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Validation of the New York University Langone Eye Test Application, a Smartphone-Based Visual Acuity Test

Iskander, Mina; Hu, Galen; Sood, Shefali; Heilenbach, Noah; Sanchez, Victor; Ogunsola, Titilola; Chen, Dinah; Elgin, Ceyhun; Patel, Vipul; Wronka, Andrew; Al-Aswad, Lama A
Purpose/UNASSIGNED:To validate and assess user satisfaction and usability of the New York University (NYU) Langone Eye Test application, a smartphone-based visual acuity (VA) test. Design/UNASSIGNED:Mixed-methods cross-sectional cohort study. Participants/UNASSIGNED:Two hundred forty-four eyes of 125 participants were included. All participants were adults 18 years of age or older. Participants' eyes with a VA of 20/400 (1.3 logarithm of the minimum angle of resolution [logMAR]) or worse were excluded. Methods/UNASSIGNED:Patients were tested using the clinical standard Rosenbaum near card and the NYU Langone Eye Test application on an iPhone and Android device. Each test was performed twice to measure reliability. Ten patients were selected randomly for subsequent semistructured qualitative interviews with thematic analysis. Main Outcome Measures/UNASSIGNED:Visual acuity was the parameter measured. Bland-Altman analysis was used to measure agreement between the results of the NYU Langone Eye Test application and Rosenbaum card, as well as test-retest reliability of each VA. The correlation between results was calculated using the intraclass correlation coefficient. Satisfaction survey and semistructured interview questions were developed to measure usability and acceptability. Results/UNASSIGNED:Bland-Altman analysis revealed an agreement between the application and the Rosenbaum near card of 0.017 ± 0.28 logMAR (iPhone) and 0.009 ± 0.29 logMAR (Android). The correlation between the application and the Rosenbaum near card was 0.74 for both the iPhone and Android. Test-retest reliability was 0.003 ± 0.22 logMAR (iPhone), 0.01 ± 0.25 logMAR (Android), and 0.01 ± 0.23 logMAR (Rosenbaum card). Of the 125 participants, 97.6% found the application easy to use, and 94.3% were overall satisfied with the application. Thematic analysis yielded 6 key themes: (1) weaknesses of application, (2) benefits of the application, (3) tips for application improvement, (4) difficulties faced while using the application, (5) ideal patient for application, and (6) comparing application with traditional VA testing. Conclusions/UNASSIGNED:The NYU Langone Eye Test application is a user-friendly, accurate, and reliable measure of near VA. The application's integration with the electronic health record, accessibility, and easy interpretation of results, among other features, make it ideal for telemedicine use.
PMID: 36245756
ISSN: 2666-9145
CID: 5360102

Comparison Between the Recommendations of Glaucoma Specialists and OCT Report Specialists For Further Ophthalmic Evaluation in a Community-Based Screening Study

Ramachandran, Rithambara; Joiner, Devon B; Patel, Vipul; Popplewell, Deborah; Misra, Poonam; Kaplan, Chad M; Hood, Donald C; Al Aswad, Lama A
PURPOSE/OBJECTIVE:To compare glaucoma referral patterns between glaucoma and OCT report specialists and to determine what influence, if any, a designated OCT reading could have on glaucoma specialist judgments. DESIGN/METHODS:Retrospective exploratory study. SUBJECTS/METHODS:449 eyes (239 individuals) from high-risk NYC neighborhoods screened as part of a mobile van glaucoma screening study from July 2017 to October 2017 were included. METHODS:All participants underwent comprehensive testing including visual acuity, commercial OCT imaging, gonioscopy, intraocular pressure, frequency doubling testing, and funduscopic assessment. Three glaucoma specialists independently evaluated all collected data to determine if further glaucoma workup referral was recommended. Two OCT report specialists evaluated just the OCT image for each eye using the commercial report as well as a specialized customized report. In phase 2, the glaucoma specialists then re-evaluated a subset of these eyes, this time with an OCT report specialist's judgments made available. MAIN OUTCOME MEASURE/METHODS:Comparison of glaucoma specialist referrals made by glaucoma specialists versus OCT report specialists. RESULTS:Inter-grader agreement between glaucoma specialists was 60% (k= 0.42) and report specialists was 95% (k= 0.77). There was agreement between a single OCT report specialist and the consensus (2 of 3) glaucoma specialists in 74% of eyes (k= 0.32). 25% of eyes studied were referred for further glaucoma evaluation by the glaucoma specialists alone and 1% of eyes were referred for further glaucoma workup by only the report specialist. With the addition of the report specialist's judgments, referral pattern changes varied by glaucoma specialist, but overall agreement increased to 85% (κ=0.53). CONCLUSIONS:There was a fair level of agreement regarding glaucoma referral recommendations between glaucoma specialists with access to comprehensive screening data and those made by OCT report specialists with access to only OCT data. Overall agreement increased when the designated OCT evaluation was made available to the glaucoma specialists. These results may aid in the design of future large-scale glaucoma screening studies.
PMID: 35688330
ISSN: 2589-4196
CID: 5248562

Real-Time Mobile Teleophthalmology for the Detection of Eye Disease in Minorities and Low Socioeconomics At-Risk Populations

Al-Aswad, Lama A; Elgin, Cansu Yuksel; Patel, Vipul; Popplewell, Deborah; Gopal, Kalashree; Gong, Dan; Thomas, Zach; Joiner, Devon; Chu, Cha-Kai; Walters, Stephen; Ramachandran, Maya; Kapoor, Rahul; Rodriguez, Maribel; Alcantara-Castillo, Jennifer; Maestre, Gladys E; Lee, Joseph H; Moazami, Golnaz
PURPOSE/OBJECTIVE:To examine the benefits and feasibility of a mobile, real-time, community-based, teleophthalmology program for detecting eye diseases in the New York metro area. DESIGN/METHODS:Single site, nonrandomized, cross-sectional, teleophthalmologic study. METHODS:Participants underwent a comprehensive evaluation in a Wi-Fi-equipped teleophthalmology mobile unit. The evaluation consisted of a basic anamnesis with a questionnaire form, brief systemic evaluations and an ophthalmologic evaluation that included visual field, intraocular pressure, pachymetry, anterior segment optical coherence tomography, posterior segment optical coherence tomography, and nonmydriatic fundus photography. The results were evaluated in real-time and follow-up calls were scheduled to complete a secondary questionnaire form. Risk factors were calculated for different types of ophthalmological referrals. RESULTS:A total of 957 participants were screened. Out of 458 (48%) participants that have been referred, 305 (32%) had glaucoma, 136 (14%) had narrow-angle, 124 (13%) had cataract, 29 had (3%) diabetic retinopathy, 9 (1%) had macular degeneration, and 97 (10%) had other eye disease findings. Significant risk factors for ophthalmological referral consisted of older age, history of high blood pressure, diabetes mellitus, Hemoglobin A1c measurement of ≥6.5, and stage 2 hypertension. As for the ocular parameters, all but central corneal thickness were found to be significant, including having an intraocular pressure >21 mm Hg, vertical cup-to-disc ratio ≥0.5, visual field abnormalities, and retinal nerve fiber layer thinning. CONCLUSIONS:Mobile, real-time teleophthalmology is both workable and effective in increasing access to care and identifying the most common causes of blindness and their risk factors.
PMID: 34582428
ISSN: 2162-0989
CID: 5061622

Robotic radical prostatectomy with concomitant repair of inguinal hernia: is it safe?

Rogers, Travis; Parra-Davila, Eduardo; Malcher, Flavio; Hartmann, Carlos; Mastella, Bernardo; de Araújo, Guiherme; Ogaya-Pinies, Gabriel; Ortiz-Ortiz, Carlos; Hernandez-Cardona, Eduardo; Patel, Vipul; Cavazzola, Leandro Totti
Robotic radical prostatectomy (RARP) is well established as a safe and effective treatment for prostate cancer. According to published studies, patients undergoing RARP are at increased risk of being diagnosed with an inguinal hernia after RARP and are four times more likely to have an inguinal hernia repair (IHR) following RARP. Several studies have demonstrated the effectiveness and safety of IHR during RARP. Overall, it has been observed that IHR adds on average, 12-15 min in total surgical time and there were no significant differences between RARP with or without IHR with respect to postoperative complications. This study analyzes a large series of patients undergoing RARP (1100) and compares them to a group that underwent RARP with IHR (39). Between December 2008 and January 2015, 1139 patients underwent RARP at Florida Hospital in Celebration, FL. Of the total patients, 39 underwent concomitant IHR. All procedures were performed by the same surgeons (urologist and general surgeon), using the same techniques of RARP and TAPP inguinal hernia repair. After 30 days, the differences were evaluated between groups regarding surgical time, EBL and postoperative complications. The average age of patients undergoing the procedure was 61.65 years. The mean procedure time was approximately 120 min (min), with an additional period of 68 min for IHR (mean = 188; p = 0.0001). There was a significant difference in BMI between the groups, 28.3 kg/m2 for patients undergoing RARP and 26.8 kg/m2 for those who underwent RARP and IHR (p = 0.028). The EBL averaged 110.87 mL, with no significant difference between groups (p = 0371). There was no significant association between clinical stage of the patient and the type of procedure performed (p = 12:35). There was no significant difference in the presence of comorbidities and the operation preformed. There were 61 events recorded postoperatively, 57 (5.2%) among patients who underwent only RARP and 4 (10.26%) among those who had both. Taken together, the small amounts of complications in both groups prevent statistical significance. This study compared two groups of patients undergoing RARP: those with IHR and those without. Our study demonstrated an increase in surgical time; however, there was no increase in postoperative complications. From the data presented, we suggest that the performance of both procedures concomitantly is feasible and safe.
PMID: 28831728
ISSN: 1863-2491
CID: 4995852

Fracture of the Distal Ulna Metaphysis in the Setting of Distal Radius Fractures

Paksima, Nader; Khurana, Sonya; Soojian, Michael; Patel, Vipul; Egol, Kenneth
BACKGROUND: Fracture of the metaphyseal region of the distal ulna is an uncommon injury that has been reported to occur concomitantly with distal radius fracture. We aimed to report the incidence and types of distal ulnar head and neck fractures associated with distal radius fractures and compare outcomes in operatively versus non-operatively treated patients. METHODS: Over a 5-year period a distal radius fracture registry was maintained at our institution. Eleven of 512 consecutive patients had metaphyseal distal ulna fractures in association with distal radius fractures and at least 1-year follow-up. Baseline radiographs and functional data were obtained, and patients were followed at 1-week, 2-week, 3-week, 6-week, 3-month, 6-month, 1-year, and 2-year intervals. Patients were split into two treatment groups: Group 1 consisted of five non-operatively treated patients, and Group 2 consisted of six operatively treated patients. RESULTS: Four separate fracture patterns were observed: simple transverse or oblique fracture of the ulnar neck just proximal to the ulnar head, fracture of the neck region with concomitant fracture of the tip of the ulnar styloid, simple fracture of the ulnar head, and comminuted fracture of the ulnar head. There were no statistical differences between the two groups with regard to flexion, extension, supination, pronation, and functional outcomes. CONCLUSIONS: Ulnar fracture patterns observed did not easily fall into previously described categories, and we have proposed a new classification system. Simple fractures of the ulnar neck or head often do not require operative fixation.
PMID: 28583055
ISSN: 2328-5273
CID: 2609452

Complications of distal radius fracture fixation

Patel, Vipul P; Paksima, Nader
PMID: 20632986
ISSN: 1936-9727
CID: 111382

Biomechanical study of cross-locked cruciate versus Strickland flexor tendon repair

Vigler, Mordechai; Palti, Ram; Goldstein, Rachel; Patel, Vipul P; Nasser, Phillip; Lee, Steve K
PURPOSE: Zone II flexor tendon repairs may create a bulging effect with resistance to tendon gliding. A biomechanical study was performed comparing the 4-strand cross-locked cruciate (CLC) to a 4-strand Strickland repair, both with and without an interlocking horizontal mattress (IHM) suture, in terms of strength characteristics and work of flexion. METHODS: Sixteen fresh-frozen human fingers were placed in a custom jig. Flexor digitorum profundus tendons were sectioned at the A3 pulley level. Fingers were separated into 2 repair groups: 4-strand CLC and 4-strand Strickland core suture. Work of flexion was determined for each group, with and without an IHM circumferential suture. Final repair including IHM was tested for 2-mm gap failure and ultimate load to failure. RESULTS: The CLC-IHM had a significantly smaller increase in work of flexion than the Strickland-IHM. For both suture types, the circumferential suture resulted in a statistically significant increase in work of flexion; however, peak entry force produced upon entry of the repair into the A2 pulley was reduced, although the decrease was not statistically significant for each group. The CLC-IHM had a significantly higher ultimate load to failure. CONCLUSIONS: (1) The CLC-IHM suture method is stronger with less work of flexion than the Strickland-IHM method. (2) This new, combination repair method of CLC core suture with IHM circumferential suture is biomechanically superior to the commonly performed Strickland-IHM technique
PMID: 19084186
ISSN: 1531-6564
CID: 97750

Effect of anesthesia type on limb length discrepancy after total hip arthroplasty

Sathappan, Sathappan S; Ginat, Daniel; Patel, Vipul; Walsh, Michael; Jaffe, William L; Di Cesare, Paul E
A retrospective study of 132 patients (63 spinal anesthesia and 69 general anesthesia) undergoing total hip arthroplasty was performed by 4 fellowship-trained adult reconstructive surgeons to determine the influence of anesthesia type on postoperative limb length and medial offset. Limb length discrepancy occurred in 87.0% of patients who received regional anesthesia as opposed to 47.6% patients who had general anesthesia (P<.001). Differences in postoperative medial offset measurements between the 2 groups were not statistically significant. It was concluded that surgeons operating on patients who receive regional anesthesia should supplement intraoperative tests for assessing hip stability with meticulous preoperative templating to avoid overlengthening the operative limb
PMID: 18280413
ISSN: 0883-5403
CID: 78022

Relative risk factors for requirement of blood transfusion after total hip arthroplasty

Walsh, Michael; Preston, Charles; Bong, Matthew; Patel, Vipul; Di Cesare, Paul E
One thousand thirty-five total hip arthroplasty (THA) cases were retrospectively reviewed, and the number and type (autologous and allogenic) of postoperative units of blood transfused were analyzed with respect to pre-, intra-, and postoperative variables. The most significant and consistent predictors of a blood transfusion after THA were advanced age and the use of low-molecular-weight heparin for deep venous thrombosis prophylaxis. Our recommendations for predonation are 1 unit for THA patients younger than 75 years if hemoglobin is 130 g/dL or greater and 2 units or a combination of 1 unit of predonated blood and 1 unit of directed or banked blood for THA patients older than 75 years
PMID: 18078885
ISSN: 0883-5403
CID: 76386

Heparin-induced thrombocytopenia and thrombosis

Patel, Vipul P; Bong, Matthew; Di Cesare, Paul E
Heparin-induced thrombocytopenia (HIT) and heparin induced thrombocytopenia with thrombosis (HITT) ar rare complications associated with use of unfractionate heparin (UFH) or low-molecular-weight heparin (LMWH) HIT is a benign clinical condition characterized by a mil drop in platelet count with no clinical significance. HIT is an immune-mediated reaction associated with a wide spread 'hypercoagulable' state resulting in arterial an venous thrombosis. There is a higher incidence of HIT with UFH use than with LMWH use. Orthopedic surger patients are at higher risk for developing HITT than are patients who receive prophylactic heparin for cardiovascular surgery or medical reasons. Therapy for patients suspected of having HITT should begin with immedi ate discontinuation of heparin in any form followed by pharmacologic inhibition with thrombin (e.g., recombinant hirudin [lepirudin], argatroban, danaparoid sodium)
PMID: 17571830
ISSN: 1078-4519
CID: 73118