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In This Issue of JAMA Ophthalmology
October 2014


JAMA Ophthalmol. 2014;132(10):1163. doi:10.1001/jamaophthalmol.2013.5963


Because most patients with low vision are older and have functional limitations from other health problems that could add to the functional limitations caused by their visual impairments, Goldstein and colleagues identify factors associated with visual ability measures among new patients of a prospective observational study seeking outpatient low vision rehabilitation services. Patients (N = 779) from 28 US clinical centers completed an adaptive visual function questionnaire and other questionnaires. Correlations were observed between visual acuity and baseline visual ability overall (r = −0.42) and across the 4 functional domains evaluated. The authors concluded that visual ability is a multidimensional construct, with visual acuity, depression, physical ability, and cognition explaining more than one-third of the variance in visual ability as measured by these questionnaires.

Quinn and colleagues evaluate the validity of a telemedicine system to identify infants who have sufficiently severe retinopathy of prematurity (ROP), as the present strategy requires repeated examinations of at-risk infants by physicians, although less than 10% require treatment. In this observational study, 1257 premature infants with birth weight less than 1251 g were examined starting at 32 weeks’ postmenstrual age by an ophthalmologist with digital imaging using a wide-field digital camera graded by 2 masked nonphysicians. Remote grading of images had a sensitivity of 81.9% and specificity of 90.1%, providing support for the validity of remote evaluation by trained nonphysician readers of digital retinal images taken by trained nonphysician imagers from infants at risk for ROP.

Continuing Medical Education

Guidelines recommend that long-term users of chloroquine or hydroxychloroquine sulfate undergo regular evaluations to check for maculopathy. Nika and colleagues investigate whether patients with rheumatoid arthritis (RA) or systemic lupus erythematosus (SLE) taking these medications are regularly visiting eye care providers and being screened for maculopathy in a managed care network. Among 18 051 beneficiaries with RA or SLE, 35.1% had at least 1 record of chloroquine or hydroxychloroquine use and 7.8% had used chloroquine or hydroxychloroquine for at least 4 years. Among these, 27.9% lacked regular eye care visits, 6.1% had no visits to eye care providers, and 34.5% had no diagnostic testing for maculopathy over 5 years. These data suggest that many patients at high risk for maculopathy associated with the use of chloroquine or hydroxychloroquine are not undergoing routine monitoring for ophthalmic adverse effect.

Journal Club

Melki and colleagues report on a wireless intraocular pressure transducer in a human eye to evaluate preliminary safety data on the transducer prospectively. In a study participant with open-angle glaucoma who consented to receive the transducer in 1 eye, the device was implanted into the ciliary sulcus following extracapsular cataract extraction and “in the bag” intraocular lens implantation. No complications were noted intraoperatively, and no persistent intraocular inflammation, pigment dispersion, or angle narrowing were noted through 18 months. Further follow-up with more patients would be needed to gain a greater understanding of the safety of a device that might allow for constant monitoring of intraocular pressure in the future.