Dr. Aizuss was featured in Los Angeles Medicine Magazine this month, detailing his installation as the 151st president of the California Medical Association. Read more in the November / December 2018 edition of Los Angeles Medicine Magazine here!
Many patients with various connective tissue diseases such as rheumatoid arthritis, systemic lupus erythematosus and other less well-defined connective tissue inflammatory illness are often treated with oral plaquenil or generic hydroxychloroquine. Patients who take this drug find it may give tremendous relief to pain related to their chronic immune mediated connective tissue disease or inflammatory syndromes.
Unfortunately, there may be retinal toxicity associated with the use of these agents. Classically it was taught that cessation of plaquenil use resulted in reversal of retinal toxicity. We now know that this is, in fact, not the case and that it is important to undergo periodic screenings to guard against and monitor for the development of retinal toxicity so that the drug can be halted. Typically, plaquenil toxicity develop in about 1% of patients after five years of use.
Clinical signs include paracentral and central scotomas resulting in a central spot in the vision. Risk factors predisposing to the development of retinal toxicity includes a dose of greater than 5mg/kg daily or a cumulative dose of more than 1gram. This equates to a dose of about 300mg in a typical 130 pound woman or 350 mg in a 154 pound man. Since most people receive either 200mg or 400mg daily, the risk becomes apparent with prolonged use. Other factors predisposing to retinal toxicity include use for over five years, advanced age, kidney or liver problems, preexisting macular degeneration and use of certain other medications.
There can be irreversible visual loss. It is very important that patients on oral plaquenil see their ophthalmologist on at least an annual basis, have a screening with spectral domain optical coherence tomography (SD-OCT) which is done in my office, and central visual field testing. Please call for an appointment if you are presently on plaquenil or hydroxychloroquine and have not had an exam in the past year.
When it comes time to take the plunge and get corrective eye surgery, there are a few options you should consider. LASIK or PRK might be the best options for you if you have healthy, normal eyes, but if you have cataracts, you may want to look at multifocal lens implants to give you the most freedom from wearing glasses after your surgery.
Many of us consider surgery to correct our vision because we’re sick of contacts, tired of breaking our glasses, or our eyes can’t be corrected with glasses. Cataracts, for example, cause cloudy, hazy or blurry vision that can’t be corrected with a new pair of glasses. Replacing the lenses in your eyes can give you clearer vision that you didn’t even know you were missing.
While you used to have to choose a lens for close vision or distance vision, that left people still needing glasses. But why choose to wear readers or glasses for distance vision when we can offer a multifocal lense that gives you the best of both worlds?
What is the procedure like?
There is no difference between the normal cataract procedure and a cataract procedure that features multifocal lenses. The lens is the only difference! We remove the cloudy lens and replace it with the lens you choose. We can replace the clouded lens with a multifocal lens to give you vision that adjusts to whatever you want to see! Imagine not needing glasses on a daily basis.
How will my brain adjust?
Your brain is a powerful tool. We can adjust to a lot of different things when it comes to our bodies. Interestingly, our eyes are able to adjust extremely well to multifocal implants. Look at it like this: we are able to adjust to many different pieces of stimuli every day. We can sit in a restaurant with music and focus on the person sitting across from us and what they’re saying. Multifocal lenses don’t lock in your vision, in fact. Your brain can use the lens however it chooses. Just as we can decide what to listen to, our brain can adjust to which distance it needs to tune into. Multifocal lenses are not the best option for everyone. We can determine what will best improve your vision after performing a comprehensive eye examination and discussing your particular visual needs and your desires.
If you’re ready to take the plunge and see without cloudiness, contacts or glasses, then give us a call. Call us at (818) 907-1038 to schedule a consultation at our Encino location or (818) 346-8118 for our West Hills location.
Imagine waking up in the morning and not experiencing your normal vision. What’s the first thing you would do? We would take a look in the mirror first thing, to see if we could find something wrong with the eye in question. Sometimes a stray eyelash can fall into the eye, causing discomfort or even redness. Alternatively, if your vision is affected, it is likely not an eyelash causing the trouble. Keratitis may be the issue, and it can cause a lot of trouble, so keep reading to learn about what to watch out for, especially when your vision is suddenly different.
What is Keratitis?
Keratitis is defined as inflammation of your cornea, the clear part of your eye that is in front of the iris and pupil. You can think of it like the surface of a watch, behind the watchglass are the contents of the eye. Similarly, behind the cornea is the iris, pupil and lens of the eye. Keratitis can occur when your eye is injured, you wear your contacts for too long, or if you inadvertently introduce bacteria into your eye through poor hygiene. Unfortunately, Keratitis can cause serious damage and even cause blindness in severe, untreated cases.
How can I tell if it’s Keratitis?
General symptoms of Keratitis can be identified by looking at your eye, or even having a family member or friend help you. Usually, you will notice the symptoms yourself without waiting for someone to comment that your eyes look red, though. Look for the following:
- Pain or tenderness in the eye
- Sensitivity in the sun or bright lights
- Blurry vision (even while wearing glasses or contacts)
- Difficulty opening your eye fully due to pain
- Irritating feeling that something is in your eye
- Redness of the eye
How do you treat Keratitis?
Your eye doctor will need to see you to determine if you have Keratitis, so call to make an appointment as soon as you notice something is wrong. Catching and starting treatment of Keratitis early can cut down on treatment time and also the risk of damage due to the infection such as permanent scarring. You will likely need antibiotic ointment or antibiotic eye drops to help you get rid of the Keratitis and occasionally keratitis treatment also requires the use of steroid eye drops to prevent permaent scarring.
If you or a loved one are currently experiencing pain or decreased vision, please call us today at (818) 346-8118 to schedule a consultation. Treating your issue early is key to keeping your eye healthy.
We often take our eyes for granted. We drive, squint, play sports, and work in the yard without worrying about what we’re able to see or not see. But it’s when our eyes exhibit problems that we really realize how useful they are. It’s when our glasses break that we realize all we aren’t suddenly able to do! Keep reading to learn about one of the most common eye problems that is often preventable: a stye also know as a chalazion.
A stye or chalazion often occurs when the area at the base of your eyelashes or a gland along your eyelid becomes irritated and clogged (usually with staphylococci bacteria). Similar to a pimple on the skin, a stye is simply a pore that is no longer breathing and operating properly. When pores get clogged, the buildup can cause issues. With skin, a pimple is filled with bacteria, white blood cells, and it is often raised. Styes have similar symptoms, but are obviously going to be different, since they will affect a sensitive body part: the eye. A stye or chalazion is caused by a clogged meibomian gland.
A stye will likely cause one or some of the following reactions:
- A solid red bump with a small spot in the center
- An aggravating feeling that something is trapped in your eye
- Scratching or itchiness near the eye
- Light sensitivity
- Extra discharge or crust along the eyelid
- Watery eye(s)
If you have a stye, there are some things you can do to treat it at home. Put warm washcloths on the eye several times a day for ten minutes at a time. This will help open up the stye and drain faster. Try to avoid squeezing or pressing the stye, as that can make it worse. Keep it clean and avoid touching the stye (unless you are cleaning your eye). Take out contacts during the duration of your stye, and consider throwing them out and starting with a new pair once the stye is gone.
A stye will often go away on its own, but if it’s not going away after a few days give us a call at (818) 907-1038 to schedule a consultation at our Encino location or (818) 346-8118 for our West Hills location. It has been my experience that if we treat a stye or chalazion immediately at onset with a combination of topical combination antibiotic and steroid drops as well as a mild oral antibiotic that well over 80% of chalazia will resolve without surgical intervention. The greatest error that patients make is failing to come in quickly at the onset of their stye or chalazion. If you wait two weeks or more, we have usually missed the opportunity for medical treatment to work and surgical incision and drainage in the office is then more likely to be needed.
The sun’s out for good (hopefully) and we’re feeling fine. There’s nothing like the hot days of summer to get us out and in the mood for all things outdoors: we’re working on the garden, getting ready for neighborhood barbeques, and taking the dog for walks more regularly. But even though we love the sun, we also know to be wary of it. Too much of a good thing–is definitely not a good thing when it comes to the sun. Keep reading for the best ways to keep your eyes safe while you’re out enjoying the sunny weather this summer!
The first step to great eye protection is getting in the habit of reaching for sunglasses when you’re heading camping, to the beach, or even just outside to watch your child’s soccer game. These sunglasses should be high-quality and labeled “100% UV Protection.” A lot of cheaper sunglasses are not actually able to keep out most UV light so don’t skimp on quality. If you’re not sure they’ll protect your eyes, don’t buy them.
Wear A Hat
Having extra eye protection from a hat will make sure all angles are covered. A good wide-brimmed hat or baseball hat can keep UV rays from slipping in from above. Make sure to wear sunglasses with your hat to make sure you’re keeping your eyes safe.
Know When You’re At Risk
The sun’s damaging UV rays can still affect you on a cloudy day. Don’t put your eyes at risk by forgoing eye-protection on a cloudy day. Also, remember that sunlight is reflected off of water. If you’re out fishing at a lake or river, make sure to pack your sunglasses along with your bait and tackle. Also, if you take any trips to colder climates, remember that snow reflects light even more intensely than water. If you’re headed to see some snow, pack some certified eye protection.
Interested in learning more about keeping your eyes healthy, or looking for a consultation to see if your eyes are already affected by too much exposure to UV radiation? Give us a call at 818-990-3623 or 818-346-8118 and we can help you get an appointment set up.
Laser-assisted in situ keratomileusis, more commonly known as LASIK, is a procedure that reshapes the cornea of the eye to correct refractive errors that cause an improper bending of light that enters the eyes. The three most common types of refractive errors are astigmatism, nearsightedness (myopia) and farsightedness (hyperopia). LASIK is an exceptional tool for vision correction, yet traditional techniques have some shortcomings. Dr. Aizuss addresses these limitations by offering LASIK procedures with the iDesign Advanced Wavescan Studio System.
How Does LASIK Correct Vision?
Refractive errors are caused by abnormalities in the cornea. These abnormalities bend the light in a way that interferes with the path to the back of the eye where the visual information is collected and sent to the brain for translation. The result is a blurry vision. LASIK works by correcting the shape of the cornea to improve visual acuity without glasses or contact lenses.
- Flattening the center of the cornea corrects nearsightedness or myopia
- Removing tissue from around the center of the cornea thus steepening the cornea helps with farsightedness or hyperopia
- Rounding out the cornea helps with astigmatism
Astigmatism offers unique challenges for LASIK procedures.
What is Astigmatism?
Everyone has some level of astigmatism in the cornea, but most people do not experience vision problems as a result. Astigmatism simply means that the cornea is not shaped like a perfect dome or sphere, it is shaped more like a football with two different curves. It is only of concern when the combination of astigmatism and nearsightedness or farsightedness work in combination to cause vision problems. Nearsightedness and farsightedness cause blurring, whereas astigmatism causes distortion which may also be perceived as blurring.
Advantages of the iDesign Advanced Wavescan Studio System for Astigmatism
Each person’s astigmatism is unique in the sense of how the cornea is distorted. Correcting corneal shape relies on 3D mapping that uses hundreds of data points. The number of data points that are collected by any given LASIK system may indicate the extent to which astigmatism can be corrected in a specific patient. The iDesign Advanced Wavescan Studio System excels above other systems in this regard. It gathers 1200 data points, thus allowing correction in patients who may not be good candidates for LASIK with other systems.
Learn More About LASIK for Astigmatism. Contact Dr. David Aizuss.
To learn more about LASIK vision correction, premium lens implants, treatments for diseases of the ocular surface and our other services, contact Dr. David Aizuss today to schedule a personal consultation. You can contact our office in Encino at (818) 907-1038 and our office in West Hills at (818) 346-8118.
The ocular surface disease commonly known as dry eye affects millions and millions of people in the United States and worldwide. To date, there has been no simple solution for this very vexing problem. There are a variety of artificial tear products on the market which differs in composition and complexity. Different tear products may offer an advantage for your specific problem.
Some patients develop dryness due to a decrease in their normal corneal sensation. This form of dry eye is often called neuropathic dry eye and may be related to the severing of the corneal nerve endings during a variety of corneal procedures. As a result, these patients blink less frequently and less completely than normal patients thus developing a secondary dry eye problem. Some of these patients develop lagophthalmos which are incomplete lid closure when sleeping. These patients note foreign body sensation upon awakening as well as burning or pain. Such patients will often benefit from an ointment or gel at bedtime to coat the ocular surface. Products such as Refresh PM, Lacrilube, Duolube, or Genteal Gel may provide some comfort.
Many patients develop dry eye related to decreased blink frequency while performing prolonged reading or computer work or other near vision tasks. The patients often complain of ocular fatigue or tired eyes and benefit from the use of an artificial tear while doing their prolonged close work. Alternatively, giving your eyes a break by looking off in the distance and focusing outside a window or across the office, often provides the necessary break that allows the accommodation mechanism or near focusing muscles in the eyes the opportunity to relax and recover leading to less burning and tiredness of the eyes.
Many patients are concerned about red eyes and look for a drop that “gets the red out” such as Visine. I strongly advise against the use of these “ocular decongestants” for a variety of reasons. First, most of these products contain vasoconstrictors. They “get the red out” by using a pharmacologic agent that constricts the blood vessels. Thus, the eye looks whiter. However, as the medication wears off, rebound dilation of the vessels takes place and the eye then looks even redder. This prompts the patient to reinstill the eye drop creating more whiteness, further rebound dilation and increased reddening. Over time this can result in permanently increased redness due to increased vascularity associated with the rebound dilation of the vessels.
May medications taken orally may also provoke increased dry eye. Some of these include antihistamines for allergies, medications used to treat Parkinson’s Disease, some medicines taken for depression and medicines used to relieve anxiety. Patients who require such oral medications will often benefit from artificial tear supplements. Some of my favorites are Theratears, Blink, Refresh, and Systane Ultra.
Artificial tears have a variety of components including carboxymethylcellulose, hydroxypropyl methylcellulose, polyethylene glycol, propylene glycol and hyaluronic acid all of which act as lubricants in the drop. No drop is necessarily better than another. Whichever drop provides an individual patient the most comfort is the drop the patient should continue to use.
Finally, there are now two prescription agents on the market which may be beneficial to dry eye patients. These include Restasis and Xiidra both of which work by suppressing immune-mediated infiltration of the lacrimal gland. Each has their pros and cons, and both are very expensive.
In our office prior to using either Restasis or Xiidra, I prefer to first try collagen punctal plugs. These are inserted into the canalicular system which is the gutter pipe into which your tears drain. They collagen plugs last up to six months and can easily be replaced twice yearly during a two-minute office procedure right in the exam chair at the slit lamp. By plugging the drain or gutter pipe into which your tears flow and keeping your own tears around longer, this often results in significant improvement in comfort at substantially less cost. I am happy to discuss any aspect of ocular surface disease with you at your office visit!
Studies have shown that approximately three million people in the country have glaucoma, and many do not know that they have the condition. One in ten people suffers total blindness because glaucoma is not detected and treated. While the condition cannot be cured, glaucoma treatments aim to minimize the damage that is caused to the eyes to preserve vision. Laser treatments now offer patients improved outcomes compared to traditional approaches.
What is Glaucoma?
Glaucoma is a condition that describes excess pressure in the eye that causes damage to the optical nerve. The disease affects patients of all ages, and, in some cases, does not cause any symptoms. There are some patients with a variant of glaucoma where the pressure remains normal, this is called low pressure or normal pressure glaucoma or low tension glaucoma.
Open-angle glaucoma increases the pressure inside the eye. Trabeculoplasty is a procedure that aims to relieve some of the pressure by modifying the trabecular structures inside the eye. Laser trabeculoplasty is typically performed with argon or ALT. A newer procedure which is more commonly used is called selective laser trabeculoplasty or SLT. In selective laser trabeculoplasty, the laser heats the trabecular meshwork causing contraction of the bridging tissue and increasing the facility of outflow of the fluid inside the eye known as the aqueous humor. This results in lower pressure. Some physicians recommend SLT as first line treatment before the use of eye drops.
Iridotomy with lasers may be recommended for patients who have narrow-angle glaucoma. The laser is used to make a tiny hole in the iris that improves fluid drainage within the eye. In narrow angle glaucoma, the anatomy is such that the iris root may block the outflow of fluid causing a rapid rise in pressure also called an acute or narrow angle glaucoma attack. The laser iridotomy is used to both prevent an acute attack as well as to treat an acute attack, if one occurs. It is best to treat the narrow angle early to prevent an acute glaucoma attack whenever possible and when evaluation of the outflow channels indicate that an iridotomy is medically necessary.
Reducing the production of fluid in the eye has proven beneficial for some glaucoma patients. Laser cyclophotocoagulation modifies the portion of the eye that produces fluid. Patients who undergo this procedure may need follow-up treatments. This procedure is not commonly performed unless the glaucoma is severe or cannot be treated with more effective surgical procedures.
Recovery from Laser Treatments for Glaucoma
A slight stinging of the eyes is noted after laser treatments for glaucoma, but patients can return to their activities immediately after the procedure. The laser treatments will not eliminate the need for medications. Rather the surgery, may reduce the dosage of medications or help prevent increased dosing in the future. Laser surgery for narrow angle glaucoma may rarely increase your risk for cataracts. However, this risk is very slight.
Learn More About Laser Treatments for Glaucoma. Contact Dr. David Aizuss.
To learn more about your options for treating, glaucoma, cataracts, dry eye, ocular surface disease and other conditions, contact Dr. David Aizuss to schedule a consultation. We also offer eye exams, LASIK vision correction, contact lenses and optical services. You can contact our Encino office directly at (818) 907-1038 and our West Hills office at (818) 346-8118.
Diabetes is a complex condition that changes how your body metabolizes foods that you eat. Glucose is essential for every part of your body, and insulin helps your cells absorb glucose. Diabetes is a condition in which the insulin levels are not adequate to ensure that your cells absorb the glucose. Left untreated, diabetes may cause serious medical concerns that affect your heart, kidneys, extremities, and eyes. People with diabetes should be screened for signs of these complications, including diabetic retinopathy.
The Effects of Diabetes on Your Eyesight
As insulin levels in your body decrease, glucose levels increase. The higher amounts of sugar in your blood stream damages the vessels in your eyes and may cause the vessels to swell, rupture or impede blood flow. In some cases, new blood vessels develop in the eyes as the body attempts to route blood to the tissues. Over time, eyesight is diminished and left untreated; diabetic retinopathy can cause a complete loss of sight.
How Does Diabetic Retinopathy Develop?
Diabetic retinopathy has two stages, and the condition may be diagnosed in either stage. In the earliest stage, the small blood vessels in the eye begin to leak into surrounding tissues, and the fluid causes swelling of the retina. At the center of the retina is an area is known as the “macula” that helps you to discern details with your vision. The retinal swelling typically occurs in this area, and a person will gradually lose eyesight. The problem worsens as blood vessels to the macula no longer carry blood. In the second stage of diabetic retinopathy, the retina starts to develop new blood vessels that rupture and leak blood into other areas of the eyes.
Can Diabetic Retinopathy Be Treated?
Managing your blood sugar is the best approach for preventing diabetic retinopathy. If Dr. Aizuss detects signs of the condition during your eye exam, he may recommend medications, laser treatments or surgery.
Learn More About Diabetic Eye Care. Contact Dr. David Aizuss.
To learn more about diabetic eye care, cataracts, glaucoma, LASIK laser vision correction and our other services, contact Dr. David Aizuss to schedule an appointment. We have two convenient locations to serve you. You can call our Encino office at (818) 907-1038 and our West Hills office at (818) 346-8118.