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In This Issue of JAMA Ophthalmology
September 2014

Highlights

JAMA Ophthalmol. 2014;132(9):1041. doi:10.1001/jamaophthalmol.2013.5958
Research

There is minimal information on the subsequent effect of telemedicine activities on eye care resources. Chasan and colleagues retrospectively evaluate the effect of a community-based diabetic telemedicine retinal screening program on eye care use. Common referral diagnoses were nonmacular diabetic retinopathy (43.2%), nerve-related disease (30.8%), lens or media opacity (19.1%), age-related macular degeneration (12.9%), and diabetic macular edema (5.6%). The percentage of agreement among these was 90.4%, with a total sensitivity of 73.6%. Using Medicare cost data estimates, the mean cost incurred in 2 years per patient seen in the eye clinic was about $1000.

While hydroxychloroquine sulfate retinopathy can progress after the drug is stopped, it is not clear how this relates to the stage of retinopathy or whether identification at an early stage of the retinopathy with modern imaging technology can prevent progression and visual loss. Marmor and Hu determine the relationship between worsening of retinopathy and severity of disease using objective data from optical coherence tomography (OCT) in patients with hydroxychloroquine retinopathy monitored with repeated anatomical and functional examinations for 13 to 40 months after the drug was stopped. Patients with hydroxychloroquine retinopathy involving the retinal pigment epithelium demonstrated progressive damage on OCT for at least 3 years after the drug was discontinued. Study findings suggest that early recognition of hydroxychloroquine toxic effects before any fundus abnormalities are visible should minimize late worsening and the risk of visual loss.

Continuing Medical Education

Understanding relationships between measurements obtained on different optical coherence tomography (OCT) machines is critical. Investigators from the Diabetic Retinopathy Clinical Research Network evaluate the reproducibility of retinal thickness measurements from OCT images obtained by time-domain (TD) (Stratus) and spectral-domain (SD) (Cirrus and Spectralis) instruments and formulate equations to convert retinal thickness measurements from this SD-OCT to equivalent values on TD-OCT in eyes with diabetic macular edema. The Bland-Altman coefficient of repeatability for relative change in central subfield thickness (CST) was lower with Spectralis (7%) compared with Cirrus (14%) and Stratus (12% and 15% within Cirrus/Stratus and Spectralis/Stratus groups, respectively). The conversion equations predicted a Stratus CST within 10% of the observed thickness 86% and 89% of the time for Cirrus/Stratus and Spectralis/Stratus groups, respectively.

Approximately 5% to 10% of patients continue to experience persistent epiphora following an anatomically successful dacryocystorhinostomy (DCR) for nasolacrimal duct obstruction or stenosis. Shams and colleagues investigate the management and success rate of so-called “functional failure” of DCR for nasolacrimal duct obstruction by experienced lacrimal surgeons. Among 61 patients with functional epiphora after 65 DCRs, epiphora recurred a mean of 8.9 months after primary DCR. Intubation with a lacrimal stent was performed in 82% of the cases, and all stents were removed a mean of 8 weeks postoperatively. Among 39 interventions of intubation with a silicone stent, 54% were successful and almost half undergoing intubation elected to keep the stent permanently. Twenty-two had an eyelid-tightening procedure, with success in 50%. The authors concluded that while functional epiphora after DCR among patients with preoperative nasolacrimal duct obstruction or stenosis appears to be uncommon, additional intervention can result in subsequent benefits in most patients with intubation or eyelid tightening.

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