Symptoms of Presumed Ocular Histoplasmosis
Histoplasmosis is an infection that affects the respiratory system before it affects the eyes. Respiratory symptoms are usually mild. Some people feel a little achy, like they have the flu or a cold. The symptoms usually pass without treatment. For unknown reasons, however, in some people the disease quietly spreads from the lungs to the eyes.
In the eyes, scientists believe the histoplasmosis infection causes an inflammation in capillaries (tiny blood vessels) under the retina called the choroid.
The retina lies flat on the back wall of the inside of the eye and contains cells that tell the brain what is in the visual field. Within the central part of the retina is the macula, which is responsible for sharp, central vision. Presumed ocular histoplasmosis syndrome can affect this central vision. In the early stages though, there are no obvious symptoms.
POHS is usually diagnosed when a person comes to the doctor with a complaint of a blind spot in his or her field of vision, blurred vision, and of straight lines appearing wavy. These symptoms are an indication that POHS has caused the capillaries of the choroid to grow abnormally and to leak. The leaked fluid pushes portions of the retina outward, like wallpaper from a wet wall. This causes the blurring and distorted vision. Scar tissue can form, too, and interfere with vision. Peripheral vision is usually spared in POHS.
The physicians of the National Retina Institute remind you that POHS can seriously affect vision. Treatment is most effective when it is begun early. Anyone who has been exposed to histoplasmosis and perceives even slight changes in vision should have a checkup by an eye care specialist.
Detection of Presumed Ocular Histoplasmosis
An eye that has been affected by histoplasmosis contains telltale signs called histo spots. The histo spots are small scars in the retina that tell the doctor that a person has breathed in spores of the fungus that causes histoplasmosis. In a small number of people, for unknown reasons, the spores pass from the lungs to the retina.
The retina of someone with presumed ocular histoplasmosis (POHS) also contains changes similar to age-related macular degeneration (AMD). In both disorders, tiny blood vessels of the retina send off abnormal shoots. The process is called choroidal neovascularization. Unfortunately, these shoots are delicate and they leak blood and fluid.
To examine the retina on the back inside wall of the eye, the doctor must dilate the pupil with special eye drops. In addition to histo spots, the doctor looks for signs of swelling caused by the leaking blood vessels.
Tests are performed to determine the extent of the condition. One test is called fluorescein angiography. The doctors of the National Retina Institute also use a second test called high-speed indocyanine green angiography (HSICGA) to see blood vessels in deeper layers of the retina that feed the choroidal neovascularization.
In both tests a non-toxic dye (fluorescein or indocyanine green) is injected into an arm vein and allowed to circulate to the retina. At the retina, the doctor detects the leaking blood vessels. HSICGA involves the use of a high-speed computerized camera to trace the flow of the dye through the abnormal blood vessels.
Additional testing, such as Optical Coherence Tomography and Macular Microperimetry, will provide the doctor with more infomation to guide treatment. Optical Coherence Tomography can give the doctor quantified information about the swelling in the eye, and the Macular Microperimeter can show the doctor how the disease is affecting vision.
The physicians of the National Retina Institute want people who have been exposed to histoplasmosis to know that a simple eye exam can help prevent loss of vision from POHS. Early treatment is important.
Treatment of Presumed Ocular Histoplasmosis
Presumed ocular histoplasmosis (POHS) cannot be cured. It can, however, be treated by sealing leaks from the new, abnormal blood vessels (choroidal neovascularization) that form in the retina. This is done with a form of laser surgery called photocoagulation.
The choroidal neovascularization is fed by blood vessels beneath the retina. The doctors and scientists of The Bert M. Glaser National Retina Institute have introduced a new technique for identifying these feeder vessels. Once identified, they are sealed with low-intensity laser photocoagulation, a treatment that is far less damaging to healthy parts of the retina than older treatments that used a more intense laser.
This new technique for identifying feeder vessels is called high-speed indocyanine green angiography (HSICGA). A non-toxic dye is injected into an arm vein and allowed to circulate to the retina. Special high-speed computerized cameras track the dye through the retina. The doctor sees the leaking vessels, traces them to the deeper vessels that feed them, and seals off the feeder vessels with the laser. Several treatments are usually necessary.
Leakage can also be treated by surgically removing the leaking blood vessels under the retina. The surgery is delicate and there is a small associated risk of retinal detachment. Generally, laser treatment is used before resorting to surgical removal of the leaking blood vessels.
The physicians of the National Retina Institute remind people with POHS that it is a stubborn problem that cannot be cured, but can be managed. Choroidal neovascularization may recur and should be treated early before it causes significant damage.
back to work in the morning! Well I thought today would be a great day to take the kids out for some photos for our Christmas Card (I still don’t have it done). Well the kids were in a great mood and were willing but the weather didn’t allow. When we went out it started to snow and got very windy. After we came in and one kid took off then it got nice, go figures. There was no way anyone would go back out though, hopefully next weekend I can get it done but who knows!!!! I did get a few shots of the them separately before the blizzard conditions sent us running. Kendall colored her hair (with that temporary stuff) and she just loves it haha. 
I ask that if you made it this far reading that you could pray for JD’s eyes, we would really appreciate it, thanks!
