Therapeutic Decisions in Intermediate and Posterior Uveitis
Ozzello and Palestine evaluated the physician decision-making process among uveitis and retina specialists in the treatment of intermediate and posterior uveitis. They found that cost, prior authorization from patients’ insurance providers, subspecialty practice, and pregnancy concerns all had a significant impact on the choice of therapy.
A total of 934 uveitis and retina specialists were surveyed via e-mail regarding their choice in long-term therapy for three hypothetical patients with uveitic conditions: Behçet disease, birdshot retinochoroiditis, and intermediate uveitis. Respondents were asked to select first- and second-choice therapies and then reselect first and second choices assuming 1) costs of all options were the same for the patient, and 2) there would be no issues with insurance prior to treatment authorization. They were also asked for their treatment preferences if the patient desired a pregnancy.
Out of the 106 respondents who completed the survey, 44 were uveitis specialists and 62 were retina specialists. Cost and prior authorization affected the therapy choices of uveitis specialists treating ocular Behçet disease. In addition, when cost and prior authorization were equalized, the two specialist groups differed in their first choice in therapy for Behçet disease and pars planitis, with uveitis and retina specialists choosing a biologic agent and immunomodulator, respectively, for Behçet disease and an immunomodulator and local implant, respectively, for pars planitis. When pregnancy was a consideration, both uveitis and retina specialists changed their therapeutic choices for intermediate uveitis.
Circadian Macular Volume Changes in the Choroid
Seidel et al. investigated the circadian fluctuation of the macular choroidal volume in healthy adults by means of spectral-domain optical coherence tomography (SDOCT) and found higher values at night and lower values during the day.
In this prospective, observational case series, 30 eyes of 15 patients with a median age of 26 years underwent SD-OCT scans to measure macular choroidal volume every three hours over a 24-hour period. The mean ocular perfusion pressure was calculated for each eye at each of the eight time points. The circadian fluctuation of the choroidal volume and its association with axial length, mean ocular perfusion pressure, and intraocular pressure were then assessed using a linear mixed model.
The researchers found that macular choroidal volume was lowest at midday and highest at 3 a.m. Of all factors tested, only mean ocular perfusion pressure showed a significant association with volume fluctuation.
Predicting Uveitis in Children With Juvenile Idiopathic Arthritis
Haasnoot et al. analyzed inflammatory parameters as possible predictors for the development of uveitis in children with juvenile idiopathic arthritis. They found that elevated erythrocyte sedimentation rates (ESRs) were a significant predictor for the occurrence of chronic anterior uveitis in these patients.
This retrospective cohort study included 358 children with oligoarthritis and rheumatoid factor–negative polyarthritis. The researchers assessed the following for their predictive value regarding onset of uveitis: ESRs, C-reactive protein, leukocyte count, the presence of antinuclear antibodies and HLA-B27, age of onset of juvenile idiopathic arthritis, and sex.
One hundred forty-seven patients (41 percent) were diagnosed with chronic anterior uveitis. According to univariate analyses, younger age at onset, the presence of antinuclear antibodies, and elevated ESR appeared to be predictive factors. According to multivariate analysis, younger age and elevated ESR appeared to be predictive.
Use of Smartphone Ophthalmoscopy for Grading Diabetic Retinopathy
Russo et al. compared the accuracy and reliability of smartphone ophthalmoscopy and slit-lamp biomicroscopy in grading diabetic retinopathy (DR) and found considerable agreement between the two methods.
This comparative clinical study included 120 patients (240 eyes) with type 1 or type 2 diabetes. After pupil dilation, all patients first underwent smartphone ophthalmoscopy, followed by dilated retinal slit-lamp examination, to grade DR based on a five-step scale.
Overall exact agreement between the two methods was observed in 85 percent of patients. Agreement within one step was observed in 97 percent. Compared with biomicroscopy, the sensitivity and specificity of smart-phone ophthalmoscopy for the detection of clinically significant macular edema were 81 percent and 98 percent, respectively. Smartphone ophthalmoscopy and biomicroscopy could not be used to grade DR and examine the fundus in 3 percent and 13 percent of patients, respectively, because of cataract and/or small pupil diameter.
The researchers concluded that the portability, affordability, and connectivity of a smartphone ophthalmoscope make it a promising device for community screening programs.
American Journal of Ophthalmology summaries are edited by Thomas J. Liesegang, MD.
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