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In This Issue of JAMA Ophthalmology
February 2020


JAMA Ophthalmol. 2020;138(2):111. doi:10.1001/jamaophthalmol.2019.3836


Holmen and coauthors determine the frequency of artifacts in optical coherence tomography angiography (OCTA) images and how these artifacts are identified. In a cross-sectional study that included 406 OCTA images of eyes with diabetic retinopathy, the prevalence of artifacts was 53.5%, with shadow, defocus, and movement seen as the most common artifacts. Proprietary quality indices commonly used for identifying unreliable images had a high sensitivity (99%) but low specificity (37% to 41%). The results of this study suggest that knowledge of OCTA artifacts may be important in accurately interpreting these images for patient care and in clinical trials.

Invited Commentary

Author Audio Interview and Continuing Medical Education

Fry and coauthors determine if a mild choroideremia phenotype can be explained by genotype. In a case series study, 2 patients with a splice site variant outside the canonical donor sequence (c.940+3delA) demonstrated a mild phenotype compared with a cohort of 30 patients with choroideremia. Mildly affected patients expressed residual levels of full-length CHM transcript, while a control patient with normal disease progression due to a canonical donor splice site variant (c.940+2T>A) did not express any CHM transcript. These findings suggest residual levels of full-length CHM transcript are associated with milder disease, providing evidence of an association of genotype with phenotype in choroideremia and suggesting the transcript level required to slow degeneration with gene therapy.

Laurie and coauthors investigated if the ocular changes that develop in a ground-based analogue of weightlessness were similar to the ocular changes experienced by astronauts during weightlessness. Peripapillary total retinal thickness increased to a greater degree among individuals exposed to bed rest than among astronauts during spaceflight, while choroidal thickening developed only among astronauts during spaceflight. Differences in peripapillary total retinal thickness and choroidal thickness observed in astronauts vs individuals exposed to bed rest suggest that the mechanism(s) underlying optic disc edema may differ between those groups.

Invited Commentary

Wang and coauthors characterize the typical patterns of central visual field loss in end-stage glaucoma and evaluate if deteriorations follow trajectories specific to their baseline patterns. In their cohort study of 1103 patients with glaucoma, 14 central visual field patterns were determined by archetypal analysis, most of which preserve the inferotemporal regions entirely or partially. Initial encroachments on an intact central visual field at follow-up in end-stage glaucoma were more likely to be nasal loss. These results suggest that central visual field loss in end-stage glaucoma exhibits characteristic patterns that might be related to different subtypes, and initial central visual field loss is likely to be nasal loss.

Invited Commentary