Children eye health and safety month

August Is Children’s Eye Health and Safety Month!

It’s almost back-to-school time and are you prepared with your child’s enrollment forms, orientation schedules, and immunizations–but what about their eyes?

August is Children’s Eye Health and Safety Month—a great signal for you to get your child’s eyes checked before school starts.

Let’s Talk Eye Safety:

Use this month to discuss the importance of eye safety with your children.

CDC states “Approximately 6.8% of children younger than 18 years in the United States have a diagnosed eye and vision condition. Nearly 3 percent of children younger than 18 years are blind or visually impaired, defined as having trouble seeing even when wearing glasses or contact lenses.”.

Children should:

• Wear protective eyewear while participating in sports or recreational activities
• Play with are age-appropriate toys. Avoid toys with sharp or protruding parts

One of the best ways to ensure your child keeps his/her good vision throughout life is to set a good health example.

Talk to your child’s pediatrician if you suspect your child has any of the eye diseases below:

-Amblyopia (lazy eye) – also known as lazy eye, is a vision development disorder in which an eye fails to achieve normal visual acuity, even with prescription eyeglasses or contact lenses. Amblyopia begins during infancy and early childhood. In most cases, only one eye is affected. However, a common cause of amblyopia is strabismus. So if you notice your baby or young child has crossed eyes or some other apparent eye misalignment, schedule an appointment for a children’s eye exam immediately — preferably with an optometrist or ophthalmologist who specializes in children’s vision.

Another clue that your child may have amblyopia is if he or she cries or fusses when you cover one eye.

You can try this simple screening test at home by simply covering and uncovering your child’s eyes (one eye at a time) when he or she is performing a visual task, such as watching television.

-Strabismus (crossed eyes) – Strabismus is a condition that interferes with binocular vision because it prevents a person from directing both eyes simultaneously towards the same fixation point; the eyes do not properly align with each other. Heterotropia is a medical synonym for the condition. Colloquial terms for strabismus include “cross-eye”, “wall-eye”, and a “cast of the eye”. Strabismus in children does not go away on its own and strabismus in adults is treatable, so strabismus treatment is necessary.

-Ptosis (drooping of the eyelid) – Ptosis” is the medical term for a drooping upper eyelid. Eyelid drooping can sometimes affect your vision if it’s severe. Ptosis isn’t a disease. It’s actually a symptom of a condition that you should seek treatment for. Many things can cause ptosis. Some causes being stroke, diabetic neuropathy, myasthenia gravis, muscular dystrophy, botulism, brain aneurysm, adult brain tumor, pituitary cancer, & necrotizing vaculitis. An eye doctor will diagnose ptosis by carefully examining the eyelids. He or she will take detailed measurements of the height of the eyelids and will assess the strength of the eyelid muscles.Surgery can be an effective treatment for ptosis in both children and adult, improving vision as well as cosmetic appearance. It is very important that children with ptosis have regular ophthalmic examinations early in life to monitor their vision and prevent severe vision loss from untreated amblyopia..

-Color deficiency (color blindness) – Two of the most common inherited forms of color blindness are protanopia and deuteranopia. Color vision deficiency (sometimes called color blindness) represents a group of conditions that affect the perception of color. Red-green color vision defects are the most common form of color vision deficiency which is in about 8 percent and 0.5 percent of females of European (northern) ancestry. Affected individuals have trouble distinguishing between some shades of red, yellow, and green. Blue-yellow color vision defects (also called tritan defects), which are rarer, cause problems with differentiating shades of blue and green and cause difficulty distinguishing dark blue from black. These two forms of color vision deficiency disrupt color perception but do not affect the sharpness of vision (visual acuity).

A less common and more severe form of color vision deficiency called blue cone monochromacy causes very poor visual acuity and severely reduced color vision. Affected individuals have additional vision problems, which can include increased sensitivity to light (photophobia), involuntary back-and-forth eye movements (nystagmus), and nearsightedness (myopia). Blue cone monochromacy is sometimes considered to be a form of achromatopsia, a disorder characterized by a partial or total lack of color vision with other vision problems

-Refractive errors (nearsightedness, farsightedness and astigmatism) – The most common types of refractive errors are myopia, hyperopia, presbyopia, and astigmatism. Myopia (nearsightedness) is a condition where objects up close appear clearly, while objects far away appear blurry. With myopia, light comes to focus in front of the retina instead of on the retina.

What are refractive errors?

Refractive errors occur when the shape of the eye prevents light from focusing directly on the retina. The length of the eyeball (longer or shorter), changes in the shape of the cornea, or aging of the lens can cause refractive errors.

What is refraction?

Refraction is the bending of light as it passes through one object to another. Vision occurs when light rays are bent (refracted) as they pass through the cornea and the lens. The light is then focused on the retina. The retina converts the light-rays into messages that are sent through the optic nerve to the brain. The brain interprets these messages into the images we see.

Frequently Asked Questions about Refractive Errors

What are the different types of refractive errors?

The most common types of refractive errors are myopia, hyperopia, presbyopia, and astigmatism.

Myopia (nearsightedness) is a condition where objects up close appear clearly, while objects far away appear blurry. With myopia, light comes to focus in front of the retina instead of on the retina.

Hyperopia (farsightedness) is a common type of refractive error where distant objects may be seen more clearly than objects that are near. However, people experience hyperopia differently. Some people may not notice any problems with their vision, especially when they are young. For people with significant hyperopia, vision can be blurry for objects at any distance, near or far.

Astigmatism is a condition in which the eye does not focus light evenly onto the retina, the light-sensitive tissue at the back of the eye. This can cause images to appear blurry and stretched out.

Presbyopia is an age-related condition in which the ability to focus up close becomes more difficult. As the eye ages, the lens can no longer change shape enough to allow the eye to focus close objects clearly.

Risk Factors

Who is at risk for refractive errors?

Presbyopia affects most adults over age 35. Other refractive errors can affect both children and adults. Individuals that have parents with certain refractive errors may be more likely to get one or more refractive errors.

Symptoms and Detection

What are the signs and symptoms of refractive errors?

Blurred vision is the most common symptom of refractive errors. Other symptoms may include:

• Double vision
• Haziness
• Glare or halos around bright lights
• Squinting
• Headaches
• Eye strain

• How refractive errors are diagnosed?

• An eye care professional can diagnose refractive errors during a comprehensive dilated eye examination. People with a refractive error often visit their eye care professional with complaints of visual discomfort or blurred vision. However, some people don’t know they aren’t seeing as clearly as they could.

• How are refractive errors treated?

• Eyeglasses are the simplest and safest way to correct refractive errors. Your eye care professional can prescribe appropriate lenses to correct your refractive error and give you optimal vision.If you have certain eye conditions you may not be able to wear contact lenses. Discuss this with your eye care professional.
• Refractive Surgery aims to change the shape of the cornea permanently. This change in eye shape restores the focusing power of the eye by allowing the light rays to focus precisely on the retina for improved vision. There are many types of refractive surgeries. Your eye care professional can help you decide if surgery is an option for you.
• Contact Lenses work by becoming the first refractive surface for light rays entering the eye, causing a more precise refraction or focus. In many cases, contact lenses provide clearer vision, a wider field of vision, and greater comfort. They are a safe and effective option if fitted and used properly. It is very important to wash your hands and clean your lenses as instructed in order to reduce the risk of infection.
• Refractive errors can be corrected with eyeglasses, contact lenses, or surgery

“The research picture has brightened considerably in the last decade for people with chromosome 5-related spinal muscular atrophy (SMA) types 0 through 4.

Research Trials for SMA leading to actual care for SMA:

The research picture has brightened considerably in the last decade for people with chromosome 5-related spinal muscular atrophy (SMA) types 0 through 4.

Since 1995, scientists have known that a deficiency of functional SMN protein (SMN stands for survival of motor neuron) is the underlying cause of chromosome 5 SMA. Two nearly identical genes carry the genetic instructions for making SMN protein: SMN1 and SMN2. Proteins made from the SMN1 gene are full-length, functional, and appear to be necessary for the survival and proper function of motor neurons. By contrast, proteins made using instructions from the SMN2 gene are shorter and tend to be less stable but can compensate for a lack of SMN protein when the SMN1 gene is not functioning.

In SMA types 0 through  4, flaws (mutations) in each of the two copies of the SMN1 genes result in insufficient production of full-length, functional SMN protein. Fortunately, a certain amount of full-length SMN protein can be made from the SMN2 gene. Many people have multiple copies of the SMN2 gene. These extra SMN2 copies can lessen the impact of a flaw in both SMN1 copies. In chromosome 5-related SMA, the more copies of SMN2 a person has, the milder the course of SMA is likely to be.

Researchers are seeking to exploit this unique redundancy through development of strategies that restore levels of full-length SMN protein.

1- Nusinersen is a drug that has been shown to increase the survival of motor neurons that die off in SMA, robbing children of muscle control. The drug compensates for the effects of the SMN1 mutation by rallying a “backup” gene, known as SMN2. SMN2, like SMN1, also makes the SMN protein needed to keep motor neurons healthy, but most of it is truncated and nonfunctional. Nusinersen uses a genetically based technology called antisense oligonucleotide to shore up this backup gene. This enables people to make more of the full-length, functional SMN protein.

2-Risdiplam is an oral drug taken daily that also appears to boost the production of the SMN protein through the SMN2 gene. Our researchers are an essential part of the clinical testing of risdiplam in the FIREFISH and JEWELFISH studies, which both continue to look at the drug’s efficacy and side effects in infants through adults.

The FIREFISH study involves infants age 1 month to 7 months with infantile-onset SMA, the most severe type. The babies receive risdiplam given as an oral drug daily. The drug increases SMN protein in the infants and improves their ability to sit without support. After two years of treatment, the FIREFISH study shows that 59 percent of treated babies were able to sit without support for five seconds, 65 percent maintained upright head control, 29 percent were able to turn over, and 30 percent were able to stand with support or supporting weight.

One-year results from the JEWELFISH study of risdiplam in children with all types of SMA aged 6 months to 60 years and previously treated with other SMA therapies, showed that risdiplam increases SMN protein levels. The drug appears to double SMN levels among patients who were previously treated with nusinerson or Zolgensma, highlighting its potential as an alternative or add-on therapy to those drugs.

3-Gene Therapy Trials:  To learn more about the potential for gene replacement in children with SMA, we have been involved in several clinical studies. The first, the STR1VE trial, studied intravenous administration of the therapy in infants less than 7 months of age with type 1 SMA. This trial, which followed infants until they were 18 months old, provided the data used by the FDA to approve Zolgensma for the treatment of babies under 2 years.

The STRONG study involves intrathecal (inside the spinal canal) administration of the gene therapy for children between the ages of 6 months to 5 years with SMA type 2. STRONG is on an FDA-hold pending evaluation of pre-clinical information.

Treatment for SMA:

As yet, there is no complete cure for SMA. However, the discovery of the genetic cause of SMA has led to the development of several treatment options that affect the genes involved in SMA — a gene replacement therapy called Zolgensma, and two drugs, called nusinersen (Spinraza) and risdiplam (Evyrsdi).

There is no complete cure for SMA. Treatment consists of managing the symptoms and preventing complications.

Medications

• The U.S. Food and Drug Administration (FDA) approved nusinersen (Spinraza™) as the first drug approved to treat children and adults with SMA. The drug is designed to increase production of the SMN protein, which is critical for the maintenance of motor neurons.
• The FDA approved onasemnogene abeparovec-xioi (Zolgensma ™) gene therapy for children less than two years old who have infantile-onset SMA. A safe virus delivers a fully functional human SMN gene to the targeted motor neurons, which in turn improves muscle movement and function and survival.
• The FDA approved the orally-administered drug risdiplam (Evrysdi) to treat patients age two months of age and older with SMA.

Physical therapy, occupational therapy, and rehabilitation may help to improve posture, prevent joint immobility, and slow muscle weakness and atrophy. Stretching and strengthening exercises may help reduce contractures, increase range of motion, and keeps circulation flowing. Some individuals require additional therapy for speech and swallowing difficulties. Assistive devices such as supports or braces, orthotics, speech synthesizers, and wheelchairs may be helpful to improve functional independence.

Proper nutrition and calories are essential to maintaining weight and strength, while avoiding prolonged fasting. People who cannot chew or swallow may require insertion of a feeding tube. Non-invasive ventilation at night can improve breathing during sleep, and some individuals also may require assisted ventilation during the day due to muscle weakness in the neck, throat, and chest.

“Spinal muscular atrophy (SMA) is a neurodegenerative disease characterized by loss of motor neurons in the anterior horn of the spinal cord and resultant weakness. The most common form of SMA, accounting for 95% of cases, is autosomal recessive proximal SMA associated with mutations in the survival of motor neurons (SMN1) gene.”

National Library of Medicine (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3860273/)

Spinal muscular atrophy (SMA) is a disorder affecting the motor neurons—nerve cells that control voluntary muscle movement. These cells are located in the spinal cord. Because the muscles cannot respond to signals from the nerves, they atrophy — weaken and shrink — from inactivity.

Healthline through Dr. William Morrison Director, Musculoskeletal/General Diagnostic Muscle at Jefferson University Hospital, states atrophy is when muscles waste away. The main reason for muscle wasting is a lack of physical activity. This can happen when a disease or injury makes it difficult or impossible for you to move an arm or leg. A symptom of atrophied muscles is an arm that appears smaller, but not shorter, than the other arm.

You should schedule an appointment with your doctor if you think you are experiencing muscle atrophy. Your doctor will determine what treatment you need. In some cases, muscle wasting can be reversed with a proper diet, exercise, or physical therapy.

Symptoms of muscle atrophy

You may have muscle atrophy if:

• One of your arms or legs is noticeably smaller than the other.
• You are experiencing marked weakness in one limb.
• You have been physically inactive for a very long time.

Contact your doctor to have a complete medical examination if you believe you may have muscle atrophy or if you are unable to move normally. You may have an undiagnosed condition that requires treatment. Your doctor will be able to provide you with diet and exercise options.

S/S of Spinal Muscular Atrophy (SMA):

Symptoms of SMA may include:

• muscle weakness and decreased muscle tone
• limited mobility
• breathing problems-Remember we say  the weakness tends to be more severe in the muscles that are close to the center of the body (proximal) compared to muscles away from the body’s center (distal).   So your respiratory muscles are close to the center.
• problems eating and swallowing
• delayed gross motor skills
• spontaneous tongue movements
• scoliosis (curvature of the spine)

At birth, infants may appear normal, but can develop some of these signs as they age ^{6 mths or 18mths and 3,4,6 (it all depends on what stage level they are in since the stages happen at different ages, discussed after the s/s}:

Spinal Muscular Atrophy (SMA)-WHEN S/S start?

All signs snd symptoms depends on the type of Spinal Muscular Atrophy you are diagnosed with.  Lets look:

• Type 1  This is the most common and severe form of SMA. It’s sometimes called Werdnig-Hoffmann disease or infantile-onset SMA. Children with type 1 have limited movement, can’t sit without support, and have trouble breathing, feeding, and swallowing. Symptoms begin at birth or within the first six months of life. Many children with type 1 do not live past age 2.
• Type 2  This is an intermediate form of SMA. Children with this type may sit without support at some point but cannot walk on their own. Symptoms typically start between 6 and 18 months of age. Depending on the severity of symptoms, children with type 2 may have a normal life span.
• Type 3 is a milder form of SMA. It’s also known as Kugelberg-Welander disease and resembles muscular dystrophy. While children with type 3 usually are able to walk, most have some difficulty walking. Some may eventually need to use a wheelchair. Symptoms usually appear around 18 months of age or in early childhood. Children with this type of SMA generally have an almost normal life expectancy.
• Type 4 is very rare. It usually symptoms start in young adulthood, & causes mild motor impairment.

“Your muscular heart, the main organ in your cardiovascular system, is vital for life. Its parts work together to move blood through your body in a coordinated way. It constantly sends oxygen to your cells and takes away waste. Many conditions can affect this organ and keep it from working well. Your heart contains four muscular sections (4 chambers) that briefly hold blood before moving it. Electrical impulses make your heart beat, moving blood through these chambers. Your brain and nervous system direct your heart’s function. Your heart controls the speed of your heart rate and B/P.  The heart is the main organ of your circulatory system, your heart keeps you alive. It pumps blood throughout your body, bringing oxygen to your cells and tissues. Since your heart plays such a vital role, it’s important to take care of it. Conditions that affect your heart are very common, but you have the power to make changes for a stronger heart especially before heart problems occur.  The key is prevention.”

Cleveland Clinic (https://my.clevelandclinic.org/health/body/21704-heart)

How the heart is structured and functions:

The human heart is a four-chambered muscular organ that are called atriums at the top LA and RA and the bottom ones called ventricles- right ventricle=RV and left ventricle=LV.  The heart is shaped and sized roughly like a man’s closed fist with two-thirds of the mass to the left of midline which is due to the left ventricle works the hardest pumping blood throughout the body so it makes that chamber the most muscular area.  The right side of the heart pumps blood blood returning to the heart that went throughout the body using up most of the oxygen in it that has mainly carbon dioxide in the blood going the the right side chambers.  First the right atrium and than the right ventricle to just the lungs for more oxygen to the lungs that carries mainly oxygenated blood to the left side of the heart first to the left atrium to the left ventricle that pumps that oxygenated blood through out the body to deliver to all tissues oxygen.

Think of the heart as the engine of the body.  Without a engine the car would not work and without a heart the body would die.  Without the lungs the heart and other tissues would not function and die.  A car without a transmission would not engine would not function and the car would die.

Without oxygen our tissues would go through oxygen starvation and the body would die.  A car without oil would die due to oil starvation and you need the car engine to start the car for the transmission to work with oil to be pumped.

Valves of the Heart:

Pumps need a set of valves to keep the fluid flowing in one direction and the heart is no exception. The heart has two types of valves that keep the blood flowing in the correct direction. The valves between the atria and ventricles are called atrioventricular valves (also called cuspid valves), while those at the bases of the large vessels leaving the ventricles are called semilunar valves.

The right atrioventricular valve is the tricuspid valve. The left atrioventricular valve is the bicuspid, or mitral, valve. The valve between the right ventricle and pulmonary trunk is the pulmonary semilunar valve. The valve between the left ventricle and the aorta is the aortic semilunar valve.

When the ventricles contract, atrioventricular valves close to prevent blood from flowing back into the atria. When the ventricles relax, semilunar valves close to prevent blood from flowing back into the ventricles.

What can happen to the heart if it does not function properly:

Congestive heart failure, or heart failure, is a long-term condition in which your heart can’t pump blood well enough to meet your body’s needs. Your heart is still working. But because it can’t handle the amount of blood it should, blood builds up in other parts of your body. Most of the time, it collects in your lungs, legs and feet.

Think of it like a shipping department that can’t keep up with getting all the shipments where they need to go. The shipping department is always running behind and things pile up. When things pile up, they cause issues OR think of it like plumbing if there is a problem with the water getting through the pipe lines (like our blood flow getting through the veins and arteries) you will need a plumber to fix the blockage, valve problem or broken pipe (just like the blood getting through the body due to a blockage in the vein or artery or bad heart valve or failure elsewhere in that system)

Heart Failure or Congested Heart Failure (CHF) there are types Right sided CHF or heart failure or Left sided CHF or heart failure.   Sometimes the MD may even see High output failure but rare.  More than 6 million people in the United States have congestive heart failure. It’s the leading cause of hospitalization in people older than 65.

Some of the complications from congestive heart failure include:

• Irregular heartbeat.
• Sudden cardiac arrest.
• Heart valve problems.
• A collection of fluid in your lungs.
• Pulmonary hypertension.
• Kidney damage.
• Liver damage.
• Malnutrition.

MOST IMPORTANTLY REMEMBER THIS:

There’s no cure for heart failure. As congestive heart failure gets worse, your heart muscle pumps less blood to your organs, and you move toward the next stage of heart failure(there are A,B,C,D stages). Since you can’t move backward through the heart failure stages, the goal of treatment is to keep you from moving forward through the stages at its slowest pace or to slow down the progression of your heart failure with giving you the chance to live as long as possible at your optimal level.

Regarding Heart Valves there is this to know:

Heart valve disease can affect anyone. But people over 65 are at higher risk. In fact, 2.5 million people over the age of 75 have aortic stenosis, one of the most common types of heart valve disease. While its symptoms can be subtle they shouldn’t be brushed off as “getting older.” Left untreated, it can progress to severe aortic stenosis, also known as heart valve failure.

People over 65 y/o are at highest risk for this and that is based on the my theory like a car the older you are the higher the risk your car is going to be worn down just like the heart (the engine to the body) the older it is the higher the risk that individual will have body part problems like the heart.

Symptoms are your body’s way of sending warning signs that you may be in danger. Unfortunately, diet and exercise can’t fix a failing heart valve. Take control by asking for a referral to a Heart Valve Team or Cardiologist so you can be evaluated.

Without treatment, 1 in 10 people with heart valve failure may die within 5 weeksof symptoms starting if they don’t get a recommended valve replacement!

Remember this important note the better you care for the car the longer it lasts and the better you take care of yourself the longer it lasts.

“During hip replacement, a surgeon removes the damaged sections of the hip joint and replaces them with parts usually constructed of metal, ceramic and very hard plastic. This artificial joint (prosthesis) helps reduce pain and improve function.

Also called total hip arthroplasty, hip replacement surgery might be an option if hip pain interferes with daily activities and nonsurgical treatments haven’t helped or are no longer effective. Arthritis damage is the most common reason to need.

Hip replacement may be an option if hip pain:

• Persists, despite pain medication
• Worsens with walking, even with a cane or walker
• Interferes with sleep
• Affects the ability to walk up or down stairs
• Makes it difficult to rise from a seated position”

MAYO CLINIC (https://www.mayoclinic.org/tests-procedures/hip-replacement/about/pac-20385042)