Migraines and Brain Retina Damage

July 17, 2009 By Leave a Comment

According to recent article in  the Journal of the American Medical Association by Scher, Ann a study in Iceland has shown evidence that women who suffer from migraines with visual auras were twice as likely to have lesions (damaged areas) in the cerebellum later in life. The cerebellum is part of the lower brain that participates in balance and movement. It is not known if these lesions have any effect or significance.

These are interesting findings in light of the evidence that some people who suffer from migraines also have effects (small areas of vision loss) in their peripheral vision. To the best of our knowledge, these defects are inconsequential on overall vision. The advent of automated testing of peripheral vision brought these defects to awareness, patients have not complained of symptoms prior to the findings. Perhaps the cerebellum damage will fall in the same category, interesting findings on MRI tests that have no effect on overall health.

The larger question is why these problems occur. Conjecture would be vascular, or blood flow changes associated with migraines but migraines are not strictly vascular changes. Hopefully understanding these complications can lead to better understanding of migraines and preventative treatments.

Any severe  headaches associated with flashing lights, loss of vision, or other vision symptoms warrant a visit to your eye doctor and family doctor, with further evaluation by a neurologist if needed.  Migraine headaches are considered a diagnosis of exclusion, meaning after every other potential cause has been ruled out they can be diagnosed. Usually there are specific characteristics that help in making the diagnosis after a complete evaluation, but occasionally they can have complications that resemble strokes or other neurological problems. Vision insurance such as Vision Service Plan often provide coverage for vision exams associated with migraine symptoms. Because other serious problems like retinal detachments can cause flashing lights you should immediately call your optometrist if this a new problem that has not been previously diagnosed.

Filed Under: Flashes Tagged With: , , , , , , , , , , , , , , , , , , , , , , , , , ,

Cataracts

May 18, 2009 By Leave a Comment

A cataract is a clouding, opacification, yellowing, or accumulation of fluid in the lens of the eye that results in a loss of vision that interferes with your lifestyle. Most cataracts are related to aging, and by the time you reach the age of 70 it is almost universal to have some early signs of cataracts.

Age related cataract may occur in one eye first but with time will usually be present in both.

The lens is a clear part of the eye that helps to focus light, or an image, on the retina. The retina is the light-sensitive tissue at the back of the eye that is lined with the photoreceptor cells registering light.

A healthy lens is transparent and passes most of the light to the retina, filtering out some UV. The retinal photoreceptor cells change light into nerve signals that are sent to the brain area in the back of the head.

When the lens becomes cloudy from a cataract, the image you see will be blurred.

Most cataracts are related to aging, but some are have other causes such as trauma, eye diseases,and developmental abnormalities. Eye surgery for glaucoma and other conditions can lead to cataract formation. Certain health conditions like diabetes can also cause cataracts, occasionally very rapidly and in some instances reversible. Prescription steroid medications used long term can result in cataract development. Traumatic cataracts result after serious eye injuries but usually will not progress over time like age related cataracts. Infants occasionally are born with cataracts or develop them in early childhood, often in both eyes. These cataracts may be so small that they do not affect vision. While technically a cataract, I feel opacities need to cause lifestyle interruptions before they should be labeled as a cataract. If they do, the lenses may need to be removed. Radiation exposure can result in cataracts if the dose is high enough or accumulates over repeated exposure.

The lens lies behind the iris and the pupil, the black opening you see in the eyes. The lens adjusts the eye’s focus like the zoom on a camera, allowing us to see things clearly both up close and far away. The lens is made of mostly water with small amounts of protein and other substances. The protein is arranged in precise layers that keep the lens clear and lets light pass through it. When this pattern is disrupted vision becomes hazy and blurry.

There are steps you can take to reduce your risk of developing cataracts. Smoking is a major risk factor for cataract development as well as most causes of blindness. Reducing your UV sun exposure by wearing quality sunglases that meet A.N.S.I. standards is helpful. Sunwear that wraps and blocks sun exposure from the side is even more helpful.

Although research studies have given mixed results, time will probably bear out a protective effect of antioxidants on the lens tissue. Supplementation with vitamin C, lutein, zeaxanthin, and vitamin E likely will be shown to reduce cataract development. Eating foods that are complex carbohydrates such as whole grains and less refined foods with a lower glycemic index are associated with a decreased risk of cataract formation. Leafy green leafy vegetables, fruit, and other foods with antioxidants are always the best source of supplements.

Annual comprehensive dilated eye health exams are vital to monitor for cataracts and allow your optometrist to check for signs of macular degeneration, glaucoma, and other eye diseases. Early treatment and detection of eye disease may save your sight and life!

The most common symptoms of a cataract are:

  • Cloudy or blurry vision.
  • Colors seem faded.
  • Glare. Headlights, lamps, or sunlight may appear too bright. A halo may appear around lights.
  • Poor night vision.
  • Frequent prescription changes in your eyeglasses or contact lenses as your eyes become more nearsighted.

    • Cataracts do not require surgery until they interfere with your lifestyle. In rare cases, the lens can rupture causing serious problems. This is almost unheard of today as eye doctors are widely accessible in all areas of the United States. A new eyeglasses prescription, brighter lighting, anti-glare sunglasses, or magnifying lenses can all be used to help in the interim period. Cataract surgery has a success rate over 95% today and replaces the lens with an artificial implant. Frequently your prescription for distance will be significantly reduced after surgery. Many patients find they have only occasional need for glasses for distance. Some lens implants available today provide some reading capacity also. Most of the time delaying cataract surgery will not cause long-term damage to your eye so you should not feel a need to rush into surgery.

    Cataract removal may become essential when other eye diseases in the eye such as macular degeneration or diabetic related complications need to be visualized well to be followed. Even if your eye doctor tells you you have a cataract, your cataract may never develop to the point where surgery is required.

    If you have cataracts in both eyes, the surgery may be necessary on one eye only for good vision. If surgery is required on both eyes it will be done at separate times several months apart. This is a much safer approach should complications occur, and allows for refinement of procedure if the first outcome is slightly off.

    As with any surgery, cataract surgery does have some risks. Infection inside the eye is the most serious, but rare complication. Lenses may be displaced, cause damage to other tissues in the eye, and the retina tissue in the back of the eye may have swelling or detachments. Some prescription medications predispose you to problems during surgery so be sure to discuss all of your prescriptions with your eye doctor well in advance of eye surgery. Flomax, a prescription used to treat benign prostatic hyperplasia (BPH) has been associated with Intraoperative Floppy Iris Syndrome (IFIS). IFIS can cause problems during cataract surgery so you should be sure to inform your eye doctor if you are any prostate medications. Before cataract surgery, your doctor may ask you to temporarily stop taking certain medications that increase the risk of bleeding during surgery. Over the counter drugs like aspirin and advil may fall in this category. After surgery, you must keep your eye clean, wash your hands before touching your eye, and use the prescribed medications to help minimize the risk of infection. Serious infection can result in loss of vision.

    Cataract surgery slightly increases your risk of retinal detachment. Other eye disorders, such as high myopia (nearsightedness), can further increase your risk of retinal detachment after cataract surgery. One sign of a retinal detachment is a sudden increase in flashes or floaters. Floaters are little “cobwebs” or specks that seem to float about in your field of vision. If you notice a sudden increase in floaters or flashes, call your optometrist immediately. A retinal detachment is a medical emergency. If necessary, go to an emergency service or hospital. Early treatment for retinal detachment often can prevent permanent loss of vision.

    For a few days after surgery, your eye doctor may ask you to use several eyedrops to help healing and decrease the risk of infection. You will need to wear an eye shield or eyeglasses to help protect your eye. Avoid rubbing or pressing on your eye. Sun glasses will be needed to protect your eyes from the bright glare we have in Fort Collins and Northern Colorado.

    When you are home, try not to bend from the waist to pick up objects on the floor. Do not lift any heavy objects. You can walk, climb stairs, and do light household chores.

    In most cases, healing will be complete within eight weeks. Your doctor will schedule exams to check on your progress.

    Problems after surgery are rare, but they can occur. These problems can include infection, bleeding, inflammation (pain, redness, swelling), loss of vision, double vision, and high or low eye pressure. With prompt medical attention, these problems can usually be treated successfully.

    Months or years after cataract surgery cell growth can occur on the artificial lens obscuring vision. This is frequently referred to as after cataracts. A simple, brief laser procedure done in the office quickly resolves this problem.

    Cataracts surgery is one of the most successful procedures done today. While you don’t want to rush into any surgery you can rest assured knowing if your vision does become problematic you have a good treatment option available. Medicare will cover cataract surgery when your eyesight has degraded to a designated level. Many types of vision insurance, including Vision Service Plan, provide coverage of cataract surgery under some of their policies. You will need to check with your provider to find out what is covered under your plan. Some types of lens implants are usually excluded.

Filed Under: Cataracts, Common Eye Questions for Your Optometrist, Eye Symptoms, Eye Vitamins, Flashes, Floaters, Fort Collins Eye Doctor, Fort Collins Optometrist, glaucoma, Pinkeye, Retina, Vision Service Plan -VSP Tagged With: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,

Posterior Vitreous Detachment

May 15, 2009 By Leave a Comment

What is Posterior Vitreous Detachment?

Posterior Vitreous Detachment (PVD) is a common condition which occurs in about 75 per cent of people over the age of 65. As people get older the vitreous, a jelly-like substance inside the eye changes. This can cause Posterior Vitreous Detachment.

What is the Vitreous?

The vitreous is a clear jelly-like substance within the eye which takes up the space behind the lens and in front of the retina, the light sensitive layer at the back of the eye. It is 99 per cent water. The other 1 per cent consists of substances which are important in maintaining the shape of the vitreous. The outer part of the vitreous (the cortex) has the highest concentration of collagen. The vitreous is attached to the retina, more strongly in some places than others. When a PVD starts the jelly comes away from the retina.

Why does the vitreous detach?

The firm jelly-like substance of the vitreous changes with age. The central part of the vitreous becomes more liquid and the outer part (cortex) peels away from the retina. As it comes away from the retina it can cause the symptoms of posterior vitreous detachment.

What are the symptoms of PVD?

Many people are not aware that they have developed PVD but some notice symptoms such as floaters or flashing lights. Floaters can take many forms from little dots, circles, lines, to clouds or cobwebs. Sometimes people experience one large floater which can be distracting and make things difficult to read.

The flashing lights that occur are also caused by the PVD. As the outer part of the vitreous detaches from the retina it can pull on this light sensitive membrane, especially where the vitreous is attached quite strongly to the retina. The pull of the vitreous in these areas stimulates the retina. This stimulation causes the sensation of flashing lights since the brain interprets all stimulation signals from the retina as light. In Fort Collins with all of the outdoor activities and sports we participate in sudden head movements are  common causes to elicit flashes as the gel inside the eye moves.

Can anything be done to help with the PVD?

Unfortunately at the moment nothing can be done medically for this condition, usually people find that the symptoms calm down after about six months and people do eventually get used to living with the floaters. The brain tends to adapt to the floaters and eventually is able to ignore them, so they then only become a problem in very bright light.

Will I lose any sight?

Posterior vitreous detachment does not in itself cause any permanent loss of vision. Your visual acuity should remain the same that is you will be able to see just as you could before the posterior vitreous detachment started. You may have some difficulties to begin with because of the floaters and flashing lights though these do not cause permanent sight loss.

The only threat to vision is the small chance of a retinal tear leading to a retinal detachment.

It is important to stress that retinal tears and detachments are much rarer conditions and that very few people with PVD go on to develop either of these problems

Are retinal tears serious?

Sometimes the vitreous is so firmly attached to the surface of the retina that as the jelly collapses it pulls quite strongly on the retina. In a few people this may lead to the retina tearing which in turn could lead to a loss of vision because of a retinal detachment.

Warning signs of a retinal tear or detachment could be an increase in size and number of your floaters, a change / increase in the flashing lights you experience or a blurring of vision. If you experience any of these symptoms you should seek medical advice within 24 hours. This is particularly important if you notice a dark “curtain” falling across your vision, as this may mean that the retina has already partially detached. Early intervention may allow treatment of a tear before it becomes a detachment and increase the chances of a good recovery from a retinal detachment which has already occurred.

It is important to remember that PVD has been estimated to have occurred in over 75 per cent of the population over 65, that PVD is essentially a harmless condition although with some disturbing symptoms and that it does not normally threaten sight.

Will I need to keep seeing my doctor?

Your optometrist will give you a thorough examination during your first visit. They will pay special attention to whether or not the retina is in any danger. If it isn’t then they may not need to see you again for another year. However, if you have ongoing symptoms of light flashes  you will need to be monitored every 1-2 months until the symptoms  stop. Symptoms warning of a possible retinal detachment, such as sudden increase or definite change in floaters, more severe flashing lights and / or a ‘curtain’ falling over your vision are reason to call the eye doctor immediately. Unfortunately, even a few days delay can result in blindness from a retinal detachment.

Is there anything I can do to cope with these annoying symptoms?

Floaters can be particularly annoying. They get in the way of seeing things and can make some things difficult, for example reading a book. There is a way of trying to cope with this that some people find useful. If you move your eyes around you can create currents in the jelly within your eyes this can sometimes move the floater out of your direct field of vision.

This works best if you have one large floater rather than lots of small ones. Making things bigger can also help while you have floaters so that you are able to see things around the blank spots the floaters cause. Using tinted lenses, especially some of the blue blocker colors may help reduce the awareness of floaters. Altering contrast levels  may help, white backgrounds are particularly annoying with floaters,  changes in illumination or even a lightly colored transparency over reading material may help. However most people find that with time the floaters become less and less of a problem.

Don’t delay in seeking a diagnosis for any new episode of floaters. Most vision insurance plans like Vision Service Plan and EyeMed provide annual eye  visits. Don’t hesitate to use them for preventative care.

Filed Under: Common Eye Questions for Your Optometrist, Eye Symptoms, Flashes, Floaters, Fort Collins Eye Doctor, Fort Collins Optometrist, Retina, Vision Service Plan -VSP Tagged With: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,

Glaucoma-What to Expect in a Visual Field Test

April 14, 2009 By Leave a Comment

Visual field testing is done for a number of different reasons but most frequently to test or manage patients who have glaucoma. So just what is this test that your Eye Doctor wants you to have? It may be referred to by different names; automated perimetry, visual field test, threshold test, SITA (slang for Swedish Interactive Thresholding Algorithm) or various other terms. The original testing method was called a tangent screen which is a black square of material hanging on the wall.. The Goldmann Bowl Perimeter was next and it was a manual version somewhat like the automated devices your eye doctor uses today. Your sensitivity to light on the retina (the light sensitive layer lining the inside of the eye) resembles a topographical map of a hill. The most sensitive point is in the center like the high point on a hill and the farther you move away from this central vision point the less sensitive the tissue is to light (like the lower elevations on a topographical map). The central high point corresponds to the macula, which is why macular degeneration only has to compromise a small area to have devastating effects on vision. A visual field test measures the eyes sensitivity out into the peripheral parts of the retina. Most eye exams only test the small central peak of the hill. The visual field test measure not only the peripheral retina but to some extent the pathway of the eye nerves through the brain.

Your visual field test will be either a screening test or a threshold test. Screening test are used by an Optometrist to check for eye diseases and vision problems in a methodology similar to how your family doctor would do a single blood pressure reading to screen for high blood pressure. If your family doctor was more concerned they would want multiple readings and more refined testing methods, perhaps a cardiac stress test to see how your heart and blood pressure performs under different conditions with a much higher number of data points. Likewise, a threshold visual field test done by your eye doctor is much more detailed testing. Since the hill of vision shrinks with age, a threshold test will compare your results to an age matched population sample without glaucoma and other eye diseases. The eye test will yield a detailed statistical analysis. You can expect to the test to take about 3 to 5 minutes for each eye in most cases. The vision test is standardized for eyes that are dilated so you will need to plan on 30 to 60 minutes in the office even though the visual testing itself is fairly brief. For the actual visual field test you will be seated with a half of a bowl like instrument in front of you. If you wear contact lenses they will need to be removed. The visual field instruments calculate a different prescription compensating for the distance you are viewing. Prescription lenses are placed in a holder in front of your eyes to substitute for your contact lenses or eyeglasses. One eye will be covered and you will need to fixate on a central light throughout the testing. A device resembling a computer mouse will be held in one hand and you simply click it each time you think you see a small point of light flash anywhere in the bowl. The flashes are very brief and may be close to the point your eye is fixating on or very far off in the peripheral field of sight. The brightness of the flash of light also varies from very dim to very visible. In our Eye Center we usually start the testing sequence in demonstration mode to familiarize patients with the process. Many people worry about their responses; if they clicked too late, clicked accidentally, and are uncomfortable with the dimness of some light points just on the edge of visual perception. This should not be a concern. Visual field testing is vary sophisticated today and measures your mistakes, retests them, and gives an index telling us how much variation there was in your eye exam. If the reliability is too low we repeat the test on another day and almost always find the reliability of the eye exam goes up to acceptable levels. There are even adjustments made by the software to factor out the fact that you may have cataracts or other conditions that are not in the retina or visual pathway through the brain. With most visual field instruments you can pause the test yourself by holding down the clicker. That can give you a chance to relax, change position, or ask a question to clarify what you responses should be. We usually start on a demonstration mode to familiarize patients with the process and change over to actual testing once patients appear to be comfortable. You can always request a demonstration period first. Besides glaucoma, a visual field test can be used to diagnose pituitary tumors, neurological problems, and unexplained loss of sight and headaches. Your vision insurance plan services may cover visual field testing or it could fall under your medical policy. One last point- if you live in area like Fort Collins the Colorado sunshine is extremely bright after your eyes are dilated. Be sure you leave with temporary sunglasses if you don’t already have quality sunwear.

Filed Under: Common Eye Questions for Your Optometrist, Contact Lenses, Eye Symptoms, Flashes, Floaters, Fort Collins Eye Doctor, Fort Collins Optometrist, glaucoma, Vision Service Plan -VSP Tagged With: , , , , , , , , , , , ,

Fort Collins Eye Doctors Third Eye Guy

April 10, 2009 By Leave a Comment

Strange title I know- but it is just a reminder that you really only have two eyes and you need to take care of them with preventative eyecare. We can’t supply you with a a spare eye yet!

fortcollinseyedoctorsthirdeyeguy-someday!

Filed Under: Flashes, Floaters, Fort Collins Eye Doctor, Fort Collins Optometrist

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