Why should I replace my contacts regularly?

“Dr. Ross, why should I replace my contacts regularly?”
“They feel fine.”
“I just replace them when they start to bug me.”
“I know I should replace them every month but sometimes I just leave them in for a few months and I haven’t had a problem.”
“You guys always tell me to replace my contacts every month. It’s a scam, isn’t it? You just want my money!”

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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 TwitterFacebookGoogle +, 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

Cataracts: They're not what you might think they are!

Often when I talk with my patients about cataracts they’re very unclear about what a cataract really is! Lots of people seem to think it’s something affecting the front of the eye and can be peeled off. Others think it can just be lasered off. Others think cataracts only happen in older people. None of these things are strictly true. Cataracts are one of the most common eye disorders in the world and so of course lots of myths have sprung up around them. Let’s figure out what cataracts are, who they affect and what you can do to prevent or treat them.

To fully understand cataracts you need to know a very little bit about the anatomy of the eye. The biggest thing to absorb here is that the pupil, the dark central part of your eye, is not an actual thing. The pupil is actually nothing! It’s just a hole. Behind that hole though is a very cool structure called the crystalline lens. The lens in your eye not only provides some of the focusing ability of your eye so you can see far away it also flexes and changes shape to allow you to see clearly when you look at things that are close to you as well. Overtime that lens can become cloudy. This prevents as much light from getting to your retina and also causes light to scatter. This leads to a combination of blurred vision and night glare. This is a cataract.

This is an example of an extremely dense cataract. They almost never get this bad in Canada as people usually seek treatment before their vision is this bad.

So now that we know what a cataract is, what causes it? There are actually a lot of different causes so today I’ll go over just a few. One of the most important causes of cataracts is exposure to UV light. Over the long term UV light causes the lens inside of our eye to cloud up. Your best protection against this is to wear sunglasses as much as possible when outside, even on cloudy days or as the sun is going up or down. Many people think there is a much lower risk of UV exposure when it’s cloudy or during sunrise or sunset but while the UV exposure is somewhat reduced UV is still getting through to your eyes and skin.

An impact or other types of injury (such as electric shock) can also cause cataracts in otherwise young and healthy people. The trauma to the eye and to the lens can cause the lens itself to rupture or crack. These cracks allow fluid to enter into the rigidly organized lens and allows a cataract to form. The most obvious way to prevent this is to protect yourself against injury! Wear safety glasses if you’re doing work where something might hit you in the eye and definitely while participating in sports like squash that carry a high risk of getting hit in the eye.

The last type of cataract I’ll go over today is congenital. Congenital is fancy word for ‘you’re born with it’. Roughly ⅓ of congenital cataracts are genetic, ⅓  are caused by a disorder or disease and ⅓ are idiopathic… another fancy word that means we don’t really know where they come from. Hospitals do typically check newborns to make sure they don’t have an obvious or significant congenital cataract that requires treatment . That said I have a lot of patients that have minor congenital cataracts that aren’t really an issue but they had no idea were there.

So cataracts are inside the eye and are the clouding of the lens behind our pupil. They can affect anyone from newborns to seniors depending on a lot of different factors. These facts probably fly in the face of what you thought cataracts really were! The good news is that cataracts can be easily removed with a relatively quick and easy surgery. That’s a topic for another blog though! For now, if you have any questions you can always contact us on Twitter, FacebookGoogle + or via our website. For more information check out the following links.

Doctors of Optometry Canada - Cataracts

CNIB - Cataracts

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, FacebookGoogle + or via our website. For more information feel free to explore these other sites.

CNIB - Macular Degeneration

Doctors of Optometry Canada - Macular Degeneration