Nonmedical costs and implications for patients seeking vitreoretinalcare

To measure nonreimbursable, nonmedical costs incurred by patients attending a vitreoretinal clinic appointment. A nurse-administered questionnaire designed to capture the nonmedical costs for a single clinical appointment was administered to patients attending an appointment at a single-center, single-physician, university-based vitreoretinal clinic. First day postoperative visits were excluded. End points were time commitment, time missing work, and median total nonmedical costs incurred. A subgroup analysis of Medicare patients who lived locally was performed. Three hundred and six patients completed the survey. The median nonreimbursable, nonmedical cost incurred was $23.32; the mean cost was$236.53 (range, $0-$7,259). The largest component of cost was transportation costs ($13.43). The patient took at least a day off from work in 27$21.53); the mean cost was $51.29 (range,$0-$1,255.80). This cohort also had a lower incidence of missing work (6%), and a higher incidence of an accompanying person (68%) who had a lower incidence of missing work (16%). The costs and distributions varied minimally by visit type. Physicians and policymakers may not recognize or consider the potential impediment to care that nonreimbursable costs may present when developing treatment strategies and designing policies

Comparison of Krypton and Argon Laser Photocoagulation: Results of Simulated Clinical Treatment of Primate Retina

• We compared the clinical and histological effects of argon blue-green laser (ABGL), argon green laser (AGL), and krypton red laser (KRL) photocoagulation on the primate retina. Burns were produced in juxtafoveal and papillomacular bundle and in nonmacular areas in a manner simulating treatment of a choroidal neovascular membrane (NVM). In the juxtafoveal and papillomacular bundle areas, ABGL photocoagulation caused extensive inner retinal damage while KRL photocoagulation spared inner retinal structures. The effects of AGL photocoagulation in the fovea were intermediate in extent between KRL and ABGL photocoagulation. Axonal transport studies also showed differential effects of these wavelengths on retinal ganglion cell function. Nonmacular effects were similar for all three modalities. These results suggest that the krypton red wavelength may be more suitable than the argon green or argon blue-green wavelengths in treating choroidal NVMs near the fovea

Simulated Treatment of Recurrent Choroidal Neovascularization in Primate Retina: Comparative Histopathologic Findings

• We simulated the treatment of recurrent choroidal neovascular membranes (CNVM) by applying two courses of laser treatment to monkey retinas. Argon green, argon blue-green, and krypton red lasers (KRLs) were used in juxtafoveal, papillomacular bundle, and nonmacular areas. The effects were examined clinically and histopathologically. Results of once-treated control eyes were consistent with those of previous studies. Repeat treatment, however, resulted in full-thickness retinal destruction or necrosis with all laser modalities and in all fundus locations. These results are consistent with the absorptive characteristics of xanthophyll and melanin and suggest only limited advantages to the KRL when treatment of recurrent CNVM is performed in a previously treated area of the fundus. However, treatment of recurrent CNVM is still probably most successful with a KRL, because recurrent CNVM is usually at a border of a photocoagulation scar, where the retina is still untreated, and because histologic studies have demonstrated inner retinal sparing with a KRL in juxtafoveal areas

Cell Proliferation After Laser Photocoagulation in Primate Retina: An Autoradiographic Study

• Argon blue-green laser and krypton red laser (KRL) photocoagulation were applied to primate retinas at intervals ranging from two to 23 days before the animals were killed. An injection of tritiated thymidine was given intravitreally three days before death. Argon bluegreen laser photocoagulation induced cell proliferation in the retina and retinal pigment epithelium seven days after treatment, with quiescence at 23 days. Krypton red laser photocoagulation induced similar cell proliferation not only in the retina and retinal pigment epithelium but also around choroidal vessels and in the stroma of the choroid. Peak thymidine uptake occurred seven days after KRL treatment. There was less uptake at two and 11 days and no uptake at 23 days. Thymidine uptake in the retina and choroid also was detected with low levels of KRL treatment. True cell hyperplasia (cell division) occurred after laser treatment; only KRL treatment induced cellular reaction in the choroid