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Biomedical subjects

Henry D Jampel

Publications and source records attributed to Henry D Jampel.

17 recordsLinked to original sources
PubMed2006

A multicenter, retrospective pilot study of resource use and costs associated with severity of disease in glaucoma.

OBJECTIVE: To examine resource consumption and the direct costs of treating glaucoma at different disease severity levels. DESIGN: Observational, retrospective cohort study based on medical record review. PARTICIPANTS: One hundred fifty-one records of patients with primary open-angle or normal-tension glaucoma, glaucoma suspect, or ocular hypertension (age > or =18 years) were randomly selected from 12 sites in the United States and stratified according to severity based on International Classification of Diseases, Ninth Revision, Clinical Modification codes. Patients had to have been followed up for a minimum of 5 years. Patients with concomitant ocular disease likely to affect glaucoma treatment-related resource consumption were excluded. METHODS: Glaucoma severity was assessed and assigned using a 6-stage glaucoma staging system, modified from the Bascom Palmer (Hodapp-Anderson-Parrish) system. Clinical and resource use data were collected from the medical record review. Resource consumption for low-vision care and vision rehabilitation was estimated for patients with end-stage disease based on specialist surveys. For each stage of disease, publicly available economic data were then applied to assign resource valuation and estimate patient-level direct costs from the payer perspective. MAIN OUTCOME MEASURES: Average annual resource use and estimated total annual direct cost of treatment were calculated at the patient level and stratified by stage of disease. Direct costs by specific resource types, including ophthalmology visits, glaucoma surgeries, medications, visual field examinations, and other glaucoma services, were also assessed. RESULTS: Direct ophthalmology-related resource use, including ophthalmology visits, glaucoma surgeries, and medication use, increased as disease severity worsened. Average direct cost of treatment ranged from $623 per patient per year for glaucoma suspects or patients with early-stage disease to $2511 per patient per year for patients with end-stage disease. Medication costs composed the largest proportion of total direct cost for all stages of disease (range, 24%-61%). CONCLUSIONS: The study results suggest that resource use and direct cost of glaucoma management increase with worsening disease severity. Based on these findings, a glaucoma treatment that delays the progression of disease could have the potential to significantly reduce the health economic burden of this chronic disease over many years.

Adult↗
PubMed2006

The prevalence of open-angle glaucoma among blacks and whites 73 years and older: the Salisbury Eye Evaluation Glaucoma Study.

OBJECTIVE: To determine the prevalence of glaucoma among black and white persons 73 years and older. DESIGN: Participants in the fourth round of a population-based study, the Salisbury Eye Evaluation, were examined. The main outcome measure was glaucoma, based on optic nerve damage and visual field loss or obvious glaucomatous optic neuropathy without an available, reliable, reproducible visual field. RESULTS: A total of 1250 individuals (95.9% of those eligible) participated, 1233 (98.6%) of whom agreed to screening and an eye examination. The prevalence (95% confidence interval) of open-angle glaucoma was 3.4% (0.5%-6.4%) for white individuals aged 73 and 74 years, increasing to 9.4% (7.4%-11.5%) for those 75 years and older. There was no increasing prevalence in those older than 75 years. Among black persons, the prevalence (95% confidence interval) was 5.7% (0%-11.9%) in those aged 73 and 74 years and 23.2% (17.8%-28.5%) in those 75 years and older. CONCLUSIONS: Many older individuals have open-angle glaucoma, and black persons 75 years and older have substantially higher rates than whites. These findings have important implications for public health initiatives, in which screening programs may be of benefit.

Aged↗
PubMed2006

Medicare prescription drug cards: effectiveness for patients with glaucoma.

OBJECTIVE: To assess the level of discounts on glaucoma medications provided by the Medicare prescription drug card program. METHODS: We compared the cost of a 1-month supply of 10 brand-name drugs and 1 commonly prescribed combination of drugs purchased at retail cash price, Medicare card-discounted price, and online price. Retail cash prices were collected through a telephone survey of 36 chain pharmacies in 4 states. Card-discounted prices were obtained from an online database updated weekly by Medicare for each drug, drug card, and state in our survey. Prices for drugs purchased online were collected from a leading online drugstore not affiliated with any retail stores that were included in the telephone survey. RESULTS: Card-discounted prices for each drug ranged between 13% and 25% lower on average than retail prices. However, drugs purchased online were cheaper on average than drugs purchased with cards for 7 of the 10 medications surveyed. CONCLUSIONS: Drug cards provide significant discounts over retail prices. However, cards may be a secondary option to online purchasing, which may be cheaper and may offer seniors more flexibility to switch between glaucoma therapies. Ophthalmologists can take simple steps to guide seniors to the optimal purchasing option for a given drug in their region.

Antihypertensive Agents↗
PubMed2006

Test-retest variability in structural and functional parameters of glaucoma damage in the glaucoma imaging longitudinal study.

PURPOSE: To determine the test-retest variability in perimetric, optic disc, and macular thickness parameters in a cohort of treated patients with established glaucoma. PATIENTS AND METHODS: In this cohort study, the authors analyzed the imaging studies and visual field tests at the baseline and 6-month visits of 162 eyes of 162 participant in the Glaucoma Imaging Longitudinal Study (GILS). They assessed the difference, expressed as the standard error of measurement, of Humphrey field analyzer II (HFA) Swedish Interactive Threshold Algorithm fast, Heidelberg retinal tomograph (HRT) II, and retinal thickness analyzer (RTA) parameters between the two visits and assumed that this difference was due to measurement variability, not pathologic change. A statistically significant change was defined as twice the standard error of measurement. RESULTS: In this cohort of treated glaucoma patients, it was found that statistically significant changes were 3.2 dB for mean deviation (MD), 2.2 for pattern standard deviation (PSD), 0.12 for cup shape measure, 0.26 mm for rim area, and 32.8 microm and 31.8 microm for superior and inferior macular thickness, respectively. On the basis of these values, it was estimated that the number of potential progression events detectable in this cohort by the parameters of MD, PSD, cup shape measure, rim area, superior macular thickness, and inferior macular thickness was 7.5, 6.0, 2.3, 5.7, 3.1, and 3.4, respectively. CONCLUSIONS: The variability of the measurements of MD, PSD, and rim area, relative to the range of possible values, is less than the variability of cup shape measure or macular thickness measurements. Therefore, the former measurements may be more useful global measurements for assessing progressive glaucoma damage.

Adult↗
PubMed2005

Perioperative complications of trabeculectomy in the collaborative initial glaucoma treatment study (CIGTS).

PURPOSE: To describe the incidence of, and risk factors for, surgical complications reported during and within the first post-operative month after trabeculectomy in the Collaborative Initial Glaucoma Treatment Study (CIGTS). DESIGN: Review of prospectively collected data from a multicenter, randomized clinical trial. METHODS: Complications were tabulated for the 300 CIGTS patients randomized to surgery. Logistic regression analyses were used to identify risk factors for complications. RESULTS: Among the 300 patients randomized to initial surgery, 465 trabeculectomies were performed. Intraoperative complications were reported in 55 eyes (12%). The most frequent reported complications were anterior chamber bleeding during surgery (37 eyes, 8%) and conjunctival buttonhole (five eyes, 1%). Early post-operative complications were reported in 232 eyes (50%). Complications with a frequency over 10% included shallow or flat anterior chamber (62 eyes, 13%), encapsulated bleb (56 eyes, 12%), ptosis (55 eyes, 12%), serous choroidal detachment (52 eyes, 11%), and anterior chamber bleeding or hyphema (48 eyes, 10%). There were three localized suprachoroidal hemorrhages (0.7%) and no cases of endophthalmitis. Older patients were more likely to experience serous choroidal detachment, new anterior or posterior synechiae, and wound leak. Blacks were less likely to experience anterior chamber bleeding, but more likely to experience post-operative ptosis. The number of subjects experiencing bilateral complications was higher than that which would have been predicted by chance alone. CONCLUSIONS: The incidence of transient and self-limiting complications was high in the perioperative period, but we observed few complications with the potential to cause severe sustained vision loss in this group of previously untreated eyes.

Adult↗
PubMed2005

Chart documentation by general physicians of the glaucoma medications taken by their patients.

PURPOSE: To estimate the frequency of documentation of glaucoma medications by primary care physicians. DESIGN: Cross-sectional, observational study. METHODS: The general medical records of 100 patients of one glaucoma specialist were reviewed. We recorded whether the mention of eyedrops appeared in the medical record. RESULTS: The median number of glaucoma medications used was 2.5 (range 1 to 5). Fifty-five (55%, 95% confidence interval: 45%-65%) of the medical records of the primary physicians mentioned eyedrops. Alpha-agonists were statistically less frequently documented (13%) in the general medical record than beta-adrenergic blockers (47%) and prostaglandins (44%). CONCLUSION: Almost half of the charts of these primary physicians had no documentation of any eyedrop use by their patients with glaucoma. An important step in reducing drug-induced side effects and interactions with other medications would be better recognition by primary physicians of the ophthalmic drugs used by their patients.

Adult↗
PubMed2005

Preferences for eye drop characteristics among glaucoma specialists: a willingness-to-pay analysis.

PURPOSE: To determine the importance that US glaucoma specialists place on attributes of eye drops for lowering intraocular pressure. MATERIALS AND METHODS: We performed a cross-sectional survey by conducting a telephone interview with 113 members of the American Glaucoma Society. We administered a willingness-to-pay (WTP) instrument asking glaucoma specialists how much they would pay to obtain particular characteristics in an eye drop. Demographic data were correlated with the WTP responses. We compared the glaucoma specialists' responses to those previously obtained from patients. The main outcome measure was willingness-to-pay more (in US dollars). RESULTS: Almost all respondents were willing to pay extra to reduce the frequency of administration of eye drops from 3 times a day to once a day, and to avoid blurred vision, drowsiness, or inhibition of sexual performance. Only 54 (48%) were willing to pay more to avoid iris darkening. The mean amount that respondents were willing to pay (relative to US 50 dollars) differed significantly across eye drop characteristics (P < 0.001). The mean amount that the respondents were willing to pay was highest for avoidance of inhibition of sexual performance (US 105 dollars), blurred vision (US 92 dollars), and drowsiness (US 92 dollars). When compared with glaucoma and glaucoma suspect patients, more ophthalmologists were likely to pay extra for desirable eye drop attributes. However, the magnitude of the extra amount was similar between ophthalmologists and patients. CONCLUSIONS: Glaucoma specialists place differing value on various eye drop characteristics. Although the proportion of glaucoma specialists willing to pay more is generally greater than the proportion of patients, the preferences of glaucoma specialists and patients are alike.

Adult↗
PubMed2003

Patient preferences for eye drop characteristics: a willingness-to-pay analysis.

OBJECTIVE: To determine the importance that patients place on the characteristics of topical therapy for lowering intraocular pressure. METHODS: We administered a willingness-to-pay instrument to 230 patients from 4 glaucoma subspecialty practices, asking them how much they would be willing to pay to obtain particular characteristics in an eye drop. Data about the subjects' demographics, economic status, attitudes toward eye drops and systemic medications, and symptoms from eye drops were correlated with their willingness to pay using 2-part models. RESULTS: Of our subjects, 169 (77%) were using eye drops to lower their intraocular pressure. Fatigue, blurred vision, and tearing were the most commonly reported symptoms. Eye drop medications most valued by the subjects did not produce blurring, drowsiness, or inhibition of sexual performance; 85% were willing to pay more for an eye drop that did not cause blurring, and on average they were willing to pay 40% more. Higher educational levels and income were generally associated with a willingness to pay more for eye drops with desirable attributes. MAIN OUTCOME MEASURE: Willingness to pay more (in dollars). CONCLUSIONS: Patient preferences for eye drop characteristics can be assessed using a willingness-to-pay instrument. Patients place differing value on various eye drop characteristics. A better understanding of patient preference could lead to better compliance.

Aged↗
PubMed2003

How are glaucoma patients identified?

PURPOSE: To determine the events that lead to the diagnosis of glaucoma. PATIENTS AND METHODS: This prospective study administered a questionnaire to consecutive patients in a university glaucoma service with questions about the visit at which their glaucoma was diagnosed. RESULTS: Among 308 patients (85% of those eligible) with glaucoma and those suspected of having glaucoma, more than half were diagnosed at a routine examination with no ocular symptom. One hundred fourteen of 202 (56%) of those patients were diagnosed with open angle glaucoma (OAG). Symptoms present at the diagnostic visit were infrequently related to glaucoma. Sixty-one percent of OAG patients (124 of 202) recalled elevated intraocular pressure (IOP) as the sole reason for their initial diagnosis; an additional 12% (24 of 202) recalled a combination of IOP with either disc or visual field findings. Only 18% (36 of 202) recalled being diagnosed due to disc or visual field damage alone. CONCLUSION: The detection of glaucoma is strongly associated with IOP measurement. Glaucoma is most frequently diagnosed at routine visits to eye care specialists at which patients either have no symptoms or have symptoms unrelated to glaucoma. Questionnaire information on large numbers of persons in the health care system may add to our knowledge of practice patterns.

Aged↗
PubMed2002

Randomized clinical trial of latanoprost and unoprostone in patients with elevated intraocular pressure.

PURPOSE: To compare the intraocular pressure (IOP)-lowering effect and safety of latanoprost 0.005% once daily with that of unoprostone 0.15% twice daily for patients with primary open-angle glaucoma or ocular hypertension. DESIGN: Randomized clinical trial. METHODS: In a prospective, 8-week, investigator-masked, parallel-group study conducted at numerous centers in the United States, 165 previously treated patients with IOP >or= 25 mm Hg in one or both eyes after washout were randomly assigned to receive either latanoprost 0.005% once daily in the evening or unoprostone 0.15% twice daily. Observations procedures were Goldmann applanation tonometry, best-corrected visual acuity, slit lamp biomicroscopy, and ophthalmoscopy. The main outcome measure was change in the mean of the IOPs measured at 8:00 AM, 12 noon, and 4:00 PM between baseline (before treatment) and after 8 weeks of treatment. RESULTS: The change in the mean +/- SD of the IOPs measured at 8:00 AM, 12 noon, and 4:00 PM was -7.2 +/- 3.2 mm Hg (28%) for latanoprost (25.3 +/- 2.8 mm Hg at baseline to 18.2 +/- 2.8 mm Hg at 8 weeks) and -3.9 +/- 2.6 mm Hg (15%) for unoprostone (25.5 +/- 3.3 mm Hg at baseline to 21.6 +/- 4.0 mm Hg; P <or=.001. No serious adverse event related to either medication was reported. CONCLUSIONS: Over an 8-week period, latanoprost 0.005% once daily lowered IOP more than unoprostone 0.15% twice daily in patients with elevated IOP. Both agents were safe and well tolerated.

Adult↗
PubMed2002

Methodologic rigor of clinical trials on surgical management of eyes with coexisting cataract and glaucoma.

OBJECTIVE: To assess the methodologic quality of published studies of the surgical management of coexisting cataract and glaucoma. DESIGN: Literature review and analysis. METHOD: We performed a systematic search of the literature to identify all English language articles pertaining to the surgical management of coexisting cataract and glaucoma in adults. Quality assessment was performed on all randomized controlled trials, nonrandomized controlled trials, and cohort studies. Overall quality scores and scores for individual methodologic domains were based on the evaluations of two experienced investigators who independently reviewed articles using an objective quality assessment form. MAIN OUTCOME MEASURES: Quality in each of five domains (representativeness, bias and confounding, intervention description, outcomes and follow-up, and statistical quality and interpretation) measured as the percentage of methodologic criteria met by each study. RESULTS: Thirty-six randomized controlled trials and 45 other studies were evaluated. The mean quality score for the randomized, controlled clinical trials was 63% (range, 11%-88%), and for the other studies the score was 45% (range, 3%-83%). The mean domain scores were 65% for description of therapy (range, 0%-100%), 62% for statistical analysis (range, 0%-100%), 58% for representativeness (range, 0%-94%), 49% for outcomes assessment (range, 0%-83%), and 30% for bias and confounding (range, 0%-83%). Twenty-five of the studies (31%) received a score of 0% in the bias and confounding domain for not randomizing patients, not masking the observers to treatment group, and not having equivalent groups at baseline. CONCLUSIONS: Greater methodologic rigor and more detailed reporting of study results, particularly in the area of bias and confounding, could improve the quality of published clinical studies assessing the surgical management of coexisting cataract and glaucoma.

Cataract↗
PubMed2002

Surgical strategies for coexisting glaucoma and cataract: an evidence-based update.

OBJECTIVE: To assess short- and long-term control of intraocular pressure (IOP) with different surgical treatment strategies for coexisting cataract and glaucoma. DESIGN: Systematic literature review and analysis. METHOD: We performed a search of the published literature to identify all eligible articles pertaining to the surgical management of coexisting cataract and glaucoma in adults. One investigator abstracted the content of each article onto a custom-designed form. A second investigator corroborated the findings. The evidence supporting different approaches was graded by consensus as good, fair, weak, or insufficient. MAIN OUTCOME MEASURES: Short-term (24 hours or fewer) and long-term (more than 24 hours) IOP control. RESULTS: The evidence was good that long-term IOP is lowered more by combined glaucoma and cataract operations than by cataract operations alone. On average, the IOP was 3 to 4 mmHg lower in the combined groups with fewer medications required. The evidence was weak that extracapsular cataract extraction (ECCE) alone results in short-term increase in IOP and was insufficient to determine the short-term impact of phacoemulsification cataract extraction (PECE) on IOP in glaucoma patients. The evidence was weak that short-term IOP control was better with ECCE or PECE combined with an incisional glaucoma procedure compared with ECCE or PECE alone. The evidence was also weak (but consistent) that long-term IOP is lowered by 2 to 4 mmHg after ECCE or PECE. Finally, there was weak evidence that combined PECE and trabeculectomy produces slightly worse long-term IOP control than trabeculectomy alone, and there was fair evidence that the same is true for ECCE combined with trabeculectomy. CONCLUSIONS: There is strong evidence for better long-term control of IOP with combined glaucoma and cataract operations compared with cataract surgery alone. For other issues regarding surgical treatment strategies for cataract and glaucoma, the available evidence is limited or conflicting.

Cataract↗
PubMed2002

Effect of technique on intraocular pressure after combined cataract and glaucoma surgery: An evidence-based review.

TOPIC: To analyze the literature pertaining to the techniques used in combined cataract and glaucoma surgery, including the technique of cataract extraction, the timing of the surgery (staged procedure versus combined procedure), the anatomic location of the operation, and the use of antifibrosis agents. CLINICAL RELEVANCE: Cataract and glaucoma are both common conditions and are often present in the same patient. There is no agreement concerning the optimal surgical management of these disorders when they coexist. METHODS/LITERATURE REVIEWED: Electronic searches of English language articles published since 1964 were conducted in Pub MED and CENTRAL, the Cochrane Collaboration's database. These were augmented by a hand search of six ophthalmology journals and the reference lists of a sample of studies included in the literature review. Evidence grades (A, strong; B, moderate; C, weak; I, insufficient) were assigned to the evidence that involved a direct comparison of alternative techniques. RESULTS: The preponderance of evidence from the literature suggests a small (2-4 mmHg) benefit from the use of mitomycin-C (MMC), but not 5-fluorouracil (5-FU), in combined cataract and glaucoma surgery (evidence grade B). Two-site surgery provides slightly lower (1-3 mmHg) intraocular pressure (IOP) than one-site surgery (evidence grade C), and IOP is lowered more (1-3 mmHg) by phacoemulsification than by nuclear expression in combined procedures (evidence grade C). There is insufficient evidence to conclude either that staged or combined procedures give better results or that alternative glaucoma procedures are superior to trabeculectomy in combined procedures. CONCLUSIONS: In the literature on surgical techniques and adjuvants used in the management of coexisting cataract and glaucoma, the strongest evidence of efficacy exists for using MMC, separating the incisions for cataract and glaucoma surgery, and removing the nucleus by phacoemulsification.

Antimetabolites, Antineoplastic↗
PubMed2002

The development and demise of a cataract surgery database.

BACKGROUND: The American Academy of Ophthalmology (AAO; San Francisco) launched a national eye care outcomes initiative in 1996, in response to strong interest by third-party payers and managed care in performance measurement and outcomes. The AAO's outcomes initiative NEON (National Eyecare Outcomes Network) began with the design and launch of a prospective observational registry of patients undergoing cataract surgery. METHODS: Participants submitted a common set of data regarding patients' demographics, preoperative ophthalmologic history, physical exam, test results, functional status and symptoms, intraoperative procedures and events, and postoperative outcomes for all patients undergoing first or second eye cataract surgery. RESULTS: Between January 1, 1996, and March 30, 2001, a total of 249 ophthalmologists submitted data on 17,876 patients undergoing first or second eye surgery. All preoperative, intraoperative, and postoperative clinical data forms were submitted for 9,937 patients (55.7%). After surgery, 93% of patients achieved a best corrected visual acuity of 20/40, 89% improved their visual functioning, and 92% experienced fewer cataract-related symptoms. DISCUSSION: At the end of March 2001, NEON was discontinued because of a lack of participation and demand by members or third parties for this information. The momentum for accountability and performance measures never quite materialized into advantages for contracting for physicians or requirements by payers. In the future, more scientific evidence regarding the validity and meaning of outcome measures and differences in measurements, investment in health information technology infrastructure, use of technology to collect information at the point of care, and incentives favoring data collection and analysis will be needed to pave the way for renewed interest in outcomes.

Cataract Extraction↗
PubMed2002

Glaucoma patients' assessment of their visual function and quality of life.

PURPOSE: To determine how glaucoma and glaucoma suspect patients' rating of their vision correlates with Esterman binocular visual field testing and other visual function tests. METHODS: One hundred ninety-one glaucoma patients and 46 glaucoma suspect patients underwent binocular visual field testing and evaluated their vision using the linear rating scale and time-tradeoff utility tests, the National Eye Institute Visual Functional Questionnaire (NEI VFQ-25), and the Short Form 36 (SF-36) quality-of-life instruments. RESULTS: The mean Esterman score was 88.2 +/- 17.4 for the glaucoma subjects and 95.2 + 6.9 for glaucoma suspect subjects (maximum score 100). On a scale from 0 (blind) to 100 (ideal), the mean rating of vision for glaucoma patients and glaucoma suspect patients was 74.8 +/- 17.3 and 78.9 +/- 18.5, respectively. The Esterman test correlated moderately with the overall NEI VFQ-25 score (partial correlation coefficient (PCC) = 0.32, P = 0.001), but only weakly with the linear rating scale (PCC = 0.17, P = 0.02), and the time-tradeoff (PCC = 0.14, P = 0.06). CONCLUSION: Utility values that glaucoma and glaucoma suspect patients assign to their vision do not correlate well with Esterman results. A challenge for the future is the design of clinical tests of vision that better correlate with patient perceptions.

Aged↗
PubMed2002

Correlation of the binocular visual field with patient assessment of vision.

PURPOSE: To determine which measures of the binocular visual field correlate best with the patient's assessment of vision. METHODS: Esterman binocular visual field testing and four other binocular visual field tests (designated peripheral 20 dB [p20], peripheral 22 dB [p22], central 24 dB [c24] and central 26 dB [c26]) were performed in 101 patients with glaucoma or suspected glaucoma. Scores from these five tests, as well as binocular visual field scores calculated from monocular testing (best-location summation and probability summation), were correlated with performance on the National Eye Institute's Visual Function Questionnaire (VFQ)-25 and Short-Form (SF)-36 quality of life instruments, as well as with the linear rating scale utility test. RESULTS: The mean percentage of correct responses was 87%, 69%, 59%, 78%, and 71% for the Esterman, p20, p22, c24, and c26 tests, respectively. The distribution of scores was much broader for the p20 and p22 tests than for the Esterman test. The mean decibels for the binocular visual fields calculated from the monocular visual fields were 21.5 +/- 7.7 dB for the best-location algorithm and 25.1 +/- 6.7 dB for the probability-summation algorithm. The binocular visual field score calculated with the best-location algorithm correlated better with the overall, general vision, distance activities, and peripheral vision domains of theVFQ-25 (partial correlation coefficients of 0.48, 0.48, 0.49, and 0.51, respectively) than did the probability-summation algorithm and all five binocular visual field tests. The best-location algorithm also had the strongest correlation with the linear rating scale utility test (partial correlation coefficient, 0.40). CONCLUSIONS: In this sample of clinic-based patients with glaucoma or suspected glaucoma, a global score derived from a combination of two monocular fields correlated better with patient assessment of vision than did the Esterman and four novel binocular visual field tests.

Adult↗