eLetters

8 e-Letters

  • How to tame synthetic biodegradable materials in ophthalmology: the importance of medications An opinion from physiological viewpoints

    I read with interest the publication by Ramachandran et al, and offer the following comments.

    Synthetic Bioresorbable polyglycolic acid (PGA) sheets are widely used in surgery and have recently been applied to ulcers resulting from endoscopic submucosal dissection (ESD)in upper gastrointestinal endoscopy treatment[1]. In vivo, PGA sheets undergo nonenzymatic hydrolysis with the resulting glycolic acid being completely metabolized in about 15 weeks. Animal and human studies have shown that PGA implantation provokes acute and prolonged inflammation by foreign-body reaction and localized acidification. In only a few hours, degraded PGA and glycolic acid induce acute inflammation, as demonstrated by neutrophil infiltration [2].

    In the Ramachandran study, the safety of poly- lactic co- glycolic acid (PLGA) electrospun membranes as carriers for limbal tissue explants was demonstrated. The ocular surface remained clear with no epithelial defects in three in five subjects at 12 months. It should be noted that degradation of biosynthetic materials including PLGA triggers inflammatory reactions. Thereore in the package instructions and guidelines often recommends not to use these materials in ophthalmology. However, host inflammatory reactions could be controlled with adequate medications such as topical or systemic steroid administrations. Although in the article, no information on such medications was provided,I hope they would be providesd elsewhere. Then, The oph...

    Show More
  • Response to editor - 'Sore eyes as the most significant ocular symptom experienced by people with COVID-19: a comparison between pre-COVID-19 and during COVID-19 states

    Dear Editor
    We respond to the comments by Solomon regarding our manuscript entitled “Sore eyes as the most significant ocular symptom experienced by people with COVID-19: a comparison between pre-COVID-19 and during COVID-19 states” http://dx.doi.org/10.1136/bmjophth-2020-000632 as follows:
    1. The assertion that CVS causes sore eyes is true. However, as the author suggests, CVS syndrome causes other eye symptoms including photophobia, tearing, itching eye and red eye. Our study examined these symptoms too and compared pre-COVID states to during-COVID states. Apart from sore eyes – no significant differences were shown in our study. In fact, the reported prevalence of dry eye which is the most commonly reported symptom of CVS as people ‘forget’ to blink, actually reduced during COVID state. In addition, participants reported the duration of the eye symptoms - usually between 1-3 weeks - which tallied with the experience of other COVID-19 symptoms such as dry cough and fever. Therefore it is not likely that the sore eyes symptoms were caused by CVS.
    2. Regarding the transmission – it may be possible that virus spreads from the oropharynx through the lacrimal canal to the conjunctiva (as mentioned by the author of the letter as a personal opinion [1]) - or it may indeed be from the conjunctival into the nasal meatus as shown for SARS virus [2]. Unless more evidence is available it is not possible t...

    Show More
  • Sore eyes - the story behind ?!

    Sore eyes is a symptom which can be found in a large population with no COVID-19 involvement. It is a very common symptom in a large population starting from early child age to older age above 60 years. The modern life, which force people to use virtual screens in their every day work , and the exposure to the mobilescreen, in an epidemic form, are the cause of sore eyes and photophobia too. A new eye disease appeared ,in our modern world , about three decades ago. The disease is called Computer Visual Syndrome (CVS). It is presented by sore eye,photophobia,tearing, itchinh, red eye . It is the result of diminish of blinking during screen work and creating dry eye condition. The population presented in this article included young to old age people. Many people may have already CVS with no sore eye at the begining.When examining them , the conjunctiva is red and smoothness is lost. We may hypotise that many people included in the presented study did have already CVS whic was agravated by COVID-19.
    Regarding the transmition of COVID-19 through conjunctiva. We must take in consideration that the tight connection of the conjunctiva to the oropharinx space through the lacrimal canal might be a source of infection of the conjunctiva from that site. The first days, the persons who are already contaminated by COVID-19 are with no symptoms. The virus may spread from the oropharinx through the lacrimal canal to the conjunctiva and starts the conjunctival reaction.
    ...

    Show More
  • Better patient contact lens-related education is needed to address the high prevalence of behavioural risk factors for contact lens complications.

    We read with great interest the recent publication by Stellwagen et al titled 'Personal hygiene risk factors for contact lens-related microbial keratitis'.[1] Findings by Stellwagen et al mirror patterns of modifiable behavioural risk factors for contact lens-related keratitis seen in our practice. We recently evaluated the prevalence of behavioural risk factors, as well as contact lens-related education given to our patients.
     
    We recruited 100 consecutive patients referred with contact lens-related keratitis to an acute ophthalmology clinic at a tertiary eye hospital in Edinburgh, UK. A set questionnaire covering contact lens hygiene and recall of contact lens related education was used as part of the history taking process on presentation. 
     
    98 out of 100 patients were soft contact lens wearers, with 34% purchasing contact lenses online. 61 out of 100 reported receiving advice regarding contact lens usage and hygiene on initial purchase only and none thereafter. Seven percent did not recall receiving any contact lens-related advice at all. Contact lenses (excluding extended wear contact lenses) were worn for a median duration of 12 hours per day (Range 4.5-18).  27 out of 100 reported wearing contact lenses longer than prescribed for their specified lens type (eg. monthly or fortnightly disposable contact lenses) and 27 out of 100 reported swimming in their contact lenses. Excluding extended wear contact lens users, 17 out of 84 report...

    Show More
  • RE: Diabetic retinopathy screening in persons with mental illness: a literature review

    Bradley and Delaffon conducted a literature review regarding diabetic retinopathy screening (DRS) in people with severe mental illness (SMI) (1). People with SMI have reduced attendance at DRS, because of poorer compliance with general diabetic care. The authors verified that anxiety and depression were barriers in attending DRS and strategies of preventative health programs such as DRS should be developed and prepared for people with SMI. I want to present two information.

    Chen and Lu reviewed the association between diabetic retinopathy (DR) and depression (2). Depression in patients with DR had a negative effect on the condition of DR, and they recommended psychiatric therapies for depression to achieve optimal prognosis in patients with DR and depression. Diabetes control is closely related to keeping good lifestyles including nutrition, exercise, resting and stress management. Taken together, diabetes supporting system in patients with depression could be developed by comprehensive medical and health care strategies.

    Khoo et al. specified that severity of DR, diabetic macular edema (DME) and vision loss were significantly associated with poor psychosocial outcomes (3). Bi-directional associations might be existed and increased incidence and progression of DR was predominant in subjects with depression or depressive symptoms. Based on a systematic review, they proposed two actions. First, prevention of poor psychological outcomes is needed by delaying pro...

    Show More
  • Reponse: Ophthalmology practice during the COVID-19 pandemic

    Thank-you to the authors for sharing their departmental protocol based current international research and recommendations [1]. We have put in place many of the precautions outlined however wished to share our recent experience with regard to intravitreal injections (IVI), and additional measures put in place as a result.

    IVIs have continued in our service for sight threatening pathology throughout the UK government lockdown of the past 8 weeks. Patients have self-isolated for 7 days prior to their procedure and are screened for symptoms of COVID19 or contacts before attendance. Arriving at our facility they wash their hands, don a surgical mask and have their temperature, oxygen saturations and blood pressure checked. Social distancing is maintained in waiting areas by blocking alternate seats as mentioned.

    For the procedure itself the patient is draped and injectors wear sterile gloves, a theatre gown and a fluid resistant surgical mask as per national guidance [2].

    There was no protocol to routinely test patients attending for IVI at our units for coronavirus, however tests were performed on four consecutive injection lists on 4th and 5th May. 48 patients were tested with a mean age of 76 years (range 54-92). 2 (4%) tested positive despite being asymptomatic. They were asked not to attend and will be rescheduled. 4 (13%) decided not to attend voluntarily.

    As mentioned by the authors retinal services tend to serve an elderly population with a...

    Show More
  • The Controversial Role of Inhibitory Complement Factors in Age-Related Macular Degeneration
    Article Title: Complement factors and reticular pseudodrusen in intermediate age-related macular degeneration staged by multimodal imaging BMJ Open Ophthalmology Jan 2020, 5 (1) e000361; DOI: 10.1136/bmjophth-2019-000361
    E-letter sender: Anne M Lynch, Brandie D Wagner, Alan G Palestine, Jennifer L Patnaik, Ashley A Frazier-Abel, Marc T Mathias, Frank S Siringo, V. Michael Holers, Naresh Mandava
    E-Letter Title: Response to letter entitled “The Controversial Role of Inhibitory Complement Factors in Age-Related Macular Degeneration”
    February 12, 2020
     
     
    Dear Editor,
     
    We appreciate the comments from Shiwani et al. regarding our manuscript entitled “Complement factors and reticular pseudodrusen in intermediate age-related macular degeneration staged by multimodal imaging.” As reported in the manuscript, (1) we found significantly elevated levels of C3a, Ba, C5a and C2 in cases with the intermediate phenotype of age-related macular degeneration (AMD) compared with cataract controls without AMD. We also found significantly lower levels of Factor B, Factor H, Factor I, C1q, iC3b/C3b, and C5 in the AMD cases compare...
    Show More
  • The Controversial Role of Inhibitory Complement Factors in Age-Related Macular Degeneration

    Dear Editor,

    We read with interest the role of complement in age-related macular degeneration (AMD) explored by Lynch and colleagues1. The authors have expertly examined the numerous components of the complement system and provided much novel data, particularly in the context of intermediate AMD.

    Their results are congruent with that of the literature, especially with regard to lower levels of C3a, C5a and Ba in the setting of AMD2. Furthermore, the results of the FILLY trial have shown positive effects of the inhibition of C3 in limiting geographic atrophy and thus lend an element of support to the conclusions of this study3. We hope that the subsequent phase 3 trials – DERBY and OAKS – will lend further support and allow research such as this to translate to clinical benefit for patients4.

    However, we do feel that there may be an element of multiple hypothesis testing evident in this study that increases the risk of generating some erroneous results. We feel a Bonferroni statistical correction would have been an appropriate tool to add further robustness to the positive findings that have been demonstrated. We especially feel that the results relating to the inhibitory factors of the complement system do not tend to correlate with some of the findings in the literature. Although Lynch et al have identified lower levels of Factor B, Factor H and Factor I in the AMD arm of the study, there are numerous reports in the literature reporting the opposite...

    Show More