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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.
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1 to 25 of 29 Research Studies DisplayedLock LJ, Channa R, Brennan MB
Effect of health system on the association of rurality and level of disadvantage with receipt of diabetic eye screening.
The goal of this retrospective cohort study was to determine the role of level of disadvantage in diabetic eye screening to explain the effect of health systems on rural and urban disparities. Researchers used an all-payer, statewide claims database to include adult Wisconsin residents with diabetes who had claims billed throughout the baseline and measurement years. Results indicated that patients from urban underserved clinics were more likely to receive screening than those from rural underserved clinics; similar findings emerged for both Medicare and non-Medicare subgroups. The researchers concluded that health systems, especially those that serve urban underserved populations, have an opportunity to increase screening rates by leveraging health system-level interventions and supporting patients in overcoming barriers.
AHRQ-funded; HS026279.
Citation: Lock LJ, Channa R, Brennan MB .
Effect of health system on the association of rurality and level of disadvantage with receipt of diabetic eye screening.
BMJ Open Diabetes Res Care 2022 Dec;10(6):e003174. doi: 10.1136/bmjdrc-2022-003174..
Keywords: Rural Health, Access to Care, Screening, Diabetes, Eye Disease and Health, Disparities, Chronic Conditions, Health Systems
VanderVeen DK, Oke I, Nihalani BR
Deviations from age-adjusted normative biometry measures in children undergoing cataract surgery: implications for postoperative target refraction and IOL power selection.
The purpose of this longitudinal cohort study was to assess whether children’s eyes that deviate from age-adjusted normative biometry measures are predictive of variations in target refraction and IOL power selection after cataract surgery. The researchers prospectively collected biometry data from the normal eyes of children under 10 years of age (100 eyes) with biometry data from eyes undergoing cataract surgery (162 eyes). The study analysis found greater myopic shift associated with younger age and male gender and concluded that adjustments can be made for cataract surgery for children’s eyes whose measures deviate from the norm for their age.
AHRQ-funded; HS000063.
Citation: VanderVeen DK, Oke I, Nihalani BR .
Deviations from age-adjusted normative biometry measures in children undergoing cataract surgery: implications for postoperative target refraction and IOL power selection.
Am J Ophthalmol 2022 Jul;239:190-201. doi: 10.1016/j.ajo.2022.02.022..
Keywords: Children/Adolescents, Eye Disease and Health, Surgery
Chou R, Selph S, Blazina I
Screening for glaucoma in adults: updated evidence report and systematic review for the US Preventive Services Task Force.
This evidence report and systematic review updated the 2013 USPSTF final recommendation to assess benefits and harms of screening for primary open-angle glaucoma (OAG) in adults. After an extensive literature review, 83 studies were included (30 trials and 53 diagnostic accuracy studies). One randomized clinical trial (RCT) found screening of frail elderly persons associated with no difference in vision outcomes vs no screening but with significantly greater falls risk. There was limited direct evidence on glaucoma screening, with no association of benefits.
AHRQ-funded; 290201500011I.
Citation: Chou R, Selph S, Blazina I .
Screening for glaucoma in adults: updated evidence report and systematic review for the US Preventive Services Task Force.
JAMA 2022 May 24;327(20):1998-2012. doi: 10.1001/jama.2022.6290..
Keywords: U.S. Preventive Services Task Force (USPSTF), Screening, Eye Disease and Health, Prevention, Guidelines, Evidence-Based Practice
Maloney MH, Payne SR, Herrin J
Risk of systemic adverse events after intravitreal bevacizumab, ranibizumab, and aflibercept in routine clinical practice.
Intravitreal anti-vascular endothelial growth factor (VEGF) pharmacotherapy plays a central role in the management of neovascular age-related macular degeneration (nAMD), diabetic retinal disease (DRD), and retinal venous occlusive disease (RVO). The goal of this study was to compare the systemic safety of intravitreal bevacizumab, ranibizumab, and aflibercept in real-world practice. The investigators observed no differences in the risk of acute MI, CVD, major bleeding, or all-cause hospitalization after treatment initiation with intravitreal bevacizumab, ranibizumab, or aflibercept during routine clinical practice.
AHRQ-funded; HS024075; HS025164; HS025402; HS025517; HS026379.
Citation: Maloney MH, Payne SR, Herrin J .
Risk of systemic adverse events after intravitreal bevacizumab, ranibizumab, and aflibercept in routine clinical practice.
Ophthalmology 2021 Mar;128(3):417-24. doi: 10.1016/j.ophtha.2020.07.062..
Keywords: Eye Disease and Health, Medication, Risk, Adverse Drug Events (ADE), Adverse Events
Gopal AD, Wallach JD, Shah SA
On-label and off-label clinical studies of FDA-approved ophthalmic therapeutics.
The authors characterized the frequency, accrual, and quality of on-label and off-label prospective studies of novel FDA-approved ophthalmic therapeutics. They concluded that ophthalmologists should recognize that, for some therapeutics, prospective data guiding off-label use may be limited; expanding post-approval evaluation of FDA-approved and off-label indications may mitigate uncertainties and aid ophthalmologists in optimally assessing the decision to adopt approved therapeutics for off-label use.
AHRQ-funded; HS025164; HS022882.
Citation: Gopal AD, Wallach JD, Shah SA .
On-label and off-label clinical studies of FDA-approved ophthalmic therapeutics.
Ophthalmology 2021 Feb;128(2):332-34. doi: 10.1016/j.ophtha.2020.07.028..
Keywords: Medication, Eye Disease and Health
Jiramongkolchai P, Lander DP, Kallogjeri D
Trend of surgery for orbital cellulitis: an analysis of state inpatient databases.
This study examined trends in surgery for orbital cellulitis from 2008 to 2015. Retrospective data was extracted from AHRQ’s State Inpatient Databases (SIDs) and patients with an ICD9-CM diagnosis code for orbital cellulitis were identified from Arkansas, Florida, Iowa, Maryland, Nebraska, New York and Wisconsin. The number of hospitalizations declined from a high of 1,574 down to 865 in 2014. The number of surgeries ranged from 103 to 154 from 2008 to 2015. For children, surgery was associated with age, ophthalmologic cormobidity, and conjunctival edema. For adults - male gender, private insurance, optic neuritis, and cranial nervs III/VI/VI palsy were associated with surgery.
AHRQ-funded; HS019455.
Citation: Jiramongkolchai P, Lander DP, Kallogjeri D .
Trend of surgery for orbital cellulitis: an analysis of state inpatient databases.
Laryngoscope 2020 Mar;130(3):567-74. doi: 10.1002/lary.28050..
Keywords: Healthcare Cost and Utilization Project (HCUP), Eye Disease and Health, Surgery, Hospitalization
French DD, Wang A, Prager AJ
Association of the Robert Wood Johnson Foundations' social determinants of health and Medicare ocular hospitalizations: a cross sectional data analysis.
The purpose of this paper was to determine whether social determinants of health are associated with ocular hospitalizations. Results showed that, compared to an all-condition hospitalized population, ocular hospitalizations tended to have small, yet statistically significant, associations with health behaviors, socioeconomic, and physical environment factors. Further research is recommended on how these variables affect ocular health relative to all-cause hospitalizations.
AHRQ-funded; HS000078; HS000084.
Citation: French DD, Wang A, Prager AJ .
Association of the Robert Wood Johnson Foundations' social determinants of health and Medicare ocular hospitalizations: a cross sectional data analysis.
Ophthalmol Ther 2019 Dec;8(4):611-22. doi: 10.1007/s40123-019-00220-1..
Keywords: Social Determinants of Health, Eye Disease and Health, Hospitalization, Medicare
Mafi JN, Godoy-Travieso P, Wei E
Evaluation of an intervention to reduce low-value preoperative care for patients undergoing cataract surgery at a safety-net health system.
This study analyzed the effects of an intervention program to reduce preoperative costs for care in patients undergoing cataract surgery. Most surgery centers require a battery of tests before surgery is approved. All patients must undergo primary care visits with chest x-rays, laboratory tests, and electrocardiograms required for many of them depending on age and presence of other conditions. This case-control study was conducted at 2 academic safety-net medical centers, Los Angeles County and University of Southern California (LAC-USC) (intervention, n = 469) and Harbor-UCLA (University of California, Los Angeles) (control, n = 585), from April 13, 2015, through April 12, 2016, with 12 additional months (April 13, 2016, through April 13, 2017) to assess sustainability (intervention, n = 1002; control, n = 511). All preoperative care decreased in the intervention group and mostly decreased in the control group. Financial losses occurred at these centers, but there was an overall savings for patients and society. These findings suggest that this may be a barrier to eliminating low-value care.
AHRQ-funded; HS024067.
Citation: Mafi JN, Godoy-Travieso P, Wei E .
Evaluation of an intervention to reduce low-value preoperative care for patients undergoing cataract surgery at a safety-net health system.
JAMA Intern Med 2019 May;179(5):648-57. doi: 10.1001/jamainternmed.2018.8358..
Keywords: Healthcare Costs, Surgery, Eye Disease and Health, Value, Quality Improvement, Quality of Care
Guirguis-Blake JM, Evans CV, Rushkin M
Ocular prophylaxis for gonococcal ophthalmia neonatorum: updated evidence report and systematic review for the US Preventive Services Task Force.
This evidence report and systematic review was commissioned for the U.S. Preventive Services Task Force to update the evidence of using prophylactic ocular topic medication for all newborns to prevent gonococcal ophthalmia neonatorum (GON) which can cause blindness if not treated immediately. Many articles were screened for inclusion, and of those included the recommendations remained an “A” grade recommendation, which is to apply the topical medication on all newborns due to an increase in syphilis prevalence.
AHRQ-funded; 290201500007I.
Citation: Guirguis-Blake JM, Evans CV, Rushkin M .
Ocular prophylaxis for gonococcal ophthalmia neonatorum: updated evidence report and systematic review for the US Preventive Services Task Force.
JAMA 2019 Jan 29;321(4):404-06. doi: 10.1001/jama.2018.17847..
Keywords: Evidence-Based Practice, Eye Disease and Health, Guidelines, Newborns/Infants, Prevention, U.S. Preventive Services Task Force (USPSTF)
Sterling MR, Jannat-Khah D, Vitale S
Can your patients with heart failure see? The prevalence of visual impairment among adults with heart failure.
This study used data from the 2005-2008 National Health and Nutrition Examination Survey to determine the prevalence of visual impairment among adults with heart failure. There is a higher prevalence of visual impairment with that cohort, even with wearing glasses. This finding warrants more collaboration between general internists, cardiologists, ophthalmologists, and other caregivers.
AHRQ-funded; HS000066.
Citation: Sterling MR, Jannat-Khah D, Vitale S .
Can your patients with heart failure see? The prevalence of visual impairment among adults with heart failure.
J Gen Intern Med 2018 May;33(5):605-07. doi: 10.1007/s11606-018-4366-1..
Keywords: Eye Disease and Health, Heart Disease and Health, Cardiovascular Conditions
Roberto SA, Bayes J, Karner PE
Patient harm in cataract surgery: a series of adverse events in Massachusetts.
This study examined the reported adverse events (AEs) involving cataract surgery in Massachusetts from 2011 to 2015. There were 37 AEs reported, with 15 anesthesia related, 5 were wrong eye blocks, 3 cases of hemodynamic instability, 2 retrobulbar hematoma/hemorrhages, and 5 globe perforations resulting in permanent loss of vision. However, the authors believe the numbers reported to Massachusetts state agencies are lower than the true number of AEs.
AHRQ-funded; HS024764.
Citation: Roberto SA, Bayes J, Karner PE .
Patient harm in cataract surgery: a series of adverse events in Massachusetts.
Anesth Analg 2018 May;126(5):1548-50. doi: 10.1213/ane.0000000000002526..
Keywords: Adverse Events, Eye Disease and Health, Patient Safety, Risk, Surgery
Nanji KC, Roberto SA, Morley MG
Preventing adverse events in cataract surgery: recommendations from a Massachusetts expert panel.
The purpose of this article is to identify contributing factors to the adverse events (AEs) reported in Massachusetts and present the panel's recommended strategies to prevent them. The panel identified 2 principal categories of contributing factors to the state's cataract surgery-related AEs: systems failures and choice of anesthesia technique. The panel recommended several strategies to prevent AEs during cataract surgery, including performing a distinct time-out with at least 2 care-team members before block administration.
AHRQ-funded; HS024764.
Citation: Nanji KC, Roberto SA, Morley MG .
Preventing adverse events in cataract surgery: recommendations from a Massachusetts expert panel.
Anesth Analg 2018 May;126(5):1537-47. doi: 10.1213/ane.0000000000002529.
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Keywords: Adverse Events, Evidence-Based Practice, Eye Disease and Health, Patient Safety, Surgery
Slota C, Davis SA, Blalock SJ
Patient-physician communication on medication cost during glaucoma visits.
The aim of this secondary analysis was to describe the frequency and nature of patient-physician communication regarding medication cost during glaucoma office visits. Most participants did not discuss medication cost during their glaucoma office visit. The majority of the subjects who discussed cost had mild disease severity (51 percent), took one glaucoma medication (63 percent), and had Medicare (49 percent) as well as a form of prescription insurance (78 percent).
AHRQ-funded; HS023054.
Citation: Slota C, Davis SA, Blalock SJ .
Patient-physician communication on medication cost during glaucoma visits.
Optom Vis Sci 2017 Dec;94(12):1095-101. doi: 10.1097/opx.0000000000001139.
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Keywords: Eye Disease and Health, Healthcare Costs, Medication, Patient and Family Engagement, Clinician-Patient Communication
Jonas DE, Amick HR, Wallace IF
Vision screening in children aged 6 months to 5 years: Evidence report and systematic review for the US Preventive Services Task Force.
The researchers reviewed the evidence on screening for and treatment of amblyopia, its risk factors, and refractive error in children aged 6 months to 5 years to inform the US Preventive Services Task Force. They concluded that studies directly evaluating the effectiveness of screening were limited and do not establish whether vision screening in preschool children is better than no screening.
AHRQ-funded; 290201200015I.
Citation: Jonas DE, Amick HR, Wallace IF .
Vision screening in children aged 6 months to 5 years: Evidence report and systematic review for the US Preventive Services Task Force.
JAMA 2017 Sep 5;318(9):845-58. doi: 10.1001/jama.2017.9900.
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Keywords: U.S. Preventive Services Task Force (USPSTF), Eye Disease and Health, Children/Adolescents, Screening, Newborns/Infants
Chandakkar PS, Venkatesan R, Li B
MIRank-KNN: multiple-instance retrieval of clinically relevant diabetic retinopathy images.
Computer-aided diagnosis has the potential of improving diabetic retinopathy (DR) screening or diagnosis. The researchers developed a feature space of a modified color correlogram appended with statistics of steerable Gaussian filter responses selected by fast radial symmetric transform points. Experiments with real DR images collected from five different datasets demonstrate that the proposed approach is able to outperform existing methods.
AHRQ-funded; HS019792.
Citation: Chandakkar PS, Venkatesan R, Li B .
MIRank-KNN: multiple-instance retrieval of clinically relevant diabetic retinopathy images.
J Med Imaging 2017 Jul;4(3):034003. doi: 10.1117/1.jmi.4.3.034003.
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Keywords: Diabetes, Imaging, Eye Disease and Health, Health Information Technology (HIT), Diagnostic Safety and Quality
Coyle CE, Steinman BA, Chen J
Visual acuity and self-reported vision status.
This study examined the associations of two measures of vision impairment (i.e., a clinical measure of visual acuity and self-reported vision status) and social isolation in a nationally representative sample of Americans aged 60 and older. Effects of both measures of vision impairment in predicting social isolation were substantially reduced or eliminated in adjusted models.
AHRQ-funded; HS017589.
Citation: Coyle CE, Steinman BA, Chen J .
Visual acuity and self-reported vision status.
J Aging Health 2017 Feb;29(1):128-48. doi: 10.1177/0898264315624909.
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Keywords: Elderly, Eye Disease and Health, Health Status
Pershing S, Morrison DE, Hernandez-Boussard T
Cataract surgery complications and revisit rates among three states.
The authors studied cataract procedures from California, Florida, and New York, to characterize population-based 30-day procedure-related readmissions following surgery. Their results highlight the importance of age as a risk factor for cataract surgery readmissions, and suggest a relationship between black or Hispanic race, Medicaid insurance, and diabetes associated with higher risk for cataract surgery complications.
AHRQ-funded; HS018558.
Citation: Pershing S, Morrison DE, Hernandez-Boussard T .
Cataract surgery complications and revisit rates among three states.
Am J Ophthalmol 2016 Nov;171:130-38. doi: 10.1016/j.ajo.2016.08.036.
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Keywords: Healthcare Cost and Utilization Project (HCUP), Eye Disease and Health, Surgery, Hospital Readmissions, Adverse Events
Chou R, Dana T, Bougatsos C
Screening for impaired visual acuity in older adults: updated evidence report and systematic review for the US Preventive Services Task Force.
This update of a 2009 systematic review on screening for impaired visual acuity among older adults found that new evidence on the diagnostic accuracy of visual acuity screening tests was limited and consistent with previous findings that screening questions or a visual acuity test was associated with suboptimal accuracy. Direct evidence found no significant difference between vision screening in older adults in primary care settings vs no screening for improving visual acuity or other clinical outcomes.
AHRQ-funded.
Citation: Chou R, Dana T, Bougatsos C .
Screening for impaired visual acuity in older adults: updated evidence report and systematic review for the US Preventive Services Task Force.
JAMA 2016 Mar 1;315(9):915-33. doi: 10.1001/jama.2016.0783.
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Keywords: Diagnostic Safety and Quality, Evidence-Based Practice, Eye Disease and Health, Primary Care, Screening, U.S. Preventive Services Task Force (USPSTF)
Lipton BJ, Decker SL
The effect of Medicaid adult vision coverage on the likelihood of appropriate correction of distance vision: evidence from the National Health and Nutrition Examination Survey.
This paper examined whether providing adult vision benefits is associated with an increase in the percentage of low-income individuals with appropriately corrected distance vision as measured during an eye exam. Findings imply that Medicaid adult vision coverage is associated with a significant increase in the percentage of Medicaid beneficiaries with appropriately corrected distance vision.
AHRQ-authored.
Citation: Lipton BJ, Decker SL .
The effect of Medicaid adult vision coverage on the likelihood of appropriate correction of distance vision: evidence from the National Health and Nutrition Examination Survey.
Soc Sci Med 2016 Feb;150:258-67. doi: 10.1016/j.socscimed.2015.10.055.
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Keywords: Access to Care, Eye Disease and Health, Health Insurance, Low-Income, Medicaid
Lipton BJ, Decker SL
The effect of health insurance coverage on medical care utilization and health outcomes: evidence from Medicaid adult vision benefits.
The reserarchers examined the effect of vision insurance on eye care utilization and vision health outcomes by taking advantage of quasi-experimental variation in Medicaid coverage of adult vision care. They found that Medicaid beneficiaries with vision coverage are 4.4 percentage points more likely to have seen an eye doctor in the past year,and 5.3 percentage points less likely to report needing but not purchasing eyeglasses or contacts due to cost.
AHRQ-authored.
Citation: Lipton BJ, Decker SL .
The effect of health insurance coverage on medical care utilization and health outcomes: evidence from Medicaid adult vision benefits.
J Health Econ 2015 Dec;44:320-32. doi: 10.1016/j.jhealeco.2015.10.006.
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Keywords: Medicaid, Eye Disease and Health, Healthcare Utilization, Health Services Research (HSR), Outcomes
Lipton BJ, Decker SL
Association between diagnosed diabetes and trouble seeing, National Health Interview Survey, 2011-13.
This study used nationally representative 2011–2013 data from the United States to estimate the association between diagnosed diabetes and trouble seeing. Diagnosed diabetes was associated with approximately double the odds of self-reported trouble seeing. Older age, less education, and a history of comorbid conditions were positively correlated, while male sex, being married, and having health insurance were negatively correlated with trouble seeing.
AHRQ-authored.
Citation: Lipton BJ, Decker SL .
Association between diagnosed diabetes and trouble seeing, National Health Interview Survey, 2011-13.
J Diabetes 2015 Sep;7(5):743-6. doi: 10.1111/1753-0407.12311.
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Keywords: Chronic Conditions, Diabetes, Elderly, Eye Disease and Health, Risk
Bartels CM, Wong JC, Johnson SL
Rheumatoid arthritis and the prevalence of diabetic retinopathy.
The objective of this study was to examine RA as a risk factor for diabetic retinopathy compared with other vascular risk factors. It found that compared with patients without RA, the adjusted model demonstrated that patients with diabetes and RA were 28 percent less likely to have diabetic retinopathy.
AHRQ-funded; HS018368.
Citation: Bartels CM, Wong JC, Johnson SL .
Rheumatoid arthritis and the prevalence of diabetic retinopathy.
Rheumatology 2015 Aug;54(8):1415-9. doi: 10.1093/rheumatology/kev012..
Keywords: Arthritis, Risk, Eye Disease and Health, Diabetes
Slota C, Sayner R, Vitko M
Glaucoma patient expression of medication problems and nonadherence.
The purpose of this article was to evaluate what patient characteristics led patients to express (1) medication problems, including difficulty with side effects and eye drop administration, and (2) problems with nonadherence to glaucoma medications. It found that patients with lower health literacy are less likely to express medication-related problems and patients who express medication problems often express nonadherence.
AHRQ-funded; HS023054.
Citation: Slota C, Sayner R, Vitko M .
Glaucoma patient expression of medication problems and nonadherence.
Optom Vis Sci 2015 May;92(5):537-43. doi: 10.1097/opx.0000000000000574..
Keywords: Eye Disease and Health, Patient Adherence/Compliance, Medication, Health Literacy
Press VG, Matthiesen MI, Ranadive A
Insights into inpatients with poor vision: a high value proposition.
The researchers studied the initial feasibility and efficacy of screening and correcting inpatients’ vision. Over 800 hospitalized patients’ vision was screened. Those participants who failed a vision screen (Snellen chart) test performed by research assistants were given non-prescription readers that corrected most participants’ vision.
AHRQ-funded; HS016967.
Citation: Press VG, Matthiesen MI, Ranadive A .
Insights into inpatients with poor vision: a high value proposition.
J Hosp Med 2015 May;10(5):311-3. doi: 10.1002/jhm.2342..
Keywords: Eye Disease and Health, Screening, Inpatient Care, Hospitalization
Robinson JC, Brown T, Whaley C
Reference-based benefit design changes consumers' choices and employers' payments for ambulatory surgery.
The researchers analyzed the impact of reference-based benefit (RBB) designs on cataract surgery patients choice of less-expensive ambulatory surgery centers over more expensive hospital outpatient departments. Examining two groups of patients, one in plans incorporating RBB and the other in non-RBB plans, they found that the shift to RBB led to an 8.6 percent increase in ambulatory surgery centers as well as a 19.7 percent decrease in payments per procedure.
AHRQ-funded; HS022098
Citation: Robinson JC, Brown T, Whaley C .
Reference-based benefit design changes consumers' choices and employers' payments for ambulatory surgery.
Health Aff. 2015 Mar;34(3):415-22. doi: 10.1377/hlthaff.2014.1198..
Keywords: Ambulatory Care and Surgery, Eye Disease and Health, Health Insurance, Healthcare Costs, Health Insurance
