Intraocular Pressure Response in the Untreated Contralateral Eye After Selective Laser Trabeculoplasty.

AIM: To examine the impact of selective laser trabeculoplasty (SLT) on intraocular pressure (IOP) in the untreated contralateral eye within 12 months after the procedure. METHODS: A retrospective chart review was conducted on patients with primary open-angle, normal-tension, pigmentary, or pseudoexfoliation glaucoma who received 360-degree SLT at George Washington University. Exclusion criteria included prior or subsequent laser or glaucoma surgery within 12 months of SLT, other glaucoma types, or corticosteroid use during follow-up. Primary outcomes were IOP and medication reduction, and SLT success, defined as reducing IOP by ≥20% without additional IOP-lowering procedures or medications. Follow-up occurred at six weeks, six months, and 12 months. Demographic and clinical data were analyzed using ANOVA, paired t-tests, and chi-squared tests. RESULTS: A total of 125 patients were included, representing a range of backgrounds: African American (57.6%), Caucasian (31.2%), Asian (5.6%), and Hispanic/Latino (4%), and 1.6% did not report their background. Significant reductions in mean IOP and medication numbers were observed in the contralateral eye at six weeks and six months (p<0.05) but not at 12 months. The contralateral eye success rates were 24% at six weeks and six months and 20.8% at 12 months. The contralateral eye was more likely to achieve success if the ipsilateral eye was successful at six weeks (odds ratio (95% confidence interval): 5.05 (1.89-13.48)), six months (16.1 (4.56-57.17)), and 12 months (5.94 (2.07-17.04)) (p<0.001 for all). CONCLUSION: First-time SLT results in statistically significant IOP and medication reductions in the contralateral eye at six weeks and six months. The contralateral eye was 5.05-16.1 times more likely to achieve success if the ipsilateral eye was successful within 12 months.

United States Medicare Reimbursement Trends for Glaucoma Procedures: 2000-2020.

PURPOSE: The purpose of this study is to investigate US Medicare reimbursement trends for common glaucoma procedures from 2000 to 2020. MATERIALS AND METHODS: Current Procedural Terminology codes for Glaucoma procedures in the US centers for Medicare and Medicaid Services database were used to conduct this economic analysis. Reimbursement data from the Physician Fee Schedule look-up tool from the Centers for Medicare and Medicaid Services were compiled for the selected procedures and compensation trends were investigated after adjusting for inflation in 2020 US dollars from the unadjusted data between 2000 and 2020. RESULTS: The average adjusted reimbursement for the analyzed procedures decreased by 20.5% [95% confidence interval (CI), -15.4% to -25.6%] over the 20-year period. On average, there was a 1.03% decrease in reimbursement rates per year (95% CI, -0.74% to -1.33%), with an adjusted compound annual growth rate of -1.35% (95% CI, -1.07% to -1.64%). The results show an overall declining rate in reimbursement for the glaucoma procedures analyzed in this study. CONCLUSIONS: The US Medicare reimbursement for glaucoma procedures in the United States showed a significant decline between 2000 and 2020. These findings may be relevant to understanding changing practice patterns for glaucoma care.

Reading Speed and Reading Comprehension in Age-related Macular Degeneration.

PURPOSE: To evaluate the impact of age-related macular degeneration (AMD) on short out-loud and sustained silent reading speeds, and reading comprehension. DESIGN: Prospective, cross-sectional. METHODS: Setting: Wilmer Eye Institute. POPULATION: Literate, native-English speakers with and without AMD. AMD participants had better-eye visual acuity (VA) <20/32 and >20/100, while controls had binocular VA >20/32. PROCEDURES: MNRead was used to assess short-duration out-loud reading speed. Sustained silent reading test was used to evaluate sustained silent reading speeds, while reading comprehension was assessed based on silent reading test text. OUTCOME MEASURES: MNRead maximum reading speed, sustained-silent reading speed, and comprehension score. RESULTS: Analyses included 24 AMD patients and 22 controls. In age-adjusted regressions, AMD participants, compared to controls, read 46 words per minute (wpm) slower on MNRead (95% confidence interval [CI]: -66, -26, P < .001), but there was no difference in sustained reading speeds between groups (ß = 0.99, 95% CI: -41.8, 43.8, P = .96). In other models, there was a decrement of 12.6 wpm on MNRead per 0.1 worsening logMAR (95% CI: -18.7, -6.6, P < .001), but VA was not associated with a decrement in sustained reading speed (ß = -10.1, 95% CI: -22.4, 2.1, P = .10). However, AMD participants had substantially lower comprehension scores than controls (53% vs 85% correct, P < .001), and each 1-line VA decrement was associated with 5.9% lower comprehension score (95% CI: -9.1, -2.7, P = .001). CONCLUSIONS: AMD patients read slower than controls when forced to read out loud. When asked to read silently over a longer duration, both groups read at similar speeds, though AMD patients demonstrated substantially lower comprehension scores, suggesting that they chose to sacrifice comprehension for speed.

Gait Characteristics of Age-Related Macular Degeneration Patients.

PURPOSE: To identify potential differences between age-related macular degeneration (AMD) patients and controls in fall-relevant gait characteristics. METHODS: Spatiotemporal gait characteristics using the GAITRite walkway were collected from 29 AMD patients and 20 controls, aged 60 to 90 years, at the Wilmer Eye Institute. Multiple linear regressions, controlling for age, sex, body mass index (BMI), and comorbidities were used to assess associations between gait characteristics and AMD. RESULTS: Study participants were predominantly white (86%) and female (55%). Mean age of the full study population was 73.51 (SD: 8.14) years, and mean BMI was 27.80 (SD: 5.44) kg/m2. Median better-eye acuity (logMAR) was 0.23 (interquartile range [IQR] = 0.18, 0.36) and -0.02 (IQR = -0.08, 0.02), while median binocular log contrast sensitivity was 1.44 (IQR = 1.32, 1.56) and 1.76 (IQR = 1.76, 1.80) for the AMD and control groups, respectively. In multivariable regression models, AMD patients had significantly slower walking speeds (ß = -0.118 m/sec [95% confidence interval (CI): -0.229, -0.007], P = 0.038) and stride velocities (ß = -0.119 m/sec [95% CI: -0.232, -0.007], P = 0.038), and greater double support time (ß = 3.381% of the walk cycle, 95% CI = 1.006, 5.757, P = 0.006) than controls. There were no group differences in base of support, step length, stride length, or gait variability measures. CONCLUSION: AMD patients exhibited many fall-relevant gait characteristics. TRANSLATIONAL RELEVANCE: The finding of fall-relevant gait characteristics suggests that AMD patients may be at a greater risk of falls during ambulation than those without AMD.