Welcome to the first issue of Clinical Insights in Eyecare for 2024! This issue includes five interesting case reports. The case report, Posterior Radiation Optic Neuropathy by Toms, Klein, and Cummings, featured on the cover describes the ravages of radiation therapy for head and neck tumors (a “double-edged sword”). Therapy is needed, although obviously at an expense to vision. The authors point out that any patient with a history of cancer and radiation treatment of the head and/or neck who experiences any change in vision should immediately receive a thorough evaluation. The report highlights the features of postradiation optic neuropathy. Unfortunately, there is a lack of evidence-based information regarding intervention for postradiation neuropathy.
This issue features two case reports highlighting the value of scleral lens use. One case report discusses the many challenges of using scleral lenses in a 3-year-old with an open globe injury. The other describes the use of a scleral lens in a patient with neurotrophic keratitis following an acoustic neuroma, focusing on the benefits of scleral lenses in promoting healing and preventing ulceration/perforation and the caveats in caring for such a debilitating disease.
Another case report highlights conjunctival and macular hyperpigmentation associated with the use of tetracycline and derivative medications (most commonly seen with minocycline). This report discusses the many causes of macular pigmentation, including those medications causing a “bull’s-eye” appearance.
Our fifth case report discusses a rather unique management of combining corneal surgery—Descemet stripping only—for Fuchs dystrophy and then correcting refractive error with a light adjustable lens implant.
This month’s provocative question in our Point/Counterpoint is presented by the Retina Special Interest Group. This group examines options for the patient who is significantly bothered by floaters/vitreous degeneration. We thank Drs. Garg and Pizzimenti for their well-researched and complete discussions. They make noteworthy recommendations on who might want to consider a surgical remedy for floaters. Well-designed studies are certainly needed to fully answer the question as to which procedures make sense in patients who present with troubling symptoms and the appropriate timing for any intervention.
Once again, we thank Drs. Rixon and Bonner for their 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.
If you have considered sending us a case report, start the process now. As always, 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