Dr. Travis Stork: As a doctor I will be the first to admit that it could be the worst when it comes to getting important as that we need so that they were each undergoing a different life saving test to show you that there is nothing to be afraid of. So you can start making excuses and get them for yourselves. DR. Jim is next.
Dr. Jim: I am here, the Orange County Retina Medical Group.
Female Speaker: Dr. is here?
Jim: Right. For the past year or two, I had a little blind spot in my eye and I have ignored it. Not the best thing to do. We are going to get to the bottom of it. Do some testing. I am hoping they don't find anything bad.
Female Speaker: -Okay, you are ready?
Dr. Sanford Chen: I am Dr. Chen pleasure to meet you
Jim: Nice to meet you.
Dr. Sanford Chen: Alright, the first things we are going to is use this little lamp. We are going to take a look at the front part of the eye and looking at your cornea, your lens for cataract, to be Irish, your two balls pretty bright, huh. I would also like to get of course an angiogram. I mean this is going to involve putting a dye in your arm and looking at the circulation of the blood vessels in your retina.
Jim: And more bright light.
Dr. Sanford Chen: And more bright light, we specialize in bright lights.
Jim: This thing hurts.
Female Speaker: Let me take colored photographs of your retina first.
Jim: Is all that going into me?
Female Speaker: All that will go into you.
Dr. Sanford Chen: As soon as I give you the injection the dye goes up into your eyes and about ten seconds, start injection. Okay the dye is all in. Okay so we got the initial results of the photographs here. So I think we will be able to get some information out of that.
Jim: Feels good too. Finally got in here, get these tests done and finally we are going get some answers and hopefully either good luck.
Dr. Travis Stork: Dr. Chen, walk us through what exactly you're doing in this procedure, because it's something that most of us don't even know about.
Dr. Sanford Chen: It's actually basically just a diagnostic procedure that evaluates the flow characteristics and the micro circulation of the retina blood vessels at the back of the eye. It also examines the integrity of these blood vessels at the back of your eye to make sure that they are not causing any leakage. What we do first is we give an injection of a dye that goes right into the arm. It flows into the heart and actually circulates out of the heart and goes up directly into the eye and that basically takes a total of about a 11 seconds. So yes, we do everything pretty quickly and then we have a high speed photographer that basically catches camera image of this.
Dr. Travis Stork: And that's what we are looking at there. All the blood vessels basically, they all lie up.
Dr. Sanford Chen: Yeah, they lied up and if not normal then it sometimes leak as well.
Dr. Travis Stork: And this is the test good person of like Jim who had some visual disturbances.
Dr. Sanford Chen: Absolutely, because we don't know what's causing that, so we want to make sure that he doesn't have a blockage in one of the blood vessels or may be a stroke or something like that?
Dr. Travis Stork: So you are anxious. I am anxious also, because this is sometimes my ride to the studio,
Dr. Sanford Chen: yeah I need careful.
Dr. Jim: May be - might have to start giving your eyes. Results, anything look good?
Dr. Sanford Chen: Well, good news and bad news. The good news is that plus angiogram portion of the test actually looks great. The blood flow is good, the circulation was fine.
Jim: So my retina looks good.
Dr. Sanford Chen: Your retina looks good. Interestingly the pictures that we took of the color photographs prior to actually even giving you the dye, was where we actually sensed abnormality.
Dr. Travis Stork: So I want to bring these images up so that you can show us these abnormalities that you saw in Jim. You walk through that?
Dr. Sanford Chen: Sure, over here we can see on the left hand of the split screen is actually a normal eye. Here you can see the optic nerve and this is the most things to pay attention to here, you can see it's a nice round saucerized looking appearance. The edges are very sharp and well demarcated. And you actually have a central area here at the white area which is known as the cup. Now if you contrast Dr. Jim's eye's which is over here, which is what we took with the color photographs, you can see there is a great distinction. First of all the nerve is a little bit oblong shaped, it's a little bit elliptical, doesn't have that great round saucerized look. You will also notice the central white cup is gone. That's no longer there. And also down here at the bottom, it looks like someone just took a bite of the bottom half of his nerve. So that too is gone. So this is distinctly abnormal optic nerve relative to a normal optic nerve over here.
Jim: So, why is my nerve like that?
Dr. Sanford Chen: Here is some, there could be several explanations and the simple is may be just the way that the optic nerve inserts into your eye wall. In a normal person, the optic nerve comes back into the eye walls straight and that is why it is so crisp and clean. In your particular case it may actually be going on a tilt and therefore that would explain a lot of images that we were seeing. Secondly it actually could represent a growths or lesion that are deposited inside the optic nerve head itself and that is why you get a little bit of a blurring in the margins.
Jim: Doesn't sound good.
Dr. Sanford Chen: The most worried something is of course a brain tumor and that's what we always worry about when we see abnormal optic nerves and you may ask, how I know, you have a brain tumor, just by looking at your nerves. What happens is the brain, if the tumor is growing inside your brain it is in a confined space. The pressure inside the head gets high and that pressure is actually transmitted down the nerve and you actually see it as a repetition of a swollen nerve and abnormal looking optic nerve.
Dr. Travis Stork: The important point here is that, why not saying that Jim has a tumor? You're saying you taking a very low, low, low chance, but you can't ruled out.
Dr. Sanford Chen: Absolutely.
Dr. Travis Stork: So, next step Jim probably needs something more thrill, like an MRI.
Dr. Sanford Chen: The talk is not over yet. I would probably recommend getting an MRI and a CT scan in the brain and I probably also recommend getting an ultra sound of your optic nerve to see whether or not we can actually see these deposits or growths that are going within the optic nerves themselves.
Dr. Travis Stork: So more investigation and we will follow this with you Jim, right.
Dr. Jim: Yeah.
Dr. Travis Stork: Jim, okay?
Dr. Jim: Yeah --
Transcription by:
Scribe4you Transcription Services