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Month: June 2018

The History of Cataract Surgery

Cataracts have been a medical problem throughout history. In early times, strange concoctions and eye drops were used to treat cataracts until physicians in ancient Babylon and India began surgical treatment. Their highly primitive method, known as couching, involved using a sharp instrument to push the cloudy cataract lens to the back of the eye clearing the visual axis or line of sight. This method is still used in some parts of Africa today.

In the 18th century, surgeons progressed to making an incision in the eye to remove the entire cloudy lens instead of pushing it back into the eye. Surgeons initially tried replacing the natural cataractous lens with a small glass lens, but were unsuccessful. This made it necessary for patient’s glasses to have very thick lenses in order to see because the lens of the eye provides such a large portion of the power of the eye. Therefore, once the natural lens was removed, the only alternatives were to wear thick heavy glasses or contact lens.

By the 20th century, surgeons learned to remove only part of the cloudy lens and leave the outer clear capsule in the eye. Then during World War II British surgeons discovered that pieces of Plexiglas from a shattered canopy of a fighter plane, lodged in a pilots’ eye, did not cause any harmful reaction. That is, the material was not recognized by the body as a foreign substance causing an infection or inflammation. Using this light, plastic material, British surgeon Harold Ridley designed a lens that was successfully implanted in the clear capsule left behind. This made thick heavy glasses unnecessary after cataract surgery.

In 1968, American surgeon Charles Kelman adapted a new technology called phacoemulsification to remove cataracts. This sophisticated procedure uses ultrasound through a tiny probe to gently break up the cataract and remove it from the inside of the eye. Phacoemulsification is performed through a tiny 2-3mm incision that does not require stitches unlike previous methods that required much larger incisions and several stitches.

Cataract surgery was revolutionized when ultrasound and plastic lens implant technology were combined. Today, after decades of development, modern cataract surgery is considered one of the safest surgeries performed with millions of successful procedures completed yearly around the world. As of late last year, lasers can now be used to make incisions in the cornea and lens, as well as, soften the lens material to be removed.

Oklahoma is proud to have one of the first surgeons to actually use artificial lens implant technology. Dr. J. Harley Galusha from Tulsa, Oklahoma was introduced to implants while on a mission trip in Africa. After his trip he went to Europe and was able to acquire some of the implants that he successfully used on 5 patients in 1974. He was only the fourth surgeon in the United States to implant the lenses and since that time millions of implants with hundreds of different designs have been implanted. Lens implants used today are foldable, silicone or acrylic, can correct astigmatism, and in some cases are multifocal, similar to bifocal contact lens. These lens implants can be inserted through a micro-incision and do not require stitches. These techniques result in very rapid visual recovery and healing with little down time. Drops are used to avoid infection and swelling for 3-4 weeks after surgery at which time they are discontinued.

After cataract surgery, glasses are required to fine tune vision in the distance and almost always for reading. Patients who required thick lenses for high prescriptions prior to cataract surgery can enjoy thin light lenses afterwards because the majority of the power required is in the lens implant. Most patients can be fitted with glasses 4-6 weeks after surgery. At this point patients are dismissed for yearly eye health examinations.

If you have questions concerning cataracts or cataract surgery, please contact us in Stillwater at 405-372-1715. We also invite you to visit our website at www.cockrelleyecare.com and like us on Facebook at Cockrell Eye Care Center!

The Optomap Retinal Exam

For centuries the art of medicine has been dominated by breaks, bumps, bruises or other symptoms felt by the patient or discovered by the physician. Over time, clinical findings have been enhanced by increasingly sophisticated technology like the microscope, the x-ray, and the MRI. To find an illness, doctors first had to look or listen for the symptom. With chronic eye diseases however, symptoms are often very late in the disease process, and more often than not, are painless. What a patient believes to be the need to change their glasses can actually be a vision threatening condition like glaucoma, macular degeneration or a retinal detachment. Unfortunately, in some cases, by the time the patient makes it in for the exam, the condition has advanced and vision loss is irreversible. Avoiding scenarios like this can only be accomplished through yearly vision and eye health examinations.

At Cockrell Eyecare Center we utilize the most advanced technology available for diagnosis and management of eye disease. One of the instruments we utilize is the Optomap Retinal Exam. This instrument is one of the most sophisticated retinal imaging technologies available today. The test takes just seconds to perform and is usually done immediately prior to you seeing your doctor. The retinal image produced from the Optomap exam is unique in that it gives your eye doctor a much larger view (200 degrees) of the inside of your eye vs. conventional eye exam equipment. Each Optomap image is as individual as a fingerprint or DNA strand. It provides a unique view of your eye health very quickly, and comfortably. The image is captured in less than one second and is immediately available for your doctor to review with you. The image can be minified, magnified or scrolled through to various views of the retina, the retinal blood vessels, macula and optic nerve. It allows the doctor to view your retina without a continuous blinding light for what feels like forever.

We recommend and offer the Optomap Retinal Exam to all patients. We trust in this technology for great baseline information on every patient as well as for continued care and management of their eye health. We strongly encourage those who have greater than normal eye disease risk to consider the technology. Those include patients with a family or personal history of diabetes, vascular disease including heart disease, high cholesterol, and hypertension, glaucoma, macular degeneration, or collagen vascular diseases such as Lupus or Rheumatoid Arthritis. In addition, patients experiencing flashes or floaters, unexplained headaches, recent changes in vision, lazy eye, or those with significantly large prescriptions are all encouraged to have the exam.

Patients who feel they don’t fall into these categories should consider the testing to establish baseline findings for the future. The Optomap retinal images can be aligned side by side to allow the comparison of multiple years of exams. It’s like comparing yearly X-rays or MRI’s over time. One of the greatest benefits of this technology is it allows you to see what your doctor sees and helps you understand your eye health better. Being able to visualize diabetic retinopathy, the actual blood vessels leaking, the beginning of, or advancement of damage from glaucoma, macular degeneration, or the beginning of a retinal tear or detachment, can help you understand your situation more clearly.

If you are interested in learning more about this technology or would like to have an Optomap Retinal Exam please contact our office in Stillwater at 405-372-1715. We also invite you to visit our website at www.cockrelleyecare.com and like us on Facebook at Cockrell Eye Care Center!

Thyroid Eye Disease

Do your eyes ever ache, become red and irritated or maybe overly sensitive? Do you ever have a sensation of pressure in or behind your eyes? A first thought might be dry eyes or a sinus infection however, if you’re a middle aged female it could be Thyroid Eye Disease. Thyroid eye disease is a rare condition affecting about 16 women out of every 100,000 people. In men it is less common, about 3 out of every 100,000. Most of those affected have a problem with an overactive thyroid gland and have an underlying autoimmune condition. Some people are genetically pre-disposed making it more likely that they will get thyroid eye disease however; it is also more likely to develop if you smoke.

The thyroid gland is a small butterfly-shaped gland sitting near the top of your windpipe at the front of your neck. It has an important role in controlling the speed at which chemical reactions occur throughout tissues of your body. These reactions establish your metabolic rate. The thyroid gland can become overactive or underactive. These changes are most often due to an autoimmune disease. Autoimmune diseases are not fully understood but occur when our own immune system turns on, and attacks, our own body tissues.

Autoimmune thyroid disease occurs when the body’s immune system attacks the thyroid gland. Although not fully understood, when the thyroid gland is attacked, it sometimes is followed by the tissue around the eye being attacked as well. This condition is called Thyroid Eye Disease or Graves Disease.

Signs and symptoms of Thyroid Eye disease include marked swelling of the muscles and fatty tissues surrounding the eyeball within the eye socket or orbit. The swelling is due to inflammation of these tissues. There is limited space inside the orbit so, as the tissues swell, the eyeball can be pushed forward. Many people with thyroid eye disease appear to have bulging eyes as a result. As the eyeball is pushed forward it makes the cornea more exposed and the eyelids cannot completely cover the eye as they close or blink. This causes the cornea to become dry and more susceptible to infection and scarring. In addition, because the eye muscles are swollen the eyeball cannot move as well, double vision may occur.

Treatments include medications to suppress the production of hormone by the thyroid gland, radioactive iodine to eliminate hormone-producing cells, and surgery to remove the thyroid tissue. Active eye inflammation is treated with prednisone for short periods along with artificial tears and ointments for corneal protection. In some cases, orbital decompression surgery is necessary to provide room for the swollen tissues and allow the eye to reseed back into the orbit.

If you have questions about Thyroid Eye disease, please contact us in Stillwater at 405-372-1715. We also invite you to visit our website at www.cockrelleyecare.com and like us on Facebook at Cockrell Eyecare Center!

Vision and Eye Health After 40

If you are over 40 years of age, you’ve probably noticed changes in your vision. Difficulty seeing clearly for reading and close work is among the most common problems adults develop between ages 41 to 60. However, this is also the time when other changes in your eyes can start to affect your work and other daily activities or hobbies.

If you have experienced relatively good vision throughout your life and haven’t needed eyeglasses or contact lenses to correct distance vision, then the development of near vision problems after age 40 can be somewhat of a concern and a frustration. Losing the ability to read the newspaper or to see cell phone numbers may seem to have occurred abruptly. Actually, these changes have been occurring gradually since childhood. But up until now, your eyes have had adequate focusing power to allow you to see clearly for reading and close work. Now your eyes no longer have enough focusing power for clear and comfortable near vision tasks. This normal aging change in the eye’s focusing ability, called presbyopia, will continue to progress over time.

Initially, you may have found you needed to hold reading materials farther away to see them clearly. Print in the newspaper or on a restaurant menu may appear blurred, especially under dim lighting. If you already wear prescription glasses or contact lenses to see clearly in the distance, the near vision changes caused by presbyopia can bring about the need to use bifocal or multifocal lenses. If you are nearsighted, you may have discovered that you now need to remove your glasses to see better up close. Fortunately, people with presbyopia now have many options to improve their ability to see well. These include glasses with a lined bifocal or no-line bifocal, monovision or bifocal contact lenses, or laser eye surgery.

Along with the onset of presbyopia, an increase in the incidence of eye health problems occur during these years. Whether or not there is a need for eyeglasses, adults should be examined for signs of developing eye health and vision problems. A comprehensive eye examination is recommended every year. Don’t rely on substitutes like a health fair vision screening or a driver’s license vision test to determine if you have an eye health or vision problem.

Adults over 40 may be particularly at risk for the development of eye health and vision problems if any of the following exist:

  • Chronic, systemic conditions such as diabetes or high blood pressure.
  • A family history of glaucoma or macular degeneration.
  • A visually demanding job or work in an eye-hazardous occupation.
  • Health conditions like high cholesterol, thyroid conditions, anxiety or depression, and arthritis for which medications must be taken.

Early warning signs of eye health problems include fluctuating vision, increased glare or light sensitivity, changes in color perception, seeing flashes and floaters, loss of side vision, and distorted vision.

If you have questions about your vision or eye health or, are interested in having your eyes examined, please contact our office in Stillwater at 405-372-1715. We also invite you to visit our website at www.cockrelleyecare.com and like us on Facebook at Cockrell Eye Care Center!

Back to School Eye Exams

Vision screenings are an important service provided by most schools and without question provide benefits. It is important to recognize however, that studies have demonstrated screenings are not as effective as comprehensive eye exams. In fact, The National Institutes of Health found that school screenings catch only 37% of children with poor vision or vision skills. With the limitations of vision screenings and the prevalence of vision disorders in K-12th graders, there is clearly a need for early detection through a comprehensive eye and vision examination performed by an eye doctor.

Comprehensive vision examinations can only be conducted by eye care professionals who have the proper training needed to make a definitive diagnosis and prescribe treatment. Specialized equipment and procedures which are not available as part of a vision screening program are needed to adequately evaluate a child’s eye and vision health.

Listed below are essential elements of a comprehensive eye examination used to insure that learning is maximized through good vision.

  • Visual acuity is measured at several distances so that the child can comfortably and efficiently read, work on the computer or see the board.
  • The refractive state of the visual system such as nearsightedness, farsightedness, or astigmatism is determined.
  • Focusing or accommodation is an important skill that is tested. The eyes must be able to focus on the object at which they are aimed and easily shift focus from one object to another. This allows the child to move attention from a book or paper, to the chalkboard and back. Sustained focus affects the ability to read or write for long periods of time.
  • The doctor evaluates visual alignment and ocular motility which means the muscles aiming each eye converge so that both eyes are aimed at the same object, which is required for depth perception.
  • Binocular fusion (eye teaming) skills are assessed. These skills are critical to coordinate and align the eyes precisely so the brain can fuse the pictures it receives from each eye into a single image.
  • Eye tracking skills are tested to determine if the child can track across a page accurately and efficiently while reading or copying material from the board to paper.
  • Testing color vision prior to beginning school is part of a comprehensive examination because a large part of the early educational process involves the use of color identification and discrimination.
  • Eye-hand coordination is critical for handwriting, throwing a ball or playing an instrument. Visual perception is used to interpret and understand visual information such as form, size, orientation, texture, and color perception. Both are important visual functions that are investigated during a comprehensive eye examination.
  • Ocular health is determined by examining the external and internal structures of the eye.

There is clearly a difference between vision screenings and vision exams. Both are important however, exams will ultimately provide the most effective avenue to ensuring your child has every opportunity to be successful in school.

Please contact our office with questions regarding the difference between an eye health and vision exam vs. a vision screening. We can be contacted in Stillwater at 405-372-1715. We also invite you to visit our website at www.cockrelleyecare.com and like us on Facebook at Cockrell Eye Care Center!

Vision Problems in Parkinson’s Disease

Parkinson’s disease is a progressive neurological condition that was first described in 1817 by Dr. James Parkinson. The London doctor first reported the symptoms calling the condition the “shaking palsy”. It is mostly characterized by problems with body movements referred to as “motor symptoms”. The most identifiable motor symptom is a tremor. Other difficulties that are not related to movement can also occur such as pain, sleep disturbance, sensory problems and depression. These are known as “non-motor symptoms”. According to the Global Declaration for Parkinson’s disease, 6.3 million people suffer from Parkinson’s worldwide affecting all races and cultures. The age of onset is usually over 60 however, it is estimated that ten percent of people are diagnosed before the age of 50, slightly more men than women. Parkinson’s is life-altering but it is not life-threatening.

Parkinson’s disease is the result of an abnormal destruction of brains cells that produce dopamine. Dopamine is a chemical that is critical in driving the way the brain controls our movements. If there is not enough dopamine a person cannot control movements well and many times can’t move at all. Dopamine also helps control our brains ability to function with respect to memory, attention to detail and problem-solving tasks.

There are four main motor symptoms of Parkinson’s disease: tremors, stiffness of the limbs and trunk, slowness of movement, and impaired balance. These symptoms start very gradually and grow worse with time. People with the disease eventually have trouble with walking, talking and completing simple tasks. There is no cure for Parkinson’s disease and as previously mentioned, it is not fatal, but complications such as choking, pneumonia or falls may lead to death.

Sensory problems are very common in Parkinson’s and may include visual loss, loss of smell, hearing problems, and “restless legs” syndrome (RLS). Visual signs and symptoms of Parkinson’s disease may include defects in visual acuity, side vision, color vision, eye movements, pupil function, blink reflex, and more complex visual tasks that involve the ability to judge distance or the shape of an object. Double vision may also occur. The ability to process something visually slows especially for rapidly changing visual situations like watching children play sports. Facial recognition can become a problem and many Parkinson’s patients also experience visual hallucinations.

By identifying and correcting visual problems as much as possible with prescription lenses and in some cases surgery, a Parkinson’s patient may significantly improve their quality of life. Eliminating or reducing visual issues have proven to affect overall motor function and reduce the possibility of developing hallucinations. Care for the Parkinson’s patient should include a comprehensive eye and vision health exam on a yearly basis. Co-existing eye diseases such as glaucoma and macular degeneration and dry eye must be monitored and treated when possible to preserve vision and hopefully play a role in improving motor function.

Please contact one of our offices if you have questions concerning your eye and vision health. We can be reached in Stillwater at 405-372-1715. We also invite you to visit our website at www.cockrelleyecare.com and like us on Facebook at Cockrell Eye Care Center!

Are School Vision Screenings Enough?

Vision screening programs were designed to help identify children who have eye or vision problems that could impair their ability to develop and learn normally. Visual clues are key to how children learn and function. Vision problems that go uncorrected can affect all aspects of a child’s growth including their emotional, neurological, cognitive and physical development. Studies have found that visual factors are better predictors of academic success than race or socioeconomic status.

The National Institutes of Health found that professional vision screenings catch only 37% of children with poor vision. This is especially troubling because the most recent National Eye Institute (NEI) prevalence study revealed that 4% of preschoolers have significant nearsightedness, 21% have significant farsightedness, 10% have significant astigmatism, and 3% have significant strabismus (eye turning in or out), as assessed through eye examination. Vision screenings will miss the majority of children with strabismus, astigmatism and most of those with farsightedness. Other facts to consider:

  • Many screening facilities lack the equipment and knowledgeable staff, which are essential to screen young children. Traditional screening methods by non-eyecare professionals are extremely difficult for children less than 4 years of age.
  • Most vision screenings test for visual acuity only. Use of a vision chart alone will identify only 5% of the vision problems in children according to the American Foundation for Vision Awareness. A child may be able to see letters 20 feet away but that does not demonstrate whether his/her eyes are able to work together to read materials 12 inches away, or if there is an eye health problem or vision perception problem.
  • Amblyopia, poor eyesight in one eye, sometimes known as “lazy eye, is often missed if the eyes appear aligned.
  • A vision screening can give a parent a false sense of security. When a child reports that he is seeing 20/20, parents often assume that no further testing is needed and fail to ever take the child for a comprehensive eye examination.
  • Fewer than 50% of the children identified as needing professional eye and vision care ever receives that care, and of those who do, the average time between the screening and the examination is 18 months.

Vision screenings are an important service provided by most schools and without question provide benefits. There are many children however, who simply need their mild farsightedness or nearsightedness corrected but are overlooked because of never having had a comprehensive vision exam. Unfortunately, these children are many times labeled learning challenged, learning disabled, ADHD, or ADD when they simply have a focusing problem from computer vision syndrome or from being on their cell phone or IPAD too much.

Screenings should be recognized as limited in truly assessing a child’s ability to function in the classroom. They should be considered a triage for the timing of the full eye exam which should be performed yearly starting with Kindergarten.

Please contact Cockrell Eyecare Center with questions regarding the difference between an eye health and vision exam and a vision screening. If your child has a vision screening this fall it would be our pleasure to review the results with you. We can be reached in Stillwater at 405-372-1715. We also invite you to visit our website at www.cockrelleyecare.com and like us on Facebook at Cockrell Eye Care Center!

What is Ocular Hypertension?

Ocular hypertension is a term used to describe an increase in eye pressure that is above the normal healthy range. Normal healthy eye pressure typically ranges from 10-21. Patients diagnosed as “ocular hypertensives” have eye pressure over 21 however, have no detectable changes in vision or damage to the structure of their eyes. The term ocular hypertension is used to distinguish people with elevated eye pressure from those with glaucoma, a serious eye disease that causes damage to the optic nerve. Patient’s with ocular hypertension are at greater risk to develop glaucoma and therefore should be monitored accordingly.

Ocular hypertension can occur in people of all ages, but occurs more frequently in African Americans, those over age 40, and those with a family history of high eye pressure or glaucoma. It is also more common in diabetics, those with high blood pressure, nearsighted patients and patients with sleep apnea. Like glaucoma, ocular hypertension has no noticeable signs or symptoms. Studies have clearly demonstrated that patients with ocular hypertension are at greater risk to develop glaucoma over time however, the percentage of those that go on to develop glaucoma can vary from 10-50%.

There is no cure for ocular hypertension. Careful monitoring and treatment, when indicated, can decrease the risk of an ocular hypertensive patient advancing to glaucoma. Patients with ocular hypertension can be thought of like someone who has been told they are pre-diabetic. These individuals must make serious efforts to lower their blood sugar and change their lifestyle to avoid progressing on to diabetes. Patients’ with ocular hypertension should have their eye pressure evaluated yearly at minimum. Making strides to improve overall systemic health through diet and exercise can also play a role in avoiding ocular hypertension from progressing to glaucoma. Individuals who have had good vision all their life and don’t believe they need their eyes examined should reconsider an eye health and vision exam to make sure they do not have this symptom free condition.

As the baby boomer population explodes over the next ten years the National Eye Institute (NEI) believes the incidence of glaucoma will rise significantly. In fact, in the next 25 years the NEI estimates that the incidence of glaucoma will double. Those with additional risk factors, such as ocular hypertension, should absolutely have regular eye pressure evaluations. Glaucoma is ranked as the leading cause of preventable blindness in the United States. A simple eye pressure test may help make the difference between having good vision in your retirement or not.

If you have questions concerning ocular hypertension or would like to have your eye pressure evaluated please contact our office in Stillwater @ 405-372-1715. We also invite you to visit our website at www.cockrelleyecare.com and like us on Facebook at Cockrell Eye Care Center!

Ocular Migraines

Migraine Awareness Month:

An ocular migraine is any migraine headache that involves a visual disturbance such as flashes of light, seeing stars or zigzags or the appearance of blind spots in the visual field. Ocular migraines can interfere with your ability to go about your daily tasks such as driving, reading or writing, however, the visual symptoms don’t last long and do go away completely once the migraine has passed. 

What is an Ocular Migraine?

The term ocular migraine may refer to a couple of different conditions. Firstly, migraines with auras often have eye-related symptoms that precede the actual headache. An aura is a physical symptom that is experienced usually within 5 minutes to an hour before a migraine comes on, and can include:

  • Blind spots (scotomas) or partial vision loss
  • Flashes of light, spots or zigzag patterns
  • Visual, auditory (hearing) or olfactory (smell) hallucinations or disruptions
  • Tingling or numbness
  • Mental fog, trouble finding words and speaking

These types of ocular migraines commonly appear by obstructing a small area of vision which spreads gradually over 5 minutes. 

A second type of ocular migraine is when you actually experience temporary vision loss or disruptions (flashes, blind spots, zigzag lines etc.) during or immediately following the migraine headache. Ocular migraines can also sometimes appear without any head pain at all. They may also be called eye, ophthalmic, or retinal migraines. 

What Causes Ocular Migraines?

Similar to classic migraines, the exact cause of an ocular migraine is unknown. Genetic predisposition seems to be a factor to some extent, and having a family history of migraines does put you at greater risk. 

While they don’t know the cause, experts have seen that spasms in the blood vessels and nerve cells in the retinal lining at the back of the eye are associated with ocular migraine symptoms. 

For some, there are certain environmental triggers, or a combination of factors, that cause migraines. These differ on an individual basis but can include:

  • Stress
  • Bright lights or loud sounds
  • Strong smells
  • A sudden or drastic change in weather conditions
  • Eating, or exposure to, certain food substances such as, alcohol, caffeine, nitrates, MSG (monosodium glutamate), artificial sweeteners and tyramine. 

Since triggers are different for everyone it’s advised to try to identify yours by keeping a journal to track your environment, diet and lifestyle habits, when you experience a headache. 

Treatment for Ocular Migraines

Treatment for ocular migraines is usually not necessary as the symptoms typically resolve themselves within 30 minutes. It is advised to rest and avoid doing things that require vision and concentration until the headache goes away and the vision symptoms cease. If you are experiencing an ocular headache:

  • Lie down in a quiet, dark room when possible
  • Massage or apply pressure to the temples and scalp
  • Apply a damp towel to the forehead

If you experience auras, taking a migraine medication when the aura occurs, can often reduce the intensity of the headache that follows. In other words, you can use the aura as a warning sign that a headache is coming on and treat it preventatively. Your doctor may prescribe a pain reliever for associated head pain and, if migraines are chronic, a preventative medication may be given. 

It’s important to note that if you are experiencing any unusual visual symptoms or an increase in frequency or duration of symptoms, you should see an eye doctor right away to rule out any serious, vision threatening conditions. Symptoms such as floaters or flashing lights can also be a sign of a retinal tear or hole. 

If you get migraines, among the best ways to prevent them are to keep your mind and body healthy by eating nutritious foods, getting enough rest and managing stress effectively.