Cost effect of surgeon and patient discretion in regard to cataract surgery

Tyler D Oostra,1 Thomas F Mauger2 1Havener Eye Institute, Department of Ophthalmology, The Ohio State University Wexner Medical Center, Columbus, OH 43212, USA; 2West Virginia University Eye Institute, Department of Ophthalmology, West Virginia University, Morgantown, WV 26506, USA Purpose: The purpose of this study is to examine the cost effect of surgeon and patient discretion in regard to cataract surgery and how this affects population health care costs.Methods: A model of cataract progression was created from preexisting published data and combined with mortality data and Medicare cataract statistics to estimate the effect of mortality on decreasing the rate of cataract surgery if surgery was delayed until any cataract progression occurred.Results: Five-year cataract progression rates were determined for a given patient age, sex, and type of cataract. Combined with 5-year death rates, delaying surgery until progression occurred resulted in a 1.1% decrease in surgery for nuclear sclerosis at age 45 that increased to a 33.8% decrease by age 90; a 1.5% decrease in surgery for cortical cataract at age 45 that increased to a 51.1% decrease by age 90; and a 1.6% decrease in surgery for posterior subcapsular at age 45 that increased to a 59.7% decrease by age 90. The effect of this decrease in surgical volume on Medicare was estimated to result in a 13% overall decrease in cataract surgery annually at a cost of ~$660 million dollars per year.Conclusion: Overall, we conclude that surgeon and patient discretion in regard to cataract surgery has a substantial cost effect with the potential to reduce surgical volume by as much as 13% by the decision to delay surgery as a result of patient mortality. Keywords: cataract surgery, cataract progression, cost effect, health care cost

The effects of the presence of the corneal epithelium and supplemental hydrocortisone on ß-glucuronidase levels with corneal preservation

Thomas Mauger, Eric QuartettiHavener Eye Institute, Department of Ophthalmology, The Ohio State University, OH, USAPurpose: To analyze the levels of ß-glucuronidase during prolonged (14 day) corneal preservation with epithelialized (EPI) and deepithelialized (DEP) corneas and the effect of supplemental hydrocortisone (HCT) on these levels.Methods: Thirty-six freshly excised bovine corneas were preserved in Optisol solution (4°C) for 14 days with the following conditions EPI/no supplemental HCT, DEP no supplemental HCT, EPI/10-8 M HCT, and EPI 10-4 M HCT. ß-glucuronidase activity levels were measured at the end of this period.Results: ß-glucuronidase levels (nmol/mL/h) for each group were found to be: EPI – No HCT: 4.302, SEM 0.586; DEP – No HCT: 2.178, SEM 0.271; EPI – 10-8 M HCT: 4.472, SEM 0.435; EPI – 10-4 M HCT: 2.072, SEM 0.437. The EPI – No HCT and EPI – 10-8 M HCT were not significantly different as were the DEP – No HCT and EPI – 10-4 M HCT groups. The EPI – No HCT group and the EPI – 10-8 M HCT group were independently significantly different from the DEP – No HCT and the EPI – 10-4 M HCT groups.Conclusions: The corneal epithelium contributes significantly to the formation of the lysosomal enzyme, ß-glucuronidase, during preservation. The addition of 10-4 M HCT decreases the production of ß-glucuronidase during corneal preservation in this model.Keywords: ß-glucuronidase, preservation&nbsp

Lack of relationship between cigarette smoking and alcohol use with dysplasia grade in ocular surface squamous neoplasia

Alison D Early, Sarah Adelson, Craig J Miller, Thomas F Mauger Department of Ophthalmology, The Ohio State University Havener Eye Institute, Columbus, OH, USA Objective: To evaluate smoking and alcohol use as risk factors for higher-grade dysplasia in a population of patients with histopathologically proven ocular surface squamous neoplasia. Materials and methods: This is a retrospective chart review of data extracted from a database comprising demographic information and medical diagnosis information based on International Classification of Disease codes. Outcome measures were analyzed using the Wilcoxon two-sided test, a non-parametric t-test. Results: Database review yielded 35 patients with ocular surface squamous neoplasia lesions proven by histopathologic analysis. The mean age was 64.51 years with SD 17.54 years. Patients were 28.57% female and 71.43% male. Nearly all patients were White (88.57%), and 5.71% were African American, 2.86% Hispanic, and 2.86% Other. There was no significant difference in dysplasia grade between smokers and non-smokers (P=0.7044), those who used alcohol vs did not use alcohol (P=0.2470), those who used tobacco and alcohol vs those who did not (P=0.5117), and those who used either tobacco or alcohol vs those who did not (P=0.8259). Conclusion: No statistically significant relationship was found between high-grade dysplasia and cigarette smoking, alcohol use, or both cigarette smoking and alcohol use. Keywords: ocular surface squamous neoplasia, corneal dysplasia, conjunctival dysplasia, carcinoma in situ, squamous cell carcinoma, ocular surface tumor

The effect of transcranial direct current stimulation of the motor cortex on exercise-induced pain

Purpose: Transcranial direct current stimulation (tDCS) provides a new exciting means to investigate the role of the brain during exercise. However, this technique is not widely used in exercise science, with little known regarding effective electrode montages. This study investigated whether tDCS of the motor cortex (M1) would elicit an analgesic response to exercise-induced pain (EIP). Methods: Nine participants completed a VO2max test and three time to exhaustion (TTE) tasks on separate days following either 10 min 2 mA tDCS of the M1, a sham or a control. Additionally, seven participants completed 3 cold pressor tests (CPT) following the same experimental conditions (tDCS, SHAM, CON). Using a well-established tDCS protocol, tDCS was delivered by placing the anodal electrode above the left M1 with the cathodal electrode above dorsolateral right prefrontal cortex. Gas exchange, blood lactate, EIP and ratings of perceived exertion (RPE) were monitored during the TTE test. Perceived pain was recorded during the CPT. Results: During the TTE, no significant differences in time to exhaustion, RPE or EIP were found between conditions. However, during the CPT, perceived pain was significantly (P < 0.05) reduced in the tDCS condition (7.4 ± 1.2) compared with both the CON (8.6 ± 1.0) and SHAM (8.4 ± 1.3) conditions. Conclusion: These findings demonstrate that stimulation of the M1 using tDCS does not induce analgesia during exercise, suggesting that the processing of pain produced via classic measures of experimental pain (i.e., a CPT) is different to that of EIP. These results provide important methodological advancement in developing the use of tDCS in exercise