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COFFEE TALK
Hi, everybody. Welcome back to coffee talk. I’m Dr Erica Barron and this is our head LVT, Ellen Carozza. We have a special guest today which we will introduce you to in just a minute. But it’s nice to see you here in Arlington, Virginia, and feel free to comment below with any questions you have. And today, we have a very special guest. We’re very excited. I’m going to let Ellen do the honors and introduce him to you.
DR TRAVIS STRONG Well, this is Dr. Travis And you guys all know him online as the vegan veterinarian. He has been coming up the East Coast since he went to go take his ophthalmology boards recently in North Carolina. So cross your fingers he has passed. And he can visit us here at NOVA Cat clinic. And today, we’re going to discuss everything about the feline eye. So before we jump into that real fast, Travis, what’s your favorite color? Probably burnt sienna or puce. One of those two. What color is puce? I think that’s exactly what that was. No. That’s great. My favorite color is red. And Ellen’s is purple. Yes. We all know that. I wanted throw on a little ice breaker. Anybody below wants to tell us what your favorite color is that’d be great. But today, we’re going to talk to you since Dr. Strong really likes eyes. We figured we talk to you. And help give you some tips about things you would want owners to know about eyes. So what is something you would want an owner who brought a cat to you to know?
EYE EXAM
Well, first of all, if it’s usually pretty charismatic then it’s pretty obvious when there’s an eye problem. You’re walking around. you’re squinting. And then you’re like, “Well, could there be something wrong with the tail?” You kind of know that, “Hey. That’s probably an eye issue,” at that point. So squinting is definitely a reason to come see an ophthalmologist. Nine times out of ten it’s going to be probably something called feline herpes virus that’s causing a problem. But it could be other things. And there’s things that we can do to identify that. It might be an ulcer caused by the feline herpes virus. And it might get infected. Or it might have something called the [inaudible] associated with it that you really need an ophthalmologist to identify and talk to you about the treatment options. That’s one reason.
DIFFERENT LOOKING EYES
Well, another one is you’re seeing things different. The eye looks different to you for whatever reason. I think you need to trust your instincts on that. You’ll have the old phots of the eye. And if you think the eye looks different consult those old photos. Sometimes those can be very telling. And I’m sure many of you have taken lots of photos of your cat. And lots of them of the eyes because you all think your cat eyes are so beautiful. So you’re seeing pigment changes with the iris in particular. That’s one that you want to watch out for, little freckles on the iris might look fine. But if they’re changing, if they’re growing, you want to identify that. You want to know that. And you want to start taking photographs of that to watch it change.
NOTICE CHANGES Real fast, just to interject to remind you, the iris is the colored portion of the eye. The pupil is the dark part in the middle. And I always remind people since everybody thinks their cat is the cutest yes. Everybody’s cat is the cutest. Just ever so often when you take a picture of your cat’s face on the phone just open it and make it bigger and look at their eyes and see if something’s changed. And a lot of times when I have a patient and I start noticing differences or things like that I just remind them to start doing that. Is that familiar with what you tell people? Exactly. And many times it’s good to use a light source that will cause that pupil to get smaller. And then you can see more of the iris face. Because the pupils going to get small in the light and you can see better details if you can make that pupil small. We try to get the same photos under the same lighting situations, whether it’s on same table or at the same time of day, so you can compare apples to apples. Now going, just to rewind it back a little bit, when you’re talking about changing of the color of the iris, what about the older cats when they start having that old cat-eye look when the color starts to change a little bit? What can a client do to know the difference between, “Is there something really happening to my cat-eye, or is this normal or the aging?”
COLOR CHANGES
Well, when in doubt, always have somebody to take a look at it. Because color change can happen for many reasons. And this little freckle, as we call it, that can enlarge and represents something more pernicious called feline sequentrum and a few as iris melanoma?
Ellen’s referring to is just maybe more diffused changes of the iris, just kind of slowly looks a different color. So what you want to look for is to see if it’s the same between the two eyes, as one changing color compared to the other one. It’s bilateral, maybe it’s not a big deal. But there’s something called anterior uveitis.
And chronic anterior uveitis can occur for many different causes. There’s intraocular inflammation. If that’s there, chronically, it can change the color of the iris as well. And there’s some serious conditions that can lead to this, infectious disease, other chronic underlying systemic disease, or can be completely idiopathic and meaningless, but you need to treat it anyway. So when in doubt, seek veterinary care to help work it out.
ACUTE BLINDNESS
HYPERTENSION But the other one– I think there’s one that you should– it seems pretty obvious, but if you ever noticed acute blindness, if your cat is suddenly wild at home, that’s something to bring in right away. With cats and acute blindness, there’s a few causes, but the most common one is going to be some retinal problem. And for most cats, we worry about hypertension that led to either retinal hemorrhages or retinal detachment. And any chance of getting vision back– it’s touchy, to begin with, but you need to act quickly to try to come in, determine if the blood pressure is high, and start treatment right away. So don’t put that off if you notice acute blindness. Your cat will often be disoriented and the pupil will be wildly dilated. Yeah, so a lot of times, for me, when I feel that I’m looking at one of my patients on the table, and if the others haven’t really noticed that they’re blind, is a chronic thing, right? Because they’ve gotten used to it, or they’ve, sort of, hit it as it went along, or it’s not as jarring because it took a while, right? But usually, with acute blindness, I find when I see a patient and they went acutely blind, a lot of times they’re howling or yowling, they’re pushing in the things. And sometimes they’re head pressing because they’re trying to find things that their whiskers are trying a little bit. Ellen, what are some of the things you’ve noticed, in passing, If you’ve seen a patient go blind, suddenly?
OCULAR TUMOR Well, I mean, unfortunately, I don’t have the opportunity to go downstairs and actually see clients with you guys. But when we have patients that come up here, and they’re presented for a medical procedure, sometimes I can be like, “Do we know that this cat’s eyes are actually really swollen?” We had a case of a patient that came in for a nasal flush and the face, the shape of the face was actually changed. And then it’s like, is he really here for a nasal flush or does this cat have a tumor behind its eye? What else is going on? So when we have patients that come in for procedures, the first thing I always do is I actually look at them for any kind of visual facial changes, or even with the eyes, and I always bring it up beforehand because the last thing I need is a patient under anesthesia with more complications or a different problem we need to address, since some of these problems actually crop up quite quickly.
FELINE HERPES So what I’m hearing you all say, what Dr. Strong is saying is the most common things he would want you to know or to think about when you’re bringing your cat in for any eye issue is to know that if they’re walking around squinting, it might be an ulcer or something like that, even though a lot of times it’s feline herpes viruses. We did. Everybody likes to know about the kitten eyeballs. It’s one of our biggest questions is about the kitten eyes and how everybody wants to know the over-the-counter cures. Right. Good luck. And we’re always saying, “You need to see your veterinarian because you don’t want to be putting anything in the eyes that can actually cause further problems.” We keep reiterating it, especially to our foster and rescues out there. Just because you have the medication at home doesn’t mean you should start treating immediately.
CORNEAL ULCER Yes, there’s certain things, for example, if you have a cat with an ulcer and you put certain drugs in there, it’s not going to end well. So make sure you talk to your veterinarian if you have a cat walking around like this, or sneezing and walking around like this. Don’t just assume it’s herpes. It might be just herpes, but you should get it checked out. Also, if you notice any changes in the iris or any other changes in your cat’s eyes, [you need this?]. Dr. Travis gave us a lot of examples of how to take pictures of them in different lighting and things like that. Make sure you do that and have them seen. And then the third thing is if you notice any sudden blindness, you should bring your cat in right away. Right? Very cool. Absolutely. What’s the most bizarre thing you’ve ever seen when you’re working on some eyes? Don’t make me sick. Or what are the most interesting [cases?]? The most interesting case, so I used to live in Florida and I would work with green sea turtles down there. Oh, I thought you were going to say something else.
TURTLES
And I think half the audience just went away like, “Make it about cats [laughter].” So green sea turtles or sea turtles, in general, are vulnerable to a type of tumor called fibropapillomas. And it’s a virus-induced one and a lot of them will get these rolls around the eyes and they can even grow on the corneas themselves. So traditionally, the treatment for that, if it was invading the cornea, was to just remove the eye completely. And so I tried some surgeries on there. I was actually cutting these off the cornea and then freezing the cornea. And so that’s a lot of sea turtles and that’s one of the fields that I want to work on, more wildlife. So probably those I’ve helped in surgeries were sea lions with cataract surgeries. I didn’t do them myself since I was a resident at the time, but those are really fun. And I’m trying to see as much wildlife as I possibly can, so I’m willing to travel anywhere in the world and see anything. So if anyone’s hearing this, you’ve got something really neat on there.
POST TRAUMA SARCOMA
I would love to work with a tiger. So the most interesting thing with a cat, so there is this tumor that cats get in their eyes. The technical word for it is post-traumatic ocular sarcoma. So if you ever had a cat that had damaged the eye in a cat-claw injury that ruptured what’s called the lens– the lens is that– it’s a part of the eye that helps focus light on the retina. It lies right behind the pupil.
So cat-claw injuries that actually go through the cornea and lacerate the lens capsule or– I think I see it mostly in vehicular traumas, they get hit by cars. This can happen years later – they can develop tumors based on the lens of their eyes. It’s called a post-traumatic ocular sarcoma. They can track into the brain and track through the bones of the skull. And we talk about doing a CT scan at that point.
OCULAR ORBIT Would you actually remove the eye as part of the treatment protocol or do you have to actually see whether or not it’s already invaded other space behind the eye? You need to do imaging first because it will track through the orbit of the eye. It can break through the eye into the orbit with the orbit’s tissue around the eye, the bones around the eye. Or it can go through the– it can track, along with the optic nerve, into the brain. So you want to do imaging first. And we know if a lot of these cats have had damage to their eyes, whether it be vehicular trauma or otherwise, and they’ve done here, which means to look at the tissues after for whatever reason, we find that many of these eyes actually had early tumors that were forming. So it’s still relatively uncommon, nothing that people need to panic about, if you ever had like a cat-claw injury or your cat’s been hit by a car or something like that. But it’s something to keep in mind. And if you feel like something’s different, go see a veterinarian and mention this historical trauma.
ENUCLEATION There was one about an enucleation in an older cat. How challenging an enucleation with an older cat, 16-year-old cat? So as long as they’re systemically healthy, I do the blood work. And I might recommend doing a chest x-ray in an older cat just because you wanted to catch like heart disease early. Not that it always comes up in an x-ray, but you also want to look for just catching [inaudible] disease or cancers that have already spread to the chest just by that [inaudible] catching them before you do the expensive surgery. So those are just little nuances to an older cat. Enucleation, though, in cats is– they can be a little tricky in so far as that they have very short optic nerves. So dogs– am I allowed to mention dogs? I’ll do it briefly.
LESSER SPECIES (CANINE) EYES
So dogs have longer optic nerves, and you can play with it a little bit more during surgery. Cats have very tight, short optic nerves. And so any undue tension during removal of the eye can actually damage the optic chiasm where the nerves come together. They cross over, and you can get concurrent blindness in the other eye. It’s rare, but if there’s ever the recommendation that the eye] and the cat just– it’s okay to ask your veterinarian if they’re comfortable or if they’re familiar with the differences in cat enucleations, which is removal of the eye, compared to a dog and that they just need to be a little bit more careful about it. That is one of the worst. I do not like helping in those surgeries at all. I don’t like doing those surgeries.
ELLEN AND DR BARRON BANTER
Hey Ellen, remember that time when I was pregnant and I was sick and we had to fix that one and I was just sitting there the whole time and you were yelling at me?
But she wound up with like a post enucleation infection and we had to clean it out.
But Ruby didn’t technically have enucleation. She was born with I guess just tissue that was supposed to be where the eyes were. So it kind of looked like little red M&Ms.
If it was anybody besides Ruby, I wouldn’t have done that. I would have made somebody else do that.
What makes you get into ophthalmology?
So I’ve always liked eyes. And this is super nerdy right now.
EYE EXAM
They’re windows to the body, right. So the eyes first it’s the only place that you can actually look into the body directly. It’s also the only place that you can see blood vessels directly in the retina. So that’s really cool. You can see if there’s some sort of vascular problem, hypertension, or– in cats you see hypertension [inaudible] because the vessels rupture and they bleed or they cause retinal detachment. It’s also the only place that you can see a central nervous system directly? So when you look in the back of the eye there’s a layer of the retina called the ganglion cells and the optic nerve head itself which is the end of the optic nerve. That’s a tract of the brain. That’s actually the central nervous system. So when you look at your cat in the eye or if you look at anybody in the eye– You’re looking literally, and it’s not just poetically, you’re looking literally at somebody’s brain. And that is kind of maybe why eye contact is kind of powerful, right. So you’re looking directly. So I always loved that. And I was really into evolution and I still am.
SCALLOP EYES And how eyes evolve. And so I went to study in grad school before doing vet school. So when I was a kid I would read about how eyes could evolve and like how scallops have eyes. And simple– Really? Scallops have eyes? At the edge of their mantle which is the edge of the shell. Everyone right now just Ready to google. Look up scallop eyes and then that’s going to be like a trending thing on Google. Scallop eyes. You’ll see there are a whole bunch of little eyes and I think this is really important because people say, “Look. What good does limited vision in an eye?” Like, well, it helps the scout find out if its predator is coming. Even rudimentary vision like dark is helpful for your cat but lots of animals this is what their eyes see and, so. Yeah, lots of animals have very different types of eyes out there, so.
BLINDNESS and QUALITY OF LIFE
What about dispelling the myth for our cat owners at home that cats that are blind ultimately many of them feel like they have a diminished quality of life and we always like to say that’s not true. How do you feel about that? Whether it be cats aren’t dogs that I see in the clinic that will come in and say for whatever reason they’ve lost vision and now how can I let my cherished friend go on this way? He wouldn’t want to be blind. I know I wouldn’t want to be blind. And that [pure effort?] mortifies me. We are a very visual species. We have about a third of our brain devoted to visual processing.
And so we just have to get out of our skin a little bit, empathize with our furry companions and realize that they can smell, they can hear far better than we can. And so they delegate a lot of their senses out to hearing and smelling and they can use these to navigate their environment, even in the absence of vision.
So as long as it’s an indoor cat, they’ll do just fine. Sometimes we need to know if there’s a systemic disease that led to the vision loss and get that under control but if that’s under control and they’re just vision loss, your cat will adjust and will still live a very rich life.
It’s best not to change the home environment too much if you can help it because they can map out the home really well. I still wack my shin on the coffee table that’s been there for a long time but cats will know exactly where these things are. And so there’s no need to euthanize your cat for having loss of vision alone. They’ll adapt and they’ll still make great companions. I know some people when their pets lose vision suddenly they’ll wear like a bell or something on them so they can hear them. Not on the cat but maybe on the second cat so the blind cat knows where the other cat is