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In This Issue of JAMA Ophthalmology
October 2016


Author Affiliations

Copyright 2016 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.

JAMA Ophthalmol. 2016;134(10):1083. doi:10.1001/jamaophthalmol.2015.3262

While Oklahoma is one of the few states where optometrists have surgical privileges to perform laser trabeculoplasty (LTP), little is known whether outcomes of patients undergoing this procedure by optometrists are different from those undergoing LTP by ophthalmologists. Stein and coauthors investigate whether there are differences in the frequency and likelihood of undergoing additional LTP among Medicare enrollees in Oklahoma who underwent LTP by an ophthalmologist vs by an optometrist. Among the 1384 eyes receiving LTP, the proportion of eyes treated by optometrists requiring additional LTP in the same eye (35.9%) was more than double the proportion of those treated by ophthalmologists (15.1%). Optometrist-treated eyes had a 189% increased risk of requiring additional LTP.

Invited Commentaries 1 and 2

Continuing Medical Education

Because determining the national epidemiologic trends of chemical ocular burns might assist with allocation of resources for treatment and prevention, Haring and coauthors evaluate which populations are at highest risk for such burns. In a cross-sectional analysis of the US Nationwide Emergency Department Sample, children aged 1 to 2 years were at a higher risk for ocular chemical burns than any other group. In general, ocular chemical burn injuries were most common in those aged 18 to 64 years (73.2%). These findings suggest that US children aged 1 to 2 years are at much higher risk for an ocular chemical burn than previously recognized.

Continuing Medical Education

Although individual-level characteristics are associated with eye care use, the influence of contextual factors, including demographic and social composition of communities, collective and organizational values, cultural norms, and political perspectives on vision and eye health, as well as health behavior, is unknown. Chou and coauthors determine the association between county-level characteristics and eye care use in adults 40 years and older in 22 states. They found the odds of reporting an eye care visit in the past year or receipt of a dilated eye examination in the past year was higher among people living in counties with high percentages of black individuals or low-income households than among those in counties with the lowest tertile of each county-level characteristic. These data suggest that US eye care use is associated with county-level characteristics independent of individual-level characteristics.

Invited Commentary

Because corneal abrasions are frequent after standard (epithelium-off [epi-off]) corneal collagen cross-linking (CXL) in patients with progressive keratoconus, Bata and coauthors evaluate a matrix therapy agent to determine whether it improves corneal wound healing after standard corneal epi-off CXL. Patients were randomized to receive the matrix therapy agent or hyaluronic acid–containing eye drops, 0.1%, every other day starting immediately after surgery. The corneal wound healing rate, defined as the size of the defect over time, was faster in patients receiving matrix therapy agent–containing eye drops compared with control individuals. Data from this small study suggest that a matrix therapy agent improves corneal wound healing after standard corneal epi-off CXL in patients with keratoconus.

Invited Commentary