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In This Issue of JAMA Ophthalmology
January 2017


JAMA Ophthalmol. 2017;135(1):1. doi:10.1001/jamaophthalmol.2016.3712


There are limited data regarding patient-reported outcomes using validated questionnaires prior to and following laser in situ keratomileusis (LASIK) surgery. Eydelman and coauthors investigate the rates of visual and ocular symptoms and satisfaction prevalence after LASIK surgery. In 2 observational studies of participants undergoing LASIK surgery for myopia, hyperopia, and/or astigmatism, a large proportion reported decreases in visual symptoms, while many without visual symptoms at baseline developed symptoms after the procedure. Participants were more likely to report visual symptoms on the questionnaire than to their health care professionals. Although visual symptoms were common, few participants reported functionally important limitations due to symptoms. The findings suggest that a valid questionnaire after LASIK surgery more accurately assesses symptoms and satisfaction.

Related Article

While a third nerve palsy is important because a subset is caused by life-threatening aneurysms, there is substantial disagreement regarding its incidence and reported etiologies. Fang and coauthors determine the incidence and etiologies of acquired third nerve palsy from a series of all newly diagnosed cases. The age- and sex-adjusted annual incidence of acquired third nerve palsy was 4.2 per 100 000. There was a higher incidence of microvascular and lower incidence of aneurysm than previously reported. Because of its population-based method, this study provides evidence regarding etiologies of acquired third nerve palsies that can be considered by clinicians when evaluating patients with such palsies.

Invited Commentary

Because rare variants in the complement system have been described in age-related macular degeneration (AMD), but their functional consequences remain largely unexplored, Geerlings and coauthors evaluate whether there is a functional effect of rare genetic variants in the complement system on complement levels and activity in serum. Carriers of complement factor I gene variants had decreased factor I levels; carriers of the complement 9 Pro167Ser gene had increased C9 levels, whereas C3 and factor H levels were not altered. Carriers of complement factor H and complement factor I gene variants had a reduced ability to degrade C3b, which for the complement factor I gene was associated with reduced serum factor I levels. The study suggests that carriers of rare variants in the complement factor I and complement factor H genes are less able to inhibit complement activation and may benefit more from complement-inhibiting therapy than patients with AMD in general.

While myopia is associated inversely with spending time outdoors, the mechanism underlying this protective association is poorly understood. Williams and coauthors evaluate the association between myopia and ultraviolet B radiation, serum vitamin D concentrations, and polymorphisms in vitamin D metabolism genes among participants 65 years and older. In this secondary analysis of the European Eye Study, only ultraviolet B radiation exposure was associated with a reduced odds ratio for myopia, especially in adolescence and early adulthood, despite adjustment for years in education. While not designed to determine cause-and-effect relationships, this study suggests that increased ultraviolet B exposure, a marker of sunlight exposure, is associated with reduced myopia.

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