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A Virtual Reality Simulated Alternate Cover Test to Evaluate Adults with Strabismus.
No full textOBJECTIVE: Obtaining precise strabismus measurements is key in the diagnosis and management of strabismus in adults. Virtual reality (VR) has the potential to address the limitations of the standard alternate cover test (ACT) in measuring strabismus. The goal of this study was to evaluate the performance of a VR-simulated ACT in adults with strabismus.
DESIGN: Prospective cohort study.
PARTICIPANTS: Eligible consecutive participants ≥18 years with manifest strabismus ≥5 prism diopters (PD) at either distance or near were prospectively enrolled.
INTERVENTION: Each patient underwent a VR-simulated ACT with eye-tracking technology (Olleyes VisuALL) followed by an ACT by a masked pediatric ophthalmologist. Bland-Altman plots, intraclass correlation coefficient (ICC), and Spearman correlation were used to compare the limits of agreement (LOA) and association between the 2 examinations for the entire cohort as well as those with deviations ≥10 PD.
MAIN OUTCOME MEASURES: Level of agreement between VR and standard strabismus measurements obtained from the VR and ACT.
RESULTS: Of the 61 participants enrolled, 56 completed the VR test at near and 50 at distance. At distance, VR measurements were 0.88 PD higher than the ACT (upper LOA: 19.3, lower LOA: -17.6). At near, VR measurements were 0.28 PD higher than the ACT (upper LOA: 26.1, lower LOA: -25.5). For patients with manifest strabismus ≥10 PD, VR measurements were 0.26 PD lower than the ACT at distance (upper LOA: 19.5, lower LOA: -20.1) and at 3.97 PD lower at near (upper LOA: 18.8, lower LOA: -2). Wider variability was observed in patients with larger deviations. Significant correlations between VR and ACT measurements were observed at distance greater than near (ICC = 0.78,
CONCLUSIONS: A VR-simulated ACT demonstrated good correlation to standard strabismus measurements at distance and moderate correlation at near. The VR device underestimated deviations with larger deviations and tended to overestimate in those with smaller deviations. Virtual reality with eye-tracking technology holds promise in the assessment of adults with strabismus.
FINANCIAL DISCLOSURES: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article
Dual resistance to ticagrelor and prasugrel leading to subacute stent thrombosis: a diagnostic and therapeutic challenge.
No full textStent thrombosis (ST) may occur due to variability in platelet response to P2Y12 inhibitors, particularly after excluding common causes such as mechanical complications or medication non-compliance. Although ticagrelor and prasugrel typically provide more potent and consistent platelet inhibition than clopidogrel, some individuals still demonstrate inadequate response due to drug resistance. We describe a healthy, non-smoking male in his mid-60s who developed subacute ST 4 days after drug-eluting stent placement while on dual antiplatelet therapy with aspirin and ticagrelor. After excluding mechanical and clinical aetiologies, ticagrelor resistance was suspected. His regimen was switched to aspirin and prasugrel; however, thromboelastography (TEG) platelet mapping demonstrated persistently high on-treatment platelet reactivity to prasugrel, even after doubling the prasugrel dose. This case highlights rare resistance to newer P2Y12 inhibitors as a cause of unexplained ST and underscores the value of TEG platelet mapping to identify antiplatelet non-responsiveness and guide individualised therapy
Primary care provider referral patterns and awareness of biologic therapy for uncontrolled asthma.
No full textBACKGROUND: Asthma is a chronic airway disease associated with substantial morbidity. Most patients with uncontrolled asthma in the United States are managed by primary care providers (PCPs) and not by asthma specialists who are frequently updated on asthma treatment advances, including biologics, which decrease asthma exacerbation rates.
OBJECTIVE: We sought to investigate PCP referral patterns to asthma specialists, their familiarity with asthma biologic therapies, and the use of laboratory tests in asthma management.
METHODS: This was a cross-sectional survey study administered to PCPs in 47 US states. Respondent characteristics were analyzed using descriptive statistics. Bivariate analyses were conducted to examine associations between respondent characteristics and outcomes, with variables significant at
RESULTS: The survey was completed by 404 PCPs, of whom 51.4% referred patients with uncontrolled asthma to a specialist after ≥3 annual exacerbations, 32.8% were unfamiliar with asthma biologic therapy, and 72.1% did not routinely order laboratory tests to guide management. PCPs who manage patients with asthma more frequently were more likely to be familiar with asthma biologics (odds ratio = 1.74, 95% CI 1.42-1.88,
CONCLUSION: Most PCPs delay specialist referrals until patients experience ≥3 annual asthma exacerbations and do not use laboratory tests in asthma management, and many are unfamiliar with asthma biologics. Enhancing communication and education between PCPs and specialists on asthma therapies may help reduce asthma exacerbations
Interrupting Viscous Vortex and Preventing Flare-ups: Outcomes of Chronically Colonized Bacterial Populations and Chronic Antibiotic Suppression
No full textTackling Post Stroke Transitions: Leveraging Electronic Medical Records (EMR) and Interprofessional Teams
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