Parkinson's disease (PD) is a progressive neurological condition that causes considerable disability in the elderly. Drugs used to treat PD, such as levodopa, offer symptomatic relief but often have neuropsychiatric adverse effects, most prominently psychosis and delirium. Aged patients and those with dementia are particularly vulnerable to these adverse effects. Evaluating PD patients with drug-induced neuropsychiatric adverse effects is made difficult by their complex clinical presentations. The treatment of drug-induced psychosis and delirium begins with manipulating the antiparkinsonian drug regimen, but this frequently worsens motor function. Atypical antipsychotics such as clozapine have been successfully employed to treat the psychosis without worsening the motor disability. Patient intolerance of clozapine therapy has prompted open-label studies with newer agents such as risperidone, remoxipride, zotepine, mianserin and ondansetron.
Background/aimsBest-corrected visual acuity (BCVA) is the most common primary endpoint in treatment trials for choroideremia (CHM) but the long-term natural history of BCVA is unclear.MethodsWe searched in seven databases to identify studies that reported BCVA of untreated eyes with CHM. We sought individual-level data and performed segmented regression between BCVA and age. For eyes followed longitudinally, we introduced a horizontal translation factor to each dataset to account for different ages at onset of a rapid BCVA decline.ResultsWe included 1004 eyes from 23 studies. BCVA of the right and left eyes was moderately correlated (r=0.60). BCVA as a function of age followed a 2-phase decline (slow followed by rapid decline), with an estimated transition age of 39.1 years (95% CI 33.5 to 44.7). After the introduction of horizontal translation factors to longitudinal datasets, BCVA followed a 2-phase decline until it reached 0 letters (r2=0.90). The BCVA decline rate was 0.33 letters/year (95% CI −0.38 to 1.05) before 39 years, and 1.23 letters/year (95% CI 0.55 to 1.92) after 39 years (p=0.004).ConclusionBCVA in eyes with CHM follows a 2-phase linear decline with a transition age of approximately 39 years. Future trials enrolling young patients may not be able to use BCVA as a primary or sole endpoint, but rather, may need to employ additional disease biomarkers that change before age 39. BCVA may still have utility as a primary endpoint for patients older than 39 years who have measurable BCVA decline rates.
A minority of surgeons reported using PPS. Surgeons were less likely to use PPS if they had completed residency or begun practice within 14 years, had fewer than 200 cases annually, or were university affiliated. This study highlights the need to advocate for the use of North American Spine Society guidelines regarding the use of PPS.
martphones and other handheld devices have become increasingly ingrained into daily life. 1 There is substantial potential to integrate mobile applications (apps) in clinical ophthalmology. 2,3 However, mobile apps can be published without any external testing for validity or reliability yet still may be used widely in clinical practice. 4,5 The coronavirus disease 2019 (COVID-19) pandemic illustrates the increasingly important role of telemedicine as a method of clinician-patient interaction. Given the considerable expansion in number of apps and increasing need for such apps in telemedicine during the 6,7 this study aims to assess the accuracy and usability in the context of teleophthalmology of currently available visual acuity testing apps. MethodsThe US Apple App Store was queried for mobile apps that test visual acuity from April 17, 2020, to May 5, 2020. The search terms "eye test," "Snellen," "visual acuity," "vision test," "optometry," and "letter chart" were used. Apps were downloaded if they were free, in English, and not in the category of entertainment or advertised as "eye workouts." Inclusion of a downloaded app in the analysis required that it state the distance to hold the device to measure visual acuity. Data regarding the publisher, rating, most recent update, functionalities of the app, and distance were recorded. Optotype size was manually measured on the iPhone 7, iPhone 11, 11-inch iPad Pro (second generation), and Mini 4 for visual acuity lines 20/200, 20/100, 20/40, and 20/20. The expected optotype size was calculated using the equation Height (in mm) = Inverse of Snellen Fraction × Viewing Distance (in mm) × tan (5/60) and compared with measured optotype size. Mean (SD) errors were calculated per device, and the average mean error was reported across devices. Mean (SD) errors are not available from the apps themselves. A Rosenbaum Near Vision Card was also tested to validate our methodology, with a mean (SD) error of 0.0% (3.7%). Analyses were completed with Excel version 16.16.27 (Microsoft). IMPORTANCEThe coronavirus disease 2019 pandemic illustrates the increasingly important role of telemedicine as a method of clinician-patient interaction. However, electronic applications (apps) for the testing of ophthalmology vital signs, such as visual acuity, can be published and used without any verification of accuracy, validity, or reliability. OBJECTIVE To reassess the accuracy of visual acuity-testing apps and assess their viability for telehealth. DESIGN, SETTING, AND PARTICIPANTSThe US Apple App Store was queried for apps for visual acuity testing. Anticipated optotype size for various visual acuity lines were calculated and compared against the actual measured optotype size on 4 different Apple hardware devices. No human participants were part of this study.MAIN OUTCOMES AND MEASURES Mean (SD) errors were calculated per device and across multiple devices.RESULTS On iPhones, 10 apps met inclusion criteria, with mean errors ranging from 0.2% to 109.9%. On the iPads, 9 apps met inclusion ...
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