Hyperopia - A frustrating lack of focus

Much like myopia (or nearsightedness), hyperopia isn't a word you hear very often. If you've heard the term if was likely in your optometrists' office and you probably have it. Your doctor of optometry might have taken the easier route though and called it by it's common, though misleading, name 'farsightedness'.

I don't know about you but when I see the word farsighted it implies that you can see far away but not up close. That simply isn't true. A farsighted person may see clearly at all distances, may have trouble at near or may have trouble seeing at all distances! To understand why we need to understand what hyperopia really is.

Hyperopia occurs when the eye is 'too weak' and light focuses behind the retina. This generally is because either the cornea (the front of the eye) is too flat OR the eye is too short (it may be a combination of both). We are all born somewhat farsighted and as we age our eyes get bigger and the farsightedness decreases. In some people the farsightedness never fully goes away. Depending on how much farsightedness there is it can cause problems like amblyopia, only cause headaches and strain while reading or even go completely unnoticed for many years. How is this possible!?

Being able to see clearly without glasses while being farsighted is all thanks to the lens inside of the eye. Its job is to flex and change shape so we can see all distances clearly without needing reading glasses. One way of thinking is that when we are reading our eyes, without the lens, would be 'too weak'. The lens changing shape gives us more focusing power so we can see. People with hyperopia have eyes that are 'too weak' at all distances, not just looking up close. The natural lens in the eye compensates for the eye being too weak both far away and up close. If they have a mild amount of farsightedness this usually doesn't cause problems but as the prescription goes up the eye and lens have a harder and harder time compensating for the uncorrected hyperopia! This can lead headaches, eyestrain or blurred vision which in children can cause amblyopia.

Light focuses behind the retina in hyperopia

One of the very frustrating things about hyperopia is that in many people it doesn't become an issue until they are in their 40's. Hyperopia is different from presbyopia (the need for reading glasses) but the same thing that causes us to need reading glasses also causes distance vision to become blurrier in farsighted people. Remember how I mentioned that the lens in the eye compensates for the eye being too weak? Eventually, in all of us, that lens doesn't work as well as it once did. That will usually start with trouble reading but in farsighted people they also eventually have blurred distance vision as well. Going from never needing glasses to needing them to see at all distances is immensely frustrating to my farsighted patients and is sometimes difficult to adapt to.

So how do we deal with farsightedness? Glasses and contact lenses are the most common and easiest forms of treatment. Both glasses and contacts refocus the light coming into the eye allowing it to focus on the back of the eye clearly. You can also consider surgery, like LASIK or PRK though they don't work as well for hyperopia as they do myopia. I'll talk about surgical options more in another blog.

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.

Back to school - Time for an eye exam?

It's mid August. Summer is slowly leaving us and our thoughts turn to back to school (at least in part because the ads on TV and in stores are everywhere)! In the run up to going back to school parents typically think about shopping for new clothes, school supplies and worrying about schedules.

Have you thought about an eye exam for your kids?

You definitely should. One in four children has a visually related learning difficulty. I've lost count of the number of children I've seen who have been told they have a learning disability when in reality the problem was their vision. It can be hard to catch up if for the first several years of school you struggled to see and fell behind in the basics of reading, writing and math.

This is all very preventable. Make sure your child comes in for their first exam at age 6 months  and then is seen every year after. If they're older than 6 months and haven't had an eye exam yet be sure to get them checked soon! You might be thinking, 'Why? My child sees just fine and passed a vision screening at school." Well, we can't rely on vision screenings. They really should be called sight screenings since they're only checking sight (as in 20/20 or not) and not vision. Optometrists don't just check sight. We check how well the eyes work together and how sight is processed. Children don't have a solid understanding of how the world should look and children often assume what they see is what everyone else sees too. Many times vision screenings also only check sight with both eyes open. If one eye has a high prescription it will be missed and can lead to amblyopia.

Seeing 20/20 is important but it isn't everything. Book an eye exam to make sure your child isn't suffering from an undiagnosed vision problem.

So what should you watch for? Often there are no obvious symptoms of a vision problem (especially if it's a problem with only one eye). When a child is having vision related learning problems though they may reverse words when writing or copying, confuse the same word in the same sentence, skip lines while reading or read the same line twice to name only a few possible problems.

The best way to prevent and avoid problems is to have your child's eye examined yearly. Children's eye exams are fully covered by Alberta Health Care every year (or more frequently if required). The Alberta Association of Optometrists also has the Eye See, Eye Learn program for children age 5 to receive a free pair of glasses if required!

There's no excuse! Book your child's eye exam today.

If you have any questions about this or anything else or if you want to book an eye exam feel free to contact us on TwitterFacebookGoogle +, via our website or phone us at (403) 474-6744.

Myopia? What's myopia?

Myopia is one of the most common eye conditions out there. I bet many of you reading this blog have myopia! So what is it? Myopia is the official, technical term for nearsightedness. Myopia affects approximately 40% of the North American population making it one of the most common vision problems. Despite that, many people don't really understand what myopia is! Let's shed some light on this important topic.

Myopia occurs when the eye is 'too strong' and light focuses too soon. This generally is because either the cornea (the front of the eye) is too steep OR the eye is too long (more commonly it's a combination of both). Most of us, including me, start becoming nearsighted in childhood and our vision gets progressively worse until early adulthood (around 25) at which point it stabilizes. In some cases myopia still gets worse even once we're in adulthood. It's important to remember that 'stable' vision really just means it isn't changing as much or as quickly. There are always some small changes year to year so the term stable is a bit misleading.

Luckily, myopia is very easy to treat. Glasses and contact lenses are the most common and easiest forms of treatment. Both glasses and contacts refocus the light coming into the eye allowing it to focus on the back of the eye clearly. You can also consider surgery, like LASIK or PRK which I'll talk about more in another blog.

The most common question I get from people about nearsightedness is how they can prevent it from getting worse. There are a few techniques that may help reduce how quickly a person becomes nearsighted or reduce how nearsighted they become and I'll discuss them all in more detail in a future blog. Current options to control myopia include multifocal contact lenses, Ortho-K lenses, progressives/bifocal glasses and atropine drops. The two that have shown the most success have been multifocal contacts and Ortho-K lenses and are believed to work by reducing defocus in the peripheral retina (meaning the outer edge of your eye isn't as out of focus as it might be with traditional lenses).

The biggest challenge facing us with myopia is that we still do not fully understand it. Your genetics play a role in whether you end up nearsighted or not but it isn't the whole story. Some recent research has found that people who spend more time outside have lower nearsighted prescriptions than those that spend more time indoors. The jury is still out on whether this is related to lower vitamin D levels, due to things just being further away or something else we haven't thought of yet.

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.

 

Amblyopia - How do we treat it?

My last blog about amblyopia discussed what amblyopia is and why it happens. It’s been a while so if you forget what amblyopia was or missed that blog follow the link back and find  out more before reading about how we treat amblyopia.

So what do we do about amblyopia? It’s actually not all that difficult! If there is a large amount of farsightedness or astigmatism our first step is to correct the prescription. A lot of parents get lost about now. We’ve just spent the last several minutes explaining to them that their child can’t see properly even with glasses and now we’re saying that they need glasses to fix the problem. This is especially tricky if there is no change in how well the kid sees without glasses or with!  It’s totally fair to question what we’re doing and why. The idea is to provide the eye (or eyes) with a nice sharp image. It may not make any difference in how well they see at first but over time as the eyes receive a nice sharp image they will learn more and more how to see better. If we go back to our earlier analogy with the flowers it’s sort of like watering the poor neglected flower. Just because you watered it doesn’t mean it instantly comes back to health and looks amazing. It takes care and time to nurse that flower back into full bloom.

If the amblyopia is only in one eye or is strabismic (eye turn) patching an eye is often required. The reason we have to patch in cases where only one eye is affected is  because if we don’t the better eye will just take over and keep doing all the work. This prevents the weaker eye from doing any work and slows or eliminates how well it will improve. The good news is that research has found that patching is NOT required all day every day! In fact it is only required for a few hours each night though we do recommend that the patient does some visually stimulating activities like reading, colouring or even video games.

There are certainly some cases that are more complicated and require more intervention and far more intensive vision therapy. Some patients may eventually require an eye surgery if they have an eye turn but the majority of patients with amblyopia can be easily treated so long as it is detected early. The older we are the harder it is to treat amblyopia as our brains are more set in their ways. So book your kids in for an eye exam today! You may think they see just fine, they may seem to see well but remember amblyopia may only affect one eye and young kids often don’t realize what they aren’t seeing!

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.

Doctors of Optometry Canada - Amblyopia

Mayo Clinic - Amblyopia

 

Amblyopia - An introduction to a common and confusing problem

Let me introduce you to one of the  most commonly misunderstood eye disorders that occurs in children and can continue into adulthood: amblyopia. Why is amblyopia so confusing? The biggest problem is that it’s hard to explain in a way that makes sense to everyone. So let’s hunker down and understand what amblyopia is.

Amblyopia is often also called lazy eye. This is horribly confusing because strabismus (where the eye turns in, out, up or down all or most of the time) is also commonly called a lazy eye. While an eye turn can lead to amblyopia, it doesn’t always and many people have amblyopia without an eye turn. Confused yet? What is amblyopia then? Officially it is decreased vision, even with glasses on, without any other disease or health problem being present. To really understand amblyopia though we need to know where it comes from. Remember that when we are born we don’t see perfectly well! In fact our eyes develop and learn how to see from the time we’re born until we are about eight years old.

There are two types of amblyopia. One type is called refractive  (meaning related to the prescription) the other type is called strabismic (meaning that there is an eye turn). The prescription related type of amblyopia is almost always caused by either very high amounts of farsightedness or very high amounts of astigmatism that have not been corrected with glasses. Sometimes this will happen in only one eye but it will often happen in both. The problem is that if you have a very large amount of farsightedness or astigmatism it’s not possible to see well at any distance.  Strabismic amblyopia occurs when an eye is always turned out or turned in. Since that eye is always off to the side our brain edits out any images from it and it doesn’t get used. This is a great example of use it or lose it! Remember that when we are young our eyes are still learning how to see. If during that time, when we are learning how to see, our eyes never have a clear image (or just isn't used!) we never develop the ability to see as well as we should. To put it another way imagine you had two potted flowers. One flower you diligently watered and fertilized every day but the other flower you more or less ignored. Even if they started out with the same potential the flower that got taken care of would thrive while the other would wither away. Eyes are obviously not exactly the same but an eye that gets daily stimulation with sharp clear images will learn and develop much better than an eye that doesn’t.

So what do we do about it? I'll cover how we treat amblyopia in my next blog! Until then if you want to read more feel free to check out the following links or as always contact us on Twitter, Facebook, Google + or via our website or phone us at (403) 474-6744.

Doctors of Optometry Canada - Amblyopia

Mayo Clinic - Amblyopia

Retinoblastoma - Eye Cancer in Kids

There’s a story that’s been going around on social media about retinoblastoma, a rare but serious eye cancer that affects young children (I reposted it here). I realize that most people have probably never even heard of retinoblastoma and given how serious it is I thought it was worth writing about. It can be treated and, like any cancer, the sooner it’s caught the better the outcome.

So first, what is retinoblastoma? It is a cancer of the retina itself caused by a genetic mutation that can happen all on its own or be inherited. The reason it happens in young kids and not older people is the cells that lead to retinoblastoma are only found in children. They are called retinoblasts and their job is to divide and fill in the retina as the child grows (our eyes aren’t fully developed when we’re born). If they start growing and dividing uncontrollably we end up with a retinoblastoma.

So how do you detect it? The best way is to have regular eye exams. Remember that kids can start getting eye exams as young as 6 months old! You can also detect retinoblastoma yourself as a parent  by watching out for a few key things. If your child’s pupil appears white in photographs,  your child has developed an eye turn (also called a strabismus or lazy eye) or the eye is red and irritated or doesn’t seem to see as well I would strongly advise getting your child seen by your optometrist or family doctor as soon as possible. It is very important to note that most white pupils, eye turns and red, irritated eyes are not cancer. There are a variety of potential causes of these signs, some serious, others less serious and it is the job of your optometrist to  figure it out.

 If you see this in a picture of your child you want it's important to have it checked immediately.

If you see this in a picture of your child you want it's important to have it checked immediately.

So what do you do if you do find that your child has retinoblastoma? How can it be treated?Your retinal oncologist (fancy name for an ophthalmologist or eye surgeon that specializes in eye cancer)  will set up a treatment plan depending on the size, type and location of the tumour. The number one priority in all cases of eye cancer is to save the person’s life. Retinoblastoma is fast growing and there is a possibility of it spreading to other parts of the body or into the brain. Saving the eye or the vision is less important than saving the child’s life. Radiation, chemotherapy, cryotherapy and a number of other  common cancer treatments are typically used to start in an effort to reduce the size of the tumour or eliminate it. In some cases it is necessary to remove the eye. Even if they eye itself can be saved it often is not able to see after treatment is completed. Retinoblastoma is never something we want to see but if caught early much can be done to help.

So now you have a better understanding of retinoblastoma. If you have any questions always feel free to contact us on Twitter, Facebook, Google + or via our website or phone us at (403) 474-6744.

For more information follow the links below!

Canadian Cancer Society

Ask a Doctor of Optometry - Retinoblastoma

Part 2: So, eye doctors do exams on babies? How does that even work? Why bother?

In this continuation from Part 1 of our two part blog about children's eye exams we talk more about how our eye work together, eye health and how we check these areas out on young children.

We often don’t think about it, but it’s pretty amazing that we don’t see double all the time. Our eyes have to line up perfectly all the time and work together well to allow us to see properly. It’s perhaps not surprising to hear that sometimes the system breaks down. It’s very obvious when someone has a big eye turn in or out and most parents would notice that. What is trickier is when the eye only turns sometimes, only turns when reading or there’s a muscle problem that doesn’t result in any eye turns at all! Many people have a muscle alignment problem that causes a lot of symptoms  but the eyes themselves don’t actually visibly turn in or out when both eyes are open. For a child trying to learn how to read this is a big deal! Kids may skip words, confuse letters, say letters are moving or have any other number of problems that people think is a learning problem but is actually an eye problem. A simple test to confirm the alignment of the eyes, standard on all eye exams, can help to prevent or solve a whole host of problems.

The thing about eyes is we only get two. It’s important to take care of them right from the start. We encourage our kids to take care of their first set of teeth even though they’re going to get more! We want a dentist to make sure they have healthy mouths. If something goes wrong with our eyes we don’t get to have a replacement! The majority of kids are, again, very healthy. Unfortunately though eye health problems in kids are either extremely serious and require early detection and treatment or are very minor like pink eye that just require drops. Most eye cancer, for example, strikes young kids under the age of five. It’s very rare but very serious.  There are many eye diseases that can affect children and by looking inside the eye and out optometrists can detect them early.

80% of learning is visual. I see so many kids that are being treated for attention problems or are getting special tutoring because they’re falling behind in school but their only problem is that they can’t see or their eyes aren’t working together. I don’t know about you, but I would probably act out too if I couldn’t see what was going on all day! Kids 18 and under are 100% covered by Alberta Health Care so you don’t have to pay a dime! You really don’t have an excuse not to bring your kids in and get them checked!

If you have more questions about this, or any other topic, always feel welcome to contact us on Twitter, Facebook, Google + or via our website.

For more information about children's eye exams check out the links below:

Eye Exams for Infants

Eye Exams for Preschoolers

Eye Exams for School Age Children

Part 1: So, eye doctors do exams on babies? How does that even work? Why bother?

People love their kids, that’s pretty much a given fact. Everyone wants to make sure they do the best they can to help their kids be everything they want to be! You take them in for their shots and check ups, make sure their teeth are healthy with the dentist and keep them busy with sports or music or any number of things! What many parents forget is to have their child’s eyes checked by an Optometrist.

I completely understand how this happens: People don’t think we can do eye exams on young kids; they think that little Timmy sees just fine thank you very much; they just don’t think it’s necessary!  The thing is the consequences of assuming everything is fine can be quite serious. It's much better to check and know everything is fine than to not check and hope for the best.

Optometrists are fully trained to do eye exams on just about anyone including small children. We actually start seeing kids as young as 6 months (and we really only wait that long because the eyes are still learning how to work together properly before then). I know you’re thinking “But, what on earth are you going to do with my 6 month old!” Don’t worry. We don’t require that our patients answer all those questions to get the information we need. Without any questions we can still assess the three major areas all optometrists check: how well the eyes focus, how well the eyes work together and how healthy the eyes are inside and out.

To check how well the eyes focus, especially on kids or people who are non-verbal, optometrists use a tool called a retinoscope. When we shine it back and forth at someone’s eyes we see a light reflex. Depending on how that reflex moves we can tell if someone is near-sighted, far-sighted or has astigmatism. We use lenses to ‘neutralize’ that reflex and that tells us  what the prescription is. We can do this on anyone of any age but it only gives us an estimate of the prescription so we still ask adults all those darn questions. Most kids don’t have a significant prescription, even if they may develop one later in life. Some children though have very extreme prescriptions. If the prescription isn’t corrected it can lead to amblyopia, a condition that prevents someone from having  clear vision even with glasses on.  

A lot of parents assume that if their child hasn’t complained they must not have a problem. This isn’t accurate for a couple reasons. If only one eye is affected your little guy can see just fine… it’s just only out of one eye. Since most kids don’t walk around with one eye closed they don’t usually notice the problem! The other issue is that kids don’t really know what they should be seeing, especially when they’re very young. If both eyes are affected he or she may not realize there’s a problem and assume that this is just how everyone sees. It’s not until they’re much older, 7 or 8, that they start to realize something isn’t quite right at which point it’s almost too late to treat.

Our next blog will continue to explore kids eye exams and talk a bit more about how our eyes work together, eye health and how we check those out on young kids.

If you have more questions about this, or any other topic, always feel welcome to contact us on Twitter, Facebook, Google + or via our website.

For more information about children's eye exams check out the links below:

Eye Exams for Infants

Eye Exams for Preschoolers

Eye Exams for School Age Children