Correspondence
Intravenous tocilizumab in the treatment of resistant optic perineuritis
Optic perineuritis (OPN) is a rare orbital inflammatory disease that mainly involves the optic nerve sheath and surrounding tissues. It is accompanied by eye pain and various levels of optic nerve dysfunction, such as decreased vision, visual field defect, and positive afferent pupillary defect. In contrast to optic neuritis, OPN is not a self-limited disease and always requires treatment.1Retinal pigment epithelium apertures associated with subretinal fluid and acquired vitellifom lesions in non-neovascular age-related macular degeneration
Classic features of non-neovascular age-related macular degeneration (AMD) include drusen, drusenoid retinal pigment epithelial (RPE) detachment, and RPE atrophy. More recent studies have shown that intra- and subretinal fluid also may complicate the non-neovascular form of AMD.1Corneal limbal xanthogranuloma in Erdheim-Chester disease
Adult orbital xanthogranulomatous disease is a rare non-Langerhans cell histiocytic condition with 4 clinical subtypes: adult‐onset xanthogranuloma, adult‐onset asthma with periocular xanthogranuloma, necrobiotic xanthogranuloma (NBX), and Erdheim–Chester disease (ECD). We report, to our knowledge, the first case of ECD with limbal infiltration.Kodamea ohmeri keratitis
Kodamaea ohmeri is a yeast-like fungus and a rare but emerging pathogen.1 It has been identified as the causative organism in fungemia, funguria, endocarditis, cellulitis, and peritonitis, often with high fatality rates.1 To the best of our knowledge, there is only 1 previous report of K. ohmeri keratitis in the literature.2Rare case of extramacular choroidal macrovessel
Choroidal macrovessel (CM) is a rare, mostly unilateral vascular anomaly of the choroidal circulation.1 These abnormally large vessels may cause disturbances in the overlying retinal pigment epithelium (RPE) and the development of subretinal fluid. Some CMs can even masquerade as a choroidal tumour or parasitic infestation.1–3 Reports showing early filling of CMs during indocyanine green angiography (ICGA) suggest that most CMs are arterial in nature.1,3,4 The short posterior ciliary circulation is comprised of a medial and lateral posterior choroidal artery (PCA)5,6; the latter may represent the origin of most CMs and may explain why almost all previously reported CMs arise in the macula.Varied management of idiopathic intracranial hypertension in female-to-male transgender patients
Idiopathic intracranial hypertension (IIH) is characterized by elevated intracranial pressure, visual disturbances, papilledema, and headache. There is an association between sex hormone excess and IIH, particularly in patients undergoing hormonal therapy for gender transition.1 The increased androgen concentration during testosterone therapy for gender reassignment presents an opportunity for studying different treatment modalities. First-line treatment of IIH involves dietary changes and a carbonic anhydrase inhibitor such as acetazolamide.A masquerader epidemic: five heterogeneous ocular syphilis presentations
Syphilis is a spirochete infection transmitted through intercourse or congenital infection. Despite declining incidence since the 1990s, ocular syphilis has re-emerged in developed countries.1 We describe 5 distinct presentations of ocular syphilis to promote recognition of this increasingly prevalent disease.Wellness among Canadian ophthalmology resident physicians: a national survey
Residency is a particularly stressful and dynamic period during which learners must balance the demands of patient care, education, and personal responsibilities. Evidence of high levels of burnout among resident physicians has driven the development of initiatives and programs to help address this negative consequence of residency training. As a novel topic in the realm of medical education, more information is required to further characterize the sources of burnout and depression and the nuances of various specialities.Multiple myeloma with concurrent herpes zoster ophthalmicus: a case report
Hyperviscosity syndrome, which typically results from elevated serum levels of monoclonal protein, can present with bleeding, retinopathy, and neurologic symptoms.1 We present a case of hyperviscosity syndrome confounded by herpes zoster reactivation in a patient with newly diagnosed multiple myeloma.Delayed diagnosis of autosomal dominant optic atrophy until seventh decade of life
Autosomal dominant optic atrophy (ADOA) is the most common hereditary optic neuropathy, manifesting in approximately 1 in 50 000 people, and up to 1 in 10 000 in Denmark, owing to a founder mutation.1 Isolated ADOA typically manifests in the first 2 decades of life as bilateral painless progressive vision loss and is therefore mostly diagnosed in childhood to young adulthood. We present a series of 2 older patients, aged 63 and 64 years, who had delayed ADOA diagnosis as proband patients in their families, emphasizing the point that chronological age should not be the sole determining factor for ordering testing for ADOA in cases of unexplained optic neuropathy.Papilledema associated with COVID-19 multisystem inflammatory syndrome in children
Multisystem inflammatory syndrome in children (MIS-C), also called pediatric inflammatory multisystem syndrome, is characterized by a wide range of symptoms and can present a diagnostic challenge given its myriad presentations. On top of the more well-known inflammatory manifestations of MIS-C, recent reports have also surfaced of MIS-C causing increased intracranial pressure.1,2 MIS-C can present similarly to other systemic inflammatory disorders such as Kawasaki disease and can be especially difficult to distinguish from Kawasaki disease if a Kawasaki-like presentation is accompanied by a positive test for coronavirus disease 2019 (COVID-19).Late-onset bilateral epithelial ingrowth following rapid corneal decompensation owing to amantadine
Epithelial ingrowth (EI) can occur at the interface between the flap and the stromal bed of the patient's cornea following laser assisted in situ keratomileusis (LASIK) surgery. The introduction of corneal epithelial cells into the interface can happen during surgery or after the procedure owing to loss of contact inhibition and the presence of a pathway to the interface. Epithelial ingrowth is a relatively uncommon complication, with a reported incidence of 3.9% following primary LASIK and up to 12.8% following enhancement with a flap lift.Late progression of visual loss from ocular quinine toxicity
A 64-year-old Caucasian man was admitted to hospital with acute loss of vision after ingesting at least 3 grams of quinine, risperidone, and paracetamol. His medical history was significant for schizophrenia and nocturnal leg cramps. His usual medications were risperidone and quinine as required. No ophthalmic history was noted. An inpatient examination revealed bilateral no-light-perception vision and grossly constricted visual fields. Electrocardiogram showed sinus rhythm and blood tests, including glucose, haematology, liver, renal, coagulation profiles, and paracetamol levels were normal.Intrastromal voriconazole for refractory infectious crystalline keratopathy associated with Candida pararugosa
Infectious crystalline keratopathy (ICK) is an infrequent complication of long-term topical steroid use following penetrating keratoplasty,1 classically caused by Streptococcus viridans.2 It has been reported in association with local immunosuppression after any ocular surgery (lamellar keratoplasty, cataract surgery, trabeculectomy, corneal cross-liking, and laser in situ keratomileusis), as well as in contact lens wearers, herpetic and Acanthamoeba keratitis, and corneal anaesthesia.3,4 Besides α-haemolytic streptococci,2 multiple additional microorganisms have been causally linked to ICK, including Gram-positive or -negative bacteria, atypical mycobacteria, and fungi,3 most of them bearing biofilm-forming capacity.Cadaveric simulation improves ophthalmology resident confidence and preparedness for emergent ophthalmic procedures
Simulation-based training programs have become an essential tool in medical education.1 Surgical simulation on platforms, including the Eyesi, which are now widely adopted throughout ophthalmology training, reduces intraoperative complication rates.2 Even virtual training utilizing computer graphics and surgical models, which may be lacking in qualities provided by real-life scenarios or cadavers, helps trainees perform faster and with fewer errors compared with trainees who went without virtual training.Corneal imaging with optical coherence tomography assisting the diagnosis of mucolipidosis type IV
Mucolipidosis type IV (MPS-IV, OMIM #252650), a lysosomal storage disorder caused by dysfunctional mucolipin-1, is characterized by neurologic and visual impairment, developmental delay, and achlorhydria. MCOLN1 gene mutation identification is diagnostic but requires clinical suspicion. The latter is challenging, however, because most systemic and ocular findings are nonspecific and rarely evolve simultaneously.1 Bilateral corneal clouding is the earliest hallmark sign of MPS-IV. Unlike in other metabolic causes of corneal opacification, it is owing to preferential accumulation of abnormal material in the corneal epithelium as opposed to other corneal layers.Optical coherence tomography angiography in choroidal metastasis before and after treatment
Choroidal metastases represent the most common intraocular malignant tumor in adults.1 With the advent of optical coherence tomography angiography (OCTA), there is a unique opportunity to visualize choroidal vascular pathologies in more detail using a noninvasive technique concurrent with anatomical evaluation of the retina, retinal pigment epithelium (RPE), and choroid. Depth-selective characterization is one of the most significant advantages of OCTA, allowing better visualization of choroid circulation and, particularly, the choriocapillaris layer, which is the main source of perfusion to the RPE and photoreceptors.Late-onset recurrent Acremonium fungal keratitis after therapeutic penetrating keratoplasty
Fungal keratitis is a prominent cause of blindness worldwide. Therapeutic penetrating keratoplasty (TPK) has been demonstrated as an effective treatment for fungal keratitis that does not respond to antifungal medications. Recurrent fungal infection after TPK is uncommon but occurs typically within 2 weeks after surgery.1Endoscopic cyclophotocoagulation and Kahook Dual Blade trabeculotomy in combination with phacoemulsification
Convenient to perform alongside cataract surgery and relatively safe, minimally invasive glaucoma surgeries (MIGS) are growing in popularity. Few studies have examined the effect and safety of performing combined MIGS.Biopsy of a diffuse anterior chamber angle melanocytoma using a Kahook Dual Blade
A 68-year-old female was referred to the emergency ophthalmology clinic with a pigmented iris lesion and an intraocular pressure (IOP) of 38 in her left eye. Initial clinical assessment revealed the presence of a localized, flat, plaque-like peripheral and midperipheral iris lesion in one quadrant. Pigmented seeding on the rest of the iris surface and associated mild corectopia were observed. There were no notable episcleral sentinel vessels, and there was no iris neovascularization. On gonioscopy, heavy pigment invaded 8 clock hours of the angle (Fig.Crossed-quadrant homonymous hemianopsia in a monocular patient
A 75-year-old male presented to the clinic reporting that upon waking up from a nap 4 days earlier, he noticed he could “only see in certain spots.” He has an ocular history of moderate-stage primary open-angle glaucoma in both eyes, dry eye syndrome, and pseudophakia. He had previously undergone enucleation of his blind, painful right eye due to neovascular glaucoma from a previous central retinal vein occlusion. He was a former smoker, and his medical history is significant for multiple myeloma, bladder cancer, pulmonary embolism, hypertension, and hyperlipidemia.Superior oblique myositis following targeted therapy for papillary thyroid carcinoma
Papillary carcinoma of the thyroid gland (PCTG) constitutes 80%–85% of thyroid cancers globally. Despite early lymphatic invasion, PCTG has a relatively indolent course and rarely metastasizes outside of the neck.1 Metastasis to the brain from PCTG is even more uncommon and usually occurs in the context of widely disseminated disease. While the mainstay of treatment for intracranial metastasis from PCTG includes surgical excision and radiotherapy, recent advances into our understanding of the molecular pathways governing PCTG have facilitated development of novel targeted chemotherapeutics.Simple limbal epithelial transplantation (SLET) in conjunction with keratoplasty for severe congenital corneal opacities
Congenital corneal opacities (CCO) are rare, with an incidence of 1 in 26,000 to 37,000 live births.1,2 There is a wide spectrum of CCO disease severity from mild and small opacities to fully opaque cornea with severe lens involvement and vascularization or conjunctivalization of the cornea. The severe form of CCO is usually associated with large corneal opacity and the presence of extensive superficial corneal vascularization. Such eyes may have conjunctival epithelial ingrowth, which can increase the risk of allograft rejection.Junctional scotoma in moyamoya disease
A 66-year-old Hispanic woman presented to the eye clinic with chronic, progressively worsening vision in the right eye over 2 years associated with right-sided temporal headaches, cutaneous allodynia of the scalp, and jaw claudication. She denied fevers, chills, joint pains, nausea, photophobia, phonophobia, personal history of autoimmune disease, and family history of hereditary ophthalmological diseases. Her ocular history included pterygium removal from the OD. Seven years prior to presentation, she had an episode of light-headedness, blurry vision for 30 minutes, a severe headache, and mild weakness of the left hemiface and left body lasting 2 hours.Senior-Loken syndrome secondary to IQCB1 mutation in association with retinitis pigmentosa
Senior-Loken syndrome (SLS) is a rare autosomal recessive disease characterized by nephronophthisis and early-onset retinal degeneration.1 Nephronophthisis leads to end-stage renal failure. Several genes can cause SLS, including NPHP1-6 and NPHP10.2 We herein report a case of SLS type 5 caused by IQCB1 mutation.Conjunctival and periorbital petechiae presumed secondary to self-inflicted asphyxiation in a pediatric patient
The presence of petechiae of the face and conjunctiva is a well-described finding seen in strangulation injuries. These petechiae are commonly seen post-mortem in deaths by asphyxia and are consequently used in forensic analysis.1 Conjunctival and facial petechiae have also been noted to occur in nonfatal asphyxia, and their presence may be a sign that a severe strangulation injury has occurred.2 The mechanism for facial and conjunctival petechial hemorrhages in asphyxia is thought to be rupture of capillaries with little connective tissue support secondary to local pressure elevation from continued arterial flow while venous output is obstructed.Murine typhus presenting as pseudotumor cerebri
Murine typhus is an acute infection transmitted by rodent or cat fleas carrying gram-negative, obligate intracellular bacteria, Rickettsia typhi. This vector for transmission is most often carried on rodents, but opossums are thought to be a reservoir in suburban settings.1 Associated with overcrowding, pollution, and poor hygiene, murine typhus has been documented worldwide, but the majority of cases in the United States are in Texas and California.2Central retinal artery occlusion associated with Sweet syndrome
A 64-year-old Caucasian man presented with a 1-day history of acute painless vision loss in the right eye. On examination, his visual acuity was hand motions OD and 20/30 OS. His intraocular pressures were normal OU and he had a 3+ relative afferent pupillary defect OD. The anterior segment examination was unremarkable OU. Fundoscopic examination of the right eye revealed a cherry red spot (Fig. 1A). No vitreous cell, vasculitis, or chorioretinitis was noted OU. A fluorescein angiogram of the right eye showed an arterial filing line (Fig.Iris stromal defect in an infant masquerading as a tumour: the sailing iris?
Congenital iris lesions are rare and generally identified early in life.1,2 A pigmentary lesion on the iris ranges from a simple nevus or cyst to tumors including melanoma. These lesions can arise from both iris stroma and iris epithelium.2 Thorough examination as well as anterior segment imaging studies may be required to establish a diagnosis.3 Here, we report a rare case of congenital iris stromal defect masquerading as an iris tumour.Leber hereditary optic neuropathy harboring a rare m.12811 T>C mitochondrial DNA mutation
Leber hereditary optic neuropathy (LHON) is the first hereditary disease recognized to be caused by mitochondrial DNA (mtDNA) mutation.1 It is the most commonly inherited optic neuropathy resulting in bilateral visual impairment.2 More than 90% of LHON cases harbor 1 of the 3 major mtDNA mutations m.11778G>A, m.3460G>A, and m.14484T>C; however, other variants have been previously identified.3–5 We report on a case of LHON with an m.12811T>C mtDNA mutation, a rare variant mutation that has only been previously reported as a secondary mutation of LHON.Waxing and waning poppers maculopathy
Poppers are volatile aromatic liquids typically available in vials. They make a popping sound upon opening. Poppers are a member of the alkyl nitrites, chemicals with nitric oxide donor characteristics. Poppers have been a popular recreational drug for years owing to their transient euphoric, myorelaxant, and aphrodisiac effects presenting just seconds after inhalation.1,2 Although they are illegal to sell as such, they are easily obtainable, and are often sold as air fresheners online or in nightclubs.Infliximab for management of severe refractory posterior scleritis in a 9-year-old boy
Posterior scleritis (PS) is a chronic inflammatory condition of the sclera posterior to the rectus muscle insertions. PS predominantly affects adult women and is rare in children.1,2 Adult form of PS is typically associated with autoimmune systemic diseases; however, pediatric PS is mostly idiopathic with no known underlying conditions.2–4 The initial presentation of PS in children is nonspecific with painful red eye, potential vision loss, light sensitivity, and eye movement restriction, which make the diagnosis difficult.Data reporting in ophthalmology during COVID-19 pandemic: need for a Canadian registry
Registries assist public health in documenting the incidence of new infections and gathering clinical data about patients to inform clinicians on presentation and evolution of emerging diseases. This becomes even more important during the coronavirus disease 2019 (COVID-19) pandemic.Telemedicine for postoperative consultations following vitrectomy for retinal detachment repair during the COVID-19 crisis: a patient satisfaction survey
The most recent World Health Organization (WHO) report on the coronavirus disease 2019 (COVID-19) pandemic confirms a total of 4 013 728 cases, with a death toll of 278 993.1 The staggering number of deaths has thrust us into embracing telemedicine within ophthalmology, with the increased use of video and telephone consultations, to reduce the risk of virus transmission.2 At our tertiary eye unit, we continue to provide a 7-day-a-week emergency retinal surgical service; however, our postoperative review has been modified to include telephone consultations, rather than face-to-face patient contact.Follicular dendritic cell sarcoma: a novel orbital tumour
Follicular dendritic cell sarcoma is a rare neoplasm of lymphoid cells predominantly found in lymph nodes and rarely in extranodal locations. We report the first case of follicular dendritic cell sarcoma occurring in the orbit.Multimodal imaging of sclerochoroidal calcification associated with choroidal neovascular membrane
Sclerochoroidal calcification is a benign condition typically diagnosed in asymptomatic, older, white adults, which can simulate other more serious conditions such as choroidal melanoma, metastasis, or lymphoma.1 It is characterized as yellow or yellow-white single or multifocal lesions typically found in the superotemporal quadrant near the vascular arcades, which can be unilateral or bilateral.1 Although sclerochoroidal calcification is most often idiopathic, systemic testing at the time of diagnosis is required to exclude associated disorders of calcium-phosphorus metabolism.Bilateral interstitial keratitis as the presenting manifestation of systemic lupus erythematosus in a child
Interstitial keratitis (IK) is defined as a nonsuppurative inflammation of the corneal stroma with associated cellular infiltration and vascularization commonly caused by infections or rheumatologic conditions. Although extremely rare, IK may be seen with systemic lupus erythematous (SLE). We present the first case of a child without known history or symptomatology of rheumatologic or infectious disease presenting with bilateral IK that ultimately led to a diagnosis of SLE.Continuity of ophthalmology education during a pandemic by combining video conferencing application with a slit-lamp camera
The on-going coronavirus disease 2019 (COVID-19) outbreak has dramatically changed the way of work and communication in health care. As of March 22, 2020, public hospitals in Israel have ceased to provide nonurgent office-based visits and surgeries, and the presence of faculty and residents is kept to a minimum. Clinical departments’ staff is commonly divided into separate teams, to diminish their vulnerability in case of exposure to COVID-19 carriers. Worldwide, quarantine and social distancing regulations have now put new barriers between ophthalmologists, their patients, and their colleagues.Treatments for inherited retinal degenerations are coming to Canada: brief update on a new standard of care for inherited retinal degenerations
The last 25 years brought a spectacular amount of knowledge on the genetic basis of inherited retinal disorders and a paradigm shift on how they can be managed. We entered the era of gene therapy for inherited retinal degenerations (IRDs).Intraorbital foreign body giant cell granuloma secondary to a gelatin sponge
Gelatin-based sponges are water-insoluble hemostatic agents derived from purified porcine skin and gelatin granules. These sponges are approved for placement against mucosalized surfaces and within soft tissues.1,2 Herein, the authors report a case of an orbital foreign body giant cell granuloma secondary to a gelatin sponge.Conservative management of periorbital necrotizing fasciitis caused by methicillin-resistance Staphylococcus aureus
Necrotizing fasciitis (NF) of the periorbital region is a rare occurrence, though has been shown to cause severe facial disfigurement, blindness, and death.1,2 We report a case of community-acquired methicillin-resistant Staphylococcus aureus (MRSA)–associated periorbital NF in a 25-year-old woman, who presented with left eye and nostril redness and swelling after picking a pimple on her nose a few days prior. She had no significant medical history and was not diabetic. She was initially diagnosed with facial cellulitis and commenced on antibiotics, but returned 2 days later with worsening cellulitis, bilateral leg pain and redness, and shortness of breath.Capnocytophaga sputigena as a cause of severe orbital cellulitis and subperiosteal abscess in a child
Orbital cellulitis is an infection of the soft tissues lying behind the orbital septum. The etiologic agents differ across age group, but gram-positive cocci colonizing the skin and the nasopharynx, such as Staphylococcus and Streptococcus species, are most commonly identified in children. Haemophilus influenzae, a gram-negative facultative anaerobe, was frequently identified before the introduction of the Haemophilus vaccine in 1985. We report the case of a 15-year-old man who presented with a severe orbital cellulitis complicated by a subperiosteal abscess (SPA) secondary to Capnocytophaga sputigena.A case of multifocal presumed solitary circumscribed retinal astrocytic proliferation lesions in the same eye
Presumed solitary circumscribed retinal astrocytic proliferation (PSCRAP) is a recently described retinal tumour that is a distinct entity from other white lesions of the retina such as astrocytic hamartoma and acquired astrocytoma.1 The exact origin of these lesions is of some debate within the literature as no histological diagnosis exists to date.2,3 These lesions are not associated with tuberous sclerosis complex or related syndromes and can be distinguished from astrocytic hamartomas with imaging.Canadian ophthalmology resident experience during the COVID-19 pandemic
The ongoing worldwide pandemic of coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has greatly affected our lives. At the time of writing this report, there have been 18 166 298 confirmed cases and 690 953 deaths worldwide owing to SARS-CoV-2, with 118 966 cases and 8995 deaths in Canada.1Branch retinal vein occlusion as the presenting feature of germ cell tumour
Retinal vein occlusion (RVO) is the second most common retinal vascular disease after diabetic retinopathy. RVO stands as one of the common causes of visual morbidity and blindness in the elderly population. RVO can be classified into central retinal vein occlusion (CRVO) and branch retinal vein occlusion (BRVO) based on the site of vascular occlusion. The incidence of BRVO is generally higher than the incidence of CRVO. Systemic hypertension, hyperlipidemia, and increased body mass index are important risk factors for BRVO in young patients,1 similar to older population.Serous retinal detachment following bronchoscopy-induced hypertensive emergency
Flexible bronchoscopy is a widely used procedure with multiple therapeutic and diagnostic uses. Although considered fairly low risk, ocular complications including subconjunctival hemorrhage and Valsalva retinopathy1 have been reported. We present a case of serous retinal detachment (SRD) that was primarily caused by a hypertensive emergency occurring during bronchoscopy.Retinal ganglion cell loss in postmortem tissue of Alzheimer disease, glaucoma, and healthy normal subjects
Loss of retinal ganglion cells (RGCs), the hallmark of glaucoma (GL), is also thought to occur in patients with Alzheimer disease (AD).1,2 Structural measures derived with optical coherence tomography have been used as proxies for RGC estimates in GL3,4 and AD,5 both independently and in comparative studies.6,7 Although optic nerve damage in GL8,9 and AD10 has been reported in postmortem tissue, quantification in the retina is limited to the use of generic techniques, such as Nissl staining in the ganglion cell layer,11,12 which label all nuclei and not specifically RGCs.Anterior uveitis following collagen crosslinking in a patient with X-linked chronic granulomatous disease
A 14-year-old boy of Middle Eastern heritage with X-linked chronic granulomatous disease (CGD) was referred to the cornea clinic for keratoconus. He had no history of uveitis. He had been diagnosed with CGD 6 years ago after suffering pneumonia requiring broad-spectrum intravenous antibiotics. He had no significant infections since starting prophylactic antibiotics and antifungals. His mother stated that he “constantly rubs his eyes.” His mother was a CGD carrier and also had keratoconus. No other family members had CGD or keratoconus.Access, an unintended consequence of virtual continuing medical education during COVID-19: a department's experience at the University of Toronto
Coronavirus disease 2019 (COVID-19) has irreversibly affected the lives of millions of people globally; to control its spread, many activities including clinical care have been limited to essential services.1 Continuing medical education (CME) activities in many specialities, however, have expanded and even flourished by moving to online platforms, allowing for broader interactions across hospitals, organizations, and borders. In this perspective, we highlight what we believe is the most important benefit to come from the rise in virtual CME during the pandemic drawing from our own department's experience, namely, increased access to those who have historically been excluded from traditional CME activities.Paracentral acute middle maculopathy following high-intensity interval training
High-intensity interval training (HIIT) is a cardiovascular exercise strategy that combines short bursts of intense anaerobic exercise with quick recovery periods. There are significant cardiovascular, metabolic, and mental health benefits associated with HIIT.1 Furthermore, this exercise regimen is correlated with better macular and optic nerve head capillary perfusion, microvascular remodelling, and decreased size of the foveal avascular zone in the long-term.1,2
