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Causes of gradual vision loss
1.Painless loss
Refractive error - this is characterised by an improvement of the visual acuity with the use of a pinhole (if you don't have a specific occluder with pinholes, a biro point-sized hole in a stiff piece of cardboard will do). Refer to the optician.
Cataracts - the patient often complains of glare in dark conditions (and so difficulty in driving at night) and may complain that colours appear more dull than they used to. There may be an abnormal red reflex and, in advanced cases, the cataract may be visible to the naked eye (this is increasingly rare these days). Other aspects of the examination should be normal unless there is concurrent pathology. Refer routinely.
Age-related macular degeneration (AMD) - suspect AMD if the patient is aged >50 years and is presenting with either of the following symptoms, usually affecting one eye at a time:
Distortion of vision, where straight lines appear crooked or wavy.
Painless loss or blurring of central or near-central vision. The person may describe a black or grey patch affecting their central field of vision (scotoma).
Various other visual symptoms can occur, or AMD may be an incidental finding by an optometrist. Visual acuity on a Snellen chart may be normal or reduced. When viewing an Amsler chart (or graph paper), patients may see breaks, waviness, or missing portions of the lines. Refer urgently if AMD is suspected.
Chronic (primary) open-angle glaucoma - is most commonly picked up through screening. If it is so advanced that the patient is the first to notice it, very little can be done. It is characterised by a progressive peripheral visual field loss and 'cupping' of the optic discs (the central area of the optic disc enlarges and the peripheral rim thins out). The degree of urgency depends on how advanced the damage is.
Diabetic retinopathy - the problem may be due to the diabetic microvascular problems (ie exudates and haemorrhages), to associated pathology (eg, diabetic cataract) or unrelated pathology (eg, glaucoma). Refer promptly (within a week), as prompt treatment may prevent deterioration.
Compression of optic nerve or optic pathway - rare, but should be considered if there is a history of headaches and if you find any neurological or endocrinological abnormalities (eg, acromegaly) on examination. Look for a relative afferent pupillary defect (not usually present in the above conditions), a pale or swollen optic disc (the margins are not clear) and visual field defects.
Drugs, toxins or nutritional deficiency - eg:
Amiodarone - various effects on the eye
Antituberculous drugs - ethambutol and isoniazid (optic neuritis).
Hydroxychloroquine (maculopathy).
Systemic steroids (cataracts and glaucoma)
Phosphodiesterase inhibitors (eg, sildenafil).
Others drugs - tetracyclines (benign intracranial hypertension), isotretinoin, tamoxifen (various possible effects on vision).
Alcohol, smoking and nutritional deficiency - eg:
Tobacco-alcohol amblyopia.
Methanol poisoning.
Vitamin A deficiency (classically causes night blindness).
Hereditary retinal dystrophies are rare and, depending on the exact problem, present anywhere from early childhood to middle age. Some are rapidly progressing; others are very slow. Typical features particularly include poor night vision and intolerance to light. Poor appreciation of movement in the peripheral visual field may also be a feature. Ask about similar problems in family members (who may not have been diagnosed). Children should be referred more promptly than adults for whom a routine referral is fine. These patients will need genetic counselling as well as support where the prognosis is poor.
Cerebrovascular disease (stroke and TIA) - although these are likely to present acutely. TIA causing visual loss is termed amaurosis fugax.
Papilloedema - eg, from intracranial hypertension.
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2. Painful loss
This is much rarer and tends to suggest a more sinister pathology such as:
A progressive neoplastic (eg, choroidal melanoma) or inflammatory process (eg, chorioretinitis).
A systemic problem (eg, sarcoidosis or collagen vascular disease).
Lesions on the optic nerve (eg, optic neuritis, granuloma or neuroma).
Intracranial pathology or masses (may present with headache, or with endocrine symptoms if a pituitary tumour).
Intracranial hypertension (may have headache).
All these patients should be referred. Referral is more urgent than with painless conditions and patients should really be seen within a few days.
If there is a problem, don't wait seek medical help.
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Candid street shot Bergen, Norway.
Gracias to KSYM 90.1 + Dave at Hogwild Records!
There's a secret stigma, reaping wheel.
Diminish, a carnival of sorts.
Chronic town, poster torn, reaping wheel.
Stranger, stranger to these parts.
Gentlemen don't get caught,
cages under cage.
Gentlemen don't get caught,
Boxcars (are pulling) out of town.
Boxcars (are pulling) out of town.
Boxcars (are pulling) out of town.
Make It Louder.
#IrregularFrequency @rem @hogwildrecords @ksymradio
This photo is beginning a new series for me, one based on my struggles with having chronic fatigue. It's largely not well understood, by both the medical community and the population at large. People who have it are often have their symptoms questioned, are made to believe it's all in their head, and sometimes accused of simply being downright lazy. From my own experience and speaking with many other people who have chronic fatigue, nothing could be further from the truth. We fight extremely hard against this illness and try every possible treatment, go through every test imaginable. I myself have had almost 30 doctors appointments and have seen eight different specialists just this year.
I wanted to start this series to address many of the misconceptions surrounding the disease and also give those who do not have it the ability to experience it vicariously through my works. It's hard to grasp how life-altering and truly debilitating being exhausted all the time, no matter what you do is. I hope that this series will help raise awareness off the disease and help eradicate many of the misconceptions the public has about it.
The one I chose to kick things off with is about the feeling of constant fatigue itself, which is often accompanied by an inability to sleep once you're actually in bed. It's incredibly frustrating. You spend your entire day wishing you could just go back to bed, and once you're there, you do nothing but lie awake. Very similar to people who have insomnia. I often feel like I'm living in my own twilight world, neither fully awake, nor quite asleep.
I hope you all enjoy this one and the many which will follow it.
Chronic phone use is a recently developed form of addiction. The American Psychiatric Association does not officially recognize the condition. Still, it is acknowledged as a behavioral addiction by many medical professionals and researchers worldwide. According to several studies, over time, the devoted use of smartphones can alter and negatively impact an individual much like gambling.
Skeletons, skulls and alcohol sure seem to go together. Especially in October. This picture is of bottles of Chronic Cellars Purple Paradise red wine with fancy skulls on them.
taken from favorite bench site up in a Steilacoom hills neighborhood and looking out on South Puget Sound - that is McNeil Island smack dab in the middle and the lights toward the left side of the island are from a prison now being used to house chronic and violent sex offenders.
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Litaly resident : )
Does anyone suffer from those inner doubts from time to time. Well I suffer with constant bouts of depression growing up in an a disfunctional family. Where my mother would either verbally or physically abuse me! I didn't want to have children because I was afraid I would be an abuser. So you lot in life, is I have a awesome son, I'm in chronic pain due to eyes and other stuff, I broke the cycle of abuse, but when I look in the mirror I see this disgusting piece of garbage, looking back at me! Yeah I'm working on it.
YORKSHIRE TRACTION
Seen on Midland St. next to the bus station, 461 (YWG461T), is a Leyland National 11351A/1R, new in March, 1979.
It has an overall advert for the Barnsley Chronical, which is still going today.
I wanted to capture the feeling of a chronic illness in a self-portrait using rot, decay, and the feeling that something is leeching from you like a parasite. I set out to portray these often invisible and unspoken feelings in a single image. Initially I wanted to complete this piece in 2 weeks, however, I kept adding more and more to it, even re-shooting the base image and starting again at one point. In the end the process became quite chronic where it was taking a long time and was unable to stop.
I picked these snowdrops to bring indoors. Just inside I noticed an insect on them so went just outside to photograph. I think it's a bee fly but ID is always welcome. Due to chronic poor health I'm unable to take on new contacts but do my best to reply to comments. Thank you so much for your interest, comments and favours on my photostream. Also for your good wishes and I send mine to you joy and peace
Dhaka , one of the oldest cities ... it still has its history alive in every sphere.. it seems like everything is coming more and more alive and proving its chronicle tenor when the sun sets!
August 5th, 2012
Kings Park Psychiatric Center
Long Island, NY
Had an amazing day with Jonathan Marvel photographing this historic abandoned Psych Hospital on Long Island, NY this morning.
He brought me to this infamously decorated "Hall of Chairs" inside Building 93. What more could you ask for in an abandoned psych hospital? A Morgue maybe? Yup, we covered that part of Building 7 as well.
Some history on the hospital:
"The Kings Park Psychiatric Center was established in 1885 by Kings County in nearby Suffolk County, adjoining the 'Society of St. Johnland' established by William Augustus Muhlenberg, prior to the merger of Kings County with Queens County, New York County, Richmond County, and the Bronx County, to form the modern New York City. The official name of the hospital in its first ten years was the 'Kings County Asylum,' taken from the name of the county that Brooklyn occupied. The hospital was revolutionary at the time in the sense that it was a departure from the asylums of folklore, which were overcrowded places where gross human-rights abuses often occurred. The asylum, built by Brooklyn to alleviate overcrowding in its own asylums, was a 'Farm Colony' asylum, where patients worked in a variety of farm-related activities, such as feeding livestock and growing food, as this was considered to be a form of therapy at the time.
Eventually, the Kings County Asylum began to suffer from the very thing that it attempted to relieve—overcrowding. New York State responded to the problem in 1895, when control of the asylum passed into state hands, and it was subsequently renamed the Kings Park State Hospital. The surrounding community, which previously was known as "Indian Head," adopted the name "Kings Park," which it is still known as today. The state eventually built the hospital into a self-sufficient community that not only grew its own food, but also generated its own heat and electricity, had its own Long Island Rail Road spur, and housed its staff on-site.
As patient populations grew throughout the early part of the 20th century, the hospital itself continued to grow, and by the late 1930s the state began to build upward instead of outward. During this period, the famous 13-story Building 93 was constructed. Designed by state architect William E. Haugaard and funded with Works Progress Administration money, the building, often dubbed "the most famous asylum building on Long Island," was completed in 1939 and would be used as an infirmary for the facility's geriatric patients, as well as for patients with chronic physical ailments.
Post-World War II, Kings Park and the other Long Island asylums would see their patient populations soar. In 1954, the patient census at Kings Park topped 9,303, but would begin a steady decline afterwards. By the time Kings Park reached its peak patient population, the old "rest and relaxation" philosophy surrounding farming gave way to pre-frontal lobotomies and electro-shock therapy. However, those methods would quickly be abandoned in 1955 following the introduction of Thorazine, the first widely used drug in the treatment of mental illness. As medication made it possible for patients to live normal lives outside of a mental institution, the need for large facilities like Kings Park diminished, and the patient population began to drop. By the early 1990s, the Kings Park Psychiatric Center, as it came to be known, was operating as a ghost of its former self, with many buildings shut down or in limited usage (including the massive Building 93, by the early 1990s, only the first few floors of the building were in use).
In the early 1990s, with patient populations at increasingly low levels, the New York State Office of Mental Health (formerly the Department of Mental Hygiene) developed plans for the closure of Kings Park as well as another Long Island asylum, the Central Islip Psychiatric Center. The plans called for Kings Park and Central Islip to close, and any remaining patients from both facilities transferred to Pilgrim Psychiatric Center, or be discharged. In the fall of 1996, the plans were implemented, ending Kings Park's 111-year run."