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Red Light Therapy for Macular Degeneration

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Will I lose vision from AMD?
anatomy of the eye (click on image to enlarge)

What is Red Light Therapy for AMD?

Red light therapy for dry-type age-related macular degeneration (AMD) is a new treatment authorized by the FDA in 2024 for the treatment of dry-type age related macular degeneration (AMD). It is delivered by the Valeda Light Delivery System to the eye. In the medical literature it is called photobiomodulation.

How does red light therapy work?

Red light therapy appears to work by increasing the energy available for retinal cells to function better. Specifically, the light (photons) is absorbed by cytochrome C in the mitochondria (the powerhouse) of the retinal cells. This increases the amount of ATP (energy) available for the retina to do its work.

Who is a good candidate for red light therapy?

The studies included eyes with early and intermediate dry age-related macular degeneration. These are eyes with drusen deposits under the retina without profound loss of vision. Drusen deposits are hallmark of macular degeneration; they are the earliest findings to make the diagnosis of AMD.

Who is a poor candidate for red light therapy?

Eyes with advanced loss of vision from AMD are poor candidates for red light therapy. There is no evidence that red light therapy helps this group of eyes. Also, red light therapy does not help eyes with wet AMD. These are eyes that have abnormal leaking blood vessels from AMD.

How well does red light therapy work?

Red light therapy is not a cure for dry AMD, but it does appear to offer limited improvement in vision and may reduce the risk of losing vision from dry AMD. In a small study of 80 patients, red-light treated eyes were able to see almost one line better on the eye chart compared with sham treated eyes after two years of treatment. Furthermore, eyes treated with red light therapy showed a decrease in drusen and a lower incidence of geographic atrophy (advanced AMD) compared with sham treated eyes treated for two years. These are important markers that are associated with loss of vision.

What are the adverse effects of red light therapy?

Overall, the safety of red light therapy appears good for eyes with early to intermediate dry AMD based on limited data. However, it does appear that patients with any form of wet AMD in one eye may be at higher risk of developing wet AMD in the fellow eye if it is treated with red light therapy.

Should I undergo red light therapy for dry AMD?

If you have dry age-related macular degeneration, you may be helped by red light therapy to reduce the risk of loss of central vision over time. Keep in mind that we have limited evidence on safety and efficacy at this time. We have no data beyond two years regarding the need for continued treatment, as well as the safety and effectiveness of treatment. Your doctor will help you make the important decision as to whether to start red light therapy.

By Scott E. Pautler, MD

Copyright 2026 Designs Unlimited of Florida. All Rights Reserved.

Retina Implant Restores Vision in AMD

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Can a retinal implant restore vision in dry age-related macular degeneration?

In a preliminary study, the PRIMA implant was reported to restore some useful vision to patients with advanced dry age-related macular degeneration.  It is estimated that 80% of patients with the PRIMA implant have meaningful improvement in vision at 12 months from surgery.  Meaningful improvement was defined as at least two lines of improvement on a standard eye chart (Snellen chart).  On average in this study, if a patient started with 20/320 vision, his vision with PRIMA would be about 20/100.  Thus, the improvement in vision, although significant, does not mean a return to normal vision.  Furthermore, about 13% of patients experienced no improvement with PRIMA.

How does PRIMA work?

PRIMA stands for Photovoltaic Retina Implant Microarray System.  It includes an implant that is placed under the macula (the center of the retina) in an operation.  The system is composed of glasses with a camera that converts visual images into a signal that is sent into the eye as infrared light.  The retina implant converts the infrared light into electrical signals that can be transmitted by the retina to the brain to provide vision.

What are the risks of the retina implant?

In the landmark study, 19 (50%) of 38 patients experienced at least one serious adverse event.  This included elevated eye pressure, retinal breaks, retinal detachment, bleeding, and new wet macular degeneration.  Although these complications were managed, some patients required additional surgery.        

Is the PRIMA implant available at this time?

No.  The PRIMA implant is not currently FDA approved.  Further testing is needed to prove effectiveness and safety.  The only FDA-approved treatments for advanced dry AMD include Syfovre and Izervay.  Low vision aids remain a staple in the management of vision loss.    

By Scott E Pautler, MD

Copyright  © 2025 Designs Unlimited of Florida.  All Rights Reserved.

The Risk of Infection after Eye Injections

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What is infection after an eye injection?

Infection results from the introduction of bacteria into the eye after a needle penetrates the eye wall. It is called endophthalmitis. It is a very serious complication that requires urgent evaluation and management, as it threatens loss of vision and blindness. Eye injections are given for many reasons including wet macular degeneration, diabetic retinopathy, retinal vein occlusion, and uveitis.

What are the chances of getting an infection after injection?

A common response to this question is one in several thousand. This is the risk of infection after a single injection. However, in many diseases, injections are given repeatedly over time. This is an important issue because the risk of infection in a given patient over the course of multiple injections increases to as high as one in 200. This is a much higher risk than is usually quoted.

What factors affect the risk of infection?

There are many factors that affect the risk of infection. Patient-dependent risk factors include diminished immune response. This may be due advanced age, diabetes, AIDS, or medications. Other patient-dependent factors include poor eyelid hygiene and the tendency to rub the eye after injection, potentially introducing bacteria to the eye. Wearing make-up may increase the risk of endophthalmitis, because bacteria may reside in make-up. .

What precautions can the doctor take to reduce the risk of infection?

There may things a doctor does to reduce the risk of injection. Standard practice is to use Betadine or Chlorhexidine to reduce the amount of bacteria on and around the eye at the time of injection. Additional steps that may be taken include the use of an eyelid speculum to hold the eyelids open, especially if the patient cannot hold their lids still for the injection. The need for a speculum may be reduced by the use of a shielded needle, which isolates the edge of the lid from the needle in order to reduce bacterial contamination. Additional steps that may be considered optional include the use of sterile gloves, masking the face (patient and/or physician; in order to reduce contamination from the breath), and preparation of the eyelids with a Betadine swab. The use of antibiotic eye drops is controversial. Although intuitively, antibiotics might appear to be helpful, some feel they are unnecessary, and others feel they may increase the risk of infection.

Finally, the type of medication may affect the risk of infection. For example, there is a higher risk of endophthalmitis after injection of steroids compared to antiVEGF medications.

What can a patient do?

A patient can be a partner to reduce the risk of infection. Keeping healthy (diet, exercise, and adherence to medication schedules) will help maintain a strong immune system to help prevent infection. Eyelid hygiene helps to reduce the amount of bacteria that live on the eyelids. Avoiding the use of make-up may reduce bacterial contamination. Finally, it is important to avoid touching or rubbing the eyes after injection, as this may introduce bacteria to the eye.

If you do experience pain and/or loss of vision, especially after the first day of injection, it is important to notify your doctor. Early detection of infection is critical to avoiding permanent loss of vision.

By Scott E. Pautler, MD

Copyright  © 2025 Designs Unlimited of Florida. All Rights Reserved.

Encelto for MacTel

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What is macular telangiectasia (MacTel)?

Macular telangiectasia is a disorder of the tiny blood vessels located in the center of the retina. The retina in your eye is like the film inside a camera. The retina “takes the picture” of objects you look at and sends the message to the brain. The macula is the central portion of the retina that is responsible for sharp reading vision. In MacTel the macula undergoes slow degeneration, and tiny foveal blood vessels become irregular and dilated for unknown reasons. They rarely leak blood or clear fluid in the macula.  

What is Encelto?

Encelto is a treatment for MacTel approved by the FDA in 2025.  It consists of cells programed to produce ciliary neurotrophic factor (CNTF) encapsulated in a semipermeable cylinder that is sutured inside the eye at surgery.  CNFT is a cytokine (cell signaling chemical) that is produced by cells in the eye to protect retinal cells.  

How does Encelto help treat MacTel?

By producing CNTF, Encelto slows the rate of deterioration in MacTel.  Without treatment, there is a slow loss of central vision with blind spots and distortion from MacTel.  Although Encelto does not improve the vision, it does appear to slow further loss of vision over time. 

What are the risks of Encelto treatment?

Common side effects of Encelto are usually mild and self-limited.  They include eye discomfort/pain, inflammation, redness, tearing, and blurred vision after surgery to implant the device.  Sometimes, the pupil of the eye remains smaller than normal.  This may create cosmetic concerns and sometimes causes delayed dark adaptation (23%) in the treated eye.  Serious risks of Encelto treatment are not common (5%), but important to understand and accept.  They include suture exposure (a suture is used to attach the Encelto implant inside the eye, attached to the eye wall), bleeding inside the eye, infection inside the eye, cataract, and retinal detachment.  Sometimes, additional surgery is needed.  Finally, there is no information of the use of Encelto in pregnant or breast-feeding women.         

What other treatment is available?

There is no cure, but treatment may improve vision or keep the vision from worsening in certain instances. No specific treatment may be recommended if the symptoms are mild. There is limited experience with L-serine supplements.  Medicine injections help selected patients with macular neovascularization.  Treatment usually does not return the vision to normal.  

Your doctor is going to order appropriate tests and recommend the best course of action to take at this time. Physical activity and use of your eyes will not worsen macular telangiectasia. Magnification may help with reading. The doctors at RVAF are experts in the diagnosis and treatment of MacTel.  If you have any questions, please feel free to ask.

By Scott E. Pautler, MD

Copyright  © 2025 Designs Unlimited of Florida. All Rights Reserved.

Low Vision TV Glasses

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Although low vision aids are available in a number of formats, both optical and electronic, there is a need for magnifiers to help with seeing the TV. Now there are glasses that free the hands and the focus is adjustable.

They may be of use to anyone with limited vision and no prescription is required. It is important to avoid excessive movement of the head to avoid rapid movement of the visual field, which can cause nausea similar to motion sickness. For this reason, the magnifying glasses may not be appropriate for a patient with a head tremor. They are best used while sitting quietly. These glasses fit most adults head sizes with pupillary distances ranging from 60-68mm. If your eyes are closely spaced or far apart, you may wish to have your pupillary distance measured at a local optical shot by an optician just to make sure the glasses will fit your face. Many of my patients report improvement in the ability to view their TV programs with these high-quality magnifiers. For current pricing, please click this link.

By Scott E. Pautler, MD

Note:  As an Amazon Associate we may earn a small commission from qualifying purchases.  You pay no additional fees by accessing the links provided.  These funds help defray the costs of maintaining this website.  Thank you for your support.

Castle Conolly Top Doctor 2025

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I am grateful to my peers for recommending me for inclusion in the prestigious Castle Connolly Top Doctor Listing for 2025, my tenth year on the list. I am propelled by all of my medical associates at Retina Vitreous Associates of Florida who were also included in this listing. There are many great doctors who were not listed this year and I hope to see them in the listing next year. Many thanks go to my patients who keep me on my toes and inspire me to better understand their problems and find innovative ways to help.

Scott E. Pautler, MD

Tampa, FL

Diet and Eye Health

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Will I lose vision from AMD?
anatomy of the eye (click on image to enlarge)

Does diet make a difference in eye health?

The simple answer is yes.  While more research is needed, there is abundant evidence in the medical literature showing the effects of diet on general health of the body, as well as the health of the eyes.  Specifically, a healthful diet appears to improve the outcome of patients with macular degeneration, diabetic retinopathy, glaucoma, cataract, and dry eye disease. 

What diet is recommended to improve eye health?

Diets mainly composed of vegetables, legumes, fruits, and nuts are recommended.  Among vegetables, include leafy greens.  In general, select fruits and vegetables with different colors for a variety of carotenoids (antioxidants).  Lean poultry and fish rich in omega-3 fatty acids are preferred over red meat.  For cooking, olive oil is preferred over other oils.  Consider, one serving of alcohol (preferably, red wine) per day…avoid over indulgence.  Hydration is important.  Drink plenty of water throughout the day (3-4 quarts, depending on your size).  

In general, avoid manufactured/processed foods.  These are foods that have been altered from their original form in preparation for consumption.  Examples of processed or ultra-processed foods include sweetened breakfast cereals, soda, flavored potato chips, flavored candy.  The longer the ingredient list, the greater the processing (and, generally, the less healthful).     

What other lifestyle changes offer protection against eye disease?

Over the years, mounting evidence shows that lifestyle changes are helpful to limit the risk of vision loss from age-related macular degeneration (AMD), diabetic retinopathy, glaucoma, and cataract.  For example, tobacco and nicotine exposure appear to worsen macular degeneration.  On the other hand, exercise appears to lessen the risk of vision loss from AMD.  Try to walk 20 minutes a day for starters.  Later, try to add some light weight-bearing exercises with dumbbells.  Finally, there is marginal evidence to recommend protecting your eyes from excess sunlight.  Wear a hat and sunglasses if outdoors for several hours.  Sleep is important to health.  Aim for 8 hours of sleep per night.  

By Scott E. Pautler, MD

Copyright  © 2024 Designs Unlimited of Florida.  All Rights Reserved.

Eylea HD Every 4 Weeks

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What is Eylea HD?

Eylea HD (High Dose) is an FDA-approved medication for the treatment of wet AMD and diabetic retinopathy.  It is a more concentrated form of Eylea, a medication that has been approved for use and effectively used for many years.  Regular Eylea contains 2mg of medication per injection, whereas Eylea HD has 8mg of medication per injection.  The higher dose allows for prolonged treatment effect for many patients.  Currently, Eylea HD may be used no less than every 8 weeks after a loading dose.  This has caused problems for patients who are helped by Eylea HD, but cannot sustain a treatment schedule of 8 weeks because the drug effect wears off too soon.  

What is being done to expand the treatment schedule of Eylea HD?

A new drug trial has begun in order to gain FDA approval for the use of Eylea HD every 4 weeks.  The study will accept patients who are already being treated for diabetic macular edema or wet macular degeneration.  Prior to entering the study, patients must have had at least 3 medication injections within the past 5 months.  Eylea HD injections in the study begin as early as 4 weeks from the last pre-study injection and are continued monthly for 7 shots.  At that time, the eye is evaluated to extend the treatment to a longer time interval.  The study lasts about two years (96 weeks) and all costs of treatment are covered by the sponsor.     

How can I decide if the Eylea HD study is right for me?

Your doctor will help you to decide.  The diagnosis will be confirmed and the entry criteria will be checked.  If eligible, all details will be discussed prior to entry into the study.     

By Scott E. Pautler, MD

Copyright  © 2024 Designs Unlimited of Florida.  All Rights Reserved.

The Carotid Stump Syndrome and the Eye

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Carotid Stump Syndrome
Small blood clots formed at the thrombus in the “stump” of internal carotid artery pass to the brain and eye along the path outlined by the white arrows. Image modified from Baker et al. Cureus 2022 Mar; 14(3): e22746

What is the carotid stump syndrome?

The internal carotid artery is the main artery in the neck that brings blood from the heart to the eye.  Due to hardening of the arteries, the carotid artery may become blocked.  Risk factors include high blood pressure, diabetes, high cholesterol, obesity, and tobacco use.  If the carotid artery becomes completely blocked, there is a dead-end or stump beyond which the blood cannot flow.  Due to lack of blood flow from this blockage, tiny blood clots may form in the carotid artery.  Then, they may find their way to the eye through bypass channels that develop in response to the blocked carotid artery.

What eye symptoms result from the carotid stump syndrome?

When tiny blood clots enter the eye from the carotid artery, they may cause blind spots in the vision. Sometimes, the blind spots are small and may not be noticed by the patient.  At other times, the blind spot may appear like a reddish or black bar or arc in the vision.  In severe cases, the entire vision may black out…either temporarily or permanently. 

How can the eye doctor help?

The symptoms from the carotid stump syndrome may also be caused by many other disorders.  The role of the eye doctor is to determine the cause of the symptoms and determine if they are due to the carotid stump syndrome.  Eye examination and testing is necessary.  There is often no specific treatment needed for the eye condition.  The symptoms frequently improve with time if the underlying condition is treated.    

How is the carotid stump syndrome treated?

Medicines and surgery are used to treat the carotid stump syndrome.  Anti-platelet medications are the mainstay of treatment.  They work by limiting the tendency of the blood to clot.  Surgery may open the blocked carotid artery. 

By Scott E. Pautler, MD

Copyright  © 2023 Designs Unlimited of Florida.  All Rights Reserved.

Lens Anterior Capsular Deposits

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I reviewed 271 abstracts that were cited from the PubMed search terms “lens and capsule and deposit.”  I have included some references from my search, as well as hyperlinks for convenience. 

The preponderance of cases involved pseudoexfoliation (PEX).  Uncommon manifestations of common problems must be considered1. It may be helpful to check the pupillary ruff for atrophy and gonio the angle looking for pigment deposition as seen in pre-clinical PEX.2

There are many rare causes of lens capsular deposits reported.  I have listed some below along with suggested investigation:

-foreign substances (silicone oil3): did this patient have a silicone IOL? Consider reviewing the operative report for the IOL to see if they used anything unusual like triamcinolone.

-infectious agents4: remain on the look-out for inflammation into the future.

-Fabry disease5: rare but important to consider…any sign of retinal vascular tortuosity or cornea verticillata?

-familial amyloidosis6: amyloid deposits on anterior capsule are more prevalent than vitreous amyloid…but were there any vitreous opacities or retinal vascular changes?

-rock inhibitor7: (more out on a limb in terms of possibility).  They affect the lens epithelial cells.

-Healon8: Any crystalline deposits on IOL surface?

By Scott E Pautler, MD

References:

1. Sorkou KN, Manthou ME, Meditskou S, Ziakas N, Tsinopoulos IT. Exfoliation Fibrils within the Basement Membrane of Anterior Lens Capsule: A Transmission Electron Microscopy Study. Curr Eye Res. 2019;44(8):882-886. doi:10.1080/02713683.2019.1608262

https://pubmed.ncbi.nlm.nih.gov/30986086/

2. Suwan Y, Kulnirandorn T, Schlötzer-Schrehardt U, et al. Light and electron microscopic features of preclinical pseudoexfoliation syndrome. PLoS One. 2023;18(3):e0282784. Published 2023 Mar 9. doi:10.1371/journal.pone.0282784

https://pubmed.ncbi.nlm.nih.gov/36893133/

3. Liu W, Huang D, Guo R, Ji J. Pathological Changes of the Anterior Lens Capsule. J Ophthalmol. 2021;2021:9951032. Published 2021 May 4. doi:10.1155/2021/9951032

https://pubmed.ncbi.nlm.nih.gov/34055399/

4. Tandon A, Tay-Kearney ML, Metcalf C, McAllister L. Bacillus circulans endophthalmitis. Clin Exp Ophthalmol. 2001;29(2):92-93.

https://pubmed.ncbi.nlm.nih.gov/11341454/

5. Rothstein K, Gálvez JM, Gutiérrez ÁM, Rico L, Criollo E, De-la-Torre A. Ocular findings in Fabry disease in Colombian patients. Manifestaciones oculares de la enfermedad de Fabry en pacientes colombianos. Biomedica. 2019;39(3):434-439. Published 2019 Sep 1. doi:10.7705/biomedica.3841

https://pubmed.ncbi.nlm.nih.gov/31584758/

6. Beirão JM, Malheiro J, Lemos C, Beirão I, Costa P, Torres P. Ophthalmological manifestations in hereditary transthyretin (ATTR V30M) carriers: a review of 513 cases. Amyloid. 2015;22(2):117-122. doi:10.3109/13506129.2015.1015678

https://pubmed.ncbi.nlm.nih.gov/26096568/

7. Imaizumi T, Kurosaka D, Tanaka U, Sakai D, Fukuda K, Sanbe A. Topical administration of a ROCK inhibitor prevents anterior subcapsular cataract induced by UV-B irradiation. Exp Eye Res. 2019;181:145-149. doi:10.1016/j.exer.2019.01.016

https://pubmed.ncbi.nlm.nih.gov/30690025/

8. Jensen MK, Crandall AS, Mamalis N, Olson RJ. Crystallization on intraocular lens surfaces associated with the use of Healon GV. Arch Ophthalmol. 1994;112(8):1037-1042. doi:10.1001/archopht.1994.01090200043019

https://pubmed.ncbi.nlm.nih.gov/8053816/

Visual Hallucinations and the Eye

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What are visual hallucinations?

A visual hallucination is the perception of a visual image that is not the result of seeing an object outside the eye. Normally, the eye perceives light from objects outside the eye and sends the image to the brain for interpretation. However, there are a number of circumstances that result in images being “seen” by a patient that do not originate from outside the eye.  These images are referred to as hallucinations, especially if they appear as formed images of recognizable objects, like faces, trees, or other familiar things.  Sometimes, hallucinations appear as dots, lines, or geometric shapes.  The hallucinations may be in color or black and white.     

What causes hallucinations?

A large list of problems may cause visual hallucinations.  These include drug use and abuse, delirium, mental illness, and a variety of neurological conditions (including stroke, multiple sclerosis, and dementia).  Sometimes, eye disease causes visual hallucinations; this is called the Charles Bonnet syndrome.  It is a common condition in which the brain “makes up images” as a result of loss of vision from an eye condition (such as macular degeneration, diabetic retinopathy, or glaucoma).  Charles Bonnet was an 18th century botanist and philosopher who described complex visual hallucinations in his grandfather after loss of vision.  

How can a doctor find the underlying cause of visual hallucinations?

A doctor may determine the cause of visual hallucinations by careful examination and testing.  If the hallucinations are interpreted by the patient as being “real,” the cause is more likely related to mental illness or may be due to drug intoxication or neurological disease.  In these cases, the mental status exam is usually not normal.  In the Charles Bonnet syndrome, the patient knows what he is seeing is not real, but sees the images nonetheless.  An eye exam may make the diagnosis, but in some cases, further testing is needed.  And these may include blood tests and imaging studies (CT scan and/or MRI brain scan). The final diagnosis of Charles Bonnet syndrome is made only after other more serious diagnoses are excluded.   

What is the treatment of visual hallucinations?

The treatment depends on the underlying cause.  In the case of the Charles Bonnet syndrome, 
counseling may help. Much relief comes from knowing that the symptoms are benign and do not represent a serious medical condition.  Some patients find the symptoms improve if they move their eyes up-and-down, or left-and-right, or look away from the hallucinations.  Others find it helps to stare at the hallucination until it fades away.  It may help to talk about the hallucination with a family member or friend.  Because stress and fatigue may precipitate the hallucinations, some recommend getting plenty of sleep and rest.  Exercise and meditation are helpful.  Thankfully, the visual hallucinations from Charles Bonnet syndrome often subside with time and may disappear over months to years.  Rarely, medication may be prescribed by a neurologist.  New treatments are on the horizon. 

Related blog: The Visual Snow Syndrome   

By Scott E. Pautler, MD

Copyright  © 2023 Designs Unlimited of Florida.  All Rights Reserved.

Laser for Central Serous Retinopathy

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laser for central serous retinopathy
anatomy of the eye (click on image to enlarge)

What is central serous retinopathy?

Before we discuss laser for central serous retinopathy, we must ask what is central sero retinopathy. Central serous retinopathy (CSR) is an eye condition associated with loss of vision from water (serous) leakage from the choroid beneath the macula (central retina).  Although it may be seen at any age, it is most common among young adult males.  The leakage may be initiated by emotional stress and aggravating factors include stimulants (caffeine, cocaine, amphetamines), steroids (cortisone, prednisone, testosterone and other androgens), lack of sleep (sleep apnea), over-the-counter dietary supplements (niacin, body-builders), prescription medications (possibly Viagra and related meds), and medical conditions (Cushing’s syndrome, pheochromocytoma).      

What treatment is available?

The first line of treatment is identification and elimination of any factors that are suspected to aggravate CSR.  However, if leakage persists, there are a number of treatments that may be helpful. These include a special class of oral diuretics, antiVEGF injections, and lasers.  Although thermal lasers may be used in selected cases, often cold lasers are preferred.

How do cold lasers (PDT) work?

Verteporfin photodynamic therapy (PDT) is the cold laser used in ophthalmology for the treatment of retinal problems.  It is called “cold” because it does not use heat to cauterize tissue.  Verteporfin dye is injected into the vein of the arm after which a laser is aimed into the eye to activate the dye.  The activated dye releases highly reactive oxygen radicals, which chemically seal the leaking blood vessels under the retina.  PDT is very effective in treating CSR.  It is expensive and sometimes not covered by private insurance.  PDT rarely causes a blind spot in the vision and this risk is minimized by using a low dose of Verteporfin or low power laser (reduced fluence).  After PDT treatment has been completed, it is important to avoid direct sunlight (or exposure to halogen light) for 48 hours to allow time for the Verteporfin to leave the body. 

Below are the photos of a 49-year-old man who had blurred vision and some distortion in his left eye for a year.  His condition did not improve after a trial off caffeine.  He had no medical problems and no other inciting factors were identified.  

Color photos revealed some white changes in the retina (arrow) due to permanent degeneration of the retina near center of vision (fovea) due to longstanding leakage. Fundus autofluorescence photos are even more sensitive in showing this damage.  

OCT (above) shows fluid under the retina (between the retina and the retinal pigment epithelium).  

FA/ICGA photos (above) show the site of active leakage under the retina.  Because of the lack of improvement with medical therapy and the threat of permanent loss of central vision due to long-standing leakage, this patient underwent reduce-fluence PDT.  He experienced no adverse effects of laser and his vision returned to 20/20 over several months’ time.  

The OCT above shows resolved subretinal fluid one month after PDT.    

By Scott E. Pautler, MD

Copyright  © 2023 Designs Unlimited of Florida. All rights reserved.

Choroidal Macrovessel

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Choroidal macrovessel is the term currently used for a rare choroidal vascular abnormality that may present as a small choroidal mass with or without symptoms.  It usually appears as a dilated, tortuous choroidal vessel beneath the temporal macula and may extend to the periphery. A dilation of the posterior ampulla may elevate the overlying retina (see OCT image below) and cause secondary changes in the retinal pigment epithelium, rarely with subretinal fluid.  Choroidal macrovessel is usually diagnosed during adulthood with a female predilection.  There is no known associated systemic vascular abnormality.

Another term that may be somewhat more specific for this condition is posterior aneurysmal choroidal varix. An aneurysmal varix is a markedly dilated and tortuous vessel, sometimes used to describe a dilated vascular channel due to a direct communication of an artery and a vein. In the example below, there appeared to be a direct communication between a short posterior choroidal artery and a choroidal vein (Haller vein) as seen on ICG angiography where there was early filling of the lesion in the arterial phase. On the color photo, the prominence of the lesion diminishes in appearance as the vessels track toward the vortex outflow. This is likely due to numerous collateral venous channels that are known to exist, which allows for a reduction in blood flow and intraluminal pressure. Thus, the peripheral choroidal venous channels appear unremarkable.

The most helpful diagnostic tests include optical coherence tomography (OCT) and indocyanine green angiography (ICGA).  OCT shows a small hyporeflective choroidal mass temporal to the fovea.  There may be disruption of the outer retinal bands and/or subretinal fluid.  ICGA shows early filling of the prominently dilated and tortuous choroidal vessel.  

As choroidal macrovessels are usually asymptomatic, no treatment is needed.  Their importance is primarily to differentiate them from tumors.  Rarely, they cause disruption of retinal pigment epithelium resulting in simulated “tracks”, which may be confused for ophthalmomyiasis (subretinal larva). 

By Scott E Pautler, MD

Copyright © 2023 Designs Unlimited of Florida.  All Rights Reserved.

HTLV1-Associated Uveitis

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HTLV1-associated uveitis
Anatomy of the eye (click on image to enlarge)

What is HTLV1?

HTLV1 is a virus that causes HTLV1-associated uveitis. It is an abbreviation for human T-lymphotropic virus type 1.  First isolated in 1980, HTLV1 belongs to the retrovirus group that also includes the virus that causes HIV/AIDS.  Retroviruses are called “retro” because they use a pathway to reproduce that is the reverse of what most organisms use.  The genetic map of retroviruses is RNA, which is converted inside host cells to DNA by a special enzyme (reverse transcriptase).  The host cell is then directed to produce more virus particles.  HTLV1 is called “lymphotropic” because it tends to infect lymphocytes, which are a type of white blood cell involved with immunity (see Legrand).  

How and where do you get exposed to HTLV1?

Because most people with HTLV1 infection remain without symptoms, they carry the virus and spread it to others by sexual contact (semen), shared blood (e.g. IV drug-shared needles, organ transplantation), and by breast milk.  HTLV1 is found in most frequently in people from Brazil, Japan, sub-Saharan Africa, Honduras, Iran and the Caribbean islands.  However, due to international travel, HTLV1 may be found anywhere in the world.

What problems does HTLV1 cause?

Many people who are exposed to HTLV1 develop no symptoms. However, because HTLV1 affects white blood cells, it may cause autoimmune conditions, as well as blood cancer. For example, autoimmune conditions include seborrheic dermatitis (infective rash), paralysis (tropical spastic paresis), and uveitis (see Schierhout). Examples of blood cancer include T-cell lymphoma and leukemia.

What is Uveitis?

Uveitis (pronounced, “you-vee-EYE-tis”) is a general term used to describe inflammation inside the eye.  The uvea is the name given to the layer of tissue in the eye that has a brown color (melanin pigment) and blood vessels, which serve to provide blood supply and protect the eye from excessive light.  The uvea can be divided into separate parts, which perform different functions in the eye: the iris, the ciliary body, the pars plana, and the choroid (see anatomy of the eye).  Therefore, in any one patient uveitis is usually given a more specific name depending on where most of the inflammation is located in the eye. Sometimes, uveitis affects tissues not considered a part of the uvea.

What type of uveitis is most common with HTLV1?

Intermediate uveitis is the most common type of uveitis caused by HTLV1. In intermediate uveitis the inflammation mainly centers in the vitreous gel (the clear gel that fills the eye). This type of uvetiis is called intermediate because it affects the middle or intermediate part of the eye. That is, the vitreous gel fills the eye and is located in an intermediate position between the front and the back of the eye. Vitritis and pars planitis are other names for intermediate uveitis.    

Who is most likely to develop HTLV1-associated uveitis (HAU)?

The age group most likely to be affected by HAU is between 20-49 years; however, any age group may develop HAU (see Mochizuki).  Female are affected by HAU twice as often as males (see Takahashi).  It appears that the eye inflammation (uveitis) is caused by the effect of HTLV1 infection on the behavior of white blood cells (lymphocytes), rendering them more likely to mistakenly attack the eye (see Mochizuki).  HAU may occur with or without other ocular inflammatory conditions, such as thyroid eye disease (see Nakao). Likewise, HAU may occur with or without non-ocular HTLV1-associated conditions, such as paralysis, rash, or blood cancer. 

What are the symptoms of HTLV1-associated uveitis (HAU)?

The most common symptoms include tiny floating spots which move or “float” in the vision.  They are usually numerous and may cause a veil-like appearance in the vision.  Sometimes blind spots, blurred vision, distortion, or loss of side vision occurs. The eye may be painful, red, tearing, and light sensitive if other parts of the eye are also inflamed (5-10% of cases).  Symptoms may be mild or they may be severe and disabling.  Only one eye is affected in about half of all cases of HAU (see Takahshi).

How is HTLV1-associated uveitis (HAU) diagnosed?

Diagnosis can be difficult.  Blood tests are performed to identify HTLV1 infection in patients with findings that suggest HAU.  One FDA-approved test is produced by MP Biomedicals Diagnostics: HTLV blot 2.4 (EIA).  Sometimes, accurate diagnosis requires multiple tests.  

How is HTLV1-associated uveitis (HAU) managed?

There is no cure for HTLV1 infection.  To limit the damage from inflammation, HAU is treated with anti-inflammatory medication in the form of eye drops, injections, or pills.  When pills are used, the eye doctor may coordinate medical care with the expert assistance of a rheumatologist.  Rarely, surgery is required to treat uveitis.  Episodes of inflammation may last from weeks to many years.  HAU is a serious eye problem and may result in loss of vision (see Takahashi).  However, by seeing your eye doctor and taking the medications exactly as recommended, damage to your vision can be minimized.  Most people with HAU keep good vision (See Nakao).  In some cases, HAU may go away, but return at a future date in about 50% of cases (see Takahashi).  Therefore, if you become aware of symptoms of uveitis in the future, do not hesitate to contact your doctor. 

By Scott E. Pautler, MD

Copyright  © 2023 Designs Unlimited of Florida.  All Rights Reserved.

Pain After Eye Injections

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Why are eye injections given?

There are many conditions, which threaten loss of vision, that are treated by injecting various medications into the eye. The eye conditions include macular degeneration, diabetic retinopathy, retinal vein occlusion, uveitis, and others.  The injections may be given into the tissues outside the eyeball (subtenon’s injections) or into the eyeball (intravitreal injections).  It is very important to avoid pain as these injections may need to be given repeatedly over time.

Why do I have pain after eye injections?

Although pain during eye injections can usually be minimized with anesthetics given before the injection, sometimes there is pain for hours after the injection.  There are many reasons why this may occur:

1.) The antibiotic (betadine) may irritate the eye for hours after it has been applied to the eye.

2.) The eye may become dried out after the injection due to insufficient blinking.

3.) The eye may be accidentally scratched by rubbing the eye while it is still anesthetized.  

4.) The drug that is injected into the eye may cause an inflammatory reaction.

5.) Rarely, a severe infection called endophthalmitis may occur after injection into the eyeball.  

What can be done to prevent pain after injections?

The key to eliminating pain after eye injections is to identify the underlying cause. This may take some detective work.  Although betadine is given at the time of injection to prevent infection, only a small dose is needed.  If a large amount of betadine is used or if the betadine has not been thoroughly rinsed off the eye, it may cause blurred vision, persistent burning, itching, and/or a scratchy sensation like sand in the eye (called a foreign body sensation).  Therefore, it is important for the eye doctor or technician to completely rinse the betadine off the eye after an eye injection in order to avoid pain later.

Sometimes, the surface of the eye may become dry after an injection because the patient does not blink frequently enough or not completely enough.  This often happens as a result of the anesthetic used in preparation for the injection.  After the injection is over, the anesthetic may continue to work for 15-30 minutes.  During that time, the patient does not have the normal sensation necessary to indicate that it is time to blink.  If the eye does not blink often enough, the surface may dry out and cause blurred vision, pain or foreign body sensation.  Therefore, the patient may need to purposefully blink frequently or simply rest the eye closed for a while after an eye injection in order to prevent drying.  Similarly, if a patient does not close the eye completely with each blink, part of the eye can become dry.  In some cases, it may be necessary to forcibly close the eyes with each blink in order to be sure the lids close completely.

At times a patient may unknowingly rub and scratch the eye after an injection because of persistent numbing after an injection.  Therefore, it is very important to avoid touching the eye for 15-30 minutes after an injection.  If the eye needs to be dried off, a clean tissue may be used with a gently damping or blotting motion in the corner of the eye where the lids come together at the bridge of the nose.  It is best not to move the tissue left and right or up and down in a rubbing fashion.  Once the eye becomes dry or irritated for any reason listed above, it may take 1-2 days for the pain to go away and the eye to return to normal. 

Rarely, a drug that is injected into the eye can cause an inflammation that causes pain or blurred vision.  The doctor makes this diagnosis by examining the eye under the biomicroscope (called a slit lamp).  If a medication is determined to be the cause of inflammation, it is treated with prescription eye drops and the offending drug is not used again in that patient in the future. 

Infection is an extremely rare cause of pain after an eye injection.  In about one in several thousand injections, germs may enter the eye through the needle tract after an eye injection.  This rare infection is called endophthalmitis (pronounced like “end-off-thal-my-tiss”).  Symptoms usually start with pain, redness, and loss of vision several days to a few weeks after an injection.  There is no perfect way to prevent endophthalmitis.  The doctor uses techniques like applying betadine before the injection.  The patient tries to avoid contaminating the eye by avoiding exposure the unclean areas (like a barnyard) and avoid rubbing the eyes after injection.  Endophthalmitis is very serious and may result in permanent loss of vision.  Therefore, any patient having deep aching pain, increasing redness, and loss of vision starting several days or weeks after an eye injection should notify their eye doctor for prompt evaluation.  

What can be done to make the eye feel better?

If the cause of the pain and irritation is from betadine, drying, or rubbing the eye, the best treatment is lubrication.  Lubricants are available over-the-counter in the form of eye drops, eye gels, and eye ointments (see examples at the end of this article).  The thicker the lubricant, the better the relief of pain and discomfort.  However, gels and ointments may be difficult to place into the eye and they tend to make the vision blurry for several minutes or more.  Lubricants may be used as often as needed.  Resting the eyes closed may also provide relief.  Cold compresses help many patients.  Over-the-counter pain medications like ibuprofen and/or Tylenol may be helpful.  Prescription pain medications are rarely needed and may cause undesirable side effects.

If the cause of the pain and irritation is from a drug reaction or from infection inside the eye, the doctor will prescribe special anti-inflammatory eye drops.  If the eye exam shows infection, antibiotic injections must be given into the eye and surgery in the operating room may be necessary. 

If pain keeps occurring after eye injections despite taking the measures listed above, sometimes prescription eye medication can help. Non-steroid (NSAID) eyes drops or steroid/antibiotic ointments may help prevent the pain. Most instances of pain after eye injections may be avoidable. Please talk with your eye doctor to help resolve the problem in order to undergo treatment without pain.

Check the current price of Systane Gel on Amazon.

Gels are easier to apply than ointments and may be used immediately after an eye injection to prevent eye pain and they may be used later to soothe eye discomfort.

Check the current price of Lacri-Lube on Amazon.

Ointments are more difficult to place in the eye. However, they provide longer duration of action. They may be used immediately after an eye injection to prevent eye pain and they may be used later to soothe eye discomfort.

By Scott E. Pautler, MD

Please note: As an Amazon Associate I may earn from qualifying purchases. You pay no additional fees by accessing the link. These funds help defray the costs of maintaining this website. Thank you for supporting this blog.

Copyright  © 2020-2022 Designs Unlimited of Florida.  All Rights Reserved.

AAO 2019 Cases with a Point Handouts

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We thank senior instructor David J. Browning, MD, PhD for organizing this course and we thank the attendees for their participation and input for improvement. The following are the handouts from the individual cases that may be downloaded for review. The files are listed in alphabetical order by instructor’s last name followed by case number and subject of the talk.

Browning Case Asymmetric Retinitis PigmentosaDownload
Browning Case Management of Proliferative Diabetic RetinopathyDownload
Browning Case Asymmetric Retinitis PigmentosaDownload
Browning Case Patchy Ischemic Retinal WhiteningDownload
Browning CaseThe Nonadherent Patient with Diabetic Macular EdemaDownload
Agarwal CasesDownload
Kokame Case 1 Endo CNVDownload
Kokame Case 2 Macular hole CMEDownload
Kokame Case 3 PCVDownload
Kokame Case 4 macular edemaDownload
Pautler Case 1 disc collateralsDownload
Pautler Case 2 AEPVMDownload
Pautler Case 3 SNIFRDownload
Wong Case 1 CRAO HandoutDownload
Wong Case 2 antiVEGF half-life HandoutDownload
Wong Case 3 HandoutDownload

The Best Vitamins for Macular Degeneration

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What are vitamins?

Before discussion about the best vitamins for macular degeneration, just what are vitamins? Vitamins are organic compounds that are needed by your body to function, but cannot be made by your body. Therefore, they must be consumed to promote good health. Vitamin and nutritional supplements are not regulated or tested by the Food and Drug Administration. Claims by manufacturers that these supplements improve health must be scientifically proven. 

Should I take vitamins?

Doctors and nutritionists are limited in their ability to make firm recommendations in many situations because nutrition research is still in its infancy. Beware of authors and marketers who make grand claims as to the effectiveness of vitamins and herbs. Most healthy individuals who eat a well-rounded diet do not need to take supplemental vitamins, although there are some situations in which supplements have been shown to be beneficial. In general, vitamins are useful in the following situations: advanced age, age-related macular degeneration, food fads, gastrointestinal absorption abnormalities, and hemodialysis.

Vitamins and nutritional supplements—the more the better?

Although vitamin deficiency causes illness, excess vitamin intake may result in toxicity. Toxic effects are especially seen with the fat-soluble vitamins (Vitamins A, E, D, and K). However, even dosages of vitamin B6 exceeding 500mg per day may cause light sensitivity, and vitamin C may cause nausea and diarrhea in large doses of 2 grams per day. Vitamin A may cause liver damage, visual changes, and birth defects in dosages as low as 15,000 IU per day and long-term use of vitamin A may cause osteoporosis and increased risk of bone fracture. Beta carotene may cause smokers and former smokers/asbestos workers to be at increased risk of lung cancer. Vitamin E appears safe up to 400 IU, but daily dosages exceeding 800 IU may cause abnormal bleeding and dosages exceeding 1200 IU may cause headache, fatigue, nausea, diarrhea, cramping, weakness, blurred vision, and gonadal dysfunction. Vitamin D may cause abnormal calcium deposits in soft tissues when taken during kidney failure or in doses greater than 2,000 IU. 

So what are the best vitamins for age-related macular degeneration (AMD)?

The AREDS2 formula is the most carefully studied vitamin combination proven to reduce the risk of vision loss in AMD. There are many companies that manufacture the AREDS2 formula, but the most economical source (to the best of my knowledge) is Equate Advanced Eye Care Complex from Walmart. Another more expensive brand is Preservision AREDS2. There is NO vitamin A or beta carotene in AREDS2. Be aware that mineral supplements such as zinc in the AREDS2 formula may interfere with the absorption of prescription medications such as thyroid pills. Therefore, take AREDS2 vitamins 4 hours apart from prescription medications to minimize their interactions. Iron supplements may worsen macular degeneration and should be avoided unless prescribed by a physician.

Click here to check updated prices of Preservision AREDS2 on Amazon.

Preservision AREDS 2
Preservision AREDS 2 (click to enlarge)

By Scott E. Pautler, MD

Please note: As an Amazon Associate I may earn from qualifying purchases.  You pay no additional fees by accessing the link.  These funds help defray the costs of maintaining this website. Thank you for your support.

Copyright  © 2021-2023 Designs Unlimited of Florida.  All Rights Reserved.

Optic Disc Drusen

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What are optic disc drusen?

globe anatomy
Anatomy of the Eye (click on image to enlarge)

The optic nerve is the nerve that connects the eye to the brain. It sends the “picture” taken by the eye to the brain. The optic disc is the part of optic nerve that can be directly seen by the eye doctor on an examination. Optic disc drusen are calcified deposits in the optic disc that may be detected directly on exam or by testing with cameras or ultrasound.  They are present in about 2% of the population. 

ON drusen image
Top color image shows optic disc as round structure without clearly seen drusen.
Bottom fundus autofluorescence image shows the optic disc drusen as bright white spots in optic disc..

What causes optic disc drusen and why are they important?

Optic disk drusen are present from birth, but often go undetected until later in life. Usually they cause no problem, but they may crowd the nerve fibers in the optic nerve. The crowded optic nerve may be predisposed to blood vessel blockage later in life, especially with hardening of the arteries. The condition of blocked blood supply to the optic nerve is called ischemic optic neuropathy (ION). Sleep apnea may play a role in some patients and SSRI anti-depressants may be a risk factor for ION.

Sometimes, optic disc drusen can cause loss of side vision as in glaucoma. In this case, eye drops are sometimes prescribed. Rarely, bleeding under the retina may occur due to blood vessel growth (similar to wet macular degeneration). In that instance, medicine injections or laser may be used.

Finally, optic disc drusen may be buried in the optic disc and the appearance may resemble optic disc edema (papilledema). True papilledema is caused by elevated pressure in the brain. It is, therefore, important to make a correct diagnosis. Although a number of tests may be used, optical coherence tomography (OCT) is the single most reliable test for diagnosis.

How are optic disc drusen managed?

Most cases of optic disc drusen cause no problems and require no treatment. There is no accepted method to remove them. The usual recommendations to prevent hardening of the arteries may be helpful to avoid ION (avoid tobacco and control weight, blood pressure, cholesterol and blood sugar). In order to detect early changes in the vision, it may be helpful to monitor the vision each week with an Amsler grid test. If a sudden blind spot or distortion (straight lines look wavy or crooked) is detected, contact the eye doctor within 2-3 days for evaluation and management.

By Scott E. Pautler, MD

 

Copyright  © 2019-2023 Designs Unlimited of Florida.  All Rights Reserved.

On-Time Doctor Award

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On-Time Award

Being on-time is an important issue for me, as waiting in the doctor’s office can seem like an eternity. I know your time is important. As such, I strive to train my staff to work with me to make your visit as pleasant and efficient as possible. When you approach the front desk, you are promptly greeted by our receptionist, not ignored as though you are invisible. Within short order a technician brings you back to the examination area of the office designed for optimal preparation for the doctor. You wait only long enough for the eye drops to dilate your eyes for retinal examination. I seek to spend time directing my attention to you and your eye problem, so I have my technicians take notes on the computer while I examine the retina. At this time, I use technical language that sound strange, but I soon translate the findings of my exam into everyday language. Because it is easy to forget what you hear in a doctor’s office, I encourage you to bring a family member or friend with you. Also, I supply information sheets for most retinal conditions and maintain an active blog site to help inform you about your condition.

Sometimes, the day does not go as planned. If an emergency patient is sent directly to see me for urgent care, I do fall behind. Nonetheless, I usually do not remain behind schedule for long because I allow extra time in my schedule for unforeseen delays in my schedule. Despite our best effort, first-time patients usually take extra time. Many forms are required by the government and the insurance company. An extensive history at the first visit is required to help identify the problem. Photographic testing can be time consuming. In complicated cases, we place a telephone call after the visit to communicate the results of exam and testing.

Regardless of how busy we are, I aim to treat you with courtesy and compassion. Wherever possible, I will minimize waiting. I am humbled and honored to have been awarded the “On-Time Doctor Award” by Vitals for 2018-2019. And I thank you for your patience on those days I am unable to meet my goal of “no wait.”

With sincerest regards,

Scott E. Pautler, MD, FACS

On-Time Award

Lens Implant Options

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Cataract
Cataract is a foggy lens inside the eye (click image to enlarge).
Image courtesy of Caitlin Albritton.

See Eye Anatomy

Why are lenses implanted during cataract surgery?

Cataract is the name given to the natural lens inside your eye when it becomes cloudy. When cataract interferes with vision, surgery is performed to remove the cloudy lens. In order to replace the focusing power of your natural lens, a synthetic lens implant is placed inside the eye at the time of cataract surgery.

What lens implant power options are available?

The patient may choose to have the power of the lens implant adjusted to focus the eye at various distances. The power calculations are not perfect and often glasses still must be worn by many patients. Most people choose to have the lens implant focused mainly for distance. Rarely, near-sighted patients prefer to keep the primary focus at near. Standard lens implants are fixed-focus lenses. That is, they do not focus at distance and near. For example, an eye with a standard lens implant focused for distance must use reading glasses for near work.

How can we decrease our dependence on glasses after cataract surgery?

In order to decrease the need for glasses, there are options to consider, each with advantages and disadvantages. Options include bifocal contact lenses, mono-vision lens implant correction, and multifocal lens implants.

Bifocal Contact lenses: This option may be good for patients who already use bifocal contact lenses. The contacts lenses help focus at near and may refine distance vision as needed.

Mono-vision Lens Implants: In this option one eye is focused mainly at distance and one eye is focused mainly for near. Not everyone can adapt to this situation and there is slight loss of depth perception with mono-vision correction. This option is best for those who already have adapted to mono-vision contact lenses.

Multifocal Lens Implants: This is a new option offered by premium lens implants that cost more for the patient. Basically, these implants offer improved range of focus for both distance and near. Many brands are available. The choice of lens depends on how much help with distance and near vision is desired. However, the greater the range of focus a given lens offers, the greater the side effects of the multifocal lens. Side effects include decreased contrast sensitivity and glare/halos from light especially at night. Loss of contrast sensitivity makes it more difficult to see gray print on white paper. Glare and halos bother some patients more than others.

A combination of strategies may be used. For example, a low-range-of-focus multifocal lensimplant (Symfony) may be used with mild mono-visionfocusing to minimize the downsides compared with each method when used alone.

Examples of multifocal lens implants include Symfony, Restor 2.5, and Restor 3.0. There are many others. Below is a chart to demonstrate the trade-offs among these lenses.

Lens Implant Styles: Benefits and Limitations    
Style Distance vision Intermediate vision Near vision Need for reading glasses Contrast sensitivity Glare/Halos
Standard IOL (monofocal) Excellent Fair Poor Most of the time Excellent Rare
Symfony IOL Very good Good Fair Much of the time Good Mild
Restor 2.5 IOL Fairly good Good Good Some of the time Poor Moderate
Restor 3.0 IOL Fairly good Fair Good Rarely needed Poor > Moderate

If you have strong preferences, be sure to communicate with your doctor to be given the best lens implant for your situation. Keep in mind that the eye changes over time and the need for glasses may change over months to years after cataract surgery.

By Scott E. Pautler, MD

Copyright © 2018 Designs Unlimited of Florida.  All Rights Reserved.

Pain in and Around the Eye

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globe anatomy
anatomy of the eye (click on image to enlarge)

Pain is a symptom that often warns of serious problems. The nature of the pain may help to determine the origin of the pain and, sometimes, the cause. The following are types of pain and their causes:

Severe, sharp, jabbing pain in the eye: If persistent and associated with a sensation like sand in the eye, this pain often suggests a problem in the cornea. The cornea is the clear front window at the front of the eye. It is replete with very sensitive nerve endings that may be irritated by any disruption of the “skin” on the surface like a corneal abrasion. Treatment is important to relieve pain and prevent infection or scarring of the cornea as this may result in a loss of vision.

A very brief isolated episode of a jab in the eye: May be due to a benign blockage of an oil gland in the eyelid margin (blepharitis). It may also be a symptom of a type of migraine called an “ice pick” headache.

A burning, tingling pain over the forehead: May indicate the onset of shingles (Herpes Zoster). The pain often precedes the onset of a painful rash composed of small vesicles (blisters) on the forehead. It is important to start antiviral medication and evaluate the eye to determine if there is direct eye involvement.

Deep, boring pain: May be seen with sinus pathology alone and may be present in varying severity. However, this type of pain may also be due to problems in the brain such as aneurysm or brain tumor. This pain may also be caused by high pressure in the eye (acute glaucoma) or serious inflammation inside the eye (uveitis). Rarely, poor blood flow to the eye from the carotid artery may cause a deep pain around the eye; atherosclerosis or giant cell arteritis may be the cause.

Pain may be caused by dry eye syndrome. It is usually associated with dryness, burning, and foreign body syndrome.

This monograph does not cover all types or causes of eye pain. Any significant, persistent pain in the eye warrants evaluation. In many cases the more severe the pain, the more urgent the need for evaluation.

By Scott E. Pautler, MD

Copyright  © 2018-2022 Designs Unlimited of Florida. All rights reserved.

Whiter Eyes with Lumify

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What is Lumify?

Lumify is an eye drop to reduce redness of the eyes and is available without a prescription. It is a weaker concentration of a well-known eye drop used to treat glaucoma and it became available in 2018.  Although Lumify works to reduce eye redness, It does not treat any underlying eye disease.

How does Lumify work?

Lumify works by constricting the tiny blood vessels on the surface of the eye so the white part of the eye looks whiter.  Unlike older eye drops used to “get the red out,” Lumify does not tend to cause a rebound redness when it wears off.

How do you use Lumify?

Apply a drop of Lumify to each eye. The drop takes affect within an hour and lasts up to eight hours. It may be repeated as needed with little risk of rebound redness.

 What are the precautions?

Lumify is not a treatment for eye disease. It is only used for the purpose of whitening the eyes. If there is an underlying ocular infection or inflammation, an examination by an ophthalmologist is essential.  Symptoms that suggest the need for an eye examination include light sensitivity, pain, new floaters, discharge, matting of the eyelids, and/or loss of vision.  Furthermore, if Lumify does not work well to whiten the eyes, there may be an underlying condition that needs to be diagnosed and treated.

Click here for an updated price of Lumify on Amazon.

By Scott E. Pautler, MD

Note:  As an Amazon Associate I earn a small commission from qualifying purchases.  You pay no additional fees by accessing the link.  These funds help defray the costs of maintaining this website.  Thank you.

Copyright  © 2021-2023 Designs Unlimited of Florida.  All Rights Reserved.

Low Vision Resources in Tampa

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Although medical and surgical treatments often help to restore vision or minimize loss of vision, many people lose vision permanently from various eye conditions. This information was compiled to inform you about what is available in the community to assist in overcoming some of the problems encountered with low vision. Keep in close contact with trusted friends and family members who can provide help. Remain as active as your health and vision with allow. Identify and treat depression with the help of your internist. You will not harm your eyes by trying to use them. You may sit close to the TV to see it better without risking damage to your eyes. When reading, good lighting is important (a gooseneck lamp may be helpful). To reduce glare when outdoors, consider wearing glasses tinted dark-yellow or amber.

For a light-weight illuminated magnifier, click here.

For help viewing the TV, click here.

TRANSPORTATION

CTI “Share-A-Van” transportation service………….272-7272

HARTline buses (discount for legal blindness)…….623-5835

Angel Wings/Red Cross (Free, Non-Medicaid).……251-0921

Evacuation Preparedness and Assistance………….272-6900

MAGNIFICATION

The Lighthouse for the Blind
1106 W. Platt Street
Tampa, FL 33606
(813) 251-2407
Harbor Freight

154 W Fletcher Ave

Tampa, FL 33612

(813) 930-0774

TELEPHONE DIRECTORY SERVICE

Free directory assistance over the phone from Verizon is available with a form filled out at our office.

HELP FOR VETERANS

VIS Program offers low-vision aids and training.

Call (813) 903-2441

TALKING BOOK LIBRARY

Applications for the free books on cassette tape are available from our office. Tapes are mailed to your home.

Hillsborough County Talking Book Library

3910 South Manhattan Avenue

Tampa, Florida 33611-1214

(813) 272-6024

U.S. National Library Service 1-800-424-8567

www.loc.gov/nls (books and magazines on tape)

Books and magazines on tape to keep (free):

American Printing House for the Blind 1-800-223-1839

Choice Magazines 1-888-724-6423

Large-print books (loan):

National Association for Visually Handicapped

1-212-889-3141 (www.navh.org)

SUPPORT GROUPS AND CLASSES

Eyes Only Support Group

Lighthouse for the Blind

1106 W. Platt Street

Tampa, Florida 33606

(813) 251-2407

REHABILITATION

Division of Blind Services

415 S Armenia Ave

Tampa, FL 33609

(813) 871-7190

Comprehensive Home Care

(813) 373-8438

 

LOW VISION CATALOG

Maxiaids Catalog (free catalog of helpful aids)

1-800-522-6294

LOW VISON SOFTWARE FOR COMPUTER

Freedom Scientific

http://www.freedomscientific.com/product-portal.asp)

1-800-444-4443

NEWSPAPER READING SERVICE

 USF Newspaper Reading Service broadcast by radio.

Applications are available in our office.

TAX RELIEF

 Tax deductions on property tax and income tax are available to persons who are legally blind. Your eye doctor can supply you with proper documentation of legal blindness.

ADDITIONAL INFORMATION ON LOW VISION:

National Eye Health Educational Program

National Institutes of Health (English and Spanish)

www.nei.nih.gov
Association for Macular Diseases (1-212-605-3719)

www.macula.org
Macular Degeneration Partnership (1-888-430-9898)

www.amd.org
MD Support (information and video: Learning to live with low vision)

www.mdsupport.org

Self-Help Books:

Making Life More Livable, M. Duffy, NY: American Foundation for the Blind, 2001; 1-800-232-3044

Macular Degeneration: The Complete Guide to Saving and Maximizing Your Sight, L. Mogk, MD & M. Mogk, PhD, NY: Ballantine 2003; available in bookstores and www.amazon.com

Overcoming Macular Degeneration: A Guide to Seeing Beyond the Clouds, S. Soloman, MD and J. Soloman, NY: Avon 2000; available in bookstores and www.amazon.com

This list was compiled to help provide information on available services for the visually impaired. It does not represent an endorsement of listed businesses or services. Please verify phone numbers and addresses as they may have changed since this publication was printed.

By Scott E. Pautler, MD

Copyright © 2017-2022 Designs Unlimited of Florida. All Rights Reserved.

Plaquenil Dosing Schedule

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According to the Amercian Academy of Ophthalmology 2017 guidelines, the dosage of Plaquenil should be adjusted for patient weight. Patients with lower weight may be at increased risk of retinal damage over time if treated with unadjusted dosing schedules. Other researchers emphasize the importance of dosing by height as well. The PDF document below may be downloaded and used as a reference guide.  Please note that if a patient has kidney disease or liver disease the dose may need to be reduced by one half.

By Scott E. Pautler, MD

Plaquenil dosing schedule 2017

Eyelid Hygiene

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What is lid hygiene and why is it important?

Lid hygiene is the routine cleansing and care of the eyelids. It is especially important for people with skin problems such as seborrhea, rosacea, and acne. It is also important to improve comfort and vision in eye problems such as blepharitis and chalazion. Lid hygiene helps to remove oily secretions that build up and interfere with the tear film and also lead to bacterial overgrowth. The key to treating these problems is to routinely clean the eyelids with saline solution warm soaks. For additional comfort, take one flaxseed oil capsule by mouth twice a day.

How do I prepare the saline solution for the warm soaks?

Add 1/4th teaspoon of table salt to two cups (16 ounces) of warm tap water and mix thoroughly. Take care not to make the water so hot that it burns the eyelid as the skin is very thin in this area. Use sterile cotton balls soaked in the saline solution and slightly wrung. Place the moistened cotton ball on the closed eyelids until it cools. Replace with fresh warm cotton balls as needed for a total duration of ten minutes.

For a quicker method use a warm wet wash cloth at the sink. These soaks will dissolve secretions, help soothe burning eyes, and decrease the redness of the lids. It is often necessary to do the eye soaks several times a day for the first week and daily thereafter. A simple alternative to using saline solution is to use warm tap water and a wash cloth to soak the eyelids with or without baby shampoo.

A superior method to apply moist heat effectively to the eyelids is with the use of the Bruder mask.

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Moist heat for eyelid hygiene

 

How do I clean the lashes?

Use a Q-tip moistened with warm salt water or diluted baby shampoo. Gently brush the lashes from the base to the lip of the lashes. The upper lashes can be easily cleaned with the eyelids closed. The lower lashes are more difficult and require extra care. Pull down the lower lid while cleaning these lashes to avoid touching the sensitive cornea (the clear window of the eye). The lashes should be cleansed twice a day for the first week and daily thereafter. Tea tree oil face wipes offer convenience and the added benefit of antibacterial qualities.

By Scott E. Pautler, MD

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