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In This Issue of JAMA Ophthalmology
April 2014


JAMA Ophthalmol. 2014;132(4):375. doi:10.1001/jamaophthalmol.2013.5933


Visual field loss due to retinal damage is considered irreversible, but methods to achieve vision restoration, such as behavioral vision training, might be beneficial. In a randomized clinical trial, Sabel and Gudlin evaluated 1-hour daily computer-based vision restoration training compared with visual discrimination sham training for 3 months in 30 patients with glaucoma. Patients assigned to vision restoration training were more likely to demonstrate detection accuracy gains in high-resolution perimetry than the control group (P = .007). The authors proposed that neuroplasticity of the visual cortex or higher cortical areas may account, at least in part, for the findings.

Journal Club

Because spectral-domain optical coherence tomography has an integral role in diagnosing and treating glaucoma, understanding the types of artifacts commonly seen in the imaging of patients being evaluated for glaucoma may help physicians better implement these data in the care of patients. To expand this understanding, Asrani and colleagues determined the frequency and distribution of imaging artifacts in patients being evaluated for glaucoma, providing examples of common artifacts in a retrospective cross-sectional study design of 277 patients who had a diagnosis of glaucoma of any stage or suspected glaucoma. Of the macular thickness scans, 37 (28.2%) had imaging artifacts, while of the retinal nerve fiber layer scans, 55 (19.9%) contained artifacts, most commonly due to the presence of an epiretinal membrane and not always evident on the final printout.

Outcomes following acute optic neuritis in individuals of African descent compared with individuals of white race/ethnicity have been inconsistent across studies. Therefore, Moss and colleagues investigated the associations of race/ethnicity with visual outcomes following acute optic neuritis through application of longitudinal data analysis techniques to the Optic Neuritis Treatment Trial data set. Among 58 black and 388 white trial participants, race/ethnicity appeared to be related to contrast sensitivity and visual acuity during a 15-year period following acute optic neuritis, with black race/ethnicity being associated with worse scores for both. These results have implications for understanding prognostic determinants of optic neuritis outcomes.

Ocriplasmin cleaves fibronectin and laminin, components of the vitreous gel, and is used as a pharmacologic treatment for vitreomacular traction. Laminin is also found throughout multiple retinal layers. Ocriplasmin injection may lead to acute panretinal dysfunction in some eyes, but the mechanism of this toxic reaction has not been described. In a report by Fahim and colleagues, the authors described patients with acute panretinal dysfunction after intravitreous ocriplasmin injection for vitreomacular interface abnormalities. The findings indicated that retinal dysfunction associated with intravitreous ocriplasmin injection is not limited to the macular region and seems to involve the entire retina. In an accompanying editorial, Kim suggested that the findings highlight the need to further investigate risk factors for adverse events, the duration and extent of recovery, and ways to minimize toxic effects following ocriplasmin injection.

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