JAMA Ophthalmology

2014 JAMA Ophthalmology

doi: 10.1001/jamaophthalmol.2013.5923

2014 JAMA Ophthalmology

doi: 10.1001/jamaophthalmol.2013.5924

Higginbotham, Eve J.; Upadhyay, Aparna; Egbuonu-Davis, Lisa

2014 JAMA Ophthalmology

doi: 10.1001/jamaophthalmol.2013.5645pmid: 24310429

Musch, David C.

2014 JAMA Ophthalmology

doi: 10.1001/jamaophthalmol.2013.7443pmid: 24309835

, ; Chew, Emily Y.; Clemons, Traci E.; SanGiovanni, John Paul; Danis, Ronald P.; Ferris, Frederick L.; Elman, Michael J.; Antoszyk, Andrew N.; Ruby, Alan J.; Orth, David; Bressler, Susan B.; Fish, Gary E.; Hubbard, George Baker; Klein, Michael L.; Chandra, Suresh R.; Blodi, Barbara A.; Domalpally, Amitha; Friberg, Thomas; Wong, Wai T.; Rosenfeld, Philip J.; Agrón, Elvira; Toth, Cynthia A.; Bernstein, Paul S.; Sperduto, Robert D.

2014 JAMA Ophthalmology

doi: 10.1001/jamaophthalmol.2013.7376pmid: 24310343

ImportanceThe Age-Related Eye Disease Study (AREDS) formulation for the treatment of age-related macular degeneration (AMD) contains vitamin C, vitamin E, beta carotene, and zinc with copper. The Age-Related Eye Disease Study 2 (AREDS2) assessed the value of substituting lutein/zeaxanthin in the AREDS formulation because of the demonstrated risk for lung cancer from beta carotene in smokers and former smokers and because lutein and zeaxanthin are important components in the retina. ObjectiveTo further examine the effect of lutein/zeaxanthin supplementation on progression to late AMD. Design, Setting, ParticipantsThe Age-Related Eye Disease Study 2 is a multicenter, double-masked randomized trial of 4203 participants, aged 50 to 85 years, at risk for developing late AMD; 66% of patients had bilateral large drusen and 34% had large drusen and late AMD in 1 eye. InterventionsIn addition to taking the original or a variation of the AREDS supplement, participants were randomly assigned in a factorial design to 1 of the following 4 groups: placebo; lutein/zeaxanthin, 10 mg/2 mg; omega-3 long-chain polyunsaturated fatty 3 acids, 1.0 g; or the combination. Main Outcomes and MeasuresDocumented development of late AMD by central, masked grading of annual retinal photographs or by treatment history. ResultsIn exploratory analysis of lutein/zeaxanthin vs no lutein/zeaxanthin, the hazard ratio of the development of late AMD was 0.90 (95% CI, 0.82-0.99; P = .04). Exploratory analyses of direct comparison of lutein/zeaxanthin vs beta carotene showed hazard ratios of 0.82 (95% CI, 0.69-0.96; P = .02) for development of late AMD, 0.78 (95% CI, 0.64-0.94; P = .01) for development of neovascular AMD, and 0.94 (95% CI, 0.70-1.26; P = .67) for development of central geographic atrophy. In analyses restricted to eyes with bilateral large drusen at baseline, the direct comparison of lutein/zeaxanthin vs beta carotene showed hazard ratios of 0.76 (95% CI, 0.61-0.96; P = .02) for progression to late AMD, 0.65 (95% CI, 0.49-0.85; P = .002) for neovascular AMD, and 0.98 (95% CI, 0.69-1.39; P = .91) for central geographic atrophy. Conclusion and RelevanceThe totality of evidence on beneficial and adverse effects from AREDS2 and other studies suggests that lutein/zeaxanthin could be more appropriate than beta carotene in the AREDS-type supplements. Trial Registrationclinicaltrials.gov Identifier: NCT00345176

Schoenberger, Scott D.; Kim, Stephen J.; Sheng, Jinsong; Calcutt, M. Wade

2014 JAMA Ophthalmology

doi: 10.1001/jamaophthalmol.2013.5692pmid: 24264034

ImportanceInhibition of proinflammatory prostaglandins in the retina may have therapeutic effects for retinal disease. ObjectiveTo determine vitreous levels of ketorolac and prostaglandin E2 (PGE2) in eyes treated with topical ketorolac tromethamine 0.45% (Acuvail). Design, Setting, and ParticipantsA prospective comparative interventional study, performed in a university academic hospital, included 24 eyes in 22 consecutive patients undergoing pars plana vitrectomy. InterventionApplication of topical ketorolac 0.45%, 4 times daily, for 3 days before pars plana vitrectomy in the first 12 consecutive eyes. The next 12 eyes were untreated and served as controls. Undiluted vitreous samples were obtained at the time of surgery and immediately frozen at −80°C. Main Outcomes and MeasuresVitreous ketorolac and PGE2 levels. ResultsSeven of the 12 eyes (58%) had ketorolac levels above the lower limit of quantitation. All 7 were in pseudophakic eyes, and 4 of the 5 below this limit were phakic (P = .01). The mean ketorolac level in the 7 eyes was 7.55 ng/mL (range, 5.0-14.9 ng/mL). The mean (SD) PGE2 levels were 13.8 (3.8) pg/mL in control eyes and 11.7 (4.4) pg/mL in ketorolac-treated eyes (P = .04). Treatment with ketorolac resulted in a 15% reduction in PGE2 levels. When only pseudophakic eyes were analyzed, mean (SD) PGE2 levels were 14.1  (4.1) pg/mL in control eyes and 11.6 (4.5) pg/mL in ketorolac-treated eyes (P < .05). Conclusions and RelevanceTopical ketorolac 0.45% can obtain a vitreous level that exceeds its median inhibitory concentration and can significantly decrease vitreous PGE2 levels. Vitreous levels of ketorolac were significantly higher in pseudophakic eyes than in phakic eyes. The results of this study suggest that topically administered ketorolac 0.45% may allow meaningful inhibition of prostaglandins in the retina. Trial Registrationclinicaltrials.gov Identifier: NCT01609881

Tourtas, Theofilos; Schlomberg, Juliane; Wessel, Julia M.; Bachmann, Bjoern O.; Schlötzer-Schrehardt, Ursula; Kruse, Friedrich E.

2014 JAMA Ophthalmology

doi: 10.1001/jamaophthalmol.2013.6222pmid: 24336933

ImportanceIt is essential to devise strategies that improve graft adhesion after Descemet membrane endothelial keratoplasty (DMEK) to reduce the rebubbling rate. ObjectiveTo evaluate the influence of the extent of descemetorhexis on graft adhesion properties after DMEK. Design, Setting, and ParticipantsSingle-surgeon, retrospective, observational case series conducted in the Department of Ophthalmology, University of Erlangen-Nuremberg, Germany, that reviewed the medical records of 200 consecutive patients undergoing DMEK. Fifty-three eyes of 51 patients undergoing DMEK for Fuchs endothelial dystrophy fulfilling the inclusion criteria were enrolled in this study. Based on intraoperative drawings, postoperative slitlamp examination, and photographs, eyes were divided into 2 groups. The diameter of the descemetorhexis was approximately 10 mm in group A (30 eyes), resulting in a peripheral 1-mm zone of denuded stroma between the graft and the host’s Descemet membrane, and approximately 6 mm in group B (23 eyes), resulting in a peripheral 1-mm zone of overlapping between the graft and the host’s Descemet membrane. Main Outcomes and MeasuresGraft detachment rate, extent of graft detachment (in clock hours of graft’s circumference), and rebubbling rate. ResultsFour days after DMEK, the graft detachment rate was 33.3% (10 of 30) in group A and 78.3% (18 of 23) in group B (P = .002). The mean (SD) extent of graft detachment was 0.6 (0.9) and 2.8 (2.5) clock hours in groups A and B, respectively (P < .001), 4 days after surgery. The rebubbling rate was 6.7% (2 of 30) and 30.4% (7 of 23) for groups A and B, respectively (P = .03). Conclusions and RelevanceA larger descemetorhexis in DMEK is correlated with better graft adhesion and lower rebubbling rates. Therefore, patients with a larger descemetorhexis require less intensive follow-up.

Gale, Richard Peter; Pilly, Bertrand; Tschuor, Patrizia

2014 JAMA Ophthalmology

doi: 10.1001/jamaophthalmol.2013.155pmid: 24525933

MacLennan, Paul A.; McGwin, Gerald; Heckemeyer, Christine; Lolley, Virginia R.; Hullett, Sandral; Saaddine, Jinan; Shrestha, Sundar S.; Owsley, Cynthia

2014 JAMA Ophthalmology

doi: 10.1001/jamaophthalmol.2013.6046pmid: 24310149

ImportanceLittle is known regarding eye care use among low-income persons with diabetes mellitus, especially African Americans. ObjectiveTo investigate eye care use among patients with diabetes who were seen in a county hospital clinic that primarily serves high-risk, low-income, non-Hispanic African American patients. Design, Setting, and ParticipantsA retrospective cohort study with 2 years of follow-up examined eye care use among adult patients with diabetes seen in 2007 in an outpatient medical clinic of a large, urban county hospital that primarily serves low-income, non-Hispanic African American patients. Patients with a history of retinopathy and macular edema or a current diagnosis indicating ophthalmic complications were excluded. Eye care use was defined dichotomously as whether or not patients had a visit to the eye clinic for any eye care examination or procedure. We estimated crude and adjusted rate ratios (aRRs) and 95% CIs for the association between eye care use and selected clinical and demographic characteristics. ResultsThere were 867 patients with diabetes identified: 61.9% were women, 76.2% were non-Hispanic African American, and 61.4% were indigent, with a mean age of 51.8 years. Eye care utilization rates were 33.2% within 1 and 45.0% within 2 years. For patients aged 19 to 39 years compared with those aged 65 years or older, significantly decreased eye care utilization rates were observed within 1 year (aRR, 0.48; 95% CI, 0.27-0.84) and within 2 years (aRR, 0.61; 95% CI, 0.38-0.99). Conclusions and RelevanceOverall eye care utilization rates were low. Additional education efforts to increase the perception of need among urban minority populations may be enhanced if focused on younger persons with diabetes.

Bressler, Neil M.; Varma, Rohit; Doan, Quan V.; Gleeson, Michelle; Danese, Mark; Bower, Julie K.; Selvin, Elizabeth; Dolan, Chantal; Fine, Jennifer; Colman, Shoshana; Turpcu, Adam

2014 JAMA Ophthalmology

doi: 10.1001/jamaophthalmol.2013.6426pmid: 24357541

ImportanceThickening of the center of the retina, diabetic macular edema (DME), is the most common cause of visual loss due to diabetes mellitus. Treatment of DME has improved dramatically, and the prompt diagnosis of DME and referral of these patients have become more critical. Nonetheless, awareness of and care for DME in the US population is uncharacterized. ObjectiveTo characterize eye care and awareness of eye disease among persons with DME in the general US population. Design, Setting, and ParticipantsCross-sectional analysis of data from participants in the 2005 to 2008 National Health and Nutrition Examination Survey 40 years or older with diabetes mellitus and fundus photographs. Main Outcomes and MeasuresAmong persons with DME, (1) awareness that diabetes has affected their eyes; (2) report on the last time they visited a diabetes specialist; (3) report on their last eye examination with pupil dilation; and (4) prevalence of visual impairment. ResultsIn 2010, only 44.7% (95% CI, 27.0%-62.4%) of US adults 40 years or older with DME reported being told by a physician that diabetes had affected their eyes or that they had retinopathy; 46.7% (95% CI, 27.5%-66.0%), that they had visited a diabetes nurse educator, dietician, or nutritionist for their diabetes mellitus more than 1 year ago or never; and 59.7% (95% CI, 43.5%-75.9%), that they had received an eye examination with pupil dilation in the last year. Among persons with DME, 28.7% (95% CI, 12.7%-44.7%) were visually impaired (defined as visual acuity worse than 20/40 in the eye with DME) based on visual acuity at the initial examination and 16.0% (95% CI, 2.5%-29.4%) based on best-corrected visual acuity. Conclusions and RelevanceMany persons with diabetes mellitus in the United States are not getting care that can prevent visual impairment and blindness. Strategies to increase awareness are warranted, especially given the recent availability of improved therapies for DME.