Category: “Other” Eye Conditions

Meaningful Memorial Day

Today, the United States celebrates Memorial Day, a day where we remember our veterans and their families who have lost their lives fighting to protect their fellow Americans.

At the same time, we want to remember all of those who have lost their lives to the pandemic and remember those on the frontline and our essential workers around the world.

Memorial Day | Don’t Say Thank You

Memorial Day became a federal holiday only in 1971, but “Decoration Day” had been celebrated since the Civil War to commemorate lives lost in the Civil War. As America became engaged in additional wars, more veterans lost their lives and Memorial Day is now celebrated on the last Monday of May.

“Have a Meaningful Day.”

While the exact origin of Memorial Day is uncertain, records show that the first “Memorial Day” was created by a group of freed slaves in Charleston, South Carolina. Federal records designate Waterloo, New York as the official birthplace of the holiday.

Veterans Day in the United States is similar to Memorial Day in that we acknowledge and celebrate our veterans of war. During Veterans Day, it is appropriate to thank our veterans for their service and sacrifice. During Memorial Day, it is appropriate to wish that a veteran have a “meaningful day” as they are likely to be remembering their fallen comrades.

3 PM local time is designated as a National Moment of Remembrance.

Coronavirus

Around the world, as the United States approaches 100,000 deaths due to coronavirus, we all pay respects to those we have lost from the pandemic. We also acknowledge and thank the bravery of our frontline workers and essential personnel who risk their health and safety to keep the rest of us safe.

Our frontline workers keep us safe from COVID-19. Our essential workers keep us safe from COVID-19 and keep our communities functioning.

In the United States alone, the number of lives lost to the coronavirus is greater than the number of lives lost during the Vietnam and Korean Wars combined (see chart).

Thank you.

Have a safe and meaningful day.

Randall V. Wong, M.D.
Retina Specialist
Virginia and Washington D.C.

Tags COVID-19, Memorial Day

“Other” Eye Conditions

Central Serous Retinopathy

Post author By Randall Wong, M.D.
Post date May 11, 2020

Central serous retinopathy, aka CSR, is a recurrent idiopathic swelling of the retina. The disease usually affects males more often than females ages 25-45. As the patient ages, the time in between episodes gets longer.

The term idiopathic means that scientists have not figured out a cause.

The arrows show the area of accumulated serous fluid.

Patients often complain of blurred vision, poor color perception, minification (objects appear smaller) and distortion. Onset of symptoms usually occurs rapidly, such as overnight.

Retinal Swelling

For reasons unknown, fluid develops underneath the layers of the retina. Symptoms are most noticeable when the macula is involved, in fact, some patients may not be aware of swelling outside of the macular area.

The disease is commonly known for its association with Type A personalities or stress. It’s difficult to say, however, how a personality type or stress causes the condition.

Use of steroids or medications containing steroids may exacerbate the condition in certain patients.

Evaluation of CSR

Fluid underneath the retina associated with central serous retinopathy can usually be easily seen during a dilated eye examination.

Use of the optical coherence tomography (OCT) and fluorescein angiography are ancillary tests that help clinch the diagnosis.

There is a characteristic “hyperopic shift” where the eye becomes more far-sighted due to the elevation of the retina.

Symptoms of Central Serous Retinopathy

All the symptoms listed above are common when the macula is involved.

The fluid causes a separation between the layers of the retina. A healthy macula normally allows us to see 20/20, read fine print and detail and gives us excellent color perception.

The serous fluid underneath the retina elevates the retina and can cause minification (objects are smaller than the other eye), poor color perception, blurriness and distortion.

Treatment

There is usually no treatment necessary for CSR patients. The disease is “self-limited.” Self-limited diseases usually cause no permanent injury. In most cases, full vision returns without treatment. Once in a while, a patient may be left with some slight blurring or distortion.

Laser treatment is reserved for those patients with a “hot-spot” identified by fluorescein angiography that is far enough away from the center of the macula so that the laser burn does not cause a blind spot. Still, laser treatment is not thought to improve eventual visual outcomes.

Photodynamic therapy (PDT) and intravitreal injections are sometimes helpful.

Randall V. Wong, M.D.
Retina Specialist
Virginia and Washington D.C.

Tags CSR, macular edema

“Other” Eye Conditions How I Practice My Opinion

What are Retinal Eye Emergencies?

Post author By Randall Wong, M.D.
Post date March 28, 2020

As suggested by the Centers for Disease Control and the American Academy of Ophthalmology, eye doctors should see only patient with urgent emergent eye conditions?

As a retina specialist, we are used to seeing patients everyday with both urgent and emergent eye conditions. Here are few common diseases we treat daily.

By the way, this article expresses my opinion and how I treat my own patients. I am not your eye doctor and if you have questions, concerns or are experiencing problems with your vision, please call your own doctor.

Diabetic Retinopathy

Most patients with diabetes will develop some degree of diabetic retinopathy in their lifetime. The disease progresses very slowly and all patients need to be seen regularly through the year, regardless of symptoms.

If patients are receiving injections or are experiencing new symptoms, your doctor should be aware during this pandemic. Many offices have closed and are not seeing patients, but the phone lines should remain open. Trips to the emergency room in this scenario are not going to be helpful.

Patients with new vision loss or distortion or who need injections should call their retina specialist.

New Floaters

The most common cause of new floaters is a posterior vitreous detachment (PVD). The most common symptoms of a PVD are new onset floaters. A PVD can cause a retinal tear, possibly leading to a retinal detachment. A retinal detachment requires surgery and can cause blindness.

While a PVD is not necessarily and emergency, a PVD with possible retinal tear can be.

Macular Degeneration

Macular degeneration causes loss of central vision with/without distortion. Patients who experience new blurry vision or distortion should be seen urgently, especially if they are already receiving injections for wet macular degeneration. The new symptoms could mean active disease and should be examined and treated promptly by your retina specialist.

Complications from Cataract Surgery

I added this for the sake of mentioning that while a retina specialist normally takes care of complications from cataract surgery, there should not be any elective cataract surgery being performed at this time, ergo, this should not be an urgent or emergent eye condition.

Retinal Detachments

Not all retinal detachments are necessarily an emergency, but can be if central vision is spared or lost recently. The goal of retinal detachment surgery is to repair the detachment before central vision can be jeopardized.

Tags Coronavirus, COVID-19

“Other” Eye Conditions Cataract Surgery Social Media and Health

Elective Surgery May Be Cancelled

Post author By Randall Wong, M.D.
Post date March 24, 2020

As the pandemic spreads, elective surgery and routine office visits are being cancelled or postponed.

How will this affect ophthalmologists, optometrists and you?

For eye doctors, the American Academy of Ophthalmology recommends that we stop office visits for “routine” eye care: as examples, routine follow ups, glasses prescription, etc.

The AAO is recommending that ophthalmologists restrict office hours to those patients with urgent and emergent conditions. An example would be sudden loss of vision, pain or retinal detachment.

Contact your own doctor to determine if you should keep a pre-existing appointment or if you are having questions or concerns about your own vision.

Surgery May be Cancelled

The American Hospital Association and the Centers for Disease Control and Prevention (CDC) have recommended elective and non-urgent surgical procedures be cancelled or postponed. As of this writing, there is no national mandate, but do check with your doctor if you are or were planning to have surgery.

What is elective surgery? Examples include hip and knee replacements, plastic surgery and, even, cataract surgery.

Not all eye surgery would be cancelled. As a retina specialist, I’ll be cancelling surgeries for epiretinal membranes and macular holes, but will need to continue emergency surgery for retinal detachments.

Preserve Healthcare Resources

Why are we restricting patient care and cancelling surgery?

The goal of limiting patient care in our offices is to reduce the chances of healthy people becoming exposed to the virus. It is an effort to protect patients, office staff and healthcare providers. It allows patients with active problems to receive care during this crisis.

The postponement of elective surgical procedures also reduces exposure of healthy individuals, but also preserves valuable and limited healthcare resources. For instance, cancellation of elective surgery preserves hospital beds and staff for those who may have significant illness and need care. As an example, our outpatient surgical center can now send our nurses and aides to the main hospital and ER where they may be needed.

Keep in mind that patients will still need chemotherapy, suffer heart attacks and strokes, sustain accidents in addition to contracting coronavirus.

Both these measures will aid in “flattening the curve.”

Tags Coronavirus, COVID-19