This Issue at a Glance

Abstract

Uhr et al (p. 516) conducted a retrospective case-control study to investigate the incidence of and risk factors for development of delayed retinal breaks and retinal detachments (RDs) after acute posterior vitreous detachment (PVD). The study included 7999 eyes with acute PVD, of which 1280 eyes (16.0%) showed a retinal break and 499 (6.2%) showed an RD on presentation. Delayed retinal breaks and RDs were found in 209 (2.6%) and 80 (1.0%) eyes, respectively, and a substantial proportion of them developed 6 weeks after presentation. Vitreous hemorrhage and male gender were significant risk factors for development of delayed retinal breaks and RDs. Pseudophakia and younger age were also risk factors for delayed RD development, while vitreous hemorrhage was a risk factor for earlier retinal breaks. The researchers conclude that clinically significant rates of newly detected retinal breaks and RDs may occur after acute PVD and suggest that these patients may benefit from re-examination. Newman-Casey et al (p. 477) evaluated the longitudinal relationship between medication adherence and visual field progression among participants enrolled in the medication arm of the Collaborative Initial Glaucoma Treatment Study (CIGTS). Of the 306 patients in the medication arm of the CIGTS who underwent at least 1 follow-up visit, 142 (46%) reported never missing a dose of medication over all available follow-up, 112 patients (37%) reported a missed dose at up to one-third of visits, 31 patients (10%) reported a missed dose for between one-third and two-thirds of visits, and 21 patients (7%) reported a missed dose for more than two-thirds of visits. An increase in visits during which a patient reported a missed dose of medication was significantly associated with a worsening in mean deviation over time. The authors conclude that there is a statistically and clinically significant association between medication nonadherence and glaucomatous vision loss. Breeze et al (p. 458) conducted a retrospective cohort study of the United States and United Kingdom military Joint Theatre Trauma Registries to compare the management of eye injuries at US and UK Military Treatment Facilities (MTFs). Between 2003 and 2011, 67 586 persons were admitted to a US or UK MTF in Iraq or Afghanistan for treatment of injuries, and 5719 (8%) had ocular soft tissue injuries. The most common eye injuries were open-globe injury without intraocular foreign body, present in 3201 patients (56%). The odds of undergoing evisceration or enucleation for open-globe injury was highest in host nation civilians, but there was no evidence of a difference between US and UK military service member casualties. Primary repair of open globe injury was undertaken more commonly at US MTFs than UK MTFs, which was explained by the presence of an ophthalmic surgeon at US MTFs. The authors suggest that the study provides evidence to support the maintenance of specialist ophthalmic surgical competencies in MTFs. In a large, multicenter, retrospective cohort study of commercially insured patients in the MarketScan database, Ludwig et al (p. 535) evaluated the relationship between pentosan polysulfate sodium (PPS) use for interstitial cystitis (IC) and pigmentary maculopathy. In 277 325 patients with IC, the most common diagnoses of maculopathy were exudative age-related macular degeneration (AMD) (1.5%), drusen (0.8%), nonexudative AMD (0.3%), toxic maculopathy (0.1%), and hereditary dystrophy (0.04%). The percentage of patients who filled a PPS prescription and were diagnosed later with a maculopathy (2.37%) was very similar to the percentage of patients who did not fill a prescription (2.77%). Survival models showed no significant associations between PPS exposure and diagnosis of drusen, nonexudative AMD, exudative AMD, toxic maculopathy, hereditary dystrophy, or an aggregate variable of any maculopathy. The findings remained stable in models that excluded patients with diabetes mellitus. The researchers find within this dataset that there was no association between PPS exposure and subsequent diagnosis of maculopathy. Chen et al (p. 445) conducted a cross-sectional study using private equity (PE) acquisition and investment data to examine trends in PE-backed acquisitions of ophthalmology and optometry practices in the United States. The study identified 29 PE-backed platform companies acquiring 228 practices associated with an estimated 1466 total clinical locations and 2146 ophthalmologists and optometrists between January 1, 2012 and October 20, 2019. Acquisitions increased rapidly between 2012 and 2019. Financing rounds of PE-backed platforms mirrored acquisition trends with a spike in financing during 2017. Acquisitions occurred in 40 states with the greatest number in New York and California, and a majority of PE firms developed multistate platform companies. The researchers conclude that PE-backed acquisitions of ophthalmology and optometry practices have increased rapidly since 2012, with an associated increase in financing frequency of emerging platform companies.