This report describes the case of a 21-year-old heroin user who presented with a 6-day history of decreased vision in her right eye, preceded by 1 week of headache and tender scalp nodules, neck stiffness, and photophobia. A broad infectious workup for acute vision loss was completed, and she was ultimately presumed to have acquired toxoplasmic chorioretinitis (ocular toxoplasmosis). We review the initial workup for chorioretinitis, and the epidemiology, diagnosis, and treatment of ocular toxoplasmosis. Intravenous drug users may be at increased risk of acquired ocular toxoplasmosis.
Read the full article Co-authored by Dr. David Reichstein in the WMJ at
ABSTRACT - Purpose of review: Radiation retinopathy remains a devastating cause of visual morbidity in patients undergoing radiation for globe, orbit, and head and neck malignancies. This review discusses the recent efforts of several authors to treat radiation retinopathy once it has developed and efforts to prevent its development with early aggressive management.
Recent findings: Intravitreal anti-vascular endothelial growth factor agents and intravitreal steroid agents have been used to successfully treat radiation-induced macular edema and neovascular events secondary to radiation retinopathy. The visual outcomes, however, have varied. Recent work has been directed towards prevention of radiation retinopathy prior to its development. This has been done with preventive scatter laser and intravitreal bevacizumab therapy. Effective customization of radiation dose to the tumor has also reduced some collateral radiation damage. Preventive vitrectomy and silicone oil placement at the time of plaque brachytherapy may shield normal ocular structures from radiation injury.
Summary: Radiation retinopathy remains a major source of visual morbidity following radiotherapy for malignancies. Promising, albeit unproven, new therapies and preventive efforts may ameliorate the negative visual outcomes.
The full article by Dr. David Reichstein can be found at http://journals.lww.com/co-ophthalmology
A recent article in Ophthalmology, the most widely-cited eye care scientific journal, reinforces the hypothesis that the genetics of individuals with age-related macular degeneration (AMD) have a major impact on the response to nutritional supplements. Written by Dr. Carl Awh and colleagues, the published article compares the disease's progression in response to zinc and antioxidant therapies for those who carry certain genetic markers (genotype groups).
Awh CC, Hawken S, Zanke BW: "Treatment response to antioxidants and zinc based on CFH and ARMS2 genetic risk allele number in the Age-Related Eye Disease Study". Ophthalmology 2015 Jan;122(1):162-9.
In October 2014, a US Patent for a "System to identify viscosity of aspirated material during vitreous surgery" was granted to Dr. Carl Awh. The invention may lead to improved devices for pars plana vitrectomy (PPV), the most commonly performed retina operation worldwide. This is Dr. Awh's 7th US Patent.
Tennessee Retina's own, Dr. David Reichstein, performs a specialized biopsy to aid in the management of uveal melanoma. The biopsy samples genetic material within the tumor and can provide information about the tumor's aggressiveness. The resultant genetic analysis can provide a prediction of the likelihood of the cancer to spread into other areas of the body. "Genetic analysis can actually give a more accurate prediction of metastatic potential than the tumor characteristics themselves," says Dr. Reichstein. Biopsy for genetic analysis can be done as an outpatient procedure and is performed along with radiation treatment of the tumor.