Welders’ maculopathy: Mystery unravelled on en face OCT

Author: Anushree Chauhan (India)

Co-authors: Abhishek Desai, Rushikesh Naigaokar

Purpose

To enhance our understanding of structural changes in Welders' arc maculopathy by obtaining high resolution in vivo En face OCT images. Maculopathy associated to the use of welding devices is an infrequent entity, usually seen in under developed and developing countries. Retinal toxicity secondary to chronic exposure is more frequent. Acute toxicity caused by exposure to welding is very rare.

Setting/Venue

An observational study involving a case series of 6 patients (12 eyes) all males and welders by occupation who presented with blurring of vision after exposure to photo toxic radiations at Vitreoretina department at Shri Ganpati Netralaya, Jalna, Maharashtra, India.

Methods

A comprehensive ocular examination was done including BCVA (best corrected visual acuity), slit-lamp bio microscopy examination, dilated fundus examination by indirect ophthalmoscope and amsler’s grid test. Image acquisition with Swept source OCT (b scans), OCT angiography (OCTA) & En face OCT (Topcon DRI Triton) and fundus photography was done.

Results

The age of the patients ranged from 21 to 44 years (mean age 31.17 years).The duration of exposure varied from 1 month to 60 months (mean 19.33 months). BCVA ranged from 6/7.5-6/12 with normal anterior segment. Fundus examination showed yellow spot at the fovea in 8/12 eyes. OCT b scans revealed defect in ellipsoid & interdigitation zone at fovea in all eyes. OCTA was within normal limits. En face OCT revealed hyper reflective area with central hypo reflectivity at the level of outer retina (ellipsoid zone) in all eyes corresponding to central scotoma on Amsler’s grid. The area of defect noted on En face OCT ranged from 124.10 μm2 to 1187.57 μm2 (mean 496.85 μm2 ).The area of defect showed a positive correlation with the duration of exposure. Also an inverse relationship was found between area of defect and BCVA.

Conlusions

To the best of our knowledge no one has studied En face OCT changes in welders' maculopathy till now. It is one of the first series to describe these observations & can be an adjunct in understanding pathology and natural history in photic retinopathies. Corresponding reflectivity changes can be seen on En face OCT, especially in the outer retina. OCTA reveals no changes in vasculature. There is a need for educating people involved in this profession who are mainly in the young age group, regarding appropriate protective measures mainly in the developing countries where the prevalence is more.

Financial Disclosure

NO FINANCIAL DISCLOSURE