glaucoma

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.

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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.


Seeing Signs: Teen Driving

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Photo of a blurry stop sign.The beginning of the new school year for high schoolers often means the start of driver’s education courses and getting permits for most teenagers. While most kids focus on passing the written portion exam for their permit, there’s another, equally important exam to pass: the vision test. As part of the permitting process, eye exams are given at the state’s motor vehicle facility to ensure that peripheral (side) and distance vision are up to the task of driving.

It can also be a time when teens and their parents first learn about myopia, or “nearsightedness.”

As children grow into their teenage years, their eyes grow as well, and this can change the shape of the eye. This, according to the Mayo Clinic, causes light rays to bend (refract) incorrectly, focusing images in front of your retina instead of on your retina. Thus, making objects farther away, blurry. Objects like road signs and license plates in the car ahead.

Nearsightedness is a rapidly growing concern in the United States. From 1972 to 2004, myopia in people ages 12-54 increased from just 25 percent of the population to nearly 42 percent, according to the National Eye Institute. Why? Computers and hand-held devices are the culprits. The Nielsen Report, which monitors media usage, says that Americans are now spending upwards of 11 hours a day on their devices, up from 10 hours a day last year. All this time spent on computers and smartphones is causing problems for people in their distance vision.

Myopia, for some people, can be associated with other eye disorders like cataracts, glaucoma, and retinal detachment. Signs of the condition include squinting, eye strain, headaches, and feeling tired when driving. Nearsightedness can be corrected with prescription eyeglasses, contact lenses, and in some cases, refractive surgery.

Schedule a comprehensive eye exam today!


Effects of Smoking on the Eyes

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smoking-infographic-580x2218Smoking. It’s not just bad for your lungs, heart, and pretty much every organ in your body according to the Centers for Disease Control, but it’s detrimental for your eyes, too. In addition to increased risks of heart and lung cancer, stroke, and type 2 diabetes, smoking can dramatically increase your chances of vision loss as you age.

Eye diseases such as age-related macular degeneration (AMD) skyrocket by 25 percent for smokers. And it doesn’t end there: nonsmokers will double their risk of getting AMD just by living with a smoker and being exposed to second-hand smoke. AMD is an incurable vision disease that attacks the center part of the retina causing a dark spot in the center of your field of vision. Cataracts, a white, cloudy film that forms over the lens, are two times more likely to develop in a heavy smoker (15 or more cigarettes a day) than to a nonsmoker.

Smokers are twice as prone to uveitis (an inflammation of the iris area of the eye) and dry eye syndrome (where there aren’t enough tears to lubricate the eye).

And if all that wasn’t bad enough, the risk of developing diabetes is 30–40 percent higher for smokers, which can trigger eye diseases like glaucoma and diabetic retinopathy.

Traditional cigarettes are not the only cause for concern amongst smokers either. According to Vaping Daily, an online trade magazine covering the latest trends in e-cigarettes (smoking e-liquids via an electronic cigarette), the vapor clouds that are created in exhalation are being studied for their effects on vision as well.

To increase your chances of slowing down or halting the onset of these diseases the solution is simple: stop smoking and limit your exposure to people who do in your environment.


Life After Enucleation Surgery: Prosthetic Eyes

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Losing an eye, whether due to an injury, birth defect, or diseases — such as end-stage glaucoma, diabetes, or cancers like retinoblastoma and choroidal melanoma — can be an emotionally and physically traumatic experience. But all hope is not lost. While vision itself cannot be restored in the affected eye, appearance can be, and for most, this is an important aspect of restoring self-esteem.

After the enucleation surgery has been performed to remove the affected eye from the socket, usually keeping the muscles and bone structure intact, a temporary prosthesis is inserted to allow the patient time to heal. A specialist known as an ocularist makes a custom designed artificial eye and can expertly match iris colors to the remaining eye and form the eye shape to the existing socket. Once the inserted, the muscles and blood vessels can conform to the new prosthetic, allowing for both eyes to track objects simultaneously. The result is a restored appearance.

The prosthetic must be checked yearly and polished to maintain it. As age, weight, and movement all affect the eye socket over time, adjustments will need to be made to the artificial eye to keep it in good shape and in good condition. For people who are blind, ocular prosthetics are available. These are similar to contact lenses and are called scleral covers.

Prosthetic EyeProsthetic eyes have been around for a long, long time and, thankfully, have come a long way! The ancient Roman and Egyptian priests in the fifth century B.C. were known to have crafted painted clay eyes attached to cloth that were then worn on the outside of the eye socket. Fast forward several centuries later, and you’ll find the first in-socket artificial eyes made out of gold and colored with enamel. Venetians in the 16th century started making glass eyes and dominated that market until the 18th century, when the Germans perfected the technique. In the United States, glass eyes were made starting in the 19th century but stopped during World War II, as the glass was being imported from Germany, and developed plastic polymers instead. Today, prosthetic eyes are largely crafted from acrylic or silicone polymers as well as glass. With the advent of 3-D printing capabilities, there is hope that prosthetic eyes might one day be able to incorporate Wi-Fi signals and transmit visuals to the wearer.

For more information, visit the websites of the American Society of Ocularists so and the National Eye Institute.


An Overview: Comprehensive Eye Exams

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We have a lot of blog posts here at All About Eyes that mention and/or encourage our visitors to get a comprehensive eye exam. So we thought we take this opportunity to talk about what it is and why it’s important to not just your eye health, but your overall health as well.

The first phase of the comprehensive eye exam focuses on your vision and any issues you may have there. The second phase of the exam evaluates your eye health.

What is a Comprehensive Eye Exam?

At the start of the visit, a technician will have a medical history conversation with you and will perform a pre-test using an autorefraction machine that measures the eyes for the preliminary prescription and also does keratometry, an examination of the curvature of the eye itself. This is useful in determining astigmatism. Then they perform what’s called tonometry with the non-contact tonometer (no drops needed). A tonometer is used to apply a puff of air onto the eye to measure eye pressure and is used to determine if you have glaucoma.

If the results from that test are high, then the doctor will apply numbing drops in the eyes and a further check of the intraocular pressure with an applanation tonometer will happen. Applanation tonometry uses a small lens to rest on the tear film/cornea to check the pressure. This test is usually painless and quick.

The other tests offered during pretesting are the Optomap digital retinal imaging which gives a wider, more complete picture of the retina and can detect problems not seen with the other tests. All About Eyes also uses an ocular coherence tomographer (OCT) which is a non-invasive imaging machine used to check the layers of the retina. It is beneficial for early glaucoma detection and in diagnosing macular problems.

Classic Eye Chart: Comprehensive Eye Exam

A visual acuity test will be given, where you will be asked to read off rows of random letters that gradually decrease in size until you reach a point to where you can no longer read with certainty. Also in included in the visual acuity testing are checking your vision for color blindness (if any) and 3-D testing to check your depth perception.

In the visual mobility tests, your practitioner will use various instruments (lights, eye covers) to see how your eyes are working. They will watch for eye muscle movements, check your peripheral (side) vision, and for your pupils’ response to light. Phoropter: Comprehensive Eye Exam

A phoropter is a refractor machine that determines the lens power needed for glasses (nearsighted, farsighted, and/or astigmatism). The doctor will give you an option of which lens looks clearer (“one or two”) and this helps to set your prescription for glasses or contact lenses if needed.

Slit Lamp: Comprehensive Eye ExamTo look at the back of the eye, the doctor will use a small, high magnification lens in addition to a biomicroscope. The biomicroscope, also called a slit lamp, is used to shine a light onto the eye so that its structure can be examined up close. This binocular microscope looks at all the areas towards the front of the eyes: eyelids, cornea, conjunctiva, iris (colored area), and the lens itself. This test can detect many diseases including cataracts, macular degeneration, corneal ulcers, and diabetic retinopathy. Sometimes dilating drops are necessary during this exam if the patient has tiny pupils, is very light sensitive, or they have retinal problems.

Why are Comprehensive Eye Exams Important?

First and foremost, as the American Optometric Association says, annual comprehensive eye exams can help with early diagnosis of vision issues which can help to prevent vision loss. Quite simply, they help to save your sight.

But, as we talked about in our article, Eye Checkup = Health Checkup, a comprehensive eye exam can also go a long way toward early detection of other major health issues such as stroke, heart disease, and sexually transmitted diseases, to name a few.

So schedule an appointment with either Dr. Dave Roell or Dr. Cheryl Roell today!


Learn About Your Eyes and Diabetes

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November is National Diabetes Month

Did you know that this disease can be detected through a routine, comprehensive eye exam? The American Optometric Association says that diabetes is the leading cause of vision loss for Americans under the age of 74. If left untreated, it may lead to blindness, so it is important to keep diabetes under control through dietary choices, exercise, not smoking, and if needed, medicine.

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What is diabetes?

The Diabetes Research Institute describes this condition as, “A group of diseases where there is too much sugar (glucose) in the blood. Sugar comes from the foods we eat, like bread, cereals, pasta, rice, fruit, starchy vegetables and dairy items. Sugar is used by the body for energy. Insulin is a hormone that is made in the pancreas and works like a key to a door – insulin opens the door of the cells of our body allowing the sugar to go from the bloodstream into the cells where it is then used for energy. If there is not enough insulin or if the insulin can’t open the door to the cell, the sugar levels rise in the blood and diabetes occurs.”

The most common type of the disease is type 2 diabetes (a chronic condition that affects the way the body processes glucose), type 1 diabetes (also a chronic condition where the pancreas produces little or no insulin), prediabetes (where blood sugar is high, but not high enough to trigger type 2 diabetes), and gestational diabetes (which affects pregnant women).

The primary effects of diabetes are high blood pressure, high cholesterol, and a lack of blood glucose control.

What are the symptoms of diabetes?

Typically, people with diabetes will feel thirsty, hungry, tired, have to urinate frequently, and have blurry vision.

How does diabetes affect the eyes?

Because diabetes increases blood sugars in blood vessels, causing them to swell and leak, it can affect the blood vessels in the eyes as well. This can lead to several eye conditions, most noticeably in the retina, the light-sensitive tissue at the back of the eye.

A major complication of the disease is diabetic retinopathy, which is a condition causing progressive damage to the tiny blood vessels in the retina.

According to the American Diabetes Association, having diabetes may increase your chances of having additional eye-related complications as well: a 60 percent increased risk for cataracts, a 40 percent increased risk for glaucoma.

How can comprehensive eye exams help?

During the comprehensive eye exam, eyes are dilated with eye drops, allowing a clear view of the blood vessels at the back of the eye. By having yearly exams, an eye-care professional can detect retinopathy, cataracts, and glaucoma early and start treatment programs.

 

 

 


Glaucoma: Closed-Angle – Part two

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closedangleglaudoma

Graphic: Glaucoma Research Foundation

This is part two of a two-part series on glaucoma that includes the main types of the disease, the symptoms and risk factors, and treatments available to combat the disease.

In last week’s post, the focus was on the most common form of glaucoma, open-angle, which affects about three million Americans and accounts for 90 percent of all glaucoma cases. The next most common type is called closed-angle glaucoma (also known as narrow-angle glaucoma and/or angle-closure glaucoma).

Closed-Angle Glaucoma

While the drainage canals are also blocked as with open-angle glaucoma and this causes eye pressure, in this form of the disease, the angles are narrow or closed, which can result in sudden, severe pain, requiring immediate medical attention.

Risk Factors

According to the American Academy of Ophthalmology, people with a family history of closed-angle glaucoma, those of Asian descent, and people with hyperopia (farsightedness) tend to be at risk of developing this type of glaucoma. As with glaucoma in general, age is also a factor. 

Symptoms and Treatment

Typically, closed-angle glaucoma is a medical emergency with an onset of severe eye pain, blurry vision, a headache, nausea, and seeing halos around lights. People at risk for developing this form of glaucoma often have no symptoms ahead of an acute attack. Once an acute attack happens, the patient will need to seek medical care straight away, otherwise, they risk permanent vision loss in that eye.

However, yearly eye exams can help in detecting this form of the disease, which can allow the patient the opportunity to have an iridectomy performed in a non-emergency situation. An iridectomy is a procedure whereby a laser beam is used to create a drainage hole in the iris, which provides relief of eye pressure. The procedure is done on an out-patient basis and has minimal recovery time.

Don’t let glaucoma steal your vision, contact All About Eyes and get your eyes examined today!


Glaucoma – A two-part series

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This will be a two-part series on glaucoma that will include the main types of the disease, the symptoms and risk factors, and treatments available to combat the disease.  

What is Glaucoma? 7544734516_bc4180a6f4_z

Glaucoma is a group of eye diseases which produces increased pressure within the eye, due to a fluid build-up. Over time, according to the Glaucoma Foundation, this pressure can cause damage to the optic nerve and cause vision loss. The optic nerve is part of the central nervous system and carries the visual information from the eye to the brain. Once pressure builds on this nerve, it can start to die, and may lead to blindness.

There are several types of glaucoma, but the two most common are open-angle and closed-angle, with open-angle being far more common of the two. In fact, it is estimated that at least 90 percent of all glaucoma cases are this type, affecting about three million Americans.

Open-Angle Glaucoma

Open-angle glaucoma tends to develop slowly over time and does not present with noticeable symptoms until well into the disease. The Glaucoma Research Foundation says, “Glaucoma is an eye disease that gradually steals vision.” By the time the patient is aware of vision loss, it is often too late to prevent it. Vision loss due to glaucoma is permanent. Open-angle glaucoma is caused by the slow clogging of drainage canals within the eye structure, which results in increased eye pressure. The aspect of “open angle” refers to the angle where the iris meets the cornea is as wide and open as it can be.

Risk Factors 

So the question begs, if you don’t know it’s happening, how can you prevent it or stop it? One way is to understand common risk factors. Knowing your family medical history is an excellent place to start since glaucoma tends to be hereditary. Those of African-American or Latino descent are also at risk. And those who are diabetic, obese, or have cardiovascular disease may also be at higher risk of developing glaucoma. Of course, age plays a factor as well.

Prevention

Knowing if you are at risk is just one part of the equation, however. The best line of defense is getting annual check-ups with your eye-care professional. They will perform a comprehensive dilated eye exam, which will help to diagnose early signs of glaucoma.

Treatment

If it is determined that you have open-angle glaucoma, medications are available to help reduce eye pressure, and several different types of surgery are available as well, including selective laser trabeculoplasty and argon laser trabeculoplasty.

Part two of this series will focus on closed-angle glaucoma and will be posted on Monday, October 10.