The edition · Ophthalmology
Two diseases with one name, and only one is an emergency
A joint ophthalmology and internal medicine consensus on anterior ischaemic optic neuropathy sets out the split that decides everything: the arteritic form, which needs treatment the same day, and the far commoner non-arteritic form, for which nothing specific works. Plus mini-monovision with an extended-depth-of-field lens, macular oedema after endothelial cell injection, ray-tracing LASIK at a year, and the vision measurement that tracked cognition.
The edition in brief
Today's ophthalmology desk opens with intraocular lens targeting. A masked randomised trial in 55 patients compared a refractive extended-depth-of-field lens implanted for mini-monovision, at minus 0.75 dioptres in the non-dominant eye, against bilateral emmetropia. Distance, intermediate and near acuity did not differ significantly, and stereopsis was preserved in both, but low-contrast acuity was better with emmetropia at 5% and 1.25% contrast by 0.10 logMAR, and the monovision group reported more glare in exchange for slightly less near spectacle dependence. A multicentre Japanese review of 57 eyes given cultured human corneal endothelial cell injection found cystoid macular oedema in 26.3%, strongly associated with preoperative prostaglandin analogue use (60.0% of oedema cases against 14.3%, P = .001); all resolved with topical NSAID or sub-Tenon triamcinolone and six-month acuity did not suffer. A prospective series of 800 eyes treated with ray-tracing-guided LASIK reports 100% reaching 20/20 uncorrected at 12 months, 96.5% within half a dioptre of target, and refractive change beyond 0.50 D in 0.38% of eyes between one month and a year. In 3,650 rural Chinese adults over 50, near visual impairment - present in 92% - was associated with poorer cognitive scores after full adjustment (OR 3.44), while the association with distance impairment did not survive adjustment. The edition closes on a joint Spanish internal medicine and retina society consensus on anterior ischaemic optic neuropathy, which exists because management of this presentation is heterogeneous and the arteritic form, tied to giant cell arteritis, is a same-day emergency while the non-arteritic form has no specific effective treatment.
Mini-monovision with an EDF lens costs contrast, and buys less than expected
With this extended-depth-of-field lens, target emmetropia in both eyes unless the patient specifically prioritises reading without glasses and accepts more glare.
A quarter of eyes developed macular oedema after endothelial cell injection, and the prostaglandin was the clue
Review prostaglandin analogue use before corneal endothelial cell injection and image the macula both before and after.
Ray-tracing LASIK at one year: every eye at 20/20, and the astigmatism held
Ray-tracing-guided LASIK delivers excellent and stable one-year outcomes including in high astigmatism, but no comparative trial yet ranks it against existing platforms.
Near vision, not distance vision, tracked cognition in rural China
Test near vision, not just distance, in older adults - and treat uncorrected near vision as the commonest correctable visual problem in this age group.
Ask which eye, and ask what time
Cover each eye during the history and ask the time of onset - both are free and both change the differential.
A consensus that exists because AION is managed inconsistently
Establish a named same-day pathway for sudden painless monocular vision loss over 50, and make sure someone owns the vascular risk assessment after a non-arteritic diagnosis.
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