Showing papers by "Paul P. Lee published in 2004"

Statins and Other Cholesterol-Lowering Medications and the Presence of Glaucoma

Abstract: Objective To explore whether oral statin and other antihyperlipidemic medicationsare associated with open-angle glaucoma. Methods The administrative clinical databases maintained at the Veterans AffairsMedical Center, Birmingham, Ala, were used to conduct a matched case-controlstudy. Cases were all male patients aged 50 years and older with a new diagnosisof glaucoma on an outpatient or inpatient visit during the period January1, 1997, through December 31, 2001. Ten control subjects were matched to eachcase according to age (within 1 year). Prescription files were assessed forstatin use as well as additional medications to lower cholesterol levels.Information on comorbid medical conditions was also obtained. Conditionallogistic regression was used to calculate odds ratios (ORs) and 95% confidenceintervals (CIs). Results Longer duration of statin use was associated with a lower risk of open-angleglaucoma ( P for trend = .04) primarily among subjects with 24months or more of use (OR, 0.60; 95% CI, 0.39-0.92). When stratified by comorbidmedical condition, among those with cardiovascular disease (OR, 0.63; 95%CI, 0.42-0.97), lipid metabolism disorders (OR, 0.63; 95% CI, 0.41-0.99),and the absence of cerebrovascular disease (OR, 0.76; 95% CI, 0.58-0.99),statins demonstrated a protective effect on open-angle glaucoma. Finally,a protective association was also observed among those who used nonstatincholesterol-lowering agents (OR, 0.59; 95% CI, 0.37-0.97). Conclusions Initial examination of an administrative clinical database indicatesthe intriguing possibility that long-term use of oral statins may be associatedwith a reduced risk of open-angle glaucoma, particularly among those withcardiovascular and lipid diseases. Nonstatin cholesterol-lowering agents werealso associated with a reduced risk of having open-angle glaucoma. Additionalinvestigation is warranted as to whether these classes of agents may providean additional therapeutic addition for glaucoma.

Monitoring visual status: why patients do or do not comply with practice guidelines

Abstract: National practice guidelines specify recommended diagnostic and treatment patterns for individuals at risk for particular conditions. Optimal care assumes adherence to guidelines. Yet, for a variety of conditions, compliance tends to be far from complete (Brenes and Paskett 2000; Cheng, Kalis, and Feifer 2001; Erhardt 1999; Hilber et al. 2000; Hsia et al. 2002; Lawler and Viviani 1997; Pate et al. 2002). Well-established guidelines exist for most common eye diseases. The American Academy of Ophthalmology (AAO) and American Diabetes Association (ADA) recommend that individuals with diabetes should be screened annually for diabetic retinopathy (DR) (American Academy of Ophthalmology 1998; American Diabetes Association 2002), although other guidelines recently allow exams every two years in specific situations. The AAO also recommends annual visits (at a minimum) for those diagnosed with age-related macular degeneration (ARMD) (2000, 2001). Since treatment options were more limited for ARMD in the 1990s, the benefit of timely eye exams was lower, providing an interesting contrast to diabetes (American Academy of Ophthalmology 2001). In the national longitudinal data on Medicare beneficiaries used for this study, compliance was far below levels specified in guidelines. Only 25 percent of persons with DM received an exam for each 15-month consecutive period spanning 1991–1999. For ARMD, the corresponding percentage was 41–70, depending on the ARMD form. To better understand why this occurs, we analyzed patient demographic health-related and system-related factors from the NLTCS Medicare sample. Because effective therapeutic interventions were far better for treating ocular complications of diabetes than for ARMD, this provided a unique opportunity to empirically assess the potential role of effective therapy availability in compliance behavior.

Associations of presbyopia with vision-targeted health-related quality of life

Abstract: OBJECTIVE To evaluate the associations of presbyopia and its correction, particularly monovision optical correction, with vision-targeted health-related quality of life. METHODS The National Eye Institute Refractive Error Quality of Life (NEI-RQL) Instrument was prospectively self-administered by subjects from 6 medical centers in the following age and correction categories: subjects with emmetropia younger than 45 years (n = 75), subjects with emmetropia aged 45 years or older (n = 38), and subjects with ametropia aged 45 years or older without monovision (n = 486) or corrected with monovision (n = 38). Differences in the 13 NEI-RQL Instrument subscale scores among subjects in the 4 groups were examined. The age of 45 years or older was used as a surrogate for presbyopia. RESULTS A comparison of older (age > or =45 years) vs younger (age <45 years) persons with emmetropia suggests that presbyopia was associated with reduced scores in 7 of 13 subscales (P<.05). In those aged 45 years or older, correction of presbyopia with monovision was associated with statistically significantly better scores on 3 subscales (expectations, dependence on correction, and appearance) compared with single-vision correction. One subscale (dependence on correction) showed worsening scores with increasing age without adjustment for need or type of correction. Older persons with monovision correction had significantly worse scores than younger subjects with emmetropia on all subscales except suboptimal correction and appearance. CONCLUSIONS Presbyopia is associated with worse vision-targeted health-related quality of life compared with younger subjects with emmetropia. Monovision correction of presbyopia is related to some improvements in health-related quality of life, but it is still worse than that for younger subjects with emmetropia in several areas.

Adherence to Guidelines and its Effects on Hospitalizations with Complications of Type 2 Diabetes

Abstract: OBJECTIVES: To study the discrepancy between actual and recommended rates of use among several measures of screening for complications of diabetes in a national longitudinal sample, the correlations among measures of adherence, and whether or not higher rates of adherence reduce hospitalizations for complications of diabetes. The key study hypothesis was that lack of adherence to professional recommendations for diabetes care leads to adverse health outcomes for elderly persons. METHODS: Administrative claims and survey data for 1994-­1999 on a nationally representative sample of Medicare beneficiaries age 65+. Principal components analysis and instrumental variables probit regression methods were used. RESULTS: Most Medicare beneficiaries diagnosed with type 2 diabetes had at least one physician visit per year, but rates of screening (eye examinations and HbA1c, lipid, microalbumin and urine tests) fell far short of recommendations. Correlations among use rates for various types of screening were positive but far less than one, suggesting that failure to screen reflects a complex set of underlying factors. Increased rates of adherence were observed for HbA1c and lipid testing over the observation period. Higher use was associated with lower rates of hospitalization for complications of diabetes (vascular (p=0.007), renal (p=0.002), and other complication (p=0.005)). CONCLUSIONS: Adherence to guidelines was associated with significantly reduced rates of hospitalization. Continued analysis of the trends in clinical practice is needed to demonstrate the effectiveness of standardized guidelines for the care of patients with diabetes.

The Associations Between Self-Rated Vision and Hearing and Functional Status in Middle Age

Abstract: Objectives: To describe the correlations between self-reported visual and hearing impairment and an index of global functional status. Design: Multivariate analyses of functional status based on cross sectional data from Wave 1 (1992) of the Health and Retirement Study (HRS) controlling for demographic and socioeconomic status, common chronic conditions and general health status. Participants: 9,744 U.S. community-dwelling persons age 51-61 years Main Outcome Measure: A global index of functional status based on self-reported limitations in 11 activities Results: About 12% of respondents rated their vision or hearing as poor. Controlling for demographic factors, socioeconomic status, medical conditions, and general health status, limitations in both vision and hearing were independently correlated with worse functional status. Controlling for income, wealth, education did not greatly reduce the strength of the associations between vision and hearing impairment and function. Conclusions: Visual and hearing impairment appear to have a significant relationship with overall physical functioning in the elderly.

What patients want to know before they have cataract surgery

Abstract: AIMS To investigate what patients want to know before undergoing cataract surgery. METHODS A written questionnaire was answered by 190 patients prior to cataract surgery. RESULTS The five pieces of preoperative information rated most important were: chance of visual improvement; when vision would improve; overall risk of losing vision from the operation; effect of not having the operation, and the types of serious complications. When asked \"should you be warned of a serious complication if it has a risk of happening\", 93.5% said yes to a risk of 1 in 50 and 62.4% to 1 in 1000. Written information was requested by 85.7%. There were few differences between the sexes, and between those having their first or second operation. CONCLUSIONS Patients most wanted to know benefits and risks, even very small risks. Written information should be provided to ensure coverage and reinforce verbal information.

Do Routine Eye Exams Improve Vision

Abstract: We use a longitudinal national sample of Medicare claims linked to the National Long-Term Care Survey (NLTCS) to assess the productivity of routine eye examinations. Although such exams are widely recommended by professional organizations for certain populations, there is limited empirical evidence on the productivity of such care. We measure two outcomes, the ability to continue reading, and no onset of blindness or low vision, accounting for potential endogeneity of frequency of eye exams. Using instrumental variables, we find a statistically significant and beneficial effect of routine eye exams for both outcomes. Marginal effects for reading ability are large, but decline in the number of years with eye exams. Effects for blindness/low vision are smaller for the general elderly population, but larger for persons with diabetes. Instrumental variables provide a useful approach for assessing the productivity of particular interventions, particularly in situations in which randomized controlled trials are expensive or perhaps unethical and difficult to conduct over a lengthy time period.

A method of preventing or treating glaucoma

Abstract: The present invention relates, in general, to glaucoma and, in particular, to a method of preventing or treating glaucoma using statins.

The effect of surgery on intraocular pressure fluctuations with electroconvulsive therapy in a patient with severe glaucoma.

Abstract: We sought to report glaucoma surgery as a possibly protective measure in patients with elevated intraocular pressure (IOP) during electroconvulsive therapy (ECT). An interventional case report is reported. IOP measurements were taken in patients with progressive glaucoma who had one eye fitted with a glaucoma tube implant and other without tube implant before, during, and after ECT treatment. IOP fluctuation was reduced in the eye that had undergone double tube implant surgery. Surgical intervention may blunt the IOP spikes associated with ECT.