Vision loss from glaucoma - preventable if caught early - is on the rise in Canada: Canadians are not taking easy steps to protect themselves

Research published in the June issue of the Journal of Ophthalmology shows that Canadians are not taking easy steps to protect themselves against glaucoma.  The study found that 50% of those who are newly diagnosed with the disease are already in the moderate to advanced stages of the disease.  By this time they have suffered irreversible and often devastating vision loss.

Early detection is key because if caught early glaucoma can be managed and its progress halted.  But there are virtually no symptoms in the early stages of the disease.  That is why early detection is only possible through a complete eye exam by an optometrist or ophthalmologist. 

The obvious implication of the study is that Canadians are not doing enough to protect themselves against glaucoma.  Everyone should have an annual eye exam.

An article in the Toronto Star presented the following story that puts a human face on the tragedy that can occur if one ignores the need for eye exams as well as how fortunate you can be if you see your optometrist:

Keith Henderson, 62, a retired millwright in Alvinston, Ont., is fortunate. Ten years ago his brother was diagnosed with advanced glaucoma, which prompted Henderson to see an optometrist and request extra vigilance. Extra tests — which he had to pay for — showed he had high pressure. He eventually had prophylactic laser treatment to relieve the pressure.
“I won’t lose my eyesight to glaucoma because of what has been done,” says Henderson.

Henderson’s brother, Larry, now 65, is just about completely blind now, he says. The factory worker, was 55 when diagnosed, didn’t know to get regular exams.
“He didn’t get checked because he didn’t have coverage and then it started to get severe,” Henderson says. “They’ve got him as good as they could get him, but he’s lost a terrific amount of his vision.”

Diagnoses before there is vision loss is key. For patients, who catch it early and are diligent with treatment, vision can be preserved, Buys says.

Too many are doing it too late. “In a country that boasts of universal health care, our patients are coming in with already serious and significant loss of vision,” Hutnik says.

While we have a health care systems that calls itself "universal", eye exams are not covered.  Yet, as the story above demonstrates, they are critical.  The rationale for not insuring critical health services is often founded on the principle that people must have personal responsibility for their own health.  For whatever reason - lack of knowledge, lack of resources, lack of awareness of what can go wrong with their health - too many people are not doing the right things.  I hope some of them will read this blog post and make an appointment with their optometrist. 

Children's eye exams

Did you know that a child should have their first eye exam at the age of six months and then annually thereafter?  Like most medical conditions, eye health and vision problems are much more treatable when caught early.

Good vision in infants is also critical for visual, brain and overall development.  A child with poor vision is prevented from effectively exploring and understanding the world and deprived of valuable brain stimulation.  Studies have also proven what eye doctors already know, that vision problems that persist lead to adult problems such as joblessness, incarceration, lower income and behaviour problems.  Life threatening diseases can also lurk in the eyes of young child.  Read more...

 

Here is a video of Dr. M. K. Randhawa talking about a patient story from our Vancouver eye clinic involving a five-year-old girl who had been legally blind her whole life - until she came in for an eye exam:

Image courtesy of arztsamui / FreeDigitalPhotos.net

The unseen danger of diabetes

More than 20 Canadians are diagnosed with diabetes every hour of every day. I encourage anyone who has, or may be at risk for, diabetes to have an annual eye examination.

Diabetes affects 3 million Canadians, many of whom may not know they have the disease. One of the health problems associated with diabetes is diabetic retinopathy, a disease of the eye which can cause blindness.

Diabetic retinopathy can weaken and cause changes in the blood vessels that nourish the retina. Symptoms may include blurred vision, cloudiness and/or “floaters”.

Diabetes also increases a person’s risk for developing other eye diseases. Persons living with diabetes are 40% more likely to develop glaucoma and 60% more likely to develop cataracts.

The most worrying aspect of diabetes may be the fact that in the early stages diabetic retinopathy may produce no visual symptoms at all. That is why it is so important for anyone who has diabetes or a family history of diabetes to have a yearly comprehensive eye health examination.  Early detection and treatment are essentialbecause once damage has occurred, the effects are usually permanent.

An added benefit of eye exams, is that they are often the medical test that is the first to detect a variety of diseases - not just diabetes.

New study supports orthokeratology for myopia control and for astigmatism correction

The Faculty of Health and Social Sciences at Hong Kong's Polytechnic University issued a press release today on the results from two studies on orthokeratology.  One, called the "ROMIO" study, was a single blind, randomized, controlled clinical trial on the effectiveness of orthokeratology for myopia control.  The other, called the "TO SEE" study, looked at the effectiveness of orthokeratology for astigmatism correction.

Brief description of orthokeratology

Patients who wish to receive orthokeratology must have a thorough eye examination to see if they are suitable for the treatment. The optometrist will specially designed and dispense a pair of rigid retainer contact lenses made from high oxygen permeable material to be worn during sleep. The lens will reshape the cornea resulting in perfect vision the next day without the need to wear glasses or contact lenses.

Orthokeratology is the only non-surgical treatment that allows you to be free of corrective lenses like eye-glasses and contact lenses.

Myopia

Myopia and its progression is a serious problem.  Not only does it cause progressively worsening eyesight, requiring thicker and more expensive lenses, it increases the risk of serious eye diseases such as glaucoma and retinal detachment which can cause permanent vision loss.

After 24 months of research, the ROMIO study found that the increase in eyeball length (also called "axial length" -the progression of myopia is measured by observing the elongation of the eyeball)  in a group of subjects that were treated with orthokeratology was 0.36mm.  In the group that was not treated with orthokeratology and only wore spectacles, the eyeball length was 0.63mm. The results indicate that orthokeratology slowed down the progression of myopia by 43%.

Astigmatism

Researchers at the same university also concluded the "TO-SEE" study which looked at 37 children aged 6 to 12 years to study the potential of orthokeratology for the reduction of astigmatism. The team found that toric design orthokeratology lens retainers effectively reduced astigmatism by 79% after one month of wear. At the end of 24 months, the eyeball length of the participants was 0.31mm which indicated that myopia was also being controlled.

Orthokeratology is a reversible treatment and can be stopped anytime. The results of these two studies show that orthokeratology is a safe and effective solution for refractive error correction, myopic control and astigmatism reduction.

I posted about the dangers of the myopia epidemic here.

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.

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.