How Trevor Linden Sold Out: The Prequel

OK, OK, I get it... People in Vancouver loooooove Trevor Linden. I know, I'm from here. So I expected a few people to be a little ticked off with me for recently writing a blog titled "How Trevor Linden Sold Out".

But, like any great story, there is always a pre-story; the prequel that provides you with greater insight into the original saga and how things came to be. Batman had Batman Begins. James Bond had Casino Royale. And Star Wars had (however unfortunately) Episodes 1, 2, and 3. This, my friends, is the Hobbit to my Lord of the Rings.

It all started in 2007. A company named clearly contacts (aka coastal contacts) that sells contact lenses online, had a lawsuit filed against them in BC Supreme Court because they were breaking the law by not requiring their customers to present valid prescriptions before ordering contacts. The law in all Canadian provinces and US states is that all patients must have a valid prescription and the online company must confirm it with the eye care professional who provides it.

This rule is in place to help prevent the misuse and incorrect fitting of contact lenses which can lead to serious, potentially vision threatening complications.

In 2009, the courts made a decision. clearly contacts must start abiding by the law OR have it changed. They decided to pursue the latter.

Abracadabra...

In 2010, Health Minister Kevin Falcon created new legislation that allowed online sales without the requirement of a prescription from an eye care professional. I can hear the gasps... He did what?? He changed the rules, with no regard for public health, to suit the needs of one corporation.

Apparently, Health Minister Falcon believed that buying contacts and glasses for cheaper was in the public's best interest, but having regular eye health examinations was not. Are these the types of decisions a HEALTH minister is supposed to be making?

MLA Adrian Dix put it well when he said "Health Minister Kevin Falcon will lower eye care standards to satisfy the commercial interests of one company, ignoring the open opposition from the Canadian National Institute of the Blind, physicians, and several health professional bodies..."

How is it possible that British Columbia is the only place in North America that is satisfied with these third world standards of health care? We often refer to American health care as an example of a flawed system, one that does not promote wellness and disease prevention. But now Americans (and other Canadians) are looking at us and wondering how or why we would possibly allow our standards to be lowered in such a way. The answer, my friends, is money.

That last point to resonates quite loudly in recent news articles which shed light on some large endorsements that the "honorable" Kevin Flacon has been receiving from a certain online company. *Cough* clearly contacts *Cough*
http://www.news1130.com/news/local/article/173102--falcon-may-be-too-cozy-with-business-community

By the way, this person is planning on becoming the next Premier of British Columbia.

So, What About Trevor Linden?
Our captain joined clearly contacts as their spokesperson early in 2010. Please refer to the original conversation of How Trevor Linden Sold Out for more information.

Someone recently said to me "...that's what celebrities and athletes do. Companies give them money to promote their product, and they do it... what's the big deal?"

Is that not the definition of selling out? Doing something ethically questionable for money. Especially when the very thing you are promoting is ultimately causing a decline in the overall well being and quality of care in the same community that has raised you and embraced you as its hero and idol.

My Life in 3D

I can't seem to take a breath these days without hearing something about 3D movies, 3D TVs, and now even 3D Nintendo games. A lot of time, effort, and resourses have been directed toward this market and it really seems to picking up steam. Personally, I don't see what all the fuss is about. I watched Avatar in 3D and I was not impressed.

I "see" you, Jake Sully.

Whether you believe in intelligent design or evolution, God or Charles Darwin, no matter how we got here, its pretty amazing to think that we are naturally born with the ability to see our world in 3 dimensions (well, at least most of us are). And that's without the sweet red-green glasses that Biff's friend, 3-D, wore in Back to the Future (I know you remember him).

How does it all work?
The basic premise behind 3D is that each eye is viewing a slightly different image. You can experience this by simply holding your finger up in front of you and looking at it with one eye open. When you switch to the other eye, you'll notice a little shift in the background. The two images are put together by the brain, allowing us to perceive depth. This is called Stereopsis or stereoscopic vision.

The "old school" way to present images in the 3D was to project two slightly mis-aligned images on to a screen, one image with more red and one with more green (called Anaglyphic 3D). Then, of course, you wear the super cool red-green glasses and voila! The red lens would see the red image and the green sees the green. Your brain does the rest.

These days, its a little more advanced. 3D cameras use two side-by-side lenses to shoot two separate images, basically imitating the way our eyes work. Glasses are still required, but now they have polarized lenses (they look a little like sunglasses), which allow each eye to view separate images without using the red-green.


Is it just me, or does this remind you of Johnny 5 from Short Circuit?



TVs are currently being developed to allow for 3D viewing without glasses. The way most of these TVs work is by putting something called a lenticular lens over the front screen of the TV. This lens basically splits the images from the TV into two directions, so each eye sees something slightly different. To give you an example of what a lenticular lens or screen looks like, its a little like those holographic stickers or posters that have little grooves on them. They show you different images as you change the angle or walk by. Apparently a lot of work is still required for these sets.

What better example could I use?

Is it dangerous?
Nintendo is coming out with a new version of their hand held game system called the Nintendo 3DS. Surprisingly, they have take some initiative and warned consumers that these little devices may not be appropriate for children under the age of 6. But, when the device was analyzed by the American Optometric Association, it was decided that they were not harmful.

In fact, that is generally the case with most 3D devices. If the person using the device has a fully developed, normally functioning visual system, there shouldn't been too many negative side effects. HOWEVER, there are some situations in which people may have mild problems with ocular alignment (in most cases the patient doesn't know about these problems). When these visual systems are stressed by the work of viewing 3D images, they may experience strain and possibly double vision. Visit your eye doctor to see if these issuses can be resolved.

There are a few people out there who will never be able to experience the luxury of upgrading their lowly 2 dimensional programming to 3D. These are people who have significant eye turns or big differences in prescription between their eyes. Generally these people have amblyopia or lazy eye, so they are unable use both eyes together to see stereoscopically.

Luckily they're not missing out on much. At least I don't think so :)

Thanks for reading. Please feel free to pass this information on to anyone who might find it interesting. As usual, questions and comments are welcome.

What Parents Should Not Do: An Eye Doctor's Perspective

I was initially going to break this topic into multiple segments. Each would described my experience with a different young patient (and his or her parents). Instead, to my surprise, I recently encountered a 6 year old boy whose mother unfortunately embodied all of the poor tendencies that doctors try their hardest to discourage.

To maintain the annonymity of this dynamic duo, let's call the boy John and his mother Jane.

Jane brought John in for his eye exam and mentioned that he had (not so recently) lost his glasses and may need another pair.

As I entered the exam room, I immediately noticed that, while he fiddled with all of my instruments as his mother sat idle, little John's left eye had an outward turn (aka Exotropia). I took my seat and asked Jane about the eye turn. She responded very casually with "Oh yes, his dad and his older brother both have the same thing. Its no big deal." No big deal?? I controlled my initial urge to scold this mother of two and I politely suggested to Jane that this is something we will need to discuss at the end of the exam.

Next came the refraction. Trying to determine John's glasses prescription was about as easy as teaching my dad how to use the bluetooth function on his phone (not easy). Both tasks required a lot of patience and reiteration of instructions. At the end of it all, I was able to improve John's vision with a prescription that involved a lot of astigmatism, but he still was not seeing as well as I would have liked. Especially with the left eye.

While we normally aim to have our patients seeing 20/20 with both eyes, John was only seeing 20/40 with the right eye and 20/60 with the left.

What we are seeing here is the development of  amblyopia, or a lazy eye. Basically, if the brain is receiving a blurry image or double vision, it will start to shut the blurry (or turned eye) off in an effort to make vision more comfortable.

This process occurs at a young age. In fact, after the age of 8 it is very difficult to recover the quality of vision that is lost. And the older the patient gets, the harder it is. Eventually, no amount of glasses, contacts, or lasers will help. From this point on, it is a problem with the brain and not the eyes.

In John's case, because of the high prescription in both eyes, he is at risk of both eyes becoming lazy.

Luckily he is still young and with aggressive therapy, I am confident that most, if not all, of his vision can be recovered.

But what is required? The first step is a pair of glasses with the full prescription worn every waking moment of the day. The second, is the use of a patch. It is worn over the right eye (the one that is not turned) for a certain number of hours a day to force the left eye back into action. If the eye turn is not resolving, surgery to help straighten the eye is a possibilty.

After discussing all of this with Jane, she conceded that she was provided most of this information by another optometrist a couple of years earlier. In fact, that eye doctor had also scheduled a follow up visit a couple of months after the initial exam. But, since her older son and husband have similar problems and are "doing fine", she figured that it was "no big deal" and didn't follow up. I was really beginning to lose my patience with Jane's nonchalant attitude towards her young son's vision.

After all of the things I had just finished explaining to her, Jane asked if it was ok not to get the glasses yet. She was hoping to let John decide when he was older if he wanted to wear glasses or get laser surgery. That way she didn't feel like she was forcing it on him. What??

NO THAT IS NOT OK. AND IT IS A BIG DEAL!

When your child's vision is at stake, its a big deal. When his aptitude to read and learn is affected, its a big deal. When his ability to see and experience the world is degraded, its a big deal! How could anything be more important???

While Jane is an extreme example, there are a lot of people who exhibit this type of behaviour to a lesser degree. For as long as I can remember, as a student and now as a doctor, I have watched far too many people carry a complacent disposition regarding their health. Too often, I've heard people say "its no big deal" or "it'll get better". I'm guilty of it myself. But, if there is one situation in which I can't ever imagine having that kind of attitude, it is when a child's health is in question.

In British Columbia, annual eye exams are free for all children under the age of 19. If there's one thing our government is doing right, this is it.

So bring your kids in. We'll be happy to see them :)

Reading in the Dark is Bad for Your Eyes

Myth or truth?

I get asked about this almost every day at work. Will it make my eyes worse? Is it why my eyes feel tired? Should I turn the lights up? No. Probably. Yes.

Our eyes have to work to focus every time we are reading or looking at things up close. It's called accomodation. Little muscles inside the eye cause the little lens inside the eye to change shape so near objects come into focus.

It doesn't take a genius to figure out that things are harder to see in the dark. So, in the dark, the stimulus for accomodation is decreased and our eyes lose focus.

Our eyes will continually lose focus and then re-focus causing them to fatigue and strain.

There is a little myth to it though. Your eyes won't "get worse" from reading in the dark. By this I mean there won't be any change in prescription or need for stronger glasses.

Botox

Most people have heard of botox therapy for cosmetic purposes to get rid of wrinkles. But what exactly is botox and what else is it used for?

Botox = Botulinum Toxin AKA one of the strongest neurotoxins known to man, which is produced by the bacteria Clostridium botulinum.

Basically, it causes complete paralysis of all muscles it comes into contact with and can be lethal if it somehow enters the bloodstream.

Botulinum toxin is so potent that a dose as small as 100-200 nanograms can be lethal to an average human (one nanogram is one billionth of a gram). 4kg of the stuff would be enough to wipe out the entire world's population!!
But Botox has some real Medical Uses:

In Eye Care:Blepharospasms - Spasms of the muscles that control blinking (uncontrolled twitching or blinking)
Strabismus - Eye turns due to over-action of muscles that control eye movement

The effects of Botox last about 4-6 months, so patients would need to have multiple injections per year.