Giving Support and Suicidal Ideation in Older Adults with Vision-Related Diagnoses.

Objectives: Visual impairment in older adults may increase risk for depression and suicide. Research suggests that giving support to others may be associated with lower depressive symptoms in older adults, but much of the research has been in non-clinical populations. Furthermore, there is limited research on giving support and suicide risk.Methods: Using a sample of older adults with vision-related diagnoses (N = 101), this study investigated the association between informal support giving (unpaid support given to family, friends, or neighbors) and formal support giving (volunteering) on depressive symptoms and suicidal ideation. Linear regressions examined the relation between support giving and depression, and logistic regressions examined the relation between support giving and suicidal ideation.Results: Greater informal support giving was related to lower likelihood of reported suicidal ideation (OR: .82, 95% CI: .68-.99, p = .04), whereas volunteer activity was not significantly related to suicidal ideation. Neither volunteer behavior nor informal support giving was related to depressive symptoms.Conclusions: Providing informal support was associated with lower likelihood of endorsing suicidal ideation in older adults with vision impairment.Clinical Implications: Informal support giving may be a target for decreasing suicidal ideation among older adults with health impairments.

Visual function affects prosocial behaviors in older adults.

Eye-related pathological conditions such as glaucoma, diabetic retinopathy, and age-related macular degeneration commonly lead to decreased peripheral/central field, decreased visual acuity, and increased functional disability. We sought to answer if relationships exist between measures of visual function and reported prosocial behaviors in an older adult population with eye-related diagnoses. The sample consisted of adults, aged ≥ 60 years old, at an academic hospital's eye institute. Vision ranged from normal to severe impairment. Medical charts determined the visual acuities, ocular disease, duration of disease (DD), and visual fields (VF). Measures of giving help were via validated questionnaires on giving formal support (GFS) and giving informal support; measures of help received were perceived support (PS) and informal support received (ISR). ISR had subscales: tangible support (ISR-T), emotional support (ISR-E), and composite (ISR-C). Visual acuities of the better and worse seeing eyes were converted to LogMAR values. VF information converted to a 4-point rating scale of binocular field loss severity. DD was in years. Among 96 participants (mean age 73.28; range 60-94), stepwise regression indicated a relationship of visual variables to GFS (p < 0.05; Multiple R (2) = 0.1679 with acuity-better eye, VF rating, and DD), PS (p < 0.05; Multiple R (2) = 0.2254 with acuity-better eye), ISR-C (p < 0.05; Multiple R (2) = 0.041 with acuity-better eye), and ISR-T (p < 0.05; Multiple R (2) = 0.1421 with acuity-better eye). The findings suggest eye-related conditions can impact levels and perceptions of support exchanges. Our data reinforces the importance of visual function as an influence on prosocial behavior in older adults.

A UNIQUE CASE OF ACUTE MACULAR NEURORETINOPATHY ASSOCIATED WITH COTTON WOOL SPOTS AND INTRARETINAL FLUID.

PURPOSE: To discuss the clinical findings in a unique case of acute macular neuroretinopathy with a focus on the pathophysiology of this rare entity. METHODS: The patient's clinical course was documented with color fundus photography and spectral domain ocular coherence tomography registered to infrared reflectance imaging. The visual field was assessed using the Amsler grid testing and Humphrey visual field 24-2. RESULTS: Initial fundus photography showed cotton wool spots and slight darkening of the central macula in each eye. Optical coherence tomography showed initial hyperreflective plaques at the level of the outer plexiform layer/outer nuclear layer junction with subsequent thinning of the outer nuclear layer and corresponding disruption of the ellipsoid and outer segment/retinal pigment epithelium. Infrared reflectance imaging revealed perifoveal hyporeflective lesions in each eye with corresponding visual field defects on the Amsler grid and visual field testing. The hyporeflective infrared lesions became more discreet during the ensuing weeks and remained stable beyond 11 weeks. CONCLUSION: The authors present the case of a 15-year-old girl diagnosed with acute macular neuroretinopathy. This case is notable in that she presented with cotton wool spots and intraretinal fluid, both of which are unusual for acute macular neuroretinopathy. The authors suggest that the presence of cotton wool spots and several small foci of intraretinal fluid seen in their patient may lend support to the ischemic hypothesis described by Sarraf et al. The optical coherence tomography images obtained in this case have the typical wedge-shaped or petaloid configuration, and the authors suggest that the shape of the lesions themselves also lends support to a vascular mechanism.

Central retinal artery occlusion following laser treatment for ocular ischemic aortic arch syndrome.

OBJECTIVE: Ocular ischemic syndrome is a rare blinding condition generally caused by disease of the carotid artery. We describe a 69-year-old female with a 50 pack-year smoking history with aortic arch syndrome causing bilateral ocular ischemic syndrome. METHODS: The patient presented with progressive visual loss and temple pain. Slit lamp biomicroscopy revealed bilateral iris neovascularization. This finding prompted a cardiovascular work up. Panretinal photocoagulation with retrobulbar block was performed in the right eye. RESULTS: A temporal artery biopsy was negative. The carotid duplex ultrasound showed only a 1-39% stenosis. MRA revealed a more proximal occlusion of the aortic branch for which she underwent subclavian carotid bypass surgery. At the one month follow up, the right eye suffered profound vision loss secondary to a central retinal artery occlusion. CONCLUSION: Ocular neovascularization may be one of the clinical manifestations of aortic arch syndrome. This case also illustrates the limitations of relying solely on carotid duplex ultrasound testing. We caution against overly aggressive panretinal photocoagulation utilizing retrobulbar anesthesia.

Melanoma-associated retinopathy: a paraneoplastic autoimmune complication.

OBJECTIVES: To study 11 patients with melanoma-associated retinopathy (MAR) to clarify the reliability of various methods of diagnostic testing, to determine the underlying antigenic retinal proteins, and to study the clinical histories and types of associated melanomas. METHODS: Clinical data were obtained from patients with melanoma who developed marked visual problems. Testing included electroretinography, kinetic visual fields, comparative studies of Western blots, and indirect immunohistologic examination to detect antiretinal antibodies, as well as proteomic studies to identify underlying antigenic retinal proteins. RESULTS: Patients with MAR typically have rapid onset of photopsias, scotomata, and loss of central or paracentral vision. Ophthalmoscopy seldom shows significant changes early, but electroretinograms are abnormal. Results of Western blots and immunohistologic examination can show antiretinal antibodies but not always. Most patients (9 of 11) had a strong family history of autoimmune disorders. Any type of melanoma (cutaneous, choroidal, ciliary body, or choroidal nevi) may be associated with this paraneoplastic autoimmune reactivity. MAR may precede or follow the diagnosis of melanoma. Patients with MAR have the same antigenic retinal proteins that have been associated with cancer-associated retinopathy. In addition, 2 new antigenic retinal proteins, aldolase A and aldolase C, were found. CONCLUSIONS: There was a high prevalence of positive family histories of autoimmune disease in patients with MAR. To confirm the disorder, multiple clinical and serum diagnostic techniques (Western blot or indirect immunohistologic examination) are needed. Two newly observed antigenic retinal proteins, aldolase A and aldolase C, are associated with MAR.

Intravitreal bevacizumab for the treatment of choroidal neovascularization secondary to pseudotumor cerebri.

BACKGROUND: In pseudotumor cerebri (PTC), elevated intracranial pressure (ICP) results in papilledema and, rarely, choroidal neovascularization (CNV). Pseudotumor cerebri-induced CNV often regresses following medical or surgical ICP reduction, but additional treatments, such as photocoagulation, photodynamic therapy, peri-ocular steroid injections and/or subretinal surgery, may be necessary. Anti-angiogenic intravitreal injections have been shown to cause regression of both CNV and optic nerve edema. CASE REPORT: We describe a patient with PTC and CNV whose CNV regressed and vision normalized after a single intravitreal injection of bevacizumab (Avastin; Genentech, San Francisco, CA).