Long-term anatomical and functional findings of solar maculopathy

BACKGROUND

Solar maculopathy (SM) is a rare cause of acquired maculopathy related to direct viewing of the sun. Primary symptoms include central scotomata, blurred vision and/or metamorphopsia due to thermal/photochemical damage to foveal photoreceptors.

METHODS

Patients were identified from clinic records surrounding a solar eclipse. Clinical examination and multimodal retinal imaging were performed at each follow-up visit. Informed consent was provided by each patient for publication of anonymized data.

RESULTS

Seven affected eyes of 4 patients (mean 21.75 years, all female) were identified with mean presenting visual acuity (VA) of LogMAR 0.18. Well-defined photoreceptor ellipsoid zone (EZ) defects were identified on optical coherence tomography (OCT) for all eyes. VA improved for all eyes (median 12 letter improvement) over a mean 5.7-year follow-up (range 5 months to 11 years).

CONCLUSIONS

While no effective treatment has been identified for SM, VA can significantly improve in some cases, but persistent scotomata are reported and may be debilitating; thus, prevention by public health measures remains critical.

Eye disease and international travel: a critical literature review and practical recommendations

RATIONALE FOR REVIEW

Eye diseases pose a significant public health and economic burden, particularly for travellers exposed to ocular hazards who may lack access to specialist eye care. This article offers an evidence-based review for travel-health practitioners, with a particular emphasis on ocular infections and trauma that are more prevalent among travellers. Providing an overview of these issues will allow travel health practitioners to comprehensively address ophthalmic considerations of travel.

METHODS

A systematic literature search was conducted on PubMed and Embase electronic databases, using keywords related to travel medicine and ophthalmology. Inclusion was based on the relevant contribution to epidemiology, aetiology, diagnostics, management and long-term consequences of travel-related eye conditions. The data were analysed using narrative synthesis.

KEY FINDINGS

This literature review highlighted that various travel-related eye conditions may occur. Travellers should be aware of the risk of travel-related ocular complications, which can arise from ocular infections, high-risk activities, high altitude and space travel. The economic and logistical challenges associated with medical tourism for ophthalmic procedures are discussed. For travellers with pre-existing eye conditions or visual impairment, careful planning may be needed to promote eye health and ensure safety of travel.

CONCLUSIONS

Travel medicine practitioners should have a comprehensive understanding of the major ocular risks associated with overseas travel, including eye infections, eye injuries and solar eye damage. Further research in this area can enhance overall wellness and alleviate the burden of ocular diseases on travellers. Evidence-based guidelines based on research can also improve the quality of care and prevent long-term vision problems.

Differentiating primary dry eye disease from ocular neuropathic pain: implications for symptom management

CLINICAL RELEVANCE

Eyecare practitioners' management of ocular surface disease is essential in managing increasing dry eye disease (DED) presentations including ocular neuropathic pain (ONP). Topical Proxymetacaine offers a simple, readily available and practical method of detecting ONP in practice and can be used to differentiate ONP from DED by eyecare practitioners, when accompanied with an anterior segment examination.

BACKGROUND

Differentiating DED from ONP presents a significant opportunity to eyecare providers, allowing appropriate treatment choices for more adequate symptom control, greater patient satisfaction, and reduced emergent re-presentations. This study aims to differentiate patients presenting with DED symptoms into DED or ONP using a simple diagnostic tool, which can be used in practice to allocate appropriate treatment options for the patient's respective condition. A comparison of the prevalence of presentations of ONP presenting with DED symptoms in hospital ophthalmology settings and in optometric primary care settings will also be made.

METHODS

Patients with symptoms of DED were opportunistically recruited as they presented to ophthalmology outpatient clinics and primary care optometric services. Patients were then categorised as DED, ONP, or mixed DED/ONP based on their subjective response 30 seconds post-Proxymetacaine Hydrochloride 2% instillation.

RESULTS

Twenty-one patients were recruited, including 12 patients from ophthalmologic outpatient clinics and nine patients from primary care optometric services. Twelve patients were identified to have primary DED, while nine patients were identified to have ONP. 43% of patients presenting with DED symptoms had features of neuropathic pain in ophthalmologic outpatient presentations compared to 44% of patients in primary care optometric services.

CONCLUSION

Categorising DED and ONP patients by their response to Proxymetacaine can be used as a simple diagnostic tool in guiding future patient management and can be indicative of their potential response to topical therapies. The use of topical Proxymetacaine and the resultant change in ocular pain score can facilitate selection of patients who may benefit from centrally acting neuropathic pain agents over topical ocular therapy.

Insidious ocular surface lesion in an 81-year-old woman

Ocular surface melanoma (OSM) is rare. An 81-year-old Caucasian woman presented with a 4-month history of right eye pain and reduced vision. Histopathological examination of the excisional biopsy identified invasive amelanotic melanoma of the conjunctiva expressing Melan A and SOX10. X-ray of chest, CT of liver and MRI of the brain and orbit did not identify macroscopic metastases. She was given adjuvant topical mitomycin-C 0.04% for four cycles of 2 weeks. Her vision improved and the cornea was clear at 6 months.

Investigating the Role of Optometrists in Teleophthalmology and the Implications of Increasing Access to Advanced Imaging Techniques and Digital Referral: A Systematic Search and Review

Introduction: The objective of this systematic search and review was to investigate the role of optometrists in teleophthalmology and digital referral. We examine the implications of the optometric communities' increasing access to advanced imaging, such as optical coherence tomography (OCT), in ophthalmic telemedicine schemes. Methods: A systematic search was conducted, using PubMed and Embase, in April of 2019. Eight hundred eight (n = 808) texts were retrieved and 99 articles were deemed eligible for full-text review. Twenty-six (n = 26) studies were included in the qualitative synthesis. All studies involved optometrists as principal service providers. Results: Findings demonstrate that optometrist-facilitated teleophthalmology results in consistent reductions in hospital referrals and waiting times, as well as high patient satisfaction. Optometrists are identified as crucial to the success of many projects and their access to advanced imaging technology is observed to position optometry practices as the most convenient location to establish a teleophthalmology program. OCT imaging demonstrated the potential to increase diagnostic accuracy and is increasingly prevalent in optometry practice. The importance of additional training for optometrists participating in teleophthalmology schemes is highlighted, as is the need for appropriate remuneration for those involved. Conclusion: The role of community-based ophthalmic care in reducing demands on hospital eye services (HES) is highlighted by our results, demonstrating that optometrist-facilitated teleophthalmology can dramatically reduce referrals and streamline care. In addition, the increasing prevalence of OCT in optometric practice represents an underutilized resource for HES.