In this week’s issue
- Myopia, especially high myopia, significantly increases both glaucoma risk and the likelihood of requiring surgery.
- Cataract surgery outcomes are successful but widely used quality metrics may exclude many real-world patients, limiting their generalizability.
- Where patients store their glaucoma drops at home may impact adherence, highlighting the role of environmental factors in medication use.
- Baseline findings may predict which patients with sarcoid uveitis are more likely to achieve remission.
Ophthalmology
Risk of glaucoma and glaucoma surgeries in myopic eyes
Myopia is among the most common causes of visual impairment worldwide, and its prevalence has increased dramatically in recent years. Given this trend is only expected to accelerate in the near future, knowing which other ocular conditions myopes are most at risk for is of paramount importance for protecting vision at the population level. Evaluating the relative risk of developing glaucoma, the most common cause of irreversible vision loss, among myopes is thus a high-value endeavor. In a longitudinal, nationwide cohort study, over 14 million patients without glaucoma were classified as either non-myopic, myopic, or highly myopic. The number of patients in each group that developed glaucoma and/or required filtering surgery over the subsequent 7.5 years was then recorded. The adjusted hazard ratio (HR) for developing glaucoma was 1.44 for the myopia group and 2.67 for the high myopia group. Regarding glaucoma surgery, the adjusted HR was 1.71 for the myopia group and 3.07 for the high myopia group. These data illustrate the importance of monitoring myopic individuals for signs of glaucoma.
JAMA Ophthalmology
MIPS-based quality metric in cataract surgery outcomes
Clear vision or clouded metrics? The Centers for Medicare & Medicaid Services Merit-Based Incentive Payment System (MIPS) for cataract surgery defines success as achieving best recorded visual acuity (VA) of at least 20/40 in the operative eye within 90 days. However, this metric excludes patients with comorbid chronic ocular diseases (CCODs), potentially limiting generalizability. Using data from tertiary care health systems in the Sight Outcomes Research Collaborative (SOURCE), the authors conducted a retrospective cohort study of over 55,000 patients undergoing cataract surgery from 2010 to 2023 to evaluate demographic and clinical factors associated with surgical success. Overall, 91% of patients achieved VA ≥20/40 at 90 days. However, applying CCOD exclusion criteria removed nearly half of patients (46%) from quality assessment, disproportionately affecting older and Black patients. Across the full cohort, lower odds of success were associated with residence in less affluent communities, Medicaid insurance, rural location, complex or combined surgical procedures, diabetes, and worse preoperative VA (≤20/60). These findings suggest that while cataract surgery is highly effective, the current MIPS metric excludes a substantial proportion of patients and disproportionately impacts older and Black patients, underscoring the need for case-mix adjustment and more inclusive measures of surgical quality.
American Journal of Ophthalmology (AJO)
Medication storage location and glaucoma drop adherence
Could better glaucoma drop adherence start with where that bottle lives? Poor adherence to glaucoma medications remains a major reason patients continue to lose vision despite the availability of effective treatments. While efforts to improve adherence have focused on patient education, reminder systems, and proper drop technique, less attention has been paid to how a patient’s home environment and daily routines shape medication use. In this prospective, home-based observational study, 93 community-dwelling adults ≥60 years old with bilateral glaucoma were followed for 7 days using sensor-equipped bottle caps and in-home minoring to objectively track missed eyedrop doses, storage locations, and local environmental factors. Eyedrops stored in kitchens or bathrooms were associated with significantly fewer missed doses compared to those stored in bedrooms (OR for missed dose <1). Evening doses were nearly twice as likely to be missed as morning doses, while lighting, clutter, visual contrast, and time spent in the storage location were not associated with adherence. Overall, encouraging patients to adopt simple behavioral changes, such as storing eyedrops in routine-driven spaces and prioritizing morning dosing when possible, may meaningfully improve glaucoma medication adherence.
British Journal of Ophthalmology
What factors predict remission in sarcoid uveitis?
For some patients with sarcoid uveitis, the disease may quiet but not without clues along the way. Sarcoid uveitis has a variable clinical course, and predicting which patients will achieve sustained remission remains challenging. Identifying prognostic factors can help guide counseling and long-term management. In this multicenter retrospective study, investigators followed 329 patients with sarcoid uveitis for at least 3 years to evaluate predictors of remission and patterns of recurrence. Remission was defined as being free of symptoms of sarcoidosis without treatment for ≥3 years. 30% of patients achieved remission after a median follow-up of 6.5 years. Baseline macular edema was associated with delayed remission, while baseline pulmonary involvement was associated with faster remission. Recurrence after remission was uncommon, occurring in just 6% of patients, and most presented as anterior uveitis with a similar phenotype at recurrence compared to the initial presentation. These findings suggest that clinical features at presentation may help stratify prognosis in patients with sarcoid uveitis, with remission achievable in a subset of patients and low recurrence rates in patients who achieve remission.
