Some of the common diseases which can put a patient at higher risk for NAAION are Diabetes mellitus, Rheumatoid Arthritis, Herpes Zoster, Anemia, Sickle Cell Trait, Syphilis, Behcet’s, Antiphospholipid Antibody Syndrome, and Polyarteritis nodosa. Other systemic conditions that may increase a patient’s risk for developing a NAAION are systemic low blood pressure, gastro-intestinal ulcers, severe high blood pressure, atherosclerosis, arteriosclerosis, internal carotid artery disease, cardiac valvular disease, vasculitis, collagen vascular diseases, defective cardiovascular autoregulation, migraine and other vasospastic diseases, massive or recurrent hemorrhages, type A personality, and sleep apnea.
Cryotherapy
Cryotherapy or the freezing of the retinal tissue has been used since the 1970s to treat ROP. Today, laser therapy has been shown to be as effective as cryotherapy, but with less systemic side effects. Both therapies work by destroying a small part of the retina, thus reducing the need for oxygen and abnormal blood vessel growth. It may also thin the retina allowing more oxygen to diffuse into the retina.
Medical Weight Loss
There are two different mechanisms responsible for causing the vision loss from AION. The first and most dangerous form is the “arteritic” form caused by a disease called Giant Cell Arteritis (GCA). This disease affects those over the age of 55 and is three times more common in women than men. About 80% of GCA patients report feeling ill for some time prior to the episode of vision loss. Common signs and symp tom s may include general fatigue, weight loss, fever, temple pain, neck pain, pain on chewing, scalp tenderness when combing their hair, headache, anemia and achy joints. Unfortunately, there is also a variant of GCA that produces none of the above mentioned symp tom s, and the patients generally are in good health. A very important visual symp tom in an arteritic AION is a transient blurring or loss of vision that precedes the permanent vision loss.
Primary Care
Dr. Prible also completed low vision, neuro-ophthalmic, retinal, and corneal training at the Indiana University Indianapolis Eye Care Center. She also trained in primary care and contact lenses at Marine Corps Base Quantico, providing care for active duty military personnel. She is available to provide low vision and primary eye care for infants to seniors, and specialized treatment and management of patients with ocular diseases such as glaucoma, dry eye disease, macular degeneration, and diabetic eye disease, as well as other inherited retinal disorders.
The delegation spent much of their time being introduced to the newest low vision systems plus new equipment available to help diagnose and treat eye diseases, including glaucoma and dry eyes. Drs. Richard Windsor and Craig Ford of the Eye Associates Group demonstrated the use of diagnostic equipment including the GDx scanning laser ophthalmoscope, automated visual field testing, corneal thickness testing as well as other technology used daily at their office.
Ophthalmology
The candidate must be examined by a doctor of optometry or ophthalmology and have an application for a bioptic driver’s license submitted by his low vision specialist following fitting and training with the bioptic. A rehabilitation driving evaluation must be performed by a BMV approved driving rehabilitation specialist. The bioptic application completed by the doctor and the results of the driving rehabilitation specialist’s evaluation are submitted to the Medical Advisory Committee for approval. If approved, a permit is issued which may only be used with a driving rehabilitation specialist. Thirty hours of behind-the-wheel driver’s training must be completed. If the driving rehabilitation specialist determines the patient has achieved mastery in driving with bioptics, the patient is referred for an extended behind-the-wheel evaluation by the Bureau of Motor Vehicles followed by an extended driving road test by the BMV.
Macular Degeneration
Overcoming macular degeneration and other central vision losses, including Histoplasmosis, Stargardt’s macular dystrophy, albinism, myopic macular degeneration, achromatopsia, cone dystrophies, etc. when watching television can be achieved in most cases. Below are several options to helping patients with vision loss to watch television.
Laser Eye Surgery
LASIK or laser refractive surgery has not been as effective in the highly myopic corrections, as it has in the lower ranges of myopia. An alternative for the profoundly myopic patients is a “Bear Claw” intraocular lens implant. It is affixed in the anterior chamber through a simple incision and can correct extreme amounts of myopia. In some cases, a clear lens extraction may be performed. The procedure is identical to a cataract extraction. The patient’s lens is removed, but an intraocular lens in not inserted. By removing the lens, about fifteen diopters of myopia is automatically corrected.
Cataracts
Early onset nystagmus often accompanies vision loss acquired at birth or soon after and may be one of the first signs that a child has a loss of vision. Studies suggest 1 in every 1000 children have nystagmus. In 80-90% of cases, it is a side effect of vision loss from eye diseases such as albinism, aniridia, optic nerve hypoplasia, achromatopsia congenital cataracts, coloboma or retinopathy of prematurity. This type of nystagmus is usually observed around the sixth to eighth week of life and is rarely seen before then. In about 10-20% of cases, it presents with mild vision loss not associated with other diagnosed ocular diseases. The discovery of nystagmus in a child is reason for an immediate examination!The typical nystagmus related to vision loss during childhood is a pendular nystagmus. The eyes rotate back and forth evenly, much like a pendulum. Patients with early onset nystagmus do not notice the movement of their vision when their eyes shake. Although nystagmus is associated with early vision loss, it may vary from stress, emotional status and direction of view. It is uncommon to permanently worsen over time. In fact, nystagmus often improves mildly from childhood to adulthood.Most cases of early onset nystagmus are associated with ocular disease many of which are inherited conditions. Genetic counseling can help the patient and family understand the odds of passing the condition to their children. Not all cases of early onset nystagmus are hereditary.
Eye Exam
Follow-up Eye Examinations: The State of Indiana requires an annual or biannual eye examination, depending on the eye problem, with report to the Medically Advisory Board. Failure to complete these checkup can result in cancelation of the license. Color Vision & Bioptic Driving Issues Color vision is important while driving. You must rely on your ability to see the red brake lights and the determine what the color of the traffic light is. You must be able to discern these color differences easily while driving. Many adaptations including special filters can be used while driving with a bioptic system. Contact lenses with special filters may also be used. Color vision problems should be addressed with your doctor before the behind-the-wheel training.
Double vision which is known as diplopia causes the patient to see two images of one object. Double vision can cause many problems in reading, driving and mobility. Double vision can be horizontal, vertical or diagonally. It is caused by an eye muscle deviation and can be from many different conditions. Eye muscle deviations can be mechanical issue with the innervation or muscles of the eyes. This can also be caused by traumatic brain injuries, stroke, neurological conditions, cancers, multiple sclerosis and systemic conditions like diabetes, thyroid problems, myasthenia gravis and others.
Diabetes is the leading cause of blindness in the United States for patients age 20 to 74. Diabetes can affect vision in a variety of ways. Vision loss occurs commonly from two major problems proliferative diabetic retinopathy and macular edema. Both are treatable with laser if detected early, but laser treatments may also create additional vision problems for the diabetic.
Several surgical procedures have been developed to reduce null positions and thus improve a patient’s cosmetic appearance. Botox, botulinum toxin, has been used to paralyze ocular muscles and thus reduce nystagmus. It has not become a practical treatment since the effect of this drug lasts only three to four months and requires injection into the ocular muscles under general anesthesia. Baclofen has also been used to lessen certain forms of nystagmus. Additionally, biofeedback has also been used to treat nystagmus.
Histoplasma capsulatum. This fungus is found throughout the world, but is endemic in the Mississippi and Ohio River Valley areas of the United States. This fungus is found in soil where bird and bat droppings have accumulated including chicken coops, caves and in old buildings. People who live or work on farms, landscapers, construction workers, and others who work outdoors can be exposed. The fungal spores become airborne when the soil is disrupted and are inhaled into the lungs. It usually produces only mild flu or cold like symptoms, so the person may be totally unaware that he or she has been exposed to Histoplasmosis.
It is initially diagnosed by a combination of patient behavior and several basic tests. The most important is the Behavioral In-attention Test (BIT). Visual neglect patients usually benefit from occupational therapy to learn to attend the affected side. Our experience has shown that many patients with visual neglect and homonymous hemianopsia together benefit also from optical aids like the Gottlieb Visual Field Awareness System.
The National Academy of Practice is composed of ten academies including Medicine, Optometry, Osteopathic Medicine, Dentistry, Psychology, Pharmacy, Nursing, Veterinary Medicine, Social Work and Podiatric Medicine.