CLINICAL COMMUNICATIONS: Clinical Pearls
This month, “Clinical Communications,” under the clinical editorship of Editorial Board member Larry Alexander, OD, FAAO, includes color image content and optional supplementary digital content, with no cost to our authors.
Each article in this section is followed by a clinical comment by our clinical editor, emphasizing the clinical take-home message. We provide these “Clinical Pearls” of the publication following the article’s title, authors, and abstract. The full text and illustrations are found online with the colored images and any video clips.
Dr. Larry Alexander provides all of the clinical comments (“Clinical Pearls”) on each article in “Clinical Communications.” This is all part of our OVS program to enrich the clinical content of OVS and make it very accessible, in color and motion, to clinicians, readers, and authors alike.
Tony Adams, OD, PhD, FAAO
Relenza-Induced Acute Myopia Change
Tzu-Heng Weng, Shih-Min Lin, Sui-I Pao, and Shang-Yi Chiang
Purpose. To report a case of a patient with a notable side effect to Relenza, an anti–influenza virus medication, who also developed acute transient myopia.
Case Report. A 31-year-old woman was diagnosed as having seasonal influenza and treated with Relenza. However, an allergic reaction and blurred vision caused by a transient myopic change were noted after she received Relenza treatment. Relenza-induced acute transient myopia had never been reported. The possible mechanisms include (1) ciliary spasm, (2) lens edema, (3) ciliary body and/or choroidal effusion. Fortunately, the drug-inducedmyopic changemostly resolved spontaneously after discontinuation of the drug and had a benign course.
Conclusions. Patients suspected of having drug-induced myopia should be examined by an internist for a systemic allergic reaction and referred to an optometrist or an ophthalmologist for further special examinations such as A-scan, B-scan, and ultrasound biomicroscopy. Optometrists and ophthalmologists should keep in mind and be aware of the possible ocular side effect (myopic change) of Relenza and warn patients of this potential condition.
Variability in Presentation of Bilateral Vitreomacular Traction
Julie Rodman, Brandon Prete, Jessica Steen, and Diana Shechtman
Purpose. Vitreomacular traction (VMT) is a condition characterized by an incomplete posterior vitreous detachment resulting in traction on the macula and possible subsequent decrease in visual acuity and/or other symptomatology. Vitreomacular traction often presents as a unilateral condition, with some cases developing bilaterality with disease progression. The natural course and presentation of VMT vary widely among individuals. There is no extensive literature regarding the prevalence of VMT in the general population; therefore, little is known on the laterality.
Case Reports. We present eight cases of bilateral VMT encountered in a primary care setting. These cases highlight the variability in presentation, symptomatology, and clinical outcome between and within eyes of patients with bilateral VMT.
Conclusions. Spectral-domain optical coherence tomography has provided new insight into VMT by allowing better visualization of the vitreoretinal interface. Using spectral-domain optical coherence tomography, eight unique cases of bilateral VMT were confirmed and classified. However, despite the bilaterality noted in each case, the clinical presentation and course of disease varied among patients. Because of the paucity of epidemiological data regarding VMT, the laterality of the condition, risk factors for involvement, and overall prognosis remain unclear.