What is a Retinal detachment? Should I be worried?

Courtesy of GreenFlames09 on Flickr

Courtesy of GreenFlames09 on Flickr

Let me hopscotch over to the second question first.  Should I be worried if I develop a retinal detachment (RD)?  Certainly, YES!  However, knowing what I know about the symptoms of RD and what you will soon learn can literally save your sight.

When someone like you or I harbor an RD, we can be absolutely symptom free if the RD is small and away from our line of sight.  So in these cases, yearly comprehensive eye examination with dilation of the pupils is highly important.  On the flip side, we can be so symptomatic that it would be hard not to notice.  If the RD is large and just in the right spot, our vision may be so severely affected that we may only see form or even darkness.  So remember these few words – FLASHES, FLOATERS, and CURTAIN – coming over your vision.  What should I do if I experience one or all of the above symptoms?  See your eye doctor immediately.  Do not wait for the symptoms to change or get worse.

While there are other eye and health conditions that share similar symptoms, your eye doctor will certainly go through a checklist of potential warning signs, complete a detailed evaluation and reach a probable cause.  The review of symptoms will likely include FLASHES, FLOATERS, and CURTAIN.

FLASHES are caused by the act of the retina being tugged on or pushed (elevated) from behind. This in turn stimulates the retina, and the sight center in our brain interprets that as a random flash of light.  If at all possible, confirm which eye you are experiencing the flash and in what direction might the source of the flash be coming from.

FLOATERS indicate that pigment cells or red blood cells or both are being liberated from the retinal tissue or retinal blood vessels, respectively.  In the case of a RD, you may experience a shower of floaters streaming in front of your vision. This is made worse by any sort of head movement.

CURTAIN suggests that the retina is falling off the wall of the eye.  As the curtain draws over the critical areas of the retina, you may experience a drastic reduction in vision.

What is a retinal detachment?  When educating my patients about retinal detachment, I often use the analogy of wallpaper falling off the wall.  So my patients see the immediacy of tacking the wallpaper back on so further damage does not take place beyond repair.  A RD is basically a separation of the retinal nervous tissue (wallpaper) that lines the inside wall of the eye.  The separation prevents the eye centers of the brain from receiving any message from the outside world.  The separation can be caused by a weakening or thinning of the retina, eye trauma, high nearsightedness, aging changes, diabetes, eye malignancies just to name a few.  Whatever the cause, repair of the retina to restore your vision is the highest priority.

So remember these three important words that can simply save your sight:  FLASHES, FLOATERS, and CURTAIN.

~Judy Tong, OD, FAAO
California Optometric Association
http://www.coavision.org

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Winter eye care – How can I protect my eyes during winter?

Photo credit: adwriter from Flickr

Photo credit: adwriter from Flickr

Got dry eyes?

We are now in the heart of winter, which means I have seen a number of patients come in with complaints associated with the season.  A common complaint? Dry eyes.  With cold weather comes increased use of heating systems both in our houses and cars. While the  warm air certainly feels great, the heat and decreased humidity dry your skin and eyes.  This is particularly true for my contact lens patients. An easy way to stay comfortable is to keep artificial tears handy and to point vents away from your face.  Also, a humidifier can come in very handy for both your eyes and other sensitive tissues like the inside of your nose.

Playing in the snow?

Photo credit: LaRimdaME from Flickr

Photo credit: LaRimdaME from Flickr

I also had a couple patients tell me they were going on a winter sports trip in the mountains. While playing in the snow is definitely fun, it can be unhealthy for your eyes.  Ultraviolet light is even more powerful when reflected off of snow and with increased altitude.  Too much exposure to ultraviolet light can cause a condition called photokeratitis.  Unfortunately, I had a mild case of this after building a snow fort as a child.  While the fort turned out great, my eyes did not.  My eyes stung and my vision was blurry for about a day.  Some people suffer much worse, so it is very important to use UV-protecting sun glasses when hitting the slopes.

Interestingly, a new coating for your glasses has been invented that eliminates fogging.  So, if you find yourself going from hot to cold environments quickly for work or play, or eating a hot bowl of soup on a cold day, you may want to ask your doctor about this new technology. As you can see with a few simple steps, your eyes can be healthier and better protected in winter. So get out there, stay protected and have a great time!

~David C. Ardaya, OD
California Optometric Association
http://www.coavision.oeg

Health care reform & vision coverage for your children

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Children’s vision now covered by most plans
If your child is covered by an individual or group health insurance plan in California, their annual eye exam and eye glasses are covered with no out-of-pocket cost until the child reaches age 19. This is required for health plans purchased through or outside Covered California.

Legal residents of California will be able to get health coverage through a new marketplace established by Covered California. Starting in 2014, there will be several new and expanded government programs, including Medi-Cal, that offer financial assistance to reduce the cost of health insurance.

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  1. Premium assistance — Federal help will be available to reduce the cost of an individual’s or family’s monthly health insurance payments.
  2. Cost-sharing assistance — Cost-sharing subsidies reduce the amount of health care expenses an individual or family has to pay at the time of medical care.
  3. Medi-Cal assistance — Starting in 2014, Medi-Cal will cover more people under age 65, including people with disabilities and those with incomes $15,856 or less a year for a single individual and $32,499 or less for a family of four. Medi-Cal is free for those who meet the requirements and is part of the changes included in the Patient Protection and Affordable Care Act (Affordable Care Act).

An online calculator at the Covered California website helps estimate how much it will cost to purchase health insurance in 2014 and the amount of financial assistance available to qualified individuals. In addition, by completing a Covered California application, an individual will learn whether he or she qualifies for financial assistance.

~Kristine Shultz, Government and External Affairs Director
California Optometric Association

What’s gradual, painless and dubbed the Silent Thief of Sight?

The answer is Glaucoma, an eye disease that slowly causes you to lose your vision.  If you’ve been proactive in monitoring your health, you should hopefully have a pretty good idea of certain health conditions that run in the family.  For example, mom has high cholesterol, dad has diabetes and you remember your grandmother uses eye drops for something.  Knowing your family eye history is very important because most eye diseases tend to be genetic.  Glaucoma, for example, tends to run on the mother’s side of the family.  If your mom has glaucoma, make sure you tell your optometrist.

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Courtesy of 55Laney69 on Flickr
(Left – Normal Vision, Right – with glaucoma)

What exactly is Glaucoma?  It’s a disease where the optic nerve slowly deteriorates as a result of poor blood flow and is often accompanied by high intraocular pressures.  The optic nerve is a bundle of smaller nerve fibers, similar to a conduit, which transmits electrical signals from the retina to the brain.  In glaucoma, the smaller nerve fibers slowly deteriorate, resulting in a gradual loss of vision.  The first areas of vision loss will occur in the periphery, off to the sides, which is very difficult to detect since we are not often aware of our peripheral visual field.  If a patient experiences symptoms, the first symptom may be poor night vision.  As the disease progresses, vision loss creeps in toward the center of your visual field.  By the time you notice that you are losing your peripheral vision and developing “tunnel vision,” you will be in the late stages of glaucoma.

The good news is that glaucoma is the leading cause of PREVENTABLE blindness.  Routine eye examinations will allow an optometrist to detect glaucoma sooner.  There are a variety of tests necessary to detect glaucoma such as a visual field screening, measurement of the intraocular pressures, and careful evaluation of the optic nerve to detect changes.  Many offices now incorporate retinal photos into their routine examinations that are invaluable in detecting many retinal diseases including glaucoma.  Glaucoma is a diagnosis over time, it is rarely diagnosed on a first visit.  When change is detected in the structure of the optic nerve or in the thickness of its surrounding nerve layer over time, then glaucoma is diagnosed.  This is where comparing current retinal photos to older ones are helpful in detecting small changes over time.  Another important tool in the last few years is the Optical Coherence Tomography, which measures microscopic layers of the retina to detect microscopic changes.

So what happens if you do have glaucoma?  Treatment is often pretty simple.  There are a few different forms of glaucoma.  The majority of them are treated with eye drops with dosages as little as once a day.  The medicated eye drops lower the intraocular pressures in the eyes, which help to slow down the progression of glaucoma.  Some patients require laser treatments to lower their pressures.  Most cases of glaucoma are manageable and treatable if detected early.

I usually tell my patients that the ages of 20s and 30s is for establishing a baseline.  This is where routine examinations and photos are useful.  The ages of 40s and onward is for detecting change and eye diseases, and treating early.  Of course, as with any other diseases of the body, staying healthy is key.  Those with diabetes have a much higher likelihood of developing glaucoma so keep your blood sugar under control.  Those of Asian, Latino and African descent have a higher tendency for developing glaucoma.  Having a high amount of nearsightedness also puts you at greater risk.

The take home message is that glaucoma is treatable if detected early.  So know your family health history, stay healthy and see your optometrist routinely for comprehensive eye examinations.

~Cindy P. Wang, O.D., F.A.A.O.
California Optometric Association
http://www.coavision.org