Jasleen Singh

Specialty Practice and Cost Considerations in the Management of Uveitis Associated With Juvenile Idiopathic Arthritis

PURPOSE To evaluate whether cost, prior insurance authorization concerns, and subspecialty practice influence therapeutic decisions in the treatment of uveitis associated with juvenile idiopathic arthritis. METHODS A total of 2,965 pediatric ophthalmologists, uveitis specialists, retina specialists, and rheumatologists across the United States were surveyed via e-mail regarding their choice in long-term therapy for a hypothetical patient with uveitis associated with juvenile idiopathic arthritis. Outcomes of interest were differences in therapy choice based on cost/prior authorization and specialty practice. RESULTS There were significant differences in the use of methotrexate and biologics among specialists, both with and without consideration for cost and prior authorization. CONCLUSIONS Physicians in four different specialties who treat uveitis associated with juvenile idiopathic arthritis agree on methotrexate as a first-line treatment choice and a biologic immunosuppressive medication as a second choice, but there are significant differences between the specialties in their use of these medications. Cost and insurance considerations did not affect therapy selection. [J Pediatr Ophthalmol Strabismus. 2016;53(4):246-251.].

Ocular Manifestations of Allergic and Immunologic Diseases

The immune system is a complex defense system of the human body. Allergy is an exaggerated response of the immune system, and immunodeficiency is the lack of an adequate immune system. Both of these disease processes have both systemic and ophthalmic manifestations, which can include hypersensitivity reactions, infections, autoimmunities, and uveitides. This chapter reviews the common and rare manifestations of both allergic and immunologic diseases.

Pediatric ocular trauma caused by recreational drones: two case reports

Drones are increasingly being used by children and adults recreationally and commercially. The propeller blades when spinning at high speeds may cause serious harm to the eye and orbital structures. We report 2 cases of injuries to the eye and orbital structures caused by drones.

Validation of the CHOP model for detecting severe retinopathy of prematurity in a cohort of Colorado infants

Editor, A recently published large-scale study (Mimouni et al. 2016) identified hyperopia as the parameter that demonstrated the strongest association with retreatment after excimer laser refractive surgery. We do share this observation as we also note less accurate refractive predictability and, most frequently, final undercorrection after hyperopic corneal refractive surgery. To improve refractive predictability, preceding studies (Zaldivar et al. 2005; Spadea et al. 2006) suggested that preoperative cycloplegic or manifest refraction, or a combination of both (Zadok et al. 2003), could be used in the laser nomogram. Previously, we reported that a manifest-cycloplegic difference (MCD) in spherical equivalent (SE) of 1.00 dioptre (D) or more occurs in about 13% of hyperopic eyes. In these cases, a correction of the manifest SE only did not appear to be adequate (Frings et al. 2016a). In a recent multicentre study, we thus evaluated the efficacy, predictability and safety of LASIK retreatment based on manifest refraction in hyperopic patients with a preoperative difference between cycloplegic and manifest refraction of 1.00 D or less who had LASIK retreatment based on manifest refraction. We analysed the refractive outcome of 113 hyperopic eyes according to standard graphs for reporting the efficacy, predictability and safety of refractive surgery. We found that efficacy (p < 0.001) and safety (p = 0.004) were statistically significant improved by the retreatment without being negatively influenced by preoperative manifest SE, manifest cylinder or keratometry, which we analysed. Still showing a trend towards undercorrection, retreatment resulted in 88 eyes (78.0%) that reached 0.50 D of the attempted correction. The optical zone diameter of the retreatment did not correlate with efficacy, predictability or safety. Treatment predictability, however, was statistically significant worse in eyes with a preoperative SE of more than 2.50 D (p = 0.005, tested with chisquare test). In our opinion, the main objective criterion for a retreatment is a difference between targeted and achieved manifest SE of 0.50 D or more after at least 6 months. We do not retreat eyes earlier after LASIK as keratometric and refractive changes are likely to occur up to 6 months (Frings et al. 2016b). The results of our study indicate that in hyperopic eyes with a preoperative difference between cycloplegic and manifest refraction of 1.00 D or less a LASIK retreatment is efficient, predictable and safe and therefore, finally meets preoperative patients’ expectations. To summarize, the improvement of hyperopic LASIK still is a matter of discussion, hyperopes should not be treated earlier than 6 months and the difference between cycloplegic and manifest refraction should be taken into account during treatment planning. Many hyperopic cases will likely need a retreatment, most of which result in high efficacy, predictability and safety after all. We would highly recommend clarifying this fact to hyperopic LASIK candidates before the treatment.