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In This Issue of JAMA Ophthalmology
May 2015

Highlights

JAMA Ophthalmol. 2015;133(5):501. doi:10.1001/jamaophthalmol.2014.3717
Research

To compare telemedicine with traditional eye examinations in their ability to provide diabetic retinopathy screening examinations, Mansberger and coauthors randomized and followed up to 5 years 567 participants with diabetes. They assigned participants to telemedicine with a nonmydriatic camera in a primary care medical clinic (n = 296) or traditional surveillance with an eye care professional (n = 271). The telemedicine group was more likely to receive a diabetic retinopathy screening examination when compared with the traditional surveillance group during the 6-month or less and greater than 6-month through 18-month time bins. The authors conclude that primary care clinics can use telemedicine to screen for diabetic retinopathy and monitor for disease worsening over a long period.

Invited Commentary

In this retrospective case-series study of children attending Give Kids Sight Day (GKSD) in 2012 at a low-socioeconomic urban setting, Dotan et al describe the demographic characteristics and ophthalmic conditions of the children. Provision of free glasses and failure of previous vision screening were the most common reasons families elected to attend GKSD (64% and 49%, respectively), including 10% of attendees who needed continuous ophthalmic care, most commonly for amblyopia. With the assistance of a social worker, 59% of children requiring continuous treatment returned to the clinic, compared with 2% in prior years before social worker intervention, suggesting that social worker intervention is useful in overcoming common barriers to follow-up care.

Kaplan and coauthors assess the cost-effectiveness of trabeculectomy with mitomycin vs tube insertion vs maximal medical treatment. Using a Markov cohort model with a 5-year time horizon to study a hypothetical cohort of 100 000 patients who required glaucoma surgery, they found that the mean costs for medical treatment, trabeculectomy, and tube insertion were $6172, $7872, and $10 075, respectively, resulting in a cost difference of $1700 (95% CI, $1644-$1770) for medical treatment vs trabeculectomy, $3904 (95% CI, $3858-$3953) for medical treatment vs tube insertion, and $2203 (95% CI, $2121-$2261) for trabeculectomy vs tube insertion. The authors conclude that trabeculectomy and tube insertion are cost-effective compared with medical treatment alone, although trabeculectomy is cost-effective at a substantially lower cost per quality-adjusted life-year compared with tube insertion.

Continuing Medical Education

Bressler and colleagues for the Diabetic Retinopathy Clinical Research Network assessed the risk of sustained intraocular pressure (IOP) elevation or the need for IOP-lowering treatments for eyes with diabetic macular edema following repeated intravitreous injections of ranibizumab. The cumulative probability of sustained IOP elevation or of initiation or augmentation of ocular hypotensive therapy by 3 years, after repeated ranibizumab injections, was 9.5% for the participants who received ranibizumab plus prompt or deferred focal/grid laser treatment vs 3.4% for the participants who received a sham injection plus focal/grid laser treatment (difference, 6.1% [99% CI, −0.2% to 12.3%]; hazard ratio, 2.9 [99% CI 1.0-7.9]; P = .01). The authors conclude that, in eyes with center-involved diabetic macular edema and no prior open-angle glaucoma, repeated intravitreous injections of ranibizumab may increase the risk of sustained IOP elevation or the need for ocular hypotensive treatment.

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