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Altitude May Affect Eye Health, Vision

A recent study published in BMC Ophthalmology examines the potential risks of high-altitude environments on the optic disc, drawing from a small case series of Tibetan hikers. The study highlights the physiological challenges posed by high altitudes, where lower oxygen levels and atmospheric pressure can lead to hypoxic conditions affecting the optic nerve. The case series describes six patients (five males and one female) between 22 to 43 years of age, who experienced visual disturbances after trekking at altitudes of between 3,900 and 5,300 meters. Five of the hikers presented with decreased visual function and visual field defects. However, only one was diagnosed with nonarteritic anterior ischemic optic neuropathy (NAION), characterized by optic disc edema and altitudinal visual field loss. The other cases showed optic disc changes without a precise NAION diagnosis, suggesting possible high-altitude optic neuropathy, though diagnostic criteria remain undefined.

For optometrists, this underscores the importance of considering environmental factors in patients with a history of high-altitude exposure. The study notes that high-altitude retinopathy, marked by retinal hemorrhages and vascular changes, is better documented, but optic disc pathology is less understood. Hypoxia-induced vascular dysregulation may contribute to optic nerve ischemia, particularly in susceptible individuals. Clinicians should be vigilant for symptoms such as blurred vision or visual field defects in patients who have recently traveled to high altitudes, especially above 3,000 meters. Comprehensive evaluations, including fundus photography, OCT, and visual field testing, are critical for differentiating high-altitude effects from other optic neuropathies. While the study’s small sample limits generalizability, it raises questions about the need for pre-trek eye exams and patient education on altitude-related risks. Optometrists should advocate for further research to establish diagnostic criteria and management protocols for high-altitude optic neuropathy.

My Two Cents

I’ve always been curious about how exercise and traveling affect the eye. This (extremely) small study offers information on both, so I had to profile it. I know it involves only six patients, but it makes sense logically! We understand that the higher our altitude, the more difficult it is for us to breathe. The Tibetans are notorious for living in these extreme elevations. (For those unaware, a little peak called Mount Everest lies on the border between Nepal and Tibet.) I would be interested to see data from the American Academy of Ophthalmology’s Intelligent Research in Sight Registry to see if there are statistically significantly higher rates of NAION or optic disc edema compared with flatlanders, such as those of us here in Louisiana.

OUTSIDE THE LANE

A PSA for Patients to Seek Professional Advice for Eye Issues

A recent article on National World highlights a critical case for optometrists, detailing how Jordan Niles, a 28-year-old father of two narrowly escaped death after initially dismissing what he thought was conjunctivitis. On March 24, Niles woke with a sore right eye, treated it with sterile water, and continued his routine, assuming it was a minor issue. Within 2 days, his condition worsened dramatically. His eye throbbed, swelled, and partially closed, causing temporary blindness and facial swelling that tripled the size of his face. Urged by his wife Courtney, Niles visited a pharmacy, where he was directed to go to the hospital. A CT scan, eye tests, and antibiotic IV drip at the emergency department revealed orbital cellulitis. Doctors warned that if left untreated, the infection could have spread to the optic nerve or brain, potentially costing Niles his sight, or even his life.

The National Health Service notes that orbital cellulitis causes redness, swelling, and pain and can obstruct the optic nerve or retinal blood supply, leading to permanent vision loss if not addressed promptly. Niles’ case underscores the importance of timely intervention for eye symptoms that persist or worsen beyond typical conjunctivitis. For optometrists, this serves as a reminder to educate patients on recognizing red flags such as severe swelling, pain, or vision changes and advocate for urgent medical evaluation when symptoms suggest a deeper infection. Niles credits Courtney’s persistence for saving his life, emphasizing the role of family in prompting action.

My Two Cents

It's not exactly Outside the Lane material, but I thought it was important to share. You could always post this on your social media to remind your followers that even the dreaded “pink eye” that every patient self-diagnosis could be so much more and that timely visits to see their eye doctor are incredibly important!

CAN YOU RELATE

A few years ago, I shared how I had been dealing with burnout professionally. Burnout is often defined as a state of chronic physical, emotional, and mental exhaustion caused by prolonged workspace stress. It typically results from excessive job demands, long hours, or an imbalance between effort and reward. I was (thankfully) able to push through the factors contributing to my burnout and am not feeling it anymore—at least not to an extent that it affects my daily life.

Be that as it may, I’m still interested in anything having to do with burnout, as it affects many and lurks in the shadows, ready to reclaim your soul if you let it. That said, a new study on the topic has been released, headed by Kaleb Abbott, OD, MS, FAAO, and his findings are extremely interesting. He and his colleagues sought to determine the prevalence of burnout among optometrists and identify any demographic or clinical factors associated with said burnout. In his study, 1,436 optometrists responded, with 53.6% exhibiting burnout and 61.4% describing their burnout as mild, 30.4% as moderate, and 8.2% as severe. Also of note is that female optometrists reported much higher burnout rates than their male counterparts, with 60.9% of females and 40.6% of males reporting burnout. Those with children reported less burnout than those without (49.6% vs 61.0%, respectively), those with a spouse/partner reported lower burnout than single optometrists (47.7% vs 53.3%, respectively), and those in the middle of their careers (5-29 years) reported the highest rates of burnout compared with those practicing less than 5 years (51.1%) and those practicing more than 30 years (33.7%).

Additionally, those using electronic health records reported higher rates of burnout, while those practicing in private and academic settings also reported the lowest burnout rates.

Fascinating stuff, Dr. Abbott! One recommendation from me, however, is that future studies broaden the pool of doctors. The list of optometrists surveyed were obtained via listservs from the American Academy of Optometry and other optometric societies. In my experience (with an n=1), those doctors who seem to be the most disenfranchised and burned out typically are not those with “FAAO” after their name or those who are active in their local societies (or even members). I’m unsure how to get those doctors' information to the poll, but it would be interesting to see if doing so would change the numbers.