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Biomedical subjects

R W Beck

Publications and source records attributed to R W Beck.

At least 37 records · Page 2Linked to original sources
PubMed1999

The treatment of traumatic optic neuropathy: the International Optic Nerve Trauma Study.

OBJECTIVE: To compare the visual outcome of traumatic optic neuropathy treated with corticosteroids, treated with optic canal decompression surgery, or observed without treatment. DESIGN: Comparative nonrandomized interventional study with concurrent treatment groups. PARTICIPANTS: A total of 133 patients with traumatic optic neuropathy (127 unilateral and 6 bilateral) who had an initial visual assessment within 3 days of injury. At least 1 month of follow-up was required for inclusion in the primary analysis. INTERVENTIONS: On the basis of treatment received within 7 days of injury, patients with unilateral injuries were categorized as being in one of three treatment groups: untreated (n = 9), corticosteroid (n = 85), or optic canal decompression surgery (n = 33). MAIN OUTCOME MEASURE: Visual acuity. RESULTS: Visual acuity increased by > or = 3 lines in 32% of the surgery group, 57% of the untreated group, and 52% of the steroid group (P = 0.22). The surgery group had more patients whose initial vision was no light perception. After adjustment for the baseline visual acuity, there were no significant differences between any of the treatment groups. There was no indication that the dosage or timing of corticosteroid treatment or the timing of surgery was associated with an increased probability of visual improvement. CONCLUSIONS: No clear benefit was found for either corticosteroid therapy or optic canal decompression surgery. The number of patients studied was sufficient to rule out major effects in the treatment groups, although clinically relevant effects in specific subgroups could have been missed. These results and the existing literature provide sufficient evidence to conclude that neither corticosteroids nor optic canal surgery should be considered the standard of care for patients with traumatic optic neuropathy. It is therefore clinically reasonable to decide to treat or not treat on an individual patient basis.

Adult↗
PubMed1998

The natural history of acute traumatic sixth nerve palsy or paresis.

BACKGROUND: Spontaneous resolution of traumatic sixth nerve palsy or paresis has been reported to range between 12% and 54%. However, previous studies have been based in tertiary referral centers, have been retrospective in nature, have included a heterogeneous group of patients, and have included patients with long-standing palsies. To provide a more accurate estimate of the true recovery rate, we performed a prospective natural history study. METHODS: All members of the American Association for Pediatric Ophthalmology and Strabismus and the North American Neuro-Ophthalmology Society were invited to enroll patients with acute traumatic sixth nerve palsy or paresis between March 1996-February 1997. Recovery at 6 months after injury was defined as absence of diplopia in primary position and less than or equal to 10 PD distance esotropia in primary position. Patients who had been treated with botulinum toxin (n = 8) within 6 months after injury and patients with <6 months of follow-up (n = 3) were excluded. RESULTS: Thirty-three eligible patients were enrolled by 27 investigators. Twenty-five (76%) of the palsies were unilateral and 8 (24%) were bilateral. The overall spontaneous recovery rate was higher than previously reported (73%, 95% CI 54%-87%). Spontaneous recovery was more frequent in unilateral cases (84%, 95% CI 64%-95%) than in bilateral cases (38%, CI 9%-76%; P = .02). CONCLUSIONS: In this prospective multicenter study of acute traumatic sixth nerve palsy or paresis, the overall spontaneous recovery rate, particularly in unilateral cases, was much higher than previously reported. Our results have important sample size implications for the planning of any randomized treatment trial and may help guide early treatment decisions.

Abducens Nerve Diseases↗
PubMed1998

Effect of a transient, geographically localised economic recovery on community health and income studied with longitudinal household cohort interview method.

STUDY OBJECTIVE: The main purpose of the study was to determine whether the health or economic status of a cohort of residents in an economically troubled geographical area changed between 1990 and 1993. DESIGN: Longitudinal, single cohort, interview survey method with the key variables of health status and economic status. Quasi-experimental pre-post design with economic rebound as the intervention. SETTING: A relatively low income geographical area in a rural, mountainous region before and after an economic rebound. In 1990, the local economy and health care system collapsed because of the closure of a series of manufacturing plants; outward migration from the area peaked. Between 1990 and 1993, new industries opened, and state and private community assistance programmes intervened, resulting in an economic rebound, migration into the area, and marked growth of the health service sector. PARTICIPANTS: A 2% sample of residents of households, using a combination of random, stratified, and clustered sampling. Residents included in the study had lived within the area throughout the 1990-1993 period of the study. MAIN RESULTS: Stable, non-migrating residents had a statistically significant 7% reduction in health status between 1990 and 1993, as measured by a composite of subjective and objective measures. The non-migrating residents also had a significant decrease in average household income ($14,700 in 1990 and $12,400 in 1993 in constant 1990 dollars) during the strong economic expansion, and therefore did not participate in or receive direct economic benefit from the expansion. There was a rapid population increase during the expansion, attributable to inward migrants who were younger and healthier than existing residents. The decline in health for the non-migrating residents was tentatively attributed to either direct or indirect effects of the decline in family income. CONCLUSIONS: Local economic development accompanied by expanded health care services availability can leave existing area residents poorer and less healthy, and this problem may be masked by an abundance of healthier, wealthier inward migrants.

Adolescent↗
PubMed1998

The predictive value of CSF oligoclonal banding for MS 5 years after optic neuritis. Optic Neuritis Study Group.

The predictive value of CSF oligoclonal banding for the development of clinically definite MS (CDMS) within 5 years after optic neuritis was assessed in 76 patients enrolled in the Optic Neuritis Treatment Trial. The presence of oligoclonal bands was associated with the development of CDMS (p = 0.02). However, the results suggest that CSF analysis is only useful in the risk assessment of optic neuritis patients when brain MRI is normal and is not of predictive value when brain MRI lesions are present at the time of optic neuritis.

Adolescent↗
PubMed1997

Visual symptoms after optic neuritis. Results from the Optic Neuritis Treatment Trial.

As part of the Optic Neuritis Treatment Trial, vision-specific quality-of-life data were collected on the patients at their 6-month visits. The purpose of this study was to determine the types of visual tasks in day-to-day living in which patients have difficulty and to compare the patients' subjective assessment of visual impairment with measurements of visual acuity, contrast sensitivity, mean deviation, and color vision. The questionnaire was completed by 382 (87%) of the 438 patients who had 6-month study visits. Associations between ophthalmic test scores and self-reported vision were examined using both a summary problem index and selected individual items. Although a substantial percentage of the patients (63%) indicated that vision had not recovered to normal in the affected eye, the reported visual deficits generally were mild. For most of the visual tasks of daily living, patients reported little or no problem. Among the 215 patients who perceived their vision at 6 months to be somewhat or much worse than it was before optic neuritis, 20% had normal results on none of the four visual function tests, 14% had normal results on one of the four tests, 23% had two of four, 23% had three of four, and 20% had normal results on all four. Reported visual symptoms 6 months after optic neuritis generally were mild. When patients were symptomatic, the four visual function tests often did not detect abnormality. This finding supports previous reports that visual deficits are frequently perceived even when vision testing is normal.

Adult↗
PubMed1997

Aspirin therapy in nonarteritic anterior ischemic optic neuropathy.

PURPOSE: To determine the benefit of aspirin in reducing the risk of nonarteritic anterior ischemic optic neuropathy in the fellow eye following its occurrence in the first eye. METHODS: A retrospective cohort study was conducted on 431 patients, 153 of whom were and 278 of whom were not prescribed aspirin following the development of unilateral nonarteritic anterior ischemic optic neuropathy. RESULTS: The 2-year cumulative probability of nonarteritic anterior ischemic optic neuropathy in the fellow eye was 7% in the aspirin group and 15% in the no-aspirin group, and 5-year cumulative probabilities were 17% and 20%, respectively. Compared with the no-aspirin group, the rate ratio for nonarteritic anterior ischemic optic neuropathy in the fellow eye in the aspirin-user group was 0.43 (95% confidence interval, 0.19 to 0.92) over the first 2 years and 0.68 (95% confidence interval, 0.36 to 1.26) over the 5-year period. The overall calculated 5-year risk was 19%; however, if none of the patients with incomplete follow-up developed nonarteritic anterior ischemic optic neuropathy in the fellow eye, then the 5-year risk would be about 12%. CONCLUSIONS: The 5-year risk of nonarteritic anterior ischemic optic neuropathy occurring in the second eye is far lower than that reported by previous studies. Our results suggest a possible short-term but little or no long-term benefit to aspirin in reducing the risk of nonarteritic anterior ischemic optic neuropathy in the fellow eye. However, this finding must be viewed with caution because this study was not conducted prospectively with a controlled protocol.

Aspirin↗
PubMed1997

Cataract progression in India.

AIMS: The study was undertaken to test the feasibility of using the LOCS III cataract grading scale in the field and to determine the rate of cataract progression over a 1 year period of time. METHODS: For 150 subjects between the ages of 33 and 55 who attended the refraction clinic at Aravind Eye Hospital in Madurai, India, lens abnormalities were graded at the slit lamp using the LOCS III scale. One year later, 99 of the subjects were re-evaluated by the same methodology to assess the amount of lens change. RESULTS: Interrater reliability was high. A change of 0.5 or more in lens colour, cortical, nuclear, or posterior subcapsular cataract was observed in at least one eye of 54% of the subjects. CONCLUSION: The LOCS III grading scale is a feasible method for measuring lens changes in the field with the slit lamp. Cataract progression in India is rapid enough to permit intervention studies to be performed with relatively small numbers of subjects over a short period of time (that is, 600 subjects for 2 years).

Adult↗
PubMed1996

Control of familywise errors in multiple endpoint assessments via stepwise permutation tests.

We describe permutation based sequentially rejective multiple comparison procedures useful in multiple endpoint assessments. We used Monte Carlo methods to compare the power of these newly devised tests to that of tests due to Holm and Rom as well as to the classical Bonferroni method. We illustrate applications of the methods with analysis of visual field data collected from optic neuritis patients. We conclude that the new methods are particularly useful when there are many endpoints involved, the data are significantly correlated, and/or the distributional assumptions are questionable.

Adolescent↗
PubMed1996

Uveitis associated with topical beta-blockers.

OBJECTIVE: To assess the incidence of uveitis associated with topical beta-blockers. DESIGN: Retrospective cohort study. SETTING: A computerized database of a health maintenance organization was used to identify patients who were prescribed metipranolol or other beta-blockers. PATIENTS: Two groups: 1928 patients using 0.3% metipranolol and 3903 patients using other beta-blockers. MAIN OUTCOME MEASURE: Cases of uveitis were identified by noting a prescription of a topical corticosteroid and then conducting a chart review. RESULTS: No cases of uveitis were identified among the 5831 patients. The upper limits of the 95% confidence intervals for the incidence of uveitis in cohorts of this size are 1.87 cases per 1000 person-years of exposure for metipranolol and 1.38 for other beta-blockers. CONCLUSION: Drug-induced uveitis from metipranolol or other beta-blocker administration is a rare event, even if a causal relationship exists.

Administration, Topical↗
PubMed1996

Contrast sensitivity and other vision tests in the optic neuritis treatment trial.

PURPOSE: To determine the intercorrelation, prevalence of abnormality, and incremental detection value of vision tests in optic neuritis. METHODS: We calculated the linear correlation of paired vision tests and prevalence of abnormal test values from baseline and six-month measurements of Snellen visual acuity, Pelli-Robson contrast sensitivity, Humphrey Field Analyzer mean deviation, and Farnsworth-Munsell 100-hue color vision in 438 patients entered in the Optic Neuritis Treatment Trial from 1988 to 1991. The incremental detection value of nonvisual acuity tests was defined as their frequency of abnormality when visual acuity was 20/20 or better. RESULTS: All four vision-test results were highly intercorrelated at baseline and at six months. At baseline, contrast sensitivity had the highest prevalence of abnormality, but all vision tests were so often abnormal that differences were not clinically relevant. At six months, when visual recovery had occurred, contrast sensitivity was most often abnormal (2.2 X visual acuity; 1.8 X mean deviation; 1.5 X Farnsworth-Munsell 100-hue color vision test); when contrast sensitivity, mean deviation, or Farnsworth-Munsell 100-hue color vision was normal, visual acuity was 20/25 or better in 98% of patients. CONCLUSIONS: The high intercorrelation of four vision tests suggests that optic neuritis affects a broad range of visual functions. Among non-visual acuity tests, Pelli-Robson contrast sensitivity proved to be a particularly practical and sensitive indicator of visual dysfunction in optic neuritis.

Adolescent↗
PubMed1996

Remote clinic/patient monitoring for multicenter trials. Optic Neuritis Study Group.

Clinic monitoring is essential for the quality control of multicenter clinical trials. In studies of eye diseases, certification of visual function testers is integral to such monitoring. Routine site visits, while useful for evaluating clinic performance and certifying visual function testers, are expensive and not suitable for every study. As part of the Longitudinal Optic Neuritis Study (LONS), a follow-up study of the patients entered into the Optic Neuritis Treatment Trial (ONTT), we established a central system for clinic monitoring and visual function tester certification in lieu of performing site visits. We also established a centralized and well-defined system for maintaining patient contact in an attempt to enhance follow-up visit compliance. Both have been used over the first three years of the LONS. Coordinators at two of the participating clinical centers were selected to serve as regional coordinators; each was responsible for overseeing seven or eight clinics and 200 patients. Annually by phone these coordinators perform certification of each technician's visual function testing. Clinic monitoring is performed by monthly phone calls. Conference calls involving each clinic's personnel, the regional coordinator, and Data Coordinating Center personnel are held one or two times per year. Patient phone contact at four-month intervals between annual patient exams is done to evaluate visual and general health status, to review study information, and to coordinate and encourage annual protocol exams at the respective centers. This system has helped achieve a visit completion rate of over 90% for active study patients. Patient phone contact by the regional coordinators has been well received. Telephone certification of visual function technicians by the regional coordinators appears to be as effective as on-site certification. Clinic performance appears to be continuing at the same high level as during the period of annual site visits. Although site visits are valuable for clinical trials, if routine site visits are not feasible the methods we have implemented for remote monitoring may be useful.

Appointments and Schedules↗
PubMed1996

The relationships among gender, perceived financial barriers to care, and health status in a rural population.

This study examined the relationships among gender, perceived financial barriers to health care, and selected health status indicators in a randomly selected rural Appalachian sample. The data were gathered through the Johnson County Health Survey. The survey was conducted through personal interviews with 207 females and 178 males representing 197 households. The Duke Health Profile was used to measure the perceived health of the respondents. Analysis of variance, t tests, and descriptive statistics were used to analyze the data. Analysis of the data revealed that women perceive financial barriers to health care significantly more than men (P < 0.01), even when living in the same household; women had significantly poorer health than men (P < 0.01); and both women and men with perceived financial barriers experienced poorer health (P < 0.01) than those who did not perceive such barriers. Conclusions from the study suggest that in this rural sample women were the most compromised by both gender and health status, and that they perceived that their health care needs were not being adequately met.

Community Health Centers↗