Pub Date : 2025-01-01DOI: 10.1001/jamaophthalmol.2024.5105
Sridevi Thottarath, Wei-Shan Tsai, Sarega Gurudas, Elizabeth Pearce, Chui Ming Gemmy Cheung, Taffeta Ching Ning Yamaguchi, Sobha Sivaprasad
Importance: Some eyes with proliferative diabetic retinopathy (PDR) treated to stability with panretinal photocoagulation (PRP) continue to lose vision without diabetic macular edema. One presumed cause is macular capillary nonperfusion (CNP)-associated ischemia or infarction. Natural history data of macular CNP might guide treatment trials for it.
Objective: To assess visual function and optical coherence tomography angiography (OCTA) changes over 12 months in PRP-treated stable eyes with PDR and macular CNP.
Design, setting, and participants: This prospective observational cohort study was conducted in a single center in the United Kingdom. Participants had stable laser-treated PDR in at least 1 eye with macular CNP and a best-corrected visual acuity (BCVA) letter score of at least 54 (Snellen equivalent ≥20/80) using Early Treatment Diabetic Retinopathy Study (ETDRS) chart. Recruitment was from December 2019 to August 2021 and follow-up for 12 months; data were analyzed from May to July 2024.
Main outcomes and measures: Changes in BCVA, low-luminance visual acuity (LLVA), and OCTA metrics over 12 months using linear mixed-effects models with unstructured variance accounting for within-participant correlation between the eligible study eye and repeated measures across time.
Results: The cohort included 63 participants and 88 eyes. The mean (SD) age was 57.4 (11.9) years; 41 were male (65.1%) and 22 female (34.9%). Mean BCVA and LLVA ETDRS letter scores were 77.52 (SD, 8.0; approximate Snellen equivalent, 20/32) and 68.33 (SD, 8.9; Snellen, 20/40) at baseline and 78.76 (SD, 8.3; Snellen 20/25) and 70.20 (SD, 8.1; Snellen, 20/40) at 12 months. However, 7 participants (9.3%) lost at least 5 letters of visual acuity at 12 months. Linear mixed-effects analysis showed the foveal avascular zone (FAZ) area deteriorated over 12 months, with a mean increase of 1.80% (95% CI, 0.01%-3.63%; P = .05) at 6 months and 2.26% (95% CI, 0.29%-4.26%; P = .03) from baseline. Eyes that lost 5 or more letters had lower baseline superficial vascular density in both the 3 × 3-mm scan (mean [SD], 36.7 [4.8] vs 33.5 [2.0]; P = .006) and parafoveal area (38.7 [5.6] vs 34.7 [2.6]; P = .005). No association was found between a loss of 5 or more letters at 12 months and any baseline FAZ parameters.
Conclusions and relevance: This study found that FAZ area deteriorated over 12 months in eyes with stable laser-treated peripheral retina in eyes and macular CNP. Vision loss was uncommon and more prevalent in eyes with decreased SVD at baseline rather than FAZ parameters. Longer trials may be required to observe more events of change of 5 or more letters.
{"title":"Macular Capillary Nonperfusion in Eyes With Stable Laser-Treated Proliferative Diabetic Retinopathy.","authors":"Sridevi Thottarath, Wei-Shan Tsai, Sarega Gurudas, Elizabeth Pearce, Chui Ming Gemmy Cheung, Taffeta Ching Ning Yamaguchi, Sobha Sivaprasad","doi":"10.1001/jamaophthalmol.2024.5105","DOIUrl":"10.1001/jamaophthalmol.2024.5105","url":null,"abstract":"<p><strong>Importance: </strong>Some eyes with proliferative diabetic retinopathy (PDR) treated to stability with panretinal photocoagulation (PRP) continue to lose vision without diabetic macular edema. One presumed cause is macular capillary nonperfusion (CNP)-associated ischemia or infarction. Natural history data of macular CNP might guide treatment trials for it.</p><p><strong>Objective: </strong>To assess visual function and optical coherence tomography angiography (OCTA) changes over 12 months in PRP-treated stable eyes with PDR and macular CNP.</p><p><strong>Design, setting, and participants: </strong>This prospective observational cohort study was conducted in a single center in the United Kingdom. Participants had stable laser-treated PDR in at least 1 eye with macular CNP and a best-corrected visual acuity (BCVA) letter score of at least 54 (Snellen equivalent ≥20/80) using Early Treatment Diabetic Retinopathy Study (ETDRS) chart. Recruitment was from December 2019 to August 2021 and follow-up for 12 months; data were analyzed from May to July 2024.</p><p><strong>Main outcomes and measures: </strong>Changes in BCVA, low-luminance visual acuity (LLVA), and OCTA metrics over 12 months using linear mixed-effects models with unstructured variance accounting for within-participant correlation between the eligible study eye and repeated measures across time.</p><p><strong>Results: </strong>The cohort included 63 participants and 88 eyes. The mean (SD) age was 57.4 (11.9) years; 41 were male (65.1%) and 22 female (34.9%). Mean BCVA and LLVA ETDRS letter scores were 77.52 (SD, 8.0; approximate Snellen equivalent, 20/32) and 68.33 (SD, 8.9; Snellen, 20/40) at baseline and 78.76 (SD, 8.3; Snellen 20/25) and 70.20 (SD, 8.1; Snellen, 20/40) at 12 months. However, 7 participants (9.3%) lost at least 5 letters of visual acuity at 12 months. Linear mixed-effects analysis showed the foveal avascular zone (FAZ) area deteriorated over 12 months, with a mean increase of 1.80% (95% CI, 0.01%-3.63%; P = .05) at 6 months and 2.26% (95% CI, 0.29%-4.26%; P = .03) from baseline. Eyes that lost 5 or more letters had lower baseline superficial vascular density in both the 3 × 3-mm scan (mean [SD], 36.7 [4.8] vs 33.5 [2.0]; P = .006) and parafoveal area (38.7 [5.6] vs 34.7 [2.6]; P = .005). No association was found between a loss of 5 or more letters at 12 months and any baseline FAZ parameters.</p><p><strong>Conclusions and relevance: </strong>This study found that FAZ area deteriorated over 12 months in eyes with stable laser-treated peripheral retina in eyes and macular CNP. Vision loss was uncommon and more prevalent in eyes with decreased SVD at baseline rather than FAZ parameters. Longer trials may be required to observe more events of change of 5 or more letters.</p>","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":" ","pages":"45-52"},"PeriodicalIF":7.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11603379/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142728748","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 : 2025-01-01DOI: 10.1001/jamaophthalmol.2024.4867
Todd P Margolis, Anat Galor, Gary D Novack
{"title":"Implications of Diagnostic Error in Ocular Surface Disease: The Role of Anchoring and Ambiguous Diagnostic Terminology.","authors":"Todd P Margolis, Anat Galor, Gary D Novack","doi":"10.1001/jamaophthalmol.2024.4867","DOIUrl":"10.1001/jamaophthalmol.2024.4867","url":null,"abstract":"","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":" ","pages":"5-6"},"PeriodicalIF":7.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142620651","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 : 2025-01-01DOI: 10.1001/jamaophthalmol.2024.5103
Anthony P Khawaja, Pirro G Hysi, Paul J Foster
{"title":"The Emerging Clinical Utility of Polygenic Prediction Models.","authors":"Anthony P Khawaja, Pirro G Hysi, Paul J Foster","doi":"10.1001/jamaophthalmol.2024.5103","DOIUrl":"10.1001/jamaophthalmol.2024.5103","url":null,"abstract":"","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":" ","pages":"23-24"},"PeriodicalIF":7.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142681568","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 : 2025-01-01DOI: 10.1001/jamaophthalmol.2024.5076
Marselle A Rasdall, Chloe Cho, Amy N Stahl, David A Tovar, Patrick Lavin, Cailey I Kerley, Qingxia Chen, Xiangyu Ji, Marcus H Colyer, Lucas Groves, Reid Longmuir, Amy Chomsky, Martin J Gallagher, Adam Anderson, Bennett A Landman, Tonia S Rex
Importance: Individuals with mild traumatic brain injury (TBI) often report vision problems despite having normal visual acuity and fundus examinations. Diagnostics are needed for these patients.
Objective: To determine if a battery of assessments or machine-learning approaches can aid in diagnosing visual dysfunction in patients with mild TBI.
Design, setting, and participants: This prospective, observational, case-control study was conducted between May 2018 and November 2021. The study setting was at a level 1 trauma research hospital. Participant eligibility included adult males and females with recorded best-corrected visual acuity and normal fundus examination. Individuals in the case group had a history of mild TBI; controls had no history of TBI. Exclusion criteria included a history of ocular, neurological, or psychiatric disease, moderate-severe TBI, recent TBI, metal implants, age younger than 18 years, and pregnancy. Cases and controls were sex- and age-matched. Data analysis was performed from July 2023 to March 2024.
Exposures: History of mild TBI in the case group.
Main outcomes and measures: The single-session visit included the Neurobehavioral Symptom Inventory and measurements of oculomotor function, optical coherence tomography, contrast sensitivity, visual evoked potentials, visual field testing, and magnetic resonance imaging.
Results: A total of 28 participants (mean [SD] age, 35.0 [12.8] years; 15 male [53.6%]) with mild TBI and 28 controls (mean [SD] age, 35.8 [8.5] years; 19 female [67.9%]) were analyzed. Participants with mild TBI showed reduced prism convergence test breakpoint (-8.38; 95% CI, -14.14 to -2.62; P = .008) and recovery point (-8.44; 95% CI, -13.82 to -3.06; P = .004). Participants with mild TBI also had decreased contrast sensitivity (-0.07; 95% CI, -0.13 to -0.01; P = .04) and increased visual evoked potential binocular summation index (0.32; 95% CI, 0.02-0.63; P = .02). A subset of participants exhibited reduced peripapillary retinal nerve fiber layer thickness, increased optic nerve/sheath size, and brain cortical volumes. Machine learning identified subtle differences across the primary visual pathway, including the optic radiations and occipital lobe regions, independent of visual symptoms.
Conclusions and relevance: Results of this case-control study suggest that the visual system was affected in individuals with mild TBI, even in those who did not self-report vision problems. These findings support the utility of a battery of assessments or machine-learning approaches to accurately diagnose this population.
{"title":"Primary Visual Pathway Changes in Individuals With Chronic Mild Traumatic Brain Injury.","authors":"Marselle A Rasdall, Chloe Cho, Amy N Stahl, David A Tovar, Patrick Lavin, Cailey I Kerley, Qingxia Chen, Xiangyu Ji, Marcus H Colyer, Lucas Groves, Reid Longmuir, Amy Chomsky, Martin J Gallagher, Adam Anderson, Bennett A Landman, Tonia S Rex","doi":"10.1001/jamaophthalmol.2024.5076","DOIUrl":"10.1001/jamaophthalmol.2024.5076","url":null,"abstract":"<p><strong>Importance: </strong>Individuals with mild traumatic brain injury (TBI) often report vision problems despite having normal visual acuity and fundus examinations. Diagnostics are needed for these patients.</p><p><strong>Objective: </strong>To determine if a battery of assessments or machine-learning approaches can aid in diagnosing visual dysfunction in patients with mild TBI.</p><p><strong>Design, setting, and participants: </strong>This prospective, observational, case-control study was conducted between May 2018 and November 2021. The study setting was at a level 1 trauma research hospital. Participant eligibility included adult males and females with recorded best-corrected visual acuity and normal fundus examination. Individuals in the case group had a history of mild TBI; controls had no history of TBI. Exclusion criteria included a history of ocular, neurological, or psychiatric disease, moderate-severe TBI, recent TBI, metal implants, age younger than 18 years, and pregnancy. Cases and controls were sex- and age-matched. Data analysis was performed from July 2023 to March 2024.</p><p><strong>Exposures: </strong>History of mild TBI in the case group.</p><p><strong>Main outcomes and measures: </strong>The single-session visit included the Neurobehavioral Symptom Inventory and measurements of oculomotor function, optical coherence tomography, contrast sensitivity, visual evoked potentials, visual field testing, and magnetic resonance imaging.</p><p><strong>Results: </strong>A total of 28 participants (mean [SD] age, 35.0 [12.8] years; 15 male [53.6%]) with mild TBI and 28 controls (mean [SD] age, 35.8 [8.5] years; 19 female [67.9%]) were analyzed. Participants with mild TBI showed reduced prism convergence test breakpoint (-8.38; 95% CI, -14.14 to -2.62; P = .008) and recovery point (-8.44; 95% CI, -13.82 to -3.06; P = .004). Participants with mild TBI also had decreased contrast sensitivity (-0.07; 95% CI, -0.13 to -0.01; P = .04) and increased visual evoked potential binocular summation index (0.32; 95% CI, 0.02-0.63; P = .02). A subset of participants exhibited reduced peripapillary retinal nerve fiber layer thickness, increased optic nerve/sheath size, and brain cortical volumes. Machine learning identified subtle differences across the primary visual pathway, including the optic radiations and occipital lobe regions, independent of visual symptoms.</p><p><strong>Conclusions and relevance: </strong>Results of this case-control study suggest that the visual system was affected in individuals with mild TBI, even in those who did not self-report vision problems. These findings support the utility of a battery of assessments or machine-learning approaches to accurately diagnose this population.</p>","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":" ","pages":"33-42"},"PeriodicalIF":7.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11603381/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142728750","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 : 2024-12-26DOI: 10.1001/jamaophthalmol.2024.5462
Aikaterini K. Seliniotaki, Maria Lithoxopoulou, Christina Virgiliou, Helen Gika, Aristides Dokoumetzidis, Konstantinos I. Bougioukas, Nikolaos Raikos, Elisavet Diamanti, Nikolaos Ziakas, Anna-Bettina Haidich, Asimina Mataftsi
ImportanceCommercial mydriatics administered in preterm infants during retinopathy of prematurity (ROP) screening have been associated with various cardiorespiratory and gastrointestinal adverse events.ObjectiveTo examine whether microdrops of a combined mixture of 1.67% phenylephrine and 0.33% tropicamide are noninferior to standard drops regarding mydriatic efficacy at 45, 90, and 120 minutes. The occurrence of systemic adverse events and systemic absorption of phenylephrine eyedrops were additional secondary outcomes.Design, Setting, and ParticipantsThis randomized clinical trial with a double-masked, noninferiority, crossover design included infants undergoing ROP screening at a tertiary center in Northern Greece from September 2021 to January 2023. Eligible participants were infants with gestational age below 32 weeks and/or birthweight under 1501 g, or infants beyond these thresholds referred by an attending neonatologist due to comorbidities.InterventionsEither microdrops or standard drops of the diluted mixture were administered at a random allocation sequence with a 1-week washout period.Main outcomes and measuresThe horizontal pupil diameter at 45, 90, and 120 minutes was measured using a customized ruler in 0.5-mm increments. Mixed-effects linear regression models were developed, and the confidence interval (CI) approach was used for assessing noninferiority. The predefined noninferiority margin was −0.4 mm. Heart rate; oxygen saturation; blood pressure measurements at 45, 90, and 120 minutes; 24-hour hypertensive episodes; and 48-hour systemic adverse events were assessed. Phenylephrine concentration in peripheral blood within 3 hours postinstillation was measured using hydrophilic liquid chromatography–tandem mass spectrometry. Pooled pharmacokinetic parameters were calculated based on a developed mathematical model.ResultsA total of 83 infants were randomized (mean [SD] gestational age, 29.7 [2.0] weeks; mean [SD] birth weight, 1277 [374] g). Microdrops proved to be superior regarding mydriatic efficacy at 45 minutes (mean difference, 0.12; Bonferroni-corrected 95% CI, 0.01 to 0.23; <jats:italic>P</jats:italic> = .008) and noninferior at 90 minutes (Bonferroni-corrected 95% CI, −0.10 to 0.17) and 120 minutes (Bonferroni-corrected 95% CI, −0.18 to 0.14). Lower levels of oxygen saturation at 45 minutes (mean difference, 0.66; 95% CI, 0.09 to 1.24; <jats:italic>P</jats:italic> = .03) and 90 minutes (mean difference, 0.58; 95% CI, 0.03 to 1.14; <jats:italic>P</jats:italic> = .04) and higher percentage of 24-hour hypertensive episodes (median [IQR] percentage of hypertensive episodes: microdrops, 0.10% [0.02%-0.19%] vs standard drops, 0.14% [0.06%-0.40%]; <jats:italic>P</jats:italic> = .01) were observed after standard drops. A 1-compartment model with first-order absorption best described the pharmacokinetic data.Conclusion and RelevanceTo our knowledge, this is the first study establishing noninferiority of microdrops compared with sta
{"title":"Efficacy and Safety of Mydriatic Microdrops for Retinopathy of Prematurity Screening","authors":"Aikaterini K. Seliniotaki, Maria Lithoxopoulou, Christina Virgiliou, Helen Gika, Aristides Dokoumetzidis, Konstantinos I. Bougioukas, Nikolaos Raikos, Elisavet Diamanti, Nikolaos Ziakas, Anna-Bettina Haidich, Asimina Mataftsi","doi":"10.1001/jamaophthalmol.2024.5462","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2024.5462","url":null,"abstract":"ImportanceCommercial mydriatics administered in preterm infants during retinopathy of prematurity (ROP) screening have been associated with various cardiorespiratory and gastrointestinal adverse events.ObjectiveTo examine whether microdrops of a combined mixture of 1.67% phenylephrine and 0.33% tropicamide are noninferior to standard drops regarding mydriatic efficacy at 45, 90, and 120 minutes. The occurrence of systemic adverse events and systemic absorption of phenylephrine eyedrops were additional secondary outcomes.Design, Setting, and ParticipantsThis randomized clinical trial with a double-masked, noninferiority, crossover design included infants undergoing ROP screening at a tertiary center in Northern Greece from September 2021 to January 2023. Eligible participants were infants with gestational age below 32 weeks and/or birthweight under 1501 g, or infants beyond these thresholds referred by an attending neonatologist due to comorbidities.InterventionsEither microdrops or standard drops of the diluted mixture were administered at a random allocation sequence with a 1-week washout period.Main outcomes and measuresThe horizontal pupil diameter at 45, 90, and 120 minutes was measured using a customized ruler in 0.5-mm increments. Mixed-effects linear regression models were developed, and the confidence interval (CI) approach was used for assessing noninferiority. The predefined noninferiority margin was −0.4 mm. Heart rate; oxygen saturation; blood pressure measurements at 45, 90, and 120 minutes; 24-hour hypertensive episodes; and 48-hour systemic adverse events were assessed. Phenylephrine concentration in peripheral blood within 3 hours postinstillation was measured using hydrophilic liquid chromatography–tandem mass spectrometry. Pooled pharmacokinetic parameters were calculated based on a developed mathematical model.ResultsA total of 83 infants were randomized (mean [SD] gestational age, 29.7 [2.0] weeks; mean [SD] birth weight, 1277 [374] g). Microdrops proved to be superior regarding mydriatic efficacy at 45 minutes (mean difference, 0.12; Bonferroni-corrected 95% CI, 0.01 to 0.23; <jats:italic>P</jats:italic> = .008) and noninferior at 90 minutes (Bonferroni-corrected 95% CI, −0.10 to 0.17) and 120 minutes (Bonferroni-corrected 95% CI, −0.18 to 0.14). Lower levels of oxygen saturation at 45 minutes (mean difference, 0.66; 95% CI, 0.09 to 1.24; <jats:italic>P</jats:italic> = .03) and 90 minutes (mean difference, 0.58; 95% CI, 0.03 to 1.14; <jats:italic>P</jats:italic> = .04) and higher percentage of 24-hour hypertensive episodes (median [IQR] percentage of hypertensive episodes: microdrops, 0.10% [0.02%-0.19%] vs standard drops, 0.14% [0.06%-0.40%]; <jats:italic>P</jats:italic> = .01) were observed after standard drops. A 1-compartment model with first-order absorption best described the pharmacokinetic data.Conclusion and RelevanceTo our knowledge, this is the first study establishing noninferiority of microdrops compared with sta","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":"20 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142887185","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 : 2024-12-26DOI: 10.1001/jamaophthalmol.2024.5533
Elizabeth V. Roti, Shuibin Ni, Yakub Bayhaqi, Susan R. Ostmo, Spencer S. Burt, Mani K. Woodward, John D. Jackson, Aaron S. Coyner, Michael F. Chiang, David Huang, J. Peter Campbell, Yifan Jian, Benjamin K. Young
ImportanceCapturing high-quality images of the entire peripheral retina while minimizing the use of scleral depression could increase the quality of examinations for retinopathy of prematurity (ROP) while reducing neonatal stress.ObjectiveTo evaluate whether an investigational handheld ultra-widefield optical coherence tomography (UWF-OCT) device without scleral depression can be used to document high-quality images of the peripheral retina for use in ROP examinations.Design, Setting, and ParticipantsThis was a prospective, cross-sectional study in the neonatal intensive care unit at a single academic medical center. Study participants were neonates in the neonatal intensive care unit who met standard ROP screening criteria (birth weight ≤1500 g; gestational age ≤30 weeks). Examinations were performed from January 2, 2023, to May 12, 2024. Data analysis was performed in July 2024.ExposureAn investigational, contact-based, 800-kHz, 140° (visual angle) UWF-OCT field-of-view handheld device was used during regular ROP examinations.Main Outcomes and MeasuresImages from each examination were captured using the UWF-OCT device, and the zone, stage, and presence of plus disease were diagnosed. If the UWF-OCT system was unable to capture diagnosis, this was recorded.ResultsA total of 507 examinations were performed on 83 neonates (mean [SD] birth weight, 905.1 [362.5] g; mean [SD] gestational age, 189.5 [19.1] days) with this system. The vascular border and disease was able to be visualized in 100% of cases, including to and beyond zone III. In some cases, images were able to clearly demonstrate the ora serrata and even the ciliary body.Conclusions and RelevanceThe UWF-OCT device was able to be safely used to perform ROP screenings and subsequent evaluations and provided volumetric imaging of the ora serrata and sometimes the ciliary body. The findings suggest that such devices may be associated with reduced technical challenges of capturing the entire peripheral retina in telemedicine programs, may reduce pain and stress for delicate neonates owing to the reduced use of scleral depression, and, with adaptation of the system, could potentially allow for peripheral imaging of the whole retina in older children and adults.
{"title":"Ultra-Widefield Optical Coherence Tomography Beyond the Ora Serrata in Retinopathy of Prematurity","authors":"Elizabeth V. Roti, Shuibin Ni, Yakub Bayhaqi, Susan R. Ostmo, Spencer S. Burt, Mani K. Woodward, John D. Jackson, Aaron S. Coyner, Michael F. Chiang, David Huang, J. Peter Campbell, Yifan Jian, Benjamin K. Young","doi":"10.1001/jamaophthalmol.2024.5533","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2024.5533","url":null,"abstract":"ImportanceCapturing high-quality images of the entire peripheral retina while minimizing the use of scleral depression could increase the quality of examinations for retinopathy of prematurity (ROP) while reducing neonatal stress.ObjectiveTo evaluate whether an investigational handheld ultra-widefield optical coherence tomography (UWF-OCT) device without scleral depression can be used to document high-quality images of the peripheral retina for use in ROP examinations.Design, Setting, and ParticipantsThis was a prospective, cross-sectional study in the neonatal intensive care unit at a single academic medical center. Study participants were neonates in the neonatal intensive care unit who met standard ROP screening criteria (birth weight ≤1500 g; gestational age ≤30 weeks). Examinations were performed from January 2, 2023, to May 12, 2024. Data analysis was performed in July 2024.ExposureAn investigational, contact-based, 800-kHz, 140° (visual angle) UWF-OCT field-of-view handheld device was used during regular ROP examinations.Main Outcomes and MeasuresImages from each examination were captured using the UWF-OCT device, and the zone, stage, and presence of plus disease were diagnosed. If the UWF-OCT system was unable to capture diagnosis, this was recorded.ResultsA total of 507 examinations were performed on 83 neonates (mean [SD] birth weight, 905.1 [362.5] g; mean [SD] gestational age, 189.5 [19.1] days) with this system. The vascular border and disease was able to be visualized in 100% of cases, including to and beyond zone III. In some cases, images were able to clearly demonstrate the ora serrata and even the ciliary body.Conclusions and RelevanceThe UWF-OCT device was able to be safely used to perform ROP screenings and subsequent evaluations and provided volumetric imaging of the ora serrata and sometimes the ciliary body. The findings suggest that such devices may be associated with reduced technical challenges of capturing the entire peripheral retina in telemedicine programs, may reduce pain and stress for delicate neonates owing to the reduced use of scleral depression, and, with adaptation of the system, could potentially allow for peripheral imaging of the whole retina in older children and adults.","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":"40 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142887176","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 : 2024-12-26DOI: 10.1001/jamaophthalmol.2024.5542
Jiahui Wu, Zhengyu Wang, Lili Lang
A 14-year old girl presents with sudden painless vision decline in the left eye for 5 days and reports constant fatigue, occasional dizziness, mild pain in the lower limbs, and intermittent claudication over the past 12 months with no history of trauma, surgery, COVID-19 infection, influenza, or other infection. What would you do next?
{"title":"Bilateral Acute Optic Neuropathy in a Teenaged Girl","authors":"Jiahui Wu, Zhengyu Wang, Lili Lang","doi":"10.1001/jamaophthalmol.2024.5542","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2024.5542","url":null,"abstract":"A 14-year old girl presents with sudden painless vision decline in the left eye for 5 days and reports constant fatigue, occasional dizziness, mild pain in the lower limbs, and intermittent claudication over the past 12 months with no history of trauma, surgery, COVID-19 infection, influenza, or other infection. What would you do next?","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":"23 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142887234","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 : 2024-12-05DOI: 10.1001/jamaophthalmol.2024.5219
Helen Tesfaye, Julie M. Paik, Miin Roh, Phyo T. Htoo, Heidi Zakoul, Niklas Schmedt, Lisette Koeneman, Deborah J. Wexler, Elisabetta Patorno
ImportanceEmpagliflozin might lower the risk of diabetic retinopathy (DR) by preventing retinal pericyte loss. However, the role of empagliflozin with respect to DR in patients with type 2 diabetes (T2D) remains unclear.ObjectiveTo compare the risk of incident nonproliferative DR (NPDR) and DR progression in patients with T2D initiating empagliflozin vs a dipeptidyl peptidase 4 inhibitor (DPP4i).Design, Setting, and ParticipantsA new-user active-comparator cohort study was conducted using US nationwide insurance claims data from 2 commercial insurers and Medicare from August 2014 to September 2019. Adults with T2D initiating study drugs without prior diagnosis or treatment for proliferative DR or other advanced retinal diseases were included. To assess incident NPDR, patients with a history of NPDR were additionally excluded, while for the DR progression outcome, patients were required to have a history of NPDR. Data were analyzed from August 2022 to May 2024.ExposuresInitiation of empagliflozin or a DPP4i.Main Outcomes and MeasuresIncident NPDR was defined using diagnostic codes for mild, moderate, or severe NPDR. The DR progression outcome was defined as a composite of incident proliferative DR, vitreous hemorrhage, initiation of intravitreal anti–vascular endothelial growth factor injection, or panretinal photocoagulation. Incidence rates, hazard ratios (HRs), and rate differences (RDs) with 95% CIs were estimated.ResultsA total of 34 239 pairs of propensity-score matched adults were identified in the incident NPDR cohort and 7831 pairs in the DR progression cohort. In the incident NPDR cohort, 35 867 patients (52.4%) were male, and the mean (SD) age was 65.6 (10.3) years. In the DR progression cohort, 8229 patients (52.5%) were male, and the mean (SD) age was 67.0 (10.0) years. Over a mean (SD) follow-up period of 8 (7.5) months receiving treatment, the risk of incident NPDR was not different across groups (HR, 1.04; 95% CI, 0.94 to 1.15; RD, 1.30; 95% CI, −1.83 to 4.44), while the risk of DR progression was lower among individuals who initiated empagliflozin compared with those who began DPP4i therapy (HR, 0.78; 95% CI, 0.63 to 0.96; RD, −9.44; 95% CI, −16.90 to −1.98). Results were consistent across multiple subgroups and sensitivity analyses.Conclusions and RelevanceCompared with initiation of a DPP4i, empagliflozin initiation was not associated with incident NPDR, although it may be associated with a lower risk of DR progression. Although residual confounding cannot be entirely ruled out due to the observational nature of our study, these findings may be helpful when weighing the risks and benefits of various glucose-lowering agents in adults with T2D.
{"title":"Empagliflozin and the Risk of Retinopathy in Patients With Type 2 Diabetes","authors":"Helen Tesfaye, Julie M. Paik, Miin Roh, Phyo T. Htoo, Heidi Zakoul, Niklas Schmedt, Lisette Koeneman, Deborah J. Wexler, Elisabetta Patorno","doi":"10.1001/jamaophthalmol.2024.5219","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2024.5219","url":null,"abstract":"ImportanceEmpagliflozin might lower the risk of diabetic retinopathy (DR) by preventing retinal pericyte loss. However, the role of empagliflozin with respect to DR in patients with type 2 diabetes (T2D) remains unclear.ObjectiveTo compare the risk of incident nonproliferative DR (NPDR) and DR progression in patients with T2D initiating empagliflozin vs a dipeptidyl peptidase 4 inhibitor (DPP4i).Design, Setting, and ParticipantsA new-user active-comparator cohort study was conducted using US nationwide insurance claims data from 2 commercial insurers and Medicare from August 2014 to September 2019. Adults with T2D initiating study drugs without prior diagnosis or treatment for proliferative DR or other advanced retinal diseases were included. To assess incident NPDR, patients with a history of NPDR were additionally excluded, while for the DR progression outcome, patients were required to have a history of NPDR. Data were analyzed from August 2022 to May 2024.ExposuresInitiation of empagliflozin or a DPP4i.Main Outcomes and MeasuresIncident NPDR was defined using diagnostic codes for mild, moderate, or severe NPDR. The DR progression outcome was defined as a composite of incident proliferative DR, vitreous hemorrhage, initiation of intravitreal anti–vascular endothelial growth factor injection, or panretinal photocoagulation. Incidence rates, hazard ratios (HRs), and rate differences (RDs) with 95% CIs were estimated.ResultsA total of 34 239 pairs of propensity-score matched adults were identified in the incident NPDR cohort and 7831 pairs in the DR progression cohort. In the incident NPDR cohort, 35 867 patients (52.4%) were male, and the mean (SD) age was 65.6 (10.3) years. In the DR progression cohort, 8229 patients (52.5%) were male, and the mean (SD) age was 67.0 (10.0) years. Over a mean (SD) follow-up period of 8 (7.5) months receiving treatment, the risk of incident NPDR was not different across groups (HR, 1.04; 95% CI, 0.94 to 1.15; RD, 1.30; 95% CI, −1.83 to 4.44), while the risk of DR progression was lower among individuals who initiated empagliflozin compared with those who began DPP4i therapy (HR, 0.78; 95% CI, 0.63 to 0.96; RD, −9.44; 95% CI, −16.90 to −1.98). Results were consistent across multiple subgroups and sensitivity analyses.Conclusions and RelevanceCompared with initiation of a DPP4i, empagliflozin initiation was not associated with incident NPDR, although it may be associated with a lower risk of DR progression. Although residual confounding cannot be entirely ruled out due to the observational nature of our study, these findings may be helpful when weighing the risks and benefits of various glucose-lowering agents in adults with T2D.","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":"19 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142777394","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 : 2024-12-05DOI: 10.1001/jamaophthalmol.2024.5139
Shreya Sirivolu, Sarah Pike, Mark W. Reid, Jesse L. Berry, Melinda Y. Chang, Angeline M. Nguyen
ImportanceDiscrimination in the workforce is a barrier to achieving diversity, equity, and inclusion. A previous study of ophthalmologists in Australia and New Zealand reported high rates of discrimination, but little is known about discrimination among ophthalmologists in the US.ObjectiveTo describe the frequency, nature, and outcomes of discrimination experienced by US ophthalmologists and trainees.Design, Setting, and ParticipantsThis cross-sectional study collected anonymous online survey responses from May 5 to July 22, 2022, from ophthalmologists and ophthalmologists in training from 10 US-based ophthalmology organizations.Main Outcomes and MeasuresMain outcomes included (1) the frequency of discrimination based on gender, race and ethnicity, and LGBTQIA+ (lesbian, gay, bisexual, transgender, queer, intersex, and asexual) status; (2) the bases, negative consequences, and sources of discrimination; and (3) the association of discrimination with job satisfaction and achieving career goals.ResultsOf 463 respondents (249 women [53.8%]), 194 (41.9%) reported experiencing discrimination. Women more commonly encountered discrimination based on gender than men (73 of 108 [67.6%] vs 2 of 21 [9.5%]; difference, 58.1 percentage points [95% CI, 42.7-73.4 percentage points]; <jats:italic>P</jats:italic> &lt; .001). Among women, pregnancy (27 of 108 [25.0%]) and maternity (12 [11.1%)] were the most frequently cited bases of discrimination outside of gender. Women (19 of 108 [17.6%]) reported discrimination due to race or ethnicity less frequently than men (13 of 21 [61.9%]; difference, −44.3 percentage points [95% CI, −66.3 to −22.3 percentage points]; <jats:italic>P</jats:italic> &lt; .001). Reported negative consequences of discrimination included disrespect or passive aggression (44 of 129 [34.1%]), loss of employment opportunities (24 of 129 [18.6%]), and misrepresentation (eg, mistaken for nurse, janitor, etc; 18 of 129 [14.0%]), with loss of income being reported exclusively by women (25 of 108 [23.1%]). Those who reported at least 1 encounter of discrimination experienced significantly lower job satisfaction than those who did not (3.9 [1.0] vs 4.3 [0.8] on a scale of 1-5, where 1 indicates very dissatisfied and 5 indicates very satisfied; difference, −0.4 [95% CI, −0.7 to −0.2]; <jats:italic>P</jats:italic> &lt; .001), as well as lower achievement of current career goals (3.9 [1.1] vs 4.3 [0.8] on a scale of 1-5; difference, −0.4 [95% CI, −0.6 to −0.2]; <jats:italic>P</jats:italic> &lt; .001).Conclusions and RelevanceThis study suggests that discrimination remains prevalent among ophthalmologists in the US, with gender-based discrimination being reported most frequently. Discrimination was negatively associated with income, employment opportunities, job satisfaction, and achievement of career goals for respondents. With increased recognition of the prevalence and outcomes of discrimination in the workplace, ophthal
{"title":"Discrimination Within the US Ophthalmology Workforce","authors":"Shreya Sirivolu, Sarah Pike, Mark W. Reid, Jesse L. Berry, Melinda Y. Chang, Angeline M. Nguyen","doi":"10.1001/jamaophthalmol.2024.5139","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2024.5139","url":null,"abstract":"ImportanceDiscrimination in the workforce is a barrier to achieving diversity, equity, and inclusion. A previous study of ophthalmologists in Australia and New Zealand reported high rates of discrimination, but little is known about discrimination among ophthalmologists in the US.ObjectiveTo describe the frequency, nature, and outcomes of discrimination experienced by US ophthalmologists and trainees.Design, Setting, and ParticipantsThis cross-sectional study collected anonymous online survey responses from May 5 to July 22, 2022, from ophthalmologists and ophthalmologists in training from 10 US-based ophthalmology organizations.Main Outcomes and MeasuresMain outcomes included (1) the frequency of discrimination based on gender, race and ethnicity, and LGBTQIA+ (lesbian, gay, bisexual, transgender, queer, intersex, and asexual) status; (2) the bases, negative consequences, and sources of discrimination; and (3) the association of discrimination with job satisfaction and achieving career goals.ResultsOf 463 respondents (249 women [53.8%]), 194 (41.9%) reported experiencing discrimination. Women more commonly encountered discrimination based on gender than men (73 of 108 [67.6%] vs 2 of 21 [9.5%]; difference, 58.1 percentage points [95% CI, 42.7-73.4 percentage points]; <jats:italic>P</jats:italic> &amp;lt; .001). Among women, pregnancy (27 of 108 [25.0%]) and maternity (12 [11.1%)] were the most frequently cited bases of discrimination outside of gender. Women (19 of 108 [17.6%]) reported discrimination due to race or ethnicity less frequently than men (13 of 21 [61.9%]; difference, −44.3 percentage points [95% CI, −66.3 to −22.3 percentage points]; <jats:italic>P</jats:italic> &amp;lt; .001). Reported negative consequences of discrimination included disrespect or passive aggression (44 of 129 [34.1%]), loss of employment opportunities (24 of 129 [18.6%]), and misrepresentation (eg, mistaken for nurse, janitor, etc; 18 of 129 [14.0%]), with loss of income being reported exclusively by women (25 of 108 [23.1%]). Those who reported at least 1 encounter of discrimination experienced significantly lower job satisfaction than those who did not (3.9 [1.0] vs 4.3 [0.8] on a scale of 1-5, where 1 indicates very dissatisfied and 5 indicates very satisfied; difference, −0.4 [95% CI, −0.7 to −0.2]; <jats:italic>P</jats:italic> &amp;lt; .001), as well as lower achievement of current career goals (3.9 [1.1] vs 4.3 [0.8] on a scale of 1-5; difference, −0.4 [95% CI, −0.6 to −0.2]; <jats:italic>P</jats:italic> &amp;lt; .001).Conclusions and RelevanceThis study suggests that discrimination remains prevalent among ophthalmologists in the US, with gender-based discrimination being reported most frequently. Discrimination was negatively associated with income, employment opportunities, job satisfaction, and achievement of career goals for respondents. With increased recognition of the prevalence and outcomes of discrimination in the workplace, ophthal","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":"20 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142782815","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 : 2024-12-01DOI: 10.1001/jamaophthalmol.2024.4515
Jay B Lusk, Brian Mac Grory, Fan Li
{"title":"Considerations Regarding Association of Semaglutide and Nonarteritic Anterior Ischemic Optic Neuropathy.","authors":"Jay B Lusk, Brian Mac Grory, Fan Li","doi":"10.1001/jamaophthalmol.2024.4515","DOIUrl":"10.1001/jamaophthalmol.2024.4515","url":null,"abstract":"","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":" ","pages":"1173-1174"},"PeriodicalIF":7.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142545443","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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