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In This Issue of JAMA Ophthalmology
August 2016


JAMA Ophthalmol. 2016;134(8):853. doi:10.1001/jamaophthalmol.2015.3250


For the Infant Aphakia Treatment Study Group investigators, Drews-Botsch and coauthors evaluate the efficacy of patching to treat unilateral congenital cataract in children with deprivation amblyopia. In a secondary analysis of a randomized clinical trial of treatment for unilateral congenital cataract, an intraocular lens implanted during cataract surgery did not affect caregivers’ reported adherence to prescribed patching. A greater number of reported hours of patching throughout the first 4 years of life were associated with better visual acuity. These results support the association of occlusion throughout the preschool years with improved visual acuity in infants treated for unilateral congenital cataract. However, similar visual outcomes were achieved with varying amounts of patching.

Baig and coauthors evaluate rates of visual field (VF) loss associated with risk of falling in patients with glaucoma. In an observational cohort study of 116 patients diagnosed as having glaucoma followed up for a mean (SD) of 7.5 (2.6) years, each 0.5-dB/y faster rate of VF loss was associated with a history of self-reported falls, even after adjusting for confounding factors. They conclude that a history of rapid VF loss in patients with glaucoma was associated with risk of falls.

Invited Commentary

Continuing Medical Education

While a randomized clinical trial comparing anti–vascular endothelial growth factor agents for patients with decreased vision from diabetic macular edema (DME) found that aflibercept (2.0 mg) achieved better visual outcomes than repackaged (compounded) bevacizumab (1.25 mg) or ranibizumab (0.3 mg) at 1 year when the starting visual acuity was 20/50 or worse, aflibercept and ranibizumab are approximately 31 and 20 times more expensive, respectively, than bevacizumab. Ross and coauthors for the Diabetic Retinopathy Clinical Research Network determine the incremental cost-effectiveness of these anti–vascular endothelial growth factor therapies over bevacizumab for the treatment of DME. Visual acuity benefits of aflibercept and ranibizumab translated into modest quality-of-life improvements but at a high cost relative to bevacizumab, with incremental cost-effectiveness ratios substantially higher than frequently cited thresholds.

Continuing Medical Education

The US Physician Payments Sunshine Act provides insight into the financial relationship between physicians and the pharmaceutical industry, creating opportunities of using data to better understand prior research that implicates pharmaceutical promotions as an important factor in a physician’s decision-making process. Taylor and coauthors evaluate the association between industry payments and physician choice of anti–vascular endothelial growth factor injections. They reviewed 2013 data from the US Centers for Medicare & Medicaid Services Open Payments program and found increasing numbers and amounts of industry payments correlated with higher use of total aflibercept and ranibizumab injections more so than with bevacizumab. Although pharmaceutical payments to physicians were associated with increased use of aflibercept and ranibizumab, the study could not determine whether the payments reported caused increased use, resulted in increased use, or were associated with other factors that caused increased use.

Invited Commentary

Author Audio Interview