Letter to the Editor
Comments on the mechanisms of retinal phototoxicity
Comentario acerca de los mecanismos de fototoxicidad retiniana
J. González Martín-Moro
, J. Zarallo Gallardo
Corresponding author
Servicio de Oftalmología, Hospital Universitario del Henares, Madrid, Spain
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In both eyes, delimited by the blue arrows, the affected peripapillary area is hypopigmented. C) and D) Autofluorescence. In both eyes, patchy hyperautofluorescence. Discontinuous AZOOR line, indicated in some sections by red arrows. E) and F) Fluoresceinic angiography. Peripapilar granular hyperfluorescence in both eyes. G) and H) OCT of both eyes. Focal subretinal deposits in transition zone 2 (yellow arrows). Loss of outer layers and choriocapillary atrophy (black arrows). In right eye (G), outer plexiform thickening (blue arrow).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "T. Rueda-Rueda, J.L. Sánchez-Vicente, M.A. Espiñeira-Periñán, A. Muñoz-Morales, C. Rodríguez-Fernández, F. López-Herrero" "autores" => array:6 [ 0 => array:2 [ "nombre" => "T." "apellidos" => "Rueda-Rueda" ] 1 => array:2 [ "nombre" => "J.L." "apellidos" => "Sánchez-Vicente" ] 2 => array:2 [ "nombre" => "M.A." "apellidos" => "Espiñeira-Periñán" ] 3 => array:2 [ "nombre" => "A." "apellidos" => "Muñoz-Morales" ] 4 => array:2 [ "nombre" => "C." "apellidos" => "Rodríguez-Fernández" ] 5 => array:2 [ "nombre" => "F." "apellidos" => "López-Herrero" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0365669120303117" "doi" => "10.1016/j.oftal.2020.07.015" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365669120303117?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579420302206?idApp=UINPBA00004N" "url" => "/21735794/0000009600000009/v1_202109010611/S2173579420302206/v1_202109010611/en/main.assets" ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Comments on the mechanisms of retinal phototoxicity" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "505" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "J. González Martín-Moro, J. Zarallo Gallardo" "autores" => array:2 [ 0 => array:4 [ "nombre" => "J." "apellidos" => "González Martín-Moro" "email" => array:1 [ 0 => "juliogmm@yahoo.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Zarallo Gallardo" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Oftalmología, Hospital Universitario del Henares, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Comentario acerca de los mecanismos de fototoxicidad retiniana" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The recent article on the mechanisms of retinal phototoxicity published by Mora Sáez et al. contains very illustrative images of three types of photic maculopathy.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> However, the commentary on the mechanisms that intervene in said phototoxicity is vague.</p><p id="par0010" class="elsevierStylePara elsevierViewall">As the authors state, it is true that presumably there are three fundamental mechanisms (phototoxic, photothermal and photodisruptive). However, it is incorrect to state that solar maculopathy or eclipse maculopathy is mediated by a thermal mechanism. This maculopathy is not strictly speaking a burn. For sunlight to induce a burn in the retina, the retina needs to reach temperatures above those necessary to induce coagulation of cellular proteins. It is believed that this never happens after exposure to sunlight, probably largely due to the cooling effect of the very high choroidal flux.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2–4</span></a> A true retinal burn mediated by a thermal mechanism would only occur in exceptional situations, when this choroidal cooling mechanism is overwhelmed. This occurs when the retina is exposed to a very high dose of energy in a short period of time (e.g., in patients looking at the flash produced by an atomic explosion or when the retina is intentionally photocoagulated with an argon laser).<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5–9</span></a> If the mechanism by which staring at the sun damages the retina were thermal, the visual loss would be immediate and not delayed, as is often the case.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The mechanism by which sunlight induces retinal damage is not fully understood, but since Vos proposed his theory of phototoxic damage in 1962 it is believed that increased retinal temperature does not play a major role.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> Both experimental studies in which retinal temperature has been measured in experimental animals and the chronology of visual loss suggest that as in the case of laser pointers, the damage is primarily phototoxic. We believe that this confusion stems from the fact that in the classical literature these retinal lesions have frequently been referred to as sunburns.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: González Martín-Moro J, Zarallo Gallardo J. Comentario acerca de los mecanismos de fototoxicidad retiniana. Arch Soc Esp Oftalmol. 2021. <span class="elsevierStyleInterRef" id="intr0005" href="https://doi.org/10.1016/j.oftal.2021.01.009">https://doi.org/10.1016/j.oftal.2021.01.009</span></p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Phototoxic mechanism on the retina" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S. Mora-Sáez" 1 => "M. Ortiz-Salvador" 2 => "J. Montero-Hernández" ] ] ] ] ] "host" => array:2 [ 0 => array:1 [ "Revista" => array:2 [ "tituloSerie" => "Arch Soc Esp Oftalmol." 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