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In This Issue of JAMA Ophthalmology
July 2014


JAMA Ophthalmol. 2014;132(7):797. doi:10.1001/jamaophthalmol.2013.5948

Initial treatment for amblyopia of the fellow eye with patching and atropine sulfate eyedrops improves visual acuity (VA). Because long-term data on the durability of treatment benefit are needed, Repka and colleagues reported VA at 15 years of age among patients who were younger than 7 years when enrolled in a treatment trial for moderate amblyopia. A total of 419 children with amblyopia (VA, 20/40 to 20/100) were randomly assigned to patching (minimum of 6 h/d) or atropine sulfate eyedrops, 1% (1 drop daily), for 6 months. Treatment after 6 months was at the discretion of the investigator. Two years after enrollment, an unselected subgroup of 188 children were enrolled into long-term follow-up. At 15 years, most children treated for moderate amblyopia when younger than 7 years had good VA, although mild residual amblyopia was common. The outcome was similar regardless of initial treatment with atropine or patching. The results indicated that improvement with amblyopia treatment is maintained until at least age 15 years.

Journal Club and Continuing Medical Education

Yang and colleagues characterized the macular and foveal architecture of 9 patients with achromatopsia during early childhood using handheld spectral-domain optical coherence tomographic imaging to make phenotype-genotype correlations. They reported a spectrum of foveal pathology that was milder than reported in older individuals with achromatopsia, which suggests a potential for early therapeutic intervention. Neither age alone nor genotype alone predicted the degree of photoreceptor loss or preservation. Thus, in anticipation of future gene therapy trials in humans, the authors proposed that handheld spectral-domain optical coherence tomography is an important tool for the early assessment and stratification of macular architecture in young children with achromatopsia.

Adherence with glaucoma medications is a known problem. Boland and colleagues assessed the ability of an automated telecommunication-based intervention to improve adherence with glaucoma medications in a randomized intervention of 70 participants found to be nonadherent and randomized to receive daily messages, either text or voice, reminding them to take their medication or to receive usual care. The median adherence rate in the 38 participants randomized to the intervention increased from 53% to 64% (P < .05), with no definitive change in the usual care group. The authors concluded this intervention could be implemented in ophthalmology practices with minimal effort on the practice or the patient to improve adherence with once-daily glaucoma medication dosing.

Related Article

Doi and colleagues described the delivery of ophthalmologic care in the disaster zone in Miyagi Prefecture 1 month after the Great East Japan Earthquake on March 11, 2011, when the authors were granted free use of a customized mobile eye clinic airlifted to Japan. Of the 914 diagnoses, 39% were refractive disorders, which were the most common; 17% were cataracts; 11.6% were dry eye; and 8% were infectious diseases such as conjunctivitis. They provided emergency prescriptions for 871 bottles of eyedrops. They concluded that a substantial number of individuals in earthquake-damaged areas need replacements for eyeglasses, contact lenses, and eyedrops and that the mobile clinic appears to be a useful way to provide ophthalmologic examinations and support after a disaster.