EyeWorld Asia-Pacific March 2018 Issue

60 EWAP NEWS & OPINION March 2018 Beyond eclipsing concerns by Maxine Lipner EyeWorld Senior Contributing Writer Eye health and the sun D uring the recent solar eclipse, all eyes were on the sun as it hid behind the moon. While most heeded warnings to wear protection when viewing this rare spectacle, some patients later emerged in ophthalmic offices. However, even on normal days without the proper protection, the sun can wreak havoc. EyeWorld took a closer look at this. Avnish Deobhakta, MD , as- sistant professor, New York Eye and Ear Infirmary at Mount Sinai, New York, found that after the eclipse quite a few patients came in fearful that they had damage from the sun. “We had a few patients who had mild symptomatic change, whether that be blurry vision or a gener- alized light sensitivity,” he said. “Most did not have any permanent damage.” However, Dr. Deobhakta did have a few cases, including an especially notable patient, with some substantial damage to the retina. Post-eclipse concerns In one case, a patient was nervous that he had damaged his eyes after misinterpreting some of the preven- tioninformation that he had gleaned online regarding using a pinhole for seeing the eclipse. Instead of viewing the shadow that emerged on another surface after the sun went through the pinhole, this patient put a pinhole through a garbage bag and then looked throughthis at the sun. “So he ended up having some transient symptoms,” Dr. Deobhakta said. In the most serious of his eclipse cases, a woman went outside just as the eclipse was occurring and noticed that the person next to her was wearing glasses. “This person said, ‘Why don’t you take a look? I have these glasses,’” Dr. Deobhak- ta said. “She put those glasses on and looked at the sun for 15 to 20 seconds.” The problem was that those were not the standard glasses, and since she didn’t think she was doing anything wrong, she ended up having more exposure than those who knew they were unprotected but who glanced up at the sun anyway. Dr. Deobhakta said that after the eclipse some patients came in saying that they felt as if their eyes weren’t right. “I think there was a worry that maybe they had done something wrong and they wanted reassurance,” he said. However, the patient who borrowed the glasses from a passerby was different. “She mentioned that she had a hole in her vision that would not go away,” Dr. Deobhakta said. Practitioners ran a battery of tests on those who they thought might have damage. “We did an OCT to see if there were any layers that were affected by the eclipse, and we did other things like microperimetry, which showed patients if there was any damage to their visual field and where that corresponded on their retina,” Dr. Deobhakta said. “This provided some peace of mind to patients in whom there was minimal change of the OCT that we could see; we could show them on the micrope- rimetry that they didn’t have any real changes.” For patients who had changes on the OCT and on the microperimetry, Dr. Deobhakta used adaptive optics. “One of the most notable things that we saw was a distinct difference in the eyes that were affected by the eclipse,” he said. “We could see actual damage.” There were changes noticed with the adaptive optics modality. This could be helpful in continuing to follow the most severe patient because the adaptive optics show at a precise level that damage reached almost down to individual photo- receptors. “If there is some kind of resolution, we could follow that with this imaging technique,” Dr. Deobhakta said. While there isn’t any known treatment for eclipse-re- lated sun damage, the American Society of Retina Specialists consid- ered beforehand what physicians might try. “There was a statement made that we could try the AREDS2 vitamin that we use for macular degeneration patients to see if that helps the structures of the retina to heal,” he said. “We don’t know if anything will change but we’re happy to try something.” Regular viewing Even without an eclipse, it’s import- ant to be aware of the sun. “It’s important to be thinking about eye health in general,” Dr. Deobhakta said. “People who have cataracts or who have a history of light sensitiv- ity or allergies should always be cognizant of wearing sunglasses.” Even when the sun doesn’t seem particularly strong, it is important to be careful. Dr. Deobhakta pointed out that when the sun’s rays reflect off something like snow, it polarizes differently. “It’s a reflection, and the beam itself is different from looking at the sun,” he said. “You have a different orientation of the way the