1. JAMA Ophthalmol. 2015 Nov 19:1-7. doi: 10.1001/jamaophthalmol.2015.4636. [Epub
ahead of print]

Effect of Ranibizumab on the Decision to Drive and Vision Function Relevant to
Driving in Patients With Diabetic Macular Edema: Report From RESTORE, RIDE, and
RISE Trials.

Bressler NM(1), Varma R(2), Mitchell P(3), Suñer IJ(4), Dolan C(5), Ward J(6),
Ferreira A(7), Ehrlich JS(6), Turpcu A(6).

Author information: 
(1)Retina Division, Wilmer Eye Institute, Johns Hopkins University School of
Medicine, Baltimore, Maryland2Editor, JAMA Ophthalmology. (2)University of
Southern California Eye Institute, Keck School of Medicine, University of
Southern California, Los Angeles. (3)University of Sydney, Sydney, New South
Wales, Australia. (4)Retina Associates of Florida, Tampa. (5)CMD Consulting,
Sandy, Utah. (6)Genentech Inc, South San Francisco, California. (7)Novartis
Pharma AG, Basel, Switzerland.

Importance: The potential effect of treatments for diabetic macular edema (DME)
on driving should be of value to patients and clinicians, such as
ophthalmologists and other physicians, who treat patients with diabetes mellitus.
Objective: To determine the effect of ranibizumab on driving and patient-reported
vision function relevant to driving among patients with DME.
Design, Setting, and Participants: This exploratory post hoc analysis was
conducted between October 1, 2011, and July 25, 2015, based on deidentified data 
from phase 3, multicenter, randomized clinical trials (RIDE, RISE, and RESTORE
trials). Individuals assigned randomly to monthly sham, 0.3-mg ranibizumab, or
0.5-mg ranibizumab in RIDE and RISE or to macular laser, macular laser plus
0.5-mg ranibizumab (3-monthly doses, then as needed), or 0.5-mg (3-monthly doses,
then as needed) in RESTORE.
Main Outcomes and Measures: Driving items from the National Eye Institute (NEI)
Visual Function Questionnaire-25 (VFQ-25) at baseline through 24 months in
RIDE/RISE (pooled) and through 12 months in RESTORE.
Results: A total of 71.2% of 753 patients in RIDE/RISE and 50.4% of 345 patients 
in RESTORE reported driving at baseline; at least 55% reported still driving at
follow-up. Among those not driving at baseline in RIDE/RISE, at 12 months, 7.0%
(95% CI, -5.0 to 19.0) more in the 0.3-mg group and 14.4% (95% CI, 1.1 to 27.7)
more in the 0.5-mg group vs the sham group reported driving. Among those not
driving at baseline in RESTORE, at 12 months, 4.2% (95% CI, -7.7 to 16.1) more in
the laser plus 0.5-mg group and 0.9% (95% CI, -10.3 to 12.1) more in the 0.5-mg
group vs the laser group reported driving. Although balanced at baseline across
treatment groups for RESTORE and RIDE/RISE, the proportion of patients with
best-corrected visual acuity typically required for an unrestricted license
(20/40 or better in at least 1 eye) appeared greater at month 12 in the
ranibizumab groups (77 of 80 [96.3%] for 0.5 mg + laser and 91 of 93 [97.8%] for 
0.5 mg) vs laser (71 of 79 [89.9%]) in RESTORE, and at months 12 (112 of 123
[91.1%] and 136 of 137 [99.3%] in 0.3- and 0.5-mg groups, respectively) and 24
(113 of 123 [91.9%] and 135 of 137 [98.5%] in the 0.3- and 0.5-mg groups,
respectively) vs sham (121 of 147 [82.3%] and 122 of 147 [83.0%]) in RIDE/RISE.
Conclusions and Relevance: These results suggest that 12 months after initiating 
ranibizumab for vision impairment from center-involved DME, patients not driving 
at initiation of treatment are more likely to report driving and have
driving-eligible visual acuity of 20/40 or better in the better-seeing eye than
those treated with sham or laser.
Trial Registration: clinicaltrials.gov Identifier: RESTORE: NCT00687804; RIDE:
NCT00473382; and RISE: NCT00473330.

PMID: 26584450   [PubMed - as supplied by publisher]


2. JAMA Ophthalmol. 2015 Nov 19:1-10. doi: 10.1001/jamaophthalmol.2015.4606. [Epub
ahead of print]

Effects of Prior Intensive Insulin Therapy and Risk Factors on Patient-Reported
Visual Function Outcomes in the Diabetes Control and Complications
Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC)
Cohort.

Writing Team for the DCCT/EDIC Research Group, Gubitosi-Klug RA(1), Sun W(2),
Cleary PA(2), Braffett BH(2), Aiello LP(3), Das A(4), Tamborlane W(5), Klein
R(6).

Author information: 
(1)University Hospitals Case Medical Center, Cleveland, Ohio. (2)Biostatistics
Center, George Washington University, Rockville, Maryland. (3)Beetham Eye
Institute, Joslin Diabetes Center, Department of Ophthalmology, Harvard Medical
School, Boston, Massachusetts. (4)University of New Mexico, Albuquerque. (5)Yale 
University School of Medicine, New Haven, Connecticut. (6)Department of
Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and
Public Health, Madison.

Importance: Preservation of vision in patients with diabetes mellitus is
critical. Interventions to improve glycemic control through early intensive
treatment of diabetes reduce rates of severe retinopathy and preserve visual
acuity.
Objective: To assess the effects of prior intensive insulin treatment and risk
factors on patient-reported visual function in the Diabetes Control and
Complications Trial/Epidemiology of Diabetes Interventions and Complications
(DCCT/EDIC) cohort.
Design, Setting, and Participants: Cohort study of 1184 participants with type 1 
diabetes from the DCCT/EDIC study (randomized clinical trial followed by an
observational follow-up study) who completed the 25-item National Eye Institute
Visual Function Questionnaire (NEI-VFQ-25) during EDIC years 17 through 20
(September 1, 2009, through April 30, 2014) in 28 institutions across the United 
States and Canada.
Main Outcomes and Measures: The primary outcome was the composite NEI-VFQ-25
score. Secondary outcomes were visual acuity (measured by the Early Treatment
Diabetic Retinopathy Study protocol), retinopathy level (determined by masked
grading of stereoscopic color fundus photographs), and NEI-VFQ-25 subscale
scores. The composite NEI-VFQ-25 scale and its subscales were scored 0 to 100,
corresponding to poor to excellent function, respectively.
Results: The overall average NEI-VFQ-25 score for 1184 DCCT/EDIC participants
(mean [SD] age, 52.3 [6.9] years; 48% female) with a 30-year duration of diabetes
was high (all participants: median, 91.7; interquartile range [IQR], 89.7-96.9;
intensive treatment [n = 605]: median, 94.7; IQR, 91.0-97.2; conventional
treatment [n = 579]: median, 94.0; IQR, 88.4-96.1; P = .006 for intensive vs
conventional). After adjustment for sex, age, hemoglobin A1c level, and
retinopathy level at DCCT baseline, the former intensive treatment group had a
significant, albeit modest, improvement in overall NEI-VFQ-25 score compared with
the former conventional diabetes treatment group (median difference, -1.0; 95%
CI, -1.7 to -0.3; P = .006). This beneficial treatment effect was fully
attributed to the prior glycemic control in DCCT (explained treatment effect:
100%). Those with visual acuity worse than 20/100 reported the largest decline in
visual function (median difference, -21.0; 95% CI, -40.5 to -1.6; P = .03).
Conclusions and Relevance: In the DCCT/EDIC cohort, patient-reported visual
function remains high in both treatment groups, comparable to previous reports of
overall health-related quality of life. Intensive diabetes therapy modestly
improved NEI-VFQ-25 score 30 years after the start of the DCCT, the benefit
underestimated owing to more nonparticipants from the conventional treatment
group. Visual acuity had the greatest effect on patient-reported visual function 
from among all risk factors.
Trial Registration: clinicaltrials.gov Identifiers: NCT00360815 and NCT00360893.

PMID: 26584339   [PubMed - as supplied by publisher]


3. JAMA Ophthalmol. 2015 Nov 19:1-7. doi: 10.1001/jamaophthalmol.2015.4587. [Epub
ahead of print]

The Royal College of Ophthalmologists' National Ophthalmology Database Study of
Vitreoretinal Surgery: Report 6, Diabetic Vitrectomy.

Jackson TL(1), Johnston RL(2), Donachie PH(2), Williamson TH(3), Sparrow JM(4),
Steel DH(5).

Author information: 
(1)Department of Ophthalmology, King's College London, King's College Hospital,
London, England. (2)Royal College of Ophthalmologists' National Ophthalmology
Database, London, England3Gloucestershire Hospitals National Health Service (NHS)
Foundation Trust, Cheltenham, England. (3)Guy's and St Thomas' NHS Foundation
Trust, London, England. (4)Royal College of Ophthalmologists' National
Ophthalmology Database, London, England5Bristol Eye Hospital, Bristol, England.
(5)Sunderland Eye Infirmary, Sunderland, England7Institute of Genetic Medicine,
Newcastle University, Newcastle upon Tyne, England.

Importance: Patients and clinicians need to accurately assess the risks and
benefits of pars plana vitrectomy for proliferative diabetic retinopathy, but
clinical trial data may not reflect real-world experience.
Objective: To prospectively audit the complications of vitrectomy for
proliferative diabetic retinopathy and help establish benchmarks.
Design, Setting, and Participants: Royal College of Ophthalmologists' National
Ophthalmology Database study of 939 eyes of 834 patients undergoing primary
vitrectomy for proliferative diabetic retinopathy at 16 different vitreoretinal
units in the United Kingdom. Data were obtained for the period from January 2001 
to November 2010.
Interventions: Pars plana vitrectomy with or without delamination/segmentation.
Main Outcomes and Measures: Descriptions of the primary procedures performed,
intraoperative complication rate, and proportion of eyes undergoing further
surgery. An exploratory analysis of visual outcome was undertaken, with visual
success and visual loss defined as a gain or reduction of 0.3 logMAR or more,
respectively (approximately 2 Snellen lines), 6 to 12 months after surgery.
Results: Of 420 eyes (among 408 patients) that underwent vitrectomy without
delamination, the intraoperative complication rate was 13.1% (95% CI, 10.2%-16.7%
[55 of 420 eyes]), with 126 eyes (30.0%) requiring an intravitreal tamponade and 
49 eyes (11.7%) undergoing further vitrectomy (median follow-up, 6.9 months);
17.9% of 127 phakic eyes developed cataracts within a year, with 63.6% achieving 
visual success and 8.2% visual loss. Of 519 eyes (among 463 patients) that
underwent vitrectomy with delamination, the intraoperative complication rate was 
30.4% (95% CI, 26.6%-34.5% [158 of 519 eyes]), with 299 eyes (57.6%) requiring an
intravitreal tamponade and 78 eyes (15.0%) undergoing further vitrectomy (median 
follow-up, 7.1 months); 21.2% of 126 phakic eyes developed cataracts within a
year, with 62.8% achieving visual success and 14.9% visual loss.
Conclusions and Relevance: Diabetic vitrectomy has an appreciable complication
rate, particularly if delamination or segmentation are required. Nonetheless, the
data available on visual acuity suggest that a majority of patients achieve
clinically meaningful gains in vision.

PMID: 26584210   [PubMed - as supplied by publisher]


4. JAMA Ophthalmol. 2015 Nov 19:1. doi: 10.1001/jamaophthalmol.2015.4581. [Epub
ahead of print]

Incidence of Orbital Recurrence After Enucleation or Ophthalmic Artery
Chemosurgery for Advanced Intraocular Retinoblastoma-Reply.

Yannuzzi NA(1), Francis JH(2), Abramson DH(2).

Author information: 
(1)Ophthalmic Oncology Service, Memorial Sloan-Kettering Cancer Center, New York,
New York. (2)Ophthalmic Oncology Service, Memorial Sloan-Kettering Cancer Center,
New York, New York2Department of Ophthalmology, Weill Cornell Medical College,
New York, New York.

PMID: 26584063   [PubMed - as supplied by publisher]


5. JAMA Ophthalmol. 2015 Nov 19:1. doi: 10.1001/jamaophthalmol.2015.4578. [Epub
ahead of print]

Incidence of Orbital Recurrence After Enucleation or Ophthalmic Artery
Chemosurgery for Advanced Intraocular Retinoblastoma.

de Jong MC(1), Kors A(2), de Graaf P(1).

Author information: 
(1)Department of Radiology and Nuclear Medicine, VU University Medical Center,
Amsterdam, the Netherlands. (2)Department of Pediatric Oncology, VU University
Medical Center, Amsterdam, the Netherlands.

PMID: 26583950   [PubMed - as supplied by publisher]


6. JAMA Ophthalmol. 2015 Nov 19. doi: 10.1001/jamaophthalmol.2015.4597. [Epub ahead 
of print]

Vitrectomy for Proliferative Diabetic Retinopathy: Does Anyone Know the
Complication Rate?

Browning DJ(1).

Author information: 
(1)Charlotte Eye, Ear, Nose, and Throat Associates, Charlotte, North Carolina.

PMID: 26583811   [PubMed - as supplied by publisher]


7. JAMA Ophthalmol. 2015 Nov 19:1-3. doi: 10.1001/jamaophthalmol.2015.2465. [Epub
ahead of print]

Open-Angle Glaucoma and an Enlarged Superior Orbital Fissure Caused by Trauma.

Heydenrych LG(1), Du Toit N(2), Le Feuvre D(3).

Author information: 
(1)Department of Cornea and External Eye Disease, Moorfields Eye Hospital,
London, United Kingdom. (2)Division of Ophthalmology, University of Cape Town,
Groote Schuur Hospital, Cape Town, South Africa. (3)Division of Neurosurgery,
University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa.

PMID: 26583691   [PubMed - as supplied by publisher]


8. JAMA Ophthalmol. 2015 Nov 19:1-2. doi: 10.1001/jamaophthalmol.2015.5079. [Epub
ahead of print]

A Novel Treatment for Proliferative Diabetic Retinopathy: Anti-Vascular
Endothelial Growth Factor Therapy.

Gross JG(1), Glassman AR(2).

Author information: 
(1)Carolina Retina Center, PA, Columbia, South Carolina. (2)Jaeb Center for
Health Research, Tampa, Florida.

PMID: 26583372   [PubMed - as supplied by publisher]


9. JAMA Ophthalmol. 2015 Nov 12:1-9. doi: 10.1001/jamaophthalmol.2015.4518. [Epub
ahead of print]

Corneal Nerve Regeneration After Collagen Cross-Linking Treatment of Keratoconus:
A 5-Year Longitudinal Study.

Parissi M(1), Randjelovic S(2), Poletti E(3), Guimarães P(3), Ruggeri A(3),
Fragkiskou S(4), Wihlmark TB(4), Utheim TP(5), Lagali N(4).

Author information: 
(1)Department of Medical Biochemistry, Oslo University Hospital, University of
Oslo, Oslo, Norway2The Norwegian Dry Eye Clinic, Oslo, Norway. (2)The Norwegian
Dry Eye Clinic, Oslo, Norway. (3)Department of Information Engineering,
University of Padova, Padova, Italy. (4)Faculty of Health Sciences, Institute for
Clinical and Experimental Medicine, Department of Ophthalmology, Linköping
University, Linköping, Sweden. (5)Department of Medical Biochemistry, Oslo
University Hospital, University of Oslo, Oslo, Norway2The Norwegian Dry Eye
Clinic, Oslo, Norway5Department of Oral Biology, Faculty of Dentistry, University
of Oslo, Oslo, Norway.

Importance: It is unknown whether a neurotrophic deficit or pathologic nerve
morphology persists in keratoconus in the long term after corneal collagen
cross-linking (CXL) treatment. Nerve pathology could impact long-term corneal
status in patients with keratoconus.
Objective: To determine whether CXL treatment of keratoconus results in
normalization of subbasal nerve density and architecture up to 5 years after
treatment.
Design, Setting, and Participants: Observational study of 19 patients with
early-stage keratoconus indicated for a first CXL treatment with longitudinal
follow-up to 5 years postoperatively (examinations were performed from 2009 to
2015; analysis was performed from February to May 2015) and 19 age-matched
healthy volunteers at a primary care center and a university hospital
ophthalmology department.
Exposure: The patients with keratoconus underwent standard epithelial-off
UV-A/riboflavin CXL treatment with 30-minute UV-A exposure at 3 mW/cm2
irradiance.
Main Outcomes and Measures: Central corneal subbasal nerve density and subbasal
nerve architecture by use of laser-scanning in vivo confocal microscopy; subbasal
nerve analysis by 2 masked observers and by use of a fully automated method;
wide-field mosaics of subbasal nerve architecture by use of an automated method; 
and ocular surface touch sensitivity by use of contact esthesiometry.
Results: Mean (SD) age of the 19 patients with keratoconus was 27.5 (7.1) years
(range, 19-44 years), and minimal corneal thickness was 428 (36) μm (range,
372-497 μm). Compared with the mean (SD) preoperative subbasal nerve density of
21.0 (4.2) mm/mm2 in healthy corneas, the mean (SD) preoperative subbasal nerve
density of 10.3 (5.6) mm/mm2 in the corneas of patients with stage 1 or 2
keratoconus was reduced 51% (mean difference, 10.7 mm/mm2 [95% CI, 6.8-14.6
mm/mm2]; P < .001). After CXL, nerves continued to regenerate for up to 5 years, 
but nerve density remained reduced relative to healthy corneas at final follow-up
(mean reduction, 8.5 mm/mm2 [95% CI, 4.7-12.4 mm/mm2]; P < .001) despite recovery
of touch sensitivity to normal levels by 6 months. Preoperatively, more frequent 
nerve loops, crossings, and greater crossing angles were observed in the corneas 
of patients with keratoconus compared with healthy corneas. Postoperatively, the 
frequency of nerve looping increased, crossings were more frequent, and nerve
tortuosity increased. Wide-field mosaics indicated persistent disrupted
orientation of the regenerating subbasal nerves 5 years after CXL.
Conclusions and Relevance: Keratoconus is characterized by a neurotrophic deficit
and altered nerve morphology that CXL treatment does not address, despite
providing a positive biomechanical effect in the stroma. Given the widespread use
of CXL in the management of patients with keratoconus, the progression of
abnormal innervation after CXL should be recognized.

PMID: 26562763   [PubMed - as supplied by publisher]


10. JAMA Ophthalmol. 2015 Nov 12:1-8. doi: 10.1001/jamaophthalmol.2015.4486. [Epub
ahead of print]

Variability of Ocular Deviation in Strabismus.

Economides JR(1), Adams DL(2), Horton JC(1).

Author information: 
(1)Department of Ophthalmology, University of California, San Francisco.
(2)Department of Ophthalmology, University of California, San Francisco2Center
for Mind/Brain Sciences, The University of Trento, Trento, Italy.

Importance: In strabismus, the fixating eye conveys the direction of gaze while
the fellow eye points at a peripheral location in space. The stability of the
eyes may be reduced by the absence of a common target.
Objective: To quantify the stability of eye position in strabismus and to measure
variability in the ocular deviation.
Design, Setting, and Participants: From 2010 to 2014, a prospective comparative
case study of 25 patients with alternating exotropia with normal visual acuity in
each eye and 25 control individuals was conducted in a laboratory at a tertiary
eye center. A video eye tracker was used to measure the position of each eye
while participants alternated fixation on the center of a cross under dichoptic
conditions or scanned pictures of natural scenes.
Main Outcomes and Measures: Spatial and temporal variability in the position of
the fixating eye and the nonfixating eye in patients with strabismus and control 
individuals, quantified by the log area of ellipses containing 95% of eye
positions or mean SDs of eye position.
Results: In the 25 patients with strabismus, the mean (SD) age was 28 (14) years 
(range, 8-55 years) and the mean (SD) ocular deviation was 14.2° (5.9°) (range,
4.4°-22.4°). In the patients with strabismus, the mean position variability (1.80
log units; 95% CI, 1.66-1.93) for the deviating eye was greater than for the
fixating eye (1.26 log units; 95% CI, 1.17-1.35) (P < .001). The fixating eye of 
patients with strabismus was more variable in position than the fixating eye of
individuals without strabismus (0.98 log units; 95% CI, 0.88-1.08) (P < .005).
Conclusions and Relevance: In patients with strabismus, even without amblyopia,
the deviated eye is more variable in position than the fixating eye. Both eyes
are less stable in position than the eyes of control individuals, which indicates
that strabismus impairs the ability to fixate targets steadily. Saccades
contribute to variability of the deviation angle because they are less conjugate 
in patients with strabismus.

PMID: 26562632   [PubMed - as supplied by publisher]


11. JAMA Ophthalmol. 2015 Nov 12;133(11):e152143. doi:
10.1001/jamaophthalmol.2015.2143. Epub 2015 Nov 12.

Myopic Cleavage of Retinal Nerve Fiber Layer Assessed by Split-Spectrum
Amplitude-Decorrelation Angiography Optical Coherence Tomography.

Chihara E(1).

Author information: 
(1)Division of Glaucoma, Sensho-kai Eye Institute, Uji, Kyoto, Japan.

PMID: 26562515   [PubMed - in process]


12. JAMA Ophthalmol. 2015 Nov 12;133(11):e151931. doi:
10.1001/jamaophthalmol.2015.1931. Epub 2015 Nov 12.

Enhanced Depth Imaging Optical Coherence Tomography of Endogenous Fungal
Chorioretinitis.

Adam MK(1), Rahimy E(1).

Author information: 
(1)Retina Service, Wills Eye Hospital, Philadelphia, Pennsylvania.

PMID: 26562514   [PubMed - in process]


13. JAMA Ophthalmol. 2015 Nov 12;133(11):e151886. doi:
10.1001/jamaophthalmol.2015.1886. Epub 2015 Nov 12.

Polypoidal Choroidal Vasculopathy: Imaging by Indocyanine Green Angiography and
En Face Optical Coherence Tomography.

Kokame GT(1), Hirai K(2), Yanagihara R(2).

Author information: 
(1)Division of Ophthalmology, Department of Surgery, University of Hawaii School 
of Medicine, Honolulu2Retina Center at Pali Momi, Aiea, Hawaii3Retina Consultants
of Hawaii, Honolulu4Hawaii Macula and Retina Institute, Aiea. (2)Retina Center at
Pali Momi, Aiea, Hawaii3Retina Consultants of Hawaii, Honolulu4Hawaii Macula and 
Retina Institute, Aiea.

PMID: 26562513   [PubMed - in process]


14. JAMA Ophthalmol. 2015 Nov 12;133(11):e151687. doi:
10.1001/jamaophthalmol.2015.1687. Epub 2015 Nov 12.

Hemispheric Retinal Arteriovenous Anastomoses: (Wyburn-Mason Syndrome).

Chin EK(1), Critser DB(1), Almeida DR(1).

Author information: 
(1)Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa
City.

PMID: 26562512   [PubMed - in process]


15. JAMA Ophthalmol. 2015 Nov 1;133(11):1239. doi: 10.1001/jamaophthalmol.2014.3748.

JAMA Ophthalmology.

[No authors listed]

PMID: 26562511   [PubMed - in process]


16. JAMA Ophthalmol. 2015 Nov 1;133(11):1235. doi: 10.1001/jamaophthalmol.2014.3747.

Highlights.

[No authors listed]

PMID: 26562510   [PubMed - in process]


17. JAMA Ophthalmol. 2015 Nov 12:1-6. doi: 10.1001/jamaophthalmol.2015.4459. [Epub
ahead of print]

Evaluation of Frequency-Doubling Technology Perimetry as a Means of Screening for
Glaucoma and Other Eye Diseases Using the National Health and Nutrition
Examination Survey.

Boland MV(1), Gupta P(2), Ko F(3), Zhao D(4), Guallar E(4), Friedman DS(5).

Author information: 
(1)Glaucoma Center of Excellence, Wilmer Eye Institute, Johns Hopkins University 
School of Medicine, Baltimore, Maryland2Division of Health Sciences Informatics, 
Johns Hopkins University School of Medicine, Baltimore, Maryland3Web Editor, JAMA
Ophthalmology. (2)Glaucoma Center of Excellence, Wilmer Eye Institute, Johns
Hopkins University School of Medicine, Baltimore, Maryland. (3)Dana Center for
Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School
of Medicine, Baltimore, Maryland. (4)Department of Epidemiology, Johns Hopkins
University Bloomberg School of Public Health, Baltimore, Maryland6Welch Center
for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University
Bloomberg School of Public Health, Baltimore, Maryland. (5)Glaucoma Center of
Excellence, Wilmer Eye Institute, Johns Hopkins University School of Medicine,
Baltimore, Maryland4Dana Center for Preventive Ophthalmology, Wilmer Eye
Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.

Importance: Glaucoma is a significant cause of global blindness and there are, as
yet, no effective means of screening.
Objective: To assess the potential role of frequency-doubling technology (FDT)
perimetry in screening for glaucoma using data collected as part of the National 
Health and Nutrition Examination Survey (NHANES).
Design, Setting, and Participants: Reanalysis of cross-sectional data of 6797
participants in the 2005-2008 cycles of the NHANES, which evaluated a sample of
the noninstitutionalized US population with at least light-perception vision. A
subset of optic nerve photographs were regraded by 3 glaucoma specialists in
December 2012. Each participant underwent visual field testing, including FDT
perimetry screening, and had fundus photographs taken.
Main Outcomes and Measures: Sensitivity and specificity of FDT perimetry to
detect glaucoma, macular disease, or decreased visual acuity.
Results: A total of 5746 NHANES participants had optic images originally graded. 
We regraded 1201 images of 1073 eyes of 548 participants with initial cup-disc
ratio (CDR) of 0.6 or greater and 423 images of 360 eyes of 180 randomly selected
participants with initial CDR less than 0.6. Diagnoses of glaucoma by disc
photograph were 1.6% (3 of 180) in the CDR less than 0.6 group and 31.4% (172 of 
548) in the CDR of 0.6 or greater group. The sensitivity of FDT was 33% (95% CI, 
0%-87%) and specificity was 77% (95% CI, 71%-84%). For the group with at least 1 
CDR of 0.6 or greater, sensitivity of FDT was 66% (95% CI, 59%-73%) and
specificity was 70% (95% CI, 66%-75%). When analyzed to give FDT credit for
identifying glaucoma, macular disease, or decreased visual acuity, the
sensitivity of the test was 80% (95% CI, 77%-83%) and the specificity was 83%
(95% CI, 82%-84%). Approximately 25% of the NHANES population was not able to
successfully complete FDT testing, representing screening failures and decreasing
specificity.
Conclusions and Relevance: Using the 2005-2008 waves of the NHANES as a model of 
population-based screening for eye disease, FDT perimetry lacks both sensitivity 
and specificity as a means of screening for glaucoma, the presence of retinal
disease, or decreased acuity in a population-based setting. Given that no single 
test of glaucoma has yet been shown to be appropriate in a screening setting, to 
our knowledge, investigators should consider novel methods of detecting glaucoma 
or combinations of tests that might work better in a screening setting.

PMID: 26562502   [PubMed - as supplied by publisher]


18. JAMA Ophthalmol. 2015 Nov 12:1-5. doi: 10.1001/jamaophthalmol.2015.4499. [Epub
ahead of print]

Association Between Graft Storage Time and Donor Age With Endothelial Cell
Density and Graft Adherence After Descemet Membrane Endothelial Keratoplasty.

Rodríguez-Calvo de Mora M(1), Groeneveld-van Beek EA(2), Frank LE(3), van der
Wees J(2), Oellerich S(1), Bruinsma M(1), Melles GR(4).

Author information: 
(1)Netherlands Institute for Innovative Ocular Surgery (NIIOS), Rotterdam, the
Netherlands2Melles Cornea Clinic, Rotterdam, the Netherlands. (2)Netherlands
Institute for Innovative Ocular Surgery (NIIOS), Rotterdam, the
Netherlands3Amnitrans EyeBank, Rotterdam, the Netherlands. (3)Department of
Methodology and Statistics, Utrecht University, Utrecht, the Netherlands.
(4)Netherlands Institute for Innovative Ocular Surgery (NIIOS), Rotterdam, the
Netherlands2Melles Cornea Clinic, Rotterdam, the Netherlands3Amnitrans EyeBank,
Rotterdam, the Netherlands.

Importance: After retrospectively evaluating the clinical outcome of 500
consecutive cases after Descemet membrane endothelial keratoplasty (DMEK), we
extended the analysis in this study by assessing the effect of donor-related
parameters on endothelial cell density (ECD) decline and detachment rate in this 
group.
Observations: This retrospective case series included 500 cases who had undergone
DMEK from October 2007 to September 2012 at the Netherlands Institute for
Innovative Ocular Surgery (NIIOS), Rotterdam, the Netherlands. Logistic
regression analysis (n = 332 eyes) showed that donor age might be associated with
a 3% increase in the risk for a detachment (odds ratio, 0.97; 95% CI, 0.94-1.00; 
P = .049) (ie, higher donor age seems to be associated with lower chances of a
detachment). In addition, linear regression analysis indicated that graft storage
time in medium was associated with ECD decrease (ie, the longer the storage time,
the larger the decrease at 6 months after DMEK) (P = .01).
Conclusions and Relevance: We showed an association between graft storage time
and ECD decline after DMEK and possibly between donor age and graft detachment.
Therefore, donor storage times should be kept as short as possible to improve
short-term ECDs. More research is needed to draw definite conclusions on the
possible effect of donor age on the chance of a detachment after DMEK.

PMID: 26562408   [PubMed - as supplied by publisher]


19. JAMA Ophthalmol. 2015 Nov 5:1-4. doi: 10.1001/jamaophthalmol.2015.4331. [Epub
ahead of print]

Effect of Regulatory Requirement for Patient-Specific Prescriptions for Off-Label
Medications on the Use of Intravitreal Bevacizumab.

Holfinger S(1), Miller AG(2), Rao LJ(2), Rowland DY(3), Hornik JH(2), Miller
DG(2).

Author information: 
(1)Riverside Methodist Hospital, Columbus, Ohio. (2)Retina Associates of
Cleveland, Cleveland, Ohio. (3)DY Rowland Associates, Cleveland Heights,
Ohio4Department of Epidemiology and Biostatistics, Case Western Reserve
University School of Medicine, Cleveland, Ohio.

Importance: Requirements regulating pharmaceutical prescriptions can affect
physicians' choice of therapy in a clinical setting.
Objective: To evaluate the change in bevacizumab use after the regulatory
requirement for patient-specific prescriptions (PSPs) for off-label medications
in Ohio.
Design, Setting, and Participants: This study retrospectively reviewed the
aggregate data from the billing records of patients receiving 1.25-mg injections 
of bevacizumab, 0.3- or 0.5-mg injections of ranibizumab, or 2.0-mg injections of
aflibercept for age-related macular degeneration or diabetic macular edema in a
9-member retinal specialty private practice. The review assessed 4488
intravitreal injections in the 3-month period before (May 1 to July 30, 2012) and
5253 injections in the 3-month period after (May 1 to July 30, 2013) the Ohio
Board of Pharmacy's requirement of PSPs for bevacizumab. Relative proportions of 
the drugs used for intravitreal injections were calculated and frequencies were
compared. A Likert scale survey was conducted among the 9 physicians to identify 
reasons for their change in prescription of bevacizumab. The survey inquired
about (1) the burden of PSPs, (2) concern about differences in efficacy, and (3) 
concern about differences in safety.
Main Outcomes and Measures: Difference in drug use before and after the PSP
requirement for bevacizumab and the physicians' reasons for change in their drug 
use.
Results: Bevacizumab use decreased from 2752 of 4488 pre-PSP injections (61.3%)
to 1503 of 5253 post-PSP injections (28.6%), a change of -32.7% (95% CI, -34.6%
to -30.8%; P < .001). Use of 0.5-mg ranibizumab injections increased from 1122 of
4488 pre-PSP injections (25.0%) to 1838 of 5253 post-PSP injections (35.0%), a
change of 10.0% (95% CI, 8.2% to 11.8%; P < .001). Use of 0.3-mg ranibizumab
injections increased from 0 of 4488 (before US Food and Drug Administration
approval) to 429 of 5253 post-PSP injections (8.2%), a change of 8.2% (95% CI,
7.4% to 8.9%; P < .001). Use of aflibercept injections increased from 614 of 4488
pre-PSP injections (13.7%) to 1483 of 5253 post-PSP injections (28.2%), a change 
of 14.6% (95% CI, 13.0%-16.1%; P < .001). In the survey of the 9 physicians
concerning their reasons for decreased use of bevacizumab, 7 (78%) strongly
agreed and 1 (11%) agreed that the burden of PSPs changed their choice of drug
used for injection.
Conclusions and Relevance: Use of bevacizumab was reduced by 32.7% 1 year after
the regulatory requirement for PSPs for compounded (repackaged) medications. This
change seemed to have more association with the requirement for PSPs than with a 
known change in efficacy or safety concerns. Although this study was based on a
single US practice, regulation of repackaged medication for safety concerns
should also consider the evaluation of treatment burden, cost, and adherence.

PMID: 26540671   [PubMed - as supplied by publisher]


20. JAMA Ophthalmol. 2015 Nov 5. doi: 10.1001/jamaophthalmol.2015.4351. [Epub ahead
of print]

Periorbital Necrotizing Fasciitis Following Dexamethasone Intravitreal Implant
Injection.

Danan J(1), Heitz A(1), Bourcier T(1).

Author information: 
(1)Department of Ophthalmology, Strasbourg University Hospital, Fédération de
Médecine Translationnelle de Strasbourg, University of Strasbourg, Strasbourg,
France.

PMID: 26540636   [PubMed - as supplied by publisher]


21. JAMA Ophthalmol. 2015 Nov 5:1-3. doi: 10.1001/jamaophthalmol.2015.4105. [Epub
ahead of print]

Proteomic Analysis of Macular Fluid Associated With Advanced Glaucomatous
Excavation.

Patel S(1), Ling J(1), Kim SJ(1), Schey KL(2), Rose K(2), Kuchtey RW(3).

Author information: 
(1)Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville,
Tennessee. (2)Vanderbilt Eye Institute, Vanderbilt University Medical Center,
Nashville, Tennessee2Department of Biochemistry, Vanderbilt University,
Nashville, Tennessee. (3)Vanderbilt Eye Institute, Vanderbilt University Medical 
Center, Nashville, Tennessee3Department of Molecular Physiology and Biophysics,
Vanderbilt University, Nashville, Tennessee.

PMID: 26540576   [PubMed - as supplied by publisher]


22. JAMA Ophthalmol. 2015 Nov 5:1-2. doi: 10.1001/jamaophthalmol.2015.4115. [Epub
ahead of print]

Patient and Physician Convenience and the Choice of Intravitreal Anti-Vascular
Endothelial Growth Factor Medications.

Thompson JT(1).

Author information: 
(1)Department of Ophthalmology, Greater Baltimore Medical Center, Baltimore,
Maryland.

PMID: 26540479   [PubMed - as supplied by publisher]


23. JAMA Ophthalmol. 2015 Nov 5:1-2. doi: 10.1001/jamaophthalmol.2015.2522. [Epub
ahead of print]

Asymptomatic Intraocular Mass.

Andreoli MT(1), Farooq AV(1), Mieler WF(1).

Author information: 
(1)Illinois Eye and Ear Infirmary, Department of Ophthalmology and Visual
Sciences, University of Illinois at Chicago.

PMID: 26540359   [PubMed - as supplied by publisher]


24. JAMA Ophthalmol. 2015 Nov 5:1-6. doi: 10.1001/jamaophthalmol.2015.4343. [Epub
ahead of print]

Depression, Anxiety, and Regret Before and After Testing to Estimate Uveal
Melanoma Prognosis.

Schuermeyer I(1), Maican A(2), Sharp R(3), Bena J(4), Triozzi PL(5), Singh AD(2).

Author information: 
(1)Department of Psychiatry and Psychology, Cleveland Clinic, Cleveland, Ohio.
(2)Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio. (3)Center for Ethics,
Humanities, and Spiritual Care, Cleveland Clinic, Cleveland, Ohio.
(4)Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio. (5)Solid
Tumor Oncology, Cleveland Clinic, Cleveland, Ohio.

Importance: To our knowledge, longitudinal assessment of depression, anxiety, and
decision regret (a sense of disappointment or dissatisfaction in the decision) in
patients undergoing prognostication for uveal melanoma does not exist.
Objective: To report on depression, anxiety, and decision regret before and after
testing to estimate uveal melanoma prognosis.
Design, Setting, and Participants: Prospective interventional case series
conducted at an institutional referral practice of 96 patients with clinical
diagnosis of uveal melanoma who underwent prognostication at the time of primary 
therapy.
Main Outcomes and Measures: Depression, anxiety, and decision regret prior to
prognostication (baseline) and at 3 and 12 months afterwards. The Hospital
Anxiety and Depression Scale (HADS) and Decision Regret Scale were
self-administered by the patients prior to prognostication (baseline) and at 3
and 12 months afterwards. Data were summarized using means and standard
deviations for continuous measures, frequencies, and percentages for categorical 
factors. A mixed model was used to assess the trajectory of HADS anxiety and the 
associations between HADS anxiety and baseline HADS depression, baseline decision
regret, prognostication test result, and adjuvant therapy, respectively, while
adjusting for age and sex.
Results: Ninety-six patients (median age 60.7 years) completed baseline
questionnaires. The mean (SD) HADS anxiety score at baseline (7.4 [4.0]) was
higher than at 3 months (5.4 [3.7]; P < .001) or 12 months (4.7 [3.4]; P < .001),
and decreased with older age (coefficient estimate [SD], -0.06 [0.02]; P < .001).
The decision regret score was associated with baseline HADS depression score
(coefficient estimate [SE], -1.17 [0.43]; P < .007), and HADS depression score
increased with baseline HADS anxiety score (coefficient estimate [SE], 0.39
[0.06]; P < .001).
Conclusions and Relevance: Our study raises questions about decision regret in
patients who agree to have a prognostic test that may not help guide treatment.
Although decision regret appears to lessen or dissipate with time, study on
larger numbers of patients is necessary to elucidate factors that may be
addressed to mitigate decision regret.

PMID: 26539659   [PubMed - as supplied by publisher]


25. JAMA Ophthalmol. 2015 Oct 29:1-9. doi: 10.1001/jamaophthalmol.2015.4070. [Epub
ahead of print]

Systemic Safety of Prolonged Monthly Anti-Vascular Endothelial Growth Factor
Therapy for Diabetic Macular Edema: A Systematic Review and Meta-analysis.

Avery RL(1), Gordon GM(1).

Author information: 
(1)California Retina Consultants and Research Foundation, Santa Barbara.

Importance: Anti-vascular endothelial growth factor (VEGF) therapy is commonly
used to treat numerous retinal conditions and appears safe, yet controversy
remains regarding systemic safety.
Objective: To evaluate the systemic safety of intravitreous anti-VEGF injections 
in high-risk patients with diabetic macular edema (DME) and to investigate
separately the subgroup of these patients with the highest level of exposure to
anti-VEGF monthly treatment for 2 years.
Data Sources: A search of MEDLINE, Cochrane Central Register of Controlled
Trials, clincaltrials.gov, and ophthalmology congress abstracts January 1, 1947, 
to May 19, 2015.
Study Selection: Randomized clinical trials were selected that evaluated monthly 
anti-VEGF injections for DME for 2 years and reported the outcome measures of
cerebrovascular accidents, myocardial infarctions, arteriothrombotic events, and 
mortality.
Data Extraction and Synthesis: Two reviewers collected data independently from
each study for the meta-analysis. Data were pooled using a fixed-effects model
and analyzed from November 6, 2014, to June 28, 2015. Peto odds ratios with 95%
CIs were calculated.
Main Outcomes and Measures: Primary end points included cerebrovascular accidents
and all-cause mortality in the highest-dose arms. Secondary outcomes included
myocardial infarctions, arteriothrombotic events, and vascular-related death.
Results: Of 1126 articles reviewed, 598 were removed as duplicate studies and
524, for lack of monthly treatment data for 2 years, leaving 4 studies for the
meta-analysis that met the search criteria: 2 trials using monthly aflibercept
and 2 using monthly ranibizumab, representing 1328 patients. The primary
evaluation (1078 patients) combined the monthly aflibercept and the 0.5-mg
ranibizumab arms and yielded an increased risk for death compared with sham and
laser treatments (odds ratio [OR], 2.98; 95% CI, 1.44-6.14; P = .003). Analysis
including monthly aflibercept and 0.5-mg ranibizumab yielded an increased risk
for cerebrovascular accidents (OR, 2.33; 95% CI, 1.04-5.22; P = .04) and vascular
death (OR, 2.51; 95% CI, 1.08-5.82; P = .03). No definitive increased risk for
myocardial infarctions and arteriothrombotic events was seen with all dose
combinations.
Conclusions and Relevance: In this meta-analysis of anti-VEGF agents for patients
with DME, assessment of the highest-level exposure group (those high-risk
patients with DME who received 2 years of monthly treatment) revealed a possible 
increased risk for death and potentially for cerebrovascular accidents.
Consideration of total exposure to anti-VEGF agents when treating those at high
risk for vascular disease may be important.

PMID: 26513684   [PubMed - as supplied by publisher]


26. JAMA Ophthalmol. 2015 Oct 29:1-3. doi: 10.1001/jamaophthalmol.2015.4100. [Epub
ahead of print]

Optical Coherence Tomography Angiography of Acute Macular Neuroretinopathy and
Paracentral Acute Middle Maculopathy.

Pecen PE(1), Smith AG(1), Ehlers JP(1).

Author information: 
(1)Ophthalmic Imaging Center, Cole Eye Institute, Cleveland Clinic, Cleveland,
Ohio.

PMID: 26513596   [PubMed - as supplied by publisher]


27. JAMA Ophthalmol. 2015 Oct 29. doi: 10.1001/jamaophthalmol.2015.4270. [Epub ahead 
of print]

Controversy Surrounding the Proposed Ocular Adverse Events of Fluoroquinolones.

Forooghian F(1).

Author information: 
(1)Department of Ophthalmology, University of British Columbia, St Paul's
Hospital, Vancouver, British Columbia, Canada.

PMID: 26513492   [PubMed - as supplied by publisher]


28. JAMA Ophthalmol. 2015 Oct 29. doi: 10.1001/jamaophthalmol.2015.4113. [Epub ahead 
of print]

Detection of Socially Significant Strabismus in an Ethnically Diverse Model Set.

Pineles SL(1).

Author information: 
(1)Jules Stein Eye Institute, Department of Ophthalmology, University of
California, Los Angeles.

PMID: 26513381   [PubMed - as supplied by publisher]


29. JAMA Ophthalmol. 2015 Oct 29:1-6. doi: 10.1001/jamaophthalmol.2015.4110. [Epub
ahead of print]

Comparison of Aflibercept, Bevacizumab, and Ranibizumab for Treatment of Diabetic
Macular Edema: Extrapolation of Data to Clinical Practice.

Heier JS(1), Bressler NM(2), Avery RL(3), Bakri SJ(4), Boyer DS(5), Brown DM(6), 
Dugel PU(7), Freund KB(8), Glassman AR(9), Kim JE(10), Martin DF(11), Pollack
JS(12), Regillo CD(13), Rosenfeld PJ(14), Schachat AP(11), Wells JA 3rd(15);
American Society of Retina Specialists Anti-VEGF for Diabetic Macular Edema
Comparative Effectiveness Panel.

Author information: 
(1)Ophthalmic Consultants of Boston, Boston, Massachusetts. (2)Wilmer Eye
Institute, The Johns Hopkins University School of Medicine, Baltimore,
Maryland3Editor, JAMA Ophthalmology. (3)California Retina Consultants, Santa
Barbara. (4)Mayo Clinic, Rochester, Minnesota. (5)Retina Vitreous Associates
Medical Group, Keck School of Medicine of University of Southern California, Los 
Angeles. (6)Retina Consultants of Houston, Baylor College of Medicine, Houston,
Texas. (7)Retinal Consultants of Arizona, Phoenix9University of Southern
California Eye Institute, Keck School of Medicine of University of Southern
California, Los Angeles. (8)Vitreous-Retina-Macula Consultants of New York, New
York University School of Medicine, New York. (9)Jaeb Center for Health Research,
Tampa, Florida. (10)Medical College of Wisconsin, Milwaukee. (11)Cole Eye
Institute, Cleveland Clinic, Cleveland, Ohio. (12)Illinois Retina Associates,
Chicago15Department of Ophthalmology, Rush University Medical Center, Chicago,
Illinois. (13)Wills Eye Hospital Retina Service and Mid Atlantic Retina,
Philadelphia, Pennsylvania17Department of Ophthalmology, Thomas Jefferson
University, Philadelphia, Pennsylvania. (14)Bascom Palmer Eye Institute,
University of Miami Miller School of Medicine, Miami, Florida. (15)Palmetto
Retina Center, West Columbia, South Carolina.

Importance: The Diabetic Retinopathy Clinical Research Network (DRCR Network),
sponsored by the National Eye Institute, reported the results of a comparative
effectiveness randomized clinical trial (RCT) evaluating the 3 anti-vascular
endothelial growth factor (anti-VEGF) agents aflibercept (2.0 mg), bevacizumab
(1.25 mg), and ranibizumab (0.3 mg) for treatment of diabetic macular edema (DME)
involving the center of the retina and associated with visual acuity loss. The
many important findings of the RCT prompted the American Society of Retina
Specialists to convene a group of experts to provide their perspective regarding 
clinically relevant findings of the study.
Objectives: To describe specific outcomes of the RCT judged worthy of
highlighting, to discuss how these and other clinically relevant results should
be considered by specialists treating DME, and to identify unanswered questions
that merit consideration before treatment.
Evidence Review: The DRCR Network-authored publication on primary outcomes of the
comparative effectiveness RCT at 89 sites in the United States. The study period 
of the RCT was August 22, 2012, to August 28, 2013.
Findings: On average, all 3 anti-VEGF agents led to improved visual acuity in
eyes with DME involving the center of the retina and with visual acuity
impairment, including mean (SD) improvements by +13.3 (11.1) letters with
aflibercept vs +9.7 (10.1) letters with bevacizumab (P < .001) and +11.2 (9.4)
letters with ranibizumab (P = .03). Worse visual acuity when initiating therapy
was associated with greater visual acuity benefit of aflibercept (+18.9 [11.5])
over bevacizumab (+11.8 [12.0]) or ranibizumab (14.2 [10.6]) 1 year later
(P < .001 for interaction with visual acuity as a continuous variable, and
P = .002 for interaction with visual acuity as a categorical variable). It is
unknown whether different visual acuity outcomes associated with the use of the 3
anti-VEGF agents would be noted with other treatment regimens or with adequately 
repackaged bevacizumab, as well as in patients with criteria that excluded them
from the RCT, such as persistent DME despite recent anti-VEGF treatment.
Conclusions and Relevance: On average, all 3 anti-VEGF agents led to improved
visual acuity in eyes with DME involving the center of the retina and visual
acuity impairment. Worse visual acuity when initiating therapy was associated
with greater visual acuity benefit of aflibercept over bevacizumab or ranibizumab
1 year later. Care needs to be taken when attempting to extrapolate outcomes of
this RCT to differing treatment regimens. With access to adequately repackaged
bevacizumab, many specialists might initiate therapy with bevacizumab when visual
acuity is good (ie, 20/32 to 20/40 as measured in the DRCR Network), recognizing 
that the cost-effectiveness of bevacizumab outweighs that of aflibercept or
ranibizumab.

PMID: 26512939   [PubMed - as supplied by publisher]


30. JAMA Ophthalmol. 2015 Oct 29:1-6. doi: 10.1001/jamaophthalmol.2015.4092. [Epub
ahead of print]

Oral Fluoroquinolones and the Risk of Uveitis.

Sandhu HS(1), Brucker AJ(1), Ma L(2), VanderBeek BL(3).

Author information: 
(1)Scheie Eye Institute, Department of Ophthalmology, Perelman School of
Medicine, University of Pennsylvania, Philadelphia. (2)Leonard Davis Institute,
Perelman School of Medicine, University of Pennsylvania, Philadelphia. (3)Scheie 
Eye Institute, Department of Ophthalmology, Perelman School of Medicine,
University of Pennsylvania, Philadelphia2Leonard Davis Institute, Perelman School
of Medicine, University of Pennsylvania, Philadelphia3Center for Clinical
Epidemiology and Bi.

Importance: Fluoroquinolones are the most commonly prescribed antibiotic class in
the outpatient setting. Recent reports have implicated an association between
oral fluoroquinolones and an increased risk of uveitis.
Objective: To determine the hazard of uveitis with oral fluoroquinolone use.
Design, Setting, and Participants: A retrospective cohort study was conducted
using medical claims data from a large national US insurer (N = 4 387 651).
Cohorts from ambulatory care centers across the United States were created
including every new user of an oral fluoroquinolone or β-lactam antibiotic
prescription with at least 24 months of data prior to the date of the
prescription from January 1, 2000, to January 30, 2013. Exclusion criteria
consisted of any previous diagnosis of uveitis or a uveitis-associated systemic
illness. Participants were censored for a new diagnosis of a uveitis-associated
systemic illness, the end of an observation period, use of the other class of
antibiotic, or removal from the insurance plan. Data analysis was performed from 
January 2 through March 15, 2015.
Main Outcomes and Measures: The hazard of a uveitis diagnosis after a
fluoroquinolone prescription compared with a β-lactam prescription using
multivariate regression with Cox proportional hazards models.
Results: Of the 4 387 651 patients in the database, 843 854 individuals receiving
a fluoroquinolone and 3 543 797 patients receiving a β-lactam were included in
the analysis. After controlling for age, race, and sex using multivariate
analysis, no hazard for developing uveitis at the 30-, 60-, or 90-day observation
windows was seen (hazard ratio [HR] range, 0.96; 95% CI, 0.82-1.13; to 1.05; 95% 
CI, 0.95-1.16; P > .38 for all comparisons). The 365-day observation period
showed a small increase in the HR for the fluoroquinolone cohort (1.11; 95% CI,
1.05-1.17; P < .001). Moxifloxacin produced an increased hazard for uveitis at
every time point (HR range, 1.47-1.75; 95% CI, 1.27-2.37; P < .001 for all
comparisons). Secondary analysis demonstrated a similar hazard at 365 days for a 
later diagnosis of a uveitis-associated systemic illness after fluoroquinolone
use (HR range, 1.46-1.96; 95% CI, 1.42-2.07; P < .001 for all comparisons).
Conclusions and Relevance: These data do not support an association between oral 
fluoroquinolone use and uveitis. Instead, this study shows an association between
oral fluoroquinolone use and the risk for uveitis-associated systemic illnesses, 
which is a possible source of bias that could explain the findings of previous
studies.

PMID: 26512796   [PubMed - as supplied by publisher]