Acute opioid use may cause choroidal thinning and retinal nerve fiber layer increase

Assessment of RNFL and macular changes in the eye related to multiple substance use using OCT

Substance use is a chronic and recurrent public healthcare concern increasing in the world, causing negative outcomes. Two or more substance use is common among people who have substance use disorders and who receive treatment. For this reason, the present study aimed to measure Retinal Nerve Fiber Layer (RNFL), Mean Macular Thickness (MMT), Central Macular Thickness (CMT) in patients who have Multiple substance use disorder (MSUD) using Optical Coherence Tomography (OCT), considering that it will contribute to the literature. Among the inpatients who were rehabilitated in Elazig Mental Hospital Alcohol and Substance Addiction Treatment Center, 75 people who were diagnosed with MSUD according to DSM-5 and met the criteria, and 51 control groups were included in the study. RNFL, MMT and CMT measurements of both eyes of all participants were made by using the OCT. Total RNFL measurement were significantly thicker than the control group (p < 0.001). MMT and CMT of the eyes of the patient were thinner than the control group (p = 0.009, p < 0.001). The findings provide important contributions to the literature data and in light of these findings, it can be recommended to consider visual findings and possible neurodegeneration when evaluating patients in the addiction group and planning their treatment.

Establishing Optic Nerve Diameter Threshold Sensitive and Specific for Optic Atrophy Diagnosis

PURPOSE

To determine a potential threshold optic nerve diameter (OND) that could reliably differentiate healthy nerves from those affected by optic atrophy (OA) and to determine correlations of OND in OA with retinal nerve fiber layer (RNFL) thickness, visual acuity (VA), and visual field mean deviation (VFMD).

METHODS

This was a retrospective case control study. Magnetic resonance (MR) images were reviewed from individuals with OA aged 18 years or older with vision loss for more than 6 months and an OA diagnosis established by a neuro-ophthalmologist. Individuals without OA who underwent MR imaging of the orbit for other purposes were also collected. OND was measured on coronal T2-weighted images in the midorbital section, 1cm posterior to the optic disc. Measurements of mean RNFL thickness, VA and VFMD were also collected.

RESULTS

In this study 47 OA subjects (63% women, 78 eyes) and 75 normal subjects (42.7% women, 127 eyes) were assessed. Healthy ONDs (mean 2.73 ± 0.24 mm) were significantly greater than OA nerve diameters (mean 1.94 ± 0.32 mm; P < 0.001). A threshold OND of ≤2.3 mm had a sensitivity of 0.92 and a specificity of 0.93 in predicting OA. Mean RNFL (r = 0.05, p = 0.68), VA (r = 0.17, p = 0.14), and VFMD (r = 0.18, p = 0.16) were not significantly associated with OND.

CONCLUSION

ONDs are significantly reduced in patients with OA compared with healthy nerves. A threshold OND of ≤2.3 mm is highly sensitive and specific for a diagnosis of OA. OND was not significantly correlated with RNFL thickness, VA, or VFMD.

Early Lifetime Substance Use and Development of Visual Impairment: Analysis of the National Survey on Drug Use and Health Data

Purpose

To investigate the association between early lifetime substance use on the development of severe visual acuity impairment or blindness on a national level.

Methods

National Survey of Drug Use and Health data was used to identify cases of substance use before 21* years of age, within the past year, and cases of self-reported blindness or visual impairment. Univariable and multivariable binary logistic regression with time-dependency was performed to evaluate odds of visual impairment influenced by 16 substances separated into three classes: prescription, non-prescription, and illicit drugs. Adjusted variables of interest included gender, marital status, race, level of education, total family income, poverty level, population density, and history of chronic disease.

Results

55,824 total responses were analyzed with 2577 (4.6%) cases of self-reported blindness or significant visual impairment. All early-use substance categories, including prescription, non-prescription, and illegal substances, were significantly associated with self-reported VI (OR 2.068, CI 1.451-2.949, p<0.001; OR 1.352, CI 1.227-1.489, p<0.001); OR 1.211, CI 1.086-1.352, p<0.001), respectively). Non-prescription substances displayed parallel significances amongst all constituents (alcohol, cigarettes, inhalants, and marijuana) (OR=1.227, CI 1.12-1.344, p<0.001; OR 1.363, CI 1.243-1.495, p<0.001; OR 1.418, CI 1.134-1.774; OR 1.388, CI 1.27-1.518, p<0.001, respectively). Univariable and multivariable analysis revealed several significant demographical and clinical adjustors.

Conclusion

Early lifetime use of all three classes of substances is associated with enhanced odds of subsequent visual impairment or blindness. Several readily available and commonly used substances have a greater risk. These findings may help clinicians and public health agencies in mitigation ventures including education, prevention, and rehabilitation efforts.