This Week's Eye-Openers

American Journal of Ophthalmology

Trials and Tribulations of the Tanning Bed: Lighting up the Lens 

Light Adjustable Lens with ActivShieldTM is an intraocular lens that enables postoperative refractive adjustments with targeted ultraviolet (UV) light. It was designed to optimize protection from ambient UV exposure and mitigate the risk of unintentional polymerization secondary to unintentional refractive changes. 

This case describes a 70-year-old female with a history of LASIK and cataracts who underwent an uncomplicated bilateral LAL 2.0 implantation. Despite reported use of postoperative UV protective glasses, her vision worsened. On exam, her central lens showed hyperpolymerization and an unintended refractive change. The patient later shared that she frequents a tanning bed and likely uses inappropriate eye protection. Due to irreversible damage, her lenses were ultimately replaced with Softport IOLs. 

This case reveals a key limitation of ActivShield technology: it provides protection against routine ambient UV exposure but does not prevent unintended polymerization under high-UV exposure conditions, such as a tanning bed. Ophthalmologists should specifically ask about and educate their patients on the risk of high UV exposure and reinforce the need for appropriate eye protection in the post-operative period, especially before the final lock-in treatment. 

Written By: Sophie Gorup

A 10-week-old infant is referred to your clinic after the parents notice a “white reflex” in the baby’s eyes on photographs. The parents have no other concerns. He was born at term and is exclusively breastfed with appropriate weight gain. There is no jaundice, hepatosplenomegaly, vomiting, lethargy, or other developmental concerns. Family history is insignificant on the mother’s side. It is unknown on the father’s side, as he was adopted, but both are from the same region of Turkey. Vital signs are within normal limits. The exam is benign besides bilateral leukocoria, with dilated exam revealing bilateral central lens opacities with a surrounding clear cortex. There is no corneal clouding. CBC, CMP, liver function, ammonia, and coagulation studies came back normal. Routine UA was also unremarkable. What would be the best next step in diagnostic workup?

1. Repeat the routine urine dipstick
2. RB1 germline sequencing
3. Urine copper-reduction test
4. Fluorescein angiography
5. Congenital infection panel

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