For some people, it ‘snows’ every day

by Dr. Ryo on January 27, 2012

In my most recent post I wrote about “seeing stars”— not those in the night sky, but rather the “stars” (actually called phosphenes) we see if we press on or rub our closed eyes (not recommended!), those that astronauts see in space with their closed eyes (probably the result of being hit by cosmic rays), those reported by prisoners locked in dark cells (a phenomenon called “Prisoner’s Cinema”) and, of course, the “stars” that boxers report seeing when they are knocked out.

In this post we’re going to talk a little bit about “snow”—not the kind that we shovel or ski on, but the kind that some people report seeing all the time, in any season.

People with the condition called ‘visual snow’ report seeing small, moving dots—comparable to television static—in their field of vision. This snow or static is always there, but can be worse in the dark. The cause of the condition is not yet understood, and there do not appear any successful treatments available, which makes it a confounding condition for both physicians and patients.

by xJason.Rogersx

“Although the vision is affected,” says one sufferer, “very few people have had irregular eye test results. Most come back within normal range, leading doctors to believe that patients may be making their symptoms up. CT scans and MRIs also tend to come back normal, again stumping doctors.”

Indeed, frustration about how difficult it is to get the condition diagnosed and treated seems to be one of its hallmarks—there are quite a few videos posted on the Web in which patients tell sometimes heart-wrenching stories about inconclusive tests and skeptical physicians.

You can see for yourself what living with visual snow is like by visiting this simulator, which allows you to change the background, as well as the density and flicker rate of the “snow.” The simulator makes it clear how troubling this condition must be.

The patient I quoted above is so determined to understand the cause of her disease, and to find a treatment for it, that she started a foundation dedicated in part to doing just that. On the foundation’s site is information about a study of visual snow being conducted under the auspices of The University California, San Francisco Headache Center. The study’s lead physicians are looking for people with the condition to participate in 30-minute phone interviews to help them better understand the condition.

 

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Remember when you were in grade school and your teacher told the whole class to “put your heads down and close your eyes?” You were probably bored by the forced rest, and you may have discovered that rubbing your closed eyes could produce some very interesting visual effects, including flashing lights resembling stars. Did you know there’s a scientific name for that? These often amazing, colorful patterns are called phosphenes.

I got to thinking about seeing “stars” and other related phenomena, when I saw a Tweet from the folks at the fun website OMGFacts. The Tweet said simply: “Astronauts can see stars with their eyes closed!” It turns out, according to the site, that NASA astronauts often report seeing frequent flashes of light during space travel even when their eyes are shut.

NASA scientists attribute what must a rather unsettling experience to cosmic rays, which travel unimpeded through space but are largely stopped by our atmosphere. They are small enough, the researchers tell us, to pass through space travelers’ eyelids. What happens next—what specifically causes the flashes—is not fully understood. It may be that the cosmic rays cause the eye’s vitreous humor to produce light, or perhaps the flashes are caused by a direct impact of the rays on the retina.

Now imagine being incarcerated alone in a pitch-black cell for months or years (not a pleasant prospect, I know, but please bear with me). You would think you wouldn’t “see” anything at all during that time, right? But that doesn’t seem to be the case. Like those astronauts, according to this source and others, “prisoners who are put in solitary confinement, with zero light, report seeing a ‘light show’ of sorts, appearing out of the darkness. While most find it difficult to describe its form, some have reported the ‘cinema’ lights forming human figures.” The “cinema” effect may be related to the psychological effects of prolonged duration in low or no-light situations. And, yes, this visual phenomenon is known in the literature as “Prisoner’s Cinema.”

And we’d certainly be remiss if we didn’t touch on the classic example of “seeing stars”—which is how boxers have long described what happens when they get knocked out. The phosphenes they see as the hit the canvas may result from the pressure of the boxing glove to the eye, or changes in blood pressure in the brain due to the impact.

A few words of caution on this topic:

  • Never apply pressure to your eyes or rub them unnecessarily. You could hurt yourself!
  • Please avoid getting locked up in a dark jail cell. That’s not healthy either.
  • Try not to get knocked out. If you are a boxer, be sure you use the right protective equipment (not to mention the right amount of ducking and weaving).
  • And very important: Seeing flashes, “stars” or anything else unusual can indicate a serious condition. Don’t ignore symptoms like that—have them checked out!

Bottom line: If you want to see stars, take a walk on a nice clear night and look up. (And if you want to see an artistic interpretation of what phosphenes look like, watch this video.

 

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Until April of this year, Stephanie Handler, a 42-year-old California resident, had no reason to believe that she would ever be fighting to save her vision.

Although she was in good health (she says having a cold was the sickest she had ever been) she had not been to an eye specialist in almost 15 years. But in April, she saw one soon after noticing blurring in her left eye. The diagnosis was immediate and unequivocal: she had glaucoma.

Her reaction? “Shock. Tears. Waves of nausea.”

I’m sharing Stephanie’s story with you now because January is National Glaucoma Awareness Month—a great opportunity for us to focus our attention on what truly can be a devastating disease.

According to the Glaucoma Research Foundation, the disease is the leading cause of preventable blindness in the world. The foundation estimates that more than four million Americans and nearly 70 million people worldwide have glaucoma—and almost half of them have no idea their vision is under attack.

Stephanie was one of those people. At the time of her diagnosis she learned she had been living with glaucoma for at least ten years. She had noticed no changes in her vision over the course of that decade. That’s not unusual: Because we unconsciously accommodate for slowly failing vision, as much as 40 percent of it can be destroyed before we notice it.

Glaucoma is caused by a buildup of intraocular pressure (IOP) that affects the optic nerve, which transmits visual information to the brain. Although Stephanie thought wearing non-prescription eyeglasses as a fashion accessory or getting too much sun might have caused her condition, her doctors told her nothing she had done was at its root: the cause is most likely hereditary.

IOP is measured using millimeters of mercury (mm HG). A healthy eye has an IOP of 10-21 mmHg. Because the IOP is Stephanie’s left eye at her time of diagnosis was a very unhealthy and dangerous 56 mm Hg, medical intervention was immediate. Stephanie’s ophthalmologist is treating her condition with eye drops and has told her that if it worsens, surgery may be necessary to help stem further vision loss.

I’m sure Stephanie regrets not having regular comprehensive eye exams over the ten years that preceded her diagnosis. Those exams most likely would have picked up her disease and resulted in earlier, potentially vision-saving, intervention.

“I will never neglect my eyes ever again,” says Stephanie, who now works with the Glaucoma Research Foundation to raise awareness of the disease and funding for research that hopefully will someday find a cure for the disease.

As Stephanie’s story makes clear, glaucoma can happen to anyone, at any time. And once it takes your vision, it is gone forever. You can see how profoundly it can affect vision by using this glaucoma simulator developed by Eye Care America, the foundation of the American Academy of Ophthalmology.

Please make comprehensive eye exams a routine part of your preventive health regimen. Don’t allow the “silent thief of sight” to sneak up on you!

Stephanie tells her story in this video.

 

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As we begin 2012, I hope you will join me in resolving to do whatever we can to keep our eyes—and those of the people we love—safe and healthy all year. To get us started looking forward to the year ahead, I thought I’d take a quick look back at some of what we covered here in 2011.

One of the most frequent topics on this blog last year was children’s eye health. In fact, the year’s first post discussed the “Know the Glow” campaign, an awareness initiative organized by The Vision Center at the Children’s Hospital of Los Angeles. The “glow” is one that appears in one or both eyes of kids in flash photographs that is often the first indication of a serious eye disease.

We focused primarily on children in several sports-related posts. If you are a regular reader of this blog, you know that more than 90 percent of sports-related eye injuries can be prevented with the right eye protection—a statistic we all should keep in mind. This year we looked at how important that protection in a post timed to coincide with the spring sports season, in a summer-themed post and in the story of Mike Delaney, who became a sports-eye-protection advocate after losing the vision in one eye after being hit by a softball.

Technology was another frequent topic on the blog in 2011. Our technology-related posts included a look at computer vision syndrome, reports on vision-related apps (here and here) and a remembrance of Steve Jobs, a technology visionary whose company’s products reflected his commitment to accessibility.

I am not a veterinary ophthalmologist, but in looking back at last year’s posts, I wonder if I might have missed my calling! That’s because we used this blog to learn about the amazing eyes of several animal species including scallops, barreleye fish and whales, sharks, eagles and even flies.

We also met some amazing humans—historical and fictional. We used “True Grit” hero Rooster Cogburn as the peg for a blog at Civil War-era eye care, wondered if we’ll see Sam Foster (of Foster Grant fame) selling sunglasses on HBO’s “Boardwalk Empire,” questioned if Ben Franklin really invented bifocals (apparently he did), checked in on Woodstock-era activist Wavy Gravy, who is now fighting blindness in the developing world and met champion triathlete (and Seattle resident) Aaron Scheidies, who happens to be blind.

Interestingly, the most popular post on this blog last year was not about eye disease, the mechanisms of human or animal vision, technology or bigger-than-life personalities. It was about, of all things, love songs! Yes, this post, a roundup of songs with “eye” or “eyes” in the title that we published just before Valentine’s Day, appears to be our winner. Go figure! (I may just have to come up with a follow-up list in February for all you “eye-tunes” fans!)

It was my great pleasure and privilege last year to share more than 50 posts with you here (not to mention hundreds of Tweets!). I’m sure this year we’ll cover many important topics related to eye health, meet some more very interesting people (and probably a few animals, birds or insects) and also have some fun along the way.

Thanks for spending time with me here, and best wishes for a safe and healthy 2012!

 

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Rand Paul is one of the newest members of the U.S. Senate. He is, of course, the son of Rep. Ron Paul. And like his father, who practiced obstetrics and gynecology, he is a physician – an ophthalmologist. He graduated from Duke University School of Medicine and began practicing medicine in Kentucky in 1993, specializing in cataract and glaucoma surgeries, LASIK procedures, and corneal transplants. But, at least for the time being, he’s traded crafting new corneas for crafting domestic and foreign policy.

Rand Paul’s careers as an ophthalmologist and a politician got me thinking about other ophthalmologists who ventured into different areas. It turns out that Dr. Paul has some distinguished company in this area. Here are few examples:

  • José Rizal, who lived from 1861 to 1896, is a renowned in his native Philippines as a hero and martyr. His execution by the Spanish for his advocacy of reform was a cause of the Philippine Revolution, which ended Spanish rule there. He was an astounding intellect and conversant in more than ten languages. In addition to helping foster his country’s liberation, Rizal also worked as a sculptor, painter, educator, farmer, historian, playwright, journalist and ophthalmologist. He began his ophthalmology studies after learning that his mother was going blind, eventually operating on her. It is truly amazing what this man accomplished in his too-short 35-year life.
  • If you scanned the AM radio band anywhere in the U.S. during the last several decades, chances are very good that you came across “The Dr. Dean Edell” radio program. At the peak of its run, which lasted from 1979 until last year, the program was featured in more than 200 U.S. markets and on XM satellite radio. Edell used his show to provide advice on many health topics and, although he didn’t focus solely on eye health and vision, he was certainly qualified to do so, having completed an ophthalmology residency at the University of California, San Diego after earning his MD at Cornell before embarking on his successful radio career.
  • Howard Schatz was a prominent San Francisco retina specialist when he began taking pictures. “I love medicine,” he told the New York Times. “I was a serious academician and physician, and I didn’t want to give any of that up. So I decided to spend just Saturdays on photography. My colleagues were playing golf anyway, so what the heck?” Fast-forward a few years and Schatz is now one of the world’s most sought-after and successful photographers. His photos are exhibited in museums and galleries around the world and have been published prominent magazines that include Time, Sports Illustrated, Vogue,The New York Times Magazine, and The New Yorker. And his success as a still photographer has led him into other creative endeavors. For example, since 2001 he’s been interviewing and directing actors, including Sissy Spacek and Ben Kingsley, in one-on-one improvisations for a book project and a regular feature for Vanity Fair. In this clip, Schatz discusses how he approached a photo shoot of six boxers for Showtime.

  • In 1976, Jack Rootman began the Orbit Clinic as a joint endeavor with the University of British Columbia and the Vancouver Hospital & Health Sciences Centre in Vancouver, British Columbia, Canada. Since then, he has built the clinic into a first-class facility for the diagnosis and management of orbital disorders and ocular melanomas.  A professor in the Department of Ophthalmology and Visual Sciences at the University of British Columbia, Dr. Rootman is a prolific speaker at universities and ophthalmology meetings and has authored more than 130 journal papers and several textbooks. He is also a well-known artist, whose work exemplifies the interplay of light and color in nature. Dr. Rootman has participated in dozens of solo and group exhibitions throughout Canada and internationally, and has taken courses at the Emily Carr Institute of Art and Design in Vancouver, the National Academy of Design in New York and The New York Academy of Art. Click here to view some of his original paintings – you may even find one to add to your own art collection.

  • Richard Raskind was born in 1934 into a family of physicians: his father was an orthopedic surgeon, his mother a psychiatrist. Raskind went to Yale, where he was the captain of the tennis team, and then studied medicine at the University of Rochester. He went on to serve in the U.S. Navy and then practiced eye surgery. In 1975, Raskind underwent successful gender reassignment surgery and became Renee Richards. The controversy over whether Richards should be allowed to play professional tennis as a woman without having to submit to gender testing made her world famous. She won that battle and played professionally from 1977 to 1981, at one point ranking 20th in the world. She would go on to coach Martina Navratilova to two Wimbledon championships. Vanessa Redgrave portrayed Richards in a 1986 television movie about her life called Second Serve, and this year a documentary about her life, Renee, was released. You can watch the trailer for the new documentary here.

That’s a very interesting line-up of “moonlighting” ophthalmologists, isn’t it?

 

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A common question those of us in vision care hear from patients is “what’s the difference between ophthalmologists, optometrists and opticians?” I can understand the confusion, since the three words are so similar, but the differences between the three professions are important, and easy to understand.

  • Ophthalmologists are specialists in medical and surgical eye problems. Becoming an ophthalmologist requires eight years of study beyond college; during that time we are trained to provide the full spectrum of eye care, from prescribing glasses and contact lenses to complex and delicate eye surgery. Many ophthalmologists are also involved in scientific research into the causes of eye diseases and vision problems and developing treatments, as I am with my work at Acucela. This video, titled “I Am Ophthalmologist,” produced by the American Academy of Ophthalmology, does a great job of communicating the passion I see in so many of my colleagues.
  • Optometrists are licensed medical professionals trained to prescribe and fit lenses to improve vision and diagnose and treat various eye diseases. Earning a Doctor of Optometry degree requires completing a four-year program at an accredited school of optometry. Most U.S. states allow optometrists to treat eye diseases through topical therapeutic agents and oral drugs, and to perform certain types of laser surgery.
  • Opticians are trained to fill prescriptions for eye correction. Opticians do not perform medical tests; rather, they interpret prescriptions written by ophthalmologists or optometrists and work with patients to determine which eyeglasses or contact lenses best meet their needs. Unlike optometrists and ophthalmologists, opticians do not require a license and cannot conduct eye exams or treat patients. Opticians may hold an associate opticianry degree or may have apprenticed for a required number of hours.

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If someone asked us to quickly name a few of the risks inherent in space travel, what would we come up with? Running out of oxygen might be one, collisions with asteroids or “space junk” another. A few of us might express concern about encounters with unfriendly aliens.

But chances are pretty good that we wouldn’t mention blurry vision.

The results of a recent NASA-sponsored study found that space flights of six months or longer can blur the vision of astronauts, and that the symptoms often last long after they return to earth. The results are important, given that the agency has its eyes set on someday getting a crew to Mars and back safely—a voyage that would take three years.

The seven astronauts studied were all about 50 years old and had spent at least six continuous months in space. All of them said their vision had become blurry during their mission and that it did not improve for several months afterwards.

Examinations showed that all of the astronauts studied had experienced one or more of the following changes:

  • Flattening of the back of the eyeball
  • Folds in the choroid, the vascular tissue behind the retina
  • Excess fluid around and presumed swelling of the optic nerve

The researchers hypothesize the changes may have resulted from fluid shifts toward the head that occur during extended time in microgravity, and they are now trying to determine why some astronauts are less affected than others.

Good vision will be a prerequisite for a successful Mars mission, so I’m confident the agency will find ways of protecting the eyes of its astronauts. And, by the way, as you can see in this video, NASA is recruiting candidates who might just end up taking that Mars trip. Interested?

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Expectant women know their bodies will experience a great number of changes over the course of the nine months (or so) leading up to the big day. Weight gain is to be expected, of course, as are perhaps sleeping issues and even changes in the sense of smell.

Pregnancy can also affect a woman’s vision. In most cases, the changes are temporary and not do not result in permanent or severe difficulties. There are rare exceptions, such as the case I wrote about few weeks ago of a New Jersey mother who is recovering from the detached retinas she suffered as a side effect of her pregnancy.

Here are a few things to be aware of:

  • Corneal changes – Your cornea might change shape or swell slightly during pregnancy. This could prevent your contact lenses from fitting and working correctly, and result in blurred vision. If this occurs your physician may advise you to make a temporary switch back to glasses. And, of course, it’s probably best to wait until after you give birth to get a new prescription for contact lenses or glasses.
  • Dry eyes – The hormonal-related changes that accompany pregnancy can also result in dry eyes. This can create the sensation that there is a piece of sand in your eye and may be accompanied by burning, itchiness and excessive tearing. Tell your doctor if you experience any of these symptoms—chances are he or she will recommend “artificial tears” to treat your condition, which will very likely be resolved after you give birth.
  • Diabetic retinopathy – If you have diabetes and are pregnant you may be susceptible to development of diabetic retinopathy, a condition that in some cases can result in blindness. If you already have diabetic retinopathy, it could worsen during pregnancy. Keep the lines of communication open between your obstetrician and your ophthalmologist!
  • Blind spots – You may develop blind spots called scotomata during your pregnancy. These need to be taken very seriously and reported to your physician immediately, because they could signal the onset of a dangerous condition known as preeclampsia. The good news is that they usually resolve once your baby is born.

Here is more on this important topic. Best wishes for a healthy pregnancy!

 

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Why flies always see you coming

by Dr. Ryo on November 14, 2011

Although the main focus of this blog is human vision, from time to time we take a look at how other creatures see the world. A while back we examined the amazing eyes of several sea creatures and in another post we discussed the anatomy of eagles’ eyes. So, in that tradition, I thought in this post we’d take a look at the eye of the common housefly.

One of the most compelling facts I turned up in my research is that flies’ brains are very highly evolved for processing visual information. Pest-management experts estimate that about 70 percent of a fly’s brainpower is devoted to seeing. That makes the fly essentially an airborne eye—a very cool way to think of these pesky little creatures.

Flies have “compound eyes” a term that describes eyes that comprise thousands of light-capturing structures called ommatidia. An adult housefly has about 3,000 ommatidia in each eye—the hexagonal patterns we see in close-ups of fly eyes are the outermost section of these structures. Compound eyes are particularly handy for seeing things up close, and things that are moving—attributes very important to flies and their insect brethren.

Each of the thousands of ommatidia in a fly’s eye has sensory cells that contain a photopigment that responds to specific light wavelengths. The structure ensures, as one source puts it, that “…light from any point is collected by six different ommatidia, and therefore the intensity of the image on the retina is greatly enhanced. This makes the vision of the flies much more sophisticated than that of almost any other insect.”

Of course, all flies do not see the world the same way; as one expert says, “Each fly species has different visual sensitivity that changes according to the sex of the fly, its age, its feeding status, its reproductive stage, etc.”

We’ve only just scratched the surface of a topic that I am sure is the subject of many doctoral dissertations and perhaps even entire careers, but I’ve hoped it’s help you understand why it’s so hard to swat a fly—it’s those amazing eyes that allow them to always see you coming!

 

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The day before Steve Jobs died in October, Apple, the company he co-founded, from which he was once fired and to which he returned to lead to unprecedented success, announced the latest generation of the iPhone—the iPhone 4S.

It is fitting that one of the most compelling features of the new phone is Siri, a voice-recognition application that promises to make the latest iPhone even more useful for all users, especially people with visual and other impairments.

On the Siri web site, Apple says: “Talk to Siri as you would to a person. Say something like ‘Tell my wife I’m running late.’ ‘Remind me to call the vet.’ ‘Any good burger joints around here?’ And Siri answers you. It does what you say and finds the information you need. And then it hits you. You’re actually having a conversation with your iPhone.”

That’s pretty amazing stuff. And to reinforce the potential of the application, the Siri demo video showcases a blind woman pausing while reading Braille to confirm a dinner date using Siri-enabled voice recognition.

I’ve pointed out several times on this blog (including here and here) that under Steve Jobs’ leadership Apple took great pains to ensure its products are as accessible as possible. That commitment, which is expressed very eloquently here, is making a positive impact on countless lives.

Here’s one example of that impact: Jobs’ death inspired a Wire.com writer named Tim Carmody to post a thoughtful, personal essay about how important Apple products, especially the iPod Touch, are to his four-year-old son, who has autism. In the essay, he wrote:

“It may be a stretch to say Steve Jobs invented the iPod Touch or most of the technologies contained in it. But Steve Jobs certainly put it in my son’s hands, both by making it a sub-$200 device (and in our case, giving it away free with a laptop) and by helping to create an ecosystem of software applications for people with disabilities — perhaps especially communication disabilities.”

It is still too early to know if Siri will live up to the excitement that accompanied its introduction (voice recognition software is not new, although a seamless, versatile and consistent voice-recognition interface would indeed be revolutionary). But we have reason to be confident Siri will deliver because Apple, especially in recent years, has done an excellent job delivering on its promises.

Steve Jobs will certainly be missed, but I’m confident the commitment to accessibility he instilled in his company will continue to open up the world to people with impairments – visual or otherwise.

 

 

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