Clinicians and their patients, especially the elderly and women, assign very different levels of severity to dry eye, according to multicenter, U.S. and Canadian analysis. The cross-sectional, observational study measured the degree of agreement between clinicians' assessment and subjects' self-assessment of dry eye severity. A secondary purpose was to identify the role of gender and age in that concordance.
The study recruited 162 dry-eye subjects and 48 controls from clinical databases of ICD-9 codes in six clinical sites. Before examination, subjects gave a global self-assessment of the severity of their dry eye from "none" to "extremely severe." After a clinical examination that included dry-eye tests, the clinician discussed the subjects' symptoms and then gave global clinician assessment of dry eye from "none" to "severe."
Although the correlation and agreement between clinician and self-assessment was significant (r=0.720, p=0.000; weighted K=0.471; 95 percent CI=0.395, 0.548; p=0.000), the clinician assessment underestimated the severity in 40.9 percent of the subjects by at least one grade compared with the subjects' self-assessment. More than 54 percent of subjects over age 65 and 43 percent of the female subjects had their condition underestimated by the clinician (p<0.05). The group concludes that eye-care practitioners need better, more quantitative tools to assess ocular surface symptoms to improve the concordance in severity assessment and to meet the needs of this symptomatic patient population by offering them appropriate treatments.
Chalmers R, Begley C, Edrington T, Caffery B, Nelson D, Snyder C, Simpson T.
Early Detection Improves Macugen Treatment
Early detection and treatment with pegaptanib (Macugen, Pfizer/Eyetech Pharmaceuticals) may result in superior vision outcomes in patients with neovascular AMD, says the VEGF Inhibition Study in Ocular Neovascularization (VISION) Clinical Trial Group. Their most recent report assessed the vision benefit of treating early subfoveal choroidal neovascularization secondary to age-related macular degeneration.
The exploratory analysis looked at the week 54 vision outcomes of subject subgroups with early disease who received 0.3 mg of pegaptanib (Groups 1 [n=34] and 2 [n=30]) or sham injections (usual care). Two sets of clinical characteristics typical of early disease defined the subgroups.
Pegaptanib responder rates (loss of <15 letters of visual acuity) were 76 percent in Group 1 and 80 percent in Group 2 vs. 50 percent in Group 1 and 57 percent in Group 2 for usual care (p=0.03 and p=0.05 respectively). Compared with subjects assigned to pegaptanib, those receiving usual care lost on average 11.1 more letters of visual acuity in Group 1 and 12.7 more letters in Group 2 (p<0.01 and p<0.006 respectively). Subjects assigned to usual care were approximately 10 times more likely to have severe vision loss than were those treated with pegaptanib (Group 1, 29 percent vs. 3 percent, respectively; p<0.01). In Group 1, 12 percent of pegaptanib-treated subjects gained >=15 letters of visual acuity versus 4 percent receiving usual care; 20 percent of Group 2 pegaptanib-treated subjects gained >=15 letters of visual acuity versus none of the usual-care subjects.
The VEGF Inhibition Study in Ocular Neovascularization (V.I.S.I.O.N.) Clinical Trial Group.
Post-PK Study Finds Different Healing Between Fluoroquinolones
A preliminary study from the Moran Eye Center at the University of Utah suggests that the postoperative use of gatifloxacin in corneal transplant patients may allow the early stages of corneal graft reepithelialization to proceed more quickly than does treatment with moxifloxacin. The single-center, open-label, prospective study, alternately assigned 46 consecutive patients requiring penetrating keratoplasty to receive either postop moxifloxacin 0.5% ophthalmic solution (n=23; Vigamox, Alcon) or gatifloxacin 0.3% ophthalmic solution (n=23; Zymar, Allergan). The primary outcome measure was the area of the epithelial defect measured by slit-lamp evaluation during the postop period.
The mean area of the epithelial defect was similar in both treatment groups at baseline (p=0.104), but it was significantly larger in the moxifloxacin group than in the gatifloxacin group at day four (23.9 mm2 vs. 10.6 mm2, respectively; p<0.001) and day 7 (3.8 mm2 vs. 0.85 mm2, respectively; p=0.03). At every follow-up visit after day four, there were more eyes with complete reepithelialization of the corneal graft in the gatifloxacin group than in the moxifloxacin group (statistically significant at days seven and 14). The findings suggest that a larger, masked, randomized clinical study in a more homogeneous patient population is warranted to further investigate the relative effects of moxifloxacin and gatifloxacin on postop corneal wound healing.
(Cornea 2005 Oct;24:833-6)
Moshirfar M, Marx DP, Kumar R.
OCEX Passes Muster for Resident Testing
The Ophthalmic Clinical Evaluation Exercise (OCEX), a tool designed to assess the ophthalmology resident's competence in patient care, shows both reliability and validity and, therefore, meets the Accreditation Council for Graduate Medical Education criteria for an acceptable assessment tool, say researchers at the University of Cincinnati.
The coefficient alpha statistic (a measure of reliability/internal consistency) for the OCEX as a whole was 0.81. The alpha statistics for three of four subscales that comprise the OCEX (i.e., interviewing skills=0.65, interpersonal skills/professionalism=0.73, case presentation=0.70) were lower than the OCEX as a whole, but were acceptable for new scales. However, the alpha for the examination subscale (i.e., 0.27) was extremely low. Interrater reliability assessment showed that of 33 individual OCEX items, 31 (94 percent) had at least 85 percent of the raters rating the student in one of two consecutive rating categories.
Golnik KC, Goldenhar L.