To determine whether vision-related quality-of-life outcomes were different between natamycin, 5%, and voriconazole, 1%, topical treatments in the Mycotic Ulcer Treatment Trial I, Rose-Nussbaumer and colleagues analyze secondary outcomes from a randomized clinical trial. Among 292 participants who completed the questionnaire at 3 months, study participants in the natamycin-treated group scored, on average, 4.3 points higher than those in the voriconazole-treated group. The authors suggested that quality-of-life measures in clinical trials are important to evaluate when studying interventions of corneal fungal ulcers.
To examine the clinical and economic impact of electronic health record (EHR) system implementation into a large multispecialty ophthalmic practice, Singh and colleagues conduct a retrospective case-control study within a large multispecialty ophthalmic practice comparing pre- and post-EHR periods. Among a total of 28 161 patient encounters, no change was identified with total net fiscal revenue between the periods, and no change in patient volume or revenue per visit volume was identified. While implementation of an EHR involves costs, the analyses did not identify differences in revenue or productivity following EHR conversion in this clinical setting. Boland provides a related editorial.
Continuing Medical Education
To describe a centralized system for grading retinopathy of prematurity (ROP) digital images by trained readers in the Telemedicine Approaches to Evaluating Acute-Phase Retinopathy of Prematurity (e-ROP) Study, Daniel and colleagues determine whether gradings using a computerized algorithm led to referral-warranted ROP (RW-ROP) defined as the presence of plus disease, zone I ROP, and stage 3 or worse ROP in digital images from infants with birth weight less than 1251 g. Among a total of 5520 image sets double graded, with 24.5% requiring adjudication for at least 1 component of RW-ROP, for individual RW-ROP components, the adjudication rate was 3.9% for plus disease, 12.4% for zone I ROP, and 16.9% for stage 3 or worse ROP. The weighted κ for intergrader agreement (n = 80 image sets) was 0.72 for RW-ROP, 0.57 for plus disease, 0.43 for zone I ROP, and 0.67 for stage 3 or worse ROP. These data suggest that this e-ROP system for training and certifying nonphysicians to grade ROP images under the supervision of a reading center director reliably detects potentially serious ROP.
In the Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error Study, Zadnik and colleagues determine predictors for myopia onset among 4512 ethnically diverse, nonmyopic school-aged children from grades 1 through 8 in an observational cohort study. A total of 414 children became myopic from grades 2 through 8 (ages 7 through 13 years), with 10 of 13 factors evaluated being associated with the risk for myopia onset including 8 factors that retained their association in multivariate models. These 8 factors included spherical equivalent refractive error at baseline, parental myopia, axial length, corneal power, crystalline lens power, ratio of accommodative convergence to accommodation, horizontal/vertical astigmatism magnitude, and visual activity. The authors concluded that future myopia can be predicted in a nonmyopic child using a simple, single measure of refractive error.
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