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In This Issue of JAMA
May 21, 2019


JAMA. 2019;321(19):1847-1849. doi:10.1001/jama.2018.15333

The best approach to treating patients with diabetic macular edema involving the center of the macula but with good visual acuity is unknown. Baker and colleagues randomized 702 patients and found no significant difference in vision loss at 2 years for patients treated with aflibercept, laser photocoagulation, or observation followed by treatment with aflibercept only if visual acuity worsened. In an Editorial, Chew suggests that delaying therapy would reduce health care costs and allow many patients to avoid having intraocular injections.


Visual Abstract

Adverse levels of lipids and apolipoprotein B in childhood are associated with early evidence of atherosclerosis. Perak and colleagues analyzed serial cross-sectional surveys of US population-weighted data for 26 047 respondents and observed favorable trends in lipids and apolipoprotein B for US youths aged 6 to 19 years.

It is well-established that air pollution can trigger asthma attacks, but it is uncertain whether exposure to specific pollutants is associated with the development of childhood asthma. Garcia and colleagues followed 4140 elementary school children during a period of improved air quality in Southern California and found that decreases in ambient nitrogen dioxide and particulate matter less than 2.5 μm were associated with a lower incidence of asthma. In an Editorial, Thurston and Rice suggest that decisions about environmental policy should be based on scientific evidence of benefit and harm.



Associations of income and life expectancy may be attributable to differences in access to health care, behavioral risk factors, neighborhood characteristics, and social stress. Kinge and colleagues conducted a registry-based study of all 3 041 828 Norwegian residents aged 40 years and older and observed substantial and increasing gaps in life expectancy associated with income from 2005 to 2015. In an Editorial, Cutler comments that in Norway and the United States, residents at every level of income live longer on average than residents at the next lower income level.



Clinical Review & Education

Metformin is the first-line pharmacologic treatment for patients with type 2 diabetes. This JAMA Insights article by Flory and Lipska discusses the efficacy and safety for this widely used therapeutic agent.

In this JAMA Clinical Guidelines Synopsis of a 2017 guideline developed by the American Thyroid Association, Dickens and colleagues discuss the clinical management of women with thyroid disease during pregnancy and the postpartum period.

This JAMA Clinical Challenge by Gaston and colleagues presents a 24-year-old farm worker with persistent fever, migratory polyarthralgias, and a truncal rash that spread to her palms and soles. What would you do next?