Polycoria Due to Extensive Persistent Pupillary Membranes
This case report describes a man in his 40s with best-corrected visual acuity of 20/20 OU who had extensive iris strands in the anterior segment of the right eye, causing multiple pupillary openings in the iris. (Source: JAMA Ophthalmology)
Source: JAMA Ophthalmology - September 15, 2021 Category: Opthalmology Source Type: research

Hypoplasic Vitreous in Stickler Syndrome
This case report describes a 9-year-old patient with a presumed ocular-only variant of Stickler syndrome. (Source: JAMA Ophthalmology)
Source: JAMA Ophthalmology - September 15, 2021 Category: Opthalmology Source Type: research

SARS-CoV-2 on Ocular Surfaces in a Cohort of Patients With COVID-19 From the Lombardy Region, Italy
This cohort study investigates the presence of SARS-CoV-2 in tears collected from patients with COVID-19 by means of a reverse transcription –polymerase chain reaction assay and assesses the association of virus presence with concomitant clinical conditions. (Source: JAMA Ophthalmology)
Source: JAMA Ophthalmology - September 1, 2021 Category: Opthalmology Source Type: research

Subacute Vision Loss in a 37-Year-Old Man With a Rash
A 37-year-old man presents with subacute vision loss after experiencing malaise, low-grade fever, and a rash 2 weeks earlier. The rash persists on his scalp and extremities. What would you do next? (Source: JAMA Ophthalmology)
Source: JAMA Ophthalmology - September 1, 2021 Category: Opthalmology Source Type: research

Bilateral Visual Acuity Loss in a 28-Year-Old Man With Duchenne Muscular Dystrophy
A 28-year-old man with Duchenne muscular dystrophy but no ophthalmic history presents with recent visual acuity loss. What would you do next? (Source: JAMA Ophthalmology)
Source: JAMA Ophthalmology - September 1, 2021 Category: Opthalmology Source Type: research

Application of 5G Technology to Conduct Real-Time Teleretinal Laser Photocoagulation for Diabetic Retinopathy
This study assesses the feasibility of real-time telephotocoagulation treatment for diabetic retinopathy. (Source: JAMA Ophthalmology)
Source: JAMA Ophthalmology - September 1, 2021 Category: Opthalmology Source Type: research

Whole-Volume Automated Segmentation of OCT in Retinal Disease Using Deep Learning
This diagnostic study evaluates a deep learning model for whole-volume segmentation of 4 clinically important pathological features as well as clinical applicability. (Source: JAMA Ophthalmology)
Source: JAMA Ophthalmology - September 1, 2021 Category: Opthalmology Source Type: research

Deep Learning –Based Automated OCT Segmentation in Clinical Routine
Recently, many ophthalmologists have heard the keywords artificial intelligence, machine learning, deep learning, and automatization at every conference and keynote lecture and seen them in every ophthalmology journal. Many studies have evaluated the use of such algorithms on large retrospective data sets —primarily on color fundus photographs at first, then on optical coherence tomography (OCT) images as well. Most of these have been study data sets with standardized and well-structured imaging protocols and reading center image collections with a predefined protocol, and therefore of good quality . However, how fun...
Source: JAMA Ophthalmology - September 1, 2021 Category: Opthalmology Source Type: research

Split Down the Middle of the Fovea
A woman presents with blurred vision with slight metamorphopsia in the right eye. Imaging showed hyperreflective layering on the foveal surface and splitting of the outer plexiform layer. What would you do next? (Source: JAMA Ophthalmology)
Source: JAMA Ophthalmology - September 1, 2021 Category: Opthalmology Source Type: research

Effect of Combined Atropine and Patching vs Patching Alone for Treatment of Severe Amblyopia in Children Aged 3 to 12 Years
This randomized clinical trial compares the efficacy of combined atropine and patching therapy vs patching alone in children with severe amblyopia. (Source: JAMA Ophthalmology)
Source: JAMA Ophthalmology - September 1, 2021 Category: Opthalmology Source Type: research

Minimally Invasive Glaucoma Surgical Techniques for Open-Angle Glaucoma
This meta-analysis examines systematic reviews conducted by Cochrane Eyes and Vision to evaluate techniques and devices used in minimally invasive glaucoma surgeries alone or with cataract extraction. (Source: JAMA Ophthalmology)
Source: JAMA Ophthalmology - September 1, 2021 Category: Opthalmology Source Type: research

Patching and Atropine for Severe Amblyopia
Guidance on the treatment of amblyopia has benefited substantially from outcomes obtained from randomized clinical trials (RCTs). Most RCTs on amblyopia treatment have been conducted by the National Eye Institute –supported Pediatric Eye Disease Investigator Group (PEDIG). The PEDIG public website shows the breadth of amblyopia research reported by that group and provides a key resource not only for guiding amblyopia eye care professionals, but also for instructing the design, conduct, and interpretation o f contemporary clinical research on amblyopia treatment. (Source: JAMA Ophthalmology)
Source: JAMA Ophthalmology - September 1, 2021 Category: Opthalmology Source Type: research

Metamorphopsia in a Middle-aged Man
A 47-year-old man with a history of hypertension, obesity, left adrenalectomy, and pterygium excision surgery presents with gradual onset of blurry vision in both eyes for several months. What would you do next? (Source: JAMA Ophthalmology)
Source: JAMA Ophthalmology - September 1, 2021 Category: Opthalmology Source Type: research

Association of Monogenic and Polygenic Risk With the Prevalence of Open-Angle Glaucoma
This cross-sectional study compares polygenic and monogenic variants associated with risk of glaucoma. (Source: JAMA Ophthalmology)
Source: JAMA Ophthalmology - September 1, 2021 Category: Opthalmology Source Type: research

Home-Use Evaluation of a Wearable Collision Warning Device for Individuals With Severe Vision Impairments
This randomized clinical trial evaluates the effect of a collision warning device on the number of contacts experienced by blind and visually impaired people in their daily mobility. (Source: JAMA Ophthalmology)
Source: JAMA Ophthalmology - September 1, 2021 Category: Opthalmology Source Type: research

The Complexity of Integrating Observations Into Observational Research
Recent years have seen an increase in the use of technology to measure behaviors in epidemiologic research. This has clear advantages because it reduces the need to rely on self-reporting and objective yet potentially biased measurements. This is particularly advantageous when the behaviors being measured are embedded in the complexity and unpredictability of the everyday world. Two recent examples of the success of this approach are studies on driving and hazard detection among persons with visual impairment. Pundlik et al take an in-the-world approach with their randomized clinical trial examining the at-home use of a ch...
Source: JAMA Ophthalmology - September 1, 2021 Category: Opthalmology Source Type: research

Labeling Errors in Figure
This article was corrected online. (Source: JAMA Ophthalmology)
Source: JAMA Ophthalmology - September 1, 2021 Category: Opthalmology Source Type: research

Presumed SARS-CoV-2 Viral Particles in the Human Retina of Patients With COVID-19
This case series describes the presence of presumed SARS-CoV-2 viral particles in the retina of individuals who died of COVID-19. (Source: JAMA Ophthalmology)
Source: JAMA Ophthalmology - September 1, 2021 Category: Opthalmology Source Type: research

Efficacy of a Web App –Based Music Intervention During Cataract Surgery
This randomized clinical trial describes the effects of a web app –based music intervention on the incidence of hypertension in patients during cataract surgery performed under local anesthesia. (Source: JAMA Ophthalmology)
Source: JAMA Ophthalmology - September 1, 2021 Category: Opthalmology Source Type: research

Live and Replication-Competent SARS-CoV-2 in Ocular Fluids —Reply
In Reply We read with great interest the letter from Colavita and colleagues on our article, and we add some considerations here in light of newly available literature. Colavita and colleagues demonstrated the presence of the replication-competent virus from external ocular fluids at the beginning of the pandemic. Our study found the virus in 52 of 91 patients with COVID-19 (57.1%), and these findings were possible thanks to strict procedural measures. It is interesting to note that very similar percentages have recently been found in SARS-CoV-2 RNA prevalence in the corneas of patients with COVID-19 viremia, albeit in sma...
Source: JAMA Ophthalmology - September 1, 2021 Category: Opthalmology Source Type: research

Live and Replication-Competent SARS-CoV-2 in Ocular Fluids
To the Editor We read with great interest the research by Azzolini and colleagues. From the virologic perspective, the authors showed that SARS-CoV-2 RNA was found on the ocular surface in 52 of 91 patients with COVID-19 (57.1%; 95% CI, 46.3-67.5), and 10 of 41 patients with nasopharyngeal swab results available the same day or within 2 days had positive results with conjunctival swab and negative results with nasopharyngeal swab. We believe it is useful to elucidate the role of the ocular apparatus and lacrimal secretions in COVID-19 pathogenesis, both in the interest of infection control and diagnosis. To this end, more ...
Source: JAMA Ophthalmology - September 1, 2021 Category: Opthalmology Source Type: research

Identification of COVID-19 Virus in Human Intraocular Tissues
The article by Araujo-Silva et al in this issue of JAMA Ophthalmology provides important evidence that SARS-CoV-2 can be detected in the retina of patients who have died of severe COVID-19 infection. There have been numerous reports describing ophthalmic disorders in patients infected with COVID-19 that are thought to be associated with the virus. These include conjunctivitis, keratoconjunctivitis, blepharitis, uveitis, retinal vascular occlusion, optic neuritis, and cranial nerve dysfunction. In some of these studies, COVID-19 has been identified in ocular tissues, particularly the conjunctiva, typically using reverse-tra...
Source: JAMA Ophthalmology - September 1, 2021 Category: Opthalmology Source Type: research

Masking Is Not Just for COVID-19
A randomized clinical trial by Guerrier et al in this issue of JAMA Ophthalmology evaluates music as a nonpharmaceutical intervention for managing preoperative and intraoperative anxiety during cataract surgery. Possible interventions included either headphones with music or noise-canceling headphones with no music for 20 minutes in the preoperative area. The authors concluded that music reduced patient-reported anxiety, as well as hypertension, tachycardia, and the requirement for anxiolytic medication intraoperatively. The authors are to be congratulated on this valuable contribution to the literature, because anxiety su...
Source: JAMA Ophthalmology - September 1, 2021 Category: Opthalmology Source Type: research

Addressing Disparities in Eye Care —The Time Is Now
This Viewpoint describes racial/ethnic disparities in eye care and suggests ways in which clinicians can begin to address them. (Source: JAMA Ophthalmology)
Source: JAMA Ophthalmology - September 1, 2021 Category: Opthalmology Source Type: research

Intravitreal Aflibercept for the Treatment of Severe Nonproliferative Diabetic Retinopathy
This randomized clinical trial evaluates whether treatment with intravitreal aflibercept vs sham injections results in anatomic improvement from baseline through 100 weeks in eyes with moderately severe to severe nonproliferative diabetic retinopathy and no diabetic macular edema. (Source: JAMA Ophthalmology)
Source: JAMA Ophthalmology - September 1, 2021 Category: Opthalmology Source Type: research

Ophthalmic Injuries After the Port of Beirut Nonnuclear Explosion
This study reports the ocular injuries sustained by survivors of the Port of Beirut blast in Beirut, Lebanon, on August 4, 2020. (Source: JAMA Ophthalmology)
Source: JAMA Ophthalmology - September 1, 2021 Category: Opthalmology Source Type: research

Ophthalmic Injuries in the Port Explosion in Beirut, Lebanon
In this month ’s issue of JAMA Ophthalmology, Kheir et al report ophthalmic injuries after the port explosion in Beirut, Lebanon, the largest explosion in a population center in recent history, and their institutional response to the resulting major incident, including by staff who attended on foot after destru ction of both home and car. They also report the wider context of the explosion (which rendered 300 000 people newly homeless), including 400 ophthalmic injuries occurring across the city associated with the explosion. Beirut is a city of 2.2 million people, similar in population to the metropolit an area of...
Source: JAMA Ophthalmology - September 1, 2021 Category: Opthalmology Source Type: research

Clinical and Histopathologic Correlates of Asymmetric Retinitis Pigmentosa
This case report evaluates whether additional information can be obtained about asymmetric RP from studying clinical imaging and pathology correlates, including pathology samples from autopsied eyes. (Source: JAMA Ophthalmology)
Source: JAMA Ophthalmology - September 1, 2021 Category: Opthalmology Source Type: research

JAMA Ophthalmology
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. (Source: JAMA Ophthalmology)
Source: JAMA Ophthalmology - September 1, 2021 Category: Opthalmology Source Type: research

Severe Bilateral Conjunctivitis With Corneal Limbal Infiltrates Associated With Dupilumab Treatment
This case report describes bilateral conjunctivitis associated with dupilumab use. (Source: JAMA Ophthalmology)
Source: JAMA Ophthalmology - August 18, 2021 Category: Opthalmology Source Type: research

Fundus Autofluorescence in Juxtapapillary Choroidal Hemangioma
This case report describes a man with swan-shaped hyperautofluorescence surrounding a mass associated with circumscribed choroidal hemangioma. (Source: JAMA Ophthalmology)
Source: JAMA Ophthalmology - August 18, 2021 Category: Opthalmology Source Type: research

Bilateral Macular Schisis in a Woman
A 64-year-old woman presents for evaluation of an epiretinal membrane of her right eye. She reported no ocular symptoms and had no history of surgical procedures or trauma. Her visual acuity is 20/20 OU with correction. Her examination results show mild nuclear sclerotic cataracts, radial spokelike striae of the fovea with a central cyst in the right eye and macular edema of the left eye, and cystlike changes in the outer retina in the foveal and parafoveal regions and in the inner retina in the right temporal macula and cystlike changes in the outer retina in the left inferior macula. What would you do next? (Source: JAMA Ophthalmology)
Source: JAMA Ophthalmology - August 1, 2021 Category: Opthalmology Source Type: research

Purulent Conjunctivitis and Progressive Corneal Stromal Necrosis
A 65-year-old man presents with right eye pain and purulent discharge. His medical history includes HIV managed by antiretroviral therapy. Examination of the right eye shows visual acuity of hand motions as well as purulent discharge, an inflamed conjunctiva, diffuse cornea opacification and thinning, and a flat anterior chamber. He has a 0.5-mm corneal perforation treated with corneal glue. He is treated with topical fortified vancomycin, tobramycin, intravenous levofloxacin, and doxycycline, but the purulent conjunctivitis and corneal stromal necrosis do not improve. What would you do next? (Source: JAMA Ophthalmology)
Source: JAMA Ophthalmology - August 1, 2021 Category: Opthalmology Source Type: research

Equity and the JAMA Network
The key objective of JAMA is “To promote the science and art of medicine and the betterment of the public health”; similar objectives and mission statements are supported by all 12 JAMA Network Journals. Together this family of journals is committed to publishing the best research, reviews, and opinion articles to advance m edical science, promote public health, and improve patient care. The ultimate goal is to promulgate truth in science and medicine. (Source: JAMA Ophthalmology)
Source: JAMA Ophthalmology - August 1, 2021 Category: Opthalmology Source Type: research

Utility of the Short-term Assessment of Glaucoma Progression Model in Clinical Practice
This cohort study describes a study design based on preliminary results comparing rates of change with varying follow-up times and observation frequencies to provide guidance on sample size and power calculations for shorter clinical trials. (Source: JAMA Ophthalmology)
Source: JAMA Ophthalmology - August 1, 2021 Category: Opthalmology Source Type: research

Association of Allergic Conjunctivitis With Quality of Life in Children and Their Parents
This case-control study examines health-related quality of life reported by children with allergic conjunctivitis and their parents. (Source: JAMA Ophthalmology)
Source: JAMA Ophthalmology - August 1, 2021 Category: Opthalmology Source Type: research

Retinal Microvascular and Choroidal Changes in Parkinson Disease —Reply
In Reply We thank Ahn and colleagues for their interest in our article characterizing retinal microvascular and choroidal changes in Parkinson disease (PD). Individuals with vascular risk factors, including diabetes mellitus, uncontrolled hypertension, prior cerebrovascular incident, and vascular dementia, were excluded from study participation. It is well recognized that vascular parkinsonism due to cerebral ischemic or hemorrhagic lesions is an entity that is distinct from idiopathic neurodegenerative PD, which is characterized by nonspecific neuroimaging abnormalities. Available evidence also shows that neurodegenerativ...
Source: JAMA Ophthalmology - August 1, 2021 Category: Opthalmology Source Type: research

Retinal Microvascular and Choroidal Changes in Parkinson Disease
To the Editor We read with interest the article by Robbins et al characterizing retinal microvascular and choroidal changes in Parkinson disease (PD). There have been numerous studies on structural retinal changes in PD and its association with nigral dopaminergic loss. However, there are relatively few studies using optical coherence tomography angiography. We would like to point out some important issues in the article by Robbins et al. (Source: JAMA Ophthalmology)
Source: JAMA Ophthalmology - August 1, 2021 Category: Opthalmology Source Type: research

Planning Clinical Research and Clinical Care
Proudfoot et al describe an approach to planning an efficient clinical trial designed to determine whether 2 groups have different rates of glaucomatous progression, for example, 2 groups with different treatments. They were able to calculate that in principle it may be possible to detect a difference between 2 groups in the rate of change in visual field (mean deviation) if the 2 rates differ by at least 0.32 dB/y and a difference in the change of retinal nerve fiber layer thickness if they differ by at least 0.54 μm/y. From longitudinal data on a group of patients, they calculate that such differences can be detected ...
Source: JAMA Ophthalmology - August 1, 2021 Category: Opthalmology Source Type: research

Drawing Attention to the Burden of Allergic Conjunctivitis in Children and Their Families
Zhang et al present a prospective, case-control study from a single tertiary referral center in China, investigating the association of allergic conjunctivitis (AC) with the health-related quality-of-life (QOL) scores on a questionnaire administered to pediatric patients and their parents. The investigators describe 92 patients with AC and 96 age-matched control patients and the health-related QOL of these patients and their parents. Both children with AC and their parents had significantly lower health-related QOL scores compared with healthy controls and their parents, and the investigators noted a significant correlatio...
Source: JAMA Ophthalmology - August 1, 2021 Category: Opthalmology Source Type: research

Short Stature With Optic Atrophy and Cone Dystrophy
A 26-year-old man presents with reduced visual acuity in both eyes since early childhood. He has short stature and progeroid appearance. Examination results show diffuse optic atrophy and fine pigmentary mottling changes at the fovea in both eyes, normal dark-adapted responses and severely reduced light-adapted responses, and thinning of retinal nerve fiber layers and disruption of outer nuclear layers and ellipsoid zone at the center of the fovea. What would you do next? (Source: JAMA Ophthalmology)
Source: JAMA Ophthalmology - August 1, 2021 Category: Opthalmology Source Type: research

Reporting of Complications in Retinal Detachment Surgical Trials
This systematic review examines reporting on the frequency and severity of complications in randomized clinical trials on rhegmatogenous retinal detachment surgery. (Source: JAMA Ophthalmology)
Source: JAMA Ophthalmology - August 1, 2021 Category: Opthalmology Source Type: research

Clinical Outcomes of Rhegmatogenous Retinal Detachment Treated With Pneumatic Retinopexy
This cohort study investigates clinical outcomes associated with rhegmatogenous retinal detachment treated primarily with pneumatic retinopexy. (Source: JAMA Ophthalmology)
Source: JAMA Ophthalmology - August 1, 2021 Category: Opthalmology Source Type: research

Additional Considerations Regarding Timolol Eyedrops for Acute Treatment of Migraine —Reply
In Reply We thank the authors for their interest in our study. Below we elaborate on each of the points raised. (Source: JAMA Ophthalmology)
Source: JAMA Ophthalmology - August 1, 2021 Category: Opthalmology Source Type: research

Fundus Pigmentary Whorls in a Patient With Mosaicism for Tetrasomy 3q
This case report describes unusual ophthalmologic findings in a patient with mosaicism of tetrasomy of chromosome 3q. (Source: JAMA Ophthalmology)
Source: JAMA Ophthalmology - August 1, 2021 Category: Opthalmology Source Type: research

Additional Considerations Regarding Timolol Eyedrops for Acute Treatment of Migraine
To the Editor We read with interest the article by Kurian et al, who used a binary outcome superiority crossover randomized clinical trial to investigate the efficacy of topical timolol for treatment of acute migraine attacks, and the adjoining commentary. We wish to bring to the authors ’ attention a few points of interest regarding their study. (Source: JAMA Ophthalmology)
Source: JAMA Ophthalmology - August 1, 2021 Category: Opthalmology Source Type: research

When the N Is 65 Million —The Rise of Database Research
Launched in 2014, the American Academy of Ophthalmology IRIS Registry (Intelligent Research in Sight) is a repository containing data for more than 65 million unique patients, making it the largest national clinical specialty data registry currently in existence. A database of this magnitude has tremendous potential to unveil longitudinal trends and outcomes that feed our understanding of ophthalmic diseases and treatments. Over the past 7 years, as participation in the IRIS Registry has steadily grown, insights have followed. (Source: JAMA Ophthalmology)
Source: JAMA Ophthalmology - August 1, 2021 Category: Opthalmology Source Type: research

Do We Really Need More Clinical Trials of Pneumatic Retinopexy?
Following publication of a landmark trial, such as the Pneumatic Retinopexy Versus Vitrectomy for the Management of Primary Rhegmatogenous Retinal Detachment Outcomes Randomized Trial (PIVOT) study, there is a strong desire to see if the results of the trial can be replicated in clinical practice, the so-called real-world setting. Participants in randomized clinical trials are usually healthier and have fewer comorbidities than the patients in our clinics. The study by Yannuzzi and colleagues in this issue of JAMA Ophthalmology attempts to address that need. (Source: JAMA Ophthalmology)
Source: JAMA Ophthalmology - August 1, 2021 Category: Opthalmology Source Type: research

Blurred Vision in a Young Woman With Cosmetic Iris Implants
A 34-year-old woman presents with blurred vision and photophobia after having cosmetic iris implants placed 6 months earlier. What would you do next? (Source: JAMA Ophthalmology)
Source: JAMA Ophthalmology - August 1, 2021 Category: Opthalmology Source Type: research

Development and Validation of a Preference-Based Glaucoma Utility Instrument
This cross-sectional study describes the design, administration, and findings of a new instrument for measuring the burden of glaucoma and its interventions among older adults with varying severity of glaucoma in Singapore. (Source: JAMA Ophthalmology)
Source: JAMA Ophthalmology - August 1, 2021 Category: Opthalmology Source Type: research