Andrew J. Barkmeier

Long-term visual outcomes following lens-sparing vitrectomy for retinopathy of prematurity

Aim To describe the long-term outcomes of lens-sparing vitrectomy (LSV) for retinopathy of prematurity (ROP). Methods Single-centre retrospective case series of eyes that underwent LSV for ROP between 1998 and 2005 and had a follow-up of at least 5 years. The primary outcome was the mean visual acuity, and secondary outcomes were the proportion of eyes without functional vision, proportion of eyes with anatomic success, proportion of Stage 4A eyes with vision better than 20/400, proportion of Stage 4B eyes with vision better than 20/800. Results Thirty-seven eyes of 30 patients (mean age at last follow-up: 7.1 years) were included in the study, while an additional 23 patients had been lost to follow-up and were not included in the study. Of eyes that underwent LSV for Stage 4A or 4B: 63% had measurable visual acuity (mean logMAR 0.92 for Stage 4A, 1.63 for Stage 4B), 19% had form vision, but neurological comorbidities precluded visual acuity measurement, and the remaining 18% had light perception or no light perception. Conclusions While most eyes that underwent LSV for Stage 4A or 4B ROP maintain useful vision with long-term follow-up, approximately one-fifth of eyes had no functional vision, and in a further fifth, vision could not be measured due to severe neurological impairment.

High Variation of Intravitreal Injection Rates and Medicare Anti–Vascular Endothelial Growth Factor Payments per Injection in the United States

PURPOSE To estimate geographic variation of intravitreal injection rates and Medicare anti-vascular endothelial growth factor (VEGF) drug costs per injection in aging Americans. DESIGN Observational cohort study using 2013 Medicare claims database. PARTICIPANTS United States fee-for-service (FFS) Part B Medicare beneficiaries and their providers. METHODS Medicare Provider Utilization and Payment Data furnished by the Centers for Medicare and Medicaid Services was used to identify all intravitreal injection claims and anti-VEGF drug claims among FFS Medicare beneficiaries in all 50 states and the District of Columbia in 2013. The rate of FFS Medicare beneficiaries receiving intravitreal injections and the mean Medicare-allowed drug payment per anti-VEGF injection was calculated nationally and for each state. Geographic variations were evaluated by using extremal quotient, coefficient of variation, and systematic component of variance (SCV). MAIN OUTCOME MEASURES Rate of FFS Medicare Part B beneficiaries receiving intravitreal injections (Current Procedural Terminology [CPT] code, 67028), nationally and by state; mean Medicare-allowed drug payment per anti-VEGF injection (CPT code, 67028; and treatment-specific J-codes, J0178, J2778, J9035, J3490, and J3590) nationally and by state. RESULTS In 2013, the rate of FFS Medicare beneficiaries receiving intravitreal injections varied widely by 7-fold across states (range by state, 4 per 1000 [Wyoming]-28 per 1000 [Utah]), averaging 19 per 1000 beneficiaries. The mean SCV was 8.5, confirming high nonrandom geographic variation. There were more than 2.1 million anti-VEGF drug claims, totaling more than

Retinal Pigment Epithelial Tears and the Management of Exudative Age-Related Macular Degeneration

2.3 billion in Medicare payments for anti-VEGF agents in 2013. The mean national Medicare drug payment per anti-VEGF injection varied widely by 6.2-fold across states (range by state,

Validity of Self-Report in Type 1 Diabetic Subjects for Laser Treatment of Retinopathy

242 [South Carolina]-

Optical Coherence Tomography in Retinal Arterial Occlusions: Case Series and Review of the Literature

1509 [Maine]), averaging

The Role of Systemic Risk Factors in Diabetic Retinopathy

1078 per injection. Nationally, 94% of injections were office based and 6% were facility based. CONCLUSIONS High variation was observed in intravitreal injection rates and in Medicare drug payments per anti-VEGF injection across the United States in 2013. Identifying factors that contribute to high variation may help the ophthalmology community to optimize further the delivery and use of anti-VEGF agents.

Central retinal vein occlusion after plateletpheresis.

Tears of the retinal pigment epithelium (RPE) are a known and potentially catastrophic complication of exudative age-related macular degeneration (AMD). Eyes with vascularized retinal pigment epithelial detachments (PED) are especially at risk for the development of RPE tears. This long-recognized complication faces increased scrutiny in an era of improved anti-angiogenic treatments for AMD, particularly given that these newly developed therapeutics have been implicated as a potential factor in the formation of some RPE tears.

Bevacizumab and diabetic vitrectomy.

PURPOSE This study sought to determine the validity of self-report of prior panretinal photocoagulation (PRP) and focal photocoagulation (FP) compared with fundus photography. DESIGN Prospective cohort study. PARTICIPANTS One thousand three hundred sixty-three type 1 diabetic subjects from the Epidemiology of Diabetes Interventions and Complications (EDIC) study, a subset of the 1441 subjects originally enrolled in the multicenter Diabetes Control and Complications Trial. METHODS At each annual visit, subjects were asked by EDIC staff whether they had undergone PRP, FP, or both since the last completed annual clinic visit. Fundus photographs were collected from one quarter of the cohort each year and from the entire cohort at EDIC years 4 and 10. Photographs were graded for the presence and extent of PRP and FP. Seventeen years of subject reporting and photograph grading of PRP and FP were compared in EDIC subjects. MAIN OUTCOME MEASURES The κ, sensitivity, specificity, and positive and negative predictive values were calculated for subject-reported PRP and FP. Factors influencing subject misreporting were investigated. RESULTS For subject reporting, 1244 (96%) of 1296 subjects with gradable photographs accurately reported whether they had a history of PRP in one or both eyes, and 1259 (97.5%) of 1291 with valid photographs correctly reported their history of FP. For PRP and FP, sensitivities were 90.4% and 74.0%, respectively; specificities were 96.0% and 98.8%, respectively; positive predictive values were 75.9% and 80.3%, respectively; negative predictive values were 98.9% and 98.4%, respectively; and κ values were 0.80 and 0.76, respectively. Risk factors associated with misreporting included prior laser for diabetic retinopathy and prior ocular surgery (each P<0.04). CONCLUSIONS For subjects with type 1 diabetes, in the absence of a clinical examination or fundus photographs, subject self-report could be a reliable tool in a well-monitored study for assessing laser treatment type in diabetic retinopathy.

Invasive conjunctival squamous cell carcinoma presenting with serous retinal detachment.

Abstract Retinal arterial occlusions (RAOs) are an uncommon source of monocular vision loss, typically occurring in patients over the age of 60. Diagnosis is typically made by history and clinical examination, while ancillary testing may include fluorescein angiography. Optical coherence tomography (OCT) is not routinely utilized in the diagnostic assessment of RAO, and its role in the diagnosis and management of patients with RAO is still evolving. In this series, we review the literature on OCT findings in RAOs, particularly noting the role of OCT in delineating anatomic findings, chronicity and natural course, and functional outcomes. A case series of five patients with RAOs is provided to illustrate these findings.

Subconjunctival Exposure to Carbopol Causes Chronic Histiocytic Inflammatory Response in Rabbits

Diabetic retinopathy is an increasingly common medical issue in the United States. The risk of developing the disease or having the disease progress is caused by many systemic health factors. This article examines the existing literature on the links between glycemic control, arterial hypertension, high cholesterol and hyperlipidemia, obesity, inflammatory markers, sleep-disordered breathing, and exercise with risk of diabetic retinopathy development and prevention. The literature shows benefit for good glycemic and blood pressure control. The effects of cholesterol, and lipid control, inflammatory markers, sleep-disordered breathing, obesity, and exercise are less well established.