JAMA ophthalmology最新文献

{"title":"COVID-19 Pandemic and Rates of Common Ophthalmic Procedures Among Medicare Beneficiaries","authors":"Raziyeh Mahmoudzadeh, Mariam Samuel, Sydney Wheeler, Mirataollah Salabati, Christopher T. Leffler, Jessica D. Randolph","doi":"10.1001/jamaophthalmol.2024.6065","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2024.6065","url":null,"abstract":"ImportanceThe COVID-19 pandemic has altered health care delivery, including ophthalmic care. Understanding how the pandemic has changed the rates of commonly performed ophthalmic procedures is crucial for assessing the broader implications for patient care and resource allocation.ObjectiveTo estimate the changes in the rates of the 10 most prevalent ophthalmic procedures among Medicare beneficiaries during the COVID-19 pandemic and to explore the geographic disparities in these shifts.DesignThis retrospective US cross-sectional study compared data from Medicare Part B National Summary Data Files for the calendar years 2019 and 2020. Participants included Medicare beneficiaries undergoing the 10 most common ophthalmic procedures. Data included a total of 3 879 533 procedure entries in 2019 and 3 181 439 entries in 2020. Data were analyzed from January 1, 2019, to December 31, 2020.ExposureCOVID-19 pandemic.Main Outcomes and MeasuresThe primary outcome was the percentage change in the number of beneficiaries for each of the 10 most common ophthalmic procedures in each state.ResultsThere was an overall decrease of −17.9% in the rates of the 10 ophthalmic procedures from 2019 to 2020 (99% CI, −24.8% to −11.3%). The largest reduction was observed in laser peripheral iridotomy (−43.6%; 99% CI, −51.7% to −31.9%), while eye drug injections saw the smallest decrease (−1.5%; 99% CI, −3.3% to 0.3%). Cataract surgery also saw a reduction of −23.0% (99% CI, −28.8% to −18.7%). Regionally, the Northeast experienced the greatest reductions in cataract surgery (−27.9%; 99% CI, −32.8% to −22.3%).Conclusions and RelevanceThese results show that the COVID-19 pandemic caused a notable drop in the number of common ophthalmic procedures among Medicare beneficiaries, especially in laser peripheral iridotomy, while eye drug injections saw minimal changes. The Northeast experienced the largest reductions, highlighting the pandemic’s association with changes in eye care and indicating a need for focused recovery efforts in the hardest hit areas.","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":"79 1 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143191969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pixel Intensity to Estimate Choroidal Tumor Thickness Using 2-Dimensional Ultra-Widefield Images","authors":"Michael D. Yu, Michael Heiferman, Edward Korot, Aneesha Ahluwalia, Gina Yu, Prithvi Mruthyunjaya","doi":"10.1001/jamaophthalmol.2024.6064","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2024.6064","url":null,"abstract":"ImportanceTumor thickness is a well-established risk factor for malignant transformation of choroidal nevus into melanoma. To date, reliable evaluation of tumor thickness relies on B-scan ultrasonography, which is frequently unavailable at nonsubspecialty clinics where most melanocytic choroidal lesions (MCLs) are first diagnosed.ObjectiveTo describe a technique for potential rapid and reliable estimation of MCL thickness using only Optomap ultra-widefield (UWF) images without B-scan ultrasonography.Design, Setting, and ParticipantsThis retrospective, exploratory, cross-sectional analysis of consecutive MCLs diagnosed at Byers Eye Institute, Stanford University, Palo Alto, California, investigates the quantitative correlation between B-scan ultrasonographic thickness of MCLs with the relative pixel intensity of MCLs on green-channel (GC) Optomap UWF images. Pixel intensity overlying the lesion was standardized to the pixel intensity surrounding the lesion (pixel intensity difference [PID]), which was then correlated with ultrasonographic tumor thickness in all study lesions using linear regression analysis. Data were collected from January 1, 2019, to July 1, 2021.Main Outcomes and MeasuresThe correlation between ultrasonographic tumor thickness and PID was measured. Performance (sensitivity and specificity) of the regression analysis trendline in estimating tumor thickness was also determined.ResultsA total of 138 MCLs from 138 patients (mean age, 57.0 years; 51% female) were included, comprising 125 that were nevi and 13 that were melanoma. The mean ultrasonographic tumor thickness was 1.1 mm (median, 0.8 mm; range, 0.2-5.5 mm), with a mean PID of 2.13. Stratifying lesions by ultrasonographic thickness (&amp;amp;lt;1.0 mm vs 1.0-2.0 mm vs &amp;amp;gt;2.0 mm), the mean PID increased (−1.95 vs 3.72 vs 17.62; <jats:italic>P</jats:italic> &amp;amp;lt; .001) as mean thickness increased (0.5 mm vs 1.4 mm vs 3.3 mm; <jats:italic>P</jats:italic> &amp;amp;lt; .001). PID was correlated with tumor thickness (<jats:italic>R</jats:italic><jats:sup>2</jats:sup> = 0.823; 95% CI, 0.770-0.875; <jats:italic>P</jats:italic> &amp;amp;lt; .001) across lesions of all sizes.Conclusions and RelevanceIn this proof-of-principle study, GC-derived lesion intensity correlated well with ultrasonographic tumor thickness. Leveraging this correlation, this study demonstrates a technique for potentially reliable and rapid estimation of tumor thickness using UWF Optomap images without the use of B-scan ultrasonography.","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":"9 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143191968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary Conjunctival Rhabdomyosarcoma Presenting as an Enlarging Papillomatous Lesion in a 3-Year-Old","authors":"Zara Saleem, Alan D. Proia, Lars M. Wagner, Olivia J. Killeen, Sharon F. Freedman","doi":"10.1001/jamaophthalmol.2024.6228","DOIUrl":"https://doi.org/10.1001/jamaophthalmol.2024.6228","url":null,"abstract":"This case report describes a rapidly growing conjunctival lesion in a 3-year-old patient, which was incompletely resected and diagnosed as rhabdomyosarcoma.","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":"14 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143191970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Progressive Eyelid Lesions in a Woman With Essential Thrombocythemia.","authors":"Akshara R Legala, Marissa K Shoji, Don O Kikkawa","doi":"10.1001/jamaophthalmol.2024.5304","DOIUrl":"10.1001/jamaophthalmol.2024.5304","url":null,"abstract":"","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":" ","pages":"176-177"},"PeriodicalIF":7.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142813022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk Factors for Retinopathy in Young Adults With Type 1 Diabetes.","authors":"Shilan Seyed Ahmadi, Johnny Ludvigsson, Henrik Imberg, Thomas Nyström, Marcus Lind","doi":"10.1001/jamaophthalmol.2024.5274","DOIUrl":"10.1001/jamaophthalmol.2024.5274","url":null,"abstract":"","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":" ","pages":"184-186"},"PeriodicalIF":7.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11843369/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142813030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Five-Year Outcomes of Lenadogene Nolparvovec Gene Therapy in Leber Hereditary Optic Neuropathy.","authors":"Patrick Yu-Wai-Man, Nancy J Newman, Valérie Biousse, Valerio Carelli, Mark L Moster, Catherine Vignal-Clermont, Thomas Klopstock, Alfredo A Sadun, Robert C Sergott, Rabih Hage, Simona Degli Esposti, Chiara La Morgia, Claudia Priglinger, Rustum Karanja, Magali Taiel, José-Alain Sahel","doi":"10.1001/jamaophthalmol.2024.5375","DOIUrl":"10.1001/jamaophthalmol.2024.5375","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Limited studies have assessed the long-term benefit/risk of gene therapy for Leber hereditary optic neuropathy (LHON).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To determine the safety and efficacy of lenadogene nolparvovec in patients with LHON due to the MT-ND4 gene variant for up to 5 years after administration.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;The RESCUE and REVERSE Long-Term Follow-up Study (RESTORE), conducted from 2018 to 2022, is the 5-year follow-up study of the 2 phase 3 clinical studies RESCUE (Efficacy Study of Lenadogene Nolparvovec for the Treatment of Vision Loss Up to 6 Months From Onset in LHON Due to the MT-ND4 Mutation) and REVERSE (Efficacy Study of Lenadogene Nolparvovec for the Treatment of Vision Loss From 7 Months to 1 Year From Onset in LHON Due to the MT-ND4 Mutation). At the end of each study, ie, 2 years after gene therapy administration, patients were offered enrollment in the RESTORE trial, a multinational, multicenter, prospective study, for an additional 3 years of follow-up. Patients with LHON due to the MT-ND4 gene variant received lenadogene nolparvovec in 1 eye and a sham injection in the other eye.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Intervention: &lt;/strong&gt;Lenadogene nolparvovec was administered as a single intravitreal injection in the RESCUE/REVERSE studies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Measures included best-corrected visual acuity (BCVA), quality of life using the National Eye Institute visual functioning questionnaire 25 (NEI VFQ-25), and adverse events.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among the 76 patients who received gene therapy in the RESCUE (n = 39) and REVERSE (n = 37) studies, 72 (94.7%) completed these studies; 62 patients (81.6%) participated in the RESTORE trial, and 55 patients (72.4%) completed the 5-year follow-up. Participants were mostly male (49 [79.0%]) with a mean (SD) age of 35.9 (15.3) years at treatment. At baseline, the mean (SD) BCVA was 1.5 (0.5) logMAR (20/600 Snellen) in eyes to be treated with lenadogene nolparvovec and 1.4 (0.5) logMAR (20/500) in sham eyes. At the end of the RESCUE/REVERSE trials, ie, 2 years after treatment, eyes treated with lenadogene nolparvovec and eyes treated with sham reached a mean BCVA value of 1.4 (0.6) logMAR (20/500). The mean (SD) change from baseline to year 2 was -0.05 (0.6) logMAR (+1 line) and 0.01 (0.6) logMAR (-0 line) in gene therapy-treated and sham eyes, respectively (difference, -0.03; 95% CI, -0.16 to 0.09; P = .60). Five years after treatment, the bilateral improvement from nadir was similar to that observed at 2 years, with a mean (SD) change in BCVA of -0.4 (0.5) logMAR (more than +4 lines) for eyes treated with lenadogene nolparvovec and -0.4 (0.4) logMAR (+4 lines) for eyes treated with sham (difference, -0.05; 95% CI, -0.15 to 0.04; P = .27). An improvement of at least -0.3 logMAR (+3 lines) from the nadir in at least 1 eye was observed in 66.1% of participants (41 of 62). Between","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":" ","pages":"99-108"},"PeriodicalIF":7.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11843360/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142854115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bilateral Retinal Nerve Fiber Layer Thickening in a Middle-Aged Woman.","authors":"Ivy Zhu, Amani A Fawzi","doi":"10.1001/jamaophthalmol.2024.5457","DOIUrl":"10.1001/jamaophthalmol.2024.5457","url":null,"abstract":"","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":" ","pages":"178-179"},"PeriodicalIF":7.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142854089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Single-Eye Gene Therapy for Leber Hereditary Optic Neuropathy.","authors":"Hendrik P N Scholl, Bence György","doi":"10.1001/jamaophthalmol.2024.5618","DOIUrl":"10.1001/jamaophthalmol.2024.5618","url":null,"abstract":"","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":" ","pages":"108-109"},"PeriodicalIF":7.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142854121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Geographic Distribution of US Ophthalmic Surgical Subspecialists.","authors":"Aishah Ahmed, Muhammad Ali, Chen Dun, Cindy X Cai, Martin A Makary, Fasika A Woreta","doi":"10.1001/jamaophthalmol.2024.5605","DOIUrl":"10.1001/jamaophthalmol.2024.5605","url":null,"abstract":"<p><strong>Importance: </strong>While urban counties maintain higher densities of ophthalmologists than rural counties, the geographic distribution of ophthalmic surgical subspecialists has not yet been elucidated. A potential workforce discrepancy may impact the burden of care faced by rural surgeons.</p><p><strong>Objective: </strong>To assess the geographic distribution of the ophthalmic subspecialist surgeon workforce and evaluate factors associated with practicing in rural areas.</p><p><strong>Design, setting, and participants: </strong>This cross-sectional population-based study of Medicare patients and surgeons performing subspecialized procedures took place from 2012 through 2022. Medicare Fee-for-Service claims were analyzed in 2023 for patients 65 years or older who underwent subspecialized ophthalmic procedures between 2012 and 2022 using Current Procedural Terminology codes (n = 1 619 043). Surgeons were defined as a subspecialist based on Current Procedural Terminology codes, indicating performance of at least 1 subspecialty procedure from the following subspecialties: cornea, glaucoma, oculoplastic, retina, or strabismus (n = 13 526).</p><p><strong>Main outcomes and measures: </strong>The primary outcome was the population density of practice for subspecialist surgeons and residence for patients (rural or urban). The secondary outcomes were the characteristics associated with rural practice.</p><p><strong>Results: </strong>Among 13 526 ophthalmic surgical subspecialists, 9823 were male (72.6%), 3235 were female (26.8%), and 4484 (33.2%) practiced in the South. There were 2540 cornea subspecialists (18.5%), 3676 glaucoma subspecialists (26.8%), 1951 oculoplastic subspecialists (14.2%), 4123 retina subspecialists (30.0%), and 1236 strabismus subspecialists (9.0%). Across subspecialties, a higher proportion of patients (17.4%; 95% CI, 16.9%-17.9%) resided in rural areas relative to surgeons (5.6%; 95% CI, 5.3%-5.9%) with differences ranging from 6.2% to 14.8% across subspecialities. Female surgeons (adjusted odds ratio [aOR], 0.63; 95% CI, 0.51-0.79; P < .001), surgeons in the Northeast (aOR, 0.62; 95% CI, 0.48-0.78; P < .001), surgeons in the West (aOR, 0.63; 95% CI, 0.50-0.79; P < .001), and recent graduates relative to those who graduated 11 to 20 years ago (aOR, 1.66; 95% CI, 1.25-2.21; P < .001), 21 to 30 years ago (aOR, 1.83; 95% CI, 1.38-2.42; P < .001), or 31 years ago or longer (aOR, 1.43; 95% CI, 1.08-1.90; P = .013), were less likely to practice rurally.</p><p><strong>Conclusions and relevance: </strong>This cross-sectional study between 2012 and 2022 identified higher proportions of rural patients compared with rural surgeons. Percentages of rural surgeons declined over time, with female surgeons and recent medical school graduates less likely to practice rurally. This suggests a disparity in the number of rural subspecialist surgeons available to serve rural patients.</p>","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":" ","pages":"117-124"},"PeriodicalIF":7.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11843353/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142914759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Addressing Representation in Ophthalmology Training.","authors":"Khalid El-Jack, Dolly Ann Padovani-Claudio, Basil K Williams","doi":"10.1001/jamaophthalmol.2024.6086","DOIUrl":"10.1001/jamaophthalmol.2024.6086","url":null,"abstract":"","PeriodicalId":14518,"journal":{"name":"JAMA ophthalmology","volume":" ","pages":"152-154"},"PeriodicalIF":7.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}