The Sum of All Fears

20 10 2015

How many people saw the movie with Ben Affleck and Morgan Freeman called, “The Sum of All Fears ?”   Terrorists build a nuclear bomb and blow up Baltimore during a football game and Ben Affleck has to try to stop WW3 with the Russians.  Scary as it is because it is realistic, for most people the sum of all fears is going blind.   A recent poll found that Americans rank “losing eyesight” highly among the worst health concerns that could affect them.  I have always heard speaking in public is the number one fear of adults.  But that you can overcome, as I did.  Short of a miracle, blindness is forever.

Blindness occurs at different levels however.  When people say someone is blind, that doesn’t necessarily mean they can’t see anything at all, like pitch black darkness.  If you are legally blind, that just means you see worse than 20/200 even with the best pair of prescription glasses possible.  You might be able to see cars and trees but they are so blurred you can’t make out the details, even if you get up closer.  Some people have “no light perception” where they cannot even see a light at all.   That only makes up about 15% of people considered legally blind.  A better term for a lot of these people who have some vision, while not very clear, is “visually impaired.”

With the large increase in the aging population now that the baby boomers are becoming senior citizens,  we see a lot more macular degeneration.  It is the leading cause of blindness in those over 65 years old.   The central retina deteriorates and causes vision loss in the central vision making reading difficult or even impossible.  In worst cases people can’t see straight ahead to drive or even a person’s face they are talking too disappears in the central blind spot.  The often can see something out of the corner of their vision, like a chair on the side of the room but when they turn to look directly at it, it disappears.

People with a visual impairment like this often can be helped with low vision devices.    Whether a hand held magnifier, high powered reading glasses or a closed circuit television, there are different tools available for those with low vision.   They are like tools.  Some times a pair of pliers can be used for lots of different tasks, but sometimes you just need a pair of needle nosed pliers to do the job well.  Or the same can be said for shoes.   Sometimes casual shoes or tennis shoes  work, sometimes dress shoes are needed but sometimes you need to have some good work boots.

Low vision devices are no different.   When ordinary spectacle glasses and bifocals just don’t help enough to see anymore,  sometimes we need a different tool for the job.   A hand held magnifier may work great for a short glance at a medicine bottle.   Trying to read your mail might require a magnifier on a stand that you don’t have to hold and try to focus just right.  Reading a letter or looking over papers for more than 5 minutes would probably do better with the CCTV that can magnify what the person is looking at and display on a monitor screen 40X bigger.

There are other “tools” that can be used around the house for low vision patients to make their life easier and to help keep their independence.  Examples are large number phones, large number playing cards, voice assisted devices, large letter pill organizers, etc…  They can also help with counseling and other referrals to help stay independent as much as possible.  We can refer those with low vision starting at 20/70 best corrected visual acuity  to the Texas Department for the Blind Services for help from the state.  They can come to your home for an assessment of your needs around the house and see what they can provide.  The nearest local office is in Amarillo and their phone number is 806-351-3870 if you have questions about how they can help.  It’s your tax dollars so don’t feel bad about asking for help if you need it.  That is what they are there for.

The best way to avoid going blind is to have regular, annual eye wellness exams.   Most people with medical eye problems still see fine, until the end stages when it’s too late and all the damage is done.   Even if you think you see great, have your eye’s health examined every year.    Better to prevent problems and catch them early then waiting and then it’s too late.

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 www.visionsource-dumas.com 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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Don’t be in Denial of West Nile

7 10 2015

West Nile Virus disease is here to stay in Dumas, Moore county and the Texas panhandle.  More cases are reported every week most likely due to the wetter than normal summer this year.

Ten years ago, we had never heard of it.  We were more likely to get sleeping sickness or malaria than something esoteric like West Nile Virus.  West Nile is a virus that originated in the Middle East and has made it’s way to the US and is moving westward.  It can infect humans, birds and horses from a mosquito bite and it can be deadly if it gets into the nervous system.   People with weakened immune systems are at most risk but it can even knock down a seemingly healthy person.

It really hit home this last month when one of my employees came down with a brain infection (encephalitis) from a mosquito bite in her backyard here in town.   She is recovering slowly after being unconscious for over a week and on a respirator and feeding tube.   Short of a miraculous healing, it will take many, many months to recover.  I have two patients that I have also seen that have the after effects of the disease.  One doesn’t have any eye problems but the other has damage to his optic nerve of the left eye, leaving him with permanent damage to his vision.

By the time people are having eye problems, they are probably in the hospital.  I have yet to see anyone in my office with early symptoms and I hope not to.  The problems that happen with the eye can have devastating complications to the vision.  Inflammation or infection can occur inside the back chamber of the eye (vitritis), in the retinal tissue (retinitis and choroiditis) as well as inflammation to the optic nerve (optic neuritis).   All can cause permanent vision loss.

Since eye problems from West Nile Virus are usually not the first sign of illness, I write about it more to create awareness of this relatively new disease to our area since it can be devastating to the body and even fatal.

Early signs and symptoms take 2-14 days incubation after a recent mosquito bite.  They vary from person to person such as fever, headaches, neck ache, joint pain, diarrhea, vomiting, fatigue and less commonly a rash on the check, back or legs.   The severe form that affects your nervous system can cause disorientation, seizures, brain infections and even death in 1% of cases.

I would encourage city, county and state agencies as well as school officials to increase awareness of the disease and prevention.  Contact them and ask what they are doing to kill mosquitos to prevent the disease.   Spraying alleys and enforcing ordinances for residences with trash and high weeds around houses and vacant lots are important.   You yourself can make sure to apply insect repellant that contains the chemical DEET when going outside and especially on your children.   Avoid putting on moisturizer creams and fragrances that might attract mosquitos as well as not going out after dark when they are most active.  Consider wearing pants and long sleeve shirts too.  Make sure to remove standing water out of old tires, buckets and flowerpots, etc., which can be used as breeding sites.

If you look at the maps that show incidences of infection, Moore county is not indicated.  ( Centers for Disease Control )   I would speculate that cases are reported from the hospital they are being treated at when diagnosed, not WHERE they were bit and infected.  In the case of my employee, she hadn’t traveled anywhere and knew she had been bit in her backyard garden a few days earlier when she got really sick.   So take care out there.   We don’t have to live in fear, we just need to be aware and be smart to help prevent the spread of the disease.   Even though we live in the middle of nowhere, Moore county is not immune.

 

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 www.visionsource-dumas.com 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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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:

http://www.cnn.com/videos/us/2015/05/08/pkg-illinois-toddler-eye-cancer.wrex

or ABC News:

http://abcnews.go.com/Health/mom-catches-year-olds-eye-cancer-snapping-photo/story?id=30954695

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 www.visionsource-dumas.com 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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Focus on Archery

31 01 2015

When you hear of famous archers in history, you can almost visualize them in their garb of the time and with different types of bows.  Robin Hood in his green felt hat (doubt he had tights on) and a recurve bow.  William Tell in maybe a Swiss type lederhosen outfit and a crossbow.  Minamoto no Tametomo in a Kyodo obi and kumi bow.  Okay, maybe THAT one doesn’t ring a bell.  He was a famous samurai that legend says sank a ship with an arrow.   More contemporaries are:  Fred Bear, Katniss from “The Hunger Games” and Legolas ( the elf), from the “Lord of the Rings” series also.  Then there is this guy, Lars Anderson.  https://www.youtube.com/watch?v=BEG-ly9tQGk   That is some amazing skill right there.

Modern archers with a compound bow usually depend on being able to use a peep sight on the bow string up close to the eye.  It basically is a little round circle that you can “peep” through.  A front sight pin that extends a little further past the bow is aligned in the peep sight with the target.  Much like a rifle or pistol has a back sight and a front sight, both which have to be aligned with a target.  The human eye can only focus on one point at a time, so it is imperative with archery or firearms to concentrate on the front sight.  The back sight and the target are usually slightly blurred when you do so.

A problem occurs as we age though and we begin to lose our focusing ability up close.  After forty something years old, the crystalline lens in the eye begins to harden and cannot change shape as easily to focus on near  objects.  Sort of like an egg being fried and the protein in the egg yolk begins to change from runny to thick and then hard.  It’s not a muscle that is too weak and needs to be strengthened.  So that is why we ALL eventually have to have some help in the form of bifocals or even better, progressive lenses that can focus in all places (mis-labeled as “no-line bifocals” often times.)

So what do you do when the front sight pins of the bow begin to be more difficult to focus after forty?  The easiest way to compensate (there is a lot of compensating after 40) is to use what is called a “Verifier,” available from Specialty Archery. https://www.youtube.com/watch?v=x_s_lpHqHXo

It is a screw-in lens that is attached to the peep sight and allows for slight magnification to see the sight pins better.  I have not found out it if can be used in competitive archery or not yet but it’s not any different than wearing bifocal glasses to correct your vision so I wouldn’t think it would be against the rules.  It is not a scope to make the target magnified like a different product called a “Clarifier,” to be used with a scope and makes the target easier to see.

I recently prescribed a daily disposable bifocal soft lens to a forty year old competitive archer and he likes it for the time being.  He hasn’t ever worn glasses and still sees 20/20 far away.  He has been noticing it is not as smooth and easy to focus those sight pins quickly like it used to be.  I told him rifle and pistol shooters have the same problem after forty years old with open, iron sights.  The only thing you can do is either use some kind of scope or a peephole sight that extends the depth of focus of the eye.  Peepholes are fine for stationary, target shooting like Olympic shooters would do but are not practical for action shooting or even hunting.  This patient of mine wears the multifocal contact lens on his dominant eye and uses it just for shooting since he still reads fine without glasses…for now at least.   It focuses the sight pins better with a very slight blurring of the distance target but not bad within 50 yards.

So if you are over forty and not seeing those sight pins on your bow quite as well, good news!  There is hope for you in maybe more than one way.   Have your eyes examined for any uncorrected vision problem or eye disease first.  Unless you still want to blame your poor shooting on your eyes or your eye doctor.

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 www.visionsource-dumas.com 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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Bariatric Surgery Patients Take Note

2 12 2014

A recent review of ophthalmic complications from bariatric surgery (weight loss) is bringing to light some of the complications that can affect the eyes and the vision system as a result of these surgeries.  In the journal, Obesity Surgery, researchers noted an increased risk of problems related to nutritional deficiencies. (1)  Since these surgeries reduce the amount of intake of food and thus nutrients, persons who do not take vitamin supplements prescribed can have serious complications to the eyes and vision.   The biggest risk is low Vitamin A.  Vitamin A in critical for the function of light receptors in the retina, which helps keep good night vision.   It can also cause severe dry eye and corneal problems as a result.   Eye muscle paralysis and involuntary eye movements  are another possibility.   Other vitamins and minerals needed for function are Vitamin E, Vitamin B1 (thiamine) and Copper.

The AREDS2 study on age related macular degeneration demonstrated less risk of the disease when people had more antioxidant vitamins (Vit. E  & C, Zinc) as well as carotenoid pigments (Lutein and Zeaxanthin) from the food we eat.  The pigment helps protect the macula area of the retina and our body doesn’t produce it.  It makes sense that the macula could deteriorate faster if you have poor nutrition.

With bariatric surgery, it may be hard to digest a tablet let alone swallowing some of those big pills.  There are liquid or chewable vitamins that can be used to help minimize malnutrition by absorbing the vitamins more effectively.  Check with a pharmacist or nutritional expert on the availability of such items.

If you have had bariatric surgery, it is important to have annual eye examinations to make sure the eyes stay healthy.  Make sure you are getting your diet supplemented with a multi-vitamin/mineral supplement that you can take easily and absorb and try to get fruits and vegetables with dark colors in your diet.

Reference

1. Rui Azevedo Guerreiro, Rui Ribeiro. Ophthalmic Complications of Bariatric Surgery. Obesity Surgery, 2014    http://link.springer.com/article/10.1007%2Fs11695-014-1472-y

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 www.visionsource-dumas.com 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!”





Extra, Extra, See All About It!

7 11 2014

This time of year during fall when the sun is shifting on the horizon it just seems like the glare is worse than normal at sunrise and evenings.  Especially in the flat, treeless plains of the Texas panhandle where you can see forever.  Sunglasses are a necessity when that sun is coming right down the street in your eyes.

In the past, photochromic lenses that change with the light have limited darkening behind the car windshield so most people would have to have a separate pair of sunglasses that stay dark all the time.  That works great but sometimes it is inconvenient for some people when they walk inside and don’t have their clear pair with them or have no place to put their sunglasses once inside.

Transitions Optical has a newer product available now called Transitions XTRactive.  The basic Transitions Signature lenses are better than ever but still need UV to change them.  Windshield glass blocks UV light and so while they are good, they aren’t the very best option if you drive a lot and want to reduce the brightness of light.

Transitions XTRactive lenses however get dark behind the windshield and yet still get almost perfectly clear inside.  The lens tint once you go inside is almost indiscernible.  So if you are one of those that seem to always be switching glasses or end up wearing your sunglasses inside because you forgot the clear pair, this might be a great option for you.

We have demonstration lenses available to see for yourself how dark and how clear they become.  We even guarantee them if you are not happy with their performance and will exchange them for another type.

Come see what they are all about!

 

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 www.visionsource-dumas.com for more information.  Like our Facebookbusiness page:  Dumas Vision Source  and you can also connect on Twitter @eyedocdumas

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





SnackPak 4 Kids and Transitions Lenses Special

17 07 2014

SnackPak 4 Kids is feeding hungry school age kids this summer and we want to help.   We support this program and we would like to team up for July and August 2014 to help them out.  If a patient brings in a 16 oz (small) jar of peanut butter or a box of Pop Tarts for SnackPak (or better yet Both!) and buys a Transitions lens add-on to their spectacle lenses, we will give them 50% off that price of the Transitions‘ add on cost(about a $45 dollar savings).   A collection container is by our front door.

Even if you do not buy any eyewear, you are welcome to drop off your donation of peanut butter or PopTarts at our office.  

It’s not the kid’s fault that they go hungry.   Studies are showing when the kids are not going hungry, they do better in school.  If they can get through school with a good education and not drop out, perhaps the generational poverty cycle can be broken.

If you have any questions about our offer, you can contact our office at 935-2020 or information about the SnackPak program in Dumas at SnackPak 4 Kids Dumas.  Thanks for your support of SnackPak 4 Kids and Dumas Vision Source.

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The following information is from SnackPak 4 Kids website (http://snackpak4kids.org/history)

“It began with 10 hungry students at Will Rogers Elementary School in Amarillo.  Bushland couple Dyron and Kelly Howell had discovered that Amarillo was the largest city west of Dallas without a weekend backpack program. And yet more than 3,200 children in the Amarillo Independent School District relied only on the meals served to them at school for their weekly food. That meant hundreds of children spent their nights and weekends hungry.

Determined to find some way to address this need, the Howells assembled ten bags of food that could be prepared without adult supervision—juice boxes, peanut butter, sandwich snack crackers, breakfast cereal, Pop-Tarts, fruit cups and more. On Friday, September 3, 2010, the first ten Snack Pak 4 Kids recipients were given those bags, which contained enough food to get them through the weekend. The Howells prepared the bags again the next week, and got others involved. Soon the number of children grew, and then the program expanded to other schools. Teachers began seeing academic improvement, better concentration, and higher attendance among SP4K recipients.
As of early 2014, the program has grown to serve 5,200 students in 30 school districts, Amarillo, Booker, Borger, Bushland, Canadian, Clarendon, Clayton NM, Dalhart, Dimmitt, Dumas, Friona, Fritch, Happy, Hereford, Highland Park, Lockney, Panhandle, Pampa, Perryton, River Road, Spearman, San Antonio, Stratford, Sunray, Tahoka, Texhoma, Texline, Tulia, White Deer, and Wildorado.

Every week, hundreds of volunteers pack 14 regular, nutritious items into plastic bags and deliver these bags to participating schools.  At the schools, officials discreetly place these bags in students’ backpacks on Fridays. Students receiving the bags have each been identified by school staff members (counselors, nurses, teachers or principals) as living in a “food-insecure” household—which means these families don’t always know the source of their next meal. The SP4K program feeds each elementary student and any siblings at home not old enough to attend school.

Our new Snack Shak program currently provides food to middle school and high school students, and is expanding quickly.”

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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 www.visionsource-dumas.com 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!”