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Hooper J, Shao K, Feng PW, Falcone M, Feng H. Periocular and ocular surface nonmelanoma skin cancer. Clin Dermatol 2024; 42:71-77. [PMID: 37866412 DOI: 10.1016/j.clindermatol.2023.10.011] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
Periocular and ocular surface nonmelanoma malignancies, including basal cell carcinoma (BCC), squamous cell carcinomas (SCC), and ocular surface squamous neoplasia (OSSN), are rare, but their management requires special considerations. The most common periocular malignancy is BCC, which constitutes 80% to 96% of tumors, followed by SCC, which represents 5% to 10% of tumors. OSSN represents a spectrum of diseases that encompass dysplastic alteration to the squamous epithelium of the eye. OSSN ranges from squamous dysplasia to conjunctival intraepithelial neoplasia/carcinoma in situ to invasive SCC, which is the most common ocular malignancy. These tumors can be staged using the eighth edition of the American Joint Committee on Cancer categorization system. The standard of care for periocular malignancies is Mohs micrographic surgery, while medical management with 5-fluorouracil (5-FU), interferon alfa-2b (INF), and mitomycin C (MMC) or "no touch" surgical excision are options for OSSN. Systemic therapies, including sonic hedgehog inhibitors for BCC and epidermal growth factor inhibitors and immune-checkpoint inhibitors for SCC, can be utilized for advanced disease. Recurrence rates are higher for periorbital and ocular malignancies than their respective cutaneous counterparts. These carcinomas and their respective treatments have unique side effects and considerations in an effort to preserve visual function.
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Affiliation(s)
- Jette Hooper
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Kimberly Shao
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Paula W Feng
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Madina Falcone
- Department of Surgery, Division of Ophthalmology, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Hao Feng
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut, USA.
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2
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Andoh JE, Feng PW, Mir TA, Yoon J, Chadha N, Teng CC. Gender Differences in Ophthalmic Procedural Volume: A Study of Male versus Female Glaucoma Specialists. Ophthalmol Glaucoma 2022; 5:594-601. [PMID: 35405381 DOI: 10.1016/j.ogla.2022.03.010] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 03/28/2022] [Accepted: 03/31/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE To investigate whether differences in procedural volume exist between practicing male and female glaucoma specialists. DESIGN A cross-sectional analysis SUBJECTS: A total of 213 female and 666 male glaucoma specialists who performed greater than or equal to 11 traditional incisional glaucoma procedures for Medicare beneficiaries between 2014 and 2018. METHODS The 2014-2018 Medicare Provider Utilization and Payment Data was queried using Current Procedural Terminology (CPT) and Evaluation and Management (E&M) codes to identify clinic visits, cataract, glaucoma drainage implant (GDI), trabeculectomy, minimally invasive glaucoma surgery (MIGS), and office-based glaucoma laser procedures. The number of procedures performed per provider was averaged and compared between male and female specialists. Univariate ordinary least squares linear regression analysis was used to investigate the effects of gender on procedural volume. Multivariate ordinary least squares linear regression analysis was used to examine the effects of gender, number of group practice members, and years after medical school graduation on cataract, GDI, trabeculectomy, MIGS, and glaucoma laser procedural volume. MAIN OUTCOME MEASURES Mean difference in the number of procedures by gender and predictors of procedural volume. RESULTS In the univariate analysis, males performed an estimated 7.8 more MIGS (95% Confidence Interval [CI] 2.7-12.9; p=0.003), 138.9 more cataract (95% CI 59.6-218.3; p=0.0006), and 1.99 more GDI procedures (95% CI 0.03-3.95; p=0.046) than their female counterparts. This relationship remained true for MIGS and cataract procedures in the multivariate analysis after controlling for clinical volume, number of group practice members, and years after medical school graduation (MIGS, ß=6.1 [95% CI 0.5-11.8], p=0.03; cataract, ß= 110.2 [95% CI 16.9-203.5]; p=0.02). Glaucoma drainage implant procedures were no longer associated with the gender of the surgeon in the multivariate analysis (ß= 2.1 [95% CI -0.1-4.2], p=0.06). The volume of trabeculectomy and office-based glaucoma laser procedures did not differ between genders in both the univariate (glaucoma laser, ß= 7.0 [95% CI -4.4-18.5], p=0.23; trabeculectomy, ß= 2.7 [95% CI -0.8-6.2], p=0.13) and multivariate analyses (glaucoma laser, ß= -7.3 [95% CI -18.7-4.1], p=0.21; trabeculectomy, ß= -1.7 [95% CI -5.6-2.1], p=0.38). CONCLUSIONS Female glaucoma specialists performed fewer MIGS and cataract procedures compared to their male counterparts, even after controlling for clinical volume, which can be seen as a relative measure of work productivity, years after medical school graduation, a proxy for experience, and number of group practice members. After controlling for these factors, there were no differences in incisional glaucoma or glaucoma laser procedure volume between male and female specialists. Further research is needed to understand factors contributing to these differences.
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Affiliation(s)
- Joana E Andoh
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut.
| | - Paula W Feng
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut
| | - Tahreem A Mir
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut
| | - James Yoon
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut
| | - Nisha Chadha
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York Eye and Ear, Eye and Vision Research Institute, New York, New York
| | - Christopher C Teng
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut
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Lee AJ, Feng PW, Chow JH. Trends in Ophthalmology Inpatient Consultations among Medicare Beneficiaries, 2010-2018. Ophthalmic Epidemiol 2021; 29:349-352. [PMID: 34229532 DOI: 10.1080/09286586.2021.1946828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Aidan J Lee
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Paula W Feng
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Jessica H Chow
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut, USA
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Gronbeck C, Feng PW, Cohen JM, Feng H. Cost-effectiveness of skin biopsies performed by non-physician clinicians for Medicare beneficiaries. Dermatol Online J 2021; 27. [PMID: 34387052 DOI: 10.5070/d327654051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 07/08/2021] [Indexed: 11/08/2022] Open
Abstract
An increasing number of non-physician clinicians (NPCs) are providing dermatologic care. We compared the cost-effectiveness of skin biopsies performed by dermatologists and dermatology NPCs using publicly-available Medicare claims data and numbers needed to biopsy (NNBs) published in the literature. We estimated that dermatology NPCs performed slightly greater mean numbers of skin biopsies per beneficiary (0.51 versus 0.47) at a lower payment per biopsy ($44.93 versus $55.10) as compared to dermatologists. However, we estimated a higher mean cost per malignancy diagnosed by dermatology NPCs relative to dermatologists (range based on literature NNB values, $39.08 to $190.23). This translated to a $16.7M-$43.3M aggregate cost of additional, benign biopsies performed by NPCs on Medicare beneficiaries. Although this preliminary analysis has several limitations, including the reliance on NNB values for calculations, it likely highlights the importance of training, education, and supervision to promote diagnostic accuracy. Further investigation is needed so that the potential cost of additional skin biopsies performed by NPCs can be appropriately weighed against the improvement in dermatologic access by including NPCs in the dermatology workforce.
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Affiliation(s)
| | | | | | - Hao Feng
- Department of Dermatology, University of Connecticut Health Center, Farmington, CT.
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Feng PW, Lin J, Sakurada Y, Yannuzzi NA, Smiddy WE, Chilakamarri P, Mehta N, Modi YS, Parikh R. Cost and Outcomes Analysis of Polypoidal Choroidal Vasculopathy (Aneurysmal Type 1 Neovascularization) Treatment Strategies. Journal of VitreoRetinal Diseases 2021; 5:227-231. [PMID: 37006516 PMCID: PMC9979034 DOI: 10.1177/2474126420946599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: This work compares the relative cost utility of ranibizumab and aflibercept with and without verteporfin photodynamic therapy (vPDT) for the treatment of polypoidal choroidal vasculopathy. Methods: A retrospective cost and outcomes analysis of the PLANET (Efficacy and Safety of Intravitreal Aflibercept for Polypoidal Choroidal Vasculopathy) and EVEREST II (Efficacy and Safety of Ranibizumab With or Without Verteporfin Photodynamic Therapy for Polypoidal Choroidal Vasculopathy) studies was performed. Clinical utilization and outcomes were based on data from these clinical trials, and costs were obtained from Medicare fee schedules. Cost utility was derived from published visual outcomes and expressed as quality-adjusted life-years (QALYs). Cost per QALY and cost per line of vision gained for each treatment strategy (in US dollars) were assessed as the main outcome measure. Results: The 1-year facility (nonfacility) costs per QALY were $295,744.41 ($260,088.19), $209,574.09 ($182,831.77), $211,072.63 ($188,425.33), and $212,275.22 ($189,703.05) for ranibizumab as-needed monotherapy, ranibizumab as-needed with combination therapy, aflibercept monotherapy, and aflibercept with delayed vPDT combination therapy, respectively. Conclusions: Ranibizumab as-needed monotherapy was the least clinically effective and least cost efficient over 1 year. Ranibizumab as-needed with combination therapy, aflibercept monotherapy, and aflibercept with deferred vPDT combination therapy all had similar overall cost utility at 1 year. If bevacizumab were to be substituted for ranibizumab, the cost per QALY could be reduced by approximately a factor of 5, showing the benefit of bevacizumab for increasing the cost utility of polypoidal choroidal vasculopathy treatment.
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Affiliation(s)
- Paula W. Feng
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, CT, USA
| | - James Lin
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Yoichi Sakurada
- Department of Ophthalmology, University of Yamanashi, Yamanashi, Japan
| | - Nicolas A. Yannuzzi
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - William E. Smiddy
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL, USA
| | | | - Nitish Mehta
- Cullen Eye Institute, Baylor College of Medicine, Houston, TX, USA
| | - Yasha S. Modi
- Department of Ophthalmology, New York University School of Medicine, New York, NY, USA
- Department of Ophthalmology, New York University Ophthalmology Associates, New York, NY, USA
| | - Ravi Parikh
- Department of Ophthalmology, New York University School of Medicine, New York, NY, USA
- Manhattan Retina and Eye Consultants, New York, NY, USA
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Feng PW, Kovacs KD, Fisayo AA. A 4-Year-Old Girl With Earache and Double Vision. JAMA Ophthalmol 2021; 139:232-233. [PMID: 33301003 DOI: 10.1001/jamaophthalmol.2020.4057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Paula W Feng
- Department of Ophthalmology and Visual Science, Yale Medical School, New Haven, Connecticut
| | - Kyle D Kovacs
- Department of Ophthalmology, Weill Cornell Medical College, New York, New York
| | - Adeniyi A Fisayo
- Department of Ophthalmology and Visual Science, Yale Medical School, New Haven, Connecticut.,Department of Neurology, Yale Medical School, New Haven, Connecticut
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Gronbeck C, Feng PW, Feng H. Comparison of practice patterns and geographic distribution of osteopathic and allopathic dermatologists. J Am Acad Dermatol 2021; 85:1339-1342. [PMID: 33616069 DOI: 10.1016/j.jaad.2020.10.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 10/14/2020] [Accepted: 10/16/2020] [Indexed: 10/23/2022]
Affiliation(s)
| | - Paula W Feng
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut
| | - Hao Feng
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut.
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Gronbeck C, Feng PW, Feng H. Improved performance and participation by dermatologists in the evolving merit-based incentive payment system: A cross-sectional analysis of 2018 data. J Am Acad Dermatol 2021; 86:658-661. [PMID: 33600910 DOI: 10.1016/j.jaad.2021.02.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 02/09/2021] [Accepted: 02/11/2021] [Indexed: 10/22/2022]
Affiliation(s)
| | - Paula W Feng
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut
| | - Hao Feng
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut.
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Gronbeck C, Feng PW, Feng H. Assessment of dermatologist-patient race and ethnicity concordance in the Medicare population. J Am Acad Dermatol 2021; 86:651-653. [PMID: 33600913 DOI: 10.1016/j.jaad.2021.02.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 12/30/2020] [Accepted: 02/09/2021] [Indexed: 10/22/2022]
Affiliation(s)
| | - Paula W Feng
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut
| | - Hao Feng
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut.
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10
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Siddiqui N, Chen EM, Parikh R, Douglas VP, Douglas KA, Feng PW, Armstrong GW. Epidemiology of United States Inpatient Open Globe Injuries from 2009-2015. Ophthalmic Epidemiol 2021; 28:469-478. [PMID: 33522349 DOI: 10.1080/09286586.2021.1875008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE To study the epidemiology of inpatient open globe injuries (OGI) in the United States (US). METHODS This was a retrospective cohort study of patients with a primary diagnosis of OGI in the National Inpatient Sample (NIS) from 2009 to 2015. Sociodemographic characteristics, including age, gender, race, ethnicity, insurance, and income were stratified for comparison. Annual prevalence rates were calculated using 2010 US Census data. Statistical analysis included Chi-square tests, ANCOVA, and Tukey tests. RESULTS A total of 6,821 US inpatient hospital discharge records met inclusion/exclusion criteria. The estimated national prevalence of OGI during the 5-year period from 2009 to 2015 was 34,061 (95% confidence interval [CI] 31,445-36,677). The overall annual prevalence rate was 1.58 per 100,000 per year (CI 1.56-1.59). Overall, average annual prevalence rates were highest among patients 85 years or older (7.72, CI 6.95-8.49), on Medicare (3.92, CI 3.84-4.00), males (2.28, CI 2.25-2.30), African Americans (2.38, CI 2.32-2.44), and Native Americans (1.80, CI 1.62-2.00). OGI rates were lowest among Whites (1.21, CI 1.19-1.22), females (0.89, CI 0.87-0.91), those with private insurance (0.84, CI 0.82-0.86), and Asians (0.69, CI 0.64-0.74). Being in the lowest income quartile was a risk factor for OGI (p < .05). CONCLUSIONS Inpatient OGIs disproportionately affected those over 85, young males, elderly females, patients of African-American descent, on Medicare, and in the lowest income quartile. Additionally, children and young children had lower rates of OGI compared to adolescents. Further studies should delineate causes for socioeconomic differences in OGI rates to guide future public health measures.
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Affiliation(s)
- Neha Siddiqui
- University of Illinois Hospital and Clinics, Chicago, Illinois, USA; Carle Illinois College of Medicine, Champaign, Illinois, USA
| | - Evan M Chen
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, CT, USA
| | - Ravi Parikh
- NYU Langone Health Department of Ophthalmology, New York University School of Medicine, New York, NY, USA.,Manhattan Retina and Eye Consultants, New York, NY, USA
| | - Vivian Paraskevi Douglas
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts; Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Konstantinos Aa Douglas
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts; Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Paula W Feng
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, CT, USA
| | - Grayson W Armstrong
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts; Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
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Gronbeck C, Feng PW, Feng H. Geographic variation in reduced minority representation at dermatology clinics in the Medicare population. J Am Acad Dermatol 2020; 84:524-526. [PMID: 33280902 DOI: 10.1016/j.jaad.2020.04.152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 04/22/2020] [Accepted: 04/25/2020] [Indexed: 11/30/2022]
Affiliation(s)
| | - Paula W Feng
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut
| | - Hao Feng
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut.
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12
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Ahluwalia A, Feng PW, Feng H, Chow JH. Disciplined Ophthalmologists Excluded from Federally Funded Medical Programs. Ophthalmology 2020; 127:1578-1579. [DOI: 10.1016/j.ophtha.2020.04.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/23/2020] [Accepted: 04/28/2020] [Indexed: 10/24/2022] Open
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Gronbeck C, Feng PW, Feng H. Trends in Medicare Part D prescription claims for biologic and nonbiologic immunosuppressive medications by dermatologists. J Am Acad Dermatol 2020; 84:848-851. [PMID: 33068642 DOI: 10.1016/j.jaad.2020.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 10/06/2020] [Accepted: 10/08/2020] [Indexed: 10/23/2022]
Affiliation(s)
| | - Paula W Feng
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut
| | - Hao Feng
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut.
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Gronbeck C, Feng PW, Feng H. Economic assessment of the 2020 site-neutral payment reform for dermatologists. J Am Acad Dermatol 2020; 83:1196-1198. [DOI: 10.1016/j.jaad.2020.02.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 02/06/2020] [Accepted: 02/10/2020] [Indexed: 10/24/2022]
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Feng PW, Ahluwalia A, Feng H, Adelman RA. National Trends in the United States Eye Care Workforce from 1995 to 2017. Am J Ophthalmol 2020; 218:128-135. [PMID: 32445703 DOI: 10.1016/j.ajo.2020.05.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 05/09/2020] [Accepted: 05/12/2020] [Indexed: 11/17/2022]
Abstract
PURPOSE To describe temporal and geographic trends in the US eye care workforce. DESIGN Cross-sectional study. METHODS We obtained data from the 2017 Area Health Resources File. The main outcomes were ophthalmologist and optometrist density, as defined as the number of providers per 100,000 individuals, the ratio of ophthalmologists ≥55 years of age to those <55 years of age, and county characteristics associated with the availability of an ophthalmologist. RESULTS From 1995 to 2017, the national ophthalmologist density decreased from 6.30 to 5.68 ophthalmologists per 100,000 individuals. Although rural counties experienced a mean annual increase in ophthalmologist density by 2.26%, they still had a lower mean ophthalmologist density (0.58/100,000 individuals) compared with nonmetropolitan (2.19/100,000 individuals) and metropolitan counties (6.29/100,000 individuals) in 2017. The ratio of older to younger ophthalmologists increased from 0.37 in 1995 to 0.82 in 2017, with the greatest ratio increase occurring in rural counties (0.29 to 1.90). The presence of an ophthalmologist was significantly associated with a greater proportion of individuals with a college degree and health insurance, and more developed health care infrastructure. From 1990 to 2017, the density of optometrists increased from 11.06 to 16.16 optometrists per 100,000 individuals. CONCLUSIONS Over the last 2 decades, the national density of ophthalmologists has decreased and the workforce has aged. In contrast, the density of optometrists has increased. Rural counties continue to have a disproportionately lower supply of eye care providers, although some growth has occurred. Given the rising ratio of optometrists to ophthalmologists, it is of interest for future work to determine how the optometrist workforce can best complement potential shortages of ophthalmologists.
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Affiliation(s)
- Paula W Feng
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut
| | - Aneesha Ahluwalia
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut
| | - Hao Feng
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut
| | - Ron A Adelman
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut.
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Feng PW, Ahluwalia A, Adelman RA, Chow JH. Gender Differences in Surgical Volume among Cataract Surgeons. Ophthalmology 2020; 128:795-796. [PMID: 32987047 DOI: 10.1016/j.ophtha.2020.09.031] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 09/19/2020] [Accepted: 09/23/2020] [Indexed: 10/23/2022] Open
Affiliation(s)
- Paula W Feng
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut
| | - Aneesha Ahluwalia
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut
| | - Ron A Adelman
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut
| | - Jessica H Chow
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut.
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Nip I, Feng PW, Feng H. Characteristics of physicians with dermatology board certification by the American Board of Physician Specialties. J Am Acad Dermatol 2020; 83:947-949. [DOI: 10.1016/j.jaad.2020.01.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 01/18/2020] [Accepted: 01/21/2020] [Indexed: 10/25/2022]
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Gronbeck C, Feng PW, Feng H. Assessment of dermatologist-patient gender concordance among medicare beneficiaries. J DERMATOL TREAT 2020; 33:1130-1133. [PMID: 32643459 DOI: 10.1080/09546634.2020.1793894] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Physician-patient gender concordance has been linked to more effective patient communication and preventative care screening in the primary care setting. We sought to characterize physician-patient gender concordance among dermatologists based on dermatologist practice setting and characteristics as well as compare these rates to those in other physician specialties. MATERIALS AND METHODS Retrospective, cross-sectional review of the 2017 Medicare Physician and Other Supplier Public Use File. RESULTS In the Medicare population, the mean gender concordance rates among male (52.7) and female (59.9) dermatologists were greater than the overall prevalence of male (46.7) and female (53.3) dermatology beneficiaries (p < .0001). Female concordance rates were higher among dermatologists with an increased frequency of beneficiary visits (62.0 vs. 54.0, p < .0001), while gender concordance rates for male dermatologists were higher than those for all other assessed specialties (52.7 vs. 38.3-46.0, all p < .0001). CONCLUSIONS Male and female dermatologists experienced high degrees of physician-beneficiary gender concordance across various practice settings in the Medicare population, especially when compared to other specialties. Reasons for the observed gender concordance and potential implications for dermatologic care merit further investigation.
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Affiliation(s)
- Christian Gronbeck
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Paula W Feng
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, CT, USA
| | - Hao Feng
- Department of Dermatology, University of Connecticut Health Center, Farmington, CT, USA
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Feng PW, Gronbeck C, Chen EM, Teng CC. Ophthalmologists in the First Year of the Merit-based Incentive Payment System. Ophthalmology 2020; 128:162-164. [PMID: 32522555 DOI: 10.1016/j.ophtha.2020.05.049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/14/2020] [Accepted: 05/22/2020] [Indexed: 10/24/2022] Open
Affiliation(s)
- Paula W Feng
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut.
| | | | - Evan M Chen
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut
| | - Christopher C Teng
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut
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20
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Gronbeck C, Feng PW, Feng H. Metric selection by dermatologists in the 2017 Merit-Based Incentive Payment System. J Am Acad Dermatol 2020; 83:1192-1196. [PMID: 32284187 DOI: 10.1016/j.jaad.2020.02.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 01/11/2020] [Accepted: 02/03/2020] [Indexed: 11/16/2022]
Affiliation(s)
| | - Paula W Feng
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut
| | - Hao Feng
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut.
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21
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Affiliation(s)
| | - Paula W Feng
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut
| | - Hao Feng
- Department of Dermatology, University of Connecticut Health Center, Farmington
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Parikh R, Feng PW, Tainsh L, Sakurada Y, Balaratnasingam C, Khurana RN, Hemmati H, Modi YS. Comparison of Ophthalmic Medication Prices Between the United States and Australia. JAMA Ophthalmol 2020; 137:358-362. [PMID: 30629105 DOI: 10.1001/jamaophthalmol.2018.6395] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Importance Health care prices may drive differences in health care costs across high-income nations. Adalimumab, ranibizumab, and aflibercept are high-cost medications in the United States and Australia. A comparison of their prices over time may elucidate how ophthalmic medication prices contribute to health care costs. Objective To compare changes in the prices of adalimumab, ranibizumab, and aflibercept in the United States and Australia, the highest and lowest spenders on health care, respectively, among high-income nations. Design, Setting, and Participants This retrospective price comparison study examined prices paid by government entities in the United States (Medicare) and Australia (Pharmaceuticals and Benefits Scheme). The analysis and data collection were conducted from March 28 to May 4, 2018, in accordance with guidelines set by the International Society for Pharmacoeconomics and Outcomes Research Task Force on Good Research Practices and prior published studies. No human participants or related data were included in this study. Exposures The change in mean prices of adalimumab, ranibizumab, and aflibercept in the United States and Australia. Main Outcomes and Measures Initial, final, and change in medication price annually from 2013 to 2017 in inflation-adjusted 2017 US dollars. Results The mean prices (US dollar prices unadjusted for inflation) in 2013 and 2017 in the United States were $1114 ($1053) and $1818 ($1818), respectively, for adalimumab; $2102 ($1988) and $1904 ($1904), respectively, for ranibizumab; and $2074 ($1961) and $1956 ($1956), respectively, for aflibercept. The mean (Australian dollar prices unadjusted for inflation) 2013 and 2017 prices in Australia were $1854 (A $1797) and $1206 (A $1574), respectively, for adalimumab; $2157 (A $2090) and $972 (A $1268), respectively, for ranibizumab; and $2030 (A $1967) and $996 (A $1300), respectively, for aflibercept. The estimated annual change in price for adalimumab was +12.8% (95% CI, 9.1%-16.5%) in the United States compared with -11.1% (95% CI, -15.0% to -7.1%) in Australia, a difference of 23.9% per year (95% CI, 19.7%-28.0%; P < .001). The annual change in price for ranibizumab was -2.6% (95% CI, -3.9% to -1.3%) in the United States compared with -18.5% (95% CI, -29.3% to -7.8%) in Australia, a difference of 15.9% per year (95% CI, 7.6%-24.2%; P = .003). The annual change in price for aflibercept was -1.5% (95% CI, -2.2% to -0.7%) in the United States compared with -16.9% (95% CI, -25.1% to -8.6%) in Australia, a difference of 15.4% (95% CI, 9.1%-21.8%; P = .001). Conclusions and Relevance Results of this study indicate that the prices of adalimumab, ranibizumab, and aflibercept significantly decreased during the past 5 years in Australia compared with the United States. These data do not indicate why these differences are noted or what actions might affect future pricing in either country.
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Affiliation(s)
- Ravi Parikh
- Vitreous Retina Macula Consultants of New York, New York.,LuEsther T. Mertz Retina Research Foundation, New York, New York.,Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston
| | - Paula W Feng
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut
| | - Laurel Tainsh
- Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston.,Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut
| | - Yoichi Sakurada
- Vitreous Retina Macula Consultants of New York, New York.,LuEsther T. Mertz Retina Research Foundation, New York, New York.,Department of Ophthalmology, University of Yamanashi, Yamanashi, Japan
| | - Chandrakumar Balaratnasingam
- Centre for Ophthalmology and Visual Science, University of Western Australia, Perth, Australia.,Lions Eye Institute, Nedlands, Australia.,Department of Ophthalmology, Sir Charles Gairdner Hospital, Nedlands, Australia
| | - Rahul N Khurana
- Northern California Retina Vitreous Associates, Mountain View.,Department of Ophthalmology, University of California, San Francisco
| | - Houman Hemmati
- Roski Eye Institute, University of Southern California, Los Angeles.,Optigo Biotherapeutics, Vancouver, British Columbia, Canada
| | - Yasha S Modi
- Department of Ophthalmology, New York University, New York, New York.,New York University Ophthalmology Associates, New York, New York
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23
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Abstract
Importance As the US population continues to increase and age, there is an unmet need for dermatologic care; therefore, it is important to identify and understand the characteristics and patterns of the dermatologist workforce. Objective To analyze the longitudinal dermatologist density and urban-rural disparities using a standardized classification scheme. Design, Setting, and Participants This study analyzed county-level data for 1995 to 2013 from the Area Health Resources File to evaluate the longitudinal trends and demographic and environmental factors associated with the geographic distribution of dermatologists. Main Outcomes and Measures Active US dermatologist and physician density. Results In this study of nationwide data on dermatologists, dermatologist density increased by 21% from 3.02 per 100 000 people to 3.65 per 100 000 people from 1995 to 2013; the gap between the density of dermatologists in urban and other areas increased from 2.63 to 3.06 in nonmetropolitan areas and from 3.41 to 4.03 in rural areas. The ratio of dermatologists older than 55 years to younger than 55 years increased 75% in nonmetropolitan and rural areas (from 0.32 to 0.56) and 170% in metropolitan areas (from 0.34 to 0.93). Dermatologists tended to be located in well-resourced, urban communities. Conclusions and Relevance Our findings suggest that substantial disparities in the geographic distribution of dermatologists exist and have been increasing with time. Correcting the workforce disparity is important for patient care.
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Affiliation(s)
- Hao Feng
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York
| | - Juliana Berk-Krauss
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York.,Yale University School of Medicine, New Haven, Connecticut
| | - Paula W Feng
- Yale University School of Medicine, New Haven, Connecticut
| | - Jennifer A Stein
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York
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Erickson BP, Feng PW, Ko MJ, Modi YS, Johnson TE. Gun-related eye injuries: A primer. Surv Ophthalmol 2019; 65:67-78. [PMID: 31229522 DOI: 10.1016/j.survophthal.2019.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 06/01/2019] [Accepted: 06/07/2019] [Indexed: 02/03/2023]
Abstract
Gun-related eye injuries are relatively common in the context of gunshot wounds to the head and neck. Many of the fundamental principles of gunshot wound management apply to the care of these patients, but the complex anatomy and functional relationships of the periocular region do pose special challenges. We provide a focused primer for physicians seeking a more in-depth understanding of gun-related eye injuries and present 3 representative cases outlining the spectrum of pathology, provide a focused review of the relevant ballistics concepts, and discuss the management of injuries to the periocular soft tissues, orbital structures, and globe. We found that good cosmetic and functional results can often be achieved with appropriate early intervention, but visual prognosis may remain guarded despite optimal treatment.
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Affiliation(s)
- Benjamin P Erickson
- Stanford Health Care, Byers Eye Institute at Stanford, Palo Alto, California, USA.
| | - Paula W Feng
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut, USA
| | - Marcus J Ko
- Nevada Centre for Eye Plastic Surgery, Reno, Nevada, USA
| | - Yasha S Modi
- Department of Ophthalmology, New York University School of Medicine, New York, New York, USA
| | - Thomas E Johnson
- Oculofacial Plastic Surgery, Bascom Palmer Eye Institute, Miami, Florida, USA
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Abstract
Objectives: Antibiotics are commonly used in dermatology for infectious and inflammatory diseases, and dermatologists prescribe the most antibiotics per physician of any specialist in the United States (US). While oral antibiotics are effective for many conditions, adverse effects and increase in resistance are important public health issues. The purpose of this study is to examine trends in oral antibiotic prescription by US dermatologists using Medicare claims.Materials and Methods: Retrospective review using publicly available Medicare Part D prescriber public use files from 2013 to 2016.Results: The number of dermatologists within the Medicare system increased from 10,210 to 10,749. The proportion of prescriptions by dermatologists that were oral antibiotics increased from 10.0% to 10.7% (p = .023). The use of oral antibiotics increased 10.1% (2.9 claims per 1,000 beneficiaries) from 28.7 to 31.6 claims per 1,000 beneficiaries. There were more oral antibiotic prescriptions in the South than in other regions. Doxycycline was the most commonly prescribed antibiotic each year in all regions.Conclusions: Between 2013 and 2016, the number of oral antibiotics prescribed by dermatologists has increased among Medicare patients. Dermatologists must continue to reevaluate antibiotic prescription practices, particularly among the elderly population, in order to provide optimal care to patients.
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Affiliation(s)
- Efe Kakpovbia
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY, USA
| | - Hao Feng
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY, USA
| | - Paula W Feng
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, CT, USA
| | - Jeffrey M Cohen
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY, USA
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26
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Abstract
Dog bites result in a diverse range of injuries and complications in the periocular region, particularly in school aged children. It is therefore incumbent on the oculoplastic surgeon to be well versed in both acute and long-term management. The intent of this review is to provide a systematic evaluation of the epidemiology, principles of dog bite wound care, and specific considerations related to common patterns of ophthalmic injury. Review of clinical literature from 1976 to 2014. The majority of periocular injuries result from seemingly benign interactions between young children and familiar dogs. Aggressive saline lavage combined with selective debridement of devitalized tissue is essential. High-risk wounds and vulnerable patient groups may benefit from preventive antibiotic coverage as well as appropriate rabies and tetanus prophylaxis. While the nuances of surgical repair are variable given the heterogeneity of presentation, systematic examination and an algorithm-driven approach underlie the optimal management of these complex injuries.
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Affiliation(s)
- Benjamin P Erickson
- a Department of Ophthalmology , Stanford Health Care, Byers Eye Institute at Stanford , Palo Alto , California , United States
| | - Paula W Feng
- b Department of Ophthalmology and Visual Science , Yale School of Medicine , New Haven , Connecticut , United States
| | - Sophie D Liao
- c Department of Ophthalmology , University of Colorado School of Medicine , Aurora , Colorado , United States
| | - Yasha S Modi
- d Department of Ophthalmology , New York University School of Medicine , New York , United States
| | - Audrey C Ko
- e Department of Ophthalmology and Visual Sciences , The University of Iowa Hospitals and Clinics , Iowa City , Iowa , United States
| | - Wendy W Lee
- f Bascom Palmer Eye Institute , University of Miami Miller School of Medicine , Miami , Florida , United States
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Parikh R, Feng PW, Del Priore LV, Adelman RA, Chaudhry NA. Relationship Between Claims Data and the Preferences and Trends Survey: An Analysis of Anti-Vascular Endothelial Growth Factor Medication Choice for Age-Related Macular Degeneration. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/2474126417753433] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: To compare published self-reported practice patterns among retina specialists with published claims data representing actual practice patterns for the use of anti-vascular endothelial growth factor (anti-VEGF) medications in the treatment of age-related macular degeneration (AMD) in the United States. Methods: We compared physician self-reported preference for anti-VEGF medications to treat AMD in the American Society of Retina Specialists’ Preferences and Trends (PAT) survey with a previously published study using claims data from 2006 to 2015 from OptumLabs Data Warehouse as a data source. A Pearson χ2 test compared the relative proportions of drug use between the 2 groups, with <.05 indicating statistical significance. Results: From 2006 to 2015, the PAT surveys had approximately 3548 respondents to questions on which anti-VEGF medication was used for the treatment of AMD. Over the study period, 62.3% (2211/3548) of respondents preferred bevacizumab, 30.4% (1078/3548) ranibizumab, and 7.3% (259/3548) aflibercept in the treatment of AMD. Claims data on anti-VEGF use for AMD noted 59.7% (359 267/601 917) of injections were for bevacizumab, 23.8% (143 200/601 917) were for ranibizumab, and 16.5% (99 450/601 917) were for aflibercept. The difference in the relative use of bevacizumab, ranibizumab, and aflibercept use was not significant between the data sets ( P = .1991). Conclusions: The PAT survey responses appear to reflect actual physician practices based upon claims data and demonstrate the prevalence of bevacizumab as the prevailing treatment for AMD.
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Affiliation(s)
- Ravi Parikh
- Department of Ophthalmology and Visual Sciences, Yale University School of Medicine, New Haven, CT, USA
- Department of Ophthalmology, Weill Cornell Medical College, New York NY, USA
- Vitreous, Retina, and Macula Consultants of New York, New York, NY, USA
| | - Paula W. Feng
- Department of Ophthalmology and Visual Sciences, Yale University School of Medicine, New Haven, CT, USA
| | - Lucian V. Del Priore
- Department of Ophthalmology and Visual Sciences, Yale University School of Medicine, New Haven, CT, USA
| | - Ron A. Adelman
- Department of Ophthalmology and Visual Sciences, Yale University School of Medicine, New Haven, CT, USA
| | - Nauman A. Chaudhry
- Department of Ophthalmology and Visual Sciences, Yale University School of Medicine, New Haven, CT, USA
- Retina Group of New England, New London, CT, USA
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