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In This Issue of JAMA Ophthalmology
March 2016


JAMA Ophthalmol. 2016;134(3):245. doi:10.1001/jamaophthalmol.2015.3220


To investigate the associations of generalized (defined by body mass index [BMI]) and abdominal obesity (assessed by waist to hip ratio [WHR]) with diabetic retinopathy (DR), Man and colleagues evaluate 420 patients with diabetes at a tertiary eye care institution in Singapore. The median (interquartile range) for BMI and WHR were 25.7 (5.7) and 0.94 (0.08), respectively. In multivariable models, BMI was inversely associated with mild-moderate and severe DR, while WHR was positively associated with mild-moderate and severe DR in women. The authors concluded that in Asian patients with diabetes, a higher BMI appeared to confer a protective effect on DR, while higher WHR was associated with the presence and severity of DR in women.

Invited Commentary

To identify factors among patients with glaucoma that could lead to intentions to use marijuana for treatment, Belyea and colleagues survey a cross-section of 204 patients with glaucoma or suspected to have glaucoma. Regression analysis of the 204 respondents indicated that perceptions of legality of marijuana use, false beliefs regarding marijuana, satisfaction with current glaucoma care, and relevance of marijuana and glaucoma treatment costs were associated with intentions to use marijuana for glaucoma treatment after controlling for demographic variables, disease severity, and previous marijuana use.

Invited Commentary

To assess the extent of geographic variation in patient age at initial cataract surgery and the age-standardized cataract surgery rate among insured US patients with cataracts, Kauh and colleagues review a cross-sectional study of 1 050 815 beneficiaries older than 40 years with cataracts enrolled in a nationwide managed-care network. A total of 243 104 patients with cataracts (23.1%) underwent 1 or more surgical procedures. Communities with the youngest and oldest patients at initial surgery differed in age by nearly 20 years. The highest age-standardized cataract surgery rate was 5-fold higher than the lowest. Compared with white patients, black patients had a 15% decreased hazard of surgery, while Latino and Asian patients had an increased hazard.

Invited Commentary

To evaluate the association between dietary nitrate intake and primary open-angle glaucoma (POAG), Kang and colleagues follow up participants biennially in the prospective cohorts of the Nurses’ Health Study and the Health Professionals Follow-up Study at each 2-year risk period. During 1 678 713 person-years of follow-up, 1483 incident cases of POAG were identified. Compared with the lowest quintile of dietary nitrate intake, the pooled multivariable rate ratio for the highest quintile was 0.79. Green leafy vegetables accounted for 56.7% of nitrate intake variation. Compared with consuming 0.31 servings per day, the multivariable rate ratio for consuming 1.45 or more servings per day was 0.82 for all POAG and 0.52 for POAG with paracentral visual field loss. The data suggest that higher dietary nitrate and green leafy vegetable intake were associated with a lower POAG risk.

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