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In This Issue of JAMA Ophthalmology
December 2016


JAMA Ophthalmol. 2016;134(12):1341. doi:10.1001/jamaophthalmol.2015.3274


Because myopia is becoming the most common eye disorder to cause blindness in young people, Tideman and coauthors evaluate the association between axial length, refractive error, and risk of visual impairment. In a cross-sectional study of data from population-based studies and a case-control study, axial lengths of 26 mm and greater and refractive errors of −6 diopters and less were significantly associated with an increased lifetime risk of visual impairment. Extrapolating these results to regions that have experienced a rise in myopia suggests that it will become a major cause of blindness in the working-age population.

Invited Commentary

Author Audio Interview

Recognizing that the best treatments for fungal keratitis have not been well characterized, Prajna and colleagues investigate whether oral voriconazole is beneficial when added to topical antifungals in treating fungal keratitis. In a randomized clinical trial of 240 patients with severe filamentous fungal keratitis, oral voriconazole or placebo was administered in addition to topical antifungal eyedrops. The study was not able to show that oral voriconazole decreased the rates of perforation or need for therapeutic penetrating keratoplasty. The authors concluded there was no benefit to adding oral voriconazole to topical antifungal eyedrops in this population.

Invited Commentary

Continuing Medical Education and Journal Club

With the recent advocacy of a binocular approach to treat anisometropic and strabismic amblyopia, Holmes and coauthors for the Pediatric Eye Disease Investigator Group study whether amblyopic-eye visual acuity (VA) improvement treated with a binocular iPad game is not worse than part-time patching. In a noninferiority randomized clinical trial enrolling 385 children, the 16-week mean amblyopic-eye VA improved 1.05 lines in the binocular group and 1.35 lines in the patching group, an adjusted treatment group difference of 0.31 lines favoring patching. While this trial could not establish whether binocular iPad treatment is not worse than 2 hours of prescribed daily patching, a post hoc analysis suggested that VA improvement with this particular binocular iPad treatment was not as good as 2 hours of prescribed daily patching.

Invited Commentary

Continuing Medical Education

As the Zika virus (ZIKV) can cause changes in the retina and choroid that may result in marked visual impairment in infants with congenital Zika syndrome (CZS), Ventura and coauthors seek to expand the understanding of these changes by evaluating the optical coherence tomographic (OCT) findings in infants with CZS who present with chorioretinal scars. In a case series of 8 infants with CZS and associated retinal abnormalities, OCT imaging was performed in 9 of the 16 eyes, of which 8 were affected, showing substantial neurosensory retinal thinning with discontinuation of the ellipsoid zone, choroidal thinning, and hyperreflectivity underlying areas of presumed atrophic retinal pigment epithelium.

Invited Commentary