Welcome to the June issue of Clinical Insights in Eyecare. This issue includes 4 interesting case reports, a fascinating point/counterpoint, and multiple journal scans. This issue’s featured report, “A Changing and Fragile Landscape—Contact Lens Fitting After Corneal Cross-linking” by Elaine Chen, discusses the nuances of fitting lenses after a corneal cross-linking procedure. It’s well established that both corneal topography and pachymetry continue to change for some time after cross-linking, often making a postprocedure lens fitting a challenge. A highlight in this report shows that corneal-bearing lenses may not be easily tolerated despite what appears to be adequate corneal healing. Also, previously successful lens wear will often necessitate the use of a scleral lens to restore vision.
This issue has 3 additional case reports. One of the reports, “Bilateral Retinal Edema after Gastrointestinal Bleed” by Kirsten Canini, describes an anemic retinopathy and how the bleed sets up a cascade for ocular complications as well as systemic concerns. A rapid recovery following successful treatment for anemia and patient history aided in making the differential diagnosis.
Another one of the case reports, “Diagnosing Arteritic Anterior Ischemic Neuropathy Secondary to Giant Cell Arteritis: Utilizing the Updated 2022 American College of Rheumatology/European Alliance of Associations for Rheumatology Classification Guide as an Aid” by Sarah Thomas, highlights the benefits in using this classification guide to assist in making a timely diagnosis. This guide appears to enhance the accuracy and efficiency of making a giant cell arteritis diagnosis. We should be reminded that when there is clinical suspicion, immediate use of steroids is a necessity. An artery biopsy and/or ultrasound, generally the temporal artery, is needed to guide further treatment. There are several risk calculators that can also be used looking at pertinent risks (age, sex, temporal pain, jaw claudication, and key blood markers) that can help direct appropriate management. The author is quick to point out validation is always necessary to gauge any classification’s effectiveness in stratifying potential cases.
Our last case report/series, “Case Series of Chorioretinal and Choroid Folds” by Jacqueline MacCallum and Danielle Weiler, describes undulations/folds of the inner choroid, outer retina, and Bruch membrane occasionally seen with a dilated retinal examination. The authors highlight the key components in making the important differential diagnosis that includes many different ocular and extraocular conditions. A wide array of testing is recommended, including orbital imaging.
This issue’s provocative question in our Point/Counterpoint series is presented by the Glaucoma Section. Written by Rex Ballinger, Sarah MacIver, Michael Sullivan-Mee, and Pathik Amin, it examines first-line therapy options for glaucoma. Specifically, are we at the point at which we recommend selective laser trabeculoplasty as first-line treatment prior to initiating a topical agent? In many countries, selective laser trabeculoplasty is tried before using any topical agent. The Laser in Glaucoma and Ocular Hypertension Trial (LiGHT) study provides evidence supporting its efficacy in first-line therapy and the benefits of laser first may be more profound in patients that have never used topical agents in the past. It’s clear that many patients are suitable candidates for first-line laser treatment, but not all are ideal for such an option. Multiple factors, including anticipated patient compliance, access to laser treatment, baseline intraocular pressure, etc, must be assessed prior to making any recommendations to your patient, and these factors have been admirably highlighted by each discussant.
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. We bring your attention to a few of the articles cited in this issue’s scans. One in particular caught our attention, “Risk of Alzheimer’s Disease and Related Dementias in Persons with Glaucoma: A National Cohort Study.” There appears to be a higher risk of dementia with an increasing age of glaucoma diagnosis. Also, different forms of glaucoma carried a different risk for the type of dementia diagnosed.
Our number of case report submissions is growing tremendously. 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