Healthy Eyes 101 Steven Suh, MD

Inflammation can occur in any part of the body and the eye is no exception. In this episode, we discuss uveitis and scleritis, two specific inflammatory conditions of the eye. 
Uveitis, one of the major causes of vision loss, is an intraocular inflammatory condition that can be broken up into three categories: infectious, non-infectious, and traumatic. It can further be classified by where the inflammation occurs in the eye: anterior (front part - iris), intermediate (middle part – ciliary body), posterior (back part – choroid), and panuveitis (entire eye).
Infectious uveitis can be caused by bacteria, viruses, fungi, and parasites in the eye or by a systemic infection like herpes, tuberculosis, syphilis, toxoplasmosis, or Lyme disease. Noninfectious uveitis, the most common type, can be caused by autoimmune conditions like rheumatoid arthritis, lupus, sarcoidosis, Reiter syndrome, ankylosing spondylitis, Behcet’s disease, psoriatic arthritis, and inflammatory bowel disease. The most common reason for uveitis is called idiopathic – no reason can be found. 
Symptoms of uveitis will vary according to its location in the eye. Anterior uveitis, also called iritis, can cause ocular pain, photophobia (light sensitivity), red eye, and decreased vision. Uveitis in the back of the eye mainly causes vision loss but usually does not cause pain.
After a thorough eye examination, a lab work-up should be performed especially after the second recurrent episode or if the first episode affects both eyes. Ruling out an infectious cause can be done in the office. Bloodwork to rule out some of the autoimmune diseases is the next step. Sometimes a chest x-ray may be necessary to help rule out TB or sarcoidosis.
Treatment of infectious uveitis is directed at the pathogen causing the infection. This may involve a combination of topical antibiotics or anti-virals and systemic medications. Steroids are the mainstay of treatment of non-infectious uveitis. Most anterior uveitis is treatable with topical steroid eye drops. Intermediate and posterior uveitis is mainly treated with oral steroids and steroid injections around or in the eye. For patients with chronic or recurrent uveitis, immunomodulatory therapies may be necessary. Some of these medications may include methotrexate, Cellsept, Humira, and Remicade.
Scleritis is an inflammatory condition of the outer coating of the eye (sclera). Symptoms include severe eye pain, red eye, and sometimes a decrease in vision. If the back part of the eyewall is inflamed, the eye may not appear red. An ultrasound of the eye may be necessary to properly diagnose this condition. Some of the causes of scleritis include rheumatoid arthritis, HLA-B27-related diseases, and gout. Oral and injectable steroids are the primary treatments for this condition. Sometimes immunomodulatory therapies are also needed to control the inflammation.
 Here are some more links to learn more about inflammation in the eye.
Uveitis.org
Preventblindness.org/uveitis/
Scleritis

 To find out more about Dr. Lou Chorich and his practice, go to Midwest Retina’s website.
This is intended for informational and educational purposes only, and nothing in this podcast/blog is to be considered as recommending or rendering medical advice or treatment to a specific patient. Please consult your eye care specialist for proper diagnosis and treatment of any eye conditions that you may have.

Billions of people around the world can see more clearly because of eyeglasses. To help us learn about glasses and the latest in lens technology, Dr. Suh interviews Kara Jones, a licensed optician with Comprehensive EyeCare.
We discuss the importance of the measurements performed on your eyes. The various types of lenses can be confusing – single vision, bifocals, trifocals, progressive, no-line bifocals, etc. Lens materials are improving and are enabling people who have higher prescriptions to wear thinner lenses. Digital lenses are all the rage in the optical world and allow people to see clearer than before. We also discuss polarized lenses in sunglasses, blue-filtering lenses, Transition lenses, and anti-glare coatings. Many people who purchase their glasses online can end up with buyer’s remorse. Find out the advantages of ordering your glasses from an optical shop.
For more information about choosing the right frames and lens materials, please go to this website from the American Academy of Ophthalmology.
To find out more about Comprehensive EyeCare of Central Ohio, go to the practice’s website or Facebook page.
This is intended for informational and educational purposes only, and nothing in this podcast/blog is to be considered as recommending or rendering medical advice or treatment to a specific patient. Please consult your eye care specialist for proper diagnosis and treatment of any eye conditions that you may have.

Side effects from medications are common. What may not be common knowledge is that there are systemic medications that can affect the eyes. For example, anti-hypertensive medications and some psychiatric medications are known to exacerbate dry eyes. Some oral medications can also adversely affect the retina, the delicate tissue inside the eye that receives the visual information.  
One of the most commonly used medications that can affect the retina is hydroxychloroquine (Plaquenil), a medication used to treat rheumatoid arthritis and systemic lupus erythematosus. Its cousin, chloroquine, an anti-malarial medication, can also have the same effect on the retina. Use of hydroxychloroquine after years may cause accumulation of the medication in the RPE (retinal pigment epithelium), the layer underneath the retina. It is most likely to accumulate in the macula, the part of the retina that is responsible for central vision. Thus, this can cause significant loss of distance and reading vision. 
Risk factors for retinal toxicity from hydroxychloroquine or chloroquine
Daily dosage greater than 400 mg per day or total cumulative dosage of over 1,000 grams.Medication use for over 5 yearsKidney or liver diseaseHistory of macular disease such as macular degenerationAge greater than 60 yearsPatients who take these medications should have an annual eye examination that may include OCT (ocular coherence tomography), visual field testing, color vision testing, and possibly an ERG (electroretinogram). Many times, early changes can be detected by the examination and ancillary testing even before the patient has symptoms. There is no treatment for this other than to stop the medication immediately. The blind spots that can occur are usually irreversible.
Pentosan polysulfate (Elmiron) is a medication used for interstitial cystitis, a condition that can cause bladder pressure and pain. This drug can also affect the central macula and mimic macular degeneration. The risk factors for these changes are similar to hydroxychloroquine. There is no treatment other than to stop taking the medication. 
 
Here are some links to learn more about how these medications can affect the retina.
https://www.aao.org/eyenet/article/hydroxychloroquine-induced-retinal-toxicity
https://www.aao.org/eyenet/article/pentosan-polysulfate-maculopathy
To find out more about Dr. Christiane Hunt and her practice, go to her practice’s website or Facebook page.
 
I am pleased to announce that in the past few weeks, Healthy Eyes 101 was ranked as the number 6 eye health podcast by Feedspot. Without all of you devoted listeners, this honor would not have been possible - so thank you for supporting this podcast!
 
This is intended for informational and educational purposes only, and nothing in this podcast/blog is to be considered as recommending or rendering medical advice or treatment to a specific patient. Please consult your eye care specialist for proper diagnosis and treatment of any eye conditions that you may have.

Angle-closure, or narrow-angle, glaucoma is the other major type of glaucoma that can afflict patients. Fluid inside of the eye drains in the trabecular meshwork, the space between the cornea and the iris. When this space, or angle, narrows down, the trabecular meshwork can get blocked, which can cause the eye pressure to rise and increase the risk of glaucoma. In this episode, Dr. Wendy Kirkland explains all aspects of angle-closure glaucoma.
There are several categories for this type of angle configuration in the eye.
Primary angle-closure suspect  Primary angle-closure  Primary angle-closure glaucoma Acute angle-closure crisisThe risk factors for angle-closure include 
Asian descentHyperopia (farsightedness)Older ageFemale genderShort axial length (length of the eyeball)The size, shape, or position of the crystalline lensLike primary open-angle glaucoma, many patients with angle-closure have no symptoms so this is why it is important to have your eyes examined on a regular basis. The eye doctor can perform a gonioscopy exam to diagnose whether you need to have treatment to correct this condition. 
The signs and symptoms of an acute angle-closure crisis or attack include blurred vision, slightly dilated pupil, a red eye, extreme eye pain, headache, and nausea and vomiting.
Plateau iris and secondary causes of angle-closure need to be ruled out to administer the proper treatment. 
Treatments include a YAG laser peripheral iridotomy or cataract surgery.
Here is another site where you can learn more about narrow-angle glaucoma. 
To find out more about Dr. Wendy Kirkland and her practice, go to Arena Eye Surgeons' practice website.


This is intended for informational and educational purposes only, and nothing in this podcast/blog is to be considered as recommending or rendering medical advice or treatment to a specific patient. Please consult your eye care specialist for proper diagnosis and treatment of any eye conditions that you may have.

Ophthalmic, or visual, migraines are a common reason for urgent visits to the eye doctor. In this episode, Dr. Suh interviews Dr. Vin Hoye, a neuro-ophthalmologist, about this condition. He will discuss the various images that people can see when they are experiencing the migraine aura, which may or may not be followed by the classic headache. There are certain foods and risk factors that may trigger migraines. We will discuss the other diagnoses that may mimic ophthalmic migraines and whether or not there are treatments for the visual symptoms.                                                                                                                                                                                          
Here are some extra links about ophthalmic migraines.
https://www.mayoclinic.org/diseases-conditions/migraine-headache/expert-answers/ocular-migraine/faq-20058113
https://www.brighamandwomens.org/neurology/neuro-ophthalmology/visual-migraine

Here is a video simulation of an ocular migraine.

To find out more about Dr. Vin Hoye, go to his practice’s website.  


This is intended for informational and educational purposes only, and nothing in this podcast/blog is to be considered as recommending or rendering medical advice or treatment to a specific patient. Please consult your eye care specialist for proper diagnosis and treatment of any eye conditions that you may have.
 

The treatment of glaucoma, one of the leading causes of blindness in the world, involves lowering the eye pressure. In previous episodes, we discussed glaucoma medications and minimally invasive glaucoma surgeries, or MIGS. Dr. Megan Chambers, a glaucoma specialist from Ophthalmic Surgeons & Consultants of Ohio, will be discussing the use of lasers and more traditional surgeries to help lower eye pressure in the quest to halt the progression of glaucoma.
Selective laser trabeculoplasty (SLT) has gained in popularity over argon laser trabeculoplasty (ALT). SLT applies laser energy to create changes in the trabecular meshwork (drainage tissue) to allow fluid to filter out easier. This relatively quick, in-office procedure may take up to 3 months for the pressure-lowering effect to occur. It has about an 80% success rate and can be used as a first-line treatment or as a replacement for glaucoma eye drops.
Trabeculectomy is a surgical procedure performed in the operating room that is designed to lower intraocular pressure when medications and laser have failed to lower the pressure enough. A small flap is made in the eye wall near the cornea, and a small hole is made underneath this flap to let the eye fluid filter out slowly. The conjunctival tissue above the flap forms a “blister” called a bleb. Many times, patients will be able to stop their glaucoma drops after a trabeculectomy. 
Glaucoma drainage implants, or tube shunts, are devices that are placed underneath the conjunctiva. The tube is placed into the eye and drains fluid into the plate portion of the implant. Usually this procedure is done after a trabeculectomy has failed.
Preserflo, formerly known as InnFocus microshunt, is undergoing FDA trials as a possible alternative to these traditional surgeries but with fewer side effects and complications. 
Here is another great resource on glaucoma treatments. 
To find out more about Dr. Megan Chambers and her practice, go to Ophthalmic Surgeons & Consultants of Ohio’s practice website.
This is intended for informational and educational purposes only, and nothing in this podcast/blog is to be considered as recommending or rendering medical advice or treatment to a specific patient. Please consult your eye care specialist for proper diagnosis and treatment of any eye conditions that you may have.