Multifocal ERG showed reduced amplitudes for central responses in 3 patients. Color vision, visual fields including microperimetry, and findings of full-field ERG were normal or showed minimal abnormalities. Accordingly, an increased ERG after NO administration was described in rats,12 and another study suggested that NO potentiates the light response of cones, while it decreases that of rods.13 At higher doses, it has been shown that photoreceptors are among the most sensitive retinal neurons to the toxic effects of NO, both in vitro and in vivo.14,15 Nitric oxide is also known to decrease the threshold of light toxicity.16,17 Yet, these studies were performed in retinas that do not have a fovea; thus, their relevance to the clinical toxicity described here is questionable. All patients described here were HIV positive; however, this is probably coincidental because poppers are popular among the gay community and the cases described by us6 were in HIV-negative subjects. MSM can easily be introduced to these products through sexual partners without realising the substances they are inhaling. Another important aspect of purchasing these poppers from the online sites is that they also list the poppers dangers on their pages to make the people aware of the dangers that the product can have due to the misuse.
Poppers can be easily acquired at super low prices where I live, and if I can’t nail the ratios for a sangria that won’t make you call out of work the next day, I’m definitely not going to play with chemicals that are actually dangerous. The news was enough to make any anyone who indulges in anal sex to feel tense, which really isn’t what they need right now. Research typically combines these groups into the category of men who have sex with men, and little is known about between-group differences. There is little knowledge regarding the pharmacological effects of inhaled alkyl nitrites on neural tissues.7,8 At physiological doses, NO modulates photoreceptor metabolism and function,9,10 in particular through activation of guanylate cyclase, a key enzyme of phototransduction.11 The presence of photopsias in many patients suggests permanent activation of central cones rather than their inhibition, which would be expected if only guanylate cyclase activation was involved. That, and the little church I grew up in, the little Presbyterian church.
To bring this conversation into the light, I reached out to people in several closed recovery groups on social media, and asked them to weigh in through an anonymous online survey. We experience the redemptive conversation they model as the subject of same-sex marriage is before the Supreme Court. In 1999, the Medicines Control Agency took poppers manufacturers to court on the basis that poppers containing the chemical isobutyl nitrite were medicines, and therefore required a licence for sale and supply in the UK. To our knowledge, during the past 10 years there have been only 2 case reports of vision loss following inhalation of poppers.4,5 A similar case of vision loss has been reported by Pece et al,4 in which a patient experienced acute, bilateral vision loss hours after inhaling isobutyl nitrite. We report here that there is no evidence of extrafoveal extension of the lesions or of aggravation of visual loss, even after several years of poppers intake. Fifty years ago, when society was even less accepting of homosexuality than it is today, that shame could feel overwhelming. Hence, poppers-related foveal toxicity is not cumulative, is restricted to the fovea even after prolonged exposure, and causes overall limited visual impairment in the long term.
Indeed, in our cases, careful, iterative scanning of the fovea by OCT was often necessary to highlight disruption of central outer segments, a procedure that is easier to perform with current high-speed, high-resolution spectral-domain OCTs. Accordingly, the elective targeting of the fovea in our patients suggests light-induced damage, although patients denied having stared at bright lights. The finding of minute foveal damage may also be complicated by the fact that patients will tend to avoid fixation into this area. If you’re comfy doing so, talk to potential intercourse companions about the very fact that you’re into poppers, but not open to meth use. I can just say, “Oh, you’re a bad person and you’re stupid.” But to actually know where we disagree requires effort from you and from me. As Badge has chronicled, this can produce practical difficulties. I don’t know – I think that’s the best answer I can give. It is really important that these chemicals are not used for nefarious purposes like for inhaling during copulation to get a better experience or as a recreational drug as the poppers dangers can go a long way in destroying a person’s life.