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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.

 

 

 

Happy Thanksgivine 2016

Happy Thanksgiving 2016

Happy Thanksgivine 2016Happy Thanksgiving – wherever you might be. I wish the best to you and your family during this Thanksgiving holiday.  Thanksgiving is celebrated 11/24 in the U.S.

Amy and I are looking forward to all the family that can convene at our house on Thursday.  As of August we became “empty nesters” with the younger two leaving; one to college and the other to play juniors hockey.

Not all the kids will be able to make it home.  We are still getting used to the empty house and it will be tough not to have everyone together, but we understand it’s a necessary evil of having them grow up.

Frying Turkey and Eating Well

As has become a tradition, we are frying a turkey. Here’s a video of how I fried a turkey, 2015. We gave up the oven roasted version a few years ago. That particular Thanksgiving we had several turkeys. No one touched the oven roasted and the fried were devoured. Message was received.

A few years ago, I wrote entitled Eat Right…See Good!: Eye Nutrients and the Thanksgiving Repast. There are just a few tidbits of information which might become useful if the conversation gets a little dry when you are eating on Thursday. It’s a lighter view of dissecting what we are eating and how it might affect your eyes.

My Apology for Laziness

I apologize in the long delay and inconsistency of my posts. I’m in the midst of trying to consistently post on RetinaEyeDoctor.com (here), YouTube and a podcast. It has taken a lot more time than I had initially thought.

At the same time, I am expanding our subject matter from retinal diseases of the eye to all of general ophthalmology. Similar subject matter will posted across the different platforms. The idea is to provide patient education across what ever type of platform you prefer;

  1. Reading a website/blog article
  2. Watching and listening to a video
  3. Listening to a podcast

Please Share, Subscribe, Download

I have an ambitious goal of reaching 100k readers per month.  This will take some work on my end, but by expanding the content, I should be able to keep this informative, relevant and interesting.

To help me in this endeavor, please share articles, videos or podcasts which may be of interest to your friends and family.

Subscribing would be appreciated!

Happy Thanksgiving!

 

 

 

Cataract Surgery after a Vitrectomy

This article is contributed by Alaina Kronenberg MD, a cataract specialist in Dearborn, Michigan. I asked her to write this article to better explain cataract surgery after a vitrectomy. I hope you enjoy the article.

Randy

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Vitrectomy

A vitrectomy is an operation when a retinal specialist cleans out the jelly in the back of the eye (the vitreous). This is may need to be performed if you have a retinal detachment, bleeding into the vitreous and to sometimes obtain better access to the retina so your surgeon can fix many various problems on the retina.

Cataract DevelopmentCataract Surgery After a Vitrectomy

If you need to have a vitrectomy, it is very likely that the surgery will cause you to develop a cataract. A cataract is when the natural lens inside the eye becomes cloudy. The cataract can sometimes develop fairly quickly after your retinal surgery.

If the cataract develops to the point that it interferes with your day to day vision, your comprehensive ophthalmologist may recommend that it is removed. The purpose of the cataract surgery is to improve your vision as much as possible.

If you have the start of a cataract before your require a vitrectomy surgery, often your comprehensive ophthalmologist and retinal surgeon may agree to remove the cataract before your retinal surgery. This is often recommended because it is safer to remove a cataract before retinal surgery.

Cataract Surgery After a Vitrectomy

Cataract surgery after a vitrectomy has a higher risk of a complication. The vitreous usually supports the capsule of the cataract. If the vitreous has been removed, it is often more floppy with a higher risk of being damaged during cataract surgery. Also, sometimes the capsule that surrounds the cataract was damaged during the vitrectomy. There is a higher chance you will need more that one surgery to completely get out the cataract if you had a prior vitrectomy.

Expectations

Patients who have had cataract surgery after a vitrectomy need to have realistic expectations on the improvement in vision they may experience. If you have had a prior vitrectomy you also may not be a good candidate for some of the premium implants that help correct both distance and near vision.

Alaina Kronenberg, M.D.
Cataract Specialist
Comprehensive Ophthalmologist
Dearborn, Michigan 48126

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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