Ocular Risks Research Articles

Ultraviolet radiation: ocular risks and prevention

Ultraviolet radiation: ocular risks and prevention

The eye in CHD.

In recent years, there has been a rise in the number patients with CHD surviving into adulthood. Many have complications related to their CHD or its treatments, outside the heart, including ocular abnormalities. The objective of this review is to highlight the ocular abnormalities that occur in adults with CHD, either from their condition or related to the common drugs prescribed to manage it. In particular, we reviewed the effects of cyanosis, coarctation of the aorta, endocarditis, and the side effects of Sildenafil and Amiodarone. A change in the retinal vasculature is a common observation with cyanosis or coarctation of the aorta. Occlusion of the retinal vessels may also be observed in cyanotic patients, as well as those with infectious endocarditis. Sildenafil has established ocular side effects; here they are explored in the context of therapy for pulmonary hypertension. Similarly, Amiodarone has established ocular risks, which are summarised. The high prevalence of ocular consequences in adult CHD patients reinforces the need for knowledge of the risks involved and for frequent ophthalmological screening where appropriate.

Hydroxychloroquine retinal toxicity in two patients with dermatological conditions

Two patients with dermatological conditions developed retinal toxicity after treatment with hydroxychloroquine that exceeded dosing recommendations. There is no treatment for hydroxychloroquine retinal toxicity and associated visual loss, so appropriate monitoring is imperative. All members of a patient's multidisciplinary team should be aware of the ocular risks of hydroxychloroquine, the importance of dosing within recommended guidelines and appropriate monitoring in reducing the risk of visual loss.

An Eye on Travel: An Overview of Travel-Related Ocular Complications

Travellers are at risk of a diverse range of environmental and infectious conditions, some of which may affect the eyes and lead to blindness in severe cases. Travel-related ocular infections include onchocerciasis, leishmaniasis, cysticercosis, trachoma, dengue, loiasis, and leptospirosis. The travel medicine adviser should also recognise other hazards encountered during travel which may adversely affect the eye. These include recreational activities such as high altitude trekking, bungee jumping, skiing, scuba diving, and sun exposure. There is a subset of travellers who have underlying eye conditions, which predispose them to complications during international travel, including angle-closure glaucoma, and expansion of intraocular gas from previous vitreoretinal surgery. Contact lens wearers have a greater risk of ocular infection and corneal erosion during travel, especially where hygiene standards are low. Despite the susceptibility of the eye to infection, traumatic injury and environmental damage during international travel, this topic is not frequently discussed in the context of pre-travel consultations. Travel medicine professionals should have a reasonable knowledge of the major ocular risks associated with travel overseas.

Chronic pesticide exposure and consequential keratectasia & corneal neovascularisation

Ocular toxicity as a consequence of chronic pesticide exposure is one of the health hazards caused due to extended exposure to pesticides. The cornea, due to its position as the outer ocular layer and its role in protecting the internal layers of the eye; is gravely affected by this xenobiotic insult to the eye, leading to ocular irritation and damage to normal vision. The deleterious effects of chronic pesticide exposure on the various corneal layers and the ocular risks involved therein, were explored by mimicking the on-field scenario. Cytological, histological and flowcytometric parameters were taken into consideration to determine the enhanced risk of corneal neovascularisation and keratectasia, specifically, keratoconus. Chronic exposure to pesticides leads to heightened ocular morbidity wherein there were visible pathophysiological changes to the ocular surface. The cornea was found to be adversely affected with visible protuberance in a cone-like shape, characteristic of keratoconus in a majority of the experimental animals. Further analyses revealed a detrimental impact on all the corneal layers and an amplified expression of inflammation markers such as TNF-α, VCAM-1 and ICAM-1. Additionally, it was found that post pesticide exposure, the corneal surface developed hypoxia, leading to a significant increase of angiogenesis promoting factors and consequential neovascularisation. Apart from ocular toxicity, chronic exposure to pesticides significantly increases the risks of keratectasia and corneal neovascularisation; disorders which lead to diminished vision and if untreated, blindness.

Practice Patterns Among Eye Care Providers at US Teaching Hospitals With Regard to Assessing and Educating Patients About Smoking

To investigate practice patterns of eye care providers at academic medical centers in the United States (US) with regard to assessing patients' smoking status and exposure, educating patients regarding ocular risks of smoking, and counseling patients about smoking cessation. Cross-sectional survey. An anonymous survey including multiple choice and Likert-style questions was constructed on http://www.surveymonkey.com and emailed to the coordinators of all 113US ophthalmology residency programs, with a request to forward to all faculty, fellows, residents, and optometrists at their institution. Main outcome measures include proportion of eye care providers who assess patients' smoking status, educate patients regarding ocular risks of smoking, and discuss with patients smoking cessation options. Of the 292 respondents, 229 (78%) "always" or "periodically" ask patients about their smoking status, 251 (86%) "seldom" or "never" ask patients about secondhand smoke exposure, 245 (84%) "always" or "periodically" educate patients about ocular diseases associated with smoking, 142 (49%) "seldom" or "never" ask patients who smoke about their willingness to quit smoking, and 249 (85%) "seldom" or "never" discuss potential methods and resources to assist with smoking cessation. Most eye care providers assess patients' smoking status and educate patients regarding ocular risks of smoking. However, approximately half do not ask, or seldom ask, about patients' willingness to quit smoking, and most do not discuss smoking cessation options.

Injury risk prediction from computational simulations of ocular blast loading.

A predictive Lagrangian-Eulerian finite element eye model was used to analyze 2.27 and 0.45 kg trinitrotoluene equivalent blasts detonated from 24 different locations. Free air and ground level blasts were simulated directly in front of the eye and at lateral offset locations with box, average, less protective, and more protective orbital anthropometries, resulting in 96 simulations. Injury risk curves were developed for hyphema, lens dislocation, retinal damage, and globe rupture from experimental and computational data to compute risk from corneoscleral stress and intra-ocular pressure computational outputs. Corneoscleral stress, intra-ocular pressure, and injury risks increased when the blast size was larger and located nearer to the eye. Risks ranged from 20-100% for hyphema, 1-100% for lens dislocation, 2-100% for retinal damage, and 0-98% for globe rupture depending on the blast condition. Orbital geometry affected the stresses, pressures, and associated ocular injury risks of the blast conditions simulated. Orbital geometries that more fully surrounded the eye such as the more protective orbit tended to produce higher corneoscleral stresses and compression of the eye against the surrounding rigid orbit contributing to high stresses as the blast wave propagated. However, the more protective orbit tended to produce lower intra-ocular pressures in comparison with the other three orbital geometries which may indicate that the more protective orbit inhibits propagation of the blast wave and reduces ocular loading. Results of this parametric computational study of ocular blast loading are valuable to the design of eye protection equipment and the mitigation of blast-related eye injuries.

In vivo and in vitro sustained release of ranibizumab from a nanoporous thin-film device

Current administration of ranibizumab and other therapeutic macromolecules to the vitreous and retina carries ocular risks, a high patient treatment burden, and compliance barriers that can lead to suboptimal treatment. Here we introduce a device that produces sustained release of ranibizumab in the vitreous cavity over the course of several months. Composed of twin nanoporous polymer thin films surrounding a ranibizumab reservoir, these devices provide release of ranibizumab over 16weeks in vitro and 12weeks in vivo, without exhausting the initial drug payload. Following implantation in vivo, devices were well-tolerated and showed no sign of immune response. This platform presents a potential solution to the challenge of delivering protein therapeutics to the vitreous and retina for sustained periods of time.

Amines as occupational hazards for visual disturbance

Various amines, such as triethylamine and N,N-dimethylethylamine, have been reported to cause glaucopsia in workers employed in epoxy, foundry, and polyurethane foam industries. This symptom has been related to corneal edema and vesicular collection of fluid within the corneal subepithelial cells. Exposure to amine vapors for 30 min to several hours leads to blurring of vision, a blue-grey appearance of objects, and halos around lights, that are probably reversible. Concentration-effect relationships have been established. The visual disturbance is considered a nuisance, as it could cause onsite accidents, impair work efficiency, and create difficulties in driving back home. Occupational exposure limits have been established for some amines, but there is shortage of criteria. Volatility factors, such as vapor pressure, should be considered in industrial settings to prevent human ocular risks, while trying to reduce levels of hazardous amines in the atmosphere.

Recent Innovations in Medical and Surgical Retina.

To summarize major innovations in retinal disease management during fiscal year 2014. Literature review. A subset of papers published in the peer-reviewed literature were selected. Major innovations in retina include: (1) advances in the treatment of diabetic macular edema, including the use of aflibercept and sustained delivery dexamethasone intravitreal implants as well as subthreshold micropulse diode laser therapy; (2) reduced progression of age-related macular degeneration (AMD) using zinc, vitamin C, vitamin E, lutein, and zeaxanthin supplements as reported in the Age-Related Eye Disease Study-2; (3) use of enhanced-depth imaging optical coherence tomography for choroidal imaging; (4) use of gene therapy to treat choroideremia; (5) use of combination pharmacotherapy (i.e., squalamine + ranibizumab) and gene therapy to treat the neovascular complications of AMD; and (6) use of stem cell-derived retinal pigment epithelium transplants to treat atrophic AMD and Stargardt macular dystrophy. In addition, we review the ocular and systemic risks associated with sustained intraocular steroid delivery and inhibition of vascular endothelial growth factor signaling pathways. We also review potential applications of gene- versus cell-based therapy for the treatment of retinal degenerative diseases. Several treatment approaches are effective in the treatment of diabetic macular edema. Prophylaxis against AMD progression with Age-Related Eye Disease Study-2 supplements seems to reduce the risk of developing neovascular but not atrophic complications of AMD. Enhanced-depth imaging optical coherence tomography data provide new information on the role of the choroid in a variety of conditions. Advances in gene- and cell-based therapy will revolutionize the development of regenerative medicine in ophthalmology.

Pars Plana Vitrectomy for Vitreous Floaters

Pars Plana Vitrectomy for Vitreous Floaters

Interferon-associated retinopathy in a patient with metastatic melanoma.

We present the unusual case of a 35 year-old woman with stage IV melanoma and widespread metastases, who was undergoing treatment with interferon alpha-2b and who presented with interferon-associated retinopathy. The patient, who had been taking interferon treatment for three months, complained of a sudden loss of visual acuity in the left eye. An ocular examination revealed multiple cotton wool spots along the retina and macular involvement. Interferon treatment was suspended. Although rare, retinopathy represents a potentially serious adverse effect of interferon treatment. Although normally patients are asymptomatic, complications derived of its use may arise, which can lead to significant visual impairment. We therefore suggest that before initiating treatment with this drug, patients should be informed of its potential ocular risks, and that regular eye examinations are conducted along with the treatment.

What practitioners and your patients understand about UV

Purpose: A primary role that Eye Care Professionals perform is to make patients aware of avoidable ocular health risks. Research into patient and practitioner understanding of chronic UV exposure implications was conducted to see how this relates to communication imperatives.

Sildenafil for Pediatric Orbital Lymphangioma

Orbital lymphangiomas, congenital hamartomas of the lymphovascular tissue, are often associated with significant ocular complications and can be challenging to treat. To date, therapeutic approaches have demonstrated variable results and have significant ocular and systemic risks. We present 2 cases of pediatric orbital lymphangioma that responded to treatment with oral sildenafil. This is a report of a series of 2 patients at the University of California-Davis Medical Center treated between March 2011 and October 2012. The first patient was a 12-month-old male infant whose extensive orbital and facial lymphangioma responded to sildenafil after repeated sclerosing and drainage procedures failed to achieve remission. The second patient was a 12-year-old boy whose orbital lymphangioma and associated ocular pain improved with sildenafil, making enucleation unnecessary. These reported cases demonstrate promise for sildenafil as a noninvasive therapy for pediatric lymphangioma. Larger clinical trials are needed to clarify the optimal length of treatment, use as monotherapy, and long-term adverse effects.

Topical ocular anesthetic abuse among Iranian welders: Time for action

Purpose:The purpose of this study is to estimate the prevalence of topical ocular anesthetic abuse among welders in Iran and suggest public health solutions for this issue.Methods:In this cross-sectional study, 390 welders were randomly recruited and queried on the use of anesthetic drops. A questionnaire was administered through structured one-on-one interviews conducted by the first author.Results:A total of 314 welders (80.5%) declared that they had used topical anesthetics at least once during their working lives. Almost 90% of them stated a preference for self-treatment over seeking help from a physician due to cultural and financial reasons. The most commonly used topical anesthetic was tetracaine. Most of the subjects (97.4%) had obtained the drugs from pharmacies without a prescription.Conclusions:The prevalence of topical ocular anesthetic abuse among welders in Iran is alarmingly high and may partially be due to cultural issues. Although most physicians are aware that topical anesthetics should only be used as a diagnostic tool, there is a crucial need to re-emphasize the ocular risks associated with chronic use of these medications. Educational programs for both physicians and the public are necessary to address the problem.

Adverse ophthalmic reaction in poppers users: case series of ‘poppers maculopathy’

Poppers are a recreational substance of abuse belonging to the alkyl nitrite family of compounds. In the United Kingdom, where they are legal to purchase but illegal to sell for human consumption, 10% of the general population have tried them. They are considered low risk to physical and mental health. Two recent case series from France demonstrated foveal pathology in individuals associated with poppers use. A case series of seven patients presenting to four hospitals in the United Kingdom with visual impairment and maculopathy associated with inhalation of poppers. All patients experienced visual symptoms associated with poppers use. The majority had impaired visual acuity, central scotomata, distortion, or phosphenes. Clinical signs on fundoscopy ranged from normal foveal appearance to yellow, dome-shaped lesions at the foveola. Spectral domain optical coherence tomography (SD-OCT) showed varying degrees of disruption of the presumed inner segment/outer segment (IS/OS) junction. Although poppers have been in use for several decades, in 2007, following legislative changes, there was a change in the most commonly used compound from isobutyl nitrite to isopropyl nitrite. There were no reports of 'poppers maculopathy' before this. Poppers maculopathy may be missed if patients are not directly questioned about their use. The disruption or loss of the presumed IS/OS junction on SD-OCT are a characteristic feature. Further study of maculopathy in poppers users is now needed. Raising public awareness of the ocular risks associated with their use may be necessary.

Systemic and Ocular Risks Associated With Therapies for Macular Degeneration: Clarification vs Confusion

Systemic and Ocular Risks Associated With Therapies for Macular Degeneration: Clarification vs Confusion

Systemic and Ocular Risks Associated With Therapies for Macular Degeneration: Clarification vs Confusion—Reply

Systemic and Ocular Risks Associated With Therapies for Macular Degeneration: Clarification vs Confusion—Reply

Clinical safety of ranibizumab in age-related macular degeneration

Importance of the field: Clinical safety of pharmaceutical products in the elderly is vital because of their increased risk of cardiac and other adverse events.Areas covered in this review: Search of the Medline database, including articles and abstracts from 1984 to 2009.What the reader will gain: Knowledge of ocular and systemic risks: The rate of endophthalmitis was 0.05% per injection (MARINA) and <0.1% per injection (ANCHOR), rates confirmed in a retrospective analysis of 14,320 injections. Moderate increases in intraocular pressure were transient, and incidences of intraocular inflammation were rarely serious. Systemic arterial thromboembolic events occurred in 4.6 and 0% of ranibizumab-treated patients and in 3.8 and 0% of sham-treated patients in MARINA (2 years) and PIER (1 year), respectively. In SAILOR, there was a numerically higher rate of cerebrovascular stroke with 0.5 mg ranibizumab compared with 0.3 mg ranibizumab (1.2 vs 0.7%), which was a non-statistically significant trend in patients with a history of stroke.Take home message: Although further studies to investigate the risk of stroke with ranibizumab therapy are required, repeated intravitreal ranibizumab was well tolerated and not associated with clinically significant safety risks during up to 2 years of treatment.

COMBINATION PHOTODYNAMIC THERAPY AND INTRAVITREAL RANIBIZUMAB IN NEOVASCULAR AMD IN A NORTH INDIAN POPULATION

To evaluate photodynamic therapy (PDT) with verteporfin along with intravitreal Ranibizumab in treatment of neovascular age related macular degeneration. This prospective interventional care series included 16 patients (17 eyes) of choroidal neovascularization secondary to neovascular AMD, who were treated with PDT with verteporfin followed by an injection of 0.5mg Ranibuzimab on the same day. The main outcome measures were best corrected visual acuity (VA) as recorded by both Snellen's and ETDRS charts (logMAR), contrast sensitivity (Pelli-Robson Chart), retreatment frequency and frequency of side effects. Seventeen eyes underwent PDT with verteporfin and intravitreal 0.5mg Ranibizumab, following PDT. Patients were followed up every month for a total period of 6 months. Initial VA ranged from CF to 20/32 and final acuity ranged from CF to 20/20. VA stabilizes (gain/loss <2 lines) in 14 out of 17 eyes (82.24%) and improved in 3 out of 17 (17.65%). Contrast sensitivity improved in 15 out of 17 eyes (82.24%) Lesion type, patient age had no influence on the outcome. There were no cases of ocular/systematic adverse events. Retreatment was required in only 2 out of 17 cases (11.76%) with only a single injection of ranibizumab. The combination of PDT with intravitreal Ranibizumab improves contrast sensitivity and stabilizes vision and reduces the number of retreatments, without significant ocular and/or systematic risks.