Prospective, randomized, fellow eye comparison of WaveLight® Allegretto Wave® Eye-Q versus VISX CustomVueTM STAR S4 IRTM in photorefractive keratectomy: analysis of visual outcomes and higher-order aberrations

Majid Moshirfar1, Daniel S Churgin2, Brent S Betts3, Maylon Hsu1, Shameema Sikder4, Marcus Neuffer1, Dane Church5, Mark D Mifflin11University of Utah, John A Moran Eye Center, Department of Ophthalmology and Visual Sciences, Salt Lake City, UT, USA; 2University of Arizona College of Medicine, Phoenix, AZ; 3Temple University School of Medicine, Philadelphia, PA, USA; 4Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USA; 5Virginia Commonwealth University School of Medicine, Richmond, VA, USABackground: The purpose of this study was to compare differences in visual outcomes, higher-order aberrations, contrast sensitivity, and dry eye in patients undergoing photorefractive keratectomy using wavefront-guided VISX CustomVue™ and wavefront-optimized WaveLight® Allegretto platforms.Methods: In this randomized, prospective, single-masked, fellow-eye study, photorefractive keratectomy was performed on 46 eyes from 23 patients, with one eye randomized to WaveLight Allegretto, and the fellow eye receiving VISX CustomVue. Three-month postoperative outcome measures included uncorrected distance visual acuity, corrected distance visual acuity, refractive error, root mean square of total and grouped higher-order aberrations, contrast sensitivity, and Schirmer’s testing.Results: Mean values for uncorrected distance visual acuity (logMAR) were —0.03 ± 0.07 and —0.06 ± 0.09 in the wavefront-optimized and wavefront-guided groups, respectively (P = 0.121). Uncorrected distance visual acuity of 20/20 or better was achieved in 91% of eyes receiving wavefront-guided photorefractive keratectomy, and 87% of eyes receiving wavefront-optimized photorefractive keratectomy, whereas uncorrected distance visual acuity of 20/15 was achieved in 35% of the wavefront-optimized group and 64% of the wavefront-guided group (P ≥ 0.296). While root mean square of total higher-order aberration, coma, and trefoil tended to increase in the wavefront-optimized group (P = 0.091, P = 0.115, P = 0.459, respectively), only spherical aberration increased significantly (P = 0.014). Similar increases were found in wavefront-guided root mean square of total higher-order aberration (P = 0.113), coma (P = 0.403), trefoil (P = 0.603), and spherical aberration (P = 0.014). There was no significant difference in spherical aberration change when comparing the two platforms. The wavefront-guided group showed an increase in contrast sensitivity at 12 cycles per degree (P = 0.013).Conclusion: Both VISX CustomVue and WaveLight Allegretto platforms performed equally in terms of visual acuity, safety, and predictability in photorefractive keratectomy. The wavefront-guided group showed slightly improved contrast sensitivity. Both lasers induced a comparable degree of statistically significant spherical aberration, and tended to increase other higher-order aberration measures as well.Keywords: wavefront-guided, wavefront-optimized, photorefractive keratectom

Do electronic health records affect the patient-psychiatrist relationship? A before & after study of psychiatric outpatients

<p>Abstract</p> <p>Background</p> <p>A growing body of literature shows that patients accept the use of computers in clinical care. Nonetheless, studies have shown that computers unequivocally change both verbal and non-verbal communication style and increase patients' concerns about the privacy of their records. We found no studies which evaluated the use of Electronic Health Records (EHRs) specifically on psychiatric patient satisfaction, nor any that took place exclusively in a psychiatric treatment setting. Due to the special reliance on communication for psychiatric diagnosis and evaluation, and the emphasis on confidentiality of psychiatric records, the results of previous studies may not apply equally to psychiatric patients.</p> <p>Method</p> <p>We examined the association between EHR use and changes to the patient-psychiatrist relationship. A patient satisfaction survey was administered to psychiatric patient volunteers prior to and following implementation of an EHR. All subjects were adult outpatients with chronic mental illness.</p> <p>Results</p> <p>Survey responses were grouped into categories of "Overall," "Technical," "Interpersonal," "Communication & Education,," "Time," "Confidentiality," "Anxiety," and "Computer Use." Multiple, unpaired, two-tailed t-tests comparing pre- and post-implementation groups showed no significant differences (at the 0.05 level) to any questionnaire category for all subjects combined or when subjects were stratified by primary diagnosis category.</p> <p>Conclusions</p> <p>While many barriers to the adoption of electronic health records do exist, concerns about disruption to the patient-psychiatrist relationship need not be a prominent focus. Attention to communication style, interpersonal manner, and computer proficiency may help maintain the quality of the patient-psychiatrist relationship following EHR implementation.</p

Dissecting cause and effect in host-microbiome interactions using the combined worm-bug model system

High-throughput molecular studies are greatly advancing our knowledge of the human microbiome and its specific role in governing health and disease states. A myriad of ongoing studies aim at identifying links between microbial community disequilibria (dysbiosis) and human diseases. However, due to the inherent complexity and heterogeneity of the human microbiome we need robust experimental models that allow the systematic manipulation of variables to test the multitude of hypotheses arisen from large-scale ‘meta-omic’ projects. The nematode C. elegans combined with bacterial models offers an avenue to dissect cause and effect in host-microbiome interactions. This combined model allows the genetic manipulation of both host and microbial genetics and the use of a variety of tools, to identify pathways affecting host health. A number of recent high impact studies have used C. elegans to identify microbial pathways affecting ageing and longevity, demonstrating the power of the combined C. elegans-bacterial model. Here I will review the current state of the field, what we have learned from using C. elegans to study gut microbiome and host interactions, and the potential of using this model system in the future

A prospective, randomized, fellow eye comparison of WaveLight&amp;reg; Allegretto Wave&amp;reg; Eye-Q versus VISX CustomVue&amp;trade; STAR S4 IR&amp;trade; in laser in situ keratomileusis (LASIK): analysis of visual outcomes and higher order aberrations

Majid Moshirfar1, Brent S Betts2, Daniel S Churgin3, Maylon Hsu1, Marcus Neuffer1, Shameema Sikder4, Dane Church5, Mark D Mifflin11John A Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, UT, USA; 2Temple University School of Medicine, Philadelphia, PA, USA; 3University of Arizona College of Medicine &amp;ndash; Phoenix, Phoenix, AZ, USA; 4Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USA; 5Virginia Commonwealth University School of Medicine, Richmond, VA, USAPurpose: To compare outcomes in visual acuity, refractive error, higher-order aberrations (HOAs), contrast sensitivity, and dry eye in patients undergoing laser in situ keratomileusis (LASIK) using wavefront (WF) guided VISX CustomVue and WF optimized WaveLight Allegretto platforms.Methods: In this randomized, prospective, single-masked, fellow eye study, LASIK was performed on 44 eyes (22 patients), with one eye randomized to WaveLight Allegretto, and the fellow eye receiving VISX CustomVue. Postoperative outcome measures at 3 months included uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), refractive error, root-mean-square (RMS) value of total and grouped HOAs, contrast sensitivity, and Schirmers testing.Results: Mean values for UDVA (logMAR) were -0.067 &amp;plusmn; 0.087 and -0.073 &amp;plusmn; 0.092 in the WF optimized and WF guided groups, respectively (P = 0.909). UDVA of 20/20 or better was achieved in 91% of eyes undergoing LASIK with both lasers while UDVA of 20/15 or better was achieved in 64% of eyes using the Allegretto platform, and 59% of eyes using VISX CustomVue (P = 1.000). In the WF optimized group, total HOA increased 4% (P = 0.012), coma increased 11% (P = 0.065), and spherical aberration increased 19% (P = 0.214), while trefoil decreased 5% (P = 0.490). In the WF guided group, total HOA RMS decreased 9% (P = 0.126), coma decreased 18% (P = 0.144), spherical aberration decreased 27% (P = 0.713) and trefoil decreased 19% (P = 0.660). One patient lost one line of CDVA secondary to residual irregular astigmatism.Conclusion: Both the WaveLight Allegretto and the VISX CustomVue platforms had equal visual and safety outcomes. Most wavefront optimized HOA values trended upward, with a statistically significant increase in total HOA RMS. Eyes treated with the WF guided platform showed a decreasing trend in HOA values.Keywords: wavefront guided, wavefront optimized, laser in situ keratomileusis, LASIK, Allegretto, VIS