Welcome to the September issue of Clinical Insights in Eyecare. This issue includes 5 interesting case reports, a clinically relevant point-counterpoint discussion, and multiple journal scans. Our featured case report in this issue, “Solar Retinopathy Secondary to the Viral TikTok Trend ‘#SunGazing’” by Ana Schroeder, Aaron Zimmerman, and Nick Fogt, discusses the alarming trend in using social media for medical advice. The authors note that, unfortunately, most of the information on eye-related topics is provided by non-eyecare providers. They go on to stress the importance of health care providers staying up to date on social media trends. In this case, there were nearly 77 million views of sun gazing. Unfortunately, some social media promoted the trend that staring at the sun can enhance vision.
This issue has 4 additional case reports. One of the reports, “Gross Convergence Therapy for the Treatment of Sensory Exotropia in a Patient With Severe Vision Loss” by Angela Chen and Susan Cotter, looks at a nonsurgical option for sensory exotropia. The authors stress that even when the prognosis for achieving binocular vision is poor with vision therapy, patients may be happy with a cosmetic alignment without having surgery.
Another case report, “Ocular Side Effects of Tyrosine Kinase Inhibitors for Chronic Myeloid Leukemia” by Daniel Kowalsky Moskaliuk and Harriette Canellos, highlights a case of periocular edema in a patient being treated for myeloid leukemia, one of the many ocular side effects from both conventional and nonconventional treatments for blood dyscrasias. Clinicians should be familiar with the list of potential ocular side effects from the newer immune and targeted approaches and procedures for cancer. They also stress it’s important for clinicians to know whether patients with leukemia and other blood dyscrasias have undergone hematopoietic stem cell transplants so that they can be better equipped to identify the presence of graft-versus-host disease.
Our fourth case report, “Proliferative Hypertensive Retinopathy” by Monica Albertson and Lee Vien, looks at an uncommon complication of uncontrolled hypertension. Proliferative retinopathy due to hypertension is exceedingly rare, but clinicians should be able to recognize this complication to avoid significant vision loss when it does occur.
Our last case report, “Scheimpflug Angle Width Insufficient to Rule Out Iridocorneal Angle Closure Risk” by Alexander Hynes, investigates the potential pitfalls in relying too heavily on image assessments of the angle. Pentacam Scheimpflug angle width assessments may not be useful due to misguiding measurements. In this report, Scheimpflug angle width assessments are shown to misrepresent the actual angle in their patients with narrow angles described in this case report. The authors remind us that gonioscopy remains the gold standard in angle assessment and intermittent angle closure is not that uncommon.
This issue’s provocative question in our Point-Counterpoint series is presented by the Comprehensive Eye Care Section, chaired by Danielle Weiler. The writing committee (Stephanie Klemencic, April Lewis, Alissa Coyne, Grace Bissonnette, and Danielle Toms) investigates the use of 5% povidone-iodine (PVP-I) for adenoviral disease. They present a very balanced debate over the question of when, why, and how this treatment should be employed. Of particular note, they stress who should not receive such treatment and why. Available research reviewed in this article specifically looks at using 5% povidone-iodine. Clinicians should weigh the pros and cons when considering PVP-1 use. One of our ophthalmology colleagues contracted adenoviral conjunctivitis last month and used an unconventional approach. He formulated 1% PVP-I in artificial tears and dosed it multiple times a day for more frequent use (more free iodine but less capacity to kill). Overall, it was well tolerated and allowed for the early use of topical steroids for a quicker return to work (after tearing subsided and redness decreased significantly).
Once again, Drew Rixon and Aaron Bonner provide excellent journal scans and 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 commend to you all of the articles cited in this issue’s scans; however, one in particular caught our attention, “Long-term Follow-up of a Phase 1/2A Clinical Trial of a Stem Cell–Derived Bioengineered Retinal Pigment Epithelium Implant for Geographical Atrophy,” which appeared in Ophthalmology 2024;131(6):682-691. There have been many attempts at using stem cell injections and composite replacements in retinal disease. This premarket FDA Phase 1/2A study shows promise in treating geographic atrophy (GA) with bioengineered RPE implants. Phase 2B and 3 studies will follow and hopefully show efficacy in treating GA. We are reminded patients shouldn’t go blind from retinal fluid with the many treatment options (injections) for macular degeneration, but many go blind from GA due to the paucity of treatment options available today.
Our number of case report submissions continues to grow each month. Keep them coming! We are striving to provide a great publication, so please share any suggestions you may have!