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2.
Digit J Ophthalmol ; 29(1): 1-8, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37101563

RESUMO

Purpose: To identify temporal and geographic trends in private equity (PE)-backed acquisitions of ophthalmology and optometry practices in the United States from 2012 to 2021. Methods: In this cross-sectional time series, acquisition data from 10/21/2019 to 9/1/2021 and previously published data from 1/1/2012 to 10/20/2019 were analyzed. Acquisition data were compiled from 6 financial databases, 5 industry news outlets, and publicly available press releases. Linear regression models were used to compare rates of acquisition. Outcomes included number of total acquisitions, practice type, locations, provider details, and geographic footprint. Results: A total of 245 practices associated with 614 clinical locations and 948 ophthalmologists or optometrists were acquired by 30 PE-backed platform companies between 10/21/2019 and 9/1/2021. Of 30 platform companies, 18 were new vis-à-vis our prior study. Of these acquisitions, 127 were comprehensive practices, 29 were retina practices, and 89 were optometry practices. From 2012 to 2021, monthly acquisitions increased by 0.947 acquisitions per year (P < 0.001*). Texas, Florida, Michigan, and New Jersey were the states with the greatest number of PE acquisitions, with 55, 48, 29, and 28 clinic acquisitions, respectively. Average monthly PE acquisitions were 5.71 per month from 1/1/2019 to 2/29/2020 (pre-COVID), 5.30 per month from 3/1/2020 to 12/31/2020 (COVID pre-vaccine [P = 0.81]), and 8.78 per month from 1/1/2021 to 9/1/2021 (COVID post-vaccine [P = 0.20]). Conclusions: PE acquisitions increased during the period 2012-2021 as companies continue to utilize regionally focused strategies for acquisitions.


Assuntos
COVID-19 , Oftalmologia , Optometria , Humanos , Estados Unidos , Estudos Transversais , Fatores de Tempo , COVID-19/epidemiologia
3.
Retina ; 43(2): 182-190, 2023 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-36695789

RESUMO

PURPOSE: Foveal herniation occurs when neuroretinal tissue protrudes through and above the level of an epiretinal membrane. This study describes the visual symptoms and spectral domain optical coherence tomography findings associated with foveal herniation and evaluates the postoperative visual, anatomical, and surgical outcomes. METHODS: A multicenter retrospective review of patients diagnosed with epiretinal membrane identified 59 patients with preoperative foveal herniation on spectral domain optical coherence tomography. Data regarding visual symptoms, preoperative and postoperative best-corrected visual acuity (BCVA), central retinal thickness, macular volume, and size of foveal herniation were collected, and statistical analysis was performed. RESULTS: A total of 58 of the 59 patients with foveal herniation underwent surgical epiretinal membrane peeling, with foveal contour restored in 53.5% of patients after surgery. Average BCVA improved from 20/80 to 20/40 Snellen equivalent at most-recent postoperative visit (P < 0.0001). The average central retinal thickness decreased from 632 µm to 432 µm (P < 0.0001) and the average macular volume decreased from 11.3 mm3 to 9.5 mm3 (P < 0.0001) at 3 months postoperatively. Preoperatively, greater herniation height was associated with worse BCVA (P = 0.008), greater central retinal thickness (P = 0.01), retinoschisis, cystoid macular edema, foveolar detachment, ellipsoid zone abnormality, and external limiting membrane abnormalities (P < 0.05). Postoperatively, there was a decrease in retinoschisis, cystoid macular edema, foveolar detachment, ellipsoid zone, and external limiting membrane abnormality (P < 0.05) on spectral domain optical coherence tomography. CONCLUSION: Patients with larger foveal herniation height had greater preoperative central retinal thickness, worse preoperative and postoperative BCVA, and more intraretinal abnormalities on spectral domain optical coherence tomography. Surgical epiretinal membrane peeling in patients with foveal herniation resulted in a significant improvement in patients' BCVA and microstructural abnormalities.


Assuntos
Membrana Epirretiniana , Edema Macular , Retinosquise , Humanos , Membrana Epirretiniana/diagnóstico , Membrana Epirretiniana/cirurgia , Edema Macular/diagnóstico , Edema Macular/etiologia , Edema Macular/cirurgia , Retinosquise/cirurgia , Vitrectomia/métodos , Tomografia de Coerência Óptica/métodos , Estudos Retrospectivos , Resultado do Tratamento
4.
Ophthalmology ; 127(4): 445-455, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32067797

RESUMO

PURPOSE: To identify temporal and geographic trends in private equity (PE)-backed acquisitions of ophthalmology and optometry practices in the United States. DESIGN: A cross-sectional study using private equity acquisition and investment data from January 1, 2012, through October 20, 2019. PARTICIPANTS: A total of 228 PE acquisitions of ophthalmology and optometry practices in the United States between 2012 and 2019. METHODS: Acquisition and financial investment data were compiled from 6 financial databases, 4 industry news outlets, and publicly available press releases from PE firms or platform companies. MAIN OUTCOME MEASURES: Yearly trends in ophthalmology and optometry acquisitions, including number of total acquisitions, clinical locations, and providers of acquired practices as well as subsequent sales, median holding period, geographic footprint, and financing status of each platform company. RESULTS: A total of 228 practices associated with 1466 clinical locations and 2146 ophthalmologists or optometrists were acquired by 29 PE-backed platform companies. Of these acquisitions, 127, 9, and 92 were comprehensive or multispecialty, retina, and optometry practices, respectively. Acquisitions increased rapidly between 2012 and 2019: 42 practices were acquired between 2012 and 2016 compared to 186 from 2017 through 2019. Financing rounds of platform companies paralleled temporal acquisition trends. Three platform companies, comprising 60% of platforms formed before 2016, were subsequently sold or recapitalized to new PE investors by the end of this study period with a median holding period of 3.5 years. In terms of geographic distribution, acquisitions occurred in 40 states with most PE firms developing multistate platform companies. New York and California were the 2 states with the greatest number of PE acquisitions with 22 and 19, respectively. CONCLUSIONS: Private equity-backed acquisitions of ophthalmology and optometry practices have increased rapidly since 2012, with some platform companies having already been sold or recapitalized to new investors. Additionally, private equity-backed platform companies have developed both regionally focused and multistate models of add-on acquisitions. Future research should assess the impact of PE investment on patient, provider, and practice metrics, including health outcomes, expenditures, procedural volume, and staff employment.


Assuntos
Administração Financeira/tendências , Oftalmologia/tendências , Optometria/tendências , Setor Privado/tendências , Prática Profissional/tendências , Estudos Transversais , Bases de Dados Factuais , Administração Financeira/economia , Geografia , Humanos , Oftalmologistas/estatística & dados numéricos , Oftalmologia/economia , Optometristas/estatística & dados numéricos , Optometria/economia , Setor Privado/economia , Estados Unidos
5.
Eye (Lond) ; 34(10): 1875-1882, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-31900437

RESUMO

BACKGROUND: To report the indications, visual outcomes, and intra-operative and post-operative complications of iris-sutured posterior chamber intraocular lens (IOL) in eyes with inadequate capsular support and complex ocular history. METHODS: A chart review and data analysis of eyes that underwent iris fixation of posterior chamber (PC) IOL for correction of aphakia, dislocated and subluxed IOLs, ectopia lentis, and IOL exchange. Data included clinical risk factors, associated eye conditions, previous surgeries, and concomitant procedures. The pre-operative and post-operative vision, manifest refraction, endothelial cell density, intraocular pressure (IOP), as well as intra-operative and post-operative complications were also recorded. RESULTS: One hundred and seventeen eyes from 114 patients were examined with a mean follow-up of 22.4 months. The most common identifiable predisposing risk factor was high myopia in 23 eyes. A significant improvement in uncorrected and best corrected visual acuity compared with baseline was observed. The most common post-operative complications included recurrent IOL subluxation in 16 (13.7%) eyes, IOP spike in 7 (5.9%) eyes, cystoid macular oedema in 5 (4.3%) eyes, and epiretinal membrane formation in 4 (3.4%) eyes. There was one (0.85%) case of sterile endophthalmitis. CONCLUSIONS: Iris suture fixation of PC IOLs is a good treatment option for eyes with inadequate capsular support and complex ocular history.


Assuntos
Implante de Lente Intraocular , Lentes Intraoculares , Humanos , Iris/cirurgia , Implante de Lente Intraocular/efeitos adversos , Lentes Intraoculares/efeitos adversos , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Técnicas de Sutura , Resultado do Tratamento , Acuidade Visual
6.
Ophthalmology ; 126(11): 1480-1489, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-30974182

RESUMO

PURPOSE: The primary objective was to assess associations between annual surgeon case volume and visual acuity outcomes after cataract surgery. Secondary objectives included (1) assessing associations between other case and patient characteristics and visual acuity outcomes and (2) assessing associations between annual surgeon case volume and complication rates. DESIGN: Database study. PARTICIPANTS: All adult eyes that underwent small-incision cataract surgery (SICS) or phacoemulsification cataract extraction (PECE) with intraocular lens placement at the Aravind Eye Hospital, Madurai, India, during 2015. METHODS: Descriptive statistics were used to characterize the study population. Uncorrected visual acuity (UCVA) at follow-up was assessed relative to annual surgeon case volume and other case and demographic factors using bivariate linear regression with random effects modeling. Factors with P values of less than 0.20 on bivariate regression were included in multivariate linear regression with random effects modeling. MAIN OUTCOME MEASURES: Postoperative UCVA after cataract surgery. RESULTS: Of 91 084 surgeries, 35 880 eyes were included in this study. Cases were performed by 69 surgeons, who varied in annual case volume from 76 to 2900 cases during the study period. Increasing annual surgeon case volume was independently associated with a statistically significant but clinically modest improvement in UCVA in PECE but not in SICS. This association was most pronounced when comparing surgeons with case volumes of 350 PECE/year or fewer; surgeons with more than 350 PECE/year had similar results to one another. Similarly, increased annual case volume was associated with significantly lower complication rates, both in PECE and SICS. Younger patient age was independently associated with improved visual acuity outcomes and lower complication rates in both PECE and SICS. Greater surgeon experience was associated with lower complication rates in PECE, but not SICS, and there was no significant association with visual acuity outcomes. CONCLUSIONS: High-volume cataract surgeons showed improved visual acuity outcomes in PECE and lower complication rates in PECE and SICS. These findings further support the benefit of high-output ophthalmology clinics wherein individual surgeons perform a high number of cataract extractions annually, particularly in developing nations where there is a large backlog of untreated cataracts and the cataract patient-to-surgeon ratio is high.


Assuntos
Extração de Catarata/estatística & dados numéricos , Implante de Lente Intraocular , Oftalmologistas/estatística & dados numéricos , Pseudofacia/fisiopatologia , Acuidade Visual/fisiologia , Idoso , Feminino , Hospitais com Alto Volume de Atendimentos , Hospitais com Baixo Volume de Atendimentos , Humanos , Índia , Masculino , Microcirurgia/métodos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Resultado do Tratamento
7.
Ophthalmic Plast Reconstr Surg ; 34(6): 583-586, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29659434

RESUMO

PURPOSE: In evaluating patients sustaining bilateral isolated internal orbital fractures, the authors have observed both similar fracture locations and also similar expansion of orbital volumes. In this study, we aim to investigate if there is a propensity for the 2 orbits to fracture in symmetrically similar patterns when sustaining similar trauma. METHODS: A retrospective chart review was performed studying all cases at our institution of bilateral isolated internal orbital fractures involving the medial wall and/or the floor at the time of presentation. The similarity of the bilateral fracture locations was evaluated using the Fisher's exact test. The bilateral expanded orbital volumes were analyzed using the Wilcoxon signed-rank test to assess for orbital volume similarity. RESULTS: Twenty-four patients with bilateral internal orbital fractures were analyzed for fracture location similarity. Seventeen patients (70.8%) had 100% concordance in the orbital subregion fractured, and the association between the right and the left orbital fracture subregion locations was statistically significant (P < 0.0001). Fifteen patients were analyzed for orbital volume similarity. The average orbital cavity volume was 31.2 ± 3.8 cm on the right and 32.0 ± 3.7 cm on the left. There was a statistically significant difference between right and left orbital cavity volumes (P = 0.0026). CONCLUSIONS: The data from this study suggest that an individual who suffers isolated bilateral internal orbital fractures has a statistically significant similarity in the location of their orbital fractures. However, there does not appear to be statistically significant similarity in the expansion of the orbital volumes in these patients.


Assuntos
Fraturas Orbitárias/patologia , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Órbita/diagnóstico por imagem , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Adulto Jovem
8.
J Pediatr Surg ; 50(2): 267-71, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25638616

RESUMO

AIMS: The surgery of gastroesophageal reflux disease (GERD) is common in modern pediatric surgical practice. Any differences in perioperative and long-term clinical outcomes following laparoscopic (LN) or open Nissen (ON) fundoplication have not been comprehensively described in young children. This randomized, prospective study examines outcomes following LN versus ON in children<2 years of age. METHODS: Four surgeons at a single institution enrolled patients under 2 years of age that required surgical management of GERD, who were then randomized to LN or ON between 2005 and 2012. A universal surgical dressing was employed for blinding. Analgesia and enteral feeding pathways were standardized. The primary outcome was postoperative length of stay. Perioperative outcomes and long-term follow up were collected as secondary outcomes and used to compare groups. RESULTS: Of 39 enrolled patients, 21 were randomized to ON and 18 to LN. Length of postoperative hospital stay, time of advancement to full enteral feeds, and analgesic requirements were not significantly different between treatment cohorts. The LN group experienced longer median operating times (173 vs 91 min, P<0.001) and higher surgical charges ($4450 vs $2722, P=0.002). The incidence of post-discharge complications did not differ significantly between the groups at last follow-up (median 42 months). CONCLUSIONS: This randomized trial comparing postoperative outcomes following LN vs ON did not detect statistically significant differences in short- or long-term clinical outcomes between these approaches. LN was associated with longer surgical time and higher operating room costs. The benefits, risks, and costs of laparoscopy should be carefully considered in clinical pediatric surgical practice.


Assuntos
Fundoplicatura/métodos , Refluxo Gastroesofágico/cirurgia , Laparoscopia/métodos , Laparotomia/métodos , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Masculino , Período Pós-Operatório , Estudos Prospectivos , Método Simples-Cego , Resultado do Tratamento
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