Doctors presented their latest findings on dry eye treatment, computer vision syndrome, as well as a case of nanophthalmos due to MFRP and BEST1 mutations, during a free paper session at the recently held 5th meeting of the ASEAN Ophthalmology Society (AOS Virtual 2022).
Nanophthalmos and Ocular Genetics
Nanophthalmos is a rare and blinding disease characterized by a small eye with a short axial length, severe hyperopia, an elevated lens/eye ratio, and a high incidence of angle-closure glaucoma. Due to its rarity, this disease may go undiagnosed until adulthood. Dr. Carmelita Jocson from the Philippines presented the first genetically confirmed case of nanophthalmos in the Philippines involving a 27-year-old female.
Two weeks before the initial consultation, the patient started having sudden and severe pain in the left eye with redness, blurring of vision and left-sided headache. Two days before the consultation, she was seen by a private ophthalmologist and was diagnosed with acute angle-closure glaucoma.
Upon observing the unusual use of very thick corrective glasses in the patient — who had no history of intraocular surgeries or trauma, glaucoma, cataract or ocular neoplasms — Dr. Jocson and her colleagues suspected and confirmed the presence of a high hyperopia refractive error. Family history revealed that the patient’s parents were first-degree cousins (consanguinity). Meanwhile, ocular examination revealed that the left eye had a 6 mm pupil that was non-reactive to light, with a hazy cornea and an elevated intraocular pressure of 42 mmHg. At this point, the patient was diagnosed with angle-closure glaucoma, likely secondary to nanophthalmos.
Upon referral to a retina specialist, the patient was found to have cystoid macular edema in both eyes. She was also referred to an ocular geneticist and a microphthalmia/anophthalmia panel showed mutations in the MFRP and BEST1 genes. MFRP mutation is associated with autosomal recessive nanophthalmos and retinal dystrophy.
“In comparison to normal eyes, the ocular parameters of the patient are below normal range, except for increased lens-to-eyeball volume ratio (LEVR), scleral thickness and macular thickness, all of which are consistent with a nanophthalmic eye,” she said.
“Nanophthalmic eyes pose a great challenge to ophthalmologists, but prognosis may be favorable if correctly identified and promptly treated by piecing together a comprehensive history, examination and ocular imaging with a high index of suspicion. Our findings highlight the importance of integrating genetics unto medical practice. Ocular genetics is vital for forthcoming generations to make informed decisions on early detection and risk reduction,” explained Dr. Jocson.
Potential of PRP in Dry Eye Treatment
Autologous platelet rich plasma (PRP) has emerged as a significant tissue regenerative therapy due to its anti-microbial, anti-fibrotic and anti-inflammation properties. These characteristics exalt PRP as an appropriate treatment for ocular surface disorders, such as dry eye syndrome. Dr. Thapakorn Sirirattanasoporn from Thailand evaluated the efficacy of autologous PRP eye drops in nine patients with dry eye disease (DED) who did not respond to autologous serum treatment.
The patients received topical PRP six times a day until week 6, before changing to topical autologous serum treatment on week 12. Results showed that their ocular surface disease index (OSDI) improved significantly at weeks 1, 4 and 6. Signs of dry eye also improved significantly as shown in corneal staining, conjunctival staining and Schirmer’s test with anesthesia. This likely occurred because PRP has a higher content of growth factors and reduced pro-inflammatory activity compared to autologous serum.
“Our study shows that topical use of PRP demonstrated therapeutic efficacy in terms of DED symptoms in patients with DED refractory to autologous serum treatment, and is a good option for treatment of severe dry eye,” he said.
Health Effects of e-Learning During Lockdown
During the pandemic, students spent an increasing number of hours on digital devices due to digital or e-learning replacing face-to-face classroom sessions, thereby increasing the prevalence of computer vision syndrome (CVS). Dr. Kasem Seresirikachorn from Thailand investigated the effects of digital devices and online learning on CVS in 2,476 students from grades 7-12 in Bangkok, Thailand, during the COVID-19 pandemic through a cross-sectional, online, questionnaire-based study. The data was collected for 15 days.
“We found that more than half of the students used digital devices for 9-12 hours per day, and over 60% spent over 6 hours in online learning during the lockdown period (mean = 7.03 ± 2.06 hours/day). Seventy-point-one percent (70.1%) of students have CVS, with headache as the most common symptom, followed by eye burning and pain. The number of hours on digital devices, the number of hours of online learning, myopia, multiple digital device use, presence of back pain, presence of neck pain, and younger age are contributory factors of developing CVS,” he said.
He noted that among those with CVS, the severity was significantly correlated with the number of hours of screen time, and inversely correlated with age. “In this study, we found that the overall hour of digital device usage of over 6 hours, and online learning of over 5 hours increased the risk of CVS by nearly 2 and 5 times, respectively. Hence, learning schedules should be adjusted to have appropriate durations and breaks. The overall hours of digital device usage should be under 6 hours per day, and online learning should be limited to 5 hours per day, especially in younger students,” he suggested.
Editor’s Note: The 5th AOS Congress was held virtually on March 26-27, 2022. Reporting for this story took place during the event.