Scott E. Pautler, M.D. Tampa

Treatment of diseases of the retina and vitreous

The Smudged Contact Lens

Posted on July 30, 2023 by Scott Pautler

Blurred vision due to smudge on the contact lens?

There are many causes of blurred vision. Sometimes, the eye doctor needs to update the power of the contact lens. At other times, there may be an eye disorder that requires diagnosis and treatment by an ophthalmologist. However, a smudged contact lens may be the problem. To find out, remove and inspect the contact lens for a smudge.

What are the causes of a smudge on the contact lens?

Many things may cause a smudge on the contact lens. A factory defect is rare and the contact lens specialist usually detects damaged lenses prior to dispensing. Makeup, creams, oils, or moisturizers on your fingers may cause the contact lens to be smudged. A moisturizer in your hand soap may cause blurred vision by smudging the lens.

What can be done to prevent smudges on the contact lens?

Proper contact lens maintenance and hygiene is important. Follow all instructions given by your contact lens provider to the letter. Make sure to wash your hands with hand detergent without moisturizers prior to inserting your contact lenses. This is very important to keep your lenses clear and free of germs that can cause serious infection.

How do you remove a smudge from a contact lens?

The management of a smudged contact lens depends, in part, on the type of contact lens you wear. If you use daily-wear contact lenses, it may be best to dispose of the smudged contact lens and replace it with a new lens. When wearing lenses made to wear for longer than a day, carefully clean them daily by following the manufacturer’s recommendations.

Rigid gas-permeable lenses are made for long-term use. If they become smudged, gently rinse them with conditioning solution or a cleaning solution. If this fails, an enzymatic cleaner may help. Follow all instructions on the contact lens product recommended by your doctor. Professional polishing is available by your contact lens provider.

Where do I go for urgent care?

If you have pain while wearing your contact, remove it immediately. If your eye remains blurred after you remove the contact lens, you may have a damaged cornea. Make a prompt appointment with your eye doctor. If you have pain or persistent foreign-body sensation (a feeling like sand in the eye), notify your eye doctor without delay. If you are unable to contact your eye doctor and there is significant pain and/or loss of vision, report to the hospital emergency department urgently.

By Scott E. Pautler, MD

Note: As an Amazon Associate I 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.

Lattice Degeneration

Posted on March 4, 2022 by Scott Pautler

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

What is lattice degeneration?

Lattice degeneration is a condition in which the retina develops areas of abnormal thinning. The thinning occurs as the retina stretches during growth of the eye. The retina is a “tissue-paper” thin layer of nerve tissue, which lines the inside of the eye like the film in a camera. In the eye, light is focused onto the retina, which “takes the picture” and sends the image to the brain. Lattice degeneration is most common in near-sighted people and affects about 7% of the general population.

What causes lattice degeneration?

Lattice degeneration appears to be an inherited condition that usually develops in childhood or early adulthood. The eye, which is round like a ball at birth, becomes oval like an egg. The elongation of the eye causes the retina to stretch. As a result, thin areas develop in the retina similar to “stretch marks” that occur in the skin with growth or weight gain.

Why is it important to know about lattice degeneration?

Lattice degeneration in itself causes no symptoms or loss of vision. It is important because lattice degeneration predisposes eyes to retinal detachment, which can cause permanent blindness without treatment. With age, trauma, or inflammation, the vitreous gel that fills the eye begins to condense and pull away from the retina. If the retina has become weakened by lattice degeneration, it is more likely to tear when pulled upon. A tear in the retina allows fluid from the vitreous gel to seep under the retina as the retina detaches. Fortunately, only one in 200 eyes with lattice degeneration ever develop retinal detachment. Usually no treatment of lattice degeneration is needed, but symptoms of new floating spots or fibers should be reported to the doctor promptly. An examination may disclose breaks in the retina, which may be treated in the office with laser. The appearance of a dark curtain or shadow from the side-vision like an eclipse of the moon is an even more serious symptom that may indicate retinal detachment and require major eye surgery to repair.

By Scott E. Pautler, MD

For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida. Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida.

Myopic Macular Degeneration

Posted on March 17, 2019 by Scott Pautler

What is myopic macular degeneration?

Myopic macular degeneration (MMD) is a degeneration of the center of the retina seen in some people who are myopic (near-sighted). MMD is not the same as age-related macular degeneration. The macula is the area of the retina in the back of the eye that is responsible for seeing details in the central vision. The retina is a thin layer of delicate nerve tissue that lines the inside wall of the eye like the film in a camera. In the eye, light is focused onto the retina, which “takes the picture” and sends the image to the brain. Although macular degeneration affects the central vision, it does not affect peripheral vision— the ability to see objects off to the side when looking straight ahead. This means that macular degeneration alone does not result in total blindness.

What causes myopic macular degeneration?

Changes in the shape of the near-sighted eye cause myopic macular degeneration. The normal shape of the eye is round like a ball. As an eye becomes myopic, the eye elongates and looks more like the shape of an egg. The elongation of the eye means that the retina becomes stretched and thin. This causes macular degeneration in some eyes over time. The higher the amount near-sightedness (the thicker your glasses), the greater the chances of myopic macular degeneration. Two forms of MMD are “dry” and “wet”. However, the wet type may become “dry” and the dry type may become “wet” over time:

Dry macular degeneration is the most common type and involves the disintegration of the light-sensitive tissues in the macula. Loss of vision is usually gradual in dry macular degeneration.

Wet macular degeneration occurs in a small group of eyes with MMD. It occurs when abnormal blood vessels grow under the macula and cause fluid leakage, bleeding, and scarring of the macula. Vision loss may be rapid and severe. An important, but under-recognized form of wet MMD is dome-shaped maculopathy.

What are the symptoms of myopic macular degeneration?

Macular degeneration may cause no symptoms in its early stages. Over time, symptoms may include the need for more light while reading and blurring of central vision, often with distortion or a blind spot. Although macular degeneration is usually present in both eyes, it may cause visual symptoms in only one eye. Rarely, severe loss of vision occurs in both eyes, and render a person legally blind. However, total blindness is extremely rare in myopic macular degeneration.

How is myopic macular degeneration diagnosed?

A dilated eye examination can detect myopic macular degeneration before visual loss occurs. The hallmark of myopic macular degeneration is a thinning of the macula due to stretching of the retina and the underlying blood vessel layer that gives nutrition to the retina. After the diagnosis is made, a fluorescein angiogram is often helpful. In this procedure the ophthalmologist injects an organic dye into the vein of the arm. Photographs of the retina are taken to reveal the presence and location of the leaking blood vessels marked by the organic dye.

How is dry myopic macular degeneration treated?

No specific treatment is required for eyes with MMD and no symptoms. However, it may be helpful to avoid eye rubbing. If the eyes feel tired at the end of the day, warm compresses are safer than rubbing the eyes. A Bruder mask may be purchased at the drug store or online. It may be heated in the microwave for 10 seconds and placed on the eyes after testing the temperature. It provides warm moist heat that soothes the eyes.

How is wet myopic macular degeneration treated?

Medication injections (Avastin or Lucentis) performed in the office often help preserve vision in wet MMD. Treatment rarely returns vision to normal, but may limit the amount of vision loss from blood vessel growth and leakage. Frequent office visits and photographs are needed to monitor for activity and determine the need for treatment. The Amsler grid test is used at home to help monitor the vision. If the grid test shows new or progressive distortion in the vision, notify the eye doctor within a few days.

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 provided. These funds help defray the costs of maintaining this website. Thank you for your support.

The Amsler Grid Test

Posted on June 27, 2018 by Scott Pautler

What is the Amsler grid?

The Amsler grid is a test used to detect and monitor macular disease (see Anatomy of the Eye). The macula is the area of the retina in the back of the eye that is responsible for seeing details in the central vision. The retina is a thin layer of delicate nerve tissue that lines the inside wall of the eye like the film in a camera. In the eye, light is focused onto the retina, which “takes the picture” and sends the image to the brain.

How is the Amsler grid used?

The grid is observed one eye art a time with reading glasses if needed for proper focusing at normal reading distance. The patient is asked to fixate on the center of the grid while using “side vision” to see if there are any missing areas. The lines on the grid should appear straight and uniform. If any abnormalities are noted, an ophthalmologist (retinal specialist) may be consulted to determine the cause of the problem.

Below is a link to download or print an Amsler grid chart for use at home.

Amsler grid RVAF

Some patients prefer a more sensitive (and more expensive) test to monitor the vision called the Foresee Home Monitoring Program.

By Scott E. Pautler, MD

Distortion of lines on Amsler Grid (click on image to enlarge)

Slow Myopic Progression

Posted on December 3, 2016 by Scott Pautler

Although most people with myopia (near-sightedness) do not suffer from complications, highly near-sighted eyes (greater than 6 diopters) are at risk of vision loss. Myopia is fairly prevalent, affecting about 25-35% of adults in the United States. Extensive visual tasks focused at near may be increasing the risk of myopia. Highly myopic eyes are at increased risk of myopic macular degeneration, cataract, glaucoma, and retinal detachment. Therefore, treatment to reduce the progression of myopia is important to prevent loss of vision.

The simple act of spending time away from near work appears to offer help in reducing the onset of myopia. In one study the incidence of myopia was decreased by 10% by spending 40 minutes per day outdoors.

Recent studies support the use of dilute atropine eye drops to slow the progression of myopia. Atropine 0.01% must be prepared by a pharmacy with a doctor’s prescription. The cost is about $20-30 per month. The drop is used once per day. This low-concentration eye drop had minimal effects on the eye. A dilated pupil and difficulty focusing at near are rarely encountered. Therefore, light sensitivity is minimized. Very rare side effects of atropine including rapid heart rate, dry mouth, and urinary retention, constipation, and flushing of the skin are not generally reported with diluted atropine used to treat myopia. Allergic reactions with redness and itching are rare with low-concentration atropine, as well.

Eligible patients include children (aged 5-15) with progressively worsening myopia (1 diopter of more in one year). However, there are no hard and fast rules; a strong family history of high myopia may play into the decision to treat a child with myopia to slow its progression. Treatment may continue until age 18 years. More studies are needed to better define the best time to start treatment and the optimal duration of treatment. For now, however, it appears that atropine may be the safest and most effective pharmacological treatment to slow the progression of myopia.

By Scott E. Pautler, MD

Metamorphopsia (Visual Distortion)

Posted on June 3, 2016 by Scott Pautler

What is metamorphopsia?

Metamorphopsia (“meta-more-FOP-see-ya”) is a medical term used to describe an abnormal visual perception in which images appear distorted. For example, straight lines appear curved or jagged. It is an important symptom of retinal disease. Metamorphopsia is not caused by the need for new glasses, cataract, glaucoma, or optic nerve damage. Metamorphopsia is a sign of a retinal problem. It is detected and monitored with an Amsler grid.

What causes metamorphopsia?

The retina is a thin layer of nerve tissue that acts like film inside a camera. The retina “takes a picture” and sends the image to the brain. The root cause of distortion in vision is a retina that is not smooth and flat against the eye wall. This distortion of the retina may be caused by many different conditions. Sometimes, problems under the retina cause fluid leakage resulting in metamorphopsia. Such conditions include macular degeneration, central serous retinopathy, histoplasmosis, high myopia, angioid streaks, and inflammation. In other situations, distortion may be caused by scar tissue under the retina from inflammation, trauma, bleeding, or chronic leakage of fluid under the retina. Distortion of the retina may also be caused by vitreomacular traction, macular hole, or macular pucker. The ophthalmologist (retinal specialist) will undertake examination and testing to determine the cause.

Is metamorphopsia an urgent situation?

Metamorphopsia may be an urgent situation if it is new in onset or has significantly increased recently. If the cause of distortion is inflammation or bleeding, prompt treatment is needed to prevent further loss of vision and worsening of symptoms. Longstanding distortion is less likely an emergency but merits an eye examination to determine the cause.

What is the treatment?

Metamorphopsia is a symptom rather than a diagnosis, so the treatment depends on the underlying cause of the distortion of vision. This is the reason why it is important to have an eye examination in order to determine the best course of action. Contact your eye doctor or retinal specialist if you have this important symptom.

By Scott E. Pautler, MD

Laser Surgery and the Retina

Posted on April 2, 2016 by Scott Pautler

There are many different kinds of lasers used to treat eye problems and many different ways lasers can be used to help the eye function. For example, the most common type of laser performed after cataract surgery is YAG capsulotomy. In this procedure the YAG laser is designed to open up a foggy window that develops behind the lens implant. It is a very brief, painless laser that usually gives a rapid improvement in vision. Other uses for lasers include treatment for glaucoma, droopy eyelids, and near-sightedness. Lasers with specific properties are chosen for a specific purpose. This blog discusses the photocoagulating laser used to treat retinal problems.

What is the retina?

The retina is a thin layer of delicate nerve tissue, which lines the inside wall of the eye like the film in a camera. In the eye, light is focused onto the retina, which “takes the picture” and sends the image to the brain. The retina has two main areas. The macula is the central area that gives you sharp, central vision and color vision. The peripheral retina is the part of the retina that gives you side vision and night vision.

What types of problems affect the retina?

The most common problems for which laser is used to treat the retina include diabetes, retinal vein occlusion, macular degeneration, retinal macroaneurysm, and retinal tears.

How does the laser help?

Most retinal lasers work by producing a carefully measured amount of heat to the retina in very small spot sizes. This heat may help to cauterize leaking blood vessels as in diabetes or macular degeneration. Alternatively, laser may simply seal down the retina to help keep it from detaching from the inside wall of the eye in cases of retinal tears and limited retinal detachments.

What are the risks of retinal laser treatment?

While laser is generally safe and effective, there is always some risk of adverse effects. Depending on the purpose of the laser, risks include blind spots in the vision that may be permanent, loss of central vision, loss of color vision, loss of night vision, and distortion of vision.

What is it like to experience a laser treatment?

Laser treatment is performed in the office in a matter of a several minutes. To avoid pain and discomfort, the ophthalmologist anesthetizes the eye with eye drops. An injection of anesthetic around the eye is rarely required. You sit in the examining chair with your chin in the chin-rest and forehead against the supporting bar. A contact lens is placed on the eye to hold the eyelids open. You may blink normally during the laser. Try not to squeeze your eyes together, because it may push the contact lens off the eye. You may be asked to look in a specific direction or follow a small light in order to keep the eye in position for treatment. It is important to follow instructions carefully to avoid side effects of laser treatment, which may include seeing blind spots in the vision afterwards. During treatment, it is normal to see bright flashes of light. Sometimes, you may feel a pulsing sensation with the flash. If it becomes painful, please notify the doctor. The treatment may last one to fifteen minutes depending on how much retinal damage is present.

What can you expect after a laser treatment?

Immediately after the contact lens is removed, your vision may be temporarily tinted red or blue. The vision is usually blurred for a few hours because of the dilating drops. Temporary blurring from laser sometimes lasts a week or more, but is usually mild. If your laser treatment was for macular degeneration, you may see a new permanent blind spot in the vision where abnormal blood vessels were cauterized. If you had laser for retinal break, it is normal for you to see floating specks in your vision and occasional flashes of light off to the side after laser. There are usually no restrictions to your activities. You may read, watch TV, stoop, bend, and lift objects just as before your treatment. No special eye drops are required after laser treatment, but be sure to continue any eye drops you were using before the treatment. You may use sunglasses for comfort, but they are not required. If you were told that laser is being used to improve your vision, it usually takes weeks or months to see the improvement. Sometimes, more than one treatment is required. Your doctor will give you an appointment to assess the results and determine whether any more treatment is needed.

What warning signs should I report after treatment?

Although it is normal to have blurred vision right after laser, the following symptoms are important to report to your Eye MD:

Pain
Severe loss of vision
Dark curtain or shadow across vision

By Scott E. Pautler, MD

Eylea (aflibercept) Therapy

Posted on March 31, 2013 by Scott Pautler

What is Eylea® therapy?

Eylea therapy is a treatment for diabetic retinopathy, retinal vein occlusion and wet-type macular degeneration. It involves repeated painless injections of medication into the eye to prevent blindness by stopping abnormally leaky blood vessels that occur in the eye conditions listed above. Other similar medications that are also used in these conditions include Avastin, Lucentis, Vabysmo, and Beovu.

How effective is Eylea therapy?

Eylea was proven in FDA-approved studies to be effective. In wet-type macular degeneration, monthly or bimonthly injections of Eylea over a one-year period offered a 95% chance of losing less than three lines on a standard eye chart. Eylea was also shown to be effective in the treatment of diabetic retinopathy and retinal vein occlusion to improve vision and prevent severe complications. The results with Eylea are similar to treatment with Lucentis, Avastin, and Beovu. Eylea therapy often starts with injections every 4-6 weeks. Afterwards, the injections may be given less frequently. In some cases the injections may be stopped, but continued monitoring is necessary. There are several medication options apart from Eylea. The best choice of medication may depend on the underlying diagnosis. For example, patient who have glaucoma may have better pressure control while under treatment with Eylea compared with other drugs.

What are the risks of Eylea therapy?

Severe complications are very rare, but risks of Eylea injection include bleeding, inflammation, infection, retinal detachment, cataract, glaucoma, and loss of vision/loss of the eye. The risk of retinal detachment is about 1 in 5,000 injections, but the results of surgical repair are poor. There may be an increased risk of difficultly with future cataract surgery estimated to be about 1% of cases. In these cases the fibers (zonules) that hold the cataract in place may become weaken from Eylea injection. When this occurs, special techniques are required to remove the cataract and place a lens implant. Rarely, two procedures are required to accomplish the task. Studies are ongoing to determine if there may be an increased risk of stroke with Eylea therapy. The possible risk of stroke may be related to the older age of patients with AMD. Further investigation will provide more information. Pregnancy should be avoided while on Eylea therapy.

intra-ocular injection — Intra-vitreal injection

What do I expect after an Eylea injection?

Be careful not to rub the eye after the injection because the eye may remain anesthetized for several hours. You may be given eye drops and instructions on how to use them. Physical activity is not limited after the injection. Tylenol or Ibuprofen may be used if there is discomfort after the injection, but severe pain should be reported to your doctor without delay. It is normal to experience a red area on the white of the eye, which disappears in one to two weeks. If you have any questions or concerns, please call the doctor’s office.

By Scott E. Pautler, MD

Myopia (near-sightedness)

Posted on February 6, 2013 by Scott Pautler

What is myopia?

A myopic eye is a near-sighted eye. Without glasses the vision is usually quite good at near, but blurred at distance. Myopia affects 25% of Americans and about 22% of the world population. High myopia (greater than -6.00 diopters) is less common, affecting about 2% of the world population and projected to rise to 10% by the year 2050.

What causes myopia?

Myopia is an inherited condition that usually develops in childhood or early adulthood. The eye, which is round like a ball at birth, becomes oval like an egg. The outer appearance of the eye is not usually changed, but the elongation of the eye changes the focus of the eye from distance to near. There is evidence to suggest that extensive near work (e.g. reading) may worsen myopia.

Why is it important to know about myopia?

Although most people with myopia do not develop complications, highly near-sighted people are at increased risk of losing vision from glaucoma, cataract, macular degeneration, and retinal detachment. The higher the degree of near-sightedness (myopia greater than -6.00 diopters), the greater the risk of loss of vision.

Glaucoma is a condition in which the pressure inside the eye damages nerve tissue that helps you see. This pressure usually causes no pain or discomfort and pressure measurements may be normal at times. Over months to years, the pressure slowly takes away the side vision. If undetected and untreated, it may cause total blindness. The best way to diagnose glaucoma is to have regular eye exams each year with pressure measurements. Treatment is effective in preventing vision loss through the use of eye drops. Sometimes, laser or surgery is needed.

Myopic macular degeneration is an uncommon cause of vision loss from severe myopia. The macula is the central part of the retina in the back of the eye. The retina is a thin layer of delicate nerve tissue that lines the inside wall of the eye like the film in a camera. In the eye, light is focused onto the retina, which “takes the picture” and sends the image to the brain. In very near-sighted eyes, the retina becomes stretched as the eye elongates. As a result, the central vision may become blurred or distorted even with proper glasses. Distortion is when straight lines look wavy or crooked. Blood vessels under the macula may bleed causing sudden blurring, blind spot, or distortion. Any of these symptoms should be reported to the eye doctor without delay, as early treatment with medicine injections and/or laser may prevent further loss of vision.

Retinal detachment is a separation of the retina from the inside wall of the eye. When the retina detaches, it is no longer in proper position inside the eye. Instead, it is like film that has unrolled inside a camera. When this occurs, a camera cannot take a picture. Similarly, when the retina detaches, the eye loses vision. Warning symptoms prior to retinal detachment may include new floaters or brief flashes of light in the side-vision. Later, a dark curtain or shadow slowly starts off to the side and takes away the vision as the retina detaches. Laser or surgery repairs most retinal detachments. It is important to diagnose a retinal detachment early in order to prevent permanent damage to the retina. Report any new floaters, flashes, or loss of side-vision to your eye doctor without delay.

How is myopia treated?

The standard treatment of myopia is to refocus the eye with eye glasses or contact lenses. LASIK and PRK surgery flatten the cornea to focus images onto the retina. Orthokeratology is a controversial method used to flatten the cornea with contacts lenses worn overnight. Lens implants are a more aggressive measure to focus light in highly near-sighted eyes. All of these methods of treatment are simply aimed to focus the vision. They are not designed to correct the underlying problem of elongation of the eye that leads to complications and loss of vision. Diluted atropine eye drops appear to reduce the progression of myopia in an effort to avoid complications of severe elongation of the eye.

Will LASIK surgery help prevent these complications of myopia?

Although LASIK surgery is very effective at flattening the cornea to help eliminate the need for glasses, it does not restore the spherical shape to the eye. Therefore, it is still necessary to be aware of the warning signs of possible complications from myopia.

What are the Do’s and Don’ts?

Using your eyes to read or work at a computer will not weaken them. Avoid intensive rubbing of your eyes. Remember to have your eyes examined once a year. Report the following symptoms to your eye doctor without delay:

¨ Blind spot or distortion of central vision

¨ New floaters or flashes of light

¨ Loss of side-vision

By Scott E. Pautler, MD

Blurred vision due to smudge on the contact lens?

What are the causes of a smudge on the contact lens?

What can be done to prevent smudges on the contact lens?

How do you remove a smudge from a contact lens?

Where do I go for urgent care?

Share this:

Like this:

What is lattice degeneration?

What causes lattice degeneration?

Why is it important to know about lattice degeneration?

Share this:

Like this:

Share this:

Like this:

What is the Amsler grid?

How is the Amsler grid used?

Share this:

Like this:

Share this:

Like this:

What is metamorphopsia?

What causes metamorphopsia?

Is metamorphopsia an urgent situation?

What is the treatment?

Share this:

Like this:

What is the retina?

What types of problems affect the retina?

How does the laser help?

What are the risks of retinal laser treatment?

What is it like to experience a laser treatment?

What can you expect after a laser treatment?

What warning signs should I report after treatment?

Share this:

Like this:

What is Eylea® therapy?

How effective is Eylea therapy?

What are the risks of Eylea therapy?

What do I expect after an Eylea injection?

Share this:

Like this:

What is myopia?

What causes myopia?

Why is it important to know about myopia?

How is myopia treated?

Will LASIK surgery help prevent these complications of myopia?

What are the Do’s and Don’ts?

Share this:

Like this: