Stars' Eyes: Michael Jordan

I have few rules in life, but “when there’s a 10-part documentary about your childhood hero/the greatest basketball player of all time, and it’s on during the COVID pandemic so there’s nothing else to watch, and he seems like he’s having an eye problem, I write about it,” is one of them.

Some people have wondered whether MJ has jaundice. I don’t believe that to be the case. The dark brown spots on the whites of his eyes look to me like complexion-associated melanosis, also known as ethnic melanosis.

The brown pigmentation overlying the whites of the eyes in this case is likely to be complexion-associated melanosis

These brown spots are found in the conjunctiva, which is the clear covering overlying the sclera (the white part of the eyeball). They are almost always present on both eyes, and can enlarge over time. They are more common in people that have darker skin tones. They are not cancerous or precancerous, but people who have them can also develop melanoma of the conjunctiva.

If you have a brown spot on your eye, it’s best to see an eye doctor. I’m sure Michael has. But the way these is affecting both his eyes, I very much suspect this is complexion-associated melanosis.

Stars' Eyes: Steph Curry and Keratoconus

As his Golden State Warriors prepare for the NBA Playoffs, hoping to become the first team to win three consecutive championships since the 2000-2002 Los Angeles Lakers, star point guard Stephen Curry revealed the secret to his improved three-point shooting in recent weeks in an interview with The Athletic, as reported by ESPN.

The secret? Contact lenses.

Curry also reported that he has long suffered from an eye disease known as keratoconus, and that his new contact lenses have dramatically improved his vision, to the point where “it’s like a whole new world has opened up,” according to The Athletic.

Keratoconus affects the cornea, the clear, front part of the eye pictured at the left in this image.

Keratoconus is a condition that affects the cornea, which is the clear, front part of the eye which sits in front of the colored iris.

Keratoconus causes the cornea to become thinner and steeper (think of a taller mountain) than it should be, and it may progress over time.

Sometimes, keratoconus can cause painful episodes of swelling of the cornea, known as hydrops, which may result in scarring of the cornea.

Keratoconus ranges in severity from mild, to moderate, to severe. Mild disease may require no treatment at all, or simple glasses wear. More moderate disease can benefit from contact lens wear. Sometimes, large “scleral” contact lenses can be helpful, as they can neutralize the warped cornea and improve a person’s vision. For severe keratoconus, a corneal transplant can be done, where a surgeon will remove all or part of a person’s cornea and replace it with a donor cornea. Here’s a video of my friends and former colleagues, Dr. Matt Ward and Dr. Mark Greiner, doing a type of corneal transplantation surgery called a DALK, which is sometimes done for keratoconus.

In the past few years, an exciting breakthrough in treatment for patients with keratoconus has become available. It is called corneal collagen cross-linking, and there are surgeons throughout the United States that offer this procedure. Here’s an article from the American Academy of Ophthalmology that discusses cross-linking.

Have you heard of LASIK surgery? For patients considering LASIK, which helps reduce or eliminate the need for glasses and contact lenses, the surgeon will do a careful examination and diagnostic testing in the clinic before the day of surgery, looking for, among other things, signs of early keratoconus. Why? Because LASIK, if performed on a person with early keratoconus, or a tendency toward it, can dramatically accelerate the disease.

The prospect of an even more accurate Steph Curry, now that his vision has improved, is sure to strike fear in the hearts of opposing defenses.

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Stars' Eyes: Vivian Stancil

Between her mother dying when Vivian Stancil was just seven years old, and her father suffering from alcoholism and tuberculosis, you would think that Vivian would have already dealt with her lifetime allotment of challenges before she left grade school. But you’d be wrong.

Or perhaps you’d guess that maybe this girl who started raising her four younger siblings when their father died, before eventually living in three different foster homes, couldn’t possibly bear any more adversity. But again, you’d be wrong.

At age 19, Vivian was diagnosed with retinitis pigmentosa, a genetic eye disease that causes gradual vision loss, and as of this writing, does not have a treatment that can reverse it. Retinitis pigmentosa causes the light-sensing cells in the retina, the rods and cones, to die, and patients with this condition typically experience difficulty seeing especially in dim light, as well as reduced peripheral vision; it can sometimes take away their central vision as well.

Despite all these hardships, Vivian — who is now legally blind — didn’t let life get her down. After earning her degree, she went on to teach kindergarten in southern California for more than two decades. After retirement, unfortunately, Vivian’s problems were far from over, as she experienced depression and became severely overweight, at more than 300 pounds at 5 feet tall.

Faced with extremely high blood pressure, and told by her doctor that he didn’t expect her to live ten more years, Vivian again beat the odds, by doing something she had never done before: swimming.

Beginning at age 50, Vivian learned to swim, and has taken to the water like, well, a fish. Counting her strokes and listening to the sound of the water hitting the lane markers to tell where she was in the pool — because, remember, she doesn’t have useful vision! — Vivian began to lose weight and become healthier. She’s lost over 100 pounds, and has become a competitive senior swimmer, winning a whopping 271 medals at the local and state level.

“What I want to tell children and adults is, ‘you can be whatever you want to be, if you put your mind to it.’ I have problems just like everybody else, but I don’t allow them to get to me. I want to be able to leave a legacy to my friends and to the community.” - Vivian Stancil, in an interview for Amy Poehler’s Smart Girls website

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Stars' Eyes: Danelle Umstead

Umstead has won three Bronze medals in alpine skiing in the Paralympic Games

Danelle Umstead is used to turning heads as she flies down the alpine slopes. An accomplished skiier, Umstead has made three Paralympic teams and won three bronze medals, an incredible feat for anyone, let alone someone with severely limited vision.

Umstead has a genetic eye condition called retinitis pigmentosa (RP), which affects the photoreceptor cells in the retina — the rods and cones — and has caused Umstead to lose her vision. Like so many people with severe eye disease, she hasn’t let this stop her.

Now, Umstead is turning heads for a different reason. Fulfilling a longstanding dream, she is competing on ABC’s fall season of “Dancing with the Stars,” partnering with Artem Chigvintsev. Umstead is the program’s first visually impaired contestant.

“I have no central vision whatsoever,” Umstead says according to an article on Team USA’s website, and also acknowledges that in her “peripheral vision, there’s big, black blind spots closing into my central. So I just have little pieces left between the two here and there.”

Patients with RP typically experience decreased vision in dim light and reduced peripheral vision, which may progress to involve their central vision as well. At the time of this writing, there is no cure for this disease. However, the future is bright for patients with inherited eye diseases like RP, thanks to the determined research and tireless efforts of many, many patients, scientists, and doctors, who have recently produced the first commercially-available treatment for an inherited eye disease, as I discuss here.

Here’s Umstead’s first performance on Dancing with the Stars, dancing the foxtrot:

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Stars' Eyes: Joel Embiid

Joel Embiid, 7'0" star of the Philadelphia 76ers, was back in the lineup tonight after missing a few weeks because of an orbital fracture he sustained in a March 28 game against the New York Knicks during a collision with rookie teammate Markelle Fultz.

The bones of the orbit (eye socket). Image courtesy of wikipedia.

The orbit, or "eye socket" in lay terms, is made up of seven different bones, and can be thought of as a room with a floor, walls, and a ceiling. Aside from the obvious opening at the front through which the eye is able to see, there are several other much smaller openings through which nerves and blood vessels pass.

In facial trauma, the bones that make up the orbit, like any other bones in the body, can break. Fractures of the orbit most commonly affect two sites: the thin, inner bones that make up the wall between the eye and the nose, or the bones of the "floor" of the orbit. Fractures of the thicker bones that make up the "rim" at the front of the orbit are more rare, as they require much more force.

Symptoms of orbital fracture may include pain around the eye, displacement (often backward or downward) of the eye itself, double vision, bruising around the eye, inability to move the eye in different directions, or numbness of the cheek. The diagnosis is confirmed by a computed tomogram (CT scan) of the maxillofacial area.

The oval shows a "blowout" type fracture of the floor of the left orbit.

For patients who have sustained a fracture of the orbit, an ophthalmologist is typically consulted to evaluate the eye, rule out serious vision- or even eye-threatening injuries, and to check for signs of muscle entrapment. The eye has six different muscles that attach to it, allowing it to move in all different directions, and sometimes, when the bones around the eye break, these muscles will get snagged in the fractured bone. When this happens, it usually causes double vision, inability to look up or down, and nausea, vomiting, or low heart rate when the patient tries to look up or down. Muscle entrapment is more common in children, because their bones, more flexible than adults', often break and then "snap back," trapping muscle.

Here's a video of a young patient with an entrapped muscle after an orbital fracture. This patient was seen, and the video created, by my good friends and former colleagues at the University of Iowa, Dr. Jordan Rixen and Dr. Priya Gupta.

The majority of orbital fractures do not require surgery to fix. Conservative treatments often include ice packs, antibiotics, nasal decongestants, and caution to avoid blowing the nose for a few weeks, as this can cause air to get into the eye socket through the fracture, potentially putting undue pressure on the eye and its supporting structures and causing permanent vision loss.

Reasons for a patient to have surgery to fix their orbital fracture include things like persistent double vision, an entrapped muscle, significant enophthalmos (an eye that is "sunken back" into the orbit), or a cosmetically unacceptable appearance. Surgeons typically wait for 1-2 weeks for swelling to subside before performing surgery. However, in cases of muscle entrapment, surgery is much more urgent, as the trapped muscle can lose its blood flow and become irreparably damaged if not promptly freed from the fracture.

Three days following his injury, Embiid's orbital fracture was surgically repaired by Dr. Jurij Bilyk (oculoplastic surgeon) and Dr. Howard Krein (reconstructive head and neck surgeon). No public mention has been made as to whether Embiid suffered from double vision or whether this factored into the decision to have surgery.

Embiid looked sharp in his return to action against the Heat, scoring 23 points and grabbing 7 rebounds in 30 minutes of action, all while wearing a protective mask.

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Stars' Eyes: Casey Harris

You may not know Casey Harris by name, but odds are, you've heard his work:

Casey is the keyboard player for the alternative rock band X Ambassadors. Their hit single "Renegades," a tribute to people with disabilities who use and overcome them to accomplish greatness, came out in 2015, peaked at #17 on the US Billboard Hot 100 chart, and went platinum.

Why was this song so personal for Casey and his bandmates? Because Casey is blind.

He was born with Senior-Loken syndrome, a genetic disease that affects his eyes and his kidneys. Senior-Loken is a type of Leber congenital amaurosis (LCA), a blinding eye disease of childhood. Unlike other forms of LCA, Senior-Loken also affects kidney function; Casey needed a kidney transplant at age 23. At the time of this writing, there is no cure for this condition.

LCA can be caused by mutations in at least 19 different genes, and is usually inherited in autosomal recessive fashion, meaning one "bad copy" of the gene must come from both parents in order for a person to have it. A landmark gene therapy treatment trial has been performed for patients with LCA due to mutations in the RPE65 gene. One of several peer-reviewed publications from this study can be found here.

During my career, I have often been simply awestruck by the incredible accomplishments of patients with severe visual impairments like Casey has. They can do things -- like star in a band, run in the Olympics, be a champion weightlifter or golfer, or a prestigious scholar, to name a few -- that would be impressive for anyone, let alone someone with a disability. Their success helps give hope to others, and I'm grateful to be able to share their stories.

After my ophthalmology residency, I did an extra year of fellowship training in ophthalmic genetics, which gave me the opportunity to see patients with inherited eye diseases like LCA. Working with and learning from my mentors Dr. Edwin Stone and Dr. Arlene Drack at the University of Iowa, I marveled at the perseverance of the people I met, both the patients with the severe eye diseases and the doctors and scientists who had dedicated their lives to helping them. Here in eastern Washington, I have a special clinic just for patients with inherited diseases, and it's one of my favorite parts of what I do.

Here's the official music video of "Renegades," which shows different people with disabilities excelling, overcoming, and dominating. It's just awesome!

Stars' Eyes: Babe Ruth

Many people don't know that Babe Ruth had severe amblyopia.

You probably know that George Herman Ruth Jr., also known as Babe, The Great Bambino, and The Sultan of Swat, was indisputably one of the greatest baseball players of all time. You may know that he came up with the Boston Red Sox before joining the New York Yankees. You might even know that began his career as a pitcher.

But did you know he had 20/200 vision in his left eye? Shocking, isn't it?

After his playing days were over, Ruth was examined by Dr. Gerald Kara, who found that the prolific slugger had surprisingly poor vision in his left eye (and 20/15 vision in his right), which Dr. Kara attributed to amblyopia. Because Ruth said he had never had an eye exam before, it is theoretically possible that his poor vision developed after his career was over, but Dr. Kara found no evidence that this was the case.

Amblyopia is the most common cause of reversible vision loss in children, affecting between 3-5% of all kids. It is defined as decreased vision due to abnormal development of vision in childhood, typically in one eye, and most commonly occurs due to unrecognized need for glasses or due to eye misalignment (strabismus). It is treated sometimes with glasses wear, and most frequently by patching the child's better-seeing eye. This forced use of the amblyopic eye helps the neural connections between the eye and brain develop properly, allowing for better vision.

I love treating amblyopia. Seeing a child start with one eye that doesn't see well at all, and then, over a period of months, thanks to the diligent work of the patient and parents in helping him/her keep the patch on, watching the vision improve -- it's a very gratifying experience.

With regard to Ruth, he is just one of the countless examples of people with a vision problem overcoming their circumstances and excelling in life.

Stars' Eyes: Jeremy Poincenot

Over the past year or so, on my Facebook and Instagram accounts, I've shared dozens of short posts with the tag "Stars Eyes Sunday," describing a famous person with an eye disease. These were popular posts, and I plan to continue sharing similar stories on this blog. Here's the first!

Jeremy Poincenot ("Points-en-oh") was a 19-year-old college sophomore at San Diego State when he suddenly lost his central vision in his right eye, followed shortly thereafter by his left. He was diagnosed with a rare optic nerve disorder, called Leber hereditary optic neuropathy (LHON).

LHON is a genetic condition caused by mutations in the DNA within mitochondria. Patients with LHON typically develop sudden, painless, central vision loss in one eye, followed weeks later by the other eye. The likelihood of developing LHON in a person who carries the mutation depends in part on what fraction of their mitochondria, the energy-producing organelles within each cell, harbor the genetic change. LHON occurs most frequently in young males, but females and much older patients can be affected, as well.

Jeremy hasn't let his severe vision loss hamper his love of the links. In fact, just today, he won the United States Blind Golf Association's National Championship! Jeremy has been featured on ABC's 20/20, MTV, and GolfWorld, and his website can be found here.

Jeremy Poincenot, winner of the 2016 US Blind Golf Championship, as shared on his Twitter account.