Retinoblastoma (Cancer of the Retina)

12 05 2015

One of the saddest cases I have ever seen was a little girl who was brought in by her father because one eye looked white in the pupil of one eye.  I have seen a white pupil often in adults, usually from an advanced cataract or even a retinal detachment.  But in a child, your first thought is cancer of the eye. You may have seen the story recently about the mother that detected a problem in her child by taking a cell phone picture.  Either on Facebook or CNN:

or ABC News:

First of all, the pupil is the window into the eye.   Some say it’s the window to the soul but definitely it is a window into the overall health of the body.  It looks black normally because light doesn’t escape or reflect out easily as in some animals like cats and dogs.   If the pupil is big enough or you get enough light to shine in, you can see a reddish-orange reflection with the right tools.

The retina is the inner back lining of the eyeball that detects light and sends the signals through the optic nerve to our brain in order for us to interpret what we see.   The eye is the camera, the brain is the TV set basically.  I used to say the retina is like film in a camera but with everything digital now, I have changed the analogy to the digital sensors in your phone or digital camera.  Anyway, the retina have ALOT of blood supply.  Between that and the layer of pigment cells on the outer layer, the color generally appears reddish-orange.

Eye doctors use that reddish-orange reflection to determine the amount of refractive error like nearsightedness or astigmatism a person has for glasses.  That is how we can tell what power glasses need to be for little babies or people who can’t talk.  It is also how we know if your child is malingering (faking) the need for glasses.

If that reflection is dim, has shadows, or a different color, that tells us there is something wrong with the pathway for light entering the eye.  Either the lubricating tear film on the front surface, the cornea, the crystalline lens, the vitreous fluid, or the retina could have a problem.

Retinoblastoma is a fairly rare cancer that usually develops in very young children but it is possible for an adult to develop it too.  It is from a genetic mutation of the retinal cells and the risk of passing the gene to offspring can be higher for those families that have had someone affected.  It is very aggressive and can spread to other parts of the body very quickly.  The sooner the eye is removed that better chance of survival.  Yes, the eye needs to be removed quickly.  As tragic as that sounds, children adapt fairly well since they are not seeing out of the affected eye anyway.

I encourage young parents to take a picture of their child with a flash straight on from 3-4 ft away.   I do it to screen children and to help them relax by showing them their picture so they get comfortable with me examining their eyes before I do more.  Both pupils will either be dark if the pupils are too small or both a reddish-orange glow, which is the reflection off the retina. If it is orange, you can enlarge the picture and look for shadows, which could indicate a problem with the surface of the eye or cataracts.   Yes, children can have cataracts, though rare.   If a reflection is white, it could be a refractive error (nearsightedness, astigmatism, etc.), a cataract, a retinal detachment or retinoblastoma possibly and you would want that checked immediately by having the child’s eyes dilated.  They may have to be given a sedative to get them to cooperate and get a good view. If the doctor is not getting a view because the child is not cooperating or crying, the child should be referred to someone who will perform a sedated eye examination, most often a pediatric ophthalmologist.

As a side note, there should also be a little white reflection on the cornea, the front surface of the eye, from the flash.  That white dot from the flash should both be in the same relative position to the pupil of each eye. If not, your child could have an eye turn.

Also, all children under 18 are mandated to be covered for at least a wellness eye exam once a year under the Affordable Care Act (Obamacare).

Please have your kids eyes examined at 3-4 years of age at a minimum and every year after that.   Just because they seem to get around doesn’t mean that both eyes are okay.  If one is not seeing well or turned, the vision won’t develop properly and it is permanent after age 6-7 years old when the optic nerve quits developing.  Don’t take any chances with the vision and the health of your child.


Courtesy of Dumas Vision Source, PLLC and Dr Tory W. Moore, Optometric Glaucoma Specialist and Diplomate of the American Board of Optometry.    Serving the Dumas, Texas,  Moore County and upper Texas Panhandle area for 25 years.   Call (806) 935-2020 for appointment or visit our optical gallery without an appointment.  Visit our website for more information.  Like our Facebook business page:  Dumas Vision Source  and you can also connect on Twitter @eyedocdumas

Tory Moore, OD  – “A Hometown Eye Doctor You Know and Can Trust!”

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Oooh baby, baaby…

14 03 2014

Baby baaaby…baby, baaaby….Push it.  Push it good.  Oooh…Baby baaaby.   Yup, got my grove on (in my mind). Who remembers the group Salt N Pepa?  Yes, I’m going back to the 80’s…girls with big hair, Miami Vice,  OP shorts, Member Only jackets…glad that era is over. Almost as bad as the disco 70’s.  But I digress.

Babies.  Just how do we check babies and those little kids eyes?

Well, it’s not easy.  It helps to be quick, creative and sometimes a goof ball to get their attention and help them not be scared.

When we check little children’s eyes, we are looking for three main things:

1. Clear vision in each eye

2. The eyes are aligned straight ahead

3. The ocular health is normal.

While we often can’t be as detailed in the exam data as an adult, we get what information we can.

To determine if the child is seeing clearly, we shine a light streak at the pupils which gives us a red reflection, much like that of a bad photograph where someone’s pupil has got a red reflex.  By moving the light streak in different directions, we can use that red reflex to determine the refractive power of the eye and thus what power of glasses they would need.  If they are old enough to sit for it, a computerized machine called an auto-refractor can read the approximate power of the eye within seconds.  This gives us a second opinion from the manual method.  So if the child is handicapped, won’t speak or too young to respond to questions, we can determine very closely what the refractive status of the eyes are without them saying a word.  When the two readings are close, especially with the help of eye drops that make the focusing system of the eye relax, we can be assured the refractive status of the eye is determined accurately.  That is how we know often times if a child is trying to fake a vision problem.

We usually use pictures instead of letters if they are old enough to speak to help determine what their visual acuity is on the eye chart.  A spinning hand held drum with alternating black and white lines can be used also to get a gross screening of what an infant is capable of seeing.

To determine if the eyes are straight, we cover and uncover the eyes back and forth to see if the covered eye moves to look at a target when the eye is uncovered.  This is called the “Cover Test.”   We also can shine a flashlight toward the eyes and look at the reflection off of the corneal surface and compare it to the pupil location and with the other eye reflection to look for symmetry.  If the reflection differs in one eye, it usually because one is turned a certain direction.  We also use a 3D picture the child looks at with special polarized glasses that makes the picture seem to be floating in the air if they have good stereopsis or depth perception.  If there is an eye turn, usually their depth perception is weak.

Finally, to determine the eye health, we look inside the eye as much as possible.  We try to utilize eye drops that make the pupil dilate and increases the view inside with our special equipment.  At the very least, a good bright red reflection should be coming out of the child’s pupils from the light.  If there is not a good red reflection or especially a white color coming from the pupil, that could indicate a serious eye problem that should be checked immediately by an eye doctor.

I recommend an Optomap Retinal scan be performed on everyone, every year to help see a more complete view of the retina inside the eye.   Even retinal specialists can overlook small things that an Optomap can bring attention to.  It was developed by a Scottish engineer whose 5 year old son had a retinal detachment that was not seen by regular means until it was too late.  Many kids even as young as 2 or 3 years old can often have an Optomap picture taken to see almost the entire back of the eye at one time.

If there is a suspicious finding and the child is just too young or too uncooperative, they can be sedated slightly with medicine that makes them sleepy and just not care or even totally sedated if needed for a more thoroughly internal eye examination.

Since the nerves from the eye to the brain quit developing by age 7-8 years, we want to make sure children are seeing clearly well before that age.   Ideally, children should have an early childhood, wellness eye exam to look for any abnormalities that could affect the eyes development by ages 3-4.  Now with Obamacare, children under the age of 18 are mandated to be covered by a yearly vision exam as a routine procedure.  Check with your insurance provider for specifics.

Don’t assume those big, bright baby eyes are seeing perfectly.  Often the problems are subtle and hard to tell they have a problem.  The child certainly doesn’t know any difference.   We need to correct those problems as early in life as possible so they can develop clear, comfortable,  binocular vision at all distances they are looking at by age 7 or 8. Especially when they look at your old high school yearbook and laugh at your big hair and Madonna outfit.

Don’t gamble with your children’s eyes.  Start checking their eyes by 3-4 years old.  Schedule your kids for an eye exam today.


Courtesy of Dumas Vision Source, PLLC and Dr Tory W. Moore, Optometric Glaucoma Specialist and Diplomate of the American Board of Optometry.    Serving the Dumas, Texas,  Moore County and upper Texas Panhandle area for 23 years.   Call (806) 935-2020 for appointment or visit our optical gallery without an appointment.  Visit our website for more information.  Like our Facebook business page:  Dumas Vision Source  and you can also connect on Twitter @eyedocdumas

Tory Moore, OD  – “A Hometown Eye Doctor You Know and Can Trust!”

Why are glasses so expensive?

19 09 2013

From time to time I hear the question, “Why are your glasses so expensive?  I can get them a lot cheaper at Bigmart.”  To which I reply, “The real question is why are their glasses so cheap?”

Let’s think about this.  Why are some glasses more expensive and some so cheap?  It’s like anything else, you get what you pay for.  Whether it is a car, furniture, jewelry, tools or shoes.  Yes, you technically can get a pair of glasses at some places for $37.53.  That should be your first red flag because there is no tax on glasses as a health care device.  So why is there some crazy, arbitrary sounding, odd number like they added tax or something?   I submit it is a marketing ploy.

There is a lot of advertising done by the discount opticals, both in print and on television.  They usually have a large store with several employees also.  The optical equipment that it takes to make eyewear is not cheap as well.  So…just how can they pay for all those expenses with high overhead costs and still make it as a business.  Well, you sell low quality materials and don’t pay employees very much.  I assure you that you don’t get the best trained employees and the best customer service with minimum wage salaries and limited benefits.

Just like other material goods, eyewear can have different levels of quality.  Ever bought a piece of particle board furniture that lasted only a year or less?   A hardwood bookcase that your grandma has could be 75 years old and still going strong.  Materials used to make eyewear frames and optical lenses matters.  A lot!   All metal is not the same.  Iron and aluminum are both metal but have very different strengths and weight.   Frames made of inferior metals bend out of shape and turn green with the oils from your skin.  It’s almost impossible to keep them adjusted well on your nose and ears.  They don’t have good soldering points and break under the littlest of pressure.  The finish on them that is supposed to protect them and keep them shiny can come off very easily as well.

Plastic frames also vary in quality.  Plastic is plastic you might think.  Well the plastic cutting board you might have is a lot harder than your plastic kitchen spatula.  Plastics vary in quality as well.  If you have a cheap plastic frame, it will not stay in adjustment to your face too.  The hinges often loosen in cheap plastic frames and can even pull out of the plastic.  Cheap plastic is very brittle and breaks very easily.

Optical lens materials vary as well.  Plain plastic lenses(CR-39) and polycarbonate are known to have distortion.  Some brands are more optically pure than others but many big opticals are using the cheaper made versions that have inferior quality from places in China to keep down costs.  The optical quality is not good with distortion and waves in them, much like a fun house mirror.  This can cause headaches, eye strain as well as just poorer vision.  The Transitions tint they supposedly sold you, that makes your glasses change darker outside are probably not the actual,  better Transitions brand.  Scratch resistant and no glare lens treatments are often one-sided protection and older, inferior technology that peels off easily.

It also takes time and money to train good opticians.  Part of the eyewear price includes their services in helping you select eyewear, take measurements and for their education and training.  The best opticians are certified by the American Board of Opticianry.  In the course of interviewing opticians from these Bigmart stores and applying myself for a job at one once, it is a fact they employee minimum wage or slightly higher employees with rudimentary training.  How does it feel knowing that someone in the tire shop or the ladies clothing department 10 minutes earlier is now measuring your eyes for glasses?   I don’t know about you but I want someone who is an expert at it.

So how do I know what I’m getting is better quality?

First of all, go to a reputable, independent optometry office.  Someone that is going to be there for you and not gone the next year at a Bigmart or a mall store.  There usually is a reason they are working in places like that.

Secondly, use an optical that has ABO certified opticians.  They at least have taken a 4 hour exam to certify they have more optical knowledge and training.

Next, opticians should be able to explain why they are using certain brands of materials.  Why they will perform better for you.  They should be able to customize eyewear for your specific needs.

Try on an expensive frame that is well made of better material and you will be able to see and feel the difference in a cheaper frame.  It won’t be as flimsy and bendable.  It just feels solid.

Brand name materials that are better quality will often have a card or certificate of authenticity to make sure you are getting a real Transitions or other lenses like Hoya digital progressive lenses with EX3 anti-glare treatment.  Make sure the optician gives you that documentation if you are not sure.  If you are paying for the best brand, you should get that brand.

The best materials will have better warranties that come with the eyewear, not something you pay extra for.  Most optometry offices provide one year warranties on good frames and lenses at no extra charge.

Quality eyewear is not expensive when you realize that compared to other common items like an Iphone or Ipad, that cost as much or more and are really just convenience items, they are helping your eyes function well and see your best with little inconvenience.   You use your eyes everyday, all day.   Why settle for something second-rate?    If you are sacrificing clarity of vision, always needing them fixed or adjusted and making your life aggravated, is that really worth paying for cheap glasses?  You may get “cheaper” glasses but you are not getting the same thing cheaper.  It’s not apples to apples.  You are getting cheaply made, inferior glasses for a low cost.  A Kia is a cheaper car but it is not a Mercedes.  I don’t think you would brag excitedly to someone, “I’m driving a Kia!” but you would with a Mercedes or Cadillac.   Take pride in your eyewear and take pride in knowing your vision and your eyes are going to be at their best with good quality eyewear.  You do get what you pay for.

Courtesy of Dumas Vision Source, PLLC and Dr Tory W. Moore, Optometric Glaucoma Specialist and Diplomate of the American Board of Optometry.    Serving the Dumas, Texas,  Moore County and upper Texas Panhandle area for 23 years.   Call (806) 935-2020 for appointment or visit our optical gallery without an appointment.  Visit our website for more information.  Like our Facebook business page:  Dumas Vision Source  and you can also connect on Twitter @eyedocdumas

Tory Moore, OD  – “A Hometown Eye Doctor You Know and Can Trust!”

Back to School Time…. Can Your Kids Use Their Eyes Well To Learn?

22 08 2013

c0016751It’s that time again.  Summer is over and time for the routines to start again.  “Get your homework done, get your clothes laid out for tomorrow, do you have lunch money?, get to bed.”  Ah, the joys of parenthood.

We do those things because we love our kids though and we want the best for them.  We  teach them so one day they can be on their own.  To be able to learn and succeed in life.

Have you ever stopped to think that you may be neglecting one of the most important aspects of learning for your kids? Their vision.  Vision consists of more than just seeing 20/20 on an eye chart or having a school nurse check them at school or at the doctor’s office.  Just because they appear to be able to “see things” doesn’t mean their vision functions properly.

Not only does an eyeball have to focus light from far away onto the back of the eyeball (the retina) clearly, it has to use eye muscles for near vision (accommodate), and do this in co-ordination with another eyeball that are both connected with 6 extra-ocular muscles working in tandem.  It then has to send these light signals from the eye to the brain where our brain’s perception interprets what we see.  There is a lot going on there.   Anything that disrupts any of those systems can cause the vision system to be affected and make it harder to see and likewise learn.

Did you know 80% of learning comes from what we see?  (AOA)   Signs that may indicate a child has vision problem include:

  • Frequent eye rubbing or blinking
  • Short attention span
  • Avoiding reading and other close activities
  • Frequent headaches
  • Covering one eye
  • Tilting the head to one side
  • Holding reading materials close to the face
  • An eye turning in or out
  • Seeing double
  • Losing place when reading
  • Difficulty remembering what he or she read

It makes sense that if a child is uncomfortable doing schoolwork or reading because it makes his eyes tired or the letters move around the page or just doesn’t make sense due to a perception problem are not going to do well in school.   I don’t want to do hard work naturally either if I don’t have to!

Many children are mislabeled as ADHD or have poor attention because of this.

Please have your children examined by a reputable eye doctor, not at a quickie, Bigmart store or at the mall, to ensure their complete vision system is working well.   They must be able to ensure you if your child is seeing 20/20,  that they are not farsighted at all.  Also that their focusing is good, their eye coordination is good and eye health is normal at a minimum.   Too many kids are labeled dyslexic as well because of simple, undiagnosed eye problems and then they have that stigma placed on them for no reason as well as delaying their development unnecessarily.

If you haven’t had your children’s eyes examined this year, why wait any longer?   Don’t let them get behind.

Courtesy of Dumas Vision Source, PLLC and Dr Tory W. Moore, Optometric Glaucoma Specialist.    Serving the Dumas, Texas,  Moore County and upper Texas Panhandle area for 23 years.   Call (806) 935-2020 for appointment or visit our optical gallery without an appointment.  Connect on Twitter @eyedocdumas  and like our Facebook business page:  Dumas Vision Source You also can visit our website for more information.   Tory Moore, OD  – “A Hometown Eye Doctor You Know and Can Trust!”