Migraines and Your Eyes

Migraines affect a lot of people and those who suffer from them know, they can be very debilitating.

What causes migraines?
The exact cause is still not fully understood. But most evidence generally points to fluctuations in the size of blood vessels in the brain and over-active neurons.

Auras
The changes that occur in the brain slowly spread into the areas that control eye sight (occipital cortex). Eventually causing distortions in vision. These are called Auras.

Often, people will notice flashes of light, zigzag patterns, or even loss of certain parts of vision for up to 15-20 minutes.

Visual Migraines
It is possible to experience these visual side effects without the headaches. It is important to separate these signs from flashes of light that can be associated with retinal detachments.


FAQ:
Q: How can I tell the difference between visual migraines and retinal detachments?
A: Generally flashes associated with retinal detachments are very brief and tend to be in peripheral parts of vision. Visual migraines tend to last for at least a few minutes and can involve up to half of you field of vision. If you ever notices flashes of light or changes in vision, see your eye doctor to be sure.

Q: How do you treat migraines?
A: For some people simple pain killers like Aspirin and Ibuprofen are sufficient. In more serious cases doctors my prescribe neuro-inhibitor like gabapentin or even anti-depressants like amitriptyline.

Q: Does caffeine help?
A: For some people caffeine can be a trigger. But it has been shown in studies that caffiene can actually help reduce migraines. Possibly because caffience causes blood vessels to constrict so it decreases the fluctuations that are occuring. Excedrin is aspirin plus caffeine.

Thanks for reading. Please feel free to pass this information on to anyone who may find it useful. And as always, questions and comments are welcome and appreciated.

See you all in the new year :)

How Trevor Linden Sold Out: An Eye Doctor's Perspective

Before I begin, I would like to say that as most kids growing up in Vancouver through the 1990's, I considered Trevor Linden to be an idol. A great hockey player and role model. As an adult, and more specifically as an eye care professional, my opinions have evolved.

As usual, I'll try to present my information as fact and do my best to remain impartial. But, I can't make any promises ;)

Many of you have probably seen our good friend Trevor on TV, or on the many obnoxious billboards around Vancouver, advertising for clearly contacts. Smiling with his spectacles on while promoting glasses and contact lenses for cheaper prices. "Glass, plastic, and two tiny little screws..." says Mr. Linden. Is that so?

Allow me to present the following points in a bulleted format.

• First, I would like to challenge the notion that glasses are simply glass, plastic, and screws. For those people for whom glasses are a daily necessity, their presence cannot be so cheaply simplified and their importance so easily ignored. Glasses change people's lives. When Johnny Nash sang "I can see clearly now, the rain is gone...", what he was really saying was "I can see clearly now, I have my glasses on". True story. Glasses are a patient's windows into the world. They are a reflection of a person's personality and style. Try to fit that into $38, Trevor.

• Second, my boy Trev had laser surgery a few years back so he's probably forgotten about the importance of specs. We'll see where he shops once he starts needing reading glasses.

• Third, quality and service (or lack there of) cannot be overlooked. What happens when the arm falls off your glasses? Or you need to have the frames adjusted? Will you take them to the Linden residence?

Buying Contact Lenses Online:
A contact lens can be considered a medical device. A lens is essentially a prosthesis. A piece of precisely designed silicone and plastic placed on the surface of the eye for a medical purpose.

If poorly fit, over-worn, or misused contacts can cause inflammations, infections, and neovascularization of the eye which can potentially be vision threatening.

Would you consider it prudent for an amputee to go shopping for a prosthesis online without the consultation of his doctor? Or maybe a cardiac patient can look for good deals on heart valves while buying his new glasses? After all, they are both just pieces of plastic, right?

Trevor Linden, it's time to stop making a "spectacle" of yourself.

For more background information about clearly contacts and Trevor Linden, check out my more recent blog titled How Trevor Linden Sold Out: The Prequel.

Sunglasses: Fashion Or Function?

Function:
UV light from the sun is the biggest environmental factor related to two of the most common eye diseases: cataracts and macular degeneration.

Also, the eyelids have the thinnest skin of any part of the body which makes them more susceptible to damage from sunlight.

Sunglasses provide protection from these harmful rays of light.

Fashion:
A survey by the American Optometric Association showed that a large percentage of patients believed that brand name sunglasses provided more protection than non-brand name glasses. MYTH!!
Even the $10 sunglasses you can buy at the gas station block at least 95% of UV rays.

Yes, some of the more expensive lenses can provide more comfortable vision with better lens material and polarization. But this does increase protection from UV.

So, when you're looking at buying those $300 Prada shades, remember that you're paying mostly for style and branding. Not like that has stopped anyone in the past :)

FAQ:
Q: Is it important for kids to wear sunglasses?
A: YES!! Most of the damage done to our eyes by UV rays from sunlight is during the first 17 years of our lives. Protect your child's long term eye health by putting on them in some shades.

Q: Why are polarized lenses good?
A: Polarized lenses cut down the amount of reflections seen off surfaces like glass and water. This means clearer, more comfortable vision especially when driving or boating.

Q: Are Transitions (lenses that change from light to dark outdoors) better for protecting your eyes?
A: Clear plastic lenses actually provide a lot of UV protection. Transitions don't increase the UV protection but they provide more comfortable vision when outside.

Notice how she becomes happier as the lens tint gets darker. Amazing!

Q: I heard Transitions don't go dark when in a car. Is this true?
A: Yes. Car windows block 100% of UV light so the lenses will not change.

Q: Do my Ed Hardy shades make me look cool?
A: Ummmmmm....

Thanks for reading. Hope you all found this info useful. Please feel free to pass it on to anyone who may find it interesting.

Ocular Dominance

The same way we are right or left- handed, we also have one eye that dominates over the other. However, these two concepts are not all related and it is possible to be left-handed and have right eye dominance or vice versa.

Knowing which eye is dominant is important in eye surgeries and when fitting contact lenses. It's also important for athletes, especially in sports that require precise aim, such archery.

So how do you know which eye is dominant? I have devised a little test (follow with pictures below):
- Form a diamond shape with your hands
- Holding this diamond, stretch your arms out ahead
- With both eyes open, view a small object at a distance through the diamond (such a clock or light switch on the wall)
- Close one eye at at time

When your dominant eye is closed, the object will be hidden by your hands. When your non-dominant eye is closed, the object will be visible.

I have attached pictures with examples of a person who is Right eye dominant.

Thanks for reading. Please feel free to send any questions or comments my way. Merry Christmas!

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.

Why Josh Koscheck Lost: An Eye Doctor's Perspective

Of course, I'm here to discuss reasons other than Georges St. Pierre's obvious superiority as an MMA fighter. After all, this eye doctor is unbiased and simply here to impart knowledge related to eyes and eye health.

So, why did  Josh Koscheck lose?

It all started early in the first round of the UFC 124 championship bout on Saturday evening. GSP began landing his lightning quick, left-handed jabs to the right side of Koscheck's face. By the end of the first round, his right eye was almost completely swollen shut.

Now, fighting with one eye closed presents multiple challenges. The first, and most obvious, is that Koscheck was not able to see attacks coming from his right side very well anymore. But what I believe to be a more difficult problem to adjust to is the loss of depth perception one encounters when both eyes are not open.

We need both eyes open and working together to perceive depth. Its the main concept behind 3-D movies. Koscheck was basically trying to fight GSP in 2 dimensions. That must have made it nearly impossible for him to judge not only the punches coming towards him but also the punches he was trying to throw (especially if that is his dominant eye).

Doctors confirmed that Koscheck suffered a broken orbital bone, which is serious injury that can result in damage to the muscles and nerves surrounding the eyeball. Also of concern in this case would be the potential for retinal detachments which could lead to blindness if not dealt with immediately.

Josh Koshcheck, it's time to see your eye doctor.

See also Mirko Cro Cop's Eye Injury before his previous fight with Frank Mir.

Computer Vision Syndrome

I have a lot of patients who come in with complaints of eye strain while on the computer, while at work and home.

This is a condition referred to as Computer Vision Syndrome (CVS).
What causes CVS?
1) Need glasses? Uncorrected refractive error (learn more here) can make viewing the computer monitor very uncomfortable.

2) Looking at a computer monitor requires the focusing system inside our eyes to work constantly. Essentially fatiguing the tiny muscles inside our eyes.

3) Reflections from the screen can make it difficult for our eyes to focus accurately, thus causing our eyes to work harder.

4) Incorrect viewing angle can force the muscles on the outside of our eyes to work harder and fatigue.

5) People tend to blink less when at the computer. This leads to dry eyes.

What can be done?
1) First and foremost, get an eye exam. Even if you don't need glasses for other things in life, a simple pair of computer glasses may cure all woes.

2) Take breaks!! Remember 20/20/20. Every 20 minutes, look into the distance (at least 20 feet away) for at least 20 seconds. This will help relax your eyes.

3) Screen protectors are useful. Also, anti-reflective coatings on glasses are very helpful.

4) Ergonomics! Our eyes are most comfortable when looking slightly downward. There are very detailed workplace guidlines available for positioning and posture at the computer.  The American Optometric Association recommends that the center of the monitor should be approximately 15-20 degrees below eye level.

5) Blink more. Make a conscious effort. Also, using artificial tears can help moisturize your eyes. Remember our last discussion on Visine. Always best to ask your eye care professional which drops are best for you.

Thanks for reading. As always, questions are welcome and please feel free to forward this information on to anyone who may be interested.

Visine

Picture this: You're eyes are a little irritated, possibly even a little red. You're not sure why this is happening, but you figure an eye drop could help. You walk into the eye drops section in the pharmacy and you're bombarded by about 131,239 different types of eye drops that tell you they do all sorts of wonderful things. So you pick the one with the name you've heard and claims to do what you want... Visine.

Sometimes it works, sometimes it doesn't. But you give it a try nonetheless.

So, is Visine bad for your eyes and why?

1) The active ingredient in the original Visine is Tetrahydrozaline Hydrochloride. It works by constricting blood vessels. Over time, the blood vessels will stop responding to it and even have a rebound effect, where they get more dilated and red than before.

2) The preservative used in all Visine drops is Benzalkonium Cholride (aka BAK). It has been shown to be one of the most likely to cause ocular toxicity and irritation. Most pharmaceutical companies don't BAK in their medicated eye drops for this reason.

If you insist on using Visine for dry eyes, consider using the preservative-free formula.

FAQ:
Q: Can I use Visine to get rid of Pink Eye?

A: No. Pink eye is a viral infection of the eye and should be looked at by your doctor. He or she can then determine which drops (if any) are needed. Learn more about Pink Eye Here.

Q: What other drops should I use?

A: There are many options for dry eyes, allergies, contact lenses, and infections. Its best to ask your friendly neighborhood eye doctor what is best for your eyes.

Q: Is it true that a few drops of Visine in someone's drink can give them an upset stomach (like in Wedding Crashers)?

A: A few drops probably wouldn't do much. However, a lot would likely make a person very sick. Aside from vomit and/or diarrhea, it could affect a person's vision, heart rate, and body temperature. So, I would not recommend trying it :)