Researchers from the Bascom Palmer Eye Institute in Miami conducted a retrospective case series to compare the outcomes in eyes with Fuchs’ endothelial corneal dystrophy after standard phacoemulsification with those undergoing femtosecond laser-assisted cataract surgery.
The researchers reviewed charts from patients diagnosed with Fuchs’ dystrophy who had phacoemulsification at Bascom Palmer between January 1, 2014, and January 1, 2017. The Institutional Review Board at the University of Miami Human Subjects Research Office approved the study protocol. Complicated surgeries and cases with concurrent keratoplasty, previous keratoplasty or glaucoma surgery, or a follow-up shorter than three months were excluded. The corrected distance visual acuity, central corneal thickness, and corneal edema at each visit were analyzed. Clinically significant corneal decompensation was defined as corneal edema with CDVA worse than 20/50 lasting more than three months, any case resulting in keratoplasty or both.
The study comprised 207 eyes of 207 patients (64 femtosecond laser-assisted cataract surgery, 143 conventional phacoemulsification). Demographics and follow-up time (mean 30 months) were similar between groups (p>0.05). The proportion of cases progressing to clinically significant decompensation (13 percent) was similar between the groups (p>0.05). Univariate Cox survival analysis also found no difference (hazard ratio, 1.0; 95 percent confidence interval, 0.4 to 2.7; p=0.96).
From these results, the researchers concluded that compared with conventional phacoemulsification, femtosecond laser-assisted cataract surgery did not lower the rate of corneal decompensation in eyes with mild to moderate Fuchs’ endothelial corneal dystrophy.
J Cataract Refract Surg 2018;44:534-540.
Zhu DC, Shah P, Feuer WJ, Shi W, Koo EH
Appointments: Medicaid vs. Private Insurance
In this prospective, cohort study conducted from January 1, 2017, to July 1, 2017, researchers made phone calls to a randomly selected sample of vision-care professionals in Michigan and Maryland stratified by neighborhood (urban vs. rural) and professional type (ophthalmologist vs. optometrist) to request the first available appointment. Appointments were sought for an adult needing a diabetic eye examination and a child requesting a routine eye examination for a failed vision screening. Researchers called each practice twice, once requesting an appointment for a patient with Medicaid and the other time for a patient with Blue Cross Blue Shield insurance, and asked whether the insurance was accepted and, if so, when the earliest available appointment could be scheduled.
A total of 603 telephone calls were made to 330 eye-care professionals (414 calls [68.7 percent] to male and 189 calls [31.3 percent] to female doctors). The sample consisted of ophthalmologists (303 [50.2 percent]) and optometrists (300 [49.8 percent]) located in Maryland (322 [53.4 percent]) and Michigan (281 [46.6 percent]). The rates of successfully obtaining appointments among callers were 61.5 percent (95% CI, 56.0 to 67 percent) for adults with Medicaid and 79.3 percent (95% CI, 74.7 to 83.9 percent) for adults with BCBS (p<0.001) and 45.4 percent (95% CI, 39.8 to 51.0 percent) for children with Medicaid and 62.5 percent (95% CI, 57.1 to 68 percent) for children with BCBS (p<0.001). Mean wait time didn’t vary significantly between the BCBS and Medicaid groups for either adults or children.
Adults with Medicaid had significantly decreased odds of receiving an appointment compared with those with BCBS (odds ratio [OR], 0.41; 95% CI, 0.28 to 0.59; p<0.001) but had increased odds of obtaining an appointment if they were located in Michigan vs. Maryland (OR, 2.40; 95% CI, 1.49 to 3.87; p<0.001) or with an optometrist vs. an ophthalmologist (OR, 1.91; 95% CI, 1.31 to 2.79; p<0.001). Children with Medicaid had significantly decreased odds of receiving an appointment compared with those with BCBS (OR, 0.41; 95% CI, 0.28 to 0.60; p<0.001), and also had better odds of getting an appointment if they were in Michigan vs. Maryland (OR, 1.68; 95% CI, 1.04 to 2.73; p=0.03), or with an optometrist vs. an ophthalmologist (OR, 8.00; 95% CI, 5.37 to 11.90; p<0.001).
The researchers say that these results suggest a disparity in access to eye care based on insurance status, although confounding factors may have contributed to this finding. Improving access to eye-care professionals for those with Medicaid may improve health outcomes and decrease healthcare spending in the long term, the investigators add.
JAMA Ophthalmol 2018;136:622629.
Lee Y, Chen A, Varadaraj V, et al
Choroidal Thickness with Drusenoid PED
In a consecutive observational case series, researchers from New York City analyzed the changes in visual acuity and subfoveal choroidal thickness in patients with non-neovascular age-related macular degeneration and drusenoid pigment epithelium detachments.
The researchers conducted a retrospective review of eyes diagnosed with drusenoid PED in a single clinical setting. Demographic and clinical data included age, sex, laterality, best-corrected visual acuity and subfoveal choroidal thickness measured at baseline, before and after the collapse of the PED, and at the last available follow-up. The presence of geographic atrophy was also assessed.
Thirty-seven eyes of 25 patients (18 female) were included in the analysis. Mean age at baseline was 71 ±8.4 years. During a mean follow-up period of 4.9 ±1.9 years, PED collapse was observed in 25 eyes (68 percent). Mean BCVA, mean maximum PED height, and mean subfoveal choroidal thickness significantly decreased from baseline to the last available follow-up (p<0.001) in patients showing PED collapse. Choroidal thinning was faster during the PED collapse (speed rate of 35.9 μm/year). From those, 23 eyes (92 percent) developed GA. A significant correlation between the area of GA and the decrease in choroidal thickness was found (p=0.010).
Based on these results, choroidal thickness significantly decreased in eyes showing drusenoid PED collapse, but not in eyes in which the PED persisted. Researchers found a significant correlation with resultant GA area following PED collapse and the magnitude of choroidal thinning. They note that further studies are warranted to better understand the mechanisms involved in the occurrence of choroidal changes during the life cycle of drusenoid PEDs.
Am J Ophthalmol 2018;191:2333.
Dolz-Marco R, Balaratnasingam C, Gattoussi S, et al.