No abstract

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BACKGROUND AND OBJECTIVE: To evaluate the financial sustainability of teleophthalmology screening for diabetic retinopathy (DR) using telehealth billing codes. PATIENTS AND METHODS: The authors performed an Institutional Review Board-approved retrospective review of medical records, billing data, and quality metrics at the University of California Davis Health System from patients screened for DR through an internal medicine-based telemedicine program using CPT codes 92227 or 92228. RESULTS: A total of 290 patients received teleophthalmology screening over a 12-month period, resulting in an increase in the DR screening rate from 49% to 63% ( P < .0001). The average payment per patient was $19.86, with an estimated cost of $41.02 per patient. The projected per-patient incentive bonus was $43.06 with a downstream referral revenue of $39.38 per patient. One hundred seventy-eight clinic visits were eliminated, providing an estimated cost savings of $42.53 per patient. CONCLUSION: Sustainable teleophthalmology screening may be achieved by billing telehealth codes but only with health care incentive bonuses, patient referrals, and by accounting for the projected cost-savings of eliminating office visits. [ Ophthalmic Surg Lasers Imaging Retina. 2020;51:S26–S34.]

BACKGROUND AND OBJECTIVE: To determine if age-related macular degeneration (AMD) status affects longitudinal retinal vessel changes. PATIENTS AND METHODS: Retrospective, cohort study of 125 eyes (75 patients) with AMD, following retinal vessel density (VD) and foveal avascular zone (FAZ) measurements using optical coherence tomography angiography (OCT-A) over 24 months. RESULTS: FAZ area ( P < .001) and perimeter ( P < .001) increased over 2 years, with no difference between nonexudative and exudative AMD ( P = .134–.976). Eyes with geographic atrophy (GA) showed greater progressive VD loss ( P = .023–.038), and greater increase in FAZ area ( P = .044) and perimeter ( P = .040) compared to eyes without GA. Neither baseline nor 2-year change in vascular parameters were associated with choroidal neovascularization (CNV) or GA incidence in nonexudative AMD, or anti-VEGF injection frequency in exudative AMD ( P = .070–.952). CONCLUSION: AMD eyes with GA undergo more rapid loss of retinal vessel density and FAZ enlargement over 2 years, suggesting a relationship between the retinal vasculature and AMD pathophysiology. [ Ophthalmic Surg Lasers Imaging Retina 2022;53:529–536.]

Objective: Perceived stress, lower fruit intake, and comfort eating are all risk factors for chronic disease. The present pilot study aimed to simultaneously mitigate all three risk factors by applying Pavlovian conditioning to change the nature of comfort eating. Specifically, stressed participants underwent a Pavlovian conditioning intervention designed to elicit comforting effects of fruit intake and thereby reduce negative mood while promoting fruit intake. Methods: We developed a seven-dose Pavlovian conditioning intervention wherein participants temporally paired together Progressive Muscle Relaxation (unconditioned stimulus) with fruit intake (conditioned stimulus) daily for 1 week. Participants (N = 100, mean [standard deviation] age = 20.7 [4.6] years; 74% female) with moderate to high levels of baseline perceived stress were randomized to the intervention or an active explicitly unpaired control group, wherein the Progressive Muscle Relaxation and fruit intake also occurred but were not temporally paired together. After the intervention, participants' negative mood was assessed immediately before and after fruit intake to assess conditioning effects. Then, participants logged their regular food intake for 4 days using the MyFitnessPal smartphone app. Results: After the intervention, fruit intake acutely improved negative mood to a greater extent among the intervention versus control group (F(1,98) = 3.99, p = .048, η 2 p = 0.039). However, there was not a significant between-group difference in intake of fruit or traditional comfort foods at postintervention. Conclusions: Repeated pairing of fruit intake with a reliable distress-reducing activity led to the conditioning of comforting effects of fruit intake. Further refinement of the intervention design is necessary to translate this conditioned association to actual intake of fruit and other foods.