Tag Archives: distortion

Pentosan (Elmiron) and Your Eyes

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See Anatomy of the Eye

What side effects can pentosan polysulfate have on my eyes?

Although pentosan polysulfate (PPS) is of proven benefit for interstitial cystitis, it may cause damage to the eyes.  Early symptoms may be subtle.  Blurred vision, especially with reading, is common.  Straight lines may appear wavy or distorted.  There may be a slow adaptation from light to dark environments.  Blind spots or missing areas may occur in the central vision.  These symptoms are due to retinal damage; however, they are not specific to pentosan polysulfate damage.  The Eye MD (retina specialist) must use special tests to determine whether vision symptoms are due to pentosan polysulfate or other types of retinal conditions such as macular degeneration.    

Who is at risk of losing vision?

Ocular side effects appear to be related to a build-up of medicine in the body over years.  The longer a person has been on PPS, the greater the chances of developing retinal damage.  Although the average duration of use at the time of diagnosis is 15 years, some patients develop symptoms as early as three years after starting the medication.  With continued use of PPS, additional permanent damage occurs that may result in loss of vision.

What can I do to protect myself?

Pentosan polysulfate is an effective medication for control of pain with interstitial cystitis.  However, it is important to monitor your eyes for side effects that might indicate the need to stop the medication.  The Amsler grid chart should be checked at least once a week testing each eye separately, using glasses if needed.  Look for a missing part of the grid either above or below the central dot while looking only at the center of the grid.  Additionally, your Eye MD should examine your eyes every year with specific testing to look for early signs of retinal changes.  It may be useful to see a retinal specialist who has training in this area.

What happens if I develop retinal changes from pentosan polysulfate?

If early retinal changes are found, pentosan polysulfate may be discontinued.  By discontinuing pentosan polysulfate at an early stage, vision may be saved.  Continued examination is important to monitor the eyes for further changes.  There is no specific treatment for retinal toxicity from pentosan polysulfate. However, if blood vessels grow under the retina, treatment may be helpful as with wet macular degeneration.

By Scott E. Pautler, MD

For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida. Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.

Copyright  © 2019-2022 Designs Unlimited of Florida. All Rights Reserved.

The Ocular Histoplasmosis Syndrome

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globe anatomy
anatomy of the eye (click on image to enlarge)

What is the ocular histoplasmosis syndrome (OHS)?

OHS is a condition where abnormal blood vessels may grow under the retina causing blurred, distorted vision. The retina is a thin layer of delicate nerve tissue that lines the inside wall of the eye like the film in a camera. In the eye, light is focused onto the retina, which “takes the picture” of objects you look at and sends the image to the brain.

What causes the ocular histoplasmosis syndrome?

Most cases of OHS occur as a result of an infection by the fungus Histoplasma capsulatum. This organism is found in bird and bat dropping and is most common in the Ohio and Mississippi river valley areas. High-risk activities include farmers, pest control workers, poultry keepers, construction workers, roofers, landscapers, and cave explorers. When soil is disturbed by wind or human activity, the fungal spores become airborne. After the spores are inhaled, they may cause a brief “flu-like” infection or may cause no symptoms at all in a healthy individual. In infants, the elderly, and those with compromised immune systems severe complications may include acute respiratory distress syndrome (ARDS), pericarditis, adrenal insufficiency, and meningitis.

Usually there are no visual symptoms at the time of active infection. However, after the infection is gone, scars are left in the body. These scars may be seen on x-rays of the lung, liver, and other parts of the body. Many years after the initial active infection, scars under the retina may cause loss of vision from the growth of abnormal blood vessels. At this stage, there is no active infection and a person with OHS cannot transmit an infection to someone else. The risk of loss of vision from OHS appears greater in those who smoke tobacco.

What are the symptoms of the ocular histoplasmosis syndrome?

Decreased central vision is common. It may be most notable at near and is usually associated with distortion, which means straight lines appear wavy or crooked. These symptoms come from active leakage of fluid and blood under the retina from abnormal blood vessels associated with OHS scars. Without treatment more scare tissue forms under the retina and a permanent blind spot develops in the center of vision.

What treatment is available?

There are a number of treatments for OHS and it is important to start treatment as soon as possible after the start of symptoms. The main treatment for the abnormal leaking blood vessels involves medication injection in the office. Medicine injections may be given painlessly in the office with anesthetics. Repeat injections may be required if leakage from the abnormal blood vessels returns. Most people respond well with an improvement in vision. The eye should be monitored because new areas of leakage may occur at a future date. An Amsler grid chart should be used at home on a regular basis to detect recurrent activity at a future date.

By Scott E. Pautler, MD

For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida. Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.

Copyright © 2017-2022 Designs Unlimited of Florida. All Rights Reserved

Metamorphopsia (Visual Distortion)

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globe anatomy
anatomy of the eye (click on image to enlarge).
Image courtesy of Caitlin Albritton.

What is metamorphopsia?

Metamorphopsia (“meta-more-FOP-see-ya”) is a medical term used to describe an abnormal visual perception in which images appear distorted. For example, straight lines appear curved or jagged. It is an important symptom of retinal disease. Metamorphopsia is not caused by the need for new glasses, cataract, glaucoma, or optic nerve damage. Metamorphopsia is a sign of a retinal problem. It is detected and monitored with an Amsler grid.

Distortion
Distortion of lines on Amsler Grid in right eye (click on image to enlarge)

What causes metamorphopsia?

The retina is a thin layer of nerve tissue that acts like film inside a camera. The retina “takes a picture” and sends the image to the brain. The root cause of distortion in vision is a retina that is not smooth and flat against the eye wall. This distortion of the retina may be caused by many different conditions. Sometimes, problems under the retina cause fluid leakage resulting in metamorphopsia. Such conditions include macular degeneration, central serous retinopathy, histoplasmosis, high myopia, angioid streaks, and inflammation. In other situations, distortion may be caused by scar tissue under the retina from inflammation, trauma, bleeding, or chronic leakage of fluid under the retina. Distortion of the retina may also be caused by vitreomacular traction, macular hole, or macular pucker. The ophthalmologist (retinal specialist) will undertake examination and testing to determine the cause.

Is metamorphopsia an urgent situation?

Metamorphopsia may be an urgent situation if it is new in onset or has significantly increased recently. If the cause of distortion is inflammation or bleeding, prompt treatment is needed to prevent further loss of vision and worsening of symptoms. Longstanding distortion is less likely an emergency but merits an eye examination to determine the cause.

What is the treatment?

Metamorphopsia is a symptom rather than a diagnosis, so the treatment depends on the underlying cause of the distortion of vision. This is the reason why it is important to have an eye examination in order to determine the best course of action. Contact your eye doctor or retinal specialist if you have this important symptom.

By Scott E. Pautler, MD

For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida. Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.

Copyright © 2016-2022 Designs Unlimited of Florida. All Rights Reserved.

Macular Pucker

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globe anatomy
anatomy of the eye (click on image to enlarge)

What is the Macula?

The macula is a special area of the retina that gives you fine, central, reading vision. The retina is a thin layer of tissue that lines the back of the eye. It acts like the film in a camera. The retina “takes a picture” of objects you look at and sends it to the brain.

What is Macular Pucker?

Macular pucker occurs when abnormal scar tissue grows like a sheet of cellophane on the macula and causes wrinkling. Macular pucker is present in about one in twenty eyes and is more common later in life. It may occur from aging of the gel inside the eye (vitreous separation), from a torn or detached retina, or from inflammation. Macular pucker is also called cellophane maculopathy, and “wrinkled retina.”  Macular pucker is not the same problem as macular degeneration. Macular pucker does not lead to macular degeneration

What are the Symptoms?

The presence and severity of symptoms vary widely with macular pucker. Symptoms include distortion and blurred vision. Distortion means that straight lines look crooked or wavy. It is readily detected and monitored with the Amsler grid test. Many patients have few or no symptoms and the macular pucker remains stable without worsening.

What is the Treatment?

If symptoms are mild and well-tolerated, no treatment is needed. The macular pucker may not progress and the vision may not worsen further. New glasses will not restore the vision to normal. There is no role for vitamins, exercises, eye drops, pills, or laser in the treatment of macular pucker. This problem usually affects one eye, although occasionally both eyes are involved. When the symptoms of macular pucker interfere with daily activities, vitrectomy surgery can improve vision by removing the abnormal tissue that wrinkles the retina. The amount of visual improvement depends upon the health of the retina under the scar tissue. Usually, there is a significant improvement in vision with much less distortion. Rarely, does the vision return completely to normal. Improvement in vision after surgery takes month to years. The most common side effect from vitrectomy is progression of cataract.

Below is a time-lapse video of a retina scan (OCT) of a 64 year-old woman with longstanding blurred vision and distortion in her right eye with 20/100 vision. After surgery her thickened retina gradually thinned (although it did not return to normal). Her vision returned to 20/25 over time.

For more information please visit Retina Vitreous Associates of Florida.

By Scott E. Pautler, MD

For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida. Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.

Copyright © 2016-2022 Designs Unlimited of Florida. All Rights Reserved.

Macular Telangiectasia

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normal macular OCT
The macula is the center of the retina (in box). The bottom image is an optical coherence tomogram of the macula. (Click to enlarge)

What is macular telangiectasia (MacTel)?

Macular telangiectasia is a disorder of retinal cells and tiny blood vessels located in the center of the retina. It has also been called juxtafoveal telangiectasis. The retina in your eye is like the film inside a camera. The retina “takes the picture” of objects you look at and sends the message to the brain. The macula is the central portion of the retina that is responsible for sharp reading vision. In MacTel the macula undergoes slow degeneration, and tiny foveal blood vessels become irregular and dilated for unknown reasons. They rarely leak blood or clear fluid in the fovea. MacTel may resemble changes in the retina from drugs that are used to treat breast cancer (Tamoxifen).

Who is at risk for developing macular telangiectasia?

Macular telangiectasia is usually found in males and females during their 5th to 8th decade of life. It may occur in as many as one in every 1,000 persons. MacTel is associated with diabetes, high blood pressure, and tobacco use, but the exact cause has not been determined. Hereditary factors appear significant. Low serum levels of an amino acid called L-serine may play a role, but there are no clear recommendations for supplementation to date.

What are the symptoms of macular telangiectasia?

Blurring of vision is the most common symptom. Distortion of vision may also make reading or seeing small details difficult. Distortion is when straight lines appear wavy or crooked. It may be monitored with the Amsler grid test. Symptoms and clarity of vision may change from day to day. If sudden loss of vision or increased distortion occurs, your doctor should be notified without delay (within a week) as treatment may be needed.

What treatment is available?

There is no cure, but treatment may improve vision or keep the vision from worsening in certain instances. No specific treatment may be recommended if the symptoms are mild. Supplements containing the amino acid L-serine are being investigated. Laser and medicine injections help selected patients. Treatment usually does not return the vision to normal.

Your doctor is going to order appropriate tests and recommend the best course of action to take at this time. Physical activity and use of your eyes will not worsen macular telangiectasia. Magnification may help with reading. If you have any questions, please feel free to ask. If you would like to participate in research, contact www.mactelresearch.com.

By Scott E. Pautler, MD

For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida. Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.

Copyright  © 2014-2022 Designs Unlimited of Florida. All Rights Reserved.

Vitreomacular Traction Syndrome

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vitreous gel
Clear vitreous gel fills the eye (click on image to enlarge)
normal macular OCT
The macula is the center of the retina (in box). The bottom image is an optical coherence tomogram of the macula. (Click to enlarge)

What is the vitreomacular traction syndrome?

The vitreomacular traction syndrome is a condition in which the vitreous gel, which fills the inside of the eye, pulls on the macula. The macula is the center of the retina and gives sharp central vision for reading and seeing fine details. The retina is a thin layer of tissue in the back of the eye that lines the inside wall like the film inside the back of a camera.  The retina “takes a picture” of objects you look at and sends it to the brain. When the macula is damaged, the central vision worsens.

What causes the vitreomacular traction syndrome?

The vitreomacular traction is caused when the clear gel that fills the eye (vitreous) pulls on the macula.  At birth the vitreous is a thick and perfectly clear gel.  With age or trauma the vitreous gel begins to condense and pull away from the retina.  If the attachment of the vitreous to the macula is unusually strong, the vitreous may pull the macula away from its normal position, distorting this normally smooth tissue.

normal OCT
Normal macula as seen on optical coherence tomography (click to enlarge)
VMT
Vitreomacular traction as seen on optical coherence tomography (click to enlarge)

What are the symptoms of the vitreomacular traction syndrome?

Blurring of vision is mild at first, noted especially while trying to read fine print.  It slowly worsens, often with distortion (straight lines look crooked).  Sometimes there is a vague blind spot in the center of vision. The visual symptoms may be detected and monitored with the Amsler grid test.

What treatment is available?

If the symptoms are mild, no treatment is needed.  Medicine injection (Jetrea®) or vitrectomy surgery may help if there is significant loss of vision.  In most cases the vision improves with injection or a surgery that releases the abnormal pulling of the vitreous on the macula.  A gas bubble may be placed in the eye to smooth out the macula.  Strict facedown positioning may be recommended for one week following surgery.  Special cushions and massage tables are available to help maintain the proper head position.  The surgery is usually successful in returning vision, though the vision may not return completely to normal.

The image below shows the separation of vitreous fibers from the macula after Jetrea injection:

Jetrea VMT
Vitreomacular traction relieved by Jetrea (click to enlarge)

Below is a video that reviews the anatomy of the eye, information on vitreomacular traction, and an example of vitrectomy surgery:
https://youtu.be/r-5Az8_DU3U

Below is the case of a 70-year-old woman who had mild VMT. She was observed over several years and the traction released without surgery.

By Scott E. Pautler, MD

For a telemedicine consultation with Dr Pautler, please send email request to spautler@rvaf.com. We accept Medicare and most insurances in Florida. Please include contact information (including phone number) in the email. We are unable to provide consultation for those living outside the state of Florida with the exception of limited one-time consultations with residents of the following states: Alabama, Arkansas, Connecticut, Georgia, Minnesota, and Washington.

Copyright  © 2013-2022 Designs Unlimited of Florida.  All Rights Reserved.