One of the perks of working with physicians is being able to come away with mind blowing knowledge from a simple conversation in passing. Today I had the pleasure of filling in for a coworker who specializes in Visual Field testing and an optic nerve photography (for the lack of a better reference...) The entire afternoon consisted of 5 patients, one of which had 20/30 vision in both eyes. Her pressure readings were below 20 in both eyes and she had no complaints regarding her vision. After reviewing her chart and finishing her eye exam we walked to the visual field room where I conducted a test of her peripheral vision. Next, I took photos of her optic nerves with and printed them, she asked if I could see her "pit" ... thoroughly confused I asked if she was referencing her a dog? maybe? She laughed and said that she was diagnosed with something called a "pit" in her right eye and wanted to know if I could see it..... I reviewed her HRT photos and noticed what she was describing. Something that resembled a bubble located right on the edge of her optic nerve! She told me that she learned about this pit after visiting an Ophthalmologist about 30 years ago who made her very nervous during the exam when he said to his assistant "Go get my book that lists all the eye diseases!" She told me that after hearing those words she knew for sure that she was going blind, but here she is 30 years later .. Ironically with 20/30 vision in both eyes!
During a break in clinic, I asked her physician about the infamous "pit" and how common it was.. is it congenital.... does it effect vision.... how many cases of pits had he seen in his career etc
He informed me that it is congenital and potentially can have a negative effect on vision leading up to worse case scenarios of a retinal detachment. He has seen about a dozen in his career of 25+ yrs at this practice. I did a little research (typed in optic disc pit in Wikipedia) and learned that it can contribute to PVD which is short for posterior vitreous detachment which is commonly called "floaters" or "black spots" people see in their field of vision.(sometimes associated with flashes of light which may indicate a retinal detachment) It may potentially be hereditary as I'm guessing there were cases of parents and their children having optic disc pits but I am not sure how much research has been done about that aspect of this diagnosis specifically. The pit is a malformation of the optic nerve due to the embryonic fissure closing completely. Usually asymptomatic and usually only being in one eye. Common in about 1 in 10,000 people.. So if you are ever diagnosed with having one.. consider yourself lucky...!?
next post ... Aniridia!
Tuesday, October 22, 2013
Wednesday, October 16, 2013
Era of Good feelings
There are moments in life when you immediately reap the benefits of helping others..
Today is Wednesday and for the past 3 days Ive had at least one HUGE experience each day that was so meaningful that I had to share...so this is that!.
Monday.
Just a usual day at work when a "new patient" come through the door. She was a middle aged woman seeking a comprehensive eye exam who wanted to make sure that her changes in vision were evaluated as she has had difficulty seeing up close (presbyopia) and difficulty seeing in the distance as well as problems driving at night( cataracts). As the visit proceeded and we continued to talk. She mentioned the frequent headaches that she has been experiencing and wondered if there could be a correlation between eyes and headaches. I made detailed notes of her concerns and encouraged her to speak with the doctor when he visits with her. I checked her intraocular pressure which was slightly elevated at 22 in the right eye and 20 in the left eye. After further examination I noticed that the anterior chamber in both eyes appeared rather shallow ( narrow angles) as cataract formation has taken place over time, her eye have become "crowded" putting her at risk for a potential sudden attack of glaucoma. The doctor confirmed my diagnosis and she was NOT dilated but scheduled for a simple laser procedure that makes it safe for her to be dilated in the future as well as significantly decreasing her risk for such an attack. On the way out she thanked me for detecting her condition and NOT dilating her eyes as dilation drops can induce such an attack. She then scheduled her follow appointments and I encouraged her to have a nice day!
Tuesday
A chart was in the bin for a technician to call back a patient who had questions about his diagnosis of glaucoma. The young African American male in his early 20s had been evaluated the previous week at a lasik center and was told that he was not currently a candidate for laser vision correction surgery as he showed signs of having glaucoma. I called the patient who did not answer the phone and his voicemail box was full preventing me from leaving a message, however he did return my call about an hour later. I told him who I was and asked what questions he had about his visit. He said that his mother told him that he is too young to have glaucoma and with his contacts and glasses he has good vision. He was wondering if someone at the office can "sign off" of his surgery so he can get lasik without being treated for glaucoma. At that moment, I was taken back by the patients will to ignore the gravity of his diagnosis and prioritize lasik rather than glaucoma treatment. I asked the patient if he knew what glaucoma was and how it can potentially effect ones vision. He said the Doctor explained everything to him the day before however he was not paying attention because he was distracted by the fact that he had gotten a speeding ticket on the way to the office! Basically starting from scratch... I shared with the patient that Glaucoma is the result of increased (sometimes decreased) intraocular pressure in the eye that can cause the optic nerve in the back of the eye to become damaged. This damage is irreversible and potentially devastating to a patients peripheral vision if gone untreated. He then ask what the cause of glaucoma is and is there a correlation between contact lens use and glaucoma. I explained a person can have glaucoma even if they do not wear glasses or contacts and this disease is usually inherited from someone in your family who already has glaucoma. Having a family history of glaucoma myself I shared with the patient that my grandmother lost her vision to glaucoma as the availability of health care and the advancements in medicine today where not available to her. She was blind in both eyes probably never really knew what I looked like... I explained that my father (her son) in addition to all of her children were diagnosed with glaucoma and are all being treated for the disease. After the conversation was over, I noticed that the the patients tone had shifted significantly as he understood that ignoring glaucoma to get lasik would have been an unwise decision as a potential loss in vision from glaucoma would mean that laser vision correction surgery would not be able to improve his vision at all. Before hanging up, he said that he will return for further treatment and make ocular health priority in his life. Then he said... "Thank you for taking the time to explain things to me, I really appreciate it!"
Wednesday
Today I had the pleasure of spending time with a patient who was confined to a wheelchair as a result of cerebral palsy. She was 30 years old. She very articulate and very much aware of the nature of her visit. She came in with a pair of glasses that were about 4 years old. She had a lazy eye and an overall vision of about 20/200. Due to her condition, she was unable to get automatic measurements and the level of difficulty for a technician preparing a patient with such special needs is significantly more challenging than others.... I decided to wheel her out into the hallway.. Grab some trial frames with a handful of lenses and kneel down testing her vision one lens at a time. With the uncontrollable movement of her head, this made for a rather difficult task... BUT after several minutes and trial lenses everywhere.... She was able to see letters on the 20/60 line which is about about twice as better as she was seeing before.. She was then dilated and seen by the doctor who commended me of my efforts to help this woman.. I was appreciative of his comments but the feeling that I got when she was able to read those letters and show signs of improved vision was indescribable.
Everyday in life we are presented with opportunities to go above and beyond what is required to ensure a quality a experience for others. Despite the jaded views and opinions that exist in the world Ghandi encouraged us to "BE" that change we wish to see in the world." Dr. Martin Luther King Jr explained that "you cannot expect change to roll in on the wheels of inevitability." Small detailed changes make up larger drastic changes over time. Be watchful and stay aware of ways that you can help others!
Today is Wednesday and for the past 3 days Ive had at least one HUGE experience each day that was so meaningful that I had to share...so this is that!.
Monday.
Just a usual day at work when a "new patient" come through the door. She was a middle aged woman seeking a comprehensive eye exam who wanted to make sure that her changes in vision were evaluated as she has had difficulty seeing up close (presbyopia) and difficulty seeing in the distance as well as problems driving at night( cataracts). As the visit proceeded and we continued to talk. She mentioned the frequent headaches that she has been experiencing and wondered if there could be a correlation between eyes and headaches. I made detailed notes of her concerns and encouraged her to speak with the doctor when he visits with her. I checked her intraocular pressure which was slightly elevated at 22 in the right eye and 20 in the left eye. After further examination I noticed that the anterior chamber in both eyes appeared rather shallow ( narrow angles) as cataract formation has taken place over time, her eye have become "crowded" putting her at risk for a potential sudden attack of glaucoma. The doctor confirmed my diagnosis and she was NOT dilated but scheduled for a simple laser procedure that makes it safe for her to be dilated in the future as well as significantly decreasing her risk for such an attack. On the way out she thanked me for detecting her condition and NOT dilating her eyes as dilation drops can induce such an attack. She then scheduled her follow appointments and I encouraged her to have a nice day!
Tuesday
A chart was in the bin for a technician to call back a patient who had questions about his diagnosis of glaucoma. The young African American male in his early 20s had been evaluated the previous week at a lasik center and was told that he was not currently a candidate for laser vision correction surgery as he showed signs of having glaucoma. I called the patient who did not answer the phone and his voicemail box was full preventing me from leaving a message, however he did return my call about an hour later. I told him who I was and asked what questions he had about his visit. He said that his mother told him that he is too young to have glaucoma and with his contacts and glasses he has good vision. He was wondering if someone at the office can "sign off" of his surgery so he can get lasik without being treated for glaucoma. At that moment, I was taken back by the patients will to ignore the gravity of his diagnosis and prioritize lasik rather than glaucoma treatment. I asked the patient if he knew what glaucoma was and how it can potentially effect ones vision. He said the Doctor explained everything to him the day before however he was not paying attention because he was distracted by the fact that he had gotten a speeding ticket on the way to the office! Basically starting from scratch... I shared with the patient that Glaucoma is the result of increased (sometimes decreased) intraocular pressure in the eye that can cause the optic nerve in the back of the eye to become damaged. This damage is irreversible and potentially devastating to a patients peripheral vision if gone untreated. He then ask what the cause of glaucoma is and is there a correlation between contact lens use and glaucoma. I explained a person can have glaucoma even if they do not wear glasses or contacts and this disease is usually inherited from someone in your family who already has glaucoma. Having a family history of glaucoma myself I shared with the patient that my grandmother lost her vision to glaucoma as the availability of health care and the advancements in medicine today where not available to her. She was blind in both eyes probably never really knew what I looked like... I explained that my father (her son) in addition to all of her children were diagnosed with glaucoma and are all being treated for the disease. After the conversation was over, I noticed that the the patients tone had shifted significantly as he understood that ignoring glaucoma to get lasik would have been an unwise decision as a potential loss in vision from glaucoma would mean that laser vision correction surgery would not be able to improve his vision at all. Before hanging up, he said that he will return for further treatment and make ocular health priority in his life. Then he said... "Thank you for taking the time to explain things to me, I really appreciate it!"
Wednesday
Today I had the pleasure of spending time with a patient who was confined to a wheelchair as a result of cerebral palsy. She was 30 years old. She very articulate and very much aware of the nature of her visit. She came in with a pair of glasses that were about 4 years old. She had a lazy eye and an overall vision of about 20/200. Due to her condition, she was unable to get automatic measurements and the level of difficulty for a technician preparing a patient with such special needs is significantly more challenging than others.... I decided to wheel her out into the hallway.. Grab some trial frames with a handful of lenses and kneel down testing her vision one lens at a time. With the uncontrollable movement of her head, this made for a rather difficult task... BUT after several minutes and trial lenses everywhere.... She was able to see letters on the 20/60 line which is about about twice as better as she was seeing before.. She was then dilated and seen by the doctor who commended me of my efforts to help this woman.. I was appreciative of his comments but the feeling that I got when she was able to read those letters and show signs of improved vision was indescribable.
Everyday in life we are presented with opportunities to go above and beyond what is required to ensure a quality a experience for others. Despite the jaded views and opinions that exist in the world Ghandi encouraged us to "BE" that change we wish to see in the world." Dr. Martin Luther King Jr explained that "you cannot expect change to roll in on the wheels of inevitability." Small detailed changes make up larger drastic changes over time. Be watchful and stay aware of ways that you can help others!
Tuesday, October 8, 2013
Ocular Awareness...
This post is an attempt to motivate patients who seek treatment in any area of medicine but specifically those who visit the eye doctor. Millions of patients visit doctor offices around the globe everyday. Some visits are as straight forward as a routine check ups while other visits can be as intense as surgery or extensive special testing. No matter the nature of the diagnosis, routine or emergency, it is best for the patient and the physician to be on the same page. Ocular awareness could literally be defined as "ones awareness of their eyes..?" specifically in this post I'm referring to the a patient taking an active role in their treatment.
As a technician I ask questions like..What kind of drops are you are using? How often do you use them? Have you noticed any changes in your vision since your last visit? Any changes in your medical history since your last visit? Some patients know their medical history forwards and backwards but others give me a response along the lines of "I don't know?"
With that being said, if you or someone you know has an appointment approaching with any physician, take time to consider things to be discussed with the doctor such as: If a reaction occurred to a medication that you were prescribed, if your vision is blurry, if your are having problems driving at night, you have noticed a few small black spots in your vision and some times you thought you noticed a few flashes of light in your vision, can't see road signs, diagnosed with a diabetes or high blood pressure since your last visit. All of these scenarios listed could be vital information for a physician to consider before he or she formulates a treatment plan.
In addition to accurately reporting symptoms to a physician during the visit, following instructions given by that physician is a step in the right direction on your road to recovery. With that being said, using drops as directed, regularly checking home vision test like Amsler Grids for patients who suffer from Macular degeneration, and making recommend lifestyle changes are all great contributions to your ocular health.
In many instances patients visit the doctor as with the same level of excitement as completing an arduous chore....but remember to ask questions, take note of any changes in vision, and have a clear understanding of the plan that your doctor has for you. Increase your OCULAR AWARENESS!!
As a technician I ask questions like..What kind of drops are you are using? How often do you use them? Have you noticed any changes in your vision since your last visit? Any changes in your medical history since your last visit? Some patients know their medical history forwards and backwards but others give me a response along the lines of "I don't know?"
With that being said, if you or someone you know has an appointment approaching with any physician, take time to consider things to be discussed with the doctor such as: If a reaction occurred to a medication that you were prescribed, if your vision is blurry, if your are having problems driving at night, you have noticed a few small black spots in your vision and some times you thought you noticed a few flashes of light in your vision, can't see road signs, diagnosed with a diabetes or high blood pressure since your last visit. All of these scenarios listed could be vital information for a physician to consider before he or she formulates a treatment plan.
In addition to accurately reporting symptoms to a physician during the visit, following instructions given by that physician is a step in the right direction on your road to recovery. With that being said, using drops as directed, regularly checking home vision test like Amsler Grids for patients who suffer from Macular degeneration, and making recommend lifestyle changes are all great contributions to your ocular health.
In many instances patients visit the doctor as with the same level of excitement as completing an arduous chore....but remember to ask questions, take note of any changes in vision, and have a clear understanding of the plan that your doctor has for you. Increase your OCULAR AWARENESS!!
Thursday, February 16, 2012
DM/NIDDM
Hello Everyone!
In route to achieving greatness.. sometimes I neglect the blog life and I apologize for that ..However, Today in clinic I saw a Patient who is a Diabetic.. she's about 40 years of age and came in for an eye exam... she complained of changes in Vision ...
During the course of her exam I asked her what her blood sugar was ... she responded with 328!!!! then said she told me that her A1C was 11.3 yesterday! and that in the past 4 months .. her blood sugar has been well over 500!!!!
These number are off the charts !!!!
with that said.... Diabetes is the number one cause of new blindness in America SO if you or someone that you know has diabetes ... PLEase get an complete eye exam!!!!!!
Your vision is precious ... don't lose it over a condition that can be treated and monitor it frequently!
until next time...
-Ronnie
In route to achieving greatness.. sometimes I neglect the blog life and I apologize for that ..However, Today in clinic I saw a Patient who is a Diabetic.. she's about 40 years of age and came in for an eye exam... she complained of changes in Vision ...
During the course of her exam I asked her what her blood sugar was ... she responded with 328!!!! then said she told me that her A1C was 11.3 yesterday! and that in the past 4 months .. her blood sugar has been well over 500!!!!
These number are off the charts !!!!
with that said.... Diabetes is the number one cause of new blindness in America SO if you or someone that you know has diabetes ... PLEase get an complete eye exam!!!!!!
Your vision is precious ... don't lose it over a condition that can be treated and monitor it frequently!
until next time...
-Ronnie
Friday, December 16, 2011
OPHTHALMIC CYSTICERCOSIS
Recently I researched and presented to a class of undergraduate students concerning the topic of Ophthalmic Cysticercosis. I felt obligated to share this information regarding the complications associated with the consumption of undercooked pork. The presentation went rather well and feedback from students, as well as the professor was rather inspiring. Enjoy!
•Ophthalmic Cysticercosis
by H. Ronnie Nelson II
by H. Ronnie Nelson II
What is ophthalmic cysticercosis?
•An infection in and around the
ocular organs caused
by Taenia solium (the pork tapeworm). The Infection occurs when the tapeworm larvae
enter the body and form cysticerci. When cysticerci are found in the brain, the
condition is called neurocysticercosis
Scientific
Classification
•Kingdom:
Animalia
•Phylum:
Plathelminthes
•Class:
Cestoda
•Order:
Cyclophyllidea
•Family:
Taeniidae
•Genus:
Taenia
•Species:
Taenia Solium
Transmission
to humans
Humans are the intermediate hosts for T solium, and pigs are the definitive
hosts. A tapeworm larval cyst (cysticercus) is ingested with poorly-cooked
infected pork. The larva escapes the cyst and passes to the small intestine,
where it attaches to the mucosa with scolex suckers. Egg-containing proglottids develop as the worm matures in 3-4
months.
The adult worm may live in the small
intestine for as long as 25
years without
symptoms. When the primary larvae (oncospheres) penetrate the intestinal mucosa,
the Larvae enters into the circulatory system spreading to the Neural,
muscular, and ocular tissues of the human body.
•Symptoms
•Nausea
•Week Muscles
•Loss of Weight
•Malnutrition
•Abdominal Pain
•Passing worm sections in stool
Ophthalmic Cysticercosis can affect ALL ocular Tissue including:
•Vitreous cavity
•Subretinal tissue
•Conjunctiva
•Extraocular muscles
•Optic Nerve
Damage to these areas can result in
the following:
•Cataract formation
•Iritis
•Severe Headache
•Strabismus
•Diplopia
•Severe redness
•Proptosis
Facts about Ophthalmic Cysticercosis…
•A LIVE cyst may be freely mobile inside
the anterior chamber or attached to an ocular structure surrounded in a bed of
inflammation.
•Cyst death causes the release of
TOXIC products also resulting in severe inflammation.
•Cases with intense inflammation may
prevent the cyst from being clinically visualized by ocular and neural imaging
technology.
•Cysticercosis affects an estimated 50
million people
worldwide.
• Ocular cysticercosis is endemic in tropical areas, such
as sub-Saharan Africa, India, and East Asia. Other endemic areas include Mexico
and Latin America.
•There is a correlation between new
diagnosed cases in the U.S. and immigration increases from endemic areas.
•An estimated 1000 new cases per
year are diagnosed in the United States.
•There is no statistical evidence
showing diagnosed cases being related to race, sex, or specific to one eye.
•Ocular Cysticercosis is more commonly reported younger
age groups.
Treatment
•Surgical removal is required in individuals with intraocular
cysts.
•Deep orbital dissection in conjunction
with difficulty in completely excising/removing the cyst because of the
surrounding inflammatory response increase the chances of postoperative
complications.
•Cysts deep within the orbit are
best treated conservatively with a 4-week regimen of oral albendazole (Benzamidazole) in conjunction with oral steroids/corticosteroids in a tapering dose over a 1-month period.
•Resolution of the cyst may take
from a few days to months depending on the density of the surrounding
inflammation. Based on the individual’s response to medical therapy, another
course of medication may be required.
Tuesday, October 25, 2011
EYE JUST WANTED TO SAY THANKS! :0)
Blogging has turned out to be a lot more successful than I anticipated. Thanks to my viewers and followers for your time and support!
While I have your attention... I hear from many patients who complain of Dry EYES and allergy related irritation. There is a drop called ZADITOR which was previously RX only but is now over the counter. This drop is used to treat allergy related irritation and is safe for contact lens wearers. So run out and go get it..
Also, for those who have chronic red eyes, increase the use of artificial tears as needed and TURN DOWN/OFF THE CEILING FAN WHILE YOU SLEEP!!! AND finally Stay away from drops that "GET THE RED OUT" you know who you are..."WOW......" Those get the red out but are more harmful than not with frequent use due to their Vaso-constricting abilities which are not beneficial for long term use for your eyes. A preservative free artificial tear is one that can make your eyes feel great and keep your eyes lubricated!
While I have your attention... I hear from many patients who complain of Dry EYES and allergy related irritation. There is a drop called ZADITOR which was previously RX only but is now over the counter. This drop is used to treat allergy related irritation and is safe for contact lens wearers. So run out and go get it..
Also, for those who have chronic red eyes, increase the use of artificial tears as needed and TURN DOWN/OFF THE CEILING FAN WHILE YOU SLEEP!!! AND finally Stay away from drops that "GET THE RED OUT" you know who you are..."WOW......" Those get the red out but are more harmful than not with frequent use due to their Vaso-constricting abilities which are not beneficial for long term use for your eyes. A preservative free artificial tear is one that can make your eyes feel great and keep your eyes lubricated!
Monday, October 24, 2011
NarroW ANGLES
Recently I’ve encountered an increased amount of both new
and existing patients who have a condition known as “Narrow Angle’s”. This
diagnosis is a form of Glaucoma, which is related to the increased intraocular
pressure inside the eye. Glaucoma is a hereditary disease mostly commonly found in eyes with darker pigmented iris colors. There are
available treatments for Glaucoma, the most common being daily drops “gtts” that
patients can use once or twice a day. Drop treatment allows fluid inside of the
eye (aqueous humor) to flow more freely from the front of the eye to the back
without obstructions that can and cause the pressure to increase inside of the
eye. Other treatments include the use of lasers to open new pathways in the
iris to allow better flow.
If gone untreated, increased pressure can damage a
person’s optic nerve. The optic nerve interprets visual images and relays them
to our brain, increase IOP has the potential to decrease peripheral vision over
time and can ultimately lead to tunnel vision only. Special testing (including
but not limited to) Humphrey Visual field, HRT scans of the optic nerve and OCT
scans can be done periodically by an Ophthalmologist to track the health of the
optic nerve and detect even the slightest decrease in peripheral vision.
Patients who are hyperopic are commonly labeled as “farsighted” due to the
curvature of the cornea and how light is refracted (bent) by the cornea of a hyperopic
eye the image is projected behind the retina. This overshot of light is the
reason why distant images are clearer than near images. Due to the anatomy of
the eyes, a hyperopic person is at more a risk to have Narrow Angles... in conjunction
with developed cataracts which have the potential to crowding the inside of the eye and induce narrow
angles.
Okay so we’ve gone through a very basic explanation of
glaucoma, hyperopia and how cataracts can have an effect, and how they can all
be related, but what’s so bad about Narrow Angles?
Acute Narrow Angle Closure!!!
When those already narrow angles close and deny the flow
of intraocular fluid, the pressure
builds, and builds and builds and causes an increase amount of pressure on the
optic nerve which can cause redness, nausea/vomiting , and potential vision
loss.. Yes.. Vision loss.
Hopefully this post has been informative. If you have
specific questions please feel free to comment below or contact your
Ophthalmologist.
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