Roje Kacmaz - Academia.edu (original) (raw)

Papers by Roje Kacmaz

AMIA ... Annual Symposium proceedings. AMIA Symposium, 2005

Supporting data entry by clinicians is considered one of the greatest challenges in implementing ... more Supporting data entry by clinicians is considered one of the greatest challenges in implementing electronic health records. In this paper we describe a formative evaluation study using three different methodologies through which we identified obstacles to point-of-care data entry for eye care and then used the formative process to develop and test solutions to overcome these obstacles. The greatest obstacles were supporting free text annotation of clinical observations and accommodating the creation of detailed diagrams in multiple colors. To support free text entry, we arrived at an approach that captures an image of a free text note and associates this image with related data elements in an encounter note. The detailed diagrams included a color pallet that allowed changing pen color with a single stroke and also captured the diagrams as an image associated with related data elements. During observed sessions with simulated patients, these approaches satisfied the clinicians' d...

Extensive utilization of mobile devices at the point of care will depend on device acceptance by ... more Extensive utilization of mobile devices at the point of care will depend on device acceptance by the providers. We conducted focus groups involving nine eye care professionals to evaluate and elucidate the most important features of a tablet Personal Computer (PC) for data entry at the point of care. Ease of use, and quality and size of display were considered to be the most critical features of such a mobile device by the majority of the participants. Keyboard and weight of device were deemed to be the least important features of a tablet PC.

Ophthalmology and Therapy

Introduction: Noninfectious keratitis is a painful corneal inflammation treated with topical cycl... more Introduction: Noninfectious keratitis is a painful corneal inflammation treated with topical cyclosporine and other immunosuppressants. Additional treatment options are needed for keratitis that does not improve with standard therapies. Repository corticotropin injection (RCI; Acthar Ò Gel) is approved to treat severe acute and chronic allergic and inflammatory processes involving the eye and its adnexa, including keratitis. This phase 4, multicenter, open-label study assessed the efficacy and safety of RCI for refractory severe noninfectious keratitis. Methods: Patients were C 18 years old with persistent severe keratitis despite treatment with topical immunosuppressants. Patients received 80 U of RCI subcutaneously twice weekly for 12 weeks followed by a 4-week taper. Assessments included all domains of the Impact of Dry Eye on Everyday Life (IDEEL) Questionnaire, Ocular Discomfort and 4-Symptom Questionnaire, and Visual Analog Scale (VAS). Corneal fluorescein and conjunctival lissamine green staining, Conjunctival Redness Scale, tear production (Schirmer's test), visual acuity, slit lamp examination, and intraocular pressure were also assessed. Safety was evaluated via treatment-emergent adverse events. Analyses were performed using the modified intent-to-treat (mITT) population (patients who received C 1 dose of RCI and contributed any post-baseline efficacy data). Results: In the mITT population (N = 35), 50.0% (95% confidence interval, 33.2% to 66.8%) of patients experienced clinically important improvements in the symptom bother domain of the IDEEL Questionnaire at week 12 of RCI therapy. All domains of the IDEEL and the Ocular Discomfort and 4-Symptom Questionnaire showed improvements at week 12 of RCI treatment. The most pronounced improvements in the VAS at week 12 were for eye dryness and eye discomfort. Corneal staining, conjunctival staining, conjunctival redness, and tear production showed early improvements that were sustained through week 12. No new safety signals for RCI were identified. Conclusions: RCI is safe and effective for refractory severe noninfectious keratitis that has not improved with other approved therapies.

Amia Annual Symposium Proceedings Amia Symposium Amia Symposium, Feb 1, 2005

Capturing the nuances of clinical observations in an electronic format has been a major challenge... more Capturing the nuances of clinical observations in an electronic format has been a major challenge in implementing electronic health records. In a formative evaluation study using three different methodologies, we identified that the greatest obstacle to point-of-care data entry for eye care was supporting free text annotation of clinical observations. To overcome this obstacle, we developed an approach that captures an image of a free text entry and associates this image with related data elements in an encounter note. Through simulated patient studies, we observed that this approach successfully supported complex documentation at the point of care by clinicians.

Ocular immunology and inflammation, Jan 22, 2016

To evaluate adalimumab as an immunomodulatory treatment for non-infectious ocular inflammatory di... more To evaluate adalimumab as an immunomodulatory treatment for non-infectious ocular inflammatory diseases. Characteristics of patients treated with adalimumab were abstracted in a standardized chart review. Main outcomes measured were control of inflammation, corticosteroid-sparing effect, and visual acuity. In total, 32 patients with ocular inflammation were treated with adalimumab. The most common ophthalmic diagnoses were anterior uveitis, occurring in 15 patients (47%), and scleritis, occurring in 9 patients (28%). At 6 months of therapy, among 15 eyes with active inflammation, 7 (47%) became completely inactive, and oral prednisone was reduced to ≤10 mg/day in 2 of 4 patients (50%). On average, visual acuity decreased by 0.13 lines during the first 6 months of treatment. Adalimumab was discontinued because of lack of effectiveness in four patients within 6 months. Adalimumab was moderately effective in controlling inflammation in a group of highly pre-treated cases of ocular infl...

AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium, 2005

Capturing the nuances of clinical observations in an electronic format has been a major challenge... more Capturing the nuances of clinical observations in an electronic format has been a major challenge in implementing electronic health records. In a formative evaluation study using three different methodologies, we identified that the greatest obstacle to point-of-care data entry for eye care was supporting free text annotation of clinical observations. To overcome this obstacle, we developed an approach that captures an image of a free text entry and associates this image with related data elements in an encounter note. Through simulated patient studies, we observed that this approach successfully supported complex documentation at the point of care by clinicians.

AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium, 2006

Collecting clinical data directly from clinicians is a challenge. Many standard development envir... more Collecting clinical data directly from clinicians is a challenge. Many standard development environments designed to expedite the creation of user interfaces for electronic healthcare applications do not provide acceptable components for satisfying the requirements for collecting and displaying clinical data at the point of care on the tablet computer. Through an iterative design and testing approach using think-aloud sessions in the eye care setting, we were able to identify and resolve several user interface issues. Issues that we discovered and subsequently resolved included checkboxes that were too small to be selectable with a stylus, radio buttons that could not be unselected, and font sizes that were too small to be read at arm's length.

Ophthalmology, 2010

Purpose-To evaluate the clinical outcomes of cyclosporine treatment for non-infectious ocular inf... more Purpose-To evaluate the clinical outcomes of cyclosporine treatment for non-infectious ocular inflammation Design-Retrospective cohort study Participants-Three hundred seventy-three patients with non-infectious ocular inflammation managed at four tertiary ocular inflammation clinics in the United States observed to use cyclosporine as a single non-corticosteroid immunosuppressive agent to their treatment regimen, between 1979-2007 inclusive. Methods-Participants were identified from the Systemic Immunosuppressive Therapy for Eye Diseases Cohort Study. Demographic and clinical characteristics, including dosage of cyclosporine

Ophthalmology, 2012

We sought to describe the risk and risk factors for hypotony in a noninfectious uveitis cohort. D... more We sought to describe the risk and risk factors for hypotony in a noninfectious uveitis cohort. Design: Retrospective cohort study. Participants: Patients with noninfectious uveitis seen between 1979 and 2007 at 4 academic ocular inflammation specialty clinics. Methods: Data were collected from medical records by trained, certified, expert reviewers. Main Outcome Measures: Hypotony (Ͻ5 mmHg) and low intraocular pressure (Ͻ8 mmHg), each sustained for Ն2 visits spanning Ն30 days. Results: During follow-up, 126 of 6785 patients (1.86%) developed hypotony at the rate of 0.61% (95% confidence interval [CI], 0.50Ϫ0.75%) per eye-year. Cataract surgery was associated with a 7.5-fold risk (adjusted hazard ratio [aHR], 7.51; 95% CI, 3.97Ϫ14.23) of incident hypotony. Phacoemulsification, the type of cataract surgery associated with the least hypotony risk still was associated with nearly 5-fold higher hypotony incidence (aHR, 4.87; 95% CI, 2.25Ϫ10.55). Increased risk was observed in children (aHR, 2.92; 95% CI, 1.20Ϫ7.10) with respect to young adults, and duration of uveitis of Ͼ5 years (aHR, 3.08; 95% CI, 1.30Ϫ7.31) with respect to uveitis of Ͻ6 month duration. Band keratopathy, Ն3ϩ vitreous cells, exudative retinal detachment, posterior synechia, and a history of pars plana vitrectomy also were associated with greater hypotony incidence. With respect to anterior uveitis, intermediate uveitis (aHR, 0.17; 95% CI, 0.05Ϫ0.56) and posterior uveitis (aHR, 0.11; 95% CI, 0.03Ϫ0.45) were associated with lower hypotony risk, whereas panuveitis (aHR, 1.25; 95% CI, 0.67Ϫ2.35) was similar. Approximately five-sixths (84.1%) of eyes presenting with hypotony had a visual acuity of Յ20/200 (aOR for visual acuity Յ20/200, 13.85; 95% CI, 7.23Ϫ26.53). Risk factors for prevalent hypotony were similar. Conclusions: The risk of hypotony is low among eyes with noninfectious uveitis, but is more frequently observed in cases with anterior segment inflammation. Signs of present or past inflammation were associated with greater risk, suggesting excellent inflammatory control may reduce the risk of hypotony. Prior ocular surgery also was associated with higher risk; cataract surgery in particular was associated with much higher risk of hypotony. Lower risk of hypotony with phacoemulsification than with alternative cataract surgery approaches suggests the phacoemulsification approach is preferable. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references.

The Journal of Rheumatology, 2013

Objective.To evaluate the outcome of tumor necrosis factor-α inhibition (anti-TNF) for pediatric ... more Objective.To evaluate the outcome of tumor necrosis factor-α inhibition (anti-TNF) for pediatric uveitis.Methods.We retrospectively assessed children (age ≤ 18 yrs) with noninfectious uveitis receiving anti-TNF at 5 uveitis centers and 1 pediatric rheumatology center. Incident treatment success was defined as minimal or no uveitis activity at ≥ 2 consecutive ophthalmological examinations ≥ 28 days apart while taking no oral and ≤ 2 eyedrops/day of corticosteroids. Eligible children had active uveitis and/or were taking higher corticosteroid doses.Results.Among 56 eligible children followed over 33.73 person-years, 52% had juvenile idiopathic arthritis (JIA) and 75% had anterior uveitis (AU). The Kaplan-Meier estimated proportion achieving treatment success within 12 months was 75% (95% CI 62%–87%). Complete absence of inflammatory signs with discontinuation of all corticosteroids was observed in an estimated 64% by 12 months (95% CI 51%–76%). Diagnoses of JIA or AU were associated w...

British Journal of Ophthalmology, 2010

To evaluate how smoking affects the time to disease quiescence and time to disease recurrence in ... more To evaluate how smoking affects the time to disease quiescence and time to disease recurrence in patients with ocular inflammation. A retrospective cohort study of patients with ocular inflammation who were followed longitudinally and had smoking information available in the Systemic Immunosuppressive Therapy for Eye Diseases Cohort Study database. Among 2676 patients with active ocular inflammation, smokers were more likely to have bilateral ocular disease and poorer visual acuity on presentation compared with non-smokers and previous smokers. In a multivariate analysis, there was no statistically significant difference in the time to disease quiescence between groups. However, the median time to recurrence of ocular inflammation was statistically significantly longer for non-smokers (9.4 months) and for previous smokers (10.7 months) than for current smokers (7.8 months) (p=0.02). The RR of ocular inflammation recurrence was higher for smokers than for non-smokers (adjusted HR=1.19, 95% CI 1.03 to 1.37) and tended towards significance in previous smokers (adjusted HR=1.11, 95% CI 0.93 to 1.35). Smoking was associated with an increased likelihood of bilateral ocular inflammation and reduced vision upon presentation, and an increased risk of recurrence compared with not smoking. These results suggest that patients with ocular inflammation should be counselled to stop smoking as part of routine management.

BMJ: British Medical …, 2009

Design Retrospective cohort study evaluating overall and cancer mortality in relation to immunosu... more Design Retrospective cohort study evaluating overall and cancer mortality in relation to immunosuppressive drug exposure among patients with ocular inflammatory diseases. Demographic, clinical, and treatment data derived from medical records, and mortality results from United States ...

Ophthalmic …, 2008

To evaluate potential epidemiologic methods for studying long-term effects of immunosuppression o... more To evaluate potential epidemiologic methods for studying long-term effects of immunosuppression on the risk of mortality and fatal malignancy, and present the methodological details of the Systemic Immunosuppressive Therapy for Eye Diseases (SITE) Cohort Study. Advantages and disadvantages of potential study designs for evaluating rare, late-occurring events are reviewed, and the SITE Cohort Study approach is presented. The randomized, controlled trial is the most robust method for evaluating treatment effects, but long study duration, high costs, and ethical concerns when studying toxicity limit its use in this setting. Retrospective cohort studies are potentially more cost-effective and timely, if records exist providing the desired information over sufficient follow-up time in the past. Case-control methods require extremely large sample sizes to evaluate risk associated with rare exposures, and recall bias is problematic when studying mortality. The SITE Cohort Study is a retrospective cohort study. Past use of antimetabolites, T-cell inhibitors, alkylating agents, and other immunosuppressives is ascertained from medical records of approximately 9,250 ocular inflammation patients at five tertiary centers over up to 30 years. Mortality and cause-specific mortality outcomes over approximately 100,000 person-years are ascertained using the National Death Index. Immunosuppressed and non-immunosuppressed groups of patients are compared with each other and general population mortality rates from US vital statistics. Calculated detectable differences for mortality/fatal malignancy with respect to the general population are 22%/49% for antimetabolites, 28%/62% for T-cell inhibitors, and 36%/81% for alkylating agents. Information from the SITE Cohort Study should clarify whether use of these immunosuppressive drugs for ocular inflammation increases the risk of mortality and fatal cancer. This epidemiologic approach may be useful for evaluating long-term risks of systemic therapies for other ocular diseases.

American Journal of Ophthalmology, 2008

Purpose-To estimate the risk of structural ocular complications and loss of visual acuity in case... more Purpose-To estimate the risk of structural ocular complications and loss of visual acuity in cases of Behçet's Disease (BD); to evaluate potential risk and protective factors for these events Design-Retrospective cohort study Setting: Five academic center ocular inflammation subspecialty practices Study Population: A total of 168 consecutive patients with BD-associated ocular inflammation Procedures: Clinical data on these patients were ascertained by standardized chart review Outcome Measures: Visual acuity, structural ocular complications of inflammation, intraocular pressure (IOP) Results-Over a median follow-up of 1.05 years, the incidence of specific structural complications and IOP disturbances were common: the incidence rate of any ocular complication was 0.

AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium, 2005

Supporting data entry by clinicians is considered one of the greatest challenges in implementing ... more Supporting data entry by clinicians is considered one of the greatest challenges in implementing electronic health records. In this paper we describe a formative evaluation study using three different methodologies through which we identified obstacles to point-of-care data entry for eye care and then used the formative process to develop and test solutions to overcome these obstacles. The greatest obstacles were supporting free text annotation of clinical observations and accommodating the creation of detailed diagrams in multiple colors. To support free text entry, we arrived at an approach that captures an image of a free text note and associates this image with related data elements in an encounter note. The detailed diagrams included a color pallet that allowed changing pen color with a single stroke and also captured the diagrams as an image associated with related data elements. During observed sessions with simulated patients, these approaches satisfied the clinicians' d...

AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium, 2005

Extensive utilization of mobile devices at the point of care will depend on device acceptance by ... more Extensive utilization of mobile devices at the point of care will depend on device acceptance by the providers. We conducted focus groups involving nine eye care professionals to evaluate and elucidate the most important features of a tablet Personal Computer (PC) for data entry at the point of care. Ease of use, and quality and size of display were considered to be the most critical features of such a mobile device by the majority of the participants. Keyboard and weight of device were deemed to be the least important features of a tablet PC.

AMIA ... Annual Symposium proceedings. AMIA Symposium, 2005

Supporting data entry by clinicians is considered one of the greatest challenges in implementing ... more Supporting data entry by clinicians is considered one of the greatest challenges in implementing electronic health records. In this paper we describe a formative evaluation study using three different methodologies through which we identified obstacles to point-of-care data entry for eye care and then used the formative process to develop and test solutions to overcome these obstacles. The greatest obstacles were supporting free text annotation of clinical observations and accommodating the creation of detailed diagrams in multiple colors. To support free text entry, we arrived at an approach that captures an image of a free text note and associates this image with related data elements in an encounter note. The detailed diagrams included a color pallet that allowed changing pen color with a single stroke and also captured the diagrams as an image associated with related data elements. During observed sessions with simulated patients, these approaches satisfied the clinicians' d...

Extensive utilization of mobile devices at the point of care will depend on device acceptance by ... more Extensive utilization of mobile devices at the point of care will depend on device acceptance by the providers. We conducted focus groups involving nine eye care professionals to evaluate and elucidate the most important features of a tablet Personal Computer (PC) for data entry at the point of care. Ease of use, and quality and size of display were considered to be the most critical features of such a mobile device by the majority of the participants. Keyboard and weight of device were deemed to be the least important features of a tablet PC.

Ophthalmology and Therapy

Introduction: Noninfectious keratitis is a painful corneal inflammation treated with topical cycl... more Introduction: Noninfectious keratitis is a painful corneal inflammation treated with topical cyclosporine and other immunosuppressants. Additional treatment options are needed for keratitis that does not improve with standard therapies. Repository corticotropin injection (RCI; Acthar Ò Gel) is approved to treat severe acute and chronic allergic and inflammatory processes involving the eye and its adnexa, including keratitis. This phase 4, multicenter, open-label study assessed the efficacy and safety of RCI for refractory severe noninfectious keratitis. Methods: Patients were C 18 years old with persistent severe keratitis despite treatment with topical immunosuppressants. Patients received 80 U of RCI subcutaneously twice weekly for 12 weeks followed by a 4-week taper. Assessments included all domains of the Impact of Dry Eye on Everyday Life (IDEEL) Questionnaire, Ocular Discomfort and 4-Symptom Questionnaire, and Visual Analog Scale (VAS). Corneal fluorescein and conjunctival lissamine green staining, Conjunctival Redness Scale, tear production (Schirmer's test), visual acuity, slit lamp examination, and intraocular pressure were also assessed. Safety was evaluated via treatment-emergent adverse events. Analyses were performed using the modified intent-to-treat (mITT) population (patients who received C 1 dose of RCI and contributed any post-baseline efficacy data). Results: In the mITT population (N = 35), 50.0% (95% confidence interval, 33.2% to 66.8%) of patients experienced clinically important improvements in the symptom bother domain of the IDEEL Questionnaire at week 12 of RCI therapy. All domains of the IDEEL and the Ocular Discomfort and 4-Symptom Questionnaire showed improvements at week 12 of RCI treatment. The most pronounced improvements in the VAS at week 12 were for eye dryness and eye discomfort. Corneal staining, conjunctival staining, conjunctival redness, and tear production showed early improvements that were sustained through week 12. No new safety signals for RCI were identified. Conclusions: RCI is safe and effective for refractory severe noninfectious keratitis that has not improved with other approved therapies.

Amia Annual Symposium Proceedings Amia Symposium Amia Symposium, Feb 1, 2005

Capturing the nuances of clinical observations in an electronic format has been a major challenge... more Capturing the nuances of clinical observations in an electronic format has been a major challenge in implementing electronic health records. In a formative evaluation study using three different methodologies, we identified that the greatest obstacle to point-of-care data entry for eye care was supporting free text annotation of clinical observations. To overcome this obstacle, we developed an approach that captures an image of a free text entry and associates this image with related data elements in an encounter note. Through simulated patient studies, we observed that this approach successfully supported complex documentation at the point of care by clinicians.

Ocular immunology and inflammation, Jan 22, 2016

To evaluate adalimumab as an immunomodulatory treatment for non-infectious ocular inflammatory di... more To evaluate adalimumab as an immunomodulatory treatment for non-infectious ocular inflammatory diseases. Characteristics of patients treated with adalimumab were abstracted in a standardized chart review. Main outcomes measured were control of inflammation, corticosteroid-sparing effect, and visual acuity. In total, 32 patients with ocular inflammation were treated with adalimumab. The most common ophthalmic diagnoses were anterior uveitis, occurring in 15 patients (47%), and scleritis, occurring in 9 patients (28%). At 6 months of therapy, among 15 eyes with active inflammation, 7 (47%) became completely inactive, and oral prednisone was reduced to ≤10 mg/day in 2 of 4 patients (50%). On average, visual acuity decreased by 0.13 lines during the first 6 months of treatment. Adalimumab was discontinued because of lack of effectiveness in four patients within 6 months. Adalimumab was moderately effective in controlling inflammation in a group of highly pre-treated cases of ocular infl...

AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium, 2005

Capturing the nuances of clinical observations in an electronic format has been a major challenge... more Capturing the nuances of clinical observations in an electronic format has been a major challenge in implementing electronic health records. In a formative evaluation study using three different methodologies, we identified that the greatest obstacle to point-of-care data entry for eye care was supporting free text annotation of clinical observations. To overcome this obstacle, we developed an approach that captures an image of a free text entry and associates this image with related data elements in an encounter note. Through simulated patient studies, we observed that this approach successfully supported complex documentation at the point of care by clinicians.

AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium, 2006

Collecting clinical data directly from clinicians is a challenge. Many standard development envir... more Collecting clinical data directly from clinicians is a challenge. Many standard development environments designed to expedite the creation of user interfaces for electronic healthcare applications do not provide acceptable components for satisfying the requirements for collecting and displaying clinical data at the point of care on the tablet computer. Through an iterative design and testing approach using think-aloud sessions in the eye care setting, we were able to identify and resolve several user interface issues. Issues that we discovered and subsequently resolved included checkboxes that were too small to be selectable with a stylus, radio buttons that could not be unselected, and font sizes that were too small to be read at arm's length.

Ophthalmology, 2010

Purpose-To evaluate the clinical outcomes of cyclosporine treatment for non-infectious ocular inf... more Purpose-To evaluate the clinical outcomes of cyclosporine treatment for non-infectious ocular inflammation Design-Retrospective cohort study Participants-Three hundred seventy-three patients with non-infectious ocular inflammation managed at four tertiary ocular inflammation clinics in the United States observed to use cyclosporine as a single non-corticosteroid immunosuppressive agent to their treatment regimen, between 1979-2007 inclusive. Methods-Participants were identified from the Systemic Immunosuppressive Therapy for Eye Diseases Cohort Study. Demographic and clinical characteristics, including dosage of cyclosporine

Ophthalmology, 2012

We sought to describe the risk and risk factors for hypotony in a noninfectious uveitis cohort. D... more We sought to describe the risk and risk factors for hypotony in a noninfectious uveitis cohort. Design: Retrospective cohort study. Participants: Patients with noninfectious uveitis seen between 1979 and 2007 at 4 academic ocular inflammation specialty clinics. Methods: Data were collected from medical records by trained, certified, expert reviewers. Main Outcome Measures: Hypotony (Ͻ5 mmHg) and low intraocular pressure (Ͻ8 mmHg), each sustained for Ն2 visits spanning Ն30 days. Results: During follow-up, 126 of 6785 patients (1.86%) developed hypotony at the rate of 0.61% (95% confidence interval [CI], 0.50Ϫ0.75%) per eye-year. Cataract surgery was associated with a 7.5-fold risk (adjusted hazard ratio [aHR], 7.51; 95% CI, 3.97Ϫ14.23) of incident hypotony. Phacoemulsification, the type of cataract surgery associated with the least hypotony risk still was associated with nearly 5-fold higher hypotony incidence (aHR, 4.87; 95% CI, 2.25Ϫ10.55). Increased risk was observed in children (aHR, 2.92; 95% CI, 1.20Ϫ7.10) with respect to young adults, and duration of uveitis of Ͼ5 years (aHR, 3.08; 95% CI, 1.30Ϫ7.31) with respect to uveitis of Ͻ6 month duration. Band keratopathy, Ն3ϩ vitreous cells, exudative retinal detachment, posterior synechia, and a history of pars plana vitrectomy also were associated with greater hypotony incidence. With respect to anterior uveitis, intermediate uveitis (aHR, 0.17; 95% CI, 0.05Ϫ0.56) and posterior uveitis (aHR, 0.11; 95% CI, 0.03Ϫ0.45) were associated with lower hypotony risk, whereas panuveitis (aHR, 1.25; 95% CI, 0.67Ϫ2.35) was similar. Approximately five-sixths (84.1%) of eyes presenting with hypotony had a visual acuity of Յ20/200 (aOR for visual acuity Յ20/200, 13.85; 95% CI, 7.23Ϫ26.53). Risk factors for prevalent hypotony were similar. Conclusions: The risk of hypotony is low among eyes with noninfectious uveitis, but is more frequently observed in cases with anterior segment inflammation. Signs of present or past inflammation were associated with greater risk, suggesting excellent inflammatory control may reduce the risk of hypotony. Prior ocular surgery also was associated with higher risk; cataract surgery in particular was associated with much higher risk of hypotony. Lower risk of hypotony with phacoemulsification than with alternative cataract surgery approaches suggests the phacoemulsification approach is preferable. Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references.

The Journal of Rheumatology, 2013

Objective.To evaluate the outcome of tumor necrosis factor-α inhibition (anti-TNF) for pediatric ... more Objective.To evaluate the outcome of tumor necrosis factor-α inhibition (anti-TNF) for pediatric uveitis.Methods.We retrospectively assessed children (age ≤ 18 yrs) with noninfectious uveitis receiving anti-TNF at 5 uveitis centers and 1 pediatric rheumatology center. Incident treatment success was defined as minimal or no uveitis activity at ≥ 2 consecutive ophthalmological examinations ≥ 28 days apart while taking no oral and ≤ 2 eyedrops/day of corticosteroids. Eligible children had active uveitis and/or were taking higher corticosteroid doses.Results.Among 56 eligible children followed over 33.73 person-years, 52% had juvenile idiopathic arthritis (JIA) and 75% had anterior uveitis (AU). The Kaplan-Meier estimated proportion achieving treatment success within 12 months was 75% (95% CI 62%–87%). Complete absence of inflammatory signs with discontinuation of all corticosteroids was observed in an estimated 64% by 12 months (95% CI 51%–76%). Diagnoses of JIA or AU were associated w...

British Journal of Ophthalmology, 2010

To evaluate how smoking affects the time to disease quiescence and time to disease recurrence in ... more To evaluate how smoking affects the time to disease quiescence and time to disease recurrence in patients with ocular inflammation. A retrospective cohort study of patients with ocular inflammation who were followed longitudinally and had smoking information available in the Systemic Immunosuppressive Therapy for Eye Diseases Cohort Study database. Among 2676 patients with active ocular inflammation, smokers were more likely to have bilateral ocular disease and poorer visual acuity on presentation compared with non-smokers and previous smokers. In a multivariate analysis, there was no statistically significant difference in the time to disease quiescence between groups. However, the median time to recurrence of ocular inflammation was statistically significantly longer for non-smokers (9.4 months) and for previous smokers (10.7 months) than for current smokers (7.8 months) (p=0.02). The RR of ocular inflammation recurrence was higher for smokers than for non-smokers (adjusted HR=1.19, 95% CI 1.03 to 1.37) and tended towards significance in previous smokers (adjusted HR=1.11, 95% CI 0.93 to 1.35). Smoking was associated with an increased likelihood of bilateral ocular inflammation and reduced vision upon presentation, and an increased risk of recurrence compared with not smoking. These results suggest that patients with ocular inflammation should be counselled to stop smoking as part of routine management.

BMJ: British Medical …, 2009

Design Retrospective cohort study evaluating overall and cancer mortality in relation to immunosu... more Design Retrospective cohort study evaluating overall and cancer mortality in relation to immunosuppressive drug exposure among patients with ocular inflammatory diseases. Demographic, clinical, and treatment data derived from medical records, and mortality results from United States ...

Ophthalmic …, 2008

To evaluate potential epidemiologic methods for studying long-term effects of immunosuppression o... more To evaluate potential epidemiologic methods for studying long-term effects of immunosuppression on the risk of mortality and fatal malignancy, and present the methodological details of the Systemic Immunosuppressive Therapy for Eye Diseases (SITE) Cohort Study. Advantages and disadvantages of potential study designs for evaluating rare, late-occurring events are reviewed, and the SITE Cohort Study approach is presented. The randomized, controlled trial is the most robust method for evaluating treatment effects, but long study duration, high costs, and ethical concerns when studying toxicity limit its use in this setting. Retrospective cohort studies are potentially more cost-effective and timely, if records exist providing the desired information over sufficient follow-up time in the past. Case-control methods require extremely large sample sizes to evaluate risk associated with rare exposures, and recall bias is problematic when studying mortality. The SITE Cohort Study is a retrospective cohort study. Past use of antimetabolites, T-cell inhibitors, alkylating agents, and other immunosuppressives is ascertained from medical records of approximately 9,250 ocular inflammation patients at five tertiary centers over up to 30 years. Mortality and cause-specific mortality outcomes over approximately 100,000 person-years are ascertained using the National Death Index. Immunosuppressed and non-immunosuppressed groups of patients are compared with each other and general population mortality rates from US vital statistics. Calculated detectable differences for mortality/fatal malignancy with respect to the general population are 22%/49% for antimetabolites, 28%/62% for T-cell inhibitors, and 36%/81% for alkylating agents. Information from the SITE Cohort Study should clarify whether use of these immunosuppressive drugs for ocular inflammation increases the risk of mortality and fatal cancer. This epidemiologic approach may be useful for evaluating long-term risks of systemic therapies for other ocular diseases.

American Journal of Ophthalmology, 2008

Purpose-To estimate the risk of structural ocular complications and loss of visual acuity in case... more Purpose-To estimate the risk of structural ocular complications and loss of visual acuity in cases of Behçet's Disease (BD); to evaluate potential risk and protective factors for these events Design-Retrospective cohort study Setting: Five academic center ocular inflammation subspecialty practices Study Population: A total of 168 consecutive patients with BD-associated ocular inflammation Procedures: Clinical data on these patients were ascertained by standardized chart review Outcome Measures: Visual acuity, structural ocular complications of inflammation, intraocular pressure (IOP) Results-Over a median follow-up of 1.05 years, the incidence of specific structural complications and IOP disturbances were common: the incidence rate of any ocular complication was 0.

AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium, 2005

Supporting data entry by clinicians is considered one of the greatest challenges in implementing ... more Supporting data entry by clinicians is considered one of the greatest challenges in implementing electronic health records. In this paper we describe a formative evaluation study using three different methodologies through which we identified obstacles to point-of-care data entry for eye care and then used the formative process to develop and test solutions to overcome these obstacles. The greatest obstacles were supporting free text annotation of clinical observations and accommodating the creation of detailed diagrams in multiple colors. To support free text entry, we arrived at an approach that captures an image of a free text note and associates this image with related data elements in an encounter note. The detailed diagrams included a color pallet that allowed changing pen color with a single stroke and also captured the diagrams as an image associated with related data elements. During observed sessions with simulated patients, these approaches satisfied the clinicians' d...

AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium, 2005

Extensive utilization of mobile devices at the point of care will depend on device acceptance by ... more Extensive utilization of mobile devices at the point of care will depend on device acceptance by the providers. We conducted focus groups involving nine eye care professionals to evaluate and elucidate the most important features of a tablet Personal Computer (PC) for data entry at the point of care. Ease of use, and quality and size of display were considered to be the most critical features of such a mobile device by the majority of the participants. Keyboard and weight of device were deemed to be the least important features of a tablet PC.