Publications by authors named "Paul P Lee"
Importance: National estimates regarding the frequency of presentations and patterns of care for eye pain are unknown. This information could guide research and clinical efforts to optimize outcomes.
Objective: To estimate eye pain visits in the US in the outpatient and emergency department (ED) settings.
Purpose: To develop and validate a novel patient-reported outcome (PRO) measure to assess vision-related functioning in individuals with severe peripheral field loss (PFL).
Design: Prospective outcome measure development/validation study.
Methods: A 127-item questionnaire was developed based on a prior qualitative interview study.
Purpose: To assess the efficacy of the Support, Educate, Empower (SEE) glaucoma coaching program on medication adherence among poorly adherent patients with glaucoma for 12 months after cessation of the intervention.
Design: Uncontrolled intervention study with a pre-post design.
Participants: The SEE cohort was recruited from the University of Michigan and included patients with glaucoma aged ≥ 40 years, taking ≥ 1 medication, who self-reported poor adherence.
Importance: In 2019, the US Centers for Medicare & Medicaid Services implemented the Patients Over Paperwork initiative, allowing hospitals and ambulatory surgery centers to establish their own policies on preoperative history and physical requirements. A risk-based approach to preoperative medical evaluation may allow surgeons to provide high-value patient care.
Objective: To assess the feasibility of a risk-based approach to cataract surgery preoperative medical evaluation through a lens of safety and throughput.
Purpose: To assess the accuracy of 5 subjective self-assessment tools (3 adherence measures and 2 psychometric scales) and pharmacy refill data in predicting objective electronically monitored nonadherence.
Design: Prospective cohort study.
Participants: Glaucoma patients (> 40 years old, >1 medication with poor self-reported adherence) were recruited from University of Michigan Kellogg Eye Center for a study assessing the impact of a personalized glaucoma coaching program on medication adherence.
Purpose: To assess the relationship between telemedicine utilization and sociodemographic factors among patients seeking eye care.
Design: Comparative utilization analysis.
Methods: We reviewed the eye care utilization patterns of a stratified random sample of 1720 patients who were seen at the University of Michigan Kellogg Eye Center during the height of the COVID-19 pandemic (April 30 to May 25, 2020) and their odds of having a video, phone, or in-person visit compared with having a deferred visit.
Importance: Emerging vision scientists who have yet to be awarded their first independent funding may have their research careers disproportionately affected by early COVID-19-related disruptions. In September 2020, the Alliance for Eye and Vision Research convened a panel of 22 such scientists (nominated by their academic institutions) to communicate to the US Congress about the importance of vision research. As part of the effort, interviews were conducted with scientists about the effect of the pandemic on their research.
View Article and Find Full Text PDFPurpose: To investigate whether demographic, clinical, or psychosocial factors act as moderators of change in medication adherence in the Support, Educate, Empower (SEE) program.
Design: Prospective, single-arm pilot study with a pre-post design.
Participants: Patients with glaucoma aged ≥ 40 years and taking ≥ 1 glaucoma medication were recruited from the University of Michigan Kellogg Eye Center.
The Burden of Caring for and Treating Glaucoma: The Patient Perspective.
Ophthalmol Glaucoma
April 2022
Purpose: To understand the treatment burden experienced by patients receiving care for primary open-angle glaucoma.
Design: Semistructured, one-on-one, qualitative interviews.
Participants: Patients with primary open-angle glaucoma and age ≥40 years who were scheduled for a follow-up glaucoma appointment at the Kellogg Eye Center.
Background: Existing patient-reported outcome (PRO) measures may not be relevant to the full range of functional and vision-related quality of life (VR-QOL) concerns of individuals with vision impairment due to severe peripheral field loss (PFL). Measurement of VR-QOL in severe PFL is important in order to determine the effectiveness of vision rehabilitation interventions for this population. The purpose of this study was to characterize the impact of severe PFL due to retinitis pigmentosa (RP) and glaucoma on VR-QOL as the initial phase in the development of a novel PRO measure.
View Article and Find Full Text PDFPurpose: To assess the efficacy of the Support, Educate, Empower (SEE) glaucoma coaching program on medication adherence among glaucoma patients with low adherence.
Design: Uncontrolled intervention study with a pre-post design.
Participants: Glaucoma patients ≥ age 40, taking ≥1 medication, who self-reported poor adherence were recruited from the University of Michigan Kellogg Eye Center.
Ophthalmic clinicians report low confidence in telemedicine-based eye care delivery, but it may have changed given its rapid expansion during the coronavirus 2019 (COVID-19) pandemic. The purpose of this study was to determine clinician confidence in telemedicine-based eye care services during COVID-19. An electronic survey was sent to clinicians at University of Michigan Kellogg Eye Center (April 17, 2020-May 6, 2020) when nonemergent in-person visits and procedures were restricted.
View Article and Find Full Text PDFPurpose: Timely mammography to screen for breast cancer in accordance with the United States Preventive Services Task Force (USPSTF) recommendations can reduce morbidity and mortality substantially. This study assessed whether the odds of undergoing screening mammography are similar for women with and without visual impairment (VI).
Design: Retrospective, longitudinal cohort study.
Importance: During the coronavirus disease 2019 (COVID-19) pandemic, eye care professionals caring for patients with sight-threatening diseases, such as glaucoma, have had to determine whether some patient appointments could safely get postponed, weighing the risk that the patient's glaucoma could worsen during the interim vs the morbidity risk of acquiring COVID-19 while seeking ophthalmic care. They also need to prioritize appointment rescheduling during the ramp-up phase (when pandemic-associated service reductions are eased).
Objective: To describe a flexible and scalable scoring algorithm for patients with glaucoma that considers glaucoma severity and progression risk vs the presence of high-risk features for morbidity from COVID-19, using information from a large data repository.
Importance: Using corticosteroids to treat acute demyelinating optic neuritis has been identified as an area for shared decision-making. However, no analysis exists to support personalized shared decision-making that considers long- and short-term treatment benefits.
Objective: To develop models of individual-level visual outcomes for patients with optic neuritis.
Purpose: The majority of patients with glaucoma do not take their medications as prescribed. Estimates of the cost-utility value of adherence to prescribed glaucoma medication are vital to implement potentially effective interventions.
Design: Cost-utility analysis using Monte Carlo microsimulations incorporating a series of Markov cycles (10 000 iterations per strategy).
Importance: Patients with vision loss who are hospitalized for common illnesses are often not identified as requiring special attention. This perception, however, may affect the outcomes, resource use, and costs for these individuals.
Objective: To assess whether the mean hospitalization lengths of stay, readmission rates, and costs of hospitalization differed between individuals with vision loss and those without when they are hospitalized for similar medical conditions.
Purpose: The purpose of this study was to characterize a pilot program using e-health to monitor glaucoma suspects in a large integrated health system.
Methods: A retrospective chart review of patients enrolled in the first 2 years of a new glaucoma suspect telemedicine monitoring program was conducted. Patients were enrolled in the program after being diagnosed as glaucoma suspects in the regular clinic setting and were eligible for the program if they had better than 20/40 vision, intraocular pressure (IOP) <25 mmHg, a normal baseline visual field, and an optical coherence tomography (OCT) retinal nerve fiber layer (RNFL) without clear evidence of glaucomatous optic nerve damage.
Purpose: The purpose of this study was to ascertain determinants of unreadable fundus images for participants enrolled in the Philadelphia Telemedicine Glaucoma Detection and Follow-up Study.
Methods: Individuals were screened for glaucoma at 7 primary care practices and 4 Federally Qualified Health Centers using telemedicine. Screening (visit 1) included fundus photography, assessing family history of glaucoma, and intraocular pressure (IOP) measurements.
Background: About half of people with glaucoma do not adhere to their recommended medications. Interventions for other chronic conditions have successfully utilized reminder systems and motivational interviewing (MI)-based counseling. This study was designed to pilot a personalized intervention that leverages these strategies to assess their impact on medication adherence in glaucoma patients.
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