Thursday, 18 September 2014

The reason we dilate pupils is so we can see inside the eye. Historically, we needed to do that so we had a good view of the retina. Since 2002, however, we use the Optomap which allows for a wide-field digital retinal image taken through a normal-sized pupil without drops. Optomap allows us to see the full extent of the retina and you get to review that with us on a flat-panel monitor so you can see what we see.  

A June 2012 American Journal of Ophthalmology report compared non-dilated ultra-widefield images and dilated diabetic 7 field (ETDRS) photos in 103 patients with varying levels of diabetic retinopathy. The two images exactly matched for clinical level of diabetic retinopathy in 84% of patients and were within one level of agreement in 91%.  Sensitivity and specificity of ultra-widefield images for detecting the presence or absence of diabetic retinopathy (DR) diagnosed on ETDRS photos were 99% and 100%.

There are cases where dilation is necessary, such as peripheral cataracts and certain retinal problems where we need a more 3-D view. Routine dilation for a vision exam is not always necessary. When we do have to dilate, the drops make the pupil bigger and freeze the focusing system. In summary, while a comprehensive eye health exam formerly required dilation, technology with ultra-wide field digital imaging has redefined the standards. Our patients benefit and appreciate this new technology.

Posted on 09/18/2014 4:01 PM by Dr. Susan Kegarise
Tuesday, 2 September 2014
Have You Been Flashed?

We always tell patients to call us immediately if they notice "flashing lights" or "floating spots" suddenly in your vision. Our primary concern is a tugging on the retina that could lead to a retinal detachment. The retina is a very thin transparent tissue supplied by blood vessels. In front of the retina is a clear fluid called the vitreous. It has an outer layer that keeps the fluid contained and is connected to the retina in a few key spots. Over time, and especially in nearsighted people, the fluid can move and tug on the retina. When this occurs, there could possibly be a retinal detachment which can be vision threatening. If you think you may have a retinal detachment, call us immediately.  

On the other hand, other flashing lights can occur. One of the most common occurs in patients with a migraine history and in fact, recently happened to my husband who is also an optometrist. This flash is called an ophthalmic migraine and typically comes on suddenly. In his case, he was working on the computer and suddenly noticed that his straight-ahead vision was blurry. Over the next few minutes the blur became a shimmering, jagged light which gradually moved from the central part of his vision toward the outside part of his vision. You can see in the attached drawings I made while the event was going on exactly what it appeared like to me at certain times of this progression. Typically after 15-30 minutes, the zigzag lines go away. Most of the time these ophthalmic migraines do not result in any side vision loss or headache. The patient may report mild tiredness after. Ophthalmic migraines are innocuous in that they do not suggest any other neurologic condition. 

So, flashing lights are a concern. We want to make sure you don't have a retinal detachment. But all flashing lights do not mean retinal problems. If you have ophthalmic migraine questions don't hesitate to e-mail me so we can discuss.

Posted on 09/02/2014 11:18 AM by Dr. Susan Kegarise
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