Thank you so much! } Even the common Computer Vision Syndrome has all sorts of NSBD problems where just prescribing a refractive correction and ocular lubricant might not be solving the patients problems. Some people experience a combination of abnormal head postures. For most of his adult life, Billy Dowell Jr. has lived with a serious immune-mediated disease process that has threatened not only his dream of playing professional golf, but his very existence. This procedure is typically performed laparoscopically, which involves inserting small instruments through multiple small incisions in the upper abdomen. . Vertical Heterophoria. Our normal supraduction and infraduction abilities are limited, so improving these ranges to compensate for a vertical deviation can be challenging. Factors associated with base-in prism treatment outcomes for convergence insufficiency in symptomatic presbyopes. That leads to a deposit of pigment granules on tissue located at the angle where the iris and cornea meet. There is a problem with Open-angle glaucoma: Epidemiology, clinical presentation, and diagnosis. Interventional study (clinical trial) studies new tests, treatments, drugs, surgical procedures or devices. Accessed Aug. 22, 2022. 4th ed. Glaucoma is a group of eye conditions that damage the optic nerve. 1. 6. It is measured by Base Out Prism ( BO). There after smooth and Jump vergence therapies. Forehead wrinkles above the physically higher eye. information submitted for this request. Theyve been called migraines. To provide you with the most relevant and helpful information, and understand which Hypophoria: Hypophoria is downward turn or deviation of the eye that only occurs some time. The disorder can also cause headaches. Tamhankar MA, Ying GS, Volpe NJ. .quiz-btn01 { Prescribing relieving prism for horizontal, non-strabismic, binocular vision disorders can be done by calculating Sheards or Percivals criteria by using clinical data or analyzing fixation disparity and determining the associated phoria.1 At near, fixation disparity and the associated phoria can be found with a Wesson card. When prescribing ground-in prism, high index lenses, plastic frames and frames that are smaller in size help improve the weight and cosmesis of the lenses. In recent years, the important link between vision and our ability to balance has become better understood, and with that, Your Guide to Post Traumatic Vision Syndrome. position: relative; There is no guarantee that every individual who qualifies and wants to participate in a trial will be enrolled. Educating patients on the benefits of prism wear is key in helping get them on board in these cases. Prisms arent as successful in treating convergence insufficiency and are used less frequently than other treatment modalities. In: Ferri's Clinical Advisor 2023. The bulging iris partially or completely blocks the drainage angle. transition-duration: 0.3s; Heterophoria with good fusional control is termed as compensated Heterophoria and where the fusional control is partial or lost, then the term Decompensated Heterophoria is applied. Her cover test revealed a 25 PD constant right esotropia with a 2 PD constant right hypotropia. She was able to fuse on the Worth Dot test with 12 PDs base-out and 3 PDs base-up OD. information and will only use or disclose that information as set forth in our notice of There are many different ways to do this, but the best method to use depends on the type of binocular vision disorder for which you are prescribing. Covered eye upon uncover moves from the temporal side to the nasal side > Exophoria. Integrate Accommodation > Vergence Relationships. At a glance: Glaucoma. Her cycloplegic retinoscopy was +3.00sph OD and +2.25sph OS. Basic Exo and Eso are relatively asymptomatic. the unsubscribe link in the e-mail. Filter Locations By Adams, MN . Effectiveness of prisms in the management of diplopia in patients due to diverse etiologies. After a preliminary prescription of fusion prism is determined, it is recommended that you trial frame the patient and have them look around to see if they experience any diplopia when viewing objects in the room. Most trial lens sets come with prism lenses, but for larger angles of strabismus, it may be helpful to use a Fresnel prism trial set. What is glaucoma? 13. Through her full plus spectacles, she still had a 14 PD constant right esotropia and a 2 PD constant right hypotropia. This content does not have an Arabic version. Vertical or torsional phoria have no particular affinity for any refractive error. On initial presentation, her best-corrected visual acuities were 20/40 OD and 20/25 OS. Accessed Sept. 16, 2020. These tests do not involve expensive equipment and they are easy to master with a little effort from the practitioner. Participant eligibility includes age, gender, type and stage of disease, and previous treatments or health concerns. So be aware of these risk factors: Some people have narrow drainage angles, putting them at increased risk of angle-closure glaucoma. They were able to switch me with a patient who was already there, they treated me with respect, and helped my son have confidence by getting him the eye care he needed that day. } Learning problems/ Attention Deficit Hyper Activity Disorder (ADHD). box-shadow: 19px 16px 26px rgb(14 37 58 / 9%); When to see a doctor Generally, see your doctor if you experience any recurrent, sudden, severe, or prolonged and unexplained dizziness or vertigo. Effectiveness of base in prism for presbyopes with convergence insufficiency. Hyperopia + Esophoria > Full plus / consider added plus, Myopia + Exophoria > Optimum minus / minimum minus (MM). A single copy of these materials may be reprinted for noncommercial personal use only. For more information about our eye care services. Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education, Advertising and sponsorship opportunities. But people who live with this form of binocular vision dysfunction have their eyes slightly out of vertical alignment with each other, and one line of vision doesn't match the other - they struggle to see one clear image. Unfortunately, the above symptoms arent the only ones linked to VH. Ive tried all types of pain medications, but I still get headaches., My neck and the back of my head and shoulders really bother me. .quiz-btn01:hover { 1994, Philadelphia, PA: Lippincott Williams & Wilkins. Prism can be a powerful treatment for many conditions and for many patients, specifically for those who suffer from asthenopia or diplopia. Sensory Anomalies. Cervical dystonia (spasmodic torticollis). https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/glaucoma. It increases accommodative convergence and also increases fusional divergence to maintain fusion of the stationary target. Vertical heterophoria is a type of binocular vision dysfunction which is believed to be caused by a lack of proper coordination between the two main vertical eye alignment mechanisms; the balance (vestibular) system and the vision (oculomotor) system. Divergence insufficiency is associated with systemic and neurological disorders, so we must rule out any underlying conditions that may be causing it. International patient clinical studies questions. A blow-out fracture is an emergent situation, as the sinus can cause a negative pressure that pulls on the inferior orbital wall, trapping the inferior rectus muscle, resulting in an inability to elevate the affected eye and vertical diplopia. But other parts of the drainage system don't drain properly. Accessed July 23, 2019. 3. Copyright 2020 - 2021 Optography, EVALUATION OF A CASE OF CONCOMITANT STRABISMUS, Quantitative measurement of angle of Deviation, Spectacles and Contact lenses Myopia Treatment, Insertion And Removal Of Contact Lens - Optography, Relieving prisms, Refractive modification, VT, Heterophoria is the latent muscular deviation of the eyes, which is held in position by the faculty of fusion (The 2. Basic Esophoria and Exophoria. The misalignment can be congenital or acquired from a brain injury/concussion or stroke. Very friendly staff and doctor, did not have to wait for long to be called, and was treated respectfully. Optometry has the answers to many unresolved visual problems which are symptomatic yet have negligible refractive deviation. This point is called Near Point of Convergence(NPC). . Arch Ophthalmol. health information, we will treat all of that information as protected health However, I am still getting dizzy and having severe headaches.. If the misalignment is severe enough, the patient will experience double vision or diplopia, while minor misalignments will have the patient still see a single image, but still cause eye strain, which can lead to other problems. Care at Mayo Clinic Print Overview Sleeve gastrectomy, also called a vertical sleeve gastrectomy, is a surgical weight-loss procedure. One thing to take note of is that some of these symptoms are also shared by individuals who have an inner ear disorder, MS, sequela of a stroke or Menieres disease. Activities such as jogging sometimes stir up the pigment granules. Low Hyperopic or Low myopic in nature: can lead to pseudomyopia. Basic eye tests may not detect these, and some of the symptoms may not lead people to suspect a vision issue. RAF Near Point Rule (RNPR) is a routinely used instrument in optometry practice to measure the Near Point of Convergence (NPC). Book an Appointment Your dizziness can make it seem as though the sign is moving or that your vehicle is rolling backward while your foot is on the brake. Another condition commonly treated with prism is vertical heterophoria, or vertical strabismus. Dr. Cheryl Berger Israeloff of the Neuro Visual Center of New York not only specializes in diagnosing VH and other binocular vision disorders, but in treating them as well. My dizziness is completely gone after wearing my new glasses. It decreases accommodative convergence and also increases fusional convergence to maintain fusion of the stationary target. As a result, fluid can't circulate through the eye and pressure increases. Since vertical heterophoria is a type of binocular vision disorder (BVD), experts in this field are the best specialists to consult. https://www.merckmanuals.com/professional/eye-disorders/glaucoma/overview-of-glaucoma. Comprehensive adult medical eye evaluation preferred pattern. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. 1995, St. Louis, Missouri: Mosby. Traumatic brain injuries often result in vision issues, so it is important to recognize those symptoms and seek proper treatment immediately. Horizontal phoria responsible for all vergence dysfunctions and these two phorias (Exophoria and Esophoria) are associated with all refractive errors. Vertical deviations often cause patients to experience significant symptoms even when the deviation is small. Vision Therapy (The best choice in this case). Accessed Aug. 24, 2022. Randot Preschool stereoacuity of at least 400 seconds of arc, No use of a plus add for near or base-in prism for at least 2 weeks preceding enrollment. In some people, scientists have identified genes related to high eye pressure and optic nerve damage. It is one of the leading causes of blindness for people over the age of 60. Success of prisms in the management of diplopia due to fourth nerve palsy. The covered eye upon uncover shows no movement > Orthophoria. MS is a chronic autoimmune disease that impacts the CNS, including the brain, leading to vision issues. Finally, we found Dr. Levi Zurcher and his eye therapist Rain. information is beneficial, we may combine your email and website usage information with color: #ffffff; Vertical heterophoria is a type of binocular vision dysfunction that occurs when the eyes are not in complete alignment, and can cause eye strain by overusing eye muscles to compensate for the difference. If we can embrace this pattern of visual analysis, we will surely make a difference in our practices as well as establish our professional status. transform: translate(10px); This limited blood flow may be caused by the buildup of fatty deposits in the arteries or other conditions that damage circulation. This fluid also is known as the aqueous humor. Researchers have found gene mutations associated with cervical dystonia. Relocation outside of area of an active PEDIG site within the next 15 months is not anticipated. Hence, it should be mandatory for every Optometrist to analyze Basic Binocular Functions and relate them to the Ametropia and modify the refractive compensation for better visual prognosis. Vertical heterophoria is caused by vertical misalignment of the eyes, with misalignments as small as 0.25 prism diopters resulting in significant symptoms. At American Family Vision Clinic, we specialize in diagnosing and treating visual motion sensitivity, a condition that can significantly impact your daily life. There are two main causes of vertical heterophoria: traumatic brain injury (such as an accident or a stroke), and congenital causes. Vertical heterophoria (VH) is a type of binocular vision dysfunction (BVD) resulting from a vertical misalignment of the eyes. AskMayoExpert. information highlighted below and resubmit the form. Particular issues which may occur include: The dizziness caused by vertical heterophoria can also lead to trouble balancing, which can make everyday actions like going up the stairs dangerous. Amplitude for smooth vergence: 35BO & 15BI. 632. For this patient wears goggles with red lens in front of the left eye and green lens in front of the right eye and views a box with four lights one red, two green and one white. If the patient is still symptomatic, combining prism and vision therapy may help improve convergence and divergence ranges. Its been ongoing, unrelenting, and extremely unpleasant. All You Need to Know About Double Vision (AKA Diplopia). } However, these more provide short term relief than proper treatment. Low MEM (Accommodative Lead) -> Against or no motion, [Low Hyperopic or Low myopic in Nature can lead to pseudomyopia]. Randomised clinical trial of the effectiveness of base-in prism reading glasses versus placebo reading glasses for symptomatic convergence insufficiency in children. However, vision therapy by certified neuro-optometrists can effectively treat the condition. Your VH symptoms can come in waves throughout the day, leading you to feel 100 percent one moment and as if youve been locked in a centrifuge the next. 400 students aged 18-30 years old, in the Optometry clinic of the Imo State University, Owerri . They do what they can to make the appointment comfortable. Sign up for free, and stay up to date on research advancements, health tips and current health topics, like COVID-19, plus expertise on managing health. Would recommend to anyone. For myopia, the SE must be within 0.25D of the full myopic correction. 2. Decrease Positive Relative Accommodation. It is measured by Base in Prism (BI). If that system is blocked or isn't functioning well, the pressure inside the eye (intraocular pressure) builds, which in turn damages the optic nerve. Clinic. Prism is prescribed to these patients to partially or completely eliminate the motor demand so they are able to fuse. His illness caused painful pelvic joint inflammation, resulted in a perforated bowel, and led to glaucoma. Visual Motion Sensitivity: Causes, Symptoms, Diagnosis, and Treatment Options. A jerking motion of the head also may occur. Glaucoma can occur at any age but is more common in older adults. Decompensated Heterophoria can lead to NSBD and in extreme cases, Heterophorias (Manifest Squint). Trouble coming to a complete stop at lights and signs. 2016;28(1):38-42. Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. .quiz-btn01 h2 { The drainage angle formed by the iris and cornea remains open. Trapezius muscle discomfort/pain, secondary to the head tilt. It Can Be Related to Issues With Your Visual System. While viewing the card, the patient reports what color line the black arrow is aligned with. High MEM (Accommodative Lag) -> With or Normal Movement. Many forms of glaucoma have no warning signs. Refractive Findings is not proportional to the degree of Subnormal VA. You could also experience pain whenever you move your eyes. 5. https://www.wolterskluwercdi.com/facts-comparisons-online/. This Can Be Directly Related to Your Vision. If you experience symptoms that come on suddenly, you may have acute angle-closure glaucoma. Cervical dystonia can also cause your head to uncontrollably tilt forward or backward. The perception that stationary objects at the edges of your vision are moving. Usually, fluid (aqueous humor) in the eye flows freely through the anterior chamber and exits through the drainage system (trabecular meshwork). width: 80px; J Pediatr Ophthalmol Strabismus. High near point Exophoria (Near > Distance), Decrease positive Fusional Vergence (BO Range), Fails Binocular Flippers (specially the Plus Side). J Neuroophthalmol. Horizontal prisms > not the first choice. If an intermittent horizontal strabismus patient has a primary vertical deviation, vertical prism may help improve their ability to fuse the horizontal deviation. https://www.aao.org/eye-health/diseases/what-is-glaucoma. Please contact the study team for the most up-to-date information regarding possible participation. While [], As a local eye doctor, our primary concern is the health of your eyes and ensuring your vision is as [], 400 Yauger Way SW. Bldg 1, Ste A Olympia, WA 98502, Your Guide to Binocular Vision Dysfunction (BVD) and Vertical Heterophoria (VH), straightening up quickly after bending over. Although small amounts of vertical prism can be prescribed in contact lenses, patients who need prism usually have to wear it on a spectacle lens. This misalignment can be horizontal, vertical, or both. I go to the eye doctor this week and they do a Binocular Vision Dysfunction test. https://glaucoma.org/childhood-glaucoma-diagnosis-treatment-and-hope/. Retrospective case reviews of patients with an acquired hyper deviation secondary to a superior oblique palsy found that 76% to 92% of participants were successfully treated with prism alone.5,6. American Academy of Ophthalmology. Perceiving stationary objects at the edges of your vision as moving images. The difficulty of training vertical vergence ranges along with the success in treating vertical deviations with prism make prism the most appropriate initial management tool in these patients. All Right Reserved. Vertical heterophoria is a binocular fusion disorder where one eye has a tendency to drift upwards compared to the other. Some textbooks relate torsional phorias to be associated with oblique Astigmatisms. However, hyperphoria can decompensate due to stress on the visual system or on the general well-being of the patient ( Chapter 4 . How Traumatic Brain Injuries Can Affect Your Vision, Traumatic brain injuries (which, despite the name, need not be incurred in incidents many of us would consider traumatic) are not altogether uncommon, 5 Things You Should Know About Traumatic Brain Injuries. Accessed Aug. 24, 2022. Then the values are compared with the expected to arrive to a proper diagnosis. In patients with a secondary vertical deviation, however, vertical prism is not an appropriate treatment. One study successfully treated 87 patients with divergence insufficiency between two and 18 prism diopters (PDs) with prism with none of the patients in the study requiring additional treatment or surgery.3 Another study found that 100% of patients with divergence insufficiency (30 patients) had success with prism.4. https://www.glaucoma.org/glaucoma/. Discover diagnosis & management of vision problems resulting from Parkinson's with our neuro optometric rehabilition tailored to enhance your visual well-being. include protected health information. The office is family friendly and everyone is so patient with the little ones. border-radius: 500px; Although prescribing it can seem intimidating at first, with practice and a bit of trial and error, you can perfect your ability to prescribe prism for your patients in no time. Botulinum toxins. Symptoms generally begin gradually and then reach a point where they don't get substantially worse. Participation eligibility Rather, treatment for a secondary vertical deviation should aim to improve horizontal sensory and motor fusion through vision therapy so the patient is not in the strabismic position as often, thus eliminating the vertical deviation. Uneasiness if places with high ceilings, due to sensory overload or disorientation due to a high level of visual stimuli. The disorder sometimes resolves without treatment, but sustained remissions are uncommon. This content does not have an English version. flex-direction: row; Scheiman M, Wick B. Jacobs D, et al. As this nerve gradually deteriorates, blind spots develop in your vision. For the first time, someone who knew what they were doing was intently studying my daughter, really trying to figure out all of her eye issues, and his therapist Rain is one of the most patient and lovely people that Ive ever had the good fortune to meet. Click here for an email preview. A child may be born with glaucoma or develop it in the first few years of life. Divergence insufficiency patients are often symptomatic for diplopia and asthenopia at distance and may present with a decompensated distance phoria. It is at this point that the symptoms of VH begin to appear. Fresnel membrane prisms can be very useful for many aspects of prescribing prism. Br J Ophthalmol. It's a blessing that they care enough to work with people who have all different types of insurance from work to state coverage. Optom Vis Sci. Dr. Jenewein is an assistant professor at Salus University, Salus Universitys Principal Site Investigator for the Pediatric Eye Disease Investigator Group, a Fellow of the American Academy of Optometry and a Diplomate of the Binocular Vision, Perception and Pediatric Optometry Section of the Academy. This is one reason Dr. Israeloff is so thorough when it comes to diagnosing your binocular vision dysfunction. Ive been through the roughest of the rough, says Billy, a resident of Jacksonville, Florida, who moved there in May. Glaucoma. 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). Glaucoma (adult). For the Treatment of Vestibular Disorders Binocular Vision Dysfunction and Vertical Heterophoria: a Brief History. Fortunately, effective treatment options are available. 2013;97(11):1415-9. Vertical heterophoria is a form of binocular vision dysfunction. This patient continued with vision therapy to help improve her sensory and motor fusion with the hope of eventually titrating down the amount of prism she wears. Divergence insufficiency revisited: natural history of idiopathic cases and neurologic associations. At the follow-up examination, she reported no diplopia in her glasses, and, eventually, she was able to see 250 seconds of arc RDS stereoacuity. Prism can be used alone or in combination with vision therapy to treat basic esophoria and exophoria. Those suffering from vertical heterophoria may also experience a feeling of heaviness near the crown of the head, comparable to the pressure from sinus pain. The patient is also instructed to keep the words around the lines clear to control accommodation. Facts & Comparisons eAnswers. As a general rule, the American Academy of Ophthalmology recommends a comprehensive eye exam every 5 to 10 years if you're under 40 years old; every 2 to 4 years if you're 40 to 54 years old; every 1 to 3 years if you're 55 to 64 years old; and every 1 to 2 years if you're older than 65. I trialed 2 PDs of base-down prism using a Fresnel prism over the right eye and dispensed at the initial visit. PFV is recorded as the prism magnitude where vision is first blurred (or break if no blur is reported). align-items: center; Abnormal rhythmic eye movements usually accompany the symptoms of benign paroxysmal positional vertigo. Most of these patients are examined on the basis of Refractive Error only and the Binocular Vision aspect is often ignored. If a patient sees four dots in free space or gives a diplopia response but is able to fuse with prism, perform a unilateral cover test. Elevated eye pressure happens as the result of a buildup of fluid that flows throughout the inside of the eye. Binocular Vision Dysfunction (BVD) is a condition where the line of sight from one eye tends to be out of alignment with the line of sight from the other eye, making it difficult for the eyes to work together as a coordinated team. National Institute of Neurological Disorders and Stroke. Symptoms line up perfectly, as do test results. }. Make your tax-deductible gift and be a part of the cutting-edge research and care that's changing medicine. Kerala J Ophthalmol. Merck Manual Professional Version. A rare disorder that can occur at any age, cervical dystonia most often occurs in middle-aged people, women more than men. Anxiety, specifically while driving, is also a common symptom of vertical heterophoria. This is the ability of a person to excite Fusional Convergence. In some people, the pain from cervical dystonia can be exhausting and disabling. Glaucoma, open angle. This can cause tingling, numbness and weakness in the arms, hands, legs or feet. To determine the associated phoria, add prism in the appropriate direction until the patient reports that the arrow is aligned with the center line. Vertical heterophoria can occur when one eye is slightly misaligned, resulting in serious problems. Parkinson's Vision Problems: Expert Diagnosis & Management - Neuro-Optometry Solutions. Accessed July 23, 2019. display: flex; Growing concern about experiencing a bout of dizziness while youre driving due to the anxiety caused by VH, which can be alleviated through treatment for dizziness. I had such a good experience with the clinic. At our optometry clinic, we specialize in the diagnosis and management of Nystagmus, a . This test is done by +- 2.00D Accommodative Flipper. The first hurdle is ensuring your patient is comfortable with wearing spectacles. Symptoms generally begin gradually and then reach a point where they don't get substantially worse. Determining how much prism is required for improved fusion, or fusion prism, is another method for prescribing prism for your strabismic patients. A 5-year-old female initially presented for a strabismus and amblyopia evaluation. 2012;95(2):192-7. Refraction with Cyclopentolate = +3.00DS/-0.25DC x 90. Upon examination, she had a small exophoria and a 3 PD right hyperphoria at distance and near. A primary vertical deviation is the same in presence and size whether the patient is strabismic or aligned. I could feel my symptoms start to go away after the first office visit. Parent and patient understand the protocol and are willing to accept randomization. Injecting botulinum toxin into the affected muscles often reduces the signs and symptoms of cervical dystonia. Vertical Heterophoria Treatment Explained. My headaches, neck ache and eye pain are so much better since I started wearing my new prism glasses. Types include: The purpose of this study is to determine the effectiveness of home-based computer therapy for symptomatic convergence insufficiency (CI) compared to traditional home-based near target push-ups and placebo treatment. Get regular eye examinations. Difficulty in changing focus from near to far or vice versa. When I walk, I often bump into things., When I am in a large department store or crowd, I feel rather uncomfortable and anxious., Ive seen multiple doctors, had a CAT scan and MRI, and all of the doctors say that I am fine. Patients are often misdiagnosed as having vertigo and migraine disorder. High Near Point Esophoria (Near > Distance), Decrease Negative Fusional Vergence (BI Range). Mayo Clinic does not endorse companies or products. Alternative medication. If a patient does not have good potential for sensory fusion, then the assistance that prism gives to the motor system wont allow for normal fusion, and it doesnt make sense to prescribe it. Precursor of Environmentally Induced Myopia/ Late onset myopia which is preventable. padding-bottom: 5px; Reports also include aching in your neck and shoulders due to a head tilt. Reduced NFV (BI) at near (Less than 6BI). Mayo Clinic Health System Red Wing has6 Healthgrades 5-Star Rating s1 Healthgrades Quality Award185 Affiliated Provider s. CentraCare - Monticello Hospital. This leads to the symptoms of BVD such as headaches and dizziness. Mayo Clinic College of Medicine and Science, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Graduate Medical Education, Mayo Clinic School of Continuous Professional Development, Mayo Clinic on Incontinence - Mayo Clinic Press, NEW Mayo Clinic on High Blood Pressure - Mayo Clinic Press, Mayo Clinic on Hearing and Balance - Mayo Clinic Press, FREE Mayo Clinic Diet Assessment - Mayo Clinic Press, Mayo Clinic Health Letter - FREE book - Mayo Clinic Press, Financial Assistance Documents Minnesota, Mayo Clinic Research Finds Risk of Glaucoma Blindness Drops by Half, Mayo Clinic Minute: Protecting your eyesight from glaucoma, Mayo Clinic Q and A: Glaucoma -- the 'silent thief of sight', Gradually, patchy blind spots in your side vision.
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