Welcome to the April issue of Clinical Insights in Eyecare. This issue includes 4 interesting case reports/series. The Case Series: Neuroplasticity and Vision Therapy in Adults with Unilateral Small-Angle Esotropia by Silvia Han, Jeffrey Baker, and Erin Jenewein is featured on our cover. They present 3 interesting case reports of adults with unilateral esotropia who achieved random dot stereopsis with vision therapy. These 3 cases highlight the success that can be attained in motivated adult patients when visual therapy is used. This suggests neuroplasticity continues even through adult life. Vision therapy can facilitate this process in adult patients with longstanding strabismus to achieve stereopsis.
This issue has 3 additional case reports. One of the reports describes the use of neurotization (nerve grafting), an indirect interpositional technique, in a child aged 3 years with a neurotrophic cornea/ulcer secondary to a hypoplastic trigeminal nerve. Multiple topical therapies were used to treat the recalcitrant ulcer and provided short-term relief. It’s fascinating to think about retrograde neuronal restoration of the trigeminal nerve from the rerouted sural donor nerve graft. A timely patient-focused therapy is crucial to minimize the potential risk of corneal infection. Read this challenging case report to learn more about this effective surgical remedy for neurotrophic keratopathy.
Another one of the case reports highlights the ravaging morbidity and high mortality rate with glioblastomas due to its unfortunate daily growth rate. This report describes visual field defects and hallucinations associated with this parietal lobe brain tumor. Surgical resection is associated with its own morbidity and dysfunction impairing neurosensory function.
Our last case report in this issue describes the potential for adverse events in patients with atopic disease taking the monoclonal antibody, dupilumab. Dupilumab is a fully human monoclonal immunoglobulin G antibody that blocks the shared interleukin 4 and interleukin 13 receptor, thus having a direct effect on the ocular surface ecosystem and in particular, goblet cells. Dupilumab is a highly effective treatment for atopic diseases and, in many instances, can still be used with careful monitoring for adverse ocular surface changes. The authors carefully point out that the exact mechanisms in which dupilumab causes or exacerbates ocular surface disease is yet to be determined.
This issue’s provocative question in our Point/Counterpoint is presented by the Retina Special Interest Group. Jessica Haynes and Rachel Steele from the Charles Retinal Institute in Memphis, TN, examine treatment options for the patients who have moderately severe to severe nonproliferative retinopathy without significant macular edema. Until recently, this group has been excluded from the treatment protocols. Recent evidence has shown some improvement in the Diabetic Retinopathy Severity Score (DRSS) and a decreased risk of sight-threatening complications in diabetic patients with moderately severe or severe nonproliferative retinopathy who lack center-involved macular edema treated with intravitreal antivascular endothelial growth factors. Controversy exists regarding any long-term benefits as it relates to the proper endpoints and the concerns for potential rebounds from abruptly stopping the injections.
Once again, Drew Rixon and Aaron Bonner provide excellent journal scans, pertinent reviews from other publications, for this month’s issue. The reviews are chock-full of valuable pearls on several topics that should help us provide better care for our patients.
The Academy thanks all who have submitted case reports and looks forward to receiving many more in the future. Keep them coming! We are striving to always provide a great publication, so we look forward to hearing from you with any suggestions.
Joseph P. Shovlin, OD, FAAO
Editor-in-Chief
Raman Bhakhri, OD, FAAO
Associate Clinical Editor