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In This Issue of JAMA Ophthalmology
April 2015


JAMA Ophthalmol. 2015;133(4):369. doi:10.1001/jamaophthalmol.2014.3712


To assess patient mortality outcomes associated with uveal melanoma staging according to the 7th edition of the American Joint Committee on Cancer’s (AJCC) AJCC Cancer Staging Manual, the AJCC Ophthalmic Oncology Task Force retrospectively evaluate patient-specific data fields for 3809 patients with uveal melanoma across 10 ophthalmic oncology centers from 4 continents. Among patients entered into the database, with 3377 (88.7%) having complete records, the 5-year Kaplan-Meier metastasis-free point estimates by tumor size categories ranged from 97% (95% CI, 95%-98%) for T1 tumors to 61% (95% CI, 49%-71%) for T4 tumors. The authors contended that their results support the continued use of the 7th edition of the AJCC Cancer Staging Manual for uveal melanoma, recognizing that future modifications are inevitable.

Gracitelli and colleagues evaluate the relationship between the rates of retinal nerve fiber layer (RNFL) loss from glaucoma in the better eye and changes in vision-related patient-reported outcomes. The study used the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) in 130 patients with glaucoma followed up for a mean of 3.5 years. In a multivariable model adjusting for baseline disease severity and the rate of change in binocular standard automated perimetry sensitivity, each 1-μm-per-year loss of RNFL thickness was associated with a decrease of 1.3 units (95% CI, 1.02-1.56) per year in NEI VFQ-25 scores (P < .001). This progressive binocular RNFL loss was associated with longitudinal loss in this patient-reported outcome, even after adjustment for visual field loss, suggesting that rates of binocular RNFL change are valid markers for the degree of neural loss in glaucoma related to glaucoma-associated disability.

Continuing Medical Education, Author Audio Interview, and Journal Club

Because patients are increasingly using the Internet to supplement searches for medical information, online ophthalmologic materials should be written at an appropriate reading level. Huang and colleagues evaluate online patient education materials on ophthalmologic association websites to determine whether they are above the reading level recommended by the American Medical Association and National Institutes of Health. Among 339 online patient education materials assessed, the mean Flesch Reading Ease score was 40.7 (range, 17.0-51.0), correlating with a difficult level of reading. While analysis of variance demonstrated substantial differences among the websites for each reading scale, the data suggest that consideration should be given to revising some materials to allow greater comprehension among a wider audience.

Because the ocular status of many homeless populations remains unknown, Noel and colleagues assess the prevalence of visual impairment to identify unmet eye care needs in an adult homeless population. One hundred homeless persons were recruited using a stratified random sampling technique from January to March 2014 at 10 randomly selected adult shelters in Toronto, Ontario, Canada. Based on the participants’ presenting visual acuity, the age-standardized rate of visual impairment was 25.2% (95% CI, 16.7%-33.7%) decreasing to 15.2% (95% CI, 7.7%-22.7%) after pinhole occlusion, with 1 or more abnormal findings identified in 34% (95% CI, 24.7%-43.3%) including 8% (95% CI, 2.7%-13.3%) requiring urgent referral to an ophthalmologist. Although the major problem was refractive error, this cross-sectional study suggested that homeless adults have a high prevalence of visual impairment, even when living within a system of universal health insurance.