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In This Issue of JAMA Ophthalmology
June 2019


JAMA Ophthalmol. 2019;137(6):599. doi:10.1001/jamaophthalmol.2018.4773


Nicholson and coauthors investigate the amount and distribution of retinal nonperfusion associated with the development of proliferative diabetic retinopathy. In a post hoc analysis, a threshold of 118.3 disc areas of retinal nonperfusion was identified to have a specificity of 84.9% for proliferative features. Peripheral nonperfusion appears to be larger by at least 48.3 disc areas in eyes with proliferative diabetic retinopathy; eyes with neovascularization of the optic disc had the largest total area of retinal nonperfusion. These results suggest that eyes with nonproliferative diabetic retinopathy to a threshold of 118.3 disc areas of retinal nonperfusion are at an increased risk of proliferative diabetic retinopathy.

Invited Commentary

Morse and coauthors study whether hospitalized patients with vision loss experience greater resource use and costs compared with hospitalized patients without vision loss. In their study of 12 330 Medicare beneficiaries and 11 858 commercial health insurance enrollees with or without vision loss, severe vision loss was associated with longer mean lengths of stay, higher readmission rates, and higher costs during hospitalization and 90 days after discharge. These results suggest that, by addressing vision-related issues, opportunities exist to reduce lengths of stay, readmission rates, resource use, and costs while enhancing outcomes and patient satisfaction.

Invited Commentary

Continuing Medical Education

Scott and coauthors investigated whether exercise and swimming goggles modulated cerebro-ocular pressures and dynamics in a model of spaceflight-associated neuro-ocular syndrome (SANS). In this study of 20 healthy men, exercise was associated with decreases in intraocular pressure and estimated translaminar pressure gradient in a spaceflight analogue of head-down tilt. Adding swimming goggles was associated with increases in intraocular pressure and translaminar pressure gradient during head-down tilt. These findings suggest that modestly increasing intraocular pressure with swimming goggles could be used to mitigate spaceflight-associated neuro-ocular syndrome.

Invited Commentary

Audio Author Interview

Park and coauthors evaluated the perfusion status of different retinal layers with optical coherence tomography angiography to determine how parapapillary choroidal vessel density within the β-zone peripapillary atrophy as measured by optical coherence tomography angiography at baseline was associated with future glaucoma progression. In their cohort study of 108 patients with open-angle glaucoma, baseline parapapillary choroidal vessel density was associated with progression of glaucoma as measured by visual field using Cox proportional hazard regression analysis, as was older age and poorer mean deviation of the visual field. These data suggest that lower parapapillary choroidal vessel density within the β-zone peripapillary atrophy at baseline among individuals with glaucoma could play a role in the risk of progression of glaucoma as measured by the visual field.

Invited Commentary