Welcome to the December issue of Clinical Insights in Eyecare. This issue includes 5 diverse case reports, a clinically relevant point-counterpoint discussion, and multiple journal scans. Our featured case report in this issue, “Acute Macular Neuroretinopathy Following Hepatitis A and Typhoid Vaccinations,” by Bradley Salus, OD, FAAO, highlights the clinical presentation and chronicity of acute macular neuroretinopathy and identifies new risk factors after hepatitis A and typhoid vaccination. The author describes a patient who presented with a persistent paracentral scotoma with a multimodal retinal image confirming outer retinal disease. Clinicians should be aware that routine vaccinations, including hepatitis A and typhoid vaccinations, may potentiate an immune response causing various ocular complications, including acute macular neuroretinopathy.

This issue has 4 additional case reports. One of the reports, “Multiple Intraocular Metallic Foreign Bodies After Phacoemulsification,” by Benjamin I. Graham, OD, FAAO, describes a case of multiple retained metallic foreign bodies in the cornea at the incision site, paracentesis site, and iris stroma following cataract surgery. Fortunately, the retained material remained unchanged for over 2 years of observation. He stressed that when contemplating surgical removal, shared decision-making integrates the patient’s goals, values, and preferences as they relate to any medical decision.

Another report (case series), “Optically and Retinally Induced Aniseikonia,” by Grace Brasel, OD, FAAO, used the Awaya New Aniseikonia Test to measure image size differences. Spectacles were prescribed to decrease the perceived image size difference between the 2 eyes and improve symptoms. Symptoms associated with aniseikonia include diplopia, headache, eyestrain and pain, eye fatigue, distorted spatial perception, and dizziness.

Our fourth report (case series), “Geographic Corneal Epithelial Defects Secondary to Presumed Epidemic Keratoconjunctivitis,” by Katheryn Hohs, OD, FAAO, Negar Sohbati, OD, FAAO, and Megan Byer, OD, FAAO, highlights large corneal defects, a relatively uncommon corneal finding secondary to presumed epidemic keratoconjunctivitis. These large and superficial defects respond nicely to bandage lens application with antibiotic prophylaxis therapy.

Our last case report, “Xerophthalmia as the Initial Finding in a Patient with Multiple Vitamin Deficiencies and Alcoholic Cirrhosis,” by Betty Z. Li, OD, and Angela Shahbazian, OD, FAAO, shares an interesting case of xerophthalmia due to severe vitamin deficiencies secondary to liver cirrhosis and alcohol abuse. The authors share the pathognomonic signs of vitamin A deficiency and the critical need to identify its cause. They note that other vitamin deficiencies in addition to vitamin A are common. Alcoholism results in multiple deficiencies due to poor nutrition, malabsorption, and liver disease.

The “Cornea, Contact Lenses, and Refractive Technologies” section presents this issue’s provocative question in our Point-Counterpoint series, “Treating Corneal Haze With 0.8 mg/mL Topical Losartan.” The writing committee, Andrew Pucker, OD, PhD, FAAO, Melanie Frogozo, OD, FAAO, Marsha Malooley, OD, FAAO, and Jennifer Harthan, OD, FAAO, opines on the potential merits of using losartan for treating corneal scarring. Topical losartan has potential uses for any significant injury to the cornea by impeding transforming growth factor β signaling. A list of possible uses includes thermal or chemical burns, microbial keratitis (bacterial, fungal, protozoan), herpetic keratitis, persistent epithelial defects (including neurotrophic keratitis), and other injuries such as lacerations or surgical complications of the cornea. Conjunctival fibrotic diseases such as ocular cicatricial pemphigoid and Stevens-Johnson syndrome are also part of a list of potential uses. Additional uses may apply to glaucoma surgery (filtering and tube procedures) and even diabetic retinopathy or other fibrotic retinal diseases. Active infections will always require concurrent antimicrobial therapies. In addition, losartan should help with existing scars and haze following late photorefractive keratectomy haze, breakthrough haze, and complicated LASIK, SMILE, or corneal crosslinking haze.

Once again, Drew Rixon, OD, FAAO, and our new journal scan editor, Eddie Chu, OD, FAAO, provide excellent journal scans and pertinent reviews from other publications for this month’s issue. (A special thank you to Aaron Bonner, OD, FAAO, who provided wonderful reviews the past 2 years.) 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 the articles cited in this issue’s scans. One, in particular, caught our attention, “Repeated Low-Level Red Light Therapy for Myopia Control in High Myopia Children and Adolescents: A Randomized Clinical Trial,” which appeared in a recent issue of Ophthalmology. A stronger treatment efficacy when compared with a spectacle lens-only control was demonstrated with repeated low-level red light therapy. Axial length shortening was experienced in 53.3% of the red light treatment group. Additional studies looking at regression will be needed.

As I have overextended my initial 2-year commitment, I’d like to announce that this will be my last issue as Editor-in-Chief. I want to thank the Academy’s Board of Directors for their confidence in appointing me as the first Editor-in-Chief and Founding Editor. A very special thank you to our new Editor-in-Chief, Raman Bhakhri, who has served admirably as both Associate Editor and Managing Editor over these opening years. Raman is an amazing educator, clinician, and researcher and will be an exceptional leader. I look forward to working with him in a more limited editorial capacity for a few more years. I’d also like to thank our talented topical editors who have contributed significantly to our success and Kayla Ritten, our Academy staff liaison for her logistical expertise. I have immensely enjoyed working with such a talented group.

We welcome our new Associate Editor, Jim Williamson, who will bring a wealth of knowledge and expertise to the journal.

Keep those case reports coming!

Joseph P. Shovlin, OD, FAAO
Editor-in-Chief

Raman Bhakhri, OD, FAAO
Associate Clinical Editor