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In This Issue of JAMA Ophthalmology
July 2017


JAMA Ophthalmol. 2017;135(7):683. doi:10.1001/jamaophthalmol.2016.3742


Recognizing that outcome measures that are sensitive to disease worsening are needed as clinical end points for future treatment trials in Stargardt disease, Strauss and coauthors for the ProgStar Study Group examine the incidence of atrophic lesions in patients with Stargardt disease. In a review of data of 217 patients, the median time to develop a definitely decreased autofluorescent lesion was 4.9 years among the eyes with questionably decreased autofluorescence but no definitely decreased autofluorescence at the baseline visit. Among eyes without questionably decreased autofluorescence, the median time to develop such a lesion was 6.3 years.

Invited Commentary

Continuing Medical Education

Although uncorrected refractive error is a leading cause of visual impairment, the unique ocular determinants of refractive error in Chinese American individuals have not been previously studied. Richter and coauthors for the Chinese American Eye Study Group investigate the ocular determinants of refractive error in 4582 Chinese American adults. They noted that women had shorter axial length, shorter anterior chamber depth, and steeper corneal power compared with men. Furthermore, older compared with younger individuals had shallower anterior chamber depth, greater lens thickness, and more nuclear opalescence. Overall, axial length was the strongest determinant of refractive error. These data suggest that compared with US Latino or non-US Chinese populations, Chinese Americans appear to have longer axial length, with greater contribution to refractive error.

Invited Commentary

Diniz-Filho and coauthors note that visual field variability may impair detection of glaucoma worsening over time, but despite the possible overlap between neurocognitive disorders and glaucoma in older individuals, no study has investigated the association between cognitive changes and visual field variability. The authors evaluate whether individuals who develop cognitive decline over time experience an increase in variability of standard automated perimetry results. In an observational cohort study of 211 eyes of 115 patients, a 5-unit decline in Montreal Cognitive Assessment score was associated with an increase of 0.23 dB in the SD of residuals of standard automated perimetry mean deviation. The results suggest that cognitive decline is associated with increased visual field variability over time in patients with glaucoma and those suspected of having glaucoma.

Invited Commentary

Journal Club

Because current practice to diagnose idiopathic orbital inflammation is inconsistent, Mombaerts and coauthors for the Expert Panel of the Orbital Society presume that by specifying criteria, diagnosis of idiopathic orbital inflammation, which is a disorder diagnosed by exclusion, will be improved. They use a modified Delphi consensus process with 35 international experts on orbital diseases who agreed on clinical and radiologic criteria for idiopathic orbital inflammation. The result was supported by tissue biopsy results for a nonmyositic construct and by a prompt clinical response to a trial with systemic corticosteroids for a myositic construct. The findings, while not yet tested in a clinical practice setting, suggest that criteria specific for the diagnosis of idiopathic orbital inflammation can be defined and would include tissue biopsy for lesions not confined to the extraocular muscles.