Eye Exams first to detect chronic diseases - the benefits of eyecare insurance

A study released earlier this year confirms that eye exams by an optometrist or ophthalmologist are often the first to detect chronic diseases like diabetes and hypertension. The researchers found that eye doctors detected signs of certain chronic conditions before any other health care provider recorded the condition—65 percent of the time for high cholesterol, 20 percent of the time for diabetes, and 30 percent of the time for hypertension.

The study has important implications for the heath care system as a whole, as we try to save money by focusing on prevention and early detection. Annual eye exams are critical in detecting signs of chronic diseases at the earliest stages because eye doctors have the only unobstructed, non-invasive view of the body's blood vessels - which they observe through the eye in an eye examination. 

Predictably the research also showed that people with insurance coverage for eye exams are three times more likely get an annual eye exam than a routine eye exam.  It seems that providing employees - and citizens generally - insurance coverage for annual eye exams is an important step to promote wellness and to reduce health care costs in the long run.  Unfortunately, like many important parts of the Canadian health care system, eye exams are not covered except for children and seniors.

The researchers looked at the health records of 56 million members of a large vision insurance provider and after crunching the numbers concluded that billions of dollars were saved through early detection and treatment.  Here are the numbers:

• 65 percent of the 2.2 million members with high cholesterol (1.5 million), resulting in two year savings of $1.7 billion
• 20 percent of 1.5 million members with diabetes (296,800), resulting in two year savings of  $827 million
• 30 percent of 2.2 million members with hypertension (667,800), resulting in two year savings of $2 billion

Vision insurance plans that cover annual eye exams are also a benefit to employers.  Employers who provided such plans experienced 7 percent less absenteeism, 4 percent less employee turnover and savings on insurance and workers’ compensation costs. Early detection of chronic diseases like diabetes and hypertension also increased the likelihood employees would be proactive with their health care and more likely to see their family doctor to receive follow-up care.

Here is a chart showing the money saved by providing vision insurance.

 

Keep in mind that the study was funded by a vision care insurance provider and so there may be some bias.  However, the results simply confirm what most health care professionals already know about eye exams and the early detection of disease as well as the costs savings associated with early detection and treatment.

Video Game therapy, optometric vision therapy are more effective than patching alone in treating amblyopia

Optometrists have long been at the forefront of research into the vision problems and their relationship to the brain. 

Optometric vision therapy, for example, has been shown in studies to be more effective than patching alone in the treatment of amblyopia. Patching involves covering the good eye so that the weak eye is forced to received and process stimuli. The basic principle is that active therapy for the weaker amblyopic eye will improve acuity as well as promote properly functioning binocular vision. 

Many optometric clinics use video games as part of a vision therapy program to treat amblyopia.  Now a  number of studies have now shown that this approach is effective. 

In one such study, Optometrists at the University of California at Berkely did a pilot study that has found that playing video games can help improve the vision of adults with amblyopia. The study found that participants experienced marked improvement in visual acuity and 3-D depth perception after spending just 40 hours playing off-the-shelf video games.

“This study is the first to show that video game play is useful for improving blurred vision in adults with amblyopia,” lead author Dr. Roger Li, research optometrist, was reported as saying.  “I was very surprised by this finding; I didn’t expect to see this type of improvement.”  I don't think that most optometrists would be surprised.  The results confirm the clinical experience of those of us who use vision therapy to treat amblyopia.

The study was published in the August 2011 issue of the journal PLoS Biology and is freely available online.

Amblyopia is a brain disorder in which the vision in one eye does not develop properly.  It is the most frequent cause of permanent visual impairment in childhood, affecting around 3% of children.

But amblyopia is not just a problem for children.  It is also the most common cause of one-eye visual impairment among young and middle-aged adults.  Amblyopia in children can be often be successfully treated but adults do not generally respond as well to traditional treatment. 

Many eye doctors feel that treatment is hopeless after the age of 8 or so.  However, the outlook is not so bleak in the light of recent research into perceptual learning which has challenged the orthodox idea that no vision improvements are possible in adult amblyopes.

Research has shown that that intensive training on a perceptual task -like the kind of exercises prescribed  in optometric vision therapy- such as getting two horizontal lines aligned, could lead to a 30-40 percent improvement in visual acuity.

Since the PLoS Biology study on video game therapy, others have reached a similar conclusion.  Researchers from India reported similar findings from a study that looked at video game therapy for children at the American Academy of Ophthalmology 2011 Annual Meeting.  Children who had video game therapy showed 27% better vision improved that those children that were treated with patching along.

Optometrists who treat amblyopia have been saying for a long time that patching alone is not sufficient.  I'm happy to say that the recent research is proving them right and I hope that parents and patients with amblyopia get the message.

For more information visit www.amblyopia.ca

Image courtesy of imagerymajestic / FreeDigitalPhotos.net.

BC Doctors of Optometry Blog

The BC Doctors of Optometry have a new blog.  Check it out here: http://bcdoctorsofoptometry.com/?page_id=1033.  The blog already has some very interesting posts:

Glaucoma: The Silent Thief
 The Spots That Float in Your Vision
Why Styes occur and what to do about them

Laser surgery turns brown eyes blue - permanently. Which color is better?

A California eye doctor has come up with a $5,000 laser procedure - that takes only 20 seconds to complete - that will turn your brown eyes permanently blue.  You can read about the details here.  The long term risks are not known but that has not stopped thousands of people from contacting the doctor about the procedure.  For some reason, lots of people prefer blue eyes to brown.  I assume that the reason is a purely aesthetic one: they think it just looks better.

Science has nothing to say about whether something is aesthetically better than something else - that is the job of philosophers, poets and artists.  However, science does have something to say about which eye color may be better physiologically.

I've written in the past about intra-ocular light scatter, a phenomenon that results in blue-eyed individuals experiencing more glare because their blue eyes do not absorb enough light.  That's one drawback to having blue eyes.

Another drawback to blue eyes is that, according according to the National Cancer Institute, light colored eyes are a risk factor of iris melanoma, which is an eye cancer.

People who have this procedure done should do what all blue eye individuals should do, wear anti-glare lenses to reduce the glare and wear UV protected sunglasses to keep sunlight and UV radiation out.

New research on the connection between convergence insufficiency and ADHD

New research was presented in October, 2011 in Boston - during Academy 2011 Boston - on the connection between ADHD and convergence insufficiency.

Convergence insufficiency is an eye movement disorder where the two eyes do not work together properly when doing near work such as reading.

The lead researcher, Eric Borsting, OD, MS, FAAO, FCOVD, is an optometrist who for the last several years has been looking into the connection between common behaviors associated both with attention deficit hyperactive disorder (ADHD) and convergence insufficiency.

The research is important because convergence insufficiency is very effectively treated with vision therapy. To the extent that the behavior of an individual thought to have ADHD is attributable to convergence insufficiency, treatment of the latter may be a benefit to the patient in resolving some or all of the patient's academic and/or behavioral issues.

The research showed that significant improvements were found in academic behaviors and attention as a result of vision therapy for convergence insufficiency. The study was conducted under the Convergence Insufficiency Treatment Trial, involving 45 children between 9 and 17 years old with symptoms of convergence insufficiency.

"All received 16 weeks of therapy, with 8 weeks of maintenance therapy where they're not coming in every week," Dr. Borsting said.

"The Conners 3 ADHD Index is a 10-item survey that screens for attention problems in children, including 'inattention' and 'easily distracted,' and the Academic Behavior Survey is a six-item survey of behaviors a parent can observe, such as 'appears inattentive' and 'avoids reading,'" he said.

"Here I'm reporting data from the two surveys," Dr. Borsting said. "For both surveys, I found significant improvement in scores."

Learn more on the connection between convergence insufficiency and ADHD here.

Our previous posts on convergence insufficiency covered the success rate of vision therapy treatment (which has been shown to be the best treatment available), what science has to say to adults with convergence insufficiency,what symptoms may indicate convergence insufficiency as well as commonly prescribed treatments that have been proven ineffective by recent research.

Here are some other posts on convergence insufficiency:

The gold standard treatment for convergence insufficiency
Aug 31, 2012

What does convergence insufficiency look like? - See For Life
May 17, 2012

Vision therapy for convergence insufficiency improves ... - See For Life
Jan 16, 2012

Is your child smart in everything but school? The ultimate convergence insufficiency infographic- See For Life
Jun 14, 2012

Problem readers may have convergence insufficiency - See For Life
Jul 05, 2011

Adults with convergence insufficiency - See For Life
Oct 25, 2011

New research on the connection between convergence insufficiency and ADHD
Oct 25, 2011

Convergence Insufficiency Treatment Success Rate - See For Life
Oct 14, 2011

Pencil push-ups are so last decade - See For Life
Aug 26, 2011

Binocular vision dysfunctions ate my homework - See For Life
Mar 31, 2012

Your iphone can be a pain in the eye - See For Life
May 26, 2012

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Vision therapy makes the news

A CBS news affiliate in the United States aired this story about vision therapy.  The main points are that school eye screenings don't check for many treatable vision problems such as visual perceptual skills or binocular vision dysfunction which make it difficult for a child to learn.

Note that people with these problems don't have a "learning disability" as that term has come to be defined to include things like dyslexia.  However, vision problems make learning - 80% of which is done through our visual system - much more challenging than it is for classmates who do not have such disorders.

Convergence Insufficiency Treatment Success Rate

I've had some questions lately about the success rate in treating convergence insufficiency.  With opometric Vision Therapy - which is the best available treatment - the success rate is 75%.  This result was found by the recent National Eye Institute study on convergence insufficiency treatments which found vision therapy to be the best treatment and pencil pushups to be ineffective.  Read more here: http://visiontherapy.ca/convergence.html

The myopia epidemic: why it is so dangerous.

Myopia, also called nearsightedess, is increasing in the population at an alarming rate.  According to the National Institutes of Health in 1972, the frequency of myopia was 25% in Americans aged 12 to 54. By 2004, it had increased to 41.6%. (Roan,2010).

Even worse than the increasing frequency of myopia is that for affected individuals it has a tendency to get worse over time.  Some of you may say, "Who cares? People can wear glasses."  Corrective lenses may fix a myope's blurry vision but myopia is far more dangerous than blurry vision.

The danger of myopia is that it can lead to blindness due to the adverse ocular changes associated with it.  Myopia causes abnormal stretching or elongation of the eye which can cause thinning and weakening of the retina (the thin membrane at the back of the eye that contains the cells that send visual information to the brain).   This elongation may pull on the vitreous (the gel substance that fills the eye) which in turn pulls on the retina.  This proces can cause a retinal detatchment - a  medical emergency requiring immediate surgical attention.  A detached retina can lead to blindness.

Another problem with myopia is glaucoma.  Moderate to highly myopic people are twice as likely to develop glaucoma. (Mitchell 2000).  Threfore, it is important for myopic individuals to see thier optometrist regularly to ensure that glaucoma is not developing.

Because of the dangers of myopia, scientists have been working on ways to stop myopia progression.  Orthokeratology is one solution that has been shown to be effective in a number of studies from around the world.  Orthokeratology is a treatment where the patient wears a night-time retainer lens while sleeping.  The retainer changes the shape of the cornea so that the patient experiences clear vision during the day.  In addition to being an alternative to glasses, contacts and laser surgery, orthokeratology retainers can slow or stop the progression of myopia. 

Cool new technology from the Las Vegas Vision Expo

Lots of new and exciting new technology was launched at the Las Vegas Vision Expo last weekend.  I was there and my personal favorite is "Opti-Fog" lenses from Essilor.  These are the first lenses (as far as I know) that do not fog up! 

Fog irritates glasses wearers in a number of situations.  And in Canada it is often a daily bother.  When you are going from the cold outdoors to the warm indoors your lenses fog up.  When you are sipping a hot beverage, the steam from the cup fogs up your lenses.  And you can probably think of a few more situations where foggy lenses make you mad.

But no more!  I love science.

The anti-fog technology is a lens coating that is activated by a spray.  You need to treat your Opti-Fog lenses with the spray every couple of weeks and fog will never bother you again.

The miracle vitamin gets more miraculous

A recent study in the journal Archives of Ophthalmology concludes that high vitamin D intake reduces the risk of developing age-related macular degeneration (AMD) in women under 75 years of age.  This study adds to the body of knowledge on the effects of nutrition in reducing the risk of developing the disease.  Previous studies have concluded that nutrients such as anti-oxidents and carotenoids also reduce the risk of developing AMD.

AMD is the number one cause of blindness in people over 60. It destroys a person's sharp, central vision. You need central vision to see objects clearly and to do tasks such as reading and driving. AMD does not cause any pain and, in some cases, it advances so slowly that people notice little change in their vision. In others cases, the disease progresses faster and may lead to a loss of vision in both eyes. Regular comprehensive eye exams can detect macular degeneration before the disease causes vision loss. Currently available treatments can slow or stop vision loss but science has not yet developed a way to restore vision lost to AMD.

Here is what normal visoin looks like:

This is vision with AMD:

From the photos above, it is obvious that AMD can be disasterous to your quality of life.  Some people are more at risk than others. It is important to see your optometrist to learn about the risk factors for AMD and whether you are at risk.

Risk factors for AMD aside,  it can't hurt to ensure that you are getting enough vitamin D.  In addition to protecting against AMD, vitamin D has been linked to lower cancer risk, a stronger immune system, lower risk of multiple sclerosis, reduced risk of developing rheumatoid arthritis in women and it can keep the brain functioning properly as we age.

What about a women's eyes is the biggest turn off for men?

The answer is tears. They contain chemicals that seriously dampen a man's desire according to a recent Israeli study that compared the reactions of men after sniffing saline solution and women's tears.  Men found women's photographs less attractive after sniffing tears when compared to saline. 

The scent of women's tears also had a physical effect on men.  There was less blood flow to areas of the brain related to sexual desire and the men showed low levels of testosterone.  There were also signs of the absence of sexual arousal such as a slow heart rate and a slow breathing rate.

Interestingly, women are commonly sufferers of chronic dry eye.  Is this evolution's way of suppressing "repulsive" tears to ensure successful mating?  Just a thought.

Pencil push-ups are so last decade

I'm surprised that some doctors are still recommending pencil push-ups to patients with convergence insufficiency. Convergence insufficiency is an eye-muscle disorder where the two eyes do not converge properly when doing close work like reading. The symptoms are often double vision, blurriness, problems reading, eye fatigue, headaches, frequent loss of reading and more. It is the most common ocular-motor disorder.

Even more surprising is that some ophthalmologists have told patients for whom pencil push-ups did not work that there is no other treatment for convergence insufficiency. To the contrary, a landmark study funded by the National Eye Institute and published in 2008 found that in-office vision therapy was the best treatment for convergence insufficiency.

So for all those convergence insufficiency sufferers out there, pencil push-ups are not the only answer - and not the best answer.

Which doctors make you spend the most time in the waiting room?

Nobody likes sitting in the waiting room waiting for their doctor to see them. While most of the time waits are caused by emergency patients and other unexpected medical issues, excessive waits in the doctor's office are irritating for patients especially when the doctor does not apologize for the wait and gives no explanation for it. In the absence of the latter, many patients assume that the doctor was just out playing golf or otherwise wasting time.

The good news for those seeking eye and vision care is that the lowest wait times are in optometrists' offices! They have have an average wait of just 17 minutes. The worst wait times are in neurologists offices, where the average wait is 30 minutes. Among all doctors the average wait time was 23 minutes.

These results come from a survey conducted by medpagetoday.com.

The New York times has a story on waiting room frustration here.

Vitamin C lowers cataract risk

Cataracts are a clouding of the eye’s lens that commonly causes vision problems in older people. A new study published in the journal Ophthalmology shows that vitamin C can lower the risk of developing cataracts.

In contrast to previous studies, the new study focused on individuals in India rather than on people in Western countries. India is a particularly appropriate setting for a study on the effects of vitamin C because people there tend to have lower levels of vitamin C and high rates of cataracts. The study's authors evaluated more than 5,600 Indian adults of age 60 and up for cataracts, interviewed them about their diets and lifestyle habits, and measured their blood levels of vitamin C.

The study found that nearly 73 per cent of the study participants had cataracts. However, the risk of cataracts dropped as vitamin C levels in the blood and vitamin C intake rose.

In the people with highest levels of vitamin C, the risk of cataract was 39 per cent lower than in people with the lowest levels of vitamin C.

This is the latest in a long line of recent research showing the beneficial effects of a healthy diet on the eyes. Other studies have shown that a vegetarian diet also reduces the risk of developing cataracts and that antioxidants protect agaist the development of macular degeneration (which is the leading cause of blindness in people age 50 and over). In short, diet matters. And it is so easy to eat a beneficial diet - all you need to do is eat lots of fruits and vegetables. Green leafy vegetables and brightly coloured ones are the best.

I'll be on the radio today - RJ 1200 at 2:00 p.m.

Tune in to RJ 1200 (1200 on the AM dial) today at 2:00 p.m. to hear me talk about the things that people do to put their eyes at risk.

You can also call in with questions.  If you want to listen live on the internet click here.

Girl loses her eye after buying contacts at a beauty store

Fox news reports that a New York girl needs a cornea transplant after she illegally purchased a pair of colored contacts at a local beauty store. But this could happen in Vancouver. There were reports last year of kids buying coloured contacts at various night markets around Vancouver and being told that they could clean the contacts with tap water (which is wrong and very dangerous advice).

According to Fox News, Erica Barnes bought $20 contacts at a store in Queens. She wore the lenses for one day and fell asleep with them in her eyes. An infection developed and destroyed her cornea. Unless she can get a corneal transplant she will be blind for life in the affected eyes.

According to the girl's step mother, “For $20, she lost her eye. Every parent should know their girls are in danger. They are dangerous eye candy that our children can buy anywhere.”

Legally, you need a prescription from a doctor to purchase contact lenses – and they should be purchased from a licensed health care provider, who can teach you how to use them and take care of them. Shockingly, Erica was told she could clean her contacts with with tap water – not saline solution.

The following comes from the Fox News report:

Dr. Jules Winokur, a corneal specialist in New York City, said contact lenses purchased from beauty stores often don’t fit properly and the salespeople who sell them don’t give proper advice on how to take care of them or how to use them. He said he sees several people come to his office with infections because they use such lenses, and he advises it’s not a good idea.

This is an example of the dangers of buying contacts from people who are are not eye care professionals - places like beauty stores, the Internet or Vancouver night markets. It is dangerous and parents should ensure that their children are being properly fitted with their contacts and are instructed on lens use and lens care by an eye doctor.

Read more: http://www.foxnews.com/health/2011/06/30/new-york-girl-loses-sight-after-buying-illegal-contacts/#ixzz1RMT2PPE7

Problem readers may have convergence insufficiency

Image: freedigitalphotos.net/photostock

Convergence insufficiency (CI) is one of the most common childhood ocular motor disorders. It can make reading very difficult and consequently cause a child to fall behind in school.
In my office many parents of kids with convergence insufficiency report that their child is a slow reader, intensely dislikes school and is generally performing very poorly. Often, the paradox of an intelligent child who performs poorly in school is explained by a treatable ocular-motor disorder like CI.

Studies estimate that 5-15% of children are affected by convergence insufficiency.

It is vital for parents and teachers to know that a even if a child has 20/20 vision, she still may have CI. The standard eye chart only tests for visual acuity and not for ocular motor function, which is just as important for the performance of visual work such as reading and playing sports. Generally, CI can only be found in an eye examination.

The good news is that convergence insufficiency is very treatable. A recent study funded by the National Eye Institute found that optometric vision therapy is the best treatment for convergence insufficiency, with a 75% success rate.

According to the press release issued by the National Eye Institute:



“There are no visible signs of this condition; it can only be detected and
diagnosed during an eye examination,” said principal investigator Mitchell Scheiman, O.D., of Pennsylvania College of Optometry at Salus University near Philadelphia, Pa. “However, as this study shows, once diagnosed, CI can be successfully treated with office-based vision therapy by a trained therapist along with at-home reinforcement. This is very encouraging news for parents, educators, and anyone who may know a child diagnosed with CI.”

Common symptoms of CI are:

headaches

blurred vision

double vision

inability to concentrate

short attention span

frequent loss of place

squinting, rubbing

closing or covering an eye

sleepiness during the activity

trouble remembering what was read

words appear to move, jump, swim or float

problems with motion sickness and/or vertigo

Parents should ensure that they take their children to the eye doctor every year and that the doctor is testing for ocular motor disorders like CI. Don't be afraid to ask the right questions to ensure that nothing is being missed.

Never draft a baseball player with blue eyes?

Josh Hamilton of the Texas Rangers blames his difficulties on the field on his blue eyes. Sounds crazy right? Not really.

Having blue eyes can make it more difficult for a baseball player to see during day games compared to players with darker eyes. Blue eyes have less pigment in them than darker eyes resulting in excessive light entering the eye which scatters to cause unwanted glare. Optometrists know the phenomenon as "intraocular light scatter".

Apparently Hamilton is struggling to find a sunglasses that he is comfortable with. He should find something made of polycarbonate (for impact resistance), with no-glare coating and with polarization. Polarized sunglasses allow light waves traveling in only one direction to enter the eyes, eliminating the natural, scattered way that light travels and making vision sharper and clearer.

Also, given the high rate of baseball eye injuries, why not use baseball-specific saftey glasses?

Watch this video from ESPN where the announcer talks about Buck Showalters's advice never to draft a blue eyed player because they can't see as well. Fortunately for these players, there is eyewear for the problem.

Related articles

Woman gets eye color surgery in Panama and goes blind

New laser surgery turns brown eyes blue - permanently. Which color is better according to eye doctors?

Image courtesy of Idea go / FreeDigitalPhotos.net

Childhood vision disorders lead to adult problems

A 2011 study published in the journal, Pediatrics, found that in addition to refractive errors that can be corrected with glasses such as myopia and astigmatism, ocular disorders like strabismus (eye-turn, cross eyes) and amblyopia (lazy eye) that occur in infants, toddlers, and children may present lifelong problems for the child. Strabismus and amblyopia require more intense treatment such as vision therapy or surgery.

Children who become adults with these conditions must adapt and compensate for them. Moreover, vision problems that were present in childhood may continue to plague the patient into adulthood, affecting overall health, self-perception, educational attainment, job choices, and a number of other social factors.

Basically, people with these disorders find it very difficult to do things that people with healthy vision take for granted, like effortlessly understanding visual learning. The fact that 80% of classroom learning happens through our visual system means a child with lazy eye, for example, is at a significant disadvantage in school.

The study confirms what we already know about vision disorders and quality of life. A person's life can be needlessly limited if a treatable vision disorder is ignored. Amblyopia is rarely evident to parents or teachers and can only be diagnosed during an eye exam. Even the child will not know that she is not seeing as well as others. That is why all children should have an annual eye exam. In British Columbia the provincial health plan covers visits to an optometrist up to the age of 18 so there is really no reason why a child needs to have their potential needlessly limited.

In our society there is no reason for people to grow up with strabismus or amblyopia. Yet, tragically, it is still too frequent.

Laser eye sugery makes you queasy?

I came across this news article from Houston, Texas on corneal reshaping, which doctors call orthokeratology (the article curiously used the term "corneal molding", which makes it sound like your cornea is past its expiry date...).

Orthokeratology reshapes your cornea while you sleep so that you have perfect vision during the day. No glasses, no contacts, no surgery. It is very popular with people who are active in sports, especially swimming, people who don't like the discomfort of contact lenses and people who are tired of wearing glasses. It is also a good option for people who are not good candidates for laser eye surgery or who just don't like the idea of having elective surgery on their eyes.

The patient will wear custom designed hard contact lenses while they sleep (they are very comfortable) and remove them in the morning. Sometimes there is a trial and error process to get the fit perfect and to ensure maximum effectiveness and comfort. During sleep, the lens reshapes the cornea of the eye resulting in 20/20 vision upon waking.

Orthokeratology should be done under doctor supervision to ensure that the lenses are doing their job properly, that the eyes are adapting well to the lenses and that there is no risk of damage is being done. The risks of orthokeratology are generally the same as those associated with regular contact lens use, namely that improper care and cleaning can cause infections.

New research even suggests that orthokeratology can stop the progression of myopia (near-sightedness). Many young people have the unnerving experience of seeing their glasses prescription get worse and worse every time they go to the eye doctor. Orthokeratology appears to be one way to slow or stop that process. Incidentally, I have also had success in my clinic with using vision therapy to stop the progression of myopia.

Many of my patients have opted for orthokeratology and I'm happy to say that the vast majority of them really love it. If you are interested in orthokeratology, go see your optometrist who will assess your eyes and determine if you are a good candidate for it.

To read the Houston, Texas article, click here.

Prevent blindness in kids

Wear protective eyewear in sports

Eye injuries, especially sports eye injuries are the leading cause of blindness in kids (read my previous post on this subject here) but they are easily preventable by wearing protective eyewear, which can prevent 90% of sports related eye injuries.

Be smart about protective eyewear

The tragedy is that even though sports eye injuries are so easily prevented, very few athletes (adults or children) wear protective eyewear.

Even when protective eyewear is worn it is often not worn intelligently. For example, batted baseballs are 3.5 times as likely to cause an eye injury than a pitched ball. Unfortunately, most players do not wear protective eyewear when they are not at bat.

Prevention is better than surgery

Surgery is an option in extreme cases of injury but prevention is the best medicine. It also saves our taxpayer funded health care system millions of dollars a year. This is money that is more properly devoted to treating cancer and other diseases that are not so easily prevented. For example, an American study found that a basketball eye injury to a child under 15 costs the system an average of $3,996.

Four important points

Keep these points in mind regarding protective eyewear:

•All kids need protective eyewear.
•Ordinary prescription glasses do not provide adequate protection.
•Eyewear should be sport-specific and sit comfortably on the face.
•Protective eyewear is usually made of polycarbonate.


Examples of protective eyewear

Protective eyewear includes safety glasses and goggles, safety shields, and eye guards specially designed to provide the correct protection for a certain activity. Ordinary prescription glasses, contact lenses, and sunglasses do not provide adequate protection in eye-hazardous situations. Safety goggles should be worn over them.


Always use polycarbonate

The best material for safety lenses is polycarbonate. Polycarbonate lenses are lightweight, scratch-resistant, thin, and can be designed to meet most eyewear designs or prescriptions, they are also 10 times more impact-resistant than other materials.

What about athletic performance in protective eyewear?

Studies show that protective eyewear does not hinder the player’s sight while participating in athletics. In fact, an athlete may play better in protective eye wear because she is not afraid of a potential eye injury.

Sources

Prunella, W. (1999). Average societal cost of body part injured. Injury cost model. Bethesda, MD.

Miller, B.A., & Miller, S.J. (1993). Visual fields with protective eyewear. The Journal of Orthopedic and Sports Physical Therapy, 18(3), 470-472.

American Academy of Ophthalmology.

Conn, J.M., Annest, J.L., Gilchrist, J., & Ryna, G.W. (2004). Injuries from paintball game-related activities in the United States, 1997-2001. Injury Prevention, 10(3), 129-143.

Fineman, M.S. (2001). Ocular paintball injuries. Current Opinion in Ophthalmology, 12(3), 186-190.

Kids' Sunglasses Warning

Dr. Jason Morris has an important warning about certain shaped kids sunglasses (like heart and star shaped sunglasses) that can actually increase the harm to your child's eyes from UV light.

Be careful when selecting sunglasses for your children.

Read Dr. Morris's warning here.

TV interview with Fanny Keefer

Dr. Randhawa's TV interview with Fanny Keefer is on youtube. Just press play to watch it!

Kids' blindness: the leading cause is ...

I did some research on kids and blindness over the weekend and came up with some important information, which is especially relevant now as the warm weather brings kids outside to play sports.

Eye injuries are the leading cause of blindness in kids

Eye injuries are the leading cause of blindness in kids and most eye injuries among kids 11 to 14 occur while playing sports. While hockey is definitely a leading cause of eye injuries, other sports which are commonly thought of as safer and not as rough as hockey are also leading causes of eye injuries in children. Chief among these are baseball and basketball.

Baseball is a leading cause of eye injuries in children 14 and under. Research from the United Sates shows that Basketball is the leading cause of eye injuries among 15 to 24 year-olds.

The sports with the highest rates of eye injuries are baseball/softball, ice hockey, racquet sports, basketball, fencing, lacrosse, paintball and boxing .

Boys are more at risk than girls

Parents have to keep a closer eye on their boys than their girls. Boys 11-15 are five times more likely to end up in the emergency room with an eye injury than girls of the same age. Most of these injuries are sports related and related to projectiles including toys, guns, darts, sticks, stones and air guns.

What can you do to prevent the risk of eye injuries?

The first thing you can do is wear protective eye wear. The proper eye wear, made of the right materials, can prevent 90% of eye injuries. Some athletes will even play better with protective eye wear because they are less afraid of getting injured. I'll have more on protective eye wear in a subsequent post.

The most important thing you can do is to see your optometrist for a comprehensive eye health examination. This examination can reveal pre-existing conditions that can put a child (or any athlete, even an adult) at higher risk of blindness or vision loss in the event of an impact to the eye. When you know of the risk, you can take effective precautions to mitigate it and keep your eyes healthy.

As a reminder of how devastating and scary an eye injury can be, and how easy it is to prevent, read the post on Vancouver Canuck Manny Malholtra's eye injury. As I said in that earlier post, I believe that Manny Malholtra suffered a detached retina. An eye exam can determine if you are at higher risk of a detached retina. I'm not sure if Manny Malholtra had those risk factors, but if he did, he should have been wearing a visor.

Sources:

Harrison, A., & Telander, D.G. (2002). Eye Injuries in the youth athlete: a case-based approach. Sports Medicine, 31(1), 33-40. 2U.S. Consumer Product Safety Commission. (2000). Sports and recreational eye injuries. Washington, DC: U.S. Consumer Product Safety Commission.

American Academy of Pediatrics, Committee on Sports Medicine and Fitness, American Academy of Ophthalmology, Eye Health and Public Information Task Force. (2004). Protective eyewear for young athletes. Ophthalmology, 111(3), 600-603.

Ducharme, J.F., & Tsiaras, W.G. (2000). Sports-related ocular injuries. Medicine & Health Rhode Island, 83(2), 45-51.

U.S. Consumer Product Safety Commission, 2000.

American Academy of Pediatrics, Committee on Sports Medicine and Fitness; American Academy of Ophthalmology, Eye Health and Public Information Task Force, 2004

Joint Policy Statement of American Academy of Pediatrics, Committee on Sports Medicine and Fitness; American Academy of Ophthalmology, Eye Health and Public Information Task Force. (2004). Protective eyewear for young athletes. Ophthalmology, 111(3), 600-603.

Only 38 years old and risking blindness

May is vision health month. So it is appropriate that Global News did a story on the six o'clock news on Victoria Day highlighting the dangers of getting automated sight tests from opticians rather than a comprehensive eye exam from a doctor of optometry. You are risking blindness.



Eye exams by a doctor of optometry assess the health of your eye and its component parts like the optic nerve. This is only way to diagnose glaucoma and other diseases early enough to prevent permanent vision loss.

Jason Inman was getting automated sight tests from an optician for years. He thought he was too young to need an eye exam from an eye doctor. He was wrong and and tragic consequence was permanent vision loss.

In his interview he talks about having a permanent smudge in his vision. This will likely never go away. For his eyes to get this bad, he must have suffered severe and permanent vision loss. Going by what he said in his interview, he is probably barely legal to drive, if is he is legal at all.

The good news is that now that he has gone to his optometrist, his disease is diagnosed and can be treated and the progression can be halted. The tragedy, of course, is that if he just visited his optometrist regularly he would not have suffered permanent vision loss. The thing that makes glaucoma so dangerous is that the person with the disease will not know that he has it until serious vision loss has already occurred.

It is true that this blog emphasizes glaucoma and eye exams but everyone out there needs to take their health seriously and be proactive and you need to see the eye doctor regularly. The consequences are just not worth it.

Another point is that BC's eye care regulations are obviously not rational if they allow automated sight testing because people are being lulled into a false sense of security regarding their health. Like Jason Inman said in his interview, he really did not think about whether his eye health was being looked after. That is understandable. In this busy world we often don't have time to think about our health. That is why we have doctors to look after us. I think that many people are just like Jason Inman. But I hope that they don't suffer the same consequences.

Dr. Randhawa interview on TV

Dr. Randhawa was on Studio 4 and gave an interview with Fanny Keefer. The show will be repeated throughout the day on Shaw Cable channel 4 today and then will be available on the show's website here.

NHL should require visors after Manny Malholtra's eye injury

At least one optometrist is telling National Hockey League players to wear visors.  She happens to be engaged to one of them. Andrew Ladd's fiancee has tried unsuccessfully to convince Ladd to wear a visor while playing for the Atlanta Thrashers, reports the Candian Press.  Visors are already required in international hockey rules.

Ladd is rethinking his stance on a visor after the horriffic injury to Canuck, Manny Malholtra, "Just seeing what happened to Manny Malhotra and those types of injuries, it's scary," Ladd told the Canadian Press. "It can end pretty quickly if you take one in the eye."  This is what happened to Malholtra:



An injury like this can lead to permanent blindness.  Under NHL rules, no player with one blind eye can play.  However, I don't think a rule is even necessary.  A player with one blind eye will probably not have the peripheral vision and necessary depth perception required to succeed at the NHL level.

The Canucks have not disclosed exactly what kind of eye injury Malhotra suffered, but there are a few possibilities.  Dr. Harbir Sian has a list of the possible injuries here, which include detached retina, corneal abrasion, cataract, glaucoma and fractured orbital bone.  In my opinion, the most likely injury is the dreaded retinal detachment.

Georges St. Pierre has Hyphema

Georges St. Pierre tweeted today that his eye condition is, in fact, hyphema, which is essentially blood in the front of the eye.  Here is his tweet:

I am so lucky my BJJ instructor Bruno Fernandes is an ophtamologist!!! I'll be in good hands!!!
My medical condition is called Hyphema. My vision is still blurry and my eye sensitive but the blood in my eye has now been absorbed...
My retina is find as well and my vision will come back to 100%!!! Can't be more happy!!

The blood usually reabsorbs, but a doctor needs to make sure that the process is resolving as it should and needs to monitor the pressure inside the eye.  If pressure increases or more bleeding occurs, hospitalization may be necessary.  A doctor will also give instructions regarding a series of precautions that a patient must take to ensure proper healing.

According to Georges' tweet, the blood in his eye has already reabsorbed, so he seems to be well on the way to recovery.

The best way to prevent hyphema is to wear protective eye wear because the condition is caused by trauma to the eye.  Are safety goggles permitted in UFC?

UFC Fighter escapes retinal detatchment

UFC welterweight champion Georges St-Pierre had to take a break from competition because of an eye injury.

Following a fight that left him unable to see out of his left eye, he went doctors who suspected a detached retina. This is a serious condition that requires emergency surgery or else permanent blindness may result.

Luckily, Mr. St. Pierre's retina was not detached and he will fully recover in a short time.

This story highlights the importance of taking sports impact injuries seriously when they happen to the eye or the head generally. Detached retina due to impact can happen to anyone.

(But remember that retinal detachment can occur even without an impact. Go see an optometrist immediately or go to the ER if it is after business hours if you experience any sudden changes in your vision)

People who are highly myopic are at increased risk of retinal detachment and they need to be extra careful. Even if you have had laser surgery to correct your myopia, your risk level is still high. This is because the surgery merely alters the cornea at the front of your eye and does not change the physiology at the back of your eye where the retina is located.

I frequently have patients who come in to have their retina examined after being hit in the head or near the eye with a baseball or have suffered some other impact. I'm always pleasantly surprised that these patients know about the risk and take their health seriously!

Read more about Georges St. Pierre's injury here.

Fixing My Gaze - Can you imagine not having 3D vision?

I just read an inspirational book called Fixing My Gaze about neuroscientist, Susan Barry, who was born with strabismus (an eye turn) and had lived all her life without stereo vision, meaning that she could not see in three dimensions.

She had three surgeries to "correct" the eye turn cosmetically but she still could not see properly and the eye was still turned, although less than before. She had lived this way for over 40 years until she met optometrist Dr. Theresa Ruggiero.

Dr. Ruggiero treated Susan with vision therapy and corrected the eye turn and allowed her see in three dimensions for the first time in her life. Can you imaging how her world was transformed? I've heard rumors of a "Fixing My Gaze" movie but have not been able to confirm them.

Here is what Susan Barry said in an interview with Scientific American about how the world looked different after vision therapy:

"For the first time, I could see the volumes of space between different tree branches, and I liked immersing myself in those inviting pockets of space. As I walk about, leaves, pine needles, and flowers, - even light fixtures and ceiling pipes - seem to float on a medium more substantial than air. Snow no longer appears to fall in one plane slightly in front of me. Now, the snowflakes envelope me, floating by in layers and layers of depth. It's been seven years since I gained stereovision, but ordinary views like these still fill me with a deep sense of wonder and joy."

Our vision therapy practice includes many patients with strabismus but all of them are very young (obviously it is better to fix the problem when a patient is young to save her from living years with the condition).

Susan Barry's story is remarkable in that she was in midlife when she received vision therapy. The conventional wisdom, now being disproved by new studies, was that after the age of 7 or 8 , the brain could not be trained (or "rewired") to see in new ways. The old scientific thinking was that after early childhood, the brain became fixed. In fact, Susan Barry herself and other scientists thought that it was impossible for her to ever see in 3D.

Now, we know that the brain exhibits neuroplacticity and that given the proper behavioural therapy, even adults can rewire their brains. This has given hope to many people who did not receive treatment for visual processing disorders at a young age. Now it seems possible that even older patients with amblyopia or strabismus and other binocular vision disorders can benefit from treatments like vision therapy.

You can hear interviews with Susan Barry and read more about her story at her website: http://www.fixingmygaze.com/.

Are your kids dangerously inactive? It shows up in their eyes.

We already know that many diseases like diabetes and heart disease show up first in the eyes.
A new study shows that changes in the back of the eye can tell us if a child is on the path to future diseases. A new Australian study published in the journal Arteriosclerosis, Thrombosis and Vascular Biology concludes that dangerously inactive children have narrow arteries in the retina, the back of the eye that contains the cells that send visual information to the brain.

In today's world, where children spend hours sitting in front of the TV or the computer, inactivity is a major problem. Narrow retinal arteries are a marker for increased risk of high blood pressure, heart disease, and diabetes down the road. The study found that children with the highest levels of physical activity, one and half hours a day, had significantly wider average retinal arteries than those who spent less than half an hour a day being physically active.

The study shows us that knowledge (and an eye exam) is power. Because optometrists can detect narrow arteries in an eye health exam, we can identify the risk early enough in life and do something about it to prevent often deadly chronic diseases from showing up in adulthood. The doctor can then monitor the retina to track improvement or worsening of the arteries.

Retinal examinations are done by most optometrists during an eye health exam.

Allergy season will be a month longer than normal this year - what to do about itchy and watery eyes

I'm seeing more patients with complaints of itchy, watery eyes.  And my husband is complaining like crazy and begging for a prescription!  That means it's spring and allergies are here.  In fact, in the northern part of North America (which includes most of Canada), allergy season is expected to last as much 27 days longer than normal according to a study published by the Proceedings of the National Academy of Sciences. 

Eye allergies are a reaction allergens such as pollen, mold, dust mites and pet dander.  They get in the eyes and cause inflammation of the tissue that lines the inner eyelid. 

There are a number things you can do.

 If you wear contact lenses, consider switching to daily disposable lenses.  They are by far the most comfortable lenses on the market. Allergy season can make contact lenses more uncomfortable and comfort declines significant in weeks three and four for a monthly lens.  You can avoid most of these problems by switching to a daily lens.  Although daily lenses are more expensive, you don't need to buy solutions and they are super-convenient because you don't need to clean and care for them.  They are unbeatable for traveling.

Allergy medication is an another option.  Oral, all purpose allergy medication like Claritin should be used with caution, especially if your main complaint is itchy and watery eyes.  These pills can dry out the eye and replace one problem with another.

There are a number of prescription eye drops designed to eliminate itchy watery eyes that your eye doctor can tell you about and prescribe if appropriate.  Many of these are very effective, now come in "once-a-day" formulation, are pregnancy safe and can be used in children as young as two years old.  For a child, who needs a parent to apply the drops, the once-a-day option is convenient because you can give the child one drop in the morning and he is good for the next 16 hours of summer camps, sports, hikes and everything else than makes summer fun!

Vegetarians and vegans have a lower risk of cataracts than meat-eaters

Another point for the vegetarians!  There is a new British study published in the The American Journal of Clinical Nutrition (it's in the March 2011 issue, if you want to read it) that concludes that vegetarians and vegans have a much lower risk of cataracts than meat-eaters. 

The researchers monitored the medical records of 27,670 non-diabetic people aged 40 or over to see if and when they developed cataracts. They found a strong correlation between a person's diet and cataract risk.

One remarkable thing about the correlation is that the risk was highest for high meat eaters (those that eat more than 3.5 ounces of meat a day).  The next highest risk was for moderate meat eaters, then low meat eaters, followed by fish eaters (people who eat fish but no other meat).  Vegetarians and vegans had the lowest risk. This means that reducing your meat consumption, even if you do not become fully vegetarian, will reduce cataract risk.  There was a big difference in risk between vegans and meat eaters.  The risk for vegans was about 40 percent lower than it was for the high meat eater category.

What are cataracts?

Cataracts are a clouding of the eye's crystalline lens that usually develops slowly over time. (In the case of post-traumatic cataracts, however, they can also occur very quickly.) It is the leading cause of poor vision in adults.

What if you have cataracts?

I routinely diagnose cataracts and if surgery is required to remove them, I refer patients to a good surgeon.  With today's surgical techniques the surgery can be as quick as 15 minutes!  However, all surgery has some risk and should not be undertaken lightly. 

And with cataract surgery it will cost you several hundred dollars for a good quality replacement lens if you want the best vision (MSP pays for the most basic lens but it is definately far from the best).  It is always better to prevent the condition for occurring.

Watch this video to learn how cataract surgery is done.  The video makes it look simple but there is much more to it than the video suggests.

Free Prescription Eyeglasses Coupon

People like coupons that they can email to their friends.  Several readers have asked for one for the free eye glasses promotion.  So, here it is!

Click on the coupon for a bigger image and if you want to print it out.  If you want to copy the URL, here it is:

https://sites.google.com/site/doctorpromotions/home/free-eye-glasses/Mehfil%20ad%20free%20glasses%20copy.jpg

On the Radio Today - Summer Vision

Tune in to RJ 1200 (am 1200) today at 2:00 p.m. to hear me on the radio talking about eye health and vision issues that arise in the summertime when the sun is hot and the UV index is high.

"Get your eye glasses for free - and save your sight in the process"

Free Eye Glasses to See for Life

I'm doing what I call a "See for Life" campaign by giving away free prescription glasses to my patients.   In case you are wondering, that includes the frame, single vision lenses, scratch resistant coating and 100% UV protection.  The idea is to motivate people to come in for their annual eye health exam. 

What prompted me to do this?  I was seeing lots of patients who have gone years without an eye exam.   I've had the sad responsibility to tell some of these people that they have glaucoma.  Not only that, but the disease has already caused permanent vision loss in some of these people.  One unlucky man had lost enough peripheral vision that he was no longer legal to drive.  If there is one happy note in the latter story, this unfortunate fellow didn't earn his living driving a vehicle.  If there are any truckers or cab drivers or pilots out there, do not take your eye health for granted!  Being blind (pun intended) to the risks could have a huge impact on your life.  The tragedy is that only if they would have come in for an exam, we would have caught glaucoma early and stopped its progression.

No one needs to loose their vision because of glaucoma but it happens if you are not proactive.  See your eye doctor once a year to make sure that you are free of the disease and that you are not at risk. 

How do I know if I have glaucoma?

The only way to know is to see your eye doctor.  The disease slowly and imperceptibly robs you of your vision.  The poor man who lost his license suffered permanent vision loss but he never knew it was happening. It sneaks up on you quietly.  Don't let it get you!

So here is what I'm doing to motivate people to take their health seriously:  if you are between the ages of 19 and 64 you can get your glasses for free when you have your eyes examined.  You can get more information from my website: www.freeglasses.ca.

Health warning on eye drops

I've noticed something troubling lately.  People may be misusing eye drops that contain steroids (usually when prescribed by doctor who is not an eye specialist).  Steroid eye drops need to be carefully regimented and their use needs to be monitored by an eye doctor. They should never be taken "as needed". 

If not used properly, steroids can cause glaucoma - a disease that raises the pressure in the eye, damaging the optic nerve and causing permanent vision loss that starts with the peripheral vision and works its way to the center   I've seen this problem in my clinic and it is the last thing that a patient expects.  The only way to catch it before it's too late is to see your optometrist for an eye exam.

There are so many things that can sneak up on your health.  People need to see their doctors (not just optometrists) regularly so that issues like this can be nipped in the bud.  I bet dentists could tell similar stories.  Another point is that doctors shouldn't stray beyond their comfort zone or level and area of expertise.  When in doubt, refer the patient.


Eye drops image courtesy of marin / FreeDigitalPhotos.net.