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In This Issue of JAMA Ophthalmology |

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JAMA Ophthalmol. 2015;133(11):1235. doi:10.1001/jamaophthalmol.2014.3747.
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Aligning outcome measures for cataract surgery may facilitate international comparisons that can drive improvements in the outcomes most meaningful to patients, prompting Mahmud and colleagues to propose a minimum standard set of outcome measures for cataract surgery. The recommended set encompasses all patients treated for cataracts by 1 of 4 surgical approaches (phacoemulsification, sutured manual extracapsular cataract extraction, sutureless manual extracapsular cataract extraction, or intracapsular cataract extraction), preoperative metrics, and intraoperative problems and complications.

Rehnman and colleagues assess the spatial distribution and time course of the increased corneal densitometry (corneal light backscatter) seen aftercorneal cross-linking (CXL) with riboflavin and UV-A irradiation. In a randomized clinical trial of 43 patients (60 eyes) with progressive keratoconus, patients were randomized to receive conventional CXL using the Dresden protocol or CXL with mechanical compression of the cornea using a flat rigid contact lens sutured to the cornea during the treatment (CRXL) and followed up for 6 months. A densitometry increase deeper and more pronounced in the CXL group diminished with time and was proportional to the reduction in corneal steepness.

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Binenbaum and colleagues describe the prevalence and causes of retinal hemorrhage among infants and young children in an outpatient ophthalmology clinic, testing the hypothesis that if vaccination injections cause retinal hemorrhage, then retinal hemorrhage should be seen frequently and be temporally associated with immunization. In a retrospective cohort study among 5177 children 1 to 23 months old undergoing a dilated fundus examination for any reason, excluding those with intraocular surgery or retinal neovascularization, 9 had retinal hemorrhage. All 9 had abusive head trauma diagnosed from nonocular findings. Among a subset of 2210 children with complete immunization records, 163 had an eye examination within 7 days of vaccination, 323 within 14 days, and 494 within 21 days. No children had retinal hemorrhage within 7 days of vaccination, 1 within 14 days, and none within 21 days, suggesting no temporal association between vaccination and retinal hemorrhage.

To investigate the effect of visual impairment (VI) and other chronic health conditions on health-related quality of life (HRQoL), Park and colleagues evaluate relevant European Quality of Life–5 Dimensions Questionnaire (EQ-5D) data from the 29 639 participants aged 19 years and older from the 2008-2012 Korean National Health and Nutrition Examination Survey. The EQ-5D index score with VI was substantially lower than without VI. In most conditions, comorbidity, for example, individuals who had a cerebrovascular accident with VI had lower EQ-5D index scores. These results suggest that VI has a substantial effect on HRQoL, even in the presence of concurrent chronic health conditions, although this study used a representative sampling of South Koreans so that generalization to other races/ethnicities and countries should be approached with caution.





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