Week in review: COVID-19 protection in the clinic, ocular mpox, trabeculectomy and visual field damage

A weekly roundup of ophthalmic news from around the web.

Breath guards and masks provide near-complete viral droplet protection. Given the potential danger of COVID-19 infection spread between patients, clinicians, and staff in ophthalmology clinics, investigators at one such clinic in the United Kingdom created a cough model of droplet sprays to assess the reliability of breath guards donned by physicians and face masks by patients in protecting against aerosol transmission. Normal saline was stained with fluorescein and sprayed in a volume to match that of a dry cough, with images taken against paper to mimic use of breath guard only, breath guard plus face mask, or no protection (control). The models demonstrated 99.93% droplet protection with a breath guard and 99.98% droplet protection with a breath guard plus face mask, indicating that, according to the authors, “use of face-masks and breath-guards play an important role in reducing the viral load spread between the clinician and the patient.” Eye

The CDC urges timely treatment of ocular mpox. As of October 11, 2022, 26,577 confirmed and probable mpox cases had been reported to the Centers for Disease Control and Prevention (CDC). The CDC’s report of those numbers also provides demographic and clinical characteristics and treatment outcomes for 5 patients with ocular mpox. Eye redness and pain were seen in all 5 patients; additional ocular symptoms included itching, periorbital swelling, and photosensitivity. Conjunctivitis and conjunctival lesions were seen on ocular exam. Four of the five patients had no lasting vision changes once the mpox had been treated. As mpox cases are still being identified, the CDC recommends “urgent ophthalmologic evaluation and the provision of timely medical outcomes” in order to prevent sight damage. Morbidity and Mortality Weekly Report (MMWR)

What is the effect of trabeculectomy on visual field loss? To gather more information about the visual field (VF) outcomes following trabeculectomy, researchers at Moorfields Eye Hospital reviewed  data from 74 patients (80 eyes) randomly chosen from those who underwent trabeculectomy with mitomycin C for glaucoma between 2015 and 2016. Not only did trabeculectomy reduce IOP from 18 mm Hg at baseline to 10 mm Hg 1 year after surgery, it also slowed the mean rate of progression of VF damage from −0.94 dB/year to −0.33 dB/year. While the study was limited by its lack of a control arm, the results provide evidence when considering the benefits of trabeculectomy. Eye