Alcon and Lensar Call Off Merger

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Alcon and Lensar provide a major update to their proposed merger; the latest IOL on Johnson & Johnson’s Tecnis platform receives FDA approval; and the FDA issues another CRL to Aldeyra Therapeutics for its investigational dry eye drug reproxalap. Learn more about your ad choices. Visit megaphone.fm/adchoices

Refractive Lens Exchange in the Presbyopic Gray Zone

Optimizing outcomes through patient selection and expectation-setting.

Travis Parker, MD, and Greg Parkhurst, MD

Cataract and Refractive Surgery Today

Presbyopia is profoundly frustrating for patients. This age-related condition manifests as a progressive loss of accommodation that impairs their near and intermediate visual acuity. Patients may strain to read and may experience intermittently blurry distance vision due to accommodative spasm. They also find themselves increasingly reliant on optical aids and other work-arounds to perform everyday tasks—challenges that can substantially erode their quality of life. Refractive lens exchange (RLE) has emerged as a highly effective intervention for the majority of suitable presbyopic patients. The procedure can substantially reduce the spectacle dependence of appropriately selected candidates and enhance their visual function across all distances. In our practice, RLE consistently yields high patient satisfaction rates. The procedure not only corrects presbyopia, but it also preempts future cataract development, making RLE a comprehensive, long-term solution. There is, however, a presbyopic gray zone inhabited by patients who have excellent corrected distance visual acuity, no cataracts, and increasing difficulty with their near visual acuity. Achieving optimal outcomes in these individuals requires meticulous patient selection, a thorough preoperative evaluation, and precise expectation alignment.

Vigabatrin-Related Retinal Toxicity

Patients taking this medication for epilepsy should be monitored carefully for visual disturbances.

Natalia Londoño De Vivero, MD; Rafael Méndez Marulanda, MD; Daniela Rojas Pérez, MD; Clemencia De Vivero Arciniegas, MD; and Álvaro Mejía Vergara, MD

Retina Today

KEY TAKEAWAYS Vigabatrin, a drug used as an adjuvant therapy for refractory focal onset epilepsy and for the treatment of infantile spasms, can lead to retinal toxicity in some cases. Onset of retinal toxicity has been reported between 6 months to 5 years after initiating treatment, with a 5.3% risk of developing toxicity at 6 months in pediatric patients. Multifocal electroretinogram can be helpful in confirming a diagnosis of vigabatrin-related retinal toxicity. Vigabatrin, an adjuvant therapy for refractory focal onset epilepsy and the treatment of infantile spasms, is a structural analog of gamma-aminobutyric acid (GABA) that irreversibly inhibits GABA transaminase.1,2 It has a high response rate and overall good tolerability.2 In 1997, researchers reported a series of cases of bilateral concentric visual field constriction related to vigabatrin,3 with a frequency of 52% in adults and 34% in children.1 Although approximately 90% of cases are asymptomatic, severity can range from mild to severe, including potential compromise of central vision and reduced quality of life.2 Herein, we report a case of severe, fast-onset vigabatrin retinal toxicity in a pediatric patient.4 CASE REPORT A 13-year-old Hispanic girl with a long-standing history of refractory epilepsy since her second year of life presented with difficulties going down a staircase due to bilateral inferior scotomas. The patient had been prescribed vigabatrin 3 months earlier, and symptoms began within 3 weeks of use. She had no prior visual complaints and a past medical history of prior ictal frequency of two seizures per week and approximately one status epilepticus per month. She was being treated with levetiracetam, lamotrigine, and lacosamide, but her seizures persisted, so she was started on vigabatrin initially at a dose of 500 mg twice daily and later 1,000 mg twice daily. The patient also reported obstructive sleep apnea with use of a continuous positive airway pressure machine at night. The ophthalmic examination showed a VA of 20/20 OU, normal Ishihara plates in each eye, and 0.6 log units of an afferent pupillary defect in her left eye. Motility and anterior segment examinations where normal in each eye.