Ocular and facial injuries sustained by goaltenders in the National Hockey League: a preventable problem.

OBJECTIVE: Despite mandatory helmets and face masks, professional and amateur goaltenders continue to be at risk for eye and facial injuries. Better understanding of the mechanism of injury would help in optimizing goaltender equipment. The goal of this study was to identify eye and orbital injuries to goaltenders in the National Hockey League (NHL) over the past 5 seasons. DESIGN: Retrospective case series. PARTICIPANTS: All NHL goaltenders from the 2014-2015 to 2018-2019 regular seasons. METHODS: Web-based sports injury web sites were searched to identify eye and facial injuries among goaltenders between the 2013-2014 and 2018-2019 NHL seasons. RESULTS: Five in-game eye, orbital, or facial injuries to NHL goaltenders were retrieved, resulting in an incidence of 4.07 per 10 000 athlete exposures. A total of 5 games were missed due to these injuries, resulting in a lost financial value of $335 937. All goaltenders in the NHL during the study period wore noncertified goaltender masks, and the mechanism of injury was the same in all cases, involving the blade of a player's stick accidentally passing through the gaps in the goaltender's facemask. All included players left the game in which they were injured, and the mean number of games missed was 1 (range 0-2). CONCLUSIONS: Despite mandatory facial protection, the use of noncertified masks is inadequate to prevent all facial and eye injuries. Serious consideration should be made to adapt new legislation in professional hockey.

The 2016 American Academy of Ophthalmology Hydroxychloroquine Dosing Guidelines For Short, Obese Patients.

PURPOSE: The increasing prevalence of obesity over the past 60 years implies the need to reassess the risk of hydroxychloroquine retinopathy (HR) in obese women using the American Academy of Ophthalmology (AAO) 2016 guidelines. DESIGN: Cross-sectional study. PARTICIPANTS: Medical records of 64 patients with HR from the practices of 2 ophthalmologists, 11 of whom were women with body mass index of 30 kg/m2 or more, were reviewed. METHODS: Daily dosing based on real and ideal weight was calculated. MAIN OUTCOME MEASURE: Determine the number (and percentage) of patients given daily dosing according to real-weight and ideal-weight guidelines. RESULTS: In 4 patients (36%), daily dosing was more than 5 mg/kg based on real weight and more than 6.5 mg/kg based on ideal weight. In 4 patients (36%), daily dosing was 5 mg/kg or less based on real weight and 6.5 mg/kg or less based on ideal weight. In 3 patients (27%), daily dosing was 5 mg/kg or less based on real weight and more than 6.5 mg/kg based on ideal weight. No patient had daily dosing of more than 5 mg/kg based on real weight and 6.5 mg/kg or less based on ideal weight. CONCLUSIONS: Twenty-seven percent of cases of hydroxychloroquine retinopathy in obese women had ostensibly safe dosing based on 2016 AAO guidelines. Overdosing of obese women by 2016 AAO guidelines is not rare. Daily dosing based on the older 6.5-mg/kg ideal weight threshold is safer in women with a body mass index of 30 kg/m2 or more.

Eye and Orbital Injuries in Sports.

Sports-related eye and orbital injuries continue to occur regularly and may have serious consequences. They are completely preventable when appropriate protection is worn, particularly with polycarbonate lenses. Eye protection is available for most sports and should be worn in accordance with the standards of regional authorities. It is important for first responders to identify red flags in the history and physical examination of an injured athlete for urgent referral to an ophthalmologist. Common sports-related eye injuries include corneal abrasion, subconjunctival hemorrhage, hyphema, vitreous hemorrhage, retinal tears and detachment. The mechanism and treatment of these injuries are discussed in further detail.

Retinal toxicity of high-dose hydroxychloroquine in patients with chronic graft-versus-host disease.

OBJECTIVE: To evaluate retinal toxicity in patients treated with high-dose hydroxychloroquine (HCQ) (Plaquenil, Sanofi Pharmaceuticals) for chronic graft-versus-host disease (GVHD). DESIGN: Cohort study. PARTICIPANTS: Twelve patients with chronic GVHD treated with 800 mg/day HCQ between June 2005 and December 2010. METHODS: Patients in this study underwent ophthalmologic examination yearly and ancillary studies including colour vision, Amsler grid, fundus photographs, Humphrey 10-2 automated perimetry, spectral-domain optical coherence tomography (SD-OCT), and multifocal electroretinography (mfERG). Evidence of HCQ toxicity was determined by the presence of scotomas in the Amsler grid and Humphrey 10-2 automated perimetry, and confirmed by at least 1 objective test including SD-OCT or mfERG. RESULTS: Of the 12 patients, 7 were male and 5 were female. Mean age was 49 years. Mean best corrected visual acuity at baseline was 20/25 and remained 20/25 at final follow-up. Median duration of HCQ treatment was 22.8 months. Median adjusted daily dosage was 11.5 mg/kg/day. Seven patients developed vortex keratopathy. No signs of pigmentary retinopathy or bull's-eye maculopathy were found in any of the patients. Three patients developed retinal toxicity with scotomas in the Amsler grid and Humphrey 10-2 automated perimetry, as well as abnormal mfERG. Retinal structure measured by SD-OCT was abnormal in 2 of the 3 patients with retinal toxicity. Colour vision measured by Ishihara plates, as well as by 100 Hue colour test, was abnormal in 2 of the 3 patients with retinal toxicity. CONCLUSIONS: High-dose HCQ in patients with GVHD was associated with higher incidence and earlier development of retinal toxicity.

Efficient search, mapping, and optimization of multi-protein genetic systems in diverse bacteria.

Developing predictive models of multi-protein genetic systems to understand and optimize their behavior remains a combinatorial challenge, particularly when measurement throughput is limited. We developed a computational approach to build predictive models and identify optimal sequences and expression levels, while circumventing combinatorial explosion. Maximally informative genetic system variants were first designed by the RBS Library Calculator, an algorithm to design sequences for efficiently searching a multi-protein expression space across a > 10,000-fold range with tailored search parameters and well-predicted translation rates. We validated the algorithm's predictions by characterizing 646 genetic system variants, encoded in plasmids and genomes, expressed in six gram-positive and gram-negative bacterial hosts. We then combined the search algorithm with system-level kinetic modeling, requiring the construction and characterization of 73 variants to build a sequence-expression-activity map (SEAMAP) for a biosynthesis pathway. Using model predictions, we designed and characterized 47 additional pathway variants to navigate its activity space, find optimal expression regions with desired activity response curves, and relieve rate-limiting steps in metabolism. Creating sequence-expression-activity maps accelerates the optimization of many protein systems and allows previous measurements to quantitatively inform future designs.

Getting Patients to Protect Their Eyes During Sports.

Statistics and especially photographs can prove to patients that serious eye injuries can occur during a leisurely game of racquetball and even tennis. But getting players to actually wear certified polycarbonate eye guards can be challenging. Here are a few strategies to show patients that eye protection is essential to the game.

Eye Injuries in Squash and Racquetball Players: An Update.

In brief From the summer of 1978 to May 1981 there were 154 eye injuries from squash and 91 from racquetball reported to the eye surgeons of Canada. The ball caused 90% of the most serious racquetball injuries and 67% of those in squash. Fifty-two players reported eye injuries that occurred while wearing open eye guards. Only two injuries occurred involving protectors with plastic in front of the eye. Players who wear prescription lenses are particularly at risk during play, because the glasses cannot withstand balls and rackets traveling at speeds of up to 127 mph.