Why Do We Blink?

In my first year of optometry school, as part of the practical portion of our studies, we used to do vision screenings on kids in elementary schools around Boston. So picture me, the tall optometric freshman, kneeling down to examine the eyes of this adorable little 6 year old girl when she steps back and asks out loud "Harbir, why do we blink?". The whole classroom stopped and looked up at me...

I paused for a second, gathered as much information as I could from my 3 months of eye-related education, and began to answer. Well, cute little blonde-haired girl whose name I don't remember, there are 3 main reasons for blinking:

Number 1 is protection. Our eyelids and eyelashes provide a protective barrier against foreign objects such as dust, rocks, bits of metal, fruit flies, etc...

The second reason is lubrication. Every time we blink, our eyelids squeeze out small amounts of oil, water, and mucus to line the surface of the eye. Studies have shown that when we are engaged in activities that require more attention, we tend to blink less. That is why spending a lot of time on the computer can lead to dry eyes. So as soon as you're done reading this blog, get off the computer! Then come back and share it with all your friends :)

And last, but not least, the third reason for blinking is irrigation or removal of tears and waste. Our eyelids act similar to squeegees, the wonderful onomatopoeically named tool that helps smoothly remove water from car windows and such. Each time we blink, the lids pull tight and sweep tears and debris off the surface of the eye and towards the drainage duct which is located at the inner corner of the eye.

And that's why we blink.

The Importance of Early Eye Exams for Kids

Since its back to school season, I thought it would be a good idea to write a little bit about childrens vision. I've been seeing a lot of kids in the past couple of weeks, most of whom are bright, young, happy, and healthy. Its actually kind of a fun experience for me. I get to hear a lot of interesting stories about their summertime activities. I find myself living vicariously through my young friends since I've spent most of my summer locked up in my dark exam room!

While most of the kids I see are returning for their annual check up, some are coming in to experience the fun and excitement of a Dr. Sian eye exam for the first time. Parents who are bringing their kids in for the first time will often ask me "When should my child have his/her first eye exam?". The answer is usually a bit surprising.

The American Optometric Association (AOA) and the Canadian Association of Optometrists (CAO) both agree that a child's first eye exam should be at 6 months of age. Of course, we don't expect the little munchkins to be able to read letters or even complain about blurry vision. But, it is vital at this age to make sure that the major structures of the eye are developing normally. One significant concern at this age is retinoblastoma, which is a tumor of the retina, the back surface of the eye. If caught early enough, it is possible to prevent the spread of the cancer to other parts of the body and, hopefully, save the affected eye.

A few years back there was a remarkable story of a person who detected a tumor in a baby's eye just by viewing photgraph and noticing that one of the pupils seemed to have a white reflection. This simple sign probably saved the baby's life.

Here's the story:

Daily Mail - Baby saved after friend spots eye cancer

Interestingly enough, one of the tests we do on children, called the Bruckner test, actually mimics this same reflex seen with camera flashes. Simply by watching how light reflects off of the the retina, we can determine the general health of the eye, the shape of the eye (astigmatism), and a potential prescription for glasses (if necessary)

After 6 months, it is recommended that children have annual check ups to make sure everything is developing well.

In Canada, our health care system is based on prevention. In BC, Kids eye exams are free up to the age of 18. Regular check ups mean earlier detection and easier treatment.

Check Yearly, See Clearly!

If you have any questions or concerns, please don't hesitate to write to me or visit your friendly local optometrist :)

Also, take a peak at the following websites, they are very informative.

BCAO:
http://www.optometrists.bc.ca/code/navigate.aspx?Id=3
CAO:
http://www.opto.ca/en/parents/parents-corner.html

AOA:

http://www.aoa.org/x4738.xml

Buying Cheap Shades and Reading Glasses Can be a Headache. Literally.

Its always nice to write a blog that is related to conversations I have with patients in the clinic. This is a topic I discuss with patients almost every single day and I've been meaning to write about for a while. I finally got around to it thanks to a little kick in the butt which came in the form of a little story on the radio.

Recent research done by the consumer group "Which?" in the UK showed some interesting results when I came to assessing the quality of drug store/dollar store/grocery store sunglasses and reading glasses.

The most recent investigation was regarding sunglasses bought at these types of stores. Some lenses in these sunglasses didn't allow consistent amounts of light through, which can make depth perception difficult. Other lenses induced prism, which means that each eye receives two slightly separated images. This can lead to headaches and double vision. And finally, some of the glasses actually induced astigmatism, which can result in blurry vision, discomfort, and headaches.

All suglasses, expensive or cheap, do provide some amount of UV protection. Considering the fact that some of the more serious eye diseases (such as cataracts and macular degeneration) come as a result of UV exposure, I would prefer that my patients wear something cheap rather than nothing at all. However, if you do experience any discomfort, it's probably better to look into a better quality product.

A few years earlier, "Which?" looked into over-the-counter reading glasses or "cheater readers". These are glasses that many people will pick up when they start to notice problems with seeing clearly at near. This is a condition called presbyopia and it affects almost everyone over the age of 45.

While these glasses may "do the trick" for a lot of people, they can induce problems similar to those noted in the sunglasses convo. Firstly, a lot of people have some amount of uncorrected astigmatism. Also, it common for people to have slightly different prescriptions in each eye. OTC readers do not account for either of these things, which leaves patients with slightly blurry vision and forces the eyes to work harder in an effort to overcome the prescription. Secondly, it is important to remember that these glasses are a "one size fits all" variety. Beacause of this, the center points of the lenses (where the vision is most clear) often do not line up with the center of the patients pupils. This can leave patients with discomfort, fatigue, and double vision after prolonged periods of wear.

The best thing to do is have your glasses prescription and eye health checked by your friendly optometrist and then look into a quality pair of prescription glasses.

http://www.which.co.uk/news/2011/08/high-street-sunglasses-fail-british-standards--------262336/

http://www.which.co.uk/news/2010/10/ready-made-reading-glasses---one-big-headache-234513/

Thanks to Jasmina at The Beat 94.5 for passing on the info.

Eye Bling

I knew this day would come. In fact, now that I think about it, I'm a little surprised it took this long.

Dr. Chandrashekhar Chawan, based in Mumbai, has designed gold-plated, diamond encrusted contact lenses.

Dr. Chawan has taken a scleral contact lens (a large lens that extends out to the whites of the eyes), which is normally used for treating patients with complicated corneal diseases, and given it enough bling to make even the Cash Money Millionaires happy! (for those people who are unfamiliar, that is the group that made the popular rap song titled "Bling, bling" back in 1999)

Lil Wayne from Cash Money

If you are tolerant enough to get passed the discomfort of a 20-25mm diameter hard scleral lens, then all you have to pay is $15,000 for one pair. No, that is not a typo. That's 15 comma 3 zeros. But, the way the wedding industry is booming these days, I guess it won't be long until we see some lovely bride walking down the isle looking like someone out of the Twilight movies.

Btw, I'm on Team Jacob

The company is called La SER Eye Jewellery. Check out their site for more info, lasereyejewellery.com.

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.

Sports Vision Contact Lenses

Contact lenses are essential to any athlete who requires vision correction. Can you imagine pro athletes wearing glasses while playing hockey, or basketball, or football? Contacts provide clear vision while also providing unobstructed peripheral vision.

But that's not all they can provide. A few years back, Nike and Bausch & Lomb collaberated to produce a revolutionary new contact lens called Nike MAXSIGHT. The lens was designed with a tint to enhance sport-specific vision above and beyond what a normal soft contact lens could provide. There were two colours available: amber and grey.

The amber lenses were designed for fast moving ball sports such as tennis, soccer, and baseball. The theory here is that human visual acuity is actually optimized around the yellow wavelengths, so the lens will allow mostly yellow rays through and absorbs the rest.

The grey lenses were more for sports or activities generally conducted in bright environments but did not require tracking of fast moving objects such as running or golf. The lens decreased glare thus making vision more comforable.

TSN recently did a story on Henry Burris, the quarterback of the Calgary Stampeders (CFL). In the 2008 season, Burris was wearing the amber tinted lenses. Calgary went on to win the Grey Cup that year. Burris decided to go back to the lenses this season, hoping for similar results.

In the first pre-season game of the 2011 season, The Stamps were shut out by the BC Lions, 24-0. Maybe Burris wasn't wearing the lenses that day ;)

Here's the video of the interview on TSN. You can clearly see the redish tint around his iris that is coming from the amber tinted lenses. http://watch.tsn.ca/cfl-news-and-highlights/#clip487910

Unfortunately, the MAXSIGHT lenses were discontinued shortly after they were introduced. There are other lens designers that produce a similar lens, but they're harder to find. Ask your eye doctor about sports vision lenses.

Henry Burris mentions in his interview that with the lenses in, lights seemed to be dimmer and he was able to look right into the sun without any problems. I would like to interrupt Mr. Burris here for a moment... Understandably, the tinted lenses may help make vision more comfortable in sunlight, but under no circumstances should anyone be staring directly at the sun!
Please refer to Sunburn in Your Eyes for more information.

Do Cucumbers Cure Dark Circles?

Numerous times in my life, mostly in my teens, I had people approach me and ask me if I had been in a fight or punched in the face for some reason. Most of the time, the answer was no. At first I wondered why people kept asking me this question? I soon realized that, unfortunately for me, I was predisposed to developing "bags" and "dark circles" under my eyes.

I always wondered why. The answer I was given most often was that I wasn't sleeping enough. But, honestly, as a teen I was getting 8-10 hours of sleep every weeknight and probably closer to 14 on weekends (yes, I was a lazy kid). So, then the answer changed to "you're sleeping too much". I would like to take a moment here to thank everyone in the past who supplied me with this invaluable information.

So why do we get dark circles and bags under our eyes??

First, lets talk a little anatomy!
The skin covering our eyelids is very thin. In fact, its the thinnest of any part of the body. This makes the skin more translucent (somewhat see through). Immediately underneath this thin skin is a dense network of small blood vessels which can dilate and become leaky just like all other blood vessels in the body.

Genetics
Unfortunately, this is the most likely answer for the majority of people. Thin skin plus superficial blood vessels equals dark circles. Simple equation. Its usually more pronounced in fair skin individuals but can also be noticeable in dark skin as well.

Allergies
People who suffer from allergies often have puffy eyes. This is because allergies cause blood vessels to dilate and become leaky. Dilation of the vessels adds to the colour and the leaking makes the eyelids swell.

Rubbing Your Eyes
I wrote a blog on this a while back explaining why its bad. In this case, rubbing can cause the little blood vessles to break. This results in darkening and swelling. Also, in allergies, rubbing can release more of the histamines that cause the allergic response in the first place.

Sleep and Stress
Less sleep and more stress. Bad for you in so many ways.

Age
As we age, our skin loses elasticity and slowly begins to sag. This exaggerates the look of bags under the eyes.

What's the Treatment?? 

There are so many creams, ointments, and roller-thingys on the market that claim to reverse the appearance of dark circles. What I have always wondered is, if these creams, ointments, and roller-thingys all worked so well, then why is there a new product coming out every other day??

Applying Cold
What do we do when we sprain an ankle? How about for a bump on the head? One of the first things we reach for anytime there's swelling is an ice pack. The cold helps decrease swelling by decreasing inflammation and reducing blood flow to the affected area. The same simple therapy can be applied to our eyelids.

Cucumbers
As far as I can tell, there's no scientific reason for cucumbers to be the miracle cure. I've read in places that they contain some nutrients that help lighten skin, but as we have already established, the skin is not usually the problem. The only thing I can think of is that cucumbers are cool (in temperature, not social status) and as we discussed, applying something cold can reduce swelling.

Cold Tea Bags
Its possible that the caffeine in tea can help constrict the blood vessels below the skin's surface. And again, the cooling effect would be helpful.

Make-Up
My favourite solution.

Laser Treatment
This is generally reserved for people who have skin pigmentation problems.

I worked with an Oculo-Plastics surgeon for a little while during one of my clinical externships. I asked him if there was anything he could do for dark circles around the eyes. His advice: "Cover your eyes and tan the rest of your face".

If you are ever worried about the skin on or around your eyelids, please see your eye doctor or dermatologist.

May is Vision Health Month!

Vision Health Month is an initiative that was started last year by the Canadian National Institute for the Blind (CNIB).

The goal is simple: Increase awareness about ocular disease and prevent vision loss.

Many eye diseases are "silent" and cannot be detected by the patient until there is significant vision loss. Unfortunately, this lost vision often cannot be recovered.

Glaucoma is a disease which usually starts off by affecting peripheral vision. Often times it is not noticed by patients until they start bumping into objects or have difficulty changing lanes when driving.

Macular degeneration is another slow moving disease that normally doesn't show up until our 50s. But it affects the macula, which is what we use for central vision.

Although the effects of these two diseases cannot be reversed, early detection can allow us to significantly slow the progression of the disease and allow patients to continue on with healthy, clear vision.

It is important to remember that just because a lot of diseases occur later in life, doesn't mean that prevention at earlier ages is not necessary.

Cataracts are a perfect example of this. Most people understand that cataracts generally develop with age and usually become significant in patients over 50. However, recent studies have shown that a majority of the damage to our eyes from UV light actually occurs in our youth, before the age of 17!

Three easy ways to help your vision:
Eat your veggies, Wear your sunglasses, and See your eye doctor! :)
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Your Doctors of Optometry are here to help you with any questions you have regarding your eye health including kids' health, early prevention, surgery, and anything else you can think of!

In BC, kids 18 and under are free and seniors, 65 and over, are partially covered (amount depends on the clinic).

Check Yearly, See Clearly!

CNIB.ca
BCAO.ca

Georges St-Pierre's Eye Injury

If you watched the UFC 129 championship fight on April 30th or saw pictures immediately following, you probably wouldn't have suspected any serious problems with Georges St-Pierre's left eye. Fine, it was a little swollen and maybe there was a little blood but honestly, not much more than you might expect after going 5 rounds in an MMA title fight.

But during the fight GSP was poked in the left eye and, as a result, was left almost blind in that eye for the remainder of the fight. After the fight, the champ was taken straight to the hospital to be examined and it was determined that he had suffered a hyphema, which is essentially bleeding inside the front segment of the eyeball. As we know, blood is not clear, so when it starts to fill up behind the cornea (the clear dome at the front of the eye), you can assume it will begin to cloud vision.

For those who have read my blog before, you may remember I spoke a little about hyphemas recently when Vancouver Canucks center Manny Malhotra suffered a serious, season-ending injury after being hit in the eye by the puck.

Hyphemas generally clear up on their own with a little rest as the body resorbs the blood over time (kind of like a bruise). But in some cases they can lead to permanent vision loss and increase the risk for glaucoma. Basically, the blood can stick to the inside of the cornea and leave it looking "dirty", thus resulting in blurry vision. It is also possible for the blood cells to clog up the draining system inside the eye which results in a back up of fluid thus increasing the pressure inside the eye. This increased pressure is what leads to glaucoma.

Fortunately for GSP, there were no other serious problems such as retinal detachments and after a couple of weeks of rest, his vision has returned and he is back in gym training.

As you can imagine, eye injuries are pretty common in a sport where you're constantly dealing with blunt trauma to your face. From a fighter's perspective, it creates a serious challenge. Whether the eye is swollen shut or filled with blood, the fighter loses depth perception and can no longer judge distances well. That makes throwing punches, blocking punches, and attempting takedowns all very difficult.

Luckily GSP was able to overcome all of those difficulties and successfully defend his title.

Related Posts:
Eye on Manny Malhotra
Why Josh Koscheck Lost: An Eye Doctor's Perspective
Mirko Cro Cop Suffers Serious Eye Injury

Eye Love Serendipity

I'm sure most of us would agree that some of the best things in life happen by accident. Indeed, some of the greatest scientific discoveries were the fruits of good fortune. Penicillin, vulcanized rubber, and even gravity were all accidental findings.

But these discoveries all pale in comparison to pharma company, Allergan's newest serendipitous breakthrough! (yes, I'm being mildly sarcastic)

In 2001, Allergan produced an eye drop named Lumigan (bimatoprost ophthalmic solution 0.03%). It's primary function was to decrease the pressure inside the eye in patients who had, or were at risk for, Glaucoma. Lumigan was very successful, but it had some interesting side effects.

Doctors noticed that patients were returning to clinics with very specific complaints. Their eyelashes were, all of a sudden, growing at exponential rates. So significant was the growth of these cilia, in fact, that eye doctors were actually having to trim some patients' lashes!

It didn't take long for someone at Allergan (I'm sure it was a woman) to realize how huge this could be. A few years of "research" later, plus a lovely new spokeswoman (Brooke Shields) and voila! In 2008, we have a product named Latisse, which just happens to be bimatoprost ophthalmic solution 0.03%. (How did that take 7 years??)

Anyway, Latisse promises (and, for the most part, delivers) longer, thicker eyelashes. You simply dab a little bit along the upper eyelash margin once a day for 16 weeks (that's 112 days to be exact) and before you know it you'll be a modern day Elizabeth Taylor (more on her later).

Check out the Latisse website (www.latisse.com) for their FAQ section which has answers to questions including side effects, application, and where to find this miracle drug.

Here is one of the more important question and answers from the website:
Question: Does Claire Danes really use LATISSE^®?
Answer: Yes. Claire Danes is using LATISSE^® and is happy with her results.

Well I'll be damned!! Sign me up then! 

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