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In This Issue of JAMA Ophthalmology
February 2017


JAMA Ophthalmol. 2017;135(2):81. doi:10.1001/jamaophthalmol.2016.3717

To determine the value of adding low-vision (LV) rehabilitation with a therapist vs LV services without intervention, Stelmack and coauthors evaluate whether LV devices with LV rehabilitation (therapy and homework to teach device use, eccentric viewing, and environmental modification) are more effective than basic LV services (LV devices without therapy) for veterans with macular diseases and visual acuity of 20/50 to 20/200. In a randomized clinical trial, the authors reported that both treatments were found to be effective, but LV rehabilitation was more effective than basic LV services for patients with visual acuity worse than 20/63 to 20/200. These findings suggest that basic LV services are sufficient for most patients with LV who have mild visual impairment.

Invited Commentary

Author Audio Interview, Continuing Medical Education, and Journal Club

While many cross-sectional studies have evaluated risk factors for dry eye severity, few studies have assessed risk factors or symptom progression over time. Ong and coauthors assess symptom progression in dry eye and the risk factors associated with severe symptoms at 1 year. In a longitudinal study of US veterans, most patients with severe baseline dry eye symptoms reported persistent severe symptoms at 1 year. Baseline nociceptive and neuropathic ocular pain, in addition to sleep disturbances, mental health status, nonocular pain, and medications, also were risk factors. The results may mean that pain perception and severity are important when evaluating and managing dry eye.

Continuing Medical Education

Although the US rate of types 1 and 2 diabetes is increasing, the effect of diabetes on corneal donor tissue is unknown. Margo and coauthors evaluate the effect of type 1 or 2 diabetes on endothelial cell density, corneal transplant suitability, and technician-induced cell damage on eye bank donor characteristics. Their database study found that 8552 of 27 948 eyes (30.6%) during the 3-year study period were from donors with diabetes. No correlation was identified between the presence of diabetes or severe diabetes and poor transplant suitability, reduced endothelial cell counts, or technician-induced tissue damage. The data suggest the presence of diabetes in corneal donors does not reduce endothelial cell density or limit tissue suitability for transplantation, regardless of disease severity.

Recognizing that current screening approaches have low specificity for severe retinopathy of prematurity, Gurwin and coauthors evaluate whether a tiered approach to retinopathy of prematurity screening, combining a postnatal weight gain model with telemedicine fundus image grading, provides advantages compared with either approach alone. In a post hoc analysis of 242 infants from the Postnatal Growth and Retinopathy of Prematurity Study and the Telemedicine Approaches to Evaluating Acute-Phase Retinopathy of Prematurity Study, all screening approaches had 100% sensitivity for severe retinopathy of prematurity. However, the tiered approach was associated with a reduction in the number of retinal imaging sessions and examinations. These results suggest that applying a postnatal growth model and telemedicine system in a synergistic tiered approach can reduce the number of clinical retinopathy of prematurity interventions more than either approach alone.