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Sandra M Brown

Publications and source records attributed to Sandra M Brown.

At least 19 recordsLinked to original sources
PubMed2026

Management of complex lipid disorders in a community lipid clinic setting: Implementing a multidisciplinary model.

BACKGROUND: Large treatment gaps exist in the management of lipid disorders, and many high-risk patients have factors that complicate management efforts. While lipid clinics exist within academic medical centers, most of these patients are cared for in community settings. OBJECTIVE: To report our experience and results managing challenging and complex lipid disorders in a community-based lipid clinic. METHODS: We established a specialized lipid clinic in a community medical setting, with a focus on patients with management challenges and/or suspicion of a genetic lipid disorder, employing a multidisciplinary approach to optimize patient outcomes, emphasizing appropriate medical therapies and lipid genetic testing in selected patients. Retrospective electronic health record data were collected to analyze patient characteristics, treatment patterns, and lipid results. RESULTS: Over the period 2022 through 2024, 183 patients were seen (mean 63 years, 62% female). The challenging nature of the patient population was highlighted by high rates of statin intolerance (50%), no lipid medical therapy at baseline (50%), and comorbidities (atherosclerotic cardiovascular disease [ASCVD], diabetes, and/or hypertension-61%). Despite this, over a mean follow-up of 9.4&#xa0;&#xb1;&#xa0;7.3 months, we observed a mean low-density lipoprotein cholesterol&#xa0;decrease of 49&#xa0;mg/dL (-24.5%, P&#xa0;<&#xa0;.001), along with significant decreases in total cholesterol and triglycerides. Pathogenic dyslipidemia genetic variants were discovered in 21 patients (of 105 tested). Significant lipid improvements in the whole cohort, as well as multiple subgroups, were associated with greater utilization of combination therapies. CONCLUSION: Patients with complex lipid disorders can be successfully managed within a specialized lipid clinic in community medical settings. Applying such a multidisciplinary model outside of traditional academic medical centers offers the potential to raise the level of lipid management and ASCVD prevention more broadly in larger populations.

Combination medical therapy↗
PubMed2006

Opaque contact lens treatment for older children with amblyopia.

PURPOSE: To investigate the usefulness of daily-wear opaque contact lens treatment for older children with amblyopia. METHODS: A retrospective chart review of all children undergoing opaque contact lens therapy for amblyopia between 2000 and 2003 was performed. All patients were included except for those younger than 5 years of age, those undergoing maintenance treatment only, those lost to follow-up, or those unable to cooperate with Snellen visual acuity testing. RESULTS: Thirteen children were identified, and seven met the inclusion criteria. The seven patients had a mean age of 7.5 years (range, 5.7-8.7 years). The causes of amblyopia were anisometropia (five patients), cataract (one patient), and strabismus (one patient). For all seven patients, the mean logMAR improvement in visual acuity was 0.52 (range, 0.26-1.22). The average duration of opaque contact lens use was 9.3 months (range, 2-21 months). Compliance problems were encountered in three patients. No major complications occurred, but one patient had an episode of mild superficial punctate keratitis. CONCLUSIONS: Daily-wear opaque contact lens treatment is a useful occlusion method for amblyopia treatment in older children with various practical and social impediments to skin patching. Meaningful improvement in visual acuity can be obtained, even in children older than 8 years of age.

Amblyopia↗
PubMed2005

Normal values for Octopus tendency oriented perimetry in children 7 through 13 years old.

BACKGROUND: The purpose of this study was to determine age-dependent values for mean sensitivity, mean deviation, and loss variance for normal children age 6 through 13 years, using the Octopus 301 perimeter and the Tendency Oriented Perimetry 32 (TOP-32) program. METHODS: Healthy children from 6 through 13 years of age with a visual acuity of 20/20 OU and at least 60 arc seconds of stereopsis were recruited. They were tested on the Octopus 301 perimeter using the TOP-32 program, and each eye was tested twice during one session. Results for all four tests were averaged for each subject, and the average was used for statistical analysis. The main outcome measures were mean sensitivity, mean deviation, and loss variance by age. The test duration, learning and fatigue effects, and the influence of false positive responses on the average mean sensitivity were also analyzed. RESULTS: There were 142 subjects tested. Six-year-old children showed high intersubject variability and were excluded (N=23). The average age of the remaining 7- to 13-year-old cohort (N=119) was 9.8 +/- 1.7 years. The average test duration was 2.9 +/- 0.3 min. The average mean sensitivity was 28.7 +/- 1.9 dB. The mean sensitivities for tests 1 through 4 were 28.14, 28.63, 28.96, and 28.92 dB, respectively. The average mean deviation was 0.4 +/- 1.9 dB. The slope of the regression line for mean sensitivity vs age was -0.018 +/- 0.165 dB/year, which was not significantly different from zero (two-tailed t test, p=0.83). The false positive catch trial rate was high (mean 26%) and was independent of age. When the data from subjects who had more than two false positive catch trial responses on any one test were eliminated, the mean sensitivity decreased to 28.3 +/- 1.9 dB. CONCLUSIONS: When testing patients age 7 through 13 years on the Octopus 301 perimeter using the TOP-32 program, comparison against the programmed normal mean sensitivity value for 20-year-old subjects (29.0 dB) is appropriate. During a sequence of four tests, both learning and fatigue effects are evident. The false positive response rate is naturally high regardless of age, and children should not be overencouraged to respond during testing.

Adolescent↗
PubMed2005

Visual field changes after laser in situ keratomileusis.

PURPOSE: To determine whether laser in situ keratomileusis (LASIK) affects the central 30-degree visual field. SETTING: University-based ophthalmology practice. METHODS: This nonrandomized clinical trial comprised 14 normal patients (27 eyes) scheduled to have LASIK for myopia or myopic astigmatism. Automated static perimetry was performed before and 6 months after surgery using the Octopus 1-2-3 perimeter and the Dynamic-32 test strategy. Patient data included sex, age, preoperative and postoperative refractive errors, preoperative and postoperative best corrected visual acuity, preoperative corneal thickness, programmed optical zone, programmed total ablation diameter, and duration of microkeratome suction. All surgery was performed using the same Alcon LADARVision 4000 excimer laser. The main outcome measures were the mean sensitivity (MS) change in the central 15-degree visual field and the MS change in the 15- to 30-degree visual field. A multivariate analysis of the MS change as a function of preoperative clinical parameters was performed. RESULTS: There was no significant change in the MS in the central 15-degree visual field; between 15 and 30 degrees, there was a statistically significant decrease of -0.82 dB +/- 1.40 (SD) (P=.01, 2-tailed t test). The decline in MS was positively correlated with refractive error and corneal thickness; it was negatively correlated with the programmed optical zone diameter. CONCLUSIONS: Automatic static perimetry can detect decreased sensitivity in the midperipheral visual field after myopic LASIK. It may be a useful quantitative subjective test for measuring the effects of future improvements in surgical technique on vision quality.

Adult↗
PubMed2005

Six-month variability of the dark-adapted pupil diameter.

PURPOSE: To determine the individual variability of the dark-adapted pupil diameter over 6 months using a standardized dark-adaptation protocol. SETTING: Texas Tech University Health Sciences Center, Lubbock, Texas, USA. METHODS: This prospective observational cohort study comprised volunteers with no history of ocular disease, surgery, or injury other than requirement for refractive correction. The right eye was tested. A standardized dark-adaptation protocol was used that controlled for accommodation and patient alertness. Infrared, still digital photographs were taken after 10 minutes of dark adaptation at 1 lux and were analyzed using digital image software. Testing was performed at baseline in the afternoon, at 3 months in the afternoon, and at 6 months in the morning. Lifestyle factors such as diet and exercise were not controlled. RESULTS: Mean intersession differences were 0.04 mm (95% confidence interval [CI]: -0.68-0.146), 0.15 mm (95% CI: -0.001-0.297), and 0.09 mm (95% CI: -0.048-0.236) for baseline-3 month, baseline-6 month, and 3 month-6 month comparisons, respectively. None of these differences was significantly different from zero (P>.05, 2-tailed Student t tests). The likelihood that the mean intersession difference was >.25 mm was negligible for all comparisons (P=.9996, .9099, and .9829 respectively, 1-tailed Student t tests). CONCLUSION: When a consistent dark-adaptation protocol that controls for alertness and accommodation is used, normal young individuals showed no significant variation in the dark-adapted pupil diameter over a 6-month period.

Accommodation, Ocular↗
PubMed2005

Comparison of Colvard pupillometer and infrared digital photography for measurement of the dark-adapted pupil diameter.

PURPOSE: To investigate the accuracy of pupil diameter measurement using the Colvard pupillometer and to determine the learning curve for inexperienced examiners. SETTING: Texas Tech University Health Sciences Center, Lubbock, Texas, USA. METHODS: In this population study, subjects with normal pupillary behavior were tested by 1 of 2 investigators (examiner A, examiner B). After 5 minutes of dark adaptation at 1 lux, digital infrared pupil photography of the right eye was performed, followed by measurement of the horizontal pupil diameter and vertical pupil diameter with the Colvard pupillometer. The photographs were digitally analyzed to determine the horizontal and vertical pupil diameters. During phase I of the study, examiners were masked to the results of infrared pupil photography; during phase II, they reviewed the infrared pupil photography results after each testing session. Bland-Altman plots were created to detect measurement bias; results were graphed by subject test sequence to assess learning. A test difference of less than +/-0.5 mm was considered clinically acceptable. RESULTS: Fifty-nine subjects were tested in phase I, of whom 39 had adequate infrared pupil photography for analysis; 40 were tested in phase II, of whom 34 were included. The mean age of the analyzed subjects was 27 years (range 18 to 44 years). For all subjects, the infrared pupil photography median horizontal pupil diameter was 7.09 mm +/- 0.75 (SD) (range 5.44 to 8.79 mm); the median vertical pupil diameter was 7.22 +/- 0.79 mm (range 5.45 to 9.10 mm). Examiner A initially had a negative bias (Colvard pupillometer value less than infrared pupil photography value) for both horizontal and vertical pupil diameter measurements, which resolved during phase I after 23 subjects were tested; 18 of the final 19 subjects tested (11 phase I, 8 phase II) showed a test difference of less than 0.5 mm for all readings. The pupil diameter did not affect the bias. Examiner B had a strong positive bias that persisted throughout the study. Testing 26 subjects in 5 sessions during phase II did not improve the accuracy. During the final testing session, 3 of 8 subjects had a test difference of 0.5 mm or more in at least 1 dimension. The pupil diameter did not affect the bias. CONCLUSION: The Colvard pupillometer is susceptible to user errors causing unidirectional bias and seems to have a steep and variable learning curve.

Adolescent↗