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In This Issue of JAMA Ophthalmology
September 2015


JAMA Ophthalmol. 2015;133(9):981. doi:10.1001/jamaophthalmol.2014.3737


Blumberg and colleagues use 2004 to 2009 Medicare Current Beneficiary Survey data linked with Medicare claims to determine whether the implementation of the Medicare Part D prescription drug benefit affected rates of cost-related nonadherence and cost-reduction strategies. The proportion of Medicare beneficiaries with glaucoma who reported taking smaller doses and skipping doses owing to cost dropped from 9.4% and 8.2% to 2.7% and 2.8% in 2004 and 2009, respectively. After Part D, the patients had a decrease in several cost-reduction strategies, including price shopping and purchasing outside the United States. The results suggest that efforts to improve cost-related nonadherence should focus both on financial hardship and medical therapy prioritization.

Author Audio Interview and Continuing Medical Education

To evaluate the impact of vitreomacular adhesion (VMA) resolution on patient-reported visual function in symptomatic VMA/vitreomacular traction (VMT), Varma and colleagues evaluate the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) among 464 patients assigned to intravitreous ocriplasmin and 188 to placebo-injected vehicle in 2 multicenter randomized clinical trials. At 6 months, the ocriplasmin group reported greater mean improvements from baseline in the NEI VFQ-25 composite score than the placebo group, including a higher proportion with a clinically meaningful improvement in NEI VFQ-25 composite score from baseline. The results indicate that ocriplasmin produces clinically meaningful improvement in patient-reported visual function in symptomatic VMA/VMT.

Weiss and colleagues test the efficacy of behavioral activation for diabetic retinopathy prevention on rates of dilated fundus examinations (DFEs) in a masked, randomized clinical trial at 2 urban medical centers among 206 African American individuals 65 years and older with diabetes mellitus who had not obtained a DFE in the preceding 12 months. Participants were randomized to either behavioral activation for diabetic retinopathy prevention, a behavioral intervention designed to improve rates of DFEs, or supportive therapy, a control condition. More participants in the behavioral activation for diabetic retinopathy prevention group (87.9%) obtained a DFE compared with those in the supportive therapy group (34.1%) by the 6-month follow-up assessment. The authors concluded that behavioral interventions may have the potential to positively affect screening for diabetic retinopathy in at-risk populations.

Aref and colleagues for the SCORE Study Investigator Group investigate the incidence, risk factors, and time course of intraocular pressure (IOP) elevation in participants in a secondary analysis from the SCORE Study, a randomized clinical trial of 682 patients with macular edema secondary to retinal vein occlusion assigned to standard care, 1 mg of intravitreous triamcinolone acetonide (IVTA), or 4 mg of IVTA therapy. Kaplan-Meier incidences of IOP elevation greater than 10 mm Hg from baseline at 36 months were 0.02, 0.09, and 0.45 in the standard care, 1-mg IVTA, and 4-mg IVTA groups, respectively. Some IOP-related events took several months from the time of first IVTA injection to occur. Risk factors for an IOP-related event included higher treatment dose, younger age, and higher baseline IOP. The authors noted that clinicians should be mindful of these risk factors when assessing the risks and benefits of IVTA therapy.

Journal Club and Continuing Medical Education