How Trevor Linden Sold Out

This was originally written and posted in December 2010. As with all of the older posts, I've decided to leave this one in its (somewhat naive, but well-intentioned) original condition. The follow up to this was called "How Trevor Linden Sold Out: The Prequel". (Yes, I like movies)

Before I begin, I would like to say that as most kids growing up in Vancouver through the 1990's, I considered Trevor Linden to be an idol. A great hockey player and role model. As an adult, and more specifically as an eye care professional, my opinions have evolved.

As usual, I'll try to present my information as fact and do my best to remain impartial. But, I can't make any promises ;)

Many of you have probably seen our good friend Trevor on TV, or on the many obnoxious billboards around Vancouver, advertising for clearly contacts. Smiling with his spectacles on while promoting glasses and contact lenses for cheaper prices. "Glass, plastic, and two tiny little screws..." says Mr. Linden. Is that so?

Allow me to present the following points in a bulleted format.

  • First, I would like to challenge the notion that glasses are simply glass, plastic, and screws. For those people for whom glasses are a daily necessity, their presence cannot be so cheaply simplified and their importance so easily ignored. Glasses change people's lives. When Johnny Nash sang "I can see clearly now, the rain is gone...", what he was really saying was "I can see clearly now, I have my glasses on". True story. Glasses are a patient's windows into the world. They are a reflection of a person's personality and style. Try to fit that into $38, Trevor.
  • Second, my boy Trev had laser surgery a few years back so he's probably forgotten about the importance of specs. We'll see where he shops once he starts needing reading glasses.
  • Third, quality and service (or lack there of) cannot be overlooked. What happens when the arm falls off your glasses? Or you need to have the frames adjusted? Will you take them to the Linden residence?

Buying Contact Lenses Online:

A contact lens can be considered a medical device. A lens is essentially a prosthesis. A piece of precisely designed silicone and plastic placed on the surface of the eye for a medical purpose.

If poorly fit, over-worn, or misused contacts can cause inflammations, infections, and neovascularization of the eye which can potentially be vision threatening.

Would you consider it prudent for an amputee to go shopping for a prosthesis online without the consultation of his doctor? Or maybe a cardiac patient can look for good deals on heart valves while buying his new glasses? After all, they are both just pieces of plastic, right?

Trevor Linden, it's time to stop making a "spectacle" of yourself.


The path of least resistance

During my first few years in practice, I've had some distressing discussions and experiences with both prospective patients and those sitting in front of me in the exam chair. It is these experiences that compelled me to write this little manifesto.

I'll refer to one specific phone conversation I recently had at my office Highstreet Eyecare (shameless plug) which, I think, fairly represents a majority of these situations.

A very pleasant young lady (in her mid-20's) called the office with some questions about her vision. I'll briefly summarize the conversation...


Young lady: I've noticed some changes in my vision. I can't see as well with my glasses on anymore. I recently went back to the place where I usually buy my glasses. They did an eye exam and said they couldn't get my vision to 20/20.

Me: Do you know if it was an optometrist who did the exam?

YL: I'm not sure. What's the difference between an optometrist and the people I get my glasses from?

Me: (I proceeded to explain the differences between optometrists, ophthalmologists, and opticians. I explained how they are all different from the many random optical stores that have no accreditation what so ever. I also explained the difference between a complete eye exam, which includes a thorough assessment of ocular health as well as a refraction for a glasses prescription, and vision testing, which is essentially the automated refraction many optical stores will conduct and refer to as an eye exam.)

YL: Oh, I didn't know any of that. They just checked my vision and said the new glasses would make my vision better.

Me: (I explained again all the different things we would examine to determine her prescription and rule out any underlying conditions that could be limiting her vision)

YL: Ok. I'll see...


You'll see??? If I'm not mistaken, isn't that exactly what you're having trouble with right now... Seeing?!

Ok, I didn't say that. I can be a little sarcastic sometimes, but I'm not mean. Especially not to my patients.

These types of conversations bring to light many different concerns. A few of which I will try to address here.

But first, lets time a quick step back... way back... back into time... (Blackstreet reference... anyone?)

A few years ago, when I had first started practicing optometry, I wrote multiple blogs about the impending changes that my profession was about to endure. Changes that were brought on by crony politicians, whose only concern was to fill their pockets with little regard for the public, whom they were elected to serve (I'll try not to name any names... but, lets just say it was a certain "Health Minister"... who's name may or may not start with Kevin... and end with Falcon...). These were changes which ultimately contributed to the lowering of health care standards in British Columbia. And they were changes which led to the fall of a childhood hero from his perch upon a pedestal... I'll never look at Trevor Linden the same way again (See blog post titled "How Trevor Linden Sold Out"). But, I digress...

Today, ONLY in British Columbia, a person can walk into any store operated by ANY individual with absolutely zero credentials and no experience in eye care to buy glasses or contact lenses without a valid prescription. I think that makes it hard to disagree that our standards of health care, at least eye care, are lower than those of any other place in North America.

The Health Minister defended himself by saying that the average individual who has healthy eyes should not have to bother with regular exams and those who do have eye conditions will simply know to have their eyes checked regularly. So much for preventative care. I wonder if Mr. Falcon would be so kind as to describe the symptoms of the early stages of glaucoma, a disease which is one of the leading causes of blindness and affects tens of millions of people worldwide... Oh that's right, there aren't any! It is a silent disease. By the time a patient notices the symptoms, there has already been irreparable, irreversible damage. But I'm sure the average person would somehow know, right?

There is also supposed to be a regulation which, loosely translated, states that if an optical store cannot improve a person's vision to 20/20 or sees any reason for concern, they must send that patient over to an optometrist or ophthalmologist for further testing. Clearly, in the case of the young lady in the above conversation (and many others), they have not been doing that. Which means there are a lot of people walking around with a lower quality vision than they deserve AND, more importantly, potentially suffering from a vision threatening condition.

So, what needs to be done?

I've spent a lot of time pointing fingers at different people for tearing down the foundations of our health care. And there definitely are a lot people who are responsible for the failure of our system. Yes, the big companies and the crony politicians play their part. And they play it well. But, it is important to understand that WE must also bear some responsibility. By we, I mean both health care providers AND the public. It is absolutely my responsibility as a health professional to educate my patients and the public about their health. If I don't do it, then who else will? But, it is also the responsibility of the individual to actively seek out what is best for them. To ask questions, get regular exams, and do what ever else necessary to keep yourself healthy. If you don't, who else will?

Too often, I hear patients say "I've had issues for a long time, but I kept putting it off". As terrible as it sounds, I can understand, I can relate. We build routines for ourselves and follow them, often blindly (pardon the pun). Call it complacency, laziness, or anything else... We put important things off because it means going out of our way or changing our schedule.

Our bodies are made up, at the most basic level, of cells and nerves and chemical reactions. All of which are following the path of least resistance. So it is only human nature that we do what is easiest for us, to follow the simple route. But on our highest level, we are able to make the decisions about what's best for us. And I urge you, when it comes to your health, whether its your eyes or your teeth or your heart, take the time to get it done. And get it done right.

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.



contact lens addicts

Yesterday I had the not so pleasant experience of having to scare one of my patients out of wearing contact lenses. It inspired me to write a little about contact lenses and those who (over)wear them.

It has occurred to me, over the past year or so, that some patients are addicted to wearing contact lenses. These people are like the crack addicts of the ophthalmic world. They need contacts. They'll do anything to get contacts. They will come in begging for samples. And when you suggest to them that they should quit, they freak out!

For these people, going straight and cleaning up their act means having to wear glasses. And just like any other addiction, its hard for people to quit cold turkey. They come up with all sorts of excuses like "I don't like my frames", "I lost my glasses", "Glasses make my face look fat". Well I got news for you, Chubs... Its not the glasses!

Anyway, this is where I come in. I'm like the motivational speaker on those self help tapes that tell people that they are strong and in control of their lives. "Where there's a will, there's a way" and all that good stuff. Oh and also, if they don't quit, they could go blind.

That last note usually helps me get people's attention. And it worked yesterday with my 19 year old patient who had been wearing coloured contacts (not the best quality lenses) 7 days a week for the last 5 years. She does not own a pair of glasses and therefore has been wearing her contacts from morning until night.


Why is this so bad?

The cornea, which is the clear dome at the front of our eyes, has a very high demand for oxygen. The only place the cornea can get oxygen is from the air around us. As you can imagine, covering the cornea with a piece of plastic will significantly reduce the amount of oxygen that gets through. The cells of the cornea starve for oxygen and start to break down causing the cornea to become less clear thus making vision blurry.

The body's response to this lack of oxygen involves creating new blood vessels into the cornea. This is called neovascularization. While this may seem like a good idea, it is actually the exact opposite. If the blood vessels grow too far into the cornea, they can begin to obstruct/distort vision. There is no way to reverse neovascularization of the cornea. It can be stopped or slowed down by decreasing contact lens wear. But if it is very significant, the only treatment is corneal transplant surgery. And believe me when I tell you, you do not want corneal transplant surgery.

Cornea with stitches, post transplant

Cornea with stitches, post transplant


Its sad to see a person as young as 19 be at risk of permanent vision loss. But, with a little treatment and staying out of contacts for a while, her eye health (and vision) should improve.

As useful and convenient as they are, contacts can cause a multitude of different ocular problems if worn incorrectly. All patients who wear contact lenses should have regular eye exams.