Archives of Facial Plastic SurgeryVol. 14, No. 4 Free AccessThe JAMA Network JournalsNew Names for the Archives JournalsHoward Bauchner, Daniel M. Albert, Joseph T. Coyle, Julie Ann Freischlag, Wayne F. LarrabeeJr, Paul A. Levine, Rita F. Redberg, Frederick P. Rivara, June K. Robinson, and Roger N. RosenbergHoward BauchnerDr Bauchner () is Editor in Chief, JAMA and The JAMA Network. Dr Albert is Editor, JAMA Ophthalmology. Dr Coyle is Editor, JAMA Psychiatry. Dr Freischlag is Editor, JAMA Surgery. Dr Larrabee is Editor, JAMA Facial Plastic Surgery. Dr Levine is Editor, JAMA Otolaryngology–Head & Neck Surgery. Dr Redberg is Editor, JAMA Internal Medicine. Dr Rivara is Editor, JAMA Pediatrics. Dr Robinson is Editor, JAMA Dermatology. Dr Rosenberg is Editor, JAMA Neurology.Search for more papers by this authorEmail the corresponding author at howard.bauchner@jamanetwork.org, Daniel M. AlbertDr Bauchner () is Editor in Chief, JAMA and The JAMA Network. Dr Albert is Editor, JAMA Ophthalmology. Dr Coyle is Editor, JAMA Psychiatry. Dr Freischlag is Editor, JAMA Surgery. Dr Larrabee is Editor, JAMA Facial Plastic Surgery. Dr Levine is Editor, JAMA Otolaryngology–Head & Neck Surgery. Dr Redberg is Editor, JAMA Internal Medicine. Dr Rivara is Editor, JAMA Pediatrics. Dr Robinson is Editor, JAMA Dermatology. Dr Rosenberg is Editor, JAMA Neurology.Search for more papers by this authorEmail the corresponding author at howard.bauchner@jamanetwork.org, Joseph T. CoyleDr Bauchner () is Editor in Chief, JAMA and The JAMA Network. Dr Albert is Editor, JAMA Ophthalmology. Dr Coyle is Editor, JAMA Psychiatry. Dr Freischlag is Editor, JAMA Surgery. Dr Larrabee is Editor, JAMA Facial Plastic Surgery. Dr Levine is Editor, JAMA Otolaryngology–Head & Neck Surgery. Dr Redberg is Editor, JAMA Internal Medicine. Dr Rivara is Editor, JAMA Pediatrics. Dr Robinson is Editor, JAMA Dermatology. Dr Rosenberg is Editor, JAMA Neurology.Search for more papers by this authorEmail the corresponding author at howard.bauchner@jamanetwork.org, Julie Ann FreischlagDr Bauchner () is Editor in Chief, JAMA and The JAMA Network. Dr Albert is Editor, JAMA Ophthalmology. Dr Coyle is Editor, JAMA Psychiatry. Dr Freischlag is Editor, JAMA Surgery. Dr Larrabee is Editor, JAMA Facial Plastic Surgery. Dr Levine is Editor, JAMA Otolaryngology–Head & Neck Surgery. Dr Redberg is Editor, JAMA Internal Medicine. Dr Rivara is Editor, JAMA Pediatrics. Dr Robinson is Editor, JAMA Dermatology. Dr Rosenberg is Editor, JAMA Neurology.Search for more papers by this authorEmail the corresponding author at howard.bauchner@jamanetwork.org, Wayne F. LarrabeeJrCorrespondence: Dr Larrabee, Larrabee Surgical Center, 600 Broadway, Ste 280, Seattle, WA 98122 (E-mail Address: larrabee@uw.edu).Dr Bauchner () is Editor in Chief, JAMA and The JAMA Network. Dr Albert is Editor, JAMA Ophthalmology. Dr Coyle is Editor, JAMA Psychiatry. Dr Freischlag is Editor, JAMA Surgery. Dr Larrabee is Editor, JAMA Facial Plastic Surgery. Dr Levine is Editor, JAMA Otolaryngology–Head & Neck Surgery. Dr Redberg is Editor, JAMA Internal Medicine. Dr Rivara is Editor, JAMA Pediatrics. Dr Robinson is Editor, JAMA Dermatology. Dr Rosenberg is Editor, JAMA Neurology.Search for more papers by this authorEmail the corresponding author at howard.bauchner@jamanetwork.org, Paul A. LevineDr Bauchner () is Editor in Chief, JAMA and The JAMA Network. Dr Albert is Editor, JAMA Ophthalmology. Dr Coyle is Editor, JAMA Psychiatry. Dr Freischlag is Editor, JAMA Surgery. Dr Larrabee is Editor, JAMA Facial Plastic Surgery. Dr Levine is Editor, JAMA Otolaryngology–Head & Neck Surgery. Dr Redberg is Editor, JAMA Internal Medicine. Dr Rivara is Editor, JAMA Pediatrics. Dr Robinson is Editor, JAMA Dermatology. Dr Rosenberg is Editor, JAMA Neurology.Search for more papers by this authorEmail the corresponding author at howard.bauchner@jamanetwork.org, Rita F. RedbergDr Bauchner () is Editor in Chief, JAMA and The JAMA Network. Dr Albert is Editor, JAMA Ophthalmology. Dr Coyle is Editor, JAMA Psychiatry. Dr Freischlag is Editor, JAMA Surgery. Dr Larrabee is Editor, JAMA Facial Plastic Surgery. Dr Levine is Editor, JAMA Otolaryngology–Head & Neck Surgery. Dr Redberg is Editor, JAMA Internal Medicine. Dr Rivara is Editor, JAMA Pediatrics. Dr Robinson is Editor, JAMA Dermatology. Dr Rosenberg is Editor, JAMA Neurology.Search for more papers by this authorEmail the corresponding author at howard.bauchner@jamanetwork.org, Frederick P. RivaraDr Bauchner () is Editor in Chief, JAMA and The JAMA Network. Dr Albert is Editor, JAMA Ophthalmology. Dr Coyle is Editor, JAMA Psychiatry. Dr Freischlag is Editor, JAMA Surgery. Dr Larrabee is Editor, JAMA Facial Plastic Surgery. Dr Levine is Editor, JAMA Otolaryngology–Head & Neck Surgery. Dr Redberg is Editor, JAMA Internal Medicine. Dr Rivara is Editor, JAMA Pediatrics. Dr Robinson is Editor, JAMA Dermatology. Dr Rosenberg is Editor, JAMA Neurology.Search for more papers by this authorEmail the corresponding author at howard.bauchner@jamanetwork.org, June K. RobinsonDr Bauchner () is Editor in Chief, JAMA and The JAMA Network. Dr Albert is Editor, JAMA Ophthalmology. Dr Coyle is Editor, JAMA Psychiatry. Dr Freischlag is Editor, JAMA Surgery. Dr Larrabee is Editor, JAMA Facial Plastic Surgery. Dr Levine is Editor, JAMA Otolaryngology–Head & Neck Surgery. Dr Redberg is Editor, JAMA Internal Medicine. Dr Rivara is Editor, JAMA Pediatrics. Dr Robinson is Editor, JAMA Dermatology. Dr Rosenberg is Editor, JAMA Neurology.Search for more papers by this authorEmail the corresponding author at howard.bauchner@jamanetwork.org, and Roger N. RosenbergDr Bauchner () is Editor in Chief, JAMA and The JAMA Network. Dr Albert is Editor, JAMA Ophthalmology. Dr Coyle is Editor, JAMA Psychiatry. Dr Freischlag is Editor, JAMA Surgery. Dr Larrabee is Editor, JAMA Facial Plastic Surgery. Dr Levine is Editor, JAMA Otolaryngology–Head & Neck Surgery. Dr Redberg is Editor, JAMA Internal Medicine. Dr Rivara is Editor, JAMA Pediatrics. Dr Robinson is Editor, JAMA Dermatology. Dr Rosenberg is Editor, JAMA Neurology.Search for more papers by this authorEmail the corresponding author at howard.bauchner@jamanetwork.orgPublished Online:2 Jul 2012AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail The group of scientific publications that includes JAMA and the Archives specialty journals is undergoing a major evolution. In April 2012, we launched The JAMA Network, a new editorial/publishing system that closely interconnects JAMA and the 9 Archives Journals. In May, the new JAMA Network website was launched, and soon, The JAMA Network smartphone/tablet app will be available.We are now pleased to announce formally that effective January 1, 2013, all 9 of the Archives Journals will be officially renamed JAMA Dermatology, JAMA Facial Plastic Surgery, JAMA Internal Medicine, JAMA Neurology, JAMA Ophthalmology, JAMA Otolaryngology–Head & Neck Surgery, JAMA Pediatrics, JAMA Psychiatry, and JAMA Surgery. These changes continue the evolution of The JAMA Network, and the new journal names will coincide with the first major print redesign of The JAMA Network Journals in more than 20 years. While we all realize that changes in the names of our journals, which have been revered for decades, may raise some concerns among our loyal readers and authors, we believe that standardization of format and integration into The JAMA Network will justify these changes in the long run.The creation of The JAMA Network unites 10 journals linked by their commitment to the same high standards of publication, medical and scientific excellence, pursuit and development of outstanding content, and the use of technology to present that content in novel and creative formats. The JAMA Network is well served by our new website, which uses semantic tagging to link articles by concepts rather than words and ensures and reinforces the vision of a network of high-caliber journals. As a group of journals, we are stronger and more flexible. The effect of the network will be greater than the sum of its parts. The JAMA Network editors are meeting as a group more frequently and intensively to advance our common editorial, scientific, and publishing goals. Manuscripts that are not accepted for publication by one JAMA Network journal may, with the authors' consent, be referred for prompt assessment and consideration by another JAMA Network journal. In addition, information and commentaries about articles published in one journal that have importance and relevance for another journal will be featured across the Network.What will the future bring for The JAMA Network Journals? We will continue to publish the best content—including original research reports, practical review articles, and scholarly opinion pieces. Our goal is not to be print-centric or web-centric, but rather to be user-centric, regardless of who those users are—authors, researchers, clinicians, educators, policy makers, librarians, journalists, and, in some cases, patients. We will continue to introduce new article types, we are designing more contemporary structured abstracts, and we are considering data optimization in some of our research reports. We envision offering our content in different languages, available in print or on the web, to read or listen to, in short or long form. The goal is to harness the forces of innovation and technologic change to enhance the experience of our users.While The JAMA Network will continue to evolve, the primary goal will remain unchanged—to provide the best content possible to advance medical science and to help improve patient care. We look forward to hearing from you with your ideas and suggestions about The JAMA Network Journals.Published Online: July 2, 2012. doi:10.1001/archfacial.2012.775Financial Disclosure: None reported.Simultaneous Publication: This editorial is being published simultaneously in JAMA and the 9 JAMA Network Journals.This article was corrected for errors on July 16, 2012.FiguresReferencesRelatedDetails Volume 14Issue 4Jul 2012 InformationCopyright 2012 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.To cite this article:Howard Bauchner, Daniel M. Albert, Joseph T. Coyle, Julie Ann Freischlag, Wayne F. LarrabeeJr, Paul A. Levine, Rita F. Redberg, Frederick P. Rivara, June K. Robinson, and Roger N. Rosenberg.The JAMA Network Journals.Archives of Facial Plastic Surgery.Jul 2012.236-236.http://doi.org/10.1001/archfaci.2012.775Published in Volume: 14 Issue 4: July 2, 2012PDF download

Background: We present the results of a retrospective review of children undergoing implantation with bone-anchored hearing aids (BAHAs) at the Great Ormond Street Hospital for Children.Methods: The case notes of 71 children undergoing BAHA placement at the Great Ormond Street Hospital for Children between December 1990 and August 2002 were reviewed. Outcome measures included hearing thresholds, incidence of fixture loss, skin reaction and need for revision. Quality of life outcomes were also measured.Results: Eighty-five ears had been implanted. Fifty-four per cent of children had experienced no complications, 42 per cent had required revision surgery and 26 per cent had experienced fixture loss at some point. Young age at implantation was associated with an adverse outcome. Trauma and failure of osseointegration had been the commonest reasons for failure. A skin reaction around the abutment had occurred at some point in 37 per cent of children but had persisted for longer than six months in only 9 per cent; this had been associated with fixture loss. The use of fixture site split skin grafts had reduced problems with skin hypertrophy and hair overgrowth. Hearing thresholds when using BAHAs had been comparable to those when using bone conduction hearing aids. However, BAHAs had significant additional benefits in terms of sound quality, ease of use and overall quality of life.Conclusion: Bone-anchored hearing aids provide significant benefits over other types of hearing aid, both audiologically and in terms of quality of life. Careful selection of candidates and meticulous follow up are required in order to minimize complications.

A case of olfactory neuroblastoma metastatic to the choroid is reported and described. Histologically, the tumor consisted of islands of small round cells, many of them surrounding blood vessels in a 'pseudorosette' pattern. Numerous mitotic figures were present. Transmission electron microscopy reveals neuritic processes containing neurosecretory granules and microtubules, features characteristic of olfactory neuroblastoma. This is the first published case of an olfactory neuroblastoma demonstrating intraocular metastasis.

The purpose of this study was to assess the practicality and validity of laryngeal ultrasound to establish vocal fold movement in children with suspected vocal fold palsy. Fifty-five consecutive patients (age range three days to 12 years) with suspected vocal fold palsy underwent both laryngoscopy and laryngeal ultrasound. Ultrasonographic findings correlated with endoscopic findings in 81.2 per cent of cases. This, however, rose to a concordance rate of 89.5 per cent in patients aged over 12 months. Laryngeal ultrasound is well-tolerated, safe and non-invasive and the authors feel that it is a useful adjunct to endoscopy in the diagnosis of vocal fold palsy.

OBJECTIVE:To investigate the effectiveness of the vitamin D analogues 1,25-(OH)(2)-16-ene-23-yne vitamin D(3) (16,23-D(3)) and 1alpha-hydroxyvitamin D(2) (1alpha-OH-D(2)) in inhibiting retinoblastoma growth in large tumors in a xenograft model and with prolonged use in a transgenic model.METHODS:For the large-tumor study, the xenograft athymic mouse/human retinoblastoma cell (Y-79) model was used. Subcutaneous tumors were allowed to grow to an average volume of 1600 mm(3). Systemic treatment with 1 of the vitamin D analogues or with vehicle (control groups) was carried out for 5 weeks. For the long-term study, transgenic beta-luteinizing hormone-large T antigen (LHbeta-Tag) mice were systemically treated with 1 of the 2 compounds or vehicle (control groups) for up to 15 weeks. Tumor size and signs of toxicity were assessed.RESULTS:In the large-tumor study, tumor volume ratios for the 1alpha-OH-D(2) and 16,23-D(3) groups were significantly lower than those for controls (P<.002). No significant differences in tumor volume were seen between the 1alpha-OH-D(2) and 16,23-D(3) groups (P =.15). In the long-term study, the 1alpha-OH-D(2) group showed significantly smaller tumor size compared with its control (P<.001). No significant difference was seen between the 16,23-D(3) group and its control. Some toxic effects related to hypercalcemia were seen in both studies.CONCLUSIONS:In athymic mice in the large-tumor study, both 1alpha-OH-D(2) and 16,23-D(3) were effective in inhibiting tumor growth compared with controls. In the long-term study, 1alpha-OH-D(2) inhibited tumor growth but 16,23-D(3) did not. Effective doses of both compounds caused hypercalcemia and a significant increase in mortality. Clinical Relevance Use of 1alpha-OH-D(2) inhibited tumor growth in large tumors and with long-term treatment compared with controls. Because of hypercalcemia-related toxic effects seen in the present experiments, in clinical trials, serum calcium levels should be carefully monitored. This analogue may require use with drugs that lower serum calcium levels or use of relatively lower doses or skipped doses. The ideal alternative solution would be to identify vitamin D analogues that retain the antineoplastic action without the calcemic activity.

OBJECTIVETo examine slitlamp, specular, and light microscopic features of human donor corneas known to have undergone laser-assisted in situ keratomileusis (LASIK).METHODSTwenty-six donor corneas known to have undergone LASIK prospectively underwent slitlamp examination with particular attention to the presence of a flap edge, as well as specular microscopy with particular attention to the presence of highly reflective particles in the stroma corresponding to the LASIK interface. Central endothelial cell density and pachymetery were obtained. They were compared with 26 control donor corneas without LASIK. Eleven LASIK donor corneas were processed for histology. Twenty-six donor corneas with no known prior keratorefractive surgery also underwent similar slitlamp examination and specular microscopy to serve as controls.RESULTSTwelve (46%) of 26 LASIK donor corneas had an obvious flap edge, and 10 (39%) had a subtle flap edge by slitlamp examination. Four (15%) had infiltrates by slitlamp examination, of which 3 were confirmed by histopathologic examination. Highly reflective particles were seen by specular microscopy in the stroma of 23 (88%) of 26 LASIK donor corneas, but only 1 (4%) of 26 control donor corneas had a single highly reflective particle in the stroma (P<.001). The mean central endothelial cell counts were similar: 2138 cells/mm(2) in the LASIK group compared with 2250 cells/mm(2) in the controls (P =.39). Vacuolization and pyknosis of keratocytes was a consistent histopathologic finding after LASIK. Metallic particles at the interface were not detected by histology.CONCLUSIONSDetection of a flap edge by slitlamp examination may detect at least half of the donor corneas that may have undergone LASIK. The detection of highly reflective stromal particles may form an effective basis for screening for LASIK donor corneas using specular microscopy and requires further study.

Purpose: To determine the effectiveness of a vitamin D analog, 1alpha-hydroxyvitamin D-2 (1alpha-OH-D-2), in inhibiting retinoblastoma in a transgenic retinoblastoma model (LHbeta-Tag mouse) and to evaluate its toxicity.Design: Experimental study using an animal (LHbeta-Tag transgenic mouse) randomized (controlled) trial..Participants and Controls: Two hundred seventeen LHbeta-Tag transgene-positive 8- to 10-week-old mice total; 179 drug-treated animals, 38 control animals.Methods: Mice were fed a vitamin D- and calcium-restricted diet and were randomized to treatment groups receiving control (vehicle), or 0.1, 0.3, 0.5, or 1.0 mug/day of 1alpha-OH-D-2 via oral gavage 5 times weekly for 5 weeks. Body weight was measured at the start of treatment and twice weekly during treatment. Animals were euthanized on the last day of treatment. The eyes were enucleated, processed histologically, and serially sectioned. Representative sections from the superior, middle, and inferior regions of each globe were examined microscopically and tumor areas were measured using Optimas software. Serum was collected for serum calcium levels. Kidneys were removed for histologic processing and were analyzed microscopically for kidney calcification.Main Outcome Measures: Mean tumor area was measured to determine drug effectiveness. Toxicity was assessed by survival, weight loss over the treatment period, serum calcium, and kidney calcification.Results: The mean tumor size in each 1alpha-OH-D-2 group was smaller than controls (all P values < 0.02): control, 90,248 mum(2); 0.1 mug, 31,545 mum(2); 0.3 mug, 16,750 mum(2); 0.5 mug, 30,245 mum(2); and 1.0 mug, 16,049 mum(2). No dose-dependent response curve was evident. The survival percentage for each group was as follows: control, 97%; 0.1 mug, 91%; 0.3 mug, 88%; 0.5 mug, 70%; and 1.0 mug, 63%. Mortality was higher in the 0.5-mug and 1.0-mug doses (P values < 0.01) compared with other treatment groups and with the control group. Serum calcium levels were significant in all treatment groups compared with controls (all P values < 0.0001).Conclusions: In the LHO-Tag mouse, 1alpha-OH-D-2 inhibits retinoblastoma with no significant increase in mortality in lower doses (0.1-0.3 mug). 1alpha-OH-D-2 has approval by the Food and Drug Administration as an investigative drug for cancer treatment, and has shown efficacy with low toxicity in adult cancer trials. 1alpha-OH-D-2 meets the criteria for human clinical trials. (C) 2003 by the American Academy of Ophthalmology.

PURPOSE To study the antineoplastic effect of vitamin D analogues in a xenograft model of human retinoblastoma. METHODS Athymic mice were injected subcutaneously with Y79 cells and treated 5 days a week with either mineral oil (control group) or the vitamin D analogues calcitriol or 1,25-dihydroxy-16-ene-23-yne vitamin D(3) (16,23-D(3)). BrdU was injected 1 hour before death. Animals were killed after 1, 2, 3, or 5 weeks. Paraffin-embedded sections of the tumors were studied for cell proliferation by monitoring for BrdU incorporation and cell death by terminal transferase dUTP-nick end labeling (TUNEL), 3'-overhang ligation, and histology. Sections of the tumors were immunostained for p53 and p21. RESULTS There was no significant difference in incorporation of BrdU among the three groups, suggesting that cell proliferation is unaffected by vitamin D analogues. TUNEL was increased in tumors treated with vitamin D analogues compared with the control group. This increase was statistically significant for calcitriol in the time frame examined, but not statistically significant for 16,23-D(3). Alternatively, the ratio of proliferation to cell death was significantly different for both calcitriol and 16,23-D(3) compared with control tumors after 3 weeks of treatment. Dying cells contained DNA strand breaks with overhanging nucleotides and nuclear changes characteristic of apoptosis. There was an increase in staining for p53 and p21 in areas associated with cell death in specimens treated with vitamin D analogues. CONCLUSIONS Vitamin D analogues appear to attenuate retinoblastoma tumor growth in athymic mice by increasing apoptosis. Cell death is associated with the upregulation of both p53 and p21.

Latanoprost, a selective FP prostanoid receptor agonist used in the treatment of glaucoma, has a hypertrichotic side effect. Using the macaque model of androgenetic alopecia, we examined the effect of latanoprost on hair growth. Eight monkeys were divided into 2 groups; one group received a daily topical application of 50 microg/ml of latanoprost for 5 months; a control group had a daily application of vehicle. For an additional 3 months, 2 monkeys from each group were given 500 microg/ml latanoprost, while the remaining monkeys continued with the previous treatment. Hair growth was evaluated by monthly photographs and phototricho-graphic analysis. Fifty microg/ml of latanoprost caused minimal hair growth. Latanoprost at 500 microg/ml induced moderate to marked hair regrowth with 5-10% conversion of vellus hairs to intermediary or terminal hairs. The vehicle group showed no effect. Further evaluation of latanoprost as an agent for treatment of human androgenetic alopecia is indicated.

Objective: To report visual acuity during the first three years after iodine 125 (I-125) brachytherapy for medium-sized choroidal melanoma and to identify important baseline and treatment factors associated with posttreatment visual acuity in a group of patients who were treated and observed prospectively as part of a large, randomized clinical trial.Design: Observational case series within a randomized, multicenter study.Participants: Patients enrolled in the Collaborative Ocular Melanoma Study randomized trial of I-125 brachytherapy versus enucleation had choroidal melanoma of at least 2.5 mm but no more than 10.0 mm in apical height, and no more than 16.0 mm in largest basal dimension. One thousand three hundred seventeen patients enrolled from February 1987 through July 1998; 657 patients were assigned to I-125 brachytherapy. Visual acuity data for 623 patients who received I-125 brachytherapy as randomly assigned and who have been observed for at least 1 year were analyzed for this report.Methods: Under study protocol, an ophthalmic evaluation, including best-corrected visual acuity measurement of each eye, was performed at baseline, every 6 months thereafter for 5 years, and once yearly thereafter. Two poor vision outcomes, visual acuity of 20/200 or worse that was confirmed at the next follow-up examination and loss of six lines or more of visual acuity from baseline that was confirmed at the next follow-up examination, were analyzed to identify baseline and treatment characteristics that were associated with posttreatment visual acuity.Results: At baseline, median visual acuity in the eye with choroidal melanoma was 20/32, with 70% of eyes having 20/40 or better and 10% of eyes having 20/200 or worse visual acuity. Three years after I-125 brachytherapy, median visual acuity was 20/125, with 34% having 20/40 or better and 45% having 20/200 or worse visual acuity, including eyes that were enucleated within 3 years of treatment. Life-table estimates of percentages of patients who lost six or more lines of visual acuity from baseline, a quadrupling of the minimum angle of resolution, with this finding confirmed at the next 6-month follow-up examination, were 18% by 1 year, 34% by 2 years, and 49% by 3 years after treatment. Life-table estimates of percentages of patients with baseline visual acuity better than 20/200 whose visual acuity decreased to 20/200 or worse, confirmed at the next follow-up examination, were 17% by 1 year, 33% by 2 years, and 43% by 3 years after treatment. As soon as a poor vision outcome was observed, improvement of visual acuity to a level that no longer met the definition for a poor vision outcome was rare. Greater baseline tumor apical height and shorter distance between the tumor and the foveal avascular zone (FAZ) were the factors most strongly associated with loss of six or more lines of visual acuity after treatment. These two factors and baseline visual acuity also were strongly associated with visual acuity 20/200 or worse after treatment. Patient history of diabetes, presence of tumor-associated retinal detachment, and tumors that were not dome shaped also were associated with greater risk for both of the poor vision outcomes.Conclusions: Forty-three percent to 49% of treated eyes had substantial impairment in visual acuity by 3 years after I-125 brachytherapy, defined as a loss of six or more lines of visual acuity from the pretreatment level (49% of eyes) or visual acuity of 20/200 or worse (43% of eyes) that was confirmed at the next 6-month examination. Patients with a history of diabetes and patients whose eyes had thicker tumors, tumors close to or beneath the FAZ, tumor-associated retinal detachment, or tumors that were not dome shaped were those most likely to have a poor visual acuity outcome within 3 years after I-125 brachytherapy. Ophthalmology 2001,108: 348-366 (C) 2001 by the American Academy of Ophthalmology.