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In This Issue of JAMA Ophthalmology
January 2019

Highlights

JAMA Ophthalmol. 2019;137(1):1. doi:10.1001/jamaophthalmol.2018.4457
Research

Wang and coauthors studied whether implantation of a minimally invasive glaucoma device concurrent with cataract surgery had a greater association with reduced use of ocular antihypertensive medications postoperatively compared with cataract surgery alone. In a cohort study of enrollees in a US managed care network, patients who underwent bilateral iStent implantation concurrent with cataract surgery had a greater mean reduction in eyedrops used (0.99 vs 0.49) and a higher proportion using no eyedrops postoperatively (73.5% vs 55.3%) compared with matched control individuals who underwent cataract surgery only, by 20 months to 24 months postoperatively. While these associations do not prove cause and effect, the findings suggest these implants are associated with reduced medication dependence in patients with glaucoma.

Continuing Medical Education

Han and coauthors found that 48% of p.Gln368Ter carriers older than 65 years had glaucoma or ocular hypertension, with an odds ratio (OR) for primary open-angle glaucoma of 6.76 (95% CI, 4.05-11.29) compared with noncarriers. In registry-based studies, penetrance was very high, with the OR being markedly increased in individuals with advanced glaucoma (12.16 [95% CI, 6.34-24.97]) compared with individuals with nonadvanced glaucoma (OR, 3.97 [95% CI, 1.55-9.75]). Their results suggest the penetrance in population-based studies is higher than previously shown and support the consideration of early screening of p.Gln368Ter carriers.

Invited Commentary

While evidence suggests that the quality of some aspects of care provided by physicians may decrease during their late career stage, there are limited data regarding the association of advancing surgeon career phase with cataract surgical outcomes. Campbell and coauthors investigated this in a population-based study of 499 650 cataract operations and could not find an association of late surgeon career stage with an increased overall risk of cataract surgical adverse events. The results suggest that cataract surgery can be performed by surgeons at later career stages without increasing the risk of surgical adverse events.

Continuing Medical Education

Because posterior uveal melanoma in younger patients is relatively rare, Fry and coauthors investigate the clinical differences observed in cases of posterior uveal melanoma in patients younger than 21 years compared with older patients. In a case series, the authors showed that the clinical features of the intraocular tumors are not considerably different than those of other age groups, and it confirmed the rarity of uveal melanoma among patients younger than 21 years. However, these findings indicate that patients younger than 21 years have a relatively high frequency of metastasis and melanoma-associated death. The findings suggest posterior uveal melanoma in patients younger than 21 years appears to have similar if not worse prognosis than the same disease in the patient population overall.

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