Amaurosis fugax secondary to imaging methods of MRI scan.
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Amaurosis Fugax↗
Biomedical subjects
Cindy M L Hutnik
Publications and source records attributed to Cindy M L Hutnik.
Projected cost comparison of selective laser trabeculoplasty versus glaucoma medication in the Ontario Health Insurance Plan.
BACKGROUND: The projected 6-year cost comparison of primary selective laser trabeculoplasty (SLT) versus primary medical therapy in the treatment of open-angle glaucoma for Ontario patients aged 65 years or more is presented. Costs are taken from the perspective of the Ontario Health Insurance Plan at a per-patient level. METHODS: The cost of each medication was obtained from the 2003 Ontario Drug Benefits formulary. The average annual cost of medications was determined by estimating the provincial prescription rate of glaucoma medications, with reference to both a volume-per-bottle study of these drugs and a study of pharmacy claims reports. A representative provincial prescription rate was calculated by reviewing 707 patient charts selected randomly from 5 ophthalmologic practices across Ontario. Medication therapies were categorized into mono-, bi-, and tri-drug therapy groups. The cost of SLT was analyzed under the following 2 scenarios. SLT rep 2y assumed a duration of 2 years before repeat SLT was necessary. SLT rep 3y assumed a duration of 3 years before repeat SLT was necessary. Bilateral 180 degrees SLT treatment and repeatability of SLT was assumed. The cost of surgery for patients who fail SLT or medical therapy was not accounted for in this study nor was the cost of patients who required medical therapy in conjunction with SLT. RESULTS: In the SLT rep 2y scenario, the use of primary SLT over mono-, bi-, and tri-drug therapy produced a 6-year cumulative cost savings of 206.54 dollars, 1668.64 dollars, and 2992.67 dollars per patient, respectively. In the SLT rep 3y scenario, the use of primary SLT over mono-, bi-, and tri-drug therapy produced a 6-year cumulative cost savings of 580.52 dollars, 2042.82 dollars, and 3366.65 dollars per patient, respectively. INTERPRETATION: Our findings suggest that SLT as primary therapy, at a per-patient level, offers a modest potential cost saving over primary medical therapy in the management of open-angle glaucoma for Ontario patients aged 65 years or more.
Antihypertensive Agents↗
Selective laser trabeculoplasty as initial and adjunctive treatment for open-angle glaucoma.
PURPOSE: To investigate the efficacy and safety of selective laser trabeculoplasty as an initial treatment for newly diagnosed open-angle glaucoma, and its role as adjunctive therapy. PATIENTS AND METHODS: A prospective multicenter nonrandomized clinical trial was performed. Patients with newly diagnosed open-angle glaucoma or ocular hypertension were assigned to the primary (selective laser trabeculoplasty) treatment group or the control (latanoprost) group according to patient choice. Both groups were followed up at 1, 3, 6, and 12 months. A secondary treatment group was also included to study the efficacy of selective laser trabeculoplasty for patients intolerant of medical therapy or in whom such therapy was unsuccessful, with or without a history of previous argon laser trabeculoplasty. RESULTS: One hundred eyes (61 patients) were enrolled, 74 in the primary treatment group and 26 in the control group. The average absolute and percent reductions in intraocular pressure for the primary treatment group were 8.3 mm Hg or 31.0%, compared with 7.7 mm Hg or 30.6% for the control group (P = 0.208 and P = 0.879). The responder rates (20% pressure reduction) were 83% and 84% for the primary and control groups, respectively. There were no differences in intraocular pressure lowering with selective laser trabeculoplasty on the basis of angle pigmentation. A modest contralateral effect was observed in the untreated fellow eyes of patients undergoing selective laser trabeculoplasty. CONCLUSIONS: Selective laser trabeculoplasty was found to be equally efficacious as latanoprost in reducing intraocular pressure in newly diagnosed open-angle glaucoma and ocular hypertension over 12 months, independent of angle pigmentation. Nonsteroidal antiinflammatory therapy had similar efficacy to steroids after laser therapy. These findings support the consideration of selective laser trabeculoplasty as a first-line treatment for newly diagnosed open-angle glaucoma or ocular hypertension.
Anti-Inflammatory Agents, Non-Steroidal↗
Comparison of the in vitro toxicity of indocyanine green to that of trypan blue in human retinal pigment epithelium cell cultures.
PURPOSE: To compare the in vitro toxicity of indocyanine green (ICG) to that of trypan blue (TB) in human retinal pigment epithelium cell cultures. The use of ICG and TB in macular hole surgery is discussed. DESIGN: In vitro cell biology experimental study. METHODS: The ICG dye and TB were applied to ARPE-19, a commercially available human retinal pigment epithelium cell line. Cultures were established and maintained according to supplier protocols. The ICG dye, TB or Hank's balanced salt solution (controls) were then applied to the cells at varying concentrations and over various exposure periods. Fiberoptic light was also applied to cells to assess for the possibility of a potentiating phototoxic effect. Cell viability fractions were determined using a well-studied mitochondrial dehydrogenase assay. RESULTS: The TB was not toxic to the retinal pigment epithelium cell cultures at any concentration or over any period of exposure, whereas ICG dye demonstrated dose-dependent and exposure-dependent toxicity. The ICG dye was found to be toxic to the cells at all tested concentrations between 5.0 mg/ml (stock concentration, 26.1% cell survival) and 0.5 mg/ml (92.8% cell survival) over a 3-minute exposure. No toxicity to TB was seen at the stock concentration of 1.5 mg/mL. Addition of light to the cultures did not significantly alter cell viability with either dye. Long periods of exposure, 2 hours, 24 hours, and 72 hours, to minute concentrations of either dye did not produce significant cell death. CONCLUSIONS: Indocyanine green demonstrates more toxicity than TB to human retinal pigment epithelium cell cultures. This is independent of any phototoxic potentiating effect of fiberoptic light or solvent toxicity. A clinically useful concentration of 0.5-mg/ml ICG causes low cytotoxicity at 3 minutes' exposure (cell survival 92.8%) and shows no detectable toxicity at 1-minute exposure (cell survival 102%).
Cell Line↗
Informed consent for cataract surgery: what patients do and do not understand.
PURPOSE: To determine patients' understanding and opinions about the usefulness of the informed consent (IC) document for cataract surgery and evaluate the deterioration in the effectiveness of verbal and written IC over time. SETTING: Academic tertiary care center. METHODS: Multiple-choice questionnaires addressing specific information about cataract surgery were distributed to patients. The questionnaires covered topics such as treatment, risk, and outcome probabilities (assessed preoperatively and postoperatively); terminology commonly used in IC; and patients' opinions about IC. Scores were calculated and compared using paired and unpaired t tests. RESULTS: Twenty-six patients thought that their legal autonomy would be waived by signing a consent form. Patients who took part in a standardized discussion of IC before testing scored 73.4% versus 23.4% in a control group who received no IC counseling (P<.001). Patient recall of outcome probabilities significantly decreased between preoperative and postoperative testing (61.2% to 44.0%) when IC was given verbally but improved to 75.0% when patients were given written information to take home. CONCLUSIONS: Patients about to consent to cataract surgery had a reasonable grasp of basic terminology. A standardized IC discussion was effective in educating patients. Patients considered IC to be important and expected all pertinent information to be communicated. Patient recall of outcome probabilities was poorer than that of nonnumeric facts; however, memory decay may be slowed by providing supporting take-home literature.
Adult↗
Do we heed the endophthalmitis vitrectomy study in Canada?
BACKGROUND: The Endophthalmitis Vitrectomy Study (EVS) was a multicentre randomized clinical trial designed to guide the management of postoperative bacterial endophthalmitis. There is speculation that many physicians do not follow its recommendations, despite its intent. We surveyed Canadian vitreoretinal surgeons to determine whether surgeons are adopting the EVS recommendations in their management of bacterial endophthalmitis after cataract surgery. METHODS: A survey was sent to 98 vitreoretinal surgeons across Canada who manage postoperative endophthalmitis following cataract surgery. The survey explored the management of patients presenting with a hypopyon or suspected endophthalmitis, or both, early (up to 2 weeks) after cataract surgery. For purposes of comparison with the EVS, the questions were divided into presenting visual acuity categories. RESULTS: Of the 98 surgeons 30 (30.6%) responded to the survey. The preferred treatment for patients presenting with no light perception visual acuity was pars plana vitrectomy (23 respondents [76.7%]); 7 respondents (23.3%) preferred vitreous tap/biopsy. All but one of the respondents stated that they prefer pars plana vitrectomy for patients presenting with light perception vision; the remaining physician preferred either pars plana vitrectomy or vitreous tap/biopsy. For patients with hand motions visual acuity, 17 respondents (56.7%) would perform pars plana vitrectomy, 11 (36.7%) would perform vitreous tap/biopsy, and 2 (6.7%) would perform either procedure. Most of the respondents (20 [66.7%]) would perform vitreous tap/biopsy for patients with visual acuity of counting fingers, whereas 9 (30.0%) would perform pars plana vitrectomy, and 1 (3.3%) would perform either procedure. All the respondents indicated that they would use intraocular antibiotic therapy for initial treatment, 29 (96.7%) would use topical antibiotic therapy, 17 (56.7%) would inject antibiotics subconjunctivally, and 1 (3.3%) would use intravenous antibiotic therapy. Fourteen respondents (46.7%) would use intraocular steroid therapy. INTERPRETATION: Most of the Canadian vitreoretinal surgeons who responded to this survey do not follow the recommendations of the EVS.
Anti-Bacterial Agents↗