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In This Issue of JAMA Ophthalmology
January 2016


JAMA Ophthalmol. 2016;134(1):7. doi:10.1001/jamaophthalmol.2015.3208


Avery and Gordon expand on analyses evaluating the systemic safety of intravitreous anti–vascular endothelial growth factor injections in patients with diabetic macular edema by investigating a subgroup of these patients with monthly treatment for 2 years. Of 1126 articles reviewed, 4 remained after removing duplicates and those without treatment data for 2 years: 2 trials using monthly aflibercept and 2 using monthly ranibizumab. The primary evaluation combined the monthly aflibercept and the 0.5-mg ranibizumab arms and yielded an increased risk for death compared with sham and laser treatments. Analysis including monthly aflibercept and 0.5-mg ranibizumab yielded an increased risk for cerebrovascular accidents and vascular death.

Chan and colleagues examine the magnitude at which strabismus is detectable by lay observers in an ethnically diverse set of images. Among photographs of 12 ethnically diverse models simulated to have strabismus from esotropia of 21 prism diopters (∆) to exotropia of 21∆, in white and black models, the threshold allowing a 70% positive detection rate was higher for esotropia than for exotropia. For white models, the threshold was 23.2∆ for esotropia and 13.5∆ for exotropia. For black models, the threshold was 20.8∆ for esotropia and 16.3∆ for exotropia. Asian models showed an opposite trend, with the threshold allowing a 70% positive detection rate for esotropia (14.3∆) being lower than that for exotropia (20.9∆).

Invited Commentary

Because fluoroquinolones are the most commonly prescribed antibiotic class in the outpatient setting and reports have implicated an association between oral fluoroquinolones and an increased risk of uveitis, Sandhu and colleagues determine the hazard of uveitis with oral fluoroquinolone use in a cohort study conducted using medical claims data. A total of 843 854 individuals receiving a fluoroquinolone and 3 543 797 a β-lactam were included in the analysis. After controlling for age, race, and sex using multivariate analysis, no hazard for developing uveitis at the 30-, 60-, or 90-day observation windows was seen. Moxifloxacin produced an increased hazard for uveitis at every point. These data do not support an association between oral fluoroquinolone use and uveitis. Instead, this study showed an association between oral fluoroquinolone use and the risk for uveitis-associated systemic illnesses.

Invited Commentary

Continuing Medical Education

Schuermeyer and colleagues evaluate depression, anxiety, and decision regret before and after testing to estimate uveal melanoma prognosis. In a case series of 96 patients with uveal melanoma who underwent prognostication at the time of primary therapy, the mean (SD) Hospital Anxiety and Depression Scale (HADS) anxiety score at baseline (7.4 [4.0]) was higher than at 3 months (5.4 [3.7]) or 12 months (4.7 [3.4]) and decreased with older age. The decision regret score was associated with the baseline HADS depression score, and HADS depression score increased with baseline HADS anxiety score.