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Year: 2014

These Cry’n Eyes

The eye’s tear film is a vital but often neglected component of clear vision and comfortable eyes. It is one of the most frequently encountered conditions we see in our practice. An individual with dry eye disease (DED) may complain of dryness, burning, itching, stinging, watering, “stickiness”, “grittiness”, fluctuating vision, “smeary” vision, and contact lens intolerance. Symptoms can be severe or nonexistent. Curious, isn’t it, that watery eyes can be a symptom of DED! Some people are bothered with symptoms just occasionally and others continually.

Dry eye disease (DED) has recently been defined as a “multifactorial disease of the tears and ocular surface that results in symptoms of discomfort, visual disturbance and tear film instability with potential damage to the ocular surface…”1 In other words, there are several possible causes of DED with a variety of symptoms and consequences to the eye.

Along with a detailed history, there are several different tests we do to help differentiate the cause and severity of a patient’s DED. Risk factors for DED include:

  • Age – DED increases with age
  • Gender– Females have an increased risk, especially post-menopausal
  • Environment – Exposure to harsh environments, outdoor work, computer work, exposure to dust, dry air, airplanes, cosmetics
  • Smoking – Is a risk for many conditions including dry eye
  • Previous eye surgery or disease – chronic allergies, refractive surgery, abusive contact lens wear
  • Medications – Certain medications such as anti-histamines, anti-depressants, diuretics, and others.
  • Systemic disease – A higher risk in diseases such as rheumatoid arthritis, diabetes, rosacea, thyroid disease, etc..

 

Targeted treatment of DED, following a proper diagnosis, may be prescribed as periodic or continual and often over a long term. It may involve environmental or lifestyle modifications, lid care, targeted tear lubricants, topical medication, punctual occlusion (blocking the tear drainage ducts), oral medication/supplements, chronic disease management, and sometimes in severe cases, more advanced procedures.

Treatment carries a high degree of success when diligent self-management is in place. Comfortable eyes and consistent clear vision is the welcomed reward of a collaborative effort between the doctor and patient.

“Will being overweight affect my vision?”

“Will being overweight affect my vision?” This is a question I almost never hear. Maybe because most of us don’t think there is a relationship between body weight and our eyes. Obesity has become a major health concern globally in recent years with well-established evidence linking overweight to illnesses and early death.

If we review the scientific literature, it quickly becomes apparent that being overweight has a strong link to several eye conditions. Diabetes and  high blood pressure can cause significant changes to the eyes. Diabetic and hypertensive retinopathy can lead to profound vision loss if left untreated. First line management of each of these conditions is achieving and maintaining a healthy body weight.

Age-related macular degeneration is the leading cause of vision loss in Canada. There is no single cause of macular degeneration, but several excellent studies have shown obesity to be a significant risk factor for progression and severity of the disease.

A recent meta-analysis of six important studies reveals an association between obesity and cataract development, particularly posterior subcapsular cataracts which tend to occur at a younger age and develop more quickly.

Pseudotumour cerebri, retinal vascular occlusive disease, floppy eyelid syndrome, entropion, sleep apnea related eye disease and stroke related vision loss each have an association with obesity.

Overweight is just one of the “lifestyle” factors which influence health. Regular exercise, smoking cessation, healthy diet, adequate sleep and stress reduction also contribute to eye health.

The individual and societal factors that influence healthy weight management are numerous and have been discussed extensively in many circles. Weight management is a billion dollar industry with magical products, quick weight- loss programs, fads, celebrities, countless books and organizations. Medical management often includes counselling and in extreme cases, bariatric surgery. In most instances though, achieving and maintaining a healthy weight is a lifelong task assumed by the individual.

A local physician has just published a valuable resource for those willing to confront their disease.“Overweight is a Disease, A Canadian Doctor’s Prescription for Self-management”, by Dr. Lori Teeple, is a new book designed to be a key resource for those who struggle with overweight who wish to understand their disease and gain the skills necessary to self-manage for life.

Boxes of Food!

Here’s what you helped us collect for the Forest Food Bank this year. You response and generous contributions were amazing.! Thank you from all of us.

Congratulations Food Drive Winners!

Congratulations to all who made this year’s food drive such a success. Thanks to everyone who contributed to the Forest Food Bank’s shelves during the last 4 weeks. Each week we drew a name from all the contributors and gave away a prize.  Remember, you can continue to donate directly to the Food Bank. Here are the winners:

Week 1
Dina Koolen
Week 2
Chris Porter (daughter Eden standing in)
Week 3
Gwen Scott-Moffatt
Winner week 5
Jacob & Bessie Lagerwerf

Summer Food Drive

From August 18 to September 19 you have an opportunity to help us collect food donations for the Forest Food Bank again this year. Summer is quiet for donations at the Food Bank but the need is still present. During these dates, you’re invited to bring a non-perishable item when you visit our office. Peanut butter, canned vegetables, baked beans and soup are in high demand.

In exchange for a donation you can complete a bollot to win a prize. Each week we will be giving away a choice of prizes including an Eyefoods book, Eyefoods for Kids, or Baby Banz sunglasses. Thanks for helping us help the Forest Food Bank!

Online glasses and contacts

Canadians are increasingly turning to the internet to purchase products. The internet can be a “wild frontier” of unregulated trade. Websites that sell glasses and contact lenses have been operating for some time and advertise aggressively. They tend to promote low price and convenience. So is there any downside to purchasing your glasses and contact lenses online?

In Ontario, as in much of North America, the act of prescribing and dispensing contact lenses or glasses is a controlled act that must be performed by a licenced Optometrist or Ophthalmologist as dictated by the Regulated Health Professions Act. Opticians are regulated health professionals who are licensed to dispense a prescription from an Optometrist or Ophthalmologist.

Online retailers do not usually introduce you to an individual regulated health professional or allow you to meet them face to face. Most do not require proof of a valid, current prescription. Frames cannot be adequately sized or fitted and lenses cannot be adequately positioned before the eyes. Children and the elderly are particularly at risk as they may be less likely to verbalize vision problems resulting from poorly made or fitted glasses.

To ensure successful contact lens wear individuals must be properly fitted, trained and monitored. Without this, the risk of harm to the eyes is significantly increased. The wearers of contact lenses purchased online are not normally asked to submit proof of proper fitting, training and ongoing monitoring of their eye health by a regulated health professional placing them at risk of poor vision, discomfort or eye harm.

Here are some guidelines to follow when choosing where and how to fill your prescription.

  1. Meet your Optometrist or Optician face-to-face and know their name and credentials.
  2. Provide them with a physical copy of your prescription.
  3. Expect that glasses frames will be properly sized and fitted and that additional measurements will be taken for lens positioning.
  4. Plan to answer questions about your needs and lifestyle and expectations of your new eyewear.
  5. Expect to have your contact lenses properly fitted. The lenses should be assessed on the eye and you should be properly trained in their use, care and precautions. Expect more than one visit if you are a first time wearer.
  6. Your eye care professional should counsel you on the use of your eyewear and expected adaptation and limitations.
  7. Follow-up should be welcomed and is often required for adjustments, repairs and problem solving.

It makes sense to fill your prescription from your Optometrist. Your Optometrist understands your vision and already knows much about your lifestyle, needs and history. Because of this, the process of selecting, dispensing and adapting to your eyewear is streamlined and the continuity of care is maintained.

Consider your eyes. Maybe it’s more than just saving a few dollars; it’s caring for one of your most precious senses.

 

For further information visit the College of Optometrists of Ontario’s website:http://www.collegeoptom.on.ca/index.php/public/patient-faqs ,or discuss this topic at your next visit to the office.

Colour Blindness

Did you know the human eye is capable of distinguishing up to 10 million colours?  Colour discrimination is critical to how we interact with our environment and adds beauty to our world. It is also a common language. For example, we can ask a friend “Would you hand me the red container on the self?” because we share a mutual perception for the colour red.

Colour vision perception is a complex process beginning with a structure in the eye called the retina. Within the retina are receptor cells we call rods and cones. The cone receptors correspond primarily to vision in our central visual field and are best at detecting detail and colour. There are 3 different cones types, each responding best to a certain range of light’s wavelengths. The brain processes the response of each of these cones to “triangulate” the perceived colour. The visible colour spectrum extends from violet to red.

Some people have altered colour vision perception often referred to as colour blindness or colour deficiency. There are many forms and causes of altered colour vision but I will describe two of the more common inherited causes of the so called “red-green color blindness”: dichromacy and anomalous trichromacy. Dichromacy is the more severe colour deficiency caused by the absence or malfunction of one of the 3 types of cones. Anomalous trichromacy is more common and occurs when one of the 3 cones does not function properly.

In colour blindness, the colours that cannot be perceived depend on which cone is abnormal or absent. Problems with the longer wavelength or red sensitive cone results in either protanopia (a dichromacy) or protanomaly (an anomalous trichromacy). Red light may appear gray or duller. Red and greens may be difficult to distinguish.

If the medium wavelength or green sensitive cones are affected it is called deuteranopia (a dichromacy) or deuteranomaly (an anomalous trichromacy). Green appears duller or gray and differences in hues of red, orange, yellow and green are challenging.

These colour deficiencies are called “sex-linked” because many of the genes for colour vision are located on the X chromosome. Because of this males are about 8 times more likely to inherit a red-green deficiency. The most common red-green deficiency is deuteranomaly.

Most people with colour blindness adapt well to their environment. It is important to recognize altered colour perception in children so that teaching methods can be adjusted and leeway provided for responses to colour based problems. A few occupations requiring accurate colour discrimination may be difficult or impossible to achieve. Some coloured filters, software, apps and other devices can provide some limited assistance in overcoming reduce colour discrimination.

You optometrist can test for colour vision deficiency, starting at about age five. There are some interesting online tests with links listed below. Interpret these results with caution because proper room lighting and monitor calibration with external hardware are crucial to the accuracy of the test results.

Colour IQ Test

PPI Colour Vision Test

Hockey and eye protection

A true Canadian pastime is the game of hockey. In this article I am speaking to those who actually play the sport, not just watch it. Enjoyed by all ages hockey is fast paced, a great workout, a skill based team sport and is, regrettably, not without the risk of injury. I have enjoyed playing for years but always become a little nervous when playing alongside others who do not have adequate protective equipment – particularly face protection.

Basketball, field hockey, ice hockey, lacrosse, racquet sports, baseball, softball, wrestling, fencing, cricket and paintball are sports presenting the highest risk of eye injury. While face protection is mandated in most Canadian jurisdictions, adult recreational leagues, pickup hockey, and other children’s hockey groups often do not have such regulations or do not enforce them.

Eye injuries in hockey, often caused by a puck or stick, can be severe resulting in blindness or loss of an eye. This trauma is devastating to an individual resulting in reduced quality of life and increased financial burden. Fortunately, the proper use of CSA-certified eye protection drastically reduces the risk of eye injury. Full face protection is preferred as often the stick or puck will strike the face in an upward motion and can enter under a half visor. Full face protection also reduces the risk of facial lacerations and dental trauma.

Of all my protective hockey equipment, there are two or three pieces I would not go on the ice without. One of these is my face mask. I love my vision – with both eyes!

 

Some interesting links:

Excellent information for players from the Canada Safety Council:https://canadasafetycouncil.org/child-safety/smart-players-protect-their-eyes

Information from the American Academy of Ophthalmology:http://www.sciencedaily.com/releases/2013/11/131116171108.htm

Information from the CNIB: http://www.cnib.ca/en/your-eyes/safety/at-play/Pages/hockey.aspx

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