Conditions

Multiple Sclerosis and Vision

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IMG_4109Multiple Sclerosis (MS) is a disease of the central nervous system. It affects the brain, optic nerves, and spinal cord, which is why vision problems are often the first symptom of the disease. Inflammation — where parts of the body become reddened, swollen, and painful — is the main issue with MS, as it causes damage to the nerves. MS is characterized by flare-ups of inflammation that typically go away after some time or will need to be treated with steroids. (For more information please see the Multiple Sclerosis Association of America’s website.) Stress, fatigue, infection, and elevated temperature can all affect vision in people with MS, so reducing those factors is an important part of managing the disease.

How MS Affects Vision

Optic Neuritis

The most common symptom is optic neuritis, which is an inflammation of the optic nerve. According to the National Multiple Sclerosis Society, most times, it happens in one eye only. The good news is, it usually goes away on its own after a couple of weeks or more and vision returns to normal. Here’s what optic neuritis looks like:

  • Pain with eye movement.
  • Blurred vision.
  • Dimmed vision.
  • Loss of being able to see colors accurately.
  • Difficulty seeing at night.

In some cases of blurred and/or dimmed vision, the center of the visual field can be blocked out. Side, or peripheral vision, usually isn’t affected. This is called central scotoma.

Diplopia

Another common symptom is called diplopia, or double vision. This occurs due to nerve damage or inflammation as well. Diplopia may resolve on its own. If not, using an eye patch can help to retrain the affected eye. As with many symptoms of MS, a course of corticosteroids may be helpful in relieving the symptoms.

Nystagmus

Not as common, nystagmus — also known as “dancing eyes” — is caused by muscle weakness. It is an involuntary rapid eye movement to where eyes may go from side-to-side or up-and-down rapidly. Mild cases may not cause any change in vision, but severe cases will affect vision to where things don’t seem to stay still. Treatment is usually to wait and see if it resolves on its own as the overall MS symptoms resolve, and again, steroids may be necessary to help with the symptoms.

If you have any concerns about your vision, or suspect you may have MS, please consult with your health care provider and eye-care provider for an accurate diagnosis.


Anisocoria: One Pupil Larger Than the Other

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In last month’s blog post on how a concussion affects vision, we discussed that having one pupil larger than the other is a cause for concern if you’ve recently suffered a concussion. This month, we’re going to take a deeper dive into that condition, known as Anisocoria.

Causes

Anisocoria naturally affects about one-fifth of the population without any problems in vision. Outside of being born with the condition, most people who are affected by it usually have had an eye disorder of some sort or an issue with their nervous system.

Bowie-Getty-3-head-633449

Photo from The Express UK Article on David Bowie

According to the Merk Manual, eye disorders include birth defects, injuries to the eye, drugs, inflammation of the pupil itself, or are glaucoma-related. The late David Bowie, a well-known British musician and icon, is an excellent example of anisocoria. Most people think he had different colored eyes, a condition known as heterochromia, but he did, in fact, have anisocoria as a result of being hit in the eye as a teenager. To learn more about that story, here’s the link to The Express UK article on David Bowie.

Sometimes there are issues with the nervous system that result in one pupil being larger than the other. Those issues include pressure on the 3rd cranial nerve (nerve affecting the movement of the eye), stroke, injury, tumors, infections, or problems with the autonomic nervous system that result in drooping eyelids and misaligned eyes.

Symptoms to Watch For

See a medical professional if you experience any of the following and your pupils suddenly appear to be different sizes:

    • Drooping eyelid 
    • Double vision
    • Loss of vision
    • Headache or neck pain
    • Eye pain with bright light
    • Recent injury to the head or eye

 

Treatment

Eye-care professionals will first take a look at your history — and even perhaps an old photograph or your driver’s license — to see if anisocoria has been present all along. Then they will perform a series of examinations to make sure that both of your eyes are tracking correctly, responding to light and dark appropriately, and will use a slit lamp to magnify your eye for further examination.

While there isn’t anything that can be done to treat the condition itself, there may be a need and/or opportunities to treat the underlying condition that is resulting in anisocoria.

For more information on this condition, check out All About Vision, the Merk Manual for Professionals, and the American Academy of Ophthalmology.


How a Concussion Affects Vision

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A concussion, also known as a mild Traumatic Brain Injury (mTBI), happens when you get hit in the head hard enough that it bruises the brain. While not typically life-threatening, a blow to the head can leave you with headaches, dizziness, fatigue, vomiting (in more severe cases), and vision problems.

Causes of Concussions

The Centers for Disease Control says that the majority of concussions — around 47 percent — happen after a fall (off a bike, missteps, etc.). Being struck by an object (baseballs, football tackle, etc.) account for around 15 percent of mTBIs. While 14 percent happen as a result of a motor vehicle accident.

Symptoms of a Concussion

Common symptoms of a concussion are headaches, dizziness, vomiting, and at least initially, blurred vision and light sensitivity. Unlike the other symptoms, which can happen shortly after the blow, vision problems, as noted by All About Vision, can actually show up later and may not present themselves right away. So, you need to be on the lookout for them throughout the healing process.

For further reading, the Brain Injury Association of America has provided information on this condition.

Red CrossPlease note: It is a medical emergency and a strong indicator of severe trauma if one pupil (dark dot in the center of the eye) appears larger than the other. You must go to the Emergency Room straight away to be seen by a medical professional.

Vision Problems to Watch For

According to BrainInjuries.org and the Neuro-Optometric Rehabilitation Association, concussions can trigger many vision issues. They are:

NEURO-OPTOMETRIC REHABILITATION ASSOCIATION

Graphic Provided by Neuro-Optometric Rehabilitation Association

    • Blurred or fuzzy vision
    • Light sensitivity
    • Reading difficulties
    • Comprehension problems
    • Double vision
    • Aching eyes
    • Headaches when tending to visual tasks
    • Visual-field loss
    • Eye movement issues such as tracking, shifting focus, and binocular focusing

If left untreated, the concussed patient may begin to have trouble making sense of visual information, so it is important to remain vigilant for at least a month after getting an mTBI to watch for these other symptoms.

Treatments

The single best thing you can do after receiving a concussion is to rest and avoid environments where you may re-injure yourself while you are healing. The brain takes a few weeks to recover. If it is determined that your vision has been affected, there are various optometric vision therapies and vision rehabilitation therapies that can help. Talk with your eye-care professional for recommendations on which therapy would work best for you.


Are Those Stars in Your Eyes? Or is it VIIP?

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Image of stars.

NASA

Space travel, it’s the future. We’ve been hearing about it for decades. But with NASA’s commitment to a mission to Mars by 2030, Elon Musk’s Space X company single-handedly reigniting the excitement of building better rockets, and the International Space Station (ISS) orbiting Earth for nearly 18 years, life among the stars appears to be humanity’s destiny. But before we jump into our spaceships and don our space suits, there are some down-to-Earth, practical matters to attend to: vision issues.

It all started in 2005 when astronaut John Phillips noticed something when he looked down at planet Earth from the space station: it was blurry. Astronauts are expected to have 20/20 vision, so suddenly developing vision problems was, well, a problem. It’s not like you can schedule a visit to your eye doctor three months into your mission to Mars!

NASA Twins

Mike (left) and Scott Kelly. NASA Astronauts.

Years later, and now with 80 percent of long-duration mission astronauts reporting nearsightedness during and after their missions, NASA has been studying what’s happening up in space and has identified the condition as Vision Impairment and Intracranial Pressure (VIIP). In fact, the vision study is one of ten studies commissioned by NASA in their Twin Study this past year. In this study, identical twin brothers Scott and Mike Kelly are being observed for the biological effects of long-duration missions. Scott Kelly was in the ISS for 340 days while his brother Mike remained on Earth.

While the study on the effect on eyes hasn’t been completed yet, preliminary results are that being in a zero-gravity environment does affect the structure of the eyes. On Earth, we have gravity, which pulls our fluids down toward our feet. In space, there is no gravity, so those fluids can remain in the brain, putting pressure on the eyes and flattening the back of them out, causing nearsightedness. This study will help scientists plan for future space travel.


Seeing Double, Double Vision

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double visionAs the name suggests, double vision, called diplopia, is when you see two images of a single object. Double vision can happen in one eye (monocular) or both (binocular). The treatment for diplopia will largely depend on the type you have, and the underlying cause.

Diagnosis

To detect if diplopia is in one eye or both, your eye-care professional will cover one eye at a time during their exam and may use prisms to see what the level of double vision is. Not surprisingly, it is easier to detect in adults, as they can describe what they’re seeing. With children who are unable to talk about their vision, parents may need to watch for various behaviors: squinting, covering one eye to look at things, head tilting, or looking at things sideways.

Monocular Diplopia

According to Harvard Health, the causes of double vision in one eye can be cataracts, astigmatism, keratoconus (where the cornea becomes cone-shaped), pterygium (a growth of tissue on the eyeball), dislocated lens, swelling or mass in the eyelid, or dry eyes (Sjogren’s disease, etc.).

Binocular Diplopia

The causes of double vision in both eyes can be strabismus (crossed eyes), nerve damage, diabetes, myasthenia gravis (neuromuscular/autoimmune illness), Grave’s disease (hyperthyroidism), multiple sclerosis, migraines, stroke, or trauma (black eye).

Treatment

As mentioned above, treatment of diplopia largely depends on what is causing it. If other diseases such as diabetes, Sjogren’s, Grave’s, etc., are at the root of the problem, those conditions will need to be treated independently, and then the double vision problem can be revisited with your eye-care professional. For other issues — such as trauma, cataracts, or astigmatism — surgery or lens correction may resolve the double vision.


Eyelids: Focus on Blepharitis

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Eyelids are the thin skin folds covering our eyes. We use them to blink an astonishing 15-20 times per minute/1,200 times an hour to keep our eyes moist and dust-free. Eyelids block out the light when we sleep. And for some, eyelids are a canvas for applying colorful powders and mascara. From time-to-time, eyelids can develop infections that cause them to become swollen and sore. This condition is called Blepharitis.

Types of Blepharitis

There are two types of Blepharitis, anterior, meaning the outside/front of the lid, and posterior, which is the inner part of the lid, next to the eyeball itself.

Photo of a stye in the eye/Blepharitis

Photo Credit: Andre Riemann

Anterior Blepharitis is caused by bacterial infections or scalp dandruff. Posterior Blepharitis tends to be caused by clogged oil glands known as the meibomian glands. These glands can become infected due to acne rosacea or scalp dandruff.

In some cases, parasites (Demodex eyelash mites) can cause the infection. Blepharitis often occurs with pink eye (conjunctivitis), a stye (a tender, red lump near the eyelashes) and/ or a chalazion (a painless, firm lump).

Symptoms of Blepharitis

  • inflamed, red eyelids
  • burning eyes
  • crusty debris at the base of the lid
  • watery eyes
  • dry eyes

 

Treatment

The most important aspect of treating Blepharitis, according to the National Eye Institute is keeping the eyelid clean. As it is difficult to get rid of, people who get this infection will need to practice good eyelid hygiene for the rest of their lives to keep recurring infections to a minimum. To keep the eyelid clean, a warm compress on the lid will help to soften the crusty bits on the eyelashes, then a diluted solution of water and baby shampoo is used with a clean, fresh cotton swab to gently and carefully scrub the debris away. A fresh cotton swab should be used for each eye to avoid cross-contamination.

If the above solution doesn’t work, your eye-care professional may prescribe antibiotics or, if needed, steroid eyedrops.

In the cases where scalp dandruff present, then dandruff shampoo for the scalp is recommended. Similarly, acne rosacea is causing the infection, then acne treatment under the care of a dermatologist is recommended. By treating these other contributing factors, it can help to reduce the cause of inflammation in the eyelid.


General Info on Age-Related Macular Degeneration

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Image Credit: National Eye Institute

Image Credit: National Eye Institute

For 10 million Americans ages 50 and over, macular degeneration looms on the horizon of age-related concerns. Macular degeneration is an incurable vision disease that attacks the center part of the retina (at the back of the eye) where “millions of light-sensing cells that provide the sharp, central vision” reside (National Eye Institute). The macula records the images we see and relays them to the optic nerve, which then passes the information to the brain.

These cells are responsible for our ability to read, to recognize faces, for driving, and for doing any close-up, detail work such as needlepoint. If these cells become damaged, the central field of view can become blurry, distorted, or form dark splotches.

Detection of Macular Degeneration

Comprehensive eye exams are the first line of detection for macular degeneration. During the visual acuity and eye dilation portion of the exam, eye-care professionals are able to look for yellowish deposits called drusen and for any pigment changes in the retina. The size of the drusen deposits will determine how advanced the macular degeneration (if any) has become.

Stages of Macular Degeneration

There are three distinct stages of this disease:

  • Early:  In this stage, the drusen deposits are medium-sized. There typically is no change in vision for the patient.
  • Intermediate:  At this point, the drusen will be large, and there may also be changes in the retina’s pigment.
  • Late:  Drusen deposits will be large, pigment changes will be present, and there will be vision loss at this stage. According to the American Macular Degeneration Foundation, the degeneration will be classified as either atrophic (dry) or exudative (wet).
    • Atrophic cases tend to be age-related, and 85-90 percent of macular degeneration falls into this classification. There is no leakage of blood or serum into the eye. Vision may still be good but may be fluctuating. Patients may have limited reading ability in dim lighting (such as in restaurants at night).
    • Exudative cases make up the remaining 10-15 percent. Exudative – or wet – macular degeneration occurs when abnormal blood vessels grow under the retina and bleed or leak fluid. This distorts vision.
Prevention and Treatment 

While there is no cure for macular degeneration, there is strong evidence that leading a lifestyle that promotes wellness will go a long way toward staving off the advancement of the disease. Not smoking, exercising regularly, eating a healthy diet with plenty of green leafy vegetables, and maintaining normal blood pressure levels, will all go a long way toward overall good health as well as preserving vision.

For intermediate- and late-stage atrophic (dry) macular degeneration, studies have shown that high doses of vitamins C and E, along with zinc and copper, can reduce the disease by up to 25 percent. For the exudative (wet) cases, anti-VEGF treatment (periodic injections in the eye of Avastin or Eylea) allows patients to remain stable instead of getting progressively worse.

The National Eye Institute has more comprehensive information available on the studies.


Condiciones y enfermedades de los ojos

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For our Spanish-speaking patients, we’re providing a link to articles in Spanish about common eye conditions at AllAboutVision.com. This site provides information about the following conditions:

If you have specific questions about your eyes, call us at (609) 653-9933 and ask to speak to Fransheska who speaks both English and Spanish and can help you.


Melanoma in Your Eyes

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Eye Graphic - Melanoma

Graphic courtesy of National Cancer Institute

When people generally think of melanoma, they usually think of skin cancer. And while it is rare, melanoma can develop in the eyes. It is called ocular melanoma and, according to the Ocular Melanoma Foundation, up to 2,500 Americans are diagnosed with this form of cancer each year.

“Melanomas are a type of cancer that develop in the cells that produce pigment. Pigment is the substance that gives your skin, hair and eyes color,” explains the American Academy of Ophalmology’s website. Melonaomas tend to develop in the uveal part of the eye, which is one of the three layers of the eye, the other two being the sclera (outer layer) and retina (innermost layer).

The problem with ocular melanoma is that it typically doesn’t have symptoms and is usually only detected during a routine, comprehensive eye dilation exam.

Who is at Risk?

Research suggests that there is a strong genetic component for people who develop eye cancer and that it tends to affect those with lighter skin tones who have blue or green eyes and of that group, it tends to affect people ages 50 and above. Another major factor, not surprisingly, is overexposure sunlight or ultraviolet light from tanning beds. The simple act of wearing sunglasses can go a long way toward reducing the risk of developing ocular melanoma.

How is it Detected?

As mentioned above, a routine eye exam where eyes are dilated is the best detection method, given that the cancer is relatively symptom-free. That said, if you notice dark spots on your iris (colored part of your eye), a change in the shape of your pupil, blurred vision, or a loss of vision, you should see your eye care professional. These issues can also be present for other eye problems, so further assessment will be needed.

If eye cancer is suspected during the routine eye exam, the next step may be to see a specialist for an ultrasound of the eye, a fluorescine angiography (where dye is injected into your body and a special camera takes pictures of the contrast image), or a biopsy (where eye tissue is removed and examined).

How is it Treated?

Depending on the severity of the ocular melanoma, radiation and/or surgery are the traditional treatments. In the last few years, medical oncologists at Memorial Sloan Kettering Cancer Center have been testing experimental drug therapies and are having promising results.


It’s a bird! It’s a plane! Never mind, it’s just a floater.

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Floaters are tiny spots that randomly appear in your vision. According to the Mayo Clinic, “they may look like black or gray specks, strings, or cobwebs that drift about when you move your eyes and appear to dart away when you try to look at them directly.” They tend to be more visible when you look at bright surfaces such as computer screens, white paper, or a blue sky.

But where do they come from in the first place? Are they harmful? And can they be treated?

Drawing of the various components of the human eye.

Image Provided by National Eye Institute

Floaters, while an apt description, are actually formed from vitreous, the gel-like substance that makes up around 80 percent of the eyeball (see diagram) and helps to maintain the round shape of the eye. As we begin to age, it begins to shrink. During this process, microscopic vitreous fibers begin to clump together and they then form the floaters.

People who are nearsighted, those who have diabetes, or folks who have had cataract operations tend to have more floaters than others (National Eye Institute). While not harmful in and of themselves, as with most things, a sudden increase in their volume – to where they begin to affect your vision – can be problematic. If you lose your peripheral vision or see flashes of light with the increased floaters, you may have a retinal detachment, which is a serious condition requiring immediate medical attention.

In cases where the floaters are affecting vision and can no longer be simply ignored, a surgical procedure called a vitrectomy can be performed. In this surgery, the vitreous gel is removed from the eye and replaced with a salt solution. As with most surgeries, the risk of complications must be fully considered as your sight could be adversely affected.