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JAMA Ophthalmology—The Year in Review, 2020
Neil M. Bressler, MD1,2
doi : 10.1001/jamaophthalmol.2021.0272
JAMA Ophthalmol. 2021;139(5):499-500
Topographical Response of Retinal Neovascularization to Aflibercept or Panretinal Photocoagulation in Proliferative Diabetic Retinopathy
Sandra Halim, MBBS1,2; Manjula Nugawela, PhD2; Usha Chakravarthy, PhD3; Tunde Peto, PhD4; Savita Madhusudhan, MBBS4; Pauline Lenfestey, MBBS4; Barbara Hamill, BSc3; Yalin Zheng, PhD4; David Parry, BSc4; Luke Nicholson, MD(Res)1; John Greenwood, PhD2; Sobha Sivaprasad, DM1,2
doi : 10.1001/jamaophthalmol.2021.0108
JAMA Ophthalmol. 2021;139(5):501-507
Importance Eyes with proliferative diabetic retinopathy have a variable response to treatment with panretinal photocoagulation (PRP) or anti–vascular endothelial growth factor agents. The location of neovascularization (NV) is associated with outcomes (eg, patients with disc NV [NVD] have poorer visual prognosis than those with NV elsewhere [NVE]).
Patient Perceptions of SARS-CoV-2 Exposure Risk and Association With Continuity of Ophthalmic Care
Aaron Lindeke-Myers, BA1; Peter Yu Cheng Zhao, MD2; Benjamin I. Meyer, BS1; Elaine A. Liu, BA3; David A. Levine, MD4; Olivia M. Bennett, BA3; Sunjong Ji, BS3; Paula Anne Newman-Casey, MD2; Rajesh C. Rao, MD2,5,6,7,8,9; Nieraj Jain, MD4
doi : 10.1001/jamaophthalmol.2021.0114
JAMA Ophthalmol. 2021;139(5):508-515
Importance Patient perceptions regarding the risks of obtaining in-person ophthalmic care during the coronavirus disease 2019 (COVID-19) pandemic may affect adherence to recommended treatment plans and influence visual outcomes. A deeper understanding of patient perspectives will inform strategies to optimize adherence with vision-preserving therapies.
Cost Savings From a Policy to Diagnose and Prevent Transmission of Adenoviral Conjunctivitis in Employees of a Large Academic Medical Center
Irene C. Kuo, MD1; Emily W. Gower, PhD2,3
doi : 10.1001/jamaophthalmol.2021.0150
JAMA Ophthalmol. 2021;139(5):518-524
Importance Adenoviral conjunctivitis is highly contagious, can be associated with systemic infections, and can cause chronic visual impairment. It accounts for a large proportion of acute conjunctivitis. Outbreaks of epidemic keratoconjunctivitis (EKC) are costly in terms of productivity loss from work furloughs and spread to patients and have resulted in clinic and departmental closures.
A Global Assessment of Eye Health and Quality of Life
Lama Assi, MD1; Fatimah Chamseddine, MD2; Perla Ibrahim, MD3; Hadi Sabbagh, BS3; Lori Rosman, MLS4; Nathan Congdon, MD, MPH5,6; Jennifer Evans, PhD, MSc7; Jacqueline Ramke, PhD, MPH7,8; Hannah Kuper, ScD9; Matthew J. Burton, PhD7,10; Joshua R. Ehrlich, MD, MPH11,12; Bonnielin K. Swenor, PhD, MPH1,13
doi : 10.1001/jamaophthalmol.2021.0146
JAMA Ophthalmol. 2021;139(5):526-541
Importance More than 1 billion people worldwide have vision impairment or blindness from potentially preventable or correctable causes. Quality of life, an important measure of physical, emotional, and social well-being, appears to be negatively associated with vision impairment, and increasingly, ophthalmic interventions are being assessed for their association with quality of life.
Intravitreal Aflibercept Injection vs Sham as Prophylaxis Against Conversion to Exudative Age-Related Macular Degeneration in High-risk Eyes
Jeffrey S. Heier, MD1; David M. Brown, MD2; Sumit P. Shah, MD3; Namrata Saroj, OD4; Sabin Dang, MD5; Nadia K. Waheed, MD6; Charles C. Wykoff, MD, PhD7; Jonathan L. Prenner, MD8; David S. Boyer, MD9
doi : 10.1001/jamaophthalmol.2021.0221
JAMA Ophthalmol. 2021;139(5):542-547
Importance Anti–vascular endothelial growth factor (VEGF) agents may provide a prophylactic effect in high-risk eyes with intermediate dry age-related macular degeneration (AMD) against conversion to exudative AMD (eAMD), lowering the risk of vision loss.
Association of Retinal Changes With Alzheimer Disease Neuroimaging Biomarkers in Cognitively Normal Individuals
Min Soo Byun, MD, PhD1; Sung Wook Park, MD, PhD2,3,4,5; Jun Ho Lee, MD, PhD6; Dahyun Yi, PhD7; So Yeon Jeon, MD, PhD8; Hyo Jung Choi, MD, PhD9; Haejung Joung, MS9; Un Hyung Ghim, MD2,3,4; Un Chul Park, MD, PhD2,3,4; Yu Kyeong Kim, MD, PhD10; Seong A. Shin, PhD10; Hyeong Gon Yu, MD, PhD2,3,4; Dong Young Lee, MD, PhD7,9,11; for the KBASE Research Group
doi : 10.1001/jamaophthalmol.2021.0320
JAMA Ophthalmol. 2021;139(5):548-556
Importance Retinal biomarkers reflecting in vivo brain Alzheimer disease (AD) pathologic abnormalities could be a useful tool for screening cognitively normal (CN) individuals at the preclinical stage of AD.
Assessment of Cumulative Incidence and Severity of Primary Open-Angle Glaucoma Among Participants in the Ocular Hypertension Treatment Study After 20 Years of Follow-up
Michael A. Kass, MD1; Dale K. Heuer, MD2; Eve J. Higginbotham, MD3; Richard K. Parrish, MD4; Cheryl L. Khanna, MD5; James D. Brandt, MD6; Joern B. Soltau, MD7; Chris A. Johnson, PhD8; John L. Keltner, MD9; Julia B. Huecker, MS1; Bradley S. Wilson, MA1; Lei Liu, PhD1; J. Phillip Miller, AB1; Harry A. Quigley, MD10; Mae O. Gordon, PhD11; for the Ocular Hypertension Study Group
doi : 10.1001/jamaophthalmol.2021.0341
JAMA Ophthalmol. 2021;139(5):558-566
Importance Ocular hypertension is an important risk factor for the development of primary open-angle glaucoma (POAG). Data from long-term follow-up can be used to inform the management of patients with ocular hypertension.
Preterm Infant Stress During Handheld Optical Coherence Tomography vs Binocular Indirect Ophthalmoscopy Examination for Retinopathy of Prematurity
Shwetha Mangalesh, MBBS1; Neeru Sarin, MBBS1; Brendan McGeehan, MS2; S. Grace Prakalapakorn, MD, MPH1,3; Du Tran-Viet, BS1; C. Michael Cotten, MD, MHS3; Sharon F. Freedman, MD1,3; Maureen G. Maguire, PhD2; Cynthia A. Toth, MD1,4; for the BabySTEPS Group
doi : 10.1001/jamaophthalmol.2021.0377
JAMA Ophthalmol. 2021;139(5):567-574
Importance Binocular indirect ophthalmoscopy (BIO) examination for retinopathy of prematurity (ROP) is a well-known cause of repeated preterm infant stress.
The Importance of Patients’ Perspectives in Providing Ophthalmic Care—Lessons From the COVID-19 Pandemic
Alan R. Morse, JD, PhD1,2
doi : 10.1001/jamaophthalmol.2021.0121
JAMA Ophthalmol. 2021;139(5):516-517
Keeping Red Eyes From Putting Workplaces in the Red
Amanda K. Bicket, MD, MSE1,2; Joshua D. Stein, MD, MS1,2,3
doi : 10.1001/jamaophthalmol.2021.0144
JAMA Ophthalmol. 2021;139(5):524-525
Adenoviral conjunctivitis disrupts workplaces, schools, and communities, costing hundreds of millions of dollars annually. With no proven treatment and the potential for rapid spread, vision-threatening complications, and prolonged recovery, employers must take its identification and containment seriously. Meanwhile, this condition frequently presents a diagnostic dilemma, with a wide range of less contagious or treatable conditions masquerading as viral conjunctivitis. This leads to several undesirable scenarios, including the unnecessary furlough of employees who come to work with red eyes and inappropriate prescription of topical antibiotics, which can contribute to antibiotic resistance, to satisfy school, daycare, or workplace guidelines requiring 24 hours of antimicrobial therapy before a student or worker can be cleared to return. Both approaches reflect conventional guidance aimed at trying to limit contagion and absenteeism in a setting of diagnostic uncertainty.1 However, with precise diagnostic tests, such as polymerase chain reaction (PCR) testing, available, it should be possible to distinguish between patients with and without adenoviral conjunctivitis and alleviate much of this uncertainty.
Structural and Functional Retinal Changes in Preclinical Alzheimer Disease
Dilraj S. Grewal, MD1; Sharon Fekrat, MD1
doi : 10.1001/jamaophthalmol.2021.0319
JAMA Ophthalmol. 2021;139(5):556-557
It has been more than 100 years since Alois Alzheimer identified Alzheimer disease (AD), and almost 40 years since the role of amyloid-? (A?) and tau proteins, 2 key molecular factors in the AD pathophysiologic patterns, were identified.1 Alzheimer disease is now recognized as a multifaceted process that progresses along a continuum with a commonly defined starting point being the accumulation of the A? biomarker demonstrated on positron emission tomography (PET) or cerebrospinal fluid analysis. The epidemic of AD has already decreased the life expectancy in the US,2 adding to the urgency to identify a noninvasive biomarker to easily detect not only those with symptomatic AD, but also those with preclinical AD for whom lifestyle modifications, such as diet, exercise, and cognitive engagement, may delay onset. The retina holds promise in being able to provide such a biomarker, yet challenges remain, ranging from our evolving understanding of underlying AD pathophysiologic characteristics to current limitations of retinal imaging.
Unilateral Hypopyon in an Elderly Man With Dementia
Tomona Hiyama, MD1; Yosuke Harada, MD, PhD1; Yoshiaki Kiuchi, MD, PhD1
doi : 10.1001/jamaophthalmol.2020.4633
JAMA Ophthalmol. 2021;139(5):575-576
A 78-year-old man presented with decreased visual acuity and hypopyon in his right eye. He had a history of Philadelphia chromosome–positive acute lymphocytic leukemia (ALL), Stevens-Johnson syndrome (attributable to treatment with the tyrosine-kinase inhibitor [TKI] imatinib), and diabetes. He had senile dementia but did not complain of constitutional symptoms. His visual acuity was 20/80 OD and 20/32 OS, and his intraocular pressures were 31 mm Hg OD and 16 mm Hg OS. A slitlamp examination of the right eye showed redness, with small, white, nongranulomatous keratic precipitate as well as a cataract. His iris was diffusely thickened and the anterior chamber was slightly shallow, with 4+ cells and white hypopyon, which did not change position with head movements (Figure 1). There was also an extensive rubeosis iridis (Figure 1) with posterior synechiae in the right eye. The left anterior chamber was normal. A fundus examination had unremarkable results in both eyes. A complete blood cell count had normal results, and his hemoglobin A1c level was 16.5%. A syphilis test result was negative.
Painless Visual Loss in a Septuagenarian
Roger K. Henry, BS, MBS1,2; Mark L. Moster, MD3; Ralph C. Eagle Jr, MD1
doi : 10.1001/jamaophthalmol.2020.4638
JAMA Ophthalmol. 2021;139(5):577-578
A patient in their late 70s with a history of Crohn disease, coronary artery disease, hypercholesterolemia, and transient ischemic attack presented with sudden, painless, left-sided vision loss. They denied headache, scalp tenderness, and jaw claudication. The erythrocyte sedimentation rate (ESR) was 103 mm/h and a magnetic resonance angiographic examination of the brain was negative for mass, infarction, and hemorrhage. Examination results of a right, superficial, temporal artery biopsy specimen showed chronic, nongranulomatous inflammation surrounding adventitial vessels and extensive subintimal fibrosis, without giant cells or segmental loss of the internal elastic lamina, which was interpreted as compatible with temporal arteritis. High-dose corticosteroid therapy was initiated (1 g methylprednisolone intravenously for 3 days followed by 60 mg/d of oral prednisone).
Bilateral Asymmetrical Corneal Deposits in an Asymptomatic Patient
J. Christian Berry, MD1; Brett F. Gudgel, MD1; Kamran M. Riaz, MD1
doi : 10.1001/jamaophthalmol.2020.4656
JAMA Ophthalmol. 2021;139(5):579-580
A 70-year-old White woman with a history of hypertension and hyperlipidemia was referred to our institution for evaluation of bilateral asymmetric corneal lesions by her primary eye care professional. The patient required spectacles for best-corrected visual acuity but otherwise had no other significant ocular complaints. She was not taking medications known to cause corneal depositions, nor was there a known family history of corneal dystrophy. Best-corrected visual acuity was 20/20 OU. Slitlamp examination of the cornea of the right eye revealed multiple, discrete nodular opacities in the superior and inferior quadrants without neovascularization or surface elevation. Similar findings were seen in the left eye, but the superior lesions were notable for possessing well-circumscribed, plaquelike features located in the posterior stroma without involvement of the anterior surface (Figure, A). No crystalline changes were noted with these deposits.
Retinal Detachment in a 40-Year-Old Man With Sturge-Weber Syndrome
Carolina A. Chiou, MD1; Evangelos Gragoudas, MD1
doi : 10.1001/jamaophthalmol.2020.4665
JAMA Ophthalmol. 2021;139(5):581-582
A 40-year-old man with refractory glaucoma was referred for decreased vision in the right eye after an aqueous shunting surgical procedure 3 weeks prior. The surgical procedure was a 2-staged Baerveldt implantation after which he developed fluctuating but progressive visual decline. The patient’s ocular history was significant for Sturge-Weber syndrome with bilateral cutaneous port-wine stains, secondary glaucoma in the right eye, and an irregular globe with a white cataract and chronic retinal detachment (RD) in the left eye.
MOG-IgG Among Participants in the Pediatric Optic Neuritis Prospective Outcomes Study
John J. Chen, MD, PhD1,2,3,4; Stacy L. Pineles, MD5; Michael X. Repka, MD, MBA6; Sean J. Pittock, MD2; Robert J. Henderson, MS7; Grant T. Liu, MD8; for the Pediatric Eye Disease Investigator Group (PEDIG)
doi : 10.1001/jamaophthalmol.2021.0349
JAMA Ophthalmol. 2021;139(5):583-585
Myelin oligodendrocyte glycoprotein (MOG) immunoglobulin G (IgG)–associated disorder (MOGAD) is a recently described entity that is distinct from multiple sclerosis (MS) and aquaporin-4 (AQP4)-IgG–positive neuromyelitis optica spectrum disorder.1-3 A small cohort from the Pediatric Optic Neuritis Prospective Outcomes Study4 underwent MOG-IgG testing and we compared those whose results were MOG-IgG positive with those whose results were negative.
Association of Conjunctival Plaques With BRAF Inhibitor Treatment in Patients With Pediatric Brain Tumor
Kaitlin P. Sandor, BA1; Hans E. Grossniklaus, MD, MBA1,2; Phoebe D. Lenhart, MD1; Jill R. Wells, MD1; Jason H. Peragallo, MD1,3
doi : 10.1001/jamaophthalmol.2021.0169
JAMA Ophthalmol. 2021;139(5):585-586
Ocular adverse effects of BRAF inhibitor treatment, including uveitis, iritis, retinal vein occlusions, and retinal detachments, have been documented in clinical trials and the literature.1-4 To our knowledge, conjunctival adverse effects have not been described. We present 2 pediatric cases with conjunctival plaques resembling Bitot spots that developed after BRAF inhibitor treatment. Ophthalmologists should be aware of a possible association between BRAF inhibitors and these plaques and other cutaneous complications.
An Unusual, Idiopathic Scrolled Epiretinal Membrane
Libing K. Dong, BS1; Ryan A. Shields, MD2; David B. Krebs, MD1,3
doi : 10.1001/jamaophthalmol.2021.1146
JAMA Ophthalmol. 2021;139(5):e211146
A 26-year-old woman with no previous ocular history presented for an initial contact lens evaluation. She had no visual complaints, including metamorphopsia. She denied prior history of ocular trauma, head trauma, ocular procedures, or inflammation, and she had no family history of ocular disease. The patient was found to have ?2.25 myopia bilaterally, correctable to 20/20 OU. A fundus examination revealed a superiorly oriented, partially scrolled epiretinal membrane in the left eye (Figure, A). Optical coherence tomography redemonstrated the scrolled epiretinal membrane overlying the fovea (Figure, B). There was no disruption of the foveal contour, retinal layers, or underlying retinal pigment epithelium. Additionally, there was no evidence of an internal limiting membrane tear or a posterior vitreous detachment in the left eye. Her right eye showed no abnormalities. She was diagnosed with an idiopathic epiretinal membrane. The decision was made to observe the membrane, given her excellent visual acuity and lack of visual complaints.
An Emphasis on the Gap Between the Surveyed Myopia Rate and Eyeglass-Wearing Rate in the Study of Ocular Susceptibility to SARS-CoV-2 Infection
Lixiang Wang, MD1; Yingping Deng, MD1
doi : 10.1001/jamaophthalmol.2021.0494
JAMA Ophthalmol. 2021;139(5):586-587
To the Editor We read with great interest the article by Zeng et al1 about the potential protective role of eyeglasses against SARS-CoV-2 transmission. Among patients with COVID-19 infection in Suizhou, China, the authors found a lower proportion of individuals who wear eyeglasses for extended daily periods compared with the general population (5.8% vs 31.5%) and surveyed myopia rates in the same region. This study supports the ocular surface as a point of entry for SARS-CoV-2 transmission. However, according to a recent systematic review,2 ocular manifestations were found in 0% to 31.6% of patients infected with SARS-CoV-2, and only 0% to 11.1% had positive test results in tear samples. This suggests that the ocular surface is not a major transmission route for SARS-CoV-2.
An Emphasis on the Gap Between the Surveyed Myopia Rate and Eyeglass-Wearing Rate in the Study of Ocular Susceptibility to SARS-CoV-2 Infection—Reply
Weibiao Zeng, MS1; Jianjun Xu, MD, PhD1; Yiping Wei, MD, PhD1
doi : 10.1001/jamaophthalmol.2021.0511
JAMA Ophthalmol. 2021;139(5):587-588
In Reply Many thanks to the researchers who expressed interest in the results of our article.1 The issues they raised were mainly the low number of tear samples that tested positive for SARS-CoV-2 infection and the accuracy of the eyeglass-wearing rate among the population.
Survival Analysis vs Longitudinal Modeling With Multiple Imputation—A False Dichotomy
Brian L. VanderBeek, MD, MPH, MSCE1; Gui-Shuang Ying, PhD2; Rebecca A. Hubbard, PhD3
doi : 10.1001/jamaophthalmol.2021.0508
JAMA Ophthalmol. 2021;139(5):588
To the Editor We read with interest the article by Fu et al1 and were struck by their strong statements regarding the validity of survival analysis and their dismissal of multiple imputation as a statistical tool in observational studies with missing data. We were most concerned by their assertion that survival analysis is not impacted by missing data while multiple imputation leads to biased results. Both multiple imputation and survival analysis (eg, Kaplan-Meier estimates or a proportional hazards model) rely on the missing at random assumption,2 according to which the probability that an observation is missing can be predicted from the observed data. In both types of analyses, results may be biased if missingness is related to patient characteristics that have not been observed. In the survival context, this amounts to assuming that censored patients (eg, patients who discontinued treatment or were lost to follow-up) had the same outcome risk as noncensored patients.3 When this noninformative missingness assumption is violated, both survival analysis and multiple imputation can lead to biased estimates. Patients with neovascular age-related macular degeneration with poor vision outcomes are more likely to discontinue treatments and medical visits. This may lead to missing visual acuity (VA) data.4 This form of right censoring clearly violates the missing at random assumption and may have induced bias in the study by Fu et al.1 Additionally, no censoring criteria were described in the authors’ Methods section, suggesting that patients who had prolonged intervals with multiple missed visits or injections were still included in the study. An advantage of longitudinal modeling, with or without multiple imputation, is the ability to flexibly incorporate assessments conducted at variable length intervals. In contrast, such an irregular observation scheme results in interval-censored data in a survival analysis because precise event times are unknown. Because missed visits and therefore longer intervals between observations have been shown to be associated with worse VA outcomes,5 this becomes an important consideration that survival analysis has no mechanism to address without multiple imputation.
Survival Analysis vs Longitudinal Modeling With Multiple Imputation—a False Dichotomy—Reply
Catey Bunce, DSc1; Dun Jack Fu, PhD2; Irene Stratton, PhD3
doi : 10.1001/jamaophthalmol.2021.0518
JAMA Ophthalmol. 2021;139(5):588-589
In Reply We thank VanderBeek et al and the journal for giving us the opportunity to respond to this letter and hope that our reply offers some reassurance. VanderBeek et al point out that missing data may present issues to the unwary researcher, and we are pleased that our article1 has drawn attention to this matter. We completely agree that there is great value in the use of multiple imputation in observational studies with missing data and are somewhat perplexed by the suggestion that our article indicated otherwise.
JAMA Ophthalmology Peer Reviewers in 2020
doi : 10.1001/jamaophthalmol.2021.0188
JAMA Ophthalmol. 2021;139(5):e210188
