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Corneal Abrasions

Created on: Thursday, May 23, 2013
See Clearly Vision

Tags: cornea, abrasion, eye, epithelium, pain, scratched, ophthalmologist, dr. khoa hoang, see clearly

Author: Khoa D. Hoang, M.D., See Clearly Vision

The cornea is the clear structure in the front of the eye. It is very sensitive to light and touch due to the large number of nerves innervating the structure. The cornea has five anatomic layers, with the outermost layer being the epithelium. Breakdown of the epithelial layer of the cornea will leave the nerve-endings exposed; this is called an abrasion. Ultimately, this will cause the patient excruciating pain. Other symptoms will include a red eye, decreased vision, and light sensitivity. 

One way corneal abrasions can happen is when the cornea is scratched. A scratched cornea can be caused by a traumatic event, surgically induced, or inherent weakness of the cornea. We’ve seen many patients coming into our clinics because they were inadvertently scratched in their eye while playing with small children. We’ve also seen patients coming out of general surgery with excruciating pain in their eye from a scratched cornea. Lastly, we have patients that don’t know how they scratched their cornea; they simply woke up from a long night of sleep and their eye was hurting. Regardless of how the cornea is scratched, the main thing is to prevent the eye from becoming infected and decreasing patient discomfort. A corneal infection could lead to the development of serious vision loss, so it is in the patient’s best interest to be evaluated and treated by an eye care professional as soon as possible. 

What Is Migraine?

Created on: Thursday, May 09, 2013
See Clearly Vision

Tags: mirgraine, neurologic, headache, throbbing, sensory, eye, temporal, flashing lights, see clearly

Author: Robert P. Friedlaender, M.D., See Clearly Vision

Migraine is a neurologic syndrome (a group of symptoms that characteristically occur together) usually associated with moderate to severe headache, and recurrent episodes that last 4-72 hours. There is usually a throbbing headache on one side of the head (unilateral) that can be accompanied by sensory changes, gastrointestinal symptoms, or mood disturbances. The symptoms are frequently the same for repeat attacks, or stereotyped.
 
Symptoms
Five stages of migraine are generally identified:
1.) Prodrome-premonitory symptoms present 24 to 72 hours before other symptoms
2.) Aura-transient neurologic symptoms that are usually visual in nature
3.) Headache
4.) Resolution
5.) Recovery
 
The headache is typically one sided and is described as a throbbing or boring head pain. It typically occurs behind one eye, both eyes, or across the entire front of head. It will less commonly occur on the side of the head in the temporal region. Most unilateral migraine headaches change from one side to the other side at some point. Recurrent headaches always on the same side or at the same place often have another cause and less likely to be caused by a migraine; these should be thoroughly investigated to determine their cause.  

An aura is a visual disturbance that is often described by patients to appear as flashing lights, zigzag lights, blurred vision, or a visual field defect in which areas of vision are missing. Areas of missing vision are known as scotomas. The aura may last from 15 to 50 minutes, and is usually the preceding event to the migraine headache. It should be noted that a headache does not have to occur for the condition to qualify as migraine.
 
The area of visual loss typically marches or gradually spreads across the visual field, and has what’s known as a build-up or increase over 15 to 20 minutes. Scotomas are frequently, but not always, surrounded by sparkles or flickering lights called scintallations. Other visual disturbances have been reported that resemble heat waves or water running down glass.
 
Migraine accompaniments can include nausea, vomiting, mood changes, fatigue, sensitivity to light, or sensitivity to noise. There can also be temporary neurologic deficits such as local paralysis, numbness, or a tingling sensation, just to name a few. 
 

UV Protection

Created on: Wednesday, May 01, 2013
See Clearly Vision

Tags: uv protection, exposure, sun, rays, dr. christine wisecarver, damaging, eyelid, surface, sunglasses

Author: Christine Burris Wisecarver, O.D., See Clearly Vision

As the sun comes out and the rays intensify, it is important to remember how damaging UV exposure can be to the body.
 
The skin of the eyelids is thin and delicate and very susceptible to damage from UV rays. Any abnormal growth or bump on the eyelid should be carefully monitored, evaluated, and often times biopsied. Ninety percent of eyelid tumors are basal cell carcinomas (BCC) that present as pearly nodules that may break down and ulcerate. Although BCC’s are localized and don’t typically spread to the rest of the body, they can be very invasive and destructive to the local tissue. Squamous cell carcinoma and melanoma are much less common on the eyelid or ocular surface, but are significantly more dangerous. Again, any patient experiencing a new growth on the eye should be evaluated by an eye care practitioner.
 
Pingueculae and Pterygia are calluses that grow on the surface of the eye. These calluses are caused by environmental factors such as dryness, wind, and UV exposure. When these calluses become inflamed, the result is redness, irritation, and more dryness. UV protection and lubrication are critical in preventing inflammation and growth of pingueculae and pterygia.
  
The natural lens is one of the greatest UV absorbing tissues of the eye. UV absorption by the lens prevents harmful rays from reaching the retina. Over time, however, these UV rays alter the protein composition of the lens resulting in cataracts.
 
To protect the eyelids, ocular surface, and lens from UV damage, it is imperative that patients wear UV protection while outdoors. While tint intensity and polarization may aid in visual comfort, they do nothing to protect against UV exposure. Sunglasses should block 100% of UVA and UVB rays to have adequate protection and health benefits.
 

Itchy Eyes

Created on: Thursday, April 18, 2013
See Clearly Vision

Tags: allergy season, itchy, eyes, watery, swollen, allergens, environment, dr. wisecarver, see clearly vision

Author:  Christine Burris Wisecarver, O.D., See Clearly Vision

It’s that time of year again! Allergy season is underway, and many patients are starting to come in complaining of itchy, red, watery eyes, swollen lids, and nasal congestion.
 
Allergies are an over-response of patient’s immune system to what should be a benign aspect in the environment. Treatment of allergies includes: avoidance; washing hands, hair, and clothes that may have allergens; artificial tears or saline nasal spray to flush allergens; antihistamines; mast cell stabilizers; and steroids. If you are suffering from ocular allergies, make an appointment today. It is always easier to prevent an allergy than try to treat it when it is out of control.
 
Drs. Wisecarver and Rajpal recently published an article on Allergic Conjunctivitis that was the featured Cover Story for the March 2013 issue of Advanced Ocular Care. For more information on allergies as they pertain to the eye, you may click here to read their article.

Leading the Way

Created on: Friday, April 12, 2013
See Clearly Vision

Tags: see clearly vision, dr. rajesh rajpal, cataract, corneal, refractive surgery, lotemax, fda, study

See Clearly Vision is owned and directed by Rajesh K. Rajpal, M.D.  He is a leader in the cataract, corneal, and refractive surgery communities, speaking to his colleagues at conventions and meetings all over the world.  He is also a participating physician in many FDA studies.  Before a drug can be marketed and sold in the U.S., the FDA must assess its safety and effectiveness for those that will be using the drug.   

See Clearly Vision was chosen to be an FDA Study Site to determine whether Lotemax Gel 0.5% would be safe to use with patients recovering from cataract removal surgery.  As with any surgery, there will be inflammation throughout the surgical eye and some general ocular discomfort.  These symptoms are remedied by the use of steroid drops. In the past, surgeons have used several types of steroid drops to increase patient comfort and decrease the inflammation; they have proven very effective.  However, some of those drops had side effects that were not pleasing to the surgeon.  Bausch & Lomb derived a new formulation and Dr. Rajpal was selected to be the lead investigator in the FDA study.  Ultimately, the drug was FDA approved as being safe and effective in post-operative cataract patients. 
To read Dr. Rajpal’s article recently published in the Journal of Cataract and Refractive Surgery, click on the following link: glacialblog.com/userfiles/67/Rajpal 2013 JCRS 39_158-67.pdf

Eye Education

Created on: Tuesday, April 02, 2013
See Clearly Vision

Tags: see clearly vision, dr. dawn williams, optometrist, cornea, cataracts, laser vision, education, eye

Author: Dawn L. Williams, O.D., See Clearly Vision

See Clearly Vision is a group of eye care professionals that specializes in diseases of the cornea, cataracts, and laser vision correction. Our doctors are extensively trained and knowledgeable about the most up-to-date ophthalmologic surgical techniques, drug therapies, and contact lens options available. We take great pride in the patient care that we provide daily. We are also very proud to be associated with various educational institutions throughout the mid-Atlantic region, helping prepare medical students with interests in ophthalmology, optometry students, and ophthalmic technicians for their forthcoming careers. 
Not only are we proud to educate future eye care professionals, we are always very happy to educate the general public. There are numerous aspects to the eye and eye care, some of which can be quite unclear. To that end, Dr. Williams speaks at various events focused on eye care. Recently, she and Dr. Rajesh Rajpal, M.D. spoke to the Rotary Club of McLean about laser vision correction and cataracts. Additionally, Dr. Williams participates in Navy Federal Credit Union’s annual Health Fair where participants are screened for general eye issues. In the near future, she will be speaking to a group of employees with Freddie Mac about how hypertension and diabetes can affect vision. Her goal is to help shed light on many issues facing various people throughout the community. 
If your organization is interested in having Dr. Williams speak, please call the office at 703-827-5454.

Contact Lenses for Pre-teens

Created on: Thursday, March 21, 2013
See Clearly Vision

Tags: contact lenses, pre teens, teenagers, glasses, see clearly, vision, responsibility, appearance,

Author: Sushil K. Jain, O.D., See Clearly Vision

Many pre-teens and teenagers don't want to wear glasses for various and assorted reasons. Contact lenses can be a healthy option for pre-teens in order to build their self-esteem, and in some cases see more clearly.
Before prescribing contact lenses to a teenager, the child’s ability to wear and take care of them must be assessed.  While it is necessary and safe for many infants & toddlers with severe refractive errors wear contacts, some teenagers shouldn't wear them due to a lack of responsibility. In other words, each case is different and communication between eye care provider and parent is paramount.  The following information will help you decide whether contact lenses are a good idea for your child.
The appearance of a teen and his self-esteem are closely related. To that end, many pre-teens would rather wear contacts than glasses.  If they don't like the way they look in glasses, it can affect their personality, their performance in school, and overall social interactions. The use of contact lenses has been shown to increase a child’s esteem and many shy children will actually overcome their shy behavior.
Children that wear glasses sometimes have a hard time participating in sports activities. This is because they aren’t comfortable playing with glasses, and can’t see when they take them off. An alternative is to wear sports goggles. Even if your child is wearing high safety standard eyeglass lenses, if the frame breaks, an eye injury can occur. These safety goggles can decrease peripheral vision because they are customarily thick and bulky on the sides. With contact lenses, he or she will gain greater peripheral vision which can enhance performance in their sport. They can choose to wear protective goggles, but wearing them is not required as it was before. 
There are a few different types of contact lenses. You will find that some are more cost-effective than others. Monthly replacement lenses are slightly less expensive than two week replacement, which is slightly less expensive than daily disposable lenses.  For those patients that only use lenses occasionally, daily disposables are the best and most cost-effective.  Many teenagers are prescribed daily lenses as they require less time for cleaning which can make them safer. 
Unlike soft contacts, gas permeable contact lenses are made of a firm plastic material that retains its shape. This means they're easy to clean without tearing or scratching, and they generally last longer than soft contacts or glasses.  These lenses are often used in special circumstances and are not standard in most eye care professional’s offices. However, they do benefit those needing them and provide very clear vision. They can be uncomfortable in the beginning and may take some time to get used to.  
Most eye care professionals report great results with kids and contact lenses. They find that kids of all ages usually take contact lens wear seriously and are more likely to take care of them, even better than some adults.  Most eye doctors will not prescribe contact lenses for pre-teens if it’s determined they aren't ready for them, or who don't have a good reason to wear them. If a child doesn't take good care of them, the eye doctor will no longer prescribe contact lenses for the child, understanding the maintaining good ocular health is of the utmost importance.

TiE DC spotlights Dr. Rajesh Rajpal

Created on: Thursday, March 14, 2013
See Clearly Vision

Tags: dr. rajesh rajpal, see clearly vision, ophthalmologist, cornea specialist, cornea consultants,

TiE DC, The Indus Entrepreneurs, was founded in Silicon Valley in 1992 by a group of successful entrepreneurs, corporate executives, and senior professionals with roots in the Indus region. There are currently over 13,000 members, which includes 61 chapters across 17 countries. The mission of the organization is to foster entrepreneurship globally through mentoring, networking, and education.

To read more about Dr. Rajpal, please click the link below:

dc.tie.org/article/16/tie-dc-charter-member-spotlight-rajesh-rajpal-seeclearly-vision


Styes

Created on: Thursday, March 14, 2013
See Clearly Vision

Tags: dr. john yassin, stye, bump, infection, gland, eyelid, chalazion, hordeolum,

Author: John G. Yassin, M.D., See Clearly Vision

A stye is an inflammatory “bump” in the lid. There are two varieties. When the infection is in a hair follicle of the skin of the lid, it is termed a hordeolum. If it is in the gland which is in the posterior aspect of the lid, it is called a chalazion.
When the area is acutely infected it is termed a hordeolum. Patients with the infection will report pain or tenderness in that localized area. The treatment consists of hot compresses, antibiotic drops and sometimes antibiotic pills. Antibiotic therapy will eliminate the infection, but the bump may persist. 
Chalazia are benign areas of inflammation that result in a bump on the eyelid. The area typically does not hurt; it simply causes a disturbance in appearance or vision. Antibiotics are not needed as the eyelid is not infected. The use of warm compresses can cause the chalazion to decrease in size. The use of steroid creams and ointments may prove helpful as well. 
If a residual bump persists and is causing problems with vision or is a cosmetic concern, it will need to be surgically excised. Fortunately, this is usually done with an incision on the inside of the lid so there is no visually obvious scar or cosmetic defect. We do this minor surgery in our well-equipped offices on a routine basis. If this issue is affecting you, please call our office to schedule an appointment. 

 

 
 

Pinguecula and Pterygium

Created on: Thursday, March 07, 2013
See Clearly Vision

Tags: dr. khoa hoang, pinguecula, pterygium, yellow, white, growth, nodule, ocular discomfort, sunlight

Author: Khoa D. Hoang, M.D., See Clearly Vision

Pinguecula and pterygium are yellowish or white growths that appear on the front of the eyes, usually in the nasal portion. They are non-cancerous and common in their occurrences. The presence of these nodular growths may cause some ocular discomfort and changes in vision. 
 
A pinguecula is a small nodule that grows on the white part of the eye, known as the sclera. The cause of the nodule is not known, but long-term exposure to sunlight is thought to be a contributing factor. They are present in many people, but most are unaware because they have no symptoms. Those that are symptomatic will complain of feeling a small particle in their eye or ocular dryness. Often times, the use of lubricating drops will remedy the issue. Pingueculae will likely remain stable and cause very few symptoms. Conversely, they can progress in size and become what is known as a pteyrgium.   
 
A pterygium is a wing-shaped growth that has moved from the white part of the eye (sclera) onto the clear portion of the eye, known as the cornea. It will also have a nodular appearance, and will be white. The pterygium can cause the area surrounding it to become red and irritated. These patients may also complain of the eye feeling dry, more so than with a pinguecula. In some cases, the growth will progress and grow into the central visual axis near the pupil. This will cause a decrease in clear vision. In order to relieve the dryness, moisturizing drops may provide relief of symptoms. However, the growth may be large enough that lubricating drops don’t help enough. When vision is impaired and ocular discomfort persists, surgical removal may be the next step in treatment. Visit your nearby eye care provider for a complete evaluation. 
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