ADVEYES

small talk new knowledge...iPITS

2013-10-22T20:59:00.000-07:00

One of the perks of working with physicians is being able to come away with mind blowing knowledge from a simple conversation in passing. Today I had the pleasure of filling in for a coworker who specializes in Visual Field testing and an optic nerve photography (for the lack of a better reference...) The entire afternoon consisted of 5 patients, one of which had 20/30 vision in both eyes. Her pressure readings were below 20 in both eyes and she had no complaints regarding her vision. After reviewing her chart and finishing her eye exam we walked to the visual field room where I conducted a test of her peripheral vision. Next, I took photos of her optic nerves with and printed them, she asked if I could see her "pit" ... thoroughly confused I asked if she was referencing her a dog? maybe? She laughed and said that she was diagnosed with something called a "pit" in her right eye and wanted to know if I could see it..... I reviewed her HRT photos and noticed what she was describing. Something that resembled a bubble located right on the edge of her optic nerve! She told me that she learned about this pit after visiting an Ophthalmologist about 30 years ago who made her very nervous during the exam when he said to his assistant "Go get my book that lists all the eye diseases!" She told me that after hearing those words she knew for sure that she was going blind, but here she is 30 years later .. Ironically with 20/30 vision in both eyes!
During a break in clinic, I asked her physician about the infamous "pit" and how common it was.. is it congenital.... does it effect vision.... how many cases of pits had he seen in his career etc
He informed me that it is congenital and potentially can have a negative effect on vision leading up to worse case scenarios of a retinal detachment. He has seen about a dozen in his career of 25+ yrs at this practice. I did a little research (typed in optic disc pit in Wikipedia) and learned that it can contribute to PVD which is short for posterior vitreous detachment which is commonly called "floaters" or "black spots" people see in their field of vision.(sometimes associated with flashes of light which may indicate a retinal detachment) It may potentially be hereditary as I'm guessing there were cases of parents and their children having optic disc pits but I am not sure how much research has been done about that aspect of this diagnosis specifically. The pit is a malformation of the optic nerve due to the embryonic fissure closing completely. Usually asymptomatic and usually only being in one eye. Common in about 1 in 10,000 people.. So if you are ever diagnosed with having one.. consider yourself lucky...!?

next post ... Aniridia!

Era of Good feelings

2013-10-16T22:13:00.000-07:00

There are moments in life when you immediately reap the benefits of helping others..
Today is Wednesday and for the past 3 days Ive had at least one HUGE experience each day that was so meaningful that I had to share...so this is that!.

Monday.
Just a usual day at work when a "new patient" come through the door. She was a middle aged woman seeking a comprehensive eye exam who wanted to make sure that her changes in vision were evaluated as she has had difficulty seeing up close (presbyopia) and difficulty seeing in the distance as well as problems driving at night( cataracts). As the visit proceeded and we continued to talk. She mentioned the frequent headaches that she has been experiencing and wondered if there could be a correlation between eyes and headaches. I made detailed notes of her concerns and encouraged her to speak with the doctor when he visits with her. I checked her intraocular pressure which was slightly elevated at 22 in the right eye and 20 in the left eye. After further examination I noticed that the anterior chamber in both eyes appeared rather shallow ( narrow angles) as cataract formation has taken place over time, her eye have become "crowded" putting her at risk for a potential sudden attack of glaucoma. The doctor confirmed my diagnosis and she was NOT dilated but scheduled for a simple laser procedure that makes it safe for her to be dilated in the future as well as significantly decreasing her risk for such an attack. On the way out she thanked me for detecting her condition and NOT dilating her eyes as dilation drops can induce such an attack. She then scheduled her follow appointments and I encouraged her to have a nice day!

Tuesday
A chart was in the bin for a technician to call back a patient who had questions about his diagnosis of glaucoma. The young African American male in his early 20s had been evaluated the previous week at a lasik center and was told that he was not currently a candidate for laser vision correction surgery as he showed signs of having glaucoma. I called the patient who did not answer the phone and his voicemail box was full preventing me from leaving a message, however he did return my call about an hour later. I told him who I was and asked what questions he had about his visit. He said that his mother told him that he is too young to have glaucoma and with his contacts and glasses he has good vision. He was wondering if someone at the office can "sign off" of his surgery so he can get lasik without being treated for glaucoma. At that moment, I was taken back by the patients will to ignore the gravity of his diagnosis and prioritize lasik rather than glaucoma treatment. I asked the patient if he knew what glaucoma was and how it can potentially effect ones vision. He said the Doctor explained everything to him the day before however he was not paying attention because he was distracted by the fact that he had gotten a speeding ticket on the way to the office! Basically starting from scratch... I shared with the patient that Glaucoma is the result of increased (sometimes decreased) intraocular pressure in the eye that can cause the optic nerve in the back of the eye to become damaged. This damage is irreversible and potentially devastating to a patients peripheral vision if gone untreated. He then ask what the cause of glaucoma is and is there a correlation between contact lens use and glaucoma. I explained a person can have glaucoma even if they do not wear glasses or contacts and this disease is usually inherited from someone in your family who already has glaucoma. Having a family history of glaucoma myself I shared with the patient that my grandmother lost her vision to glaucoma as the availability of health care and the advancements in medicine today where not available to her. She was blind in both eyes probably never really knew what I looked like... I explained that my father (her son) in addition to all of her children were diagnosed with glaucoma and are all being treated for the disease. After the conversation was over, I noticed that the the patients tone had shifted significantly as he understood that ignoring glaucoma to get lasik would have been an unwise decision as a potential loss in vision from glaucoma would mean that laser vision correction surgery would not be able to improve his vision at all. Before hanging up, he said that he will return for further treatment and make ocular health priority in his life. Then he said... "Thank you for taking the time to explain things to me, I really appreciate it!"

Wednesday
Today I had the pleasure of spending time with a patient who was confined to a wheelchair as a result of cerebral palsy. She was 30 years old. She very articulate and very much aware of the nature of her visit. She came in with a pair of glasses that were about 4 years old. She had a lazy eye and an overall vision of about 20/200. Due to her condition, she was unable to get automatic measurements and the level of difficulty for a technician preparing a patient with such special needs is significantly more challenging than others.... I decided to wheel her out into the hallway.. Grab some trial frames with a handful of lenses and kneel down testing her vision one lens at a time. With the uncontrollable movement of her head, this made for a rather difficult task... BUT after several minutes and trial lenses everywhere.... She was able to see letters on the 20/60 line which is about about twice as better as she was seeing before.. She was then dilated and seen by the doctor who commended me of my efforts to help this woman.. I was appreciative of his comments but the feeling that I got when she was able to read those letters and show signs of improved vision was indescribable.

Everyday in life we are presented with opportunities to go above and beyond what is required to ensure a quality a experience for others. Despite the jaded views and opinions that exist in the world Ghandi encouraged us to "BE" that change we wish to see in the world." Dr. Martin Luther King Jr explained that "you cannot expect change to roll in on the wheels of inevitability." Small detailed changes make up larger drastic changes over time. Be watchful and stay aware of ways that you can help others!

Ocular Awareness...

2013-10-08T16:23:00.001-07:00

This post is an attempt to motivate patients who seek treatment in any area of medicine but specifically those who visit the eye doctor. Millions of patients visit doctor offices around the globe everyday. Some visits are as straight forward as a routine check ups while other visits can be as intense as surgery or extensive special testing. No matter the nature of the diagnosis, routine or emergency, it is best for the patient and the physician to be on the same page. Ocular awareness could literally be defined as "ones awareness of their eyes..?" specifically in this post I'm referring to the a patient taking an active role in their treatment.

As a technician I ask questions like..What kind of drops are you are using? How often do you use them? Have you noticed any changes in your vision since your last visit? Any changes in your medical history since your last visit? Some patients know their medical history forwards and backwards but others give me a response along the lines of "I don't know?"

With that being said, if you or someone you know has an appointment approaching with any physician, take time to consider things to be discussed with the doctor such as: If a reaction occurred to a medication that you were prescribed, if your vision is blurry, if your are having problems driving at night, you have noticed a few small black spots in your vision and some times you thought you noticed a few flashes of light in your vision, can't see road signs, diagnosed with a diabetes or high blood pressure since your last visit. All of these scenarios listed could be vital information for a physician to consider before he or she formulates a treatment plan.

In addition to accurately reporting symptoms to a physician during the visit, following instructions given by that physician is a step in the right direction on your road to recovery. With that being said, using drops as directed, regularly checking home vision test like Amsler Grids for patients who suffer from Macular degeneration, and making recommend lifestyle changes are all great contributions to your ocular health.

In many instances patients visit the doctor as with the same level of excitement as completing an arduous chore....but remember to ask questions, take note of any changes in vision, and have a clear understanding of the plan that your doctor has for you. Increase your OCULAR AWARENESS!!

DM/NIDDM

2012-02-16T00:11:00.002-08:00

Hello Everyone!
In route to achieving greatness.. sometimes I neglect the blog life and I apologize for that ..However, Today in clinic I saw a Patient who is a Diabetic.. she's about 40 years of age and came in for an eye exam... she complained of changes in Vision ...

During the course of her exam I asked her what her blood sugar was ... she responded with 328!!!! then said she told me that her A1C was 11.3 yesterday! and that in the past 4 months .. her blood sugar has been well over 500!!!!

These number are off the charts !!!!

with that said.... Diabetes is the number one cause of new blindness in America SO if you or someone that you know has diabetes ... PLEase get an complete eye exam!!!!!!

Your vision is precious ... don't lose it over a condition that can be treated and monitor it frequently!

until next time...
-Ronnie

OPHTHALMIC CYSTICERCOSIS

2011-12-16T23:50:00.000-08:00

Recently I researched and presented to a class of undergraduate students concerning the topic of Ophthalmic Cysticercosis. I felt obligated to share this information regarding the complications associated with the consumption of undercooked pork. The presentation went rather well and feedback from students, as well as the professor was rather inspiring. Enjoy!

•Ophthalmic Cysticercosis
by H. Ronnie Nelson II

What is ophthalmic cysticercosis?

•An infection in and around the ocular organs caused by Taenia solium (the pork tapeworm). The Infection occurs when the tapeworm larvae enter the body and form cysticerci. When cysticerci are found in the brain, the condition is called neurocysticercosis

Scientific Classification

•Kingdom: Animalia

•Phylum: Plathelminthes

•Class: Cestoda

•Order: Cyclophyllidea

•Family: Taeniidae

•Genus: Taenia

•Species: Taenia Solium

Transmission to humans

Humans are the intermediate hosts for T solium, and pigs are the definitive hosts. A tapeworm larval cyst (cysticercus) is ingested with poorly-cooked infected pork. The larva escapes the cyst and passes to the small intestine, where it attaches to the mucosa with scolex suckers. Egg-containing proglottids develop as the worm matures in 3-4 months.

The adult worm may live in the small intestine for as long as 25 years without symptoms. When the primary larvae (oncospheres) penetrate the intestinal mucosa, the Larvae enters into the circulatory system spreading to the Neural, muscular, and ocular tissues of the human body.

•Symptoms

•Nausea

•Week Muscles

•Loss of Weight

•Malnutrition

•Abdominal Pain

•Passing worm sections in stool

Ophthalmic Cysticercosis can affect ALL ocular Tissue including:

•Vitreous cavity

•Subretinal tissue

•Conjunctiva

•Extraocular muscles

•Optic Nerve

Damage to these areas can result in the following:

•Cataract formation

•Iritis

•Severe Headache

•Strabismus

•Diplopia

•Severe redness

•Proptosis

Facts about Ophthalmic Cysticercosis…

•A LIVE cyst may be freely mobile inside the anterior chamber or attached to an ocular structure surrounded in a bed of inflammation.

•Cyst death causes the release of TOXIC products also resulting in severe inflammation.

•Cases with intense inflammation may prevent the cyst from being clinically visualized by ocular and neural imaging technology.

•Cysticercosis affects an estimated 50 million people worldwide.

• Ocular cysticercosis is endemic in tropical areas, such as sub-Saharan Africa, India, and East Asia. Other endemic areas include Mexico and Latin America.

•There is a correlation between new diagnosed cases in the U.S. and immigration increases from endemic areas.

•An estimated 1000 new cases per year are diagnosed in the United States.

•There is no statistical evidence showing diagnosed cases being related to race, sex, or specific to one eye.

•Ocular Cysticercosis is more commonly reported younger age groups.

Treatment

•Surgical removal is required in individuals with intraocular cysts.

•Deep orbital dissection in conjunction with difficulty in completely excising/removing the cyst because of the surrounding inflammatory response increase the chances of postoperative complications.

•Cysts deep within the orbit are best treated conservatively with a 4-week regimen of oral albendazole (Benzamidazole) in conjunction with oral steroids/corticosteroids in a tapering dose over a 1-month period.

•Resolution of the cyst may take from a few days to months depending on the density of the surrounding inflammation. Based on the individual’s response to medical therapy, another course of medication may be required.

EYE JUST WANTED TO SAY THANKS! :0)

2011-10-25T20:43:00.000-07:00

Blogging has turned out to be a lot more successful than I anticipated. Thanks to my viewers and followers for your time and support!

While I have your attention... I hear from many patients who complain of Dry EYES and allergy related irritation. There is a drop called ZADITOR which was previously RX only but is now over the counter. This drop is used to treat allergy related irritation and is safe for contact lens wearers. So run out and go get it..

Also, for those who have chronic red eyes, increase the use of artificial tears as needed and TURN DOWN/OFF THE CEILING FAN WHILE YOU SLEEP!!! AND finally Stay away from drops that "GET THE RED OUT" you know who you are..."WOW......" Those get the red out but are more harmful than not with frequent use due to their Vaso-constricting abilities which are not beneficial for long term use for your eyes. A preservative free artificial tear is one that can make your eyes feel great and keep your eyes lubricated!

NarroW ANGLES

2011-10-24T19:46:00.000-07:00

Recently I’ve encountered an increased amount of both new and existing patients who have a condition known as “Narrow Angle’s”. This diagnosis is a form of Glaucoma, which is related to the increased intraocular pressure inside the eye. Glaucoma is a hereditary disease mostly commonly found in eyes with darker pigmented iris colors. There are available treatments for Glaucoma, the most common being daily drops “gtts” that patients can use once or twice a day. Drop treatment allows fluid inside of the eye (aqueous humor) to flow more freely from the front of the eye to the back without obstructions that can and cause the pressure to increase inside of the eye. Other treatments include the use of lasers to open new pathways in the iris to allow better flow.

If gone untreated, increased pressure can damage a person’s optic nerve. The optic nerve interprets visual images and relays them to our brain, increase IOP has the potential to decrease peripheral vision over time and can ultimately lead to tunnel vision only. Special testing (including but not limited to) Humphrey Visual field, HRT scans of the optic nerve and OCT scans can be done periodically by an Ophthalmologist to track the health of the optic nerve and detect even the slightest decrease in peripheral vision.

Patients who are hyperopic are commonly labeled as “farsighted” due to the curvature of the cornea and how light is refracted (bent) by the cornea of a hyperopic eye the image is projected behind the retina. This overshot of light is the reason why distant images are clearer than near images. Due to the anatomy of the eyes, a hyperopic person is at more a risk to have Narrow Angles... in conjunction with developed cataracts which have the potential to crowding the inside of the eye and induce narrow angles.

Okay so we’ve gone through a very basic explanation of glaucoma, hyperopia and how cataracts can have an effect, and how they can all be related, but what’s so bad about Narrow Angles?

Acute Narrow Angle Closure!!!

When those already narrow angles close and deny the flow of intraocular fluid, the pressure builds, and builds and builds and causes an increase amount of pressure on the optic nerve which can cause redness, nausea/vomiting , and potential vision loss.. Yes.. Vision loss.

How do you know if you have narrow angles? You have to be screened for it. A comprehensive eye exam will include a screening for the all forms of glaucoma, and any other ocular diseases. If you know that you are hyperopic /farsighted, it may be wise to ask for an ophthalmologist to look at your eyes before the dilation drops are instilled. A person with undiagnosed narrow angles can potentially go into an acute angle closure attack when the eyes are dilated without the detection of a shallow anterior chamber reading.

Hopefully this post has been informative. If you have specific questions please feel free to comment below or contact your Ophthalmologist.

CONTACTS!

2011-08-24T23:12:00.000-07:00

Contact Lenses are very useful and often preferred over glasses. I mentioned a few "do's" n "don'ts" in my initial post ... However, since then I've still been approached by people on the topic of sleeping in your contacts, so I felt the need to elaborate on this topic based on my own personal experience.

For starters The Contact Lens is placed on the cornea and may move around slightly but for the most part stays in place if the Base Curve is a good fit for your cornea. Despite popular Belief your contact will NOT get stuck behind your eye and stick to your brain. Its is recommended for Contact lens wearers to change the lenses at least once per month. Protein deposits and bacteria can build up on the contact causing irritation, infection and noticeable blurred vision.

From my experiences as a tech and having encountered hundreds of contact lens wearers, those who are the most successful in maintaing good vision and "allowed" to safely continue to use contacts are those who use them responsibly.

NEVER SLEEP IN CONTACTS!
When the lid is closed for an extended period of time and there is a contact lens in there, oxygen cannot reach the surface of the cornea. Ulcers often develop on the cornea which can lead to larger problems like a potential need for a cornea transplant where a cadaver cornea is sewn on to the surface of the eye.. OR contact lens neo-vascularization where blood vessels grow into the iris. Both results can potentially lead to blindness so don't sleep in them.. its not worth it!
When contacts are left in for a long period of time (a month or longer), the lenses can adhere to the surface of the eye and when they are finally removed, the epithelial layer of the cornea is removed as well... (not a good situation)
Symptoms of irritations caused by misuse of contact lenses include but are not limited to light sensitivity (photophobia), excessive tearing, general irritation.

EXTENDED WEAR CONTACTS
Don't believe the hype! Some contacts do allow more oxygen to flow to the cornea but STILL has the potential to cause complications. Just take them out !
Clean/replace contacts as needed. As mentioned earlier the deposits can cause infections and burry vision. Use rewetting drops and preservative free artificial tears NOT "Vie-ZEEN" to treat dry eyes.
In all, contacts both hard lenses or soft are great ways to improve vision when used responsibly!

p.s. dont sleep in your contacts!!! ;0)

LASIK AND MORE!

2011-08-19T00:27:00.000-07:00

There are many questions surrounding the topic of "Lasik" So here are some general facts and thoughts about the procedure and others like it.

For starters, Lasik is not the only laser surgery available . There are others that have the same outcome but very different procedures. Lasik seems to be the poster-child of laser vision correction surgery due to the fact that there is a very short healing time. Generally, patients are able to see clearly within a few hours. During a lasik procedure the cornea is cut and a flap is created. The flap is then lifted and laser treatment occurs from the laser then the flap is put back down where it will heal without sutures. Artificial tears are an imperative part of the healing process as most nerve endings that trigger tear production are severed during the creation of the flap. Other variations of this procedure including "LASEK" and "EPI-LASIK"are done but with different flap creation practices. Generally the same concept and the use of artificial tears is the still recommended. IF YOU GET THIS DONE.. USE UR DROPS!

PRK is another procedure that is used to correct vision. The United States Air Force requires PRK and prohibits Lasik as PRK Lasers are use to reshape the outer layer of the cornea. A great deal of discomfort and light sensitivity during the healing phase occurs but pain medication is usually recommended to endure what feels like multiple scratches on the surface of your eyes. The desired vision can take days to weeks to be completely attained. Unlike Lasik there is no "flap" created which has the potential to become displaced at high altitudes of frequent flyers. PRK is beneficial because research shows that regeneration of nerve endings occurs at a faster rate than those of Lasik. ALSO, for those people who are NOT a candidate for lasik becuase their corneas are too thin to cut and create flaps, PRK is an alternative solution!

There is yet another form a corrective surgery called "Clear Lens Exchange" This surgery is a much more invasive procedure yet is still one of the most safe procedures in medicine. IF a person is NOT a candidate for Lasik or PRK then removing the natural lens and an artificial lens with the corrective power can be surgically inserted. This is the same procedure as Cataract surgery but this procedure is not covered by medicare.

If you are interested in Laser Vision Correction Surgery then a consultation visit is required to ensure that you are a in fact a candidate. Cost of the surgery may be formulated based on age and the magnitude of your refraction. If corneas are naturally too thin or of one suffers from a corneal degenerative disease such as Karatokonus then most laser procedures will not be recommended and glasses and/or contact lenses can be used regularly. A stable prescription for 2 years or more decreases the possibility that the eyes will continue to change after the surgery. It is possible for the eyes to continue to change after the correction has been made by the laser. In most cases a "touch up" can be done. For more information contact an Ophthalmologist who does Laser correction surgery. Please post comments you there is additional information that was omitted or personal testimonials are requested!

FIRST POST

2011-08-16T23:50:00.000-07:00

General information pertaining to ... eyes.

Contact lenses:

1. "Thou shallt NOT EVER EVER EVER SLEEP IN YOUR CONTACTS !! " Although some brands claim to be "Extended wear" it is not wise to sleep in your contacts. Contact lenses can act as a barrier between the cornea and the lubrication it needs to stay healthy. Leaving your contacts in for a long period of time without removing them can lead to more serious issues (including but not limited to) corneal abrasions, corneal ulcers, PINGUECULA (google it), neo-vasular growth in the iris from a decrease of oxygen to the front surface of your eye.

2. Change the lenses regularly ..every 3-4 weeks

One-a-days are awesome but can potentially be a blow to the wallet.

3. Multifocal lenses are available for those who suffer from what I like to call "short arm syndrome" aka presbyopia

Dry EYE

Keratitis Sicca is a MAJOR issue in the world today. If you are wondering what that means .. its a fancy way of saying "dry eye." Eyes that are dry can cause discomfort and lead to a compromise in vision. There is no cure for K. Sicca but fortunately there are MANY treatments including tear duct plugs, lubrication drops, RX drops like "Restasis" are helpful but may take a while (2-3 months) to take affect but the claim is that they "help you make more of your own tears" Changes in your lifestyle may help as well ie sleeping with the fan on can contribute to dry eye.

DIABETES

Diabetes is the number 1 cause of new blindness in america. Diabetic Retinopathy is the condition in which the retina is damaged by the effects of long term diabetes. The progression of the disease is usually gone unnoticed by the patient until it is too late, there are treatments and procedures that can be done to monitor the changes associated with this diagnosis but ultimately maintaining controlled Blood Sugars and A1C Hemoglobin levels...

EYE think thats enough for one night. there will be many more post coming soon !