FEATURE: A sight for sore eyes

Craig Hanlon-Smith May 27, 2017

Is our use of poppers impacting our ability to see the wood for the trees? By Craig Hanlon-Smith

My own introduction to poppers back in 1993 was of a completely non-sexual nature. I arrived at a late night (straight) party in the back streets of deepest south London, to find a packed living room containing a deep shag-pile rug, behind which a gas fire was blazing. Periodically, the hosts would pour amyl nitrate or whatever the blazes was in the inch high bottle, onto the carpet. Wholly stupid fire risk aside, we all buzzed happily along for hours.

A couple of years later; the tube trip back into Soho from London’s Gay Pride event at Victoria Park, and cut to a carriage rammed with gay-men singing ABBA songs at the tops of our voices, passing round a handful of small brown bottles to dozens of homos we had never set eyes on before and would possibly never see again. “Does your mother know that you’re ‘out’?” we screamed in between the sniffs and bouts of hysterical raucous laughter. We barely noticed the handful of Japanese and American tourists who looked on aghast, clutching their children close to their bosoms in the firm belief that they had all died and gone to hell.

Fun times then, and yet, in the remembering I’m cringing somewhat and mightily thrilled that both smart phones and social media were still some 20 years away. I was taking poppers from strangers on the dance floor for years before I graduated onto their frequent use as a sexual relaxant, in the assumption that they were completely harmless and after all, they’re fun right?

For years, urban myths surrounded poppers use, particularly in relation to how many brain cells they were killing compared to alcohol, but in recent months a wholly more sinister health problem connected to the use of poppers is emerging. “I didn’t make the connection at first,” David, local and regular on the scene, tells me. “I just woke up one day and couldn’t see clearly. It was like there were patches of water on my eye, or as if I’d just stared into sunlight – you know that distortion you get immediately after, only it didn’t go away.”

David presented immediately at the accident emergency department at the Royal Sussex County Hospital, but doctors were baffled. Over several weeks his eyes appeared to get better until six months later it happened again, only much more severely. “This time I went to the optician who referred me immediately to the specialist although I had begun to make connections between the problem and poppers use myself by then.” 

David’s own connection of his vision difficulties and poppers was confirmed by the specialist who made it clear this was not the first case he had seen.

Robert Purbrick
Robert Purbrick

I spoke to Robert Purbrick, Consultant Ophthalmologist at the Royal Sussex County Hospital, and asked if the issue concerned actually getting poppers into the eye (we’ve all been there right?). “No! This issue is not a direct effect of the poppers, so closing your eyes when sniffing the bottle won’t help either. It’s chemical, so I would expect these changes [to vision] if the poppers were injected for example.” 

Poppers, which are used as a relaxant, specifically, although not exclusively, by gay men for use in anal sex, operate by expanding blood vessels, which in turn lessen involuntary muscle movement or spasms. They also bring about a temporary high in the form of light-headedness and giddiness, which is why they’re sometimes used in a non-sexual context, such as club dance floors.

In 2006, a common ingredient, isobutyl nitrite, was classified as a cancer-causing agent and banned in the UK and France. It remains in use in much of mainland Europe and the chemical composition of poppers in many countries remains unchanged, but not here. The replacement chemical, isopropyl nitrite, is what is now thought to damage the fovea, the part of the retina responsible for central vision. The issue is known as ‘Poppers Maculopathy’.

I asked Robert Purbrick if the problem is widespread in the Brighton & Hove area. “I have nine cases on my personal database. We’re planning a study to try to assess the prevalence of Poppers Maculopathy in the local population, examining clinical signs, which could be present in the absence of symptoms. Poppers use is very high in the UK amongst the population of men who have sex with men so we’d expect to pick up quite a lot.” 

A little light research indicates this issue has been knocking around for a few years with initial reports as far back as 2010 and the first recorded UK case in Sidcup in 2012.

Martin McKibbin
Martin McKibbin

Martin McKibbin, Consultant Ophthalmologist in Leeds, has reported that within the past 12 months, a small group of patients in Leeds, Manchester and North Wales who have used poppers have experienced fluctuating vision and that whilst in some patients vision has recovered to normal when they stop using poppers, in others it has not. McKibbin is clear: “Visual problems have been observed with both one-off and chronic use. Some patients have experienced damaged vision after just one dose.”

A recent report in The British Journal Of Ophthalmology suggests that poppers use may cause serious and permanent eye damage. Lead researcher, Dr Rebecca Rewbury, stated; “The mounting body of evidence [suggests] that poppers can have serious effects on central vision. Users and health care professionals may be unaware of the risk.” 

This study followed 12 men who presented with blurriness or blind spots in their vision within hours or days of poppers use. Researchers examining the chemical makeup of the brands that the men used found they all contained the post-2006 ingredient isopropyl nitrite.

In 2015, poppers were included on a list of so-called legal highs debated in Parliament prior to the introduction of a wider ban, which included synthetic cannabis and nitrous oxide as part of the Psychoactive Substances Bill. Conservative MP, Crispin Blunt, outed himself as a poppers user in the debate with much media coverage and poppers were eventually left off the list.

I asked Robert Purbrick if with hindsight he thought that leaving poppers off the ban was wise, and whilst he wouldn’t be drawn on the question directly, he told me: “There is plenty of evidence of harm from poppers in the form of poppers maculopathy.” Some of which was available prior to the debate in 2015. “I think an erroneous label of safety could be applied to poppers through their omission from this list.”

I ask him, considering the wide use of poppers amongst the gay community, what advice he has for anyone using poppers either during sex or other recreational activities. His message is clear: “It’s not advisable. And certainly in the context of any visual symptoms then they should stop use immediately and either visit an optician or attend Eye Casualty at Sussex Eye Hospital. A macular OCT scan (optical coherence tomography) is necessary for diagnosis.”

And whilst our local friend David’s vision is much improved, he remains concerned. As our conversation ends he says to me: “This issue is totally under the radar and nobody is talking about it.”

Some names have been changed at the request of those interviewed. @craigscontinuum