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Year: 2016

Tips to help you prepare for your child’s visit to the optometrist.

There’s a first for everything and now, after reading the previous blog, you realize it’s time to schedule your child for an eye examination. Every child is unique and each visit is a little different but here are a few general ideas that can make the visit a good experience for all.

First, it’s a good idea to schedule your child’s appointment at a time of day when they are well rested and not hungry. We all do better after having a good sleep and with a full stomach. Depending on your child’s needs, expect that the visit will take 30 to 60 minutes in office. Many parents who have 3 or more children, find it easier to schedule no more than 2 or 3 on the same day and book the others on another day. A “marathon” office visit can be exhausting for children and parents. Families with several young children who require close supervision, often bring along the second parent or a caretaker to help out. It’s not always possible, but if you are able, schedule your own eye examination on another day without small children so your attention to the testing is undivided. We are happy to reschedule your child if they are ill on the day of the appointment. Otherwise, we prefer 24 hours’ notice for canceled appointments. Normally, appointments will be completely covered by OHIP. Periodically, non-insured additional testing will be advised and costs explained.

Most children enjoy their experience at the eye doctor’s. After all these years in practice, the process of vision still amazes me. Leading up to the appointment day, do engage your child’s curiosity and sense of wonder by talking about vision and eyes. Ask them questions like “I wonder why we have to blink?” or “Why aren’t things completely black when I close my eyes?” I love it when children ask me questions about eyes and vision. Avoid the use of negative talk, unrealistic expectations or threats such as “I hope you won’t need glasses”, or “You better be good or the doctor will get upset”. Fortunately, there is no test or procedure in an eye test that hurts. Most babies will require eye drops during their examination. Toddlers and children sometimes require them as well. Drops can sting a little when instilled and cause bright, blurred vision for a couple of hours afterward, but children generally tolerate this quite well. I advise minimizing or avoiding prior discussion about drops to avoid “anticipation anxiety” that can develop in some kids.

On the day of the appointment, bring a familiar toy or book for your child and a snack or drink if necessary. We have many fun toys and books in the children’s play area too. Be prepared to complete a history form for your child after you arrive. The waiting room experience can be quite educational for young children, requiring them to share space with the elderly, those with disabilities, and other children. Because this is a medical facility, children should be constantly supervised and not allowed to wander. Don’t hesitate to ask one of the staff if you require anything for your child or to let us know if they have special needs.

We invite parents or caretakers to be in the room during the child’s examination, unless it is an older child who prefers to be independent. Although not always possible, a child’s siblings can sometimes be a distraction during the eye test and it may be preferable for them to remain in the waiting area. Babies and young toddlers are welcome to sit on their parent’s lap. Some young children prefer to have their parent standing right next to them, holding their hand while trust is built. Some children are very quiet and shy and some are active and easily distracted, but using a variety of methods we are able to examine each one. During a toddler’s or a young child’s examination, the optometrist will ask several questions about school, hobbies, their eyes, etc. knowing that their answers may not necessarily be accurate.  This interchange is important for the optometrist to better understand the child. The optometrist is then able to tailor the examination to the maturity and knowledge level of the child. As a parent, it can be difficult to remain silent when your child answers questions incorrectly, or does not know the answer, but please allow them some time and freedom to respond the best they can. It is very helpful for the conversation to be between the optometrist and the child. Don’t worry, there will be an opportunity later in the exam to correct things!  Following the testing, the results of the examination and recommendations for care will be explained.

For many children, treatment is not required. If your child requires treatment or follow-up, the details and options will be explained and questions from you and your child are welcomed. Treatment options may include glasses, vision training, contact lenses, patching or just simply monitoring. If your child requires glasses, the selection process can begin immediately or be rescheduled. A written prescription will always be provided. We will also recommend when your child’s next examination should occur.

We look forward to your child’s visit!

Eye Exams for Infants, Toddlers and Children

By Dr. Tina Morowat

Many Canadian parents are not aware that an eye examination is recommended for infants as early as 6 months old.  The Canadian Association of Optometrists recommends an eye exam at 6-9 months old, between 2 to 5 years old and then annually (or as recommended by the optometrist) from ages 6 to 19.  There are several reasons for these early recommendations.

  1. Certain eye conditions are without symptoms and show no visible signs.
  2. Other conditions may cause eyestrain and blurry vision, however the child may not complain as it may seem normal to them if they have never experienced clear, comfortable vision. Infants and toddlers are too young to verbalize a complaint.
  3. Eye conditions that can cause permanently reduced vision and affect depth perception are best treated in early childhood.

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You may be wondering… “How can an eye exam be performed on a baby who does not give any verbal responses?”  Optometrists objectively assess vision, refractive error, eye alignment and ocular health in order to treat and prevent common conditions, and also can detect rare life- or sight-threatening disorders.  Optometrists use a variety of techniques to achieve this, and often use drops that dilate the pupils and relax the focusing muscles for a more accurate and thorough assessment.

Between 2.5-3 years old, a more interactive eye examination is possible as the toddler is usually able to give responses.  Optometrists check vision using pictures and much of the testing is presented in the form of “games”.  We test for certain types of eye turns which typically begin to occur at this age, as well as high refractive disorders. Leaving these, often symptomless conditions, uncorrected can result in amblyopia, or a lazy eye. Significant hyperopia (farsightedness) and astigmatism are also risk factors for amblyopia and are associated with poor visual perceptual skills and learning disabilities.  Other testing such as stereopsis and colour vision is also performed.

By ages 4 and up, optometrists assess for any conditions that may interfere with visual development, visual perceptual skills and early learning.  This includes binocular vision disorders and refractive errors, including early myopia.

Twenty five percent of children have some form of vision problem, yet less than 30% of children are taking advantage of yearly OHIP-insured eye examinations.

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Eye See…Eye Learn® is a program offered by the Ontario Association of Optometrists that provides a complimentary pair of glasses by participating local optometrists to junior kindergarten students across Ontario.  The program was developed to raise awareness among parents of the importance of having their children’s eyes checked when starting school.

Much of learning begins through the eyes and our goal as optometrists is to provide clear and effective vision for children to ensure the highest visual and learning potential in life. A little prevention goes a long way.  Don’t hesitate to call our office today and reserve a convenient appointment for your child.

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Glaucoma – The Silent Thief

Imagine a thief stealing a little tiny bit of your vision every day, over the course of years, starting with your peripheral vision. Normally, we don’t pay much attention to our peripheral vision and we assume that how we are seeing is normal. A slow, progressive loss of peripheral vision sensitivity is the natural course of the most common type of glaucoma, primary open angle glaucoma, a disease affecting the optic nerve and it’s neurons. It is not until significant damage has occurred to the optic nerve and there is a profound loss of peripheral vision that a person will realize there might be a problem.

It is difficult to understand the value of our ability to perceive the world using our five senses until one of the senses is defective, as those who have lost vision or hearing will attest. Many types of vision loss can be restored using glasses, therapy,  medicine or surgery. Vision loss from glaucoma cannot be reversed, only prevented in the first place. Glaucoma is the second leading cause of blindness in the world. It is one of the reasons eye care professionals recommend regular eye examinations.

The optic nerve contains about 1 million neurons that transmit visual information from the eye to the brain. As we age, we naturally lose a few neurons year by year. When this destruction of healthy neurons is accelerated in a specific manner, it is called glaucoma. There are several types of glaucoma but I will discuss just two, primary open angle glaucoma and acute angle closure glaucoma.

The causes of primary open angle glaucoma are not yet completely understood. We know there are several risk factors for glaucoma such as elevated eye pressure, age, family history, ethnicity (such as African-American), corneal thickness, general health conditions, previous eye disease and use of certain eye medications. Glaucoma is not diagnosed with just one test and it can present quite differently between individuals. Elevated eye pressure is not always present and some people will develop glaucoma in spite of low eye pressures. Often glaucoma is diagnosed by observing changes in the eye and eye function over time. During a routine eye examination your optometrist will use special instruments to examine the optic nerve’s structure at the back of the eye for signs of glaucoma. The optometrist will also inquire about risk factors, screen for peripheral vision problems and measure the eye’s pressure. If there are risk factors or suspicious findings, the optometrist will do follow-up testing that might include detailed peripheral vision testing, pachymetry (measuring the corneal thickness), gonioscopy (using a special lens to examine an internal eye structure called the trabecular meshwork) and optical coherence tomography (measuring the thickness of the neuron layer around the optic nerve). Sometimes initial testing neither confirms nor rules out glaucoma and testing needs to be repeated over months and sometimes years to be certain of the diagnosis.

Treatment for primary open angle glaucoma is recommended following diagnosis or with a high level of suspicion or risk of vision loss. The goal of treatment is to prevent further vision loss by lowering the eye pressure to a level where damage to the optic nerve would be minimized. Treatment can involve  prescription eye drops, laser, surgery or a combination of these. Frequent follow-up is important to ensure the treatment is effective in halting damage to the optic nerve. Glaucoma is a chronic condition that requires monitoring, usually for the rest of one’s life.

Acute angle closure glaucoma is much less common and presents very differently. There is a fluid within the eye called aqueous humour that is constantly being produced and drained. The aqueous fluid pressure  “inflates” the eye giving it a normal structure. The aqueous is continually drained through the trabecular meshwork which is located in an angle where the iris and the cornea meet near the front of the eye. If the iris is too close to the cornea, for one of a few possible reasons,  the angle may close, blocking the trabecular meshwork “drain” and the eye pressure then builds up rapidly, sometimes within just a few hours. When this happens, it causes blurred vision and intense eye pain. This is an eye emergency and requires immediate attention by your optometrist, ophthalmologist or emergency department in order to preserve vision. Your optometrist can tell you if you are a higher risk for acute angle closure glaucoma during a routine eye examination.

Don’t allow the “silent thief” to steal one of your most precious senses. At Teeple Optometry, all the optometrists are trained to diagnose and treat glaucoma. Make sure to have regular eye examinations as recommended by your optometrist.

Doctor, I see spots!

If it’s not the patient asking “What are those floaty things in my vision?”, it’s the optometrist asking “Do you see floating spots?”. What are those strange things in my vision that look like fish eggs, hairs, dust, segmented worms or spider webs and which many of us will see if we look carefully enough? Should I be concerned?  Am I crazy to mention it to the optometrist? Maybe it will go away if I ignore it.

Let’s first start with some basic anatomy, followed by some of the common causes. Then we’ll discuss the kind of spots that might represent a “red flag” that should be investigated right away.

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The retina is the “image sensor” of our eye. It begins the visual process of seeing the images of our “outside” world, but  is also a source of images which are not part of our “outside” world. Coloured lights, a grainy pattern of lights, or dancing lights can be noticed, particularly by children, especially in dark rooms or with eyes closed. We tend to ignore this as we get older. These “inner world” images are the result of normal random firing of the neural retina causing an appearance like a dark grainy digital photo. This background visual “noise” is one of the entopic phenomena.  Other entopic phenomena include  lights from mechanical pressure to the eye such as with  eye rubbing, “after images” after looking away from a bright object, arcing dots of light from stimulation by blood cells flowing in the retinal capillaries, “shooting stars” after coughing or bending over, and more. Light passing through closed or semi closed eyelids can produce some interesting light and colour patterns too.

The vitreous is a clear, gel-like substance which fills much of the inside of the eye. It is positioned immediately in front of the retina and light entering into the eye passes through the vitreous before it reaches the retina. Imagine a fly flying in front of a projection screen. It will cast a shadow on the screen. The closer the fly is to the screen, the clearer is the shadow.  Any normal or abnormal irregularities in the vitreous structure can cast a shadow or “floater” onto the retina. It is difficult to look directly at the floater because as we move our eye the vitreous moves with it. Since the vitreous is a bit fluid like, the floater may appear to drift or “slosh” when we move our eyes. As we grow older our vitreous tends to become more liquid like and irregular. We may see more floaters which tend to move or drift more.

As we age into our 50s, 60s and 70s, many of us will develop a posterior vitreous detachment. Because the vitreous is liquefying and shrinking as it ages, it may gradually or suddenly pull away from the retina, where it is most loosely attached. This process frequently causes symptoms of flashes of light and/or new floaters and may include a new large floater, often web-like or “C”  shaped. Often the vitreous detaches without causing any damage to the retina. However, sometimes  the vitreous can cause a tear in the retina which may lead to a retinal detachment. This retinal damage is can threaten vision and needs to be treated promptly.

Some other abnormal causes of floaters include blood in the vitreous, inflammatory cells in the vitreous, and pigment cells released from a retinal detachment. Damage to the central part of the retina called the macula occasionally causes a more fixed spot to appear in the middle of the vision.

Most of us will see spots and unusual patterns in our vision if we look carefully enough. It is good to take an inventory of what you see. This is easier to do when you look at the sky, light colour wall or computer screen. The floaters, if large or numerous, can be annoying but they are not normally treated because of the risks associated with removal.  

If at any time you notice many new spots in your vision that you have never seen before, it is important to call our office right away and have your eyes examined to determine the cause. Early detection of an abnormal cause and treatment can make a significant difference in your visual outcome.

… Oh yes, there is one more rare but documented cause of spots – Rabbititis!

Introducing Dr. Tina Morowat

We are excited to introduce Dr. Tina Morowat, the newest member of our team!

Dr. Tina Morowat completed her Bachelor of Science degree with distinction at the University of Western Ontario followed by earning her Doctor of Optometry degree at the University of Waterloo, where she graduated on the Dean’s Honour List.

Dr. Morowat gained clinical experience in the treatment and management of ocular disease, including the use of ocular therapeutics, on internships in Oklahoma, Ingersoll and London.  She has also volunteered on an eye care mission to southern Mexico and is currently working towards her Fellowship in the American Academy of Optometry.

Outside of the office, Dr. Morowat enjoys traveling, running, hiking and playing in musical ensembles. She is excited to be practicing full scope optometry and enjoys all areas of vision care.

Why am I nearsighted?

Myopia or nearsightedness results in blurred distance vision from imprecise optics of the eye. Light entering the eye, from an object one is looking at, focuses in front of the retina instead of on the retina. Vision is worse far away than it is at near. Often myopia begins in childhood and increases through the growing years but it can advance at any age. Less frequently  myopia can improve with time,  sometimes in our older years.

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Nearsightedness can be corrected with glasses, contact lenses, and refractive surgery. But can we prevent it altogether?

There have been many theories put to rest about the cause of myopia. Reading in the dark, reading too much , playing too many video games, sitting too close to the TV, and wearing glasses  have all been cited as causes. My mother thought my brothers and I became nearsighted because we had the German measles (rubella) as young children. In reality, the true cause of myopia is still a bit of a mystery despite much research.

Myopia has an association with certain genetic disorders, birth defects and early vision deprivation. Some eye disease, such as keratoconus, and advancing cataracts can lead to increased nearsightedness. However, most of us who are nearsighted don’t have any of these conditions.

It is now being acknowledged that myopia is on the rise in the general population as illustrated in this Scientific American info-graphic article.

An obvious question is “Why?” Is it our family genetics, our excessive near work, our diet or something else? Research suggests that the cause is likely multifactorial, a catch-all phrase stating that we’re not really sure and it is likely a combination of factors that differ between individuals.

Some of the more recent research, much of it coming out of Asia where there is an unusually high prevalence of myopia in certain locales, suggests that spending more time outdoors can help reduce the risk for myopia. We have quickly become societies who are spending more and more time indoors. Spending an extra 40 minutes per day outdoors appears to have some benefit in reducing risk.

So the take home message is, have your children spend more time outdoors each day and have regular eye examinations to help them keep seeing their best. If you have questions or concerns about your own vision or that of your children, please don’t hesitate to give us a call.

Seasonal Allergic Conjunctivitis

Spring is a wonderful time of year with the evidence of new life everywhere; wonderful, unless you suffer from allergies. Whether it be pollen in the spring, grass mid-summer or  various weeds late summer, allergic symptoms can vary from mild and infrequent to quite severe throughout the growing season.

Allergic conjunctivitis effects the clear conjunctiva, a thin tissue covering the white of the eye and the inner eyelids.  Itching is the predominant symptom. Itching can be accompanied by watering, redness and puffiness. Allergic conjunctivitis can affect all ages and symptoms can vary in severity from one year to the next. Sometimes the nose and throat linings can be affected too.

Allergic conjunctivitis is an inappropriate “overreaction” response of our immune system to an otherwise harmless substance called an antigen. Antibodies are produced by the body  to try to defend the eye from the antigen. These in turn cause the release of chemicals which cause the itching, watering and swelling.

Allergic conjunctivitis
Allergic conjunctivitis

Symptoms can be reduced by avoiding exposure to the antigen and spending more time indoors with the windows closed, however, this is not always possible or desirable. Washing your hair before bed and laundering bed sheets frequently can reduce the antigen load that otherwise transfers and accumulates on the pillow overnight. Cold compresses will provide temporary relief . The use of eye lubrication drops such a Refresh Tears or Systane Eye Drops  can help dilute the antigen and reduce symptoms. Over the counter anti-histamine drops can be helpful for symptoms lasting just a day or two. If nasal symptoms are also present, oral antihistamine medication can be helpful as well.

If symptoms persist, make an appointment with our office to determine if you do have allergic conjunctivitis or some other eye condition or if there are other associated factors involved such as dry eye. Several effective prescription eye drops are available to help successfully manage mild to several seasonal allergic conjunctivitis and can be prescribed by your optometrist.

Spring should be a season to enjoy without the discomfort of itchy eyes!

The message behind the brand

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It’s spring time, and this spring Teeple Optometry also has a fresh new look.  This new “branding” is more than just appearances.  It’s a look that invites you to experience a strength of Teeple Optometry many have come to appreciate, our excellent service. Read More

The Mysterious “Pink Eye”: AKA Conjunctivitis

“Pink eye” or conjunctivitis is a common eye condition that ranges from mild to severe, acute to chronic and has a wide variety of causes. It can affect all age groups and is often misdiagnosed and mistreated. Fortunately, most conjunctivitis gets better on its own. Treatment can be helpful to reduce symptoms and sometimes prevent more serious consequences.

To confuse things, there are other diseases, such as anterior uveitis, episcleritis  and corneal disease, that can make the eye look red but are completely different. It is very important to consider  these conditions in any “pink eye”.

The conjunctiva is the transparent tissue covering the “whites”of the eye and the underside of the eyelids. When this tissue becomes inflamed for any reason, the little blood vessels in the conjunctiva enlarge and the eye looks more pink or red. Often patients correctly or incorrectly equate pink eye with an eye infection.

Important: With any red eye, if you experience significant pain, blurred vision or significant eyelid swelling, call your eye care practitioner right away.

Baterial-Conjunctivitis

There are  four main causes of conjunctivitis: infection, allergy, toxic/irritant and dry eyes.

Infectious conjunctivitis:

Viral is the most common type of infectious conjunctivitis. Many different viruses can affect the eye. Often cold or flu like symptoms are associated with the conjunctivitis and both eyes are usually effected, one more than the other. One particular viral infection, epidemic keratoconjunctivitis, is quite prolonged and very contagious. The eyes are red, weepy, scratchy and  a bit sensitive to light.

Antibiotic drops such as polysporin, allergy drops or “red eye” drops like Visine are ineffective. Supportive measures such as cold compresses, lubricating drops, avoidance of eye rubbing and rest are most helpful.  Good hygiene measures such as frequent hand washing, not sharing towels or pillows, and keeping the hands away from the eyes are most helpful to reduce the spread to others. Eye cosmetics should be discarded and new makeup avoided until the condition clears. Contact lenses should not be worn. Viral conjunctivitis can last up to 3 weeks.

More serious eye infections caused by the herpes simplex virus or the herpes zoster virus can involve the cornea and can lead to permanent scarring and loss of vision. Accurate diagnosis and aggressive treatment is important.

Chlamydial conjunctivitis is sexually transmitted disease and acts a bit like a viral conjunctivitis that doesn’t get better on its own. Accurate diagnosis and appropriate treatment is important.

Bacterial conjunctivitis is less common and can involve one or both eyes. Usually there is more thick and sticky discharge. Often this will clear on its own but antibiotic drops can clear it up faster. Warm compresses and lubricating drops can help with comfort. Again, contact lenses should not be worn and eye makeup discarded. If abnormal pain or blurred vision is present, or it involves a young child who is quite ill, examination by your optometrist is vital to rule out a more serious, vision threatening corneal ulcer, orbital disease or other problem.

Allergic conjunctivitis

Allergic conjunctivitis is a common cause of “pink eye”. Often this is seasonal with symptoms of itchy, stingy, weepy eyes. Both eyes are effected equally. Pollens, animal dander and molds are common triggers of allergic conjunctivitis. Avoidance of the cause, if possible, air filters, good house cleaning and frequent laundering of bed sheets can be helpful. Cold compresses, eye lubricating drops and avoiding eye rubbing are simple solutions. For more persistent allergies, your optometrist may prescribe allergy drops and/or anti-inflammatory drops which can be very effective.

Toxic/Irritant conjunctivitis

Toxic/Irritant conjunctivitis can occur for a variety of reasons. The conjunctiva can be inflamed because of exposure to chemicals such as chlorine in pools, volatile fumes from paints and thinners, soaps and facial cosmetics, nail polish and compounds released from chopping onions. A misdirected eyelash, poor quality eyeliner and masquera, dust exposure, UV exposure, poor eyelid closure and excessive eye rubbing can inflame the conjunctiva. Contact lens wear, contact lens solutions and eye drops sometimes irritate and inflame the eye.

Dry eye related conjunctivitis

Dry eye related conjunctivitis is quite common, especially as we age. It tends to be chronic with symptoms that wax and wane. I discussed the problem of dry eyes  more fully in a previous blog post, “These Cry’n Eyes”.

“Pink eye” is not as simple as it appears. Having a correct diagnosis of the underlying cause is important to properly treat the condition. Check with your optometrist for the most appropriate care.

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