The retinal pigment epithelium (RPE) is on the bottom of the 10-layered retina (the light-absorbing tissue that lines the inside of your eye). Within RPE cells, there is a bi-product of retinal metabolism called lipofuscin. Increased or decreased levels of lipofuscin can be markers for specific disease processes.

Very simply put, fundus autofluorescence allows us to take a photograph isolating the RPE. By doing this, it can detect abnormal amounts of lipofuscin.

Autofluorescent image of a normal retina

While autofluorescent images may just look like black and white photos, they tell a different story to a trained eye. Excessive amounts of lipofuscin “glow” or “hyperfluoresce” on the images while damaged RPE cells are dark or “hypofluoresce”.

Benefits

Autofluorescent images can pinpoint areas of poorly functioning RPE in certain retinal diseases. These signs often appear on autofluorescent images before they are visible on color photographs. Because of this, autofluorescence is a useful tool to use in addition to color images when monitoring chronic retinal diseases like macular degeneration, histoplasmosis, optic disc drusen, and even malignant melanomas.

Macular degeneration

We continue to adapt new technology in our practice to better serve our patients in Paducah. By staying current with the latest technology, we can insure that we are providing our patients with the best eye care available.

-Dr. Montgomery

Dr. Canaan Montgomery is an eye doctor in Paducah, KY. As an optometrist, he diagnoses and treats eye diseases, fits contact lenses, and sees pediatric patients.

Visual Aura: My Experience

During my lunch break, I picked up a book to read. I began reading the first line and immediately had to re-read it several times. I realized that I was unable to see well out of my left eye. Suddenly, I noticed a band of light just beneath and to the left of my point of fixation. The band had every color of the rainbow in it and was spinning, flashing, and fluttering. The bar remained in the same location regardless of where I looked. Unlike vitreous floaters, the bar did not accelerate and decelerate with my eye movements. I knew it was either a retinal issue or an ocular migraine. Needless to say, I was freaking out a little!

My visual aura was similar to this depiction, but in a different location

Thinking it was likely a migraine, I immediately went to the nearest store and bought OTC Excedrin Migraine and took two, then returned to the office. By the time I made it to the office (10 minutes after onset) the colored band was gone and replaced by a veiling glare in my lower left visual field. I had a staff member perform Confrontation Visual Fields (a gross measurement of your peripheral vision) and found that my entire inferior temporal quadrant was missing. If I was freaking out before, I was really upset now! Within 2-3 minutes, my peripheral vision had improved and was almost back to normal. I had a staff member perform a threshold visual field test on me, but by the time the machine was ready to go, my symptoms were almost gone. The visual field came out normal.

Then the headache hit. It started as a dull throb in the back of my head and quickly escalated to an intense pain deep in my head. As the headache worsened, my visual symptoms returned to normal. Needless to say, I have a new-found empathy for those experiencing this condition for the first time. It can be quite frightening.

So what causes visual auras?

Although our understanding is incomplete, we do know that visual auras are caused by the same pathophysiological processes as migraines themselves. It all has to do with reduced blood flow to different parts of the brain and nervous system. Some patients can have visual auras followed by no headache, while it serves as a warning for impending migraines to others. If and when you get one, immediately taking an OTC medication like Excedrin Migraine may reduce the severity of the impending headache. If you suffer from chronic migraines, talk to your primary care doctor about treatment options.

-Dr. Montgomery

Dr. Canaan Montgomery is an optometrist in Paducah, KY. As an eye doctor in Paducah, he treats eye diseases, fits contact lenses, and sees pediatric patients.

Note: This is not medical advice. If you have a concerning headache, you should see your doctor to come up with a treatment plan under their guidance.

What Is It?

Glaucoma is a condition that causes death of the optic nerve, which carries what you see from your eye to your brain. The optic nerve dies in a predictable pattern and damages the part of the nerve that is responsible for transmitting our peripheral vision first. Glaucoma is typically caused by increased eye pressure, which can occur due to a variety of reasons. It can sometimes occur without increased eye pressure, which is why “glaucoma screenings” that consist of eye pressure measurement alone are NOT a good substitute for a dilated exam.

Healthy Optic Nerve Head

Optic Nerve with Moderate Glaucoma damage

How Do I Know I Don’t Have It?

Unfortunately, glaucoma often goes undetected for years or even decades because there are no symptoms until the disease is in end-stage.  A dilated eye exam, pressure measurement, visual field analysis, and other sophisticated tests are the only way to detect glaucoma. This is why it is so crucial to have yearly eye exams: the sooner we catch it, the sooner we can begin treatment!

Measuring intraocular pressure

What Can I Do To Protect Myself?

Yearly eye exams are the only way to monitor the onset and progression of glaucoma. Every person should have an eye exam every year, even if you have great vision!

Dr. Montgomery

Dr. Canaan Montgomery is an optometrist in Paducah, Kentucky. As an eye doctor in Paducah, he provides eye care for glaucoma and other eye diseases, pediatrics, and general eye exams.

High blood pressure in the arteries supplying your retina and optic nerve with blood can cause a decreased in blood flow to these tissues or damage the arteries themselves, contributing to some of the following common conditions:

-Non-Arteritic Ischemic Optic Neuropathy (NAION): reduced blood flow to the optic nerve causes optic nerve swelling and irreversible damage

NAION with Optic Disc Swelling

-Central and Branch Retinal Vein Occlusions (CRVO)(BRVO): a blood clot forms in a vein, preventing blood from draining from the retina. Severe retinal damage can result

CRVO with widespread Hemorrhaging

-Central and Branch Retinal Artery Occlusions (CRAO)(BRAO): a blood clot forms in an artery, preventing the retina from receiving oxygen. This causes permanent damage to the retina within a few hours, often leading to total or partial blindness.

CRAO. Macula appears as a “Cherry Red Spot” due to underlying blood supply

-Retinal Artery Macroaneurysms (RAM): Retinal arteries under the strain of increased blood pressure develop aneurysms, which eventually burst and leak blood and lipid into the retina

RAM with widespread leakage of lipid into the surrounding retina

-Age Related Macular Degeneration (ARMD): There is an association between hypertension and progressive ARMD.

Advanced ARMD

-Stroke: A stroke can cause permanent damage to the areas of the brain that process visual information, causing partial or total vision loss.

Visual field loss associated with stroke

-Hypertensive Retinopathy: This is the most commonly encountered ocular disease associated with Hypertension. As the blood pressure increases, retinal arteries begin to leak blood and lipid into the retina, causing retinal swelling and potential vision loss.

Moderate Hypertensive retinopathy

BOTTOM LINE

Lowering your blood pressure is good not just for your eyes, but for your entire body. If you aren’t have regular checkups with your Primary Care Physician, make it a habit. You should also frequently monitor your blood pressure at home and alert your doctor if you notice a change. Lowering blood pressure is the only way to reduce your risk of these events happening.

Those with Hypertension should have a dilated eye exam every year so that your optometrist can look for these and many other conditions. You may be having an issue that you are not yet aware of, so get it checked out!

-Dr. Montgomery

Dr. Canaan Montgomery is an Optometrist in Paducah KY. His professional interests include ocular disease, pediatric eye care, and vision therapy.

The Problem

The same small blood vessels that are in your toes, kidneys, and other organs also supply the retina (inner lining of the eye) with blood. When your blood sugar gets out of control, these vessels are damaged and leak blood and lipid into the retina, making it swell. When the retina swells, it becomes damaged and can die. This leads to permanent vision loss.

The Treatment

What’s the fix? Get your blood sugar under control immediately! I will work with your Primary Care Physician and medications can be adjusted if needed to lower your glucose levels. In many cases, treatment with lasers, or retinal surgery is necessary to protect the eye from further damage.

Preventative Therapy

I see unnecessary, permanent vision loss in countless diabetic patients every month. Don’t let this be you! As a diabetic, it is your responsibility to monitor your glucose levels daily. Your team of doctors will work with you using medication and monitoring, but good diet and exercise habits are crucial to success in managing diabetes.

Bottom Line

You MUST get a dilated retinal exam every 6 months to 1 year, depending on your Optometrist’s recommendation. There are no exceptions! Diabetic retinopathy can quickly cause irreversible damage that you may not be aware of. Your Optometrist is the only one who can identify these changes and get you help. Make your appointment and protect your most precious sense: sight!

Dr. Montgomery

November 14th is World Diabetes Day

So why all the trouble? Isn’t there technology we can use to avoid dilation?

Let’s start with some good news: WE CAN REVERSE IT!! We have eye drops that will reverse the dilation and get you back to normal much faster.

And here’s even better news: We use newer drops that all but eliminate the blurriness you experience while dilated (sorry the bright lights are still there, but that’s what sunglasses are for)!

Optic Nerve

Dilating your eyes allows your eye doc to see through your pupil to your retina, lens, and vitreous (kind of a big deal!). If something were to happen to your eye like a disease or disorder, there’s a good chance that it will occur in these tissues. Furthermore, the blood vessels in your retina can tell us critical information to your overall health. You would be amazed at the number of systemic diseases that can be caught by examing the retina!

Dilating moves the iris (colored part of your eye) out of the way so we can see in. Imagine you need to look into a room. Would you rather peek through the keyhole or open the door and see the full room? Dilation opens the door so we can see your full retina.

So what about technology that can eliminate dilation? While there are cameras that can take wide angle images of your retina, they cannot fully capture the entire retina and the doctor would fail to gain critical information gleaned only when viewing the retina live, with depth perception. Dilation is here to stay.

So, the next time your optometrist dialtes you, remember how important it is to the health of your eyes and your entire body. And wear some sunglasses!

-Dr. Montgomery