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

What is Botox? | Botox For More than Just Wrinkles

Botox was first used by an ophthalmologist to correct double vision and facial spasms.  But today, Botox is best known for its ability to temporarily cure wrinkles and “crow’s feet.”

Back in the late 70s an ophthalmologist from California, Dr Scott, was looking for a way to help patients suffering from involuntary facial spasms and people with double vision. He figured out that with a purified version of botulinium toxin,  he could temporarily weaken or paralyze a muscle.  His first success was in treating patients suffering from double vision caused by the extraocular muscles which move the eye.

This discovery was just the first success story for Botox and has lead to further adoption in most of the fields of medicine.  Today, Botox is approved for various spastic disorders, headaches, over production of saliva…and all kinds of wrinkles.

The Botox discovery changed the lives of millions of people and has become one of the top used drugs of all time.

What is Botox?

Botox is a purified protein obtained from a bacteria called Clostridium botulinum.  This bacteria is responsible for causing the disease botulism. curacao .  The bacteria produces a protein called botulinum toxin.  We currently know “botulinum toxin” as simply “Botox.”

After Dr Scott sold the rights of this drug to Allergan, the pharmaceutical giant developed the many cosmetic uses for Botox.

Botox is simply injected directly into the affected muscle, the toxin then paralyzes the muscle for up to 3 months.  Side effects are few.

Botox and Lid Spasms

The original application for Botox was for certain cases of double vision.  Now, there are dozens of uses for Botox and here are a few related to ophthalmology.

Involuntary movement of a muscle is a spasm. When this occurs around the eye it is called a blepharospasm. This can appear as constant blinking when both eyes are involved or “winking” if only one side is affected.  Severe spasm of multiple groups of facial muscles can occur and cause an abnormal posture or grimace.  Bright light, dry eye, and even anxiety can make the spasms worse.

Blepharospasm can cause decreased vision, watery or dry eyes,  headaches and can even lead to social issues and depression. Most of the time the condition occurs from an unknown cause and tumors are only rarely seen. Before Botox,  the treatment was often systemic medications or disfiguring surgeries.  After the release of Botox the treatment of this disease underwent a dramatic change. Now with a few injections around the eyes the spams can be relieved for 3 months or more in most cases.

Botox at Sarasota Retina Institute

Neuro-ophthalmologist and oculoplastics surgeons commonly prescribe Botox.  We have some patients that have been getting this for almost 20 years in our practice and are still delighted with the results. It is a life changer. Insurance does cover this procedure which is a big relief to patients.

In the next article I will talk about the use of Botox for double vision and the relief of migraines.

If you or some one you know has spasms of the eyelids/face, double vision, or suffer from chronic migraines, call our office at 941-921-5335 and schedule an appointment to see if Botox could help you.

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.

 

Tumors AROUND the Eye | Ocular Tumors

Last article gave some basic information about  tumors and what it means to be a malignant tumor. I would like to start talking about some of the tumors we see around and in the eye.

Tumors of the Eyelid

The outer most structures of the ocular system are the eyelids. The skin around the eye can develop tumors (benign or malignant) and so can the deeper tissue, some which can be potentially deadly.

I strongly recommend that any new lesion (aka lump or bump) on the eyelids be evaluated by a doctor trained and comfortable evaluating eyelid lesions.  Most oculoplastic eye specialists should be very comfortable evaluating tumors of the eyelids or surrounding structures.

Basal Cell Carcinomas

Basal cell carcinomas are one of the most common type of skin cancers. The tumor arises from uncontrolled growth of the bottom layer of the skin. They are commonly occur on the lower eyelids as the lower lids receive more sun exposure than our upper lids.  These types of cancers are often seen in patients over 50.

The lesions are often raised red areas, with enlarged blood vessels around or in it, and an ulcerated center. If it is growing at the edge of the lid near the lashes there is often a loss of the lashes (called madarosis). These lesions are usually slow growing and rarely metastasize to other areas.

Basal cells are usually very superficial, but there can be extension under normal skin. The basal cell cancers are removed with surgery and often examined pathologically at the same time to ensure the entire lesion is removed. Depending on the size of the lesion removed various reconstructive techniques are used to repair the remaining healthy lid tissue.

Squamous Cell Carcinomas

Squamous cell cancers arise from uncontrolled growth of the skins upper layer of skin (epidermis). These are less common then basal cell carcinomas. They are also induced by chronic exposure to sunlight. The incidence of both squamous and basal cell cancers can be reduced by wearing sunscreen, hats, and sunglasses. These tumors appears as scaly red patches that can bleed if scratched. These lesions can grow and spread to deeper structures. The lesions needs to be completely resected (removed) and then the area reconstructed. Incomplete excision can lead to the lesion spreading down nerves and can lead to extensive disease and possible death.

Sebaceous Cell Carcinoma

Sebaceous cell carcinoma is a lethal eyelid tumor that arises from the glands around the eye. While they are rare these tumors can be misdiagnosed for benign conditions such as chalazions (styes). They can often start as a yellowish nodules and progress to a chronically red looking lesions. There is often eyelash loss in the affected areas. The cancer is usually not painful. These tumors can spread throughout the orbital area and even to other parts of the body (a malignant tumor). The treatment for this tumor is surgical excision, which can be very disfiguring and possible chemotherapy. Even with this treatment the prognosis is often poor for long term survival. Early examination and diagnosis is essential.

Tumors of the eyelids are not uncommon, especially in the south like Florida. If you have a concerning “lump or bump” on your eyelid or around your eye, make sure you see an oculoplastic surgeon like Drs. Abrams, Spoor or Levy.

In the next article we will talk about tumors that involve the inside of the eye.

 

new docs pic

Board Certified Ophthalmologist (Eye Doctors) Sarasota Florida

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

Tumors of the Eye | Ocular Tumors

As a neuro-ophthalmologist/oculoplastic specialist,  I treat patients with various tumors around their eye.

Tumors of the eye can occur on the eyelids, the eyeball itself, the tissue around the eye (the orbital area) or even the optic nerve.

Any tissue can develop a tumor.  Different types of tumors in various tissues often have characteristic behaviors.  These tendencies help us decide the appropriate treatment.  These articles are to help you understand some of the tumors that are seen around the eye.

Tumor and Cancer NOT Synonyms

Most people use the term tumor and cancer interchangeably but these do not mean the same thing. A tumor or neoplasm is an abnormal growth of tissue.  This can be any tissue in the body. Some tumors are benign and some are malignant.  The difference is based on the way the tissue act.

Benign tumors are tumors which do not spread, or metastasize, to other parts of the body.  Though a benign tumor does not spread, it can still cause damage.  For instance, large benign tumors of the optic nerve can cause loss of vision by compressing the nerve.

Depending upon the size, rate of growth and potential to blind, these tumors may be watched (i.e. left alone) or removed surgically.

Malignant Tumors

Malignant tumors can spread to other parts of the body.  There are different ways for the tumors to spread.  Parts of the tumor can spread through blood, lymphatic system, or directly invade surrounding tissue.  Often, malignant tumors are difficult to treat because they spread by multiple ways; not just one.

Treatment for malignant tumors can include surgery, chemotherapy and/or radiation.

Tumors Affecting the Eye

There can be either malignant or benign tumors around the eye. The tumor can be formed from local tissue (called a primary tumor) or have spread from other areas (called a metastasis). Sometimes in office examination , radiology imaging, or surgical biopsy with pathologic examination is needed to help determine the origin, type of tumor and then treatment course.

In our next article we will discuss some of the specific tumors we see around the eye and ways to diagnosis and or treat them.

The doctors here at Sarasota Retina Institute have special training dealing with tumors around the eye. Drs. Abrams, Spoor and Levy are part of a small group of surgeons in the country who work both on tumors of the eyelids and orbits. Using state of the  art techniques and equipment they are able to offer our patients care the rivals large academic centers around the country.

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

Getting Your Bell Rung

What Is A Concussion

A concussion is a complex pathophysiological process which results in an injury to the brain. The process starts with direct or indirect trauma to the head.

In more general terms is it an injury to the nerves that make up our brain. Direct trauma or force to the head is not needed. This can be from rotational, acceleration or deceleration of the head.

How Common Are Concussions

Concussions are very common injuries in motor vehicle accidents, athletic injuries, and even falls. In the past few years concussion are becoming a hot medical topic as we learn more of their immediate and long term effects.

It is unknown how many concussions occur every year. Most concussion go unreported. Loss of consciousness occurs only about 10%. The medical community is working to raise awareness by educating the public to recognize concussions.

This will help people get tested and treated to help limit long term effects.

 What Are Indications Of A Concussion

Signs and Symptoms of a concussion include:

  • Memory loss
  • Confusion
  • Loss of coordination
  • Double vision
  • Blurred vision
  • New onset of problems reading
  • New Headaches
  • Dizzy feeling
  • Sadness
  • Difficulty with concentration

Diagnosing A Concussion

It is important to recognize a concussion to prevent repeat damage. If a second concussion occurs while healing from the first incident, this can lead to swelling of the brain. If this is not treated quickly death can occur.

There is no specific test to diagnose a concussion. Diagnosing a concussion can be challenging. A lot of times in medicine we rely on a specific test such as blood work or MRIs.  There is no blood test or imaging (like MRI or CT ) that will show when a concussion occurs.

There are neuro-psychological tests that can be used to help diagnose a concussion. These specialized tests compares pre-concussion brain speed with post-concussion brain speed.

The problem is with this is you need a baseline of how the brain was working prior to the concussion to see the change. This type of testing is fast becoming the standard for most contact sports. For example, “pre-concussion” baseline testing is obtained prior to the start of the season. Any suspected concussion compares the athletes ability to perform the same baseline exam. Results can indicate concussion.

This is great for activities like sports where test can be done prior to the season. In patients without baseline testing neuro-psychological testing can help often have to be more extensive.

 How Do The Eyes Help Diagnosis a Concussion

Neuro-ophthalmologists can perform additional tests like visual field testing, ocular motility testing, and even VEPs to aid in making a diagnosis.

 

So when a concussion is diagnosed treatments include rest, retraining of the brain, and limiting reoccurrence of injury. Each time the brain sustains an injury cells are lost. After loosing enough cells (which varies with each person) disease such as Alzheimer’s can develop earlier in life then normal.

 

If you or someone you know has suffered a concussion and are experiencing visual problems call our office at 941-921-5335 to come in for an evaluation.

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

Reducing Migraines | Treatment for Migraine Headache

Migraine headaches can be severely debilitating.  A migraine may have a variety of symptoms but includes an intense headache lasting several hours or days and often has associated light and sound sensitivity.

Patients are often nauseated and can have episodes of vomiting.  Most patients with migraine are unable to perform normal daily activities, much less completing a day of work.

Migraines must be diagnosed by a physician based upon symptoms and elimination of other neurologic conditions.  I am usually referred patients requiring treatment after other medications have failed.

Treatments for Migraines

The first step in treating migraines is to identify the cause. This can be certain foods or sounds that trigger the migraine.  In these circumstances, treatment is easy…avoid the foods or sounds which trigger the attack.

Usually no one specific cause can be identified and medications are needed.  The first line of medication are migraine abortive medications.  Abortive medications, such as Imitrex, are taken as soon as a migraine starts. They can often stop or lessen the effect of the migraine.

The medication needs to be used as soon as signs of a migraine start. They are great for people who have the occasional migraine, but should not be used more then about 3 times a week. Overuse of the medication can actually cause headache from a rebound effect.

Prevention of Migraine Headache

Over the last 20 years medications that treat blood pressure or seizures have been used to limit the number and frequency of migraines.  These preventative medications have been used with success to allow these patients a more normal life.

Unfortunately, there are often have unintended side effects that must be balanced with the benefits they provide. The drugs have also been used “off label.”  This means that the primary indication for the drug is NOT for migraine, but since the drugs are effective, they have become the standard of care and are used routinely for these purposes (don’t worry, this is confusing, but quite common in medicine!).

Botox FDA Approved for Migraine

Botox was approved in 2010 for the prevention of chronic migraines by the FDA. This makes Botox the only FDA approved drug for the prevention of chronic migraines.

The current thought is Botox actually has some pain relieving properties. This reduces the amount of stimulus that the brain gets and stops the migraine cycle. Patients will sometime report that they feel a migraine might start but does not progress into a headache.

The drug is administered in the office through a few injections sites in the front and back of the head. The side effects of Botox are usually minimal if any. The patient will often get improvement about 4-5 days after the injection.

Studies have shown patients need at least 3 rounds of injections to get the maximal effect. The injections are 12 weeks apart. As this is now FDA approved most insurance companies are covering this treatment and patients are getting relief.

 

If you or someone you know suffers from chronic migraines, call Sarasota Retina Institute at 941-921-5335 to schedule an appointment for possible treatment.

 

 

 

 

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