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In This Issue of JAMA Ophthalmology
July 2015


JAMA Ophthalmol. 2015;133(7):739. doi:10.1001/jamaophthalmol.2014.3727


To facilitate comparative clinical outcome research in low vision rehabilitation (LVR), Goldstein and colleagues quantify the effects of currently provided LVR using patient-centered measurements that reflect clinically meaningful changes in visual ability on patients who present for outpatient LVR services. Among 779 patients from 28 US clinical centers, questionnaires were administered to measure changes in the study population and minimum clinically important differences; baseline and postrehabilitation measures were obtained for 468 patients. Minimum clinically important differences were observed in nearly half of patients in overall visual ability. While the outcomes are based on an observational study without a control group, the data suggest that outpatient LVR services are effective, pending confirmation in randomized clinical trials.

Because little is known about the long-term risk for dying of uveal melanoma after treatment with radiotherapy, Lane and colleagues describe uveal melanoma–related mortality rates up to 25 years among 3088 patients identified from a hospital-based cohort and treated with proton irradiation. Vital status and cause of death were ascertained through active follow-up and searches of government databases. Using the Kaplan-Meier method, all-cause mortality rates in this cohort were 49.0% at 15 years, 58.6% at 20 years, and 66.8% at 25 years, while melanoma-related mortality rates were 24.6% at 15 years, 25.8% at 20 years, and 26.4% at 25 years after treatment. While the retrospective study design may have led to underascertainment of mortality, these findings suggest that annual rates decrease considerably beginning around 14 years after treatment.

Because the prevalence of obstructive sleep apnea syndrome (OSAS) in patients with nonarteritic anterior ischemic optic neuropathy (NAION) and its influence on second eye involvement is not well known, Aptel and colleagues evaluate this in 118 patients with NAION referred to a tertiary care center. Using survival analysis in 89 patients with NAION who underwent polysomnography, 67 had OSAS, while second eye involvement was found in 8 of 52 patients with OSAS at 3 years and 2 of 21 patients without OSAS at 3 years. Multivariate analysis suggested nonadherence to ventilation treatment with continuous positive airway pressure increased the risk for second eye involvement. The findings suggest that OSAS is common in patients with NAION and that such patients who are nonadherent to ventilation treatment with continuous positive airway pressure have an increased risk for second eye involvement.

Continuing Medical Education and Journal Club

Recognizing that biomarkers of visual acuity (VA) improvement could influence management decisions in macular edema (ME), Radwan and colleagues investigate how disorganization of retinal inner layers (DRIL) and other spectral-domain optical coherence tomography–derived variables are associated with subsequent VA after ME resolution in cases due to and not due to diabetic ME. In a retrospective, longitudinal cohort, participants included 55 patients (70 eyes) with center-involved ME that had resolved during an 8-month period. In both groups, VA after ME resolution correlated with baseline VA. In diabetic ME involving a multivariable model including baseline VA and DRIL, total length was associated with subsequent VA as determined by a parameter estimate (PE) of 0.0003. The VA change during the 8 months, after adjusting for baseline VA, was best associated with DRIL change (PE, 0.0002). The study confirmed that the presence of DRIL at baseline and its resolution pattern may be associated with subsequent VA after resolution of center-involved diabetic ME.