My heart sank when, on a post-op visit, a patient informed me he was going to see the solar eclipse. Being in the middle of a busier-than-usual week, I had missed the hype that surrounded the solar eclipse that swept across the United States. As I counseled him regarding the importance of protective eye wear, I mentally prepared for another busy week of consults through our emergency room. Our hospital is the main eye emergency center for the region, and I expected a slew of consults for solar retinopathy. As I checked the news, I saw that hospitals across the country had been preparing for the eclipse and some had even rescheduled elective cases to be able to handle the expected increased burden of patients presenting with concerns for solar retinopathy.
As the Assistant Chief of our Ocular Emergency service, I prepared my residents (including C.C.) for the increased consults. We were surprised, to say the least, when none came. Then late on Tuesday afternoon a patient came in with concerns for solar retinopathy. He stated that during the eclipse he had looked at the sun several times, for a few seconds each time, with homemade polarized lenses. Later he noted blurred vision in his right eye. He denied any distortions or scotomas. His visual acuity with pinhole was 20/20 OU. A complete dilated eye examination, fundus imaging including optical coherence tomography, fundus autofluorescence, and optical coherence tomography angiography at initial visit and follow-up visit a week later were absolutely normal. In the few weeks since, we have not received any additional consults through the emergency room or in our clinics with concerns for solar retinopathy. The media reported other hospitals across the country also did not see the increased number of cases that they were expecting. A quick survey update from the American Society of Retina Specialists reported only about a dozen cases from the entire country of tens of millions of people who were in the path of the solar eclipse.
Thankfully, the patient has been doing well, and we are reassured that there were no cases of confirmed solar retinopathy at our institution. However, many questions came to mind. Who should be screened for solar retinopathy among people who watched the eclipse and subsequently complain of change in vision? Even before the eclipse, didn’t we see people every day who complain about their vision, while we we ascribed those complaints to refractive errors, minor conjunctival or cornea abnormalities, or minimal lens opacities? How frequently should such cases be followed for possible development of solar retinopathy not noted by this time? How long should we wait before we can say that someone who looked at the eclipse without adequate eye protection is no longer at risk of late sequelae of solar retinopathy that makes it likely it should be considered in the differential diagnosis?
An editorial in JAMA Ophthalmology published just before the eclipse discussed the mechanism of retinal injury from solar eclipse . We wondered, in this era of more sensitive imaging than existed before any previous solar eclipse going coast-to-coast in North America, what the reasons were for the fewer-than-expected cases of solar retinopathy. By creating hype around the dangers of solar retinopathy, did the media do a perfect job of spreading awareness regarding eye protection? If yes, why could it not do the same for the many other causes of preventable blindness that are considerably more common? If no, and many people, including our President, could not resist the spectacular sight and looked for seconds or longer without eye protection, is the incidence truly rare, maybe 1 in a million, that someone could stare hard enough to create solar retinopathy?
It is also possible that patients will slowly trickle in and we will see case reports and case series from across the country that will enhance our future preparedness for this rare celestial event. Only time will tell, and perhaps guide us for the next big eclipse across the continental United States on another Monday—but on April 8, 2024!