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In This Issue of JAMA Ophthalmology
August 2015

Highlights

JAMA Ophthalmol. 2015;133(8):861. doi:10.1001/jamaophthalmol.2014.3732
Research

Optimization of glycemic control is critical to reduce the number of diabetes mellitus–related complications. Aiello and colleagues determine whether point-of-care measurement of hemoglobin A1c (HbA1c) and personalized diabetes risk assessments during retinal ophthalmologic visits improve glycemic control. Investigators from 42 sites were assigned randomly to provide either a study-prescribed augmented diabetes assessment and education or the usual care among adults with type 1 or 2 diabetes enrolled into 2 cohorts. Those with a more-frequent-than-annual follow-up had an adjusted mean difference of −0.09%; those with an annual follow-up had a mean difference of −0.05%. The addition of personalized education and risk assessment during retinal ophthalmologic visits did not result in a reduction in HbA1c level compared with usual care over 1 year.

Invited Commentary

Continuing Medical Education

Because glaucoma-related adverse events constitute major sight-threatening complications of cataract removal in infancy and yet their relationship to aphakia vs primary intraocular lens (IOL) implantation remains unsettled, Freedman and colleagues identify and characterize cases of glaucoma and glaucoma-related adverse events among children in the Infant Aphakia Treatment Study by the age of 5 years. Among 114 infants with unilateral congenital cataract between ages 1 and 6 months at surgery, product limit estimates of the risk for glaucoma and glaucoma + glaucoma suspect at 4.8 years after surgery were 17% and 31%, respectively. Primary IOL placement did not mitigate the risk; surgery at a younger age increased the risk. The authors noted that glaucoma-related adverse events are common and increase between ages 1 and 5 years in infants after unilateral cataract removal at 1 to 6 months of age.

Because caloric-restriction mimetic drugs have geroprotective effects that delay or reduce risks for a variety of age-associated systemic diseases, such drugs might have the potential to reduce risks of open-angle glaucoma (OAG) for which age is a major risk factor. To investigate this possibility, Lin and colleagues perform a retrospective cohort study of patients 40 years or older with diabetes mellitus and no preexisting record of OAG. Of 150 016 patients with diabetes mellitus, 5893 developed OAG. After adjusting for confounding factors, those prescribed the highest quartile of metformin hydrochloride (>1110 g in 2 years) had a 25% reduced OAG risk relative to those who took no metformin.

Because visual acuity likely is the most frequently performed measure of visual function in clinical practice, Bastawrous and colleagues validate a smartphone-based visual acuity test (Peek Acuity) not dependent on familiarity with symbols or letters commonly used in English. Comparing monocular logMAR visual acuity scores for each test in participants’ homes and temporary clinic settings in rural Kenya in 2013 and 2014, they found that the 95% CI limits for test-retest variability of smartphone acuity data were ±0.033 logMAR. The mean differences between the smartphone-based test and the Early Treatment Diabetic Retinopathy Study (ETDRS) chart and the smartphone-based test and Snellen acuity data were 0.07 and 0.08 logMAR, respectively, indicating that smartphone-based test acuities agreed well with those of the ETDRS and Snellen charts.

Journal Club and Continuing Medical Education

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