Oral minocycline for the treatment of retinitis pigmentosa-associated cystoid macular edema: results of a phase I/II clinical trial.

PURPOSE: The etiology of retinitis pigmentosa (RP)-associated cystoid macular edema (CME) has been related to retinal neuroinflammation and microglial activation. Minocycline, a drug FDA-approved for anti-microbial indications, also inhibits microglial activation and expression of inflammatory mediators. This study investigates the safety and efficacy of oral minocycline as primary treatment for RP-associated CME. METHODS: A single-center, prospective, open-label phase I/II clinical trial enrolled five participants with RP-associated CME. Participants had lead-in assessments prior to the initiation of oral minocycline 100 mg twice daily for 12 months. Main outcome variables included changes in best-corrected visual acuity (BCVA) and retinal central subfield thickness (CST) measured using spectral domain optical coherence tomography relative to mean of pre-treatment measurements. RESULTS: The study drug was well tolerated and not associated with any severe adverse events. No significant changes in mean BCVA from study baseline were noted in either the study eye (+ 0.7 ± 4.1 letters at 6 months, - 1.1 ± 1.7 letters at 12 months) or the qualifying fellow eye (- 0.3 ± 3.4 letters at 6 months, - 0.3 ± 4.6 letters at 12 months) (p > 0.05 for all comparisons). Mean percentage changes in CST from baseline however decreased progressively with treatment (decreases at 6 and 12 months: study eyes 3.9 and 9.8%; qualifying fellow eyes 1.4 and 7.7%). Considering all eyes (n = 10), mean percentage CST decrease at 6 and 12 months was 2.7 ± 9.5% (p = 0.39) and 8.7 ± 9.5% (p = 0.02) respectively. CONCLUSION: Oral minocycline administration over 12 months was associated with no significant changes in mean BCVA and a small but progressive decrease in mean CST. TRIAL REGISTRATION: NCT02140164 (05/2014).

Opioid prescribing patterns among oculofacial plastic surgeons.

PURPOSE: Oculofacial plastic surgeons (OPS) prescribe narcotic pain prescriptions at a rate four times higher than that of other ophthalmologists. We conducted a cross-sectional survey to understand trends in opioid prescriptions among oculofacial plastic surgeons after common oculoplastic surgeries. METHODS: This cross-sectional survey was sent to OPS in the USA between June 19, 2020 and December 1, 2020. Participants were asked about their training and practice as well as their top two choices for post-operative pain management both overall and for seven common oculoplastic surgeries. Fisher's exact and chi-square tests were performed to analyze relationships between categorical variables. RESULTS: The two most common opioid medications, in percentage of respondents (n = 82), prescribed overall by OPS were hydrocodone-acetaminophen (35%) and tramadol (21%). Between OPS completed training before 1990 (16%) and those who completed training from 1991 to 2000 (12%), the latter cohort is 4.9 times more likely to prescribe opioids overall ([95% CI = 1.3-15.4], p = .01). Additionally, OPS who are currently practicing in the Southeast USA are 4.2 times more likely to prescribe opioids overall than those practicing in the Northeast USA ([95% CI: 1.4-12.8], p = .02). CONCLUSION: This study has helped identify patterns in opioid prescribing behavior among OPS based on demographic information and common oculoplastic surgeries. This knowledge will help bring awareness of prescribing behavior to the oculoplastics community and identify areas of improvement to reduce opioid prescriptions. Kindly check and confirm the OD and ON has been correctly identified in 2nd affiliationYes.

Ophthalmology Inquiries on Reddit: What Should Physicians Know?

Purpose: Patients are seeking answers to personal medical questions on social media. Reddit, a popular social media site, has been overlooked as a source of data in the field of ophthalmology. We analyzed posts in the subreddit, r/Ophthalmology, to better understand the most common ophthalmic conditions patients are discussing online and how often those making posts are being advised to seek professional medical care. Patients and Methods: This cross-sectional study analyzed posts and comments from March 18, 2018 to November 9, 2020. All posts and comments on r/Ophthalmology are public and were accessed using the Python Reddit API Wrapper. This text was analyzed for unique references to common ophthalmic conditions and for mentions and recommendations to different types of medical care. Results: Nine hundred and nineteen posts were collected from the above timeframe. An auto-moderator makes a comment on every post to discourage patients from asking personal medical questions. Despite this, over two-thirds of posts discussed medical treatment for eye conditions in either a post, comment, or both. Almost half of all posts mention "ophthalmology", but only 9% go as far as to recommend ophthalmic care. One-third of posts have no reference to medical care. Within posts, flashes and floaters were the most common condition mentioned, making up 15% of unique mentions, followed by glaucoma (7.4%) and retinal detachments (6.7%). Within comments, cataracts were most commonly discussed, making up 12% of unique mentions, followed by glaucoma (8.9%). Conclusion: These findings show that patients are seeking information about their eye health on the r/Ophthalmology subreddit and that Reddit users are engaging with these types of posts, instead of recommending professional care in most cases. It is important for ophthalmologists to recognize the most common conditions patients are asking about online and learn how they can do a better job of educating their patients in the office.

Automated Extraction of Pain Symptoms: A Natural Language Approach using Electronic Health Records.

BACKGROUND: Pain costs more than $600 billion annually and affects more than 100 million Americans, but is still a poorly understood problem and one for which there is very often limited effective treatment. Electronic health records (EHRs) are the only databases with a high volume of granular pain information that allows for documentation of detailed clinical notes on a patient's subjective experience. OBJECTIVES: This study applied natural language processing (NLP) technology to an EHR dataset as part of a pilot study to capture pain information from clinical notes and prove its feasibility as an efficient method. STUDY DESIGN: Retrospective study. SETTING: All data were from UConn Health John Dempsey Hospital (JDH) in Farmington, CT. METHODS: The JDH EHR dataset contains 611,355 clinical narratives from 359,854 patients from diverse demographic backgrounds from 2010 through 2019. These data were processed through a customized NLP pipeline. A training set of 100 notes was annotated based on focus group-generated ontology and used to generate and evaluate an NLP model that was later tested on the remaining notes. Validation of the model was evaluated externally and performance was analyzed. RESULTS: The model identified back pain as the most common location of experienced pain with 40,369 term frequencies. Patients most commonly experienced decreased mobility with their pain with 7,375 term frequencies. Pain was most commonly found to be radiating with 26,967 term frequencies and patients most commonly rated their pain as 8/10 with 2,375 term frequencies. All parameters studied had statistical F-scores greater than 0.85. LIMITATIONS: A single-center, pilot study subject to reporting bias, recording bias, and missing patient data. CONCLUSIONS: Our customized NLP model demonstrated good and successful performance in extracting granular pain information from clinical notes in electronic health records.

Investigations of Renal Function and Age-Related Macular Degeneration Phenotypes.

Purpose: To investigate potential associations between renal function and age-related macular degeneration (AMD) features as assessed with multimodal retinal imaging. Methods: A subset of participants included in a dark adaptation study with varying AMD severities had estimated glomerular filtration rate (eGFR) values (mL/min/1.73 m2) obtained from renal function laboratory testing of serum creatinine and cystatin C. Multimodal imaging from visit dates associated with serum samples was graded by the Wisconsin Reading Center for AMD features. Associations of eGFR with AMD features and severity grades, age, smoker status and rod-intercept time were investigated. Simple univariate analyses, age-corrected multivariate analyses, and a feature-selecting least absolute shrinkage and selection operator regression were performed for eGFR as a continuous dependent variable. Results: A total of 110 patients (mean age, 75.1 ± 9.4 years; mean eGFR, 70.7 ± 18.2 mL/min/1.73 m2) were included. In univariate analyses age (estimate, -1.16 units/year; 95% confidence interval [CI], -1.46 to -0.87; P < 0.0001), rod-intercept time (estimate, -0.54 units/minute; 95% CI, -0.81 to -0.27; P < 0.001) and subretinal drusenoid deposits (-11.12 units for subretinal drusenoid deposit presence in either eye; 95% CI, -20.23 to -2.01; P = 0.017) were associated with decreased renal function. However, in age-corrected multivariate models, age was the only significant variable associated with renal function, confirmed by least absolute shrinkage and selection operator regression. Conclusions: Accounting for age, renal function parameters did not show an association with AMD features. Translational Relevance: Bruch's membrane of the eye and the glomerular basement membrane of the kidney share physiologic similarities such that decreased renal function may demonstrate associations with AMD phenotypes.

Longitudinal characterization and treatment response of retinal arterial macroaneurysms in adult-onset coats disease.

Purpose: To perform longitudinal analysis of retinal arterial macroaneurysms in 3 patients with adult-onset Coats disease. Observations: Three eyes of three patients with adult-onset Coats disease were followed longitudinally for 4-15 years. Ultra-widefield images and montage color fundus photographs of affected eyes were analyzed. Size, retinal location, and grading for predominant characteristic (hemorrhagic, exudative, or quiescent) of each individual macroaneurysm were followed longitudinally from the time of onset. Fifty-one individual retinal arterial macroaneurysms were identified. The distance of any lesion-associated hemorrhage or exudation present from the foveal center was measured. Macroaneurysms were located in all quadrants of the retina, with the majority (37/51) graded as hemorrhagic at lesion onset. Hemorrhagic and exudative macroaneurysms that entered the quiescent phase remained quiescent for an average of 26 months. Seven macroaneurysms were found to have hemorrhage or exudation that came within 125 µm of the fovea and all three eyes followed demonstrated a longitudinal decrease in visual acuity despite laser and intravitreal injection therapy. At the initial visit, visual acuities ranged from 20/40 to 20/200, but decreased to 20/80 to 20/320 by the last follow-up visit. Conclusion and Importance: There are many challenges in treating patients with adult-onset Coats disease. Long-term loss of visual acuity often results from sequelae of hemorrhage and exudation affecting the macula.

Measuring Risky Driving Behavior Using an mHealth Smartphone App: Development and Evaluation of gForce.

BACKGROUND: Naturalistic driving studies, designed to objectively assess driving behavior and outcomes, are conducted by equipping vehicles with dedicated instrumentation (eg, accelerometers, gyroscopes, Global Positioning System, and cameras) that provide continuous recording of acceleration, location, videos, and still images for eventual retrieval and analyses. However, this research is limited by several factors: the cost of equipment installation; management and storage of the large amounts of data collected; and data reduction, coding, and analyses. Modern smartphone technology includes accelerometers built into phones, and the vast, global proliferation of smartphones could provide a possible low-cost alternative for assessing kinematic risky driving. OBJECTIVE: We evaluated an in-house developed iPhone app (gForce) for detecting elevated g-force events by comparing the iPhone linear acceleration measurements with corresponding acceleration measurements obtained with both a custom Android app and the in-vehicle miniDAS data acquisition system (DAS; Virginia Tech Transportation Institute). METHODS: The iPhone and Android devices were dashboard-mounted in a vehicle equipped with the DAS instrumentation. The experimental protocol consisted of driving maneuvers on a test track, such as cornering, braking, and turning that were performed at different acceleration levels (ie, mild, moderate, or hard). The iPhone gForce app recorded linear acceleration (ie, gravity-corrected). The Android app recorded gravity-corrected and uncorrected acceleration measurements, and the DAS device recorded gravity-uncorrected acceleration measurements. Lateral and longitudinal acceleration measures were compared. RESULTS: The correlation coefficients between the iPhone and DAS acceleration measurements were slightly lower compared to the correlation coefficients between the Android and DAS, possibly due to the gravity correction on the iPhone. Averaging the correlation coefficients for all maneuvers, the longitudinal and lateral acceleration measurements between iPhone and DAS were rlng=0.71 and rlat=0.83, respectively, while the corresponding acceleration measurements between Android and DAS were rlng=0.95 and rlat=0.97. The correlation coefficients between lateral accelerations on all three devices were higher than with the corresponding longitudinal accelerations for most maneuvers. CONCLUSIONS: The gForce iPhone app reliably assessed elevated g-force events compared to the DAS. Collectively, the gForce app and iPhone platform have the potential to serve as feature-rich, inexpensive, scalable, and open-source tool for assessment of kinematic risky driving events, with potential for research and feedback forms of intervention.