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Impact of Early COVID-19 Pandemic on Common Ophthalmic Procedures Volumes: A US Claims-Based Analysis

Azad, Amee D; Mishra, Kapil; Lee, Eric B; Chen, Evan; Nguyen, Alexander; Parikh, Ravi; Mruthyunjaya, Prithvi
PURPOSE/UNASSIGNED:The COVID-19 pandemic has had a profound effect on the delivery of healthcare in the United States and globally. The aim of this study was to evaluate the impact of COVID-19 on common ophthalmic procedure utilization and normalization to pre-pandemic daily rates. METHODS/UNASSIGNED:Leveraging a national database, Clinformatics™ DataMart (OptumInsight, Eden Prairie, MN), procedure frequencies and daily averages, defined by Current Procedural Terminology codes, of common elective and non-elective procedures within multiple ophthalmology sub-specialties were calculated. Interrupted time-series analysis with a Poisson regression model and smooth spline functions was used to model trends in pre-COVID-19 (January 1, 2018-February 29, 2020) and COVID-19 (March 1, 2020-June 30, 2020) periods. RESULTS/UNASSIGNED:< .001) all declined significantly. All procedures except laser iridotomy returned to pre-COVID19 rates by June 2020. CONCLUSION/UNASSIGNED:Most ophthalmic procedures that significantly declined during the COVID-19 pandemic were elective procedures. Among these, the majority returned to 2019 daily averages by June 2020.
PMID: 34935591
ISSN: 1744-5086
CID: 5099972


Sakurada, Yoichi; Parikh, Ravi; Freund, K Bailey
PURPOSE/OBJECTIVE:To describe resolution of a subfoveal choroidal cavern after half-dose verteporfin photodynamic therapy for persistent central serous chorioretinopathy. METHODS:Case report. RESULTS:A 43-year-old man was referred for treatment of chorioretinopathy in his left eye. On presentation, swept-source optical coherence tomography demonstrated a serous retinal detachment and a 161-μm-thick subfoveal choroidal cavern showing a characteristic tail of hypertransmission extending posteriorly. Subfoveal choroidal thickness measured 456 μm in the affected eye. Complete resolution of subretinal fluid and the subfoveal choroidal cavern were observed 3 months after half-dose verteporfin photodynamic therapy. Twelve months after treatment, subfoveal choroidal thickness had decreased further to 276 μm, and visual acuity had improved to 20/15. CONCLUSION/CONCLUSIONS:After half-dose verteporfin photodynamic therapy for chorioretinopathy, resolution of subretinal fluid was accompanied by resolution of a subfoveal choroidal cavern at 3 months and a 39.5% reduction in subfoveal choroidal thickness at 1 year.
PMID: 31348118
ISSN: 1937-1578
CID: 4041252

Association of Patient Characteristics With Delivery of Ophthalmic Telemedicine During the COVID-19 Pandemic

Aziz, Kanza; Moon, Jade Y; Parikh, Ravi; Lorch, Alice C; Friedman, David S; Miller, John B; Armstrong, Grayson W
Importance/UNASSIGNED:Telemedicine has been shown to have had reduced uptake among historically marginalized populations within multiple medical specialties during the COVID-19 pandemic. An evaluation of health disparities among patients receiving ophthalmic telemedical care during the pandemic is needed. Objective/UNASSIGNED:To evaluate disparities in the delivery of ophthalmic telemedicine at Massachusetts Eye and Ear (MEE) during the COVID-19 pandemic. Design, Setting, and Participants/UNASSIGNED:This retrospective, cross-sectional study analyzed clinical visits at a single tertiary eye care center (MEE) from January 1 to December 31, 2020. Patients who had ophthalmology and optometry clinical visits at the MEE during the study period were included. Exposures/UNASSIGNED:Telemedicine vs in-person clinical encounters. Main Outcomes and Measures/UNASSIGNED:Variables associated with use of ophthalmic telemedicine during the study period. Results/UNASSIGNED:A total of 2262 telemedicine ophthalmic encounters for 1911 patients were included in the analysis. The median age of the patients was 61 (interquartile range, 43-72) years, and 1179 (61.70%) were women. With regard to race and ethnicity, 87 patients (4.55%) identified as Asian; 128 (6.70%), as Black or African American; 23 (1.20%), as Hispanic or Latino; and 1455 (76.14%), as White. On multivariate analysis, factors associated with decreased receipt of telemedical care included male sex (odds ratio [OR], 0.86; 95% CI, 0.77-0.96), Black race (OR, 0.69; 95% CI, 0.56-0.86), not speaking English (OR, 0.63; 95% CI, 0.48-0.81), educational level of high school or less (OR, 0.83; 95% CI, 0.71-0.97), and age (OR per year of age, 0.99; 95% CI, 0.989-0.998). When comparing telephone- and video-based telemedicine visits, decreased participation in video-based visits was associated with age (OR per year of age, 0.96; 95% CI, 0.94-0.98), educational level of high school or less (OR, 0.54; 95% CI, 0.29-0.99), being unemployed (OR, 0.28; 95% CI, 0.12-0.68), being retired (OR, 0.22; 95% CI, 0.10-0.42), or having a disability (OR, 0.09; 95% CI, 0.04-0.23). Conclusions and Relevance/UNASSIGNED:The findings of this cross-sectional study, though limited to retrospective data from a single university-based practice, suggest that historically marginalized populations were less likely to receive ophthalmic telemedical care compared with in-person care during the first year of the COVID-19 pandemic in the US. Understanding the causes of these disparities might help those who need access to virtual care.
PMID: 34554212
ISSN: 2168-6173
CID: 5036662

The combination therapy of subtenon triamcinolone acetonide injection and intravitreal brolucizumab for brolucizumab-related intraocular inflammation [Case Report]

Shigemoto, Yumi; Sakurada, Yoichi; Fukuda, Yoshiko; Matsubara, Mio; Parikh, Ravi; Kashiwagi, Kenji
RATIONALE/BACKGROUND:Brolucizumab is a novel anti-vascular endothelial growth factor agent with clinical trials demonstrating excellent efficacy for neovascular age-related macular degeneration (AMD) in both visual and anatomic outcomes. However, there is concern of intraocular inflammation (IOI), and we propose concurrent subtenon triamcinolone acetonide (STTA) to prevent IOI. PATIENT CONCERN/UNASSIGNED:A 73-year-old man was treated with aflibercept for neovascular AMD in his right eye. Despite 11 months of monthly intravitreal aflibercept injections, optical coherence tomography demonstrated persistent exudation. Ten days following his second brolucizumab injection, the patient presented with decreased vision due to vitritis in his right eye. DIAGNOSIS/METHODS:Brolucizumab-related IOI in neovascular AMD refractory to aflibercept. INTERVENTIONS/METHODS:A combination therapy involving of intravitreal brolucizumab and STTA. OUTCOMES/RESULTS:The anti-vascular endothelial growth factor inhibitor was changed back to aflibercept; however, exudation persisted. Therefore, a combination therapy involving STTA (5 mg/0.5 mL) and intravitreal injection of brolucizumab (6.0 mg/0.05 mL) was performed to treat the exudation and as prophylaxis to recurrent IOI. Combination therapy achieved no recurrent IOI and resolution of exudation with 8-week treatment intervals. LESSONS/CONCLUSIONS:This case might indicate that STTA is not only an optimal treatment option for brolucizumab-related IOI but also a preventive agent for this condition.
PMID: 34678906
ISSN: 1536-5964
CID: 5036632

COVID-19 and Use of Teleophthalmology (CUT Group): Trends and Diagnoses

Portney, David S; Zhu, Ziwei; Chen, Evan M; Steppe, Emma; Chilakamarri, Priyanka; Woodward, Maria A; Ellimoottil, Chad; Parikh, Ravi
PMID: 33581129
ISSN: 1549-4713
CID: 4835582

Medical Malpractice Lawsuits Involving Ophthalmology Trainees

Watane, Arjun; Kalavar, Meghana; Chen, Evan M; Mruthyunjaya, Prithvi; Cavuoto, Kara M; Sridhar, Jayanth; Parikh, Ravi
PMID: 33068616
ISSN: 1549-4713
CID: 4683902

Revisit rates and associated costs after emergency room encounters for ophthalmic conditions [Meeting Abstract]

Azad, A D; Chen, E; Parikh, R; Erickson, B; Mruthyunjaya, P
Purpose : To characterize emergency department (ED) revisit rates related to ophthalmologic conditions, variation by diagnosis, and costs. Methods : We identified 3- and 30-day ED revisit rates by diagnosis, diagnosis categories and demographic groups. Costs associated with revisits were described as a percentage of index visits and adjusted to 2016 US dollars using the Consumer Price Index. We utilized logistic multivariable regression analysis to identify factors significantly associated with revisits. Results : Among a total of 828,125 index ED encounters from 2007-2016 with an ophthalmic condition as a primary diagnosis, the 3- and 30-day revisit for the overall cohort was 2.5% and 4.1% respectively. Conditions of the cornea and external disease comprised the majority of index diagnoses (65.2%) but were associated with low rates of 30-day revisit (3.1%). Thirty-day revisits rates were highest for conditions related to cataract and lens disorders (28.3%) as well as glaucoma (15.9%). Nearly all (99%) patients revisiting the ED with cataract and lens disorders had a cataract-related procedure within 30 days of the index encounter. In multivariable analysis, younger adults, those with insurance plans lacking out-of-network coverage and cases involving an ophthalmologist were associated with a significantly higher likelihood of a revisit within 3-days of an index visit. Conversely, patients with higher out-of-pocket costs during an index visit were significantly less likely to revisit in the same period. Conclusions : Revisit rates for ocular conditions overall are low but varied by diagnosis category. Cataract and lens disorders had the highest 30-day revisit rate (with the vast majority within the 30-day postoperative period) followed by glaucomatous disorders. Younger patients, those with insurance lacking out-of-network coverage, those with lower OOP costs on an index visit and patients with an ophthalmologist participating in their ED care all had higher revisit rates. ED revisits for ocular conditions may be preventable with timely follow-up care, particularly for patients presenting in the acute post-operative period following cataract surgery
ISSN: 1552-5783
CID: 4982232


Parikh, Ravi; Gal-Or, Orly; Sakurada, Yoichi; Leong, Belinda; Freund, K Bailey
PURPOSE/OBJECTIVE:To describe the occurrence of an acquired choroidal nevus in a 73-year-old white man. METHODS:Case report. RESULTS:A 73-year-old white man was referred for an evaluation and treatment of macular changes in his left eye consistent with pachychoroid neovasculopathy. Baseline funduscopic examination and color fundus photographs showed two small peripheral choroidal nevi in the right eye and a single small choroidal nevus in the far temporal macula of the left eye. Treatment with intravitreal aflibercept was initiated in the left eye on a treat-and-extend dosing regimen. Approximately 1 year later, a new pigmented choroidal lesion was detected in the left macula in an area where previous high-resolution color fundus photographs had shown no abnormal pigmentation. Swept-source optical coherence tomography of the new pigmented lesion showed flat hyperreflectivity within the inner choroid consistent with a small choroidal nevus. The patient was referred to his internist who found no evidence of an occult malignancy. Over the course of more than 4 additional years of continuous follow-up, the new choroidal nevus remained stable, no new fundus abnormalities were detected in either eye, and the patient remained medically stable. CONCLUSION/CONCLUSIONS:To the best of our knowledge, this is the first documented case of a new choroidal nevus. Multimodal imaging performed before lesion detection and over the ensuing 4 years showed its stability, thus allowing for the conclusion that it was a benign choroidal nevus rather than a neoplastic or paraneoplastic process.
PMID: 30289791
ISSN: 1937-1578
CID: 3328472

The Impact of International Pricing Index Models on Anti-Vascular Endothelial Growth Factor (VEGF) Drug Costs in the United States

Choi, Stephanie; Chen, Evan M; Chen, Dinah; Sridhar, Jayanth; Parikh, Ravi
OBJECTIVE:To evaluate the impact of three international pricing index models on Medicare Part B spending for intravitreal anti-vascular endothelial growth factor (VEGF) drugs Design: Cost analysis Methods: U.S. and international sales data from the Multinational Integrated Data Analysis (MIDAS) database was used with data from the U.S. Centers for Medicare and Medicaid Services (CMS) to calculate Medicare Part B spending on anti-VEGF drugs Main Outcome: Medicare Part B expenditures of anti-VEGF drugs under various international pricing index models Results: Total Medicare Part B savings was greatest (75%) under the "most favored nation" proposal to peg the U.S. price to the lowest international price. Under the "most favored nation" proposal, prices of aflibercept are reduced from $1825.80 to $507.17, bevacizumab from $74.39 to $27.55, and ranibizumab (3 units or 0.3mg) from $1057.08 to $99.72. CONCLUSION/CONCLUSIONS:International pricing index models are one of many pricing strategies that could lead to savings in Medicare Part B costs.
PMID: 33822670
ISSN: 1744-5205
CID: 4858472

Single-Blind and Double-Blind Peer Review: Effects on National Representation

Kalavar, Meghana; Watane, Arjun; Wu, David; Sridhar, Jayanth; Mruthyunjaya, Prithvi; Parikh, Ravi
Purpose: To assess whether the type of peer-review (single-blinded vs double-blinded) has an impact on nationality representation in journals.Methods: A cross-sectional study analyzing the top 10 nationalities contributing to the number of articles across 16 ophthalmology journals.Results: There was no difference in the percentage of articles published from the journal's country of origin between the top single-blind journals and double-blind journals (SB = 42.0%, DB = 26.6%, p = .49), but there was a significant difference between the percentage of articles from the US (SB = 48.0%, DB = 22.8%, p = .02). However, there was no difference for both country of origin (SB = 38.0%, DB = 26.6%, p = .43) and articles from the US (SB = 35.0%, DB = 22.8%, p = .21) when assessing the top eight double-blind journals matched with single-blind journals of a similar impact factor. The US (n = 16, 100%) and England (n = 16, 100%) most commonly made the top 10 lists for article contribution. This held true even for journals established outside the United States (US=11/12, England = 11/12).Conclusions: There was no significant difference in country-of-origin representation between single-blind journals and double-blind journals. However, higher income countries contributed most often to the journals studied even among journals based outside the US.
PMID: 33760687
ISSN: 1744-5205
CID: 4836712