Iván Suñer - Academia.edu (original) (raw)

Papers by Iván Suñer

Research paper thumbnail of Taking a Broader View of

Research paper thumbnail of Direct medical costs and resource use for treating central and branch retinal vein occlusion in commercially insured working-age and Medicare populations

Retina (Philadelphia, Pa.), 2014

To quantify the burden of illness for incident branch retinal vein occlusion (BRVO) and central r... more To quantify the burden of illness for incident branch retinal vein occlusion (BRVO) and central retinal vein occlusion (CRVO) in a commercially insured working-age (commercial) and Medicare US population. Retrospective cohort analysis of health care claims from 2003 through 2008 from commercial and Medicare patients with ≥2 outpatient diagnoses for BRVO or CRVO. The index date was the first retinal vein occlusion diagnosis. Patients with medical and pharmacy benefits were followed ≥1 year preindex and then between 1 year and 3 years postindex. Incidence and prevalence of retinal vein occlusion was determined. Burden of illness was compared with matched control subjects without retinal vein occlusion. The commercial sample comprised 1,188 CRVO and 2,252 BRVO cases, whereas the Medicare sample had 2,739 CRVO and 4,573 BRVO cases. Adjusted ratio of case-to-control, all-cause expenditures for commercial patients at 1 year and 3 years postindex were 1.88 and 1.68, respectively, for BRVO ...

Research paper thumbnail of Numerical relationship between neurons in the lateral geniculate nucleus and primary visual cortex in macaque monkeys

Visual Neuroscience, 1996

We examined the numerical correlation between total populations of neurons in the lateral genicul... more We examined the numerical correlation between total populations of neurons in the lateral geniculate nucleus (LGN) and the primary visual cortex (area 17 of Brodmann) in ten cerebral hemispheres of five normal rhesus monkeys using an unbiased three-dimensional counting method. There were 1.4 +/- 0.2 million and 341 +/- 54 million neurons in the LGN and area 17, respectively. In each animal, a larger LGN on one side was in register with a larger area 17 of the cortex on the same side. Furthermore, asymmetry in the number of neurons in both the LGN and area 17 favored the right side. However, because of small variations across subjects, correlation between the total neuron number in LGN and area 17 was weak (r2 = 0.29). These results suggest that the final numbers of neurons in these visual centers may be established independently or by multiple factors controlling elimination of initially overproduced neurons.

Research paper thumbnail of A novel cytoarchitectonic area induced experimentally within the primate visual cortex

Proceedings of the National Academy of Sciences, 1991

The cerebral cortex is divisible into a number of cytoarchitectonic areas, but developmental mech... more The cerebral cortex is divisible into a number of cytoarchitectonic areas, but developmental mechanisms that regulate their number and size remain unknown. Here we provide evidence that reducing the population of selected thalamic fibers projecting into the primary visual cortex (area 17) of monkeys during midgestation induces the formation of a novel cytoarchitectonic area situated along the border of and

Research paper thumbnail of Vision-Related Function after Ranibizumab Treatment by Better- or Worse-Seeing Eye

Ophthalmology, 2010

To examine the effects of ranibizumab on the National Eye Institute Visual Function Questionnaire... more To examine the effects of ranibizumab on the National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25) scores in neovascular age-related macular degeneration (AMD) according to whether the study eye was the better- or worse-seeing eye at baseline. Within 2 randomized, double-masked clinical trials (MARINA and ANCHOR), the NEI VFQ-25 was administered at 0, 1, 2, 3, 6, 9, 12, 18, and 24 months. We included 646 MARINA and 379 ANCHOR patients. Patients were randomized 1:1:1 to monthly intravitreal ranibizumab (0.3 or 0.5 mg) or control (sham injections for MARINA; photodynamic therapy [PDT] with verteporfin for ANCHOR). Mean change from baseline in NEI VFQ-25 scores at 12 and 24 months. Across all treatment arms, 21% to 38% of enrolled eyes were the better-seeing eye. At the 24-month follow-up visit, mean change in composite scores with ranibizumab seemed to be better than control for both better-seeing eyes (8.4 [95% confidence interval (CI), 5.2-11.6], 7.5 [95% CI, 3.7-11.4], and -9.4 [95% CI, -12.5 to -6.3] for the 0.3-mg, 0.5-mg, and sham groups, respectively) and worse-seeing eyes (1.7 [95% CI, -1.1 to 4.4], 1.7 [95% CI, -0.7 to 4.1], and -5.4 [95% CI, -7.9 to -2.8] for the 0.3-mg, 0.5-mg, and sham groups, respectively) in MARINA, as well as the better-seeing eye in ANCHOR (11.3 [95% CI, 5.3-17.3], 13.3 [95% CI, 7.7-19.0], and -2.7 [95% CI, -9.0 to 3.7] for the 0.3-mg, 0.5-mg, and PDT groups, respectively). When the worse-seeing eye was treated in ANCHOR, such differences could not be detected at 24 months (1.3 [95% CI, -1.7 to 4.2], 2.6 [95% CI, -1.1 to 6.3], and 0.1 [95% CI, -3.5 to 3.7] for the 0.3-mg, 0.5-mg, and PDT groups, respectively). Analysis of patient perception of vision-related function in phase III trials evaluating ranibizumab for neovascular AMD demonstrates improved patient-reported outcomes regardless of whether the treated eye is the better- or worse-seeing eye at onset of treatment, and supports treatment of such lesions with ranibizumab, even those in the worse-seeing eye. Proprietary or commercial disclosure may be found after the references.

Research paper thumbnail of Long-term outcomes in eyes receiving fixed-interval dosing of anti-vascular endothelial growth factor agents for wet age-related macular degeneration

Ophthalmology, 2015

To report on long-term visual outcomes in patients receiving continuous fixed-interval dosing of ... more To report on long-term visual outcomes in patients receiving continuous fixed-interval dosing of anti-vascular endothelial growth factor (VEGF) treatment in neovascular age-related macular degeneration (AMD). Single-practice retrospective chart review. One hundred nine eyes with exudative AMD receiving continuous fixed-interval dosing (every 4-8 weeks) of anti-VEGF therapy (ranibizumab, bevacizumab, or aflibercept) for at least 5 years. Eyes were excluded if they averaged fewer than 6.5 injections per year. Snellen visual acuity was recorded at baseline and all subsequent injections. Changes from baseline were calculated at yearly intervals. The primary outcome measure was mean change in letter score at 5, 6, and 7 years; secondary outcomes included the percentage of patients with 20/40 vision or better at 7 years and the mean change in letter score at each yearly time point based on baseline visual grouping (20/40 or better, 20/50-20/100, 20/200 or worse). Forty-four, 75, and 109 p...

Research paper thumbnail of Ultrawide Angle Fluorescein Angiographic Imaging: A Comparison to Conventional Digital Acquisition Systems

Ophthalmic Surgery, Lasers, and Imaging, 2008

A prototype ultrawide field angiographic system and conventional technology were compared. Thirty... more A prototype ultrawide field angiographic system and conventional technology were compared. Thirty subjects with diabetic retinopathy were imaged in three centers by conventional (Topcon Inc., Paramus, NJ, or Carl Zeiss Meditec, Dublin, CA) and ultrawide field (Optos P200A; Optos Inc., Dunfermline, Scotland) digital fluorescein angiography units. A calibrated grid was digitally placed on the images to facilitate measurements. Main outcome measures were field of view and the number of grid sectors displaying retinal ischemia and neovascularization. Secondary measures were image quality and patient satisfaction scores. The P200A provided a significantly greater visual field extent of 8.7 +/- 1.6 disc diameters (DD) compared to the conventional systems (3.4 +/- 0.76 DD) (P < .001). Retinal ischemia was better revealed (16.9 +/- 15 vs 3.4 +/- 4.26 sectors) with the prototype, but image quality was superior with the conventional system. Patient satisfaction scores did not differ between systems. A prototype ultrawide angle imaging system displayed significantly more diabetic retinal pathology in a single image than conventional systems.

Research paper thumbnail of Age as an independent risk factor for severity of experimental choroidal neovascularization

Investigative ophthalmology & visual science, 2002

For many vascular diseases, aging appears to be an independent risk factor for severity of vascul... more For many vascular diseases, aging appears to be an independent risk factor for severity of vascular complications, and blood vessels of aged individuals often demonstrate exaggerated repair responses to injury. This study was undertaken to determine the influence of aging on the severity of neovascularization in a mouse model of laser-induced choroidal neovascularization (CNV). CNV was induced in young (2-month-old) and aged (16-month-old) C57BL/6 mice by making four separate choroidal burns in each eye with a diode red laser (650 nm). At 1, 2, and 4 weeks, the left eyes were removed for histopathology, and the right eyes were removed for flatmount analysis of CNV surface area, vascularity, and cellularity. Aged mice demonstrated a much larger area of CNV than did young mice (3.81 +/- 1.28 vs. 1.36 +/- 0.99 disc areas, P < 0.001) at 2 weeks, when the lesions showed maximum growth. Aged mice also demonstrated higher ratios for vascularity and cellularity of the CNV (1.34 +/- 0.06 ...

Research paper thumbnail of Responsiveness of NEI VFQ-25 to Changes in Visual Acuity in Neovascular AMD: Validation Studies from Two Phase 3 Clinical Trials

Investigative Ophthalmology & Visual Science, 2009

To examine the responsiveness of the National Eye Institute Visual Function Questionnaire-25 (NEI... more To examine the responsiveness of the National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25) by using data from the MARINA and ANCHOR trials in neovascular age-related macular degeneration (AMD) and to establish the change in the NEI VFQ-25 associated with a 15-letter change in best corrected visual acuity (BCVA). In MARINA, 716 patients were randomized to monthly intravitreal ranibizumab (0.3 or 0.5 mg) or sham injections. In ANCHOR, 423 patients were randomized to monthly ranibizumab (0.3 or 0.5 mg) with sham photodynamic therapy (PDT) or sham ocular injections with verteporfin PDT. Patients had follow-up interviews and BCVA measurements over 24 months. Data were analyzed separately for MARINA and ANCHOR, and treatment groups were pooled within each trial. The clinically relevant difference in NEI VFQ-25 was estimated based on regression models of change from baseline to month 12 in BCVA. Subgroups categorized by BCVA change (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;or=15 letters gained, &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;15 letters lost or gained, or &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;or=15 letters lost) differed substantially in mean change in NEI VFQ-25 composite scores and three pre-specified subscale scores (near activities, distance activities, and vision-specific dependency) over 12 months. According to the regression models, the difference associated with a 15-letter change was 4 to 6 points for the composite score and the three pre-specified subscales. These data support the use of the NEI VFQ-25 as a responsive and sensitive measure of vision-related function in neovascular AMD populations. Based on MARINA and ANCHOR data, a 4- to 6-point change in NEI VFQ-25 scores represents a clinically meaningful change corresponding to a 15-letter change in BCVA.

Research paper thumbnail of RaScaL: A Pilot Study to Assess the Efficacy, Durability, and Safety of a Single Intervention with Ranibizumab plus Peripheral Laser for Diabetic Macular Edema Associated with Peripheral Nonperfusion on Ultrawide-Field Fluorescein Angiography

Ophthalmologica, 2014

Background and Objectives: To determine the efficacy, durability, and safety of a single treatmen... more Background and Objectives: To determine the efficacy, durability, and safety of a single treatment with intravitreal ranibizumab plus peripheral scatter laser (RaScaL) in patients with diabetic macular edema associated with peripheral retinal nonperfusion on ultrawide-field fluorescein angiography (UWFA). Study Design: A 6-month, randomized, controlled, prospective phase I/II study of 30 treatment-naïve eyes of 22 patients (8 bilateral patients) with visual impairment secondary to diabetic macular edema associated with peripheral nonperfusion on UWFA. Patients were randomized to receive ranibizumab plus UWFA-guided peripheral scatter laser (n = 15) or triamcinolone acetonide plus macular laser (n = 15). Results: At 6 months, the RaScaL group patients had fewer recurrences warranting retreatment (33% vs. 80%, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.003). Mean change in final visual acuity and central foveal thickness were not statistically significant between groups. Conclusion: This pilot study suggests the efficacy, safety and durability of the RaScaL treatment regimen in patients with diabetic macular edema associated with peripheral nonperfusion on UWFA. © 2014 S. Karger AG, Basel.

Research paper thumbnail of Cigarette Smoke-Related Oxidants and the Development of Sub-RPE Deposits in an Experimental Animal Model of Dry AMD

Investigative Ophthalmology & Visual Science, 2006

Oxidative injury to the retinal pigment epithelium (RPE) has been proposed to be an important inj... more Oxidative injury to the retinal pigment epithelium (RPE) has been proposed to be an important injury stimulus relevant to the accumulation of subretinal deposits in agerelated macular degeneration (AMD). Cigarette smoking is a major risk factor for AMD, and cigarette smoke-related tar contains high concentrations of a potent oxidant, hydroquinone (HQ). This study was an investigation of the effects of cigarette smoke (CS) and HQ in the development of sub-RPE deposits in an experimental mouse model. METHODS. Sixteen-month-old C57BL/6 female mice were fed a high-fat diet (HFD) for 4.5 months. Mice were divided into two major experimental groups, one to examine the effects of cigarette smoke and one to study the effects of a defined cigarette smoke component such as HQ. In the first group, mice eyes were exposed to blue-green light (positive controls) or to whole cigarette smoke. A third group with no intervention served as the negative control. In the second experimental group, animals received a purified diet with HQ (0.8%) with low or high fat content for 4.5 months. Mice in both groups were euthanatized at 4.5 months and eyes processed for transmission electron microscopy. RESULTS. As previously demonstrated by our laboratory and others, most mice fed an HFD without other oxidant exposure demonstrated normal morphology or, in a few cases, small nodular basal laminar deposits. Eyes of mice exposed to whole cigarette smoke or to HQ in the food demonstrated a variable degree of basal laminar deposits and diffusely thickened Bruch's membrane. The choriocapillaris endothelium was variably hypertrophic. CONCLUSIONS. Exposure to cigarette smoke or the smoke-related redox molecule, HQ, results in the formation of sub-RPE deposits, thickening of Bruch's membrane, and accumulation of deposits within Bruch's membrane. Smoke-related oxidants may be another oxidative injury stimulus to the choriocapillaris and RPE, and may explain the association between cigarette smoking and early AMD. (Invest Ophthalmol Vis Sci. 2006;47: 729 -737)

Research paper thumbnail of Cigarette Smoke-Related Oxidants and the Development of Sub-RPE Deposits in an Experimental Animal Model of Dry AMD

Investigative Ophthalmology & Visual Science, 2006

Oxidative injury to the retinal pigment epithelium (RPE) has been proposed to be an important inj... more Oxidative injury to the retinal pigment epithelium (RPE) has been proposed to be an important injury stimulus relevant to the accumulation of subretinal deposits in agerelated macular degeneration (AMD). Cigarette smoking is a major risk factor for AMD, and cigarette smoke-related tar contains high concentrations of a potent oxidant, hydroquinone (HQ). This study was an investigation of the effects of cigarette smoke (CS) and HQ in the development of sub-RPE deposits in an experimental mouse model. METHODS. Sixteen-month-old C57BL/6 female mice were fed a high-fat diet (HFD) for 4.5 months. Mice were divided into two major experimental groups, one to examine the effects of cigarette smoke and one to study the effects of a defined cigarette smoke component such as HQ. In the first group, mice eyes were exposed to blue-green light (positive controls) or to whole cigarette smoke. A third group with no intervention served as the negative control. In the second experimental group, animals received a purified diet with HQ (0.8%) with low or high fat content for 4.5 months. Mice in both groups were euthanatized at 4.5 months and eyes processed for transmission electron microscopy. RESULTS. As previously demonstrated by our laboratory and others, most mice fed an HFD without other oxidant exposure demonstrated normal morphology or, in a few cases, small nodular basal laminar deposits. Eyes of mice exposed to whole cigarette smoke or to HQ in the food demonstrated a variable degree of basal laminar deposits and diffusely thickened Bruch's membrane. The choriocapillaris endothelium was variably hypertrophic. CONCLUSIONS. Exposure to cigarette smoke or the smoke-related redox molecule, HQ, results in the formation of sub-RPE deposits, thickening of Bruch's membrane, and accumulation of deposits within Bruch's membrane. Smoke-related oxidants may be another oxidative injury stimulus to the choriocapillaris and RPE, and may explain the association between cigarette smoking and early AMD. (Invest Ophthalmol Vis Sci. 2006;47: 729 -737)

Research paper thumbnail of Nicotine Increases Size and Severity of Experimental Choroidal Neovascularization

Investigative Ophthalmology & Visual Science, 2004

PURPOSE. Cigarette smoking is the strongest environmental risk factor for all forms of age-relate... more PURPOSE. Cigarette smoking is the strongest environmental risk factor for all forms of age-related macular degeneration (AMD). In the present study, the influence of nicotine on the severity of choroidal neovascularization (CNV) in a mouse model of neovascular AMD and its effects on vascular smooth muscle cells derived from mouse choroid were investigated.

Research paper thumbnail of Nicotine Increases Size and Severity of Experimental Choroidal Neovascularization

Investigative Ophthalmology & Visual Science, 2004

PURPOSE. Cigarette smoking is the strongest environmental risk factor for all forms of age-relate... more PURPOSE. Cigarette smoking is the strongest environmental risk factor for all forms of age-related macular degeneration (AMD). In the present study, the influence of nicotine on the severity of choroidal neovascularization (CNV) in a mouse model of neovascular AMD and its effects on vascular smooth muscle cells derived from mouse choroid were investigated.

Research paper thumbnail of Macrophage Depletion Diminishes Lesion Size and Severity in Experimental Choroidal Neovascularization

Investigative Ophthalmology & Visual Science, 2003

Macrophage recruitment to the choroid has been proposed to contribute to the pathogenesis of chor... more Macrophage recruitment to the choroid has been proposed to contribute to the pathogenesis of choroidal neovascularization (CNV) in AMD. The study was conducted to determine whether treatment with clodronate liposomes (CL 2 MDP-lip), which cause depletion of blood monocytes and lymph node macrophages, diminishes the severity of neovascularization in a mouse model of laser-induced CNV. METHODS. Laser-induced CNV was performed in female 16month-old C57BL/6 mice. Macrophages were depleted by use of CL 2 MDP-lip intraperitoneally and subcutaneously 72 and 24 hours before and every 2 to 3 days after laser injury. Control mice received injections of either PBS alone or PBS liposomes. Blood monocyte and choroidal macrophage depletion were documented by flow cytometry and choroidal flatmount preparation analysis, respectively. Two weeks after laser injury, mice were injected intravenously with fluoresceinated dextran. The right eyes were removed and prepared for flatmount analysis of CNV surface area (in relative disc areas or DA), vascularity (relative fluorescence), and cellularity (propidium iodide stain). The mice were then perfused with 10% formaldehyde, and the left eyes were removed for histopathology. The means of the various parameters for four CNV lesions per eye were calculated. Fluorescein angiography was also performed. RESULTS. Flow cytometry of circulating monocytes and immunohistochemical analysis of choroidal macrophage density confirmed the effective depletion of blood monocytes and choroidal macrophages respectively in CL 2 MDP-lip-treated mice. Compared with the control, flatmount analysis of macrophage depleted mice demonstrated a significant reduction in size of the CNV area (2.8 Ϯ 0.5 DA vs. 1.4 Ϯ 0.1 DA; P Ͻ 0.043). The treated group also revealed less vascularity (1.6 Ϯ 0.1 units vs. 1.1 Ϯ 0.0 units; P Ͻ 0.0092) and cellularity of CNV lesions (3.3 Ϯ 0.6 DA vs. 1.7 Ϯ 0.1 DA, P Ͻ 0.04). Histopathology revealed that, in the macrophage-depleted group, CNV was smaller in diameter (1270 Ϯ 73 pixels vs. 770 Ϯ 82 pixels, P Ͻ 0.0006) and thickness (120 Ϯ 7 pixels vs. 96 Ϯ 7 pixels, P Ͻ 0.019).

Research paper thumbnail of Macrophage Depletion Diminishes Lesion Size and Severity in Experimental Choroidal Neovascularization

Investigative Ophthalmology & Visual Science, 2003

Macrophage recruitment to the choroid has been proposed to contribute to the pathogenesis of chor... more Macrophage recruitment to the choroid has been proposed to contribute to the pathogenesis of choroidal neovascularization (CNV) in AMD. The study was conducted to determine whether treatment with clodronate liposomes (CL 2 MDP-lip), which cause depletion of blood monocytes and lymph node macrophages, diminishes the severity of neovascularization in a mouse model of laser-induced CNV. METHODS. Laser-induced CNV was performed in female 16month-old C57BL/6 mice. Macrophages were depleted by use of CL 2 MDP-lip intraperitoneally and subcutaneously 72 and 24 hours before and every 2 to 3 days after laser injury. Control mice received injections of either PBS alone or PBS liposomes. Blood monocyte and choroidal macrophage depletion were documented by flow cytometry and choroidal flatmount preparation analysis, respectively. Two weeks after laser injury, mice were injected intravenously with fluoresceinated dextran. The right eyes were removed and prepared for flatmount analysis of CNV surface area (in relative disc areas or DA), vascularity (relative fluorescence), and cellularity (propidium iodide stain). The mice were then perfused with 10% formaldehyde, and the left eyes were removed for histopathology. The means of the various parameters for four CNV lesions per eye were calculated. Fluorescein angiography was also performed. RESULTS. Flow cytometry of circulating monocytes and immunohistochemical analysis of choroidal macrophage density confirmed the effective depletion of blood monocytes and choroidal macrophages respectively in CL 2 MDP-lip-treated mice. Compared with the control, flatmount analysis of macrophage depleted mice demonstrated a significant reduction in size of the CNV area (2.8 Ϯ 0.5 DA vs. 1.4 Ϯ 0.1 DA; P Ͻ 0.043). The treated group also revealed less vascularity (1.6 Ϯ 0.1 units vs. 1.1 Ϯ 0.0 units; P Ͻ 0.0092) and cellularity of CNV lesions (3.3 Ϯ 0.6 DA vs. 1.7 Ϯ 0.1 DA, P Ͻ 0.04). Histopathology revealed that, in the macrophage-depleted group, CNV was smaller in diameter (1270 Ϯ 73 pixels vs. 770 Ϯ 82 pixels, P Ͻ 0.0006) and thickness (120 Ϯ 7 pixels vs. 96 Ϯ 7 pixels, P Ͻ 0.019).

Research paper thumbnail of NICOTINE INCREASES SIZE AND SEVERITY OF NEOVASCULAR MACULAR DEGENERATION

Cardiovascular Pathology, 2004

Research paper thumbnail of NICOTINE INCREASES SIZE AND SEVERITY OF NEOVASCULAR MACULAR DEGENERATION

Cardiovascular Pathology, 2004

Research paper thumbnail of Identification of Patients With Diabetic Macular Edema From Claims Data

Archives of Ophthalmology, 2008

To assess the validity of an algorithm for identifying patients with diabetic macular edema (DME)... more To assess the validity of an algorithm for identifying patients with diabetic macular edema (DME) using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes in administrative billing data from a convenience sample of physician offices. A convenience sample of 12 general ophthalmologists and 10 retina specialists applied prespecified algorithms based on ICD-9-CM diagnosis codes to the billing claims of their practices and selected the associated medical records. Four ophthalmologists abstracted data from the medical records, which were then compared with the coded diagnoses. Main outcome measures were sensitivity, specificity, and the kappa statistic for the DME algorithm (a combination of codes 250.xx and 362.53), treating medical record documentation of DME as the standard criterion. The DME algorithm had a sensitivity of 0.88 and a specificity of 0.96 for identifying DME. Excellent agreement was noted between the algorithm and the medical records (kappa = 0.84). The algorithm performed less well in identifying patients with a diagnosis of clinically significant DME (sensitivity, 0.86; specificity, 0.84; kappa = 0.64). The results of this pilot study suggest that patients with DME can be identified accurately in claims data using ICD-9-CM diagnosis codes. Application of this algorithm could improve investigations of disease prevalence and disease burden and provide an efficient means of assessing care and interventions.

Research paper thumbnail of Necrotizing fasciitis after cosmetic blepharoplasty11The conclusions drawn by the authors are their own and are not necessarily supported or endorsed by the United States Air Force or United States Government

American Journal of Ophthalmology, 1999

To report a case of necrotizing fasciitis after cosmetic blepharoplasty. Case report. A 74-year-o... more To report a case of necrotizing fasciitis after cosmetic blepharoplasty. Case report. A 74-year-old woman with history of type II diabetes mellitus underwent bilateral upper eyelid blepharoplasty. Postoperatively she developed fever, grayish discoloration of the skin, violaceous bullae, and a right facial nerve palsy. Necrotizing fasciitis was diagnosed and treated with intravenous antibiotics, debridement of necrotic tissue, and hyperbaric oxygen therapy. The infection resolved, but the patient required reconstruction for correction of cicatricial ectropion. Necrotizing fasciitis is a potentially fatal infection that typically occurs in the setting of trauma. Early recognition of its pathognomonic signs and aggressive management are paramount.

Research paper thumbnail of Taking a Broader View of

Research paper thumbnail of Direct medical costs and resource use for treating central and branch retinal vein occlusion in commercially insured working-age and Medicare populations

Retina (Philadelphia, Pa.), 2014

To quantify the burden of illness for incident branch retinal vein occlusion (BRVO) and central r... more To quantify the burden of illness for incident branch retinal vein occlusion (BRVO) and central retinal vein occlusion (CRVO) in a commercially insured working-age (commercial) and Medicare US population. Retrospective cohort analysis of health care claims from 2003 through 2008 from commercial and Medicare patients with ≥2 outpatient diagnoses for BRVO or CRVO. The index date was the first retinal vein occlusion diagnosis. Patients with medical and pharmacy benefits were followed ≥1 year preindex and then between 1 year and 3 years postindex. Incidence and prevalence of retinal vein occlusion was determined. Burden of illness was compared with matched control subjects without retinal vein occlusion. The commercial sample comprised 1,188 CRVO and 2,252 BRVO cases, whereas the Medicare sample had 2,739 CRVO and 4,573 BRVO cases. Adjusted ratio of case-to-control, all-cause expenditures for commercial patients at 1 year and 3 years postindex were 1.88 and 1.68, respectively, for BRVO ...

Research paper thumbnail of Numerical relationship between neurons in the lateral geniculate nucleus and primary visual cortex in macaque monkeys

Visual Neuroscience, 1996

We examined the numerical correlation between total populations of neurons in the lateral genicul... more We examined the numerical correlation between total populations of neurons in the lateral geniculate nucleus (LGN) and the primary visual cortex (area 17 of Brodmann) in ten cerebral hemispheres of five normal rhesus monkeys using an unbiased three-dimensional counting method. There were 1.4 +/- 0.2 million and 341 +/- 54 million neurons in the LGN and area 17, respectively. In each animal, a larger LGN on one side was in register with a larger area 17 of the cortex on the same side. Furthermore, asymmetry in the number of neurons in both the LGN and area 17 favored the right side. However, because of small variations across subjects, correlation between the total neuron number in LGN and area 17 was weak (r2 = 0.29). These results suggest that the final numbers of neurons in these visual centers may be established independently or by multiple factors controlling elimination of initially overproduced neurons.

Research paper thumbnail of A novel cytoarchitectonic area induced experimentally within the primate visual cortex

Proceedings of the National Academy of Sciences, 1991

The cerebral cortex is divisible into a number of cytoarchitectonic areas, but developmental mech... more The cerebral cortex is divisible into a number of cytoarchitectonic areas, but developmental mechanisms that regulate their number and size remain unknown. Here we provide evidence that reducing the population of selected thalamic fibers projecting into the primary visual cortex (area 17) of monkeys during midgestation induces the formation of a novel cytoarchitectonic area situated along the border of and

Research paper thumbnail of Vision-Related Function after Ranibizumab Treatment by Better- or Worse-Seeing Eye

Ophthalmology, 2010

To examine the effects of ranibizumab on the National Eye Institute Visual Function Questionnaire... more To examine the effects of ranibizumab on the National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25) scores in neovascular age-related macular degeneration (AMD) according to whether the study eye was the better- or worse-seeing eye at baseline. Within 2 randomized, double-masked clinical trials (MARINA and ANCHOR), the NEI VFQ-25 was administered at 0, 1, 2, 3, 6, 9, 12, 18, and 24 months. We included 646 MARINA and 379 ANCHOR patients. Patients were randomized 1:1:1 to monthly intravitreal ranibizumab (0.3 or 0.5 mg) or control (sham injections for MARINA; photodynamic therapy [PDT] with verteporfin for ANCHOR). Mean change from baseline in NEI VFQ-25 scores at 12 and 24 months. Across all treatment arms, 21% to 38% of enrolled eyes were the better-seeing eye. At the 24-month follow-up visit, mean change in composite scores with ranibizumab seemed to be better than control for both better-seeing eyes (8.4 [95% confidence interval (CI), 5.2-11.6], 7.5 [95% CI, 3.7-11.4], and -9.4 [95% CI, -12.5 to -6.3] for the 0.3-mg, 0.5-mg, and sham groups, respectively) and worse-seeing eyes (1.7 [95% CI, -1.1 to 4.4], 1.7 [95% CI, -0.7 to 4.1], and -5.4 [95% CI, -7.9 to -2.8] for the 0.3-mg, 0.5-mg, and sham groups, respectively) in MARINA, as well as the better-seeing eye in ANCHOR (11.3 [95% CI, 5.3-17.3], 13.3 [95% CI, 7.7-19.0], and -2.7 [95% CI, -9.0 to 3.7] for the 0.3-mg, 0.5-mg, and PDT groups, respectively). When the worse-seeing eye was treated in ANCHOR, such differences could not be detected at 24 months (1.3 [95% CI, -1.7 to 4.2], 2.6 [95% CI, -1.1 to 6.3], and 0.1 [95% CI, -3.5 to 3.7] for the 0.3-mg, 0.5-mg, and PDT groups, respectively). Analysis of patient perception of vision-related function in phase III trials evaluating ranibizumab for neovascular AMD demonstrates improved patient-reported outcomes regardless of whether the treated eye is the better- or worse-seeing eye at onset of treatment, and supports treatment of such lesions with ranibizumab, even those in the worse-seeing eye. Proprietary or commercial disclosure may be found after the references.

Research paper thumbnail of Long-term outcomes in eyes receiving fixed-interval dosing of anti-vascular endothelial growth factor agents for wet age-related macular degeneration

Ophthalmology, 2015

To report on long-term visual outcomes in patients receiving continuous fixed-interval dosing of ... more To report on long-term visual outcomes in patients receiving continuous fixed-interval dosing of anti-vascular endothelial growth factor (VEGF) treatment in neovascular age-related macular degeneration (AMD). Single-practice retrospective chart review. One hundred nine eyes with exudative AMD receiving continuous fixed-interval dosing (every 4-8 weeks) of anti-VEGF therapy (ranibizumab, bevacizumab, or aflibercept) for at least 5 years. Eyes were excluded if they averaged fewer than 6.5 injections per year. Snellen visual acuity was recorded at baseline and all subsequent injections. Changes from baseline were calculated at yearly intervals. The primary outcome measure was mean change in letter score at 5, 6, and 7 years; secondary outcomes included the percentage of patients with 20/40 vision or better at 7 years and the mean change in letter score at each yearly time point based on baseline visual grouping (20/40 or better, 20/50-20/100, 20/200 or worse). Forty-four, 75, and 109 p...

Research paper thumbnail of Ultrawide Angle Fluorescein Angiographic Imaging: A Comparison to Conventional Digital Acquisition Systems

Ophthalmic Surgery, Lasers, and Imaging, 2008

A prototype ultrawide field angiographic system and conventional technology were compared. Thirty... more A prototype ultrawide field angiographic system and conventional technology were compared. Thirty subjects with diabetic retinopathy were imaged in three centers by conventional (Topcon Inc., Paramus, NJ, or Carl Zeiss Meditec, Dublin, CA) and ultrawide field (Optos P200A; Optos Inc., Dunfermline, Scotland) digital fluorescein angiography units. A calibrated grid was digitally placed on the images to facilitate measurements. Main outcome measures were field of view and the number of grid sectors displaying retinal ischemia and neovascularization. Secondary measures were image quality and patient satisfaction scores. The P200A provided a significantly greater visual field extent of 8.7 +/- 1.6 disc diameters (DD) compared to the conventional systems (3.4 +/- 0.76 DD) (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001). Retinal ischemia was better revealed (16.9 +/- 15 vs 3.4 +/- 4.26 sectors) with the prototype, but image quality was superior with the conventional system. Patient satisfaction scores did not differ between systems. A prototype ultrawide angle imaging system displayed significantly more diabetic retinal pathology in a single image than conventional systems.

Research paper thumbnail of Age as an independent risk factor for severity of experimental choroidal neovascularization

Investigative ophthalmology & visual science, 2002

For many vascular diseases, aging appears to be an independent risk factor for severity of vascul... more For many vascular diseases, aging appears to be an independent risk factor for severity of vascular complications, and blood vessels of aged individuals often demonstrate exaggerated repair responses to injury. This study was undertaken to determine the influence of aging on the severity of neovascularization in a mouse model of laser-induced choroidal neovascularization (CNV). CNV was induced in young (2-month-old) and aged (16-month-old) C57BL/6 mice by making four separate choroidal burns in each eye with a diode red laser (650 nm). At 1, 2, and 4 weeks, the left eyes were removed for histopathology, and the right eyes were removed for flatmount analysis of CNV surface area, vascularity, and cellularity. Aged mice demonstrated a much larger area of CNV than did young mice (3.81 +/- 1.28 vs. 1.36 +/- 0.99 disc areas, P < 0.001) at 2 weeks, when the lesions showed maximum growth. Aged mice also demonstrated higher ratios for vascularity and cellularity of the CNV (1.34 +/- 0.06 ...

Research paper thumbnail of Responsiveness of NEI VFQ-25 to Changes in Visual Acuity in Neovascular AMD: Validation Studies from Two Phase 3 Clinical Trials

Investigative Ophthalmology & Visual Science, 2009

To examine the responsiveness of the National Eye Institute Visual Function Questionnaire-25 (NEI... more To examine the responsiveness of the National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25) by using data from the MARINA and ANCHOR trials in neovascular age-related macular degeneration (AMD) and to establish the change in the NEI VFQ-25 associated with a 15-letter change in best corrected visual acuity (BCVA). In MARINA, 716 patients were randomized to monthly intravitreal ranibizumab (0.3 or 0.5 mg) or sham injections. In ANCHOR, 423 patients were randomized to monthly ranibizumab (0.3 or 0.5 mg) with sham photodynamic therapy (PDT) or sham ocular injections with verteporfin PDT. Patients had follow-up interviews and BCVA measurements over 24 months. Data were analyzed separately for MARINA and ANCHOR, and treatment groups were pooled within each trial. The clinically relevant difference in NEI VFQ-25 was estimated based on regression models of change from baseline to month 12 in BCVA. Subgroups categorized by BCVA change (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;or=15 letters gained, &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;15 letters lost or gained, or &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;or=15 letters lost) differed substantially in mean change in NEI VFQ-25 composite scores and three pre-specified subscale scores (near activities, distance activities, and vision-specific dependency) over 12 months. According to the regression models, the difference associated with a 15-letter change was 4 to 6 points for the composite score and the three pre-specified subscales. These data support the use of the NEI VFQ-25 as a responsive and sensitive measure of vision-related function in neovascular AMD populations. Based on MARINA and ANCHOR data, a 4- to 6-point change in NEI VFQ-25 scores represents a clinically meaningful change corresponding to a 15-letter change in BCVA.

Research paper thumbnail of RaScaL: A Pilot Study to Assess the Efficacy, Durability, and Safety of a Single Intervention with Ranibizumab plus Peripheral Laser for Diabetic Macular Edema Associated with Peripheral Nonperfusion on Ultrawide-Field Fluorescein Angiography

Ophthalmologica, 2014

Background and Objectives: To determine the efficacy, durability, and safety of a single treatmen... more Background and Objectives: To determine the efficacy, durability, and safety of a single treatment with intravitreal ranibizumab plus peripheral scatter laser (RaScaL) in patients with diabetic macular edema associated with peripheral retinal nonperfusion on ultrawide-field fluorescein angiography (UWFA). Study Design: A 6-month, randomized, controlled, prospective phase I/II study of 30 treatment-naïve eyes of 22 patients (8 bilateral patients) with visual impairment secondary to diabetic macular edema associated with peripheral nonperfusion on UWFA. Patients were randomized to receive ranibizumab plus UWFA-guided peripheral scatter laser (n = 15) or triamcinolone acetonide plus macular laser (n = 15). Results: At 6 months, the RaScaL group patients had fewer recurrences warranting retreatment (33% vs. 80%, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.003). Mean change in final visual acuity and central foveal thickness were not statistically significant between groups. Conclusion: This pilot study suggests the efficacy, safety and durability of the RaScaL treatment regimen in patients with diabetic macular edema associated with peripheral nonperfusion on UWFA. © 2014 S. Karger AG, Basel.

Research paper thumbnail of Cigarette Smoke-Related Oxidants and the Development of Sub-RPE Deposits in an Experimental Animal Model of Dry AMD

Investigative Ophthalmology & Visual Science, 2006

Oxidative injury to the retinal pigment epithelium (RPE) has been proposed to be an important inj... more Oxidative injury to the retinal pigment epithelium (RPE) has been proposed to be an important injury stimulus relevant to the accumulation of subretinal deposits in agerelated macular degeneration (AMD). Cigarette smoking is a major risk factor for AMD, and cigarette smoke-related tar contains high concentrations of a potent oxidant, hydroquinone (HQ). This study was an investigation of the effects of cigarette smoke (CS) and HQ in the development of sub-RPE deposits in an experimental mouse model. METHODS. Sixteen-month-old C57BL/6 female mice were fed a high-fat diet (HFD) for 4.5 months. Mice were divided into two major experimental groups, one to examine the effects of cigarette smoke and one to study the effects of a defined cigarette smoke component such as HQ. In the first group, mice eyes were exposed to blue-green light (positive controls) or to whole cigarette smoke. A third group with no intervention served as the negative control. In the second experimental group, animals received a purified diet with HQ (0.8%) with low or high fat content for 4.5 months. Mice in both groups were euthanatized at 4.5 months and eyes processed for transmission electron microscopy. RESULTS. As previously demonstrated by our laboratory and others, most mice fed an HFD without other oxidant exposure demonstrated normal morphology or, in a few cases, small nodular basal laminar deposits. Eyes of mice exposed to whole cigarette smoke or to HQ in the food demonstrated a variable degree of basal laminar deposits and diffusely thickened Bruch's membrane. The choriocapillaris endothelium was variably hypertrophic. CONCLUSIONS. Exposure to cigarette smoke or the smoke-related redox molecule, HQ, results in the formation of sub-RPE deposits, thickening of Bruch's membrane, and accumulation of deposits within Bruch's membrane. Smoke-related oxidants may be another oxidative injury stimulus to the choriocapillaris and RPE, and may explain the association between cigarette smoking and early AMD. (Invest Ophthalmol Vis Sci. 2006;47: 729 -737)

Research paper thumbnail of Cigarette Smoke-Related Oxidants and the Development of Sub-RPE Deposits in an Experimental Animal Model of Dry AMD

Investigative Ophthalmology & Visual Science, 2006

Oxidative injury to the retinal pigment epithelium (RPE) has been proposed to be an important inj... more Oxidative injury to the retinal pigment epithelium (RPE) has been proposed to be an important injury stimulus relevant to the accumulation of subretinal deposits in agerelated macular degeneration (AMD). Cigarette smoking is a major risk factor for AMD, and cigarette smoke-related tar contains high concentrations of a potent oxidant, hydroquinone (HQ). This study was an investigation of the effects of cigarette smoke (CS) and HQ in the development of sub-RPE deposits in an experimental mouse model. METHODS. Sixteen-month-old C57BL/6 female mice were fed a high-fat diet (HFD) for 4.5 months. Mice were divided into two major experimental groups, one to examine the effects of cigarette smoke and one to study the effects of a defined cigarette smoke component such as HQ. In the first group, mice eyes were exposed to blue-green light (positive controls) or to whole cigarette smoke. A third group with no intervention served as the negative control. In the second experimental group, animals received a purified diet with HQ (0.8%) with low or high fat content for 4.5 months. Mice in both groups were euthanatized at 4.5 months and eyes processed for transmission electron microscopy. RESULTS. As previously demonstrated by our laboratory and others, most mice fed an HFD without other oxidant exposure demonstrated normal morphology or, in a few cases, small nodular basal laminar deposits. Eyes of mice exposed to whole cigarette smoke or to HQ in the food demonstrated a variable degree of basal laminar deposits and diffusely thickened Bruch's membrane. The choriocapillaris endothelium was variably hypertrophic. CONCLUSIONS. Exposure to cigarette smoke or the smoke-related redox molecule, HQ, results in the formation of sub-RPE deposits, thickening of Bruch's membrane, and accumulation of deposits within Bruch's membrane. Smoke-related oxidants may be another oxidative injury stimulus to the choriocapillaris and RPE, and may explain the association between cigarette smoking and early AMD. (Invest Ophthalmol Vis Sci. 2006;47: 729 -737)

Research paper thumbnail of Nicotine Increases Size and Severity of Experimental Choroidal Neovascularization

Investigative Ophthalmology & Visual Science, 2004

PURPOSE. Cigarette smoking is the strongest environmental risk factor for all forms of age-relate... more PURPOSE. Cigarette smoking is the strongest environmental risk factor for all forms of age-related macular degeneration (AMD). In the present study, the influence of nicotine on the severity of choroidal neovascularization (CNV) in a mouse model of neovascular AMD and its effects on vascular smooth muscle cells derived from mouse choroid were investigated.

Research paper thumbnail of Nicotine Increases Size and Severity of Experimental Choroidal Neovascularization

Investigative Ophthalmology & Visual Science, 2004

PURPOSE. Cigarette smoking is the strongest environmental risk factor for all forms of age-relate... more PURPOSE. Cigarette smoking is the strongest environmental risk factor for all forms of age-related macular degeneration (AMD). In the present study, the influence of nicotine on the severity of choroidal neovascularization (CNV) in a mouse model of neovascular AMD and its effects on vascular smooth muscle cells derived from mouse choroid were investigated.

Research paper thumbnail of Macrophage Depletion Diminishes Lesion Size and Severity in Experimental Choroidal Neovascularization

Investigative Ophthalmology & Visual Science, 2003

Macrophage recruitment to the choroid has been proposed to contribute to the pathogenesis of chor... more Macrophage recruitment to the choroid has been proposed to contribute to the pathogenesis of choroidal neovascularization (CNV) in AMD. The study was conducted to determine whether treatment with clodronate liposomes (CL 2 MDP-lip), which cause depletion of blood monocytes and lymph node macrophages, diminishes the severity of neovascularization in a mouse model of laser-induced CNV. METHODS. Laser-induced CNV was performed in female 16month-old C57BL/6 mice. Macrophages were depleted by use of CL 2 MDP-lip intraperitoneally and subcutaneously 72 and 24 hours before and every 2 to 3 days after laser injury. Control mice received injections of either PBS alone or PBS liposomes. Blood monocyte and choroidal macrophage depletion were documented by flow cytometry and choroidal flatmount preparation analysis, respectively. Two weeks after laser injury, mice were injected intravenously with fluoresceinated dextran. The right eyes were removed and prepared for flatmount analysis of CNV surface area (in relative disc areas or DA), vascularity (relative fluorescence), and cellularity (propidium iodide stain). The mice were then perfused with 10% formaldehyde, and the left eyes were removed for histopathology. The means of the various parameters for four CNV lesions per eye were calculated. Fluorescein angiography was also performed. RESULTS. Flow cytometry of circulating monocytes and immunohistochemical analysis of choroidal macrophage density confirmed the effective depletion of blood monocytes and choroidal macrophages respectively in CL 2 MDP-lip-treated mice. Compared with the control, flatmount analysis of macrophage depleted mice demonstrated a significant reduction in size of the CNV area (2.8 Ϯ 0.5 DA vs. 1.4 Ϯ 0.1 DA; P Ͻ 0.043). The treated group also revealed less vascularity (1.6 Ϯ 0.1 units vs. 1.1 Ϯ 0.0 units; P Ͻ 0.0092) and cellularity of CNV lesions (3.3 Ϯ 0.6 DA vs. 1.7 Ϯ 0.1 DA, P Ͻ 0.04). Histopathology revealed that, in the macrophage-depleted group, CNV was smaller in diameter (1270 Ϯ 73 pixels vs. 770 Ϯ 82 pixels, P Ͻ 0.0006) and thickness (120 Ϯ 7 pixels vs. 96 Ϯ 7 pixels, P Ͻ 0.019).

Research paper thumbnail of Macrophage Depletion Diminishes Lesion Size and Severity in Experimental Choroidal Neovascularization

Investigative Ophthalmology & Visual Science, 2003

Macrophage recruitment to the choroid has been proposed to contribute to the pathogenesis of chor... more Macrophage recruitment to the choroid has been proposed to contribute to the pathogenesis of choroidal neovascularization (CNV) in AMD. The study was conducted to determine whether treatment with clodronate liposomes (CL 2 MDP-lip), which cause depletion of blood monocytes and lymph node macrophages, diminishes the severity of neovascularization in a mouse model of laser-induced CNV. METHODS. Laser-induced CNV was performed in female 16month-old C57BL/6 mice. Macrophages were depleted by use of CL 2 MDP-lip intraperitoneally and subcutaneously 72 and 24 hours before and every 2 to 3 days after laser injury. Control mice received injections of either PBS alone or PBS liposomes. Blood monocyte and choroidal macrophage depletion were documented by flow cytometry and choroidal flatmount preparation analysis, respectively. Two weeks after laser injury, mice were injected intravenously with fluoresceinated dextran. The right eyes were removed and prepared for flatmount analysis of CNV surface area (in relative disc areas or DA), vascularity (relative fluorescence), and cellularity (propidium iodide stain). The mice were then perfused with 10% formaldehyde, and the left eyes were removed for histopathology. The means of the various parameters for four CNV lesions per eye were calculated. Fluorescein angiography was also performed. RESULTS. Flow cytometry of circulating monocytes and immunohistochemical analysis of choroidal macrophage density confirmed the effective depletion of blood monocytes and choroidal macrophages respectively in CL 2 MDP-lip-treated mice. Compared with the control, flatmount analysis of macrophage depleted mice demonstrated a significant reduction in size of the CNV area (2.8 Ϯ 0.5 DA vs. 1.4 Ϯ 0.1 DA; P Ͻ 0.043). The treated group also revealed less vascularity (1.6 Ϯ 0.1 units vs. 1.1 Ϯ 0.0 units; P Ͻ 0.0092) and cellularity of CNV lesions (3.3 Ϯ 0.6 DA vs. 1.7 Ϯ 0.1 DA, P Ͻ 0.04). Histopathology revealed that, in the macrophage-depleted group, CNV was smaller in diameter (1270 Ϯ 73 pixels vs. 770 Ϯ 82 pixels, P Ͻ 0.0006) and thickness (120 Ϯ 7 pixels vs. 96 Ϯ 7 pixels, P Ͻ 0.019).

Research paper thumbnail of NICOTINE INCREASES SIZE AND SEVERITY OF NEOVASCULAR MACULAR DEGENERATION

Cardiovascular Pathology, 2004

Research paper thumbnail of NICOTINE INCREASES SIZE AND SEVERITY OF NEOVASCULAR MACULAR DEGENERATION

Cardiovascular Pathology, 2004

Research paper thumbnail of Identification of Patients With Diabetic Macular Edema From Claims Data

Archives of Ophthalmology, 2008

To assess the validity of an algorithm for identifying patients with diabetic macular edema (DME)... more To assess the validity of an algorithm for identifying patients with diabetic macular edema (DME) using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes in administrative billing data from a convenience sample of physician offices. A convenience sample of 12 general ophthalmologists and 10 retina specialists applied prespecified algorithms based on ICD-9-CM diagnosis codes to the billing claims of their practices and selected the associated medical records. Four ophthalmologists abstracted data from the medical records, which were then compared with the coded diagnoses. Main outcome measures were sensitivity, specificity, and the kappa statistic for the DME algorithm (a combination of codes 250.xx and 362.53), treating medical record documentation of DME as the standard criterion. The DME algorithm had a sensitivity of 0.88 and a specificity of 0.96 for identifying DME. Excellent agreement was noted between the algorithm and the medical records (kappa = 0.84). The algorithm performed less well in identifying patients with a diagnosis of clinically significant DME (sensitivity, 0.86; specificity, 0.84; kappa = 0.64). The results of this pilot study suggest that patients with DME can be identified accurately in claims data using ICD-9-CM diagnosis codes. Application of this algorithm could improve investigations of disease prevalence and disease burden and provide an efficient means of assessing care and interventions.

Research paper thumbnail of Necrotizing fasciitis after cosmetic blepharoplasty11The conclusions drawn by the authors are their own and are not necessarily supported or endorsed by the United States Air Force or United States Government

American Journal of Ophthalmology, 1999

To report a case of necrotizing fasciitis after cosmetic blepharoplasty. Case report. A 74-year-o... more To report a case of necrotizing fasciitis after cosmetic blepharoplasty. Case report. A 74-year-old woman with history of type II diabetes mellitus underwent bilateral upper eyelid blepharoplasty. Postoperatively she developed fever, grayish discoloration of the skin, violaceous bullae, and a right facial nerve palsy. Necrotizing fasciitis was diagnosed and treated with intravenous antibiotics, debridement of necrotic tissue, and hyperbaric oxygen therapy. The infection resolved, but the patient required reconstruction for correction of cicatricial ectropion. Necrotizing fasciitis is a potentially fatal infection that typically occurs in the setting of trauma. Early recognition of its pathognomonic signs and aggressive management are paramount.