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Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 7845
Experience:  Ophthalmology since 1994 with Retina sub-specialty interest
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Customer Question

My son has CP and was born with a pale optic nerver. He is now 4 years old, we noticed a week ago that he has a blury small transparent spot in the middle of his cornea.

By looking from the side of his eye we can see that the spot is only on the surface of his cornea and not from inside his eye as the color of his pupil is normal.

I already went to a doctor who said that the only way to find out what this is is y doing a VEP ERG EOG test and a slit lamp examination or cornea.

My questions are:
1. I would like to validate if that makes sense and if this is really the correct approach?
2. I've already done the VEP test when my son was 2 years old and I know that it tests the optic nerve and not the cornea, I feel that the doctor should have been able to figure out whats this blury spot by a simple eye exminiation, please correct me if I was wrong
3. What could be this blury spot and are there any treatments?

Thank you
Submitted: 1 year ago.
Category: Eye
Expert:  Dr. Rick replied 1 year ago.

Dr. Rick :

Hi. I'm online and happy to answer your question today.

Dr. Rick :

I'm sorry to hear about all the difficulties your son has been having over the years. In order to better understand what is going on with this spot, let me ask you a few questions:

Dr. Rick :

Is your sons eye red or irritated looking?

Dr. Rick :

Is his eye hurting him?

Dr. Rick :

Was the doctor who examined him and recommended the ERG, VEP and EOG an ophthalmologist?

Dr. Rick :

Do you think your son could have had any trauma to his eye recently?

Dr. Rick :

Has this spot changed at all since you noticed it?

Dr. Rick :

We have been experiencing problems with the chat system for the last few days. Our engineers are working on it. However, I'll switch over to the Q&A system. This system works a lot like 'text messaging' but an email is sent to each of us anytime something is posted to this thread. We can continue to work on your question there..... :)

Expert:  Dr. Rick replied 1 year ago.
Our chat has ended, but you can still continue to ask me questions here until you are satisfied with your answer. Come back to this page to view our conversation and any other new information.

What happens now?

If you haven’t already done so, please rate your answer above. Or, you can reply to me using the box below.
Expert:  Dr. Rick replied 1 year ago.
We have been experiencing technical difficulties with the chat system. Please allow me to retype my chat here for your review:


Dr. Rick : Hi. I'm online and happy to answer your question today.
Dr. Rick : I'm sorry to hear about all the difficulties your son has been having over the years. In order to better understand what is going on with this spot, let me ask you a few questions:
Dr. Rick : Is your sons eye red or irritated looking?
Dr. Rick : Is his eye hurting him?
Dr. Rick : Was the doctor who examined him and recommended the ERG, VEP and EOG an ophthalmologist?
Dr. Rick : Do you think your son could have had any trauma to his eye recently?
Dr. Rick : Has this spot changed at all since you noticed it?

This is not an answer, but an Information Request. I need this information to answer your question. Please reply, so I can answer your question. I look forward to helping you.
Customer: replied 1 year ago.

Hi Doctor, below are the answers:


Dr. Rick : Is your sons eye red or irritated looking?


No



Dr. Rick : Is his eye hurting him?


No



Dr. Rick : Was the doctor who examined him and recommended the ERG, VEP and EOG an ophthalmologist?


Yes he was an ophthalmologist, but please note that I live in the United Arab Emirates and medical care here is robably the worst in the world, which is why I am doubting what this doctor told me



Dr. Rick : Do you think your son could have had any trauma to his eye recently?


No not recently he had hypoxia when he was born other than that he is getting stronger and has never really been sick. He even stoped having his seizure medecine 2 years ago



Dr. Rick : Has this spot changed at all since you noticed it?


My wife thinks it might have gotten a little bit bigger but we are not sure. On the other hand, I sometimes cannot even find the spot!

Expert:  Dr. Rick replied 1 year ago.
Thank you for that information.

First of all, let me confirm what you already believe. As a retina specialist, I can tell you that an ERG, EOG and VEP have no place in the workup of a spot on your sons cornea.

Now, about this corneal spot.....if you are having problems finding the spot at this point, it most likely is nothing to be concerned about, especially since his eye appears normal in all other respects and he is not having any eye pain.

What could this spot be? That is a very good question....it might be just a small dry spot (since it is hard to see now), it might be a rough area on his cornea from some minor trauma....it is hard to tell from your post. If you could obtain a picture that shows the lesion I'd be happy to take a look for you but, from what you have posted, I bet it is hard to photograph :(

So. What is the take home message? At this point I would not panic. I would try to sooth your sons eyes with artificial tears 3 to 4x/day and, if things don't seem to improve or if he takes a turn for the worse, try to him into see a different ophthalmologist -- I'd not trust the one who gave you the advice to do the retinal physiologic studies....

Let me know if you would like to try and upload a picture for me to evaluate.

Is there anything else you would like to discuss at this point or have all your questions been answered to your satisfaction?

I hope this information was helpful for you. But I do work for tips so I want to make sure you are happy with me before rating me. If you have another question on this or a related issue feel free to fire away. And please let me know if the rating system gives you any troubles.

Thanks in advance,

Dr. Rick MD FACS

Customer: replied 1 year ago.

It was very helpful doctor I through that the VEP test has nothing to do with the cornea :) and I already know he has a bad optic nerve so Im not sure whatsthe relevance of this test.


 


Please allow me to take a picture of my son's eye and post it for you. He is now sleeping :) i will take the picture once he wakes up and upload it to you then we can close this session. Thank you very much for your help.


 


By the way doctor, how far are we from optic nerve regeneration and this bionic eye ...etc do you think it would be during my son's lifetime ?

Expert:  Dr. Rick replied 1 year ago.
Ok. I will wait for the picture. If you have problems uploading it, here is one way to do this:

Save your picture on your computer, someplace easy to find it such as your desktop.
Go to www.tinypic.com
Upload your picture to the site tinypic.com by browsing for it as directed.
This opens up files on your computer. Double click on the picture you want to upload then hit open (bottom right of the screen). This will take you back to the tinypic page. Hit "upload now" then do the secret code thing and your picture will upload into the system.
Once you do that it gives you a bunch of links you can use, one of which says "direct link for layouts" It is important to use this box. It is the forth one down from the top of the page.
Copy the link from inside this box and then paste it into your justanswer dialog box and send it to your expert.


As a retina specialist, while I was not part of the team that developed the retinal implant, I have been following the progress of the system for years. Unfortunately, since your sons primary issue is with optic nerve atrophy this "bionic eye" as the press likes to call it, would not work for him.

There has been great progress in the science of nerve injury and regrowth over the last few decades, most of it relating to spinal cord injuries. At this point, there are no therapies to "fix" optic nerve damage in the pipeline but who knows what the future will bring. Heck, just look back at where medical science was when you and I were born and imagine what another few decades will bring.

I look forward to reviewing your picture. Talk to you soon.

Dr Rick MD FACS
Customer: replied 1 year ago.

Hi Doctor,


I uploadded two picture (they are the same) but in one of them I drew an arrow pointing out where the spot is and the other one has no arrow:


 


with arrow:


http://tinypic.com/view.php?pic=34jbukn&s=6


 


without arrow:


http://tinypic.com/view.php?pic=s5fs0j&s=6

Expert:  Dr. Rick replied 1 year ago.
Let me take a look at the pictures.....be right back.
Expert:  Dr. Rick replied 1 year ago.
The image is out of focus and, as such, I can't see any details. It does seem like there is something there but I can't tell.

Can you back up some (not too far) and get a clear shot that is in focus on the cornea? It seems that you are too close to allow your camera to focus.

I can magnify the image some on my end.

I look forward to your reply. Sorry about the difficulties we are having :(
Customer: replied 1 year ago.

Hi Doctor,


The problem is that it doesnt show from far, the image is high resolution so perhaps you can try downloading it and opening it with 100% zoom, or simply open it with MSPAINT then it would appear in 100% size.


 


Otherwise I would keep trying to get you a better picture.


 


But the spot is actually difficult to "SPOT" :)

Expert:  Dr. Rick replied 1 year ago.
Yes. I opened it photoshop and have full control of the image but the cornea is out of focus and I can not change that :(

even a shot of the eye that is back a bit more, but in focus, will allow me to better visualize any significant lesion that is present.....

One good thing: If the "spot" is so hard to "spot" (lol!) it is very likely to be nothing to worry about. :-)

I'll standby....
Customer: replied 1 year ago.

ok i will get another shot

Expert:  Dr. Rick replied 1 year ago.
OK :-)
Customer: replied 1 year ago.

Hi Doctor,


Thank you for your patients, no luck , I even tried my 2000$ camera :/ it is very difficult for the spot to appear on camera, we will give it one final shot tomorrow morning if you dont mind :)

Expert:  Dr. Rick replied 1 year ago.
sure. No problem. Send me whatever you can get and I'll take a look.

It is now 11:30 am on Monday in my part of the world.....
Customer: replied 1 year ago.

I think we got a good photo, please let me know if this one is clear:


 


without arrow
http://i45.tinypic.com/29c1fet.jpg

with arrow:
http://i45.tinypic.com/2hp0t1c.jpg

Expert:  Dr. Rick replied 1 year ago.
Good Morning. Let me take a look at the picture. Be right back.
Expert:  Dr. Rick replied 1 year ago.
Ok. That is an excellent photo. I was able to enlarge it with photoshop and get a good view.

While he has excellent tear production, that area of epithelial opacity looks like it might be from his eye being open just a tiny bit while he is sleeping. I do not see any evidence of infection, inflammation, trauma etc in the photo.

I do not feel that this is anything to worry about at this time. I suggest you use a little bit of eye ointment, such as lacrilube or refresh PM and put it in his eye just before bed or just after he falls asleep. This will keep his cornea protected.

Also, since a photo on the internet is not as good as a complete eye exam, if this area of corneal haziness does not resolve with this simple treatment in a week or so, I'd take him to a pediatric ophthalmologist (or at least a different eye doctor then the one who told you to do electrophysiologic studies!) just to be 100% sure nothing is going on.

What is the take home message? From what you have posted, and the pictures you have provided, I believe your son is OK and this thing on his cornea is nothing serious. Also, as we've already discussed, ERG, EOG and VEP have NO place in the management and workup of this issue.

Is there anything else you would like to discuss at this point or have all your questions been answered to your satisfaction?

I hope this information was helpful for you. But I do work for tips so I want to make sure you are happy with me before rating me. If you have another question on this or a related issue feel free to fire away. And please let me know if the rating system gives you any troubles.

Thanks in advance,

Dr. Rick MD FACS
Customer: replied 1 year ago.

Thank you for the details doctor, while it is clear the VEP test is not required, what about the Slit lamp examination of cornea which i also mensioned earlier? is that required?

And finally a friend of mine told me that sometimes lack of blood circulation causes this and it expands with time causing complete blindness :/ is this rolled out or it could be the case?

Thank you

Customer: replied 1 year ago.

Hi Doctor,


Just wondering why is it taking a while to receive a reply


thank you,

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