blurry vision

Contact lens addicts anonymous

Today's blog post comes to your courtesy a crazy day at the office. This past Sunday (yes, I work Sundays... and yes, I am a little bit crazy... thank you for asking), I felt like I was working in some sort of contact lens emergency clinic. It was like Clearly Contacts was having a sale on eye infections or something! I'm sure the Liberal government backed them on it and I must have missed Trevor Linden's ad campaign on TV...

Moving on...

A while back, I wrote a blog titled Contact Lens Addicts, which explained how some patients become so dependent on their contact lenses that they put themselves at risk of suffering many different problems, some of which could lead to permanent vision loss. Well, Sunday was like a Contact Lens Addicts Anonymous meeting with Dr. Sian mediating.

The CL-AA meeting started with a pleasant, 50-something woman whose contact lens had folded up and tucked itself so far behind her upper eyelid that I almost wished I had a third hand to help flip her eyelid, and/or hold a q-tip, and/or grab the forceps.

Now, lets just take a quick second to answer the question that is likely swirling around in some of your minds... No, the contact lens cannot go so far back that it ends up behind the eyeball. Luckily, the conjunctiva (the thin skin that covers the eye ball) actually folds over itself and covers the inside of the eyelids as well. Effectively creating a natural contact lens catching contraption (and you thought conjunctiva was hard to say).

Next up was a very friendly lady in her mid-thirties who is actually quite good at taking care of her contact lenses. She doesn't over wear them, she replaces them on schedule, and she's good at cleaning them every night (sounds too good to be true, but I believed her). However, despite all of the regular care and maintenance, she managed to fall asleep in her lenses.

Now, we all know that one night stands are a bad idea (right?). Well, sleeping with your contacts is a lot like a one night stand...  There's usually booze involved, it seems like a good idea at the time, you wake up in the morning with something feeling itchy and/or irritated (we're talking about eyes folks!), and then you're doing the walk of shame... into my exam room!

Even for someone who takes care of her contacts, one night with her lenses was enough to cause a small corneal ulcer. Yes, an ulcer. And yes, it is as unpleasant as it sounds.

Last, and certainly not least, is the poor little girl who was actually the impetus for me to write this blog, so I could tell you her unfortunate story. A 16 year old kid who has been wearing Orthokeratology lenses (aka Ortho-K, aka dream lenses). I won't go into detail, but basically these are lenses you only wear at night while sleeping. Hopefully the "only wear at night while sleeping" part raised a red flag or two for most of you. To make matters worse, she was fit for and bought the lenses overseas, so I have no idea what she's been wearing. Not all that different than buying contacts online without being fit for them by a professional, might I add.

But I digress...

The poor kid was in so much pain, she could not open her eye if her life depended on it. When I finally got a look, this is what I saw...

A very red and upset eye with a large, central corneal ulcer. Long story-short, she is and will be in need of a lot of eye drops (as much as every 30-60 minutes all day AND night) and maybe even some oral medications. The worst part of it is that when the infection is finally controlled, this ulcer will likely leave a large scar right in the center of her vision thus causing a permanent decrease in vision in that eye.

 

These were just three of the multiple cases I dealt with during the CL-AA meeting on Sunday.

Its extremely important to understand the consequences of taking our vision for granted. Online sales and deregulation have made it easy to overlook the fact that contact lenses are actually medical devices. They are pieces of plastic that we put on our eye ball to help improve our vision. We should not lose sight of that (pun intended).

I am genuinely concerned and upset about this young girl and so many other patients who suffer from serious issues due to improper contact lens wear and poor ocular hygiene. So, if you or your kids wear contacts, be sure to have the lenses fit by a professional and never hesitate to come in and have your eyes checked if you think something is wrong. As with most things, if we catch it early, its much easier to treat.

 

Note: The pictures are not of my patients, but are accurate representations of their respective issues.

 

 

Lil' Wayne and cataracts

"You can't see me baby boy, you got them cataracts" - Lil' Wayne in Best Rapper Alive

Who said rap music is bad for you? I think its educational! Lil' Wayne may not know exactly what a cataract is, but he definitely has the right idea.

A cataract is the clouding of the lens that is inside the eye. As the lens becomes more clouded, vision becomes blurred due to light being blocked or scattered. This is the same lens that we use to focus at near objects. The same lens that stops working around the age of 45 and forces people to start wearing reading glasses (See: presbyopia in the "All Kinds of Blurry" post).

Everyone will develop cataracts at some point in their lives if they live long enough. How much and how fast depends on the individual and the environment. Medical conditions like diabetes can cause cataracts to develop faster. Sunlight is the main environmental factor. So, grab those sunglasses!

Congenital cataracts - It is possible to be born with a cataract. I recently saw a 5 year old boy who had a cataract in one eye. Another reason why kids should have regular eye exams.

Traumatic cataracts - Getting hit in the eye can cause a cataract. Wear protective lenses whenever possible!

How do you treat cataracts?

The only treatment is removal. The cloudy lens is removed and new clear plastic lens is inserted in its place. The surgery takes about 10-15 minutes per eye and requires an incision less than half a millimeter in size!

Who knows, maybe next week Kanye West will rap about Macular Degeneration... Stay posted!

 

"I spent a G on these frames, but my vision is priceless" - Lil' Wayne

 

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 (see: All Kinds of Blurry) 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.

All kinds of blurry

In my very first post I wrote a little about myopia, which is near-sightedness. Here we'll discuss all the other "-opias" and "-isms" that can make your vision blurry. They are generally referred to as "refractive errors".

A quick review of Myopia. It is due the eye being longer than average. So, rather than an image being focused right on the retina, it falls a little short. Of course, this gives us blurry vision for distant objects which can be corrected with "minus" prescription glasses and contacts, or laser surgery. Example of near-sighted prescription is: -3.25.

 

Hyperopia. This is what we call far-sightedness. As you would expect, a hyperopic person would have more trouble with near and less trouble with distance. This is a result of the eye being a little bit shorter, thus images fall behind the retina. This is corrected with "plus" prescriptions. Also can be corrected with laser.

 

Astigmatism. Is not affected by the length of the eye. Astigmatism is a result of the shape of the front of the eye (the cornea). With astigmatism, the cornea is not perfectly round, it is a little steeper in one direction than the other. The common analogy is a basketball compared to a football. So, light cannot be focused to one point on the retina. It is split by the different curves of the cornea. To correct this, the prescription needs two powers (one for each curve of the cornea). An example of this would be -1.50 -0.75 x180. The "-0.75" is the astigmatism part of the prescription and "x180" shows that this prescription needs to be placed at 180 degrees. Astigmatism can be corrected with glasses, contacts, and laser.

 

Presbyopia. The first three refractive errors are mostly hereditary. The last one, however, is purely age-related and happens to everyone. As we age, the accomodative system (system inside our eyes that helps us focus at near) slowly stops working. Eventually, as we make it through our 30s into our 40s, we notice that things up close are not as clear as they used to be. Often, patients will say that they need to hold reading material further away. And eventually no matter how far away you hold it, its just not clear enough! Correction usually involves reading glasses, bifocals, or multi-focal contact lenses. Laser surgery is not a very useful option because it does nothing to improve the accomodative system.