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In This Issue of JAMA Ophthalmology
November 2018


JAMA Ophthalmol. 2018;136(11):1213. doi:10.1001/jamaophthalmol.2017.3753


Lee and coauthors investigated the rate of glaucoma surgery within the Veterans Affairs (VA) health care system. In a database review of fiscal year 2016 data, 490 926 veterans receiving care at 136 VA medical centers were given a glaucoma-related diagnosis. Data showed a 3.39-fold to 19.11-fold higher rate of glaucoma laser and filtering surgery use in care delivery models that included ophthalmologists compared with centers that included optometrists only. Their findings suggest that a disparity exists in glaucoma surgery rates across the VA health care system and that different care delivery models play a role, although outcomes of glaucoma care for the different models of eye care delivery were not analyzed.

Invited Commentary

O’Bryhim and coauthors evaluated if study participants with biomarker-positive findings for preclinical Alzheimer disease have retinal microvascular alterations detectable by optical coherence tomographic (OCT) angiography compared with control individuals with biomarker-negative findings. In a single-center, case-control study, the foveal avascular zone was larger in participants with preclinical Alzheimer disease determined by the presence of β-amyloid biomarkers (mean [SD], 0.364 [0.095] mm2) compared with those without preclinical Alzheimer disease (mean [SD], 0.275 [0.060] mm2). While these results warrant longitudinal studies in larger cohorts, the authors suggest that foveal avascular zone enlargement may offer a noninvasive, cost-efficient, and rapid screen to identify preclinical Alzheimer disease.

Invited Commentary

Audio Author Interview

Obeid and coauthors determine what percentage of patients with neovascular age-related macular degeneration (nAMD) are lost to follow-up after receiving intravitreal anti–vascular endothelial growth factor (anti-VEGF) injections. Within a cohort study of data from 9007 patients with nAMD, the percentage of patients lost to follow-up after an anti-VEGF injection was greater than 20% when choosing at least 12 months as the interval with no subsequent follow-up visit. Older age, race, lower regional adjusted gross income, greater distance to clinic, and unilateral eye disease were risk factors associated with loss to follow-up. These results suggest that a sizable number of patients with nAMD are lost to follow-up after anti-VEGF injections and that several risk factors might help to identify patients who are at high risk of being lost to follow-up.

Invited Commentary

Continuing Medical Education

Sathiamoorthi and coauthors evaluated the trends for spontaneous resolution in congenital nasolacrimal duct obstruction (CNLDO). In a large population-based study of 1998 infants with CNLDO, the rate of spontaneous resolution of CNLDO plateaued after age 9 months, and the success rate of the initial probing declined after age 15 months. The authors propose that surgical intervention may be appropriate during a new time frame, between age 9 and 15 months, capitalizing on the condition’s changing rate of resolution as well as the declining success rate of the initial probing.

Invited Commentary

CME and Journal Club