1 You had a stroke in your eye due to blocked arteries. This is probably a result, of an underlying systemic condition.  I need you to close your eyes and I will touch your eyelids in order to massage them.  Now hold this paper bag, take a deep breath and hold then breath into the bag.

ANTERIOR CHAMBER PARACENTESIS

2 We need to drain a little bit of fluid from your eyes. This procedure may improve your present visual acuity. Are you allergic to numbing drops? Please relax your eyes. I need to numb one of your eye muscles. You will feel a pressure sensation. Just keep your eyes turned towards the side.  Look at where my fingers are.

3 Now I need you to take this pill. It helps reduce your eye pressure to prevent further damage.

WORK-UP

4 I need to find the underlying cause of your condition. Your vision will not improve. But we need to preserve what remains.  Follow-up is important. I also need to refer you to an internist for a complete workup.  They will need to run blood tests (FBS, CBC, PT/PTT, ANA, FTA-ABS) and so fourth (Carotid Doppler, ultrasound, ECG). I need to see you back in 3-4 weeks to make sure there are no signs of oxygen deprivation damage.

I will have my staff make that appointment for you.

BRVO(BRABCH RETINAL ARTERY OCCLUSION)

5 You have a partial stroke to your eye due to blocked artery.  This is probably due to an underlying systemic condition. I need to see you back in 3-6 months to monitor your condition. Follow-up is important so please don't forget.

CRVO(CENTRAL RETINAL ARTERY OCCLUSION)

You have a blockage in the drainage system of blood in your eye. It is causing blood to leak out of vessels, which is the cause of your visual problems. We need to find out the underlying cause. Are you on any. medications such as oral contraceptives? Do you remember the name of your blood pressure pill? I need to discuss with your doctor and see if it's advisable to change your medication. I also need to refer you to an internist for a blood work-up.  I recommend we do a fluorescein angiography. It's a special test that will give me better information as to the extent of vessel blockage. I will need to inject this yellow dye into your system. We will then take photos of the back part of your eyes. When you go outside, it is important that you have sun protection and cover your skin because this dye makes your skin more sensitive to the sun. Some patients have even told me when they go to the bathroom, their urine turns yellow. But this won't be permanent. I need to see you back every 4 weeks for these first six months to closely monitor for signs of oxygen deprivation.

BRVO(BRABCH RETINAL ARTERY OCCLUSION)

7 You have a partial blockage of the drainage system of blood in your eye. It is causing blood to leak out of vessels, which is causing your visual problems. We need to find out the underlying cause. This is usually related to hypertension (HTN) or diabetes. I need to refer you to an internist for blood testing. I need you to come back every 1-2 months to monitor the blood leakage and for initial signs of oxygen deprivation so we can treat you right away.

DIABETIC RETINOPATHY

8 You have a condition called Diabetes (DM), which is increased blood sugar, and this is affecting your vision.  We need to refer you to an intemist to control the underlying cause with medications. Regular eye exams are important to monitor for progression.

9 What's your fasting blood sugar level?  Do you remember your glycosylated hemoglobin #? It is important to try to keep that number ＜6.5-7.0%.

DIABETES WITHOUT RETINOPATHY

10 Your eyes look great. I don't see any signs of diabetes. Keep up the good job in controlling your blood sugar level.  I want to see you back every year looking this way.

11 Since you are just in your first trimester and knowing that you are diabetic, I want to monitor your eyes closely. Everything today looks perfect. Please come back in 6 months so I can check up of things again.

DIABETES WITH MILD NPDR

12 I see early signs of diabetes affecting your eyes. If you've had diabetes for over 15 years, it's expected. I need you to come back for a dilated exam in 6 months to monitor your condition.

13 You are just in your first trimester. I do see very mild, trace signs of blood leakage. It is of no major concern at this time. I need to monitor its progression closely. Many 'have shown regression soon alter birth. So I will just need to follow up again when you've reached your second and third trimester.

DIABETES WITH MODERATE TO SEVERE NPDR

14 I see early signs of oxygen deprivation at the back of your eyes due to your diabetes.  I need to see you back in 3 months to monitor your condition. No treatment is necessary at this time.

HIGH RISK NPDR(PREGNANT)

15 I see signs of oxygen deprivation at the back of your eyes. There is a 50/50 chance it will progress.  But I’ve seen regression after birth. Please come back next month so I can monitor for any changes.

PDR

16 We need to work on how to better control your diabetes.  It is affecting your eyes in a way that can result in vision loss. I need to see you back in one month.

HIGH RISK PDR/CLINICALLY SIGNIFICANT EDEMA(CSME)

17 You need laser beatment to prevent further vision loss.  We call it Panretinal Laser Photocoagulation (Focal laser treatment). I am seeing new blood vessels growth at the optic disc (around your retina/iris) which shouldn't be there. It tells me that your eyes are not getting oxygen and your system is creating new vessels in response to that.  You are now at very high risk for visual loss. In order to preserve what you have, the laser will kill unnecessary retinal cells to decrease the oxygen demand. To put this another way, picture your retina as a forest.  But it's suffering from a draught. There is a special tree inside the center of the forest that you must save. In order to do that, you need to kill rest of the trees around so they won't compete for water.  Initially for the first week right after the treatment, you will think things looks worst (dimness of vision). But your eyes will adapt to this change.

18 I need to beat you. but it does not indicate you need to terminate your pregnancy. I need to examine you every month. At around the time of labor, it's Important to monitor your condition. If I continue to see active PDR, I will need to communicate with your doctor. We should discuss about he need for cesarean section because the energy exerted during natural birth may cause hemorrhage inside your eyes which will result in complications of your vision and treatment regimen.

HYPERTENSIVE RETINOPATHY

19 Hypertension is usually asymptomatic, so it is important to check your blood pressure daily. We are finding changes related to HTN in your eye. Come back in 2 months for a follow-up so I can see if it resolves or not.

ARTERIOSCLEROTIC RETINOPHY

20 You have a condition from long-standing hypertension. You need to be referred to an internist to treat the underlying cause.

TEMPORAL ARTERITIS(AION)

21 You have an inflammation of the large and medium sized arteries. The cause is unknown. Medications must be taken to prevent involvement of the ether eye.

MACULA

CELLOPHANE MACULOPATHY

22      A membrane has grown in the back of your eye.  This is not an urgent condition, but it needs to be monitored. Yearly follow-up examinations are a must to monitor the progression of your condition.

CSC(CENTRAL SEROUS CHOROIDOPATHY)

23      There is fluid similar to a blister, in the central vision part of the back of your eye. It will go away, but it may take some time (1-6 months).  Do your home amsler grid one eye at a time and RTC if you rtotice any changes. There is a very good chance of complete recovery.

CME(CYSTOID MACULAR EDEMA)

24      You have a condition in which there is fluid going into the back of the eye, under the retina. When this condition resolves, your vision will improve. You need to be seen by an internist to rule out any underlying cause, usually related to Htn, DM, cataract surgery.

AGE RELATED MACULAR DEGENERATION(ARMD)

NON-EXUDATIVE

25      There are signs of aging in the central part of the back of your eye. I need to monitor this condition for any changes.  I recommend you take these vitamin supplements, 4 tablets per day. I need to know if you are still smoking or if you've smoked before.  If that is the case, I won't prescribe Vitamin A for you because I don't want to create a new problem (enhance your lung cancer rate). These vitamins will not affect your cataracts. So far there are no cure for this, but we can try to slow down its rate of progression.

EXUDATIVE

26      There is a possibility of bleeding in the back of your eye. Your vision will net improve. I want to help you. There are very good Iow vision aids that can help maximize the use of your remaining vision.

27      Your visual loss is Irreversible. But we still need to monitor for retinal detachment. If there is a sudden onset of flashes and: floaters, come into our office ASAP.

PERIPHERAL RETINA

28      I see a small area of weakness at the back of your eyes. A very small piece of tissue has been tom away.  Usually the treatment for this is to leave it alone. But you must pay careful attention for signs of retinal detachment. If you see flashes and floaters or a curtain in anywhere in your flashes and floaters or a curtain in anywhere in your field of view, RTC immediately.

RETINOSCHISIS

29      You have a separation of the layers in the back of your eye. Follow-up is necessary to monitor the progression and prevent permanent vision loss. RTC ASAP if you noticed flashes and floaters.

LATTICE DEGENERATION

30      You have thinning of the tissue in the peripheral part of your eye. We need to monitor for retinal detachment.  If flashes and floaters are noticed, you need to RTC ASAP.

RETINAL DETACHMENT

31      You have a separation in the back part of your eye. The layers have to be reattached to prevent further detachment.  Do not do any strenuous activity in the mean time like golfing, weight lifting.

CHOROIDAL DETACHMENT

32      You have a separation of the back part of your eye which needs to be monitored, so that further decrease in vision does not occur.

TOXOPLASMOSIS

33      There is an infection inside your eye which is usually transferred by cat feces in the liter box or undercooked meat.  You need to take your medications to calm the inflammation otherwise, permanent decrease in vision will occur, I also need to refer you　to　a specialist　to start oral　medication treatment. It's　not possible to kill the parasite but we need to　suppress its activation because reoccurrence is possible.

TOXOCARIASIS

34      Round worms in the back of your eye are causing this condition.  The roundworms may have come from exposure to pets or eating dirt. Medications must be taken to get rid of the inflammation.

HISTOPLASMOSIS

35      There is a fungal infection active in the back of your eye from chicken or bird droppings. The condition should remain good provided you have good compliance with the daily home amsler grid monitoring. If you see sudden changes with your vision, you must retum immediately so we can start laser treatment right away.

UNKNOWNS

CHOROIDITIS

36      there are signs of inflammation at the back of your eyes. I haven't been able to identify its cause. So I am going to refer you to a very good specialist in this field for consultation.

GLAUCOMAS

ACUTE ANGLE CLOSURE GLAUCOMAS

“I feel pain around my eyes, vision is a bit hazy. When I look at light, I see colored halo around lights. At Times, I feel a bit nauseated, and have been vomiting.  I am also getting a headache at the front.”

37      The drainage structure of your. eye has been blocked.  This is due to the anatomy of your eyes with a narrow chamber compared to normal. We often see this in Asians and hyperopes. Being both, you are at higher risk.  You really need to be extra careful and monitor for signs when you go to the movie theaters going to dim illumination.  Because your vision have been severely affected to hand motion only I need to lower your pressure immediately. The oral medication I prescribe will help. I will prescribe these drops to lower your pressure. Please stay here because I need to check your eye pressure and vision again in one hour.  If it does not decrease after the second course, we need to proceed with laser peripheral iridectomy to correct this condition.

38      The drops worked well, and we see your pressure decreased.  But your cornea is still swollen.  I need to see you back tomorrow and daily (1-5 days) to monitor the inflammation.  I will need to prescribe several medications.  Then we can do the laser procedure to create more drainage holes to prevent another attack in the future. I want to treat the other eye too because Ithere is a 40-80% chance it will be blocked 5- 10 years down the road. I will do that firs[ ain-dthenonce your cornea has resolved, we will laser this eye.  You should tell your relatives about your condition. There is a 33-50% chance your first degree relatives inherit this condition.

CHRONIC OPEN-ANGLE GLAUCOMA

39      Take your medications! The medications will slow the progression of glauco(na but there is no cure.

40      The drainage structure of your eyes is not working optimally.  We measure your pressure and it is too high. You won't feel the early stages damage but we do see it in our exam findings today. That is why I need to start you on the medications to control your pressure. What is damaged is irreversible and fortunately, you came in early enough. If it progresses, it will cause your side vision to constrict. Normal pressures are less than 20. Yours is above 30. We will start treatment on one eye first to check its affects. Every patient responds differently to these eye drops. Our target (I would be very happy) if we get a 30% reduction. So come back in (3 weeks/3 days/tomorrow) and we will check pressures both eyes. if we are getting effective results then we will proceed with this therapy and keep your pressures under control. Exercise, especially walking is good too.  So I strongly encourage you to start this habit.

ANGLE RECESSION GLAUCOMA

41   Your condition is due to prior trauma to the eye. There is scarring-to the trabecular meshwork, which, is blocking drainage from your eye. Compliance with your medication is essential.

PIGMENTARY GLAUCOMA

42   The type of glaucoma you have is caused by pigment coming off the colored part of your eye. This pigment is causing a blockage in the drainage system of your eye.  Compliance with your medication is very important.

PSEUDOEXFOLIATIVE GLAUCOMA

43   You have a condition in which the colored part of your eye is rubbing up against the lens inside your eye. This is causing white flaky material into the drainage system of your eye. !t is hard to control IOP spikes due to the small pigment blocking the drainage.

NORMAL TENSION GLAUCOMA

44   You have a condition in which the pressures in your eyes are about average. But your eye is more sensitive than the average individual and it is damaging sensitive tissues even with these pressures.

45   It is difficult to decrease your eye pressure further since the pressures are already low. I will prescribe this eye drop that I want you to place one drop, four times a day. Come back in a week and we'll see how your pressures are.

PVD(POSTERIOR VITREOUS DETACHMENT)

46   It is a normal age-related change occurring at this time. But we need to monitor for higher risk of retinal problems.  RTC if you noticed sudden flashes of light, and sudden burst of floaters.