eye exam

How Trevor Linden Sold Out: The Prequel

Originally written and posted in January 2011, soon after its predecessor, "How Trevor Linden Sold Out" post. Once again, the writing has been left in its original form, so some facts will be outdated... But the passion will not!


OK, OK, I get it... People in Vancouver loooooove Trevor Linden. I know, I'm from here. So I expected a few people to be a little ticked off with me for recently writing a blog titled "How Trevor Linden Sold Out".

But, like any great story, there is always a pre-story; the prequel that provides you with greater insight into the original saga and how things came to be. Batman had Batman Begins. James Bond had Casino Royale. And Star Wars had (however unfortunately) Episodes 1, 2, and 3. This, my friends, is the Hobbit to my Lord of the Rings.

It all started in 2007. A company named clearly contacts (aka coastal contacts) that sells contact lenses online, had a lawsuit filed against them in BC Supreme Court because they were breaking the law by not requiring their customers to present valid prescriptions before ordering contacts. The law in all Canadian provinces and US states is that all patients must have a valid prescription and the online company must confirm it with the eye care professional who provides it.

This rule is in place to help prevent the misuse and incorrect fitting of contact lenses which can lead to serious, potentially vision threatening complications.

In 2009, the courts made a decision. clearly contacts must start abiding by the law OR have it changed. They decided to pursue the latter.

Abracadabra...

In 2010, Health Minister Kevin Falcon created new legislation that allowed online sales without the requirement of a prescription from an eye care professional. I can hear the gasps... He did what?? He changed the rules, with no regard for public health, to suit the needs of one corporation.

Apparently, Health Minister Falcon believed that buying contacts and glasses for cheaper was in the public's best interest, but having regular eye health examinations was not. Are these the types of decisions a HEALTH minister is supposed to be making?

MLA Adrian Dix put it well when he said "Health Minister Kevin Falcon will lower eye care standards to satisfy the commercial interests of one company, ignoring the open opposition from the Canadian National Institute of the Blind, physicians, and several health professional bodies..."

How is it possible that British Columbia is the only place in North America that is satisfied with these third world standards of health care? We often refer to American health care as an example of a flawed system, one that does not promote wellness and disease prevention. But now Americans (and other Canadians) are looking at us and wondering how or why we would possibly allow our standards to be lowered in such a way. The answer, my friends, is money.

That last point to resonates quite loudly in recent news articles which shed light on some large endorsements that the "honorable" Kevin Flacon has been receiving from a certain online company. *Cough* clearly contacts *Cough*

http://www.news1130.com/news/local/article/173102--falcon-may-be-too-cozy-with-business-community

By the way, this person is planning on becoming the next Premier of British Columbia.

So, What About Trevor Linden?

Our captain joined clearly contacts as their spokesperson in 2010. Please refer to the original conversation in "How Trevor Linden Sold Out" for more information.

Someone recently said to me "...that's what celebrities and athletes do. Companies give them money to promote their product, and they do it... what's the big deal?"

Is that not the definition of selling out? Doing something ethically questionable for money. Especially when the very thing you are promoting is ultimately causing a decline in the overall well being and quality of care in the same community that has raised you and embraced you as its hero and idol.

 

 

lazy eye

"Contrary to what some believe, a lazy eye is not one that doesn't like to wake up and go to work in the morning."

- Anonymous Eye Doctor with a sense of humour

The medical term for Lazy Eye is Amblyopia

So why do eyes become lazy?

  • The brain is very picky! When it is not receiving a clear image or if it is receiving double images, it begins to shut off connections to the eye that is causing it the most grief
  • This process usually happens during childhood and if it is caught before the age of 7, it can be reversed depending on how bad the situation is and how cooperative the patient is

There are two main situations in which this happens:

  • Eye turn
    • In this case, the patient probably has double vision so the brain will stop communicating with the eye that is turned in/out, which will stop the double vision
    • Sometimes surgery is needed to straighten the turned eye, other times simple wearing a patch over the good eye will help force the turned eye back
  • Difference in prescription
    • If there is a large difference and one eye is very blurry, the brain will again shut it off because it doesn't like dealing with two eyes producing different images
    • Glasses are the obvious answer. Sometimes a patch over the good eye will help force the blurry eye to work harder

As you can see a Lazy Eye problem actually becomes more of a Picky Brain problem.

And as the saying goes, "you can't teach an old dog new tricks".

So, once the brain has made all the connections it wants to make, it is very difficult to make it go back. This is why it is important to catch it early! (Before age 7 or 8)

After this cutoff, even providing a patient their full prescription may not improve their vision because no matter how clear the image is, it is not being sent to the brain.

 

FAQ:

Q: Can a person have 2 lazy eyes?

A: That is a fantastic question! And, yes. I recently blogged about a patient I had seen who had high astigmatism in both eyes. So the connections for both eyes were not fully formed during childhood due to blurry vision and at this point in her life, glasses did not help very much.

Q: What is astigmatism?

A: The answer to this can be found in am earlier post called "All Kinds of Blurry" along with info on other causes of blurry vision

Q: How early should kids have their eyes checked?

A: Both the Canadian and American Association of Optometrists recommend that children have their first eye exam at 6-12 months and again at age 3.

Contact lenses

They come in a variety of shapes, sizes, and colours...

Soft contact lenses (SCL):These are the most common and they are disposable.

  • This means that after wearing the lenses for a period of time, they are disposed of and a new, fresh pair is used
  • Lenses can be monthly (ex. Air Optix, Frequency 55, Proclear, Biofinity, etc), two week (Acuvue Oasys), and daily disposable (CIBA Dailies, Acuvue 1-day, etc)
  • Also available for astigmatism and patients over 40 who need reading glasses (more information in my post All Kinds of Blurry)

Daily disposable lenses are the healthier option for your eyes for the simple reason that a fresh, sterile lens is being used every single time. Most infections are a result of poor storage or lens care. A lot of these problems can be avoided with daily lenses.

Rigid Gas Permeable (RGP):AKA Hard lenses. Considered older technology but actually provide better optics, better oxygen flow, and less infections. Less popular simply because they are uncomfortable to begin with. But patients who get used to them, stick to them.

 

Hybrid Lenses:Combination of a hard lens with a soft "skirt". Supposed to provide superior vision of RGPs without being as uncomfortable. But, they haven't been as successful as expected.

Orthokeratology (Ortho-K):Contact lenses that are worn while you sleep. Over night, they flatten the cornea and temporarily correct near-sightedness. Also mentioned in my post Laser Eye Surgery.

Important things to REMEMBER: No matter how good a contact lens claims to be at allowing oxygen pass, or keeping your eyes hydrated, or preventing bacteria from sticking to it, at the end of the day it is still a piece of plastic in your eye.

Contact lenses are considered to be medical devices and, as such, should be looked at by a doctor before they are dispensed and any time the patient experiences any problems.

Three big NOs:

  • No sleeping
  • No swimming
  • No tap water

These are the quickest ways to cause infections which can be potentially vision threatening (see picture below).

Other uses:Contact lenses are not only used to improve vision. Here are a couple of other interesting uses:

  • Diabetic patients
    • Lens changes colour when sugar levels in tears increase
  • Bandage
    • Used to cover scratched corneas or after LASIK surgery
  • Administer drugs over long periods of time
  • Tracking eye movements in ocular studies

FAQ:

Q: Can I get coloured contact lenses even if I have no prescription?

A: Yes. But FYI, these lenses tend to be the least healthy for your eyes.

Q: How often should I replace my contact lens case?

A: Usually every 3 months or when your solution runs out. Whichever comes first.

Q: If I wear contact lenses, do I still need a pair of glasses?

A: Yes, you should always have a good pair of glasses to give your eyes a break and just in case something happens to the contacts.

Q: What if I'm on vacation and I forgot my contact lens solution and my contacts are bothering me and there isn't a pharmacy close by and my cousin says its no big deal, can I just store my contacts in tap water?

A: No. No tap water. Ever. I hope that is clear enough :)

Why don't my glasses help?

Last week, I had a patient (let's call her Mary) come to see me because she noticed that she was having difficulty seeing the board at the front of the class clearly. Mary was in her early 30s and mentioned she had worn glasses for a little while as a teen but never thought they helped very much.

Turns out that our friend Mary has a prescription with high astigmatism in both eyes. While many of my near-sighted friends and patients can attest that their vision progressively gets worse throughout their teenage years and into their twenties, astigmatism is generally present from childhood and remains relatively constant throughout our lives. (Learn more about astigmatism in the "All Kinds of Blurry" post)

Why is this important? This means that since Mary was a child, her brain has been receiving blurry images. And our mushy, emotion-filled noodle is a very picky person. If it sees blurry images (or double images, for that matter), it will stop forming connections with the eye that it dislikes (in Mary's case, that was both of her eyes!).

This process is called Amblyopia. If we catch these types of high prescriptions before the age of 7, its usually simple enough to reverse the process and convince our gray and white-mattered friend to start liking the patient's eyes again. Unfortunately, in a case like Mary's there is not too much to be done. At this point, not glasses or contacts, not even lasers will be able to significantly improve her vision.

But this doesn't mean we don't try! A lower prescription was given that did mildly improve vision and we hope that Mary's eyes (and brain) will adapt with time.

What is the moral of the story? Kids should get their eyes examined early and often to catch high prescriptions or changes in prescriptions and to avoid amblyopia!