Marijuana and Intrinsically Photosensitive Retinal Ganglion Cells

Expanding the Bo

Book Review: Neuro-Visual Processing Rehabilitation: An Interdisciplinary Approach

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An Uncharacteristic Case Presentation of Functional Vision Disorder

Background: Functional Vision Disorder (FVD), also commonly referred to as functional vision loss (FVL) or non-organic vision loss (NOVL), is defined as a visual acuity (VA) loss and/or visual field (VF) loss, without any identifiable ocular or cortical pathology. Many clinicians look at FVD as a diagnosis of exclusion and while it is imperative to rule out organic pathology, FVD diagnosis must be supported by clinical findings that prove normal visual function. Incorporating supplementary tests specific for demonstrating the integrity of the visual system and the non-organic nature of the symptoms will allow clinicians to be more confident when diagnosing FVD. Case Report: A 59-year-old white female presented to West Haven Acquired Brain Injury (ABI) Clinic complaining of an acute isolated episode of vision loss OU lasting 30 minutes and associated with symptoms of numbness in her right upper and lower extremities. The patient had a pertinent medical history which included hypertension, hyperlipidemia, depression, borderline personality disorder, generalized anxiety disorder (GAD), post-traumatic stress disorder (PTSD), and multiple traumatic brain injuries (TBI). Social history revealed past substance abuse with remission for several years. Pertinent ocular history was notable for a longstanding repeatable monocular right hemianopic VF defect OD due to FVD which recently resolved spontaneously. At the present examination, a new right homonymous hemianopsia OU was confirmed with VF testing. Imaging and laboratory studies were ordered to rule out causative neurological disease and were found to be within normal limits. A thorough review of the patient’s history, clinical examination findings, ancillary testing results, as well as a comprehensive interdisciplinary management with neurology, neuro-ophthalmology, and psychiatry lead to the diagnosis of a reoccurrence of FVD. Conclusion: It is crucial not to dismiss a new neurological finding in the setting of a previously diagnosed FVD. Concurrent organic disease with FVD is common and thus warrants considerable caution on the part of the eye care provider. Distinguishing between organic and nonorganic visual complaints has important clinical implications for the patient. FVD commonly occurs in situations of psychological conflict. Timely diagnosis and appropriate referrals to manage this conflict will improve prognosis and prevent unnecessary work ups as well as help alleviate the patient’s anxiety. Co-management with a psychiatrist and neuro-ophthalmologist is often essential for diagnosis and management. This case review demonstrates an atypical presentation of FVD in which complete resolution of the VF loss was followed by an acute re-occurrence of FVD but manifesting with a different VF pattern. Emphasis will be placed on the history, clinical observation, and testing techniques utilized to aid in diagnosis of FVD as well as highlight the appropriate referral and management

A Space-Occupying Lesion Manifesting as Unilateral Optic Disc Edema

Background: Primary and secondary orbital diseases can arise from different tissues in the periorbital regions as space-occupying lesion leading to ophthalmic symptoms. Therefore, eye care providers are often the first encounter for these patients. Case report: A 54-year-old Caucasian male presented as a new patient at the eye clinic with an incidental finding of edema of the left optic disc. After a thorough optometric evaluation, a referral was made to a local ear-nose-throat (ENT) specialist who confirmed a diagnosis of cavernous hemangioma by further neuroimaging. Surgical removal eventuated in resolution of disc edema with restoration of vision. Conclusion: An insidious and asymptomatic cavernous hemangioma can lead to irreversible vision loss and require surgical excision. Comprehensive ophthalmic examination and multimodal imaging are essential in early detection and timely management. A health care team consisting of an ENT surgeon, neuroradiologist and optometrist was necessary to manage this orbital space-occupying lesion successfully

IMPLEMENTATION of THE AMERICAN COLLEGE of CARDIOLOGY and AMERICAN DIABETES ASSOCIATION CLINICAL PRACTICE GUIDELINES for STATIN THERAPY in REDUCING CARDIOVASCULAR RISK AMONG PATIENTS WITH TYPE 2 DIABETES

The incidence of type 2 diabetes has significantly increased over the past decade, making it a risk factor for cardiovascular disease (Banach et al., 2022). Individuals with type 2 diabetes are four times more likely to develop atherosclerotic cardiovascular disease, accounting for up to a 75% mortality rate. Despite this, the risk for atherosclerotic cardiovascular disease remains underestimated and undertreated in this population (Banach et al., 2022). The purpose of this project was to enhance adherence to the American College of Cardiology 2019 and the American Diabetes Association 2023 clinical practice guidelines regarding statin therapy for patients with type 2 diabetes with an elevated risk of atherosclerotic cardiovascular disease. All staff and providers were educated on the project. Patients’ risks were assessed using the atherosclerotic cardiovascular disease risk score calculator in conjunction with a medication reconciliation assessment. Risk scores were documented in the charts. Providers ensured patients were taking the recommended statin or were prescribed a statin based on their risk scores. Results showed that 100% of staff and providers attended the project in-service. Atherosclerotic cardiovascular disease risk scores were documented on 90% of patients with type 2 diabetes, and 90% of patients with type 2 diabetes not previously on statins were prescribed appropriate statin therapy. Use of the atherosclerotic cardiovascular disease risk calculator helps providers identify patients with type 2 diabetes at high risk for cardiovascular events. Implementing clinical practice guideline directed statin therapy can significantly reduce mortality and long-term cardiovascular complications in this population

Editor\u27s Note: Debbie Hettler, OD, MPH

Editor\u27s not

Disc Edema Secondary to Sleep Apnea: A Case Report

Background: Bilateral optic disc edema is associated with multiple systemic conditions of potentially dire consequences. Idiopathic intracranial hypertension (IIH) is a common culprit and diagnosis of exclusion, which has been observed in multiple patients with obstructive sleep apnea (OSA) and raised questions of a pathophysiological link between the two. Case Report: A 28-year-old Caucasian male with history of transient ischemic attack-like symptoms presented with bilateral disc edema prompting a multi-disciplinary work up that included imaging, lumbar puncture, laboratory analysis, neuroophthalmological, cardiological, and pulmonary evaluations that ultimately led to a diagnosis of OSA. The case is unique in that it followed the patient ten years after initial presentation. Conclusion: In this case report, a stepwise approach worked through the differential diagnosis of bilateral disc edema in a young obese adult to isolate severe OSA as a likely cause, adding to our understanding of the pathophysiology and management of patients with this condition

A Case Report of Vitreopapillary Traction Mistaken for Optic Disc Edema

Background: Traction of the optic disc occurs during incomplete detachment of the posterior vitreous from the peripapillary glial tissue. It can sometimes cause the appearance of disc edema and bilateral cases can be confused with papilledema or cause patients to be worked up for pseudotumor cerebri. Case Report: A patient presented with an outside diagnosis of unilateral optic disc edema and was found in fact to have vitreopapillary traction. Conclusion: Costly, ultimately unnecessary testing such as magnetic resonance imaging can be sometimes avoided if vitreopapillary traction is considered as a differential for disc edema. It can be easily identified with transverse spectral domain optical coherence tomography scans

Approaches to Addressing Unsheltered Homelessness in Texas

In the United States, the trend of homelessness is increasing, which is causing negative impacts on society. The present study demonstrated the relationship of various socioeconomic factors with the trend of homelessness to address unsheltered homelessness in Houston, Texas. For this purpose, the study employed a cross-sectional quantitative research design. Under multiple linear regression analysis, the findings of the quantitative data analysis revealed that income level (p \u3c 0.001) and employment status (p \u3c 0.001) were the promotors of homelessness in the country. Though this statistical test revealed race as a less significant promotor of homelessness, chi-square highlighted a strong association of this variable with the trends of homelessness. Thus, the findings implied that policymakers and authorities must address low-income levels and unemployment to curb homelessness in Houston

Where Have All the Doctors Gone?

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