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In This Issue of JAMA Ophthalmology
December 2014


JAMA Ophthalmol. 2014;132(12):1389. doi:10.1001/jamaophthalmol.2013.5973

Gandolfi and colleagues evaluate the role of drug-induced mydriasis and laser peripheral iridotomy to manage patients with pigment dispersion syndrome in a randomized clinical trial. In their high-risk group, 3 of 21 eyes that underwent laser peripheral iridotomy (14.3%) and 13 of 21 untreated eyes (61.9%) showed an increase in intraocular pressure of 5 mm Hg or higher during the follow-up period (P < .001 for treated high-risk eyes vs untreated high-risk eyes). The results suggest that laser peripheral iridotomy on high-risk eyes can be protective over the long term.

Continuing Medical Education

Because residential (geographic) history and extent of solar exposure may be important risk factors for exfoliation syndrome (XFS), Pasquale and colleagues assess the relation between residential history, solar exposure, and XFS in a clinic-based case-control study in the United States and Israel. In multivariable analyses, each degree of weighted lifetime average residential latitude away from the equator was associated with 11% increased odds of XFS (pooled odds ratio, 1.11; 95% CI, 1.05-1.17; P < .001), and every hour per week spent outdoors during the summer, averaged over a lifetime, was associated with 4% increased odds of XFS (pooled odds ratio, 1.04; 95% CI, 1.00-1.07; P = .03). The authors concluded that lifetime outdoor activities may contribute to XFS.

Continuing Medical Education

The risk for irreversible toxic retinopathy from hydroxychloroquine sulfate may be much higher because retinopathy can be detected earlier using more sensitive screening techniques. Melles and Marmor reassess the prevalence of and risk factors for hydroxychloroquine retinal toxicity in a retrospective case-control study within an integrated health organization of approximately 3.4 million members among 2361 patients who had used hydroxychloroquine continuously for at least 5 years and were evaluated with visual field testing or spectral-domain optical coherence tomography. The overall prevalence of hydroxychloroquine retinopathy was 7.5% but varied with daily consumption (odds ratio, 5.67; 95% CI, 4.14-7.79 for >5.0 mg/kg) and with duration of use (odds ratio, 3.22; 95% CI, 2.20-4.70 for >10 years). The data suggest that hydroxychloroquine retinopathy is more common than previously recognized, especially at high dosages and long duration of use.

Invited Commentary

As spectacle independence is becoming increasingly important in cataract surgery, Visser and colleagues compare bilateral aspherical toric with bilateral aspherical control intraocular lens (IOL) implantation among 86 individuals with cataract and corneal astigmatism in a randomized clinical trial. At 6 months postoperatively, 26 (70%) of the patients in the toric group achieved an uncorrected distance visual acuity of 20/25 or better compared with 14 (31%) in the control group (P < .001; odds ratio, 5.23; 95% CI, 2.03-13.48), while spectacle independency for distance vision was achieved in 31 patients (84%) in the toric group compared with 14 (31%) in the control group (P < .001; odds ratio, 11.44; 95% CI, 3.89-33.63). The authors concluded that for patients with cataract and corneal astigmatism, bilateral toric IOL implantation results in a higher spectacle independency for distance vision compared with bilateral control IOL implantation.