Faculty Bibliography

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.

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.

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.

PURPOSE/OBJECTIVE:To study the epidemiology of inpatient open globe injuries (OGI) in the United States (US). METHODS:This was a retrospective cohort study of patients with a primary diagnosis of OGI in the National Inpatient Sample (NIS) from 2009 to 2015. Sociodemographic characteristics, including age, gender, race, ethnicity, insurance, and income were stratified for comparison. Annual prevalence rates were calculated using 2010 US Census data. Statistical analysis included Chi-square tests, ANCOVA, and Tukey tests. RESULTS:< .05). CONCLUSIONS:Inpatient OGIs disproportionately affected those over 85, young males, elderly females, patients of African-American descent, on Medicare, and in the lowest income quartile. Additionally, children and young children had lower rates of OGI compared to adolescents. Further studies should delineate causes for socioeconomic differences in OGI rates to guide future public health measures.

Under current reimbursement models, implementation of IDx-DR may not be financially practical. Adequate reimbursement is necessary to incentivize widespread adoption and realize the potential of automated imaging to increase early detection of diabetic retinopathy.

PURPOSE/OBJECTIVE:To characterize the rates of pan-retinal laser photocoagulation (PRP) and anti-vascular endothelial growth factor (anti-VEGF) medications before and after publication of the DRCR.net Protocol S. DESIGN/METHODS:A retrospective, cross-sectional study from January 1, 2012 to September 30, 2019 using a nationally representative claims-based database, Clinformatics™ Data Mart Database (OptumInsight, Eden Prairie, MN). Subjects, Participants, and/or Controls: Eyes newly diagnosed with proliferative diabetic retinopathy (PDR), continuous enrollment, and no prior treatment with PRP or anti-VEGF. Methods, Intervention, or Testing: Interrupted time series regression analysis was performed to identify the annual change in treatment rates before and after the publication of Protocol S (November 24, 2015). MAIN OUTCOME MEASURES/METHODS:Annual rates of anti-VEGF or PRP treatments per 1,000 treated eyes with PDR. RESULTS:From 2012 to 2019, 10035 PRP or anti-VEGF treatments were given to 3685 PDR eyes. 63.6% (6379) of these were anti-VEGF agents and 36.4% (3656) were PRP treatments. 88.7% of eyes treated with anti-VEGF received the same agent throughout treatment and 7.7% were treated with both PRP and anti-VEGF agents. PRP rates declined from 784/1,000 treated eyes in 2012 to 566/1,000 in 2019 (pre-Protocol S: β = -32 vs. post-Protocol S: β = -77, p=0.005) while anti-VEGF rates increased from 876/1000 in 2012 to 1583/1000 in 2019 (β = -48 vs. β = 161, p=0.001). PRP rates in DME eyes did not significantly change from 474/1000 in 2012 to 363/1000 in 2019 (β = -9 vs. β = -58, p=0.091), but anti-VEGF rates increased significantly from 1533/1000 in 2012 to 2096/1000 in 2019 (β = -57 vs. β = 187, p=0.043). In eyes without DME, PRP use declined from 1017/1000 in 2012 to 707/1000 in 2019 (β = -31 vs. β = -111, p<0.001) and anti-VEGF use increased from 383/1000 in 2012 to 1226/1000 in 2019 (β = -48 vs. β = 140, p<0.001). CONCLUSIONS:Following the publication of Protocol S, PRP rates decreased while anti-VEGF rates increased largely from increases in bevacizumab use. PRP rates significantly declined among eyes without DME. Our findings indicate the impact that randomized controlled trials can have on real-world practice patterns.

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.