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Joshua D Stein - One of the best experts on this subject based on the ideXlab platform.
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a worldwide price comparison of glaucoma medications Laser trabeculoplasty and trabeculectomy surgery
JAMA Ophthalmology, 2018Co-Authors: Peter Y Zhao, Alan L. Robin, Raheem Rahmathullah, Brian C Stagg, Faisal A Almobarak, Deepak P Edward, Joshua D SteinAbstract:Importance Medical and surgical interventions for glaucoma are effective only if they are affordable to patients. Little is known about how affordable glaucoma interventions are in developing and developed countries. Objective To compare the prices of topical glaucoma medications, Laser trabeculoplasty, and trabeculectomy relative with median annual household income (MA-HHI) for countries worldwide. Design, Setting and Participants Cross-sectional observational study. For each country, we obtained prices for glaucoma medications, Laser trabeculoplasty, and trabeculectomy using government pricing data, drug databases, physician fee schedules, academic publications, and communications with local ophthalmologists. Prices were adjusted for purchasing power parity and inflation to 2016 US dollars, and annual therapy prices were examined relative to the MA-HHI. Interventions costing less than 2.5% of the MA-HHI were considered affordable. Main Outcomes and Measures Daily cost for topical glaucoma medications, cost of annual therapy with glaucoma medications, Laser trabeculoplasty, and trabeculectomy relative to MA-HHI in each country. Results Data were obtained from 38 countries, including 17 developed countries and 21 developing countries, as classified by the World Economic Outlook. We observed considerable variability in intervention prices compared with MA-HHI across the countries and across interventions, ranging from 0.1% to 5% of MA-HHI for timolol, 0.1% to 27% for latanoprost, 0.2% to 17% for Laser trabeculoplasty, and 0.3% to 42% for trabeculectomy. Timolol was the most affordable medication in all countries studied and was 2.5% or more of MA-HHI in only 2 countries (5%). The annual cost of latanoprost was 2.5% or more of MA-HHI in 15 countries (41%) (15 developing countries [75%] and no developed countries). The cost of Laser trabeculoplasty was 2.5% or more of the MA-HHI in 15 countries (44%) (11 developing countries [65%] and 4 developed countries [24%]). The cost of trabeculectomy was 2.5% or more of the MA-HHI in 28 countries (78%) (18 developing countries [95%] and 10 developed countries [59%]). In 18 countries (53%), Laser trabeculoplasty cost less than a 3-year latanoprost supply. Conclusions and Relevance For many patients worldwide, the costs of Medical, Laser, and incisional surgical interventions were 2.5% or more of the MA-HHI. Successfully reducing global blindness from glaucoma requires addressing multiple contributing factors, including making glaucoma interventions more affordable.
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subsequent receipt of interventions for glaucoma among a nationwide sample of patients who underwent Laser peripheral iridotomy
American Journal of Ophthalmology, 2015Co-Authors: Surbhi Bansal, Jennifer S Weizer, Paul P Lee, Taylor Blachley, Asha S Balakrishnan, Joshua D SteinAbstract:Purpose To evaluate use of Medical, Laser, or incisional surgical interventions for glaucoma after Laser peripheral iridotomy (LPI). Design Retrospective longitudinal cohort study. Methods All enrollees aged ≥21 years in a US managed-care network who underwent bilateral LPIs in 2001–2011 were identified. The mean numbers of pre- and post-LPI glaucoma medication classes prescribed and the proportion of enrollees requiring cataract or glaucoma surgery within 2 years after the LPIs were determined. Multivariable logistic regression assessed factors associated with enrollees' prescription of ≥1 glaucoma medication class after bilateral LPIs. Results Of the 1660 patients undergoing bilateral LPIs, 1280 (77.1%) had no pre- or post-LPI prescriptions for any glaucoma medication class. Of the remaining patients, 251 (66.1%) required more glaucoma medication classes after than before the procedures, whereas 44 (11.6%) used fewer after the procedures; 85 (22.4%) were prescribed the same number before and after the LPIs. A total of 167 patients (10.1%) underwent cataract surgery and 79 (4.8%) received glaucoma surgery over the 2-year follow-up. Black patients had a 130% increased odds for glaucoma medication–class prescriptions after bilateral LPIs, compared with white patients ( P = .02). The odds of post-LPI glaucoma medication use increased by 21% for every additional 5 years of age ( P Conclusion Most patients undergoing bilateral LPIs received no pre- or post-LPI glaucoma medication–class prescriptions and had no cataract or additional glaucoma surgery within 2 years after LPIs. Clinicians should alert black or older patients and those already taking glaucoma medications before the procedure of their higher odds of requiring medications afterward.
Shan Lin - One of the best experts on this subject based on the ideXlab platform.
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long term outcomes of Laser iridotomy in vietnamese patients with primary angle closure
British Journal of Ophthalmology, 2011Co-Authors: Paihuei Peng, Hannah Nguyen, Hueyshyan Lin, Ngoc Nguyen, Shan LinAbstract:Background/aims To investigate the long-term outcomes of Laser peripheral iridotomy (LPI) on controlling intraocular pressure (IOP) and progression of angle closure in Vietnamese. Methods Medical charts of Vietnamese patients who were diagnosed as having primary angle-closure suspect (PACS), primary angle closure (PAC) or primary angle-closure glaucoma (PACG), and who had received LPI at least 10 years prior, in a single private practice were reviewed. The main outcomes included use of further treatments after LPI, progression rate to another classification category and ocular characteristics associated with progression. Results 359 patients with a mean follow-up period of 11.8±1.6 years after the LPI were included in this study. The proportion of patients who required additional therapies (Medical, Laser or surgical) to control IOP were 7.1, 42.4 and 100% in the PACS, PAC and PACG groups, respectively. Fifty-three patients with PACS (22.2%) progressed to PAC; nine patients with PACS (3.8%) progressed to PACG; and five PAC patients (5.2%) progressed to PACG. Cataract surgery was a significant factor associated with PACS eyes without progression (p=0.019). Conclusions Further medications, Laser or surgery are frequently required to control IOP after LPI for eyes with PAC, especially for eyes with PACG. Lens extraction seems to play a protective role in PACS eyes. Close follow-up after LPI remains necessary to prevent progression of disease.
Stefan A. Loening - One of the best experts on this subject based on the ideXlab platform.
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IN VIVO OPTICAL COHERENCE TOMOGRAPHY IN ENDOSCOPIC DIAGNOSIS OF BLADDER DISEASE
2016Co-Authors: Dmitry Daniltchenko, Eva Lankenau, Frank Koenig, Brian Shay, Gereon Huettmann, Markus D. Sachs, Dietmar Schnorr, Stefan A. LoeningAbstract:Purpose: OCT is a new imaging method which produces a 3 mm wide x 2.5 mm deep 2D picture with a resolution of 15 µm. Materials and Methods: We utilised the Tomograph Sirius 713, developed at the Medical Laser Centre in cooperation with 4-Optics AG, Lübeck, Germany. This apparatus uses a special Super-Luminescence-Diode (SLD) that produces light within the near infrared wavelength, with a central wavelength of 1300 nm. The coherence length is reduced to 15 µm. The light is introduced into a fiberglass optic which is several meters long and is easy to handle. To measure the depth of invasion and position of urothelial bladder tumours, the fibreglass optic is attached to a regular endoscope (Wolf, Knittlingen, Germany) via an OCT adapter. That way, in parallel to the regular endoscopic view of the bladder mucosa with or without pathologic findings, an OCT picture of the superficial as well as the deeper muscle layers is visible online. OCT was used to obtain 275 images from the bladder of 30 patients. Results: OCT of normal bladder mucosa produces an image with a cross section of up to 2.5 mm. It is possible to distinguish between transitional epithelium, lamina propria, smooth muscles and capillaries. In cystitis, the thickness of the mucosa is constant, but the distinction between the different layers is blurred. In squamous metaplasia there is thickening of the epithelial layer, with preservation of lamination of the lower layers. In transitional cell carcinoma there is a complete loss of the regular layered structure. Thus, the border between tumor and normal bladder tissue can be easily distinguished. Conclusions: This method can provide valuable information on tumor invasion and extension in real time and therefore influence therapeutic strategies Key words: optical coherence tomography, endoscopy, bladder disease 1
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in vivo optical coherence tomography in endoscopic diagnostics of bladder disease
Biomedical optics, 2004Co-Authors: Dmitry Daniltchenko, Eva Lankenau, Brian Shay, Gereon Huettmann, Markus D. Sachs, Dietmar Schnorr, Frank Konig, Stefan A. LoeningAbstract:Purpose: OCT is a new imaging method which produces a 3 mm wide x 2.5 mm deep 2D picture with a resolution of 15 μm. Materials and Methods: We utilised the Tomograph Sirius 713, developed at the Medical Laser Centre in cooperation with 4-Optics AG, Lubeck, Germany. This apparatus uses a special Super-Luminescence-Diode (SLD) that produces light within the near infrared wavelength, with a central wavelength of 1300 nm and spectral width of 45 nm. The coherence length is reduced to 15 μm. The light is introduced into a fibreglass optic which is a couple of meters long and is easy to handle. To measure the depth of invasion and position of urothelial bladder tumours, the fibreglass optic is attached to a regular endoscope (Wolf, Knittlingen, Germany) via a OCT adapter. That way, in parallel to the regular endoscopic view of the bladder mucosa with or without pathologic findings, an OCT picture of the superficial as well as the deeper muscle layers is visible online. OCT was used to obtaine 275 images from the bladder of 30 patients. Results: OCT of normal bladder mucosa produces an image with a cross section of up to 2.5 mm. It is possible to distinguish transitional epithelium, lamina propria, smooth muscles and capillaries. In cystitis the thickness of the mucosa is constant, but the distinction between the different layers is blurred. In squamous metaplasia there is thickening of the epithelial layer, with preservation of lamination of the lower layers. In transitional cell carcinoma there is a complete loss of the regular layered structure. Thus, the border between tumour and normal bladder tissue can be easily distinguished. Conclusions: This method can provide valuable information on tumour invasion and extension in real time and therefore influence therapeutic strategies
Paihuei Peng - One of the best experts on this subject based on the ideXlab platform.
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long term outcomes of Laser iridotomy in vietnamese patients with primary angle closure
British Journal of Ophthalmology, 2011Co-Authors: Paihuei Peng, Hannah Nguyen, Hueyshyan Lin, Ngoc Nguyen, Shan LinAbstract:Background/aims To investigate the long-term outcomes of Laser peripheral iridotomy (LPI) on controlling intraocular pressure (IOP) and progression of angle closure in Vietnamese. Methods Medical charts of Vietnamese patients who were diagnosed as having primary angle-closure suspect (PACS), primary angle closure (PAC) or primary angle-closure glaucoma (PACG), and who had received LPI at least 10 years prior, in a single private practice were reviewed. The main outcomes included use of further treatments after LPI, progression rate to another classification category and ocular characteristics associated with progression. Results 359 patients with a mean follow-up period of 11.8±1.6 years after the LPI were included in this study. The proportion of patients who required additional therapies (Medical, Laser or surgical) to control IOP were 7.1, 42.4 and 100% in the PACS, PAC and PACG groups, respectively. Fifty-three patients with PACS (22.2%) progressed to PAC; nine patients with PACS (3.8%) progressed to PACG; and five PAC patients (5.2%) progressed to PACG. Cataract surgery was a significant factor associated with PACS eyes without progression (p=0.019). Conclusions Further medications, Laser or surgery are frequently required to control IOP after LPI for eyes with PAC, especially for eyes with PACG. Lens extraction seems to play a protective role in PACS eyes. Close follow-up after LPI remains necessary to prevent progression of disease.
Robert M. Feldman - One of the best experts on this subject based on the ideXlab platform.
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Clinical Study Clinical Outcomes of Peripheral Iridotomy in Patients with the Spectrum of Chronic Primary Angle Closure
2016Co-Authors: Isrn Ophthalmology, Ricardo J. Cumba, Eep S. Nagi, Nicholas P. Bell, Lauren S. Blieden, Alice Z. Chuang, Kimberly A. Mankiewicz, Robert M. FeldmanAbstract:Copyright © 2013 Ricardo J. Cumba et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Purpose. To evaluate outcomes of peripheral iridotomy (PI) for initial management of primary angle closure suspects (PACS), chronic primary angle closure (CPAC), and chronic primary angle closure glaucoma (CPACG). Patients and Methods. Seventy-nine eyes with PACS, CPAC, or CPACG and better than 20/50 visual acuity that underwent PI as initial management were included. Eyes with previous acute angle closure attacks, Laser trabeculoplasties, surgeries, or intraocular injections were excluded. Additional treatments, glaucomatous progression, intraocular pressure, visual acuity, and the number of medications were evaluated. Results. The mean followup was 57.1 ± 29.0 months (range 13.8–150.6 months). Sixty-eight eyes (86.1%) underwent additional Medical, Laser, or surgical treatment. Forty eyes (50.6%) underwent lens extraction due to reduced visual acuity. The mean 10 × logMAR visual acuity score for all patients significantly declined from 0.94 ± 1.12 at baseline to 1.83 ± 3.49
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clinical outcomes of peripheral iridotomy in patients with the spectrum of chronic primary angle closure
International Scholarly Research Notices, 2013Co-Authors: Ricardo J. Cumba, Nicholas P. Bell, Lauren S. Blieden, Alice Z. Chuang, Kimberly A. Mankiewicz, Kundandeep S Nagi, Robert M. FeldmanAbstract:Purpose. To evaluate outcomes of peripheral iridotomy (PI) for initial management of primary angle closure suspects (PACS), chronic primary angle closure (CPAC), and chronic primary angle closure glaucoma (CPACG). Patients and Methods. Seventy-nine eyes with PACS, CPAC, or CPACG and better than 20/50 visual acuity that underwent PI as initial management were included. Eyes with previous acute angle closure attacks, Laser trabeculoplasties, surgeries, or intraocular injections were excluded. Additional treatments, glaucomatous progression, intraocular pressure, visual acuity, and the number of medications were evaluated. Results. The mean followup was months (range 13.8–150.6 months). Sixty-eight eyes (86.1%) underwent additional Medical, Laser, or surgical treatment. Forty eyes (50.6%) underwent lens extraction due to reduced visual acuity. The mean 10× logMAR visual acuity score for all patients significantly declined from at baseline to (, ) at the last followup. Conclusions. Most patients who undergo PI for CPAC spectrum will require additional intervention for either IOP lowering or improvement of visual acuity. This suggests that a procedure that not only deepens the angle but also lowers IOP and improves visual acuity would be desirable as further intervention could be avoided. Evaluation of techniques that achieve all 3 goals is warranted.