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In This Issue of JAMA Ophthalmology
June 2017


JAMA Ophthalmol. 2017;135(6):509. doi:10.1001/jamaophthalmol.2016.3737

Because Fusarium keratitis is a common cause of fungal keratitis, Prajna and coauthors for the Mycotic Ulcer Treatment Trial Group investigate the role of adjuvant oral voriconazole on clinical outcomes in Fusarium keratitis. In a prespecified subgroup analysis of a randomized clinical trial of 72 patients with culture-positive fungal ulcer and baseline visual acuity of 20/400 or worse, the authors found that Fusarium ulcers randomized to treatment with oral voriconazole in addition to topical natamycin and voriconazole had a decreased rate of corneal perforation, smaller scar size, and more rapid reepithelialization.

Invited Commentary

Continuing Medical Education

Because the Diabetic Retinopathy Clinical Research Network reported that ranibizumab was a reasonable treatment alternative to panretinal photocoagulation (PRP) when managing proliferative diabetic retinopathy (PDR), with or without concomitant baseline diabetic macular edema (DME), and because ranibizumab injections are costly, Hutton and coauthors for the network evaluate the relative cost-effectiveness of these 2 treatment modalities. A preplanned secondary analysis found that for participants with and without baseline vision-impairing DME, the incremental cost-effectiveness ratios of ranibizumab therapy compared with PRP were $55 568/quality-adjusted life-year and $662 978/quality-adjusted life-year, respectively, over 2 years. While longer-term data are needed, compared with PRP, 0.5-mg ranibizumab was within the $50 000/quality-adjusted life-year to $150 000/quality-adjusted life-year range frequently cited as cost-effective in the United States for eyes presenting with PDR and vision-impairing DME, but not for those with PDR without vision-impairing DME.

Invited Commentary

Recognizing that visual impairment in early childhood can impair development, Varma and coauthors determine demographic and geographic variations in visual impairment in US preschool children in 2015 and the projected prevalence through 2060. They found the number of preschool children with visual impairment was projected to increase by 26% in 2060, with 69% of visual impairment resulting from simple uncorrected refractive error and Hispanic white children accounting for the largest number and proportion of cases, followed by African American children. The results suggest vision screening and early intervention targeting preschool populations might prevent unnecessary visual impairment and associated developmental delays such as poor reading skills.

While SCORE2 reported that bevacizumab is noninferior to aflibercept with respect to visual acuity (VA) outcomes at 6 months in eyes with macular edema associated with a central retinal vein occlusion, identifying factors associated with better outcomes in eyes treated with anti–vascular endothelial growth factor therapy may provide useful information to counsel patients. In a secondary analysis of a randomized trial with 362 participants, Scott and coauthors for the SCORE2 Investigator Group found that younger age and worse baseline VA were associated with better 6-month VA. Aflibercept treatment was associated with better central subfield thickness but not VA outcomes than bevacizumab.

Invited Commentary and Related Article