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Objectives: To compare the quality of life in patients with visual acuity loss occurring secondary to diabetic retinopathy with visual acuity loss occurring secondary to age-related macular degeneration (ARMD). Methods: Consecutive patients with diabetic retinopathy and ARMD were evaluated using the time trade-off method of utility value analysis. Both groups were stratified according to the degree of visual acuity loss in the better-seeing eye (group 1: 20/20-20/25, group 2: 20/30-20/40, group 3: 20/50-20/100, group 4: [less than or equal to] 20/200). Utility values obtained from the patients, once stratified for visual acuity group, were compared with use of the t test and the Mann-Whitney U test. In addition, a 2-way analysis of variance was performed to control for potential confounding variables. Results: No difference was found between the utility value means of the diabetic retinopathy (n= 333) and ARMD (n = 246) subgroups stratified according to visual acuity levels: group 1, P=.54; group 2, P=.96; group 3, P=.09; and group 4, P=.32. A 2-way analysis of variance demonstrated that, among the variables of ocular disease, sex, age, and visual acuity in the better-seeing eye, only visual acuity was significantly associated with utility values (P=.003). Conclusions: At similar levels of visual acuity loss, that associated with diabetic retinopathy causes a similar reduction in quality of life to that associated with ARMD. This information has important implications for use in cost-utility analyses of ophthalmic interventions. Arch Ophthalmol. 2002; 120:481-484

We examined four healthy men who developed cilioretinal artery occlusion associated with central retinal vein occlusion. Unlike previously reported patients with this clinical entity, there appeared to be abnormal central retinal artery inflow, as evidenced by prolonged, irregular filling of the branch retinal arteries with intravenous fluorescein angiography. The patients were treated with systemic corticosteroids. All of the patients had initial improvement in vision. However, three of the four patients had recurrent episodes of visual loss. The final visual acuity was 20/40 or better in three of the four patients.

Asteroid hyalosis is a disorder of the vitreous humor (the clear watery fluid contained within the transparent jelly-like mass that fills the cavity of the eyeball behind the crystalline lens of the eye), in which spherical white bodies (calcium salts) are suspended in the vitreous. This ocular condition has been associated with several systemic diseases. A study was undertaken to clarify the relationship between asteroid hyalosis and diabetes, and other systemic diseases. Of 12,205 individuals who underwent routine eye examination; 101 (0.83 percent) were diagnosed with asteroid hyalosis. A control group of 101 patients were matched by age to this group; the average age in both groups was 70. Diabetes was present in 29 percent of the study group, compared with 10 percent of the control group. There was also an increased incidence of systemic high blood pressure in the study group (61 percent) compared with the control group (29 percent). Atherosclerotic vascular disease (characterized by the formation of plaques on the walls of the vessels) was present in 30 percent of the study group, compared with 13 percent of the control group. An additional finding was that the study group was more farsighted than the control group. Asteroid hyalosis appears to be related to the aging process; it is rarely seen in patients under 50. There is evidence that this condition is associated with the vascular and microvascular changes, which occur as a part of the aging process. (Consumer Summary produced by Reliance Medical Information, Inc.)

Bipolar depression is a condition where the patient exhibits both manic and depressive episodes. To determine what factors predict recurrence and relapse of this disorder, and an investigation of the effect of stressful life events was carried out. The authors predicted that the patients experiencing high levels of stress would be more likely to relapse than patients experiencing low stress levels. The study group was made up of 28 men and 33 women who were stable outpatients at an affective disorder clinic who had all been diagnosed with a bipolar disorder. The patients were given an initial evaluation and were then interviewed every three months over a one-year period. Stressful events were rated on a scale of 1 to 5; a score of 1 indicated 'no threat' and a score of 5 indicated 'severe threat'. There was a significant relationship between high levels of stress and the likelihood of relapse. Those patients with the highest levels of stress had a 4.53 times higher risk of relapse than those without stress. These findings affirm the impact of psychosocial factors on the course of a disorder which presumedly has a biological base. Future efforts which integrate biological and psychosocial factors could improve treatment outcomes of patients with bipolar disorders. (Consumer Summary produced by Reliance Medical Information, Inc.)

Proliferative diabetic retinopathy can develop in patients with diabetes and is a disorder of the retina characterized by neovascularization, or the growth of new blood vessels and connective tissue. This condition may be treated using panretinal laser photocoagulation. Not all patients respond to this treatment, but those who do usually experience complete regression of the neovascularization of the retina and iris, and their condition remains stable. Five cases are presented of patients treated with panretinal photocoagulation for proliferative diabetic retinopathy, who subsequently developed obstruction of the central artery of the retina. All patients had responded to photocoagulation therapy and had documented stabilization of their diabetic retinopathy prior to developing the arterial obstruction. Four of five patients developed iris neovascularization one to three months following the central retinal obstruction, despite their previous laser treatment. Iris neovascularization can result in neovascular glaucoma, which causes eye pain and blindness. Since only about 13 percent of the retinal area receives treatment during standard panretinal photocoagulation, the remaining tissue may be affected by diminished blood supply due to obstruction of the retinal artery. Retinal ischemia, or lack of blood supply, may promote iris neovascularization. Patients with proliferative diabetic retinopathy who have successful panretinal laser photocoagulation and later develop acute obstruction of the central retinal artery may be vulnerable to iris neovascularization. Because of the possibility of neovascular glaucoma, these patients should be monitored closely for three months following obstruction of the central retinal artery. (Consumer Summary produced by Reliance Medical Information, Inc.)

For the last few decades, researchers have been trying to find a sensitive indicator to identify those at high risk for suicide. One of the psychological variables that has been strongly associated with suicidal behavior, and one that has been thought to be a predictive factor, is hopelessness. A large outpatient population was evaluated between September 1978 and February 1985. All 1,958 patients were measured on the Beck Hopelessness Scale and the Beck Depression Inventory. When the patients were rated, a score of nine or more identified 16 of the 17 individuals who ultimately committed suicide. This confirmed previous studies that had identified hopelessness as a strong correlating factor for increased risk for suicide. It was concluded that the Beck Hopelessness Scale is a useful instrument in suicide risk prediction. Over 94 percent of the victims were positively identified by this test. Patients scoring over nine points on the scale were 11 times more likely to commit suicide than the other outpatients. The measure of hopelessness is a useful tool because it cuts across demographic categories such as sex, age, and socioeconomic status, and it can be used to assess the suicide potential of individuals within other known risk groups. The identification of hopelessness is also significant because prior research has indicated that this symptom can be successfully treated. Cognitive therapy, in particular, has resulted in rapid reduction of hopelessness scores. (Consumer Summary produced by Reliance Medical Information, Inc.)

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ajo.2007.12.011 Byline: Betsy P. Luo (a)(b), Gary C. Brown (a)(c)(d), Solomon C. Luo (b)(e), Melissa M. Brown (a)(d)(f) Abstract: To determine the health-related quality of life associated with the presbyopia. Author Affiliation: (a) Center for Value-Based Medicine, Flourtown, Pennsylvania (b) Department of Ophthalmology, Temple University School of Medicine, Philadelphia, Pennsylvania (c) Retina Service, Wills Eye Institute, Jefferson Medical College Philadelphia, Pennsylvania (d) Eye Research Institute, Philadelphia, Pennsylvania (e) Progressive Vision Institute, Pottsville, Pennsylvania (f) Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania. Article History: Accepted 5 December 2007

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ajo.2005.04.061 Byline: Gary C. Brown (a)(b)(d)(e), Melissa M. Brown (a)(c)(d)(e), Joseph Campanella (a), George R. Beauchamp (a)(f) Abstract: To assess the value conferred by photodynamic therapy (PDT) and the cost-utility of PDT for the treatment of classic, subfoveal choroidal neovascularization associated with age-related macular degeneration (ARMD). Author Affiliation: (a) Center for Value-Based Medicine, Flourtown, Pennsylvania (b) Retina Service, Wills Eye Hospital, Jefferson Medical College, Philadelphia, Pennsylvania (c) Scheie Eye Institute, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania (d) Eye Research Institute, Philadelphia, Pennsylvania (e) Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania (f) University of Texas Southwestern Medical Center, Dallas, Texas Article History: Accepted 27 April 2005 Article Note: (footnote) A grant for this study was given by the Eye Research Institute (ERI), a nonprofit organization, Philadelphia, Pennsylvania.

Quality in health care means many things to different people. Asking 10 people 10 questions on quality will yield a wide array of answers. Organizations that have concerned themselves with [...]