Leber hereditary optic neuropathy (LHON) is a disorder characterized by severe and rapidly progressive visual loss when caused by a mutation in the mitochondrial gene encoding NADH:ubiquinone oxidoreductase subunit 4 (ND4). We have initiated a gene therapy trial to determine the safety and tolerability of escalated doses of an adeno-associated virus vector (AAV) expressing a normal ND4 complementary DNA in patients with a G to A mutation at nucleotide 11778 of the mitochondrial genome.

“Practice makes perfect” is an age-old idiom few can disagree with. Yet in ophthalmic surgical teaching, practice has not had the emphasis it has in other motor skill–based disciplines. Even a well-stocked wet laboratory likely does not have a large quantity of eyes available for practicing, limiting robustness of skill development that could be achieved by frequent repetition. The commonly used pig eyes have only superficially similar surgical characteristics to human eyes, reducing the benefit of the time invested.

The first death I witnessed in medical school 35 years ago was avoidable. The patient had a cardiac arrest during an otherwise routine angiogram. The anesthesia resident on the crash team intubated the patient and managed the airway while the cardiologists ran the code. Unfortunately, the anesthesia machine in the angiography suite was different from those the resident normally used in the main operating room; the knobs were reversed and labeled differently. When he reached over to turn on the oxygen while holding the endotracheal tube in place before it was taped, the resident delivered pure nitrous oxide instead.

I have read with some dismay the editorial in the March 2015 issue of Ophthalmology.1 If the authors are correct in claiming that nonarteritic anterior ischemic optic neuropathy (NA-AION) is not an ischemic process, they must at least answer the following 2 questions: First, why is the optic nerve head hyperemic and edematous at outset (it does not become pale for 3-6 weeks), and why can the condition occur in a disc of normal dimensions or in a myopic disc (as in the case in 10% to 15% of NA-AION patients) and not exclusively in a so-called disc at risk?

We performed a systematic review and meta-analysis to evaluate the benefit and harms associated with implantation of toric intraocular lenses (IOLs) during cataract surgery. Outcomes were postoperative uncorrected distance visual acuity (UCDVA) and distance spectacle independence. Harms were evaluated as surgical complications and residual astigmatism.

The article by Meuer et al1 reports that epiretinal membranes were absent in 19% of those having had cataract extraction, and present in 33%, with a P value of <0.0001. This is a stunning finding and seems to indicate that cataract extraction is not as benign a procedure as it seems generally thought to be. The authors do not comment on whether this was merely a function of age, or seemed to be related to the surgery.