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

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.


Why do we blink?

In my first year of optometry school, as part of the practical portion of our studies, we used to do vision screenings on kids in elementary schools around Boston. So picture me, the tall optometric freshman, kneeling down to examine the eyes of this adorable little 6 year old girl when she steps back and asks out loud "Harbir, why do we blink?". The whole classroom stopped and looked up at me...

I paused for a second, gathered as much information as I could from my 3 months of eye-related education, and began to answer. Well, cute little blonde-haired girl whose name I don't remember, there are 3 main reasons for blinking:

Number 1 is protection. Our eyelids and eyelashes provide a protective barrier against foreign objects such as dust, rocks, bits of metal, fruit flies, etc...

The second reason is lubrication. Every time we blink, our eyelids squeeze out small amounts of oil, water, and mucus to line the surface of the eye. Studies have shown that when we are engaged in activities that require more attention, we tend to blink less. That is why spending a lot of time on the computer can lead to dry eyes. So as soon as you're done reading this blog, get off the computer! Then come back and share it with all your friends :)

And last, but not least, the third reason for blinking is irrigation or removal of tears and waste. Our eyelids act similar to squeegees, the wonderful onomatopoeically named tool that helps smoothly remove water from car windows and such. Each time we blink, the lids pull tight and sweep tears and debris off the surface of the eye and towards the drainage duct which is located at the inner corner of the eye.

And that's why we blink.

Like pulling teeth

A couple of months ago, I had the wonderful pleasure of attending the American Academy of Optometry's annual conference in Boston. I had the chance to reconnect with a lot of classmates and friends, as well as visit my school and attend lectures at the meeting. One evening, as we were enjoying a night out on the town, a current 4th year student approached me and said "Harbir, you need write a blog about the importance of regular eye exams!". I told him that I'm sure I've mentioned it a few times already. "Yeah, but why is it that people are willing to go the dentist to get their teeth cleaned every 6 months but they refuse to have their eye health checked every 2 years?!" (Yes, he was both inquisitive and exclamatory all at the same time).

This particular discussion has been a long time coming. I talk about it daily with patients, friends, family, and random unsuspecting people walking down the street who I unwittingly coerce into conversation. But, to this day, I have avoided writing about it because I was afraid that I would end up writing a novel, or it would open up a can of worms, or that all the dentists in the world would hate me and I would never be able to receive adequate oral care (I guess its a good thing I've never had a cavity!). But, with this recent encouragement from the enthusiastic intern, I decided to give it a shot. And I will try to keep it short!

Less 24 hours after being newly inspired, I had the most convenient and fortuitous encounter with friend of a friend who just happened to be a dental student. True story. After restraining myself to allow an appropriate amount of time to become acquainted (maybe 30 or 40 seconds), I jumped at the chance to talk about having my teeth examined bi-annually.

Allow me to summarize.

Harbir: Why do dentists have patients come back every 6 months to have their teeth checked?

Dental student: Because we can.

OK fine, that's not exactly what she said. But, the gist of the story was, dentists have convinced the world that having your teeth scraped with sharp tools and gargling fluoride every six months are absolutely necessary. When, in fact, according to my new acquaintance who now probably hates me, there is no direct correlation between oral hygiene and dental health. Having your teeth cleaned is not the important part. The few minutes at the end of the visit where the dentist pokes and prods around with another sharp instrument, that's the important part. But even that doesn't need to happen every 6 months. Nonetheless, oral care professionals have done an amazing job of convincing people that these regular visits are obligatory.

I'm not mad at them. In fact, I applaud them. I reach out to them and ask them how I can convince my patients to have their eye health examined more frequently.

I know this is a bit crude but honestly, what happens when your teeth fall out? You get new ones. Crowns, or veneers, or dentures. In any case, you can smile and bite and eat again. But what happens when you lose your vision? Nothing. Once its gone, its gone.

But we don't clean or polish. We refract and dilate. Maybe that's not as exciting for patients. Maybe we should start a new division of eye care where we have people come in to have their eye lids cleansed and eye drops instilled every six months. We'll call it ocular hygiene. Maybe then I'll have patients in my chair more regularly so I can check for silent eye diseases like glaucoma that can cause irreversible vision loss in asymptomatic patients. Because convincing people of the latter alone does not seem to be enough.