Can you diagnose eye diseases by looking at a photograph?

Screen Shot 2014-04-07 at 9.13.27 AMFox News recently covered a story about how a rare and serious eye condition was discovered on Facebook because friends noticed something strange when a mom posted a picture of her child. One of the child’s pupils was white.

A white pupil, otherwise known as leukocoria, may indicate a serious eye condition.

How is leukocoria observed?

Leukocoria occurs when the pupil is white instead of black. Leukocoria may be detected in a photograph when one pupil has an abnormal reflex or “white reflex” compared to the other eye having a normal “red reflex.” The red reflex is either absent or white with leukocoria due to an abnormal light reflection from the eye. If leukocoria is pronounced, the pupil may appear white while observing the other person. This is easier to inspect in a darkened room.

What is a red reflex?

A red reflex is the normal reaction when light enters the eye through the pupil. The retina absorbs most, but not all, of the light and what is reflected back is reddish-orange in color – the “red eye” you see in pictures.

How is leukocoria diagnosed?

Doctors of optometry use an instrument called a retinoscope to examine the eye to determine if that normal red reflex is present. An ophthalmoscope is used to view the inside of the eye. The doctor also dilates the eyes a in order to evaluate them more thoroughly.

What causes leukocoria?

Many conditions cause leukocoria including cataracts, retinal detachment, retinopathy of prematurity, retinal malformation, an infection such as endophthalmitis, retinal vascular abnormalities, and intraocular tumors such as retinoblastoma.

These are all serious eye conditions which may be a vision and/or life threatening emergency.

If a white reflex or leukocoria is detected, schedule an eye examination immediately.

What is the treatment for leukocoria?

The treatment is to manage the underlying condition.  Early treatment is crucial. Treating the underlying condition promptly can save both vision and a person’s life.

~Melissa Barnett, OD, FAAO
California Optometric Association
http://eyehelp.org
http://www.coavision.org

Combating eye allergies

Courtesy of paultom2104 on Flickr.

Courtesy of paultom2104 on Flickr.

It’s that time when we spring ahead and lose one hour of precious sleep.  As we set our clocks forward, we should also keep in mind that spring is literally just a few weeks away.  Many of our trees start branching out and flowers start blooming in magnificent colors.  As an allergy sufferer, I view spring as a time of burgeoning new life on one hand and of the dreaded allergies on the other.

For my patients with known seasonal eye allergies, I pre-treat them with anti-allergy eye drops from a class of medication called mast cell stabilizers.  In an ideal world, I like to initiate the anti-allergy therapy about one month before the time that their allergies would have set in.  Mast cell stabilizers work by preventing the body from releasing histamines from mast cells that cause the itchy, watery, red, puffy irritated eyes.  For those patients that have a new onset of eye allergies, immediate relief is what they are probably looking for so I turn to my combo medications that contain both antihistamines and mast cell stabilizers.  Antihistamines as the name denotes, blocks histamines from attaching to key sites and activating the course of allergies.

Here are some helpful tips I share with all my patients:

Courtesy of krossbow on Flickr.

Courtesy of krossbow on Flickr.

  • Apply cold compresses on top of closed eyelids. This will shrink down blood vessels and limit the circulation of histamines that cause itching and other eye symptoms.
  • If you are a contact lens patient, clean your contacts well. You may want to switch to daily disposables to reduce pollen accumulation. Use anti-allergy eye drops that require once a day instillation. Wear glasses if the allergy is bothersome.
  • Wash your hair at night to eliminate all the pollen that collected during the day and to prevent coming into contact on the pillow while sleeping.
  • If you own a pet, bathe him more frequently to reduce pollen that is stuck on him. Best to keep your pet strictly indoors or outdoors to prevent transporting pollen into the house and on you.
  • Avoid drying clothes or bed sheets naturally outdoors as the pollen can adhere to these items.
  • Plan outdoor activities early in the morning and late in the evening as the pollen count is the lowest at these times.
  • Pick vacation spots that have low pollen counts such as the beach.
  • Get your daily pollen forecast on www.pollen.com. See what is floating around in your neighborhood or place of work.

As a “seasoned” (no pun intended) allergy sufferer, I am ready to combat the upcoming 2014 allergy season.  Are you?  Please make sure you plan ahead and make an appointment with your optometrist.

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

Bob Costas’ eyes – An eye doc’s perspective

Screen shot of Bob Costas on air

Screen shot of Bob Costas on air

I’ve been seeing quite a bit of pink eyes these last couple of days. The first one started with Bob Costas’ left eye on TV Friday night while watching the Olympics coverage. The next day, I received two calls on my on-call line from patients worried that they might have a contagious pink eye. I returned to work Monday and have seen more pink eyes in three days than I can remember.

I believe I have Bob Costas to thank for that. Sure, Sage Kotsenburg scored the first gold medal in snowboarding slopestyle, but that wasn’t what my Facebook friends were talking about these last two days. They wanted to know what’s going on with Bob Costas’ eye.

Sadly, I noticed that his infection has spread to the other eye, although the Twitter account @BobCostasEyes probably let slip the 4-1-1 first.

I wish I could definitively diagnose his eye condition. But being that all I have to go on are pixelated images of Bob Costas frozen in mid-speech without the use of microscopes and surface dyes to judge for irregularities, I can only surmise.

If it was a bacterial infection from a contact lens, antibiotics should have cleared it up by now, and it wouldn’t have spread to the other eye.  Now that it’s spread to the right eye, it’s most likely a viral infection.  It looks much worse than it feels. The eyes are usually watery, glassy and bright red. A microscope would show bumps on the inner eyelids as well as any cloudy areas on the surface. This can be treated with medications to limit the length of the infection, although it can last up to three weeks. Cool compresses and artificial tears can provide some relief of symptoms also.

But if you look at Costas’ outer eyelids, they’re also very red and irritated. It’s quite possible that he was given medications that he discovered he was allergic too. In either case, it was smart to finally take a sick day and go off the air to give him time to recuperate. Let’s hope for a speedy recovery before Matt Lauer’s beard has its own Twitter account.

So, to all of you with healthy, white and clear eyes, keep your hands clean and away from your face, don’t shake hands with someone with a pink eye, and see your optometrist if you think you have an irritated pink eye. To read more about pink eye, see our previous blog article on this topic.

~Cindy P. Wang, OD, FAAO

California Optometric Association
http://www.coavision.org

Color blindness – the causes and the effects

When we think of someone being color blind, we may think that he sees the world in black and white, or shades of gray.  But that is extremely rare.  In fact, almost 8% of men have some form of color vision deficiency where certain colors are more difficult to distinguish, or do not appear as vivid as other colors.  (Perhaps that explains the questionable wardrobe choices my husband sometimes makes.)

What causes it?

Most cases of color vision deficiency are inherited and passed down from the mom.  The photoreceptors in the retina responsible for color are called cones.  Each cone is sensitive to a certain color, in particular, red, green or blue.  If a person has inherited a recessive gene that causes one or more of the cones to be absent or to not function properly, then he will have abnormal color perception.

Photo courtesy of entirelysubjective on Flickr

Photo courtesy of entirelysubjective on Flickr

Some cases of color vision deficiency are acquired later in life as a result of a disease.  More common causative diseases are glaucoma, macular degeneration, and diabetes.  If you notice a change in your color vision, make sure to be evaluated by your optometrist. For eyecare providers, we tend to distinguish color vision deficiency into two broad categories.  Red-green and blue-yellow.  Red-green is inherited and the most common deficiency.  Those with this defect can still see red and green, but the colors are more difficult to distinguish and they may not appear as vivid as to the normal eye.  For example, red and green signal lights may look the same.  One may appear brighter but the lights may both look white.  (For this reason, I’m not a fan of the horizontal traffic lights in some smaller towns.)  Most people who have color vision deficiency have a mild form and are not disabled by this condition.

The other form of color deficiency is blue-yellow where patients have a difficult time distinguishing blue from green or yellow from violet.  This is less common and is usually caused by certain eye diseases.  Unfortunately, for many of these patients, color deficiency is just one visual problem among others.  These patients may also suffer from dimming of vision or distortion of vision.  Often times, bright lighting is helpful for these patients, and occasionally tinted lenses. 

How can I help someone that’s color deficient?

Of course, a comprehensive eye examination is important to rule out any causes of color vision deficiency other than genetics.  This also helps to determine the severity.  Most color deficient individuals carry on like normal without it interfering with their daily lives.  A helpful tip would be to not use the colors red and green as markers because the two colors may appear very similar.  Blue and red will be easier to distinguish.  Unfortunately, those with color vision deficiency should avoid careers that require distinguishing color differences such as airplane pilots, paint mixer, interior designer, etc.

Recently, new developments in tinted lenses have been able to allow some color vision deficient patients be able to see colors they have never seen before.  Sounds promising!

~Cindy P. Wang, OD, FAAO
California Optometric Association
http://www.coavision.org

Eye color – Did you know?

1) How is eye color determined?

   Eye color is determined by two distinct factors.

  • The pigmentation of the eye’s iris – The iris is a muscle and the colored part of the eye. The amount of melanin present determines eye color.
  •  The scattering of light in the stroma of the iris – Rayleigh scattering is a similar phenomenon that accounts for the blueness of the sky. Blue and green pigments are not present in the iris of humans or ocular fluid.

2) Does eye color change with age?

Photo courtesy of Javier Manso on Flickr

Photo courtesy of Javier Manso on Flickr

  • Yes. Most babies with European ancestry have light-colored eyes before the age of one. As a child grows, melanocytes produce melanin. Melanocytes are cells found within the iris of human eyes. Most eye color changes occur when the child is around one year old, however it can happen up to three years of age.
  • Eye color (lightening or darkening) may change with age. This occurs in 10 to 15 percent of the population. However, if your eye color changes dramatically as an adult, it is important to schedule an examination with your eye doctor. Eye color changes may indicate certain diseases, such as Fuch’s heterochromic iridocyclitis, Horner’s syndrome or pigmentary glaucoma.

 3) Is it possible to see emotions such as anger or love in the eyes?

Yes. Certain emotions can change both the pupil size and the iris color. Pupil size gets larger in dimmer lighting and smaller in brighter lighting. When pupil size changes, pigment in the iris compress or spread apart, which can change the eye color.

4) What makes eyes green?

The color of green eyes is not a result of iris pigmentation. Green eyes are due to a combination of amber or light brown pigmentation of the stroma. There is a low or moderate concentration of melanin. The green appearance is due to the Rayleigh scattering of reflected light.

5) What can I do to change my eye color?

Color contact lenses are available if you want to change your eye color. There are even colored contact lenses with patterns for occasions such as Halloween. Since contact lenses are medical devices, visit your doctor of optometry for a contact lens fitting.

~Melissa Barnett, OD, FAAO
California Optometric Association
http://www.coavision.org

The SCARY… and fun truth about colored contact lenses

Colored contact lenses are a popular topic this time of year as many people prepare their Halloween costumes. How fun is it to have a cool accessory like tiger eyes, cat eyes or red or white eyes to complement the most creative of costume? Colored contacts are a great fun option.  There are also many people who like to wear colored contact lenses daily to make their eyes more blue, more green, more brown or a different color all together!

Courtesy of therefromhere on Flickr

Courtesy of therefromhere on Flickr

However, most people do not realize that even contacts worn for cosmetic purposes still pose a potential health risk for the eye if not properly fitted. This is true even if there is no prescription on the lens.  Contact lenses are classified as “medical devices” with the FDA.  Regardless of a corrective prescription, contacts are plastic on the surface of the eye and need to be fit properly and be taken care of properly to lessen the chance of vision threatening infections such as corneal ulcers.

Doctors of optometry perform additional tests above and beyond the glasses and eye health examinations when fitting contacts. We evaluate the size and shape of the cornea, the health of the tear layer and the fitting relationship between the cornea (the outer surface of the eye where the lens sits) and the contacts lens to insure the safest most appropriate lens for each individual patient.  We also educate patients on the best cleaning and wearing regimen for the them.  This greatly reduces any complications associated with contact lens use.

Buying contact lenses without a doctor’s prescription is something that happens with colored contacts often.  This practice leads to rise in vision threatening conditions that could be prevented with a proper contact lens examination. So, buy a different kind Halloween contact lens for each Halloween party this season, but get a prescription first!

~Lisa Weiss, OD, MEd, FCOVDCalifornia Optometric Association
http://www.coavision.org

Are contact lenses dangerous?

Courtesy of wader on Flickr

Courtesy of wader on Flickr

The Benefits

Contact lenses are medical devices that millions of people wear safely every single day. Many people enjoy the freedom from glasses that contact lenses allow.

Contact lenses are also great options for:

  • Sports
  • Changing eye color
  • People who have irregularities to the front of the eye, cornea, or are not able to see with glasses.

Contact lenses make it possible to see and function in everyday life.

The Dangers

Contact lenses can be dangerous if they are abused.

Contact lenses are medical devices and can only be prescribed and dispensed by a licensed eye doctor. If they are sold without being evaluated on the eye by a doctor it can lead to:

  • Eye infections
  • Eye inflammation
  • Eye injuries

Proper care is key

Proper contact lens care and handling are important components of the contact lens fitting process. Contact lens solution used incorrectly or “topping off contact lens solution” (adding more without disposing of the current solution) can lead to multiple complications. It is important to use sterile contact lens solution and not tap water due to bacteria in water. Never, ever put contact lenses in your mouth or spit on them to try to clean them.

Courtesy of listentothemountains on Flickr

Courtesy of listentothemountains on Flickr

It is also important to replace contact lenses at the recommended frequency. For example, daily disposable contact lenses should be replaced each day. Contact lenses that are overused and abused can lead to serious problems.

Certain contact lenses are approved for sleeping or extended wear. However, if your contact lenses are not approved for extended wear, this can lead to complications on the cornea, or front of the eye.

If you are interested in contact lenses, schedule an appointment with a doctor of optometry today.

~Melissa Barnett, OD, FAAO

Should I get contact lenses? Quick guide to help you decide!

Prescription contact lenses can provide the freedom and comfort to perform a number of activities that cannot be achieved in glasses.

  • The most common example is sports. For those instances where you know you will be running or jumping for extended amount of time and hopefully breaking a sweat at the same time, contact lenses are an ideal choice for vision correction. No need to worry about your frames slipping off your nose or blocking your peripheral vision. Contacts can provide you with crisp and clear vision throughout your entire visual field so you can focus on being your best.
Courtesy of nikozz on Flickr

Courtesy of nikozz on Flickr

  • Another great example is for social events or gatherings where you know there will be cameras everywhere. This can range from brides-to-be prepping for their big day to just spending a night out with friends. When you know you want to look your best in the photos commemorating important times in the lives of your family and friends, contact lenses are the best accessory you could ask for!
  • Similarly, prescription color contact lenses can give you that extra pizzazz when you want to be a little different. Whether you are just adding a little blue or green to match your outfit or a purple or gray tint to draw some extra attention to your face, prescription color contacts can be a great choice to help you stand out in a crowd.
  • I personally choose to wear my prescription contact lenses on days when it is raining or cold. That way I can avoid having rain drops on my glasses or having my lenses fog up for 30 seconds or more when I go indoors in the winter time.
Courtesy of maikel_nai on Flickr

Courtesy of maikel_nai on Flickr

  • The best thing about contact lenses is the new technology used in the current manufacturing processes of prescription contact lenses. This allows your optometrist the ability to fit nearly any prescription you can imagine in materials that are approximately 10 times better than what we used only a few years ago! Today’s prescription contact lenses are available in aspheric designs to help you see more clearly and with UV blocking filters to help protect your eyes throughout the day.

If you think contact lenses may work for you, call your optometrist today to schedule a contact lenses fitting.

~Ranjeet S. Bajwa, OD

Are computers bad for my child’s eyes?

This is a question that patients often ask me. Sometimes parents hint that they want me to tell their kids to stay off the computer/tablet/smartphone and others just really want to know how much is too much.  The fact of the matter is this: technology is not going to go away. It is everywhere. We do want our kids to be tech savvy and take advantage of all of the great learning experiences that technology offers, don’t we? We just need to be smart about it.

Courtesy of Paul Mayne on Flickr

Courtesy of Paul Mayne on Flickr

Using too much technology at a near point can have several negative effects on the body and on the visual system.  Kids who spend a lot of time in front of their devices, are less active physically and can have difficulty with posture.  We know that childhood obesity and diabetes is on the rise. One way to combat these diseases is to keep our children active, which means less time in front of the computer.

Computer vision syndrome is not a term that only applies to adults.  Symptoms such as eye fatigue, blurry vision, red eyes, headache and difficulty shifting focus to objects at a distance after computer use can also affect kids.  When focusing is fixed at a certain object in space for a long time, a child’s developing visual system does not get the benefit of practicing how to focus at different distances. This can cause persistent  problems with clarity of vision and possibly reading problems.

So how much is too much? A rule of thumb I usually give my patients is if school-aged children use the computer for schoolwork or for recreation, they should be on it for no more than 40 minutes without a break. By break, I mean at least 5 minutes away from the desk – getting up, looking outside, getting a drink of water and moving around.  For younger kids, try no more than 20 minutes per day. In fact, keep younger kids off electronic devices as much as possible. Encourage more free play, book reading and imagination. Try to use the technology only as needed or as a reward, not as a given or expected everyday activity.

There will be plenty of time to use technology as they get older. As I said, it is not going to go away!

Courtesy of sean dreilinger on Flickr

Courtesy of sean dreilinger on Flickr

In the meantime, do what you can to make computer use safe. Make sure children have annual comprehensive eye examinations to make sure their eyes are not being adversely affected by computer use.  Make sure the computer station is set up ergonomically for your child. The monitor should be slightly below eye level and a foot stool should be used to prevent dangling feet. Minimize glare on the computer by using glare filters and by positioning the computer away from windows as much as possible. These suggestions will help with healthy computer use for our children.

~Lisa Weiss, OD

Anatomy of the Eye 101

Courtesy of DVIDSHUB on Flickr

Courtesy of DVIDSHUB on Flickr

As a teacher and a doctor, I talk about the eye on a daily basis to my optometry students and patients alike.  I often use examples that my optometry students and patients can relate to.  The eye is like a high definition video camera that captures images of the visual world in real time.  If any part of your eye, that is, your “human video camera,” is affected or broken you may experience varying degrees of blurry vision, discomfort, or other common symptoms.  If you seek professional evaluation by your optometrist at the first inkling that something is out of sync, he or she can “fix or repair” your eye and get you back on a healthy track.

So let’s talk about the eye from front to back.

To start, the eyelids and lashes are the first visible structures to the outside observer.  Not only are the eyelids and lashes beautiful, but they also serve to protect the eye.  The eyelids spread lubricating tears like that of a windshield wiper across the surface of the eye with just a single blink, and the lashes act like specialized antennae sensing the smallest incoming offending particles.

Next, the conjunctiva is known to us as the “white” part of the eye.  This too is visible to the outside observer.  There are times that the conjunctiva may get inflamed or infected which results in that unwanted “pink eye” or conjunctivitis.

Much respect and attention has been given to the 5-layer-thick cornea as the clear window of the eye.  This is the layer where contact lenses are applied to correct nearsightedness or farsightedness.  Many successful surgeries like LASIK and corneal transplants have been performed on this tissue.

The anterior chamber and the vitreous are two compartments that give form to the eye and serve as conduits for circulating important fluids from one part of the eye to another.

Courtesy of entirelysubjective on Flickr

Courtesy of entirelysubjective on Flickr

The color part of the eye is called the iris.  It comes in many different colors and hues including brown, hazel, green, blue, and even violet.  The purpose of the iris is to regulate the amount of light that enters the eye.  Like that of a camera shutter, the iris controls the size of the pupil thus preventing under or over exposure of the picture of the visual world that is being seen.

The crystalline lens sits right behind the iris.  And similar to a camera lens, the human lens helps focus the things we see.

The retina, optic nerve, and macula can all be found way back in the eye.  The retina is the nervous tissue of the eye and is made up of 10 important layers. It gathers nervous signals and funnels it to the optic nerve.  As the name implies, the optic nerve is the nervous cable that connects the eye to the sight center in the back of the brain.  The macula allows you to see the finest details in vision.

This sums up the crash course on the Anatomy of the Eye 101.  Next time you are at your friendly optometrist’s office, just imagine the different parts of your eye being systematically looked at.

~By Judy Tong, OD