Amare Stoudemire's Goggles

I'm sure most Vancouver hockey fans still remember quite vividly the injury that Manny Malhotra sustained last season. At that time, I wrote a blog about the possbile consequences of traumatic injuries to the eyes. Corneal abrasions, glaucoma, retinal detachments, cataracts... these are all serious and real possibilities.

While Manny's injury was serious and required multiple surgeries, he was (and we were) very fortunate that he was able to recover vision and return to play.

But its not only hockey players that need to be aware of these types of injuries. Even in sports like basketball, players need to be cautious. And, as Amare Stoudemire will tell you, its not just the ball you need to watch out for

During the pre-season in October 2008, Stoudemire was accidentally poked in the right eye by his teammate Boris Diaw. He temporarily lost vision in that eye and suffered a torn iris. This is something I did not mention in my blog about Manny, but let me tell you now, this is very painful!

After this major scare, Amare swore that he would wear protective eyewear for the rest of his career. He did for a little while, but found the goggles to be annoying so he stopped after a few games.

Call it karma, call it bad luck, I just call it unfortunate... But a few months later, in February 2009, Amare was hit in the same eye again. This time he suffered a detached retina and required surgery. He was out for 8 weeks which meant he had to miss the remainder of the regular season. When he returned, Amare made sure to keep the goggles on.

Here's a video of Amare discussing his injury and the importance of eye health and protective eye wear.

http://www.youtube.com/watch?v=qA-SemX-mzU

Protect your eyes!

Special thanks to Dr. J. Armani.

Contact Lens Addicts

Yesterday I had the not so pleasant experience of having to scare one of my patients out of wearing contact lenses. It inspired me to write a little about contact lenses and those who (over)wear them.


It has occurred to me, over the past year or so, that some patients are addicted to wearing contact lenses. These people are like the crack addicts of the ophthalmic world. They need contacts. They'll do anything to get contacts. They will come in begging for samples. And when you suggest to them that they should quit, they freak out!

For these people, going straight and cleaning up their act means having to wear glasses. And just like any other addiction, its hard for people to quit cold turkey. They come up with all sorts of excuses like "I don't like my frames", "I lost my glasses", "Glasses make my face look fat". Well I got news for you, Chubs... Its not the glasses!

Anyway, this is where I come in. I'm like the motivational speaker on those self help tapes that tell people that they are strong and in control of their lives. "Where there's a will, there's a way" and all that good stuff. Oh and also, if they don't quit, they could go blind.

That last note usually helps me get people's attention. And it worked yesterday with my 19 year old patient who had been wearing coloured contacts (not the best quality lenses) 7 days a week for the last 5 years. She does not own a pair of glasses and therefore has been wearing her contacts from morning until night.

Why is this so bad?

The cornea, which is the clear dome at the front of our eyes, has a very high demand for oxygen. The only place the cornea can get oxygen is from the air around us. As you can imagine, covering the cornea with a piece of plastic will significantly reduce the amount of oxygen that gets through. The cells of the cornea starve for oxygen and start to break down causing the cornea to become less clear thus making vision blurry.

Neovascularization of the cornea from the 3 to 6 o'clock postion

The body's response to this lack of oxygen involves creating new blood vessels into the cornea. This is called neovascularization. While this may seem like a good idea, it is actually the exact opposite. If the blood vessels grow too far into the cornea, they can begin to obstruct/distort vision. There is no way to reverse neovascularization of the cornea. It can be stopped or slowed down by decreasing contact lens wear. But if it is very significant, the only treatment is corneal transplant surgery. And believe me when I tell you, you do not want corneal transplant surgery.

Cornea with stitches, post transplant

Its sad to see a person as young as 19 be at risk of permanent vision loss. But, with a little treatment and staying out of contacts for a while, her eye health (and vision) should improve.

As useful and convenient as they are, contacts can cause a multitude of different ocular problems if worn incorrectly. All patients who wear contact lenses should have regular eye exams.

Flashing Lights: It's A Camera... It's Lightning... No, It's Your Retina!

It's not uncommon for patients to come in to the clinic and mention they have recently seen something that looked like a streak of lightning or a flash bulb going off in some part of their vision.


How does this happen?The retina is a thin film that covers the inside of our eyes. It is the part of the eye responsible for receiving light signals and sending them to the brain. As you can expect, it needs to be very sensitive.

Due to this high sensitivity, any small movement of the retina can cause signals to be fired back to the brain, making us think that eye is sensing light.


3 most common situations in which flashes are noticed:
1) Patients with near-sighted prescriptions. Near-sightedness is mostly due to the eye ball being larger than average. As the eye grows, the retina becomes stretched. This can lead to areas of thinning and tension.

2) The vitreous gel inside the eye is attached to the retina in multiple areas. Movement of the vitreous can pull on the retina leading to the sensation of flashes.

3) Pressing on the eye. Mechanically releases the chemicals (Phosphenes) that start the signal to the brain.


FAQ:
Q: Are flashes a sign of something bad?
A: Potentially. Flashes could be the first signs of the retina is being pulled, torn, or detached.

If you notice flashes in your vision, especially if combined with new floaters, it is very important to see your eye doctor right away to make sure there are no signs of any tears or detachments.
Q: Do people who have had laser eye surgery still need to worry about their retinas?
A: YES YES YES!!! It is vital for patient's who have had any kind of surgery to have regular eye exams.


Thanks for reading. Please feel free to send me questions and comments about this or any other topic.

Laser Eye Surgery

Laser procedures are commonly used to treat refractive errors (ie. near- or far-sightedness and astigmatism), with the end goal of providing the patient with clear vision without glasses or contact lenses.

There are 2 major types of Laser Refractive Surgery. While the process is a little different, they both essentially flatten the cornea (for near-sighted) or steepen it (for far-sighted):

LASIK - Laser-ASsisted In-situ Keratomileusis

• The more recent of the 2 procedures
• Most common due to shorter recovery period after surgery (not necessarily better results)
• Requires the surgeon to make a thin "flap" of the surface of the cornea before using the laser
• The flap is replaced after the the surgery - effectively producing a natural bandage for the eye

PRK - PhotoRefractive Keratecomy

• The older of the two procedures
• Less common of the two due to longer healing period
• Still produces accurate results
• Usually used for patients with thinner corneas (not enough thickness to form flap before using laser)

FAQ:
Q: Do I still need to have regular eye exams if I can see perfectly after my surgery?
A: YES YES YES!!! Patients who have had laser surgery need regular eye exams more than the average population! Firstly, they have had surgery. Next, the majority of patients that have these procedures are near-sighted and the primary cause of near-sightedness is an increased length of the eye. This causes stretching of internal structures (such as the retina) and leaves these patients with a higher risk for retinal detachments. This does not change just because they no longer have to wear glasses!

Q: Is it safe?
A: Yes. The surgeons that do these procedures, do hundreds to thousands per year. Technology is improving daily to provide more accurate results. Complications occur in less than 0.5% of patients.

Q: Is my prescription too high?
A: Most likely not. Refractive errors as high as -12.00 can be successfully treated. Tiger Woods and Roberto Luongo were about -10.00 and -11.00 respectively before having their surgeries.

Q: What are the common side effects or complications?
A: The number one post-operative complaint is dry eyes. Halos around lights, decreased night vision, sensitivity to light, and recurrence of prescription are also well documented. Most surgeries are guaranteed for 5-10 years. After which, it is possible the patient will require glasses again or a "touch up" surgery.

Q: What are the alternatives?
A: Intacs and Ortho-K are 2 possible options. Intacs are very small corneal implants that create the same effect as laser surgery of flattening the cornea. Ortho-K are contacts that you wear while you sleep. Again, these have the effect of flattening the cornea. In the morning, you take them out and don't need to wear any glasses or contacts during the day. The benefits of these 2 alternatives is that they are both fully reversible. These are limited to lower prescriptions of approximately -1.00 to -4.00.

Thank you for reading. I hope you found this information useful. Please feel free to contact me with questions and comments.

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