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Retinal nerve fiber layer defects and microtalc retinopathy secondary to free-basing "crack" cocaine
Background:
There have been several reports in the literature documenting ocular manifestations of cocaine abuse. None have discussed the potential retinal complications stemming from cocaine inhalation.
Methods:
Approximately 60 patients with a history of free-basing "crack" cocaine were examined at the Optometry Clinic. Threshold visual field testing and fundus photographs were obtained and later reviewed.
Results:
Microtalc retinopathy and associated retinal nerve fiber layer "rake" or "slit" defects were detected exclusively in patients who had free-based "crack" cocaine. Some of these patients manifested visual field changes that mimic glaucoma. Several cases are presented that demonstrate the findings typical of those observed in the patients examined at the Optometry Clinic.
Conclusions:
Microtalc retinopathy and associated glaucoma-like retinal nerve fiber layer defects indicate the presence of permanent microvascular changes in the eyes, as well as the lungs, brain, and probably other peripheral organs. Optometrists should be aware of these new findings in order to properly manage patients who free-base "crack" cocaine.