The Average Person

The "average person" will probably not recognize what the image above shows. But the "average person" is exactly who needs to understand the importance of what is happening.

A couple of days ago, I had 19 year old healthy young man come to see me for an eye exam simply because he was noticing a little bit of blurriness in his distance vision. Everything else seemed fine. No pain, no redness, no injuries, no medications.

A quick refraction (the "which is better, one or two?" test) provided a very simple prescription for glasses and we discussed the fact that my friendly patient's vision was actually better than 20/20 with the glasses. As far as he knew, he was good to go.

In fact, if this patient had gone to an optician for a sight test, he would've been. That would've been the end of the process and the patient would be on to buying glasses.

But our next step was to examine the health of our patient's eyes. And that's where this image comes in. What you see here is an image of a large retinal tear and detachment in this patient's right eye (green areas along the bottom and right side of image). A condition that can easily lead to permanent loss of vision if it is not dealt with in short order.

It's very difficult to convey in words the significance of this very real scenario. This is the "average person". This is the person who "just needs glasses". This is the person who's vision has been stable for years so he buys a new pair of glasses or contacts online using his old prescription. Or the person who says "my vision has always been good, so I don't need any eye exam". This could be anyone. And this person could've been blind tomorrow.

Deregulation in BC has made it possible for any Tom, Dick, or Harry to sell glasses and contact lenses. This was done under the ruse of "consumer benefit". Tell me which consumer benefits from an undiagnosed retinal detachment or glaucoma or any number of eye conditions that can quietly lead to permanent vision loss.

Having regular eye exams is not just about keeping your glasses or contact lens prescription updated. It's about keeping your eyes healthy for the long term. And in some cases, it might even be about saving your vision.

An Ophthalmologist, an optometrist, and an Optician Walk into a Bar...

Ok, there's no funny punch line here. I just thought that was a catchy title.

What's the difference between an ophthalmologist and an optometrist? What about an optometrist and an optician? Are they similar in some ways? This is the conversation of The Three O's of Eye Care. Or, as my cousin from the UK who loves White Spot would rather call it, Triple O's.

Ophthalmologists are medical doctors. After completing their MD, they complete residency training (usually 4 years) in ocular disease treatment and ocular surgery. Then, they will normally do another couple of years of sub-specialty training (cataract, retina, laser refractive, etc...).
Ophthos mostly see the more complicated eye issues and do surgery for said issues. Patient's will most often require a referral from their optometrist or GP to see the ophthalmologist.

Optometrists are generally considered to be primary eye care providers. Kinda like seeing your GP for a stomach issue, which her/she will then either treat him/herself or refer to a specialist for further evaluation. Optoms have a bachelor's degree and Doctor of Optometry degree (OD), which is a 4 year program focused specifically on vision and ocular disease. ODs will of course checking your glasses and contact lens prescriptions, but we can also examine for, diagnose, and treat a wide variety of conditions. We can also see and treat patients who have experienced eye injuries, scratches, infections, and of course dig stuff out of the cornea if necessary. We also examine for systemic conditions such as high blood pressure, diabetes, cholesterol, and others than can directly affect your eyes.

Opticians are licensed professionals who are trained in the fabrication and fitting of visual aids, such as contact lenses and glasses. They do not, however, examine for or treat any eye conditions or ocular disease.

Sight Testing is not an Eye Exam

Unfortunately, due to deregulation of health care in BC and other provinces, it is possible to have your vision tested and glasses prescription using automated instruments, without examination of ocular health. This is called sight testing and will usually be seen at optical stores.

It is very important to understand the vast difference between a sight test and a comprehensive eye exam. So, next time you're in to get your eyes checked, be sure to ask if they will be examining for ocular conditions like cataracts, glaucoma, and others that can affect your eye health and vision!

How World War 2 Changed the Way We Talk About Our Eyes

The Second World War affected most of the developed world and, in terms of politics and such, it's effects will stand for the rest of our history. But, did you know that WWII has actually had changed the way that we talk about and even treat our eyes today? Well we here are a couple of little history lesson...

History Lesson #1:

We've all heard that carrots are good for our eyes. We've written about it and made a video on the topic to set the record straight. Yes, carrots are good for our retinal health because they are high in vitamin A. However, they cannot and do not improve our vision. But, where did one of the most widespread myths about our eyes even begin? Well, WWII of course...

During the war, in particular during German bombings of London, the British military successfully incorporated the use of radar to help counteract the Luftwaffe (German air force). The Brits were suddenly able to shoot down German bombers before they were able to reach their targets, which of course raised many eyebrows. When the newspapers began enquiring as to this new found success, the government decided, rather than give away their secret weapon, they would spin a little fiction and spread some propaganda.

The British military told everyone that their gunners were able to spot German planes in the night sky with deadly accuracy because they had been eating a lot of carrots! The word spread like wildfire and before you know it, everyone and their mother was eating carrots for dinner. There is even evidence that the Germans began encouraging their troops to eat more!

History Lesson #2:

During the same period, many RAF (Royal Air Force) pilots were visiting hospitals to see the ophthalmologist because they would get small shards of plastic from the cockpit canopies in their eyes during combat. One ophthalmologist at the time, Dr. Harold Ridley, realized that the plastic from the canopy was not causing any type of rejection or reaction in the eye - it was inert. This was a revolutionary discovery in the field as the eyes are very sensitive to any foreign materials penetrating the surface or residing within the eyeball. This discovery lead to the very first implantable lens to replace cataracts, a procedure that is still used to this day!
 

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our eyes are connected to our... everything.

I've written in the past about what I called the "eye-heart connection" and I've also touched on how a disease such as diabetes can effect our eyes. But very recently, a friend who has been battling through some tough health issues asked me to highlight again the importance of how intricately our organs are linked to one another.

At the end of every eye exam, I spend some time going through the following image with my patients...

Optomap retinal scan image of a healthy retina

Optomap retinal scan image of a healthy retina

This picture shows us the inside surface of an eye, which we call the retina. The yellow circle, as labelled, is the optic nerve. This nerve is less a part of the eye and more a part of the brain that "plugs" into the eye. It is where we look for glaucoma, which is specifically an eye-related condition. But it is also where many cases of multiple sclerosis are first diagnosed.

You've probably guessed what all those red lines are that stretch out beautifully like branches on a tree. They are the veins and arteries that supply blood to the retina (which happens to have some of the highest oxygen demands of any tissue in the body).

But, from whence do these meandering conduits of plasma and hemoglobin arise? (pardon the brief Shakespearean fit).

The retinal vasculature actually stems directly from the blood vessels in our brain, which come directly from the heart! So it wouldn't be surprising to learn that common systemic conditions such as high blood pressure, diabetes, and high cholesterol can all show up in some form in the retina. In fact, according to the Canadian Diabetes Association, diabetes is the leading cause of blindness in Canada! 

Optomap retinal scan of a retina with diabetic retinopathy

Optomap retinal scan of a retina with diabetic retinopathy

Heart disease, kidney disease, liver disease, autoimmune disorders (such as rheumatoid arthritis, colitis, crohn's, psoriasis, lupus, etc), not to mention many of medications that are used to treat these conditions can all effect our eyes in one way or another.

And, in fact, it is not unusual for a systemic condition to have its primary presentation in the eyes. I have personally seen a variety of patients who were consequently diagnosed with diabetes, hypertension, multiple sclerosis, and autoimmune disorders due to the presentation of these diseases during ocular examination. 

They say "the eyes are the windows to your soul".

They are certainly the windows to your health.
 

Get well soon RS.