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In This Issue of JAMA Ophthalmology
February 2015


JAMA Ophthalmol. 2015;133(2):119. doi:10.1001/jamaophthalmol.2014.3702


To investigate the effect of the severity of age-related macular degeneration (AMD) in 1 eye on the incidence, progression, and regression of AMD in the fellow eye, Gangnon and colleagues evaluate retinal photographs and adjust for age, sex, the Y402H polymorphism in the complement factor H gene on chromosome 1q, and mortality. The authors estimated that approximately 50% of participants who developed any AMD always maintained AMD severity states within 1 step of each other between eyes while 90% of participants stayed within 2 steps. Understanding the course of AMD and the risk for earlier stages of AMD worsening based on either the worse or better eye may help in determining how often patients who are at risk for worsening of AMD should be seen.

This retrospective international cooperative study involving 6 eye cancer centers during 30 years identified 106 patients with ocular adnexal diffuse large B-cell lymphoma followed up for a median of 52 months. Munch-Petersen and colleagues report the 5-year overall survival among the entire cohort as 36% (median, 3.5 years; 95% CI, 2.5-4.5 years), with a relapse in 44%. Increasing T category of the TNM staging system (based on the size and/or extent of the primary tumor [T] and whether cancer cells have spread to nearby [regional] lymph nodes [N] and whether metastasis [M], or the spread of the cancer to other parts of the body, have occurred) was predictive of disease-specific survival (P = .04).

Owsley and colleagues examine the rate and types of diabetic retinopathy (DR) identified through a telemedicine screening program using a nonmydriatic camera, as well as the rate of other ocular findings at 4 urban clinic or pharmacy settings in the United States serving predominantly ethnic/racial minority and uninsured persons with diabetes mellitus. Among 1894 persons screened, 21.7% had DR in at least 1 eye. The most common type of DR (94.1%) was mild or moderate nonproliferative DR. In addition, 44.2% of the sample screened had ocular findings other than DR, among which 30.7% were cataract. A collateral benefit of such DR screening programs that may be underappreciated is the detection of other ocular conditions.

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Narayanaswamy and colleagues randomly assign 100 patients with primary angle closure (PAC) or PAC glaucoma to selective laser trabeculopalsty (SLT), repeated if the intraocular pressure (IOP) reduction was less than 20% from baseline at the 1- or 3-month follow-up visit, or to travoprost. They could not identify differences between the SLT and travoprost groups in the absolute mean reduction of IOP (4.0 vs 4.2 mm Hg, respectively; P = .78) or in the percentage of reduction in IOP (16.9% vs 18.5%, respectively; P = .52) at 6 months, although complete success (IOP ≤ 21 mm Hg without medications) was achieved in 60.0% eyes of the SLT group compared with 84.0% of eyes in the travoprost group (P = .008). The authors concluded that while eyes with PAC or PAC glaucoma respond to SLT in the short term, the overall long-term therapeutic effectiveness needs further evaluation.

Continuing Medical Education