Alamo Optometry Blog

September 7, 2014

School and Children’s Vision

Filed under: Children's Vision — gkblog @ 5:39 pm

(As appeared in Alamo Today, September, 2014)

It is hard to believe that most of summer vacation is behind us and school is back is session.  August and September are usually the months where most parents prep their children for the upcoming school year.  The list usually includes school supplies, clothes, backpacks, etc. and yearly physicals are done with their pediatrician to ensure a healthy start to the year.  Even though most of you realize the importance of vision and eye health, it is vitally important for your child to be able to see well at all distances and have good eye-teaming skills to be able to learn and prosper at school.  I will cover some of the main eye issues related to difficulty at school.

I would say the most common diagnosis I find at the office is myopia, or near-sightedness.  For students that sit far away from the board or in the back of a large lecture hall, having uncorrected or under-corrected myopia will lead to blurry vision and an inability to see the material on the board, screen, or overhead.  I have found it common for younger children with this situation to have classroom issues in addition to lower grades due to the fact that they tend to be disruptive in class because they can’t see clearly more than a few feet in front of them.  These students are unable to take notes off of the board and therefore often fall behind in class and miss assignments.

At the opposite end of myopia is hyperopia, or far-sightedness.  These students are in a constant state of focusing to allow clear vision.  The closer the point of focus the more work that is necessary to clear the image.  That is why distance objects are easier than near ones.  A low amount of hyperopia is actually desirable, since near-sightedness tends to evolve as the child enters adolescence, so it gives them a little head start.  However, in larger prescriptions, hyperopia can cause near avoidance, headaches, fatigue, eye turns, and an overall indifference to sustained up-close tasks.  This can easily be diagnosed in the office as part of a comprehensive examination.

The last prescription issue that can be a hindrance to vision is astigmatism.  This is caused by the cornea, the clear front surface of the eye, not being completely round.  An easy analogy is that it is shaped more like an egg than a ball.  Astigmatism will generally degrade both distance and near vision; however, distance is usually a little more affected.  It is important to note that this is not a disease; it is just the way the eye is shaped and can be treated with glasses or contact lenses just like myopia and hyperopia.

In addition to having a prescription, all patients including children should have their binocular vision status evaluated.  It is quite possible to not have any of the above-mentioned prescription issues, but have poor eye teaming skills.  If the eyes are not aligned properly and do not work well as a team, there will be learning and reading issues.  These tend to present themselves more for reading than distance, but can definitely affect both.  When the eyes do not work as a unit, a child might experience double vision, “stretching” or “ghost images” of letters, skipping of letters or lines of text, eyestrain, headaches, near avoidance, or any combination of these.  Depending on the exact diagnosis, the condition can be treated with glasses or vision therapy.

I recommend having your child’s vision checked by an eye care professional instead of just relying on a school or pediatrician screening.  Most children that need to be evaluated are generally picked up by these screenings, but the comprehensive evaluation I give at the office not only encompasses vision and binocular vision, but also includes neurological testing, color vision, peripheral vision, and an ocular health examination of both the front and back portions of the eye.  We look forward to seeing your students in the office soon.

Flashes and Floaters

Filed under: Common Eye Concerns and Questions — gkblog @ 5:38 pm

(As appeared in Alamo Today, August 2014)

Thankfully in my field of practice there are very few ocular emergencies.  However, one of them is sudden onset of flashers and floaters.  This can be a potentially serious eye condition that warrants immediate attention, so I will discuss some of the causes and symptoms and what to do if you experience any of the effects.

When patients call the office complaining of sudden onset of flashes and floaters, the most common diagnosis is a posterior vitreous detachment or PVD.  Most patients will notice in their field of vision squiggly lines, small dots, a “spider-web” appearance, or any combination of these.  Most of the time the cause of floaters is idiopathic, meaning it just happens; other causes include trauma and age.  The vitreous gel, which fills the posterior 2/3 of the eye, is made of tightly-packed translucent collagen fibers.  Over time, the fibers that make up the gel liquefy and condense, causing it to move forward and pull away from the retina.  Since there is now an area of fibers that are situated in front of the retina, as light enters the eye it goes through this area and casts a shadow onto the retina; this is what the patient perceives as floaters.  This situation alone is completely benign and might cause slightly decreased vision but will have no long term effects on the eye.  However, as the gel pulls away from the retina there are tractional forces that develop and can pull a part of the retina away causing a retinal hole and/or detachment.   This is what needs immediate surgical intervention by a retina specialist.

If the retina is detached from the back of the eye, it is not receiving any oxygen and will die like any other tissue or organ in the body.  Generally speaking, the prognosis for visual recovery is directly related to how quickly the diagnosis and treatment is initiated and the location of the detachment.  This is why it is absolutely imperative that if you notice a sudden onset of floaters, flashes of light, decrease in vision, a veil or curtain coming over your vision, or any combination of these that you have your eyes dilated as soon as possible.  If you have any of these symptoms, we will always squeeze you in for a same day appointment.  If the diagnosis is a PVD, there is no treatment.  We will discuss some precautions and some things to watch for and do a repeat dilation in 4 weeks.  Most studies have shown that if a retinal complication is going to occur, it is going to happen within the first 4 weeks, most likely sooner.  If there is a retinal hole and/or detachment a prompt referral to a retinal specialist is ordered.  Many treatments now can be done in office; however, outpatient surgery is sometimes indicated.  The retinal surgeon will discuss your options with you and recommend the procedure and treatment plan with the greatest likelihood of success.

Patients will invariably ask if there is anything that can be done to remove the floaters, and unfortunately the answer is no.  The only way to clean out the floaters is to do a procedure called a vitrectomy, which involves going into the eye and removing all of the vitreous and replacing it with clear fluid.  However, the risk of retinal complications is relatively high with this procedure.  Therefore, retinal surgeons will not do surgery for a benign condition, albeit an annoying one, to risk loss of vision.  Thankfully, your brain learns to “tune out” the floaters over time so they are not as noticeable.  They never actually go away or disappear; your brain just learns to suppress them.  If you actively look for them, are out in the sun, or around a lot of light or glare it is relatively easy to find them.

If you have had a recent episode of floaters with or without flashes of light, please have your retina evaluated as soon as possible.  I would rather you come in for an office visit and the diagnosis is floaters versus waiting for the symptoms to go away and having possible decreased vision from a retinal complication.

Systemic Diseases

Filed under: Eye Diseases and Disorders — gkblog @ 5:36 pm

(As appeared in Alamo Today, July, 2014)

As many of you may or may not be aware, almost every systemic disease can have ocular effects.  Most patients are aware that common conditions such as diabetes and high blood pressure can have severe visual and ocular consequences.  However, any disease including lupus, colitis, leukemia, and high cholesterol can affect the eye.  The eye is no different from any other organ in the body; it needs blood and oxygen to survive.  If this is affected or reduced, vision and/or ocular health will definitely be compromised.  These changes can vary from a prescription change, cataract formation, or retinal disease, to name a few.  That is why it is very important to let us know of any systemic ailments and medications on the patient questionnaire, as these can have a profound effect on the eyes.  Many times patients don’t report having some conditions and medications to us because they feel it is not important or that “it has nothing to do with my eyes”.  You can safely assume that any medication you take or ailment you have can alter vision and ocular health.  For the purposes of this article I will just cover the two most prevalent diseases, diabetes and high blood pressure.

Diabetes affects about 10 percent of the population in the United States and is characterized by either a deficiency in insulin production (type 1) or insulin resistance (type 2).  The main ocular effect of diabetes is retinopathy, which is a disease of the retina. Diabetic retinopathy can lead to poor vision and even blindness.  At first the integrity of the blood vessels breaks down which can lead to blood leaking into the retina.  If blood sugar levels stay high or fluctuate, diabetic retinopathy will keep getting worse. Due to the poor retinal blood flow through these damaged blood vessels, new blood vessels grow on the retina because insufficient amounts of oxygen are reaching the cells within the retina. This may sound good, but these new blood vessels are weak. They can leak very easily, even while you are sleeping. If this happens, blood can leak into and around the macula, which will cause decreased vision.  Retinopathy can also cause swelling of the macula; macular edema reduces vision as this specialized area of the retina is compromised.  The only way to diagnose this is through a comprehensive dilated optometric examination.  Annual exams can help detect retinopathy and monitor retinopathy before it affects your vision.

High blood pressure, or hypertension, is another vascular disorder that forces your heart to work harder to pump blood through your arteries.  This can lead to hardening of the arteries and subsequent heart failure.  In addition to all of the other body organs it can affect, the eye can also be compromised.  The blood vessels of the retina over time can narrow and cause a decrease in blood to the retina.  Compromised blood flow can cause swelling of the optic nerve and macula, which over time can lead to decreased vision and possible stroke in the eye.  Since this is something that cannot be self-monitored, an annual dilated examination can help in the detection and monitoring of this potentially blinding disease.

To help combat these diseases, the absolute best thing you can do is to keep the disease under control.  The more your blood sugar and blood pressure are under control, the less likely eye consequences will be an issue.  That means visits to your doctor and taking your medications, life-style changes, etc. as prescribed.  Keep in mind that just because you “feel” fine and have your diseases under control, the fact is you still have the disease.  Along with your regular doctor visits, annual eye exams should be on your list to keep these diseases monitored and under control.

Social Media

Filed under: Our Office — gkblog @ 5:33 pm

(As appeared in Alamo Today, June 2014)

As an office we are always trying to tinker with how we do things to make ourselves and our product better.   Whether that is adding new technology to the office, offering our patients new contact lenses to the market, or finding better ways to make visits to our office more enjoyable, our goal is to enhance our office and services to be able to meet and exceed the needs of our patients.

Regardless of the type of business, that company has to continue to grow and gather new clients, patients, etc. to be able to succeed.  If a company does not alter the way they conduct business to meet market changes and demands, they will definitely not prosper.  Since we took over the office almost 7 years ago, we have made several changes including adding new frame lines and office instruments, introduce new lens products as they come to market, and changing some of the décor in the office.  Our new project is to better connect our office to our current patients and the members of our local community.  Thankfully, we have our current patient base talking and recommending our office to their friends and family members.  In conjunction with our loyal patient base, we are trying to enter the 21st century regarding social media.   Even though I am not personally into the social media sites such as Twitter, Instagram, and Pinterest, taking selfies, nor mastering the use of the hashtag, many of our current and potential patients use them all the time.

The main goal of utilizing these sites is to help share information with our patients and the community.  Whether it is an interesting article about cataracts or a new treatment for macular degeneration, new daily disposable contacts for astigmatism, or just a random good vibe, the purpose of these sites is to help educate people about good vision and eye health, and the procedures, products, and treatments that make that happen .  We are encouraging those who are so inclined, to engage the office and the community by using Twitter, Instagram, and Facebook, by posting their selfies of their new sunglasses, or their new look wearing daily disposable contacts, or to tweet any eye-related issues or questions that you have.  This will start threads about eye-related subjects or products that can shed some light on a topic of interest to you or introduce you to a new sunglass frame.

Up to this point we have had a blog on our website and a Facebook page for several years now, where we (mostly my wife) would post interesting articles or things going on at the office.  Even though that has been successful, we are trying to expand our reach to our patients and the local community about our office and services.  It is probably going to take a while for us to master the use of these sites but we are learning.   And to be honest, when you see a post, tweet, or a re-tweet, you can be pretty sure it was done by my better half.  Come follow us on Twitter @Alamo Optometry and we are Alamo Optometry on Facebook and Instagram.

Why Do I Need to Get My Eyes Dilated?

Filed under: Uncategorized — gkblog @ 5:32 pm

(As appeared in Alamo Today, May 2014)

As you can imagine, I get this question at the office on a daily basis.  Most patients understand that it is part of the comprehensive examination, but they don’t always know the reasoning behind it.  Therefore, they are always trying to get out of doing it.  The dilation is a very important (some would argue the most important) part of the exam, which helps determine the status of your ocular and systemic health.

The most valuable asset of the retina is that it is the only place in the body where neural tissue (the optic nerve and retina) and blood vessels can be directly viewed without an invasive procedure.  Trying to evaluate the retina through an undilated pupil is very difficult because as light is used to see into the eye, the pupil constricts to a pinhole.  Looking through a very small aperture does not allow the entire retina to be viewed.  The dilating drops will open up the pupil and will not allow it to constrict.  Since the muscles within the eye control the focusing power of the eye and the opening and closing of the pupil in response to light levels, paralyzing these muscles is why patients will experience light sensitivity and poor reading for a few hours after the drops are instilled.  The typical timing for the drops to wear off is between 2 and 3 hours.

A dilated examination can both diagnose and evaluate the progress of many systemic diseases;   in addition, assuring the patient that the eyes and retina are healthy and free of any conditions.  The main ocular conditions found during dilation include cataracts, diabetic and hypertensive retinopathy, glaucoma, macular degeneration, and retinal holes, tears, and detachments.  Systemic ailments such as diabetes, high blood pressure, multiple sclerosis, brain tumors, and heart and carotid artery disease can be diagnosed in the course of a dilated evaluation.  For otherwise young and healthy patients, dilation should be done about every 2 years.  For patients who are diabetic, have cataracts, glaucoma, or are taking certain medications, dilation should be done annually at the minimum.  For these patients, in addition to visiting your internist, endocrinologist, rheumatologist, etc. an annual dilated examination should be conducted.  Most physicians realize the importance of dilation and will require it of their patients.  When these patients come into the office, a letter to the doctor will be sent to update him/her on the condition of the eyes.

When an eye professional needs to assess the health of the back portion of the eye, dilation is still the standard of care.  There are new digital imaging systems that take relatively good views of the retina.  However, they are generally not able to reach the far periphery of the retina, and they are only able to give a 2-dimensional view of the retina as viewed on a computer monitor.  Dilation using an instrument called a binocular indirect ophthalmoscope (BIO) allows the doctor to see all around the retina in 3-dimensions.  Keep in mind that although reading ability will be impaired for a few hours, distance vision remains the same.  Light sensitivity might make it harder to see outdoors, but the actual vision does not change.  Please bring your sunglasses with you to the exam; if you don’t own any, we have some shields that will help protect you from the sun.

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