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Pressure patch may improve metamorphopsia
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To the Editor:
The article on patching central serous retinopathy and the resulting visual improvement was intriguing (October 2014, “Patching helps improve macular function in patients with central serous retinopathy”).
As I began the article, I anticipated a different clinical rationale than Jerome Sherman, OD, FAAO, had described. The article related improvement to reduced phototoxic stress on the macula, which makes sense.
My clinical curiosity leads me to inquire whether the patches employed were pressure patches or simply “dome type” patches to allow the eye to be open behind the patch. Would it be possible that a pressure patch could transfer some compression to the edematous macula, resulting in a minute flattening of the macular layers?
Observationally, I have noted that a +0.50 D shift in refraction occasionally is the initial clinical finding in pending maculopathy. Further, patients sometimes report that their metamorphopsia is slightly improved after a nap on their back – perhaps due to the weight of the vitreous on the posterior pole.
These are clinical observations over my 4-decade optometric career, but this nice article prompted me to “ask the experts.”
Thanks, Dr. Sherman, for all you do in optometric education.
T. Lawless, OD
Dixon, Ill.
Sherman responds:
Thanks for your intriguing comments and observations. You appear to have complicated this for us: Now we should treat some patients with a pressure patch and others with a “dome” type patch and observe whether there is a difference.
Such letters are always welcome.
Jerome Sherman, OD, FAAO
New York