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Intrauterine Mepivacaine Instillation vs Placebo for Pain During IUD Placement

This randomized clinical trial assesses whether intrauterine instillation of mepivacaine reduces pain and improved tolerability during intrauterine device placement in nulliparous individuals.

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JAMA Ophthalmology

Mission Statement: To be the indispensable source of ophthalmic knowledge by promptly publishing innovative, clinically relevant research through consistent and authoritative peer review and, thereby, to be the first choice of authors for their important manuscripts.

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Sudden-Onset Ptosis in a Young Female Patient

A 25-year-old female patient with a recent history of left-sided root canal, tooth extraction, and bone graft presented with left eye pain and blurry vision, ptosis, persistent headache, and neck stiffness. Examination revealed left mydriasis without relative afferent pupillary defect. What would you do next?

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Iris Nodule and Pulmonary Sarcoidosis in a Patient Aged 57 Years

This case report describes a woman aged 57 years who presented with a 3-month history of cough and dyspnea, during which a solitary iris nodule was discovered on ophthalmologic consultation and led to a diagnosis of pulmonary sarcoidosis.

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Progression of Pachychoroid Disease—Who Is At Risk?

Pachychoroid disease refers to a spectrum of disorders characterized by choroidal vascular remodeling, including dilated outer Haller vessels (pachyvessels), attenuation of the choriocapillaris and Sattler layer, choroidal vascular hyperpermeability, and increased choroidal thickness in many—but not all—eyes. Although its pathogenesis remains incompletely understood, accumulating evidence implicates impaired choroidal venous outflow and venous overload as key mechanisms underlying disease development. The spectrum includes pachychoroid pigment epitheliopathy (PPE), central serous chorioretinopathy, focal choroidal excavation, peripapillary pachychoroid syndrome, pachychoroid neovasculopathy, and polypoidal choroidal vasculopathy (PCV).

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Standardizing Conservative Treatment for Congenital Nasolacrimal Duct Obstruction

Congenital nasolacrimal duct obstruction (CNLDO) is one of the most common disorders encountered during infancy. Although spontaneous resolution is well recognized, clinicians must balance the potential benefits of conservative management against office probing to achieve more rapid symptom resolution. Zheng and colleagues report the first randomized comparison of massage vs immediate probing for infants with CNLDO, addressing a long-standing question in the management of CNLDO.

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Use of Fellow Eyes as Controls in Clinical Trials

To the Editor Von der Emde et al recently thoroughly assessed the correlation between eyes in enlargement rates of geographic atrophy (GA) in the Age-Related Eye Disease Study 2 (AREDS2) and found lower correlation than identified in previous studies. They advised, “Researchers should be cautious of trials and analyses relying on assumptions of highly correlated enlargement rates.” One interpretation of this advice could be that results of clinical trials for GA that involve comparison of treated eyes with untreated fellow eyes may not be valid. Indeed, in an accompanying Invited Commentary, Donovan concluded that the AREDS2 data “challenge the validity of using GA in the fellow eye as an internal control for disease progression in clinical trial design.” This interpretation requires clarification.

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Use of Fellow Eyes as Controls in Clinical Trials—Reply

In Reply We thank Maguire for her thoughtful letter and agree with the central distinction she emphasizes. Low correlation in geographic atrophy (GA) enlargement rates between fellow eyes would not, by itself, invalidate a fellow-eye comparison in a randomized clinical trial. Our conclusion was even more specific, and we reiterate, researchers should be cautious of trials and analyses relying on assumptions of highly correlated fellow-eye enlargement rates.

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Incidence and Risk Factors for Progression of Pachychoroid Subtype

This multicenter cohort study evaluates progression, diagnostic transitions, and associated risk factors in eyes with pachychoroid subtype.

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Lacrimal Sac Massage vs Probing for Congenital Nasolacrimal Duct Obstruction

This noninferiority randomized trial evaluates the noninferiority of lacrimal sac massage compared to lacrimal duct probing for congenital nasolacrimal duct obstruction in infants.

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Time-Varying Effects of Valacyclovir Prophylaxis in the Zoster Eye Disease Study

This post hoc exploratory analysis of the ZEDS randomized clinical trial assesses temporal patterns of potential benefit of suppressive valacyclovir treatment to reduce risk of new or worsening stromal keratitis, endothelial keratitis, iritis, or dendriform epithelial keratitis.