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    JAMA Ophthalmology

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    Comparing Severity, Incidence, and Progression of AMD in Both Eyes

    February JAMA Ophthalmology

    As part of the longitudinal, population-based Beaver Dam Eye Study, Gangnon et al. investigated the effect of AMD progression and regression in one eye (the primary eye) on the status of the fellow eye and determined that the severity of AMD in the one does indeed track that of the other at all stages of the disease.

    Examinations were performed every five years over a 20-year period, and retinal photographs were taken at baseline and at no more than four subsequent occasions. Study participants (n = 4,379) were between the ages of 43 and 86 at baseline. Incidence, progression, and regression of AMD were assessed by use of the Wisconsin Age-Related Maculopathy Grading System on retinal photographs.

    The researchers found that more severe AMD in the primary eye was associated with increased incidence of AMD and accelerated progression in the fellow eye at all disease stages. In addition, less severe AMD in the primary eye was associated with less progression of AMD in the fellow eye. The researchers estimated that 51 percent of participants who developed any AMD maintained AMD severity states of within one step between eyes, while 90 percent stayed within two steps. 

    Primary Ocular Adnexal Diffuse Large B-Cell Lymphoma

    February JAMA Ophthalmology 

    Munch-Petersen et al. investigated the clinical features of ocular adnexal diffuse large B-cell lymphoma (OA-DLBCL) and found that most patients with primary OA-DLBCL had Ann Arbor stage IE and TNM T2 disease.

    This 30-year retrospective study included 100 patients with OA-DLBCL from six eye cancer centers. Median follow-up was 52 months. In all, 57 patients were diagnosed with primary OA-DLBCL, 29 were diagnosed with OA-DLBCL and concurrent systemic lymphoma, and 14 were diagnosed with a relapse of lymphoma in the ocular adnexal region.

    The researchers also analyzed the prognostic utility of the two staging systems (Ann Arbor and TNM) that currently exist for ocular adnexal lymphomas. Unlike the Ann Arbor system, the TNM method employs site-specific categories to stage disease: T describes the primary tumor, N describes the regional lymph nodes, and M describes any distant metastasis. Of the 57 patients with primary OA-DLBCL, 53 (93 percent) had Ann Arbor stage IE disease, and four (7 percent) had Ann Arbor stage IIE disease. According to the TNM staging system, 43 (75.4 percent) had T2 tumors.

    Five-year overall survival for primary OA-DLBCL was between 2.5 and 4.5 years. Relapse occurred in 25 patients (43.9 percent), and women had a longer median survival rate than men. The researchers found that further subdividing the T category of the TNM staging system was predictive of survival rates in primary OA-DLBCL, whereas the Ann Arbor system was not. However, Ann Arbor staging became predictive of survival when all 100 patients were taken into account.

    Diabetes Eye Screening in Minority Populations

    February JAMA Ophthalmology 

    Owsley et al. examined the effectiveness of noninvasive diabetic retinopathy (DR) screening using a nonmydriatic camera combined with a telemedicine reading center. DR was successfully identified in approximately 1 of every 5 people with diabetes. Other ocular conditions were also detected at a high rate, the researchers noted, which is a currently underappreciated collateral benefit of DR screening programs.

    As part of the Innovative Network for Sight Research (INSIGHT) cross-sectional study, the researchers focused on screening settings accessible to patients with diabetes in four U.S. cities, including primary care clinics and pharmacies providing services to largely uninsured and/or minority populations. Participants included persons aged 18 years or older who had type 1 or 2 diabetes.

    Of the 1,894 participants in this INSIGHT screening program, 21.7 percent had DR in at least one eye—a rate similar to that reported in previous studies using telemedicine reading centers. The most common type of DR was background DR, which was present in 94.1 percent of those with DR. Almost one-half (44.2 percent) of the participants screened had ocular findings other than DR, the most common of which were cataracts (30.7 percent), hypertensive retinopathy (16.7 percent), and cotton-wool spots (11.1 percent). 

    Efficacy of Selective Laser Trabeculoplasty in Primary Angle-Closure Glaucoma

    February JAMA Ophthalmology 

    Narayanaswamy et al. assessed the intraocular pressure (IOP)–lowering efficacy of selective laser trabeculoplasty (SLT) in eyes with primary angle closure (PAC) and PAC glaucoma (PACG). They found that although eyes with PAC or PACG respond to SLT in the short term, the overall long-term therapeutic effectiveness requires further evaluation.

    This trial included 100 patients diagnosed with PAC or PACG in which the angles had opened at least 180 degrees after laser iridotomy. They were randomly assigned to either SLT or prostaglandin analogue (travoprost). SLT was repeated if the IOP reduction was less than 20 percent from baseline at the one- or three-month follow-up. The researchers could not identify any significant differences between the SLT and travoprost groups in terms of absolute mean reduction of IOP (4.0 vs. 4.2 mmHg, respectively) or the percentage of reduction in IOP (16.9 percent vs. 18.5 percent, respectively) at six months. Complete success (IOP of no more than 21 mmHg without medication) was achieved in 60 percent of eyes in the SLT group compared with 84 percent of eyes in the travoprost group. Additional medications were required in 22 percent of patients in the SLT group compared with 8 percent in the travoprost group. One patient in the SLT group had a posttreatment IOP spike greater than 5 mmHg; no other events such as persistent uveitis or increase in peripheral anterior synechiae were noted.

    Ophthalmology summaries are written by Jean Shaw and edited by Susan M. MacDonald, MD. American Journal of Ophthalmology summaries are edited by Thomas J. Liesegang, MD. JAMA Ophthalmology summaries are based on authors’ abstracts as edited by senior editor(s).

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    JAMA Ophthalmology summaries are based on authors' abstracts as edited by senior editor(s).

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