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In This Issue of JAMA Ophthalmology
November 2014


JAMA Ophthalmol. 2014;132(11):1265. doi:10.1001/jamaophthalmol.2013.5968


Because payers and patients might benefit economically by switching from delayed sequential cataract surgery (DSCS) to immediate sequential cataract surgery (ISCS), Neel performs a cost-minimization analysis comparing ISCS with DSCS in the United States from the payer, patient, and societal perspectives for the West Tennessee region and nationally. Nationally, Medicare was estimated to reduce costs by approximately $522 million with the switch from DSCS to ISCS in 2012, with the total Medicare-based societal cost reduction estimated at $783 million. The author concludes that payers and patients might benefit from an economic standpoint by switching from DSCS to ISCS.

To pursue a visual field parameter that is resistant to cataract formation and extraction, which might help monitor glaucomatous visual field worsening in patients with coexisting glaucoma and cataract, Lee and colleagues retrospectively evaluate the influence of cataract surgery on the fast and slow rate components of visual field decay in 68 patients with glaucoma with 5 or more reliable visual fields both before and after surgery. The mean (SD) mean deviation was −5.5 (5.1) dB before and −5.0 (4.9) dB after cataract surgery (P = .002), while the mean (SD) Visual Field Index was 86.4% (13.5%) before and 86.6% (13.3%) after cataract surgery (P = .30). The authors concluded that worsening cataract seems to be the main determinant for the slow rate component and does not appear to change the fast rate component. Thus, this method might help reduce the confounding effects of worsening cataract and cataract extraction on worsening perimetry measurements in glaucoma.

With limited data regarding the systemic safety of intravitreal anti–vascular endothelial growth factor (VEGF) monoclonal antibody, Thulliez and colleagues conduct a systematic review and meta-analysis evaluating major cardiovascular risks and nonocular hemorrhagic events in patients with neovascular age-related macular degeneration, diabetes mellitus–associated macular edema, or retinal vein occlusions who receive these injections. Using a fixed-effects model among 21 trials that evaluated 9557 patients, the authors were not able to identify an increased risk for major cardiovascular events (odds ratio, 1.18; 95% CI, 0.81-1.71) or nonocular hemorrhagic events (odds ratio, 1.42; 95% CI, 0.95-2.13) compared with control populations, although bevacizumab compared with ranibizumab had increased venous thromboembolic events (odds ratio, 3.45; 95% CI, 1.25-9.54). The authors stated that studies and meta-analyses were not powered enough to assess these risks confidently, that these results should be interpreted with caution, and that more safety data are needed.

Recognizing that children born prematurely who develop retinopathy of prematurity (ROP) often develop myopia and that those who require laser treatment may develop very high myopia, with considerable clinical consequences, Geloneck and colleagues report refractive outcomes from among the 150 preterm infants who developed ROP in zone I or zone II posterior as stage 3+ ROP or aggressive posterior ROP in a multicenter randomized clinical trial. Among the 109 children who received intravitreal bevacizumab or laser in the clinical trial for whom cycloplegic retinoscopic refraction at a mean age of 2.5 years was available, very high myopia (≥−8.00 D myopic) occurred in zone I in 2 of 52 eyes (3.8%) that received intravitreal bevacizumab compared with 18 of 35 eyes (51.4%) that received laser treatment (P < .001). The authors hypothesized that this difference possibly is related to anterior segment development that is present with intravitreal bevacizumab but minimal or absent following laser treatment.