Dexamethasone intravitreal implant (DEX) (Ozurdex; Allergan plc, Dublin, Ireland) is approved for... more Dexamethasone intravitreal implant (DEX) (Ozurdex; Allergan plc, Dublin, Ireland) is approved for the treatment of diabetic macular edema (DME). This study assessed the real-world effectiveness, safety, and reinjection interval of DEX in adult patients with DME. This was a phase 4, prospective, multicenter (18 U.S. sites), observational study. The study population comprised 177 patients (180 eyes; 93.8% previously treated). Baseline mean best-corrected visual acuity (BCVA) and central retinal thickness (CRT) were 54.4 letters and 424.6 μm, respectively. DEX was administered as monotherapy or with other DME therapy (55%/45%). The mean reinjection interval was 5.0 months. Mean maximum BCVA change from baseline after the first three DEX injections was +9.1 letters, +7.7 letters, and +7.0 letters, respectively (P < .001); 36.0% of eyes achieved 15-letter or greater BCVA improvement. Mean maximum CRT change from baseline was -137.7 μm (P < .001). DEX used alone or with other DME th...
The British journal of ophthalmology, Jan 25, 2014
To evaluate the visual and anatomical outcomes of dexamethasone intravitreal implant (DXI; 700 μg... more To evaluate the visual and anatomical outcomes of dexamethasone intravitreal implant (DXI; 700 μg, Ozurdex; Allergan, Irvine, California, USA) as adjunctive therapy for patients with refractory wet age-related macular degeneration (AMD). Retrospective review of the medical records of seven patients (seven eyes) who initially responded well to intravitreal ranibizumab but subsequently developed persistent intra/sub-retinal fluid (IRF/SRF) and underwent a single injection of DXI, between May 2012 and May 2013. Two weeks after DXI, the patients continued with their monthly ranibizumab injections. Best corrected visual acuity (BCVA) logarithm of the minimum angle of resolution (logMAR) and central retinal thickness (CRT) were recorded at baseline, 2 weeks, 6 weeks, 3 months and 6 months after DXI injection. Complications were recorded too. All patients had at least 24 months of ranibizumab treatment. Mean age was 81.5±5.8 years. At baseline, mean BCVA was 0.53±0.13 logMAR (20/70 Snellen...
Dexamethasone intravitreal implant (DEX implant) is a sustained-release biodegradable implant app... more Dexamethasone intravitreal implant (DEX implant) is a sustained-release biodegradable implant approved for treatment of macular edema associated with retinal vein occlusion (RVO). The safety and efficacy of treatment of RVO-associated macular edema with sequential DEX implants in clinical practice was evaluated in patients who received DEX implant as monotherapy compared with patients who received DEX implant in combination with other RVO treatments. A multicenter, retrospective, open-label chart review study (one study eye/patient) evaluated use of DEX implant and outcomes in 289 patients with branch or central RVO who received at least 2 DEX implant treatments in the study eye. Data were collected from the time of the first implant (baseline) to 3-6 months after the last implant. Subgroup analysis evaluated outcomes in patients receiving only DEX implant during the study versus patients receiving DEX implant plus adjunctive RVO treatments. Endpoints included best-corrected visual ...
The purpose of this study is to compare cancellation and no-show rates in patients with diabetic ... more The purpose of this study is to compare cancellation and no-show rates in patients with diabetic macular edema (DME) and exudative macular degeneration (wet AMD). An anonymous survey was sent to 1,726 retina specialists inquiring as to the number of appointments their patients with DME and wet AMD attended, cancelled, or did not show up for in 2014 and 2015. Data were obtained on 109,599 appointments. Patients with DME in the U.S. had a 1.591-times increased odds of cancelling or no-showing to their appointments than patients with wet AMD (P < .0001). Patients with DME in Europe had a 1.918-times increased odds of cancelling or no showing to their appointments than patients with wet AMD (P < .0001). Patients with DME in the U.S. and Europe cancelled and no-showed to their appointments significantly more often than patients with wet AMD. These findings can be taken into consideration when establishing treatment plans for patients with DME. [Ophthalmic Surg Lasers Imaging Retina...
The treatment of diabetic macular edema (DME) has become one of the most challenging management i... more The treatment of diabetic macular edema (DME) has become one of the most challenging management issues faced by ophthalmologists in daily practice. This is partly due to the multifactorial nature of DME, progression of the disease and the clinical capacity needed to administer intravitreal injections. In recent years, the treatment options for DME have expanded to include intravitreal injections of anti-vascular endothelial growth factor (VEGF) agents and steroids, and most recently, the use of intravitreal implants. In determining clinically relevant endpoints for clinical studies of these treatments, it is important to consider the patient’s journey and experience with a treatment over a specific time-period rather than isolated outcomes at a pre-specified time-point. Area under the curve (AUC) is an ideal tool for data analysis particularly when it comes to sustained release therapies such as dexamethasone (OzurdexR, Allergan Inc., California, US) and intravitreal fluocinolone ac...
AimTo analyse the peripheral extent of choroidal circulation using ultra-widefield (UWF) indocyan... more AimTo analyse the peripheral extent of choroidal circulation using ultra-widefield (UWF) indocyanine green angiography (ICGA) in healthy eyes.MethodsUWF ICGA images of 55 eyes of 36 healthy subjects were captured using the Optos California (Optos, Dunfermline, United Kingdom) in this prospective observational study. Images were analysed to locate the peripheral extent of the visible choroidal circulation, and the boundary was marked in ImageJ (v1.52). Each pixel annotated as the border of the choroidal circulation was projected individually to its anatomically correct location on the three-dimensional model eye, and spherical trigonometry was applied (using the Optos software) to calculate its respective radial distance from the centre of the optic disc in metric units (corrected by stereographic projection) for each quadrant.ResultsThe mean area of the peripheral extent was estimated to be 893.2 mm2 (95% CI: 844.2 to 942.3 mm2). The mean distance (range) of this boundary from optic...
Abstract Physician review websites allow patients to share experiences with different providers. ... more Abstract Physician review websites allow patients to share experiences with different providers. We analyzed 84,230 reviews on ophthalmologists, and found that increased wait times, history of malpractice, and incomplete profiles correlated with lower reviews. Physician review websites (PRWs) are ushering in a new era of transparency in the healthcare system allowing consumers to view patient ratings and evaluations of physicians to guide their choice. Although these ratings do not always correlate with quality of care,1 patients are willing to wait longer to see physicians with higher online ratings.2 The most trafficked physician review websites include HealthGrades, Vitals, ZocDoc, and RateMDs. PRWs have been analyzed in other medical specialties,3 including oculoplastic surgeons in the field of ophthalmology.4 The purpose of this study was to investigate how patients rate all ophthalmologists online by analyzing reviews on two of the most popular PRWs: HealthGrades and Vitals. We wanted to identify which variables are associated with outlier scores and hypothesized reviews would be generally positive. We received IRB approval for this study.
Dexamethasone intravitreal implant (DEX) (Ozurdex; Allergan plc, Dublin, Ireland) is approved for... more Dexamethasone intravitreal implant (DEX) (Ozurdex; Allergan plc, Dublin, Ireland) is approved for the treatment of diabetic macular edema (DME). This study assessed the real-world effectiveness, safety, and reinjection interval of DEX in adult patients with DME. This was a phase 4, prospective, multicenter (18 U.S. sites), observational study. The study population comprised 177 patients (180 eyes; 93.8% previously treated). Baseline mean best-corrected visual acuity (BCVA) and central retinal thickness (CRT) were 54.4 letters and 424.6 μm, respectively. DEX was administered as monotherapy or with other DME therapy (55%/45%). The mean reinjection interval was 5.0 months. Mean maximum BCVA change from baseline after the first three DEX injections was +9.1 letters, +7.7 letters, and +7.0 letters, respectively (P < .001); 36.0% of eyes achieved 15-letter or greater BCVA improvement. Mean maximum CRT change from baseline was -137.7 μm (P < .001). DEX used alone or with other DME th...
The British journal of ophthalmology, Jan 25, 2014
To evaluate the visual and anatomical outcomes of dexamethasone intravitreal implant (DXI; 700 μg... more To evaluate the visual and anatomical outcomes of dexamethasone intravitreal implant (DXI; 700 μg, Ozurdex; Allergan, Irvine, California, USA) as adjunctive therapy for patients with refractory wet age-related macular degeneration (AMD). Retrospective review of the medical records of seven patients (seven eyes) who initially responded well to intravitreal ranibizumab but subsequently developed persistent intra/sub-retinal fluid (IRF/SRF) and underwent a single injection of DXI, between May 2012 and May 2013. Two weeks after DXI, the patients continued with their monthly ranibizumab injections. Best corrected visual acuity (BCVA) logarithm of the minimum angle of resolution (logMAR) and central retinal thickness (CRT) were recorded at baseline, 2 weeks, 6 weeks, 3 months and 6 months after DXI injection. Complications were recorded too. All patients had at least 24 months of ranibizumab treatment. Mean age was 81.5±5.8 years. At baseline, mean BCVA was 0.53±0.13 logMAR (20/70 Snellen...
Dexamethasone intravitreal implant (DEX implant) is a sustained-release biodegradable implant app... more Dexamethasone intravitreal implant (DEX implant) is a sustained-release biodegradable implant approved for treatment of macular edema associated with retinal vein occlusion (RVO). The safety and efficacy of treatment of RVO-associated macular edema with sequential DEX implants in clinical practice was evaluated in patients who received DEX implant as monotherapy compared with patients who received DEX implant in combination with other RVO treatments. A multicenter, retrospective, open-label chart review study (one study eye/patient) evaluated use of DEX implant and outcomes in 289 patients with branch or central RVO who received at least 2 DEX implant treatments in the study eye. Data were collected from the time of the first implant (baseline) to 3-6 months after the last implant. Subgroup analysis evaluated outcomes in patients receiving only DEX implant during the study versus patients receiving DEX implant plus adjunctive RVO treatments. Endpoints included best-corrected visual ...
The purpose of this study is to compare cancellation and no-show rates in patients with diabetic ... more The purpose of this study is to compare cancellation and no-show rates in patients with diabetic macular edema (DME) and exudative macular degeneration (wet AMD). An anonymous survey was sent to 1,726 retina specialists inquiring as to the number of appointments their patients with DME and wet AMD attended, cancelled, or did not show up for in 2014 and 2015. Data were obtained on 109,599 appointments. Patients with DME in the U.S. had a 1.591-times increased odds of cancelling or no-showing to their appointments than patients with wet AMD (P < .0001). Patients with DME in Europe had a 1.918-times increased odds of cancelling or no showing to their appointments than patients with wet AMD (P < .0001). Patients with DME in the U.S. and Europe cancelled and no-showed to their appointments significantly more often than patients with wet AMD. These findings can be taken into consideration when establishing treatment plans for patients with DME. [Ophthalmic Surg Lasers Imaging Retina...
The treatment of diabetic macular edema (DME) has become one of the most challenging management i... more The treatment of diabetic macular edema (DME) has become one of the most challenging management issues faced by ophthalmologists in daily practice. This is partly due to the multifactorial nature of DME, progression of the disease and the clinical capacity needed to administer intravitreal injections. In recent years, the treatment options for DME have expanded to include intravitreal injections of anti-vascular endothelial growth factor (VEGF) agents and steroids, and most recently, the use of intravitreal implants. In determining clinically relevant endpoints for clinical studies of these treatments, it is important to consider the patient’s journey and experience with a treatment over a specific time-period rather than isolated outcomes at a pre-specified time-point. Area under the curve (AUC) is an ideal tool for data analysis particularly when it comes to sustained release therapies such as dexamethasone (OzurdexR, Allergan Inc., California, US) and intravitreal fluocinolone ac...
AimTo analyse the peripheral extent of choroidal circulation using ultra-widefield (UWF) indocyan... more AimTo analyse the peripheral extent of choroidal circulation using ultra-widefield (UWF) indocyanine green angiography (ICGA) in healthy eyes.MethodsUWF ICGA images of 55 eyes of 36 healthy subjects were captured using the Optos California (Optos, Dunfermline, United Kingdom) in this prospective observational study. Images were analysed to locate the peripheral extent of the visible choroidal circulation, and the boundary was marked in ImageJ (v1.52). Each pixel annotated as the border of the choroidal circulation was projected individually to its anatomically correct location on the three-dimensional model eye, and spherical trigonometry was applied (using the Optos software) to calculate its respective radial distance from the centre of the optic disc in metric units (corrected by stereographic projection) for each quadrant.ResultsThe mean area of the peripheral extent was estimated to be 893.2 mm2 (95% CI: 844.2 to 942.3 mm2). The mean distance (range) of this boundary from optic...
Abstract Physician review websites allow patients to share experiences with different providers. ... more Abstract Physician review websites allow patients to share experiences with different providers. We analyzed 84,230 reviews on ophthalmologists, and found that increased wait times, history of malpractice, and incomplete profiles correlated with lower reviews. Physician review websites (PRWs) are ushering in a new era of transparency in the healthcare system allowing consumers to view patient ratings and evaluations of physicians to guide their choice. Although these ratings do not always correlate with quality of care,1 patients are willing to wait longer to see physicians with higher online ratings.2 The most trafficked physician review websites include HealthGrades, Vitals, ZocDoc, and RateMDs. PRWs have been analyzed in other medical specialties,3 including oculoplastic surgeons in the field of ophthalmology.4 The purpose of this study was to investigate how patients rate all ophthalmologists online by analyzing reviews on two of the most popular PRWs: HealthGrades and Vitals. We wanted to identify which variables are associated with outlier scores and hypothesized reviews would be generally positive. We received IRB approval for this study.
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