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 :)

Stye In My Eye

What is a Stye?
A stye is basically a blocked gland in the eyelid which becomes infected. Kind of like getting a pimple on the eyelid. Bacteria, skin cells, and oil can cause the blockage.

The medical term for a stye is Hordeolum. They tend to be painful and they can be either internal or external.

How are styes treated?
Simple therapy involves applying heat the affected area to express the gland and release the blocked material.
In more difficult cases, doctors may prescribe ointment and/or oral meds.
And in the some cases, minor surgery may be require to remove the stye.

How do you prevent styes?
Lid hygeine. Simple things such as warm compresses and gentle lid scrubs can help keep the eyelids clean and healthy.

To do this you simply warm up a cloth or towel with warm water and apply the heat to closed eyelids for 5 minutes. At the end of the 5 minutes use the warm towel to gently massage your eyelids and then lightly scrub at the eyelid margin to wipe away any debris.

Doing this on a daily basis will help prevent blockage and inflammation of the eyelid glands.

For patient who have Blepharitis (eyelid inflammation), it is important to do these warm compresses twice daily. Click here for more info on Blepharitis.
 
Thanks for reading. Please feel free to pass this information on to anyone who may find it useful.

Contact Lenses

They come in a variety of shapes, sizes, and colours...

Soft contact lenses (SCL):These are the most common and they are disposable.

• This means that after wearing the lenses for a period of time, they are disposed of and a new, fresh pair is used
• Lenses can be monthly (ex. Air Optix, Frequency 55, Proclear, Biofinity, etc), two week (Acuvue Oasys), and daily disposable (CIBA Dailies, Acuvue 1-day, etc)
• Also available for astigmatism and patients over 40 who need reading glasses (more information in my post All Kinds of Blurry)

Daily disposable lenses are the healthier option for your eyes for the simple reason that a fresh, sterile lens is being used every single time. Most infections are a result of poor storage or lens care. A lot of these problems can be avoided with daily lenses.

Rigid Gas Permeable (RGP):AKA Hard lenses. Considered older technology but actually provide better optics, better oxygen flow, and less infections. Less popular simply because they are uncomfortable to begin with. But patients who get used to them, stick to them.

Hybrid Lenses:Combination of a hard lens with a soft "skirt". Supposed to provide superior vision of RGPs without being as uncomfortable. But, they haven't been as successful as expected.

Orthokeratology (Ortho-K):Contact lenses that are worn while you sleep. Over night, they flatten the cornea and temporarily correct near-sightedness. Also mentioned in my post Laser Eye Surgery.

Important things to REMEMBER:No matter how good a contact lens claims to be at allowing oxygen pass, or keeping your eyes hydrated, or preventing bacteria from sticking to it, at the end of the day it is still a piece of plastic in your eye.

Contact lenses are considered to be medical devices and, as such, should be looked at by a doctor before they are dispensed and any time the patient experiences any problems.

Three big NOs:

• No sleeping
• No swimming
• No tap water

These are the quickest ways to cause infections which can be potentially vision threatening (see picture below).

Other uses:Contact lenses are not only used to improve vision. Here are a couple of other interesting uses:

• Diabetic patients
• Lens changes colour when sugar levels in tears increase
• Bandage
• Used to cover scratched corneas or after LASIK surgery
• Administer drugs over long periods of time
• Tracking eye movements in ocular studies

FAQ:

Q: Can I get coloured contact lenses even if I have no prescription?

A: Yes. But FYI, these lenses tend to be the least healthy for your eyes.

Q: How often should I replace my contact lens case?
A: Usually every 3 months or when your solution runs out. Whichever comes first.

Q: If I wear contact lenses, do I still need a pair of glasses?
A: Yes, you should always have a good pair of glasses to give your eyes a break and just in case something happens to the contacts.

Q: What if I'm on vacation and I forgot my contact lens solution and my contacts are bothering me and there isn't a pharmacy close by and my cousin says its no big deal, can I just store my contacts in tap water?
A: No. No tap water. Ever. I hope that is clear enough :)

Healthy Cornea

Acanthamoeba infection (from tap water)

Corneal Ulcer due to overwear

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.