My eye doctor can detect which disease? - High blood pressure

There is a lot of confusion about what optometrists really do. We are so stereotypically associated with asking people "Which is better, 1 or 2?" and correcting vision problems that people are sometimes surprised to hear that we do a lot more! To help with the confusion I decided to start this new blog series "My eye doctor can detect which disease?". Some might surprise you, some might not. In today's blog I want to go over one that you might not expect: High blood pressure.

High blood pressure is extremely common. Approximately 20% of adults have high blood pressure with another 20% having high normal blood pressure (which puts them at higher risk of developing high blood pressure later on). Of these people another 20% are unaware that they have high blood pressure at all! This is important because as you may have heard high blood pressure is a silent killer. It has no symptoms so people are often not aware there is a problem until something serious happens like a heart attack or a stroke.

So how can your optometrist help? When we look inside of your eyes during a routine eye exam we aren't just looking for things like cataracts, macular degeneration and glaucoma. We're also looking for signs of systemic (or full body) problems like high blood pressure. The eyes are the only place in the body where we can directly look at your blood vessels without having to cut you open. This means that we can look and see exactly what is happening. In high blood pressure there a few key things that we are looking for.

In this picture you can see the silvering of some blood vessels and also see how some blood vessels are 'nicking' or pinching the ones underneath. This is typically what I see in the average person with uncontrolled, untreated high blood pressure.

  • Silvering of blood vessels - normally your blood vessels are a nice red colour but when someone has high blood pressure the blood vessel walls thicken. Over time this means that the blood vessels reflect more light and look more silver.
  • Wavy blood vessels - normal blood vessels in the eye follow a nice smooth path. If blood vessels are really curvy that can be an indication of high blood pressure.
  • Pressure on the blood vessels - as high blood pressure worsens the blood vessels may actually start to push down on other blood vessels restricting how much blood flows either in or out of your eye.
  • Bleeds - As those blood vessels crush each other blood can back up and eventually burst the blood vessel causing bleeds in your eye. You can also end up with white areas on your retina that aren't getting enough blood. Imagine it like squeezing a hose: no water comes out one end and water starts backing up on the other side of the blockage.
  • So much more - we can have things like leaking from blood vessels, swelling of the optic nerve and other signs.

This is high blood pressure gone seriously wrong. Uncontrolled high (very high) blood pressure over long periods of time can lead to a very unhealthy retina.

As you can see, there's no shortage of things that can go wrong in the eye with uncontrolled high blood pressure. Some of the more severe problems (Bleeding, leakage, swollen optic nerve etc) are fairly rare and only occur in very extreme untreated cases of high blood pressure. What I frequently see in my clinic are some of the early signs (the silvering, wavy blood vessels or pressure on blood vessels) and that let's me have a conversation about high blood pressure with you. In some cases your family doctor may already be aware and is either monitoring or already treating the issue. Sometimes though people have no idea and are shocked that they have high blood pressure and that it was found during a routine eye exam! It's important to keep blood pressure controlled to reduce your risk of so many very severe problems and early intervention and treatment is always better than trying to recover from something like a heart attack or stroke.

If you have any concerns that you might have high blood pressure I would urge you to book an appointment with your family doctor. While optometrists can detect high blood pressure it isn't our area of expertise to treat and manage high blood pressure effectively. If we detect it in office we always will send you back to your family doctor to both confirm the diagnosis and if needed start treatment. What's most important is remembering to have regular health checks with both your family doctor and your local doctor of optometry!

If you have any questions about this or anything else feel free to contact us on Twitter, Facebook, Google +, via our website or phone us at (403) 474-6744.

Macular Degeneration: A tale of two types (Dry ARMD)

In my last blog about ARMD (age related macular degeneration) I went over the bare basics of what macular degeneration is.  There’s a lot more to macular degeneration than what I discussed and many people are confused about what exactly is going on. In this blog I want to go over one form of macular degeneration: dry macular degeneration.

Dry ARMD is the most common form. It makes up about 90% of all  ARMD. The good news though is that it only accounts for about 10% of serious vision loss.  That’s not to say that people with dry ARMD don’t suffer a loss of central vision and have trouble seeing, it just means that they are still able to function reasonably well. But what IS dry ARMD. What does it mean? For that we have to dive into a little bit of anatomy and physiology (I promise it's not too hard).

You might remember from science class that our retina has a bunch of different layers. The important ones for ARMD are the photoreceptors (better known as the rods and cones) that detect light and the retinal pigmented epithelial layer that keeps food and oxygen going where it should (these layers were not named to be short… that’s why we call that one the RPE). So what goes wrong in someone with ARMD? It all starts with little yellow flecks called drusen.

The yellow flecks in the middle are drusen. You don't want these.

Drusen are thought to be clumps of waste product from the cells of the retina that haven’t been cleared out by your blood vessels. Some more recent research suggests they come from ongoing inflammation. Regardless of where they come from they mean trouble. Drusen on their own do not mean that someone has ARMD. In fact the great majority of people with drusen don’t have ARMD at all! Drusen are a huge risk factor for developing the disease though and shouldn’t be ignored.

Like many things in the eye the exact way that drusen cause damage to the RPE isn’t fully understood but the most commonly accepted reason is that drusen decrease the amount of food and oxygen that can get to the RPE. Unsurprisingly this isn’t good for the RPE and it dies. Since the RPE’s job is to feed the photoreceptors in the eye when the RPE goes the photoreceptors in the same area die off too. This degeneration of the RPE and photoreceptors is what we call dry macular degeneration or if you want to be really fancy and impress your friends the official term for this is geographic atrophy.

In some cases though, these drusen do not lead to degeneration of the RPE and photoreceptors. In some cases they cause wet macular degeneration. We'll learn more about wet ARMD in another blog.

If you want to read more feel free to check out the following links or as always you can contact us on Twitter, Facebook, Google +, via our website or phone us at (403) 474-6744.

CNIB - ARMD

Doctors of Optometry Canada - ARMD

AMD.org - Dry ARMD

Mayo Clinic - Dry ARMD

UV and you: Why sunscreen isn’t all you need to protect yourself from the sun

Everyone knows how important it is to wear sunscreen, especially if you’re going to be spending the day outside. Sunscreen has become a part of many of our daily routines and is in most skin creams. Enjoying our short summers here in Calgary usually means spending as much time as possible outside while the weather is nice and we all know we need to wear sunscreen when we’re outside all day. Protecting your eyes from the sun though is just as important.

In my last blog I talked about cataracts and how UV light increases your risk of getting cataracts sooner. Several blogs ago I talked about macular degeneration and how one of the main preventable risk factors in the disease is exposure to UV light! If you’ve been reading my blogs you already know how important protecting your eyes from the sun is. UV light also increases your risk of certain eye and eyelid cancers as well as wrinkles, lumpy fleshy elevations on the white of your eye called pingueculae or even fleshy growths over the clear part of your eye called pterygia!

So I’ve convinced you how important sun protection is (I hope!) and you get it now. Even though sun protection is really important did you know that almost one third of people don’t wear sunglasses at all? When we talk about kids that number increases to almost 50%! While it is definitely important for people of all ages to wear sun protection it is extra important for kids. A combination of very large pupils, a more transparent lens inside of their eye that allows far more UV to penetrate inside and spending more time outside than most adults leads to 80% of lifetime UV exposure to the eye to happen before the age of 18!

UV light is sneaky and may be getting to your skin and your eyes in situations you might not expect such as underwater, on cloudy days or getting a double dose from light reflected off of snow or water!

All sunglasses are the same though, right? Wrong. Not all sunglasses block all UV light rays. All sunglasses sold in Canada have some degree of UV protection but not all block 99% of UVB rays which is what is recommended to best protect your eyes! If you have sunglasses and want to know how much UV they block feel free to bring them in to our office and we can measure how much UV is blocked at no cost to you.

So you’re saying to yourself alright, I get it, I need to wear good sunglasses: I have more news. Sunglasses are often not enough. Even nice big sunglasses still let some light in around the edges and especially some of the extremely cool aviator frames are flat (they don't 'wrap' around your face) and don’t offer much protection from the side. You have some options to help protect yourself further. A good hat with a wide brim helps prevent as much sunlight from getting around your sunglasses. Another option though is to wear contacts!

I know you’re wondering how on Earth contact lenses could help. It’s a fair question since most do not. All contact lenses offered by Acuvue though have some degree of UV protection. They have many that will block over 99% of UVB!  This is a great option for protecting your eyes from the sun and at Eye Spy Optometry we carry a wide variety of Acuvue products.

So which is best? Sunglasses? A hat? UV blocking contact lenses? The answer is all of them together. All these options will work together to give you comprehensive UV protection for your eyes. It’s important to remember as well that UV exposure doesn’t decrease  very much on cloudy days, under water, in the winter or at dawn or dusk. If you think you only need sun protection from 10:00am-4:00pm on sunny days in the summer you’re going to still get a heavy dose of UV the rest of the time! Think about all those times on the ski hill when you’ve ended up with a burn on the few exposed areas of skin you had.

Remember to protect your eyes, protect your skin and protect your health with as many UV blocking options as you can find. Your body will thank you for it!

If you have more questions about this or anything else always feel free to contact us on Twitter, Facebook, Google + or via our website. For more information feel free to follow the links below:

The Vision Care Institute

Doctors of Optometry Canada - Risks Associated with Sun Exposure

Doctors of Optometry Canada - Children and Risks Associated with Sun Exposure

Macular Degeneration: an introduction

Age Related Macular Degeneration (ARMD) is the most common cause of blindness in Canada, affecting more than one million Canadians. That is more people than breast cancer, prostate cancer, Alzheimer’s and Parkinson’s combined! As you may have guessed from the name, it primarily affects people over the age of 50. In its earliest stages ARMD has no symptoms and can only be detected during a regular eye examination. In the later stages of ARMD, central vision is distorted or completely lost, leaving a central blindspot.

This is what things can look like in advanced ARMD.

So what if you’re under 50? What then? Doesn’t that mean that you have nothing to worry about? Well, sort of. ARMD doesn’t typically strike people when they’re young in the same way that skin cancer doesn’t typically affect younger people. That means that someone who is 30 is almost definitely not going to show any signs of ARMD. However, just like you can wear sunscreen to decrease your risk of skin cancer there are things that you can do to decrease your risk of getting ARMD. And just like sun protection, the younger you protect your eyes, the lower your risk.

Alright, so maybe now I’ve convinced you that prevention and detection are important. What can you do? Lifestyle plays a huge role in ARMD. People who smoke have a greatly increased risk of developing ARMD. Poor eating habits and a lack of cardiovascular activity also increase your risk. Exposure to UV light is also harmful and increases your risk. There also factors that you cannot change such as age, gender, family history and ethnicity that increase your risk. As you age your risk increases, women are more commonly affected than men, people with lighter coloured eyes or skin colours have a greater risk and if someone in your family has ARMD you have a higher risk (good ol’ genetics). All that said, if you wear sunglasses, avoid smoking or second hand smoke and live a healthy lifestyle you can greatly decrease your risk of developing ARMD. A healthy diet is often a challenge even for the most health conscious of people and there are specific eye vitamins on the market both for people with risk factors for ARMD and for people who currently have ARMD. Speak with your optometrist about which of those vitamins is right for you.

Since there are no symptoms even if you’re doing everything right it’s very important to see your optometrist regularly. Even though ARMD cannot be cured, early intervention and detection can help slow down how rapidly the disease progresses and keep your vision from worsening. Technology such as an OCT scan, which is offered at our clinic, can help to detect ARMD at its earliest stages.If you have any questions feel free to call or email us. You can also reach us on Twitter, Facebook, Google + or via our website. For more information feel free to explore these other sites.

CNIB - Macular Degeneration

Doctors of Optometry Canada - Macular Degeneration