James Kundart OD MEd FAAO FCOVD-A 7/15/18 Opt 702 Lecture #8 Eclipses, Climate 2018 Victoria Change, & the Eye Conference After this course, the practicing optometrist will know how to Pacific University prevent, differentially diagnose, College of Optometry and treat (when possible): Le Learn rning 1. Heat-induced cataract and James Kundart OD Ob Object ectives es exfoliation MEd FAAO FCOVD-A 2. UV-induced pterygia Financial Disclosures: 3. Climatic droplet keratopathy Nothing to Disclose 4. Retinal snow blindness https://en.wikipedia.org/ 5. Solar and eclipse retinopathy wiki/Photokeratitis Ultraviolet Radiation and Climate Change Cl Climate e Va Variables Th That A Affect Hea Health Ca Care: e: UV and Heat! an https://www.ncbi.nlm.nih.gov/pubmed/23722672 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5820813/ UV UV E Effects: Heat-In He Induced Basal Cel Ba Cell (G (Gla lassb ssblo lower’s) s) Ca Carci cinoma Cataract and Ca of the Ey of Eyelid: Lens Le s Exfolia liatio ion Ea Early or Late Ca Case #1: 1: 83 83 YOF Ex Exposure? https://www.jstage.jst.g o.jp/article/jnms/74/1/ https://www.ncbi. 74_1_55/_pdf/-char/en nlm.nih.gov/pub med/23722672 1
James Kundart OD MEd FAAO FCOVD-A 7/15/18 Opt 702 Lecture #8 He Heat-In Induced He Heat-In Induced (Gla (G lassb ssblo lower’s) s) (Gla (G lassb ssblo lower’s) s) Ca Cataract and Cataract and Ca True Exfoliation Tr Lens Le s Ex Exfoliation Case #1 Ca Ca Case #2: 2: 86 86 YOM https://www.jstage.jst.g https://www.jstage.jst.g o.jp/article/jnms/74/1/ o.jp/article/jnms/74/1/ 74_1_55/_pdf/-char/en 74_1_55/_pdf/-char/en UV UV Effects: Pt Ptery rygia § The Chesapeake Bay Heat-In He Induced Study (1989) of 838 watermen in (Gla (G lassb ssblo lower’s) s) Maryland found those Cataract and Tr Ca True with the highest Exfoliation Ca Ex Case 2 quartile of UV-A and UV-B exposure had a 3x higher odds ratio https://www.jstage.jst.g for pterygia o.jp/article/jnms/74/1/ 74_1_55/_pdf/-char/en https://www.ncbi.nlm.nih.gov/pubmed/23722672 Treating Tr Treating Tr Ptery Pt ryigia wi with Ptery Pt ryigia wi with To Topical Az Azasite Topical Az To Azasite Case #1: Ca 1: Ca Case #2: 2: 54 YOHM 54 58 58 YOHF https://www.pagepressjournals https://www.pagepressjournals .org/index.php/opto/article/vi .org/index.php/opto/article/vi ew/optometry.2011.e2 ew/optometry.2011.e2 2
James Kundart OD MEd FAAO FCOVD-A 7/15/18 Opt 702 Lecture #8 Tr Treating Treating Tr Pterygia Pt Pt Ptery ryigia wi with with Az wi Azasite: Topical Az To Azasite $185 (U $185 (US) a a Case #3: Ca 3: bo bottl tle, , wi with 37 YOHM 37 coupon co https://www.pagepressjournals https://www.goodrx.com/az .org/index.php/opto/article/vi asite?drug-name=azasite ew/optometry.2011.e2 Climatic Droplet Keratopathy #1 UV UV Effec ects: Cl Clima matic Dr Dropl plet Kera Ke ratopathy https://www.ncbi.nlm.nih.gov/pubmed/23722672 https://onlinelibrary.wiley.com/doi/epdf/10.1111/aos.12628 Climatic Droplet Keratopathy #2 Climatic Droplet Keratopathy #3 Found in Labrador,Newfoundland https://onlinelibrary.wiley.com/doi/epdf/10.1111/aos.12628 https://onlinelibrary.wiley.com/doi/epdf/10.1111/aos.12628 3
James Kundart OD MEd FAAO FCOVD-A 7/15/18 Opt 702 Lecture #8 How Other Species Prevent Corneal Snow Blindness Ph Phototoxici city an and the R the Reti tina na ● The concentration of vitamin C in the corneal M A Contín, M M epithelium of reindeer is Benedetto,M L Quinteros- 2x higher than that found Quintana, and M E Guido in humans Light pollution: the ● Our corneal vitamin C possible consequences of is the highest in the excessive illumination on human body retina ● Reindeer live in higher Eye (London). 2016 Feb; elevations (>100m above 30(2): 255 sea level), where there is Source: Handbook of Nutrition and 263. PMID: 26541085 Ophthalmology by Richard Semba (2007) higher UV exposure https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4763120/ Ca Case e #1: 1: 58 58 YOM M with UV Retinopathy y Ca Case e #1: 1: 58 58 YOM M with Sn Snow Blin lindness ess (Sn Snow Blin lindness) ess): 20/2 /20 OD, 20/5 /50 OS Ma Macular OCT 5-Li Line e Ra Raster er https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4501146/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4501146/ Eryth Er thropsi sia in Moun in untain ain Climber Climb ers Case Ca e #1: 1: 58 58 YOM M with Sn Snow Blin lindness ess Autofluores Au escen cence ce https://julbo-canada.ca/blogs/news/33320836-the-most- common-eye-disorders-found-in-climbers https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4501146/ 4
James Kundart OD MEd FAAO FCOVD-A 7/15/18 Opt 702 Lecture #8 Case #2: Solar Retinopathy (indirectly) from Bipolar Pr Prevention and Treat atment of Sn Snow w Disorder Blindness (and Retinal Hemor Bl orrhage!) in 45 YOF http://www.mrcophth.com/ophthalmologyonstamps/phototoxicity/c.html https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1860187/ Case #2: Time-Domain OCT Ca Case #3: 3: Ba Baseline Su Sungazin ing Retin inopathy § (A) Right eye at initial presentation showing a retinal pigment epithelial defect at the fovea. (B) Left eye at initial presentation showing a retinal pigment epithelial defect at the fovea. BCVA 20/30 OD, OS. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1860187/ https://www.ncbi.nlm.nih.gov/ pmc/articles/PMC3604317/ Su Sungazin ing Retin inopathy: Su Sungazin ing Retin inopathy: One Month Follo On llow-Up Up Six Month Follo Six llow-Up Up Right eye at 6 months: § (A) Right eye at 1 month: improvement in foveal changes persistent a retinal pigment and epithelial (RPE) changes at the fovea (B) left eye at 6 months: improvement in foveal changes § (B)Left eye at 1 month: persistent RPE changes at the Damage is thought to be fovea photochemical, not thermal! https://www.ncbi.nlm.nih.gov/ https://www.ncbi.nlm.nih.gov/ pmc/articles/PMC3604317/ pmc/articles/PMC3604317/ 5
James Kundart OD MEd FAAO FCOVD-A 7/15/18 Opt 702 Lecture #8 Ca Case #4: 38 YOWF Sol olar Retinop opathy Withou Wi out Abnor ormal Expos osure, Baseline and Six Mon Ba onths La Later r (20/2 /20) Su Sungazin ing Retin inopathy: One Year Follo On llow-Up Up § (A) Right eye at 1 year; almost full resolution of retinal pigment epithelial (RPE) changes § (B) Left eye at 1 year; almost full resolution of RPE changes https://www.ncbi.nlm.nih.gov/ http://www.scielo.br/pdf/abo/v76n2/12.pdf pmc/articles/PMC3604317/ Ca Case #5: 21 YOM Ca Case #4: 38 YOWF, Macular OCT Solar Retinopathy OD So OD, 2 20/30 B BCVA Solar Retinopathy w/ So w/o Abnormal Exposure https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3149141/ http://www.scielo.br/pdf/abo/v76n2/12.pdf Ca Case #5: 21 YOM Sol olar Retinop opathy Ca Case #5: 21 YOM Sol olar Retinop opathy Fluo Fl uores escei ein A n Angi ngiogr graph aphy Ti Time-Dom Domain OCT OD https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3149141/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3149141/ 6
James Kundart OD MEd FAAO FCOVD-A 7/15/18 Opt 702 Lecture #8 Ca Case #5: 21 YOM Sol olar Retinop opathy Pe Pediatric Case #6: 10 YOM Sp Spectral-Dom Domain OCT OD OD, B BCVA 2 20/25 So Solar Retinopathy OS OS, B BCVA 2 20/25 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3149141/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3149141/ Ca Case #6: 10 YOM Sol olar Retinop opathy Ca Case #6: 10 YOM Sol olar Retinop opathy Fl Fluo uores escei ein A n Angi ngiogr graph aphy OS OS Ti Time-Dom Domain OCT OS OS, B BCVA 2 20/20 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3149141/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3149141/ Eclipse Retinopathy Case #7: 29 YOM, BCVA 20/40 OD Ca Case #6: 10 YOM Sol olar Retinop opathy Sp Spectral-Dom Domain OCT OS https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4213866/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3149141/ 7
James Kundart OD MEd FAAO FCOVD-A 7/15/18 Opt 702 Lecture #8 Eclipse Retinopathy Case #8: Pediatric Eclipse Case #9: 29 YOF , BCVA 20/40 OD, 20/20 in 1 mo. 13 YOF , BCVA 20/20 OD, OS https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4213866/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4213866/ Pediatric Eclipse Case #10: 14 YOF , BCVA 20/80 OD x 1 year Ca Case e #11: 11: 63 63 YOF F Eclipse e Re Retinopathy BCVA BCV A 20/ 20/30 30 OD https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3545138/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4213866/ Ca Case e #11: 11: Ca Case e #11: 11: Eclipse Ec Eclipse Ec Retinopathy Re Retinopathy Re Au Auto- Ba Basel eline e fluor flu oresc scene Ma Macular OCT https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3545138/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3545138/ 8
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