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Multiple myeloma is a malignant plasma cell dyscrasia that may invade the orbits in extramedullary presentations. Common manifestations of orbital involvement include unilateral proptosis, injection, chemosis, diplopia, and occasionally pain. Additionally, the soft-tissue tumors associated with multiple myeloma typically cause bony destruction of adjacent structures. However, in certain patients, bilateral proptosis and a lack of bony destruction may occur. In these instances, it is important for physicians to consider patient history, presentation, and progression in order to ensure that a potentially fatal diagnosis is not missed. The reason this case is important is two-fold: 1) we describe a case of an individual with relapsing multiple myeloma presenting as bilateral proptosis and lacking bony destruction, highlighting the importance of understanding the disease process and 2) we discuss why patients with multiple myeloma may be more prone to developing tumors of the orbit in recurrent cases.

Background: Diabetic retinopathy is one of the leading causes of blindness in the world, and its development and progression can be prevented with appropriate glycemic control. The Health Outreach Partnership of EVMS Students (HOPES) Student-Run Free Clinic at Eastern Virginia Medical School (Norfolk, VA) provides both primary care and ophthalmology care to patients from underserved backgrounds. The purpose of this retrospective chart review is to assess whether a student-run free clinic’s primary care and ophthalmology services are effective in preventing the development and progression of diabetic retinopathy. Methods: Inclusion criteria were a diagnosis of Type 2 Diabetes Mellitus (T2DM), two or more HOPES Ophthalmology Clinic appointments separated by at least 4 months between January 2015 and July 2019, and medical management of T2DM by the HOPES Primary Care Clinic. Objective patient data collected were HbA1c, visual acuity, and documented dilated fundus examination findings. Results: There were 174 HOPES Ophthalmology visits and 66 diabetic eye exam appointments in this five-year time period. The average HbA1c for patients at the initial appointment with the Ophthalmology Clinic was 7.77% ± 1.65% and the average HbA1c at the most recent appointment was 7.4% ± 2.28%. Among all patients, there was no statistically significant change in visual acuity in either eye from baseline to the most recent visit. There was no change in fundus examination findings in any of the patients from their initial visit to their most recent visit. Conclusions: The HOPES Clinic has been effective in preventing the development and progression of diabetic retinopathy in its patients who regularly follow up with both the primary care and ophthalmology clinics. This study highlights that a student-run free clinic is capable of making an impact in the community by preventing the development of a potentially blinding disease, but that further strategies to enable consistent patient follow-up are needed.

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Spectral domain optical coherence tomography (SD-OCT) with posterior pole asymmetry analysis (PPAA) provides a mapping of posterior pole retinal thickness with asymmetry analysis between hemispheres of each eye. We investigated whether these structural abnormalities were correlated with functional retinal ganglion cell (RGC) loss, quantified by steady state pattern electroretinogram (ssPERG), in glaucoma suspects (GS). Methods: Twenty GS (34 eyes) were enrolled in a prospective study at the Manhattan Eye, Ear, and Throat Hospital. All subjects underwent ophthalmological examination, including Humphrey visual field, Spectralis Glaucoma Module Premium Edition (GMPE) SD-OCT PPAA, and ssPERG testing. The ability of ssPERG parameters (Magnitude [Mag, µv], MagnitudeD [MagD, µv], and MagD/ Mag ratio) to predict PPAA thickness (total, superior, and inferior thickness, [µm]) was tested via adjusted multivariate linear regression analysis.