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Choose safe toys this holiday season

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By Dr. Mark S. Siegel

No one chooses gifts with the intent to harm, but some popular children’s toys can cause serious eye injuries. According to the U.S. Consumer Product Safety Commission, more than 265,000 toy-related injuries were treated in emergency rooms in 2012, and almost half of these injuries affect the head or face – including the eyes. Unfortunately, most of these injuries happen to children under age 15.

Give children the appropriate protective eyewear along with their new skis, snowboards, and sleds.
Give children the appropriate protective eyewear along with their new skis, snowboards, and sleds.

‘You’ll shoot your eye out’

Some propelling toys, like air soft guns, BB guns, paintball guns and darts can be particularly hazardous, with the potential to cause serious eye injuries such as corneal abrasion, ocular hyphema (bleeding inside the eye), traumatic cataract, increased intraocular pressure and even permanent vision loss.

Another dangerous toy category is those with laser components, which have increased in power and decreased in price over the years. Lasers can be especially hazardous when used in toys that are aimed, such as a laser gun. Blue light lasers are particularly dangerous, as they are more likely to cause retinal injury compared with green or red lasers. Studies show that exposure for even fractions of a second to high-powered blue handheld laser devices can cause serious eye injuries – including macular holes – which often require surgical intervention. In addition, the FDA warns that laser pointers are not toys and should only be used with adult supervision.

The good news is that following these toy safety tips can easily prevent most eye injuries:

Top Toy Safety Tips:

  • Avoid purchasing toys with sharp, protruding or projectile parts.
  • Make sure children have appropriate supervision when playing with potentially hazardous toys or games that could cause an eye injury.
  • Ensure that laser product labels include a statement that the device complies with 21 CFR (the Code of Federal Regulations) Subchapter J.
  • Along with sports equipment, give children the appropriate protective eyewear with polycarbonate lenses. Check with your ophthalmologist to learn about protective gear recommended for your child’s sport.
  • Check labels for age recommendations and be sure to select gifts that are appropriate for a child’s age and maturity.
  • Keep toys that are made for older children away from younger children.

If your child experiences an eye injury from a toy, seek immediate medical attention.

Are you a candidate for laser cataract surgery?

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By Dr. Mark S. Siegel

The femtosecond laser technology that brought new levels of safety, accuracy and predictability to LASIK surgery is also advancing cataract surgery. In our office, we call the procedure Refractive Laser-Assisted Cataract Surgery (ReLACS), but it also is known generally as laser cataract surgery.

In laser cataract surgery, an advanced femtosecond laser replaces or assists in the use of a hand-held surgical tool for the following steps in cataract surgery:

1 The corneal incision

2 The anterior capsulotomy

3 Lens and cataract fragmentation

4 Astigmatism correction at the time of surgery

Use of a laser can improve the precision, accuracy and reproducibility of each of these steps, potentially reducing risks and improving visual outcomes of cataract surgery.

The Corneal Incision

Traditional cataract surgery is one of the most frequently performed surgeries and also one of the most safe and effective, with predictable outcomes. It is highly dependent on surgeon skill, volume and experience.

Optical coherence tomography is an imaging technology that helps your cataract surgeon to plan the location and depth of incisions made during a laser-assisted cataract surgery procedure. OCT scans offer high-resolution and even cross-sectional images, to make the cataract surgery as precise as possible.
Optical coherence tomography is an imaging technology that helps your cataract surgeon to plan the location and depth of incisions made during a laser-assisted cataract surgery procedure. OCT scans offer high-resolution and even cross-sectional images, to make the cataract surgery as precise as possible.

The first step in cataract surgery is making an incision in the cornea. In manual cataract surgery, the eye surgeon uses a hand-held metal or diamond blade to create an incision in the area where the cornea meets the sclera. This incision allows the surgeon to gain access to the interior of the eye to break up and remove the cataract, which is a clouding of the eye’s natural lens that is located right behind the pupil. Next, an intraocular lens (IOL) is inserted and implanted, to replace the cloudy natural lens.

The corneal incision is made in a special way so it will self-seal when surgery is complete, without any need for stitches.

In laser cataract surgery, the surgeon creates a precise surgical plan for the corneal incision with a sophisticated 3-D image of the eye called an OCT (optical coherence tomography). The goal is to create an incision with a specific location, depth and length in all planes, and with the OCT image and a femtosecond laser it can be performed exactly without the variable of surgeon experience or patient cooperation.

This is important not only for accuracy but also for increasing the likelihood that the incision will be self-sealing at the end of the procedure, which reduces the risk of infection.

The Capsulotomy

A very thin, clear capsule surrounds the eye’s natural lens. In cataract surgery, the front portion of the capsule is removed in a step called an anterior capsulotomy, to gain access to the cataract.

It is very important that the remainder of the lens capsule that remains intact in the eye is not damaged during cataract surgery, because it must hold the artificial lens implant in place for the rest of the patient’s life.

In traditional cataract surgery, the surgeon creates an opening in the capsule with a small needle and then uses that same needle or a forceps to tear the capsule in a circular fashion.

In laser cataract surgery, the anterior capsulotomy is performed with a femtosecond laser. Studies have shown that capsulotomies performed with a laser have greater accuracy and reproducibility.

Studies also have shown that laser capsulotomies enable better centering of the intraocular lens, and IOL positioning is a significant factor in determining final visual outcomes.

Lens and Cataract Fragmentation

After the capsulotomy, the surgeon now has access to the cataract to remove it. In traditional cataract surgery, the ultrasonic device that breaks up the cataract is inserted into the incision. During this phacoemulsification procedure, the ultrasound energy can lead to heat buildup in the incision, which sometimes can burn the incision and negatively affect the visual outcome by actually inducing astigmatism.

An incision burn also has a higher chance of leaking and sometimes needs multiple sutures to close. The smaller the incision we use, the more this issue is important to consider.

The laser, on the other hand, softens the cataract as it breaks it up. By breaking up the cataract into smaller, softer pieces, less energy should be needed to remove the cataract, so there should be less chance of burning and distorting the incision.

Laser cataract surgery may also reduce the risk of capsule breakage. After the calculation of the proper implant power, there is no step more important for visual outcome than preservation of the capsule that the natural lens sat in. This capsule is as thin as cellophane wrap and it’s important that the portion that is left inside the eye after cataract surgery is undamaged, so it can hold the IOL in the proper position for clear,
undistorted vision.

The reduced phacoemulsification energy required in laser cataract surgery may also make the procedure safer to the inner eye, which reduces the chance of certain complications, such as corneal decompensation or retinal complications.

Astigmatism Correction at the Time of Cataract Surgery

To reduce the need for prescription eyeglasses or reading glasses after cataract surgery, it is important that little or no astigmatism is present after implantation of IOLs, especially presbyopia-correcting multifocal IOLs.

Astigmatism usually is caused by the cornea being more curved in one meridian than others (in other words, it’s shaped somewhat like a football). To reduce astigmatism, small incisions can be placed in the periphery of this more curved meridian; as the incisions heal, this meridian flattens slightly to give the cornea a rounder, more symmetrical shape (like a baseball).

This procedure is called limbal relaxing incisions (LRI) or astigmatic keratotomy (AK). Surgeons can perform LRI or AK manually with a diamond blade, and it is quite effective in reducing astigmatism.

During refractive laser-assisted cataract surgery, the OCT image can be used to plan laser LRI or AK incisions in a very precise location, length and depth. This increases the accuracy of the astigmatism-reducing procedure and increased the probability of good vision without glasses after cataract surgery.

This LenSx femtosecond laser system has laser data entry at left, a joy stick control and an OCT screen at right, which offers the surgeon all-important guidance during laser-assisted cataract procedures. (Images: Alcon)
This LenSx femtosecond laser system has laser data entry at left, a joy stick control and an OCT screen at right, which offers the surgeon all-important guidance during laser-assisted cataract procedures. (Images: Alcon)

Laser Cataract Surgery Systems Currently Available

A number of medical device companies worldwide manufacture systems for performing laser cataract surgery. There are four Systems that have attained FDA approval and are currently available for laser-assisted cataract surgery performed in the United States. We use the LenSx system in our practice.

• LenSx. The LenSx system (Alcon) was the first femtosecond laser system to gain FDA approval for cataract surgery performed in the U.S. The LenSx system is approved for corneal incisions, capsulotomies and lens (cataract) fragmentation and has been used in more than 400,000 cataract refractive procedures worldwide, according to Alcon

Cost of Laser Cataract Surgery

Refractive laser-assisted cataract surgery costs more than conventional options. Medicare or private health insurance does not cover extra costs of laser cataract surgery since the laser is used to treat astigmatism or is used in conjunction with advanced technology IOLs, which is not a covered service. You will pay extra out-of-pocket per eye for a laser-assisted procedure.

Conclusion

It is important to put this new technology into proper perspective. Manual cataract surgery is very effective and successful. People who do not want to invest out-of-pocket money in laser cataract surgery can still feel confident about the manual approach.

But if you want the best possible vision, laser cataract surgery is more precise, accurate and gentle. A more accurate and precise incision, capsulotomy and astigmatic correction may help you achieve your goal of less dependence on glasses after cataract surgery.

Cataract surgeons who use lasers say that their advantages are especially evident when it comes to advanced technology, premium implants such as presbyopia-correcting multifocal IOLs and toric IOLs for astigmatism. The advantages can include better lens placement and therefore more accurate visual outcomes.

To decide if laser cataract surgery is the best choice for you, ask your cataract surgeon for more information about this exciting technology during your preoperative exam and consultation.

Avoid an eye nightmare this Halloween!

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By Dr. Mark S. Siegel

If you want your Halloween look to include cat, zombie or glow-in-the-dark eyes, or if you’d like to use lenses to change your eye color or appearance, obtain prescription costume contact lenses from an eye care professional. It’s crucial that your lenses fit properly, and your individual prescription can only be determined by an eye exam.

Skipping this step and buying lenses online or over the counter can set you up for serious eye problems, infections or even permanent vision loss.

What are costume contact lenses?

Costume contact lenses – also known as cosmetic or decorative contact lenses – are any type of contact lenses that are meant to change the appearance of your eyes. They include colored contacts, fashion lenses and lenses that can make your eyes look like vampires, animals or other characters.

Websites often advertise colored contacts as if they were cosmetics, fashion accessories or toys. With whimsical packaging and names, their targets are often teens and young adults. The truth: claims such as “one size fits all” and “no need to see an eye specialist” are misleading. Non-prescription contact lens sales are illegal.

What’s wrong with costume contact lenses? 

Contact lenses should not be thought of as fashion accessories or makeup – they are medical devices that require a prescription from an eye care professional. The eyes are one of the most delicate and important parts of the body, so what you put in and on them must be medically safe and FDA-approved.

Many people buy these lenses to use as costume accessories to enhance their Halloween costumes, and shops as well as online retailers, actively market and advertise the lenses to innocent consumers unaware of the risks. These risks include dangerous infections that can lead to permanent vision loss and even require corneal transplants. This is why many ophthalmologists see a spike in patients coming to them with these types of injuries around Halloween.

What damage can costume contact lenses cause?

Non-prescription costume contacts can cause injuries such as cuts and open sores in the cornea, the protective clear layer in front of the iris and pupil. Corneal abrasions and corneal ulcers can cause potentially blinding painful bacterial infections (keratitis). These injuries can require serious eye surgeries such as corneal transplants, and in some cases lead to permanent vision loss.

One study found that wearing costume contact lenses increased the risk for developing keratitis – a potentially blinding infection that causes a corneal ulcer– by more than 16 times, compared to people who wear regular, corrective contacts. Unfortunately, 60 percent of patients who developed keratitis from wearing non-prescription costume contact lenses in this study suffered permanent vision loss.

Novelty products, like circle lenses, are not FDA-approved. Circle lenses can be particularly harmful, because the lens covers more of the eye than regular corrective lenses, which makes it very difficult for necessary oxygen to get through to the eye.

Why are circle lenses illegal?

Unlike regular, prescription contact lenses, circle lenses cover a bigger area of the eye, extending past the iris and onto the whites of the eye so that the iris appears bigger and the wearer has a “doe-eyed,” or Anime, look. In Korea, Japan, and other Asian countries there’s a subculture that seeks to mimic the “Ulzzang” look of Anime characters (cartoon figures).

Illegally sold circle lenses bypass several crucial safeguards, such as a lens fitting and instructions on how to properly clean contact lenses. And since the industry is unregulated, the lenses may not have been cleaned or disinfected properly before sale, again raising the risk of eye infections and vision damage.

How many injuries occur each year from costume contact lenses? 

There are no comprehensive studies yet that tells us how many injuries occur each year from wearing costume contact lenses. However, we know anecdotally amongst ophthalmologists that we continue to see injuries of this type each year despite FDA regulations. In addition, a 2010 study published in Pediatrics indicated that at least 13,500 emergency room cases each year are due to contact lens injuries in children and teens.

Why are stores and online retailers selling costume contact lenses without a prescription if it’s not safe?

Although the practice has been illegal since 2005, today cosmetic contact lenses are still sold in shops and via online retailers to customers who are unaware that wearing these devices can result in serious eye injuries. Federal law classifies all contact lenses as medical devices and restricts their distribution to licensed eye care professionals. Illegal sale of contact lenses can result in civil penalties of up to $16,000 per violation. If you see contact lenses being sold by retailers not requiring a prescription, you can report the retailer to the FDA through its MedWatch program.

So if your Halloween includes costume contact lenses, please see your eye care professional to avoid an eye horror! Have a safe and happy Halloween.

September is Healthy Aging Month!

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By Dr. Mark S. Siegel

There are over 76 million baby boomers today over the age of 50 and the first of the 82.1 million Generation X-ers are turning 50 in 2015. Aging is a process that brings many changes and baby boomers, as well as gen x-ers, share an interest in staying active, vibrant, and independent as long as possible.

Traveling, biking, boating, kayaking, hiking, learning new skills and many other exciting activities become very difficult without healthy vision. Taking steps to maintain healthy vision as we age is one of the most critical things we can do to ensure our activity options remain virtually limitless. Follow these tips for healthy vision all year and enjoy healthy aging for the years to come:

#1. Get a Comprehensive Dilated Eye Exam in September

Starting at the age of 40, getting an annual dilated eye exam with an ophthalmologist is the most important step you can take – even if you have no vision problems. So take the month of September to celebrate healthy aging by calling your ophthalmologist for a comprehensive dilated eye exam. A comprehensive eye exam isn’t the same as your basic eye exam for glasses or contacts. During a comprehensive dilated eye exam your eye doctor will check for signs of cataracts, age-related macular degeneration, glaucoma and diabetic retinopathy, along with other eye conditions. Early diagnosis and treatment helps to prevent vision loss and is instrumental in enjoying life into the ages.

#2. Protect Your Eyes with Sunglasses and a Hat

We know what the sun’s UV (ultraviolet) rays do to our skin, but we often forget they also have a damaging effect on our eyes – causing cataracts and contributing to the acceleration of macular degeneration. Although sunglasses with UV protection help to protect our eyes, wearing a wide-brimmed hat while enjoying outdoor activities will provide the extra protection to keep your eyes aging healthy and supporting your active lifestyle. And don’t forget – UV rays occur throughout the year so don’t put away the shades when the temperatures drop.

#3. Reduce Eye Strain with Breaks and More Sleep

Although eye strain isn’t a vision disease or disorder, it can cause headaches, fatigue and occasionally itchy eyes – which contributes to rubbing. Eye rubbing exacerbates dry eye syndrome and ocular irritation. In order to reduce eye strain, take breaks from reading, driving, and looking at screens by focusing your eyes on something else every 20 minutes for about 20 seconds. Another step we can take to reduce eye strain is to get enough sleep. Being overtired increases eye strain while a healthy evening dose of sleep can keep our eyes ready for another active day.

#4. Stop Smoking

Studies show that smoking increases the risk of developing vision problems including macular degeneration, cataracts, glaucoma, diabetic retinopathy and dry eyes. Taking the month of September to get help in kicking the habit could be one of the most important things you could ever do to ensure healthy aging for your body and your vision.

#5. Take Advantage of Fresh Fruits and Vegetables

Choosing a diet rich in fruits and vegetables can help keep your eyes healthy and disease free. Studies suggest that the antioxidants lutein and zeaxanthin may help lower the risk of eye conditions, such as cataracts and macular degeneration that can accompany aging. Lutein and zeaxanthin are found in fruits and vegetables with yellow and orange pigments, such as corn, squash, carrots, and citrus fruits. They are also found in dark green leafy vegetables, like kale, collard greens and spinach. This September (and into the fall) take advantage of harvest time and visit one of the many farmers’ markets in the area to purchase some fresh fruits and vegetables.

#6. Enjoy Exercise to Maintain a Healthy Weight

Many eye diseases are linked to high blood pressure, diabetes and high cholesterol levels. Exercise can help keep these problems at bay or limit their impact if they do occur. Recent studies have shown that people who exercise regularly were less likely to develop serious eye disease.

Is it time for you to have cataract surgery?

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By Dr. Mark S. Siegel

A cataract diagnosis does not typically mean that surgery is required immediately. Cataracts occur as part of the body’s natural aging process and may not change vision significantly in the early stages. Small cataract-related changes may be improved with prescription glasses. But as the cataracts continue to mature over time, they may cause vision loss that can interfere with activities of daily living.

Although the prospect of cataract surgery can be intimidating, the procedure itself is the most common elective surgery among Medicare beneficiaries in the United States. Multiple studies have demonstrated that cataract surgery can lead to improved quality of life, reduced risk of falling and fewer car crashes. In addition, one study found that those who had cataract surgery had a 40 percent lower long-term mortality risk than those who did not.

The following four questions can help you determine whether or not you’re ready for cataract surgery:

Are your cataracts impacting your daily or occupational activities?

Symptoms of cataracts include dim, blurry or yellowed vision and can even cause double vision in one eye. The lack of contrast and clarity can be difficult for those who need clear vision for work, driving or for those who enjoy hobbies like reading, cooking or sewing.

Are your cataracts affecting your ability to drive safely at night?

Cataracts can cause halos around lights and difficulty seeing in low-light settings, which can impact the ability to safely drive at night. Advanced cataracts can even cause enough vision loss to fail the vision test required for a driver’s license.

Are your cataracts interfering with the outdoor activities you enjoy?

Cataracts can also increase sensitivity to glare, which can be especially troublesome for those who enjoy skiing, surfing and a number of other outdoors activities. They can also cause visual differences from one eye to the other, which can affect the distance vision required for people who play golf, tennis and similar recreational activities.

Can you manage your cataracts in other ways?

Those who decide to put off cataract surgery can make the most of their vision with a few simple tools, such as incorporating brighter lighting and contrasting colors in the home. Polarized sunglasses and a wide-brimmed hat can reduce glare, while magnifying lenses can make reading easier.

If cataracts aren’t disrupting your life, you can probably wait and have surgery when they really start to bother you. But if you feel as though cataract-related blurred or dulled vision is slowing you down, the procedure can have a significant and beneficial impact. It’s best to discuss how cataracts are affecting your life and vision with your eye doctor.

June is Cataract Awareness Month!

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By Dr. Mark S. Siegel

The American Academy of Ophthalmology has declared June as Cataract Awareness Month. Cataracts are the leading cause of treatable vision loss in the United States, and it is the leading cause of blindness in the world. There are 24 million Americans over the age of 40 who are affected by cataracts, so it seems fitting that an entire month should be dedicated to education and awareness.

In honor of Cataract Awareness Month, here are some common questions and answers about cataracts:

What is the treatment for cataracts? Even though cataracts are so prevalent, they are very successfully treated. Cataracts are a clouding of the human lens inside the eye, which prevents passage of light into the back part of the eye. The solution to cataracts is cataract surgery, which requires a surgeon to remove the deteriorated lens and replace it with an artificial lens called an intraocular lens or IOL. Over 3 million Americans undergo cataract surgery annually, making it one of the most common surgeries in the United States. In fact, the entire surgery lasts only about 20 minutes, and most people can resume normal activities after surgery fairly rapidly.

Is cataract removal safe? Cataract surgery is a twenty-minute miracle! Cataract surgery is one of the safest and most effective surgeries with a success rate well over 95 percent. Your eye surgeon will remove your clouded lens and replace it with an intraocular lens (IOL). Only a micro incision in the cornea is necessary to do this procedure, and it can be completed in about 20 minutes in an outpatient surgery center. We currently use phacoemulsification, an ultrasonic process that breaks up or emulsifies the cloudy lens and then vacuums it out. We currently have a wide variety of vision improving IOL’s that patients may choose to reduce their dependence upon eyeglasses, thereby improving their lifestyle.

Do cataracts only affect seniors? Cataracts can affect anyone! Although most people do not show symptoms of cataracts until at least the age of 40, cataracts can also affect young adults or even children. Heredity, disease, eye injury and smoking may cause cataracts to develop at an earlier age.

Can I prevent cataracts? There is no proven way to prevent age-related cataracts. However, choosing a healthy lifestyle can slow the progression of cataracts. Some ways to delay the progression of cataracts include avoiding smoking, reducing exposure to UV rays, eating healthy foods, and wearing proper eye protection to avoid eye injury.

‘Bionic eye’ is an incredible breakthrough…but not right for everyone

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By Dr. Mark S. Siegel

News stories about a ‘bionic eye transplant’ have gotten a lot of attention, but what is the reality of new technology for restoring sight to some blind patients? The Argus II Retinal Prosthesis System has sometimes been called a ‘bionic eye transplant.’ Right now it is not possible to transplant an entire human eye – only corneas and some other specific eye tissues can be transplanted. And there is no electronic replacement for the whole eye.

The Argus II is a three-part device that allows some perception of light and motion in patients who have lost their vision due to retinitis pigmentosa. Surgery is done to place a small electronic device on the patient’s retina. Later, the patient wears a camera mounted on a pair of glasses, and a portable video-processing unit. Images are taken in through the camera, processed, and then sent wirelessly to the implant in the patient’s retina. The implant stimulates the living cells in the retina, and the brain interprets these patterns as light. Over time, the patient learns to interpret the signals from the Argus II to see objects, their surroundings, and — in some cases — even read large-print text.

This is an exciting development, but the Argus II is not for everyone. It is only for patients who have no vision or almost no vision due to advanced retinitis pigmentosa (RP), a group of genetic disorders that affect the retina’s ability to respond to light. This inherited disease causes a slow loss of vision, beginning with decreased night vision and loss of peripheral (side) vision. Blindness ultimately results. Unfortunately, there is no cure for RP.

Patients must pass a careful medical screening to make sure there are no other physical reasons that they shouldn’t be given the implant. And patients should be aware that the Argus II does not restore complete, natural vision. The vision that is restored is black-and-white only, and does not include fine details.

Currently, only a handful of tertiary-care referral centers are performing the surgery. However, as more refinements are made to the Argus II and more progress is made, we may begin to see significant improvements in visual prognosis for RP and other debilitating eye disease.

Melanoma of the eye

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By Dr. Mark S. Siegel

Malignant “choroidal” melanomas arise from the blood-vessel layer “choroid” beneath the retina. In North America, 6 out of each million people will be diagnosed with a choroidal melanoma each year. Malignant choroidal melanomas can spread to other parts of the body.

Ophthalmologists can determine if you have a choroidal melanoma by performing a complete eye examination. This includes asking questions about your medical history, examining both of your eyes, looking into the eye through a dilated pupil at the tumor, performing an ultrasound examination, and specialized photography (to examine the circulation within the choroidal melanoma). HEALTH - melanomas

Your ophthalmologist will also request that you have a complete general medical check up and specific tests depending upon what they see inside your eye. Ophthalmologists can correctly diagnose an intraocular choroidal melanoma in over 96% of cases (without a biopsy). Though occasionally necessary, biopsies can be avoided because they require opening the eye (which risks letting choroidal melanoma cells out) and risk intraocular hemorrhage and infection.

Symptoms

Most patients with choroidal melanoma have no symptoms and the melanoma is found on routine eye examination. If patients have choroidal melanoma symptoms, they are usually seeing “flashes of light,” noticing “distortion” or loss of vision, and floating objects (floaters) in their vision.

1) If the choroidal melanoma is in the front of the eye (near the natural lens), it can push or tilt the natural lens causing an irregular astigmatism (blurring of vision).

2) Choroidal melanoma can leak fluid beneath the retina, making the retina detach and cause symptoms of flashing lights and floating specks.

3) If the choroidal melanoma is in the macula (center of vision), it can grow beneath the fovea making the patient far-sighted. The choroidal melanoma can also grow into and destroy the fovea causing distortion, loss of vision or changes in color perception.

It is important to note that most patients with choroidal melanoma have no symptoms at all. Their tumors are found when they visit their eye doctor for a “routine” eye examination. So everyone should have at least an annual eye examination (includingdilated ophthalmoscopy).

Other, more unusual presentations of anterior choroidal (iris) melanoma are discoloration of the iris, a brown spot on the outside of the eye, an irregularly shaped pupil and glaucoma.

Treatment

Small Choroidal Melanoma:
Patients with a small choroidal melanoma can be treated after their first visit, but since growth helps to prove that the tumor is a cancer, your doctor may suggest “observation” or watching for a small amount of choroidal melanoma growth prior to treatment. Your ophthalmologist should discuss the relative risks and potential benefits of  “observation for growth” as compared to “immediate treatment” for choroidal melanoma. Once growth is documented, your ophthalmologist will recommend definitive treatment.

Medium-sized Choroidal Melanoma:
Around the world, most patients with a medium-sized choroidal melanoma are treated with either radiation therapy or removal of the eye. Though there are several forms of eye and vision-sparing radiation therapy, ophthalmic plaque radiation therapy is the most common and widely used.

Since the results of the Collaborative Ocular Melanoma Study (COMS) suggest that plaque radiation therapy and enucleation of the eye are equally effective for the prevention of metastatic choroidal melanoma, few patients with medium-sized choroidal melanoma are treated by removal of the eye.

Because both enucleation and plaque radiation therapy for choroidal melanoma are likely to harm your vision (in that eye), you should discuss the risks and benefits of these and other treatment options in consultation with your ophthalmologist.

Large-sized Choroidal Melanoma:
A patient with a very large choroidal melanoma may be treated by removal of the eye (enucleation). This is because the amount of radiation required to destroy a choroidal melanoma that fills most of the eye may be too much for the eye
to tolerate.

However, most patients with large-sized choroidal melanoma can also be treated with eye-sparing radiation therapy. After radiation for large choroidal melanoma, these eyes are at greater risk to have poor vision, to become uncomfortable and may have to be secondarily removed.

It is important to note that as compared to like-sized malignant melanoma of the skin, patients are much more likely to survive a choroidal melanoma. This is because it is much more difficult for a choroidal melanoma to spread from (get out of) the eye to other parts of the body. However, large (choroidal melanoma) tumor size decreases the chance that vision-sparing treatments will be successful. In general, the larger the choroidal melanoma the worse the prognosis for both vision
and metastasis.

Patients often ask why they have a choroidal melanoma. Choroidal melanoma is more common among patients with blue vs. brown eyes, those with outdoor occupations and in Australia where there is an ozone hole. Therefore, it seems reasonable to assume (though unproven) that choroidal melanoma is related to sunlight (ultraviolet exposure).

Because sunlight exposure has been linked to several eye cancers and diseases of the eye, I suggest that you think of Sunglasses as Sun Block for your Eyes and start wearing your UV blocking sunglasses. They make great gifts too!

A cup of coffee a day may keep retinal degeneration away!

in Dr. Mark Siegel, MD FAAO/Health by

By Dr. Mark S. Siegel

Here’s something coffee drinkers can get excited about. Aside from java’s energy jolt, food scientists say you may reap another health benefit from a daily cup of joe: prevention of deteriorating eyesight and possible blindness from retinal degeneration due to glaucoma, age-related macular degeneration and diabetes.

Raw coffee is, on average, just 1 percent caffeine, but it contains 7 to 9 percent chlorogenic acid (CLA), a strong antioxidant that prevents retinal degeneration in mice, according to a Cornell study published in the Journal of Agricultural and Food Chemistry (December 2013).

The retina is a thin tissue layer on the inside, back wall of the eye with millions of light-sensitive cells and other nerve cells that receive and organize visual information. It is also one of the most metabolically active tissues, demanding high levels of oxygen and making it prone to oxidative stress. The lack of oxygen and production of free radicals leads to tissue damage and loss of sight.

In the study, mice eyes were treated with nitric oxide, which creates oxidative stress and free radicals, leading to retinal degeneration, but mice pretreated with CLA developed no retinal damage.

The study is “important in understanding functional foods, that is, natural foods that provide beneficial health effects,” said Chang Y. Lee, professor of food science and the study’s senior author. Lee’s lab has been working with Sang Hoon Jung, a researcher at the Functional Food Center of the Korea Institute of Science and Technology in South Korea. “Coffee is the most popular drink in the world, and we are understanding what benefit we can get from that,” Lee said.

Previous studies have shown that coffee also cuts the risk of such chronic diseases as Parkinson’s, prostate cancer, diabetes, Alzheimer’s and age-related cognitive declines.

Since scientists know that CLA and its metabolites are absorbed in the human digestive system, the next step for this research is to determine whether drinking coffee facilitates CLA to cross a membrane known as the blood-retinal barrier. If drinking coffee proves to deliver CLA directly into the retina, doctors may one day recommend an appropriate brew to prevent retinal damage. Also, if future studies further prove CLA’s efficacy, then synthetic compounds could also be developed and delivered with eye drops.

February is National AMD/Low Vision Awareness Month

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By Mark S. Siegel

AMD or Age-Related Macular degeneration is the leading cause of vision loss affecting over 15 million adults over the age of 50. To understand how AMD affects your vision, place your left hand over your left eye. Now make a fist with your right hand. Take your right fist and place it directly in front of your right eye. The only thing you should see is images in your periphery or side vision. Now imagine that this is how you are to function within the world.

AMD

Age-Related Macular degeneration can develop so slowly that it’s not until the vision is severely affected that the patient will notice. Age-Related Macular Degeneration primarily destroys the sharp central vision controlled by a spot at the back of the retina called the macula. Sharp central vision is needed to read, drive, identify faces, watch television and perform daily tasks that require straight ahead vision.

Risk Factors

The exact cause of AMD is not known. There are a number of risk factors that may play a role, some you can help control, and some you cannot. The same risks factors for heart disease and stroke also increase your risk for AMD. These include:

  • High blood pressure
  • High cholesterol
  • Obesity
  • Smoking

Risks you cannot control include age, family history, gender and race.

Symptoms

AMD symptoms include blurriness, wavy lines, or a blind spot. You may also notice visual distortions such as:

  • Straight lines or faces appearing wavy
  • Doorways seeming crooked
  • Objects appearing smaller or farther away

If you notice any of these symptoms, you should see an ophthalmologist as soon as possible. If you are diagnosed with wet AMD, it is important to see a Retina Specialist for the most appropriate care.

Living with AMD

Make the most of your Vision. Millions of people have macular degeneration and millions of them continue to do everything they always did. Because you never become completely blind with AMD, there is always sight available if you know how to use it.

The peripheral vision you have helps you to get around the house and outside. There are devices and techniques for everything from reading to cooking to watching sports on TV. You may have to stop driving at some point, but for everything else, there is a solution.

If you are losing sight, there are some simple things you can do on your own to improve your ability to see. Don’t become discouraged! You will probably need to try out multiple devices before you find one that works for you. These range from magnifiers that are held in the hand or suspended on a stand to devices that attach to your glasses or computers that help you to read.

Things you can do on your own:

  • Improve the lighting in your home and office. This may not necessarily mean that you should increase the lighting or the brightness. Glare is often a problem for people with low vision. You’ll need to experiment to see what works best for you. Special lights are available through many catalogs.
  • Use a high contrast for reading and writing. Write in large letters with a broad felt tip pen on white or light paper.
  • Use large print books, I-pads or tablets to increase the font size and contrast or try other media, like audio books. Most libraries have a section of these or you can find them online. There are also special libraries for visually impaired.
  • Use a hand held magnifier. In the beginning, you may find some help at your local drug store by trying out the various small hand-held magnifiers available. If one of them helps your vision, you should certainly use it. Other magnifying devices may be more useful if your vision is very poor.

So see your eye doctor regularly for early detection of AMD!

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