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In This Issue of JAMA Ophthalmology
July 2018


JAMA Ophthalmol. 2018;136(7):717. doi:10.1001/jamaophthalmol.2017.3733


Because considerable variation exists with respect to the profiles of patients who receive cataract surgery in the United States, Wu and coauthors evaluated what characteristics are associated with receiving cataract surgery within the US Medicare and Veterans Health Administration patient populations. In this cohort study of 1.2 million Medicare patients and 1.9 million Veterans Health Association patients, a greater proportion of Medicare patients received cataract surgery within 1 and 5 years of cataract diagnosis. Within both groups, older vs younger age, residence in the southern vs other parts of the United States, and chronic pulmonary disease vs no such disease were associated with increased odds of cataract surgery at 1 and 5 years after diagnosis. Findings from this study suggest that few disparities exist between the types of patients receiving cataract surgery who are in Medicare vs the Veterans Health Association.

Invited Commentary

Recognizing that amyloid-β is a major component of macular drusen and that autopsy and animal models suggested that anticholinergic drug use increased brain amyloid-β deposition, Aldebert and coauthors investigated the association of anticholinergic drug use with late age-related macular degeneration (AMD) (choroidal neovascularization or geographic atrophy). In this case-control study, at least 3 months’ use of anticholinergic drugs was associated with an increased risk of AMD. This association was greater with prolonged use and a high Anticholinergic Burden Score. While confounders that were not addressed could have contributed to or accounted entirely for the results, these findings suggest the risk of late AMD may be increased with at least 3 months’ use of anticholinergic drugs, with a dose-effect association.

Journal Club

Little is known about the added value of 24-hour monitoring when stratifying glaucoma risk based on rates of progression, although 24-hour intraocular pressure patterns may provide more information regarding rates of visual field progression than office-hour measurements. To test the hypothesis that 24-hour intraocular pressure–related patterns recorded with a contact lens sensor correlate with prior rates of visual field progression, De Moraes and coauthors determined the association between contact lens sensor variables and rates of visual field mean deviation change. In a cohort study including 445 patients (445 eyes) with glaucoma, a combination of contact lens sensor–derived variables was associated with prior rates of visual field progression of glaucoma. These variables performed better than Goldmann intraocular pressure measurements taken during follow-up. These findings suggest that a single 24-hour contact lens sensor session can help in risk stratification of patients with treated glaucoma.

Continuing Medical Education