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Paracentral acute middle maculopathy following high-intensity interval training

Published:April 23, 2021DOI:https://doi.org/10.1016/j.jcjo.2021.03.017
      Dear Editor:
      Recently, Arjmand and Mandelcorn
      • Arjmand P
      • Mandelcorn ED.
      Paracentral acute middle maculopathy following high-intensity interval training.
      reported a case of paracentral acute middle maculopathy (PAMM) in a 54-year-old male patient presenting with bilateral negative scotomas. Fundus examination revealed cotton wool spots in the inferior arcade and blunting of the foveal reflex in one eye. Optical coherence tomography revealed multiple hyperreflective bands at the level of the inner nuclear layer corresponding to hyporeflective lesions seen in near-infrared imaging. Optical coherence tomography angiography showed areas of capillary dropout and nonperfusion in the deep capillary plexus. Signs and symptoms resolved within 3 months.
      The authors reported that the patient's symptoms started subsequent to a high-intensity interval training (HIIT) class and, because no other risk factors for PAMM were identified, concluded that “…in the absence of a known retinal vascular disease HIIT exercise resulted in this perivenular finding…” speculating that HIIT may have caused arterial vasospasm and retinal capillary infarcts. While we appreciate the caution of the clinicians and agree on the advice to refrain from HIIT (or general strenuous exercise) during recovery, we believe that the authors overrated their observation. Apparently, a close, timely proximity between the exercise session and symptom onset existed, which, however, may not be interpreted as causal. While we are not informed about the nature of the respective exercise session (HIIT may be performed as cycling, running, or resistance exercise or in combinations), training status, and previous HIIT sessions without subsequent symptoms, the absence of previous ophthalmologic examinations is the most limiting factor. As stated, a number of known risk factors for PAMM, including diabetes and hypertension, exist. In an otherwise normal ocular examination and systemic history, a detailed assessment for contributing risk factors, including medication, migraines, and viral infections, as well as certain influenza vaccination, is indicated.
      • Scharf J
      • Freund KB
      • Sadda S
      • Sarraf D.
      Paracentral acute middle maculopathy and the organization of the retinal capillary plexuses.
      In contrast to the authors’ statement,
      • Arjmand P
      • Mandelcorn ED.
      Paracentral acute middle maculopathy following high-intensity interval training.
      we never observed arteriolar vasospasm or vision loss in our investigation of a 4-week aerobic HIIT in 58 healthy individuals, flow density of the nerve head was increased not decreased, and acute HIIT effects were not reported by our group.
      • Schmitz B
      • Nelis P
      • Rolfes F
      • et al.
      Effects of high-intensity interval training on optic nerve head and macular perfusion using optical coherence tomography angiography in healthy adults.
      ,
      • Alnawaiseh M
      • Lahme L
      • Treder M
      • Rosentreter A
      • Eter N.
      Short-term effects of exercise on optic nerve and macular perfusion measured by optical coherence tomography angiography.
      Moreover, a recent investigation of a 4-week aerobic HIIT in type 1 diabetic patients did not indicate adverse ophthalmologic effects.
      • Zinn S
      • Nelis P
      • Minnebeck K
      • et al.
      Effect of high-intensity interval training in patients with type 1 diabetes on physical fitness and retinal microvascular perfusion determined by optical coherence tomography angiography.

      Footnotes and Disclosure

      The authors have nothing to disclose.

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        Paracentral acute middle maculopathy following high-intensity interval training.
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        Paracentral acute middle maculopathy and the organization of the retinal capillary plexuses.
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        Effects of high-intensity interval training on optic nerve head and macular perfusion using optical coherence tomography angiography in healthy adults.
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        Effect of high-intensity interval training in patients with type 1 diabetes on physical fitness and retinal microvascular perfusion determined by optical coherence tomography angiography.
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