JAMA ophthalmology
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Randomized Controlled Trial Comparative Study
Association of Baseline Visual Acuity and Retinal Thickness With 1-Year Efficacy of Aflibercept, Bevacizumab, and Ranibizumab for Diabetic Macular Edema.
Comparisons of the relative effect of 3 anti-vascular endothelial growth factor agents to treat diabetic macular edema warrant further assessment. ⋯ These post hoc secondary findings suggest that for eyes with better initial VA and thicker CST, some VA outcomes may be worse in the bevacizumab group than in the aflibercept and ranibizumab groups. Given the exploratory nature of these analyses and the small sample size within subgroups, caution is suggested when using the data to guide treatment considerations for patients.
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Randomized Controlled Trial
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.
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. ⋯ 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.
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Observational Study
Variation in Prescription Drug Coverage Enrollment Among Vulnerable Beneficiaries With Glaucoma Before and After the Implementation of Medicare Part D.
It is important to understand in more detail how patients with glaucoma were affected by the implementation of Medicare Part D, which was designed to provide beneficiaries with near-universal prescription drug coverage. ⋯ Medicare Part D enrolled most beneficiaries with glaucoma who previously lacked prescription drug coverage. The results of this study suggest that coverage gains lagged among the near poor. While these data evaluated changes in coverage among cohorts of beneficiaries and not from longitudinal follow-up of patients, targeted efforts to improve prescription drug coverage among vulnerable beneficiaries would likely improve access to prescribed ocular hypotensive medications.
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Corneal transplantation restores visual function when visual impairment caused by a corneal disease becomes too severe. It is considered the world's most frequent type of transplantation, but, to our knowledge, there are no exhaustive data allowing measurement of supply and demand, although such data are essential in defining local, national, and global strategies to fight corneal blindness. ⋯ Our survey globally quantified the considerable shortage of corneal graft tissue, with only 1 cornea available for 70 needed. Efforts to encourage cornea donation must continue in all countries, but it is also essential to develop alternative and/or complementary solutions, such as corneal bioengineering.