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In This Issue of JAMA Ophthalmology
February 2016


JAMA Ophthalmol. 2016;134(2):121. doi:10.1001/jamaophthalmol.2015.3214


Because baseline visual acuity (VA) or baseline central subfield thickness (CST) from optical coherence tomography has an effect on the VA outcome comparisons of aflibercept, bevacizumab, and ranibizumab for diabetic macular edema with vision loss, Wells and colleagues from the Diabetic Retinopathy Clinical Research Network provide a post hoc exploratory analysis based on both baseline VA and CST. In the subgroup with better baseline VA and thicker baseline CST, there was a suggestion of worse VA outcomes in the bevacizumab group. Given the exploratory nature of these analyses, caution is suggested when using the data to guide treatment for patients.

Invited Commentary

Interventions to improve glycemic control through early intensive treatment of diabetes reduce rates of severe retinopathy and preserve visual acuity. Gubitosi-Klug and colleagues for the Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) Research Group evaluate these effects on patient-reported vision-related function. A total of 1184 participants with type 1 diabetes completed the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) during EDIC years 17 through 20. After adjustment for sex, age, hemoglobin A1c level, and retinopathy level at DCCT baseline, the former intensive treatment group had a significant, albeit modest, improvement in overall NEI-VFQ-25 score compared with the former conventional diabetes treatment group. In this cohort, patient-reported visual function remains high in both treatment groups.

Kinast and colleagues determine how measured concentration differs from the expected concentration of 0.4 mg/mL of mitomycin C (MMC) used in ophthalmic surgery. Among 60 samples acquired from a spectrum of common compounding (repackaging) and storage techniques and a variety of pharmacies, the measured MMC concentration determined using high-performance liquid chromatography was 12.5% lower than the expected 0.4 mg/mL value. The results suggest that variability in MMC concentration could cause inconsistency in glaucoma surgical results.

To understand how patients with glaucoma were affected by implementation of Medicare Part D, Blumberg and colleagues determine changes in prescription drug coverage and out-of-pocket spending after Medicare Part D across income strata, identifying characteristics of beneficiaries associated with prescription status. Using Medicare Current Beneficiary Survey data among 19 045 glaucoma prescriptions from 2519 Medicare beneficiaries with at least 1 filled glaucoma prescription, Medicare Part D resulted in increased rates of prescription drug coverage across all economic strata, with reductions in beneficiaries without coverage from 22.8% to 4.0%, 29.1% to 7.3%, and 19.9% to 3.7% among poor, near-poor, and higher-income beneficiaries, respectively. Near-poor status remained a risk factor for lack of prescription drug coverage after the implementation of Medicare Part D.

Invited Commentary

Journal Club