FOR YOUR EYES ONLY - ARE CARROTS GOOD FOR YOUR EYES?

You may remember a blog I wrote a while back which answered this age old questions.
Well, Dr. Eyenstein and I decided to tackle it in vlog form as well. Enjoy!

The Path of Least Resistance

Over the past few weeks I've had some distressing discussions and experiences at my new office, Highstreet Eyecare, in Abbotsford BC (shameless self promotion). These incidents are what compelled me back to my blog today.

I'll refer to one specific phone conversation which, I think, fairly represents the other similar situations as well.

A very pleasant young lady (in her mid-20's) called the office with some questions about her vision. I'll briefly summarize the conversation...
--
Young lady: I've noticed some changes in my vision. I can't see as well with my glasses on anymore. I recently went back to the place where I usually buy my glasses. They did an eye exam and said they couldn't get my vision to 20/20.

Me: Do you know if  it was an optometrist who did the exam?

YL: I'm not sure. What's the difference between an optometrist and the people I get my glasses from?

Me: (I proceeded to explain the differences between optometrists, ophthalmologists, and opticians. I explained how they are all different from the many random optical stores that have no accreditation what so ever. I also compared a complete eye exam, which includes a thorough assessment of ocular health as well as a refraction for a glasses prescription, and vision testing, which is essentially the automated refraction many unaccredited places will conduct unlawfully refer to as an eye exam.)

YL: Oh, I didn't know any of that. They just checked my vision and said the new glasses would make my vision better.

Me: (I explained again all the different things we would examine to determine her prescription and rule out any underlying conditions that could be limiting her vision)

YL: Ok. I'll see...
--

You'll see??? If I'm not mistaken, isn't that exactly what you're having trouble with right now... Seeing?!
Ok, I didn't say that. I can be a little sarcastic and condescending sometimes, but I'm not mean. Especially not to my patients.

These types of conversations bring to light many different concerns. A few of which I will try to address here.

But first, lets time a quick step back... way back... back into time... (Blackstreet reference... anyone?)

A few years ago, when I had first started practicing optometry, I wrote multiple blogs about the impending changes that my profession was about to endure. Changes that were brought on by crony politicians, whose only concern was to fill their pockets with little regard for the public, whom they were elected to serve (I'll try not to name any names... but, lets just say it was a certain "Health Minister"... who's name may or may not start with Kevin... and end with Falcon...). These were changes which ultimately contributed to the lowering of health care standards in British Columbia. And they were changes which led to the fall of a childhood hero from his perch upon a pedestal... I'll never look at Trevor Linden the same way again. But, I digress...

Today, ONLY in British Columbia, a person can walk into any store operated by any individual with absolutely zero credentials and no experience in eye care to buy glasses or contact lenses without a valid prescription. I think that makes it hard to disagree that our standards of health care, at least eye care, are lower than those of any other place in North America.

The Health Minister defended himself by saying that the average individual who has healthy eyes should not have to bother with regular exams and those who do have eye conditions will simply know to have their eyes checked regularly. So much for preventative care. I wonder if Mr. Falcon would be so kind as to describe the symptoms of the early stages of glaucoma, a disease which is one of the leading causes of blindness and affects tens of millions of people worldwide... Oh that's right, there aren't any! It is a silent disease. By the time a patient notices the symptoms, there has already been irreparable, irreversible damage. But I'm sure the average person would somehow know, right?

There is also supposed to be a regulation which, loosely translated, states that if an optical store cannot improve a person's vision to 20/20 or sees any reason for concern, they must send that patient over to an optometrist or ophthalmologist for further testing. Clearly, in the case of the young lady in the above conversation (and many others), they have not been doing that. Which means there are a lot of people walking around with a lower quality vision than they deserve AND, more importantly, potentially suffering from a vision threatening condition.

So, what needs to be done?

I've spent a lot of time pointing fingers at different people for tearing down the foundations of our health care. And there definitely are a lot people who are responsible for the failure of our system. Yes, the big companies and the crony politicians play their part. And they play it well. But, it is important to understand that WE must also bear some responsibility. By we, I mean both health care providers AND the public. It is absolutely my responsibility as a health professional to educate my patients and the public about their health. If I don't do it, then who else will? But, it is also the responsibility of the individual to actively seek out what is best for them. To ask questions, get regular exams, and do what ever else necessary to keep yourself healthy. If you don't, who else will?

Too often, I hear patients say "I've had issues for a long time, but I kept putting it off". As terrible as it sounds, I can understand, I can relate. We build routines for ourselves and follow them, often blindly (pardon the pun). Call it complacency, laziness, or anything else... We put important things off because it means going out of our way or changing our schedule.

Our bodies are made up, at the most basic level, of cells and nerves and chemical reactions. All of which are following the path of least resistance. So it is only human nature that we do what is easiest for us, to follow the simple route. But on our highest level, we are able to make the decisions about what's best for us. And I urge you, when it comes to your health, whether its your eyes or your teeth or your heart, take the time to get it done. And get it done right.


Thanks for reading. Please feel free to leave comments or questions. I'm always happy to discuss!

 

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 :)

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 :)

Lazy Eye

"Contrary to what some believe, a lazy eye is not one that doesn't like to wake up and go to work in the morning."
- Anonymous Eye Doctor with a sense of humour

The medical term for Lazy Eye is Amblyopia

So why do eyes become lazy?

• The brain is very picky! When it is not receiving a clear image or if it is receiving double images, it begins to shut off connections to the eye that is causing it the most grief
• This process usually happens during childhood and if it is caught before the age of 7, it can be reversed depending on how bad the situation is and how cooperative the patient is

There are two main situations in which this happens:

• Eye turn
• In this case, the patient probably has double vision so the brain will stop communicating with the eye that is turned in/out, which will stop the double vision
• Sometimes surgery is needed to straighten the turned eye, other times simple wearing a patch over the good eye will help force the turned eye back
• Difference in prescription
• If there is a large difference and one eye is very blurry, the brain will again shut it off because it doesn't like dealing with two eyes producing different images
• Glasses are the obvious answer. Sometimes a patch over the good eye will help force the blurry eye to work harder

As you can see a Lazy Eye problem actually becomes more of a Picky Brain problem.

And as the saying goes, "you can't teach an old dog new tricks".

So, once the brain has made all the connections it wants to make, it is very difficult to make it go back. This is why it is important to catch it early! (Before age 7 or 8)

After this cutoff, even providing a patient their full prescription may not improve their vision because no matter how clear the image is, it is not being sent to the brain.


FAQ:
Q: Can a person have 2 lazy eyes?
A: That is a fantastic question! And, yes. I recently blogged about a patient I had seen who had high astigmatism in both eyes. So the connections for both eyes were not fully formed during childhood due to blurry vision and at this point in her life, glasses did not help very much.

Q: What is astigmatism?
A: The answer to this can be found in am earlier post called "All Kinds of Blurry" along with info on other causes of blurry vision

Q: How early should kids have their eyes checked?
A: Both the Canadian and American Association of Optometrists recommend that children have their first eye exam at 6-12 months and again at age 3.

Thanks for reading. I hope this information was helpful. Please feel free to send me any questions or comments. And also pass this on to anyone who may find it useful.

The Eye Exam - Why Is It So Important?

Remember, this info plus much more is available on my Facebook and Twitter pages.


Everyone knows that your Optometrist is the person to see for your glasses and contact lens prescriptions. But, the health portion of the exam is often overlooked by patients.

There are many, many ocular and systemic conditions that can be detected and followed by your Optometrist with regular eye exams. Here is a short list of some of the more important/common conditions:

• Glaucoma
• Cataracts
• Macular degeneration
• Retinal detachments
• Retinal holes and tears (common in highly near-sighted patients)
• Bacterial and viral infections
• Eye turns and lazy eyes
• Colour deficiencies
• Stereopsis (our ability to see 3D)

• Diabetes
• High blood pressure
• High cholesterol
• Thyroid problems
• Inflammatory conditions such as: colitis, Crohn's disease, rheumatoid arthritis, psoriasis
• Vitamin deficiencies
• Brain tumors
• Nerve problems in the eye and brain
• Stroke
• Blocked arteries in the neck and head
• HIV/AIDS
• And many more...

Thanks for reading. Any and all feedback, questions and comments are always welcome. Please feel free to pass this information on to anyone who may be interested.

Diabetes and the Eye

Don't forget to check out my Twitter and Facebook pages.

Diabetes is a disease that has grown and spread exponentially in the last 20 years, reaching epidemic proportions. Yet, many people do not know how devastating it can be and the effects it can have on the eye.

Background:

There are 2 main types of diabetes:

• Type 1 (Insulin dependent):
• Early onset (usually by teenage years)
• Autoimmune disease - the body attacks itself and causes destruction of the cells that make insulin
• Insulin is the chemical which promotes uptake of sugars from the blood into muscle and other tissues
• Treated with insulin replacement
• Can lead to death if not treated

• Type 2 (Non-insulin dependent):
• Later onset (usually over the age of 40)
• Body tissues develop resistance to insulin
• Very commonly associated with sedentary lifestyle, high fat diets, and obesity (No surprise its huge in North America!)
• Treatment:
• Early/mild: weight loss, diet changes, and exercise
• Moderate: All of the above plus oral meds that encourage glucose uptake
• Severe: All of the above plus insulin
• Significantly increases risk of heart attack, stroke, and kidney failure

The end result for both, if not well controlled, is high sugar (glucose) levels in the blood stream.

Normal blood sugar levels:

• Healthy patients should have glucose levels of approx 4 mM
• Diabetic patients are instructed to try to maintain them below 6 mM
• Uncontrolled diabetics often have glucose levels of 15-20 mM (if not higher)
  

The Eye:
While high sugar levels in the blood can affect the structure and function of cells and chemicals, the main concern in the eye is loss of integrity of the blood vessel walls.

The tiny retinal blood vessels can become leaky, thus allowing fluid, blood, and proteins to seep into the retina. If left uncontrolled, this can result in any combination of the following:

• Diabetic retinopathy:
• bleeding in the back of the eye, including leakage into the vitreous gel thus causing loss of vision
• lack of blood and oxygen delivery to areas of the retina
• death of retinal tissue - permanent loss of vision
• development of new, weaker blood vessels (neovascularization) which can cause further leaking and fibrosis of the retina
• Macular edema
  
• swelling of the macula (central part of retina) causing decrease of vision
• Retinal detachment:
• Fluid leakage behind the retina or fibrosis due to new blood vessels causing it to be pulled away
• Neovascular glaucoma:
• Due to the lack of oxygen delivery, new blood vessels begin to grow at the front of the eye and block the drainage of fluid causing increased pressure in the eye which can result in damage to the optic nerve - yet another way to cause vision loss
  

If the diabetes is adequately treated, some of the milder problems can be reversed and vision may be restored.

If you have diabetes, or know someone who does, it is very important to keep in mind the effect it can have on your eyes. Regular, annual eye exams are imperative and are no less than the standard of care of diabetic patients.

If there are any questions please feel free to ask. And as usual, please forward this information on to anyone who may find it useful.

Thanks for reading.

 

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.

Find me at Facebook.com/HarbirSianOD and Twitter/HarbirSianOD!

Are Carrots Good for Your Eyes??

The answer is "Yes... However..."

• Carrots are high in Beta Carotene, which our body converts to Vitamin A
• Vitamin A is very important for the health of your eyes, helping the retina function more efficiently

However...

• Eating lots of carrots will not change/improve your glasses prescription

Find me at Facebook.com/HarbirSianOD and Twitter.com/HarbirSianOD for more info!

As usual, questions, comments, and suggestions are welcome.

Near-sightedness

• The medical term for being near-sighted is Myopia
• The term near-sighted is used simply because myopes are able to see close objects more clearly than distant objects
• The most common cause for myopia is an increase in axial length (front to back) of the eye during childhood and teenage years
• This results in images being focused in front of the retina
• Near-sightedness is easily correctable using "minus" lenses, thus a myopic person's prescription will always have a negative sign in front
  

Ex. If you consider a movie projector and screen. A myopic eye would be analogous to someone pulling the screen back so the image is out of focus.