Although ocular and visual migraines are used interchangeably, they are different entities. If the symptoms occurs in both eyes it is more likely a visual migraine; whereas if it occurs in one eye it is more likely an ocular migraine; however, if there is sudden new onset of vision loss, you should seek medical care. 

Ocular or Retinal Migraine
An ocular migraine is a rare condition and is also called a retinal migraine.  It is thought to be due to reduced blood flow or spasms of the blood vessels of the retina (back of the eye).  This leads to temporary vision loss or blindness of one of the eyes.  The person experiences a blind spot which can become enlarged during the episode.  Typically, the symptoms resolve within an hour from onset.  This can be pain-less or can occur with or be followed by a migraine.  Complications may include irreversible vision loss and the exact incidence of irreversible vision loss is unknown.

Visual Migraine or Migraine Aura
This is a much more common and is considered a more harmless condition.  It is more commonly called a migraine aura and is characterized by temporary visual loss that lasts less than 30 minutes.  It is thought to occur due to abnormal electrical activity in the cortex of the brain.  This typically affects both eyes unlike the ocular migraine.  Symptoms vary much more and may include flickering blind spot, flashing lights, wavy or zigzagged ring of colored light, or a blind spot that moves across the vision.  A migraine headache may occur shortly there after or no migraine can occur.  

Treatment
Treatment is highly individualized depending on frequency of migraines; however, those with either ocular or visual migraines are recommended to receive medications to reduce incidence of migraines (migraine prophylactic medications).  These medications may include anti-seizure medications or antidepressants.  Additionally, they are recommended to avoid potential triggers of migraines, which may inclue bright light, stress, hormonal changes, nitrates, fasting, and wine among many others.  

Image from:  ​https://www.medicalnewstoday.com/articles/314917

Most people are familiar with an ultrasound being utilized during pregnancy or for viewing abdominal disorders; however, you may not have heard of it being used to view the eye. 

What is an ultrasound?
It is a machine that utilizes high frequency sound waves (also called sonography) to create images of the inside of the body.  The reflections (or echoes) of the sounds waves create the picture.  Typically, this would be performed at an ophthalmology office with a specialized ultrasound; however mine was performed at a hospital ER with an ultrasound that can be used on any body part.

How is an ultrasound performed?
​You will be in a seated position and asked to close your eyes.  Once your eyes are closed, they will place a gel on the top of your eyelids, which will be cold.  From there they place the ultrasound wand (transducer) over your eyelid where the gel was placed and ask you to look in specific directions to view all areas of the eye. 

There is another specialized eye ultrasound machine in which the eye is numbed with special anesthetic eyedrops and a small probe is placed against your eye to visualize. 

What should I do to prepare for an eye ultrasound?
Nothing really.  The procedure is non-invasive and only takes minutes if checking for a retinal detachment, but could be 15-30 min if viewing the whole eye.  Just recognize the gel will be cool on your eyelid.  If they use anesthetic eye drops, this may sting a little when getting administered and lead to extra eye dryness afterwards.

What can an eye ultrasound detect?
This imaging can detect quite a few different abnormalities and this by no means is comprehensive.  An eye ultrasound is helpful to detect retinal detachments, cancer of the eye (retinoblastoma or melanoma), bleeding within the eye (vitreous hemorrhages), damage to the bones around the eye, foreign bodies in the eye, or significant swelling (inflammation).  Additionally, when patients have cataracts it may be difficult for the back of the eye to be visualized normally due to the cloudiness of the eye so ultrasound may be used.

Image from:  ​https://radiopaedia.org/cases/normal-eye-ultrasound

I have been wanting to write this blog since I found myself able to speak about my vision loss.  As with many things in life, I set the project to the side for unknown reasons.  This blog will follow my journey, discuss diagnostic exams for vision loss, and treatments that may be beneficial.  Perhaps it can help just one person in their own vision loss journey or describe what someone you know may be going through.

On a Saturday in August, I attended a going-away party for a sweet friend at a coffee shop.  Afterwards, I drove home and was chatting with my husband.  All of a sudden, I couldn't focus my vision on anything.  Objects were moving and blurry.  It seemed as though everything was oscillating (moving up and down rapidly).  I waited nearly 15 minutes before stating anything to my husband as I thought it would just go away.  After letting him know, I laid down, rested my eyes, and decided to meditate because I figured it was stress even though I was having a great day which felt stress free.  Nothing really changed but I convinced myself that I was okay and my vision wasn't improving because I was so focused on what I was seeing. 
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I had my own going-away since I had just completed my last day of full-time job as I transitioned to being an adjunct professor and part-time pharmacist.  My husband asked if we should cancel, but I insisted we go.  At my going-away party, I tried to act as though nothing was wrong; however, I couldn't read the menu (which is a huge problem when you have celiac disease and have to be extra cautious) and the whole world seemed to be moving.  My husband helped secretly read the menu to me and assisted me when I wasn't quite sure how to do anything without my eyes.  After we got home, we decided I should go to the ER to ensure I did not have a detached retina since intervention for that is extremely time sensitive.

At the hospital, they did not have an ophthalmologist available ​on a Saturday night and doubted that the one on call would come in on a weekend so they decided to do an eye ultrasound (more to discuss this in the future).  The eye ultrasound showed no retinal detachment so they were moving forward with blood work, a CT scan of the brain, and a MRI of the brain.  Due to the time of evening, they admitted me since the MRI would not be accomplished until 1am.  Nonetheless, all the tests came back essentially normal and I was discharged the next day.

By the second day, the oscillating movement had minimized, but my left peripheral vision was extremely blurry.  I got an "emergency" retinologist appointment for that coming Tuesday, which I had a few diagnostic exams completed with no obvious abnormalities.  My retinologist thought that it could be an ocular migraine and told me if it didn't improve to come back in a few weeks.

Needless to say, it didn't improve and continued to progress each month, each week, and even each day from there.  I will be writing soon to discuss more regarding the progressing of vision loss, diagnostic exams, and information about all of the potential diagnoses that were high probability at one time.