Reading deficits in diabetic patients treated with panretinal photocoagulation and good visual acuity

PurposePatients with proliferative diabetic retinopathy (PDR) treated with panretinal photocoagulation (PRP) can have abnormal visual functioning that may be missed by Snellen visual acuity alone. We investigated reading deficits in patients treated with PRP for PDR using the Minnesota reading (MNREAD) test.MethodsThirty patients treated with PRP and 15 controls underwent best‐corrected visual acuity (BCVA), the MNREAD, frequency doubling perimetry (FDP), and fundus photography. Panretinal photocoagulation (PRP)‐treated subjects were compared to controls on MNREAD results by two‐sample t‐tests and Wilcoxon tests and Pearson correlations were used to assess the association between performance on MNREAD and other central visual function tests within PRP subjects.ResultsPanretinal photocoagulation (PRP)‐treated patients had reduced MNREAD acuity (p < 0.0001) and increased critical print size (p = 0.01) compared to controls but not a significantly reduced maximum reading speed (p = 0.06). Logmar MNREAD acuity was strongly positive correlated with logMAR BCVA (r = 0.58, p = 0.0098) and strongly negatively correlated with FDP foveal threshold (r = −0.63, p = 0.0030). Maximum reading speed was positively correlated with FDP foveal threshold (r = 0.57, p = 0.0143) and FDP mean deviation (r = 0.51, p = 0.0432). Visual acuity did not correlate with the sensitivities on the FDP.ConclusionThe MNREAD test reveals that PRP reduces reading ability and other aspects of macular function, and thus provides new understanding of how vision‐related quality of life is impaired. These findings may lead to improved means to evaluate and enhance vision following treatment for PDR.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/152016/1/aos14097.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/152016/2/aos14097_am.pd

Personalized behavior change program for glaucoma patients with poor adherence: a pilot interventional cohort study with a pre-post design

Abstract Background About half of people with glaucoma do not adhere to their recommended medications. Interventions for other chronic conditions have successfully utilized reminder systems and motivational interviewing (MI)-based counseling. This study was designed to pilot a personalized intervention that leverages these strategies to assess their impact on medication adherence in glaucoma patients. Methods Glaucoma patients taking ≥ 1 medication will be pre-screened by telephone survey for adherence to their medication(s). Those who self-report poor adherence will be enrolled in a 3-month monitoring period to measure medication adherence using electronic medication monitors. Participants who are non-adherent (take </=80% of their medication doses) over the 3-month run in phase will be eligible for the study. We plan to enroll 57 participants who are non-adherent to their medications. Participants’ adherence will then be continuously measured with electronic medication monitors, by self-report, and via pharmacy refill data over 2 years, during which two successively more resource-intensive components of an intervention aimed to improve medication adherence will be administered. The first component is a 3-month period of reminders (audio and/or visual) and text message or automated phone call if a dose of medication is not taken within a pre-specified time frame. The second component is a 6-month MI-based counseling program with a trained glaucoma counselor. This component uses the eyeGuide, a computer-based personalized behavior change program that enables para-professional staff to provide personalized education and counseling for glaucoma. The primary outcome is change in medication adherence. The secondary outcomes include changes in clinical outcomes (intraocular pressure, IOP, and IOP fluctuation) and psychosocial mediators of adherence (e.g., competence, energy for change and satisfaction). Participants will undergo semi-structured interviews at 12 months to give feedback about the counseling program in order to improve it. Discussion This pilot study will provide insight into ways to deliver more personalized health care to non-adherent glaucoma patients in order to better support them in managing their chronic disease. Trial registration Retrospectively registered with ClinicalTrials.gov ( NCT03159247 ).https://deepblue.lib.umich.edu/bitstream/2027.42/145182/1/40814_2018_Article_320.pd

Estimating minimally important differences for two visionspecific quality of life measures,”

PURPOSE. To estimate minimally important differences (MIDs) for the Visual Activities Questionnaire (VAQ) and the National Eye Institute-Visual Function Questionnaire (NEI-VFQ). METHODS. A total of 607 subjects with newly-diagnosed open-angle glaucoma (OAG) was enrolled in the Collaborative Initial Glaucoma Treatment Study (CIGTS) and randomized to initial treatment with medications or surgery. Subjects underwent an ophthalmic examination and telephone-administered quality of life (QOL) interview before randomization and every six months thereafter. The VAQ and NEI-VFQ were used to assess participants&apos; perceptions of their visual function. Clinical measures included the mean deviation (MD) from Humphrey 24-2 full threshold visual field (VF) testing, and best-corrected visual acuity (VA) measured using the Early Treatment Diabetic Retinopathy Study (ETDRS) protocol. Anchor-based (using MD and VA) and distribution-based methods were used to estimate MIDs. RESULTS. Anchor-based cross-sectional analyses at 66 months follow-up found a 10-letter increment in better eye VA corresponded to MIDs of 5.2 units for VAQ and 3.8 units for NEI-VFQ total scores. A 3-dB increment in the better eye MD yielded MIDs of 2.6 and 2.3 units for the same two questionnaires. In longitudinal analyses, MIDs for the VAQ were 3.2 units for a 10-letter change of VA and 3.4 units for a 3-dB change in the MD. Distribution-based MIDs were larger. CONCLUSIONS. A range of MIDs for the VAQ (2.6-6.5 units) and NEI-VFQ (2.3-3.8 units) was found. Although similar in magnitude, MIDs were sensitive to the MID estimation method, the anchor chosen, and differences between questionnaires. (ClinicalTrials.gov number, NCT00000149.

Thyroid-Related Orbital Decompression Surgery: A Multivariate Analysis of Risk Factors and Outcomes

Thyroid-related orbital decompression surgery outcomes of proptosis reduction and secondary decompression can be predicted by select clinical risk factors

Evaluating clinical change and visual function concerns in drivers and nondrivers with glaucoma. Investigative Ophthalmology and Visual

for the Collaborative Initial Glaucoma Treatment Study (CIGTS) Investigators PURPOSE. To compare drivers and nondrivers, and to describe the specific concerns of drivers, among individuals with glaucoma. METHODS. Six hundred seven patients with newly diagnosed glaucoma treated at 14 clinical centers of the Collaborative Initial Glaucoma Treatment Study were randomly assigned to initial medicine or surgery and were followed up every 6 months. Driving status (drivers versus nondrivers) and patientreported visual function were determined by the Visual Activities Questionnaire and the National Eye Institute Visual Function Questionnaire. Clinical evaluation included visual field mean deviation (MD) and visual acuity. Statistical comparisons were made using t, 2 , and exact tests and regression and Rasch analyses. RESULTS. Drivers were more likely than nondrivers to be male, white, married, employed, and more educated and to have higher incomes and fewer comorbidities. More than 50% of drivers reported at least &quot;some&quot; difficulty performing tasks involving glare, whereas 22% reported at least &quot;some&quot; difficulty with tasks requiring peripheral vision. At 54 months, drivers with moderate/severe bilateral visual field loss (VFL) reported greater difficulty with night driving and tasks involving visual search and visual processing speed than drivers with less bilateral VFL (all P Ͻ 0.05). Although those who remained drivers over follow-up had better MD in both eyes than those who became nondrivers because of eyesight, a number of drivers had marked VFL. CONCLUSIONS. Inquiring about specific difficulties with tasks related to glare, visual processing speed, visual search, and peripheral vision in driving, especially among patients with substantial bilateral visual field damage, will enable physicians to more effectively counsel patients regarding driving. (Invest Ophthalmol Vis Sci

Development and Validation of a Natural Language Processing Algorithm to Extract Descriptors of Microbial Keratitis From the Electronic Health Record

PURPOSE: The purpose of this article was to develop and validate a natural language processing (NLP) algorithm to extract qualitative descriptors of microbial keratitis (MK) from electronic health records. METHODS: In this retrospective cohort study, patients with MK diagnoses from 2 academic centers were identified using electronic health records. An NLP algorithm was created to extract MK centrality, depth, and thinning. A random sample of patient with MK encounters were used to train the algorithm (400 encounters of 100 patients) and compared with expert chart review. The algorithm was evaluated in internal (n = 100) and external validation data sets (n = 59) in comparison with masked chart review. Outcomes were sensitivity and specificity of the NLP algorithm to extract qualitative MK features as compared with masked chart review performed by an ophthalmologist. RESULTS: Across data sets, gold-standard chart review found centrality was documented in 64.0% to 79.3% of charts, depth in 15.0% to 20.3%, and thinning in 25.4% to 31.3%. Compared with chart review, the NLP algorithm had a sensitivity of 80.3%, 50.0%, and 66.7% for identifying central MK, 85.4%, 66.7%, and 100% for deep MK, and 100.0%, 95.2%, and 100% for thin MK, in the training, internal, and external validation samples, respectively. Specificity was 41.1%, 38.6%, and 46.2% for centrality, 100%, 83.3%, and 71.4% for depth, and 93.3%, 100%, and was not applicable (n = 0) to the external data for thinning, in the samples, respectively. CONCLUSIONS: MK features are not documented consistently showing a lack of standardization in recording MK examination elements. NLP shows promise but will be limited if the available clinical data are missing from the chart

Converting to SITA-Standard from Full-Threshold Visual Field Testing in the Follow-up Phase of a Clinical Trial

PURPOSE. To evaluate the impact of converting from Humphrey 24-2 full-threshold (FT) visual field (VF) testing to SITA-Standard (SS) VF testing during the follow-up phase of a clinical trial. METHODS. VF data were obtained from 243 patients in the Collaborative Initial Glaucoma Treatment Study (CIGTS) who had follow-up visits in 2004. FT and SS VF tests were performed in random order on the same day. RESULTS. The average duration of the SS test (6.3 minutes) was shorter (P Ͻ 0.0001, paired t-test) than the FT test (11.8 minutes). The mean deviation did not differ between SS and FT testing. A small difference was found in the pattern SD (PSD) (P ϭ 0.02). The mean CIGTS score from the FT test (4.5) was significantly lower (P Ͻ 0.0001) than the mean CIGTS score from the SS test (6.0). Although the two tests yielded identical Glaucoma Hemifield Test (GHT) results in 179 patients (76%), 16 patients had a normal GHT result on FT testing and an SS test result that was outside normal limits. Six patients had the reverse finding. The most significant factor associated with an increased (positive) difference between the CIGTS VF score generated from SS and FT testing was conducting the FT test first (P Ͻ 0.0001). CONCLUSIONS. Although SS and FT testing yielded very similar mean deviation results, the CIGTS VF score and GHT differed between SS and FT tests. Changing the approach used to measuring a study&apos;s primary VF outcome should be accompanied by a critical evaluation of the change&apos;s impact. (Invest Ophthalmol Vis Sci. 2005;46:2755-2759) DOI:10.1167/iovs.05-0006 I n the course of conducting long-term clinical trials, key methods used to assess outcomes may become obsolete, be difficult to maintain, or be updated over time. In the Collaborative Initial Glaucoma Treatment Study (CIGTS), 1 visual field (VF) change over time is the primary outcome. Its measurement at the study onset (in the fall of 1993) was made with the Humphrey 24-2 full-threshold (FT) test (Carl Zeiss Meditec, Dublin, CA) 2 and that testing approach was uniformly used at the study&apos;s 14 clinical centers through December 2003. At that time, study investigators approved converting to VF testing by the Swedish Interactive Threshold Algorithm (SITA) Standard test. 3 This decision was based on evidence that the SITA strategy produces results similar to those of the FT test, 4 is sensitive and specific for detecting glaucomatous VF defects, 5-7 and reduced testing time substantially. 4 -10 To evaluate the impact of this conversion for the study&apos;s primary outcome, a protocol was instituted in the CIGTS to determine whether the SITA-Standard results yielded similar or different scores from those produced by the FT test. METHODS A total of 245 CIGTS patients attended study follow-up visits between January 2004 and January 2005, the time frame in which the VF conversion protocol was under way. A center-specific randomization schedule was used to determine the order of VF testing of the patient&apos;s study eye. The FT test and the SITA-Standard test were then obtained in the specified order. Recovery time was allowed between testing, with the amount dependent on the patient&apos;s assessment of readiness. The CIGTS protocol required reliable tests, based on scoring of fixation losses (criterion of Ͻ33%), false-positive and -negative errors (criterion of Ͻ33%), and the short-term fluctuation (SF) value (criterion, Յ4.0 dB). Because the SITA-Standard test does not produce an SF value, its reliability was based on the first three parameters. In two patients, pupil dilation was induced between the two VF tests, as indicated by the intertest pupil diameter being 4 mm disparate. These two patients&apos; data are not included in this report, yielding n ϭ 243 with comparable VF test results. Both VF test results were scored according to the CIGTS VF scoring algorithm, 1,11 which assigns weights to points on the VF test&apos;s total deviation probability plot according to the extent of departure from normal values, as expressed by point-specific probabilities, which are empirically derived percentiles from the distributions of values at each of the 52 points from age-specific sets of normal subjects collected by the manufacturer. 2 The proprietary distributions are built into the VF test software and are not available for inspection. The probability at each of the 52 points is reported as no defect or P Յ 0.05, Յ 0.02, Յ 0.01, or Յ 0.005, meaning that the measured value at that point was at or below the respective percentile of the age-specific empiric distribution at that position in the field for normal subjects. A point is called defective if its probability is 0.05 or less and it has at least two neighboring points with probabilities of 0.05 or less in the same vertical hemifield (superior or inferior). A weight is assigned depending on the minimum depth of the defect at the given point and the two most defective neighboring points. A minimum defect of 0.05, 0.02, 0.01, or 0.005 is given a weight of 1, 2, 3, or 4, respectively. A point without two neighboring points all depressed to at least P Յ 0.05 is given a weight of 0. For example, a point at P Յ 0.01 with only two neighboring points of defect, both at P Յ 0.05, would receive a weight of 1. The weights for all 52 points in the field are summed, resulting in a value between 0 and 208 (52 ϫ 4). The sum is then scaled to a range of 0 to 20 (by dividing by 10.4), resulting in a score that is a nearly continuous measure of VF loss. Other Humphrey VF test parameters that are common to both testing procedures-test duration, pupil From the Departments of 1 Ophthalmology and Visual Sciences

Measuring impact of a quality improvement initiative on glaucoma clinic flow using an automated real-time locating system

Abstract Background Lean methodology helps maximize value by reducing waste, first by defining what value and waste are in a system. In ophthalmology clinics, value is determined by the number of patients flowing through the clinic for a given time. We aimed to increase value using a lean-methodology guided policy change, then assessed its impact on clinic flow using an automated radiofrequency identification (RFID) based real-time locating system (RTLS). Methods A total of 6813 clinical visits occurred at a single academic institution’s outpatient glaucoma clinic between January 5, 2018 to July 3, 2018. Over that period, 1589 patients comprising 1972 (29%) of visits were enrolled, with 1031 clinical visits occurring before and 941 visits after a policy change. The original policy was to refract all patients that improved with pinhole testing. The policy change was not to refract patients with a visual acuity ≥20/30 unless a specific request was made by the patient. Pre-post analysis of an automated time-motion study was conducted for the data collected 3 months before and 3 months after the policy change occurred on March 30, 2018. Changes to process and wait times were summarized using descriptive statistics and fitted to linear mixed regression models adjusting for appointment type, clinic volume, and daily clinic trends. Results One thousand nine hundred twenty-three visits with 1588 patients were included in the analysis. Mean [SD] age was 65.9 [14.7] years and 892 [56.2%] were women. After the policy change, technician process time decreased by 2.9 min (p < 0.0001) while daily clinical patient volume increased from 51.9 ± 16.8 patients to 58.4 ± 17.4 patients (p < 0.038). No significant difference was found in total wait time (p = 0.18) or total visit time (p = 0.83). Conclusions Real-time locating systems are effective at capturing clinical flow data and assessing clinical practice change initiatives. The refraction policy change was associated with reduced technician process time and overall the clinic was able to care for 7 more patients per day without significantly increasing patient wait time.http://deepblue.lib.umich.edu/bitstream/2027.42/173600/1/12886_2022_Article_2495.pd