For those of you with patients who like to hang upside down ...
A study published in the British Journal of Ophthalmology showed that choroidal thickness increased and anterior chamber depth decreased after being upside down for 1.5 minutes.
Life is getting better for our toric presbyopic patients.
Vermont ODs didn’t get the expanded scope they had hoped for.
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WHAT YOUR PATIENT MIGHT ASK YOU
Can my bladder medication cause damage to my eyes?
It can. A new study found a 20% risk of macular toxicity in patients taking the medication pentosan polysulfate sodium (PPS).
What is PPS?
PPS (aka Elmiron) is the only FDA-approved oral medication for the management of chronic bladder pain syndrome, interstitial cystitis. The drug has anticoagulant and fibrinolytic effects.
Tell me about the study.
The study looked at 50 patients who were prescribed PPS between 2013 and 2019. They all underwent a comprehensive eye exam along with fundus photography, 30° and 50° fundus autofluorescence (FAF) of the macula, and multicolor and near infrared (NIR) photography. PPS-associated maculopathy was identified in 10 of the 50 patients screened. Two of the patients were asymptomatic, but others had symptoms of night blindness, distortion, and/or blurry vision.
Were there any trends in the affected group?
Yes, there were two noticeable risks.
1. Longer exposure time. The average length of treatment time in the unaffected group was 4.8 years compared with 19 years for the affected group.
2. Higher dosing. The mean cumulative dose in the affected patient group was significantly greater (median: 3066.0 g) than in the unaffected group (median: 456.3 g).
What did the macula look like?
Features included multifocal hypertrophic, vitelliform-like deposits at the level of the retinal pigment epithelium (RPE) with or without RPE atrophy in a parafoveal distribution. The authors pointed out that these defects could be mistaken for AMD.
How exactly does this drug affect the retina?
PPS inhibits growth factor signaling pathways, especially within RPE cells. One theory is that disruption of these pathways may injure the RPE and block the promotion of health maintenance and regeneration of the outer retina.
How should we follow these patients?
The authors recommend that all patients starting PPS therapy should be referred for baseline spectral domain OCT, NIR, and FAF testing. FAF and NIR are especially important and represent the gold standard for detecting PPS-associated maculopathy. Spectral domain OCT, NIR, and FAF should be repeated annually, especially as cumulative dosages approach or exceed 500 g.
SOCIAL MEDIA ROUNDUP
February is AMD awareness month.
According to Prevent Blindness, AMD is a leading cause of vision loss, affecting more than 2 million Americans age 50 and older.
Seeing well with your glasses? You might be overconfident.
A study in Sweden found that the majority of 70-year-olds were content with their eyesight, but many overestimated how well they can actually see. More than half were actually able to see better with an updated prescription.
See you next week!