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Fireworks Cause Significant Eye Injuries | Randall Wong MD | Retina Specialist

Happy 4th July | Avoiding Eye Injuries

Fireworks Cause Significant Eye Injuries | Randall Wong MD | Retina Specialist4th of July means BBQs and fireworks.  It can be a fun holiday, but for thousands this year, bodily injury and eye injury will occur.

Injuries occur to both bystanders and the handlers of the celebratory explosives.   Unfortunately, fireworks are marketed as toys – implying safety, but as you read, fireworks can cause serious bodily injury and eye injury.

Here are some tips to avoid eye injuries from fireworks – for both you and your children.

Eye Injuries … Exploding

Significant and permanent damage can occur from a ruptured globe (ruptured eye), retinal detachment, chemical and thermal burns and corneal abrasions.

The American Academy of Ophthalmology reports that nearly 1300 eye injuries caused by fireworks occurred in 2014 as reported by emergency rooms.  There were barely 600 cases reported in 2012.

Spectators and Children Injured

Nearly half the injuries are sustained by spectators.  Of that, 35% are children under the age of 15.

Most eye injuries are caused by bottle rockets, firecrackers and sparklers.  The heat generated by sparklers can exceed 3000 F depending upon the fuel and oxidizer used which can cause significant burns and even ignite clothing.

The American Academy of Ophthalmology (AAO) and the American Optometric Association (AOA) recommend:

  • Discuss firework safety with your children and teens
  • Children should not be unsupervised around fireworks
  • Wear protective eyewear when handling any fireworks
  • Fireworks, matches and lighters should be stored securely away from children
  • Sparklers are dangerous – refrain from purchasing
  • View fireworks from at least 500 feet away, respect barriers
  • Report unexploded fireworks to professionals, do not touch

What to Do for a Fireworks Eye Injury

  • Call 911 or go to Emergency Room
  • Do not rub eyes or apply pressure
  • Do not rinse eyes
  • Do not remove any objects stuck in the eye

Happy fourth of July!  Celebrate responsibly and enjoy the holiday.  I wish you and your family a very safe holiday.

All the best,

Randy

Echo Voice Assistant

“Alexa, Read This” | Personal Voice Assistants Aid Low Vision Patients

amazon alexa | voice assistantThis article has been contributed by Paul Burden.  Paul’s mother suffers from wet macular degeneration.  Paul founded Our Voice after he discovered the advantages of personal voice assistants and how they can help blind or low vision patients such as his mom.  I am impressed with the variety of information and tasks a personal voice assistant, such as Amazon’s Echo, can perform.  Enjoy.  – Randy.

Personal Voice Assistants have fundamentally changed the way we use technology. A voice assistant can be especially beneficial for the blind and low vision community. It’s difficult to use and keep up with ever changing technology.

Voice Instead of Keyboard

With a voice assistant, there’s no more complicated software to learn and update; no keyboard, users simply speak. Using voice only, users can:

  • have their music played
  • get the latest headlines and weather
  • listen to their favorite radio stations and podcasts
  • have books read to them
  • do their shopping
  • manage their calendars
  • contact family and friends in case of an emergency
  • query the Internet for information
  • make and receive phone calls
  • and much more

Meet Amazon’s “Alexa”

There are several voice assistants on the market, but the Amazon Echo family of products is far and away the most widely used voice assistant with more than 70% market share.

The Echo’s voice is named Alexa.

Once the Echo is connected to your Wi-Fi, you have immediate access to a wide variety of information.  For example,

Just say, “Alexa, what are today’s headlines?”  Headlines are immediately read to you.

“Alexa, what’s the weather look like for tomorrow?” You’ll get tomorrow’s forecast, or the 10 day forecast if you like.

In addition to all the information immediately available, there are lots of Apps available as well. What you think of as an App on your smartphone or computer, is called a “skill” on the Echo. They’re the same thing.   A large number of skills are particularly useful for blind and low vision users. A few examples:

My Buddy Skill

“My Buddy” allows the user to call, text or email any number of designated “buddies” or family members.

If you find yourself in distress and need help, say: “Alexa, my buddy.” Alexa will ask: “Who do you want me to contact?” You reply, “My family.”

Your family can include as many members as you’d like.  Do you have 20 members of your family you’d like contacted?  All at once?  No problem.  The call/email/text goes out to all 20 simultaneously.

Shopping by Voice

You can shop from the comfort of your home, using your voice only. Amazon has nearly 500 million products in stock!

Down to your last roll of paper towels? Say, “Alexa, order paper towels.” Alexa will offer a few options, asking for your permission to place the order.

When you hear what you like and confirm, your order is placed. Your order will arrive in a day or two, frequently your order is delivered on the same day.

Would you like to know when your order will be delivered? Just say, “Alexa, where’s my stuff?”.  Alexa responds with the day and approximate time your order will be delivered.

“Alexa – Read This!”

Alexa will read books on your Kindle.  The books are read to the listener in Alexa’s own computer generated voice.

Amazon owns another electronic book service called Audible.  Audible works very well with the Echo family of products.  The listener can bookmark particular chapters, fast forward/rewind, pause, adjust volume and summon a different book.

Audible books are read by professional voices.  While most Echo skills are free, Audible is not.  Audible requires a monthly subscription of $14.99, allowing 2 books a month.  More books can be added.

What’s the Next Step?

While the Echo is very easy to use, it can be difficult to set up and configure. That’s where Our Voice comes in, we’re Amazon Echo experts. Our Voice is a company dedicated to making voice assistants available to everyone. Our Voice installs and configures the Echo for the specific needs of the customer. We then train the customer to use device so they get the most out of their voice assistant experience. To learn more about Our Voice, visit www.ourvoice.net or call toll free: 844-voice 13 – 844-864-2313.

Our Voice | Personal Voice Assistant ExpertsPaul Burden is the Founder of Our Voice; a company dedicated to bringing voice technology to the blind and low vision community.  Prior to Our Voice, Burden held executive positions at Microsoft, Cyveillance and XAPPmedia.  You may contact Paul at www.ourvoice.net

Asteroid Hyalosis | Common Floaters of the Vitreous

Asteroid hyalosis is a common finding of the vitreous.   As you can see in beginning of the video, the “asteroid bodies” are creamy white flecks suspended in the vitreous.

Asteroid Hyalosis is Benign

The exact cause of asteroid hyalosis is not known and does not appear to be associated with any particular systemic disease though there may be an association with aging.

 

My experience has been that asteroid hyalosis is a benign finding and not associated with either systemic or eye disease.  As you are able to see in this video, the flecks really move around as they are suspended in the vitreous.

Curiously, in most cases, patients with asteroid hyalosis are completely unaware of the condition, that is, the flecks, or asteroid bodies, do not cause any problems with vision.  Patients usually do NOT complain of floaters.

Asteroid and Floaters

I included this video really to demonstrate the appearance of asteroid hyalosis.  If you listen and watch the video, this patient has been complaining of floaters for many years.  There is no real way to determine if what he is seeing is the asteroid hyalosis or “normal” floaters.

Regardless of what the cause, the floaters had been bothering him for quite a while.  Anything which moves back and forth with eye movement has to be related to the vitreous, hence, a vitrectomy should remove the opacities, aka “floaters.”

Induce PVD

Toward the end of the video, I “induce” or cause a posterior vitreous detachment (PVD).  I inject Kenalog to help me see remaining vitreous.  Unfortunately, the Kenalog is a suspension and is the same color as the asteroid hyalosis.

Though a bit difficult to see, the posterior portion of the vitreous lifts up toward the front of the eye when the PVD is successfully created.

In conclusion, I operated on this patient who had been complaining of longstanding floaters and, as an incidental finding, had floaters (not necessarily from the asteroid).

 

Raindrop for the Treatment of Presbyopia

Raindrop Mark Whitten MD Treatment for PresbyopiaThis article is contributed by Mark Whitten, M.D.  Dr. Whitten and I have known each other for over 25 years when I was a resident assisting him in surgery.  He is a world-renowned laser vision correction specialist.

There is a new treatment for a condition called presbyopia.  Presbyopia, or near vision loss, is a natural event requiring the need for reading glasses as approach our 40s.

If you have problems reading a book, seeing a menu or need glasses to read you phone, and over the age of 40, you probably have presbyopia.

There is a new procedure to correct near vision loss!  The Raindrop Near Vision Inlay is FDA approved for the treatment of presbyopia (near vision loss).

Effective Treatment for Near Vision Loss

Many of you have likely heard of a vision correction procedure called LASIK.  I treated Tiger Woods back in 1999.

LASIK is still in vogue today and is highly effective for the correction of distance vision.

In my opinion and based upon my own experience, the Raindrop corneal inlay will have the same effect on patients with presbyopia.

Ophthalmologists and optometrists have been waiting for a correction for near vision loss.  My own patients have shown me how well this surgery can treat near vision loss.

15 Minute Procedure

A complete eye exam and medical history is necessary before the procedure to ensure that you are a good candidate and that you have realistic expectations.

We also need to confirm the diagnosis and make sure there are no signs of ocular disease which could complicate your situation.

The Raindrop inlay will be placed in your non-dominant eye (FDA mandated).  The procedure takes about 15 minutes, you are awake and there is no pain.

I have my own surgical suites within my offices in Washington, D.C., Richmond, VA and Charlotte Hall, MD.  For me, it allows me to operate very efficiently and with my own “team.”

Most of my patients start reading as soon as they get off the table!

Mark Whitten, M.D.
Washington DC
Charlotte Hall MD
Richmond VA
www.WhittenLaserEye.com

Botox Injection | Retina Specialist Fairfax Virginia

Botox Injections for Wrinkles and Lines

Botox Injection | Retina Specialist Fairfax VirginiaBotox is an injectable medicine which has both medical and cosmetic applications.  It is FDA approved for a variety of conditions, but it is most often used cosmetically for the treatment of facial wrinkles and lines.

How Does Botox Work?

Botox is called a neurotoxin.  For a muscle to contract, it must be activated or stimulated by a nerve.  Neurotoxins block this normal pathway resulting in a limp or paralyzed muscle…the muscle simply can NOT contract.

Botox is a very effective neurotoxin and is used for medical conditions such as;

  • Blepharospasm – involuntary spasm of the eyelids
  • Hemifacial Spasm – spasm of facial muscles
  • Chronic Migraine
  • Dystonia – severe neck spasms
  • Shoulder Spasms
  • Overactive Bladder
  • Others

Wrinkles and Lines

As we age, our skin becomes less elastic.  Many wrinkles and lines are caused by small muscles located underneath the skin.  When the muscles contract, wrinkles can develop in areas which move and contort, such as the face.

Paralyzing the involved muscles by injecting the toxin can smooth out these wrinkles and lines.  Botox is FDA approved for the treatment of glabellar lines, but there are other areas treated as well;

  • Glabellar Lines or Frown Lines are the creases between the eyebrows
  • Frontal Lines are horizontal lines across the forehead
  • Crow’s Feet are wrinkles at the corner of  your eyes
  • Marionette Lines are at the edges of your mouth
  • Smoker Lines are around the lips

Botox Treatment

The drug is injected into the involved muscle(s).  The treatment usually take about 10-15 minutes and are performed in the office setting.

There is usually no recovery needed.

Botox does not work immediately and will take a couple of days for initial results.  The full effects  can take up to 1-2 weeks to develop.

The effects of Botox are temporary lasting 3-6 months.  Injections need to be repeated, but no more sooner than every 3 months.  Results will vary depending upon the condition treated, severity of the condition, and in the case of wrinkles, the health of your skin.

 

 

 

What is Uveitis?

Uveitis Can Cause Redness, Blurry Vision and Sensitivity to Light | Randall Wong MD | Retina Specialist VirginiaUveitis is an internal inflammation of the eye.  Arthritis is an inflammation of our joints.  Think of uveitis (or iritis) as arthritis of the eye.

Intraocular inflammation is not a common condition, but is a condition that every eye doctor sees several times a year.  Many times, a retina specialist is referred patients with uveitis.  There are subspecialists who treat ocular inflammation, but they number far fewer compared to the number of retina specialists.

The uvea is a part of the eye consisting of 3 parts;

  • Iris – the colored portion of our eye, it forms the pupil
  • Ciliary Body – the tissue which makes the aqueous humor
  • Choroid – a deep layer of the retina

Each part may become inflamed.  More specific names are based upon the location of the inflammation or part of uvea involved, for instance;

  • Anterior Uveitis – also known as iritis, is usually referred to as inflammation of only the iris
  • Intermediate Uveitis implies inflammation of the ciliary body, with or without inflammation of the iris
  • Posterior Uveitis involves inflammation limited to the choroid, the deep layer of the retina

Symptoms of Uveitis

Symptoms can include redness, blurry vision, sensitivity to light and pain.  Symptoms vary depending upon the location of the inflammation.  For example, anterior uveitis (or iritis) usually is associated with more pain as the iris and ciliary body are quite sensitive.

There are very few nerve endings underneath the retina, hence, inflammation of the choroid is often without pain.

Complications

The cornea can become swollen leading to loss of vision and additional sensitivity to light.  Cataracts are known to occur, increased eye pressure,  hypotony (very low eye pressure) in chronic cases, retinal swelling and retinal detachment (not due to a retinal tear) are also possible.

Most cases are not too complicated and localized to the front of the eye, but complete examination is necessary to assess the extent of the inflammation and amount of damage.

Causes

Trauma is probably the most common cause of inflammation, in the form of iritis (anterior inflammation).  There are technically dozens of systemic diseases associated with uveitis, but most cases of uveitis have no known association with a disease.

Viral, fungal and bacterial infections are occasionally to blame.  Uveitis is often recurrent.

Treatment

Steroids are the preferred treatment for any inflammation and the same is true for the treatment of ocular inflammation.

Topical drops, pills and injections of steroids are all possible.   Drops are usually preferred, but in more severe cases pills and injections are necessary.

More serious conditions may require immunosuppressive medications and the efforts of several docs including a retina specialist.

Cataract Surgery Can Lengthen Your Life

Cataract Surgery

As reported by the National Bureau of Economic Research, Americans over the age of 65 are living longer and with fewer disabilities.

Cataract surgery may help you live longer.

These findings are identified in an economic research study which identified certain medical conditions which improved healthy life expectancy.  The study found that treatments for heart disease and vision (cataract surgery) improve life expectancy and quality of life.

Cataract Surgery Improves Vision and Life

It’s no surprise that cataract surgery can improve our vision thus allowing us to work longer and drive more safely.

The study cited other examples perhaps not as obvious.  Patients who had cataract surgery were compared to those who had cataracts but declined to have surgery.  The group who did have cataract surgery had fewer falls leading to a broken hip compared to the comparison group.

As was reported by the American Academy of Ophthalmology, cataract surgery was associated with a 16% decrease in hip fractures.  Moreover, those patients who had severe cataracts and had surgery were noted to have a 23% decrease in hip fractures.

Fewer Car Crashes

Other studies have noted similar findings with car crashes.  Those who have undergone cataract surgery have fewer car crashes compared to those not having cataract surgery.

In the same AAO report cited above, an Australian research group found that patients having the “first eye” surgery had 13 percent fewer car accidents.  The cost savings to the society are not insignificant.

A U.S. study found a 50% reduction in car crashes.  This study also found that as this cohort (study group) aged there was a 27% increase in accidents.  Those who never had cataract surgery experienced a 75% increase.

What Does This Mean?

The improvements in vision allow us to live safer and lengthen our ability to work.  This translates into tremendous cost savings.

There are tremendous cost savings to our society by making us healthier e.g. fewer hip fractures from falls, fewer crashes from improved vision and increasing our productive work years.

The point of the study; however, is to point out that cataracts slowly decrease your vision and most patients are unaware they have compromised sight.

Get your eyes examined regularly.

 

Do You Have Dry Eye?

 

Dry EyeIt sounds counter-intuitive, but tearing is one of the more common symptoms of dry eye.

The tearing is “reflex” tearing and occurs in response to your eye being irritated due to dryness, or getting poked in the eye.

Dry eye syndrome, also known as keratoconjunctivitis sicca, is very common and affects over 300 million people around the world.  Dry eye is probably the most common reason for a visit to the eye doctor.

Symptoms of Dry Eye

With every blink, tears are evenly spread across the surface of your eye.  Tears help fight infection and also keep your cornea hydrated, smooth and clear.

The cornea is exquisitely sensitive.  If you have ever scratched your cornea, you know how sensitive and painful your eye can become.

The cornea is also responsible for about 2/3 of the overall focusing power of your eye.  Any change to the cornea can translate into blurry vision.

Common Symptoms of Dry Eye;

  • Tearing and redness
  • Burning
  • A dry sensation
  • Blurry vision
  • Heaviness
  • Itchiness

Normal Tear Film

Your tears are actually a 3 layered film.  On the surface of your tear film is an oily layer which prevents evaporation.

The middle layer is the watery part and the bottom layer, called the mucin layer, ensures that the tears are spread evenly across the eye.

The oily layer is produced by Meibomian glands located on the edges of your lids.  The actual tears are produced by the lacrimal gland – there is one lacrimal gland for each eye.

The bottom mucous layer is produced by special cells located in the conjunctiva – the clear tissue on the outside of your eye.

Causes of Dry Eye

If you search “dry eye,” you will find dozens of causes of dry eye, but in reality there are just two basic mechanisms, either of which can be caused by any one of the “causes.”

  1. Insufficient tear production
  2. Rapid evaporation

 

January is Glaucoma Awareness Month

Glaucoma Awareness Month | Risk Factors of Glaucoma | Randall Wong, M.D.Happy New Year!  January is national Glaucoma Awareness Month.

Do you or a family member have glaucoma?

Glaucoma is a leading cause of blindness and affects over 3 million Americans and 60 million others globally.

There are many forms of glaucoma, but the most common type of glaucoma in the United States is called “open angle glaucoma.”

Risk Factors for Glaucoma

Everyone is at risk for developing glaucoma.  The disease becomes more prevalent (common) as we get older.  Family history is a huge risk factor, too.

Other risk factors for glaucoma;

  • Family History
  • Diabetes
  • African American patients have a higher chance > age 40
  • Everyone above the age of 60 – especially Latino/Hispanic patients
  • Farsighted/Asian patients

Symptoms of Glaucoma

In general, there are no immediate symptoms of glaucoma.  In other words, most patients with glaucoma do not even know they have the disease.  This is especially true of patients with open angle glaucoma.  They are completely unaware until they lose central vision.

Pain, redness, tearing and nausea/vomiting can be signs of “angle closure” glaucoma and result from sudden and large increases in the eye pressure (Intraocular Pressure – IOP).

This usually does not happen in open angle glaucoma.

How to Diagnose Glaucoma?

Talk to your family if you have glaucoma.  Early detection and treatment is vital to saving your vision.

Diagnosis of glaucoma can be made with a complete dilated eye exam.

One of the early findings of glaucoma is loss of peripheral or “side” vision.  This is true of every type of glaucoma.  Subtle loss of your visual field may be the only sign of the disease.

Here are some of the diagnostic tools your eye doctor may consider;

  • Visual field testing – looking for loss of peripheral vision
  • Optical coherence tomography (OCT) is useful for actually measuring destroyed optic nerve tissue
  • Eye pressure (Intraocular Pressure, IOP)
  • Dilated Eye Examination allows direct examination of your retina and optic nerve

If you have risk factors of glaucoma or if you are concerned, make a New Year’s resolution to get examined!  Early detection and treatment is the key to saving your sight.

All the best

Randy

Randall V. Wong, M.D. is a board certified ophthalmologist practicing in northern Virginia.  Though a retina specialist, this website contains information on various eye diseases.

 

NFL Coach Zimmer Gets Retinal Detachment | What Can We Learn?

Retinal Detachment | Jireh DesignsNFL coach of the Minnesota Vikings, Mike Zimmer, just had a retinal detachment to his right eye.

He has had several “surgeries” over the past 30 days to the same eye.  While the exact details are not known, there is a lot we can learn from his recent experience.

What we do know is;

  1.  A retinal tear was discovered and treated around October 31.
  2. A second operation was performed a week later.
  3.  Emergency surgery for a retinal detachment was performed on November 30.

Retinal Tears Cause Retinal Detachment

All retinal detachments start with a retinal tear.  It has been my experience that most retinal tears simply “happen” and without trauma.

Retinal tears can happen to anyone.  Retinal tears usually, but not always, are associated with sudden onset flashes and floaters, but they can be asymptomatic.

This may have happened with Coach Zimmer.  Several accounts stated that his retinal tear was discovered after he scratched his cornea.

No, corneal abrasions can not cause retinal tears.

Treatment of Retinal Tears

The ideal treatment of a retinal tear is laser.  If laser is not an option, due to the location of the retinal tear, cryotherapy, or freezing, is an excellent treatment.

Both work equally well in treating retinal tears in situations where there is no element of retinal detachment.  Cryotherapy may be more uncomfortable.

I do not know if the second surgery was needed because additional tears were discovered or he developed a retinal detachment.

What is important to highlight is that additional retinal tears can occur and/or a retinal detachment could develop after treatment of an initial tear.

Treatment of Retinal Detachments

There are several ways to treat a retinal detachment.  Depending upon the location of the retinal tear causing the detachment, intraocular gas may be injected into the eye which requires specific head positioning afterwards to keep the gas pushing on the retinal tear.  This is an “in office” procedure.

Two other ways to fix a retinal detachment include a vitrectomy and/or scleral buckle.  These may be used along with intraocular gas, too.

Regardless of the procedure, if intraocular gas is used to repair the retinal detachment, airplane flight or traveling to higher elevations is not possible.

Too rapid a decrease in atmospheric pressure can lead to expansion of the gas inside the eye.  If this occurs too rapidly, the eye can not adjust to the increase in eye pressure caused by the expanding gas.  The high pressure could prevent normal blood flow into the eye.

This explains a few remarks about his driving to Florida for the game against the Jaguars.  No remarks about head positioning.

“Emergency Surgery”

Not all retinal detachment surgery is an emergency.  A retinal detachment starts off small and can spread.  If the macula, the functional center of the retina is attached, but may become detached by waiting, it can be an emergency.

I wish Coach Zimmer well.  I wanted to highlight his retinal detachment to emphasize a few points about retinal detachments in keeping with the headlines.

 

 

 

Randall V. Wong, M.D.

offices

Currently, I see patients with retinal diseases; macular degeneration, retinal detachment, macular holes, macular pucker within several different practices.....it's a different arrangement, but it allows more continuous care with many eye specialists. In addition, I am very accessible via the web. To schedule your own appointment, call any of the numbers below.

Virginia Lasik | Office of Anh Nguyen, M.D.
Randall V. Wong, M.D.
Contact: Layla

A: 431 Park Avenue, Suite 103 • Falls Church, Virginia 22046
Ph: 703.534. 4393
F:703.992.8158
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Dressler Ophthalmology Associates, PLC
Randall V. Wong, M.D.
Contact: Ashley (Surgery/Web)
Chrissy Megargee (Web)

A: 3930 Pender Drive, Suite 10 • Fairfax, Virginia 22030
Ph: 703.273.2398
F: 703.273.0239
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