Baltimore Washington Eye Center, Maryland

Tuesday, February 28, 2012

Baltimore Patient’s Vision-Good or Poor?

At Baltimore Washington Eye Center we sometimes hear from a patient's family, "If you say my mother's vision is good, how come she complains she can't see?" commented Baltimore Ophthalmologist Arturo Betancourt, M.D. Visual loss is devastating at any time of our lives.  In the elderly more so, with decreased physical and sensory perception, eyesight becomes all important.  It is their connection to the world.  As we age we might develop cataracts, glaucoma or macular degeneration.  Any one of these or in combination will decrease vision. Cataracts will affect your vision by slowly decreasing your ability to drive and read.  Think of it as a dirty window.  The dirtier, the harder it is to see out.  

Macular degeneration will slowly or rapidly affect your central vision.  This will cause problems reading with fine vision.  It might also cause a ring like area of poor vision, making reading or recognizing people difficult.  Glaucoma will cause a loss of peripheral vision.  As it continues to advance it will affect central vision, ultimately causing blindness if not treated.  Imagine a patient with advanced macular degeneration affecting his central vision and advanced glaucoma affecting his peripheral vision!  These are conditions that are easily diagnosed during a routine eye exam.  Some have successful treatments, others not so.

According to Lylas Mogk, M.D. Director of Vision and Rehabilitation and research at the Henry Ford Health System, that in addition to the aging changes the eyes experience you might have systemic conditions which affect your vision.  Neurological conditions such as Parkinson's and Alzheimer's can affect vision. They do so by causing deteriorations at the nerve level, in the eye the retina is nerve tissue.  Deficits in memory, understanding and balance can all be exacerbated by, and confused with, visual loss.  

In order to diagnose these, in addition to a full eye exam, you might have to perform other tests, such as OCT, visual fields, contrast sensitivity, and glare testing.  Additionally a physical exam and a referral to a neurologist might be indicated.

So what can we do to enhance remaining vision? Maximize contrast, such as a dark object against a light background. Optimize lighting, the use of light directed on the task.  Gooseneck lamps are good for this. Some have built in magnifiers. Minimize glare, with the use of vertical blinds, yellow window filters, and positioning furniture so that the person does not face the light source.

Do you know someone this posting could help?

Guest Blogger: Arturo E. Betancourt M.D., F.A.C.S., Ophthalmologist with the Baltimore Washington Eye Center

Tuesday, February 21, 2012

Crizal Optifog

Pretty nifty new technology for your glasses. Check out this link: Optifog

If you like what you see, keep Optifog in mind when you come in for your next eye exam.

Standard lens versus Crizal Optifog

Baltimore Cataract Surgery-Am I Ready?

By the time you are asking me this question, you already suspect the answer.  You have probably already noticed a rapid or slow deterioration of vision.  It might have been night driving, problems reading road signs, reading, watching television. Glare, even when using sunglasses, keeps you indoors.  You slowly or rapidly curtail your activities, you stop going out at night, reading your favorite books or newspaper. You compromise to this problem by stopping the activities that provided you with quality of life.  You slowly give in, not admitting you have a problem.  But your life as you wanted it, is not the same.  It is very hard to admit that we stop doing the things we most enjoy, because we are "getting old".

You come in for your routine eye exam, and when questioned if you have any visual problems which curtail your activities, you might answer "no".  But when asked why you don't perform certain activities, you realize that you have stopped because you can't see well enough, to perform them.  If your decreased visual function is due to cataracts, they are part of the normal aging process.  You might be offered cataract surgery.  To most this comes as a shock! "Me? Cataracts? But I have no problems!" Of course you simply stopped doing what you were visually not comfortable doing.

The indication for cataract surgery is when your vision can no longer be corrected with visual aids to fulfill your visual requirements.  Of course, this is a personal subjective measure.  Our visual requirements change with age, profession and activities.  We no longer wait until the cataract is ripe or you are blind from the cataract.

I will discuss the result of your exam, the options, the type of surgery, the best type of intraocular lens for you and the benefits and risks.  We will also discuss the pre and post op instructions and what you can expect.

Are you ready for surgery? Visit for more information.

Guest Blogger: Arturo E. Betancourt MD, F.A.C.S., Ophthalmologist with the Baltimore Washington Eye Center

Thursday, February 16, 2012

About Bulging Eyes

Bulging Eyes is the familiar description of the eye conditions known as Exophthalmos or Proptosis. Besides possibly being a bit odd looking, bulging eye conditions can also cause a number of problems such as not being able to completely close your eyes during sleep or even during normal blinking which can lead to dry eye symptoms, discomfort and ultimately damage the eye’s surface as a result of scarring. Sometimes eye bulging can restrict or interfere with normal eye movements. We need to be able to properly diagnose the difference between eyes that are simply “prominent” as compared to eyes that actually “bulging”. In instances of true bulging eyes we need to carefully determine the cause so that we can offer an appropriate treatment as necessary. Causes of bulging eyes can include Graves Disease that results in hyperthyroidism and too much thyroid hormone, inflammation of the tissue around the eye and inside the bony orbit of the eye called Cellulitis, certain tumors behind, inside or around the eye, hemorrhages behind the eye and injury to the eye.

If you or someone you know suffers from bulging eyes please feel free to schedule an examination at Baltimore Washington Eye Center at 800-495-3937.

Tuesday, February 14, 2012

Test for Macular Degeneration

Age related macular degeneration (AMD) is a disease of the retina that can severely and permanently damage vision. This disease falls into two major categories “dry” or non-exudative AMD where the seeing cells of the retina are damaged and atrophy  and “wet” or exudative AMD where new fragile blood vessels grown under the retina causing bleeding, swelling and scarring. The exudative form of the disease, while less common, is significantly more visually devastating. Happily new injectable therapies have been developed to treat this form of the disease. As with any therapy though, they are most effective if used early on. It has always been a challenge to determine when the non-exudative form of the disease converts to the exudative form of the disease. Pinpointing this change in order to intervene early on with aggressive treatments aimed at preserving vision is one of our goals. In the past we have used the Amsler Grid, an in office and take home screening test to watch for visual changes that might indicate a progression of the disease has occurred.

A new device, available in office and home versions, called the Forsee PHP has been proven to be very sensitive in detecting the change from non-exudative to exudative AMD. The test uses hyperacuity, which is our ability to detect exceptionally small misalignments of objects, to find elevations on the retina that correlate very highly with progression of AMD.

Guest Blogger: Shari E. Strier, O.D., Optometrist with the Baltimore Washington Eye Center

Saturday, February 11, 2012

Pediatric Eye Problems Can Have Lasting Effects

While intuitively it makes sense that eye problems early in life would affect people into adulthood, an article in the journal Pediatrics describes these effects in detail. Check out the following:

Click on the "Full Text (PDF)" on the right side of the page.

Thursday, February 9, 2012

Gilenya™, Multiple Sclerosis & Eye Exams

Late in 2010, the FDA approved Gilenya™ (fingolimod), the first oral medication available for the treatment of multiple sclerosis (MS).  MS is an autoimmune disorder that affects the central nervous system, occurs most commonly in women between the 20-40 years of age. Symptoms are the result of damage to the brain, spinal cord, or optic nerves; specifically the myelin sheath, which is the outer covering of the body’s nerves. MS is called “auto” immune because a person’s own immune system attacks the myelin sheath, resulting in inflammation and subsequent nerve malfunction/damage.

Typically, a person with MS experiences periods of no disease symptoms (remission), punctuated by acute episodes involving varying symptoms depending on what nerve(s) or part of the brain is being affected. Symptoms can include: numbness, tingling, muscle weakness, blurred vision, loss of vision, double vision, pain with eye movement, difficulty chewing and/or swallowing, dizziness, loss of balance, difficulty walking or talking, and urinary incontinence.

In MS, the body’s own white blood cells cause the nerve damage, Gilenya™ works by preventing white blood cells (WBC)  from exiting lymph nodes. The drug does this by inhibiting the chemical key WBC’s need to unlock the lymph node door. Because the WBC remain “locked” in the lymph nodes, they are unable to attack the myelin sheath and patients remain free from symptoms.

Studies show that Gilenya™ taken once daily significantly reduces MS attacks. However, it has serious side effects, with possible heart, lung, and eye toxicity and an increased risk of infection. Side effects include: elevated liver enzymes, macular edema (causes blurred and decreased vision), hypertension, shortness of breath, bronchitis, diarrhea, headaches, coughing and bradycardia.  Since bradycardia means a “slowing of the heart rate” and is seen only upon first treatment, the FDA panel recommended that patients be required to receive their first dose under medical supervision.

The risk of retinal macular edema (swelling) is higher in MS patients who also have diabetes or have a history of uveitis, which is inflammation inside the eyeball. It is recommended that all patients who are prescribed Gilenya™ undergo a thorough eye exam prior to beginning treatment, and again in 3-4 months after starting the medication.  This is because the retinal swelling associated with Gilenya™ usually occurs during the first 3-4 months of treatment.

Tuesday, February 7, 2012

About Your Eye Health Risk & Smoking

Smoking can have a great effect on your eyes-especially in terms of your risk of Cataracts and Age Related Macular Degeneration (AMD). Avoiding smoking, or quitting, is one of the best investments you can make in your long-term eye health. Smoking-even in your teens or twenties when your senior years seem far away-increases your future risks for Cataracts and Age Related Macular Degeneration (AMD). The more a person smokes, the greater the risks. In general if you quit smoking the risks of these eye diseases decreases to approximately the same level as if you never smoked at all. Keep on mind that smoking also increases your risk of cardiovascular disease which also can affect your eyes. Besides the vascular problems mentioned smoking and even being around smokers and their second hand smoke increase the likelihood of dry eye. Learn more about eye health and smoking at Baltimore Washington Eye Center at 800-495-3937.

Thursday, February 2, 2012

Age Related Macular Degeneration Awareness Month

Age Related Macular Degeneration (AMD) is the leading cause of visual impairment and blindness in Americans older than 50, affecting more than two million people. Although AMD is incurable, there are new treatments that can at a minimum prevent further vision loss from the disease and in many cases actually help recover lost vision,” commented Baltimore Ophthalmologist Brad Spagnolo, M.D.

AMD causes central vision to blur, but leaves peripheral vision intact. It is progressive and painless. There are two types of ARMD: Dry and Wet. Approximately 90 percent of people with AMD have the dry form which results in gradual vision loss. Although only 10 percent of people with ARMD have the wet form, it generally progresses much quicker than the dry form. Wet AMD is characterized by the growth of abnormal retinal blood vessels that leak blood or fluid, causing rapid and severe central vision loss.

Patients can often reduce the risk of developing ARMD by not smoking as well as working to eat a heart-healthy diet rich in fish, fruit and green leafy vegetables,
avoiding foods with trans fats, exercising, controlling blood pressure and weight.  
“We are fortunate to be able to offer Anti-Vascular Endothelial Growth Factor (VEGF) drugs that inhibit the development of unwanted blood vessels that cause wet ARMD as these agents are effective in helping to prevent further visual loss and even improve vision, said Dr. Spagnolo.

Patients older than 50 are encouraged to have a comprehensive, dilated eye examination every one to two years to ensure that ARMD is detected and treated early. The key to successful treatment is early detection and intervention. If you or someone you know is at risk for AMD please have the call Baltimore Washington Eye Center at 800-495-3937 to schedule and eye exam.