Eyedolatry: retinal detachment

Flashes and Floaters? Call your Optometrist!

Every time I dilate a patient (or the patient declines to be dilated for that matter) I talk about the 3 things that require an immediate call to me:

sudden onset flashes of light (like lightening blots across your vision)
sudden onset floaters (whether it is a large floater or a swarm of small floaters that obscure your vision)
or vision suddenly going dark (even if it is just one little area!)

These are the signs and symptoms of a Retinal Detachment!

LATTIC DEGENERATION: retinal thinning
can best be visualized with a dilated examination
It puts you at a slightly higher risk for a detachment

Optometrists talk so much about flashes, floaters, and a "veil" or shadow over your vision because retinal tears and detachments can cause PERMANENT vision loss. A retinal tear can happen without warning, even while you are sitting on the couch watching TV. They commonly are associated with head injuries, but I have had many patients with tears that occurred seemingly at complete random. Your eye doctor will tell you if you are at a higher risk for retinal tears at your annual comprehensive examination. Risk factors include patients who are highly myopic (or near sighted) or have thinner areas of your retina (a condition called lattice degeneration) to name a few.

Floaters can be normal, but a retinal tear has abrupt, large, disruptive floaters that are constant. Almost everyone starts getting normal floaters around age 20 as the vitreous (a jelly-like substance that fills the globe of the eye) begins to liquefy and deteriorate. This type of normal floater looks like a black spot or transparent string, and is annoying but harmless. We can also experience floaters and other visual phenomenon with migraines (even without a headache, which is called an ocular migraine!). These migraine related visual changes will last for a few hours, and then resolve. A retinal tear will have large, persistent floaters that greatly disrupt vision. A persistent phenomenon like this warrants an immediate call to your doctor!

Retinal tear with detachment coutesty acponline.org

Why it is important to call as soon as possible

Retinal detachments can be repaired, but there is a certain time limit for repair to get the best possible vision after surgery. The sooner the tear is caught, the sooner any fluid seeping under the tear can be stopped, which will prevent further detachment of retinal tissue. Acting in a timely fashion can make a huge difference in your visual outcome. Your eye doctor will treat your complaints of the 3 symptoms above as a medical emergency, and work you in as soon as possible for a dilated examination. If a tear is spotted, you will be promptly referred to a surgeon for repair.

Please don't wait weeks or months to see if your symptoms resolve. The sooner you tell your doctor could make the difference between regaining vision and being permanently blind out of the damaged eye!

A near total retinal detachment with poor potential for vision even after repair. Photo from retinagallery.com
Do not wait until your eye looks like this inside to call your doctor! It is always better to be safe and have a dilated examination performed if you experience the 3 signs and symptoms of a retinal detachement!

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NCAA Tournament Spotlight on Retinal Detachment

basketball eye injuries 8:49 PM

Echenique wearing protective glasses. The
yellow tint also increase contrast sensitivity!

Like so many Americans, I spent the past weekend on the couch, watching every basketball game I could devour. Imagine my surprise when I the words "retinal detachment" crossed the airways while I was indulging in an optometry-free weekend. Creighton has since been eliminated from the tournament, but for those of you who don't know, their star big man Gregory Echenique suffered a retinal detachment back in 2009. He was playing a pick-up game and was accidentally poked in the eye by a teammate. Immediately after the injury he experienced blurry vision, but he felt his vision improved over the following days. Several weeks later, the blurry vision returned and that is when the detachment was found. Since his surgical repair, Echenique has returned to the court wearing protective sports glasses to prevent further damage to his eyes.

I can't say enough how important it is to wear eye protection during sports. I know most athletes don't wear protective glasses, but especially for young children a stray finger or ball could result in reduced vision for the rest of their lives. It is so important to have a dilated eye exam if you do suffer an ocular injury. Every athlete should be told the signs and symptoms of a retinal detachment. They are

flashes of light
sudden onset floaters
dark or blurry vision, like a veil or curtain obstructing your sight

If you experience ANY of these three symptoms, you need to have your eyes examined for a retinal tear or detachment. Surgeons only have a brief window of time with some detachments to repair the tissue before it is permanently damaged. Please be careful out there!

In other news, I can't post about the Tournament without talking about the Wolfpack. I'm so excited to be in the Sweet Sixteen this year and hungry for more. Let's go Pack!

Ok, I love this picture of Richard Howell. He hardly ever smiles!

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Concussions and the Eye

anisocoria 9:36 PM

The 18 year old football player whose brain was found to have Alzheimer's type misfolded proteins in his brain after suffering multiple concussions on the field is still on my mind. See this post for the link. As an optometrist, I do see patients from time to time that have suffered concussions. Typically they are getting to my office several weeks to months later, so I am treating the more long-term side effects. There are ocular sequelae to concussions that patients and new ODs should be aware of, so here is a break down of the most common things I encounter.

Concussions aren't limited to football; they can be seen commonly in contact sports like hockey, soccer, but can even occur in activities where falls are likely, like cheerleading and gymnastics.

1) Accommodation Problems/ Difficulty Reading

Headaches and blurry vision when reading is something that patients may experience even months after their concussion. I recently saw a 16 year old that had suffered a concussion two months earlier playing soccer, and she was only starting to return to heavy duty reading. After a few minutes of near work her eyes felt tired, strained, and she complained of blurry vision. Before her concussion she had never worn glasses, and never had any problems with distance or near vision. We did a thorough near work-up, and she needed +1.00 reading glasses to reduce her reading strain. The focusing system is one of the primary functions impacted after head injuries, so definitely ask your concussion patients if they are having problems with near strain. They may need reading glasses and/or vision therapy as they continue to recover!

2) Anisocoria/ Pupil Differences

Immediately after a concussion there will definitely be pupil abnormalities, but pupil differences can persist for a short time afterwards. If one eye's pupil is a different size than the other (called anisocoria), the eye with the larger pupil will experience:

more light sensitivity
more glare with night driving/around headlights
more noted near strain on that eye

Picture depicting unequal pupil sizes. This patient's left eye will be more light sensitive, and potentially have reduced vision, especially at near. Pupil differences after a concussion will normalize with time.

Again, the pupil will continue to normalize with time. In the meantime, sunglasses or tinted lenses can definitely help reduce discomfort. Simply educating the patient about why they are experiencing these differences eases the problem. Alphagan dosed once daily may cause some mild pupillary constriction and has been used to reduce glare in patients with large pupils after LASIK, but the effect I have seen from this drop is minimal.

3) Floaters, Flashes, or Migraine Auras

Here's a case I recently had: A few months ago I saw a patient with sudden onset floaters in her right eye. She was experiencing no flashes of light and no vision change. A few floaters were seen upon dilation, but she had no retinal breaks and no signs of a posterior vitreal detachment (all medical findings that are associated with new floaters). When she came back a few weeks later for follow-up, the floaters were persisting, but again there were no ocular findings. Another month later I checked her again, and she reported improvement in the appearance of floaters (and again no ocular findings). She recalled that the day before she called in with floater complaints for the first time she had fallen in the attic and hit her head very hard. Floaters, headaches, and migraines with visual auras can definitely be associated with head injuries, but of course, so can retinal tears and detachments. The 3 signs to look for are: