In the Journals

Solar retinopathy photoreceptor damage post-eclipse mimics shape of solar rim

Avnish Deobhakta
Avnish Deobhakta

Acute solar retinopathy can present with foveal cone photoreceptor mosaic disturbances on adaptive optics scanning light ophthalmoscopy imaging, as seen in the case of a woman who presented with acute retinopathy symptoms after viewing the solar eclipse in August.

“This study can potentially assist in helping optometrists in identifying and helping to further investigate patients who might have laser or eclipse-related damage," researcher Avnish Deobhakta, MD, told Primary Care Optometry News.

“Patients with clinical histories of a persistent visual dark spot, metamorphopsia or blurry vision after explicit or accidental sun or laser exposure should be referred to a retinal specialist for further evaluation with these new imaging modalities,” Deobhakta said.

The patient viewed the solar rim several times for approximately 6 seconds without protective glasses and then again for approximately 15 to 20 seconds with a pair of eclipse glasses of an unknown manufacturer. Four hours later she noted blurred vision, metamorphopsia and color distortion that was worse in her left (dominant) eye.

Researchers found IOP and anterior segment examinations unremarkable in both eyes. Fundus examination of the right eye was also unremarkable, while the fovea of the left eye revealed a yellow-white spot.

Microperimetry (CenterVue) was normal in the right eye but showed multiple areas of decreased sensitivity paracentrally with a central absolute scotoma in the left eye.

An abnormal outer segment hyperreflectivity and discontinuity of the interdigitation zone in the right eye was apparent through spectral domain optical coherence tomography (Heidelberg Engineering), along with near full-thickness hyperreflectivity at the center of the fovea, with hyporeflectivity of the outer segment and interdigitation zone in the left eye.

Researchers employed custom adaptive optics scanning light ophthalmoscopy (AOSLO) with confocal and split detector optics to image the cone photoreceptor mosaic at the fovea. The right eye showed a small region of hyporeflectivity, indicating the presence of nonwaveguiding photoreceptors, while corresponding split-detector AOSLO image revealed disruption of photoreceptor structure with the presence of few enlarged inner segments, researchers wrote. The left eye showed a large area with ambiguous reflectivity due to abnormal and nonwaveguiding photoreceptors, while the corresponding split-detector AOSLO image showed the sparse intact inner segments within the area of photoreceptor disruption.

“We were impressed with how spatially consistent the damage to the photoreceptors was relative to the shape of the eclipse. That is, we were able to see a crescentic area of damage that corresponded to the crescent of the exposed sun during the eclipse,” Deobhakta told PCON.

In other words, the shape of the lesion on en face OCT and AOSLO in the left eye reflects the patient’s scotoma on Amsler grid and resembles the solar rim during a partial solar eclipse, the researchers wrote.

They plan to re-examine the patient with the same technology to determine if there are any changes in the photoreceptor layer over time. – by Abigail Sutton

Disclosures: The authors reported no relevant financial disclosures.

Avnish Deobhakta
Avnish Deobhakta

Acute solar retinopathy can present with foveal cone photoreceptor mosaic disturbances on adaptive optics scanning light ophthalmoscopy imaging, as seen in the case of a woman who presented with acute retinopathy symptoms after viewing the solar eclipse in August.

“This study can potentially assist in helping optometrists in identifying and helping to further investigate patients who might have laser or eclipse-related damage," researcher Avnish Deobhakta, MD, told Primary Care Optometry News.

“Patients with clinical histories of a persistent visual dark spot, metamorphopsia or blurry vision after explicit or accidental sun or laser exposure should be referred to a retinal specialist for further evaluation with these new imaging modalities,” Deobhakta said.

The patient viewed the solar rim several times for approximately 6 seconds without protective glasses and then again for approximately 15 to 20 seconds with a pair of eclipse glasses of an unknown manufacturer. Four hours later she noted blurred vision, metamorphopsia and color distortion that was worse in her left (dominant) eye.

Researchers found IOP and anterior segment examinations unremarkable in both eyes. Fundus examination of the right eye was also unremarkable, while the fovea of the left eye revealed a yellow-white spot.

Microperimetry (CenterVue) was normal in the right eye but showed multiple areas of decreased sensitivity paracentrally with a central absolute scotoma in the left eye.

An abnormal outer segment hyperreflectivity and discontinuity of the interdigitation zone in the right eye was apparent through spectral domain optical coherence tomography (Heidelberg Engineering), along with near full-thickness hyperreflectivity at the center of the fovea, with hyporeflectivity of the outer segment and interdigitation zone in the left eye.

Researchers employed custom adaptive optics scanning light ophthalmoscopy (AOSLO) with confocal and split detector optics to image the cone photoreceptor mosaic at the fovea. The right eye showed a small region of hyporeflectivity, indicating the presence of nonwaveguiding photoreceptors, while corresponding split-detector AOSLO image revealed disruption of photoreceptor structure with the presence of few enlarged inner segments, researchers wrote. The left eye showed a large area with ambiguous reflectivity due to abnormal and nonwaveguiding photoreceptors, while the corresponding split-detector AOSLO image showed the sparse intact inner segments within the area of photoreceptor disruption.

“We were impressed with how spatially consistent the damage to the photoreceptors was relative to the shape of the eclipse. That is, we were able to see a crescentic area of damage that corresponded to the crescent of the exposed sun during the eclipse,” Deobhakta told PCON.

In other words, the shape of the lesion on en face OCT and AOSLO in the left eye reflects the patient’s scotoma on Amsler grid and resembles the solar rim during a partial solar eclipse, the researchers wrote.

They plan to re-examine the patient with the same technology to determine if there are any changes in the photoreceptor layer over time. – by Abigail Sutton

Disclosures: The authors reported no relevant financial disclosures.

    Perspective
    jerome Sherman

    Jerome Sherman

    This appears to be the first and only case of solar retinopathy reported to date following the Aug. 21 solar eclipse. Because it usually takes at least several months for peer-reviewed scientific articles to get published, perhaps others will follow.  

    The unfortunate patient, a woman in her 20s, reported gazing at the eclipse with both eyes open for approximately 6 seconds without any eye protection and then again with eclipse glasses for 15 to 20 seconds. About 4 hours later, she first noticed distorted vision and a color vision disturbance primarily in her left eye and a central scotoma in her dominant left eye.

    The patient presented 3 days later and was fully evaluated. Fortuitously, she chose a facility (now part of Icahn Mount Sinai School of Medicine) with one of the world’s best retinal imaging centers. Although no proven treatment exists for solar retinopathy, her visual acuity was still maintained at 20/20 in the right eye and 20/25 in the left eye, but her absolute central scotoma has persisted thus far for 6 weeks.  

    Of all the images obtained, the most remarkable is the confocal adaptive optics scanning laser ophthalmoscope (AOSLO) view of the left eye. AOSLO of the macula allows us to view in vivo individual cone photoreceptors, and in the left, more symptomatic eye, a large central dark zone is present that appears to be devoid of cones. This abnormal zone of structure matches nearly perfectly with the patient’s subjective Amsler grid plot. An analysis of all the data, including the OCT cross sectional and enface images, supports the hypothesis that cone outer and inner segment mosaic disruptions account for the subjective visual disturbances.

    This report, even though it is only a single case, reminds doctors and the public alike that viewing a solar eclipse for just a matter of seconds can result in what appears to be permanent vision loss. Let’s remember this at least until April 8, 2024, when the next total eclipse for North America will occur.

    • Jerome Sherman, OD, FAAO
    • Primary Care Optometry News Editorial Board Member
      Distinguished Teaching Professor, SUNY College of Optometry
      Omni Eye Surgery, New York

    Disclosures: Sherman has lectured for, received honorarium from or consulted with Arctic Dx, Annidis, Carl Zeiss Meditec, DGH, Diopsys, Eye Solutions, Heidelberg, MacuHealth, Optos, Optovue, PHP, Quantel and Topcon.