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Biomedical subjects

Oliver D Schein

Publications and source records attributed to Oliver D Schein.

17 recordsLinked to original sources
PubMed2006

Fungal keratitis associated with non-therapeutic soft contact lenses.

PURPOSE: To report an increase in culture-positive contact lens-associated fungal keratitis. DESIGN: Retrospective, cross-sectional laboratory study. METHODS: Microbiology records of culture-positive fungal keratitis cases from January 2004 to December 2005 were reviewed. RESULTS: Recovery of fungal pathogens among wearers of contact lenses increased from 26.7% (eight of 30) to 50% (18 of 36) of isolates in 2005. Fusarium species (66 of 122, 54.1%) were the most frequent fungal pathogens. Soft contact lens wear among the Fusarium cases more than doubled (seven of 30, 23.3%, vs 17 of 36, 47.7%, P = .046) from 2004 to 2005. CONCLUSIONS: Contact lens wear may be a risk factor in fungal keratitis.

Contact Lenses, Hydrophilic↗
PubMed2006

Topical ocular hypotensive medication and lens opacification: evidence from the ocular hypertension treatment study.

PURPOSE: To determine whether topical ocular hypotensive medication is associated with refractive changes, visual symptoms, decreased visual function, or increased lens opacification. DESIGN: Multi-center clinical trial. METHODS: We compared the medication and observation groups of the Ocular Hypertension Treatment Study (OHTS) during 6.3 years of follow-up with regard to the rate of cataract and combined cataract/filtering surgery, and change from baseline in visual function, refraction, and visual symptoms. A one-time assessment of lens opacification was done using the Lens Opacities Classification System III (LOCS III) grading system. RESULTS: An increased rate of cataract extraction and cataract/filtering surgery was found in the medication group (7.6%) compared with the observation group (5.6%) (hazard ratio [HR] 1.56; 95% confidence interval [CI] 1.05 to 2.29). The medication and observation groups did not differ with regard to changes from baseline to June 2002 in Humphrey visual field mean deviation, Humphrey visual field foveal sensitivity, Early Treatment of Diabetic Retinopathy Study (ETDRS) visual acuity, refraction, and visual symptoms. For the medication and observation groups, LOCS III readings were similar for nuclear color, nuclear opalescence, and cortical opacification. There was a borderline higher mean grade for posterior subcapsular opacity in the medication group (0.43 +/- 0.6 SD) compared with the observation group (0.36 +/- 0.6 SD) (P = .07). CONCLUSIONS: We noted an increased rate of cataract extraction and cataract/filtering surgery in the medication group as well as a borderline higher grade of posterior subcapsular opacification in the medication group on LOCS III readings. We found no evidence for a general effect of topical ocular hypotensive medication on lens opacification or visual function.

Administration, Topical↗
PubMed2006

Dysfunctional tear syndrome: a Delphi approach to treatment recommendations.

PURPOSE: To develop current treatment recommendations for dry eye disease from consensus of expert advice. METHODS: Of 25 preselected international specialists on dry eye, 17 agreed to participate in a modified, 2-round Delphi panel approach. Based on available literature and standards of care, a survey was presented to each panelist. A two-thirds majority was used for consensus building from responses obtained. Treatment algorithms were created. Treatment recommendations for different types and severity levels of dry eye disease were the main outcome. RESULTS: A new term for dry eye disease was proposed: dysfunctional tear syndrome (DTS). Treatment recommendations were based primarily on patient symptoms and signs. Available diagnostic tests were considered of secondary importance in guiding therapy. Development of algorithms was based on the presence or absence of lid margin disease and disturbances of tear distribution and clearance. Disease severity was considered the most important factor for treatment decision-making and was categorized into 4 levels. Severity was assessed on the basis of tear substitute requirements, symptoms of ocular discomfort, and visual disturbance. Clinical signs present in lids, tear film, conjunctiva, and cornea were also used for categorization of severity. Consensus was reached on treatment algorithms for DTS with and without concurrent lid disease. CONCLUSION: Panelist opinion relied on symptoms and signs (not tests) for selection of treatment strategies. Therapy is chosen to match disease severity and presence versus absence of lid margin disease or tear distribution and clearance disturbances.

Algorithms↗
PubMed2005

Photodynamic therapy with verteporfin: observations on the introduction of a new treatment into clinical practice.

OBJECTIVE: To assess adherence to Food and Drug Administration-approved indications and Centers for Medicare & Medicaid Services policy through June 2001 regarding the use of photodynamic therapy in Medicare beneficiaries. DESIGN: Systematic review of pretreatment fluorescein angiograms of 1245 consecutive Medicare patients who received photodynamic therapy from physicians in 3 contiguous Medicare coverage areas (fee-for-service arrangement) and in 136 consecutive patients in a Medicare health maintenance organization. RESULTS: In the 3 Medicare fee-for-service regions, payment denial due to nonconforming fluorescein angiograms ranged from 17% to 29% by region in 1245 beneficiaries. In the health maintenance organization setting, 60 (44%) of 136 submitted angiograms were nonconforming, including 8 in which the photographic quality was too poor to grade the lesion size, composition, or both. CONCLUSIONS: A substantial proportion of the actual or intended clinical application of photodynamic therapy with verteporfin was directed to patients who did not meet concurrent published clinical criteria associated with treatment benefit or national coverage policy. Although this policy has evolved, it still depends on fluorescein angiographic interpretation, suggesting that there is an opportunity to improve the cost-effectiveness of delivery of photodynamic therapy with verteporfin to Medicare beneficiaries.

Choroidal Neovascularization↗
PubMed2005

The incidence of endophthalmitis after cataract surgery among the U.S. Medicare population increased between 1994 and 2001.

OBJECTIVE: To estimate the annual incidence rate of presumed endophthalmitis after cataract surgery, evaluate any changes in this rate over time, and examine demographic risk factors for endophthalmitis after cataract surgery. DESIGN: Population-based review of Medicare beneficiary claims data. DATA SOURCE: Medicare 5% sample beneficiary data files for inpatient and outpatient claims from 1994 through 2001 were examined to identify all cataract surgeries and subsequent cases of presumed endophthalmitis after cataract surgery. METHODS: All cataract surgery and presumed endophthalmitis cases after cataract surgery were identified based on claims submitted. The annual rate of presumed endophthalmitis after cataract surgery was calculated, and demographic risk factors for endophthalmitis were examined using multivariate models. MAIN OUTCOME MEASURES: Incidence rate of endophthalmitis after cataract surgery and prevalence of demographic risk factors for endophthalmitis over an 8-year period. RESULTS: One thousand twenty-six cases of presumed endophthalmitis occurred after 477,627 cataract surgeries, yielding an incidence rate of 2.15 per 1000 for this 8-year period. Rates of endophthalmitis adjusted for age, gender, and race were significantly higher in 1998 to 2001 than in earlier years (relative risk [RR], 1.41; 95% confidence interval [CI], 1.24-1.60). Older age and black race also were associated with increased risk of endophthalmitis (RR, 1.83; 95% CI, 1.19-2.81; age, > or =90 years, and RR, 1.30; 95% CI, 1.02-1.65, respectively). CONCLUSIONS: Analysis of Medicare claims data suggests that the incidence of endophthalmitis after cataract surgery has been increasing, but does not provide an explanation for this occurrence. An increase in the incidence of endophthalmitis after cataract surgery is of concern, because cataract surgery is the most commonly performed operation in the United States, and the number of cataract surgeries performed annually will likely increase substantially over the coming decades due to the aging of the U.S. population.

Age Distribution↗
PubMed2005

The incidence of microbial keratitis among wearers of a 30-day silicone hydrogel extended-wear contact lens.

PURPOSE: To estimate the incidence of presumed microbial keratitis with and without loss of visual acuity among wearers of a silicone hydrogel contact lens (Lotrafilcon A, Night & Day, CIBA Vision, Inc., Duluth, GA), recently approved for up to 30 days of continuous wear. DESIGN: Prospective cohort postmarket surveillance study. PARTICIPANTS: Contact lens wearers (recruited from 131 practices) who had been prescribed the lens for intended continuous wear of as many as 30 nights. METHODS: The occurrence of a corneal infiltrate was ascertained through a combination of center report and direct contact with participants at 3 and 12 months. Whenever a corneal infiltrate was suspected, study and treatment medical records were systematically reviewed by an Endpoints Committee using a predetermined classification scheme for corneal infiltration. Cases of presumed microbial keratitis were determined based on the constellation of presenting signs and symptoms and clinical course. MAIN OUTCOME MEASURES: The incidence of presumed microbial keratitis with and without loss of visual acuity. RESULTS: A total of 6245 participants were recruited between August 13, 2002 and July 2, 2003. Of these, 4999 subjects (80%) completed 12 months of follow-up, and these participants contributed a total of 5561 person years of lens wearing experience. Approximately 80% of participants routinely wore their lenses continuously for 3 or more weeks. The overall annual rate of presumed microbial keratitis was 18 per 10,000 (95% confidence interval (CI): 8.5-33.1). There were 2 cases of presumed microbial keratitis with loss of visual acuity, an annual rate of 3.6 per 10,000 (95% CI: 0.4-12.9), and an additional 8 cases without loss of visual acuity, an annual rate of 14.4 per 10000 (95% CI: 6.1-28.4). The rate of presumed microbial keratitis was lower for users reporting typical wear of 3 or more weeks than for those wearing the lens for less than a 3-week continuous period (P = 0.02). CONCLUSIONS: The incidence of loss of visual acuity due to microbial keratitis among users of the silicone hydrogel contact lens was low. The overall rate of presumed microbial keratitis with the wearing schedule of as many as 30 nights was similar to that previously reported for conventional extended-wear soft lenses worn for fewer consecutive nights.

Adolescent↗
PubMed2005

Features of the iridocorneal endothelial syndrome on confocal microscopy.

PURPOSE: To present a subtle case of iridocorneal endothelial (ICE) syndrome and discuss the utility of in vivo confocal microscopy in the evaluation of this disorder. Previous reports of the confocal microscopic features of ICE syndrome are reviewed. METHODS: A 32-year-old man presented with decreased vision and halos. Slit-lamp biomicroscopy and in vivo confocal microscopy were used to evaluate the etiology of his complaints. Clinical photographs and confocal micrographs were analyzed. RESULTS: In vivo confocal microscopy revealed marked asymmetry between the right and left corneal endothelial layers with pleomorphic epithelioid cells on the right, some with hyperreflective nuclei. A transition between cells with uniform appearance and dark nuclei and a highly irregular cellular arrangement with hyperreflective nuclei was present. CONCLUSIONS: This report supports the clinical utility of in vivo confocal microscopy in the evaluation of ICE syndrome. It demonstrates that the histopathologic features of ICE syndrome on scanning electron microscopy may be shown clinically using high-resolution confocal microscopy.

Adult↗
PubMed2004

A randomized trial of topical cyclosporin 0.05% in topical steroid-resistant atopic keratoconjunctivitis.

OBJECTIVE: To evaluate the short-term efficacy and safety of topical cyclosporin A 0.05% in the treatment of patients with severe, steroid-resistant atopic keratoconjunctivitis (AKC). DESIGN: Multicenter, placebo-controlled, double-masked, randomized trial. PARTICIPANTS: Twenty-two patients with AKC refractory to topical steroid treatment. INTERVENTION: Patients were randomly assigned (1:1) to treatment with topical 0.05% cyclosporin A eyedrops or a placebo (artificial tears) for a period of 28 days, 6 times daily during the first 2 weeks and 4 times daily during the last 2 weeks. MAIN OUTCOME MEASURES: Symptoms (itching, tearing, discomfort, mucous discharge, and photophobia) and signs (bulbar conjunctival hyperemia, upper tarsal conjunctival papillae, punctate keratitis, corneal neovascularization, cicatrizing conjunctivitis, and blepharitis) of AKC recorded on the day of enrollment and at the end of the treatment period. RESULTS: A composite score computed by summing the severity grade over all 5 symptoms and 6 signs of AKC for each patient indicated a greater improvement in the cyclosporin A group relative to the placebo at the end of the 4-week treatment period (P = 0.048 and P = 0.002, for symptoms and signs, respectively). No adverse effects of the treatment with cyclosporin A 0.05% eyedrops were observed. CONCLUSIONS: Topical cyclosporin A 0.05% seems to be safe and have some effect in alleviating signs and symptoms of severe AKC refractory to topical steroid treatment.

Administration, Topical↗
PubMed2004

Incidence and progression of lens opacities: effect of hormone replacement therapy and reproductive factors.

BACKGROUND: Hormone replacement therapy (HRT) is associated in cross-sectional studies with a decreased prevalence of lens opacities. We explored the associations of HRT and reproductive factors with the incidence and progression of lens opacities over a 2-year period. METHODS: Data were derived from 1458 women ages 65 years and older from the Salisbury Eye Evaluation population-based prospective cohort study in Salisbury, MD, 1993-1997. RESULTS: HRT was not associated with incident nuclear, cortical, or posterior subcapsular opacities, or with progression of nuclear or cortical opacification. Women who had an early menopause had a higher risk of nuclear progression, whereas those who had a later menopause had a lower risk (linear trend P = 0.013). Other variables related to reproduction, such as oral contraceptive use, age at menarche, number of births, and history of hysterectomy, were not associated with any of the outcomes. CONCLUSIONS: These data suggest no evidence of protection against the incidence or progression of lens opacities with HRT.

Age Factors↗
PubMed2003

A self-administered health questionnaire for the preoperative risk stratification of patients undergoing cataract surgery.

PURPOSE: To determine if a self-administered health status questionnaire completed by candidates for cataract surgery is beneficial for identifying medical comorbidities and patients at risk for adverse intraoperative and postoperative medical events. DESIGN: Prospective cohort study. METHODS: Data were obtained from a large, randomized clinical trial of 19,250 cataract surgeries performed between June 1, 1995, and June 30, 1997. Preoperative data were obtained from a standardized, self-administered patient health questionnaire and a history and physical form completed by the patient's physician. A record of adverse medical events on the day of surgery and through the first 7 postoperative days was recorded. RESULTS: Responses to 21 questions on the questionnaire were highly specific for 12 comorbid conditions identified by the physician history and physical, ranging from 100% specificity for arrhythmia to 91.3% specificity for coronary artery disease. Comorbid conditions identified by the questionnaire were associated with similar relative risks of adverse events as those identified by the physician history and physical. Patients who had no comorbidities identified by the questionnaire had adverse medical event rates indistinguishable from patients with no comorbid conditions identified by the health provider history and physical. CONCLUSIONS: The self-administered questionnaire showed a high degree of specificity for 12 common comorbid conditions in cataract patients. A questionnaire such as this may be useful in preoperative risk stratification.

Aged↗
PubMed2003

Is there an association between cataract surgery and age-related macular degeneration? Data from three population-based studies.

PURPOSE: To determine whether cataract surgery is associated with an increased prevalence of age-related macular degeneration (AMD) in three independent population-based data sets. DESIGN: Cross-sectional study. METHOD: Data were used from the Salisbury Eye Evaluation (2,520 subjects from Salisbury, Maryland, aged 65 to 84 years), the Proyecto VER (4,774 Hispanic subjects from Arizona aged 40 years and older), and the Baltimore Eye Survey (4,396 subjects from Baltimore, Maryland, aged 40 and older). The main outcome measure was AMD as determined by retinal photographs or clinical examination. RESULTS: A history of cataract surgery was associated with an increased prevalence of late AMD in all three data sets after adjusting for age, race, sex, and smoking, but odds ratios (OR) were not individually statistically significant. The OR for the combined analysis was 1.7 (95% confidence interval: 1.1-2.6). Having a severe cataract in the eye was also associated with a slightly higher prevalence of late AMD, although the combined OR was not statistically significant (OR = 1.4; 95% confidence interval, 0.8%-2.4). Overall, increasing time since cataract surgery was not associated with late AMD. CONCLUSIONS: A history of cataract surgery may be associated with an increased prevalence of late AMD. However, having a severe cataract in the eye may also be associated with a higher prevalence of late AMD. Additional research is needed to investigate whether a causal relationship exists between cataract surgery and AMD or whether this relationship is due to residual confounding or bias.

Adult↗
PubMed2003

A randomized trial of rigid gas permeable contact lenses to reduce progression of children's myopia.

PURPOSE: To test whether rigid gas permeable (RGP) contact lens wear can reduced the rate of myopia progression in school age children. DESIGN: Randomized clinical trial. METHODS SETTING: Single clinical center. STUDY POPULATION: Both eyes of 428 Singaporean children. INCLUSION CRITERIA: 6 through 12 years of age with myopia between -1 and -4 diopters, astigmatism <or= 2 diopters, no prior contact lens wear, no other ocular pathologies. INTERVENTION: Spectacle or RGP lens correction for myopia. After a 3-month adaptation period, 383 children were followed, and 298 (78%) remained after 24 months. OUTCOME MEASURES: Cycloplegic subjective refraction, keratometry, and axial length measured at 12 and 24 months. RESULTS: Children who adapted to contact lenses wore them for a median of 7 hours per day, but no more than 40% wore them at least 8 hours per day, 7 days per week. Spectacles were worn for a median of 15 hours per day at the time of the 24-month follow-up. There was an increase in the spherical equivalent of -1.33 and -1.28 diopters (P =.64), and axial length increased by 0.84 and 0.79 mm (P =.38) over 2 years among children randomized to contact lenses and spectacles, respectively. Adjustment for baseline differences between the groups and for hours per day of contact lens wear did not alter these findings. CONCLUSIONS: Rigid gas permeable lenses did not slow the rate of myopia progression, even among children who used them regularly and consistently. It is unlikely that this intervention holds promise as a method by which to slow the rate of progression of myopia in children.

Child↗
PubMed2003

Risks and benefits of anticoagulant and antiplatelet medication use before cataract surgery.

OBJECTIVE: To estimate the risks and benefits associated with continuation of anticoagulants or antiplatelet medication use before cataract surgery. DESIGN: Prospective cohort study. PARTICIPANTS: Patients 50 and older scheduled for 19,283 cataract surgeries at nine centers in the United States and Canada between June 1995 and June 1997. INTERVENTION: None. MAIN OUTCOME MEASURES: Intraoperative and postoperative (within 7 days) retrobulbar hemorrhage, vitreous or choroidal hemorrhage, hyphema, transient ischemic attack (TIA), stroke, deep vein thrombosis, myocardial ischemia, and myocardial infarction. RESULTS: Before cataract surgery 24.2% and 4.0% of patients routinely used aspirin and warfarin, respectively. Among routine users, 22.5% of aspirin users and 28.3% of warfarin users discontinued these medications before surgery. The rates of stroke, TIA, or deep vein thrombosis were 1.5/1000 among those who did not use aspirin or warfarin and 3.8/1000 surgeries among routine users of aspirin and warfarin who continued their medication before surgery. The rate was 1 event per 1000 surgeries among those who discontinued aspirin use (relative risk = 0.7, 95% confidence interval = 0.1-5.9). There were no events among warfarin users who discontinued use. The rates of myocardial infarction or ischemia were 5.1/1000 surgeries (aspirin) and 7.6/1000 surgeries (warfarin) among routine continuous users and no different from those of routine users who discontinued use. CONCLUSIONS: The risks of medical and ophthalmic events surrounding cataract surgery were so low that absolute differences in risk associated with changes in routine anticoagulant or antiplatelet use were minimal.

Aged↗