Tag: Care

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Two Patients With Macular Degeneration Get Artificial Retinas

LYON, France — A 72-year-old woman with dry age-related macular degeneration (AMD) was the first patient to receive an artificial retina implant as part of the multicenter PRIMAvera clinical trial, which is looking at the safety and efficacy of the PRIMA system.

“Her vision was severely impaired by this condition. We used the ETDRS chart to assess her visual acuity, as this is the current method in ophthalmology. She was able to read only nine letters,” said Laurent Kodjikian, MD, PhD, from Hôpital de la Croix-Rousse in Lyon, who is a former president of the French Society of Ophthalmology. To put that in perspective, a person with normal vision can make out 85 letters, he explained.

“The goal is to get her reading another ten letters,” he told Medscape Medical News.

The hospital where Kodjikian works is one of six centers in France selected to take part in the ongoing AMD clinical trial; other study sites are in Germany, Italy, the Netherlands, and Spain. The 38 study participants will be followed for 12 months after implantation to assess visual acuity and adverse events, and outcomes will be monitored for 3 years. Investigators hope that the findings will lead to the device receiving authorization to enter the market.

The PRIMA artificial retina system has three elements: a tiny wireless retinal implant; a pair of glasses with a camera and digital projector; and a portable processor connected to the projector. The camera captures visual scenes from the surrounding environment. The processor uses algorithms to process and simplify the images, which are then sent back to the glasses. The digital projector uses pulses of infrared light to project the processed images onto the retinal implant’s photovoltaic receptors. These receptors then convert the optical information into electrical stimulation, which excites the nerve cells of the inner retina, allowing them take in the information and transmit it, via the optic nerve, to the brain. This then induces visual perception.

A Delicate Operation

To implant the chip, Kodjikian made a rather large incision — 3.5 mm — and then peeled off the retina, all while looking through a surgical microscope.

“It’s easy to peel off the retina in a healthy eye. However, the procedure becomes more difficult in an eye affected by dry AMD, where the retina tissue is not only very thin and firmly attached to the back wall of the eye, but is also very fragile. A lot can go wrong during this step, so we have to really take our time,” he said. “You can’t go too deep, and if you go too close to the surface, you risk perforating the retina. Like walking on a very thin tightrope, there’s danger all around, and very little room for error.”

After the chip was inserted under the retina, Kodjikian put the retina tissue back into place. “This was the first time I’d ever done this kind of procedure, and it was quite a challenge,” he told Medscape.

The operation took 2.5 hours, which is much less time than the 4 to 5 hours estimated by the manufacturer.

The patient will undergo rehabilitation for 12 months to help her adapt to the system. “Our hope is that this patient will be able to see better with the implant. She probably won’t get to the point of being able to drive a car. And while reading novels in small print may not be possible, it’s quite likely that she’ll be able to read large-print editions,” Kodjikian explained.

Upon activation of the retinal prosthetic, the patient experienced visual impressions that she couldn’t see before the surgery. And 1 month after the procedure, things seem to be on track, according to a press release. “The postoperative result is excellent. There are no complications, the chip is perfectly in place and the vision has not been degraded by the operation. She should now start to improve thanks to rehabilitation,” said Kodjikian.

“Of the various artificial retina systems out there, this one is the most sophisticated because it has the most pixels. The technology will certainly continue to advance. But for the time being, the clinical study should allow us to show that it does work,” he concluded.

In December 2021, he implanted an artificial retina in a second patient, and it took him 50 minutes less than the first one.

This article originally appeared in the French edition of Medscape.

The authors have disclosed no relevant financial relationships.

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Eye care and safety

Your eyes are an important part of your health. Most people rely on their eyes to see and make sense of the world around them. But some eye diseases can lead to vision loss, so it is important to identify and treat eye diseases as early as possible. You should get your eyes checked as often as your health care provider recommends it, or if you have any new vision problems. And just as it is important to keep your body healthy, you also need to keep your eyes healthy.

Eye Care Tips

There are things you can do to help keep your eyes healthy and make sure you are seeing your best:

  • Eat a healthy, balanced diet. Your diet should include plenty or fruits and vegetables, especially deep yellow and green leafy vegetables. Eating fish high in omega-3 fatty acids, such as salmon, tuna, and halibut can also help your eyes.
  • Maintain a healthy weight. Being overweight or having obesity increases your risk of developing diabetes. Having diabetes puts you at higher risk of getting diabetic retinopathy or glaucoma.
  • Get regular exercise. Exercise may help to prevent or control diabetes, high blood pressure, and high cholesterol. These diseases can lead to some eye or vision problems. So if you exercise regularly, you can lower your risk of getting these eye and vision problems.
  • Wear sunglasses. Sun exposure can damage your eyes and raise your risk of cataracts and age-related macular degeneration. Protect your eyes by using sunglasses that block out 99 to 100% of both UV-A and UV-B radiation.
  • Wear protective eye wear. To prevent eye injuries, you need eye protection when playing certain sports, working in jobs such as factory work and construction, and doing repairs or projects in your home.
  • Avoid smoking. Smoking increases the risk of developing age-related eye diseases such as macular degeneration and cataracts and can damage the optic nerve.
  • Know your family medical history. Some eye diseases are inherited, so it is important to find out whether anyone in your family has had them. This can help you determine if you are at higher risk of developing an eye disease.
  • Know your other risk factors. As you get older, you are at higher risk of developing age-related eye diseases and conditions. It is important to know you risk factors because you may be able to lower your risk by changing some behaviors.
  • If you wear contacts, take steps to prevent eye infections. Wash your hands well before you put in or take out your contact lenses. Also follow the instructions on how to properly clean them, and replace them when needed.
  • Give your eyes a rest. If you spend a lot of time using a computer, you can forget to blink your eyes and your eyes can get tired. To reduce eyestrain, try the 20-20-20 rule: Every 20 minutes, look away about 20 feet in front of you for 20 seconds.

Eye Tests and Exams

Everyone needs to have their eyesight tested to check for vision and eye problems. Children usually have vision screening in school or at their health care provider’s office during a checkup. Adults may also get vision screenings during their checkups. But many adults need more than a vision screening. They need a comprehensive dilated eye exam.

Getting comprehensive dilated eye exams is especially important because some eye diseases may not have warning signs. The exams are the only way to detect these diseases in their early stages, when they are easier to treat.

The exam includes several tests:

  • A visual field test to measure your side (peripheral) vision. A loss of peripheral vision may be a sign of glaucoma.
  • A visual acuity test, where you read an eye chart about 20 feet away, to check on how well you see at various distances
  • Tonometry, which measures your eye’s interior pressure. It helps to detect glaucoma.
  • Dilation, which involves getting eye drops that dilate (widen) your pupils. This allows more light to enter the eye. Your eye care provider examines your eyes using a special magnifying lens. This provides a clear view of important tissues at the back of your eye, including the retina, macula, and optic nerve.

If you have a refractive error and are going to need glasses or contacts, then you will also have a refraction test. When you have this test, you look through a device that has lenses of different strengths to help your eye care professional figure out which lenses will give you the clearest vision.

At what age you should start getting these exams and how often you need them depends on many factors. They include your age, race, and overall health. For example, if you are African American, you are at higher risk of glaucoma and you need to start getting the exams earlier. If you have diabetes, you should get an exam every year. Check with your health care provider about if and when you need these exams

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Headaches and your eyes

How a Headache Can Affect Your Eyes and Vision

By Troy Bedinghaus, OD  Medically reviewed by Diana Apetauerova, MD on September 08, 2020

Have you ever had a headache that affected your vision? Sometimes a headache can cause pain around your eyes, even though the headache is not associated with a vision problem. On the other hand, a headache may be a sign that your eyes are changing and that it’s time to schedule an eye exam. Although headaches are rarely a medical emergency, a severe one should not be ignored or minimized.

headaches and vision
Verywell / Luyi Wang

Headaches That Affect Vision

Vision problems can sometimes be the consequence of a headache. This is especially true with migraines and cluster headaches.

Migraine Headache

A migraine headache can cause intense pain in and around your eyes. A migraine aura resembling flashing lights, a prismatic rainbow of lights or a zig-zag pattern of shimmering lights often precedes the actual headache. The aura typically lasts around 20 minutes.

Some people who experience a migraine aura never develop the actual headache, making the diagnosis of the visual disturbances difficult.1 Migraines can also cause tingling or numbness of the skin. People with severe migraines may experience nausea, vomiting, and light sensitivity. Medications, certain foods, smells, loud noises, and bright lights can all trigger a migraine headache.An Overview of Migraine With Aura

Cluster Headache

Cluster headaches are severe headaches that occur in clusters and typically cause pain around the eyes. The pain often radiates down the neck to include the shoulder. Other symptoms include:

Cluster headaches may occur daily for several months at a time followed by a long period with no headaches. It is not known what causes cluster headaches, but they are clearly one of the most severe headaches one can experience.

Vision Problems That Cause Headaches

On the flip side, vision problems can cause headaches when you either overwork the eyes or struggle to maintain focus. By correcting the vision problem, you can often resolve the headache.

Eye Strain

Simply overusing the focusing muscles of your eyes can cause eye strain and headaches. This is an increasing problem in our high tech world

Small-screen texting and web browsing can easily cause eye strain, in part because the words and images on a computer screen are made up of pixels and do not have well-defined edges. The eyes cannot easily focus on pixels, so they must work harder even if an image is in high-resolution.2 When the eye muscles become fatigued, a headache can develop around or behind the eyes.

Farsightedness

Adults and children with uncorrected farsightedness (hypermetropia) will often experience a frontal headache (also known as a “brow ache”). If you are farsighted, you may find it difficult to focus on nearby objects, resulting in eye strain and headaches. As you subconsciously compensate for your farsightedness by focusing harder, the headaches can become worse and more frequent.

Presbyopia

Around the age of 40, people begin to find it difficult to focus on nearby objects. Near point activities, such as reading or threading a needle, are often difficult to perform because of blurring. This is an unavoidable condition known as presbyopia that affects everyone at some point. Headaches develop as you try to compensate for the lack of focusing power. Reading glasses can often relieve the underlying eye strain.

Occupations requiring close-up work, exposure to sunlight for longer periods of time, and farsightedness were the most common risk factors for presbyopia.3Presbyopia: Close-Up Vision Loss and What to Do About It

Giant Cell Arteritis

Also known as temporal arteritis, giant cell arteritis (GCA) is an inflammation of the lining of the arteries that run along the temple. GCA usually creates a headache that causes constant, throbbing pain in the temples. Vision symptoms occur as a result of a loss of blood supply to the optic nerve and retina. Other symptoms include:

  • Fever, fatigue and muscle aches
  • Scalp tenderness
  • Pain while chewing
  • Decreased vision​

GCA is considered a medical emergency. If left untreated, the condition may cause vision loss in one or both eyes. A delayed diagnosis is the most common cause of GCA-associated vision loss.42:18

What Is a Retinal Migraine?

Acute Angle-Closure Glaucoma 

Acute angle-closure glaucoma (AACG) is a rare type of glaucoma that causes a sudden onset of symptoms, including headaches. Eye pressure rises quickly in AACG causing increased eye redness, eye pain, and cloudy vision. A mid-dilated pupil (in which pupil dilation is sluggish and incomplete) is one of the most important diagnostic features of AACG.5

Ocular Ischemic Syndrome

Ocular ischemic syndrome (OIS) is a condition that develops due to a chronic lack of blood flow to the eye. This condition often causes a headache, decreased vision, and a host of other signs, including cataracts, glaucoma, iris neovascularization (the development of new weak blood vessels in the iris), and retinal hemorrhage. White spots on the retina indicate a lack of blood flow and oxygen to the retinal tissue.2:18

What Is a Retinal Migraine?

Herpes Zoster

Also known as shingles, herpes zoster is known for causing headaches, vision changes and severe pain around the head and eye. Herpes zoster is a reactivation of the chickenpox virus and affects a single side of the body. A headache usually precedes an outbreak of painful skin blisters.

Herpes zoster around the eyes is serious and requires immediate medical attention (including antiviral medication) to prevent damage to the ocular nerves and eyes. Complications include corneal clouding, glaucoma, and optic nerve atrophy (deterioration).6

Pseudotumor Cerebri

Pseudotumor cerebri is a condition that occurs when the pressure within the skull increases for no apparent reason. For this reason, pseudotumor cerebri is also referred to as Idiopathic Intracranial hypertension (“idiopathic” meaning of unknown origin and “hypertension” meaning high blood pressure).

Pseudotumor cerebri often causes a headache and changes in vision. If left untreated, pseudotumor cerebri can lead to vision loss as the pressure places strain on the optic nerves. Fortunately, while 65% to 85% of people with pseudotumor cerebri will experience visual impairment, the condition is usually transient and will normalize when the hypertension is controlled.

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Eye care tips

Your eyes are an important part of your health. Most people rely on their eyes to see and make sense of the world around them. But some eye diseases can lead to vision loss, so it is important to identify and treat eye diseases as early as possible. You should get your eyes checked as often as your health care provider recommends it, or if you have any new vision problems. And just as it is important to keep your body healthy, you also need to keep your eyes healthy.

Eye Care Tips

There are things you can do to help keep your eyes healthy and make sure you are seeing your best:

  • Eat a healthy, balanced diet. Your diet should include plenty or fruits and vegetables, especially deep yellow and green leafy vegetables. Eating fish high in omega-3 fatty acids, such as salmon, tuna, and halibut can also help your eyes.
  • Maintain a healthy weight. Being overweight or having obesity increases your risk of developing diabetes. Having diabetes puts you at higher risk of getting diabetic retinopathy or glaucoma.
  • Get regular exercise. Exercise may help to prevent or control diabetes, high blood pressure, and high cholesterol. These diseases can lead to some eye or vision problems. So if you exercise regularly, you can lower your risk of getting these eye and vision problems.
  • Wear Transition lenses. Sun exposure can damage your eyes and raise your risk of cataracts and age-related macular degeneration. Protect your eyes by using sunglasses that block out 99 to 100 percent of both UV-A and UV-B radiation.
  • Wear protective eye wear. To prevent eye injuries, you need eye protection when playing certain sports, working in jobs such as factory work and construction, and doing repairs or projects in your home.
  • Avoid smoking. Smoking increases the risk of developing age-related eye diseases such as macular degeneration and cataracts and can damage the optic nerve.
  • Know your family medical history. Some eye diseases are inherited, so it is important to find out whether anyone in your family has had them. This can help you determine if you are at higher risk of developing an eye disease.
  • Know your other risk factors. As you get older, you are at higher risk of developing age-related eye diseases and conditions. It is important to know you risk factors because you may be able to lower your risk by changing some behaviors.
  • If you wear contacts, take steps to prevent eye infections. Wash your hands well before you put in or take out your contact lenses. Also follow the instructions on how to properly clean them, and replace them when needed.
  • Give your eyes a rest. If you spend a lot of time using a computer, you can forget to blink your eyes and your eyes can get tired. To reduce eyestrain, try the 20-20-20 rule: Every 20 minutes, look away about 20 feet in front of you for 20 seconds.

Eye Tests and Exams

Everyone needs to have their eyesight tested to check for vision and eye problems. Children usually have vision screening in school or at their health care provider’s office during a checkup. Adults may also get vision screenings during their checkups. But many adults need more than a vision screening. They need a comprehensive dilated eye exam.

Getting comprehensive dilated eye exams is especially important because some eye diseases may not have warning signs. The exams are the only way to detect these diseases in their early stages, when they are easier to treat.

The exam includes several tests:

  • A visual field test to measure your side (peripheral) vision. A loss of peripheral vision may be a sign of glaucoma.
  • A visual acuity test, where you read an eye chart about 20 feet away, to check on how well you see at various distances
  • Tonometry, which measures your eye’s interior pressure. It helps to detect glaucoma.
  • Dilation, which involves getting eye drops that dilate (widen) your pupils. This allows more light to enter the eye. Your eye care provider examines your eyes using a special magnifying lens. This provides a clear view of important tissues at the back of your eye, including the retina, macula, and optic nerve.

If you have a refractive error and are going to need glasses or contacts, then you will also have a refraction test. When you have this test, you look through a device that has lenses of different strengths to help your eye care professional figure out which lenses will give you the clearest vision.

At what age you should start getting these exams and how often you need them depends on many factors. They include your age, race, and overall health. For example, if you are African American, you are at higher risk of glaucoma and you need to start getting the exams earlier. If you have diabetes, you should get an exam every year. Check with your health care provider about if and when you need these exams

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