Healthy Eyes 101

Inflammation can occur in any part of the body and the eye is no exception. In this episode, we discuss uveitis and scleritis, two specific inflammatory conditions of the eye. 

Uveitis, one of the major causes of vision loss, is an intraocular inflammatory condition that can be broken up into three categories: infectious, non-infectious, and traumatic. It can further be classified by where the inflammation occurs in the eye: anterior (front part - iris), intermediate (middle part – ciliary body), posterior (back part – choroid), and panuveitis (entire eye).

Infectious uveitis can be caused by bacteria, viruses, fungi, and parasites in the eye or by a systemic infection like herpes, tuberculosis, syphilis, toxoplasmosis, or Lyme disease. Noninfectious uveitis, the most common type, can be caused by autoimmune conditions like rheumatoid arthritis, lupus, sarcoidosis, Reiter syndrome, ankylosing spondylitis, Behcet’s disease, psoriatic arthritis, and inflammatory bowel disease. The most common reason for uveitis is called idiopathic – no reason can be found. 

Symptoms of uveitis will vary according to its location in the eye. Anterior uveitis, also called iritis, can cause ocular pain, photophobia (light sensitivity), red eye, and decreased vision. Uveitis in the back of the eye mainly causes vision loss but usually does not cause pain.

After a thorough eye examination, a lab work-up should be performed especially after the second recurrent episode or if the first episode affects both eyes. Ruling out an infectious cause can be done in the office. Bloodwork to rule out some of the autoimmune diseases is the next step. Sometimes a chest x-ray may be necessary to help rule out TB or sarcoidosis.

Treatment of infectious uveitis is directed at the pathogen causing the infection. This may involve a combination of topical antibiotics or anti-virals and systemic medications. Steroids are the mainstay of treatment of non-infectious uveitis. Most anterior uveitis is treatable with topical steroid eye drops. Intermediate and posterior uveitis is mainly treated with oral steroids and steroid injections around or in the eye. For patients with chronic or recurrent uveitis, immunomodulatory therapies may be necessary. Some of these medications may include methotrexate, Cellsept, Humira, and Remicade.

Scleritis is an inflammatory condition of the outer coating of the eye (sclera). Symptoms include severe eye pain, red eye, and sometimes a decrease in vision. If the back part of the eyewall is inflamed, the eye may not appear red. An ultrasound of the eye may be necessary to properly diagnose this condition. Some of the causes of scleritis include rheumatoid arthritis, HLA-B27-related diseases, and gout. Oral and injectable steroids are the primary treatments for this condition. Sometimes immunomodulatory therapies are also needed to control the inflammation.

 Here are some more links to learn more about inflammation in the eye.

Uveitis.org

Preventblindness.org/uveitis/

Scleritis

 To find out more about Dr. Lou Chorich and his practice, go to Midwest Retina’s website.

This is intended for informational and educational purposes only, and nothing in this podcast/blog is to be considered as recommending or rendering medical advice or treatment to a specific patient. Please consult your eye care specialist for proper diagnosis and treatment of any eye conditions that you may have.

Billions of people around the world can see more clearly because of eyeglasses. To help us learn about glasses and the latest in lens technology, Dr. Suh interviews Kara Jones, a licensed optician with Comprehensive EyeCare.

We discuss the importance of the measurements performed on your eyes. The various types of lenses can be confusing – single vision, bifocals, trifocals, progressive, no-line bifocals, etc. Lens materials are improving and are enabling people who have higher prescriptions to wear thinner lenses. Digital lenses are all the rage in the optical world and allow people to see clearer than before. We also discuss polarized lenses in sunglasses, blue-filtering lenses, Transition lenses, and anti-glare coatings. Many people who purchase their glasses online can end up with buyer’s remorse. Find out the advantages of ordering your glasses from an optical shop.

For more information about choosing the right frames and lens materials, please go to this website from the American Academy of Ophthalmology.

To find out more about Comprehensive EyeCare of Central Ohio, go to the practice’s website or Facebook page.

This is intended for informational and educational purposes only, and nothing in this podcast/blog is to be considered as recommending or rendering medical advice or treatment to a specific patient. Please consult your eye care specialist for proper diagnosis and treatment of any eye conditions that you may have.

Side effects from medications are common. What may not be common knowledge is that there are systemic medications that can affect the eyes. For example, anti-hypertensive medications and some psychiatric medications are known to exacerbate dry eyes. Some oral medications can also adversely affect the retina, the delicate tissue inside the eye that receives the visual information.  

One of the most commonly used medications that can affect the retina is hydroxychloroquine (Plaquenil), a medication used to treat rheumatoid arthritis and systemic lupus erythematosus. Its cousin, chloroquine, an anti-malarial medication, can also have the same effect on the retina. Use of hydroxychloroquine after years may cause accumulation of the medication in the RPE (retinal pigment epithelium), the layer underneath the retina. It is most likely to accumulate in the macula, the part of the retina that is responsible for central vision. Thus, this can cause significant loss of distance and reading vision. 

Risk factors for retinal toxicity from hydroxychloroquine or chloroquine

• Daily dosage greater than 400 mg per day or total cumulative dosage of over 1,000 grams.
• Medication use for over 5 years
• Kidney or liver disease
• History of macular disease such as macular degeneration
• Age greater than 60 years

Patients who take these medications should have an annual eye examination that may include OCT (ocular coherence tomography), visual field testing, color vision testing, and possibly an ERG (electroretinogram). Many times, early changes can be detected by the examination and ancillary testing even before the patient has symptoms. There is no treatment for this other than to stop the medication immediately. The blind spots that can occur are usually irreversible.

Pentosan polysulfate (Elmiron) is a medication used for interstitial cystitis, a condition that can cause bladder pressure and pain. This drug can also affect the central macula and mimic macular degeneration. The risk factors for these changes are similar to hydroxychloroquine. There is no treatment other than to stop taking the medication. 

Here are some links to learn more about how these medications can affect the retina.

https://www.aao.org/eyenet/article/hydroxychloroquine-induced-retinal-toxicity

https://www.aao.org/eyenet/article/pentosan-polysulfate-maculopathy

To find out more about Dr. Christiane Hunt and her practice, go to her practice’s website or Facebook page.

I am pleased to announce that in the past few weeks, Healthy Eyes 101 was ranked as the number 6 eye health podcast by Feedspot. Without all of you devoted listeners, this honor would not have been possible - so thank you for supporting this podcast!

This is intended for informational and educational purposes only, and nothing in this podcast/blog is to be considered as recommending or rendering medical advice or treatment to a specific patient. Please consult your eye care specialist for proper diagnosis and treatment of any eye conditions that you may have.

Angle-closure, or narrow-angle, glaucoma is the other major type of glaucoma that can afflict patients. Fluid inside of the eye drains in the trabecular meshwork, the space between the cornea and the iris. When this space, or angle, narrows down, the trabecular meshwork can get blocked, which can cause the eye pressure to rise and increase the risk of glaucoma. In this episode, Dr. Wendy Kirkland explains all aspects of angle-closure glaucoma.

There are several categories for this type of angle configuration in the eye.

• Primary angle-closure suspect 
•  Primary angle-closure 
•  Primary angle-closure glaucoma
•  Acute angle-closure crisis

The risk factors for angle-closure include 

• Asian descent
• Hyperopia (farsightedness)
• Older age
• Female gender
• Short axial length (length of the eyeball)
• The size, shape, or position of the crystalline lens

Like primary open-angle glaucoma, many patients with angle-closure have no symptoms so this is why it is important to have your eyes examined on a regular basis. The eye doctor can perform a gonioscopy exam to diagnose whether you need to have treatment to correct this condition. 

The signs and symptoms of an acute angle-closure crisis or attack include blurred vision, slightly dilated pupil, a red eye, extreme eye pain, headache, and nausea and vomiting.

Plateau iris and secondary causes of angle-closure need to be ruled out to administer the proper treatment. 

Treatments include a YAG laser peripheral iridotomy or cataract surgery.

Here is another site where you can learn more about narrow-angle glaucoma. 

To find out more about Dr. Wendy Kirkland and her practice, go to Arena Eye Surgeons' practice website.

This is intended for informational and educational purposes only, and nothing in this podcast/blog is to be considered as recommending or rendering medical advice or treatment to a specific patient. Please consult your eye care specialist for proper diagnosis and treatment of any eye conditions that you may have.

Ophthalmic, or visual, migraines are a common reason for urgent visits to the eye doctor. In this episode, Dr. Suh interviews Dr. Vin Hoye, a neuro-ophthalmologist, about this condition. He will discuss the various images that people can see when they are experiencing the migraine aura, which may or may not be followed by the classic headache. There are certain foods and risk factors that may trigger migraines. We will discuss the other diagnoses that may mimic ophthalmic migraines and whether or not there are treatments for the visual symptoms.                                                                                                                                                                                          
Here are some extra links about ophthalmic migraines.

https://www.mayoclinic.org/diseases-conditions/migraine-headache/expert-answers/ocular-migraine/faq-20058113

https://www.brighamandwomens.org/neurology/neuro-ophthalmology/visual-migraine

Here is a video simulation of an ocular migraine.

To find out more about Dr. Vin Hoye, go to his practice’s website.  

This is intended for informational and educational purposes only, and nothing in this podcast/blog is to be considered as recommending or rendering medical advice or treatment to a specific patient. Please consult your eye care specialist for proper diagnosis and treatment of any eye conditions that you may have.

The treatment of glaucoma, one of the leading causes of blindness in the world, involves lowering the eye pressure. In previous episodes, we discussed glaucoma medications and minimally invasive glaucoma surgeries, or MIGS. Dr. Megan Chambers, a glaucoma specialist from Ophthalmic Surgeons & Consultants of Ohio, will be discussing the use of lasers and more traditional surgeries to help lower eye pressure in the quest to halt the progression of glaucoma.

Selective laser trabeculoplasty (SLT) has gained in popularity over argon laser trabeculoplasty (ALT). SLT applies laser energy to create changes in the trabecular meshwork (drainage tissue) to allow fluid to filter out easier. This relatively quick, in-office procedure may take up to 3 months for the pressure-lowering effect to occur. It has about an 80% success rate and can be used as a first-line treatment or as a replacement for glaucoma eye drops.

Trabeculectomy is a surgical procedure performed in the operating room that is designed to lower intraocular pressure when medications and laser have failed to lower the pressure enough. A small flap is made in the eye wall near the cornea, and a small hole is made underneath this flap to let the eye fluid filter out slowly. The conjunctival tissue above the flap forms a “blister” called a bleb. Many times, patients will be able to stop their glaucoma drops after a trabeculectomy. 

Glaucoma drainage implants, or tube shunts, are devices that are placed underneath the conjunctiva. The tube is placed into the eye and drains fluid into the plate portion of the implant. Usually this procedure is done after a trabeculectomy has failed.

Preserflo, formerly known as InnFocus microshunt, is undergoing FDA trials as a possible alternative to these traditional surgeries but with fewer side effects and complications. 

Here is another great resource on glaucoma treatments. 

To find out more about Dr. Megan Chambers and her practice, go to Ophthalmic Surgeons & Consultants of Ohio’s practice website.

This is intended for informational and educational purposes only, and nothing in this podcast/blog is to be considered as recommending or rendering medical advice or treatment to a specific patient. Please consult your eye care specialist for proper diagnosis and treatment of any eye conditions that you may have.

In this special 20th episode, Dr. Suh talks with Dr. Jim Caudill, an ophthalmologist from Charleston, West Virginia, about their work with Medical Ministry International (MMI), a Christian medical mission group whose volunteers participate in one- and two-week projects to developing nations.

Several of the leading causes of visual impairment in the world are preventable or treatable.  People with uncorrected refractive errors, which means they are nearsighted, farsighted, and/or have astigmatism, can see better with a pair of prescription glasses.  But in many developing countries, prescription glasses are not easy to obtain.  Cataract, a clouding of the natural lens, is responsible for about half of the world blindness, which represents about 20 million people. Lack of access to or lack of financial means for surgery as well as longer life expectancy are some of the factors that have led to this increasing number of untreated cataracts. 

In the developing world, being blind decreases one’s life expectancy by one-third. 50% report loss of social standing and decision-making authority. Children may be unable to attend school because they must care for their blind relatives. The annual worldwide productivity cost of blindness is estimated to be in the hundreds of billions of dollars. 

Many charitable medical organizations have been around for decades to do short-term trips in these developing countries to lessen the burden of their much-needed medical care.  MMI has been around for over 50 years.  They provide dental, medical, surgical, OB/GYN, eye care, and physical therapy services around the world with short-term missions and in their permanent centers.

For more information about Medical Ministry International, click here.

To find out more about Dr. Jim Caudill, go to his practice's website.

This is intended for informational and educational purposes only, and nothing in this podcast/blog is to be considered as recommending or rendering medical advice or treatment to a specific patient. Please consult your eye care specialist for proper diagnosis and treatment of any eye conditions that you may have.

Diabetes mellitus can affect the eyes in multiple ways. Even early in the diagnosis, high blood sugar levels can cause changes in the natural lens of the eye that can alter one’s refractive error (glasses prescription). Diabetes can also lead to earlier cataract formation. On this episode of the Healthy Eyes 101 podcast, Dr. Lisa Borkowski, a specialist with Midwest Retina, talks about diabetic retinopathy, one of the leading causes of vision loss in the United States and worldwide. 

Symptoms of diabetic retinopathy (DR) include blurred/distorted vision, an increase in floaters, or dark areas in the field of vision. However, many patients do not have any visual symptoms at all.  This is why diabetics should have their eyes checked on a regular basis.  Those with type I diabetes should get their first exam within 5 years of diagnosis. Those with type II diabetes should be examined soon after diagnosis because many of these patients may have had uncontrolled sugar levels for years.   

The two main categories of diabetic retinopathy are non-proliferative (NPDR) and proliferative (PDR). When blood sugar levels remain elevated, NPDR can cause the retinal blood vessels to leak or even close off. If the leakage occurs near the center of the retina (macula), there can be vision loss. With PDR, the more advanced stage of DR, new blood vessels form (neovascularization) on the surface of the retina. These fragile vessels can bleed into the vitreous gel and block vision. 

To properly diagnose DR, a dilated examination or extensive retinal photographs need to be performed by your eye care specialist. Many retina surgeons will also perform a fluorescein angiogram so that they can see areas of retinal swelling (macular edema) and new blood vessel growth. OCT (ocular coherence tomography) is useful for following changes in macular edema. 

Treatments for DR include eye injections with ant-VEGF medications, laser surgery, and vitrectomy surgery in the operating room. 

What can patients do to decrease their risk of losing vision from DR? Control the blood sugar levels and blood pressure and see your eye care specialist at the recommended intervals. 

Here is another great resource on diabetic retinopathy. 

 To find out more about Dr. Lisa Borkowski and her practice, go to Midwest Retina’s practice website.

This is intended for informational and educational purposes only, and nothing in this podcast/blog is to be considered as recommending or rendering medical advice or treatment to a specific patient. Please consult your eye care specialist for proper diagnosis and treatment of any eye conditions that you may have.

Refractive eye surgery involves changing the refractive state of the eye to decrease one’s dependency on glasses or contact lenses. The first corneal refractive surgical procedure developed was radial keratotomy (RK). Corneal instability and progressive shifting of the refraction (glasses prescription) made this surgery obsolete. 

LASIK (Laser-Assisted In-Situ Keratomileusis) and PRK (PhotoRefractive Keratectomy) use the excimer laser to reshape the cornea to help focus the light rays onto the retina like glasses or contact lenses do.  These laser vision correction (LVC) procedures can correct nearsightedness, farsightedness, and astigmatism.

Patients who may not be good candidates for LVC:

• Thin corneas
• High glasses prescriptions
• Keratoconus
• Autoimmune diseases like rheumatoid arthritis
• Perfectionists
• People who need excellent nighttime vision, like truck drivers or airline pilots
• Currently on certain medications like Accutane/isotretinoin (or other acne medications)
• Large pupils
• History of past corneal infections
• Unstable glasses prescription
• Severe dry eyes

Presbyopia (decreased ability to see up close) starts in the mid-40s. If both eyes are lasered to correct their distance, then they will need reading glasses. Monovision is an option where one eye is set for distance and the other eye is set for or left with some nearsightedness.

Nowadays, both eyes are usually lasered in the same sitting. The first step in LASIK is to use a femtosecond laser or a micro-keratome blade to make the corneal flap. In PRK, the top layer of cells (epithelium) is carefully scraped off. The excimer laser energy is then applied to the exposed cornea to reshape it. This laser may take up to ~50 seconds per eye. If PRK was performed, then a bandage contact lens is placed to help the epithelium to grow back and for pain control. With LASIK the vision may be fairly sharp immediately after the procedure. PRK has a slower recovery because the epithelium has to grow back onto the cornea. The final results of the PRK may not be seen for several weeks. PRK may be chosen because of thin corneas and for people who are in a profession where eye injuries can occur. LASIK has become the more popular procedure because of its quicker recovery and less discomfort.

Complications may include corneal infections, intra-flap inflammation (diffuse lamellar keratitis (DLK)) in LASIK, halos at night, and difficulty driving at night. Ectasia (progressive thinning and warpage of the cornea) may be difficult to treat and the patient may need to wear hard contact lenses to improve their vision.

The ICL (Implantable Contact Lens) is a refractive intraocular lens that is placed into the area behind the iris and the natural lens. This can treat high amounts of nearsightedness and astigmatism without having to sacrifice any corneal tissue.

The SMILE (SMall Incision Lenticule Extraction) procedure utilizes the femtosecond laser to create a disc of corneal tissue that is removed. This procedure, which can correct nearsightedness and astigmatism, has not been used in the United States as much as in Europe and other countries.

Here is another great resource on Laser Vision Correction.

To find out more about Dr. Curtin Kelley, go to his practice website or follow his practice on Facebook.

This is intended for informational and educational purposes only, and nothing in this podcast/blog is to be considered as recommending or rendering medical advice or treatment to a specific patient. Please consult your eye care specialist for proper diagnosis and treatment of any eye conditions that you may have.

Oculoplastic specialist, Dr. Kenneth Cahill, joins Dr. Suh to discuss a bothersome condition – epiphora, the medical term for watering eyes. Why does excessive tearing occur and what we can do about it? Blocked tear ducts are a major cause of chronic watering.  

Causes of excessive watering

• Overproduction of tears
• Abnormalities of the eyelids (ectropion (outward turning of the lower lid), entropion (in-turning of the lower lid), or lid weakness)
• Blockage of the tear drainage system (nasolacrimal duct)
• Ocular surface irritation (dry eyes, foreign body, allergies)

Tear glands on the upper part of the eyeball produce the tears. The tears will drain into the punctum, the tiny hole at the margin of each lid close to the nose. This opening leads to the canaliculus, the tube that connects the punctum to the lacrimal sac. From there the tears will end up in the nasal cavity. A blockage, temporary or permanent, can lead to excessive watering.

Symptoms of a blocked tear duct

• Tenderness and irritation of the lid margin and eyelid skin
• Crusting along the eyelash line
• Mucus build-up/discharge
• Dacryocystitis - infection of the lacrimal sac

Punctal stenosis is narrowing of the hole that can cause tearing. This can be caused by chronic use of medicated eye drops, changes from the aging process, viral infections, and dermatitis. This is treated by dilating the opening with a probe or by doing a two-snip punctoplasty to enlarge the hole. These can be performed in the office.

Causes of blocked tear ducts

• Chronic ocular irritation
• Age-related changes
• Chronic use of medicated eye drops
• Nasal trauma or polyps
• Chemotherapy medications (5-FU, Taxotere)

Congenital nasolacrimal duct obstructions are not uncommon. Usually these will spontaneously resolve within the first few months. If they do not, a quick probing procedure can open up the system.

To confirm an obstruction of the tear duct system, a probe and irrigation can be done to test for a blockage and to squirt a small amount of fluid into the system to see if it goes all the way through.

Conservative treatments for partial blocked tear ducts would include using an antibiotic/steroid eye drop and a steroid nasal spray.

There are two main surgical treatments. Silicone intubation involves putting tubing into the tear duct system and leaving it in there for 6-12 weeks. Dacryocystorhinostomy (DCR) creates an opening into the lacrimal sac and into the nose bypassing the opening in the  sac that has scarred down. This is performed with local anesthesia (sometimes general anesthesia) as an outpatient surgery. Tearing usually improves within the first week. The most common complications are nose bleeds and failure to improve the tearing. DCRs have a 90-95% success rate.  Conjunctivodacryocystorhinostomy (CDCR), a variant of traditional DCR, utilizes a glass (Jones) tube that is used when the canaliculi have also scarred.

Here is a great resource with videos about the topics in this episode.

To find out more about Dr. Cahill, go to his practice's website - Ophthalmic Surgeons and Consultants of Ohio.

This is intended for informational and educational purposes only, and nothing in this podcast/blog is to be considered as recommending or rendering medical advice or treatment to a specific patient. Please consult your eye care specialist for proper diagnosis and treatment of any eye conditions that you may have.