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Daniel J Ozzello, Jason R Kolfenbach, Alan G Palestine; Uveitis specialists and rheumatologists differ in their treatment of unilateral anterior scleritis. Invest. Ophthalmol. Vis. Sci. 2016;57(12):1880.
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There is little data from controlled studies to guide evidence-based management of anterior scleritis. Both uveitis specialists and rheumatologists may be involved in the care of patients with this condition, and treatment options vary in their cost. We hypothesized that the two groups of specialists would prefer different treatments for the condition and that cost would impact management decisions, and we performed a cross-sectional, survey-based observational study to test these questions.
1044 uveitis specialists and rheumatologists across the United States were surveyed via email regarding their choice in long-term therapy for a hypothetical patient with unilateral nodular scleritis without systemic involvement. Respondents were asked to select first and second choice therapies and then re-select first and second choices assuming cost of all options was equal to the patient and there would be no issues with insurance prior authorization. Outcomes of interest were differences in therapy choice based on specialty practice and based on cost/prior authorization considerations. Fisher exact tests were employed to compare treatment selections.
Ninety-two respondents (8.6%) completed the survey; thirty-six were uveitis specialists and fifty-six were rheumatologists. Methotrexate was the most-selected first-choice treatment for scleritis both before and after equalization of cost/insurance considerations among uveitis specialists (44.4%, 38.9%) and rheumatologists (78.6%, 60.7%). Uveitis specialists selected mycophenolate mofetil at a higher rate both before and after equalization of cost/insurance factors (27.8%, 27.8%) than did rheumatologists (5.3%, 7.1%). The difference between the specialties in their usage of methotrexate (p=0.009) and mycophenolate mofetil (p=0.015) was significant before equalization of cost/insurance factors. Cost and insurance considerations did not significantly affect treatment selection. Of note, five uveitis specialists (13.9%) and two rheumatologists (3.6%) selected steroid injections as their first-choice therapy both before and after equalization of cost/insurance.
Uveitis specialists and rheumatologists have different preferences in the treatment of unilateral nodular scleritis. The difference in selection of therapy appears to be more impacted by specialty practice than by cost/insurance considerations.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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