Question:

Mike…. the degree of the refraction on my astigmatism keeps changing… is this another bg control issue???…. i am also at that age where bifocals or trifocals are necessary (running -5.?? or more with +2.5 on the bifocals and a "minor?" astigmatism that keeps changing in the last 4-5 years)…. i don’t understand what is causing the changes…. would you kindly inform? tia k – Hide quoted text — Show quoted text – If you’ve had diabetes for years, you may be having serious complications and you should get checked up now. Retinal problems are common after a few years of Type 2 and should be monitored. But another complication is very familiar in _early_ Type 2, and that’s changes in refractive error (eyeglass prescription). This strange phenomenon signals poor control, but otherwise it is more nuisance than threat. Get temporary glasses if you need them. Get them somewhere that will remake your glasses if your Rx changes in 30 days. Diabetes is about the only common condition that affects the eyeglass prescription in both eyes so dramatically. Diabetic refractive shifts are usually bilateral and equal, but the direction of shift is unpredictable. Since Type 2 often begins in the 40’s and 50’s, these shifts can create or aggravate the ongoing process of presbyopia. Refractive shifts are said to occur because the lens inside the eye changes shape osmotically when the surrounding fluid is syrupy sweet, and then the lens resolves when serum osmolality returns to normal. The aqueous fluid circulates slowly and refractive shifts can take weeks to recover, and may settle at a new level of refractive error and stabilize. There have been major vision problems during the past two weeks. I am a type ll diabetic and would like to know what sort of vision problems others have experienced and what they did to correct them. Would also like to know what one might expect over time. thanks… Dick Fr…

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Mike…. the degree of the refraction on my astigmatism keeps changing… is this another bg control issue???…. i am also at that age where bifocals or trifocals are necessary (running -5.?? or more with +2.5 on the bifocals and a "minor?" astigmatism that keeps changing in the last 4-5 years)…. i don’t understand what is causing the changes…. would you kindly inform?

Change in axis is normal for "minor" astigmatism, the wrinkles of astigmatism are subtle and change easily. Your axis can change morning to evening and with different sustained eye postures. The cornea can change with pregnancy, dehydration, sun, wind, and many other things. These changes are too subtle to affect big bends in the cornea, but can easily affect the smaller wrinkles. If your "cylinder" value is 0.50 or so, 10 degrees of axis will hardly make a difference and two refractions on the same day should come out within 5 or 10 degrees. When your "cylinder" value is 2.50 or more, just a couple of degrees of error in axis will really blur an image and make you queasy. -MT

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There have been major vision problems during the past two weeks. I am a type ll diabetic and would like to know what sort of vision problems others have experienced and what they did to correct them. Would also like to know what one might expect over time. thanks… Dick Fr…

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If you’ve had diabetes for years, you may be having serious complications and you should get checked up now. Retinal problems are common after a few years of Type 2 and should be monitored. But another complication is very familiar in _early_ Type 2, and that’s changes in refractive error (eyeglass prescription). This strange phenomenon signals poor control, but otherwise it is more nuisance than threat. Get temporary glasses if you need them. Get them somewhere that will remake your glasses if your Rx changes in 30 days. Diabetes is about the only common condition that affects the eyeglass prescription in both eyes so dramatically. Diabetic refractive shifts are usually bilateral and equal, but the direction of shift is unpredictable. Since Type 2 often begins in the 40’s and 50’s, these shifts can create or aggravate the ongoing process of presbyopia. Refractive shifts are said to occur because the lens inside the eye changes shape osmotically when the surrounding fluid is syrupy sweet, and then the lens resolves when serum osmolality returns to normal. The aqueous fluid circulates slowly and refractive shifts can take weeks to recover, and may settle at a new level of refractive error and stabilize.

– Hide quoted text — Show quoted text – There have been major vision problems during the past two weeks. I am a type ll diabetic and would like to know what sort of vision problems others have experienced and what they did to correct them. Would also like to know what one might expect over time. thanks… Dick Fr…

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ms during the past two weeks. I am a type ll diabetic and would like to know

what sort of vision problems others have experienced and what they did to correct them. Would also like to know what one might expect over time. Dick:  One of the biggest problems that can occur in people who have diabetes is called retinopathy.  This is where the blood vessels in the back of the eye start to leak (weep).  If not taken care of when they are detected, a diabetic can lose his/hers sight. I was detected with retinopathy in August of 1987.  I was seen every 3 to 4 months on a constant bases.  In September of 97 was when I was given laser treatment to stop the bleeding in the back of my eyes.  That was about 10 yeas before I had to have lazer surgery. Laser surgery is the method to stop bleeding in the back of the eye. After the laser surgery my eye sight went more blurry than it had been(I had have blurry vision since August of 87 but this was worse).  It did not improve and I had to read with reading glasses and I stopped driving since the road signs were nothing but a blur to me. September of 98 my eye doc said I had another diabetic problem that effected both my central and side vision areas (I took a Field Vision Test to determine this problem).  I was told the reduction in those areas is caused by the diabetes and it is not curable (just like retinopathy).  All I could do was keep my blood sugars as close to normal as I can—thus putting off the disease a little longer. Eventually I can have 2 things happen.  One is that my eyes will continue to go out of focus (blurred) until I can not make out anything.  Or two my eye sight suddenly goes black.  These two opinions can happen at any time. The above is the worse case possibility.  You are just starting so you have time but not time not to be seen by a good eye doctor (a Ophthalmologist) and to keep your blood sugar levels as close to normal as possible.   GOOD LUCK!!!! God’s Speed. Robin M Smyth  USN (Ret) West Point, VA It’s the darkest right before the dawn! Hold on, JOY comes in the morning!

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Question:

Everyone has floaters if they know how to look (look at a bright blue cloudless sky and take your time).  Floaters typically increase thoughout life, independent of diabetes. Diabetic retinal problems can cause dramatic increases. -MT – Hide quoted text — Show quoted text – — After finding this forum, I’m amazed that floaters are so common!  I was told one of two things could happen.  They could disappear or the mind could block them out.  I’m still waiting……I’m not as alarmed knowing others have this problem too….  Good Luck to everyone..

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I had a floater in my right eye which disappeared in one week.  Floaters may disa[[er but it can take months.  Some floaters may never disappear.  There is a form of surgery called a vitrectomy which can remove floaters. Joe Reardon    

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– After finding this forum, I’m amazed that floaters are so common!  I was told one of two things could happen.  They could disappear or the mind could block them out.  I’m still waiting……I’m not as alarmed knowing others have this problem too….  Good Luck to everyone..

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<<Well me and the wife decided she needed new specs this week, so we went to the local Vision Express to see what was on offer.  While I was there I thought it might be an idea to see if the eye bloke could find anything wrong with MY eyes. I told him I was diabetic and concerned about retinopathy, glaucoma and all the rest so he had a squizz in myeyes, did the regular eye test to see if my scrip had changed since my lasy pair of spaecs, then promptly told me there was no sign of diabetic eye problems. Now I know this bloke isn’t an opthalmologist, just an optometrist (optician as they used to be called) but he WAS looking specifically for diabetic damage and said he didn’t find any, so is he pulling the wool or what? I tend to think he’s right, and there IS no damage (but that’s what I WANT to hear right?) but wouldn’t he be something of a dick-head telling me I was OK if he wasn’t sure, particularly given my history? I really don’t think he WAS a dick-head, but he sure didn’t spend the amount of time looking into my eyes (afraid of being hypotised no doubt:-) that my regular opto does at the diabetic clinic. The problem as I see it is that to note that someone is diabetic and therefore to look for "diabetic" type stuff might leave out a whole range of possibilities. I had neither retinopathy nor glaucoma when I lost the vision in my eye.  What I had was hardening of the arteries in my eye which had not resulted in any bleeding and did not until I went on a bloodthinning medication and all hell broke loose.  There are indications that the hardening of the arteries was caused by the diabetes, but would it be something that someone would regularly look for in a "diabetic" exam?  As I said, the optometrist who had seen me just a couple of months before said I had an astigmatism and did not notice any of the serious damage to my eye which the opthalmologist picked up on immediately. The other advantage to seeing an opthalmologist is that they ARE MDs.  My opthalmologist suspected a whole range of potential medical problems based on my eye exam.  She sent me to my PCP with a request to check on a couple of things, which he did, which is how my heart condition was diagnosed.  And had THAT not been diagnosed,  would have been a good candidate for a stroke.   I’m not trashing optometrists, really.  It’s like endos and primary care physicians — a lot of people here think you HAVE to see an endo if you’re a diabetic, and others think a PCP is fine.  With diabetes, there are so many possible medical conditions that could interact with each other in subtle ways that I think it merits seeing an MD about your eyes. Wendy "Before criticizing someone, walk a mile in their shoes.  Then when you do criticize them, you will be a mile away and have their shoes."  Jack Handy

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I believe the original complaint was that an ophthalmologist had provided a 3-minute examination. Your dentist isn’t an MD either. The idea that an optometrist can’t see diabetic retinopathy is ludicrous.

Well me and the wife decided she needed new specs this week, so we went to the local Vision Express to see what was on offer. While I was there I thought it might be an idea to see if the eye bloke could find anything wrong with MY eyes. I told him I was diabetic and concerned about retinopathy, glaucoma and all the rest so he had a squizz in my eyes, did the regular eye test to see if my scrip had changed since my lasy pair of spaecs, then promptly told me there was no sign of diabetic eye problems. Now I know this bloke isn’t an opthalmologist, just an optometrist (optician as they used to be called) but he WAS looking specifically for diabetic damage and said he didn’t find any, so is he pulling the wool or what? I tend to think he’s right, and there IS no damage (but that’s what I WANT to hear right?) but wouldn’t he be something of a dick-head telling me I was OK if he wasn’t sure, particularly given my history? I really don’t think he WAS a dick-head, but he sure didn’t spend the amount of time looking into my eyes (afraid of being hypotised no doubt:-) that my regular opto does at the diabetic clinic. Beav

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Mike and everyone, I’ve always heard opthalmologists recommended over optometrists for people with diabetes, but I’ve never given a careful hearing to what logic goes into that recommendation. Can anyone explain it to me? Why should a diabetic regularly see an opthalmologist over an optometrist? My optometrist does go by the title of "Dr." afterall…

Usually the recommendation comes from a primary care physician or endo, and they aren’t likely to refer to a non-MD. I feel like my optometrist gives me a thorough exam (spends 30+ minutes shining lights and pearing into my eyeballs, puff of air test for glaucoma, etc.). Of all my years getting eye exams, no trace of retinopathy or any other diabetes nasties have shown up. I have never had a dilated exam, but trust my optometrist to recommend one if he feels it is warranted.

I think it’s warranted, but not necessarily because of diabetes. Most optometrists today would recommend dilation at least once, because there’s about 60% of your retina that simply can’t be seen without it. On the other hand, virtually all the early changes of DM occur in the 40% that _can_ be seen without dilation, and the instruments we use to view a dilated fundus (binocular indirect ophthalmoscopy) aren’t much good at finding the dots and blots of BDR – they’re too small. Dots and blots are easiest to see with the little hand-held scope he uses when he gets right up in your face, so if they’re there, he would have seen them. But I’d have to disagree with your doc.. you need at least one dilated examination to check your peripheral retina for (non-diabetic) retinal problems. Is there some hard and fast rule or reason that dictates a diabetic should have a dilated exam and a regular visits with an opthalmologist even if there is no hint of eye complications, and nothing has been detected at the routine examination?

There are no "rules" written down anywhere. "Standard of care" is defined by case law and it’s pretty well accepted that diabetics with no retinal complications should have a dilated exam at least every couple of years, and more often once retinopathy is detected, or if control is poor. Which professional you choose to do this isn’t as important, as long as he looks and he knows what to look for. I know it’s hard to tell in advance. Maybe I should recommend that you find an optometrist with diabetes.. I wish I didn’t know so much about it. -MT

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- Hide quoted text — Show quoted text – says… I was advised to get a yearly eye examination by an ophthalmologist and my last appointment consisted of reading an eye chart and having a flashlight shined into my eyes.  Total time, less than 3 minutes. Is this the typical eye exam?  I’m a bit worried because I made the appointment because my eyes feel very dry and irritable. You need to have an examination that includes a full fundus examination. That does require the eyes to be dilated, and you’ll be annoyed by the bright light used to look around inside your eye.  This is to check for macular degeneration which is one of the wonderous side effects of this disease.

I didn’t know that (BG). Macular edema maybe, but macular degeneration is another problem that doesn’t have much to do with diabetes. Dryness and irritablility of the eye is a common side effect of diabetes.  It is due to metabolic changes that occur in the nerve cells that control the tear ducts when your blood glucose is too high.

I didn’t know that either.. I suspect it has more to do with the same osmotic changes that produce dry mouth, and not so much with nerve cells or tear ducts. -MT

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Thanks for all the replies,  I definitely know I need to get a better eye examination – over the counter eye drops are not helping. As for the Ophthalmologist versus Optometrist  thread, I don’t have any preference.  I know at my last visit to an optometrist I got a much more thorough examination and some really good glasses too. The only difference for me is that the Ophthalmologist, recommended by my doctor, is paid by my healthcare while the optometrist comes out of my pocket.    Ak

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Seriously though, perhaps you can provide us some insight with regard to same. Not knowing if a person was diabetic or not, would you provide the "deeper" examination required by them? Do many optometrists dialate eyes during exams to really get into things?

I do, and I’d say that most of the ODs who graduated in the last 15 or 20 years recognize dilation as the "standard of care" for all new patients and all patients at risk for retinal problems. Before that, many states didn’t _allow_ optometrists to dilate, but that wasn’t because they didn’t want to. providing space for rebuttal. My Dad had glaucoma, and I regularly get examined for that. Would an optometrist do that? (pressure check). I really don’t know myself.

Yes, pressure checks are almost universally accepted as a requirement, even with children (and children rarely develop glaucoma if they aren’t born with it.) -MT

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Mike and everyone, I’ve always heard opthalmologists recommended over optometrists for people with diabetes, but I’ve never given a careful hearing to what logic goes into that recommendation. Can anyone explain it to me? Why should a diabetic regularly see an opthalmologist over an optometrist? My optometrist does go by the title of "Dr." afterall… I feel like my optometrist gives me a thorough exam (spends 30+ minutes shining lights and pearing into my eyeballs, puff of air test for glaucoma, etc.). Of all my years getting eye exams, no trace of retinopathy or any other diabetes nasties have shown up. I have never had a dilated exam, but trust my optometrist to recommend one if he feels it is warranted. Is there some hard and fast rule or reason that dictates a diabetic should have a dilated exam and a regular visits with an opthalmologist even if there is no hint of eye complications, and nothing has been detected at the routine examination? Robin – Hide quoted text — Show quoted text – Keep looking for a good doc.  And check to be sure this one is not just an optometrist. Yeah.. Optometrists don’t know how to look for dot, blot, or flame hemorrhages, cotton wool spots, neovascularization, superior oblique palsies, cataracts, or refractive changes. Optometrists study from special books that have all the chapters about "real" medicine torn out.  They don’t know how to charge $120 for a 3-minute eye exam, and they recommend surgery altogether too often. And of course they delegate all their refractions to a technician with real "on-the-job" training. Don’t go to a dentist either. Be sure you see an oral surgeon. Sheesh. -MT (Just an optometrist, who gets cranky when his BG is low)

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I was advised to get a yearly eye examination by an ophthalmologist and my last appointment consisted of reading an eye chart and having a flashlight shined into my eyes.  Total time, less than 3 minutes. Is this the typical eye exam?  I’m a bit worried because I made the appointment because my eyes feel very dry and irritable.   Ak

Yes, that is a pretty typical exam for a person who shows no signs of trouble.  I used to get exams like that – NOW I get lots of pictures of the retina, computer imaging, etc.  The Doctor looks at the pictures, and looks into my eyes fro a few minutes to check on the pictures, but until I started to have retinitis, it was in and out.

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says… I was advised to get a yearly eye examination by an ophthalmologist and my last appointment consisted of reading an eye chart and having a flashlight shined into my eyes.  Total time, less than 3 minutes. Is this the typical eye exam?  I’m a bit worried because I made the appointment because my eyes feel very dry and irritable.

You need to have an examination that includes a full fundus examination.   That does require the eyes to be dilated, and you’ll be annoyed by the bright light used to look around inside your eye.  This is to check for macular degeneration which is one of the wonderous side effects of this disease.  Dryness and irritablility of the eye is a common side effect of diabetes.  It is due to metabolic changes that occur in the nerve cells that control the tear ducts when your blood glucose is too high.  However, these same symptoms can be caused by simple allergies.  If you have reasonable control of your bg, you shouldn’t have major tear duct problems due to diabetes, but this should be discussed with a competent opthamologist or diabetes specialist. Steve

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- Hide quoted text — Show quoted text – Keep looking for a good doc.  And check to be sure this one is not just an optometrist. Yeah.. Optometrists don’t know how to look for dot, blot, or flame hemorrhages, cotton wool spots, neovascularization, superior oblique palsies, cataracts, or refractive changes. Optometrists study from special books that have all the chapters about "real" medicine torn out.  They don’t know how to charge $120 for a 3-minute eye exam, and they recommend surgery altogether too often. And of course they delegate all their refractions to a technician with real "on-the-job" training. Don’t go to a dentist either. Be sure you see an oral surgeon. Sheesh. -MT (Just an optometrist, who gets cranky when his BG is low)

Hey, Dr. Mike. I can understand you being upset with most telling the original poster to seek out a good opthamologist, in lieu of a "lesser" optometrist Seriously though, perhaps you can provide us some insight with regard to same. Not knowing if a person was diabetic or not, would you provide the "deeper" examination required by them? Do many optometrists dialate eyes during exams to really get into things? Not slamming you here but providing space for rebuttal. My Dad had glaucoma, and I regularly get examined for that. Would an optometrist do that? (pressure check). I really don’t know myself. — Dave — March 4, 1999 t2 08/98  Glucophage This country needs more unemployed Republicans, and more neutered Democrats  http://www.newsfeeds.com/       The Largest Usenet Servers in the World!

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Sorry Mike.  I thought of you just after I pressed send.  And wished I could reach out and pluck a couple of those words back.

No problem. I understand your point of view, and there are diabetics who really should be seeing ophthalmologists for their routine visits; those with proliferative retinopathy, those who need photocoagulation, etc. But the majority of diabetics encountered in eye care practice have only "background" retinopathy, or none at all, and "monitoring" is all they need, which doesn’t require a surgeon’s skill. an opto, I never know how much time to keep free.  But with an opthal, I know I need at least an hour or two.

I can’t imagine what they do for two hours. My guess is you spend much of that time waiting. Interesting that you make the distinction using the dentist/oral surgeon. If I were to use the same analogy, I would say to see the optometrist first.  However, why should the consumer pay both?  An oral surgeon doesn’t clean, fill, etc., teeth.  But an opthal does do prescriptions for eyeglasses

Many don’t, particularly the "specialists", because medical insurance generally doesn’t cover refraction. And I hate to bring up insurance, but, my opthal treats my visits as medical visits because I am a diabetic.  So I pay my co-pay and am on my way.  Our eyecare insurance will pay for lenses, but not for the visit for prescriptions.

Medicare and most insurance companies recognize optometrists on par with ophthalmologists for medical services, until surgery is required. -MT

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<<I believe the original complaint was that an ophthalmologist had provided a 3-minute examination. Your dentist isn’t an MD either. The idea that an optometrist can’t see diabetic retinopathy is ludicrous. Just my experience, FWIW.   I was beginning to have trouble seeing distances (I had the farsightedness that comes with advancing senility, but this near-sightedness was new) so I went to an optometrist.  He checked my eyes and told me I had an astigmatism and sent me on my way.  A couple of months later, my PCP told me to get my butt to an opthalmologist for a yearly eye exam, which I did.  She basically told me that the inside of my eye was a disaster — the optic nerve was/is almost completely kaput, there are virtually no small blood vessels left any more, white puffies, the whole nine yards — an optic disaster.  A couple of weeks later I was blind in that eye. Was the optometrist just incompetent?  I don’t know.  But what I HAVE learned through this optic odyssey is that specialists know more than generalists.  The opthalmologist obviously knew a lot more than the optometrist, and she immediately sent me to the retina specialist and the glaucoma specialist, both of whom knew more about their areas of expertise than the other.  Given all that can go wrong with one’s eyes as the result of diabetes, I would think one would want the MOST thorough exam possible by the MOST QUALIFIED person possible. Wendy "Before criticizing someone, walk a mile in their shoes.  Then when you do criticize them, you will be a mile away and have their shoes."  Jack Handy

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-MT (Just an optometrist, who gets cranky when his BG is low)

Sorry Mike.  I thought of you just after I pressed send.  And wished I could reach out and pluck a couple of those words back. But…. I have been diabetic for 26 years.  Seen quite a few optometrists and quite a few opthalmologists.  I honestly have to say that the optometrists I have seen don’t seem to follow any standard.  Some do, some don’t.  Most of the opthalmologists, however, do seem to.  When I make an appt with an opto, I never know how much time to keep free.  But with an opthal, I know I need at least an hour or two. Interesting that you make the distinction using the dentist/oral surgeon. If I were to use the same analogy, I would say to see the optometrist first.  However, why should the consumer pay both?  An oral surgeon doesn’t clean, fill, etc., teeth.  But an opthal does do prescriptions for eyeglasses And I hate to bring up insurance, but, my opthal treats my visits as medical visits because I am a diabetic.  So I pay my co-pay and am on my way.  Our eyecare insurance will pay for lenses, but not for the visit for prescriptions. Sorry, again, Mike.  But I still think a diabetic should see an opthalmologist.  Perhaps if all of your co-optometrists were as thorough as you seem to be, I would change my opinion. Unfortunately, my experience has not been such. Probably evident by my statement that I thought the doctor referred to was an optometrist.   ) Judy  

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I believe the original complaint was that an ophthalmologist had provided a 3-minute examination. Your dentist isn’t an MD either. The idea that an optometrist can’t see diabetic retinopathy is ludicrous. -MT – Hide quoted text — Show quoted text – If this was your doctor and if he knows you are diabetic, get a new doctor ! I don’t know if your are type 1 or 2, or what meds you take. After two vitrectomies, two lens implants and a dozen laser treatments, my advice to you is "get to an opthalmologist NOW" and insist on a full eye exam including dilation. If there is even a hint of developing retinopathy, The opto-doc should see you more often than once a year.Just a reminder that an opthalmologist is an MD and an optometrist is not!

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If this was your doctor and if he knows you are diabetic, get a new doctor ! I don’t know if your are type 1 or 2, or what meds you take. After two vitrectomies, two lens implants and a dozen laser treatments, my advice to you is "get to an opthalmologist NOW" and insist on a full eye exam including dilation. If there is even a hint of developing retinopathy, The opto-doc should see you more often than once a year.Just a reminder that an opthalmologist is an MD and an optometrist is not!

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Not that this has to do with diabetes…but my son had Retinopathy of Prematurity and with his many check ups…he always had his eyes dialated.  I am assuming retinopathy is retinopathy…. Traci

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Doesn’t sound to me like a complete  ophthalmological exam. My optometrist and my ophthalmologist have it worked out so I see one of them every 6 months. As others have said, dilation is essential to a real view of the macula and the retina. The first time I went to an ophthalmologist, she injected dye in my arm and took photographs of my eyes as the dye reached the blood vessels there for a baseline image to compare changes to. I originally went when I had a macular cycst, which appeared as a fluorescent fuscia ovoid in my left eye’s field of vision. Nothing to be done about that but keep sugars in control. It eventually has shrunk so it’s not so noticeable, and the docs actually have a hard time finding it. Bright lights get shined in when your eyes are dilated, almost painful, but definitely bearable. Doc may move your eyeball around and  direct you to look left, right, up or down to get a really good look in there. In addition, any competent optometrist should be checking for glaucoma with a squirt of pressurized air: I usually get it once at the opto, once at the ophthal. Typical time at opto: 20 mins to half an hour; typical time at ophthalmologist: 1.5 – 2 hours, some of that waiting for dilation and recovering from dilation. Get a good ophthalmologist, preferably one who specializes in diabetic retinopathy. — Nanuq of the North, T2, 6 years, glucophage, diet & (not enough) exercise Remove grzl to send email: I’m only a grizzly when my bgs are low! – Hide quoted text — Show quoted text – I was advised to get a yearly eye examination by an ophthalmologist and my last appointment consisted of reading an eye chart and having a flashlight shined into my eyes.  Total time, less than 3 minutes. Is this the typical eye exam?  I’m a bit worried because I made the appointment because my eyes feel very dry and irritable.   Ak

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Is this the typical eye exam?  I’m a bit worried because I made the appointment because my eyes feel very dry and irritable.

NO.  My doc takes about 20 minutes looking around, then another 20 minutes with the charts (unless my vision hasn’t changed). Then he puts in drops, I go out and sit in the waiting room for about 40 minutes.  Then back in and he looks in with the light. Feel like he wishes my eyes were somewhere else cause he can’t seem to see as well as he would like.  Pushing and shoving. Smooshing my nose.   When I come out of there, I KNOW I have had my eyes examined. (Personally I think he can see other stuff in there (X rated?) and just isn’t letting on.) Keep looking for a good doc.  And check to be sure this one is not just an optometrist. Judy

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I was advised to get a yearly eye examination by an ophthalmologist and my last appointment consisted of reading an eye chart and having a flashlight shined into my eyes.  Total time, less than 3 minutes. Is this the typical eye exam?  I’m a bit worried because I made the appointment because my eyes feel very dry and irritable.   Ak

Not as far as I can see.. I just had mine also, last Friday. I had the standard chart readings, and the light into the eyes, but I also was dilated with three different kinds of drops. After waiting 20 minutes for them to work, I had an eyeball pressure test for glaucoma, and the inside of my eyes were scanned with the Dr. looking through a machine. He also said I had no signs of retinopathy. You did tell him you were diabetic, right? I would expect much more from an ophthalmologist.. — Dave — March 3, 1999 t2 08/98  Glucophage This country needs more unemployed politicians.  http://www.newsfeeds.com/       The Largest Usenet Servers in the World!

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Did you have to go off of your Metformin before they used the dye? I read somewhere that you should. I never got the dye stuff, but my eyes were dilated and he looked into my eyes for about thirty minutes. He didn’t test me for my eyesight…I have to see the optometrist for that. Jacquie

Doesn’t sound to me like a complete  ophthalmological exam. My optometrist and my ophthalmologist have it worked out so I see one of them every 6 months. As others have said, dilation is essential to a real view of the macula and the retina. The first time I went to an ophthalmologist, she injected dye in my arm and took photographs of my eyes as the dye reached the blood vessels there for a baseline image to compare changes to. I originally went when I had a macular cycst, which appeared as a fluorescent fuscia ovoid in my left eye’s field of vision. Nothing to be done about that but keep sugars in control. It eventually has shrunk so it’s not so noticeable, and the docs actually have a hard time finding it. Bright lights get shined in when your eyes are dilated, almost painful, but definitely bearable. Doc may move your eyeball around and  direct you to look left, right, up or down to get a really good look in there. In addition, any competent optometrist should be checking for glaucoma with a squirt of pressurized air: I usually get it once at the opto, once at the ophthal. Typical time at opto: 20 mins to half an hour; typical time at ophthalmologist: 1.5 – 2 hours, some of that waiting for dilation and recovering from dilation. Get a good ophthalmologist, preferably one who specializes in diabetic retinopathy. — Nanuq of the North, T2, 6 years, glucophage, diet & (not enough) exercise Remove grzl to send email: I’m only a grizzly when my bgs are low! – Hide quoted text — Show quoted text – I was advised to get a yearly eye examination by an ophthalmologist and my last appointment consisted of reading an eye chart and having a flashlight shined into my eyes.  Total time, less than 3 minutes. Is this the typical eye exam?  I’m a bit worried because I made the appointment because my eyes feel very dry and irritable.   Ak

Response:

Keep looking for a good doc.  And check to be sure this one is not just an optometrist.

Yeah.. Optometrists don’t know how to look for dot, blot, or flame hemorrhages, cotton wool spots, neovascularization, superior oblique palsies, cataracts, or refractive changes. Optometrists study from special books that have all the chapters about "real" medicine torn out.  They don’t know how to charge $120 for a 3-minute eye exam, and they recommend surgery altogether too often. And of course they delegate all their refractions to a technician with real "on-the-job" training. Don’t go to a dentist either. Be sure you see an oral surgeon. Sheesh. -MT (Just an optometrist, who gets cranky when his BG is low)

Response:

As I have always read it, it is a dilated eye exam they need to give you. I’ve seen several warnings that you need to ensure that you get the dilated eye exam, and not all opthamologists know how important it is. The references I believe were in Diabetes Forecast Magazine. I personally don’t trust doctors just because they have MD by their name. Do you have a good one? – Hide quoted text — Show quoted text – I was advised to get a yearly eye examination by an ophthalmologist and my last appointment consisted of reading an eye chart and having a flashlight shined into my eyes.  Total time, less than 3 minutes. Is this the typical eye exam?  I’m a bit worried because I made the appointment because my eyes feel very dry and irritable.  Ak

Response:

I was advised to get a yearly eye examination by an ophthalmologist and my last appointment consisted of reading an eye chart and having a flashlight shined into my eyes.  Total time, less than 3 minutes. Is this the typical eye exam?  I’m a bit worried because I made the appointment because my eyes feel very dry and irritable.

I don’t accept that this is good enough Ak. I tell the opto that I’m diabetic and want a REAL exam, which involves drops in the eyes to totally dilate the pupils. This allows the opto to have a good look for any "gremlins" that might be there, and without the dilated pupils it’s easier to miss early signs of retinopathy. So far no-one’s ever found any problems with my eyes, although I doubt that’s becasue of anything the opto does, but it IS nice to know the whole story. Beav

Response:

<<I’m a bit worried because I made the appointment because my eyes feel very dry and irritable Did you mention that fact to the Dr.?? Your vision was probably OK by the eye-chart test and his light shining was checking for glaucoma…… "Uncle Arnie" "STRESS is when you wake up screaming & you realize you haven’t fallen asleep yet. "

Response:

I was advised to get a yearly eye examination by an ophthalmologist and my last appointment consisted of reading an eye chart and having a flashlight shined into my eyes.  Total time, less than 3 minutes. Is this the typical eye exam?  I’m a bit worried because I made the appointment because my eyes feel very dry and irritable.   Ak

Response:

Question:

Hi Tony; Tony Wypkema <thepartn…@designwrite.nu

wrote: Can chronic glaucoma patients with stable pressures in the mid-teens experience sudden, central blind spots as a result of their glaucoma? Thank you.

Dr. Robert Ritch responds that it would be extremely unusual. "A central scotoma capable of causing a sudden decrease in visual acuity should prompt a search for another cause."

Response:

Raych responded to my providing information relative to central retinal vein occlusion, etc.:

…I believe there is some agreement today that glaucoma is a tissue defect, not a pressure abstraction.  I don’t believe glaucomatous degeneration is claimed to *cause* a pressure (although it is not unreasonable that it might be found to in some cases).  For something to be "secondary to" to glaucoma, it must, therefore, have  been *caused* by the glaucomatous defect itself, not caused some postulated pressure.  You cite reference only to an *association* of the two ailments.  Do you thoroughly reject causation in the opposite direction, i.e., from whatever central retinal problem to glaucoma?<

The problem of defining glaucoma becomes an issue here, once again. Evidently, though not expressed in so many words, the study considers "glaucoma" elevated pressure, without getting into forms of "glaucomatous" damage other than central vascular. I.e., "It has been suggested that by compressing and stretching the lamina cribosa, elevated intraocular presure might interfere with blood flow and cause endothelial damage to the traversing central retinal vein." So in answer to raych, the CRVO incidents would not appear to be "secondary" to glaucomatous damage, but "secondary" to elevated IOP; and, with the (apparently largely abandoned) definition of glaucoma as elevated pressure, "causation in the opposite direction" MAY have to be rejected as it MIGHT be difficult to make a case that occlusions in the central retinal area raise pressure, although I can imagine some serous conditions in which vitreous pressure (as opposed to aqueous) COULD rise. P.S. Entities included in elements of the study were  U of Illinois, Med College of Wisc., Mass. Eye and Ear Infirmary, Manhattan EET Hosp., Wilmer, Bascom Palmer, National Eye Institute. (Not a professional submission.)

Response:

Tony Wypkema <thepartn…@designwrite.nu wrote: Can chronic glaucoma patients with stable pressures in the mid-teens experience sudden, central blind spots as a result of their glaucoma? Ray Bonar wrote: Dr. Robert Ritch responds that it would be extremely unusual. "A central scotoma capable of causing a sudden decrease in visual acuity should prompt a search for another cause."

Ray: Thanks to you and Dr. Ritch for answering. I think then, that my  strees and blood pressure–which is a bit on the high side–is a more likely cause, and I’m trying to get the stress and blood pressure down. Thanks also to you, Mr. Halterb for all your research. The blind spot is a circle about the size of my ‘baby’ fingernail when my hand is outstretched. Macular degeneration is an unlikely cause, since I take a wide range of vitamins and mineral supplements, and have every day for four years. As I wrote, the retinal doctor didn’t see any damage to my retina (although maybe he missed something; I don’t know. He seemed to do quite a quick check of the eyes, and he couldn’t pin down my i.o.p.s. When he told me my pressures were 14/14, I exclaimed they had never been shown to be so low, so he checked again, and said, "Maybe I can revise that upward a bit" to 16 or 17 in both eyes. Does that mean he was sloppy, or is it normal to come up with a range of three points in the space of a minute?) I  wrote previously that my eye pressures were normal several hours after the spot appeared, and in the mid to high teens (14 to 17) three days after the spot appeared, so high eye pressure would probably not have been the cause. I guess I’ll have to wait another month til my next appointment with my glaucoma doctor to see if he has any answers. Thanks. Tony Wypkema

Response:

- Hide quoted text — Show quoted text -

Tony Wypkema inquired: Can chronic glaucoma patients with stable pressures in the mid-teens experience sudden, central blind spots as a result of their glaucoma?<

Halterb wrote:

I may be among good  people to respond to this having stable pressure in the mid-teens, and having had a couple of experiences with sudden, temporary central blind spots–and knowing of others with this situation. My "episodes" occurred when I was overly tired, and followed a flash of light in the perimeter of my visual field (mirrored florescent ceiling lights in one case and sunlight in another) and lasted for about 20 minutes. I also observed a jagged, bright line in my vision with objects somewhat displaced from one side of the line to another.

My ‘episode’ has lasted for eight days. Unlike floaters, which float around like jellyfish–or jetsam in waves of water–this blind spot is fixed in the same spot all the time, just below the center of vision. When I blink, it flashes blackly or brightly, depending on the background tones that I’m looking at.

The conclusion of my doctors was that this was not glaucoma related and was either a TIA (temporary ischemic attack) or the "aura" of a migraine headache which never developed into a headache.

I’ve never had a migraine, so it couldn’t be caused by that.

An unltrasound of my carotid arteries was done to rule out any reduction in blood flow, and none was found. Dilated examination of the interior of the eye revealed no damage or abnormality in structure. Others I have talked to had similar outcomes.

Tony Wypkema

Response:

This is a multiple response, to posts from Dr. Robert Ritch and raych, concerning "sudden blind spots". Dr. Ritch seemed to indicate that causes other than glaucoma should be considered for the condition poster Tony reported. I wish he had developed this concept further. My suggestion of my own instinct leading me to suspect "something like macular retinal degeneration" drew the latest barb from raych. Since I do not know the exact location of the visual defect Tony reported, but only that it seems "central", the question of macular retinal degeneration came to mind. The macula, being located lateral to and somewhat below the optic disc, is a not infrequent troublesome area. My phrase "something like macular…" could also include central retinal vein occlusion, artery occlusion, branch occlusion, etc., but the symptoms of that particular condition appear more in keeping with CRVO. CRVO is associated with histories of open-angle glaucoma. In fact the odds ratio is 5.4 (95% confidence interval, 3.5 to8.5)(P<.001) (Archives of Ophthalmology/Vol 114, May 1996, page 552). Thus, I differ with Dr. Ritch’s response by seeing some reason to consider these "blind spots" as possibly being secondary to glaucoma due perhaps to pressure on the shared fibrous tissue sheath of the central retinal artery and adjacent lumen of the central retinal vein and stuff like that! The good news is that once standard treatment is exhausted, there are a number of "alternative medicine" approaches to at least attempt to deal with central, macular and other retinal problems (chelation therapy with EDTA, zinc, selenium, vitamin C, B-2, etc.–but, of course, only after consultation with the patient’s physician). And, there is always prayer.

Response:

On 2 Nov 1998 13:58:30 GMT, halt…@aol.com (Halterb) wrote: …………

Thus, I differ with Dr. Ritch’s response by seeing some reason to consider these "blind spots" as possibly being secondary to glaucoma due perhaps to pressure on the shared fibrous tissue sheath of the central retinal artery and adjacent lumen of the central retinal vein and stuff like that!

"Stuff like that", huh?  Well, I believe there is some agreement today that glaucoma is a tissue defect, not a pressure abstraction.  I don’t believe glaucomatous degeneration is claimed to *cause* a pressure (although it is not unreasonable that it might be found to in some cases).  For something to be "secondary to" to glaucoma, it must, therefore, have  been *caused* by the glaucomatous defect itself, not caused some postulated pressure.  You cite reference only to an *association* of the two ailments.  Do you thoroughly reject causation in the opposite direction, i.e., from whatever central retinal problem to glaucoma?  (Not that I’m exactly waiting with bated breath for an answer from a thoughtful and credentialed source.  ;-)  ) Ray – Hide quoted text — Show quoted text -

The good news is that once standard treatment is exhausted, there are a number of "alternative medicine" approaches to at least attempt to deal with central, macular and other retinal problems (chelation therapy with EDTA, zinc, selenium, vitamin C, B-2, etc.–but, of course, only after consultation with the patient’s physician). And, there is always prayer.

Response:

On 1 Nov 1998 19:31:26 GMT, halt…@aol.com (Halterb) wrote: ………..

yet several doctors did feel this could well have been a "migraine that didn’t happen."

Are you quoting them or yourself?  We could use more persons who use such logic not happening.

If by My ‘episode’ has lasted for eight days.< he means that the spot is still present, and by "blind spots" he is referring to only one instance of one, single blind spot, then that would be a different situation than mine. My non-professional instinct would then lead me to suspect something like macular retinal degeneration.

Are professional instincts different from non-professional ones?  I think such a conclusion requires *experience* and/or *reading* — and decent reasoning power. Ray

Response:

Tony Wypkema followed up on my response to his message about sudden blind spots, in which I reported the possibility of TIA or failed migraine:

I’ve never had a migraine, so it couldn’t be caused by that.<

Well, if it might be helpful to Tony or others, I can also add that I, to my knowledge, have never had a migraine either–yet several doctors did feel this could well have been a "migraine that didn’t happen." If by

My ‘episode’ has lasted for eight days.<

he means that the spot is still present, and by "blind spots" he is referring to only one instance of one, single blind spot, then that would be a different situation than mine. My non-professional instinct would then lead me to suspect something like macular retinal degeneration.

Response:

Tony Wypkema inquired:

Can chronic glaucoma patients with stable pressures in the mid-teens experience sudden, central blind spots as a result of their glaucoma?<

I may be among good  people to respond to this having stable pressure in the mid-teens, and having had a couple of experiences with sudden, temporary central blind spots–and knowing of others with this situation. My "episodes" occurred when I was overly tired, and followed a flash of light in the perimeter of my visual field (mirrored florescent ceiling lights in one case and sunlight in another) and lasted for about 20 minutes. I also observed a jagged, bright line in my vision with objects somewhat displaced from one side of the line to another. The conclusion of my doctors was that this was not glaucoma related and was either a TIA (temporary ischemic attack) or the "aura" of a migraine headache which never developed into a headache. An unltrasound of my carotid arteries was done to rule out any reduction in blood flow, and none was found. Dilated examination of the interior of the eye revealed no damage or abnormality in structure. Others I have talked to had similar outcomes. Hope this is helpful.

Response:

On 5 Nov 1998 12:19:01 GMT, halt…@aol.com (Halterb) wrote: ………….

they do need first-rate attention.

*First-rate*?  Gues that leaves out ophthalmologists.  ;-) Ray

Response:

A followup to the blind spot thread as there may be a number of people interested in it. I asked the ophthalmologist last night on the Wills Chat about it. He said that if the "scotoma" is in the retina, it should be visible during an examination. If not, the problem could be in the brain. (One other source I consulted also raised the possibility of a lesion in the optic nerve between the eyeball and brain, often due to perhaps even a minor head injury, such as from a fall, at some time during a person’s life.) Evidently some of these situations can resolve on their own, but they do need first-rate attention.

Response:

Can chronic glaucoma patients with stable pressures in the mid-teens experience sudden, central blind spots as a result of their glaucoma? Thank you.

Response:

Question:

I haven’t posted a question here before, I don’t think…just kept myself busy reading them.  I’m wondering how to handle this… I was dx’ed with PPMS in April ‘98 after a 2-year messing-around period with a Lyme dx.  One of the primary symptoms was optic neuritis (as the neuro called it).  I haze out under any stress whatsoever…I’ve had to give up motorcycling, radio control planes, etc… Well – I finally went to my eye-doctor cuz my eyesight was really icky…basically due to the fact that I’m 40 (don’t tell anyone) now.  I mean, besides the haze, my focus went south…just a normal aging thing. The problem is that the optical guy saw no signs of optic neuritis.  He mentioned that the nerve looked ‘good’. Well, I still can’t see when I’m stressed.  Additionally, during all the tests the optical doc ran on me, one that stands out is the ‘field test’. This is where your head is fixed in a stationary position, one eye is covered and you stare as little eensy-teensy blinks show up all over the place and you press a button to say you saw one.  My ‘bad’ eye (the one that’s MUCH worse than the other one) didn’t show up anything abnormal…however, and I told the doc this, the blinks were almost invisible on a normal basis.  In other words, I could see them, but just barely.  I actually asked him if he was using a different light intensity on teh other eye. Any ideas, anyone?  I guess my question is why the optic doc (kind of rolls off the tongue, doesn’t it?) didn’t see any nerve ending changes. Thanks in advance – Rob

Response:

The message <705hlc$j0…@supernews.com

  from  "Rob" <sta…@megahits.com

contains these words: The problem is that the optical guy saw no signs of optic neuritis.  He mentioned that the nerve looked ‘good’.

I had severe optic neuritis last year and for a few days had *no* vision in my left eye. (Zero perception of light and a totally ‘flat’ Visual Evoked Potential test) The eye has recovered quite well. The vision is 6/9 and the field (tested with those blinking lights) is nearly full. The colour vision is poor; I can’t read any of the colour blindness charts. Subjectively I feel the vision in that eye is crap. Apparently the optic nerve head looks pretty well undamaged. I know it was rather swollen when things were at their worst but it has settled. The pupillary response of my left eye also appears ‘normal’. (It isn’t, but demonstrating this needs slightly more subtle testing and brightness perception is definitely impaired.) I would suggest that you try colour blindness tests and that somebody arranges Visual Evoked Potential tests for you. They flash a checkerboard pattern at you and measure the brain’s response. This may show abnormalities not otherwise detectable. Helen — Helen D. Vecht                   #############  WARNING!  ############ helenve…@zetnet.co.uk          #   If you *dare* send SPAM to me,  # Salisbury, Wiltshire,            #   I’ll repost it to your ISP.     # Great Britain                    #####################################

Response:

Ask your Dr about IV.IG (intravenous immunoglobulin).  It helped my vision problems, which sound a lot like yours.  It is very expensive and subject to shortages, but I think worth it.

Response:

I have vision difficulty too. My eyeballs  are OK.  Optic nerve frayed or shot. Stress is reasonable excuse for Ms problems. Late at night vision improves.  I don’t know why but I failed miserably on eye test, especially after drops where given to relax the pupils.         Maybe sight will improve with time.  Would like to drive again. "Can’t you give me some eyeglasses to see like I used to?"                                           a little overdramatic Optometrist could not help.   I’ll get to store and buy reading glasses, like 200 or 300 power.  $10-15  any mall or drug store next to sunglasses       bye

Response:

The message <pegtwo-1710980121270…@tc8-85.tc.nd.edu

  from  peg…@hotmail.com (Peggy Moody) contains these words:

In my case, a neurologist, well versed in multiple sclerosis symptoms, dealt with my eye problems, perhaps better than an opthalmologist would have. What do you think?

Well, I didn’t tell you that when I first went to the Eye Hospital with eye pain worse on movement, I was told I had sinusitis, did I? This was the day before the Easter break started and I only had eye symptoms at that time. Here in the UK, neurologists are few and far between, so it was not possible to see a neurologist the next day when it was obvious to me that I had ON. I made the diagnosis myself and got the general physicians to sort me out as soon as the hospital woke up after the break… I was referred to the neurologist the next day. Some ophthalmologists don’t know much about MS… — Helen D. Vecht                   #############  WARNING!  ############ helenve…@zetnet.co.uk          #   If you *dare* send SPAM to me,  # Salisbury, Wiltshire,            #   I’ll repost it to your ISP.     # Great Britain                    #####################################

Response:

Rob: Different kinds of optic doc’s can report different things from the same eyes. I went to an optometrist; AOK.  The opthamologist, glasses perscription not bad, eyes not great, but OK.  Opthalmic Surgeon, glasses marginal, lots of ‘floaties’ in the eye, some retinal problems, some nerve problems, some muscle problems, be very careful.  All three visits were within a few months of each other. Jeff

Response:

In article <705hlc$j0…@supernews.com

, "Rob" <sta…@megahits.com wrote:

= I was dx’ed with PPMS in April ‘98 after a 2-year messing-around period with = a Lyme dx.  One of the primary symptoms was optic neuritis (as the neuro = called it).  I haze out under any stress whatsoever…I’ve had to give up = motorcycling, radio control planes, etc… = = Well – I finally went to my eye-doctor cuz my eyesight was really = icky…basically due to the fact that I’m 40 (don’t tell anyone) now.  I = mean, besides the haze, my focus went south…just a normal aging thing. = The problem is that the optical guy saw no signs of optic neuritis.  He = mentioned that the nerve looked ‘good’. = Thanks in advance – Rob Hi, Rob; I recently had my first bout of ON. It was truely scarey; no one wants to lose their eyesight. I was clouding over in the left eye. I went to my neuro, who had originally DX’d me, NOT TO AN OPTHALMOLOGIST. He went to the trouble to rule out certain other possibilitiues, considered the fact that I had told him I was also having increased balance trouble . He drew the  conclusion that I was having an MS flare-up and assigned me to five IV treatments of Solumedrol. It cleared up my eye. (Note there are several entries currently posted here on the topic of Solumedrol.) In my case, a neurologist, well versed in multiple sclerosis symptoms, dealt with my eye problems, perhaps better than an opthalmologist would have. What do you think? God bless you. Peggy M — @@@@@@@@@@@@@@@@              PE@@Y            @@@@@@@@@@@@@@@@ LLLLLLLLLLLLLLLLLLLLLLLLLL Skiptoe Thru the Tulips LLLLLLLLLLLLLLLLLLLLLLLLL                                                       With  Me!

Response:

Question:

surely, you didn’t think that a new drug could hit the market without greatly publicised side-effects and/or side effects that might give people pause as to using it

Oh, friggin great,..here comes the bad news. I knew it. What’s this troubling news about vision side effects, i.e. blue halos, etc.? Anyone experiencing vision problems with Viagra? I personally haven’t taken it–I was toying with the idea of trying it,..but now and not so sure…

Response:

Oh, friggin great,..here comes the bad news. I knew it. What’s this troubling news about vision side effects, i.e. blue halos, etc.? Anyone experiencing vision problems with Viagra? I personally haven’t taken it–I was toying with the idea of trying it,..but now and not so sure…

Response:

writes: Oh, friggin great,..here comes the bad news. I knew it. What’s this

troubling news about vision side effects, i.e. blue halos, etc.? Anyone

experiencing vision problems with Viagra? I personally haven’t taken

it–I was toying with the idea of trying it,..but now and not so sure…

This was a documented potential side effect to Viagra all along.  No new surprises here.  Seems to be temporary but Optometrists are now recommending that men with retinal problems limit their dose to 50mg (the "normal" recommended dose) until further study.  The blue halo seems to be associated with the greater doses. Jerry in Houston, soon to be Viagra user….he hopes. Jerry Lewis League City, TX., USA

Response:

Oh, friggin great,..here comes the bad news. I knew it. What’s this troubling news about vision side effects, i.e. blue halos, etc.? Anyone experiencing vision problems with Viagra? I personally haven’t taken it–I was toying with the idea of trying it,..but now and not so sure…

It’s no big deal. I’m experiencing it right at this moment and it’s just a *very* light blue cast to everything. The interesting part is that it makes one wonder if the Blue Blocker Sun Glasses that they sell on street corners really work. The image on my monitor, things in the room, pick up additional contrast and/or brightness. Mostly more dramatic contrast, I think. Even if it became permanent I wouldn’t see it as a big deal. At least not enough to swear off Viagra. Hey, from the time I was a little kid I was hearing sex would make me go blind so this is a step up! My palms aren’t even hairy. Yet.

Response:

Question:

–Cyberdog-AltBoundary-00208BDE Content-Type: text/plain; charset=ISO-8859-1 Content-Transfer-Encoding: quoted-printable I have been taking azulfidine for a little over a year. It worked fairly quickly. I was much better in a couple of months. I continued to take Relefan which I had been taking when I was on the plaquenil. I have been able to reduce the amount of relefan I take and I have not had any problems with joints that stayed swollen despite the medication. When I was taking plaquenil I needed to have joints injected ( wrist  & hands) that would not respond to the medication periodically. This message was created and sent using the Cyberdog Mail System –Cyberdog-AltBoundary-00208BDE Content-Type: multipart/mixed; boundary="Cyberdog-MixedBoundary-00208BDE" Content-Transfer-Encoding: 7bit –Cyberdog-MixedBoundary-00208BDE Content-Type: text/enriched; charset=ISO-8859-1 Content-Transfer-Encoding: quoted-printable <SMALLER<X-FONTSIZE<PARAM10</PARAM<FONTFAMILY<PARAMGeneva</PARAM= I have been taking azulfidine for a little over a year. It worked fairly quickly. I was much better in a couple of months. I continued to take Relefan which I had been taking when I was on the plaquenil. I have been able to reduce the amount of relefan I take and I have not had any problems with joints that stayed swollen despite the medication. When I was taking plaquenil I needed to have joints injected ( wrist  & hands) that would not respond to the medication periodically. This message was created and sent using the Cyberdog Mail System </FONTFAMILY</X-FONTSIZE</SMALLER –Cyberdog-MixedBoundary-00208BDE– –Cyberdog-AltBoundary-00208BDE–

Response:

my rheumy did a blood test before i started the azulfidine, testing for my ability to "clear" the drug or "metabolize" the drug.  

Response:

dr doc, how does the "safeness" between azulfidine and metho compare?

Response:

I started on azulfidine en about ten days ago.  Good relief noted very quickly.  No side effects noted either  Urine a little yellow .   I’m taking two tablets twice a day.  Good luck The full benefit will only really start at 6 weeks to 2-3 months drdoc http://www.aztec.co.za/users/drdoc/

That’s true, but why waste a good placebo affect! Regards; Walt BTW, my x-rays were too light to scan, at least on the cheep scanner I have access to.  I’m going to have them drum scanned next week (after payday of course). — Visit my website at http://www.byu.edu/~whanks/WaltHP.html

Response:

I"ve been told since I was a child that I am allergic to Sulfa drugs but I have no recent experience with these drugs so I don’t know if I am.  Would it be safe for me to try Azulfindine?  My RD doesn’t think there would be a problem but would rather not take the chance. Lois Wilson

Response:

I"ve been told since I was a child that I am allergic to Sulfa drugs but I have no recent experience with these drugs so I don’t know if I am.  Would it be safe for me to try Azulfindine?  My RD doesn’t think there would be a problem but would rather not take the chance. Lois Wilson

difficult one — what were you told… was it a simple rash or a collapse….or other bad reaction.. drdoc http://www.aztec.co.za/users/drdoc/

Response:

I started on azulfidine en about ten days ago.  Good relief noted very quickly.  No side effects noted either  Urine a little yellow .   I’m taking two tablets twice a day.  Good luck

The full benefit will only really start at 6 weeks to 2-3 months drdoc http://www.aztec.co.za/users/drdoc/

Response:

I took plaquenil for about five years with regular checks for retinal pigmentation. I never had any difficulty  from the medication but it was never very affective. I have done much better on sulfasalazine. I am sheduled to start on Azulfidine on March 7.  I’ve looked into the side effects and they seem to be much less and more reversable than MTX.  Could you let me know how long you have been on it, how long it took to work, and if you experienced any of the side effects.  Also, do you need to take Folic Acid with it.  Are you also taking an NSAID? I have been diagnosed with PA six months ago.  The PA has not responded to any of the five NSAIDS’s that I’ve taken.

See my webpages on SSZ and MTX In fact more people are still taking MTX compared to SSZ after 5 years. I use both for the PA, but probably prefer MTX as first choice. In the right hands they have been shown to be SAFER than the NSAIDs Remember the disease is your enemy …. Regards drdoc http://www.aztec.co.za/users/drdoc/

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Has anyone gone through retinal pigmentation as a result of plaquinel? Does it go away when the medication is stopped and what can be taken in place of it (if anything).  I understand that corneal pigmentation goes away when the meds are stopped, but this is both retinas.  I see the opthamologist every 2 months now,and have extensive photography of both retinas taken. Would appreciate any help I can get. Elaine P.

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I, too, am new to the group (trying to read all of the existing articles to gain as much info/familiarity as possible), and have just been "officially" diagnosed with RA, although I know the exact date (12/24/95) that it began and have tried for that long to get diagnosed! My gp (can’t get in to see the RD I want until May!) wants me to start on plaquenil and has explained the "rare incidence" of retinal problems, so I will be going to see an opthomologist this next week.  So, I, too, would like any insight into the short-term and long-term effects of taking plaquenil. Also, for the first time in over a year, I have been completely pain free while taking a 6-day tapered dose of Prednisone; I know I can’t take it long-term, but the dr said it would take away all pain while on it, and it did!  It’s a shame it can’t be taken all the time; I’d forgotten what it was like to get a decent night’s sleep, walk around like the 36-year-old I am (instead of walking like my 97-year-old great-grandmother), be able to brush my teeth and hair within the first hour of getting up (rather than dragging myself out of bed), etc., etc. Sorry to ramble; I’m just so excited and relieved to know that I may be able to experience long-term relief such as this!!! And, thanks to all for your continued sharing of information and compassion.  I’ll be attached to this newsgroup for a long, long time! Leanah

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I took plaquenil for about five years with regular checks for retinal pigmentation. I never had any difficulty  from the medication but it was never very affective. I have done much better on sulfasalazine.

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I took plaquenil for about five years with regular checks for retinal pigmentation. I never had any difficulty  from the medication but it was never very affective. I have done much better on sulfasalazine.

I am sheduled to start on Azulfidine on March 7.  I’ve looked into the side effects and they seem to be much less and more reversable than MTX.  Could you let me know how long you have been on it, how long it took to work, and if you experienced any of the side effects.  Also, do you need to take Folic Acid with it.  Are you also taking an NSAID? I have been diagnosed with PA six months ago.  The PA has not responded to any of the five NSAIDS’s that I’ve taken.

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I read with interest your message.  I do have pigmentation and haven’t been on plaqueninl very long.  Now the opthamologist is following me every 2 months.  From what I gather, it is not reversable as is corneal pigmentation.  I can’t take sulfa drugs – am allergic.  So guess I am stuck with this whether I like it or not. Good luck. Elaine

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I started on azulfidine en about ten days ago.  Good relief noted very quickly.  No side effects noted either  Urine a little yellow .   I’m taking two tablets twice a day.  Good luck

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Hi, I’ve been on Azulfidine so long I don’t remember how long.. seven years?  eight? No side effects at all, and so far pretty effective, touch wood. I’m on an extremely low dose of prednisone (2.5) mg a day, and I take folic acid.  Occasionally I take a painkiller… hmm, a prescription one name escapes me, I don’t need it often. Best of luck, Gwen

: : I took plaquenil for about five years with regular checks for retinal : pigmentation. I never had any difficulty  from the medication but it was : never very affective. I have done much better on sulfasalazine. : I am sheduled to start on Azulfidine on March 7.  I’ve looked into the : side effects and they seem to be much less and more reversable than : MTX.  Could you let me know how long you have been on it, how long it : took to work, and if you experienced any of the side effects.  Also, do : you need to take Folic Acid with it.  Are you also taking an NSAID? : I have been diagnosed with PA six months ago.  The PA has not responded : to any of the five NSAIDS’s that I’ve taken. — "Live as one already dead." –Japanese saying I live in fear of not being misunderstood.– Oscar wilde

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Question:

Hi Johnathan, We are seriously considering buying a Border Collie.

A good choice if I may say! We have tow young kids – a sensible six year old girl and a boistrous three year old boy.  We hear that BCs can be suspicious of kids and can nip at them.

My Border was brought up around people and children and can be trusted not to jump, bite, nip etc.. But this all came about with training and discipline of both the dog and the children involved. One trick he loves to do is heard them into a group as though they were livestock! We plan to train up the dog from about one year old to come running with us – ultimately aiming for 30+miles per week. We hear there are hereditary ligament problems with the breed – any comments?

Borders love to run and have been known to run up to 80 km a day herding sheep. As long as your pup has been vacinated I shouldn’t see any trouble with you starting to run with it as early as 6 months. With respect to ligament problems make sure the parents are sound and ask a vet to inspect before purchase. Any comments about retinal problems?

CEA or collie eye anomaly is the commonest canine disease in the UK. (Very rare in Australia) Blindness occurs in 6% of affected dogs. It can be detected at birth so get one that does show the symptoms. We live in South Yorkshire, England with an enclosed garden

We live in rural Victoria, Australia on about a one acre property and even then my Border still wants room to move. If you go to work make sure your yard is fully enclosed, a Border can jump 6 feet over a fence. Boredom is another problem facing Borders that are left alone. Being a very active and inquistive breed bordeom can lead to destructive behaviour! All dog breeds have their pros and cons but who can resist a black and white puppy with sweet brown eyes? Hope this gives you some food for thought, Tom and Alpha Coolibah (The Border Collie)        ____  __.—""—.__  ____       /####/              /####      (/~~~~~)              (~~~~~)       __oo/                oo__/      Tom Heeren     __/                          __    School of Aquatic Science &  .-"    .                      .    "-.       Natural Resources Management.  |  |   .._                _../   |  | Deakin University   ___  _                    _/  /___  Australia   3280 ./    )))))                  (((((    .                                      /FAX: +61 55 633462                            /    /                   .  .|                |.  ./                Deakin     ." / |                /  |  ".           University  ."  /   |              /   |     ".    .  Warrnambool

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We are seriously considering buying a Border Collie. We have tow young kids – a sensible six year old girl and a boistrous three year old boy.  We hear that BCs can be suspicious of kids and can nip at them. We plan to train up the dog from about one year old to come running with us – ultimately aiming for 30+miles per week. We hear there are hereditary ligament problems with the breed – any comments? Any comments about retinal problems? We live in South Yorkshire, England with an enclosed garden

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We are seriously considering buying a Border Collie. We have tow young kids – a sensible six year old girl and a boistrous three year old boy.  We hear that BCs can be suspicious of kids and can nip at them. We plan to train up the dog from about one year old to come running with us – ultimately aiming for 30+miles per week. We hear there are hereditary ligament problems with the breed – any comments? Any comments about retinal problems? We live in South Yorkshire, England with an enclosed garden

Hi, Border Collies are wonderful dogs but alot of work.  They are very intelligent and need both mental and physical stimulation. It is not that they are suspicious of kids so much as they are a herding dog and if kids run away their instinctss can kick in and they will nip at them to herd them up. Check out the Border Collie rescue page  at http:www.library.law.miami.edu/~ncarter/twister.html it will fill you in on all that is required to keep a border collie. Lori

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Question:

- Hide quoted text — Show quoted text – Our Aussie-mix baby is now 10 weeks old.  She was 6 weeks old when we brought her home, blue eyes.  The eyes seemed to work almost independently, "wall-eyed," the opposite of cross-eyed.  As far as we know, she can see o.k. She knew her way around the house and yard in no time, including steps. Her eyes seem to focus more now, but one still goes "out" while the other goes "forward."  We can see it in the pupils, and also the whites of the eyes toward the inner corners.  Is this common in puppies, and just more noticeable because of the dark pupils set in the light irises?   Our very experienced and caring vet said, "No that’s not just a puppy-thing. It’s unusual.  But I’ve never heard of a problem developing from something like this."  Also, since she seems to be able to see just fine, he said he didn’t think there was anything to worry about. He asked if she runs into walls, can follow her toys, etc.  No problems there.   Our vet was honest with us in not being able to predict whether her eyes would straighten out or not.  Any advice or experiences out there?   Thanks, Pam

Pamela, The Australian Shepherd has a group of related ocular abnormalities which we collectively call "Multiple Ocular Anomalies Syndrome"  This includes lack of pigment in the irises, abnormally sized pupil, abnormally positioned pupil, cataracts, and retinal problems including coloboma and detachments.   Strabismus – decentration of the eye within the orbit – may also be associated with retinal problems.   I would recommend that you ask your veterinarian for a referral to a veterinary ophthalmologist so the sigificance of the changes may be assessed.  Many of these changes in the aussie are inherited conditions, so perhaps your breeder may be willing to subsidize your visit to the ophthalmologist. Michael Zigler D.V.M., Cert.V.Ophthal. Visit the Veterinary Ophthalmology Information Centre http://www.netrover.com/~eyevet/info.html

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Our Aussie-mix baby is now 10 weeks old.  She was 6 weeks old when we brought her home, blue eyes.  The eyes seemed to work almost independently, "wall-eyed," the opposite of cross-eyed.

Our 7 month old JRT is wall-eyed too. doesn’t seem to affect the way she goes about life. She chases balls, bounds up and down stairs and generally raises Cain. Our vet was honest with us in not being able to predict whether her eyes would straighten out or not.  Any advice or experiences out there?

Hazmat (spazmat, Mattie) has had the problem since we got her. "Problem" is a subjective word. It doesn’t seem to be a problem for her, so we don’t worry. I will tell you this much: It makes taking pictures with a flash much easier. When we take pics of both dogs at the same time, Shelby’s eyes are glowing, but Mattie’s look perfectly normal because they aren’t directly reflecting the light back at us. Scott

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Our Aussie-mix baby is now 10 weeks old.  She was 6 weeks old when we brought her home, blue eyes.  The eyes seemed to work almost independently, "wall-eyed," the opposite of cross-eyed.  As far as we know, she can see o.k.  She knew her way around the house and yard in no time, including steps. Her eyes seem to focus more now, but one still goes "out" while the other goes "forward."  We can see it in the pupils, and also the whites of the eyes toward the inner corners.  Is this common in puppies, and just more noticeable because of the dark pupils set in the light irises?   Our very experienced and caring vet said, "No that’s not just a puppy-thing. It’s unusual.  But I’ve never heard of a problem developing from something like this."  Also, since she seems to be able to see just fine, he said he didn’t think there was anything to worry about. He asked if she runs into walls, can follow her toys, etc.  No problems there.   Our vet was honest with us in not being able to predict whether her eyes would straighten out or not.  Any advice or experiences out there?   Thanks, Pam

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