Clinical and Experimental Ophthalmology Conversations

X-linked retinoschisis is a rare inherited retinal disorder in which cystoid fluid collections often develop at the macula, affecting vision. Prior retrospective studies have shown conflicting benefit of systemic acetazolamide. In this randomised controlled trial, 10 patients (17 eyes) with X-linked retinoschisis received oral acetazolamide (500mg/day for at least 16 weeks) whilst 9 patients were observed. The primary outcome measure showed no significant difference in central subfield thickness between treated and observed eyes after 32 weeks. In addition, there were no significant differences in cystoid fluid collection volume, best-corrected visual acuity, low luminance visual acuity or patient reported visual disability between both groups. This study suggests that oral acetazolamide should not be routinely used in the treatment of X-linked retinoschisis.

Transpupillary Thermotherapy (TTT) is a globe-salvage local laser treatment that has been used for the treatment of smaller choroidal melanomas. In this retrospective study of 850 patients from Sweden, long-term outcomes including local recurrence and disease-specific survival were found to be worst with TTT alone, followed by combined plaque brachytherapy with TTT, then plaque brachytherapy alone. This raises questions over whether TTT should have any role in the treatment of uveal melanoma and highlights the importance of correct local therapy in reducing long-term mortality from metastases.

Reticular pseudodrusen (otherwise known as subretinal drusenoid deposits) are an important finding in age-related macular degeneration. They are a risk for geographic atrophy development and growth. In this study, an internally and externally validated deep-learning algorithm was developed to automatically identify reticular pseudodrusen with similar to better accuracy than retinal specialists. This allows for future quantification of reticular pseudodrusen in clinical trials, an important next step to learning more about the importance of this sign.

This large case series from Australia reviews 40 patients with tattoo associated uveitis. Most cases were found to be bilateral. Although all forms of uveitis are possible, anterior uveitis is the most common presentation, occurring in 70% of eyes. Vision was commonly affected, such that two-thirds of patients required long term immunosuppression. Given that 25% of the Australian population has a tattoo, asking for this is a critical question in any patient presenting with uveitis.

A recent systematic review and meta-analysis of studies on dominant optic atrophy found that visual acuity was the only biomarker with longitudinal data, and its rate of change did not differ significantly from zero. These findings highlight a critical gap in the field - robust, sensitive biomarkers capable of capturing disease progression are lacking. Identifying alternative structural, functional or molecular biomarkers will be essential for designing and validating future therapeutic clinical trials in dominant optic atrophy.