Pub Date : 2026-03-05DOI: 10.1001/jamaophthalmol.2026.0040
Karthik Reddy,Paul Workman,Greg Eschenauer,Jill Bixler,Shahzad I Mian
ImportanceAmong patients who have a penicillin allergy label (a history of any reaction to penicillin in their medical records), many cataract surgeries are performed yearly. Less than 1% of these patients have a true allergy to penicillin. The evidence supports limited concern regarding cephalosporin cross-reactivity; however, the guidance for surgeons regarding antibiotic selection in these patients remains unclear.ObjectiveTo examine rates of perioperative antibiotic selection after penicillin allergy label reclassification vs before reclassification.Design, Setting, and ParticipantsQuality improvement study including 1905 patients identified with a penicillin allergy label undergoing cataract surgery between May 30, 2020, and May 30, 2025, at a large tertiary eye care center in the US. This analysis was conducted from June 2025 to December 2025.InterventionPolicy intervention for surgeons performing cataract surgery that featured enhanced pharmacy collaboration and guidance, suppression of automated electronic medical record alerts for cephalosporin cross-reactivity, and reclassification of the allergy in the medical record. The policy intervention date was set as November 30, 2022.Main Outcomes and MeasuresPatient receipt of intracameral antibiotics (1.0 mg/0.1 mL of cefuroxime or 0.5 mg/0.1 mL of moxifloxacin), topical antibiotics (eg, erythromycin or moxifloxacin), or no prophylaxis. Perioperative antibiotic selection rates were measured for all patients undergoing cataract surgery.ResultsAmong the 1905 patients with a penicillin allergy label in their medical record, 3077 cataract surgeries (some patients underwent >1 cataract surgery) were performed by 51 surgeons. In an unadjusted time series analysis, the mean rate of cefuroxime use was 80.0% (95% CI, 74.5%-84.7%) after the policy intervention date, which was far above the expected use rate of 3.3% (95% CI, 2.0%-4.4%) (P = .001). After adjustment, the mean rate of cefuroxime use was 71% (95% CI, 62%-79%) after the policy intervention date compared with a mean rate of 2% (95% CI, 1%-3%) before the intervention. The adjusted odds ratio was 0.37 (95% CI, 0.27-0.52; P < .001) for cefuroxime use after the policy intervention date in patients with high-risk allergies (such as a history of anaphylaxis or angioedema) noted in the medical record and prior to review by a pharmacist.Conclusion and RelevanceEvidence-based antibiotic selection policies for patients with a penicillin allergy label may enhance appropriate use of intracameral cefuroxime in cataract surgery. The rapid increase in cefuroxime use after the policy intervention date suggests surgeons may benefit from education and pharmacy support.
{"title":"Intracameral Cefuroxime Use in Cataract Surgery After Penicillin Allergy Reclassification.","authors":"Karthik Reddy,Paul Workman,Greg Eschenauer,Jill Bixler,Shahzad I Mian","doi":"10.1001/jamaophthalmol.2026.0040","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2026.0040","url":null,"abstract":"ImportanceAmong patients who have a penicillin allergy label (a history of any reaction to penicillin in their medical records), many cataract surgeries are performed yearly. Less than 1% of these patients have a true allergy to penicillin. The evidence supports limited concern regarding cephalosporin cross-reactivity; however, the guidance for surgeons regarding antibiotic selection in these patients remains unclear.ObjectiveTo examine rates of perioperative antibiotic selection after penicillin allergy label reclassification vs before reclassification.Design, Setting, and ParticipantsQuality improvement study including 1905 patients identified with a penicillin allergy label undergoing cataract surgery between May 30, 2020, and May 30, 2025, at a large tertiary eye care center in the US. This analysis was conducted from June 2025 to December 2025.InterventionPolicy intervention for surgeons performing cataract surgery that featured enhanced pharmacy collaboration and guidance, suppression of automated electronic medical record alerts for cephalosporin cross-reactivity, and reclassification of the allergy in the medical record. The policy intervention date was set as November 30, 2022.Main Outcomes and MeasuresPatient receipt of intracameral antibiotics (1.0 mg/0.1 mL of cefuroxime or 0.5 mg/0.1 mL of moxifloxacin), topical antibiotics (eg, erythromycin or moxifloxacin), or no prophylaxis. Perioperative antibiotic selection rates were measured for all patients undergoing cataract surgery.ResultsAmong the 1905 patients with a penicillin allergy label in their medical record, 3077 cataract surgeries (some patients underwent >1 cataract surgery) were performed by 51 surgeons. In an unadjusted time series analysis, the mean rate of cefuroxime use was 80.0% (95% CI, 74.5%-84.7%) after the policy intervention date, which was far above the expected use rate of 3.3% (95% CI, 2.0%-4.4%) (P = .001). After adjustment, the mean rate of cefuroxime use was 71% (95% CI, 62%-79%) after the policy intervention date compared with a mean rate of 2% (95% CI, 1%-3%) before the intervention. The adjusted odds ratio was 0.37 (95% CI, 0.27-0.52; P < .001) for cefuroxime use after the policy intervention date in patients with high-risk allergies (such as a history of anaphylaxis or angioedema) noted in the medical record and prior to review by a pharmacist.Conclusion and RelevanceEvidence-based antibiotic selection policies for patients with a penicillin allergy label may enhance appropriate use of intracameral cefuroxime in cataract surgery. The rapid increase in cefuroxime use after the policy intervention date suggests surgeons may benefit from education and pharmacy support.","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":"1 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2026-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147350693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-05DOI: 10.1001/jamaophthalmol.2026.0355
{"title":"Error in Figure and Author Contributions.","authors":"","doi":"10.1001/jamaophthalmol.2026.0355","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2026.0355","url":null,"abstract":"","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":"93 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2026-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147350834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-05DOI: 10.1001/jamaophthalmol.2026.0007
Andrew Mihalache,Rajeev H Muni,Marko M Popovic
{"title":"AMD Risk in Users of GLP-1RAs and Other Weight-Loss Drugs.","authors":"Andrew Mihalache,Rajeev H Muni,Marko M Popovic","doi":"10.1001/jamaophthalmol.2026.0007","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2026.0007","url":null,"abstract":"","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":"15 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2026-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147350691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-05DOI: 10.1001/jamaophthalmol.2026.0010
Abhimanyu S Ahuja,Alfredo A Paredes,Benjamin K Young
{"title":"AMD Risk in Users of GLP-1RAs and Other Weight-Loss Drugs-Reply.","authors":"Abhimanyu S Ahuja,Alfredo A Paredes,Benjamin K Young","doi":"10.1001/jamaophthalmol.2026.0010","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2026.0010","url":null,"abstract":"","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":"53 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2026-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147350694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-05DOI: 10.1001/jamaophthalmol.2026.0085
T Y Alvin Liu
{"title":"Funders' Role in Ophthalmic Artificial Intelligence Innovations.","authors":"T Y Alvin Liu","doi":"10.1001/jamaophthalmol.2026.0085","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2026.0085","url":null,"abstract":"","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":"45 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2026-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147350835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-05DOI: 10.1001/jamaophthalmol.2026.0197
Travis K Redd
{"title":"Novel Corneal Ulcer Diagnostics Are Cause for Optimism.","authors":"Travis K Redd","doi":"10.1001/jamaophthalmol.2026.0197","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2026.0197","url":null,"abstract":"","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":"36 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2026-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147350836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01DOI: 10.1001/jamaophthalmol.2025.5814
Praveer Singh, Sourav Kumar, Riya Tyagi, Benjamin K Young, Brian K Jordan, Brian Scottoline, Patrick D Evers, Susan Ostmo, Aaron S Coyner, Wei-Chun Lin, Aarushi Gupta, Deniz Erdogmus, R V Paul Chan, Emily A McCourt, James S Barry, Cindy T McEvoy, Michael F Chiang, J Peter Campbell, Jayashree Kalpathy-Cramer
Importance: Bronchopulmonary dysplasia (BPD) and pulmonary hypertension (PH) are leading causes of morbidity and mortality in premature infants.
Objective: To determine whether images obtained as part of retinopathy of prematurity (ROP) screening might contain features associated with BPD and PH in infants and whether a multimodal model integrating imaging features with demographic risk factors might outperform a model based on demographic risk alone.
Design, setting, and participants: A deep learning model was used to study retinal images collected from patients enrolled in the multi-institutional Imaging and Informatics in Retinopathy of Prematurity (i-ROP) study. The analysis included infants at risk for ROP undergoing routine ROP screening examinations from 2012 to 2020. Infants were recruited from 7 neonatal intensive care units. Images were limited to 34 weeks' or less postmenstrual age (PMA) so as to precede the clinical diagnosis of BPD or PH. The dataset included the period from June 2015 to April 2020. Data were analyzed from April to June 2025.
Exposures: BPD was diagnosed by the presence of an oxygen requirement at 36 weeks' PMA, and PH was diagnosed by echocardiogram at 34 weeks. A support vector machine model was trained to predict BPD or PH diagnosis using (1) image features alone (extracted using ResNet18), (2) demographics alone, or (3) image features concatenated with demographics. To reduce the possibility of confounding with ROP, secondary models were trained using only images without clinical signs of ROP.
Main outcomes and measures: For both BPD and PH, performance was reported on a held-out test set and assessed by the area under receiver operating characteristic curve (AUROC).
Results: A total of 493 infants (mean [SD] gestational age, BPD, 25.7 [1.8] weeks; normal, 27.3 [1.8] weeks; 267 male [54.2%]) were included in this analysis. Performance was reported on a held-out test set (99 patients from the BPD cohort and 37 patients from the PH cohort). For BPD, the multimodal model showed higher accuracy (AUC, 0.82; 95% CI, 0.72-0.90) than demographics-only (0.72; ∆AUC, 0.1; 95% CI, -0.008 to 0.21; P = .07) or imaging-only (0.72; ∆AUC, 0.1; 95% CI, 0.04-0.16; P = .002) models. For PH, multimodal AUC was 0.91 vs the demographics-only 0.68 (∆AUC, 0.14; 95% CI, 0.006-0.27; P = .04) and imaging-only 0.91 (∆AUC, -0.09; 95% CI, -0.3 to 0.12; P = .40) models. Results persisted when trained on images lacking clinical ROP signs.
Conclusions and relevance: Results suggest that retinal images obtained during ROP screening may be used to predict the diagnosis of BPD and PH in preterm infants, which may lead to earlier diagnosis and avoid the need for invasive diagnostic testing in the future.
{"title":"Deep Learning-Based Prediction of Cardiopulmonary Disease in Retinal Images of Premature Infants.","authors":"Praveer Singh, Sourav Kumar, Riya Tyagi, Benjamin K Young, Brian K Jordan, Brian Scottoline, Patrick D Evers, Susan Ostmo, Aaron S Coyner, Wei-Chun Lin, Aarushi Gupta, Deniz Erdogmus, R V Paul Chan, Emily A McCourt, James S Barry, Cindy T McEvoy, Michael F Chiang, J Peter Campbell, Jayashree Kalpathy-Cramer","doi":"10.1001/jamaophthalmol.2025.5814","DOIUrl":"10.1001/jamaophthalmol.2025.5814","url":null,"abstract":"<p><strong>Importance: </strong>Bronchopulmonary dysplasia (BPD) and pulmonary hypertension (PH) are leading causes of morbidity and mortality in premature infants.</p><p><strong>Objective: </strong>To determine whether images obtained as part of retinopathy of prematurity (ROP) screening might contain features associated with BPD and PH in infants and whether a multimodal model integrating imaging features with demographic risk factors might outperform a model based on demographic risk alone.</p><p><strong>Design, setting, and participants: </strong>A deep learning model was used to study retinal images collected from patients enrolled in the multi-institutional Imaging and Informatics in Retinopathy of Prematurity (i-ROP) study. The analysis included infants at risk for ROP undergoing routine ROP screening examinations from 2012 to 2020. Infants were recruited from 7 neonatal intensive care units. Images were limited to 34 weeks' or less postmenstrual age (PMA) so as to precede the clinical diagnosis of BPD or PH. The dataset included the period from June 2015 to April 2020. Data were analyzed from April to June 2025.</p><p><strong>Exposures: </strong>BPD was diagnosed by the presence of an oxygen requirement at 36 weeks' PMA, and PH was diagnosed by echocardiogram at 34 weeks. A support vector machine model was trained to predict BPD or PH diagnosis using (1) image features alone (extracted using ResNet18), (2) demographics alone, or (3) image features concatenated with demographics. To reduce the possibility of confounding with ROP, secondary models were trained using only images without clinical signs of ROP.</p><p><strong>Main outcomes and measures: </strong>For both BPD and PH, performance was reported on a held-out test set and assessed by the area under receiver operating characteristic curve (AUROC).</p><p><strong>Results: </strong>A total of 493 infants (mean [SD] gestational age, BPD, 25.7 [1.8] weeks; normal, 27.3 [1.8] weeks; 267 male [54.2%]) were included in this analysis. Performance was reported on a held-out test set (99 patients from the BPD cohort and 37 patients from the PH cohort). For BPD, the multimodal model showed higher accuracy (AUC, 0.82; 95% CI, 0.72-0.90) than demographics-only (0.72; ∆AUC, 0.1; 95% CI, -0.008 to 0.21; P = .07) or imaging-only (0.72; ∆AUC, 0.1; 95% CI, 0.04-0.16; P = .002) models. For PH, multimodal AUC was 0.91 vs the demographics-only 0.68 (∆AUC, 0.14; 95% CI, 0.006-0.27; P = .04) and imaging-only 0.91 (∆AUC, -0.09; 95% CI, -0.3 to 0.12; P = .40) models. Results persisted when trained on images lacking clinical ROP signs.</p><p><strong>Conclusions and relevance: </strong>Results suggest that retinal images obtained during ROP screening may be used to predict the diagnosis of BPD and PH in preterm infants, which may lead to earlier diagnosis and avoid the need for invasive diagnostic testing in the future.</p>","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":" ","pages":"230-237"},"PeriodicalIF":9.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12828656/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146018500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01DOI: 10.1001/jamaophthalmol.2025.6048
Victor Bellanda, Matthew J Schulgit, Gabriel Castilho S Barbosa, Nitesh Mohan, Andrea Arline, Suraj Bala, David C Kaelber, Sunil K Srivastava, Sumit Sharma
{"title":"Relative Risk of Neovascular Age-Related Macular Degeneration Following Cataract Surgery.","authors":"Victor Bellanda, Matthew J Schulgit, Gabriel Castilho S Barbosa, Nitesh Mohan, Andrea Arline, Suraj Bala, David C Kaelber, Sunil K Srivastava, Sumit Sharma","doi":"10.1001/jamaophthalmol.2025.6048","DOIUrl":"10.1001/jamaophthalmol.2025.6048","url":null,"abstract":"","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":" ","pages":"281-284"},"PeriodicalIF":9.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12878637/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146124891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01DOI: 10.1001/jamaophthalmol.2025.6047
Francisco Mendes, Sumitra S Khandelwal, Douglas D Koch
{"title":"Corneal Abrasion Leading to Stromal Melt in a Patient With Myopia.","authors":"Francisco Mendes, Sumitra S Khandelwal, Douglas D Koch","doi":"10.1001/jamaophthalmol.2025.6047","DOIUrl":"10.1001/jamaophthalmol.2025.6047","url":null,"abstract":"","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":" ","pages":"277"},"PeriodicalIF":9.2,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146124729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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