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    JAMA Ophthalmology

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    Disorganization of Retinal Inner Layers and Vision After DME

    July JAMA Ophthalmology

    The prognosis and treatment response in center-involved macular edema (ME) may vary according to underlying anatomic abnormalities. Radwan et al. investigated whether variables seen on spectral-domain optical coherence tomography (SD-OCT), particularly disorganization of retinal inner layers (DRIL), are associated with subsequent VA after resolution of edema in diabetic and nondiabetic ME.

    This was a retrospective longitudinal cohort study, in which Snellen VA testing and SD-OCT macular imaging were performed at a tertiary referral eye center for retinal diseases. The researchers reviewed the medical records of all patients with ME from Dec. 1, 2010, to Dec. 31, 2012. The date of the last follow-up was June 1, 2013.

    Participants included 55 patients (70 eyes) with center-involved ME that had resolved during an 8-month period. Patients were grouped based on diabetic vs. nondiabetic ME. Masked graders analyzed the central 1,500-μm macular region for changes, including cystoid abnormalities, length and extent of DRIL, and outer retinal layer disruption.

    In both DME and nondiabetic ME groups, VA after resolution of edema correlated with baseline VA. In a DME model including baseline VA and DRIL, total length of the DRIL was associated with subsequent VA as determined by a parameter estimate (PE) of 0.0003 (95% CI, 0-0.0006; p = .03). The VA change during the 8-month period, after adjustment for baseline VA, was best associated with DRIL change (PE, 0.0002 [95% CI, 0-0.0003]; p = .04). DME participants whose DRIL resolved, whether early or late, showed improvement in their VA deficit at 8 months (least squares mean [SE], 41.3 [28.5] and 40.9 [37.5], respectively) compared with those who did not have resolution. After adjustment for baseline VA, the largest difference in VA in DME eyes was between those with persistent DRIL after ME resolution versus those with no DRIL at baseline (−89.6 [27.2] versus 49.7 [19.6], respectively; p = .006). However, in nondiabetic ME, no association was found between DRIL and VA after resolution of edema.

    Although the interpretation of the results might be limited by the small number of eyes evaluated at a single clinical site and by a retrospective study design, the authors concluded that the presence of DRIL at baseline and its resolution pattern may be associated with subsequent VA after resolution of center-involved DME.

    NAION and Obstructive Sleep Apnea Syndrome

    July JAMA Ophthalmology

    Aptel et al. sought to evaluate the prevalence of obstructive sleep apnea syndrome (OSAS) in patients with nonarteritic anterior ischemic optic neuropathy (NAION) as well as the influence of OSAS on second-eye involvement. The researchers examined 118 patients with NAION referred to a tertiary care center from Jan. 1, 2003, through Dec. 31, 2010.

    Patients underwent polysomnography to detect OSAS and were then followed prospectively to assess the risk of second-eye involvement. In 89 patients with NAION who underwent polysomnography, 67 (75%) had OSAS. Second-eye involvement was found in 10 of 73 patients (13.7%) at 3 years, occurring in 8 of 52 patients (15.4%) with OSAS and 2 of 21 patients (9.5%) without OSAS (p = .04). In multivariate analysis, the risk of second-eye involvement was increased by nonadherence to treatment with continuous positive airway pressure (CPAP) among patients with severe OSAS (hazard ratio, 5.54; 95% CI, 1.13-27.11; p = .04).

    The results suggest that OSAS is common in patients with NAION and that polysomnography should be considered in these patients. The findings also suggest that those with severe OSAS who are nonadherent to CPAP treatment have an increased risk of second-eye involvement.

    Clinically Meaningful Low Vision Rehabilitation Outcomes

    July JAMA Ophthalmology

    Patient-centered measurements that reflect clinically meaningful changes in visual ability are necessary to facilitate comparative outcomes research in low vision rehabilitation (LVR). Goldstein et al. performed a prospective observational study to quantify the effects of currently provided LVR on patients in the United States.

    This study enrolled 779 new patients seeking outpatient LVR services at 28 U.S. clinical centers from April 2008 through May 2011. The Activity Inventory (AI), a visual function questionnaire, was administered to measure overall visual ability and visual ability in 4 functional domains (reading, mobility, visual motor function, and visual information processing) at baseline and 6 to 9 months after usual LVR care. The Geriatric Depression Scale, Telephone Interview for Cognitive Status, and Medical Outcomes Study 36-Item Short-Form Health Survey physical functioning questionnaire were also administered, and clinical findings of patients were provided by study centers.

    Of the original group of patients, baseline and postrehabilitation measures were available for 468. The main outcome measures were changes in the study population and minimum clinically important differences in the individual in overall visual ability and in the 4 functional domains as measured by the AI. Minimum clinically important differences in overall visual ability were seen in 47% of participants. In addition, the percentages of patients who achieved minimum clinically important differences in the functional domains were as follows: 44% in reading, 38% in visual motor function, 33% in visual information processing, and 27% in mobility.

    Age (p = .006) was found to be an independent predictor of changes in overall visual ability, while logMAR visual acuity (p = .002) was predictive of changes in visual information processing. The authors concluded that 44% to 50% of patients presenting for outpatient LVR show clinically meaningful differences in overall visual ability after LVR, and the average effect sizes in overall visual ability are large, close to 1 standard deviation.

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

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