About Cynthia Kiernan

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So far Cynthia Kiernan has created 181 blog entries.

What Are These Floating Things?

"What are these weird floating things I started seeing?"

The spots, strings, or cobwebs that drift in and out of your vision are called “floaters,” and they are more prominent if you’re looking against a white background.

These floaters are tiny clumps of material floating inside the vitreous (jelly-like substance) that fills the inside of your eye. Floaters cast a shadow on the retina, which is the inner lining of the back of the eye that relays images to the brain.

As you get older, the vitreous gel pulls away from the retina and the traction on the retina causes flashing lights. These flashes can then occur for months. Once the vitreous gel completely separates from the back wall of the eye, you then have a posterior vitreous detachment (PVD), which is a common cause of new onset of floaters.

This condition is more common in people who:

  • Are nearsighted.
  • Are aphakic (absence of the lens of the eye).
  • Have past trauma to the eye.
  • Have had inflammation in the eye.

When a […]

2020-09-24T04:00:00+00:00September 24th, 2020|Blog|

Hearing That Your Driving Days Are Over

One of the hardest questions eye care professionals deal with every day is when to tell people who are having difficulty with their vision that they need to stop driving.

Giving up your driving privilege is one of the most difficult realities to come to terms with if you have a problem that leads to permanent visual decline.

The legal requirements vary from state to state. For example, in New Jersey the legal requirement to drive, based on vision, is 20/50 vision or better with best correction in one eye for a “pleasure” driving license. For a commercial driving license, the requirement is 20/40 vision or better in both eyes.

In some states there is also a requirement for a certain degree of visual field (the ability to see off to the sides).

According to the Insurance Institute for Highway Safety, the highest rate of motor vehicle deaths per mile driven is in the age group of 75 and older (yes, even higher than teenagers). Much of this increased rate could be attributable to declining vision. […]

2020-09-15T04:00:00+00:00September 15th, 2020|Blog|

Visual Hallucinations? It Could Be Charles Bonnet Syndrome.

Who is Charles Bonnet?  He was a Swiss naturalist, philosopher, and biologist (1720-1793) who first described the hallucinatory experiences of his 89-year-old grandfather, who was nearly blind in both eyes from cataracts.   Charles Bonnet Syndrome is now the term used to describe simple or complex hallucinations in people who have impaired vision.  

Symptoms

People who experience these hallucinations know they aren't real.  These hallucinations are only visual, and they don't involve any other senses. These images can be simple patterns or more complex, like faces or cartoons.  They are more common in people who have retinal conditions that impair their vision, like macular degeneration, but they can occur with any condition that damages the visual pathway.  The prevalence of Charles Bonnet Syndrome among adults 65 years and older with significant vision loss is reported to be between 10% and 40%.  This condition is probably under reported because people may be worried about being labeled as having a psychiatric condition. 

Causes

The causes of these hallucinations are controversial, but the most supported theory is deafferentation, which is the loss of signals from the […]

2020-09-08T04:00:00+00:00September 8th, 2020|Blog|

Detecting Alzheimer’s though an Eye Exam?

Alzheimer's Disease International estimates that the number of people living with dementia worldwide – nearly 44 million in 2014 – will almost double by 2030 and more than triple by 2050.

There is no single test that can show if a person has Alzheimer's, but doctors can almost always determine if a person has dementia, although it may be difficult to determine the exact cause. Diagnosing Alzheimer's requires careful medical evaluation, neurological testing, and sometimes brain imaging and blood tests to rule out other causes of dementia.

Most of the testing for early disease – MRI scans of the brain, brain PET scans looking for amyloid, and spinal taps looking for certain proteins in the spinal fluid – are not very accurate, and they are invasive and often expensive.

Researchers have now turned to findings in the eye to help with early detection and are hoping to find ways to make the diagnosis earlier when potential treatments may have a better outcome. There is also hope that these tests will be less expensive and invasive then […]

2020-09-01T04:00:00+00:00September 1st, 2020|Blog|

Dropless Cataract Surgery

Eye drops can be hard for some patients to put into their eyes. After cataract surgery, there are two main issues we are trying to control: Preventing infection and controlling inflammation.  Traditionally, we prescribed antibiotic eye drops to prevent infection, as well as steroid eye drops to control post-operative inflammation. Now we have some alternatives to using eye drops after surgery.   

There are some antibiotic solutions we can place inside the eye at the end of the cataract surgery that have been shown in most studies to do as good or better a job preventing infection as using antibiotic eye drops before and after surgery.

Just recently, the FDA approved two new steroid delivery methods to reduce post-operative inflammation that have the potential to eliminate post-op steroid eye drops in most (but not all) patients who are undergoing cataract surgery. Those two products are called Dexycu and Dextenza.

Dexycu is a white bolus of steroid medication that is injected inside the eye after cataract surgery. It will not be visible in most patients because it […]

2020-08-25T04:00:00+00:00August 25th, 2020|Blog|

Help! I started seeing these floating things!

"What are these weird floating things I started seeing?"

The spots, strings, or cobwebs that drift in and out of your vision are called “floaters,” and they are more prominent if you’re looking against a white background.

These floaters are tiny clumps of material floating inside the vitreous (jelly-like substance) that fills the inside of your eye. Floaters cast a shadow on the retina, which is the inner lining of the back of the eye that relays images to the brain.

As you get older, the vitreous gel pulls away from the retina and the traction on the retina causes flashing lights. These flashes can then occur for months. Once the vitreous gel completely separates from the back wall of the eye, you then have a posterior vitreous detachment (PVD), which is a common cause of new onset of floaters.

This condition is more common in people who:

  • Are nearsighted.
  • Are aphakic (absence of the lens of the eye).
  • Have past trauma to the eye.
  • Have had inflammation in the eye.

When a posterior […]

2020-08-22T04:00:00+00:00August 22nd, 2020|Blog|

Cataract Surgery and Anesthesia Types

The majority of cataract surgeries performed in the U.S. are done with a local anesthetic and IV sedation.

The local anesthesia may be accomplished in one of two ways: either an injection of anesthetic around the eye or anesthetic eye drops placed on the eye, often combined with an injection of a small amount of anesthetic into the front of the eye at the very beginning of surgery.

The injection of anesthetic around the eye generally produces a deeper anesthesia for the surgery than the topical method but it also comes with increased risk. There is a very small chance of potentially serious bleeding behind the eye and a rare chance of inadvertent penetration of the back of the eye with the injection needle.

The topical anesthesia has lower risk but does not provide quite as deep of an anesthesia, although the overwhelming majority of people having cataract surgery with a topical anesthetic do not experience any significant pain during the procedure. 

The other difference between the two anesthesias is with that topical anesthesia you maintain your […]

2020-08-18T04:00:00+00:00August 18th, 2020|Blog|

Intraoperative Aberrometry & Cataract Lens Replacement Selection

What Is Intraoperative Aberrometry?

Yes, that is a mouthful, but the concept isn’t quite as hard as the name.

An Intraoperative Aberrometer is an instrument we can use in the operating room to help us determine the correct power of the implant we put in your eye during cataract surgery.

Cataract surgery is the removal of the cloudy natural lens of your eye and the insertion of a new artificial lens inside your eye called an intraocular lens (IOL).

The cloudy cataract that we are removing has focusing power (think of a lens in a camera) and when that lens is removed, we need to insert an artificial lens in its place to replace that focusing power. The amount of focusing power the new IOL needs has to match the shape and curvature of your eye.

To determine what power of lens we select to put in your eye, we need to measure the shape and curvature of your eye prior to surgery.  Once we get those measurements, we can plug those numbers into several different […]

2020-08-11T04:00:00+00:00August 11th, 2020|Blog|

Why Get an Early Eye Exam for Your Young Child?

What do Amblyopia, Strabismus, and Convergence Insufficiency all have in common? These are all serious and relatively common eye conditions that children can have.

Did you know that 80% of learning comes through vision? The proverb that states ”A picture is worth a thousand words” is true!  If a child has a hard time seeing, it stand to reason that she will have a hard time learning.

Let’s explore Amblyopia, or “lazy eye”. It affects 3-5% of the population, enough that the federal government funded children’s yearly eye exams into the Accountable Care Act or ObamaCare health initiative. Amblyopia occurs when the anatomical structure of the eye is normal but the “brain-eye connection” is malfunctioning. In other words, it is like plugging your computer into the outlet but the power cord is faulty.

Amblyopia need to be caught early in life–in fact if it is not caught and treated early (before age 8) it can lead to permanent vision impairment. Correction with glasses or contacts and patching the good eye are ways it is treated. Most […]

2020-08-04T04:00:00+00:00August 4th, 2020|Blog|

I’m seeing jagged lines in my vision! Help!

Have you ever seen a temporary black spot in your vision? How about jagged white lines? Something that looks like heat waves shimmering in your peripheral vision?

If you have, you may have been experiencing what is known as an ocular migraine. Ocular migraines occur when blood vessels spasm in the visual center of the brain (the occipital lobe) or the retina.

They can take on several different symptoms but typically last from a few minutes to an hour. They can take on either positive or negative visual symptoms, meaning they can produce what looks like a black blocked-out area in your vision (negative symptom), or they can produce visual symptoms that you see but know aren’t really there, like heat waves or jagged white lines that look almost like lightning streaks (positive symptoms).

Some people do get a headache after the visual symptoms but most do not. They get the visual symptoms, which resolve on their own in under an hour, and then generally just feel slightly out of sorts after the episode but don’t […]

2020-07-28T04:00:00+00:00July 28th, 2020|Blog|