"My Child Passed The School Screening, Do They Still Need An Eye Exam?"

My patients with children will often ask this question. While school screenings serve a great purpose to pick up potential vision problems with kids, they’re not a substitute for a comprehensive eye health examination. I have many pediatric patients who passed school screenings with undiagnosed visual conditions. I also have many pediatric patients who fail their school screenings, and still wind up having perfect vision at their eye health examination. Most parents that I see have vision plans, where their children are covered under their insurance for routine eye examinations. If you have any questions about your insurance, feel free to contact our staff. They can look up and verify whether your child is eligible for an eye examination. Vision screenings can easily miss eye conditions such as astigmatism, amblyopia, hyperopia, and strabismus. These screenings usually do not check the health of the eyes for any conditions with the retina, cornea, lens, and iris. The doctors at Professional Vision examine children every day. If you’ve been waiting on making sure that your child has excellent vision, and healthy eyes, please give us a call ! Have a great day!

Dr. Stuart Spind

Age-Related Macular Degeneration Genetic Testing

AMD Genetic Testing

AMD, or Age-related macular degeneration, is predominantly an inherited disease. Macula Risk is a prognostic DNA test that identifies individuals who have inherited any of the disease-causing genes. These individuals are at increased risk of vision loss as they age.

Macula Risk is a laboratory developed test (LDT) to assess the risk of AMD progression from early or intermediate AMD to advanced AMD, a common eye disorder of the elderly that can lead to blindness.

Macula Risk identifies individuals (1 in every 5 patients) that are at highest risk of vision loss due to AMD. Identifying these patients early allows the eye-care professional to implement a disease management strategy focused on sight preservation.

Increased risk (Macula Risk^® Level 3, 4 and 5) patients may benefit from:

• Increased frequency of eye examinations
• Disease education and possibly ‘at-home’ Amsler Grid or Home PHP testing
• Preventative eye vitamin therapy and possibly nutritional supplements
• Early diagnosis and treatment of wet AMD with effective therapies

Why Get Tested

The consequences of untreated neovascular AMD is blindness. Studies show that patients presenting to retinal specialists with vision loss associated with neovascular disease have a poor outcome, with only 50% achieving a meaningful improvement in vision. In contrast, those that present prior to vision loss do much better, with 80% having sustained functional vision. Unfortunately, over 80% of patients are seen too late and the functional improvement after treatment of the affected eye is minimal. The identification of individuals at risk is the responsibility of primary eye care professionals, a group that cares for and manages the vast majority of patients with visual problems.

The Macula Risk genetic test incorporates all the known genetic predictors of AMD progression and is a powerful way of identifying which individuals who present with drusen will progress to neovascularization. The test stratifies individuals into 5 risk groups as follows:

Those individuals with a Macula Risk score of 1 (MR1) are predicted to have a below average risk of progressing, while those with a MR5 score have over 70% risk of progressive disease. About 20% of the population is predicted to have an elevated risk of AMD progression, as shown by the red bars.

In conjunction with a team of retinal specialists, a co-management protocol for patients with dry AMD presenting to a primary eye care professional has been developed. The emphasis is on appropriate schedules of surveillance by an optometrist or general ophthalmologist with ultimate timely referral to a dedicated retinal specialist when specific intervention is required. This approach utilizes the broad network of community based primary eye doctors and targeted referrals creating a cost effective community-based system of care.

We recommend Macula Risk testing for the following patients, based on presenting AREDS AMD score:

Genetic testing is recommended for all patients except those with AREDS stage 1 disease, who are under 50 years of age and who do not have a family history of AMD. Management of patients after genetic testing is at the discretion of the ordering doctor but we recommend the following protocol:

Primary Eye Care Management: Patient Stratification by Macula Risk Score, AREDS Stage, and Age

 

The intensity of monitoring varies according to the genetic risk of the individual. For those over 60 years of age with AREDS 3 AMD and a low genetic risk score (MR1), the recommended follow-up frequency is every 8-12 months. For this same group at high genetic risk (MR5), optometric review should occur every 4-6 months with regular fundal photographs, OCT scans, home PHP and review by a retinal specialist. It is estimated that 20% patients will need to be enrolled into a program of enhanced care. This protocol emphasizes the importance of optometry and general ophthalmology in primary care and monitoring and details a program of concurrent care with community based retinal specialists.

Office-based continuing education and administrative support is available for all members and can be coordinated through the American Optometric Association offices at 1 (800) 365-2219.

About AMD

Introduction

Age-related macular degeneration (AMD) is the leading cause of severe vision loss among older adults in the Western world, affecting over 25 million people in the USA alone, primarily the elderly. The worldwide incidence of the disease grows from 1 in 10 people over the age of 60 to more than 1 in 4 people over the age of 75. There are close to 2 million with vision loss due to advanced AMD and more than 600,000 that are legally blind due to the disease in North America. According to the AMD Alliance, macular degeneration is more common than Parkinson’s disease, Alzheimer’s disease, Breast Cancer and Prostate cancer combined.

Age-related macular degeneration is a disease that damages the macula, the central portion of the area at the back of the eye called the retina. The macula allows for central vision and also lets you see color and fine detail—all of which are important to daily activities such as reading and driving. The macular damage caused by AMD causes central vision loss. In most cases, patients will retain peripheral vision and be able to see shapes, light and movement.

 

Image courtesy of the NEI.

Symptoms of AMD

Symptoms of Age-related macular degeneration (AMD) can include:

• A spot or hazy section blocking the center of someone`s vision
• Distortion or waviness when looking at an image
• Distortion of lines on the Amsler Grid

Changes in vision should trigger immediate evaluation from an eye doctor. For patients over the age of 50 with a family history of AMD or smokers - routine yearly eye exams are a must. Detection of the early signs of AMD is essential to help preserve as much of their vision as possible.

The majority of people with AMD have central scotomas. Scotomas are retinal areas with reduced light sensitivity compared to sensitivity results of normal sighted subjects. Scotomas are specified by the retinal location in that central scotomas are retinal areas with reduced light sensitivity involving the fovea, while paracentral scotomas are retinal areas with reduced light sensitivity within the central 20° of the visual field but not involving the fovea.

Kinds of Age-related macular degeneration

There are 2 kinds of age-related macular degeneration (AMD): dry and wet. Dry AMD is more common, representing approximately 90% of all AMD cases, and is generally not as damaging to vision as the wet form. Dry AMD can convert into wet AMD at any time.

AMD is also classified into different categories:

Category 1:

Few small (< 63 micrometers [µm]) or no drusen

Category 2:

Early AMD, having many small drusen or a few intermediate-sized (≥ 63 µm and <125 dd="" drusen.="" m="">

Category 3:

Extensive intermediate drusen or at least one large (≥125 µm) drusen.

Category 4:

Advanced AMD in 1 eye, either Geographic Atrophy (GA) in the center or neovascular AMD

Dry AMD

In dry AMD, yellowish, fatty deposits called drusen collect in the macula. Serious vision loss is rarely caused by dry AMD; however as many as 20% of Dry AMD patients will progress to wet AMD. There are no approved treatments for dry AMD, although vitamins, antioxidants and zinc supplements may slow its progression. Most dry AMD patients have no symptoms, and an eye doctor may need to conduct a variety of eye exams to aid in diagnosis.

Genetic risk for AMD may predict the therapeutic benefit of vitamins and nutritional supplements. A longitudinal Dutch study has determined that individuals with the CFH and ARMS2 risk alleles benefit from diets rich in nutrients known to slow the progression of AMD while progression in those without genetic risk factors appears to be independent of diet.

Wet AMD

Wet AMD occurs when abnormal blood vessels grow under the retinal center. These may be very fragile and leak blood and fluid. This process can damage the macula or create a retinal scar.

Due to the rapid onset of macular damage, a noticeable blurring or even loss of central vision are frequently the first symptoms noted. The vision loss may be permanent because abnormal blood vessels and scar tissue are actually destroying normal retinal tissue. Once lost, these light-sensitive cells in the retina cannot be replaced.

If a person has wet AMD in one eye, there is a 35% chance of contralateral wet AMD within 5 years. The most important action to preserve vision is to establish a schedule of regular retinal re-evaluation by an eye care professional.

The Importance of Frequent Vision Testing

The best defenses against vision loss due to AMD are:

• Regular eye exams
• Awareness of its warning signs
• Ongoing vision monitoring through self-examination

With eye exams & awareness, it is important to self-monitor for signs of AMD. Early vision changes often affect only 1 eye and occur gradually over time. One simple home-based test uses the  “Amsler grid.”

The grid is placed 12 inches away at eye level in good lighting .

• Corrective lenses are worn if required. One eye is covered and vision is directed for 1 minute at the grid's center dot
• A positive test is characterized by the perception of deviation in the regularity of the pattern
• Each eye should be tested separately

A positive test must elicit prompt eye evaluation.

While a useful adjunct, regular use of the Amsler grid cannot detect nascent vision loss and is not a substitute for regular eye exams and appropriate retinal imaging.

However, since only an eye doctor can determine if you have dry or wet AMD, Amsler grid self-examinations do not replace regular eye exams.

Eye Movements Reveal Reading Impairments in Schizophrenia

A study of eye movements in schizophrenia patients provides new evidence of impaired reading fluency in individuals with the mental illness.

The findings, by researchers at McGill University in Montreal, could open avenues to earlier detection and intervention for people with the illness.

While schizophrenia patients are known to have abnormalities in language and in eye movements, until recently reading ability was believed to be unaffected. That is because most previous studies examined reading in schizophrenia using single-word reading tests, the McGill researchers conclude. Such tests aren't sensitive to problems in reading fluency, which is affected by the context in which words appear and by eye movements that shift attention from one word to the next.

The McGill study, led by Ph.D. candidate Veronica Whitford and psychology professors Debra Titone and Gillian A. O'Driscoll, monitored how people move their eyes as they read simple sentences. The results, which were first published online last year, appear in the February issue of the Journal of Experimental Psychology: General.

eye movement measures provide clear and objective indicators of how hard people are working as they read. For example, when struggling with a difficult sentence, people generally make smaller eye movements, spend more time looking at each word, and spend more time re-reading words. They also have more difficulty attending to upcoming words, so they plan their eye movements less efficiently.

The McGill study, which involved 20 schizophrenia outpatients and 16 non-psychiatric participants, showed that reading patterns in people with schizophrenia differed in several important ways from healthy participants matched for gender, age, and family social status. People with schizophrenia read more slowly, generated smaller eye movements, spent more time processing individual words, and spent more time re-reading. In addition, people with schizophrenia were less efficient at processing upcoming words to facilitate reading.

The researchers evaluated factors that could contribute to the problems in reading fluency among the schizophrenia outpatients -- specifically, their ability to parse words into sound components and their ability to skillfully control eye movements in non-reading contexts. Both factors were found to contribute to the reading deficits.

"Our findings suggest that measures of reading difficulty, combined with other information such as family history, may help detect people in the early stages of schizophrenia -- and thereby enable earlier intervention," Whitford says.

Moreover, fluent reading is a crucial life skill, and in people with schizophrenia, there is a strong relationship between reading skill and the extent to which they can function independently, the researchers note. "Improving reading through intervention in people with schizophrenia may be important to improving their ability to function in society," Titone adds.


Article republished from http://www.sciencedaily.com/releases/2013/02/130219121451.htm

Vitreous Detachment

What is vitreous detachment?

Most of the eye's interior is filled with vitreous, a gel-like substance that helps the eye maintain a round shape. There are millions of fine fibers intertwined within the vitreous that are attached to the surface of the retina, the eye's light-sensitive tissue. As we age, the vitreous slowly shrinks, and these fine fibers pull on the retinal surface. Usually the fibers break, allowing the vitreous to separate and shrink from the retina. This is avitreous detachment.
In most cases, a vitreous detachment, also known as a posterior vitreous detachment, is not sight-threatening and requires no treatment.

Risk Factors

Who is at risk for vitreous detachment?

A vitreous detachment is a common condition that usually affects people over age 50, and is very common after age 80. People who are nearsighted are also at increased risk. Those who have a vitreous detachment in one eye are likely to have one in the other, although it may not happen until years later.

Symptoms and Detection

What are the symptoms of vitreous detachment?

As the vitreous shrinks, it becomes somewhat stringy, and the strands can cast tiny shadows on the retina that you may notice as floaters, which appear as little "cobwebs" or specks that seem to float about in your field of vision. If you try to look at these shadows they appear to quickly dart out of the way.
One symptom of a vitreous detachment is a small but sudden increase in the number of new floaters. This increase in floaters may be accompanied by flashes of light (lightning streaks) in your peripheral, or side, vision. In most cases, either you will not notice a vitreous detachment, or you will find it merely annoying because of the increase in floaters.

How is vitreous detachment detected?

The only way to diagnose the cause of the problem is by a comprehensive dilated eye examination. If the vitreous detachment has led to a macular hole or detached retina, early treatment can help prevent loss of vision.

Treatment

How does vitreous detachment affect vision?

Although a vitreous detachment does not threaten sight, once in a while some of the vitreous fibers pull so hard on the retina that they create amacular hole to or lead to a retinal detachment. Both of these conditions are sight-threatening and should be treated immediately.
If left untreated, a macular hole or detached retina can lead to permanent vision loss in the affected eye. Those who experience a sudden increase in floaters or an increase in flashes of light in peripheral vision should have an eye care professional examine their eyes as soon as possible.

Who is likely to develop Dry Eye?

Who is likely to develop Dry Eye?

Elderly people frequently experience dryness of the eyes, but Dry Eye can occur at any age. Nearly five million Americans 50 years of age and older are estimated to have Dry Eye. Of these, more than three million are women and more than one and a half million are men. Tens of millions more have less severe symptoms. Dry Eye is more common after menopause. Women who experience menopause prematurely are more likely to have eye surface damage from Dry Eye.

Treatment
How is Dry Eye treated?

Depending on the causes of Dry Eye, your doctor may use various approaches to relieve the symptoms.

Dry Eye can be managed as an ongoing condition. The first priority is to determine if a disease is the underlying cause of the Dry Eye (such as Sjögren's syndrome or lacrimal and meibomian gland dysfunction). If it is, then the underlying disease needs to be treated.

Cyclosporine, an anti-inflammatory medication, is the only prescription drug available to treat Dry Eye. It decreases corneal damage, increases basic tear production, and reduces symptoms of Dry Eye. It may take three to six months of twice-a-day dosages for the medication to work. In some cases of severe Dry Eye, short term use of corticosteroid eye drops that decrease inflammation is required.

If Dry Eye results from taking a medication, your doctor may recommend switching to a medication that does not cause the Dry Eye side effect.

If contact lens wear is the problem, your eye care practitioner may recommend another type of lens or reducing the number of hours you wear your lenses. In the case of severe Dry Eye, your eye care professional may advise you not to wear contact lenses at all.

Another option is to plug the drainage holes, small circular openings at the inner corners of the eyelids where tears drain from the eye into the nose. Lacrimal plugs, also called punctal plugs, can be inserted painlessly by an eye care professional. The patient usually does not feel them. These plugs are made of silicone or collagen, are reversible, and are a temporary measure. In severe cases, permanent plugs may be considered.

In some cases, a simple surgery, called punctal cautery, is recommended to permanently close the drainage holes. The procedure helps keep the limited volume of tears on the eye for a longer period of time.

In some patients with Dry Eye, supplements or dietary sources (such as tuna fish) of omega-3 fatty acids (especially DHA and EPA) may decrease symptoms of irritation. The use and dosage of nutritional supplements and vitamins should be discussed with your primary medical doctor.

What can I do to help myself? 

Use artificial tears, gels, gel inserts, and ointments - available over the counter - as the first line of therapy. They offer temporary relief and provide an important replacement of naturally produced tears in patients with aqueous tear deficiency. Avoid artificial tears with preservatives if you need to apply them more than four times a day or preparations with chemicals that cause blood vessels to constrict.
Wearing glasses or sunglasses that fit close to the face (wrap around shades) or that have side shields can help slow tear evaporation from the eye surfaces. Indoors, an air cleaner to filter dust and other particles helps prevent Dry Eyes. A humidifier also may help by adding moisture to the air.
Avoid dry conditions and allow your eyes to rest when performing activities that require you to use your eyes for long periods of time. Instill lubricating eye drops while performing these tasks.


Article republished from: http://www.nei.nih.gov/health/dryeye/dryeye.asp

Conjunctivitis: Do antibiotics help?

In more than half of all people who have conjunctivitis, the infection goes away without treatment within a week. Antibiotic eye drops or ointment can speed up recovery. Adverse effects are very rare.

Conjunctivitis makes people’s eyes red and inflamed. It often affects both eyes because the infection can easily spread from one eye to the other. Your eyes get watery and produce a yellowish-white discharge that makes your eyelids stick together. They may become very sore too. Conjunctivitis is contagious but often gets better within a week, even without any treatment. So it is often enough to simply wait.

Conjunctivitis is usually caused by bacteria or viruses.  Because conjunctivitis usually goes away so quickly, though, it is generally not worth doing tests to find out if it is a bacterial or viral infection. Doctors often prescribe antibiotics just in case, in the form of eye drops or ointments. Antibiotics only work against bacteria, though, and not against viruses, so they are not always effective.

Some people use non-antibiotic eye drops. The use of cold or warm compresses is common too. But there is not enough research on these approaches to be able to say whether they have a benefit, no effect, or are possibly even harmful. Sometimes conjunctivitis is linked to an allergy. Then it is treated with allergy medicines like antihistamines.

Research on antibiotics in the treatment of conjunctivitis

Two groups of researchers from the Cochrane Collaboration (an international network of researchers) and from various universities in England, the Netherlands and Australia analyzed the results of trials on the treatment of conjunctivitis with antibiotics. They wanted to find out whether antibiotics help in the treatment of ordinary conjunctivitis, as well as which possible disadvantages they have.

The researchers only analyzed the results of studies that compared at least two groups of people. One group of people used antibiotic eye drops or ointments. The other group used non-antibiotic eye drops or ointments, or did not have any treatment at first. The researchers were only interested in studies in which the participants were randomly assigned to one of the treatment groups. This kind of study, called a randomized controlled trial, delivers the most reliable results. Read our information "Evidence-based medicine" to find out more about how good-quality trials are carried out.

The researchers found 12 trials, involving a total of about 4,000 people with conjunctivitis. Both children and adults participated in the trials.

Antibiotics can speed up recovery

Overall, the analysis of the trial results showed that conjunctivitis goes away somewhat faster if antibiotics are used. This is what was found for people who went to see their family doctor because they had conjunctivitis:

• The infection cleared up within one week in 71 out of 100 people who did not use antibiotics.
• The infection cleared up within that same amount of time in 80 out of 100 people who used antibiotics.

In other words, antibiotics were found to speed up recovery in 9 out of 100 people.

In studies that were carried out in a specialist practice, it took a little longer for the infection to clear up – both in the people who used antibiotics and in those who did not use antibiotics. One possible explanation for this is that people who go to see a specialist doctor probably have more severe cases of conjunctivitis. But the antibiotics had a similar beneficial effect to that found in the family doctor trials.

None of the trials reported that antibiotics had adverse effects. The trials did not look into whether antibiotics helped lower the risk of the infection spreading.

Recognizing signs of complications and avoiding the spread of infection

As already mentioned, conjunctivitis usually goes away without treatment. But some symptoms could be signs of more serious problems. These symptoms include worsening vision, increased sensitivity to light, the feeling that you have something in your eye, and a severe headache together with nausea. It is important to see a doctor if you have any of these symptoms.

In people who wear contact lenses, the infection can spread to the cornea (the clear surface of the eye itself). Inflammation of the cornea, also known as keratitis, is not common though: it is estimated that conjunctivitis leads to keratitis in about 3 out of every 10,000 contact lens wearers. In the trials that the researchers included in their analysis, none of the participants developed keratitis.

If conjunctivitis is caused by viruses it can be highly contagious and hard to get rid of. But there are several things that can be done to try to stop viral infections from spreading. Because the virus is easily spread through finger contact, it is important to avoid touching your eyes with your hands, and to wash your hands if you do accidentally touch your eyes. It is also a good idea to have your own towels and washcloths, and not to share them with other people. Another important way to protect others from infection is by not shaking hands with them and not touching their face.

Original Article found at http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0005040/

Published by the Institute for Quality and Efficiency in Health Care (IQWiG)Next planned update:
October 2015. You can find out more about how our health information is updated in our text "Informed Health Online: How our information is produced".

References

• IQWiG health information is based on research in the international literature. We identify the most scientifically reliable knowledge currently available, particularly what are known as “systematic reviews”. These summarize and analyze the results of scientific research on the benefits and harms of treatments and other health care interventions. This helps medical professionals and people who are affected by the medical condition to weigh up the pros and cons. You can read more about systematic reviews and why these can provide the most trustworthy evidence about the state of knowledge in our information "Evidence-based medicine". We also have our health information reviewed to ensure medical and scientific accuracy.
• Jefferis J, Perera R, Everitt H, van Weert H, Rietveld R, Glasziou P et al. Acute infective conjunctivitis in primary care: who needs antibiotics? An individual patient data meta-analysis. Br J Gen Pract 2011; 61(590): e542-548. [Full text]
• Sheikh A, Hurwitz B, van Schayck CP, McLean S, Nurmatov U. Antibiotics versus placebo for acute bacterial conjunctivitis. Cochrane Database Syst Rev 2012; (9): CD001211. [Summary]

Corneal Refractive Therapy (CRT): Frequently Asked Questions

Dr. Stuart Spind in Glen Burnie, MD is certified to prescribe Paragon CRT.  His careful selection process permits more than 90% of his patients undergoing CRT to leave with their initial therapeutic lenses on their first day rather than needing to to order them. CRT Brand Contact Lenses are FDA approved therapeutic contact lenses used to gently reshape the cornea while you sleep to correct nearsightedness (myopia). Most commonly referred to as “Corneal Reshaping or Orthokeratology”, CRT offers a safe, non-invasive, non-surgical procedure that temporarily corrects nearsightedness and mild amounts of astigmatism.

  Corneal Refractive Therapy (CRT): Frequently Asked Questions

 Why should I choose Dr. Stuart Spind for CRT?

Dr. Stuart Spind uses state-of-the-art technology to measure the change in corneal curvature, along with the change in nearsightedness. Finally, Dr. Spind carefully selects his patients undergoing this procedure, maximizing the likelihood of success. An honest assessment is the first step for obtaining desired treatment outcomes, and that's what Dr. Stuart Spind is known for.

Is there an minimum age requirement for CRT?

There is no lower age limit on the FDA approval for CRT, which makes this treatment available for carefully selected children.  The scientific literature supports contact lens treatment for some children as young as eight years of age.  Any child undergoing CRT must have the aptitude and responsibility to adhere to proper lens care and hygiene, and this requires a careful and honest assessment by both the parents and Dr. Spind.

How much does CRT cost?

CRT is very affordable and the cost includes all progress visits 3 months from the initial prescribing visit, training on contact lens handling and care, and the initial pair of CRT lenses.

Is CRT risky?

No. The FDA has validated the safety and efficacy of CRT. But like all forms of contact lens treatment, eye irritation is possible.  Most cases are minor and resolve on their own if CRT wear is stopped and there is appropriate professional care. Still, there are rare and isolated reports of serious eye infection with overnight corneal reshaping where improper lens care and hygiene were suspected. Dr. Spind's patients receive a complete review of the benefits, risks, and alternatives during their consultation so that it is possible for you to make an educated decision to undergo CRT.

Can I set up a flexible spending account (FSA) for CRT?

Yes, provided that you have access to an FSA through your employer.  An FSA allows you to allocate pre-tax dollars toward qualified healthcare expenses including CRT.

Does CRT prevent myopia for getting worse?

Currently there is no definite proof that CRT prevents or slows myopia progression.  In fact the FDA approval for CRT does not permit the manufacturer from making such a claim.  However there is mounting evidence suggesting that CRT indeed can reduce the natural rate of childhood myopic progression.  Dr. Stuart Spind has provided information about this in an article on myopia control.

How do I find out if I'm a candidate for CRT?

Call Dr. Stuart Spind at (410) 766-1683 and schedule an eye examination.  During your exam, Dr. Spind will provide a complimentary CRT consultation!