Ophthalmology | Mount Sinai Today

Going Blind In One Eye? You May Be Having an Eye Stroke

Updated on Jun 30, 2022 | Eye Health, Your Health

Sudden vision loss in one eye may be a sign of Central Retinal Artery Occlusion (CRAO), commonly referred to as eye stroke. Like a stroke in the brain, it is a medical emergency and must be diagnosed and treated as quickly as possible to prevent irreversible loss of vision.

It is estimated that about 12,000 people suffer an eye stroke every year. Risk factors include smoking, cardiovascular disease, diabetes, high cholesterol, high blood pressure, and narrowing of the carotid or neck arteries, but it can affect anyone, particularly those over 60 years of age.

In this Q&A, Richard B. Rosen, MD, Chief of Retina Service at Mount Sinai Health System and Vice Chair and Director of Ophthalmology Research at the New York Eye and Ear Infirmary of Mount Sinai (NYEE), explains Mount Sinai’s unique approach in this area, and how getting to a hospital as soon as possible can help doctors diagnose your problem and restore your vision.

“Eye stroke must be addressed immediately to prevent permanent vision loss. If you wake up with vision loss, get to the emergency room as quickly as possible, don’t put it off until after breakfast,” says Dr. Rosen, who is also Professor of Ophthalmology at the Icahn School of Medicine at Mount Sinai. “That will enable doctors at Mount Sinai to restore your vision if it’s an eye stroke and, if it’s something else, we can send you to an ophthalmologist. Not all hospital emergency departments have the specialized equipment and procedures we have in place to ensure patients get treatment in an expedited fashion.”

What is an eye stroke?

Blood vessels supply oxygen and nutrients to the retina, the light-sensitive tissue in the back of the eye. The retina transfers visual signals to the brain, which enable us to see images clearly. If an artery is blocked, it can deprive the retina of oxygen and can cause the retinal nerve cells to die unless blood flow is quickly restored.

What are the symptoms?

There are four key symptoms of eye stroke. They are:

Severe blurring or complete loss of vision may occur suddenly, and almost always only in one eye. It is often described as a curtain crossing over the vision, or it may appear totally black or white.
An eye stroke is painless, which often makes it different from other causes of vision loss.
Blurring may worsen over a few minutes and sometimes improve suddenly.
Painless vision loss may also be a sign of a stroke in the brain, and patients experiencing eye stroke are at risk for brain stroke.

Why is it so important to act quickly?

Anyone experiencing these symptoms must get immediate medical treatment, even if symptoms seem to improve. Even temporary vision loss might indicate an increased risk of stroke or future vision loss. The Emergency Departments at several Mount Sinai hospitals are equipped to diagnose (or rule out) and treat eye stroke quickly: NYEE, The Mount Sinai Hospital, Mount Sinai West, and Mount Sinai Queens. Treatment must be administered within 6-12 hours (ideally in less than six hours) to prevent irreversible vision loss. A team of Mount Sinai retina specialists is available 24/7 to make a diagnosis using non-invasive imaging. If a retinal artery occlusion is not the cause, doctors can address your problem or connect you with the appropriate eye doctor.

How is eye stroke treated?

To dissolve the clot, an interventional radiologist administers an injection of tissue plasminogen activator (tPA), a clot-busting drug, directly into the blocked artery. There is a small window to intervene. To prevent permanent blindness, blood flow to the retina must be restored within six to 12 hours, and the sooner blood flow can be restored the more vision can be saved. TPA represents the latest advancement in eye stroke treatment, an area that NYEE has been actively researching.

How do doctors at Mount Sinai diagnose eye stroke?

NYEE, part of Mount Sinai Health System, has developed an eye stroke protocol, working with the Mount Sinai Stroke Center, that combines the expertise of ophthalmologists, neuroradiologists, neurologists, and emergency department faculty. Trained staff are available 24/7 to take images of the eye. The images are sent to one of NYEE’s retina specialists to make a rapid diagnosis. If an eye stroke is confirmed, the Mount Sinai Stroke Service begins treatment immediately to save the patient’s sight.

Mount Sinai doctors accurately diagnose eye stroke using advanced optical coherence tomography (OCT) systems, a technology that most hospitals do not have available at the point of care. The non-invasive system detects swelling by using infrared light to produce digital images of the retina at very high resolution. Using this system, what might take one or two hours in some facilities, can now be done in about 15 minutes at Mount Sinai, thereby saving valuable time.

Make an appointment with Dr. Rosen

Living With Vision Challenges During the Pandemic

Updated on Jun 30, 2022 | Community, Diversity and Inclusion, Ophthalmology

Large-type keyboards help improve accessibility.

Lighthouse Guild, an organization dedicated to providing services that inspire and support people who are visually impaired to attain their goals, was the featured organization during a virtual talk hosted by the Mount Sinai Office for Diversity and Inclusion (ODI). The organization provides coordinated care for eye health, vision, and rehabilitation, as well as behavioral health services. The talk entitled, “Living With Vision Challenges During COVID-19,” is available here.

Janet Weinstein, Director of Outreach for Lighthouse Guild.

“During the COVID-19 pandemic, people with low vision have had increased difficulties with the restrictions and safety precautions we have all been taking, especially as people are getting out more,” said Janet Weinstein, Director of Outreach for Lighthouse Guild. “We specialize in vision rehabilitation—that is, equipping people to resume their activities of daily living with the vision that they have, or for those who are blind, developing alternative techniques.”

In the educational session, Ms. Weinstein described the various types of vision loss, including macular degeneration, diabetic retinopathy, glaucoma, and cataracts. The talk was part of the Raising Disability Awareness Virtual Talk Series. The series, launched by ODI in 2020 for Disability Awareness Month, featured speakers from around the Mount Sinai Health System and the community to raise awareness and promote an inclusive and equitable workplace and health care environment for people with disabilities.

Lisa Beth Miller, LCSW-R, Outreach and Referral Coordinator for Lighthouse Guild.

Lisa Beth Miller, LCSW-R, Outreach and Referral Coordinator for Lighthouse Guild, discussed how the COVID-19 pandemic affected changes in lifestyle for people with vision impairments. While social distancing and wearing masks became the norm, Ms. Weinstein stressed the importance of navigating cautiously when away from home, using gloves or tissues when touching handrails, and embracing technology, such as apps with audio description and magnification features to help maintain social distance.

During the pandemic, telephones and personal computers became even more important for people with vision loss, allowing them to access telehealth and stay connected with friends, family, classes, and work, Ms. Miller said.

Lighthouse Guild is dedicated to providing resources to those who may need eye exams, education or rehabilitation services, including technology assessments and training, to address vision challenges. Ms. Miller said that “it makes a huge difference in someone’s life to know they’re not alone,” and encouraged participants to consider themselves ambassadors for those who may have vision problems, to support them in their needs. More information on the organization can be found at the Lighthouse Guild site.

Additional disabilities-related resources are available on the Mount Sinai Office for Diversity and Inclusion site.

Should I Wait to Have My Child’s Vision Checked?

Oct 26, 2020 | Children's Health, COVID-19, Ophthalmology, Your Health

This academic school year—in addition to the usual school supply lists and purchasing of new shoes—parents must think about COVID-19 positivity rates, appropriate face coverings, and reliable in-home internet access. Whether your child will be learning in the school room or remotely, their eye health is important and should not be overlooked. Douglas R. Fredrick, MD, Professor of Ophthalmology and Pediatrics at the Icahn School of Medicine at Mount Sinai, explains what parents need to know about their child’s vision.

Should I wait until after the COVID-19 pandemic to get my child’s vision checked?

Please do not delay having your children examined. It is important to make sure their vision is sharp and their eyes are healthy. Most of our sensory connection to the world is through our eyes. Children who do not see properly can have difficulty developing academically and socially. If we catch and correct vision problems early, we can improve children’s day-to-day life and functioning in school. We can also detect eye conditions that could lead to further problems down the line.

While COVID-19 is still of great concern, Mount Sinai Health System has gone to extraordinary lengths to make sure every patient receives the best possible care in a safe environment. We have developed stringent protocols to protect your family and our community. For instance, face coverings are mandatory and social distancing is enforced throughout the Health System. Additionally, we disinfect continually and regularly test our staff for COVID-19.

How often should I have my child’s eyes checked?

The American Academy of Ophthalmology and the American Academy of Pediatrics recommend that pediatricians and family practitioners examine the eyes and check vision in newborns, age two months, six months, one year, then annually until age six, then every other year until age 18. Most pediatricians check vision every year during their annual exam, and many school districts perform screening each year, beginning at age five or six.

What are the signs that my child has vision issues?

If you notice your child squinting or tilting their head to see objects that are far away, rubbing their eyes after reading, or if their eyes drift toward the nose or outward—as though they are trying to see their ears—you should schedule an appointment with your child’s pediatrician for a vision exam. The same is true if your child complains about fuzzy or foggy vision. I also recommend that parents check in with their child’s teacher as they may see vision impairment related behaviors in the classroom.

My child is struggling with vision issues. How can I help?

The first step is to see your child’s primary care provider who will check for any other health conditions that may be contributing to your child’s difficulties. If the pediatrician finds decreased vision on a screening exam or has any other concerns, they will refer you to a pediatric ophthalmologist. These ophthalmologists have additional training in caring for children and often have specialized equipment and child-friendly offices.

During the examination, the ophthalmologist will do a thorough exam of your child’s eye—probably using dilating eye drops. If the doctor finds that your child is nearsighted or has another vision issue, they may prescribe glasses. If the examination is completely normal but your child is still having a problem with reading or learning, your primary care provider may refer you to an educational specialist or school learning specialist to test for learning disorders and make recommendations.

My child will be learning remotely this school year and I am concerned about eye strain. I’ve heard that blue light glasses can help with this issue. Is this true?

Blue light glasses are special eyewear that block or filter the high-energy blue light coming from computer, tablet, and phone screens. It is not clear that they help with eye strain or eye disease. A recent study performed at the State University of New York School of Optometry found that these glasses did not decrease eye strain with “near work”—activities that require near vision such as reading, writing, and watching television.

While it won’t hurt to use these glasses, there are better ways to reduce eye strain. For instance, have your child hold their reading material, laptop, or tablet at the appropriate distance and make sure they have enough light to see—but not so much it causes glare on the screen. It can also help to have your child take breaks every 20 to 30 minutes when they are doing screen work. I recommend giving your child a task that gets them on their feet and their eyes off the screen, like feeding your pet or taking out the trash.

Should I limit how much time my children spend on screens?

All children will be spending more time with their eyes on the screen this year than in the past and that is going to make it hard to limit screen time to the typical recommendation of two hours a day. This year, instead of enforcing strict limits, try to keep track of what they’re doing with their screen time. Although most of their screen use should be educational, you’ll need to allow time for play—both to relax and to enable them to have social time with friends. Physical activity should also be a part of their daily routine. The key is finding a balance. For more on how—or whether—to limit your child’s screen time, read this blog post from Mount Sinai pediatrician Micah Resnick, MD.

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Can I Get COVID-19 from Contact Lenses?

Updated on Jun 30, 2022 | COVID-19, Health Hub, Ophthalmology, Your Health

As the novel coronavirus (COVID-19) pandemic continues, more is learned about how the virus affects the body. Recently, researchers in China noted that COVID-19 may be present in eye secretions, causing symptoms such as pink eye. For contact lens wearers, who frequently touch their eyes, this finding is cause for concern. Sumayya Ahmad, MD, Assistant Professor, Ophthalmology, Icahn School of Medicine at Mount Sinai, explains what contact lens wearers need to know about COVID-19.

Can you contract COVID-19 when putting in your contact lens?

There is no evidence showing that using contact lenses can cause people to get infected with COVID-19. What we know is that the virus tends to live in the respiratory tract, and even people with active disease do not always have eye symptoms. The largest study to-date from Wuhan, China showed live virus in a swab of the conjunctiva in 2.5 percent (3 out of 121) of known, symptomatic COVID-19 patients, which is very low.

Are people who wear contact lenses at higher risk of contracting the virus?

People who wear contact lenses tend to touch their face more than people who wear glasses. We know that the risk of viral transmission is higher when touching your face, and that includes touching the eye. Although the membranes of the eye surface—the cornea and conjunctiva—are very strong, if there are viral particles on your hand and you touch your eye, you could become infected with the virus. However, for an isolated eye exposure to cause a full-blown respiratory tract infection remains to be seen, and would be a very difficult question to study.

Should people who wear contact lenses take any special precautions?

At this time, the American Academy of Ophthalmology recommends that if you do need to wear contacts, that you be particularly cautious about practicing good hygiene. This means you should wash your hands for 20 seconds before placing contacts, take them out each night—do not shower or sleep in them—and make sure your contacts case and solution are clean. You should also avoid touching your eyes while wearing them. If you are caring for someone with known COVID-19, it may be advisable to wear glasses because of the risk of transmission.

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An Emergency Sight-Saving Surgery for a Patient Forced to Leave Puerto Rico

Updated on Jun 30, 2022 | Featured, Ophthalmology, Patient Stories

Carmen Rivera at her follow-up appointment with Jessica Lee, MD.

Carmen Rivera of Isabela, Puerto Rico, was seeing black dots in her left eye and having trouble focusing when she visited a doctor who diagnosed her with a retinal detachment and scheduled her for emergency surgery on Tuesday, September 19. As Hurricane Maria approached Puerto Rico, however, the surgery was postponed, and when the island, including the hospital where she was scheduled for surgery, was left without electricity, she faced a serious health crisis. Without immediate treatment, Ms. Rivera risked losing her central vision.

“My doctor in Puerto Rico suggested I get off the island as soon as possible to have the surgery,” recalls Ms. Rivera, whose children stepped in to help—first by driving long distances to get cellular service, and finally by reaching relatives in the Bronx who arranged for her trip to New York City. “By the time I arrived here on October 2, my vision got worse and I couldn’t see anything out of my left eye,” says Ms. Rivera.

Family members brought her to New York Eye and Ear Infirmary of Mount Sinai, where retina specialist Jessica Lee, MD, Assistant Professor of Ophthalmology, Icahn School of Medicine at Mount Sinai, performed sight-saving emergency surgery on Monday, October 9. Ms. Rivera underwent retinal detachment repair surgery, which involved placing a gas bubble into the eye to keep the retina in place. “She is recovering nicely,” Dr. Lee says a few weeks after the surgery, noting that it can take about two months for the gas bubble in the eye to dissolve, at which time vision can further improve. At a follow-up visit on Tuesday, December 5, Dr. Lee reports, “Her retina is completely attached and she is doing well.”

“There are no words to describe how grateful I am that everything fell into place so that I could be in New York City and have the surgery. I am so thankful for the excellent care I received,” says Ms. Rivera. “Regaining my vision has been amazing. If I weren’t here, I would still be waiting for the surgery.”

Leadership, faculty, and staff from the New York Eye and Ear Infirmary remain eager to help other patients from Puerto Rico. They recently partnered with Bascom Palmer Eye Institute, the Puerto Rican Society of Ophthalmology, and ophthalmologists throughout the United States to launch “Eye Care: Puerto Rico,” a program that facilitates access to eye care to evacuees in need of emergency care.

Pediatric Uveitis: Difficult to Diagnose

Oct 30, 2015 | Ophthalmology, Pediatric Care

Guest post by Sanjay Kedhar, MD, An Associate Professor of Ophthalmology and the Co-Director of the Uveitis and Ocular Immunology Program at the New York Eye and Ear Infirmary of Mount Sinai. Dr. Kedhar specializes in the medical and surgical management of patients with uveitis and other autoimmune and infectious eye diseases. He performs cataract and pharmacological implant surgeries in these patients and also participates in numerous research projects on the outcomes of these disease treatments. Dr. Kedhar is also an expert in cornea, and external disease.

Uveitis is a general term that describes a group of inflammatory diseases that affect the middle layers of the eye. These diseases can lead to reduced vision or severe vision loss. The condition may be caused by a variety of issues, including an attack from the body’s own immune system (autoimmunity), infections, or tumors occurring within the eye or in other parts of the body.

Uveitis is the third leading cause of blindness in America; and five to 10 percent of patients affected are children under the age of 16. Annually, there are approximately 115,000 ongoing cases of pediatric uveitis in the United States, with 2,250 new cases occurring each year. Unfortunately, research shows that children are more likely than adults to suffer blindness as a result of the disease. (more…)

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