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 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.


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*


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.



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.