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In This Issue of JAMA Ophthalmology
October 2017


JAMA Ophthalmol. 2017;135(10):1015. doi:10.1001/jamaophthalmol.2016.3757


Because population-based data on retinal emboli are limited in Asia, Cheung and coauthors investigate the prevalence and systemic associations of retinal emboli in a multiethnic Asian population. Within a population-based study of 9978 individuals in Singapore with gradable retinal photographs, age-standardized prevalence of retinal emboli was 0.75% (95% CI, 0.60-0.95), with the highest prevalence seen in the Indian cohort, followed by the Chinese and Malay cohorts. Besides its associations with traditional cardiovascular risk factors and stroke, prevalent retinal emboli were also independently associated with chronic kidney disease and its measures. The authors suggest the prevalence of persons with retinal emboli is generally low in Asian populations, but such persons may require general cardiovascular as well as renal assessment.

Invited Commentary

Because there have been few population-based studies of strabismus incidence conducted, Torp-Pedersen and coauthors evaluate the cumulative incidences and age-specific incidence profiles of the major strabismus subtypes in Danish children. In a Danish population-based cohort of 96 842 children, 1309 cases of strabismus were identified, giving a cumulative incidence of 2.56% (95% CI, 1.71-2.69) at 7 years. The 4 major strabismus subtypes in this population (partially accommodative esotropia, congenital esotropia, exotropia, and fully accommodative esotropia) had different age-specific patterns of incidence. These data suggest that strabismus is a common, heterogeneous disorder featuring subtypes with different ages at onset in Denmark.

Invited Commentary

Continuing Medical Education

To review the understanding of the neurodevelopmental abnormalities observed in neonates exposed in utero to Zika virus in the hope of developing treatments, Aleman and coauthors evaluate the microstructural changes of the retina in the congenital Zika syndrome. In a case series of 8 patients with congenital Zika syndrome and 8 individuals with cobalamin C deficiency, retinal regions without chorioretinal atrophy demonstrated ganglion cell layer loss on spectral-domain optical coherence tomography that was disproportionately more severe than coexisting changes in the photoreceptor and inner nuclear layers. The findings appear to be consistent with a murine model of congenital Zika syndrome. The study findings suggest that depletion of a specific neuronal population (ganglion cells) in this condition may constitute the primary event that ultimately leads to foveal maldevelopment and central chorioretinal atrophy.

Invited Commentary