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Liebman DL, Aboobakar IF. Traumatic Hyphema: Diagnostic and Management Considerations. Int Ophthalmol Clin 2024; 64:49-61. [PMID: 38525981 DOI: 10.1097/iio.0000000000000490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
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Parikh AA, Liebman DL, Armstrong GW. A Novel Ophthalmic Telemedicine Program for Follow-Up of Minor Ophthalmic Emergencies. Telemed J E Health 2024; 30:835-840. [PMID: 37751196 DOI: 10.1089/tmj.2023.0129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023] Open
Abstract
Background: Near-term follow-up for minor ophthalmic emergencies is important to ensure positive patient outcomes but can impose logistical challenges for patients and ophthalmology practices. While ophthalmic telemedicine has been used for screening and triage, its feasibility and safety for follow-up care for minor ophthalmic emergencies have not been reported. The objective of this study was to report initial results of a novel virtual emergency department (ED) follow-up clinic. Methods: Retrospective cross-sectional study of patients discharged from the ophthalmic ED who required near-term follow-up and carried diagnoses suitable for virtual evaluation, between December 6, 2021, and June 26, 2022, at a single tertiary eye care center. Main outcome measures included missed appointment rate, time interval between ED encounter and virtual follow-up, clinical diagnoses, and referrals after telemedicine follow-up (including for urgent ambulatory and ED evaluation). Results: A total of 145 virtual visits were scheduled with 99 (68.3%) completed appointments, yielding a no-show rate of 31.7%. Of the completed visits, the mean time interval between ED evaluation and virtual follow-up was 8.3 days (standard deviation ±3.9). Eighty-four (84.9%) visits were video-based and 15 (15.1%) were audio-only. Seventy-nine (94%) had at least one aspect of the ophthalmic examination documented. The most common diagnoses were chalazion (18), conjunctivitis (13), corneal abrasion (12), and encounter after corneal foreign body removal (7). After virtual follow-up, 23 patients (23.2%) had subsequent referrals, and no patients re-presented to the ophthalmic ED. Conclusions: Ophthalmic telemedicine may be a safe and feasible modality for providing timely post-acute near-term follow-up care for patients with appropriate ophthalmic diagnoses.
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Affiliation(s)
- Ayush A Parikh
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Daniel L Liebman
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Grayson W Armstrong
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
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Liebman DL, Weinert MC, Dohlman JC, Hennein L, Gaier ED. Cauterization-mediated restriction from penetrating orbital trauma. J AAPOS 2024; 28:103805. [PMID: 38216116 PMCID: PMC10947871 DOI: 10.1016/j.jaapos.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 10/12/2023] [Accepted: 11/10/2023] [Indexed: 01/14/2024]
Abstract
A healthy 32-year-old woman presented with binocular diplopia immediately after sustaining a penetrating injury to the left periocular adnexa with a hot metal skewer. Examination revealed an incomitant esotropia, with complete limitation of abduction of the left eye with downshoot in left gaze and normal afferent visual function. Computed tomography and magnetic resonance imaging demonstrated no fracture, but there was mild thickening of the medial rectus muscle and associated fat stranding. Lack of orbitomuscular tethering or hematoma led to the presumptive diagnosis of thermal cauterization injury causing left medial rectus restriction. Given the lack of literature on this mechanism of injury, the patient was monitored closely. She exhibited remarkable spontaneous improvement in motility over 6 months, with near orthophoria in primary gaze. However, bothersome residual esotropic diplopia in left gaze prompted a left medial rectus recession, with a good outcome. This case demonstrates that isolated extraocular muscle thermal injuries and consequential strabismus can recover spontaneously; longitudinal observation before surgical intervention may be appropriate in such cases.
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Affiliation(s)
- Daniel L Liebman
- Department of Ophthalmology, Mass Eye and Ear, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Marguerite C Weinert
- Department of Ophthalmology, Mass Eye and Ear, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts
| | - Jenny C Dohlman
- Department of Ophthalmology, Mass Eye and Ear, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts
| | - Lauren Hennein
- Department of Ophthalmology, Mass Eye and Ear, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts; The Viterbi Family Department of Ophthalmology, University of California San Diego, San Diego, California; Department of Ophthalmology, Rady Children's Hospital - San Diego, San Diego, California
| | - Eric D Gaier
- Department of Ophthalmology, Mass Eye and Ear, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts; Picower Institute for Technology, Massachusetts Institute of Technology, Cambridge, Massachusetts.
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Kang J, De Arrigunaga S, Freeman SE, Zhao Y, Lin M, Liebman DL, Roldan AM, Kim JA, Chang DS, Friedman DS, Elze T. Comparison of Perimetric Outcomes from a Tablet Perimeter, Smart Visual Function Analyzer, and Humphrey Field Analyzer. Ophthalmol Glaucoma 2023; 6:509-520. [PMID: 36918066 PMCID: PMC10495534 DOI: 10.1016/j.ogla.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 03/03/2023] [Accepted: 03/07/2023] [Indexed: 03/14/2023]
Abstract
PURPOSE The tablet-based Melbourne Rapid Fields (MRF) visual field (VF) test and the IMOvifa Smart Visual Function Analyzer (SVFA) are portable perimeters that may allow for at-home monitoring and more frequent testing. We compared tablet and SVFA results with outputs from the Humphrey Field Analyzer (HFA) 24-2 Swedish Interactive Threshold Algorithm Standard program. DESIGN Observational cross-sectional study. SUBJECTS Adult participants with a diagnosis of glaucoma, suspected glaucoma, or ocular hypertension seen in the Massachusetts Eye and Ear glaucoma clinic were enrolled. All participants were reliable and experienced HFA testers. METHODS Participants were tested with the SVFA and HFA. The study staff also trained participants on the MRF tablet with instructions to take weekly tests at home for 3 months. Visual field results from the 3 devices were compared. MAIN OUTCOME MEASURES Mean deviation (MD), pattern standard deviation (PSD), reliability parameters, and point sensitivity. RESULTS Overall, 79 participants (133 eyes) with a mean age of 61 ± 13 years (range, 26-79 years) were included; 59% of the participants were female, and the mean HFA MD was -2.7 ± 3.9 dB. The global indices of MD and PSD did not significantly vary between HFA and the 2 novel devices, except that the tablet VF reported a 0.6 dB higher PSD compared with HFA. However, tablet and SVFA sensitivities significantly differed from those of the HFA at 36 and 39 locations, respectively, out of 52 locations. Relative to HFA, the tablet overestimated light sensitivity in the nasal field while underestimating the temporal field. The SVFA generally underestimated light sensitivity, but its results were more similar to HFA results compared with the tablet. CONCLUSIONS Although average MD values from the 2 novel devices suggest that they provide similar results to the HFA, point-by-point comparisons highlight notable deviations. Differences in specific point sensitivity values were significant, especially between the tablet and the other 2 devices. These differences may in part be explained by differences in the devices' normative databases as well as how MD is calculated. However, the tablet had substantial differences based on location, indicating that the tablet design itself may be responsible for differences in local sensitivities. 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)
- Joyce Kang
- Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts
| | | | | | - Yan Zhao
- Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts
| | - Michael Lin
- Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts
| | | | - Ana M Roldan
- Department of Ophthalmology, Penn State College of Medicine, Hershey, Pennsylvania
| | - Julia A Kim
- Genentech Inc., South San Francisco, California
| | - Dolly S Chang
- Genentech Inc., South San Francisco, California; Stanford University School of Medicine, Palo Alto, California
| | | | - Tobias Elze
- Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts.
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Guzman Aparicio MA, Liebman DL, Chodosh J, Freitag SK, Kazlas M, Mai DD, Marando CM, Mukai S, Wu AM, Chen TC. Two pediatric cases of reticular corneal epithelial edema associated with netarsudil. Am J Ophthalmol Case Rep 2022; 27:101638. [PMID: 35813588 PMCID: PMC9259473 DOI: 10.1016/j.ajoc.2022.101638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 06/19/2022] [Accepted: 06/23/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose To report two pediatric cases of reticular corneal epithelial edema associated with the use of netarsudil ophthalmic solution 0.02%. Observations In Case 1, a six-year-old male with glaucoma following cataract surgery was treated with netarsudil for thirteen months and developed diffuse reticular corneal epithelial edema on post-operative day one after undergoing transscleral diode cyclophotocoagulation for persistently elevated intraocular pressures. In Case 2, a three-month-old male with bilateral ocular hypertension developed unilateral inferior reticular corneal epithelial edema five weeks after initiation of netarsudil, which had been discontinued in the fellow eye two weeks prior. In both cases, the reticular epithelial edema resolved following cessation of netarsudil. Conclusions and Importance Netarsudil-associated reticular corneal epithelial edema can occur in infants and young children.
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Affiliation(s)
- Maria A. Guzman Aparicio
- Harvard Medical School, Department of Ophthalmology, Boston, MA, USA
- Massachusetts Eye and Ear, Glaucoma Service, Boston, MA, USA
| | - Daniel L. Liebman
- Harvard Medical School, Department of Ophthalmology, Boston, MA, USA
| | - James Chodosh
- Harvard Medical School, Department of Ophthalmology, Boston, MA, USA
- Massachusetts Eye and Ear, Cornea Service, Boston, MA, USA
| | - Suzanne K. Freitag
- Harvard Medical School, Department of Ophthalmology, Boston, MA, USA
- Massachusetts Eye and Ear, Ophthalmic Plastic Surgery Service, Boston, MA, USA
| | - Melanie Kazlas
- Harvard Medical School, Department of Ophthalmology, Boston, MA, USA
- Massachusetts Eye and Ear, Pediatric Ophthalmology Service, Boston, MA, USA
| | - Derek D. Mai
- Harvard Medical School, Department of Ophthalmology, Boston, MA, USA
- Massachusetts Eye and Ear, Glaucoma Service, Boston, MA, USA
| | - Catherine M. Marando
- Harvard Medical School, Department of Ophthalmology, Boston, MA, USA
- Massachusetts Eye and Ear, Glaucoma Service, Boston, MA, USA
| | - Shizuo Mukai
- Harvard Medical School, Department of Ophthalmology, Boston, MA, USA
- Massachusetts Eye and Ear, Retina Service, Boston, MA, USA
| | - Annie M. Wu
- Harvard Medical School, Department of Ophthalmology, Boston, MA, USA
- Massachusetts Eye and Ear, Glaucoma Service, Boston, MA, USA
| | - Teresa C. Chen
- Harvard Medical School, Department of Ophthalmology, Boston, MA, USA
- Massachusetts Eye and Ear, Glaucoma Service, Boston, MA, USA
- Corresponding author. Massachusetts Eye and Ear Infirmary, Glaucoma Service, 243 Charles Street, Boston, MA, 02114, USA.
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Liebman DL, Tam EK, Lithgow MY, Kane JE, Fischbein NJ, Lefebvre DR, Chwalisz BK, Gaier ED. Optic Perineuritis Associated With Cryptococcal Meningitis Presenting With a "Hot Orbit" in a Patient With Chronic Lymphocytic Leukemia. J Neuroophthalmol 2022; 42:272-277. [PMID: 35421041 PMCID: PMC9124683 DOI: 10.1097/wno.0000000000001538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT A 75-year-old man presented with 3 days of progressive left retro-orbital pain, eyelid swelling, tearing, and pain with extraocular movement. His medical history was significant for type II diabetes mellitus and chronic lymphocytic leukemia, stable on no therapy since diagnosis 8 years prior. The initial examination was significant for diffuse restriction of left ocular motility, marked lid edema, and mild dyschromatopsia. Computed tomography demonstrated asymmetric left periorbital soft tissue swelling and intraconal fat stranding with an irregular left optic nerve sheath complex and clear paranasal sinuses. He was hospitalized for orbital cellulitis and treated empirically with broad-spectrum intravenous antibiotics, but his visual acuity declined over the ensuing 2 days. Subsequent MRI demonstrated left-greater-than-right circumferential optic nerve sheath enhancement, and leptomeningeal enhancement. An orbital biopsy demonstrated monoclonal B-cell lymphocyte aggregation, whereas a lumbar puncture was positive for Cryptococcus antigen with subsequent demonstration of abundant Cryptococcus by Papanicolaou stain. The final diagnosis was optic perineuritis secondary to cryptococcal meningitis presenting with orbital inflammation. Although his clinical course was complicated by immune reconstitution inflammatory syndrome, symptoms and signs of optic neuropathy ultimately resolved after 1 month of intensive antifungal therapy.
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MESH Headings
- Aged
- Diabetes Mellitus, Type 2/complications
- Edema
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/complications
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Male
- Meningitis, Cryptococcal/complications
- Meningitis, Cryptococcal/diagnosis
- Meningitis, Cryptococcal/drug therapy
- Orbit
- Pain/complications
- Vision Disorders
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Affiliation(s)
| | - Emily K. Tam
- Department of Ophthalmology, Boston Medical Center, Boston, MA
| | | | - Joseph E. Kane
- Department of Optometry, Boston VA Medical Center, Boston, MA
| | - Nancy J. Fischbein
- Department of Radiology, Stanford University Medical Center, Stanford, CA
| | - Daniel R. Lefebvre
- Department of Ophthalmology, Boston VA Medical Center, Boston, MA
- Division of Ophthalmic Plastic and Reconstructive Surgery, Mass Eye and Ear, Boston, MA
| | - Bart K. Chwalisz
- Division of Neuro-Ophthalmology, Mass Eye and Ear, Boston, MA
- Division of Neuro-Immunology, Massachusetts General Hospital, Boston, MA
| | - Eric D. Gaier
- Department of Ophthalmology, Mass Eye and Ear, Boston, MA
- Department of Ophthalmology, Boston Children’s Hospital, Harvard Medical School, Boston, MA
- Picower Institute for Learning and Memory, Massachusetts Institute of Technology, Cambridge, MA
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Liebman DL, Armstrong GW, Shah AS, Lorch AC, Miller JW, Chodosh J. The Case for Transparency in the Ophthalmology Residency Match. Ophthalmology 2020; 128:185-187. [PMID: 33308871 DOI: 10.1016/j.ophtha.2020.10.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 10/08/2020] [Accepted: 10/12/2020] [Indexed: 10/22/2022] Open
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Liebman DL, Chiang MF, Chodosh J. Realizing the Promise of Electronic Health Records: Moving Beyond "Paper on a Screen". Ophthalmology 2020; 126:331-334. [PMID: 30803511 DOI: 10.1016/j.ophtha.2018.09.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 09/13/2018] [Accepted: 09/14/2018] [Indexed: 01/20/2023] Open
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Epstein AM, Jha AK, Orav EJ, Liebman DL, Audet AMJ, Zezza MA, Guterman S. Analysis Of Early Accountable Care Organizations Defines Patient, Structural, Cost, And Quality-Of-Care Characteristics. Health Aff (Millwood) 2014; 33:95-102. [DOI: 10.1377/hlthaff.2013.1063] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Arnold M. Epstein
- Arnold M. Epstein ( ) is the John H. Foster Professor of Health Policy and Management, Harvard School of Public Health, in Boston, Massachusetts
| | - Ashish K. Jha
- Ashish K. Jha is a professor of health policy and management, Harvard School of Public Health
| | - E. John Orav
- E. John Orav is an associate professor of medicine (biostatistics) at Harvard Medical School
| | - Daniel L. Liebman
- Daniel L. Liebman is a research assistant in the Department of Health Policy and Management, Harvard School of Public Health
| | - Anne-Marie J. Audet
- Anne-Marie J. Audet is vice president for delivery system reform and breakthrough healthcare opportunities at the Commonwealth Fund, in New York City
| | - Mark A. Zezza
- Mark A. Zezza is assistant vice president for delivery system reform and cost control at the Commonwealth Fund
| | - Stuart Guterman
- Stuart Guterman is vice president for Medicare and cost control at the Commonwealth Fund
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Johnson-Arbor K, Liebman DL, Carter EM. A survey of residential carbon monoxide detector utilization among Connecticut Emergency Department patients. Clin Toxicol (Phila) 2012; 50:384-9. [PMID: 22577866 DOI: 10.3109/15563650.2012.683576] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONTEXT The use of carbon monoxide detectors may prevent deaths due to unintentional carbon monoxide poisoning. Currently, there is limited data regarding the characteristics of residential carbon monoxide detector use. OBJECTIVE To determine the characteristics of residential carbon monoxide detector use. METHODS A survey was administered to a convenience, cross-sectional sample of Emergency Department patients between June and August 2011. Inclusion criteria included patients who were older than 18 years, able to understand written or spoken English or Spanish, and lived in independent residential settings. Survey questions assessed the presence or absence of carbon monoxide and smoke detectors within the participant's home, the frequency of regular battery changes for both devices, location of carbon monoxide detectors within the home, and reasons for not installing carbon monoxide detectors (if applicable). Correlations between racial background, geographical area of residence (urban versus suburban), and income were also assessed. RESULTS A total of 1030 patients were surveyed. While 97.8% of respondents reported smoke detector use, only 44.4% had home carbon monoxide detectors installed. Only 17.2% had carbon monoxide detectors installed in or near their sleeping area, the correct location for detector placement. Carbon monoxide detector usage was found to be lowest among households earning less than $25,999 per year (27.3% reported having detectors), non-Caucasians (only 42.0% of African-Americans and 24.7% of Hispanics surveyed reported using detectors compared with 57.8% of Caucasians), renters, and urban residents. Reasons given for not having a carbon monoxide detector varied; many answers were consistent with a lack of awareness of the importance of using carbon monoxide detectors. DISCUSSION AND CONCLUSIONS Residential carbon monoxide detectors were underutilized compared to smoke detectors. Increased public education, especially for minorities and lower income populations, is necessary regarding the use of carbon monoxide detectors for poisoning prevention.
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Affiliation(s)
- Kelly Johnson-Arbor
- Department of Emergency Medicine and Traumatology, Hartford Hospital, Hartford, CT 06102, USA.
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