Importance Gait dysfunction is common in older people with visual impairment and is a major cause of falls. Objective To compare 3-year longitudinal changes in gait measures across the spectrum of baseline visual field (VF) damage in glaucoma. Design, Setting, and Participants A post hoc analysis was designed on September 1, 2018, following a prospective cohort study, which enrolled older adults with

Importance The choice of anti-inflammatory prophylaxis parallel to cataract surgery is important for patient safety and successful outcome of surgery, but which regimen to choose is contested. Objectives To determine whether a combination of prednisolone and nonsteroidal anti-inflammatory drug (NSAID) eye drops was superior in preventing increased central macular thickness (central subfield thickness

Importance Individuals with perceived experience and expertise are invited by editorial boards to provide commentary through editorials. Female representation among editorialists is not yet defined. Objective To determine female representation as editorial authors in 3 high-impact general ophthalmology journals. Design, Setting, and Participants This cross-sectional study investigates the proportion

Importance Compared with the operating room (OR), office-based intravitreal injection (IVI) is considered a more cost-effective and convenient approach, yet clinical outcomes of IVIs with anti–vascular endothelial growth factor (VEGF) agents in different settings (office-based vs OR) have not been systematically evaluated. Objective To evaluate the safety outcomes of IVI with anti-VEGF agents in the

Importance Keratoglobus is a rare corneal disorder characterized by generalized thinning and globular protrusion of the cornea. Affected individuals typically have significantly decreased vision and are at risk of corneal perforation. The genetic basis and inheritance pattern of isolated congenital keratoglobus are currently unknown. Objective To identify the genetic basis of isolated congenital keratoglobus

Importance Pathologic myopia due to an excessive increase of axial length is associated with severe visual impairments. Systematic analyses to determine the rate of and the risk factors associated with the axial elongation in adults with high myopia based on long-term follow-up of a large population are needed. Objective To determine the risk factors associated with axial elongation in adults with

Importance Uncorrected refractive error in school-aged children may affect learning. Objective To assess the effect of a school-based vision program on academic achievement among students in grades 3 to 7. Design, Setting, and Participants This cluster randomized clinical trial was conducted in Baltimore City Public Schools during school years from 2016 to 2019 among 2304 students in grades 3 to 7

Importance During the outbreak of COVID-19, outdoor activities were limited and digital learning increased. Concerns have arisen regarding the impact of these environmental changes on the development of myopia. Objective To investigate changes in the development of myopia in young Chinese schoolchildren during the outbreak of COVID-19. Design, Setting, and Participants In this observational study,

Importance This case series describes events associated with errors in intravitreous injections. Given the volume of injections performed worldwide, it is important to identify the factors associated with these wrong events to try to reduce their occurrences. Objective To evaluate a series of errors in intravitreous injections within Kaiser Permanente Northern California (KPNC). Design, Setting, and

Importance Fibroblast growth factor receptor (FGFR) 1 to 4 inhibitors are approved by the US Food and Drug Administration and suppress the mitogen-activated protein kinase (MAPK) pathway, with a potential for treatment-related retinopathy. To date, implications of FGFR inhibitor–associated ocular toxic effects are poorly described. Therefore, more detailed clinical descriptions of this ocular toxic

Importance As vaccinations against COVID-19 continue, potential ocular adverse events should be reported in detail to increase awareness among the medical community, although typically, a causal relationship cannot be established definitively. Objective To describe ocular adverse events that occur soon after receiving an inactivated COVID-19 vaccination (Sinopharm). Design, Setting, and Participants

As a major cause of vision loss, glaucoma may impair performance on many activities of daily living, such as reading, driving, and walking.1 In fact, because of the important role of vision in balance control and environment navigation, it is not surprising that glaucoma damage may affect gait and increase the risk of falls, a leading cause of injury-associated death in older people.2-4 However, the

In this issue, Fathy and colleagues1 report on the status of women as authors of editorials in 3 general ophthalmology journals with relatively high impact factors. Their findings, that the proportion of female editorialists is now approximately 30%, up from less than 20% from 2005-2009, appears to be encouraging news, at first glance. However, further analysis revealed that almost a third of the female

In a May 2020 Letter to the Editor, Pelligrini et al1 noted the possibility that prolonged home confinement due to the COVID-19 pandemic could result in more myopia development and worsening of preexisting myopia among children. The authors termed this quarantine myopia and observed that this would represent a serious public health concern owing to myopia-associated visual disability that would particularly

Pichi and colleagues1 in this issue of JAMA Ophthalmology describe ocular adverse events after Sinopharm COVID-19 vaccination, including 4 retinal events. Little is known about this vaccine.2 Despite the large number of doses of vaccine having been administered worldwide, its adverse systemic events remain uncertain. We will review the evidence regarding associations of COVID-19 infection or COVID-19

A 58-year-old man with a history of hypertensive retinopathy presented with acute-onset, painless vision loss in his right eye accompanied by tinnitus and severe intermittent headaches. His extraocular movements were full, and he had no other neurologic deficits. His visual acuity was 20/400 OD and 20/30 OS, respectively, and his fundi were notable for bilateral optic nerve edema. Results of recent

A 54-year-old man presented with a 3-day history of right ptosis and double vision. He was otherwise healthy and did not take any regular medications. Initially, he had horizontal diplopia on the first day that was worse at the end of the day, but this resolved when the right eyelid ptosis became complete. He denied any difficulty with his speech, swallowing, weakness, or sensory changes. He presented

A patient in their early 20s with no medical history or previous symptoms presented for severe frontal headaches and progressive blurred vision in the left eye more than the right eye for several weeks. No localizing signs were documented on neurologic examination. Magnetic resonance imaging (MRI) of the brain with and without contrast, magnetic resonance angiography of the head, and magnetic resonance

Premature infants with severe retinopathy of prematurity (ROP) are often treated using anti–vascular endothelial growth factor drugs such as bevacizumab. Intravitreal bevacizumab reaches the systemic circulation and is associated with reduced serum vascular endothelial growth factor levels in premature infants.1 Vascular endothelial growth factor is necessary for normal development of organs, so blocking

A patient in their late 60s was found to have a subfoveal hypopigmented tortuous lesion potentially resembling a nematode (Figure, A). Presenting visual acuity was 20/40. Indocyanine green angiography demonstrated hyperfluorescence, confirming the choroidal etiology of the pseudo-nematode pattern (Figure, B). Optical coherence tomography showed an enlarged shallow choroidal vessel causing elevation

A 69-year-old man with a history of proliferative diabetic retinopathy in both eyes presented with retinal hemorrhages and a whitish boundary demarcating the arterioles (Figure, A, yellow arrowheads, right eye shown). His visual acuity was 20/400 OU. The right eye received several anti–vascular endothelial growth factor injections. En face widefield swept-source optical coherence tomography angiography

To the Editor I read with great interest the article by Zander et al,1 which aimed to present a prediction model for edema resolution in patients with Fuchs dystrophy. However, some of their findings seem to rely on statistical assumptions that may not be justified in this study. In Figure 2,1 the lower plots, which are Bland-Altman plots, and in the related text, the 95% limits of agreement between

In Reply We appreciate Dr Neuman’s interest in our prediction model for edema resolution after endothelial keratoplasty1 and the opportunity to explain our statistical methodology for evaluating model performance. We note that Dr Neuman’s questions did not relate to the derivation of the prediction model but instead to details of the statistical methodology used for evaluating model performance.

To the Editor Kass et al1 published an extensive report on individuals who were randomized 20 years ago in the Ocular Hypertension Treatment Study (OHTS). The article provides a myriad of data and analyses to contemplate, a remarkable achievement for the investigators. I would like to call attention to one finding that is easy to overlook and to ask the investigators to elaborate on the clinical implications

In Reply We thank Dr Anderson for his interest in our recent publication1 reporting clinical outcomes of patients with ocular hypertension after 20 years of follow-up or within 2 years of death. He asked key questions about how the findings of the Ocular Hypertension Treatment Study (OHTS)1 inform the treatment of patients with ocular hypertension (OHT). Dr Anderson proposed that most patients with

Mission Statement: To be the indispensable source of ophthalmic knowledge by promptly publishing innovative, clinically relevant research through consistent and authoritative peer review and, thereby, to be the first choice of authors for their important manuscripts.

Importance Early-onset drusen maculopathy (EODM) is a severe disease and can lead to advanced macular degeneration early in life; however, genetic and phenotypic characteristics of individuals with EODM are not well studied. Objective To identify genotypic and phenotypic characteristics of individuals with EODM. Design, Setting, and Participants This case-control study collected data from the European

Importance The conventional 2.2-mm clear corneal incision is relatively narrow compared with the sleeves of Phaco handpieces, resulting in friction at the incision site and increased risk of incision-related Descemet membrane detachment (DMD). The modified 2.2-mm incision only enlarged internal width to 3.0 mm, forming a trapezoid incision shape, which may reduce the friction of surgical instruments

Patients presenting to an ophthalmologist with macular drusen at a young age is not an uncommon scenario in medical retina clinics. These young patients want to be informed regarding their future visual prognosis, possible impact on occupation or activities of daily living, and most importantly, any prospect of treatment. What criteria could contribute to an ophthalmologist’s confidence in diagnosing

Microincision cataract surgery, defined as wounds of around 2 mm or smaller, have been shown to reduce surgically induced astigmatism compared with small-incision cataract surgery wounds of 3 mm or greater.1 Therefore, cataract surgeons have intuitively concluded that the smaller the wound, the better, with regard to wound stability and topographic neutrality. However, 2.2-mm incisions have been shown

A 68-year-old man presented to the clinic with bilateral eye redness and pain for the past 6 months. He had a history of dry eye disease for which he was treated with preservative-free artificial tears. He also noted a medical history of well-controlled HIV with highly active antiretroviral therapy. His last CD 4 lymphocyte count was 750 cells/mm3 with an undetectable viral load. A review of system

To the Editor We have read the article by Ngo Ntjam et al,1 in which the authors carried out a systematic review and meta-analysis to analyze major adverse cardiovascular events (MACEs) associated with anti–vascular endothelial growth factor (VEGF) injections. Only randomized clinical trials were included in the analysis, and the study concluded that intravitreal anti-VEGF treatment was not associated

In Reply We have read the letter by Kanclerz et al with great interest. The authors have raised some interesting points. Our meta-analysis1 included only randomized clinical trials and most of the trials were not designed to assess the risk of major adverse cardiovascular events (MACE) or mortality in patients receiving intraocular anti–vascular endothelial growth factor (VEGF) therapy. The risk of

Importance An investigation of the treatment effect of lifitegrast ophthalmic solution, 5.0%, in different subgroups by severity of dry eye disease (DED) seems warranted. Objective To explore the heterogeneity across different subgroups of DED and identify which participants were most likely to achieve clinically meaningful benefit with lifitegrast treatment. Design, Setting, and Participants This

Importance Health care price transparency legislation is intended to reduce the ambiguity of hospital charges and the resultant financial stress faced by patients. Objective To evaluate the availability, usability, and variability of standard reported prices for ophthalmologic procedures at academic hospitals. Design, Setting, and Participants In this multicenter economic evaluation study, publicly

Dry eye disease (DED) is a commonly encountered ophthalmic condition that is recognized to have significant effects on visual function, work productivity, and quality of life.1 In recent years, the highly heterogenous nature of the condition has become increasingly acknowledged, with the disease pathophysiology understood to involve the complex interaction of tear film homeostatic disturbances, ocular

Price transparency has become a routine part of retail business, driven by consumers’ ability to instantly shop online from numerous vendors. Such information often includes data about the vendor’s performance and product quality, allowing choice on value. However, pricing in health care is more complicated and difficult to predict because the patient-level cost is affected by available discounts,

An 80-year-old woman presented to the emergency department with sudden-onset bilateral horizontal diplopia accompanied by left-sided upper eyelid ptosis. On further questioning, she reported a 1-week history of drooling when eating. She had no other associated neurological or constitutional symptoms. No anhidrosis was noted. Her medical history was significant for a 2-year history of constant, dull

In the article titled “Refractive Outcomes After Immediate Sequential vs Delayed Sequential Bilateral Cataract Surgery,” published online July 1, 2021, and also in the August 2021 issue of JAMA Ophthalmology,1 there was a formatting error in Supplement 2 listing the IRIS Research Analytic Center Consortium members. The supplement was corrected online. This article was also previously corrected on August

Importance As a disabling and frequent disease, geographic atrophy secondary to age-related macular degeneration (AMD) constitutes an important study subject. Emerging clinical trials require suitable end points. The characterization and validation of reading performance as a functional outcome parameter is warranted. Objective To prospectively evaluate reading performance in geographic atrophy and

Importance Telemedicine has been shown to have had reduced uptake among historically marginalized populations within multiple medical specialties during the COVID-19 pandemic. An evaluation of health disparities among patients receiving ophthalmic telemedical care during the pandemic is needed. Objective To evaluate disparities in the delivery of ophthalmic telemedicine at Massachusetts Eye and Ear

Importance The proportion of women in the field of ophthalmology in the US trails the proportion of women in the general population. Sex diversity trends have been studied in other specialties, but there is a dearth of such literature in ophthalmology. Objective To investigate trends in the proportion of female ophthalmology match applicants, residents, and clinical faculty. Design, Setting, and Participants

The COVID-19 pandemic has increased health disparities in vulnerable and marginalized populations (eg, people with disabilities, immigrants, and people who are non–English speaking) across all areas of medicine. Some of the direct health effects of the pandemic include the disproportionate risk racial and ethnic minority groups face in contracting COVID-19 because of their higher representation in

A 14-year-old boy was referred to us because of ocular and periocular pain with photophobia in his right eye for the last 5 days. Aside from atopic dermatitis, his medical history was unremarkable. Best-corrected visual acuity was 20/20 OU. Slitlamp examination of the right eye disclosed conjunctival hyperemia and ciliary congestion, anterior chamber flare 2+, and a few nongranulomatous keratic precipitates;

In the Original Investigation titled “Defining Nonadherence and Nonpersistence to Anti–Vascular Endothelial Growth Factor Therapies in Neovascular Age-Related Macular Degeneration,”1 published on June 3, 2021, in JAMA Ophthalmology, the authors updated the status of the article so that it is now Open Access. This article has been corrected online.

Importance Myopia is a common cause of vision loss, and its prevalence is increasing globally. Objective To evaluate the effects of school-based family health education via WeChat in raising parents’ awareness of myopia prevention and behavior and in controlling the development of myopia in children. Design, Setting, and Participants A single-masked cluster randomized clinical trial of children was

Ecological momentary interventions (EMIs) have become increasingly popular in health research since the introduction of smartphones. The purpose of an EMI is to intervene in an individual’s natural environment by providing feedback or encouraging behavior at predefined moments in daily life. These interventions have the potential to extend therapy from the physician’s clinic to patients’ daily lives

A 47-year-old woman, with dyslipidemia, presented to the emergency department with sudden vision loss in the right eye. Visual acuity was 20/40 OD and 20/20 OS. Anterior segment, tonometry, and pupillary light reflex were unremarkable. Ophthalmoscopy of the right eye showed discretely blurred optic disc margins, tortuous and dilated retinal veins, and intraretinal hemorrhages in all quadrants; the

Liquid biopsy is a noninvasive means to diagnose, identify targetable mutations, and monitor disease progression, recurrence, and treatment response in cancer. It can be done with circulating tumor cells, microRNAs, exosomes, and cell-free DNA (cfDNA).1 cfDNA can identify specific tumor mutations, referred to as circulating tumor DNA (ctDNA). In uveal melanoma, initiating mutations are mutually exclusive

To the Editor We read with great interest the article by Marshall-Goebel et al.1 We are grateful to the authors for sharing their valuable data with the scientific community and appreciate the opportunity to comment. The authors sought to determine if there is an association between quantitative changes in intracranial compartment volumes and peripapillary total retinal thickness (TRT), a quantitative

The societal injustices that plague the US took center stage in 2020. They played out in the murders of unarmed Black people by police officers and disproportionate low-income, Black, and brown lives lost in the US to COVID-19. Galvanizers from all walks of life insisted that Black Lives Matter were deemed terrorists instead of activists calling for equity and justice. While disparities in health and

Importance A review of the injury patterns, treatment strategies, and responding physicians’ experience during the Port of Beirut blast may help guide future ophthalmic disaster response plans. Objective To present the ophthalmic injuries and difficulties encountered as a result of the Port of Beirut blast on August 4, 2020. Design, Setting, and Participants A retrospective medical record review of

Importance Proactive treatment of nonproliferative diabetic retinopathy (NPDR) reduces the risk of progression to vision-threatening complications. Objective To evaluate vascular endothelial growth factor blockade therapy with intravitreal aflibercept injections in eyes with severe NPDR without diabetic macular edema (DME). Design, Setting, and Participants The Study of the Efficacy and Safety of Intravitreal

Importance Since February 2020, coronavirus disease 2019 (COVID-19) has spread rapidly all over the world, with an epidemiological cluster in Lombardy, Italy. The viral communicability may be mediated by various body fluids, but insufficient information is available on the presence of the virus in human tears. Objectives To investigate the rate of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)

Importance Quantitative volumetric measures of retinal disease in optical coherence tomography (OCT) scans are infeasible to perform owing to the time required for manual grading. Expert-level deep learning systems for automatic OCT segmentation have recently been developed. However, the potential clinical applicability of these systems is largely unknown. Objective To evaluate a deep learning model

Importance Interest in teleophthalmology has been growing, especially during the COVID-19 pandemic. The advent of fifth-generation (5G) wireless systems has the potential to revolutionize teleophthalmology, but these systems have not previously been leveraged to conduct therapeutic telemedicine in the ophthalmology field. Objective To assess the feasibility of 5G real-time laser photocoagulation as

Importance Glaucoma affects more than 75 million people worldwide. Intraocular pressure (IOP)–lowering surgery is an important treatment for this disease. Interest in reducing surgical morbidity has led to the introduction of minimally invasive glaucoma surgeries (MIGS). Understanding the comparative effectiveness and safety of MIGS is necessary for clinicians and patients. Objective To summarize data

Importance Patching is often less effective for severe amblyopia because of poor adherence. For the treatment of severe amblyopia, although combined atropine and patching therapy (CAPT) has been found to be efficacious, it is currently unknown whether CAPT is more efficacious than patching alone. Objective To compare the efficacy of CAPT vs patching alone in children aged 3 to 12 years with severe

Importance There is scant rigorous evidence about the real-world mobility benefit of electronic mobility aids. Objective To evaluate the effect of a collision warning device on the number of contacts experienced by blind and visually impaired people in their daily mobility. Design, Setting, and Participants In this double-masked randomized clinical trial, participants used a collision warning device

Importance Hypertensive events during cataract surgery may induce complications. Information and communication technologies applied to health are popular, but clinical evidence of its usefulness is rare and limited to treating anxiety without specific analysis. Recent publications have described the potential effects of personalized music choices as mobile-based intervention on pain but not on anxiety