What is Botox? | Part 2, Uses of Botox

In the last article I talked about the use of Botox for spasms of the eyelids and the face. This was one of the two early uses of Botox. Another early use was treating double vision secondary to strabismus (misaligned eyes).

Botox Treats Double Vision

There are multiple causes of strabismus (strokes, nerve damage, trauma to the muscle to name a few). Sometimes we can place temporary prism in glasses and help correct the double vision and occasionally surgery is needed if the problem is too loarge and not going to  improve on its own.

If the misalignment is too large for prism and is not ready of surgery (or the patient is not a good surgical candidate), Botox can be injected into one of the eye muscles to help straighten the alignment and treat the double vision.

By weakening a muscle the eyes can improve their movement. While this effect often only last 3 months this may be enough time for the double vision to resolve and as the Botox is wearing off then motility returns to normal. The injection can be done in the clinic with some topical anesthesia (drops) with little to no discomfort to the patient.

Botox for Migraines

One of the newest uses for Botox has been the treatment of chronic migraines. While we do not fully understand how Botox reduces headaches, the results are well studied and documented.

Typically, we see a reduction in BOTH the frequency and the intensity of migraine headaches.   We expect to see a 70% reduction in the frequency of headaches per month, and usually the headaches that do occur are less intense.

Botox is indicated for those patients that have 15 or more headaches a month and are diagnosed with a history of migraines. Often the treatment takes at least 2 rounds 12 weeks apart to start helping, so I tell patients not to be discouraged if the first round does not work.

If you or someone you know has a problem that Botox could help please call 941-921-5335 and schedule an appointment with Drs. Abrams, Levy, or Spoor.

Jody Abrams, MD, FACS
Oculoplastics/Neuro-ophthalmology
Sarasota Retina Institute
Sarasota, Florida 34239

Centrasight Intraocular Telescope Improves Vision for Macular Degeneration

The implantable telescope for macular degeneration continues to be successful.

For the last few years we have talked about the implantable miniature telescope. This incredible devices has been used to give patients with end stage macular degeneration improved vision. Marc Levy, M.D.  has been involved with the telescope since the early FDA trials and is currently the only surgeon in our area preforming the surgery.

Implantable Telescope Improves Vision

Recently a long term study of patients with the telescope was completed and published. This study followed 129 patients over 5 years after implantation of the telescope. The results showed that most patients got significant improvement of vision at about 2 years after the telescope was placed, and this improvement appeared to continue for at least 5 years.

The study was used to by the FDA to allow all patients 65 and older with end stage macular degeneration to be eligible for the telescope. It is now the only FDA approved surgical device to treat most advanced forms of macular degeneration. With macular degeneration affecting over 15 million people in this country the telescope gives some hope to patients that are in the advanced stage of this disease.

What is the Implantable Telescope?

The implantable telescope, by CentraSight, is a tiny telescope inserted in the eye.  In qualified patients with macular degeneration, the telescope has successfully improved vision and the quality of life for its recipients.

The “telescope” projects images onto the retina outside of the degenerated macula.  The images are larger, perhaps 2.2x or 2.7x, and projected to the healthier retina near the macula.  This enlargement enables the less sensitive, but healthy, retinal tissue to replace central vision.

Qualifications for Implantable Telescope

To be a potential candidate, your eye doctor must confirm;

1.  You have End-Stage Macular Degeneration from either Wet or Dry AMD

2.  You no longer will need treatments such as anit-VEGF injections

3.  You have not had cataract surgery in the eye with AMD.

4.  You meet the age, vision and corneal health requirements.

If you or someone you know is affected with macular degeneration please contact our office for an evaluation at 941-921-5335.

 

New Opportunity for Dry Macular Degeneration Patients

Over the last year we have talked about an incredible device that can be used for patients with dry macular degeneration. The implantable miniature telescope (IMT) has been placed in numerous patients around the country giving them increased independence. In the past the patients had to have advanced dry macular degeneration, not had cataract surgery yet, and be over the age of 75. Well needless to say that was a very limited group of patients with macular degeneration.

The Government Changes

Just recently the rules for who can get a implantable miniature telescope has changed. The patient still has to have advanced dry macular degeneration, have not had cataract surgery, but now the age limit is 65 and older. Dr Levy is very excited with this change in the rules. This now allows him to offer the treatment to a much larger group of patients that previously had little options for improvement in their vision

What is the Implantable Miniature Telescope?

In patients with dry macular degeneration they lose their central vision. The center of the back of the eye is damaged, but the side or peripheral areas is usually left untouched. Regular glasses focus light on the center part of the eye, and  with macular degeneration the light information can not be used no mater how good the glasses. The implantable miniature telescope is placed inside the eye during cataract surgery. This specially designed lens then enlarges the image in front of the patient and projects it onto areas of the peripheral retina. This can have significant improvement in the patients overall vision.

Where Can Patients Get Evaluated For a Telescope Procedure?

If you or a loved one has advanced dry macular degeneration, has not had cataract surgery in at least one eye, and is over the age of 65 there are a limited number of centers in the country that can offer you some hope by putting in an implantable miniature telescope into the eye. We are lucky in the western coast of Florida to have Dr. Marc Levy performing this procedure. Dr. Levy has been involved with the telescope and its surgical procedure since the original FDA trials since 2002.  He is currently the only physician in this area who it qualified to preform this life altering procedure.

Please watch the below videos for more information on the telescope.

Sarasota Florida ABC7 News WWSB (may be slow to load) 11/5/14

Detroit Michigan Local4 News WDIV 11/6/14

South Bend Indiana / Notre Dame NBC16 WNDU 11/6/14

Flint Michigan ABC12 WJRT aired 11/5/14

Beaumont Texas CBS 6 Nov 7, 2014 KFDM

If you notice Dr Levy is presented in these videos from around the country. This is due to his long experience and expertise with the IMT.

If you or a loved one wants to learn more about what the implantable miniature telescope can do for people with dry macular degeneration, please call 941-921-5335 to make an appointment with Dr Levy.

 

 

Jody Abrams, MD, FACS
Oculoplastics/Neuro-ophthalmology
Sarasota Retina Institute
Sarasota, Florida 34239

SRI Continues to Lead The Way

This is the best time of year in Florida. The temperature has cooled, and our Northern friends are returning here to escape snow and ice. We welcome them back to Sarasota… our paradise.

The doctors at Sarasota Retina Institute have been involved in a lot of academic activities in the last month. In the middle of October the American Academy of Ophthalmology held its annual meeting in Chicago.

SRI Doctors Continue Research

Drs. Levy and Chen were involved in new reports and information with the DRCR study. This is the NIH (National Institutes of Health) funded study investigating the relationship of diabetes and the eyes.   Overall, this study helps us determine the relationship between diabetes and its effects on the body.

Sarasota Retina Institute and our patients have been proud to participate in this study for the last few years. In fact, enrollment for this pivotal study is still open. Participants can get some drugs paid for by the study and often a gift card as a thank you for their time.

We are still recruiting patients for this study so if you or a loved one has diabetes talk with one of our staff to see if you might qualify of a part of the study. The information released at the meeting is exciting.

 

Continuing Education and Teaching

Dr. Spoor and I were invited to lecture at the annual meeting. The AAO is the world’s largest group of ophthalmologists. This year, about ⅓ of the attendees were eye doctors from overseas.

Dr. Spoor and I are both neuro-ophthalmologists. We taught other ophthalmologists how to provide better neuro-ophthalmologic care and even make it fun. We were able to share the joy and satisfaction we get as neuro-ophthalmologists. It was also neat to listen how two different generations of doctors vary in their practice styles.

 

Rikki Gilligan is an Expert

Rikki Gilligan, our certified orthoptist, spoke to a large group of ophthalmologists and orthoptists regarding her success in treating patients with Parkinson’s Disease for double vision.

Rikki has more experience than most in the country with this troubling complication of Parkinson’s Disease.   We are very proud that she was asked to share her expertise at our annual meeting. She did an awesome job!

 

Jody Abrams, M.D., F.A.C.S.

Right after the Ophthalmology meeting I flew out to San Francisco for the annual meeting of the American College of Surgeons. I was inducted to the class of 2014 and am now a “Fellow” of the American College of Surgeons.   This designation adds the professional suffix “FACS” after my name.

Entrance to the College is granted only to surgeons that are held to the highest standard of work and professionalism. It is an honor to join my partners in becoming a member of this society that has existed for over 100 years.

 

Well that is enough excitement for now. We get to use new skills learned at these meeting to provide cutting edge care for our patients. And coming soon is a major announcement for our patients with dry macular degeneration.

 

 

 

 

Jody Abrams, MD, FACS
Oculoplastics/Neuro-ophthalmology
Sarasota Retina Institute
Sarasota, Florida 34239

My Vision is Gone

I have been a Neuro-Ophthalmologist for over 7 years  and I am still amazed at some of the stories I hear. Patients describe sudden loss of vision, but decided to wait and see if it gets better. I don’t understand how this can be!

Waiting can possibly lead to long term vision loss.  In all the articles we write and when we talk with patients I try to stress a need to call our office as soon as they notice the vision change. I would rather have calls that are not serious problems, then miss a serious problem that if treated early could restore vision. I would like to go over some of the symptoms and causes of vision loss that needs you to call sooner rather then later.

Floaters and Flashes

As we age the jelly in the back of the eye can shrink and cause tears of the retina. Often the patient will notice flashes that are like fireworks in vision of one eye. This is often in conjunction or proceeding new floaters in the vision. This can be a new small floater, multiple little ones, or even a large one. This can represent a new retinal tear or even worse a retinal detachment. If this is caught early often in office procedure like laser or even gas can be used to save the vision. If this is allowed to progress for awhile it can cause irreversible damage to the retina and the vision can be lost.

Vision Black Outs

Sometimes patients will tell me their vision just went out in one eye or both. This can last a few seconds to a few hours or even possibly never come back. This should be a sign that you need to call and let us evaluate you. The causes could be as simple as a visual migraine (even with no headache), or more complex like swelling of the optic nerve or even giant cell arteritis. If treated early the vision can often be saved, but if it is allowed to progress the vision is both eyes can go to complete blindness that is irreversible.

Double Vision

True double vision is when the alignment of the eyes is off. That is one eye is focusing on something different then the other eye. This can be from a nerve problem, a muscle problem or even a problem in the brain. Some of the causes are not only a problem with vision but also can be life threatening such as a aneurysm. Caught early these can be treated with life saving procedures. Double vision is not normal so do not think you can sleep it off (things I have been told)

 

If you are experiencing any of these issues please call our office at 941-921-5335. Tell one of our trained staff what is going on and they can coordinate with doctor the urgency that you need to be seen. And even if this occurs on the weekends or night please remember one of the physicians at Sarasota Retina is always on call and be reached by call our office even after hours. Our mission is to preserve your life and sight.

 

 

 

 

 

Jody Abrams, MD, FACS
Oculoplastics/Neuro-ophthalmology
Sarasota Retina Institute
Sarasota, Florida 34239

Dr Levy’s Miniature Talk

Over the past 2 years Dr Levy has been honored to offer patients with dry macular degeneration hope. The implantable miniature telescope has been successfully implanted into patients eyes many times in Sarasota by Dr. Levy. If you or someone you know suffers from macular degeneration this could be a way to improve your life. On June 13  from 11:30 to 1, Dr. Levy will be talking at the Macular Degeneration Association in the Implantable Miniature Telescope. The lecture will be a lunchtime meeting at the Parkinson Place in Sarasota. This is a free lunch seminar with a chance to learn about a procedure that can change someones life.

 

If you are interested in attending you need to call (941) 893-4387 to reserve a spot. The lunch is free but they are asking for people to reserve a space to help ensure seats for all attendants.

Jody Abrams, MD, FACS
Oculoplastics/Neuro-ophthalmology
Sarasota Retina Institute
Sarasota, Florida 34239

Concussion and Vision Changes Part 3

Concussion and your vision (part 3): double vision

       Last time I discussed what happens to you ability to see after a concussive head injury.  When your head hits a stationary object or is struck by a concussive blow the brain is jolted around the cranial cavity and is injured by smooth and sharp bones (fig 1).   The three nerves that innervate the muscles that move your eyes exit the brain stem and travel along the base of the skull, coming together behind the eye and enter the orbit thru a narrow canal to innervate their respective muscles that move the eye (fig 2).   These nerves are susceptible to injury anywhere along the route from the brain stem to the eye muscles.   Injury to any or all of these nerves results in a distinct pattern of double vision.   With this knowledge a neuro-ophthalmologist can determine which nerve is involved and how and when to treat the patient.

   

Thomas Spoor MD

Fig 1 (Click to enlarge)

Closed Head Injuries 01 d002

Fig 2 (Click to enlarge)

 

      

 

 

Double Vision: 6th Nerve Palsy

The patient in figure 3 has a sixth nerve palsy.  This nerve only moves one muscle, the lateral rectus that moves the eye to the side.   Due to its long passage from the brainstem to the lateral rectus muscle, damage to this nerve is the most common squeal of concussive injuries (fig 3a).  These patients complain of horizontal or side-by-side double vision and cannot move their eye to the side.  The double vision is very bothersome and there is no immediate treatment except to patch either eye.   This will resolve the double vision as long as the eye is covered.  Now begins the waiting game.  You really must wait 6 months to see the extent of spontaneous recovery.  If partial recovery occurs continue to wait until the amount of misalignment is stable.  Appropriate surgery is then very effective resolving the double vision.

Closed Head Injuries 01 d025

Fig 3a (Click to Enlarge)

Fig 3(Click to enlarge) Patient looking to her Right

Fig 3 (Click to enlarge) Patient looking to her Right

If there is no improvement, surgery is still helpful but less successful.  There is always residual double vision when the patient looks to the side but you can usually resolve the double vision straight ahead and in most other gazes.

I will talk about other cranial nerve injuries that can cause double vision from closed head injuries. If you our some one you know is suffering from any of these ocular problems please contact us for evaluation and treatment.

Tom Spoor, MD
Oculoplastics and Neuro-ophthalmology
Sarasota, Florida

Tom Spoor,MD
Oculoplastics and Neuro-ophthalmology
Warren, Michigan

Eyes Squeezed Shut

Blepharospasm

Do you ever have a problem where your eyes want  to squeeze shut uncontrollably?   Do people accuse you or winking at them? Do you feel your lid twitching?

If you answered  yes to any of these you could be having blepharospasm.

What Are Blepharospasm

The eyelids have a muscle that goes around in a circle in both the upper and lower lids, called the orbicularis. This muscle is responsible for closing the eye. In patients with blepharospasm the muscle squeezes involuntarily.  This muscle over powers the muscle that opens the eyelid, the levator muscle, and causes the eye to shut.

 Causes of Blepharospasm

The spasms are caused by over stimulation of the muscle or the nerve that controls the muscle.  Sometimes this can be a tumor, trauma, dry eyes, or even an abnormality of a blood vessel. These are actually the rarer causes of blepharospasm. Most often there is no specific reason for the spasms, and this is called benign essential blepharospasm (BEB). This is a really fancy way of saying we do not know the true cause, yet it’s not due to a disease.

Treatment For Blepharospasm

30 years ago had you walked into your doctors office with blepharospasm the main treatment would have been sedating oral medications or surgery to remove the muscle, which was often very disfiguring. In the late 70s early 80s an ophthalmologist, Dr. Alan Scott, figured out that injecting botulinum toxin (Botox) into the muscle would temporally relieve the spasms.

Botox Preferred Treatment for Blepharospasm

And such Botox was created.  It was not until almost 12 years later that the use of Botox for cosmetcs was discovered.  Today injecting a botulium toxin (Botox/Xeomin/Myobloc)  for blepharospasm is still the preferred treatment.

 Botox Covered by Insurance

About 10 sticks per eye with a tiny needle is often all that is needed to reduce or eliminate the problem.   Treatment may be repeated in 3 months if needed. This is a medical problem and is paid for by most insurance plans.

If you or someone you know is suffering with blepharospasm call on of our neuro-ophthalmologsit at 941-921-5335 to get help.

 

 

 

Jody Abrams, MD, FACS
Oculoplastics/Neuro-ophthalmology
Sarasota Retina Institute
Sarasota, Florida 34239

Optical Coherence Tomography (OCT) at Sarasota Retina

Development of Optical Coherence Tomography (OCT) has been one of the greatest advances in Ophthalmology in the past 20 years.  OCT was originally used only by  retina specialists and glaucoma specialists, but now, it has become a powerful tool used by the neuro-ophthalmologists to make diagnosis and track systemic disease.

How Does the OCT Work?

If you’ve been to any of our offices, you have likely had an OCT performed on your eyes.  It is a non-contact and non-invasive scan of your retina or optic nerve.

OCT works by bouncing light off the retina and recording the time it takes to return to the machine’s sensor. By using this information the machine can show us a cross sectional image of the retina, optic nerve and surrounding structures, but at resolutions never before possible.

We are now able to see microscopic changes in the eye and start treatments often before they could normally be detected on normal exam.  In the retinal world, an OCT can show swelling of the retina,  wet macular degeneration, and even small wrinkles in the retina.  This has been used for years and has improved patient outcomes by allowing us to start treatment at an earlier stage.

Similarly, small microscopic changes can be detected to monitor glaucoma.  Glaucoma is a slow progressive loss of the optic nerve.  Subtle changes are now routinely seen with OCT.

Neuro-Ophthalmologist Use OCT

One of the new areas that we are using OCT is in the neuro-ophthalmology world. We can use the OCT to show the nerve fiber layer of the optic nerve just as in glaucoma.  This is the group of nerves which communicates information between the eye and brain.

If this layer becomes thinner it can represent a loss of the nerve tissues (think of them as wires) so less information is sent to the brain. We can  also detect thickening of this layer which results from swelling of the optic nerve or possibly from disease of the brain.

Moreover, system diseases such as Parkinson’s Disease and Multiple Sclerosis can now be detected and monitored.  These two disease affect the central nervous system, which includes the optic nerve. We are starting to track loss of the these nerves and can help show if the diseases are stable or progressing. In multiple sclerosis there are even studies showing that OCT can be used to track disease progression similar to a  MRI.

OCT is a great tool to have in our arsenal of test to watch microscopic structures of the eyes. We can detect changes much earlier then previous. If you or a loved one is affected with a disease that affects the optic nerve or central nervous system, come see one or neuro-ophthalmologist to determine if OCT could help track your disease. Call 941-921-5335  to schedule your appointment.

 

 

Talking Macular Degeneration

Recently Drs. Levy, Torres, and Rivero were asked to speak at the local Macular Degeneration Group meeting. They were happy to inform the group of recent changes in the treatment of macular degeneration.

If you were unable to attend this lecture, never fear. Through the incredible power of the web you can see the presentations here .

Dr. Torres gave a great update on emerging treatments for macular degeneration.

Dr Rivero presented what optical options are available for patients with macular degeneration for visual rehabilitation

Dr. Levy gave an update on the implantable miniature telescope. This little device is bringing incredible hope to patients with macular degeneration.

If you would like to learn more about any of these presentations, please contact our office at 941-921-5335