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In This Issue of JAMA Ophthalmology
September 2018


JAMA Ophthalmol. 2018;136(9):965. doi:10.1001/jamaophthalmol.2017.3743


Zheng and coauthors investigate how visual impairment and cognitive function are associated with each other over time in a longitudinal study of 2520 older US adults. Visual impairment was associated with declining cognitive function cross-sectionally and over time, with worsening vision having a stronger association with declining cognition than vice versa. The findings suggest visual impairment is adversely associated with future cognitive function in older adults, underscoring the importance of maintaining good vision to mitigate age-related cognitive declines.

Invited Commentary

CME Journal Club

Recognizing that cataracts are the most common cause of impaired vision worldwide and may increase a driver’s risk of a serious traffic crash, Schlenker and coauthors evaluate if cataract surgery in a driver is associated with reduced serious traffic crashes. In a population-based study of 559 546 patients who received at least 1 eye cataract surgery, the crash rate decreased from 2.36 per 1000 patient-years in the baseline interval to 2.14 per 1000 patient-years after surgery, representing a 9% reduction in serious traffic crashes. The results, while not designed to determine a causal relationship of cataract surgery and serious traffic crashes, suggest cataract surgery is associated with a patient’s reduced subsequent risk of serious traffic crash as a driver.

Continuing Medical Education

Snyder and coauthors evaluate the association between retinal vasculature and late age-related macular degeneration (AMD). They determine the potential hemodynamic contribution from the retinal vasculature in the pathogenesis of choroidal neovascularization (CNV) in AMD from a secondary analysis of fundus photograph gradings from 3647 participants. Eyes with a cilioretinal artery were associated with a lower CNV prevalence, lower AMD severity score, and lower 5-year CNV incidence. There was no definitive association identified with the prevalence or incidence of geographic atrophy involving the center of the macula. The authors conclude that a cilioretinal artery may be protective against the development of CNV; this association suggests a possible hemodynamic contribution to neovascular AMD pathogenesis.

Invited Commentary

Binenbaum and coauthors for the G-ROP Study Group note that current retinopathy of prematurity (ROP) guidelines are based on studies of high-risk infants and expert opinion and have low specificity for disease requiring treatment. Postnatal weight gain–based models improve specificity but have been limited by complexity and small development cohorts, which results in model overfitting and resultant decreased sensitivity in validation studies. Therefore, they investigate if a highly sensitive, postnatal weight gain–based ROP predictive model can be developed using data from a diverse cohort of at-risk infants. In their cohort study of 7483 premature infants, a model consisting of 6 criteria correctly predicted 100% of infants with type 1 ROP while reducing the number of infants who required examinations by 30.3% when only infants who met the criteria received examinations. If validated, these modified screening criteria might be used to reduce the number of infants who require examinations while consistently identifying treatment-requiring ROP.