The Photic Maculopathies

In the August 2017 blog post we spoke about a safe way to view the eclipse that took place that month. The biggest reason for viewing the eclipse in this way was to avoid any risk of permanent vision loss. I’m happy to say that the response I received from my patients was very positive – I understand a lot of people appreciated my post because several did not know the eclipse was even taking place until 24-48 hours ahead of time so purchasing glasses on amazon was not an option and paying $10 or more for eclipse glasses just did not make sense.

I am also happy to say that the afternoon after the eclipse into this month I received several calls to evaluate adults and children for damage following the eclipse and after careful examination exactly zero patients suffered from this condition! Unfortunately in this same time frame I did examine one young patient who was suffering from poor vision in one eye. After two exams and some discussion we determined that the vision loss was the result of this youngster using a laser pointer and a mirror to shine the laser into their own eye. To this end, I’d like to devote this blog post discussing the damage that can occur from viewing an eclipse without proper eyewear, prolonged sungazing and inappropriate use of laser pointers since all of these conditions are the result of similar processes and all can be easily avoided.

The retina is a delicate tissue, it is closely related to what makes up nerve and brain tissue. This tissue does not regenerate – meaning once it is damaged it cannot repair itself effectively. Usually once the retina suffers damage the damage cannot be undone. In the Photic Maculopathies (resulting from eclipse gazing, sungazing, misuse of laser pointers, etc) this damage results when visible light (usually on the blue end of the spectrum) kicks off a chemical cascade resulting in permanent retinal damage and injury. Laser pointers usually are a red diode close to a wavelenght of 650 nanometers.  The damage is permanent.

The following photos are courtesy of Mark Dunbar OD, FAAO. A colleague of mine who I worked with at the University of Miami Medical School. The Bascom Palmer Eye Institute is part of the University of Miami, it is world renowned and has been consistently rated as one of the top eye hospitals in the nation. While at Bascom Palmer I was in charge of the Optometry Student Training Program. This program hosted between 12-14 Doctors in Training. At the time I held clinical faculty appointments at 5-6 Doctorate level Optometry Schools around the country including the University of California at Berkeley, the University of Indiana and my alma mater The New England College of Optometry.

 

 

The reddish/orange photos represent photos of the retina- the delicate tissue in the back of the eye.  When you look at a person’s face, written words or need to see things in fine detail you are using a portion of the retina called the macula.  In the color photos, the macula is in the center of each picture.  It’s kind of a brownish spot in the center of each photo…in the middle of THAT area, if you look closely (and use your maculae) you can see a reddish spot with some yellow dots- that is a sign of solar maculopathy- this patient developed decreased vision after prolonged staring at the sun (wrong hobby).  As time goes on the lesion can take on a darker, brick red coloration.

The black and white photos represent an “OCT” an optical coherence tomograph. This is a sort of CT Scan giving us a non-invasive way to look at the retina and it’s layers in cross section.  In these photos an optometrist is able to see the retinal damage that has occurred and at what layer this occured, allowing us to make the diagnosis.

As I mentioned earlier the unfortunate part is that this damage and associated vision loss is permanent.  This damage can occur from mis-use of laser pointers, prolonged sun-gazing and unprotected eclipse viewing.  The macula is the same area impacted when one develops age related macular degeration (AMD or ARMD).  Macular degeneration can be inherited but can be mitigated.  In my next blog post I intend to talk about AMD, the latest treatments and possible nutrients that can help slow the progression of this disease.

Thank you for reading, if you need to make an appointment regarding macular degeneration, other vision problems or any reason- I can be contacted here.

Dr. Meers

 

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You can see (but not look at) the 2017 American eclipse.

By now everyone knows there is going to be an eclipse on August 21, 2017.  While the Tacoma area is not on the path of totality-we are still going to get a good view. The last time a solar eclipse crossed the entire continental US was June 8th 1918.

*What is a solar eclipse? Why should I care?

A solar eclipse occurs when the moon (that travels around the Earth) comes between the Earth (us) and the Sun (the big star that the Earth travels around). For a short while, in certain parts of the earth a HUGE shadow is cast on the Earth’s surface (moment of totality).  During this time the corona of the sun will be visible – this and other phenomena are reported to be an extraordinary sight – to the point that “eclipse chasers” travel around the world to view solar eclipses.

*But don’t look at the eclipse!

So I just told you how rare and cool a solar eclipse is but then I also told you not to look at it – why?  The sun is a star and stars are essentially the largest, most continuous, most violent thermonuclear explosions known in the universe.  So they are kind of a big deal.  On a normal day if you look at the sun it’s so bright that you naturally try to squint or evert your eyes. During an eclipse it is darker than normal so you do not have this natural tendency to shield your eyes from the sun…BUT the harmful UV rays are still present. These UV rays travel into your eyes and land on the Retina, the delicate neural tissue that lines the inside of our eyes. Common sense would lead us to believe that the damage occurs from “burning” the retina but the damage is actually created by a chemical cascade triggered by the solar rays  and you are left with permanent, irreversible vision loss.  The area of the retina that is destroyed (the Macula) is the region of the Retina devoted to your sharpest vision (like recognizing faces or seeing fine detail).  This is why older patients we see at Cascade Pacific Eyecare who have Macular Degeneration (ARMD) are so debilitated –  in ARMD the macula essentially disintegrates if treatment is not initiated.  Once this vision is gone, nothing can be done (as of 2017) to bring it back.

*So how do I see the Eclipse?

It’s 2017 – not 1918 so the answer to many questions is “Google it”, “Watch it on youtube” or “order it on Amazon” but there have been some reports of misinformation on the internet and phony eclipse glasses being sold on Amazon.  Plus there are people that are reading this post either Sunday night August 20th or early Monday morning August 21st. Remember even the bestest, priciest, most polarizedest sunglasses are NOT enough protection.

I think the answer is to make a pinhole camera like they did in 1918. Just this time with updated, readily available 2017 equipment.  My assistant and I  used 2 paper plates.  One plate is the “projector” the other plate serves as the “screen”. The greater the distance you have between the projector and the screen the larger an image of the eclipse you will have.

STEP 1) You need 2 PaperPlates, Tin Foil, A pin, Tape and Scissors.

File Aug 17, 11 40 26 AM.jpeg

STEP 2)  Cut a hole in 1 plate

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STEP 3) Tape a piece of tin foil over that hole.

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STEP 4)  Use the pin to make a pinhole in the tinfoil.

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STEP 5) Go outside, put the other plate (the screen) on the ground.

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STEP 6) Point the “projector plate” in your hand towards the sun, an image of the sun will be transmitted through the pinhole onto the “screen plate” on the ground.

File Aug 17, 11 38 30 AM

Just look at the image on the screen and not the sun and you will protect your eyes and vision.  Since you are outside you will experience all the cool natural phenomena associated with an eclipse – not to mention you just did a simple craft with your kids and shared a rare experience that will last a lifetime.

Unfortunately – with every solar eclipse there is an uptick in Solar Maculopathy.  My next post will discuss this condition…If after the eclipse you or a family member feel you may have diminished vision due to the eclipse please schedule an appointment for an evaluation with us at CPeye.  (Unfortunately there is no treatment for Solar Maculopathy but we can schedule you on a next available basis for an evaluation).

Thanks for reading and thanks to my assistant.

 

Dr. Meers