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PHOTO ESSAY
Year : 2020  |  Volume : 68  |  Issue : 10  |  Page : 2240-2241

Adaptive optics imaging in a case of welder's maculopathy


Vitreoretina Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India

Date of Submission13-Dec-2019
Date of Acceptance11-Apr-2020
Date of Web Publication23-Sep-2020

Correspondence Address:
Dr. Tejaswini Vukkadala
Vitreoretina Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi - 110 029
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_2289_19

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  Abstract 


Keywords: Adaptive optics, maculopathy, welder


How to cite this article:
Azad SV, Vukkadala T, Kumar V, Kumari A. Adaptive optics imaging in a case of welder's maculopathy. Indian J Ophthalmol 2020;68:2240-1

How to cite this URL:
Azad SV, Vukkadala T, Kumar V, Kumari A. Adaptive optics imaging in a case of welder's maculopathy. Indian J Ophthalmol [serial online] 2020 [cited 2020 Oct 31];68:2240-1. Available from: https://www.ijo.in/text.asp?2020/68/10/2240/295716



A 46-year-old male, welder by profession, presented to our center with blurred vision for a year. There was no redness, pain, metamorphosia, or loss of visual field. Patient gave no history of use of safety goggles at workplace. Visual acuity was 20/20 OD and 20/40 OS. A 2 × 2 mm nebular corneal opacity was noted OD nasally. Fundoscopy revealed a faint yellowish foveal spot OU, more prominent in OS than OD, and a dull foveal reflex OU [Figure 1].
Figure 1: Fundus photograph OD (a) and OS (b) showing faint yellowish foveal spot and dull foveal reflex

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Spectral-domain optical coherence tomography (SD-OCT) revealed disruption of IS-OS junction OU and disruption of external limiting membrane OS [Figure 2]. Adaptive optics (AO)(Rtx 1) imaging detected reduction in cone photoreceptor density and alteration in cone photoreceptor mosaic arrangement OU at the foveal region [Figure 3]. A diagnosis of Welder's maculopathy was made. Patient was advised protective filters at work and periodic follow-up.
Figure 2: Optical coherence tomography OD (a) and OS (b) showing disruption of IS-OS junction OU, disruption of external limiting membrane (ELM) OS

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Figure 3: Adaptive optics (AO) retina OD (a) and OS (b) showing reduction in cone photoreceptor density and alteration in cone mosaic arrangement

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  Discussion Top


Photic retinopathy is photochemical damage occurring at the level of photoreceptors due to direct exposure to bright light (sun, laser, or welding arc). The causes may include history of sun-gazing, eclipse viewing, use of laser pointer or occupation such as welding.

Chronic retinal injury due to welding arc can manifest as yellowish foveal spot/ring, lamellar macular hole, and permanent visual impairment.[1],[2],[3] AO imaging in our case was done using the Rtx 1 model which operates at a wavelength of 750 nm and neutralizes lower and higher order optical aberrations. Each image obtained is an average of forty frames of a 4° ×4° retinal area with good test-retest reliability.[4],[5] Our case demonstrated marked reduction in foveal cone photoreceptor density and its mosaic arrangement OU, thus, showing far greater involvement than seen clinically [Table 1].
Table 1: Foveal cone characteristics in our patient vs. normative data

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Although constraint of high cost limits its widespread availability, AO imaging is more sensitive and offers an accurate assessment of photoreceptor damage which may otherwise remain undetected clinically.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Lucas RS, Harper CA, McCombe MF, Mainster MA, Sliney DH, Zamir E. Optical coherence tomography findings in Welder's maculopathy. Retin Cases Brief Rep 2007;1:169-71.  Back to cited text no. 1
    
2.
Mahindrakar A, Toshniwal S, Doongerwala MI, Anthony H. Spectralis optical coherence tomography findings in Welder's maculopathy. Indian J Ophthalmol 2013;61:238-40.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Vedantham V. Optical coherence tomography finding in a case of chronic welder's maculopathy. Eye (Lond) 2006;20:269-71.  Back to cited text no. 3
    
4.
Bidaut Garnier M, Flores M, Debellemanière G, Puyraveau M, Tumahai P, Meillat M, et al. Reliability of cone counts using an adaptive optics retinal camera. Clin Exp Ophthalmol 2014;42:833-40.  Back to cited text no. 4
    
5.
Davoudi S, Sevgi DD, Yasa C, Laíns I, Ebrahimiadib N, Roohipoor R, et al. High reliability of cone cell measurements with adaptive optics scanning laser ophthalmoscopy in a simulated real-life clinical setting. Ophthalmic Surg Lasers Imaging Retina 2018;49:228-35.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1]



 

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