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Ophthalmology

Vitamin D: Implications for Ocular Disease and Therapeutic Potential

Vitamin D is a multifunctional hormone, which not only affects calcium homeostasis, but plays a role in immune system regulation as well as cell growth and survival. Many tissues in the eye are able to both activate and respond to vitamin D, suggesting that vitamin D is a biologically relevant molecule to study throughout the eye. Epidemiological studies demonstrate that vitamin D levels and genetic variations influence the development of a wide range of pathologies, such as myopia, age-related macular degeneration, diabetic retinopathy, and uveitis. In addition, at the cellular level, vitamin D is able to reduce inflammatory mediators, enhance barrier function, and induce cell death of cancerous cells. These studies suggest that vitamin D plays a protective role in ocular health. It will therefore be exciting to follow further work, examining the benefits of vitamin D therapeutically in the eye.

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Vitamin D3 Protects against Diabetic Retinopathy by Inhibiting High-Glucose-Induced Activation of the ROS/TXNIP/NLRP3 Inflammasome Pathway

Using in vitro and in vivo studies, we demonstrated that vitamin D3 can protect the normal retinal structure, alleviate retinal vascular permeability, and inhibit the apoptosis of retinal cells in diabetic rats. We also provided evidence that this protective effect was caused by inhibition of the TXNIP/NLRP3 pathway as a result of reduced ROS production in high-glucose-induced retinal microvascular endothelial cells. Thus, vitamin D3 possesses considerable potential for the treatment of DR. A long-term prospective study with a large number of samples is needed to verify the clinical effect of vitamin D3 in Diabetic Retinopathy.

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Vitamin D deficiency is associated with dry eye syndrome: a systematic review and meta‐analysis
This meta‐analysis suggested that vitamin D deficiency is associated with worse subjective symptoms and less tear production in patients with dry eye. Vitamin D deficiency may be a risk factor for dry eye syndrome.

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Vitamin B12 Deficiency Optic Neuropathy: a Teaching Case Report

This case report is intended to educate eyecare providers on the presentation and management of vitamin B12 deficiency optic neuropathy. It highlights the clinical importance of careful history, ophthalmic examination and use of ancillary testing. Since the advent of bariatric surgery, the importance of ophthalmic surveillance in the presence of vitamin deficiencies has been more frequently discussed in the literature. Additionally, Turkyilmaz et. al found that temporal quadrant retinal nerve fiber layer thickness correlates with plasma vitamin B12 levels. Eyecare providers should look beyond the eye and order appropriate lab work in light of pertinent ocular findings and be cognizant that incompletely treated vitamin B12 deficiency with oral supplementation with folic acid can aggravate neurological symptoms. Prompt diagnosis and recognition of vitamin B12 deficiency optic neuropathy is paramount to visual recovery.

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Vitamin B12 Deficiency as a First Sign of Acquired Horizontal Pandular Nystagmus

Early diagnosis of vitamin B12 deficiency is vital; since, when damage to nervous tissue starts, its therapy might become unresponsive. Whereas eye movement disorders are hardly caused by vitamin B12 deficiency, we believe that serum vitamin B12 should be measured in any patient with unexplained eye movement disorder, as the response to delayed therapy in vitamin B12 deficiency can be poor.

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Vitamin B12 deficiency evaluation and treatment in severe dry eye disease with neuropathic ocular pain

These findings indicate that vitamin B12 deficiency is related with Neuropathic Ocular Pain (NOP). It may be important to consider measuring the serum vitamin B12 level in patients with severe Dry Eye Disease (DED) presenting with resistant ocular pain despite taking topical treatment.

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