Systematic review of economic evaluations in pediatric ophthalmology and strabismus.

BACKGROUND: Economic evaluations in health care quantitatively compare interventions using cost and outcomes data. These evaluations can aid in the adoption of new surgical or medical treatments and inform policy decisions regarding healthcare spending. Several common types of economic analysis exist (cost-benefit, cost-analysis, cost-effectiveness, and cost-utility). We review all English-language economic evaluations in strabismus surgery and pediatric ophthalmology. METHODS: An electronic literature search of the PubMed and Health Economic Evaluations databases was conducted. Two reviewers independently reviewed the search string yield and assessed articles against inclusion and exclusion criteria. Outcome measures included journal of publication, year of publication, domain of ophthalmology, region/country of study, and type of economic evaluation. RESULTS: We identified 62 articles. Cost-utility studies comprised 30% of evaluations. The most studied domain was retinopathy of prematurity (33%), followed by amblyopia and vision screening (24%) and cataracts (14%). The Journal of the American Association for Pediatric Ophthalmology and Strabismus published the most economic evaluations (15%) followed by Ophthalmology and Pediatrics. The number of published economic evaluations did not increase over time. CONCLUSIONS: Economic evaluations in pediatric ophthalmology and strabismus have not increased over time. A minority (30%) of studies used cost utility-analysis, limiting comparisons to other domains of medicine. This suggests the need to alert pediatric ophthalmologists to the benefits of economic analysis, and cost-utility methodology specifically, to better inform and influence policy decisions regarding healthcare spending.

The Impact of Social Determinants of Health on Presentation, Treatment, and Outcomes in Branch Retinal Vein Occlusion With Cystoid Macular Edema.

BACKGROUND AND OBJECTIVE: To investigate the impact of social determinants of health on the presentation, treatment, and outcomes of branch retinal vein occlusion (BRVO) with cystoid macular edema (CME). PATIENTS AND METHODS: A retrospective chart review was conducted of patients with BRVO and CME treated with anti-vascular endothelial growth factor (anti-VEGF) injections at Atrium Health Wake Forest Baptist from 2013 to 2021. Patients' baseline characteristics including visual acuity (VA), age, sex, race, Area Deprivation Index (ADI), insurance status, baseline central macular thickness (CMT), treatment details, final VA, and final CMT were recorded. The primary outcome measure was final VA comparing more and less deprived groups, and White and non-White groups. RESULTS: Two hundred forty-four eyes of 240 patients were included. Patients with higher socioeconomic deprivation scores had thicker final CMT (P = 0.05). Non-White patients had worse presenting (P = 0.01) and final VA (P = 0.02). CONCLUSION: This study demonstrated disparities in presentation and outcomes based on socioeconomic status and race in patients with BRVO and CME treated with anti-VEGF therapy. [Ophthalmic Surg Lasers Imaging Retina 2023;54:411-416.].

Waardenburg syndrome-associated neurotrophic keratopathy in a child treated with neurotization surgery.

Waardenburg syndrome (WS) is a congenital developmental disorder characterized by congenital sensorineural hearing loss and pigmentary deficiencies in the iris, hair, and skin. Ocular associations of WS include choroidal and iris hypopigmentation and foveal hypoplasia. Possible associations include cataracts and retinal vein occlusion. We report the first case of neurotrophic cornea and relate our experience with neurotization surgery.