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In This Issue of JAMA Ophthalmology
February 2019


JAMA Ophthalmol. 2019;137(2):125. doi:10.1001/jamaophthalmol.2018.4753


De Moraes and coauthors evaluate current glaucoma staging systems to determine if they underestimate severity when macular damage is present. In a cross-sectional study of 57 participants, the main glaucoma severity staging systems classified about 70% of eyes with confirmed macular damage as having early glaucoma. These findings suggest current glaucoma staging systems tend to underestimate severity when not including 10-2 visual fields and high-resolution macular imaging in assessments of macular damage; if these results are confirmed and generalizable, new systems using macular measurements (from 10-2 and optical coherence tomography results) might improve glaucoma severity staging.

Continuing Medical Education

Ehrlich and coauthors undertake a cross-national comparison to elucidate the unique and shared factors associated with vision impairment and receipt of eye care in different countries and to target those most in need. Their investigation pursues how sociodemographic, economic, and health-related characteristics are associated with vision impairment and how receipt of eye care varies across low- and middle-income countries. In their study of cross-sectional survey data from 34 159 adults, in each low- and middle-income country studied, a unique set of characteristics associated with vision impairment and receipt of eye care was found. However, certain traits, such as educational attainment, medical comorbidities, and memory, were more consistently associated with these outcomes across most countries. Their findings suggest that cross-national comparisons to identify shared and unique characteristics associated with vision impairment and receipt of eye care may be important for targeting those most in need and optimally allocating health care resources.

Invited Commentary

Wade and coauthors identify a group of infants at low risk for retinopathy of prematurity (ROP) in North American health care centers who do not benefit from postdischarge ROP surveillance. In their study, two-thirds of the infants born at 27 weeks’ gestational age or older with birth weights greater than 750 g did not have ROP by discharge, and none without ROP noted by 37 weeks’ postmenstrual age required ROP treatment. Their results suggest that if no ROP has been detected by discharge in an infant with larger birth weights and more advanced gestational age, then further examinations have limited value.

Author Audio Interview and Journal Club

Lass and coauthors determine what donor, recipient, and operative factors are associated with endothelial cell density 3 years after Descemet stripping automated endothelial keratoplasty in a secondary analysis of the Cornea Preservation Time Study. In their study, donors with diabetes, diagnosis of pseudophakic/aphakic corneal edema in the recipient, and operative complications were associated with lower endothelial cell density at 3 years. Their findings suggest optimizing donor selection and minimizing surgical trauma could help minimize endothelial cell loss and improve graft survival after Descemet stripping automated endothelial keratoplasty.

Author Audio Interview and CME