Joseph M. Simonett, MD; Alison H. Skalet, MD, PhD; Brandon J. Lujan, MD; et al.
doi : 10.1001/jamaophthalmol.2020.5329
JAMA Ophthalmol. 2021;139(2):143-149
This case series examines the rate of and risk factors for developing blood-brain barrier disruption–associated maculopathy.
Ye Dai, MD, PhD; Zhenzhen Liu, MD, PhD; Wei Wang, MD, PhD; et al.
doi : 10.1001/jamaophthalmol.2020.5396
JAMA Ophthalmol. 2021;139(2):150-155
This case series of patients with cataract investigates the intraoperative development of incision-site Descemet membrane detachment associated with a 2.2-mm clear corneal incision during cataract surgery and its associated factors.
Yanjun Xie, MD; Andrew W. Joseph, MD, MPH; Shannon F. Rudy, MD; et al.
doi : 10.1001/jamaophthalmol.2020.5446
JAMA Ophthalmol. 2021;139(2):157-162
This cross-sectional study identifies changes in opioid prescribing patterns for oculoplastic and orbital procedures associated with the enactment of the Michigan Opioid Laws in 2017 and 2018.
Sharon F. Freedman, MD; Allen D. Beck, MD; Azhar Nizam, MS; et al.
doi : 10.1001/jamaophthalmol.2020.5664
JAMA Ophthalmol. 2021;139(2):165-173
This secondary analysis of a randomized clinical trial identifies and characterizes incident cases of glaucoma and glaucoma-related adverse events among children by the age of 10.5 years and associates these diagnoses with optic nerve head and peripapillary retinal nerve fiber layer assessment.
Arun D. Singh, MD; Emily C. Zabor, DrPH; Tomas Radivoyevitch, PhD
doi : 10.1001/jamaophthalmol.2020.5720
JAMA Ophthalmol. 2021;139(2):174-181
This study estimates cured fractions (CF) of uveal melanoma using a combination of institutional and epidemiologic data.
Cason B. Robbins, BS; Atalie C. Thompson, MD, MPH; Paramjit K. Bhullar, MD; et al.
doi : 10.1001/jamaophthalmol.2020.5730
JAMA Ophthalmol. 2021;139(2):182-188
This cross-sectional study compares the changes in optical coherence tomography parameters and choroidal structural parameters among adults with Parkinson disease and cognitively healthy individuals.
Robert C. O’Brien, PhD; Hemant Ishwaran, PhD; Loretta B. Szczotka-Flynn, OD, PhD; et al.
doi : 10.1001/jamaophthalmol.2020.5743
JAMA Ophthalmol. 2021;139(2):191-197
This cohort study reanalyzes types of intraoperative complications associated with Descemet stripping automated endothelial keratoplasty (DSAEK) graft failure in the Cornea Preservation Time Study using random survival forests.
Hanna ?kerblom, PhD; Stefan Franzén, PhD; Caddie Zhou, MS; et al.
doi : 10.1001/jamaophthalmol.2020.5892
JAMA Ophthalmol. 2021;139(2):200-205
This cohort study investigates the incidence of diabetic ocular complications in patients with type 2 diabetes after gastric bypass surgery and compared with the incidence in a matched cohort of patients with obesity and diabetes who have not undergone gastric bypass surgery.
Sophie Cai, MD; Felix Parker, BS; Muller G. Urias, MD; et al.
doi : 10.1001/jamaophthalmol.2020.5900
JAMA Ophthalmol. 2021;139(2):206-213
This cross-sectional study evaluates the development of a deep learning method to detect sea fan neovascularization in patients with sickle cell hemoglobinopathy.
Haihao Sun, MD, PhD; Jean W. Temeck, MD; Susan K. McCune, MD; et al.
doi : 10.1001/jamaophthalmol.2020.5558
JAMA Ophthalmol. 2021;139(2):214-217
This comparative effectiveness review uses pooled clinical trial data to evaluate the similarity in the cause of bacterial conjunctivitis and in the treatment response between neonates and older children and adults.
Michael Javaheri, MD; Lauren Hill, MS; Avanti Ghanekar, OD; et al.
doi : 10.1001/jamaophthalmol.2020.5130
JAMA Ophthalmol. 2021;139(2):219-223
This post hoc analysis of a randomized clinical trial investigates changes in treatment-naive pigment epithelial detachments associated with the initial anti–vascular endothelial growth factor injection.
Yuzhen Jiang, MD, PhD
doi : 10.1001/jamaophthalmol.2020.5395
JAMA Ophthalmol. 2021;139(2):155-156
Descemet membrane detachment (DMD) is one of the most commonly seen complications associated with cataract surgery. Although DMD resolves spontaneously in a considerable proportion of cases, it is a potentially vision-threatening condition owing to the possibility of causing persistent corneal edema and corneal endothelial decompensation.1 Various factors have been reported to be associated with cataract surgery–related DMD, such as sharpness of the surgical instruments, location and size of the incision, patient’s age, coexisting corneal pathologies, predisposition related to mutation of the transforming growth factor ?–induced gene, and surgical time.1-3
Anton M. Kolomeyer, MD, PhD; Brian L. VanderBeek, MD, MPH, MSCE
doi : 10.1001/jamaophthalmol.2020.5435
JAMA Ophthalmol. 2021;139(2):162-164
Although we are in the midst of the coronavirus disease 2019 pandemic, the opioid epidemic rages on. From 1999 to 2018, approximately 450?000 people died from opioid overdose, with approximately 50?000 deaths in 2018 alone, highlighting the dramatic increases in these alarming trends.1 As a field, ophthalmology has taken an active approach to analyzing and modifying its own opioid prescribing practices. Patel and Sternberg2 analyzed Medicare Part D prescriber data and showed that approximately 90% of ophthalmologists wrote 10 or fewer opioid prescriptions yearly, with an average of 7 prescriptions for a mean of 5 days of drug coverage.2 Shortly after, Kolomeyer et al3 showed that the odds of filling an opioid prescription after any incisional ocular surgery was 3.3 times higher in 2016 than in 2000 to 2001. Together, these studies demonstrated that although the ophthalmic use of opioids was not high across the specialty, similar to the rest of medicine, it had dramatically increased. Recognizing this trend, studies have focused on developing and instituting guidelines aimed at decreasing postoperative opioid prescriptions. Woodward et al4 used updated opioid prescribing guidelines to demonstrate a significant decrease in prescribed opioids after corneal surgery with adequate postoperative patient-reported pain control. Starr et al5 described the effect of standardizing postoperative opioid prescribing guidelines for patients undergoing a variety of ophthalmic surgeries. After implementation, the rate, strength, and total amount of opioid prescribed decreased significantly. Importantly, the proportion of refilled prescriptions also did not change, implying adequate pain control with considerable reduction in potential for opioid misuse.
Jonathan B. Lin, MD, PhD; Rajendra S. Apte, MD, PhD
doi : 10.1001/jamaophthalmol.2020.5719
JAMA Ophthalmol. 2021;139(2):189-190
Parkinson disease (PD) is a debilitating neurodegenerative disease caused by progressive death of dopaminergic neurons in the substantia nigra. This neurodegeneration classically causes a triad of bradykinesia, rigidity, and rest tremor. Patients with PD also develop nonmotor symptoms, such as olfactory loss, sleep dysfunction, autonomic dysfunction, neuropsychiatric disturbances, and cognitive impairment. Currently, PD is diagnosed clinically using the Movement Disorder Society clinical diagnostic criteria for Parkinson disease. However, some patients present with atypical features, complicating the diagnostic process. Therefore, there remains an unmet clinical need for noninvasive biomarkers that may improve our ability not only to diagnose PD, but also perhaps to identify individuals with presymptomatic or preclinical disease to enable earlier therapeutic interventions. Recently, there has been interest in the idea that the neurosensory retina may provide a window into pathology of the central nervous system.1,2 One potential advantage of retinal biomarkers is that they can be assessed rapidly and noninvasively.
Joelle A. Hallak, MS, PhD
doi : 10.1001/jamaophthalmol.2020.5741
JAMA Ophthalmol. 2021;139(2):198-199
Descemet stripping automated endothelial keratoplasty (DSAEK) is a predominant surgical method of endothelial keratoplasty for treating corneal endothelial dysfunction.1 Prediction, variable selection, and determining factors associated with graft failure may lead to improved clinical decision-making guidelines and surgical outcomes of DSAEK. Survival data allow for time-to-event analysis, which can be defined as death, onset of disease, or the success or failure of procedures. The traditional statistical methods used to analyze survival data include Kaplan-Meier analysis for estimating the survival function, the log-rank test for 2-group comparisons, and the Cox proportional hazards regression model to determine associations between risk factors and the probability of survival.2 More recently, machine learning techniques have been used to expand our ability in including high-dimensional data with multiple features for predictions and variable selection. In this issue of JAMA Ophthalmology, O’Brien et al3 use data from the Cornea Preservation Time Study to apply a random survival forest (RSF), an ensemble tree method for analysis of right-censored survival data, as a method to select important variables that predict graft failure after DSAEK.
Kathryn M. Haider, MD; David K. Wallace, MD, MPH
doi : 10.1001/jamaophthalmol.2020.5557
JAMA Ophthalmol. 2021;139(2):217-218
Ophthalmia neonatorum (ON) is an infectious condition of the ocular conjunctiva that occurs in infants younger than 1 month. Infants are thought to have increased levels of exposure to pathogens during the birthing process, and it is believed that many bacterial or viral infections are passed from mother to infant in the birth canal. In addition, neonates are believed to be more susceptible to acquiring infections owing to reduced immunity.
Xikun Han, MSc; Alex W. Hewitt, MBBS, PhD; Stuart MacGregor, PhD
doi : 10.1001/jamaophthalmol.2020.5404
JAMA Ophthalmol. 2021;139(2):224-231
This narrative review discusses genome-wide association studies used to map genes associated with primary open-angle glaucoma as well as the challenges and opportunities in translating such genetic discoveries.
Paula W. Feng, MD; Kyle D. Kovacs, MD; Adeniyi A. Fisayo, MD, PharmD
doi : 10.1001/jamaophthalmol.2020.4057
JAMA Ophthalmol. 2021;139(2):232-233
A 4-year-old child presents with fever, ear pain, and worsening headache and blurry vision with bilateral optic disc swelling. What would you do next?
Sruti S. Akella, MD; Anne Barmettler, MD
doi : 10.1001/jamaophthalmol.2020.4071
JAMA Ophthalmol. 2021;139(2):234-235
An 18-year-old man presents with bilateral gradual-onset ptosis and ophthalmoplegia and has a margin reflex distance 1 of ?4 mm OU and a levator function of 0 OU. What would you do next?
Nina Xie, MD; Jinxia Yang, BS; Qiying Sun, MD, PhD
doi : 10.1001/jamaophthalmol.2020.4620
JAMA Ophthalmol. 2021;139(2):236-237
A 35-year-old man presents 3 days after a 5-minute generalized tonic-clonic seizure with no other symptoms. He has had a 3-year history of hypertension and a painless decrease of vision over the last 6 years. He has unremarkable neurologic examination results; however, routine blood test results are significant for kidney insufficiency. What would you do next?
Cindy Ocran, MD; Hannah Harmsen, MD; Christine Shieh, MD
doi : 10.1001/jamaophthalmol.2020.4646
JAMA Ophthalmol. 2021;139(2):238-239
A 77-year-old man presents with painless, progressive blurring of vision in his left eye. His ocular history includes previous cataract surgery, followed by yttrium-aluminum-garnet capsulotomy, and Mohs and reconstruction for squamous cell carcinoma as well as a history of multiple skin malignancies. What would you do next?
Sophie Billioti de Gage, PharmD, PhD; Jérôme Drouin, MSc; David Desplas, MSc; et al.
doi : 10.1001/jamaophthalmol.2020.5594
JAMA Ophthalmol. 2021;139(2):240-242
This cohort study uses data from the French National Health Data System to assess the decline in the use of intravitreal anti–vascular endothelial growth factors before, during, and after pandemic-associated lockdown periods.
Cristos Ifantides, MD, MBA; Karen L. Christopher, MD; Galia A. Deitz, MD, MPH; et al.
doi : 10.1001/jamaophthalmol.2020.5325
JAMA Ophthalmol. 2021;139(2):242-244
This study investigates the experience of academic ophthalmology residency programs to assess less-lethal weapon eye trauma after the George Floyd protests in Denver, Colorado.
Dane H. Slentz, MD; Terry J. Smith, MD; Denise S. Kim, MD; et al.
doi : 10.1001/jamaophthalmol.2020.5296
JAMA Ophthalmol. 2021;139(2):244-247
This case report describes a case of compressive optic neuropathy in thyroid eye disease that was sucessfully resolved with teprotumumab.
Julie François, MD; Axelle Semler Collery, MD; George Hayek, MD; et al.
doi : 10.1001/jamaophthalmol.2020.5695
JAMA Ophthalmol. 2021;139(2):247-249
This case report describes a patient with coronavirus disease 2019 who experienced severe ocular neuropathy with panuveitis, resulting in permanent loss of visual acuity.
Fariba Ghassemi, MD; Sima Sheikhghomi, MD; Elias Khalilipour, MD
doi : 10.1001/jamaophthalmol.2020.4075
JAMA Ophthalmol. 2021;139(2):e204075
This case report describes loss of visual acuity in a single eye in a 4-year-old girl because of an oval, mildly tilted optic disc with deep outpouching of the globe.
Prem Nichani, MSc; Jonathan A. Micieli, MD
doi : 10.1001/jamaophthalmol.2020.4083
JAMA Ophthalmol. 2021;139(2):e204083
This case report describes a patient with peripapillary hyperreflective ovoid masslike structures that could be distinguished from true papilledema.
Stacey Carolyn Lam, MB ChB; Kelvin Kam-Lung Chong, MB ChB(Hon); Clement Chee-Yung Tham, BM BCh(Oxon)
doi : 10.1001/jamaophthalmol.2020.4096
JAMA Ophthalmol. 2021;139(2):e204096
This case report describes an anterior chamber mass that responded to 1.25 mg of intracameral bevacizumab, in the context of non–small cell lung cancer and new brain metastases.
Yingna Liu, MD; Matilda F. Chan, MD, PhD; Jay M. Stewart, MD
doi : 10.1001/jamaophthalmol.2020.4108
JAMA Ophthalmol. 2021;139(2):e204108
This case report describes a man with a central scotoma with a pulsating cilioretinal artery, ocular hypertension, and presumed concurrent retinal venous occlusion.
Paul B. Greenberg, MD, MPH; Ingrid U. Scott, MD, MPH
doi : 10.1001/jamaophthalmol.2020.5759
JAMA Ophthalmol. 2021;139(2):249
To the Editor We read with interest the timely article by Venincasa et al1 on applicant perceptions of the US ophthalmology residency matching process. Particularly striking were financial barriers, which necessitated that 68% of respondents obtain additional funds from family, loans, or credit cards. Given the ballooning debt of US medical students,2 the expense of the ophthalmology residency application process is an obvious area to target for reform.
Michael J. Venincasa, MD; Steven J. Gedde, MD; Jayanth Sridhar, MD
doi : 10.1001/jamaophthalmol.2020.5765
JAMA Ophthalmol. 2021;139(2):249-250
In Reply We thank Drs Greenberg and Scott for their interest in our article. The residency application process is a costly endeavor, and transitioning all residency interviews to video-conference interviews (VCIs) has the potential to reduce its effect on rising student debt. The use of VCIs eliminates travel time and increases flexibility of interview scheduling,1 allowing applicants to attend interviews that they otherwise may have missed because of transportation or temporal logistics.
Anthony Jen-Yu Chung, MBBS, BSc; My N. Dang, BSc
doi : 10.1001/jamaophthalmol.2020.5762
JAMA Ophthalmol. 2021;139(2):250-251
To the Editor We read with great interest the analytical cross-sectional study by Shiuey et al1 characterizing firework-associated ocular injuries treated in emergency departments in the US over a 19-year period. Among other conclusions, the authors reported that bottle rockets are up to 7 times more likely to cause severe eye trauma in comparison with other firework types.
Eric Shiuey, MS; Anton M. Kolomeyer, MD, PhD; Natasha Nayak Kolomeyer, MD
doi : 10.1001/jamaophthalmol.2020.5771
JAMA Ophthalmol. 2021;139(2):251
In Reply We thank Chung and Dang for discussing our article, “Assessment of Firework-Related Ocular Injury in the US.”1 The focus of this study was to characterize ocular firework injuries and inform potential regulatory efforts, especially because fireworks disproportionately affect the pediatric population.2
Barbara Burgos-Blasco, MD; Patricia Burgos-Blasco, MD
doi : 10.1001/jamaophthalmol.2020.5768
JAMA Ophthalmol. 2021;139(2):251-252
To the Editor We congratulate Shin et al1 for their impressive study of cases of foveal cavitation in patients receiving 5?-reductase inhibitor (5-ARI) treatment. Of the 14 patients included in this case series, 10 (71%) had received 5-ARIs and 4 (29%) had not received this treatment.
Yong Kyun Shin, MD; Se Woong Kang, MD
doi : 10.1001/jamaophthalmol.2020.5774
JAMA Ophthalmol. 2021;139(2):252-253
In Reply We would like to thank Barbara and Patricia Burgos-Blasco for their interest in our article.1 As they mentioned, 5?-reductase inhibitor (5-ARI) dosage varies depending on diagnosis. Dutasteride is used as a treatment for benign prostate hyperplasia (BPH) and androgenic alopecia at a dose of 0.5 mg per day, and finasteride is used at a dose of 5 mg per day for BPH and 1 mg per day for androgenic alopecia.2,3 We described in the Table of our article1 the diagnosis for each case as well as the treatment duration and cumulative dosage, through which the daily dosage can be obtained. We could not develop a dose-toxicity curve from the limited number of cases.
Rupesh Agrawal, MMed, MD; Jianbin Ding; Xin Wei, MMed
doi : 10.1001/jamaophthalmol.2020.5810
JAMA Ophthalmol. 2021;139(2):253
To the Editor We read with interest the article by Wu et al1 on ocular findings in coronavirus disease 2019 (COVID-19). We wish to understand more about the study in the following aspects.
Zhe Liu, MD; Qing Xiao, MD; Chuan-bin Sun, MD, PhD
doi : 10.1001/jamaophthalmol.2020.5813
JAMA Ophthalmol. 2021;139(2):253-254
To the Editor We read with interest the article of Wu et al1 on the characteristics of ocular findings in patients with novel coronavirus disease (COVID-19). Wu et al1 reported that ocular manifestations consistent with conjunctivitis were found in 12 of 38 patients (31.6%) with COVID-19 and concluded that ocular abnormalities frequently occurred in patients with more severe COVID-19 and acute respiratory syndrome coronavirus 2 (SARS-CoV-2) could be transmitted via the eyes. However, we consider that the conjunctivitis Wu et al1 described in their article may not be caused by SARS-CoV-2 infection, ophthalmic involvement may not be associated with the severity of COVID-19, and the eye is not likely to play as a transmission route of SARS-CoV-2 infection, based on previous investigations and the findings of Wu et al.1
Florence Cabot, MD; Kara M. Cavuoto, MD; Jean-Marie Parel, PhD
doi : 10.1001/jamaophthalmol.2020.5816
JAMA Ophthalmol. 2021;139(2):254
To the Editor We congratulate Wu et al1 for their article on the ocular manifestations of coronavirus disease 2019 (COVID-19). The authors reported that 12 of 38 patients (31.6%) with COVID-19 had ocular signs and symptoms. They described epiphora, conjunctival congestion, increased secretions, and chemosis that occurred more frequently in patients with severe systemic manifestations. Although it is true that these signs may occur in viral conjunctivitis, they are also very common findings and may occur in other ocular conditions, such as blepharitis, uveitis, keratitis, or systemic conditions, such as fluid overload. How did the authors account for whether these other diagnoses were coincidental to COVID-19? In addition, could the authors explain how the ocular assessment was performed (eg, by an ophthalmologist vs another specialist, such as an internist)? Also, could the authors summarize at what point in the course of the disease the reverse transcriptase–polymerase chain reaction test was performed in each patient, which may affect the percentages of positive vs negative results obtained from the conjunctival swabs?
Kelvin H. Wan, MBChB, MRCS; Suber S. Huang, MD, MBA; Dennis S. C. Lam, MD
doi : 10.1001/jamaophthalmol.2020.5819
JAMA Ophthalmol. 2021;139(2):254-255
To the Editor We read with interest the article by Wu et al1 evaluating the ocular manifestations in 38 patients with coronavirus disease 2019 (COVID-19). Contrary to another recent article reporting only 8 of 121 patients (6.6%) having ocular symptoms,2 Wu reported a higher proportion: 12 of 38 patients (31.6%) with conjunctival hyperemia, chemosis, epiphora, or increased secretions, which they described as “consistent with conjunctivitis.”1(p575) We have reservations about their clinical descriptions of these ocular manifestations, independent of the COVID-19 laboratory findings from the conjunctival swabs.
Ping Wu, MD; Kaili Wu, MD; Liang Liang, MD
doi : 10.1001/jamaophthalmol.2020.5822
JAMA Ophthalmol. 2021;139(2):255-256
In Reply We thank the readers for their interest in our previous report on the ocular findings of patients with coronavirus disease 2019 (COVID-19).1 With great respect, we carefully have read those letters and we provide our responses.
doi : 10.1001/jamaophthalmol.2020.6407
JAMA Ophthalmol. 2021;139(2):256
the Brief Report titled “Changes in Treatment-Naive Pigment Epithelial Detachments Associated With the Initial Anti–Vascular Endothelial Growth Factor Injection: A Post Hoc Analysis From the HARBOR Trial,”1 published online December 17, 2020, was corrected to fix the legend of Figure 2. An additional sentence at the end of the legend will read “Vertical bars represent 95% CI.” This article was corrected online.
doi : 10.1001/jamaophthalmol.2020.6882
JAMA Ophthalmol. 2021;139(2):256
the Research Letter “Intravitreal Anti–Vascular Endothelial Growth Factor Use in France During the Coronavirus Disease 2019 Pandemic,”1 published online December 17, 2020, had an error in the byline. The surname of first author Sophie Billioti de Gage was listed as de Gage. Her full surname is Billioti de Gage. The error has been corrected.
doi : 10.1001/jamaophthalmol.2020.6937
JAMA Ophthalmol. 2021;139(2):256
n the Original Investigation titled, “Characterization of Retinal Microvascular and Choroidal Structural Changes in Parkinson Disease,” which published online December 23, 2020, in JAMA Ophthalmology,1 the unit of measure for total choroidal area and luminal area should be units2 instead of pixels2. This article was corrected online.
doi : 10.1001/jamaophthalmol.2021.0050
JAMA Ophthalmol. 2021;139(2):256
n the Original Investigation by Xie et al titled “Change in Postoperative Opioid Prescribing Patterns for Oculoplastic and Orbital Procedures Associated With State Opioid Legislation,” published online December 10, 2020, in JAMA Ophthalmology,1 the data for brow-lift and blepharoptosis repair were transposed in the second-to-last sentence of the second paragraph of the Results section. The sentence should read as follows: “In contrast, soft tissue procedures had a lower mean (SD) amount of opioids prescribed (brow-lift: 73.2 [37.8] MMEs; blepharoptosis repair: 64.7 [30.5] MMEs).” This article was corrected online.
doi : 10.1001/jamaophthalmol.2020.3743
JAMA Ophthalmol. 2021;139(2):142
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