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Southerland JL, Elahi M, Zheng S, Dodson K, Rogers P, Orr A, Rowe DJ, Jalal H, Yousefi S. Factors Influencing Vision Health and Eye Care among Older Adults in Northeast Tennessee. South Med J 2024; 117:291-295. [PMID: 38830581 DOI: 10.14423/smj.0000000000001700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
OBJECTIVES The purpose of this study was to examine the factors associated with vision impairment (VI), age-related eye disease (ARED), and frequency of eye examinations among older adults. METHODS A cross-sectional study (N = 166) was designed to identify barriers in vision and eye care services among adults 50 years and older in four counties in Appalachian Tennessee. Surveys were administered in March 2023. Simple and multiple logistic regression analyses were used to determine the risk factors of VI and ARED and the frequency of eye examinations. RESULTS In two out of the three regression models, predictors such as traveling >10 mi to an eye care provider, barriers to eye care, and a lack of exposure to eye health information emerged as significant factors. Individuals who traveled >10 mi to an eye care provider were more than twice as likely than individuals who traveled shorter distances to have VI and not maintain routine eye care (adjusted odds ratio [AOR] 2.69, 95% confidence interval [CI] 1.08-6.75; AOR 2.82, 95% CI 1.05-7.55, respectively). Reporting barriers to eye care doubled the odds of ARED (AOR 2.33, 95% CI 1.02-5.34) and substantially increased the odds of reporting a 3-year or longer interval since the last eye examination (AOR 7.45, 95% CI 1.85-29.96) compared with having no barriers to eye care. Moreover, limited exposure to eye health information tripled the odds of VI (AOR 3.26, 95% CI 1.15-9.24) and not maintaining routine eye care (AOR 3.07, 95% CI 0.97-9.70) compared with more exposure to eye health information. Other predictors also were uncovered in the analysis. CONCLUSIONS This study contributes to the scarce literature on risk factors associated with vision health among older adults in Appalachia.
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Affiliation(s)
- Jodi L Southerland
- From the Department of Community and Behavioral Health, East Tennessee State University, College of Public Health, Johnson City
| | - Muhammad Elahi
- Quillen College of Medicine, College of Public Health, East Tennessee State University, Johnson City
| | - Shimin Zheng
- Department of Epidemiology & Biostatistics, College of Public Health, East Tennessee State University, Johnson City
| | - Kayla Dodson
- Department of Epidemiology & Biostatistics, College of Public Health, East Tennessee State University, Johnson City
| | | | - Alberta Orr
- Hunter College of the City University of New York, New York, New York
| | - DiAnna J Rowe
- Quillen College of Medicine, College of Public Health, East Tennessee State University, Johnson City
| | - Hamza Jalal
- Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Siamak Yousefi
- Department of Ophthalmology, University of Tennessee Health Science Center, Memphis
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Liu SH, Shaughnessy D, Leslie L, Abbott K, Abraham AG, McCann P, Saldanha IJ, Qureshi R, Li T. Social Determinants of Dry Eye in the United States: A Systematic Review. Am J Ophthalmol 2024; 261:36-53. [PMID: 38242339 PMCID: PMC11031303 DOI: 10.1016/j.ajo.2024.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 01/03/2024] [Accepted: 01/12/2024] [Indexed: 01/21/2024]
Abstract
PURPOSE To conduct a systematic review to summarize current evidence on associations between social determinants of health (SDOH) indicators and dry eye in the United States. DESIGN Systematic review. METHODS We followed a protocol registered on Open Science Framework to include studies that examined associations between SDOH indicators and dry eye. We mapped SDOH indicators to 1 of the 5 domains following the Healthy People 2030 framework and categorized dry eye measures into "dry eye diagnosis and care," "dry eye symptoms," or "ocular surface parameters." We summarized the direction of association between SDOH indicators and dry eye as worsening, beneficial, or null. We used items from the Newcastle Ottawa Scale to assess risk of bias. RESULTS Eighteen studies reporting 51 SDOH indicators, mostly mapped to the neighborhood and built environment domain, were included. Thirteen studies were judged at high risk of bias. Fifteen of 19 (79%) associations revealed an increase in the diagnosis of dry eye or delayed specialty care for it. Thirty-four of 56 (61%) associations unveiled exacerbated dry eye symptoms. Fifteen of 23 (65%) found null associations with corneal fluorescein staining. Ten of 22 (45%) associations revealed an increased tear break up time (45%) whereas another 10 (45%) showed null associations. CONCLUSIONS Most SDOH indicators studied were associated with unfavorable dry eye measures, such as a higher disease burden, worse symptoms, or delayed referral, in the United States. Future investigations between SDOH and dry eye should use standardized instruments and address the domains in which there is an evidence gap.
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Affiliation(s)
- Su-Hsun Liu
- Department of Ophthalmology, School of Medicine (S.H.L., L.L., K.A., P.M., R.Q., T.L.), University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA; Department of Epidemiology (S.H.L., D.S., A.G.A., R.Q., T.L.), Colorado School of Public Health, Aurora, Colorado, USA
| | - Daniel Shaughnessy
- Department of Epidemiology (S.H.L., D.S., A.G.A., R.Q., T.L.), Colorado School of Public Health, Aurora, Colorado, USA
| | - Louis Leslie
- Department of Ophthalmology, School of Medicine (S.H.L., L.L., K.A., P.M., R.Q., T.L.), University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Kaleb Abbott
- Department of Ophthalmology, School of Medicine (S.H.L., L.L., K.A., P.M., R.Q., T.L.), University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Alison G Abraham
- Department of Epidemiology (S.H.L., D.S., A.G.A., R.Q., T.L.), Colorado School of Public Health, Aurora, Colorado, USA
| | - Paul McCann
- Department of Ophthalmology, School of Medicine (S.H.L., L.L., K.A., P.M., R.Q., T.L.), University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Ian J Saldanha
- Department of Epidemiology (I.J.S.), Bloomberg School of Public Health, Baltimore, Maryland, USA; Johns Hopkins Center for Clinical Trials and Evidence Synthesis (I.J.S.), Baltimore, Maryland, USA
| | - Riaz Qureshi
- Department of Ophthalmology, School of Medicine (S.H.L., L.L., K.A., P.M., R.Q., T.L.), University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA; Department of Epidemiology (S.H.L., D.S., A.G.A., R.Q., T.L.), Colorado School of Public Health, Aurora, Colorado, USA
| | - Tianjing Li
- Department of Ophthalmology, School of Medicine (S.H.L., L.L., K.A., P.M., R.Q., T.L.), University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA; Department of Epidemiology (S.H.L., D.S., A.G.A., R.Q., T.L.), Colorado School of Public Health, Aurora, Colorado, USA.
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Diamond DF, Hirji S, Xing SX, Gorroochurn P, Horowitz JD, Wang Q, Park L, Harizman N, Maruri SC, Henriquez DR, Liebmann JM, Cioffi GA, Hark LA. Manhattan Vision Screening and Follow-Up Study (NYC-SIGHT): optometric exam improves access and utilization of eye care services. Graefes Arch Clin Exp Ophthalmol 2024; 262:1619-1631. [PMID: 38189973 DOI: 10.1007/s00417-023-06344-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/22/2023] [Accepted: 12/12/2023] [Indexed: 01/09/2024] Open
Abstract
PURPOSE To describe the benefits of optometric evaluation for detection of vision-affecting conditions in the context of community-based eye health screenings and identify factors associated with having a recent dilated eye exam. METHODS Enrolled participants were age 40 and older, living independently in affordable housing developments in New York City. Eye health screening failure and criteria for seeing the on-site study optometrist were defined as visual acuity 20/40 or worse in either eye, intraocular pressure 23-29 mmHg, or an unreadable fundus image. The optometrist conducted a manifest refraction using loose lenses and used a portable slit lamp and ophthalmoscope to perform a non-dilated anterior and posterior segment ocular health evaluation. Demographics, social determinants of health, eye health screening results, and rates of suspected ophthalmic conditions were recorded. To determine factors associated with having a recent dilated eye exam, which was the main outcome for this statistical analysis, a stepwise multivariate logistic regression was performed. RESULTS A total of 708 participants were screened, 308 attended the optometric exam; mean age 70.7 ± 11.7 [standard deviation (SD)] years. Among this subgroup, 70.1% identified as female, 54.9% self-identified as African American, 39% as Hispanic/Latino, and 26.6% Dominican ethnicity; 78.2% (241/308) had not undergone a dilated eye exam within the last year, 71.4% reported they did not have an eye care provider. Stepwise multivariate logistic regression analysis indicated that participants who self-reported having cataracts (odds ratio (OR) 2.15; 95% confidence interval (CI) 1.03-4.47; p = 0.041), self-reported having glaucoma/glaucoma suspect (OR 5.60; 95% CI 2.02-15.43; p = 0.001), or spoke Spanish as their primary language (OR 3.25; 95% CI 1.48-7.11; p = 0.003) had higher odds of having a recent dilated eye exam. CONCLUSIONS This community-based screening initiative demonstrated the effectiveness of optometric exams in detecting vision-affecting conditions and identified factors associated with having a recent dilated eye exam. Optometrists play a vital role in increasing access to eye care for high-risk, underserved populations. TRIAL REGISTRATION ClinicalTrials.gov (NCT04271709).
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Affiliation(s)
- Daniel F Diamond
- Department of Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Sitara Hirji
- Department of Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Samantha X Xing
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Prakash Gorroochurn
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Jason D Horowitz
- Department of Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Qing Wang
- Department of Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Lisa Park
- Department of Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Noga Harizman
- Department of Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Stefania C Maruri
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Desiree R Henriquez
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Jeffrey M Liebmann
- Department of Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - George A Cioffi
- Department of Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Lisa A Hark
- Department of Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA.
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Antonio-Aguirre B, Block SS, Asare AO, Baldanado K, Ciner EB, Coulter RA, DeCarlo DK, Drews-Botsch C, Fishman D, Hartmann EE, Killeen OJ, Yuen J, Collins ME. Association of Sociodemographic Characteristics with Pediatric Vision Screening and Eye Care: An Analysis of the 2021 National Survey of Children's Health. Ophthalmology 2024; 131:611-621. [PMID: 38086435 DOI: 10.1016/j.ophtha.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 12/05/2023] [Accepted: 12/05/2023] [Indexed: 02/17/2024] Open
Abstract
PURPOSE Vision screening and regular eye care can help detect and treat potentially irreversible vision impairment. This study aims to investigate the associations between sociodemographic and health characteristics and the receipt of eye care among children aged 17 years and younger in the United States. DESIGN This cross-sectional study used data from the National Survey of Children's Health (NSCH), a nationally representative and population-based survey of randomly sampled households. PARTICIPANTS Participants were children aged 0 to 17 years, residing in all 50 states and the District of Columbia, whose caregivers or parents answered an address-based survey by mail or online. METHODS Weighted prevalence calculations were applied to analyze the data, and logistic regression was performed to explore associations between reported eye care and demographic, health, and parent-related variables. MAIN OUTCOME MEASURES Caregiver-reported vision screenings, referral to an eye doctor after vision screening, eye doctor visits, and prescription of corrective lenses. RESULTS Caregivers reported that 53.2% of children had a vision screening at least once (if child ≤ 5 years) or within the past 2 years (if child > 5 years). Of those screened, 26.9% were referred to an eye doctor. Overall, 38.6% of all children had a previous eye doctor visit, and among them, 55.4% were prescribed corrective lenses during the visit. Factors associated with decreased odds of vision screening included younger age, lack of health care visits, no insurance coverage, parent education high school or less, and lower household income. Non-White ethnicities, households with a non-English primary language, and lower incomes were more likely to be referred to an eye doctor after vision screening. Lower rates of eye doctor visits were associated with younger age, lack of insurance coverage, and primary household languages other than English. CONCLUSIONS Children from disadvantaged backgrounds are less likely to receive vision screening and eye care. Targeted strategies are needed to increase vision screening and access to eye care services in these vulnerable groups. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
| | | | - Afua O Asare
- John A. Moran Eye Center, Department of Ophthalmology & Visual Sciences, Spencer Fox Eccles School of Medicine at the University of Utah Health, Salt Lake City, Utah
| | | | - Elise B Ciner
- Salus University Pennsylvania College of Optometry, Elkins Park, Pennsylvania
| | | | - Dawn K DeCarlo
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | | | | | | | | | - Jenay Yuen
- University of Southern California, Los Angeles, California
| | - Megan E Collins
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland.
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5
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Woodward MA, Hicks PM, Harris-Nwanyanwu K, Modjtahedi B, Chan RVP, Vogt EL, Lu MC, Newman-Casey PA. Eye Care in Federally Qualified Health Centers. Ophthalmology 2024:S0161-6420(24)00274-4. [PMID: 38697267 DOI: 10.1016/j.ophtha.2024.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 04/08/2024] [Accepted: 04/23/2024] [Indexed: 05/04/2024] Open
Abstract
PURPOSE To assess changes in vision care availability at Federally Qualified Health Centers (FQHCs) between 2017 and 2021 and whether neighborhood-level demographic social risk factors (SRFs) associated with eye care services provided by FQHCs. DESIGN Secondary data analysis of the Health Resources and Services Administration (HRSA) data and 2017-2021 American Community Survey (ACS). PARTICIPANTS Federally Qualified Health Centers. METHODS Patient and neighborhood characteristics for SRFs were summarized. Differences in FQHCs providing and not providing vision care were compared via Wilcoxon-Mann-Whitney tests for continuous measures and chi-square tests for categorical measures. Logistic regression models were used to test the associations between neighborhood measures and FQHCs providing vision care, adjusted for patient characteristics. MAIN OUTCOME MEASURES Odds ratios (ORs) with 95% confidence intervals (CIs) for neighborhood-level predictors of FQHCs providing vision care services. RESULTS Overall, 28.5% of FQHCs (n = 375/1318) provided vision care in 2017 versus 32% (n = 435/1362) in 2021 with some increases and decreases in both the number of FQHCs and those with and without vision services. Only 2.6% of people who accessed FQHC services received eye care in 2021. Among the 435 FQHCs that provided vision care in 2021, 27.1% (n = 118) had added vision services between 2017 and 2021, 71.5% (n = 311) had been offering vision services since at least 2017, and 1.4% (n = 6) were newly established. FQHCs providing vision care in 2021 were more likely to be in neighborhoods with a higher percentage of Hispanic/Latino individuals (OR, 1.08, 95% CI, 1.02-1.14, P = 0.0094), Medicaid-insured individuals (OR, 1.08, 95% CI, 1.02-1.14, P = 0.0120), and no car households (OR, 1.07, 95% CI, 1.01-1.13, P = 0.0142). However, FQHCs with vision care, compared to FQHCs without vision care, served a lower percentage of Hispanic/Latino individuals (27.2% vs. 33.9%, P = 0.0007), Medicaid-insured patients (42.8% vs. 46.8%, P < 0.0001), and patients living at or below 100% of the federal poverty line (61.3% vs. 66.3%, P < 0.0001). CONCLUSIONS Vision care services are available at a few FQHCs, localized to a few states. Expanding eye care access at FQHCs would meet patients where they seek care to mitigate vision loss to underserved communities. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
- Maria A Woodward
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan.
| | - Patrice M Hicks
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| | | | - Bobeck Modjtahedi
- Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, California; Department of Clinical Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California; Eye Monitoring Center, Kaiser Permanente Southern California, Baldwin Park, California
| | - R V Paul Chan
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, Illinois
| | - Emily L Vogt
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| | - Ming-Chen Lu
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| | - Paula Anne Newman-Casey
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
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Tang T, Tran D, Han D, Zeger SL, Crews DC, Cai CX. Place, Race, and Lapses in Diabetic Retinopathy Care. JAMA Ophthalmol 2024:2817627. [PMID: 38662344 PMCID: PMC11046402 DOI: 10.1001/jamaophthalmol.2024.0974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 02/24/2024] [Indexed: 04/26/2024]
Abstract
This cohort study investigates the association of neighborhood-level social determinants of health with lapses in diabetic retinopathy care by race and ethnicity.
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Affiliation(s)
- Tina Tang
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Diep Tran
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Dingfen Han
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Scott L. Zeger
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Deidra C. Crews
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Cindy X. Cai
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland
- Department of Biomedical Informatics and Data Science, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland
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Khurana RN, Wang JC, Zhang S, Li C, Lum F. Loss to Follow up in Patients with Proliferative Diabetic Retinopathy Treated with Anti-VEGF Therapy and/or Panretinal Photocoagulation in the United States. Ophthalmol Retina 2024:S2468-6530(24)00191-X. [PMID: 38657954 DOI: 10.1016/j.oret.2024.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 04/10/2024] [Accepted: 04/11/2024] [Indexed: 04/26/2024]
Abstract
PURPOSE To determine the rate of loss to follow up (LTFU) in patients with proliferative diabetic retinopathy (PDR) treated with anti-VEGF therapy and/or panretinal photocoagulation (PRP) in the United States. DESIGN Retrospective cohort study using the national IRIS® (Intelligent Research in Sight) Registry data. SUBJECTS A total of 73 595 eyes of 56 590 patients with PDR diagnosed between 2013 and 2015 and treated between 2013 and 2018. METHODS Multivariable logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). MAIN OUTCOME MEASURES Loss to follow up was no follow up within 12 months from last treatment. RESULTS For patient eyes treated for PDR, 11.7% (95% CI, 11.5-12.0) were LTFU. Among patients with PDR treated with anti-VEGF therapy alone, PRP alone, and anti-VEGF and PRP, the rates of LTFU were 12.3% (95% CI, 11.8-12.7), 12.6% (95% CI, 12.1-13.0), and 10.8% (95% CI, 10.4-11.1), respectively. Risk factors for LTFU include Black or African American race/ethnicity (odds ratio [OR], 1.26; 95% CI, 1.13-1.41; P < 0.001), Hispanic ethnicity (OR, 1.28; 95% CI, 1.16-1.42; P < 0.001), Native American/Alaska Native or Native Hawaiian/Other Pacific Islander race/ethnicity (OR, 2.69; 95% CI, 2.14-3.38; P < 0.001), and unilateral disease (OR, 2.05; CI, 1.88-2.23; P < 0.001). Odds for LTFU were higher with patients with baseline vision of 20/50 to 20/200 (OR, 1.25; 95% CI, 1.15-1.36; P < 0.001) and with vision worse than 20/200 (OR, 1.22; 95% CI, 1.05-1.42; P = 0.01) than for patient eyes with a baseline visual acuity of 20/40 or better. Odds for LTFU were lower for Medicare Fee-for-Service (OR, 0.71; 95% CI, 0.64-0.79; P < 0.001) and Medicare Managed (OR, 0.66; 95% CI, 0.56-0.78; P < 0.001) compared with private insurance. Odds for LTFU were lower for patients treated in the Midwest (OR, 0.72; 95% CI, 0.64-0.81; P < 0.001) and West (OR, 0.83; 95% CI, 0.74-0.94; P = 0.003) compared with in the South region. CONCLUSIONS The rate of LTFU is between 10% and 12% among patients with PDR who were treated with anti-VEGF injections and/or PRP. Risk factors include Black or African American race/ethnicity, Hispanic ethnicity, baseline vision worse than 20/40, private insurance, South region, and unilateral disease. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Rahul N Khurana
- Northern California Retina Vitreous Associates, Mountain View, California; Department of Ophthalmology, University of California, San Francisco, San Francisco, California.
| | - Jay C Wang
- Northern California Retina Vitreous Associates, Mountain View, California; Department of Ophthalmology, University of California, San Francisco, San Francisco, California
| | - Sen Zhang
- American Academy of Ophthalmology, San Francisco, California
| | - Charles Li
- American Academy of Ophthalmology, San Francisco, California
| | - Flora Lum
- American Academy of Ophthalmology, San Francisco, California
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8
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Heilenbach N, Ogunsola T, Elgin C, Fry D, Iskander M, Abazah Y, Aboseria A, Alshamah R, Alshamah J, Mooney SJ, Maestre G, Lovasi GS, Patel V, Al-Aswad LA. Novel Methods of Identifying Individual and Neighborhood Risk Factors for Loss to Follow-Up After Ophthalmic Screening. J Glaucoma 2024; 33:288-296. [PMID: 37974319 PMCID: PMC10954411 DOI: 10.1097/ijg.0000000000002328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 10/09/2023] [Indexed: 11/19/2023]
Abstract
PRCIS Residence in a middle-class neighborhood correlated with lower follow-up compared with residence in more affluent neighborhoods. The most common explanations for not following up were the process of making an appointment and lack of symptoms. PURPOSE To explore which individual-level and neighborhood-level factors influence follow-up as recommended after positive ophthalmic and primary care screening in a vulnerable population using novel methodologies. PARTICIPANTS AND METHODS From 2017 to 2018, 957 participants were screened for ophthalmic disease and cardiovascular risk factors as part of the Real-Time Mobile Teleophthalmology study. Individuals who screened positive for either ophthalmic or cardiovascular risk factors were contacted to determine whether or not they followed up with a health care provider. Data from the Social Vulnerability Index, a novel virtual auditing system, and personal demographics were collected for each participant. A multivariate logistic regression was performed to determine which factors significantly differed between participants who followed up and those who did not. RESULTS As a whole, the study population was more socioeconomically vulnerable than the national average (mean summary Social Vulnerability Index score=0.81). Participants whose neighborhoods fell in the middle of the national per capita income distribution had a lower likelihood of follow-up compared with those who resided in the most affluent neighborhoods (relative risk ratio=0.21, P -value<0.01). Participants cited the complicated process of making an eye care appointment and lack of symptoms as the most common reasons for not following up as instructed within 4 months. CONCLUSIONS Residence in a middle-class neighborhood, difficulty accessing eye care appointments, and low health literacy may influence follow-up among vulnerable populations.
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Affiliation(s)
- Noah Heilenbach
- New York University, Grossman School of Medicine, Department of Ophthalmology
| | | | | | - Dustin Fry
- Drexel University, Dornsife School of Public Health, Urban Health Collaborative
| | - Mina Iskander
- University of Miami, Miller School of Medicine, Department of Medicine
| | - Yara Abazah
- New York University, Grossman School of Medicine, Department of Ophthalmology
| | - Ahmed Aboseria
- State University of New York, Downstate Health Sciences University College of Medicine
| | - Rahm Alshamah
- New York University, Grossman School of Medicine, Department of Ophthalmology
| | - Jad Alshamah
- New York University, Grossman School of Medicine, Department of Ophthalmology
| | | | - Gladys Maestre
- University of Texas, Rio Grande Valley School of Medicine
| | - Gina S. Lovasi
- Drexel University, Dornsife School of Public Health, Urban Health Collaborative
| | - Vipul Patel
- New York University, Grossman School of Medicine, Department of Ophthalmology
| | - Lama A. Al-Aswad
- University of Pennsylvania, Scheie Eye Institute, Department of Ophthalmology
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Ali M, Dun C, Cho K, Soiberman U, Woreta F, Makary MA, Jhanji V, Srikumaran D. Infectious Keratitis After Keratoplasty in the United States: Analysis of a National Medicare Claims Data Set. Cornea 2024; 43:452-458. [PMID: 37903336 DOI: 10.1097/ico.0000000000003405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 08/26/2023] [Indexed: 11/01/2023]
Abstract
PURPOSE The aim of this study was to assess the incidence, trends, and risk factors of infectious keratitis (IK) and subsequent repeat keratoplasty after penetrating keratoplasty (PK) and endothelial keratoplasty (EK). METHODS Using a retrospective cohort study design, IK cases within 6 months of keratoplasty were identified using billing codes among 100% Medicare beneficiaries aged 65 years and older who underwent either PK or EK between 2011 and 2020. Multivariable logistic regression models were used to evaluate factors associated with postkeratoplasty IK. RESULTS We identified 115,588 keratoplasties, of which 20.0% (n = 23,144) were PK and 80.0% (n = 92,444) were EK. IK developed within 6 months with a rate of 3.32% (n = 769) post-PK and 0.72% (n = 666) post-EK. Overall rates of IK decreased from 16.05 to 9.61 per 1000 keratoplasties between 2011 and 2020 ( P < 0.001). The median interval between keratoplasty and diagnosis of IK was 73 days (interquartile range: 29-114 days) for PK and 74 days (interquartile range: 38-116 days) for EK. After IK, 22.9% (n = 176) and 23.8% (n = 159) eyes underwent repeat keratoplasty within 1 year for PK and EK, respectively. The occurrence of IK after PK was associated with age 85 years and older [odds ratio (OR): 1.38; 95% confidence interval (CI): 1.13-1.68] relative to patients aged 65 to 74 years. The occurrence of IK after EK was also associated with age 85 years and older (OR: 1.44; 95% CI: 1.14-1.82) relative to patients aged 65 to 74 years. CONCLUSIONS IK was 4 times more common after PK than EK and the complication was associated with older age. Our findings may help corneal surgeons in counseling patients at higher risk and guiding their postoperative care.
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Affiliation(s)
| | - Chen Dun
- Departments of Surgery and
- Biomedical Informatics and Data Science, Johns Hopkins University, Baltimore, MD; and
| | | | | | | | | | - Vishal Jhanji
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA
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Hekmatjah N, Ou Y. Bridging the Digital Divide: Ensuring Equity in At-Home Glaucoma Monitoring. Ophthalmol Glaucoma 2024:S2589-4196(24)00029-2. [PMID: 38530695 DOI: 10.1016/j.ogla.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 02/05/2024] [Accepted: 02/09/2024] [Indexed: 03/28/2024]
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Killeen OJ, Niziol LM, Elam AR, Bicket AK, John D, Wood SD, Musch DC, Zhang J, Johnson L, Kershaw M, Woodward MA, Newman-Casey PA. Visual Impairment from Uncorrected Refractive Error among Participants in a Novel Program to Improve Eye Care Access among Low-Income Adults in Michigan. Ophthalmology 2024; 131:349-359. [PMID: 37758028 PMCID: PMC10922592 DOI: 10.1016/j.ophtha.2023.09.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 08/07/2023] [Accepted: 09/15/2023] [Indexed: 10/03/2023] Open
Abstract
PURPOSE To assess the rate of visual impairment (VI) from uncorrected refractive error (URE) and associations with demographic and socioeconomic factors among low-income patients presenting to the Michigan Screening and Intervention for Glaucoma and Eye Health through Telemedicine (MI-SIGHT) program. DESIGN Cross-sectional study. PARTICIPANTS Adults ≥ 18 years without acute ocular symptoms. METHODS MI-SIGHT program participants received a telemedicine-based eye disease screening and ordered glasses through an online optical store. Participants were categorized based on refractive error (RE) status: VI from URE (presenting visual acuity [PVA], ≤ 20/50; best-corrected visual acuity [BCVA], ≥ 20/40), URE without VI (PVA, ≥ 20/40; ≥ 2-line improvement to BCVA), and no or adequately corrected RE (PVA, ≥ 20/40; < 2-line improvement to BCVA). Patient demographics, self-reported visual function, and satisfaction with glasses obtained through the program were compared among groups using analysis of variance, Kruskal-Wallis, chi-square, and Fisher exact testing. MAIN OUTCOME MEASURES PVA, BCVA, and presence of VI (defined as PVA ≤ 20/50). RESULTS Of 1171 participants enrolled in the MI-SIGHT program during the first year, average age was 55.1 years (SD = 14.5), 37.7% were male, 54.1% identified as Black, and 1166 (99.6%) had both PVA and BCVA measured. VI was observed in 120 participants (10.3%); 96 had VI from URE (8.2%), 168 participants (14.4%) had URE without VI, and 878 (75.3%) had no or adequately corrected RE. A smaller percentage of participants with VI resulting from URE reported having a college degree, and a larger percentage reported income < $10 000 compared with participants with no or adequately corrected RE (3.2% vs. 14.2% [P = 0.02]; 45.5% vs. 21.6% [P < 0.0001], respectively). Visual function was lowest among participants with VI from URE, followed by those with URE without VI, and then those with no or adequately corrected RE (9-item National Eye Institute Visual Function Questionnaire composite score, 67.3 ± 19.6 vs. 77.0 ± 14.4 vs. 82.2 ± 13.3, respectively; P < 0.0001). In total, 71.2% (n = 830) ordered glasses for an average cost of $36.80 ± $32.60; 97.7% were satisfied with their glasses. CONCLUSIONS URE was the main cause of VI at 2 clinics serving low-income communities and was associated with reduced vision-related quality of life. An online optical store with lower prices made eyeglasses accessible to low-income patients. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Olivia J Killeen
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Leslie M Niziol
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| | - Angela R Elam
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Amanda K Bicket
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| | - Denise John
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| | - Sarah Dougherty Wood
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| | - David C Musch
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Jason Zhang
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| | | | | | - Maria A Woodward
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Paula Anne Newman-Casey
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan.
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Rein DB, Herring-Nathan ER. Vision Need Profiles for the City of Richmond, Virginia: A Pilot Application of Calibration Methods to Vision Surveillance. OPHTHALMOLOGY SCIENCE 2024; 4:100429. [PMID: 38187127 PMCID: PMC10767496 DOI: 10.1016/j.xops.2023.100429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 11/07/2023] [Accepted: 11/08/2023] [Indexed: 01/09/2024]
Abstract
Purpose People with vision problems (VPs) have different needs based on their age, economic resources, housing type, neighborhood, and other disabilities. We used calibration methods to create synthetic data to estimate census tract-level community need profiles (CNPs) for the city of Richmond, Virginia. Design Cross-sectional secondary data analysis. Subjects Anonymized respondents to the 2015 to 2019 American Community Survey (ACS). Methods We used calibration methods to transform the ACS 5-year tabular (2015-2019) and Public Use Microdata estimates into a synthetic data set of person-level records in each census tract, and subset the data to persons who answered yes to the question "Are you blind or do you have serious difficulty seeing even when wearing glasses?" To identify individual need profiles (INPs), we applied divisive clustering to 17 variables measuring individual demographics, nonvision disability status, socioeconomic status (SES), housing, and access and independence. We labeled tracts with CNP names based on their predominant INPs and performed sensitivity analyses. We mapped the CNPs and overlayed information on the number of people with VP, the National Walkability Index, and an uncertainty measure based on our sensitivity analysis. Main Outcome Measures Individual need profiles and CNPs. Results Compared with people without VP, people with VP exhibited higher rates of disabilities, having low incomes, living alone, and lacking access to the internet or private home vehicles. Among people with VP, we identified 7 INP clusters which we mapped into 6 CNPs: (1) seniors (≥ age 65); (2) low SES younger; (3) low SES older; (4) mixed SES; (5) higher SES; and (6) adults and children in group quarters. Three CNPs had lower-than-average walkability. Community need profile assignments were somewhat sensitive to calibration variables, with 18 tracts changing assignments in 1 sensitivity analysis, and 4 tracts changing assignments in ≥ 2 sensitivity analyses. Conclusions This pilot project illustrates the feasibility of using ACS data to better understand the support and service needs of people with VP at the census tract level. However, a subset of categorical CNP assignments were sensitive to variable selection leading to uncertainty in CNP assignment in certain tracts. Financial Disclosures The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Stults CD, Liang SY, Wilcox J, Nyong’o OL. Amblyopia Care Trends Following Widespread Photoscreener Adoption. JAMA Ophthalmol 2024; 142:188-197. [PMID: 38300546 PMCID: PMC10835608 DOI: 10.1001/jamaophthalmol.2023.6434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 11/28/2023] [Indexed: 02/02/2024]
Abstract
Importance Amblyopia can result in permanent vision loss if not properly treated before age 7 years. In 2017, the US Preventive Services Task Force recommended that vision screening should occur at least once in all children aged 3 to 5 years to detect amblyopia. Objective To understand trends and factors associated with screening, referral, or diagnosis of amblyopia before and after photoscreening expansion across a relatively large health care system in late 2017. Design, Setting, and Participants This is a retrospective cohort study of electronic health record data from patients with a well child care visit at approximately age 3 years (ages 2.75-3.25 years) in a relatively large, multispecialty group practice in Northern California and linked census data between 2015 and 2022. Data were extracted and analyzed from October 2022 through August 2023. Exposures Patient sex, race and ethnicity, immunization records, previous well child care visits, and census-level median household income. Main Outcomes and Measures Vision screening, pediatric ophthalmology referral, or amblyopia diagnosis, compared using adjusted odds ratios (AORs). Results The study included 2015-2017 data from 23 246 patients aged 3 years with at least 1 well child care visit (11 206 [48.2%] female) compared with 2018-2022 postexpansion data from 34 281 patients (16 517 [48.2%] female). The screening rate increased from 5.7% (424 of 7505) in 2015 to 72.1% (4578 of 6354) in 2022. The referral rate increased from 17.0% (1279 of 7505) in 2015 to 23.6% (1836 of 7792) in 2018. The diagnosis rate was 2.7% (200 of 7505) in 2015, peaked at 3.4% (263 of 7792) in 2018, and decreased to 1.4% (88 of 6354) in 2022. Compared with White patients, patients who were Asian, Black, or Hispanic were less likely to be screened (Asian: AOR, 0.80; 95% CI, 0.72-0.88; Black: AOR, 0.71; 95% CI, 0.53-0.96; Hispanic: AOR, 0.88; 95% CI, 0.80-0.97). Compared with White patients, patients who were Asian or Hispanic were more likely to be referred (Asian: AOR, 1.49; 95% CI, 1.36-1.62; Hispanic: AOR, 1.32; 95% CI, 1.18-1.48) and were more likely to be diagnosed (Asian: AOR, 1.29; 95% CI, 1.07-1.56; Hispanic: AOR, 1.67; 95% CI, 1.33-2.11). Conclusions and Relevance In this study, increased availability of photoscreeners was associated with an increase in overall rates of vision screening for children aged 3 years in a relatively large health care system. Given that US rates of visual impairment are predicted to increase, additional targeted interventions would be needed to address remaining disparities in amblyopia care along patient- and clinician-level factors.
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Affiliation(s)
- Cheryl D. Stults
- Palo Alto Medical Foundation Research Institute, Center for Health Systems Research, Sutter Health, Palo Alto, California
| | - Su-Ying Liang
- Palo Alto Medical Foundation Research Institute, Center for Health Systems Research, Sutter Health, Palo Alto, California
| | - Joseph Wilcox
- Center for Health Systems Research, Sutter Health, Walnut Creek, California
| | - Omondi L. Nyong’o
- Crescendo MD, Portola Valley, California
- Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California
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Wu P, Yii CY, Yong SB. Comment on "The risk assessment of uveitis after COVID-19 diagnosis". J Med Virol 2024; 96:e29494. [PMID: 38402601 DOI: 10.1002/jmv.29494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 02/05/2024] [Accepted: 02/13/2024] [Indexed: 02/27/2024]
Affiliation(s)
- Patrick Wu
- College of Medicine, Lake Erie College of Osteopathic Medicine, Bradenton, Florida, USA
| | - Chin-Yuan Yii
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Landseed International Hospital, Taoyuan, Taiwan
| | - Su-Boon Yong
- Department of Allergy and Immunology, China Medical University Children's Hospital, Taichung, Taiwan
- Department of Medicine, China Medical University, Taichung, Taiwan
- Center for Allergy, Immunology, and Microbiome (A.I.M.), China Medical University Hospital, Taichung, Taiwan
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Ross E, Alfonso CA. Psychodynamic Psychiatry and the Care of Persons with Vision Loss and Blindness. Psychodyn Psychiatry 2024; 52:1-7. [PMID: 38426754 DOI: 10.1521/pdps.2024.52.1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
The authors describe the clinical relevance of the psychiatric concept of bidirectionality when caring for persons with comorbid disorders, and they propose a psychodynamic framework to guide the treatment of persons with vision loss and blindness. Since persons with vision loss have an increased risk of depressive and anxiety disorders, they recommend targeted screening, integrated services, and a biopsychosocial approach to clinical care. The psychoanalytic concept of aphanisis, first described by Ernest Jones and later developed by Lacan and Kohut, is briefly discussed. Common psychotherapy themes in the treatment of persons who experience vision loss from systemic illness include reactivation of memories of past traumas resulting in avoidance, social withdrawal, depressive states, catastrophic thinking, a sense of foreshortened future, anhedonia, and fear of disintegration and invisibility. Psychotherapy also serves to correct negative introjects from ableist societal attitudes.
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Affiliation(s)
- Edward Ross
- Lighthouse Guild International; New York Institute for Psychoanalytic Self-Psychology
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Cho WKT, Hwang DG. Sociodemographic Disparities in Preoperative Visual Acuity and Cataract Surgery Utilization in the San Francisco Bay Area. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-01914-4. [PMID: 38329693 DOI: 10.1007/s40615-024-01914-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/23/2023] [Accepted: 01/17/2024] [Indexed: 02/09/2024]
Abstract
OBJECTIVE We examined whether cataract surgery utilization and preoperative visual acuity were associated with patient-specific factors, including ocular findings and comorbidities, general biomedical factors, and/or sociodemographic factors. DESIGN Retrospective, cross-sectional study. SUBJECTS, PARTICIPANTS, AND/OR CONTROLS We reviewed the electronic health records of patients from 2012 to 2022 who were examined and followed for at least 2 years by an eye care provider at University of California San Francisco Health (UCSF Health) and who had cataract in at least one eye associated with best-corrected visual acuity of 20/25 or worse. Data include ocular factors (e.g., best-corrected visual acuity, lens opacity grade, diagnoses of glaucoma, and/or age-related macular degeneration), biomedical comorbidities, and sociodemographic factors including race/ethnicity, health insurance coverage, primary language spoken, and social vulnerability index. METHODS Logistic and multivariate regression analyses. MAIN OUTCOME MEASURES We examined cataract surgery utilization and preoperative best-corrected visual acuity. RESULTS Compared to White and Asian patients, Black patients had the lowest rates of cataract surgery utilization and the poorest mean preoperative visual acuities, with Hispanic patients following in second place in both categories. However, when the analysis controlled for sociodemographic and biomedical factors, Medicaid insurance and speaking Chinese as a primary language emerged as significant associations. In addition, higher cataract surgery utilization rates were associated with worse preoperative best-corrected visual acuity, a concurrent diagnosis of glaucoma, and a concurrent diagnosis of macular degeneration. Worse preoperative visual acuity was associated with Spanish or Chinese language preference, Medicaid status, and glaucoma diagnosis; poorer preoperative visual acuity was only weakly correlated with increased social vulnerability. CONCLUSIONS After adjusting for other biomedical and sociodemographic variables, having Medicaid insurance and being a non-English speaker were the factors most notably associated with reduced cataract surgery utilization and poorer preoperative visual acuity. Health insurance and language barriers, as well as other biomedical and sociodemographic factors, may explain a large proportion of the racial disparities in both cataract surgery utilization and preoperative visual acuity observed among Black and Hispanic patients. Chinese-speaking patients with limited English proficiency are a vulnerable subgroup that exhibits lower rates of cataract surgery utilization and higher degrees of visual loss prior to undergoing cataract surgery compared to other Asian patients.
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Affiliation(s)
- Wendy K Tam Cho
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA.
- Departments of Political Science, Statistics, Mathematics, Computer Science, and Asian-American Studies, University of Illinois, Urbana-Champaign, Urbana, IL, USA.
- The College of Law, University of Illinois, Urbana-Champaign, Urbana, IL, USA.
- The National Center for Supercomputing Applications, University of Illinois, Urbana-Champaign, Urbana, IL, USA.
| | - David G Hwang
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA
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Terheyden JH, Fink DJ, Mercieca K, Wintergerst MWM, Holz FG, Finger RP. Knowledge about age-related eye diseases in the general population in Germany. BMC Public Health 2024; 24:409. [PMID: 38331775 PMCID: PMC10851458 DOI: 10.1186/s12889-024-17889-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 01/25/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND With a rising prevalence of age-related eye diseases, prevention and early diagnosis of these conditions are key goals of public eye health. Disease-related knowledge in the general public supports these goals but there is little data available. Thus, we have assessed knowledge of cataract, glaucoma, age-related macular degeneration (AMD) and diabetic eye disease in the German adult general population in a cross-sectional study and identified target groups for health education interventions. METHODS Knowledge assessment content was identified based on a literature review, expert input, and a list of items was generated after a qualitative selection process. The resulting 16-item instrument (4 items per condition) was administered to 1,008 participants from a survey panel, demographically representative of the adult German population. Test properties were evaluated based on a Rasch model and multiple correspondence analysis (MCA). Binary-logistic regression analysis was performed to investigate associations with age, sex, education level, employment status, marital status, income, reported health status, visual difficulties, and recent general practitioner (GP) and ophthalmologist consultations. RESULTS Replies were correct for a median of 9 out of 16 (range 2 - 16) items, which differed between conditions (p < 0.0001). Most responses were correct for cataract items (median: 3 / 4) and least were correct for AMD items (median: 2 / 4). 27%, 9%, 1% and 19% of respondents replied correctly to all cataract, glaucoma, AMD and diabetic eye disease-related items, respectively. Rasch analysis suggested an adequate targeting of items and in MCA, no evidence of multidimensionality was present. Older age, being retired, decreased general health and recent GP or ophthalmology consultations were significantly associated with more knowledge about common eye conditions (p ≤ 0.005). GP or ophthalmology consultations remained significant in a multivariable model (p ≤ 0.011). CONCLUSIONS Knowledge gaps regarding eye health are considerable in the German general population and should therefore be addressed in educational interventions targeting the public. Special attention when designing such campaigns needs to be paid to infrequent users of the healthcare system. Knowledge of AMD seems to be poorer compared to other eye conditions.
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Affiliation(s)
- Jan Henrik Terheyden
- Department of Ophthalmology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, NRW, Germany.
| | - David J Fink
- Department of Ophthalmology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, NRW, Germany
| | - Karl Mercieca
- Department of Ophthalmology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, NRW, Germany
| | | | - Frank G Holz
- Department of Ophthalmology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, NRW, Germany
| | - Robert P Finger
- Department of Ophthalmology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, NRW, Germany
- Department of Ophthalmology, University Hospital Mannheim & Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
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Johnson-Griggs MA, Hicks PM, Lu MC, Sherman E, Niziol LM, Elam AR, Woodward MA, Bicket AK, Killeen OJ, Wood S, John D, Johnson L, Kershaw M, Musch DC, Newman-Casey PA. Relationship between Unstable Housing, Food Insecurity, and Vision Status in the MI-SIGHT Community Eye Disease Screening Program. Ophthalmology 2024; 131:140-149. [PMID: 37709171 PMCID: PMC11044600 DOI: 10.1016/j.ophtha.2023.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 08/21/2023] [Accepted: 09/06/2023] [Indexed: 09/16/2023] Open
Abstract
PURPOSE Assess rate of visual impairment (VI) from uncorrected refractive error (URE) and associations with demographic and socioeconomic factors among low-income patients presenting to the Michigan Screening and Intervention for Glaucoma and Eye Health through Telemedicine (MI-SIGHT) program. DESIGN Cross-sectional study. PARTICIPANTS Adults ≥ 18 years without acute ocular symptoms. METHODS MI-SIGHT program participants received a telemedicine-based eye disease screening and ordered glasses through an online optical shop. Participants were categorized based on refractive error (RE) status: VI from URE (presenting visual acuity [PVA] ≤ 20/50, best corrected visual acuity [BCVA] ≥ 20/40), URE without VI (PVA ≥ 20/40, had ≥ 2 lines of improvement to BCVA), and no or adequately corrected RE (PVA ≥ 20/40, < 2 line improvement to BCVA). Patient demographics, self-reported visual function, and satisfaction with glasses obtained through the program were compared between groups using analysis of variance, Kruskal-Wallis, chi-square, and Fisher exact testing. MAIN OUTCOME MEASURES PVA, BCVA, and presence of VI (defined as PVA ≤ 20/50). RESULTS Of 1171 participants enrolled in the MI-SIGHT program during the first year, the average age was 55.1 years (standard deviation = 14.5), 37.7% were male, 54.1% identified as Black, and 1166 (99.6%) had both PVA and BCVA measured. VI was observed in 120 (10.3%); 96 had VI from URE (8.2%), 168 (14.4%) had URE without VI, and 878 (75.3%) had no or adequately corrected RE. A smaller percentage of participants with VI from URE reported having a college degree and a larger percentage reported income < $10 000 compared to participants with no or adequately corrected RE (3.2% versus 14.2%, P = 0.02; 45.5% versus 21.6%, respectively, P < 0.0001. Visual function was lowest among participants with VI from URE, followed by those with URE without VI, and then those with no or adequately corrected RE (VFQ9 composite score 67.3 ± 19.6 versus 77.0 ± 14.4 versus 82.2 ± 13.3, respectively; P < 0.0001). 71.2% (n = 830) ordered glasses for an average cost of $36.80 ± $32.60; 97.7% were satisfied with their glasses. CONCLUSIONS URE was the main cause of VI at 2 clinics serving low-income communities and was associated with reduced vision-related quality of life. An online optical shop with lower prices made eyeglasses accessible to low-income patients. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Mikaelah A Johnson-Griggs
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan
| | - Patrice M Hicks
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| | - Ming-Chen Lu
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| | - Eric Sherman
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| | - Leslie M Niziol
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| | - Angela R Elam
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| | - Maria A Woodward
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Amanda K Bicket
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| | - Olivia J Killeen
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| | - Sarah Wood
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| | - Denise John
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| | | | | | - David C Musch
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan; Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Paula Anne Newman-Casey
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan.
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Hark LA, Lin WV, Hirji S, Gorroochurn P, Horowitz JD, Diamond DF, Park L, Wang Q, Auran JD, Maruri SC, Henriquez DR, Sharma T, Valenzuela I, Liebmann JM, Cioffi GA, Friedman DS, Harizman N. Manhattan Vision Screening and Follow-Up Study (NYC-SIGHT): Subanalysis of Referral to Ophthalmology. Curr Eye Res 2024; 49:197-206. [PMID: 37812506 DOI: 10.1080/02713683.2023.2269614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 10/08/2023] [Indexed: 10/11/2023]
Abstract
PURPOSE The Manhattan Vision Screening and Follow-up Study aims to provide access to eye care for underserved populations, detect native rates of ocular pathology, and refer participants with eye disease to ophthalmology. This subanalysis describes the reasons for referral to ophthalmology and identifies risk factors associated with being referred. METHODS Enrolled participants were aged ≥40 years, living independently in public housing developments and able to provide consent for eye health screenings. Those with habitual visual acuity 20/40 or worse, intraocular pressure (IOP) 23-29 mmHg, or an unreadable fundus image failed and were scheduled with the on-site optometrist. The optometric exam determined whether further referral to ophthalmology for a clinic exam was warranted. Those with an abnormal image or IOP ≥30 mmHg were referred directly to ophthalmology. Main outcome was factors associated with referral to ophthalmology. RESULTS A total of 708 individuals completed the eye health screening over 15 months. A total of 468 participants were referred to ophthalmology (250 had an abnormal image and 218 were referred by the optometrist). Those referred were predominantly older adults (mean age 70.0 ± 11.4 years), female (66.7%), African American (55.1%) and Hispanic (39.5%). Seventy percent of participants had not had a recent eye exam. Stepwise multivariate logistic regression analysis showed that participants with pre-existing glaucoma (OR 3.14, 95% CI 1.62 to 6.08, p = 0.001), an IOP ≥23 mmHg (OR 5.04, 95% 1.91 to 13.28, p = 0.001), or vision impairment (mild) (OR 2.51, 95% CI 1.68 to 3.77, p = 0.001) had significantly higher odds of being referred to ophthalmology. CONCLUSION This targeted community-based study in Upper Manhattan provided access to eye care and detected a significant amount of ocular pathology requiring referral to ophthalmology in this high-risk population.
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Affiliation(s)
- Lisa A Hark
- Department of Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Weijie Violet Lin
- Department of Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Sitara Hirji
- Department of Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Prakash Gorroochurn
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Jason D Horowitz
- Department of Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Daniel F Diamond
- Department of Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Lisa Park
- Department of Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Qing Wang
- Department of Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - James D Auran
- Department of Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Stefania C Maruri
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Desiree R Henriquez
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Tarun Sharma
- Department of Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Ives Valenzuela
- Department of Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Jeffrey M Liebmann
- Department of Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - George A Cioffi
- Department of Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - David S Friedman
- Harvard Medical School, Massachusetts Eye and Ear Infirmary, Glaucoma Service, Boston, MA, USA
| | - Noga Harizman
- Department of Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
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20
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Higginbotham EJ. Striving Toward Better Eye Health Beyond Our Waiting Rooms: The LXXX Edward Jackson Memorial Lecture. Am J Ophthalmol 2024; 257:165-177. [PMID: 37777079 DOI: 10.1016/j.ajo.2023.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 09/14/2023] [Accepted: 09/16/2023] [Indexed: 10/02/2023]
Abstract
PURPOSE Visual impairment (VI) negatively impacts the quality of lives of individuals and the optimal health of populations, creating both human and financial costs. Yet, VI has not risen to a level that is considered a priority in population health. This analysis assesses the evidence currently available for strengthening the value proposition for eye health, particularly the demographic characteristics and patient-centered outcomes found in clinical research. DESIGN Retrospective cross-sectional analysis. METHOD Two searches of the AJO database were performed using relevant key words: Search 1 (S1): NEI-sponsored clinical trials (1970-2023); and Search 2 (S2): Quality of life (2018-2023). The Scopus Cite Score was used as a filter for each search, specifically ≥50 for S1 and ≥20 for S2. RESULTS Of the initial 466 articles found, 100 met the preestablished criteria. Age, sex, and race/ancestry/ethnicity were reported across glaucoma, retina, uveitis, cornea, and pediatrics subspecialties in 56% ± 9.7% of the articles; 37% ± 9.5% listed either age only or age, sex, or gender. The characterizations varied and subcategories were rarely reported. Only 2% of S1 and 25% of S2 noted patient-centered outcomes. CONCLUSIONS The characterization of study populations in the ophthalmic literature is limited by underreporting of patient-centered outcomes, useful for reaffirming the value of eye and vision health in population health. This analysis highlights the need for paying greater attention to more specific demographic categories and focusing more on patient-centered outcomes in clinical research.
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Affiliation(s)
- Eve J Higginbotham
- Professor of Ophthalmology, Scheie Eye Institute; Perelman School of Medicine; Senior Fellow, Leonard Davis Institute for Health Economics; University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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21
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Li C, Lum F, Chen EM, Collender PA, Head JR, Khurana RN, Cunningham ET, Moorthy RS, Parke DW, McLeod SD. Shifts in ophthalmic care utilization during the COVID-19 pandemic in the US. COMMUNICATIONS MEDICINE 2023; 3:181. [PMID: 38097811 PMCID: PMC10721809 DOI: 10.1038/s43856-023-00416-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 11/24/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Healthcare restrictions during the COVID-19 pandemic, particularly in ophthalmology, led to a differential underutilization of care. An analytic approach is needed to characterize pandemic health services usage across many conditions. METHODS A common analytical framework identified pandemic care utilization patterns across 261 ophthalmic diagnoses. Using a United States eye care registry, predictions of utilization expected without the pandemic were established for each diagnosis via models trained on pre-pandemic data. Pandemic effects on utilization were estimated by calculating deviations between observed and expected patient volumes from January 2020 to December 2021, with two sub-periods of focus: the hiatus (March-May 2020) and post-hiatus (June 2020-December 2021). Deviation patterns were analyzed using cluster analyses, data visualizations, and hypothesis testing. RESULTS Records from 44.62 million patients and 2455 practices show lasting reductions in ophthalmic care utilization, including visits for leading causes of visual impairment (age-related macular degeneration, diabetic retinopathy, cataract, glaucoma). Mean deviations among all diagnoses are 67% below expectation during the hiatus peak, and 13% post-hiatus. Less severe conditions experience greater utilization reductions, with heterogeneities across diagnosis categories and pandemic phases. Intense post-hiatus reductions occur among non-vision-threatening conditions or asymptomatic precursors of vision-threatening diseases. Many conditions with above-average post-hiatus utilization pose a risk for irreversible morbidity, such as emergent pediatric, retinal, or uveitic diseases. CONCLUSIONS We derive high-resolution insights on pandemic care utilization in the US from high-dimensional data using an analytical framework that can be applied to study healthcare disruptions in other settings and inform efforts to pinpoint unmet clinical needs.
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Affiliation(s)
- Charles Li
- American Academy of Ophthalmology, San Francisco, CA, USA.
| | - Flora Lum
- American Academy of Ophthalmology, San Francisco, CA, USA
| | - Evan M Chen
- Department of Ophthalmology, University of California, San Francisco, CA, USA
| | - Philip A Collender
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA, USA
| | - Jennifer R Head
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, CA, USA
| | - Rahul N Khurana
- Department of Ophthalmology, University of California, San Francisco, CA, USA
- Northern California Retina Vitreous Associates, Mountain View, CA, USA
| | - Emmett T Cunningham
- Department of Ophthalmology, California Pacific Medical Center, San Francisco, CA, USA
- The Francis I. Proctor Foundation, UCSF School of Medicine, San Francisco, CA, USA
- Department of Ophthalmology, Stanford University School of Medicine, Stanford, CA, USA
| | - Ramana S Moorthy
- Associated Vitreoretinal and Uveitis Consultants, Carmel, IN, USA
- Department of Ophthalmology, Indiana University Medical Center, Indianapolis, IN, USA
| | - David W Parke
- American Academy of Ophthalmology, San Francisco, CA, USA
| | - Stephen D McLeod
- American Academy of Ophthalmology, San Francisco, CA, USA
- Department of Ophthalmology, University of California, San Francisco, CA, USA
- The Francis I. Proctor Foundation, UCSF School of Medicine, San Francisco, CA, USA
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22
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Lee T, Wollstein G, Madu CT, Wronka A, Zheng L, Zambrano R, Schuman JS, Hu J. Reducing Ophthalmic Health Disparities Through Transfer Learning: A Novel Application to Overcome Data Inequality. Transl Vis Sci Technol 2023; 12:2. [PMID: 38038606 PMCID: PMC10697175 DOI: 10.1167/tvst.12.12.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 11/01/2023] [Indexed: 12/02/2023] Open
Abstract
Purpose Race disparities in the healthcare system and the resulting inequality in clinical data among different races hinder the ability to generate equitable prediction results. This study aims to reduce healthcare disparities arising from data imbalance by leveraging advanced transfer learning (TL) methods. Method We examined the ophthalmic healthcare disparities at a population level using electronic medical records data from a study cohort (N = 785) receiving care at an academic institute. Regression-based TL models were usesd, transferring valuable information from the dominant racial group (White) to improve visual field mean deviation (MD) rate of change prediction particularly for data-disadvantaged African American (AA) and Asian racial groups. Prediction results of TL models were compared with two conventional approaches. Results Disparities in socioeconomic status and baseline disease severity were observed among the AA and Asian racial groups. The TL approach achieved marked to comparable improvement in prediction accuracy compared to the two conventional approaches as evident by smaller mean absolute errors or mean square errors. TL identified distinct key features of visual field MD rate of change for each racial group. Conclusions The study introduces a novel application of TL that improved reliability of the analysis in comparison with conventional methods, especially in small sample size groups. This can improve assessment of healthcare disparity and subsequent remedy approach. Translational Relevance TL offers an equitable and efficient approach to mitigate healthcare disparities analysis by enhancing prediction performance for data-disadvantaged group.
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Affiliation(s)
- TingFang Lee
- Department of Ophthalmology, NYU Langone Health, New York, NY, USA
- Departments of Population Health, NYU Langone Health, New York, NY, USA
| | - Gadi Wollstein
- Department of Ophthalmology, NYU Langone Health, New York, NY, USA
- Center of Neural Science, NYU College of Arts and Sciences, New York, NY, USA
- Department of Biomedical Engineering, NYU Tandon School of Engineering, Brooklyn, NY, USA
| | - Chisom T Madu
- Department of Ophthalmology, NYU Langone Health, New York, NY, USA
| | - Andrew Wronka
- Department of Ophthalmology, NYU Langone Health, New York, NY, USA
| | - Lei Zheng
- Department of Ophthalmology, NYU Langone Health, New York, NY, USA
| | - Ronald Zambrano
- Department of Ophthalmology, NYU Langone Health, New York, NY, USA
| | - Joel S Schuman
- Glaucoma Service, Wills Eye Hospital, Philadelphia, PA, USA
| | - Jiyuan Hu
- Departments of Population Health, NYU Langone Health, New York, NY, USA
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23
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Pelayo C, Mora Pinzón M, Lock LJ, Fowlkes C, Stevens CL, Hoang J, Garcia JL, Jacobson NA, Channa R, Liu Y. Factors Influencing Eye Screening Adherence Among Latinx Patients With Diabetes: A Qualitative Study. Transl Vis Sci Technol 2023; 12:8. [PMID: 38060234 PMCID: PMC10709803 DOI: 10.1167/tvst.12.12.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 11/07/2023] [Indexed: 12/08/2023] Open
Abstract
Purpose Latinx populations have the highest rates of visual impairment and blindness of any ethnic group in the United States, with most cases of diabetic retinopathy remaining undiagnosed. We aimed to identify factors influencing adherence with diabetic eye screening in Latinx communities. Methods We conducted semistructured individual interviews with adult Latinx patients in Dane County, WI. Interviews were transcribed verbatim, translated from Spanish to English, and analyzed using QSR NVivo software. We performed both inductive open coding and deductive coding using the National Institute on Minority Health and Health Disparities Research Framework, as well as the Campbell and Egede Model. Results All participants (n = 20) self-identified as Latinx and were diagnosed with type 2 diabetes. The mean age was 61.5 years (range 33-79 years). Most participants were uninsured (60%), self-reported low or moderate health literacy (60%), and preferred to speak Spanish during their clinic appointments (75%). Individual-level barriers to diabetic eye screening included limited eye health literacy, lack of insurance coverage, and low self-efficacy with diabetes management. Health system-level facilitators included a recommendation to obtain eye screening from a primary care provider and the use of nonwritten forms of patient education. Community-level barriers included social isolation, concerns about inconveniencing others, machismo, and immigration status. Conclusions We identified several health system- and community-level factors, in addition to individual-level factors, influencing adherence with diabetic eye screening in Latinx communities. Translational Relevance Strategies addressing these factors may enhance the effectiveness of interventions to prevent blindness from diabetes and contribute to advancing health equity in Latinx communities.
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Affiliation(s)
- Christian Pelayo
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Maria Mora Pinzón
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Loren J. Lock
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Christiana Fowlkes
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Chloe L. Stevens
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Johnson Hoang
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Juan L. Garcia
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Nora A. Jacobson
- Institute for Clinical and Translational Research, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Roomasa Channa
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Yao Liu
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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24
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Ali AA, Chauhan MZ, Doty M, Bui T, Phillips PH, Sallam AB. Ophthalmology Faculty Diversity Trends in the US. JAMA Ophthalmol 2023; 141:1021-1028. [PMID: 37824107 PMCID: PMC10570920 DOI: 10.1001/jamaophthalmol.2023.4476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 08/20/2023] [Indexed: 10/13/2023]
Abstract
Importance Enhancing the diversity of ophthalmologists can potentially contribute to diminishing disparities in eye care. Objectives To investigate longitudinal trends in the representation of individuals underrepresented in medicine (URiM) and women among ophthalmology faculty compared with other specialties and to assess disparities between ophthalmology faculty demographic characteristics and the US population. Design, Setting, and Participants In this cross-sectional study, a comprehensive analysis of Association of American Medical Colleges Faculty Roster data between 2000 and 2021 was conducted, using data from the US Medical School Faculty report on 56 438 ophthalmology faculty members. Main Outcomes and Measures The data set was used to differentiate ophthalmology faculty members by gender, rank, and designation as a URiM individual. Outcome measures included changes in URiM and non-URiM faculty proportions, faculty rank, gender, department chair positions, and the US population between 2000 and 2021. Results A total of 56 438 ophthalmology faculty members (37 511 men [66.5%]) were included in the study. The number of ophthalmology faculty increased from 1820 in 2000 to 3151 in 2021. Across all years, URiM female faculty represented 3.1% of ophthalmologists (1733 of 56 438), while URiM men accounted for 3.5% (1983 of 56 438). Overall, non-URiM men constituted 63.0% of ophthalmologists (35 528 of 56 438), and non-URiM women accounted for 30.5% (17 194 of 56 438). The proportion of URiM male faculty remained stable from 2000 to 2021 (63 of 1820 [3.5%] vs 104 of 3151 [3.3%]), with a small increase in URiM women faculty at junior faculty positions (2000, 40 of 1820 [2.2%]; 2021, 129 of 3151 [4.1%]; difference, 1.9% [95% CI, 0.9%-2.9%]). Proportions of non-URiM men decreased from 71.2% (1295 of 1820) in 2000 to 55.3% (1743 of 3151) in 2021 (difference, 15.8% [95% CI, 13.1%-18.6%]) and proportions of non-URiM women increased from 23.2% (422 of 1820) in 2000 to 37.3% (1175 of 3151) in 2021 (difference, 14.1% [95% CI, 11.5%-16.7%]). In terms of faculty rank, there were increases in representation of women from 2000 to 2021 at assistant professor (from 11.2% [203 of 1819] to 19.7% [622 of 3165]; difference, 8.5% [95% CI, 6.5%-10.5%]), associate professor (from 4.6% [83 of 1819] to 8.6% [271 of 3165]; difference, 4.0% [95% CI, 2.6%-5.4%]), and professor levels (from 2.8% [51 of 1819] to 7.1% [223 of 3165]; difference, 4.3% [95% CI, 3.9%-6.1%]). URiM representation remained stable at most ranks. Compared with other specialties, ophthalmology had among the lowest percentage change in URiM faculty. The expansion of ophthalmology's URiM faculty representation was less than one-third that of the diverse US population. Conclusion and Relevance These findings highlight substantial growth in ophthalmology faculty and an increase in women's representation across several faculty ranks. However, URiM representation has remained largely unchanged, despite an increase at the associate professor level. This finding emphasizes the need for continued efforts to enhance diversity in academic ophthalmology.
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Affiliation(s)
- Arsalan A. Ali
- Anne Burnett Marion School of Medicine, Fort Worth, Texas
| | - Muhammad Z. Chauhan
- Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock
| | - Madison Doty
- Anne Burnett Marion School of Medicine, Fort Worth, Texas
| | | | - Paul H. Phillips
- Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock
| | - Ahmed B. Sallam
- Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock
- Department of Ophthalmology, Ain Shams University Hospitals, Cairo, Egypt
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25
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Antonio-Aguirre B, Ambrosino CM, Dai X, Collins ME. Addressing Health Disparities in Pediatric Eye Care for School-Age Children: A Call to Action. Transl Vis Sci Technol 2023; 12:17. [PMID: 37962540 PMCID: PMC10653256 DOI: 10.1167/tvst.12.11.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 09/25/2023] [Indexed: 11/15/2023] Open
Abstract
Disparities in access to pediatric eye care among school-age children pose significant challenges to their health and well-being; addressing these disparities will necessitate coordination across multiple systems. Although vision screenings are mandated in most US states, differences persist in terms of who receives screenings and subsequent follow-up care. Racial, ethnic, and socioeconomic factors exacerbate the issue, with potential ramifications of unaddressed eye problems on learning performance and the risk of widening preexisting educational disparities. To address these challenges, various initiatives and strategic plans have emphasized the need to improve access, enhance diversity in the workforce, and promote health literacy. School-based vision programs (SBVPs) have shown promise in improving access to care and academic outcomes, but issues with integration into the health care system exist. This article explores opportunities to address structural barriers, establish resilient and equitable systems for delivering pediatric eye care to school-age children, and leverage the success of SBVPs to build stronger connections with community providers. Proposed strategies include developing standardized guidelines; establishing referral mechanisms; fostering communication with parents, teachers, and community providers; and promoting eye health literacy across the school community. Collectively, these measures aim to improve health outcomes, address social determinants of health, and reduce disparities in access to care.
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Affiliation(s)
| | | | - Xi Dai
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Megan E. Collins
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, USA
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26
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Jamal O, Mallipatna A, Hwang SW, Dimaras H. Social Determinants of Health in Pediatric Ophthalmology Patients: Availability of Data in the Electronic Health Record and Association With Clinic Attendance. Transl Vis Sci Technol 2023; 12:36. [PMID: 38019501 PMCID: PMC10691384 DOI: 10.1167/tvst.12.11.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 10/30/2023] [Indexed: 11/30/2023] Open
Abstract
Purpose To characterize the availability of social determinants of health data in the electronic health record of pediatric ophthalmology patients and to examine the association of social determinants of health with attendance at scheduled operating room and clinic visits. Methods This was a retrospective cohort study of pediatric ophthalmology patients seen at The Hospital for Sick Children between June 1, 2018, and May 23, 2022. Data were collected on demographics, diagnosis, and management-plan. The χ2 tests and multivariable regression were used to examine associations between social determinants of health and attendance at scheduled operating room and clinic visits. Results The cohort consisted of 26,102 study subjects with 31,288 unique eye-related diagnoses representing 57 unique ICD-10 codes. Availability of data in the electronic health record ranged from 100% for sex, age and postal code to 0.1% for ethnic group. Female sex (P = 0.004) and urbanicity (P = 0.05) were associated with higher operating room visit cancellations. Female sex (P = 0.002), age group 0-13 (P ≤ 0.001), low-medium neighborhood income quintile (P ≤ 0.001), residence of Northern Ontario (P ≤ 0.001), and urbanicity (P ≤ 0.001) were associated with higher clinic visit cancellations and no-shows. Conclusions At a major tertiary-care hospital in Canada, key social determinant data such as ethnicity are not consistently available in the electronic health record of pediatric ophthalmology patients. Female sex, younger age, and living in a rural area or neighborhood with low-medium income quintile may be predictors of missed visits and require further study. Translational Relevance This study highlights a need for improved documentation of social determinants of health variables in electronic health records.
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Affiliation(s)
- Omer Jamal
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children and University of Toronto, Toronto, Canada
- University of Toronto, Institute of Medical Sciences, Toronto, Canada
| | - Ashwin Mallipatna
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Stephen W. Hwang
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Canada
- Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Canada
| | - Helen Dimaras
- Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children and University of Toronto, Toronto, Canada
- University of Toronto, Institute of Medical Sciences, Toronto, Canada
- Department of Ophthalmology & Vision Sciences, Faculty of Medicine & Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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27
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Ali M, Menard M, Zafar S, Williams BK, Knight OJ, Woreta FA. Sex and Racial and Ethnic Diversity Among Ophthalmology Subspecialty Fellowship Applicants. JAMA Ophthalmol 2023; 141:948-954. [PMID: 37651110 PMCID: PMC10472264 DOI: 10.1001/jamaophthalmol.2023.3853] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 07/06/2023] [Indexed: 09/01/2023]
Abstract
Importance Physician-patient concordance in sex and race is associated with improved patient outcomes. Studies have explored diversity among ophthalmology residents and faculty, but to our knowledge, not among ophthalmology fellows. Objective To assess diversity by sex and race and ethnicity among fellowship applicants in ophthalmology subspecialties and compare match rates by applicants' sex and underrepresented in medicine (URiM) status. Design, Setting, and Participants This cohort study examined ophthalmology subspecialty fellowship data from the 2021 San Francisco Match. Main Outcomes and Measures Applicant characteristics were stratified by sex and URiM status and compared using χ2, Mann-Whitney U, and median tests. For applicants who matched, the percentages of female and URiM applicants were compared among the ophthalmic subspecialties. A multivariable logistic regression model was used to assess the association of applicant characteristics with their match outcomes. Results Included in the sample were 537 candidates who applied for an ophthalmology fellowship using the 2021 San Francisco Match; 224 applicants (42.6%) were female, and 60 applicants (12.9%) had URiM status. Females and males had similar match rates (70.5% [n = 158] and 69.2% [n = 209], respectively; P = .74), but females had a higher median (IQR) US Medical Licensing Examination (USMLE) Step 2 Clinical Knowledge (CK) score (248 [240-258] vs 245 [234-254]; P = .01). The pediatric ophthalmology subspecialty had the highest percentage of female matched applicants (67.5%; 27 of 40 matched applicants), while the retina subspecialty had the highest percentage of males (68.9%; 84 of 122 matched applicants). URiM applicants had lower match rates (55.0%, n = 33) than non-URiM applicants (72.2%, n = 293; P = .007). The URiM applicants had lower median (IQR) scores on the USMLE Step 1 (238 [227-247]) compared with Asian applicants (246 [235-254]) and White applicants (243 [231-252]; P = .04). Additionally, URIM applicants submitted fewer median (IQR) applications (10 [1-23]) than Asian (21 [8-37]) and White (17 [8-32]; P = .001) applicants and completed fewer interviews (median [IQR], 2 [0-11]) than Asian (median [IQR], 12 [3-18]) and White applicants (median [IQR], 8 [1-14]; P = .001). Among matched fellows in each subspecialty, URiM applicants comprised 13.9% (n = 11) in glaucoma, 10% (n = 4) in pediatric ophthalmology, 7.3% (n = 6) in cornea, and 6.6% (n = 8) in retina. Conclusions and Relevance Ophthalmology subspecialty fellowship match rates were lower for URiM vs non-URiM applicants in 2021. Underrepresentation of females exists in the retina subspecialty, while racial and ethnic differences exist in all ophthalmology subspecialty fellowships examined. Monitoring trends in fellowship diversity over time should help inform where targeted efforts could improve diversity.
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Affiliation(s)
- Muhammad Ali
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland
| | - Maylander Menard
- School of Medicine, Meharry Medical College, Nashville, Tennessee
| | - Sidra Zafar
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland
| | - Basil K Williams
- Cincinnati Eye Institute, University of Cincinnati School of Medicine, Cincinnati, Ohio
| | - O'Rese J Knight
- Department of Ophthalmology, University of California, San Francisco, San Francisco
| | - Fasika A Woreta
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland
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Sridhar J, Cavuoto KM. Swimming Upstream-Why Diversity in Ophthalmology Subspecialists Matters. JAMA Ophthalmol 2023; 141:954-955. [PMID: 37651135 DOI: 10.1001/jamaophthalmol.2023.4045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Andoh JE, Ezekwesili AC, Nwanyanwu K, Elam A. Disparities in Eye Care Access and Utilization: A Narrative Review. Annu Rev Vis Sci 2023; 9:15-37. [PMID: 37254050 DOI: 10.1146/annurev-vision-112122-020934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
This narrative review summarizes the literature on factors related to eye care access and utilization in the United States. Using the Healthy People 2030 framework, this review investigates social determinants of health associated with general and follow-up engagement, screenings, diagnostic visits, treatment, technology, and teleophthalmology. We provide hypotheses for these documented eye care disparities, featuring qualitative, patient-centered research. Lastly, we provide recommendations in the hopes of appropriately eliminating these disparities and reimagining eye care.
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Affiliation(s)
- Joana E Andoh
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Agnes C Ezekwesili
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kristen Nwanyanwu
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut, USA
| | - Angela Elam
- Department of Ophthalmology, WK Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, USA;
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Tseng VL, Kitayama K, Yu F, Coleman AL. Disparities in Glaucoma Surgery: A Review of Current Evidence and Future Directions for Improvement. Transl Vis Sci Technol 2023; 12:2. [PMID: 37672254 PMCID: PMC10484012 DOI: 10.1167/tvst.12.9.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 08/06/2023] [Indexed: 09/07/2023] Open
Abstract
There is a need to understand existing disparities in glaucoma surgery and to create strategies to eliminate these disparities. Disparities can exist in several aspects of glaucoma surgical management, including patient selection and timing of surgery, type of surgery performed, intra-operative and postoperative surgical complications, follow-up surgical care, and long-term surgical outcomes. Additionally, multiple types of disparities can exist within each of these realms, including disparities by race and ethnicity, age, gender, insurance type, people with disabilities, and other social, economic, and demographic factors. Disparities in glaucoma surgery have been examined in large scale datasets, retrospective clinical studies, and clinical trials, and several studies have identified likely racial and ethnic disparities in glaucoma surgical incidence and outcomes. We present existing literature on disparities in glaucoma surgery, analyze the advantages and limitations of various study designs for the investigation of these disparities, and propose directions for future research and interventions to identify and eliminate disparities in surgical glaucoma care.
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Affiliation(s)
- Victoria L. Tseng
- Department of Ophthalmology, Stein and Doheny Eye Institutes, University of California, Los Angeles, Los Angeles, CA, USA
| | - Ken Kitayama
- Department of Ophthalmology, Stein and Doheny Eye Institutes, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
| | - Fei Yu
- Department of Ophthalmology, Stein and Doheny Eye Institutes, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
| | - Anne L. Coleman
- Department of Ophthalmology, Stein and Doheny Eye Institutes, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
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Hicks PM, Asare AO, Woodward MA. Beyond Accessibility in Exploring Access to Eye Care to Achieve Vision Health Equity. JAMA Ophthalmol 2023; 141:784-785. [PMID: 37471057 PMCID: PMC10529396 DOI: 10.1001/jamaophthalmol.2023.3196] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Affiliation(s)
- Patrice M Hicks
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor
| | - Afua O Asare
- Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City
| | - Maria A Woodward
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
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Cai CX, Woreta FA, Crews DC. Taking Steps to Advance Health Equity in Ophthalmology. JAMA Ophthalmol 2023; 141:735-736. [PMID: 37318784 DOI: 10.1001/jamaophthalmol.2023.2595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- Cindy X Cai
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Fasika A Woreta
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Deidra C Crews
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
- Johns Hopkins Center for Health Equity, Johns Hopkins University, Baltimore, Maryland
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Carvajal N, Lopez J, Ahmad TR, Maru J, Ramanathan S, Seitzman GD, Padmanabhan S, Parikh N. Health Disparity Curricula for Ophthalmology Residents: Current Landscape, Barriers, and Needs. JOURNAL OF ACADEMIC OPHTHALMOLOGY (2017) 2023; 15:e162-e171. [PMID: 37564161 PMCID: PMC10411222 DOI: 10.1055/s-0043-1771356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 06/28/2023] [Indexed: 08/12/2023]
Abstract
Background Social determinants of health play a critical role in visual health outcomes. Yet, there exists no structured curriculum for ophthalmology residents to identify and address health disparities relevant to eye care or no a standard assessment of health disparities education within ophthalmology residency programs. This study aims to characterize current health disparity curricula in ophthalmology residency programs in the United States, determine resident confidence in addressing health disparities in the clinical setting, and identify perceived barriers and needs of program directors (PDs) and residents in this area. Design This was a cross-sectional survey study. Methods A closed-ended questionnaire with comments was distributed to the Accreditation Council for Graduate Medical Education-accredited ophthalmology residency PDs and residents in April 2021 and May 2022. The questionnaire solicited characteristics of any existing health disparity curricula, PD and resident perceptions of these curricula, and residents' experience with and confidence in addressing health disparities in the delivery of patient care. Results In total, 29 PDs and 96 residents responded. Sixty-six percent of PDs stated their program had a formal curriculum compared to fifty-three percent of residents. Forty-one percent of PDs and forty-one percent of residents stated their program places residents in underserved care settings for more than 50% of their training. Most residents (72%) were confident in recognizing health disparities. Sixty-six percent were confident in managing care in the face of disparities and fifty-nine percent felt they know how to utilize available resources. Residents were most concerned with the lack of access to resources to help patients. Forty-five percent of PDs felt the amount of time dedicated to health disparities education was adequate. Forty-nine percent of residents reported they felt the amount of training they received on health disparities to be adequate. The top barrier to curriculum development identified by PDs was the availability of trained faculty to teach. Time in the curriculum was a major barrier identified by residents. Conclusions Roughly half of ophthalmology residency programs who responded had a health disparity curriculum; however, both PDs and residents felt inadequate time is dedicated to such education. National guidance on structured health disparity curricula for ophthalmology residents may be warranted as a next step.
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Affiliation(s)
- Nicole Carvajal
- University of California San Francisco School of Medicine, San Francisco, California
| | - Justin Lopez
- University of California San Francisco School of Medicine, San Francisco, California
| | - Tessnim R. Ahmad
- Department of Ophthalmology, University of California San Francisco, San Francisco, California
| | - Johsias Maru
- University of California San Francisco School of Medicine, San Francisco, California
| | - Saras Ramanathan
- Department of Ophthalmology, University of California San Francisco, San Francisco, California
| | - Gerami D. Seitzman
- Department of Ophthalmology, University of California San Francisco, San Francisco, California
| | - Sriranjani Padmanabhan
- Department of Ophthalmology, University of California San Francisco, San Francisco, California
| | - Neeti Parikh
- Department of Ophthalmology, University of California San Francisco, San Francisco, California
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Yao M, Kitayama K, Yu F, Tseng VL, Coleman AL. Association Between Myopia and Primary Open-Angle Glaucoma by Race and Ethnicity in Older Adults in the California Medicare Population. JAMA Ophthalmol 2023; 141:525-532. [PMID: 37103940 PMCID: PMC10141276 DOI: 10.1001/jamaophthalmol.2023.1007] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 02/26/2023] [Indexed: 04/28/2023]
Abstract
Importance Racial and ethnic differences in the association between myopia and primary open-angle glaucoma (POAG) are not well understood. Objective To investigate the association between myopia and POAG in the 2019 California Medicare population and to investigate whether there was evidence of effect measure modification of this association by race and ethnicity. Design, Setting, and Participants This cross-sectional study used administrative claims data from 2019 California Medicare beneficiaries 65 years or older with California residence and active coverage with Medicare parts A and B. Analysis took place between October 2021 and October 2023. Exposures The primary exposure was myopia, which was defined by International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnosis codes. Main Outcomes and Measures The outcome of interest was POAG, which was defined by ICD-10-CM code. Results Of 2 717 346 California Medicare beneficiaries in 2019, 1 440 769 (53.0%) were aged 65 to 74 years, 1 544 479 (56.8%) identified as female, 60 211 (2.2%) had myopia, and 171 988 (6.3%) had POAG. Overall, 346 723 individuals (12.8%) identified as Asian, 117 856 (4.3%) as Black, 430 597 (15.8%) as Hispanic, 1 705 807 (62.8%) as White, and 115 363 (4.2%) as other race and ethnicity. In adjusted logistic regression analyses, beneficiaries with myopia had higher odds of POAG compared with beneficiaries without myopia (odds ratio [OR], 2.41; 95% CI, 2.35-2.47). In multivariable models stratified by race and ethnicity, the association between myopia and POAG was stronger in Asian (OR, 2.74; 95% CI, 2.57-2.92), Black (OR, 2.60; 95% CI, 2.31-2.94), and Hispanic (OR, 3.28; 95% CI, 3.08-3.48) beneficiaries compared with non-Hispanic White beneficiaries (OR, 2.14; 95% CI, 2.08-2.21). Conclusions and Relevance In the 2019 California Medicare population, myopia was associated with greater adjusted odds of POAG. This association was stronger among Asian, Black, and Hispanic beneficiaries compared with non-Hispanic White beneficiaries. These findings suggest possible disparities in glaucoma risk by race and ethnicity in individuals with myopia and may indicate greater need for glaucoma screening in individuals with myopia from racial and ethnic minority backgrounds.
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Affiliation(s)
- Melissa Yao
- Center for Community Outreach and Policy, UCLA Department of Ophthalmology, Stein & Doheny Eye Institutes, Los Angeles, California
| | - Ken Kitayama
- Center for Community Outreach and Policy, UCLA Department of Ophthalmology, Stein & Doheny Eye Institutes, Los Angeles, California
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, California
| | - Fei Yu
- Center for Community Outreach and Policy, UCLA Department of Ophthalmology, Stein & Doheny Eye Institutes, Los Angeles, California
- Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles, California
| | - Victoria L. Tseng
- Center for Community Outreach and Policy, UCLA Department of Ophthalmology, Stein & Doheny Eye Institutes, Los Angeles, California
| | - Anne L. Coleman
- Center for Community Outreach and Policy, UCLA Department of Ophthalmology, Stein & Doheny Eye Institutes, Los Angeles, California
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, California
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Schlottmann PG, Luna JD, Labat N, Yadarola MB, Bainttein S, Esposito E, Ibañez A, Barbaro EI, Álvarez Mendiara A, Picotti CP, Chirino Misisian A, Andreussi L, Gras J, Capalbo L, Visotto M, Dipierri JE, Alcoba E, Fernández Gabrielli L, Ávila S, Aucar ME, Martin DM, Ormaechea GJ, Inga ME, Francone AA, Charles M, Zompa T, Pérez PJ, Lotersztein V, Nuova PJ, Canonero IB, Mahroo OA, Michaelides M, Arno G, Daich Varela M. Nationwide genetic analysis of more than 600 families with inherited eye diseases in Argentina. NPJ Genom Med 2023; 8:8. [PMID: 37217489 DOI: 10.1038/s41525-023-00352-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 04/05/2023] [Indexed: 05/24/2023] Open
Abstract
This study corresponds to the first large-scale genetic analysis of inherited eye diseases (IED) in Argentina and describes the comprehensive genetic profile of a large cohort of patients. Medical records of 22 ophthalmology and genetics services throughout 13 Argentinian provinces were analyzed retrospectively. Patients with a clinical diagnosis of an ophthalmic genetic disease and a history of genetic testing were included. Medical, ophthalmological and family history was collected. A total of 773 patients from 637 families were included, with 98% having inherited retinal disease. The most common phenotype was retinitis pigmentosa (RP, 62%). Causative variants were detected in 379 (59%) patients. USH2A, RPGR, and ABCA4 were the most common disease-associated genes. USH2A was the most frequent gene associated with RP, RDH12 early-onset severe retinal dystrophy, ABCA4 Stargardt disease, PROM1 cone-rod dystrophy, and BEST1 macular dystrophy. The most frequent variants were RPGR c.1345 C > T, p.(Arg449*) and USH2A c.15089 C > A, p.(Ser5030*). The study revealed 156/448 (35%) previously unreported pathogenic/likely pathogenic variants and 8 possible founder mutations. We present the genetic landscape of IED in Argentina and the largest cohort in South America. This data will serve as a reference for future genetic studies, aid diagnosis, inform counseling, and assist in addressing the largely unmet need for clinical trials to be conducted in the region.
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Affiliation(s)
| | - José D Luna
- Centro Privado de Ojos Romagosa SA, Córdoba, Argentina
| | - Natalia Labat
- Centro Privado de Ojos Romagosa SA, Córdoba, Argentina
| | | | | | - Evangelina Esposito
- University Clinic Reina Fabiola, Córdoba, Córdoba, Argentina
- Catholic University of Cordoba, Cordoba, Argentina
| | - Agustina Ibañez
- University Clinic Reina Fabiola, Córdoba, Córdoba, Argentina
- Catholic University of Cordoba, Cordoba, Argentina
| | | | | | | | | | | | | | | | - Mauro Visotto
- Instituto Oftalmológico Trelew, Trelew, Chubut, Argentina
| | | | - Emilio Alcoba
- Hospital Materno Infantil Dr Héctor Quintana, Jujuy, Argentina
| | | | - Silvia Ávila
- Facultad de Ciencias Médicas, Universidad Nacional del Comahue, Río Negro, Argentina
| | | | | | | | - M Eugenia Inga
- Organización Medica de Investigación, Buenos Aires, Argentina
| | | | | | - Tamara Zompa
- Charles Centro Oftalmológico, Buenos Aires, Argentina
| | | | | | - Pedro J Nuova
- Ocularyb Oftalmoclinica, Yerba Buena, Tucumán, Argentina
| | | | - Omar A Mahroo
- Moorfields Eye Hospital, London, UK
- UCL Institute of Ophthalmology, University College London, London, UK
| | - Michel Michaelides
- Moorfields Eye Hospital, London, UK
- UCL Institute of Ophthalmology, University College London, London, UK
| | - Gavin Arno
- Moorfields Eye Hospital, London, UK
- UCL Institute of Ophthalmology, University College London, London, UK
| | - Malena Daich Varela
- Moorfields Eye Hospital, London, UK.
- UCL Institute of Ophthalmology, University College London, London, UK.
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Law JC, Puente MA. From Research to Action-Implementing Initiatives to Address Ophthalmologic Health Disparities. JAMA Ophthalmol 2023; 141:71-72. [PMID: 36480178 DOI: 10.1001/jamaophthalmol.2022.5238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Janice C Law
- Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Michael A Puente
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora
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Hicks PM, Woodward MA, Newman-Casey PA. Considerations for Using Large Data Sets to Assess Disparities in Eye Care and Vision Health. JAMA Ophthalmol 2022; 140:1226-1228. [PMID: 36326748 PMCID: PMC10406138 DOI: 10.1001/jamaophthalmol.2022.4601] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Patrice M Hicks
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor
| | - Maria A Woodward
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Paula Anne Newman-Casey
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
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Elam AR, Tseng VL, Coleman AL. Disparities in Vision Health and Eye Care: Where Do We Go from Here? Ophthalmology 2022; 129:1077-1078. [PMID: 36058731 PMCID: PMC10122454 DOI: 10.1016/j.ophtha.2022.06.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 06/05/2022] [Accepted: 06/07/2022] [Indexed: 11/19/2022] Open
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Legault G, Nwanyanwu K, Baxter SL. Data Sciences and Visual Health Disparities. Ophthalmology 2022; 129:1085-1086. [PMID: 36058740 DOI: 10.1016/j.ophtha.2022.06.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 05/17/2022] [Accepted: 06/06/2022] [Indexed: 11/29/2022] Open
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40
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Fountain TR, Lee P, Parke DW. Why Ophthalmologists Should Care about Disparities in Vision Health. Ophthalmology 2022; 129:1075-1076. [PMID: 36058737 DOI: 10.1016/j.ophtha.2022.06.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 06/07/2022] [Accepted: 06/08/2022] [Indexed: 11/18/2022] Open
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