leading to either inappropriate management or diagnostic delays. As a result, patients may fail to achieve optimal recovery. The treatment response to corticosteroids and long term risk of multiple sclerosis was established in the first clinical trials conducted roughly 30 years ago. Spontaneous resolution was observed in the vast majority of patients and intravenous high-dose corticosteroids hastened recovery; half of the patients eventually developed multiple sclerosis. Over the ensuing decades, the number of inflammatory conditions associated with ON has significantly expanded exposing substantial variability in the prognosis, treatment, and management of ON patients. ON subtypes can frequently be distinguished by distinct clinical, serological, and radiological profiles allowing expedited and specialized treatment. Guided by an increased understanding of the immunopathology underlying optic nerve and associated CNS injuries, novel disease management strategies are emerging to minimize vision loss, improve long-term surveillance strategies, and minimize CNS injury and disability. Knowledge regarding the clinical signs and symptoms of different ON subtypes is essential to guide acute therapy, prognosticate recovery, accurately identify underlying CNS inflammatory disorders, and facilitate study design for the next generation of clinical and translational trials.
Collapse
Affiliation(s)
- Lindsey B. De Lott
- Departments of Neurology, and Ophthalmology and Visual
Sciences, University of Michigan, Ann Arbor, Michigan, USA
| | - Jeffrey L. Bennett
- Departments of Neurology and Ophthalmology, Programs in
Neuroscience and Immunology, University of Colorado, Denver, Colorado, USA
| | - Fiona Costello
- Departments of Clinical Neurosciences and Surgery
(Ophthalmology), University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
16
|
Elam AR, Sidhom D, Ugoh P, Andrews CA, De Lott LB, Woodward MA, Lee PP, Newman-Casey PA. Disparities in Eye Care Utilization During the COVID-19 Pandemic. Am J Ophthalmol 2022; 233:163-170. [PMID: 34324852 PMCID: PMC8312151 DOI: 10.1016/j.ajo.2021.07.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 07/15/2021] [Accepted: 07/18/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE To assess the relationship between telemedicine utilization and sociodemographic factors among patients seeking eye care. DESIGN Comparative utilization analysis. METHODS We reviewed the eye care utilization patterns of a stratified random sample of 1720 patients who were seen at the University of Michigan Kellogg Eye Center during the height of the COVID-19 pandemic (April 30 to May 25, 2020) and their odds of having a video, phone, or in-person visit compared with having a deferred visit. Associations between independent variables and visit type were determined using a multinomial logistic regression model. RESULTS Older patients had lower odds of having a video visit (P = .007) and higher odds of having an in-person visit (P = .023) compared with being deferred, and in the nonretina clinic sample, older patients still had lower odds of a video visit (P = .02). Non-White patients had lower odds of having an in-person visit (P < .02) in the overall sample compared with being deferred, with a similar trend seen in the retina clinic. The mean neighborhood median household income was $76,200 (±$33,500) and varied significantly (P < .0001) by race with Blacks having the lowest estimated mean income. CONCLUSION Disparities exist in how patients accessed eye care during the COVID-19 pandemic with older patients-those for whom COVID-19 posed a higher risk of mortality-being more likely to be seen for in-person care. In our affluent participant sample, there was a trend toward non-White patients being less likely to access care. Reimbursing telemedicine solely through broadband internet connection may further exacerbate disparities in eye care.
Collapse
Affiliation(s)
- Angela R Elam
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School; Kellogg Eye Center for Eye Policy and Innovation and applies to ARE, CAA, LBD, MAW, PPL and PANC
| | - David Sidhom
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School
| | | | - Chris A Andrews
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School; Kellogg Eye Center for Eye Policy and Innovation and applies to ARE, CAA, LBD, MAW, PPL and PANC
| | - Lindsey B De Lott
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School; Kellogg Eye Center for Eye Policy and Innovation and applies to ARE, CAA, LBD, MAW, PPL and PANC
| | - Maria A Woodward
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School; Kellogg Eye Center for Eye Policy and Innovation and applies to ARE, CAA, LBD, MAW, PPL and PANC
| | - Paul P Lee
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School; Kellogg Eye Center for Eye Policy and Innovation and applies to ARE, CAA, LBD, MAW, PPL and PANC
| | - Paula Anne Newman-Casey
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School; Kellogg Eye Center for Eye Policy and Innovation and applies to ARE, CAA, LBD, MAW, PPL and PANC.
| |
Collapse
|
17
|
De Lott LB, Kolli A, Zhou Y, Hu M, Ehrlich JR. Development and Validation of a Novel Indicator of Visual Disability in the National Health and Aging Trends Study. Innov Aging 2021; 5:igab018. [PMID: 34423139 PMCID: PMC8374875 DOI: 10.1093/geroni/igab018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 03/03/2021] [Indexed: 11/21/2022] Open
Abstract
Background and Objectives The National Health and Aging Trends Study (NHATS) is an ongoing, nationally representative panel study of older adults that collects data on health and disability, including measures on self-reported visual disability (SRVD). Prior studies assessing the association of SRVD with other measures of healthy aging have classified participants as having or not having SRVD, which does not capture the full spectrum of SRVD reported by participants. Therefore, we sought to develop and validate an ordinal indicator of SRVD to facilitate research on the impact of late-life SRVD on health and disability in NHATS. Research Design and Methods We used 2015 NHATS data with community-dwelling participants who answered survey questions about visual functioning and vision aid use. Based on responses, participants were categorized into one of 6 groups: blind, near and distance SRVD without vision aid use, near and distance SRVD with vision aid use, near or distance SRVD without vision aid use, near or distance SRVD with vision aid use, or no SRVD. Multivariable Poisson regression models assessed convergent validity of the ordinal SRVD scale with functional activity and well-being scores, while adjusting for demographic factors and medical comorbidities. Results Of the 7061 eligible individuals, 8.3% (n = 742) reported SRVD. Using our novel ordinal indicator of SRVD in NHATS, higher levels of SRVD were significantly associated with lower functional activity scores (p < .001 for all) and subjective well-being (p < .001), except for participants reporting blindness. Significant differences between SRVD groups were found, which could not be captured using a binary SRVD variable. Discussion and Implications A novel 6-level SRVD scale in NHATS demonstrated convergent validity with functional activity and well-being scales. This scale provides a new tool with improved measurement precision to study the impact of late-life SRVD on health and disability in a nationally representative study of older adults.
Collapse
Affiliation(s)
- Lindsey B De Lott
- Department of Ophthalmology & Visual Sciences, Michigan Medicine, University of Michigan, Ann Arbor, USA
| | - Ajay Kolli
- Department of Ophthalmology & Visual Sciences, Michigan Medicine, University of Michigan, Ann Arbor, USA.,Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Yunshu Zhou
- Department of Ophthalmology & Visual Sciences, Michigan Medicine, University of Michigan, Ann Arbor, USA
| | - Mengyao Hu
- Institute for Social Research, University of Michigan, Ann Arbor, USA
| | - Joshua R Ehrlich
- Department of Ophthalmology & Visual Sciences, Michigan Medicine, University of Michigan, Ann Arbor, USA.,Institute for Social Research, University of Michigan, Ann Arbor, USA
| |
Collapse
|
18
|
Affiliation(s)
- Lindsey B. De Lott
- Department of Ophthalmology and Visual Sciences, Michigan Medicine, Ann Arbor, Michigan, USA
- Institute for Healthcare Policy and Innovation, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Joshua R. Ehrlich
- Department of Ophthalmology and Visual Sciences, Michigan Medicine, Ann Arbor, Michigan, USA
- Institute for Healthcare Policy and Innovation, Michigan Medicine, Ann Arbor, Michigan, USA
| |
Collapse
|
19
|
Al-Hasani H, Khan NW, Branham KH, Heckenlively JR, Sullivan SE, De Lott LB, Fahim AT. Rapid visual field constriction in a patient with retinitis pigmentosa and pituitary adenoma. Am J Ophthalmol Case Rep 2020; 19:100762. [PMID: 32566799 PMCID: PMC7296332 DOI: 10.1016/j.ajoc.2020.100762] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 05/08/2020] [Accepted: 05/31/2020] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To report a case of pituitary adenoma in a patient with retinitis pigmentosa (RP) and consequent rapid constriction of the visual field in each eye, which is atypical for either of these pathologies. OBSERVATIONS A 45-year old male, with a long-standing history of RP, presented with rapid vision loss over 3 months. Examination revealed a severe drop in visual acuity and significant progression of concentric visual field constriction in each eye compared to 3 months prior. MRI revealed a pituitary macroadenoma compressing the optic chiasm. The patient underwent endoscopic trans-sphenoidal resection of the tumor and experienced partial recovery of visual acuity but not visual field. CONCLUSIONS AND IMPORTANCE The visual field deficit in this patient was atypical for pituitary adenoma or optic neuropathy. The pattern was most consistent with RP, but the rate of progression was not. In a patient with chiasmal pathology in the setting of pre-existing retinopathy, visual field progression may not be limited exclusively to the bitemporal regions. Rapid constriction of the visual field in a patient with RP should prompt a work-up for alternative etiologies which includes neuro-imaging.
Collapse
Affiliation(s)
- Hayder Al-Hasani
- Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, 1000 Wall Street, Ann Arbor, MI, 48105, USA
| | - Naheed W. Khan
- Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, 1000 Wall Street, Ann Arbor, MI, 48105, USA
| | - Kari H. Branham
- Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, 1000 Wall Street, Ann Arbor, MI, 48105, USA
| | - John R. Heckenlively
- Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, 1000 Wall Street, Ann Arbor, MI, 48105, USA
| | - Stephen E. Sullivan
- Department of Neurosurgery, University of Michigan, 1500 E. Medical Center Drive SPC 5338, Ann Arbor, MI, 48109-5338, USA
| | - Lindsey B. De Lott
- Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, 1000 Wall Street, Ann Arbor, MI, 48105, USA
| | - Abigail T. Fahim
- Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, 1000 Wall Street, Ann Arbor, MI, 48105, USA
| |
Collapse
|
20
|
De Lott LB, Newman-Casey PA, Lee PP, Ballouz D, Azzouz L, Cho J, Valicevic AN, Woodward MA. Change in Ophthalmic Clinicians' Attitudes Toward Telemedicine During the Coronavirus 2019 Pandemic. Telemed J E Health 2020; 27:231-235. [PMID: 32706642 DOI: 10.1089/tmj.2020.0222] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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] Open
Abstract
Background: Ophthalmic clinicians report low confidence in telemedicine-based eye care delivery, but it may have changed given its rapid expansion during the coronavirus 2019 (COVID-19) pandemic. Introduction: The purpose of this study was to determine clinician confidence in telemedicine-based eye care services during COVID-19. Materials and Methods: An electronic survey was sent to clinicians at University of Michigan Kellogg Eye Center (April 17, 2020-May 6, 2020) when nonemergent in-person visits and procedures were restricted. The primary outcome was clinician confidence in using telemedicine-based eye care during COVID-19. Secondary outcomes included telemedicine utilization and its association with clinician confidence using Fisher's exact test. Results: Of the 88 respondents (90.7% response rate; n = 97 total), 83.0% (n = 73) were ophthalmologists and 17.0% (n = 15) were optometrists. Telemedicine utilization increased from 30.7% (n = 27) before the pandemic to 86.2% (n = 75) after the pandemic. Clinicians' confidence in their ability to use telemedicine varied with 28.6% (24/84) feeling confident/extremely confident, 38.1% (32/84) somewhat confident, and 33.3% (28/84) not-at-all confident. Most felt that telemedicine was underutilized (62.1%; 54/87) and planned continued use over the next year (59.8%; 52/87). Confident respondents were more likely to have performed three or more telemedicine visits (p = 0.003), to believe telemedicine was underutilized (p < 0.001), and to anticipate continued use of telemedicine (p = 0.009). Discussion: The majority of clinicians were at least somewhat confident about using telemedicine during the pandemic. Clinician confidence was associated with telemedicine visit volume and intention to continue using telemedicine. Conclusions: Policies that foster clinician confidence will be important to sustain telemedicine-based eye care delivery.
Collapse
Affiliation(s)
- Lindsey B De Lott
- Department of Ophthalmology and Visual Sciences, University of Michigan Kellogg Eye Center, Ann Arbor, Michigan, USA.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | - Paula Anne Newman-Casey
- Department of Ophthalmology and Visual Sciences, University of Michigan Kellogg Eye Center, Ann Arbor, Michigan, USA.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | - Paul P Lee
- Department of Ophthalmology and Visual Sciences, University of Michigan Kellogg Eye Center, Ann Arbor, Michigan, USA.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | - Dena Ballouz
- Department of Ophthalmology and Visual Sciences, University of Michigan Kellogg Eye Center, Ann Arbor, Michigan, USA
| | - Lyna Azzouz
- Department of Ophthalmology and Visual Sciences, University of Michigan Kellogg Eye Center, Ann Arbor, Michigan, USA
| | - Juno Cho
- Department of Ophthalmology and Visual Sciences, University of Michigan Kellogg Eye Center, Ann Arbor, Michigan, USA
| | - Autumn N Valicevic
- Department of Ophthalmology and Visual Sciences, University of Michigan Kellogg Eye Center, Ann Arbor, Michigan, USA
| | - Maria A Woodward
- Department of Ophthalmology and Visual Sciences, University of Michigan Kellogg Eye Center, Ann Arbor, Michigan, USA.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| |
Collapse
|
21
|
Reynolds EL, Kerber KA, Hill C, De Lott LB, Magliocco B, Esper GJ, Callaghan BC. The effects of the Medicare NCS reimbursement policy: Utilization, payments, and patient access. Neurology 2020; 95:e930-e935. [PMID: 32680949 DOI: 10.1212/wnl.0000000000010090] [Citation(s) in RCA: 2] [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] [Received: 12/12/2019] [Accepted: 03/02/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine whether the 2013 nerve conduction study (NCS) reimbursement reduction changed Medicare use, payments, and patient access to Medicare physicians by performing a retrospective analysis of Medicare data (2012-2016 fee-for-service data from the CMS Physician and Other Supplier Public Use File). METHODS Individual billable services were identified by Healthcare Common Procedure Coding System Current Procedural Terminology and G codes. Medicare use and payments were stratified by specialty and type of service (electrodiagnostic tests, including NCS and EMG, and other neurologic procedures). We also assessed access to Medicare physicians using the annual number of unique beneficiaries receiving initial Evaluation and Management (E/M) services. RESULTS We identified 676,113 Medicare providers included in all analysis years from 2012 to 2016 (10,599 neurologists, 5,881 physiatrists, and 659,633 other specialties). Comparing 2016 to 2012 showed that 21.1% fewer neurologists, 28.6% fewer physiatrists, and 69.3% fewer other specialists performed NCS and 3.8% fewer neurologists, 21.7% fewer physiatrists, and 5.6% fewer other specialists performed EMG. For NCS providers in 2012, the mean number of unique Medicare beneficiaries increased for neurologists (1.2%) and physiatrists (4.8%) but decreased for other specialists (-6.5%) by 2016. After the NCS cut, the number of providers performing autonomic and evoked potential testing increased substantially. CONCLUSIONS The Medicare NCS reimbursement policy resulted in a larger decrease in NCS providers than in EMG providers. Despite fewer neurologists and physiatrists performing NCS, Medicare access to these physicians for E/M services was not affected. Increased autonomic and evoked potential testing may be an unintended consequence of NCS reimbursement change.
Collapse
Affiliation(s)
- Evan L Reynolds
- From the Health Services Research Program (E.L.R., K.A.K., C.H., L.B.D.L.), Department of Neurology, University of Michigan; Veterans Affairs Healthcare System (B.C.C.), Ann Arbor, MI; American Academy of Neurology (B.M.), Minneapolis, MN; and Department of Neurology (G.J.E.), Emory University, Atlanta, GA
| | - Kevin A Kerber
- From the Health Services Research Program (E.L.R., K.A.K., C.H., L.B.D.L.), Department of Neurology, University of Michigan; Veterans Affairs Healthcare System (B.C.C.), Ann Arbor, MI; American Academy of Neurology (B.M.), Minneapolis, MN; and Department of Neurology (G.J.E.), Emory University, Atlanta, GA
| | - Chloe Hill
- From the Health Services Research Program (E.L.R., K.A.K., C.H., L.B.D.L.), Department of Neurology, University of Michigan; Veterans Affairs Healthcare System (B.C.C.), Ann Arbor, MI; American Academy of Neurology (B.M.), Minneapolis, MN; and Department of Neurology (G.J.E.), Emory University, Atlanta, GA
| | - Lindsey B De Lott
- From the Health Services Research Program (E.L.R., K.A.K., C.H., L.B.D.L.), Department of Neurology, University of Michigan; Veterans Affairs Healthcare System (B.C.C.), Ann Arbor, MI; American Academy of Neurology (B.M.), Minneapolis, MN; and Department of Neurology (G.J.E.), Emory University, Atlanta, GA
| | - Brandon Magliocco
- From the Health Services Research Program (E.L.R., K.A.K., C.H., L.B.D.L.), Department of Neurology, University of Michigan; Veterans Affairs Healthcare System (B.C.C.), Ann Arbor, MI; American Academy of Neurology (B.M.), Minneapolis, MN; and Department of Neurology (G.J.E.), Emory University, Atlanta, GA
| | - Gregory J Esper
- From the Health Services Research Program (E.L.R., K.A.K., C.H., L.B.D.L.), Department of Neurology, University of Michigan; Veterans Affairs Healthcare System (B.C.C.), Ann Arbor, MI; American Academy of Neurology (B.M.), Minneapolis, MN; and Department of Neurology (G.J.E.), Emory University, Atlanta, GA
| | - Brian C Callaghan
- From the Health Services Research Program (E.L.R., K.A.K., C.H., L.B.D.L.), Department of Neurology, University of Michigan; Veterans Affairs Healthcare System (B.C.C.), Ann Arbor, MI; American Academy of Neurology (B.M.), Minneapolis, MN; and Department of Neurology (G.J.E.), Emory University, Atlanta, GA.
| |
Collapse
|
22
|
De Lott LB, Burke JF, Andrews CA, Costello F, Cornblath WT, Trobe JD, Lee PP, Kerber KA. Association of Individual-Level Factors With Visual Outcomes in Optic Neuritis: Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open 2020; 3:e204339. [PMID: 32379333 PMCID: PMC7206503 DOI: 10.1001/jamanetworkopen.2020.4339] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
IMPORTANCE Using corticosteroids to treat acute demyelinating optic neuritis has been identified as an area for shared decision-making. However, no analysis exists to support personalized shared decision-making that considers long- and short-term treatment benefits. OBJECTIVE To develop models of individual-level visual outcomes for patients with optic neuritis. DESIGN, SETTING, AND PARTICIPANTS This secondary analysis of the Optic Neuritis Treatment Trial (ONTT), a randomized clinical trial, was performed at 14 academic eye centers and 1 large community eye center. Adults aged 18 to 46 years with incident acute unilateral optic neuritis within 8 days of vision loss onset were included. Data were collected from July 1988 to June 1991, downloaded on October 15, 2018, and analyzed from January 24, 2019, to February 20, 2020, using multivariable linear regression modeling. EXPOSURES Intravenous corticosteroids vs placebo. MAIN OUTCOMES AND MEASURES Visual acuity (VA) at 1 year. Secondary outcomes were 1-year contrast sensitivity (CS) and VA and CS at 15 and 30 days. Independent variables included age, sex, race, multiple sclerosis status, optic neuritis episodes in the fellow eye, vision symptoms (days), pain, optic disc swelling, viral illness, treatment group, and baseline VA or CS. RESULTS Of the 455 participants, median age was 31.8 (interquartile range [IQR], 26.3-37.0) years; 350 (76.9%) were women; and 388 (85.3%) were white. For 410 participants (90.1%) with 1-year outcomes, median VA improved from 20/66 (IQR, 20/28-20/630) at enrollment to 20/17 (IQR, 20/14-20/21) at 1 year. Baseline VA was the primary variable associated with 1-year VA (regression coefficient, 0.056 [95% CI, 0.008-0.103]; P = .02) if baseline VA was better than count fingers (CF). At 15 days, baseline VA and treatment status were associated with VA in those participants with baseline VA better than CF (regression coefficient, 0.305 [95% CI, 0.231-0.380]; F = 9.42; P < .001). However, the difference of medians (20/18 [95% CI, 20/17-20/19] with intravenous corticosteroids vs 20/23 [95% CI, 20/21-20/26] with placebo) was small for the median VA (20/66) in the trial. Treatment was not associated with 15-day or 1-year VA in participants with baseline VA of CF or worse. CONCLUSIONS AND RELEVANCE In this study, long-term VA was associated with severity of baseline vision loss. Early benefits with intravenous corticosteroid treatment were limited to participants with baseline VA better than CF. However, the early, temporary benefit of intravenous corticosteroids is of questionable clinical significance and should be weighed against potential harms.
Collapse
Affiliation(s)
- Lindsey B. De Lott
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor
- Department of Neurology, University of Michigan, Ann Arbor
| | - James F. Burke
- Department of Neurology, University of Michigan, Ann Arbor
| | - Chris A. Andrews
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor
| | - Fiona Costello
- Section of Ophthalmology, Department of Clinical Neurosciences and Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Wayne T. Cornblath
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor
| | - Jonathan D. Trobe
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor
- Department of Neurology, University of Michigan, Ann Arbor
| | - Paul P. Lee
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor
| | | |
Collapse
|
23
|
Walter E, Liao EA, De Lott LB, Trobe JD. Acute Isolated Sixth Nerve Palsy Caused by Unruptured Intradural Saccular Aneurysm. J Neuroophthalmol 2019; 39:458-461. [PMID: 31790372 PMCID: PMC7339113 DOI: 10.1097/wno.0000000000000782] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Unruptured intracranial aneurysms that cause isolated sixth nerve palsies are usually located extradurally in the cavernous sinus or intradurally as part of fusiform enlargement of the parent artery. Intradural saccular aneurysms of the vertebrobasilar circulation are a rare but life-threatening cause of isolated sixth nerve palsy. We provide documentation of 2 such cases. METHODS Case records of the Neuro-ophthalmology Clinics at the University of Michigan. RESULTS A 56-year-old woman with an arteriosclerotic risk profile reported new diplopia and had an isolated left sixth nerve palsy caused by an unruptured saccular aneurysm of the anterior inferior cerebellar artery. It was successfully coiled, and the sixth nerve palsy markedly improved. A 62-year-old woman with an arteriosclerotic risk profile and new diplopia had an isolated right sixth nerve palsy caused by a large unruptured vertebral artery aneurysm. It was coiled and later stented and recoiled. These procedures isolated the aneurysm and relieved the sixth nerve palsy. CONCLUSIONS Isolated sixth nerve palsies in these 2 older adult patients with arteriosclerotic risk profiles were caused by unruptured intradural vertebrobasilar aneurysms. This report adds documentation to a rare phenomenon that must be taken into consideration in deciding whether brain imaging is needed in isolated sixth nerve palsy.
Collapse
Affiliation(s)
- Eyal Walter
- Department of Ophthalmology and Visual Sciences (EW, LBDL, JDT), Kellogg Eye Center, Ann Arbor, Michigan; Departments of Radiology (EAL) and Neurology (LBDL, JDT), University of Michigan, Ann Arbor, Michigan
| | | | | | | |
Collapse
|
24
|
De Lott LB, Zerafa S, Shedden K, Dunietz GL, Earley M, Segal BM, Braley TJ. Multiple sclerosis relapse risk in the postoperative period: Effects of invasive surgery and anesthesia. Mult Scler 2019; 26:1437-1440. [PMID: 31237825 DOI: 10.1177/1352458519860304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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
BACKGROUND Postoperative multiple sclerosis (MS) relapses are a concern among patients and providers. OBJECTIVE To determine whether MS relapse risk is higher postoperatively. METHODS Data were extracted from medical records of MS patients undergoing surgery at a tertiary center (2000-2016). Conditional logistic regression estimated within-patient unadjusted and age-adjusted odds of postoperative versus preoperative relapse. RESULTS Among 281 patients and 609 surgeries, 12 postoperative relapses were identified. The odds of postoperative versus preoperative relapse in unadjusted (odds ratio (OR) = 0.56, 95% confidence interval (CI) = 0.18-1.79; p = 0.33) or age-adjusted models (OR = 0.66, 95% CI = 0.20-2.16; p = 0.49) were not increased. CONCLUSIONS Surgery/anesthesia exposure did not increase postoperative relapse risk. These findings require confirmation in larger studies.
Collapse
Affiliation(s)
| | - Samantha Zerafa
- College of Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Kerby Shedden
- Department of Statistics, University of Michigan, Ann Arbor, MI, USA
| | | | - Michelle Earley
- The Biostatistics Center, The George Washington University, Washington DC, USA
| | - Benjamin M Segal
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Tiffany J Braley
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
25
|
De Lott LB, Kerber KA, Lee PP, Brown DL, Burke JF. Diplopia-Related Ambulatory and Emergency Department Visits in the United States, 2003-2012. JAMA Ophthalmol 2019; 135:1339-1344. [PMID: 29075739 DOI: 10.1001/jamaophthalmol.2017.4508] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Diplopia is believed to be a common eye-related symptom. However, to date, there are no available population-based estimates, which are necessary to understand the impact of this disabling symptom on the health care system and to identify steps to optimize patient care. Objective To describe diplopia presentations in US ambulatory and emergency department (ED) settings. Design, Setting, and Participants Ambulatory and ED visits in the United States by patients with diplopia were analyzed in this prespecified secondary analysis of National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey data collected for a 10-year period (2003-2012). Data were analyzed for the present study from October 6, 2016 to August 18, 2017. Main Outcomes and Measures Numbers of ambulatory and ED diplopia presentations were estimated using weighted sample data. Weighted proportions of patient and clinician (ie, ophthalmologists, general practitioners, and specialty physicians) characteristics, diagnoses, and imaging use were calculated. Results In total, 804 647 (95% CI, 662 075-947 218) ambulatory and 49 790 (95% CI, 38 318-61 262) diplopia-related ED visits occurred annually; 12.3% of ambulatory visits were primarily for acute- or subacute-onset diplopia. Mean (SD) patient age was 62.1 (20.3) years for ambulatory vs 48.1 (22.3) years for diplopia-related ED visits. Most visits primarily for diplopia were by patients 50 years or older (ambulatory, 79.1% [95% CI, 72.9%-84.2%]; ED, 51.8% [95% CI, 41.0%-62.4%]) who were white (ambulatory, 81.7% [95% CI, 74.8%-87.0%]; ED, 86.1% [95% CI, 77.8%-91.6%]) women (ambulatory, 51.1% [95% CI, 44.1-58.1]; ED, 52.8% [95% CI, 41.6%-63.7%]). Most diplopia-related ambulatory visits were conducted by ophthalmologists (70.4% [95% CI, 62.2%-77.5%]) even when symptoms were acute or subacute (89.0% [95% CI, 81.0%-93.9%]). The most common diagnosis in both settings was diplopia (International Classification of Diseases, Ninth Revision, Clinical Modification code 368.2). None of the 10 most frequent diagnoses was life threatening in the ambulatory setting, but approximately 16% of diplopia-related ED visits resulted in a stroke or transient ischemic attack diagnosis. Computed tomography or magnetic resonance imaging was ordered in 6.2% (95% CI, 2.8%-12.9%) of ambulatory and 59.7% (95% CI, 38.6%-77.7%) of ED visits, primarily for diplopia. Conclusions and Relevance Approximately 850 000 diplopia visits occur in the United States annually; 95% were outpatient visits, and diagnoses were rarely serious in the ambulatory setting but potentially life threatening in 16% of diplopia-related ED visits. Given the low probability of a serious neurologic diagnosis in the ambulatory setting and higher probability in an ED, future cohort studies are needed to define the association of various diagnostic practice patterns, such as imaging, with patient outcomes.
Collapse
Affiliation(s)
- Lindsey B De Lott
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor,Department of Neurology, University of Michigan, Ann Arbor
| | - Kevin A Kerber
- Department of Neurology, University of Michigan, Ann Arbor
| | - Paul P Lee
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor
| | - Devin L Brown
- Department of Neurology, University of Michigan, Ann Arbor
| | - James F Burke
- Department of Neurology, University of Michigan, Ann Arbor
| |
Collapse
|
26
|
Bursztyn LLCD, De Lott LB, Petrou M, Cornblath WT. Sensitivity of orbital magnetic resonance imaging in acute demyelinating optic neuritis. Can J Ophthalmol 2019; 54:242-246. [PMID: 30975349 DOI: 10.1016/j.jcjo.2018.05.013] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 05/09/2018] [Accepted: 05/14/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the sensitivity of orbital magnetic resonance imaging (MRI) in acute demyelinating optic neuritis (ON) in routine clinical practice, and the added value of a dedicated neuroradiology interpretation. DESIGN Retrospective chart review. PARTICIPANTS Patients with clinically proven ON evaluated between 2004 and 2014 in the University of Michigan neuro-ophthalmology clinics. Inclusion criteria involved visual recovery and orbital MRI completed within 30days of symptom onset and before corticosteroid treatment. METHODS Demographics, clinical examination, and MRI report data (high T2 signal, gadolinium contrast enhancement) were abstracted for each eligible eye. Every MRI was reinterpreted by a neuroradiologist masked to the affected side. Descriptive statistics summarized patient and eye characteristics. Interrater agreement between the neuroradiologist and the radiology report for the radiographic diagnosis of ON was assessed with Cohen's kappa statistic. RESULTS Of 92 patients who met all inclusion criteria, 70 (76.1%) were reported to have at least 1 MRI feature consistent with ON. After dedicated review by a neuroradiologist, 77 (83.7%) were determined to have a positive MRI for ON. Agreement between the neuroradiologist and MRI report was moderate (κ = 0.63). Gadolinium enhancement was the most common feature in MRI positive ON (72 [78.3%] of neuroradiology reviewed MRIs; 66 [71.7%] of clinical MRI reports). CONCLUSIONS The sensitivity of MRI in ON was lower than previously reported and confirms the importance of making a clinical diagnosis of ON without relying on neuroimaging for confirmation. MRI interpretation by a skilled neuroradiologist increased sensitivity, underscoring the complexity of orbital MRI interpretation.
Collapse
Affiliation(s)
- Lulu L C D Bursztyn
- Department of Ophthalmology, Western University, London, Ont.; Departments of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Mich..
| | - Lindsey B De Lott
- Departments of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Mich.; Departments of Neurology, University of Michigan, Ann Arbor, Mich
| | - Myria Petrou
- Departments of Radiology, University of Michigan, Ann Arbor, Mich
| | - Wayne T Cornblath
- Departments of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Mich.; Departments of Neurology, University of Michigan, Ann Arbor, Mich
| |
Collapse
|
27
|
De Lott LB, Panarelli JF, Samimi D, Petrilli C, Snyder A, Kuhn L, Saint S, Chopra V, Whipple KM. Patient Preferences for Physician Attire in Ophthalmology Practices. J Acad Ophthalmol (2017) 2019; 11:e36-e42. [PMID: 31475243 PMCID: PMC6716523 DOI: 10.1055/s-0039-1688913] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
IMPORTANCE Interest is growing in targeting physician attire to improve the patient experience. Few studies in ophthalmology have examined patient preferences for physician attire. OBJECTIVE To understand patient preferences for physician attire in ophthalmology practices in the United States. DESIGN Survey-based, cohort study. SETTING Two private and two academic ophthalmology practices. PARTICIPANTS A convenience sample of patients receiving ophthalmic care between June 1, 2015 and October 31, 2016. METHODS A questionnaire containing 22 questions and photographs of a male and female physician in seven forms of attire were presented to patients; 14 unique questionnaires were randomly distributed. Patient preference for physician attire was the primary outcome determined by summing ratings of how knowledgeable, trustworthy, caring, approachable, and comfortable the pictured physician made the respondent feel. One-way ANOVA assessed differences in mean composite scores. Comparisons between respondent demographics, practice type, and attire preferences were assessed by chi-square tests. Patient satisfaction was assessed by agreement with questions about importance of physician attire and whether this influences happiness with care. RESULTS In total, 1,297 of 1,826 (71.0%) questionnaires were completed. Physician attire was rated as "important" by 62.9% of participants. A total of 43.6% of participants indicated that physician attire influenced how happy they were with their care. Overall, formal attire with white coat was preferred to casual, formal, and business attire (all comparisons, p < 0.05). No differences in composite scores between formal attire with white coat, scrubs alone, scrubs with white coat, or casual attire with white coat were observed. However, compared with formal attire with white coat, physicians wearing scrubs without white coat appeared less knowledgeable (mean [standard deviation]: 8.2 [1.8] vs. 7.4 [2.1]; p < 0.05) and trustworthy (8.3 [1.8] vs. 7.6 [2.1]; p < 0.05). Additionally, casual attire with white coat was rated as less knowledgeable compared with formal attire with white coat (7.4 [2.0] vs. 8.2 [1.8]; p < 0.05). Preferences for attire varied by clinical setting: patients preferred surgeons (45.2%) and physicians in emergency rooms (41.7%) in scrubs rather than formal attire with white coat. CONCLUSIONS Physician attire is important to patients receiving ophthalmic care. Policies aimed at physician attire in ophthalmology practices should be considered.
Collapse
Affiliation(s)
| | - Joseph F. Panarelli
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York
| | - David Samimi
- Eyesthetica, Los Angeles, California
- Roski Eye Institute, University of California, Los Angeles, California
| | - Christopher Petrilli
- Division of General Internal Medicine and Clinical Innovation, Department of Medicine, New York University Langone Health, New York, New York
- Division of Hospital Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Ashley Snyder
- Division of Hospital Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Latoya Kuhn
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
- Veterans Affairs/University of Michigan Patient Safety Enhancement Program, Ann Arbor, Michigan
| | - Sanjay Saint
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
- Veterans Affairs/University of Michigan Patient Safety Enhancement Program, Ann Arbor, Michigan
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Vineet Chopra
- Division of Hospital Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
- Veterans Affairs/University of Michigan Patient Safety Enhancement Program, Ann Arbor, Michigan
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | | |
Collapse
|
28
|
De Lott LB. Uncovering Reasons Why Acute Ocular Injuries in Children May Be Declining. JAMA Ophthalmol 2018; 136:904. [DOI: 10.1001/jamaophthalmol.2018.2059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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)
- Lindsey B. De Lott
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor
- Department of Neurology, University of Michigan, Ann Arbor
| |
Collapse
|
29
|
Bursztyn L, Woodward MA, Cornblath WT, Grabe HM, Trobe JD, Niziol L, De Lott LB. Accuracy and Reliability of a Handheld, Nonmydriatic Fundus Camera for the Remote Detection of Optic Disc Edema. Telemed J E Health 2017; 24:344-350. [PMID: 29027884 DOI: 10.1089/tmj.2017.0120] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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] Open
Abstract
BACKGROUND Optic disc edema can be an important indicator of serious neurological disease, but is poorly detected using the direct ophthalmoscope. Portable fundus photography may overcome this difficulty. INTRODUCTION The purpose of this study was to determine the sensitivity and specificity of a handheld, nonmydriatic fundus camera for the detection of optic disc edema. MATERIALS AND METHODS Retrospective review of nonmydriatic optic disc photographs taken with a portable fundus camera (Pictor Plus; Volk Optical, Mentor, OH) from the University of Michigan Neuro-Ophthalmology Clinics. We included 103 consecutive eyes with optic disc edema and 103 consecutive eyes without optic disc edema of 109 patients. Four masked neuro-ophthalmologists graded a single photograph of each optic disc presented in randomized order and documented the presence of optic disc edema. Sensitivity and specificity of graders' photographic interpretation was compared with clinical examinations. Reliability of assessments within and between graders was determined using kappa statistics. RESULTS The sensitivity and specificity for detection of optic disc edema were 71.8-92.2% and 81.6-95.2%, respectively. Photos were found to be ungradable in 0-8.3% of cases. The intergrader reliabilities ranged from 0.60 [95% confidence interval (CI): 0.52-0.67] to 0.72 (95% CI: 0.66-0.77). Intragrader reliability ranged from 0.76 (95% CI: 0.63-0.92) to 0.82 (95% CI: 0.69-0.95). DISCUSSION Photographs taken with portable, nonmydriatic technology met threshold sensitivity and specificity for remote screening for optic disc edema when performed by most, but not all graders. Reliability between graders was moderate-strong and strong within individual providers. CONCLUSIONS Portable photography holds promise for use in remote screening of optic disc edema.
Collapse
Affiliation(s)
- Lulu Bursztyn
- 1 Department of Ophthalmology, Western University , London, Ontario, Canada
| | - Maria A Woodward
- 2 Department of Ophthalmology & Visual Sciences, University of Michigan , Ann Arbor, Michigan
| | - Wayne T Cornblath
- 2 Department of Ophthalmology & Visual Sciences, University of Michigan , Ann Arbor, Michigan
| | - Hilary M Grabe
- 3 Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern , Bern, Switzerland
| | - Jonathan D Trobe
- 2 Department of Ophthalmology & Visual Sciences, University of Michigan , Ann Arbor, Michigan
| | - Leslie Niziol
- 2 Department of Ophthalmology & Visual Sciences, University of Michigan , Ann Arbor, Michigan
| | - Lindsey B De Lott
- 2 Department of Ophthalmology & Visual Sciences, University of Michigan , Ann Arbor, Michigan
| |
Collapse
|
30
|
Newman-Casey PA, Woodward MA, Niziol LM, Lee PP, De Lott LB. Brand Medications and Medicare Part D: How Eye Care Providers' Prescribing Patterns Influence Costs. Ophthalmology 2017. [PMID: 28625684 DOI: 10.1016/j.ophtha.2017.05.024] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To quantify costs of eye care providers' Medicare Part D prescribing patterns for ophthalmic medications and to estimate the potential savings of generic or therapeutic drug substitutions and price negotiation. DESIGN Retrospective cross-sectional study. PARTICIPANTS Eye care providers prescribing medications through Medicare Part D in 2013. METHODS Medicare Part D 2013 prescriber public use file and summary file were used to calculate medication costs by physician specialty and drug. Savings from generic or therapeutic drug substitutions were estimated for brand drugs. The potential savings from price negotiation was estimated using drug prices negotiated by the United States Veterans Administration (USVA). MAIN OUTCOME MEASURES Total cost of brand and generic medications prescribed by eye care providers. RESULTS Eye care providers accounted for $2.4 billion in total Medicare part D prescription drug costs and generated the highest percentage of brand name medication claims compared with all other providers. Brand medications accounted for a significantly higher proportion of monthly supplies by volume, and therefore, also by total cost for eye care providers compared with all other providers (38% vs. 23% by volume, P < 0.001; 79% vs. 56% by total cost, P < 0.001). The total cost attributable to eye care providers is driven by glaucoma medications, accounting for $1.2 billion (54% of total cost; 72% of total volume). The second costliest category, dry eye medications, was attributable mostly to a single medication, cyclosporine ophthalmic emulsion (Restasis, Allergan, Irvine, CA), which has no generic alternative, accounting for $371 million (17% of total cost; 4% of total volume). If generic medications were substituted for brand medications when available, $148 million would be saved (7% savings); if generic and therapeutic substitutions were made, $882 million would be saved (42% savings). If Medicare negotiated the prices for ophthalmic medications at USVA rates, $1.09 billion would be saved (53% savings). CONCLUSIONS Eye care providers prescribe more brand medications by volume than any other provider group. Efforts to reduce prescription expenditures by eye care providers should focus on increasing the use of generic medications, primarily through therapeutic substitutions. Policy changes enabling Medicare to negotiate prescription drug prices could decrease costs to Medicare.
Collapse
Affiliation(s)
- Paula Anne Newman-Casey
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan; University of Michigan Institute for Health Care Policy and Innovation, Ann Arbor, Michigan
| | - Maria A Woodward
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan; University of Michigan Institute for Health Care Policy and Innovation, Ann Arbor, Michigan
| | - Leslie M Niziol
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| | - Paul P Lee
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan; University of Michigan Institute for Health Care Policy and Innovation, Ann Arbor, Michigan
| | - Lindsey B De Lott
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan; University of Michigan Institute for Health Care Policy and Innovation, Ann Arbor, Michigan.
| |
Collapse
|
31
|
Cestari DM, Gaier ED, Bouzika P, Blachley TS, De Lott LB, Rizzo JF, Wiggs JL, Kang JH, Pasquale LR, Stein JD. Demographic, Systemic, and Ocular Factors Associated with Nonarteritic Anterior Ischemic Optic Neuropathy. Ophthalmology 2016; 123:2446-2455. [PMID: 27659545 DOI: 10.1016/j.ophtha.2016.08.017] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 08/12/2016] [Accepted: 08/12/2016] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Nonarteritic anterior ischemic optic neuropathy (NAION) is a devastating ocular condition causing permanent vision loss. Little is known about risk factors for developing this disease. We assessed demographic, systemic, and ocular factors associated with NAION. DESIGN Retrospective longitudinal cohort study. PARTICIPANTS Beneficiaries between 40 and 75 years old without NAION at baseline enrolled in a large U.S. managed care network. METHODS Enrollees were monitored continuously for ≥2 years between 2001 and 2014 to identify those newly diagnosed with NAION (International Classification of Diseases, 9th Revision, Clinical Modification [ICD-9-CM] code 377.41). All persons were under ophthalmic surveillance and all cases had ≥1 confirmatory ICD-9-CM code for NAION during follow-up. MAIN OUTCOME MEASURES Multivariable Cox regression modeling was used to generate hazard ratios (HRs) with 95% confidence intervals (CIs) to describe the statistical relationship between selected demographic characteristics, systemic and ocular conditions, and the hazard of developing NAION. RESULTS Of 1 381 477 eligible enrollees, 977 (0.1%) developed NAION during a mean ± standard deviation (SD) follow-up of 7.8±3.1 years. The mean ± SD age for NAION cases at the index date was 64.0±9.2 years vs. 58.4±9.4 years for the remainder of the beneficiaries. After adjustment for confounding factors, each additional year older was associated with a 2% increased hazard of NAION (HR = 1.02; 95% CI: 1.01-1.03). Female subjects had a 36% decreased hazard of developing NAION (HR = 0.64; 95% CI: 0.55-0.74) compared with male subjects. Compared with whites, Latinos had a 46% decreased hazard of developing NAION (HR = 0.54; 95% CI: 0.36-0.82), whereas African ancestry was not significantly associated with NAION (HR = 0.91; 95% CI: 0.72-1.15). Systemic diseases associated with NAION included hypertension (HR = 1.62; 95% CI: 1.26-2.07) and hypercoagulable states (HR = 2.46; 95% CI: 1.51-4.00). Although diabetes mellitus (DM) was not significantly associated with NAION compared with those without DM (P = 0.45), patients with end-organ involvement from DM had a 27% increased hazard of NAION relative to those with uncomplicated DM (HR = 1.27; 95% CI: 1.01-1.59). Ocular diseases associated with NAION were age-related macular degeneration (HR = 1.29; 95% CI: 1.08-1.54) and retinal vein occlusion (HR = 3.94; 95% CI: 3.11-4.99). CONCLUSIONS Our study identified several modifiable risk factors that may be associated with NAION. Should future studies confirm these findings, they may offer opportunities to prevent or treat this debilitating condition.
Collapse
Affiliation(s)
- Dean M Cestari
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.
| | - Eric D Gaier
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Peggy Bouzika
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Taylor S Blachley
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan
| | - Lindsey B De Lott
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan
| | - Joseph F Rizzo
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Janey L Wiggs
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
| | - Jae H Kang
- Department of Medicine, Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Louis R Pasquale
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts; Department of Medicine, Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Joshua D Stein
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan; Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, Michigan; University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, Michigan
| |
Collapse
|
32
|
Callaghan BC, Burke JF, Skolarus LE, Jacobson RD, De Lott LB, Kerber KA. Medicare's Reimbursement Reduction for Nerve Conduction Studies: Effect on Use and Payments. JAMA Intern Med 2016; 176:697-9. [PMID: 27018752 PMCID: PMC4911805 DOI: 10.1001/jamainternmed.2016.0162] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Brian C Callaghan
- University of Michigan, Ann Arbor2VA Center for Clinical Management Research, Ann Arbor, Michigan
| | - James F Burke
- University of Michigan, Ann Arbor2VA Center for Clinical Management Research, Ann Arbor, Michigan
| | | | | | | | | |
Collapse
|
33
|
De Lott LB, Burke JF, Kerber KA, Skolarus LE, Callaghan BC. Medicare Part D payments for neurologist-prescribed drugs. Neurology 2016; 86:1491-8. [PMID: 27009256 DOI: 10.1212/wnl.0000000000002589] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 01/07/2016] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVE To describe neurologists' Medicare Part D prescribing patterns and the potential effect of generic substitutions and price negotiation, which is currently prohibited. METHODS The 2013 Medicare Part D Prescriber Public Use and Summary files were used. Payments for medications were aggregated by provider and drug (brand or generic). Payment, proportion of generic claims or day's supply, and median payment per monthly supply of medication were calculated by physician specialty and drug. Savings from generic substitution were estimated for brand drugs with a generic available. Medicare prices were compared to drug prices negotiated by the federal government with pharmaceutical manufacturers for the Veterans Administration (VA). RESULTS Neurologists comprised 13,060 (1.2%) providers with $5.0 billion (4.8%) in total payments, third highest of all specialties, with a median monthly payment of $141 (interquartile range $85-225). Multiple sclerosis drugs had the highest payments ($1.8 billion). Within neurologic disease groups ($3.4 billion in payments), 54.2%-91.8% of monthly supplies were generic, but 11.9%-71.3% of the payment was for generic medications. Generic substitution resulted in a $269 million (6.5%) payment decrease. VA pricing resulted in $1.5 billion (44.5% of $3.4 billion) in savings. CONCLUSIONS High payment per monthly supply of medication underlies the high total neurology drug payments and is driven by multiple sclerosis drugs. Lowering drug expenditures by Medicare should focus on drug prices.
Collapse
Affiliation(s)
- Lindsey B De Lott
- From the Department of Neurology, University of Michigan, Ann Arbor.
| | - James F Burke
- From the Department of Neurology, University of Michigan, Ann Arbor
| | - Kevin A Kerber
- From the Department of Neurology, University of Michigan, Ann Arbor
| | - Lesli E Skolarus
- From the Department of Neurology, University of Michigan, Ann Arbor
| | | |
Collapse
|
34
|
Peeler CE, De Lott LB, Nagia L, Lemos J, Eggenberger ER, Cornblath WT. Clinical Utility of Acetylcholine Receptor Antibody Testing in Ocular Myasthenia Gravis. JAMA Neurol 2016; 72:1170-4. [PMID: 26258604 DOI: 10.1001/jamaneurol.2015.1444] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE The sensitivity of acetylcholine receptor (AChR) antibody testing is thought to be lower in ocular myasthenia gravis (OMG) compared with generalized disease, although estimates in small-scale studies vary. There is little information in the literature about the implications of AChR antibody levels and progression from OMG to generalized myasthenia gravis. OBJECTIVES To test the hypothesis that serum AChR antibody testing is more sensitive in OMG than previously reported and to examine the association between AChR antibody levels and progression from OMG to generalized myasthenia gravis. DESIGN, SETTING, AND PARTICIPANTS A retrospective, observational cohort study was conducted of 223 patients (mean [SD] age, 59.2 [16.4] years; 139 [62.3%] male) diagnosed with OMG between July 1, 1986, and May 31, 2013, at 2 large, academic medical centers. MAIN OUTCOMES AND MEASURES Baseline characteristics, OMG symptoms, results of AChR antibody testing, and progression time to generalized myasthenia gravis (if this occurred) were recorded for each patient. Multiple logistic regression was used to measure the association between all clinical variables and antibody result. Kaplan-Meier survival analysis was performed to examine time to generalization. RESULTS Among the 223 participants, AChR antibody testing results were positive in 158 participants (70.9%). In an adjusted model, increased age at diagnosis (odds ratio [OR], 1.03; 95% CI, 1.01-1.04; P = .007) and progression to generalized myasthenia gravis (OR, 2.92; 95% CI, 1.18-7.26; P = .02) were significantly associated with positive antibody test results. Women were less likely to have a positive antibody test result (OR, 0.36; 95% CI, 0.19-0.68; P = .002). Patients who developed symptoms of generalized myasthenia gravis had a significantly higher mean (SD) antibody level than those who did not develop symptoms of generalized myasthenia gravis (12.7 [16.5] nmol/L vs 4.2 [7.9] nmol/L; P = .002). CONCLUSIONS AND RELEVANCE We demonstrate a higher sensitivity of AChR antibody testing than previously reported in the largest cohort of patients with OMG available to date. Older age, male sex, and progression to generalized myasthenia gravis were significantly associated with a positive antibody test result. In addition, to our knowledge, this is the first report of an association between high AChR antibody levels and progression from OMG to generalized disease.
Collapse
Affiliation(s)
- Crandall E Peeler
- Neuro-Ophthalmology Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston2Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor
| | - Lindsey B De Lott
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor
| | - Lina Nagia
- Department of Neurology and Ophthalmology, Michigan State University, East Lansing
| | - Joao Lemos
- Department of Neurology and Ophthalmology, Michigan State University, East Lansing
| | - Eric R Eggenberger
- Department of Neurology and Ophthalmology, Michigan State University, East Lansing
| | - Wayne T Cornblath
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor
| |
Collapse
|
35
|
De Lott LB, Burke JF, Trobe JD. Temporal artery biopsy in giant cell arteritis--reply. JAMA Ophthalmol 2016; 133:1220-1. [PMID: 26248193 DOI: 10.1001/jamaophthalmol.2015.2554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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)
- Lindsey B De Lott
- Department of Neurology, University of Michigan, Ann Arbor2Department of Ophthalmology and Visual Sciences, University of Michigan Kellogg Eye Center, Ann Arbor
| | - James F Burke
- Department of Neurology, University of Michigan, Ann Arbor
| | - Jonathan D Trobe
- Department of Neurology, University of Michigan, Ann Arbor2Department of Ophthalmology and Visual Sciences, University of Michigan Kellogg Eye Center, Ann Arbor
| |
Collapse
|
36
|
Abstract
To increase neurologist awareness and inform future efficiency efforts, we identified all neurology-related Choosing Wisely items. Items were categorized by neurologic specialty, disease/symptom, and test/treatment. Of 370 items provided by 65 medical societies, 74 (20%) items were relevant to neurologists. Twelve were duplicated by multiple societies. Items pertaining to 10 neurologic subspecialties were identified, but none for movement disorders and neuromuscular disease. While many recommendations question the use of imaging, few address other high-cost neurologic tests such as EMG/nerve conduction studies and EEG. A rapidly growing number of neurology-related Choosing Wisely recommendations exist including areas of consensus and areas with few recommendations despite high costs. Consensus items should be prioritized for near-term interventions, while areas with few recommendations represent opportunities for future research.
Collapse
Affiliation(s)
- Brian C Callaghan
- Health Services Research Program (BCC, LDL, KAK, JFB, LES), Department of Neurology, University of Michigan; and VA Center for Clinical Management Research (BCC, JFB), Ann Arbor, MI
| | - Lindsey B De Lott
- Health Services Research Program (BCC, LDL, KAK, JFB, LES), Department of Neurology, University of Michigan; and VA Center for Clinical Management Research (BCC, JFB), Ann Arbor, MI
| | - Kevin A Kerber
- Health Services Research Program (BCC, LDL, KAK, JFB, LES), Department of Neurology, University of Michigan; and VA Center for Clinical Management Research (BCC, JFB), Ann Arbor, MI
| | - James F Burke
- Health Services Research Program (BCC, LDL, KAK, JFB, LES), Department of Neurology, University of Michigan; and VA Center for Clinical Management Research (BCC, JFB), Ann Arbor, MI
| | - Lesli E Skolarus
- Health Services Research Program (BCC, LDL, KAK, JFB, LES), Department of Neurology, University of Michigan; and VA Center for Clinical Management Research (BCC, JFB), Ann Arbor, MI
| |
Collapse
|
37
|
Affiliation(s)
- Lindsey B De Lott
- Department of Ophthalmology and Visual Sciences, University of Michigan Kellogg Eye Center, Ann Arbor2Department of Neurology, University of Michigan, Ann Arbor
| | - James F Burke
- Department of Neurology, University of Michigan, Ann Arbor
| | | |
Collapse
|
38
|
Coit P, De Lott LB, Nan B, Elner VM, Sawalha AH. DNA methylation analysis of the temporal artery microenvironment in giant cell arteritis. Ann Rheum Dis 2015; 75:1196-202. [PMID: 26038090 DOI: 10.1136/annrheumdis-2014-207116] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [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: 12/08/2014] [Accepted: 05/02/2015] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To investigate the inflammatory response in giant cell arteritis (GCA) by characterising the DNA methylation pattern within the temporal artery microenvironment. METHODS Twelve patients with non-equivocal histological evidence for GCA and 12 age-matched, sex-matched and ethnicity-matched controls with normal biopsies were studied. DNA was extracted from the affected portions of temporal artery tissue in patients with GCA and from histologically confirmed normal arteries in controls. Genome-wide DNA methylation status was evaluated using the Illumina Infinium HumanMethylation450 BeadChip Array. Differentially methylated loci between affected and unaffected arterial tissues were identified, and subsequent bioinformatic analysis performed. Immunohistochemistry was used to examine tissue expression patterns in temporal artery biopsies. RESULTS We identified 1555 hypomethylated CG sites (853 genes) in affected temporal artery tissue from patients with GCA compared with normal controls. Gene ontology enrichment analysis of hypomethylated genes revealed significant representation in T cell activation and differentiation pathways, including both TH1 and TH17 signatures. Our DNA methylation data suggest a role for increased activity of the calcineurin/nuclear factor of activated T cells (NFAT) signalling pathway in GCA, confirmed by immunohistochemistry showing increased expression and nuclear localisation of NFAT1. NFAT signalling downstream targets such as interleukin (IL)-21/IL-21R and CD40L were overexpressed in GCA-affected arteries. Further, proinflammatory genes including TNF, LTA, LTB, CCR7, RUNX3, CD6, CD40LG, IL2, IL6, NLRP1, IL1B, IL18, IL21, IL23R and IFNG were hypomethylated in the cellular milieu of GCA arteries. CONCLUSIONS We characterised the inflammatory response in GCA-affected arteries using 'epigenetic immunophenotyping' and identified molecules and pathways relevant to disease pathogenesis in GCA.
Collapse
Affiliation(s)
- Patrick Coit
- Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Lindsey B De Lott
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, USA
| | - Bin Nan
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Victor M Elner
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, USA Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA
| | - Amr H Sawalha
- Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA Center for Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, Michigan, USA
| |
Collapse
|
39
|
Woodward MA, Ple-Plakon P, Blachley T, Musch DC, Newman-Casey PA, De Lott LB, Lee PP. Eye care providers' attitudes towards tele-ophthalmology. Telemed J E Health 2015; 21:271-3. [PMID: 25635290 DOI: 10.1089/tmj.2014.0115] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [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: 11/12/2022] Open
Abstract
BACKGROUND The rapid rise of e-health and remote care systems will likely change the practice patterns of ophthalmologists. Although telemedicine practices are thriving in many specialties of medicine, telemedicine for ophthalmology has been limited primarily to asynchronous care for diabetic retinopathy. The goal of this research was to evaluate perspectives on and familiarity with telemedicine among eye care providers at a large tertiary-care medical center via an anonymous, descriptive survey. RESULTS In total, 58 eye care physicians completed surveys (response rates of 86% for physicians-in-training and 49% for faculty physicians, respectively). Although a majority of both faculty and physicians-in-training were willing to participate in telemedicine services, trainees were more likely to be willing to interpret photographs than faculty (p=0.04). Most respondents (71%) indicated that they did not use telemedicine. Over half had received photographs (via phone or e-mail) for interpretation from referring physicians (54%) or patients (56%) within the past 3 months. A majority of providers (82%) would be willing to participate in telemedicine for consultations and for interpreting photographs, but a majority (59%) had low confidence in remote care for providing an opinion on patient care. CONCLUSIONS Most eye care providers viewed telemedicine as part of the future of eye care but were concerned about the use of telemedicine. Although most providers did not practice telemedicine, over half of them were comfortable managing eye care consultations (including patients' photographs) via the Internet.
Collapse
Affiliation(s)
- Maria A Woodward
- 1 Department of Ophthalmology and Visual Sciences, University of Michigan , Ann Arbor, Michigan
| | | | | | | | | | | | | |
Collapse
|
40
|
De Lott LB, Lisabeth LD, Sanchez BN, Morgenstern LB, Smith MA, Garcia NM, Chervin R, Brown DL. Prevalence of pre-stroke sleep apnea risk and short or long sleep duration in a bi-ethnic stroke population. Sleep Med 2014; 15:1582-5. [PMID: 25454982 DOI: 10.1016/j.sleep.2014.09.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 08/15/2014] [Accepted: 09/16/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND The ethnic disparity in ischemic stroke between Mexican Americans (MAs) and non-Hispanic whites (NHWs) may be partly attributable to disparities in sleep and its disorders. We therefore assessed whether pre-stroke sleep apnea symptoms (SA risk) and pre-stroke sleep duration differed between MAs and NHWs. METHODS MA and NHW ischemic stroke survivors in the Brain Attack Surveillance in Corpus Christi (BASIC) project reported sleep duration and SA symptoms on the validated Berlin questionnaire, both with respect to their pre-stroke baseline. Log binomial and linear regression models were used to test the unadjusted and adjusted (demographics and vascular risk factors) associations of high-risk Berlin scores and sleep duration with ethnicity. RESULTS Among 862 subjects, 549 (63.7%) were MA and 514 (59.6%) had a high risk of pre-stroke SA. The MA and NHW subjects showed no ethnic difference, after adjustment for potential confounders, in pre-stroke SA risk (risk ratio (95% confidence interval (CI)): 1.06 (0.93, 1.20)) or in pre-stroke sleep duration (on average MAs slept 2.0 fewer minutes than NHWs, 95% CI: -18.8, 14.9 min). CONCLUSIONS Pre-stroke SA symptoms are highly prevalent, but ethnic differences in SA risk and sleep duration appear unlikely to explain ethnic stroke disparities.
Collapse
Affiliation(s)
- Lindsey B De Lott
- Stroke Program, The Cardiovascular Center - Stroke Program, 1500 E. Medical Center Drive - SPC#5855, Ann Arbor, MI 48109-5855, USA
| | - Lynda D Lisabeth
- Stroke Program, The Cardiovascular Center - Stroke Program, 1500 E. Medical Center Drive - SPC#5855, Ann Arbor, MI 48109-5855, USA; Department of Epidemiology, 1014 SPH I, University of Michigan School of Public Health, Ann Arbor, MI 48109-2029, USA
| | - Brisa N Sanchez
- Department of Biostatistics, M4164 SPH II, University of Michigan School of Public Health, Ann Arbor, MI 48109-2029, USA
| | - Lewis B Morgenstern
- Stroke Program, The Cardiovascular Center - Stroke Program, 1500 E. Medical Center Drive - SPC#5855, Ann Arbor, MI 48109-5855, USA; Department of Epidemiology, 1014 SPH I, University of Michigan School of Public Health, Ann Arbor, MI 48109-2029, USA
| | - Melinda A Smith
- Stroke Program, The Cardiovascular Center - Stroke Program, 1500 E. Medical Center Drive - SPC#5855, Ann Arbor, MI 48109-5855, USA
| | - Nelda M Garcia
- Stroke Program, The Cardiovascular Center - Stroke Program, 1500 E. Medical Center Drive - SPC#5855, Ann Arbor, MI 48109-5855, USA
| | - Ronald Chervin
- Sleep Disorders Center, University of Michigan, 1500 East Medical Center Drive, Med Inn C728, Ann Arbor, MI, USA
| | - Devin L Brown
- Stroke Program, The Cardiovascular Center - Stroke Program, 1500 E. Medical Center Drive - SPC#5855, Ann Arbor, MI 48109-5855, USA.
| |
Collapse
|
41
|
De Lott LB, Trobe JD, Parmar H. Restricted Diffusion of the Superior and Inferior Ophthalmic Veins in Cavernous Sinus Thrombosis. J Neuroophthalmol 2013. [DOI: 10.1097/wno.0b013e318283d7b6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
42
|
Harris Nwanyanwu KM, De Lott LB, Cornblath WT, Elner VM. Transient monocular vision loss due to churg-strauss syndrome vasculitis. JAMA Ophthalmol 2013; 131:117-9. [PMID: 23307226 DOI: 10.1001/jamaophthalmol.2013.576] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
|
43
|
De Lott LB, Morrison C, Suster S, Cohn DE, Frankel WL. CDX2 is a useful marker of intestinal-type differentiation: a tissue microarray-based study of 629 tumors from various sites. Arch Pathol Lab Med 2005. [PMID: 16119980 DOI: 10.1043/1543-2165(2005)129[1100:ciaumo]2.0.co;2] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
CONTEXT CDX2, a critical nuclear transcription factor for intestinal development, is expressed in intestinal epithelium and adenocarcinomas. OBJECTIVES To determine if CDX2 is a useful marker for intestinal-type differentiation and to correlate tumor histology with CDX2 staining in colorectal adenocarcinomas. DESIGN Tissue microarrays from 71 colorectal adenocarcinomas, 31 hepatocellular carcinomas, 47 lung adenocarcinomas, 55 squamous cell carcinomas of the lung, 69 neuroendocrine carcinomas of the lung and 43 of the pancreas, 57 pancreatic adenocarcinomas, and 256 endometrial adenocarcinomas were stained with antibody against CDX2. RESULTS CDX2 staining was positive in 51 (71.8%) of 71 colorectal cancers, including 38 (74.5%) of 51 well- or moderately differentiated tumors and 13 (65.0%) of 20 high-grade tumors. Of the high-grade tumors, 5 (71.4%) of 7 mucinous, 3 (100%) of 3 signet ring cell, and 5 (50.0%) of 10 poorly differentiated tumors were positive. Other tumors showing occasional CDX2 staining included 1 of 30 well- or moderately differentiated neuroendocrine carcinomas of the lung and 2 of 43 from the pancreas, 1 of 47 lung adenocarcinomas, 3 of 57 pancreatic adenocarcinomas, and 15 of 256 endometrial carcinomas. Hepatocellular, poorly differentiated neuroendocrine carcinoma of the lung and squamous cell carcinomas of the lung were not immunoreactive for CDX2. CONCLUSIONS CDX2 is a useful marker for intestinal-type differentiation, is rarely seen in tumors from the other sites evaluated, and may be useful in determining the site of origin for some metastatic tumors. However, CDX2 is not a sensitive marker for poorly differentiated colorectal carcinoma.
Collapse
Affiliation(s)
- Lindsey B De Lott
- Department of Pathology, The Ohio State University Medical Center, Columbus, OH, USA
| | | | | | | | | |
Collapse
|
44
|
De Lott LB, Morrison C, Suster S, Cohn DE, Frankel WL. CDX2 Is a Useful Marker of Intestinal-Type Differentiation: A Tissue Microarray–Based Study of 629 Tumors From Various Sites. Arch Pathol Lab Med 2005; 129:1100-5. [PMID: 16119980 DOI: 10.5858/2005-129-1100-ciaumo] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Context.—CDX2, a critical nuclear transcription factor for intestinal development, is expressed in intestinal epithelium and adenocarcinomas.
Objectives.—To determine if CDX2 is a useful marker for intestinal-type differentiation and to correlate tumor histology with CDX2 staining in colorectal adenocarcinomas.
Design.—Tissue microarrays from 71 colorectal adenocarcinomas, 31 hepatocellular carcinomas, 47 lung adenocarcinomas, 55 squamous cell carcinomas of the lung, 69 neuroendocrine carcinomas of the lung and 43 of the pancreas, 57 pancreatic adenocarcinomas, and 256 endometrial adenocarcinomas were stained with antibody against CDX2.
Results.—CDX2 staining was positive in 51 (71.8%) of 71 colorectal cancers, including 38 (74.5%) of 51 well- or moderately differentiated tumors and 13 (65.0%) of 20 high-grade tumors. Of the high-grade tumors, 5 (71.4%) of 7 mucinous, 3 (100%) of 3 signet ring cell, and 5 (50.0%) of 10 poorly differentiated tumors were positive. Other tumors showing occasional CDX2 staining included 1 of 30 well- or moderately differentiated neuroendocrine carcinomas of the lung and 2 of 43 from the pancreas, 1 of 47 lung adenocarcinomas, 3 of 57 pancreatic adenocarcinomas, and 15 of 256 endometrial carcinomas. Hepatocellular, poorly differentiated neuroendocrine carcinoma of the lung and squamous cell carcinomas of the lung were not immunoreactive for CDX2.
Conclusions.—CDX2 is a useful marker for intestinal-type differentiation, is rarely seen in tumors from the other sites evaluated, and may be useful in determining the site of origin for some metastatic tumors. However, CDX2 is not a sensitive marker for poorly differentiated colorectal carcinoma.
Collapse
Affiliation(s)
- Lindsey B De Lott
- Department of Pathology, The Ohio State University Medical Center, Columbus, OH, USA
| | | | | | | | | |
Collapse
|