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March 25, 2021

JAMA Ophthalmology—The Year in Review, 2020: Bringing Focus to Randomized Clinical Trials

Author Affiliations
  • 1Editor, JAMA Ophthalmology
  • 2Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
JAMA Ophthalmol. Published online March 25, 2021. doi:10.1001/jamaophthalmol.2021.0272

2020—that number has always been important in ophthalmology, representing normal visual acuity when denoted as 20/20 and being the value ophthalmologists strive to attain when treating eye diseases or preserving vision. Now, though, with the pandemic of coronavirus disease 2019 (COVID-19) brought on by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), 2020 is a number that has much more relevance in medicine beyond normal visual acuity. Despite the many challenges in medicine in 2020, the year was associated with many important milestones for JAMA Ophthalmology. These milestones again are due to the outstanding contributions of the authors, peer reviewers (for whom the authors and editors are most grateful),1 editors, and the editorial board and international advisory committee members as well as a superb editorial staff involved with the journal every day.

Associated with the onset of the pandemic in the US and Europe, the number of manuscripts received increased by 44%, from 2342 in 2019 to 3375 in 2020 (Table),2-4 a remarkable number considering that almost all of this increase occurred from April through December. About one-third of this increase was from articles related to COVID-19, a disease not reported in the ophthalmic literature in 2019; however, the other two-thirds were submissions unrelated to the pandemic. The editorial team was still able to keep the median days from receipt to first decision without peer review to 8 days, despite the increase in manuscripts received. Inevitably, though, with the same amount of space and resources for publications in 2020 compared with 2019, the overall acceptance rate had to decrease from 14% to 10%. Nevertheless, the management of submitted manuscripts, as reflected by other metrics (Table), continued to improve.

Table.  JAMA Ophthalmology Statistics for 2020
JAMA Ophthalmology Statistics for 2020

For example, the time from acceptance of a manuscript to publication was a median of 61 days, down 21% from 77 days in 2019. The number of recipients of JAMA Ophthalmology’s electronic table of contents increased from more than 34 000 in 2019 to more than 45 000 in 2020. The number of views and downloads of articles increased to more than 3.3 million around the world. The journal’s social media followers have increased to more than 32 000.

Unsurprisingly, the top 3 articles in 2020 in terms of views and Altmetric score (a measure of news and social media attention) were related to COVID-19, including a study and related commentary on the association of daily wear of eyeglasses with susceptibility to COVID-19 infection2,4 and a report of characteristics of ocular findings of patients with COVID-19 in China,3 which was also the top-cited article in 2020. The top 3 articles in terms of Web of Science citations for articles published between January 2017 and December 2020 include the report by Wu et al3 (254 citations) and 2 articles from 2018 that have continued to garner citations: a technology evaluation study investigating automated diagnosis of plus disease in retinopathy of prematurity using deep convolutional neural networks5 (97 citations) and a randomized clinical trial evaluating 5-year outcomes of panretinal photocoagulation compared with intravitreous ranibizumab among participants with proliferative diabetic retinopathy6 (69 citations).

None of this is important if the content is not scientifically rigorous, novel, clinically relevant, and reported with Key Points to clarify each investigation’s Question, Findings, and Meaning. To that end, there was no compromise in attempts to minimize bias in articles published; specifically, the number of reports of randomized clinical trials increased from 9 in 2019 to 22 in 2020. Why is the publication of randomized clinical trials such a high priority for JAMA Ophthalmology? The answer is because randomized clinical trials are designed to try to minimize bias that might be inherent in the methods of other study types. For example, a randomized clinical trial in Canada supported the hypothesis that treat-and-extend regimens do not lead to worse visual acuity outcomes compared with monthly treatment regimens using ranibizumab for patients with neovascular acute macular degeneration.7 In addition, the treat-and-extend regimen group had an average number of visits and injections reduced to 18 over 2 years compared with 24 visits and 24 injections in the monthly regimen group. These findings can influence clinical practice supporting consideration of the use of the Canadian Treat-and-Extend Analysis Trial With Ranibizumab in Patients With Neovascular Age-Related Macular Disease (CANTREAT) treat-and-extend regimen with ranibizumab7 when encountering patients similar to those enrolled in that trial. The randomized clinical trial design can minimize bias, suggesting that the only difference between the treatment groups are the treatment regimens used. That is not to say that other study types are not important, such as case-control studies. However, other study types may be more likely to have biases that influence the outcomes reported2 so that their results might be best used to generate hypotheses for new clinical trials rather than supporting hypotheses that should influence clinical practice.

In conclusion, it is an understatement that 2020 provided unique challenges to the field of ophthalmology and all of medicine. The JAMA Ophthalmology staff in 2021 will continue to focus on providing novel, clinically important randomized clinical trial results and other investigations that support the development of hypotheses for new clinical trials as part of its mission: to be the indispensable source of ophthalmic knowledge by promptly publishing innovative, clinically relevant research through consistent and authoritative peer review and, thereby, to be the first choice of authors for their important manuscripts.

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Article Information

Corresponding Author: Neil M. Bressler, MD, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Johns Hopkins Hospital, 600 N Wolfe St, Maumenee 7th Floor, Baltimore, MD 21287 (nmboffice@jhmi.edu).

Published Online: March 25, 2021. doi:10.1001/jamaophthalmol.2021.0272

Conflict of Interest Disclosures: None reported.

 JAMA Ophthalmology peer reviewers in 2020.   JAMA Ophthalmol. Published online March 25, 2021. doi:10.1001/jamaophthalmol.2021.0188Google Scholar
Zeng  W, Wang  X, Li  J,  et al.  Association of daily wear of eyeglasses with susceptibility to coronavirus disease 2019 infection.   JAMA Ophthalmol. 2020;138(11):1196-1199. doi:10.1001/jamaophthalmol.2020.3906PubMedGoogle ScholarCrossref
Wu  P, Duan  F, Luo  C,  et al.  Characteristics of ocular findings of patients with coronavirus disease 2019 (COVID-19) in Hubei province, China.   JAMA Ophthalmol. 2020;138(5):575-578. doi:10.1001/jamaophthalmol.2020.1291PubMedGoogle ScholarCrossref
Maragakis  LL.  Eye protection and the risk of coronavirus disease 2019: does wearing eye protection mitigate risk in public, non-health care settings?   JAMA Ophthalmol. 2020;138(11):1199-1200. doi:10.1001/jamaophthalmol.2020.3909PubMedGoogle ScholarCrossref
Brown  JM, Campbell  JP, Beers  A,  et al; Imaging and Informatics in Retinopathy of Prematurity (i-ROP) Research Consortium.  Automated diagnosis of plus disease in retinopathy of prematurity using deep convolutional neural networks.   JAMA Ophthalmol. 2018;136(7):803-810. doi:10.1001/jamaophthalmol.2018.1934PubMedGoogle ScholarCrossref
Gross  JG, Glassman  AR, Liu  D,  et al; Diabetic Retinopathy Clinical Research Network.  Five-year outcomes of panretinal photocoagulation vs intravitreous ranibizumab for proliferative diabetic retinopathy: a randomized clinical trial.   JAMA Ophthalmol. 2018;136(10):1138-1148. doi:10.1001/jamaophthalmol.2018.3255PubMedGoogle ScholarCrossref
Kertes  PJ, Galic  IJ, Greve  M,  et al.  Efficacy of a treat-and-extend regimen with ranibizumab in patients with neovascular age-related macular disease: a randomized clinical trial.   JAMA Ophthalmol. 2020;138(3):244-250. doi:10.1001/jamaophthalmol.2019.5540PubMedGoogle ScholarCrossref
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