Eye Care

[al24seven]

Hi,

I am quering if there is a way to improve the look of my eyes. The white area of my eyes are slighthy red. This is not the common red eye irritations or dry eyes.

This could be due to years of long hours, smoke, late nights and at times lack of sleep.

I have good eye sight and no problems with my eyes except on the above concern.

What should i do?

[John C Hagan III, MD, FACS, FAAO]

See an Eye MD have a comprehensive eye exam. Stop smoking, get more sleep and don't work so hard.

JCH III MD

[Natia1984]

Dear Doctor Hogan, please answer if you can, as I am facing panic attack every day due to my eye problems. 36 years, female, 7 years ago femto lasik, good results. No glasses. Only problem - floaters and peripheral retinal degeneration due to myopia. Tilted disc OD, no glaucoma. Problems began in August 2 months ago, with massive starburst, rays radiating from light sources, halos, ghosting,light sensitivity, burning eyes. I went to 3 different doctors, macula Oct, Vision field, IOP measure, Pachymetrie done. Same retinal degenerations peripheral, astigmatism,light crocodile shagreen on cornea. The doctors did not understand the reason of my problem. I am getting slightly mad, as going out and seeing lights make me scared. I seem them day and night. Please help me, what else can be done, I am afraid of the worse. Thank you!

[John C Hagan III, MD, FACS, FAAO]

Seeing patients today in clinic. Will answer this evening.

[Natia1984]

Thank you so much doctor, I will wait your answer. I will only add 1 detail, the reason is sure not the dry eye syndrome, after using Systane, Okuzel, Hylo Comod etc...no changes, same problem. I live in Vienna, I went to the doctors that are known to be good specialists. Still no clear reason.  Thank you!

[John C Hagan III, MD, FACS, FAAO]

Natia:  Your  description suggests a cornea problem, perhaps related to your previous surgery. You say you have "astigmatism" that brings light to focus in different parts of the retina and  could cause rays, starbursts.    I have several questions:
1. Were the 3 doctors you say Ophthalmologists? Were any of them corneal/refractive surgery specialists?
2. Did you have a refraction or glasses test and were you given a RX for glasses? If so have you tried glasses to see if it helps the problem.
3. Did you have a cornea topography test done. Irregular corneal astigmatism could cause the problem and glasses will not help that. It might require contact lens.
4. Did any of the "eye doctors" see any start of cataract? although you are young cataracts can develop in young people and your symptoms are common in early cataracts.

I will respond when you answer these questions.

[Natia1984]

Dear doctor Hagan, all 3 doctors were specialist in ophthalmology and optometry. Doctor number 1: makes control of my eyes last 10 years because of peripheral retinal degeneration. He said everything seems to be fine.
Doctro number 2-specialized on retina and Glaucoma. He said eyes look fine, tilted disc,no glaucoma.

Doctor number 3: specialist of retina and cornea, performs operations of glaucoma and cataract. None of them makes refractive surgery like femto lasik. All 3 made IOP measurements. It was between 14 and 22.

Now I tried to translate from German to English what the doctor number 3 wrote in my diagnoses and what he has done:
"Examination with the corneal microscope, determination of the astigmatism according to javal skiascopy, refractometer, fundus with enlarged pupil, macular retina examination with OCT, peripapillary determination of the nerve fiber layer with Oct.
Diagnosis: astigmatism, posterior vitreous detachment, peripheral retinal degeneration.

Papilla - both segments in the normal range, ISNT rule fulfilled. Optic disc RNFL: ISNT rule fulfilled. Values that are outside the norm correspond to the slightly atypical course of the blood vessels. Corneal thickness just below normal: 538/543 um

Lids: inconspicuous
Conjunctiva: irritation-free
Cornea clear, shiny, slight subepithelial crocodile shagreen.
Anterior chamber: no tyndal, no cells
Lens: clear
On the Foto of cornea exam I am not understanding much, there is a de screening of ceratoconus, aberration card rms o. 45um /rms o. 56 um. No idea what does this mean
Astigmatism:R: -sph:-0.75 cyl:+50 86°
L: Sph:-1,00 cyl+0.75 108°
SORRY for long text and thank you from all my heart for help!!!

[Natia1984]

I would add 1 thing to my long text above:none of them prescribed lens or glasses, they said there is no need. Dear doctor, the symptoms become unbearable day by day, the radiating thousands of rays from light sources make me mad. I have pain in my right eye all days. Traffic lights have huge halos around. I became depressive and all I want to do is to cry in my pillow, as I am afraid I can go blind. Can these symptoms be connected with some dangerous retinal disease? Is this possible that after 7 years of successful lasik I suddenly get problems due to it? What examinations would you advice me or which specialist? Can it be normal pressure glaucoma? I have feeling my eyes are not able to deal with lights any more

[John C Hagan III, MD, FACS, FAAO]

As I read it 2 of the "eye doctors" were Eye MD ophthalmologists and one was optometrist.  I think it unlikely you have anything serious going on.  However you have significant astigmatism and some myopia.  I would visit a cornea/refractive surgery/ intraocular lens specialist (yes a 4th physicians). I would take with you all the recent records from the three eye doctors that have examined you.  I would be sure you ask for and receive "a glasses refraction".  See what this specialist says, ask about a trial of glasses, perhaps with a tint or photochromic glasses that change to block our more light as things brighten.

This is the part of the exam that actually shows a glasses RX. I don't understand why they were not prescribed or at least allow you to look at the letters on the test chart with and without glasses in refractor to see if it helped.

Glasses RX (myopic astigmatism)
R: Sphere  -0.75 cylinder  +0.50 axis  86°
L: Sphere   -1.00 cylinder +0.75 axis   108°

[Natia1984]

Thank you so much doctor, that you took time to read about my problem and gave me advice. I will try to make appointment and go to cornea and refractive operation specialist. My last question to you, should I ask doctor to make ERG in order to be sure there is no retinal problem as I am afraid of this so much. Or the OCT was quite enough to be there are no problem with Retina? Thank you so much

[Natia1984]

To be sure I meant

[John C Hagan III, MD, FACS, FAAO]

The macula and nerve fiber layer OCT,  and if any doubt a fluorescein angiography are office tests, most places it is difficult to get ERG and usually not necessary. If that was a consideration the retina surgeon would have suggested it.  So If OCT was normal ERG not likely necessary.