The Eyes Have It-Or Do They?

Susan Lewallen,Terrie Taylor

doi:10.4269/ajtmh.17-0045

Abstract

The reference to “classic” malarial retinopathy in the article by Villaverde and others marks a watershed for some of us; it was not always so. Malarial retinopathy might have gone unnoticed for many more years than it did. Its recognition was not the result of a large well-funded grant but rather a serendipitous conversation between friends, over dinner in Blantyre, Malawi, in 1990. Observations by nonophthalmologist clinicians through undilated pupils with direct ophthalmoscopes had revealed hemorrhages, originally described in 1877 by Mackenzie (Figure 1). In 1990, these older observations were superseded, postprandially, by assessments carried out by an ophthalmologist armed with an indirect ophthalmoscope, through pupils dilated with short-acting pharmacologic agents. She quickly corroborated the presence of hemorrhages, but also noted two additional findings: abnormally colored retinal vessels in a seemingly random distribution, unlike those seen in other retinal vascular conditions, and patchy retinal whitening, similar in nature to the opacification in common retinal vein occlusions but in a markedly different distribution.

Highlights

The steps were slow: the ophthalmologist was the only ophthalmologist in the southern region of Malawi, so direct corroboration was difficult
In 1990, these older observations were superseded, postprandially, by assessments carried out by an ophthalmologist armed with an indirect ophthalmoscope, through pupils dilated with short-acting pharmacologic agents
Systematic documentation of the findings in a consecutive series of children, with analysis of their association with outcome was more convincing, and led to the first publication describing the range of findings and linking them to outcome in 1993.3 Further systematic observations via a rotating schedule of volunteer ophthalmologists in the context of an autopsy-based study coupled with better cameras and imaging techniques, revealed the histopathological correlates of malarial retinopathy.[4,5,6]

Summary

Introduction

The steps were slow: the ophthalmologist was the only ophthalmologist in the southern region of Malawi, so direct corroboration was difficult. Systematic documentation of the findings in a consecutive series of children, with analysis of their association with outcome was more convincing, and led to the first publication describing the range of findings and linking them to outcome in 1993.3 Further systematic observations via a rotating schedule of volunteer ophthalmologists in the context of an autopsy-based study coupled with better cameras and imaging techniques (available through a collaboration with Simon Harding, University of Liverpool), revealed the histopathological correlates of malarial retinopathy.[4,5,6]

Results

Conclusion