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In This Issue of JAMA Ophthalmology
May 2014


JAMA Ophthalmol. 2014;132(5):517. doi:10.1001/jamaophthalmol.2013.5938


Individual variation in response and duration of anti–vascular endothelial growth factor (VEGF) therapy is seen among patients with neovascular age-related macular degeneration. To understand how identification of genetic markers might affect clinical response of anti-VEGF therapy, Hagstrom and colleagues evaluated the pharmacogenetic relationship between genotypes of single-nucleotide polymorphisms in the VEGF signaling pathway and response to treatment with ranibizumab or bevacizumab for neovascular age-related macular degeneration. Among 835 participants, no association was identified with any of the genotypes or with the number of risk alleles. This study provides evidence that no pharmacogenetic associations exist between the studied VEGF single-nucleotide polymorphisms and response to anti-VEGF therapy.

Journal Club

Because effective strategies for primary prevention are lacking for exfoliation glaucoma, Kang and colleagues examined the association between B vitamin intake and exfoliation glaucoma or suspected exfoliation glaucoma risk within the Nurses’ Health Study. The authors were unable to identify an increased risk of vitamin B6 or vitamin B12 intake for this outcome in pooled analyses (P = .52 and P = .99 for linear trend, respectively), although the data suggested a reduced risk with higher intake of folate, supporting a possible causal role of homocysteine in exfoliation glaucoma. The authors warned that the results should be interpreted cautiously and the associations could be interpreted as hypothesis generating and not as proof of a cause and effect relationship.

Although electronic health record (EHR) systems have potential benefits, such as improved safety and quality of care, not all ophthalmology practices, including activities within the operating room (OR), have adopted these systems. Sanders and colleagues determined the impact of an EHR OR management system on intraoperative nursing documentation time, surgical volume, and staffing requirements. Among 13 ophthalmic OR nurses and 25 surgeons at an academic medical center, there was a worsening in total percentage of operating time documenting (83%) early in the adoption of the EHR vs paper (41%; P < .001), which improved to baseline levels (46%, P = .28) with time. The authors concluded that it is possible to implement an EHR OR management system without serious negative impacts on surgical volume and staffing requirements.

Dermal injection of cosmetic fillers can lead to numerous complications, but irreversible blindness when such fillers are injected in the forehead has not been well documented. To highlight this potential complication of a common cosmetic procedure, Carle and colleagues described irreversible vision loss from a central retinal artery occlusion occurring shortly after cosmetic facial enhancement in 3 patients. While cosmetic facial fillers are not approved by the Food and Drug Administration for use in the forehead, off-label use is reported to be common. The authors hypothesized that the filler presumably enters the central retinal artery via the rich external-internal carotid anastomoses and becomes embedded in the retinal tissues, potentially leading to irreversible and severe vision loss. Physicians performing cosmetic enhancement procedures involving facial fillers need to be aware of this potential complication.