Long Flights Can Pose a Threat to Patients at Risk for Acute-Closure Glaucoma

By Rob Goodier

October 06, 2014

NEW YORK (Reuters Health) - Patients with risk factors for acute-closure glaucoma may consider taking special precautions on long flights, researchers suggest.

Three new case studies of patients who developed the condition on flights underscore the problems, including the delay in medical attention until after touchdown which could exacerbate the damage, and the possibility that the flight itself might be an additional risk factor, according to a report published online September 25 in JAMA Ophthalmology.

"Patients with long-sightedness (hypermetropia) or with a family history of angle closure glaucoma are likely to be at highest risk of developing angle closure," Dr. Andrew Turnbull, an ophthalmologist at Bournemouth Eye Unit in Bournemouth, England, who reported the case studies, told Reuters Health by email.

"Simple strategies such as lying flat, or avoiding film-watching in low-lighting conditions may be protective against the condition. Patients should certainly mention any symptoms of severe eye pain or blurred vision to the cabin crew, so that they can receive the attention they require," Dr. Turnbull says.

The case studies include three women ages 42, 53 and 68 years old, all three at risk for acute-closure glaucoma.

Besides hypermetropia and family history, women and people older than 60 years of age are at higher risk, and so are certain ethnic groups such as East Asians and Inuits. Other risk factors include short axial length, small corneal diameter, and larger anteroposterior lentricular diameter.

Also, systemic medications may be another risk factor. In one case, the 53-year-old woman was taking the selective serotonin reuptake inhibitor citalopram hydrobromide, prescribed for depression. Blurred vision can be a side effect of the drug and the researchers say it might have played a role in her acute-closure glaucoma.

"It is unclear whether long-haul flights on their own pose an additional risk factor," Dr. Turnbull says.

If so, the risk may be related to sitting upright for a long period of time and the plane's dim lighting.

"Pupil block is believed to occur during pupillary mid-dilation, a physiologic finding in dimly lit environments," the authors write. "Angle crowding during pupil dilation may be the mechanism in case 3 (the 42-year-old woman)."

At-risk patients can take the precautions mentioned, but Dr. Turnbull's most-repeated advice is to see an ophthalmologist before long flights.

"Individuals with risk factors should be advised on the symptoms of ACG and the appropriate course of action should those symptoms occur," the report concludes. "Prophylactic therapy with pilocarpine, 2%, eyedrops may be useful for individuals with risk factors who are embarking on long-haul flights. Airline personnel should be aware of ACG and encouraged to consider the value of training cabin crews to provide appropriate first-aid measures."

SOURCE: http://bit.ly/1pxtpM9

JAMA Ophthalmology 2014.

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