The economic value added (EVA) resulting from medical care of functional amblyopia, strabismus, (pathologies of binocular vision) and asthma.

Introduction: Value analysis in health care calculates the economic value added (EVA) that results from improvements in health and health care. Our purpose was to develop an EVA model and to apply the model to typical and hypothetical (instantaneous and perfect) cures for amblyopia, surgical strabismus and asthma, as another, but non-ophthalmological disease standard for comparison, in the United States.

Methods: The model is based on changes in utility and longevity, the associated incremental costs, and an estimate of the value of life.

Evidence-based medicine: the value of vision screening.

Objective: To review the literature for evidence-based medicine (EBM), to assess the evidence for effectiveness of vision screening, and to propose moving toward value-based medicine (VBM) as a preferred basis for comparative effectiveness research.

Methods: Literature based evidence is applied to five core questions concerning vision screening: (1) Is vision valuable (an inherent good)?; (2) Is screening effective (finding amblyopia)?; (3) What are the costs of screening?; (4) Is treatment effective?; and (5) Is amblyopia detection beneficial?

Results: Based on EBM literature and clinical experience, the answers to the five questions are: (1) yes; (2) based on literature, not definitively so; (3) relatively inexpensive, although some claim benefits for more expensive options such as mandatory exams; (4) yes, for compliant care, although treatment processes may have negative aspects such as "bullying"; and (5) economic productive values are likely very high, with returns of investment on the order of 10:1, while human value returns need further elucidation.

Conclusion: Additional evidence is required to ascertain the degree to which vision screening is effective.

Anterior and nasal transposition of the inferior oblique muscles in patients with missing superior oblique tendons.

Introduction: Patients with missing superior oblique (SO) tendons present with overelevation/underdepression in adduction. Unilateral cases often exhibit abnormal head postures, whereas in bilateral cases, there may be a marked V-pattern with upgaze exotropia. These patients may have craniosynostosis.

The Amblyopia and Strabismus Questionnaire: English translation, validation, and subscales.

Purpose: To establish the English-language version of the Amblyopia and Strabismus Questionnaire (ASQE).

Design: Prospective cohort study.

Methods: A structured translation process was followed to generate the ASQE, a 26-item instrument (originally in Dutch) containing five subscales for fear of losing the better eye, distance estimation, visual disorientation, double vision, and social contact and appearance.

The cost utility of strabismus surgery in adults.

Purpose: Cost-utility analysis evaluates the cost of medical care in relation to the gain in quality-adjusted life years (QALYs). Our purpose was to develop a cost model for surgical care for adult strabismus, to estimate the mean cost per case, to determine the associated gain in QALYs, and to perform cost-utility analysis.

Methods: A cost model incorporated surgery, pre- and postoperative care, and a mean of 1.

The burden of age-related macular degeneration: a value-based medicine analysis.

Purpose: To assess the quality-of-life loss and the macroeconomic financial consequences associated with age-related macular degeneration (ARMD).

Methods: Time tradeoff utility analysis was performed to assess the quality-of-life diminution caused by ARMD (both dry and neovascular) in cohorts consisting of (1) patients with ARMD, (2) ophthalmologists asked to assume they had various degrees of severity of ARMD, (3) healthcare providers asked to assume they had various degrees of severity of ARMD, and (4) participants from the general community asked to assume they had various degrees of severity of ARMD. ARMD was classified according to vision in the better-seeing eye as (1) mild: 20/20 to 20/40, (2) moderate: 20/50 to 20/100, (3) severe: < or = 20/200, or (4) very severe: < or = 20/800.

The utility of strabismus in adults.

Purpose: To determine the utility (quality-of-life weight) associated with adult strabismus.

Methods: Time tradeoff utility values were measured in physician-conducted interviews with 140 adult patients with strabismus in a private practice setting. Patients also completed a questionnaire containing six items that rated the following aspects of disability: specific health problems, problems with tasks of daily living, problems with social interaction, self-image problems, concerns about the future, and job-related problems.

The burden of age-related macular degeneration: a value-based analysis.

Purpose Of Review: The quality-of-life loss and the financial consequences associated with age-related macular degeneration are assessed.

Recent Findings: The quality-of-life loss associated with macular degeneration is markedly underestimated by the general public, nonophthalmic physicians, and ophthalmologists who treat patients with this condition. Mild age-related macular degeneration causes a 17% decrement in the quality of life of the average patient, similar to that encountered with moderate cardiac angina or symptomatic human immunodeficiency virus syndrome.

The cost-utility of photodynamic therapy in eyes with neovascular macular degeneration--a value-based reappraisal with 5-year data.

Purpose: 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).

Design: Average cost-utility analysis utilizing clinical trial data, patient-based time tradeoff utility preferences, and a third party insurer cost perspective.

Methods: Five-year visual acuity data from the TAP (Treatment of Age-related Macular Degeneration With Photodynamic Therapy) Investigation were modeled into a 12-year, value-based, reference case, cost-utility model utilizing year 2004 Medicare costs and an outcome of dollar/QALY (dollars/quality-adjusted life-year).

The management of strabismus in adults--III. The effects on disability.

Introduction: This is the third article in a series on the various facets of the management of strabismus in adults. Here, we give a broad overview of the types and severity of disability and provide initial validation of an instrument (questionnaire) to assess these disability aspects.

Methods: After undergoing strabismus surgery, 101 patients from 6 centers completed a 6-item questionnaire in which they rated both the before-surgery and after-surgery severity of problems associated with their strabismus, ranging from specific health, daily functioning, social interaction, concerns about the future, and self-image to job-related difficulties.

Screening for amblyopia in preverbal children with photoscreening photographs: IV. Interobserver variability in photograph grading: origin and method of reduction.

Background: Earlier detection of childhood vision disorders is a prominent goal of vision screening. The Medical Technology and Innovation (MTI) PhotoScreener addresses this objective. Use of this camera does not require verbal feedback and may be administered early in a child's development.

Age-related macular degeneration: economic burden and value-based medicine analysis.

It can be estimated that 17,100 new cases of neovascular (wet) AMD and 180,000 new cases of geographic-atrophy (dry) AMD occur in Canada annually. In addition to having a devastating effect on patients' lives, the condition causes significant adverse consequences for the economy. The deleterious effect of AMD on quality of life is markedly underestimated by ophthalmologists who treat patients with AMD, by non-ophthalmic physicians and by the public.

The management of strabismus in adults--II. Patient and provider perspectives on the severity of adult strabismus and on outcome contributors.

Purpose: As part of a larger study intended to evaluate the management of strabismus in adults, we documented and compared patient and provider perspectives on the various factors that may contribute to treatment outcome and value of strabismus care.

Methods: By completing a questionnaire, 170 patients with strabismus (ages 19 to 87 years) and 11 strabismus specialists who performed surgery on these patients each indicated the relative weight of several disease- and treatment-related contributors to the outcome and value of care. In addition, each respondent rated the severity of the strabismus before and after surgery.

Reasons for delay of surgical intervention in adult strabismus.

Background: It has been our impression that adult patients with strabismus frequently delay surgical intervention.

Objectives: To determine the length of time adult patients waited before undergoing strabismus surgery and to determine the reasons why these delays occurred.

Design, Setting, And Participants: Prospective survey of consecutive patients who delayed strabismus surgery for more than 1 year.

Nasal myectomy of the inferior oblique muscles for recurrent elevation in adduction.

Purpose: Recurrence of inferior oblique overaction (IOOA) after recession or anterior transposition of the inferior oblique (IO) muscles is a common problem. We have been treating such cases by nasal myectomy of the IO, where a segment of approximately 5 mm is removed from the nasal portion, leaving the temporal portion of the IO with its insertion and its ancillary origin, the neurofibrovascular junction, intact. Here we report long-term findings on this procedure.

The management of strabismus in adults--I. Clinical characteristics and treatment.

Introduction: This is the first in a series of articles intended to evaluate the management of strabismus in adults, including clinical outcomes and the quality, cost, and value of treatment from the perspectives of patients and health care providers. Here we present clinical characteristics, complexity of surgery, treatment success, and resolved complaints in a group of adult patients who underwent strabismus surgery.

Methods: This is a multicenter retrospective study analyzing the type and amount of ocular misalignment before and after surgery in adult patients with strabismus onset before (BVM, or age < 9 years) or after (AVM, or age >/= 9 years) visual maturation.

Anterior and nasal transposition of the inferior oblique muscles.

Background: When performing anterior transposition of the inferior oblique (IO) muscle, placement of the posterior suture close to the lateral border of insertion of the inferior rectus (IR) muscle decreases the incidence of antielevation syndrome (AES). We hypothesized that placement of the suture nasal to the IR muscle insertion will convert the IO muscle into an intorter and depressor. Here we present the first series of results obtained with a new procedure for the treatment of elevation in adduction with extorsion and abnormal head postures.

Intensity and complexity index of disease for strabismus surgery.

Background: The value of health care must be calculated by weighing quality of care with cost of care, and quality of care must be measured not only by objective clinical outcomes but also by resulting health-related quality of life and patient satisfaction. To date, no validated method allows this determination. In this article, we present results of a survey to determine an intensity and complexity index (ICI) for strabismus surgery and discuss how this information can be used in a larger system of determining treatment outcomes and value.

A cost-utility analysis of therapy for amblyopia.

Objective: Evaluation of the incremental cost-effectiveness of therapy for amblyopia.

Design: Cost-utility reference-case analysis.

Methods: A cost-utility analysis was performed from a third-party insurer perspective by using decision analysis, evidence-based data from the literature, and patient preference-based time trade-off utility values.