Is this an infection or allergies?

Q:  My eyes are swollen, itchy, and tearing a lot.  The last couple of days it even feels like my eyelids are getting stuck together in the mornings.  Is this an infection or allergies?  I’ve never had allergies before.

A:  It definitely sounds like you are having allergic eye symptoms. 

Most allergy suffers are advised to “avoid the allergen” which is easier said than done.  There would be nothing nicer than to write a prescription to move to a different location (Hawaii, Arizona all sound nice) but this is not possible in most cases and we need to keep working, going to school etc in the same environment that the allergens are in.

Cold compresses help stabilize the mast cells which are releasing histamine.  Histamine causes the itching and swelling which the cold compresses help to soothe (scratching and rubbing your eyes aggravate the mast cells to secrete even more histamine and you create a cascade effect).

Oral anti-histamines are great if you have other allergy symptoms such as sinus congestion, however be aware that they do dehydrate all the mucous membranes and it is important to drink lots of water (otherwise you can end up with dry eye symptoms and general dehydration).  If you only have eye symptoms, then consult your optometrist for the best prescription drop for the symptoms you are experiencing (Patanol, Zaditor, Alrex are some examples).  Localizing the anti-histamine directly to the eyes reduces the systemic effect of an oral anti-histamine and is generally appreciate by those that only have eye symptoms.

Look for red, swollen eyes (especially under the eyes) in children as well.  Many of the kids playing outdoor sports where they are sitting on grass (soccer, football, baseball) exposes them to possible allergens which may only last for a few hours after the practice/game.  Using cold compresses and not rubbing their eyes will be helpful.  If the symptoms are severe enough, several of the prescription anti-allergy drops are safe to use (down to age 3).

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Dr. Patricia Fink

OPTOMETRIST

Millcroft Shopping Centre
2080 Appleby Line, Unit E6
Burlington, Ontario, L7L6M6
Tel: (905) 319-1066

Optical Illusion - Moving Stars

Q. I was looking at the stars the other night and noticed that the star was moving…is this an optical illusion?  What does this say about my eyes?

A:  The illusion of the star moving around is due to very small, minute eye movements that keep a small, light image visible to you.  On a large black sky, it makes the star appear as if it is moving when in fact it is your micro-saccades (small quick eye movements) that you are noticing.  You may also have noticed that the star may have been flickering and that you could see it more brightly by not looking at it directly.  This is because the peripheral part of your retina or the rod vision is more in tune for seeing objects at night.  This part of the retina is also responsible for movement and reaction.  Unfortunately, it is not as clear as your fovea or cone vision…so as your eye moves around the star is in and out of your central vision creating a flickering effect.

Optical illusions are a result of the very important part of your vision that is not central or 20/20.  This is your peripheral vision, your movement cells, the “blurry” part of your vision that is necessary for speed and reaction.  The human body could not function if it only had sharp, central 20/20 vision.  Many people have inadequate visual function because this often under looked part of their vision may not be working.  This can result in motion sickness, dizziness, and vertigo.

Below, I have attached a link to a very interesting optical illusion of your normal blind spot and how this blind spot can be very noticeable however, when an object passes it through it the optical centers in the brain fill it in so you don’t miss anything.  This is very important for day to day functioning.  Our eyes and our visual centers in the brain are quite amazing.  Enjoy the link.

Dr. Patricia Fink

OPTOMETRIST

Millcroft Shopping Centre
2080 Appleby Line, Unit E6
Burlington, Ontario, L7L6M6
Tel: (905) 319-1066

The Importance of Eye Exams

Q:  Eye exams have changed so much from when I was a child.  There is so much more technology that is foreign to me and yet I need to make decisions as to having a retinal photograph or an OCT scan.  Can you shed some light on the need for these and how important they are to my visual health?

A:  You are absolutely correct in that eye examinations have changed tremendously over the last number of years.  Not only have they changed for the patient but they have changed for the doctors as well.  I know most of us would not contemplate practising without this technology as it gives us far more information not only to treat a potentially visually threatening condition but also to implement preventative measures.

These technologies are so quick and efficient, many of them can be done without the use of dilating drops which have caused concerns of blurred vision (up to 4 hours) and discomfort in sunlight.  There may still be a need to use dilating drops if the view of the photo or OCT scan is not clear but for most people that do not wish to be dilated, the technology of photo and OCT permits for much more detailed information than could be seen through an undilated eye.  People with diabetes, hypertension, glaucoma or macular degeneration should definitely consider having these tests done as the retina is greatly affected in these conditions.

A baseline retinal photo is always recommended, also in children, especially if they have moles or nevi on their lids/retina etc.  If these change over time, there is no better way to document than with a photograph.

The OCT is a technology that permits us to see all the layers of the retina.  This is important in macular degeneration as it helps determine if it is “wet” or “dry”...the “wet” form requires immediate attention by a retinal specialist.  These are difficult to discern without an OCT.  Glaucoma is detected much more quickly with an OCT scan of the optic nerve than through traditional visual field monitoring.  This can help prevent peripheral vision loss far earlier than before.

Many of these tests are not covered under OHIP yet their importance is undeniable.  It would be a disservice for a doctor not to let you know that a technology would benefit you.  The choice is yours.  What price would you put on your vision?

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Dr. Patricia Fink

OPTOMETRIST

Millcroft Shopping Centre
2080 Appleby Line, Unit E6
Burlington, Ontario, L7L6M6
Tel: (905) 319-1066

What is colour deficiency?

Colour deficiency occurs when your ability to distinguish certain colours and shades is less than normal. The term "colour blind" is often used, but usually incorrectly. Only a very small number of people are completely unable to identify any colours.  Congenital deficiencies result from an inborn abnormality of the cone photoreceptors.  There are three types—dichromacy (protanopia, deuteranopia, tritanopia), anomalous trichromacy, and rod monochromacy. Red-green deficiency (protanopia & deuteranopia) is by far the most common and results in the inability to distinguish certain shades of red and green. Blue-yellow deficiency (tritanopia)is less common and affects the perception of blue and yellow colours. In very rare cases, colour deficiency exists to an extent that no colours can be detected (rod monochromacy). This person sees all things in shades of black, white and gray and matches hues based on brightness.

There are different methods of testing colour vision which is generally used during routine visual assessments.  Colour vision can be altered due to injuries, cataracts, and macular degeneration.

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Dr. Patricia Fink

OPTOMETRIST

Millcroft Shopping Centre
2080 Appleby Line, Unit E6
Burlington, Ontario, L7L6M6
Tel: (905) 319-1066

When should my child have their eyes examined?

The Ontario Association of Optometrists recommends that all children have an eye examination at the age of six months, at age 2; then every 12- 24 months as recommended by an optometrist.

Vision screenings are often no longer done in schools by public health nurses. A screening does not replace a comprehensive eye examination, it only tries to identify at risk children and identify the basics of visual acuity. Even with a vision screening it is important to have your child's eyes examined by an optometrist - and OHIP covers eye exams for all those under 20 years of age.

After your child's eye examination, you should know the essentials including:

1. If your child has good depth perception
2. If your child has good colour vision
3. If your child's eyes are healthy
4. If your child can focus well
5. If your child's eyes are working together

One of the most important aspects of the full and comprehensive optometric eye exam is the ability to assess overall eye and vision health. There are many causal factors that may contribute to vision challenges and only your optometrist is trained to help identify these factors.

Your child’s vision is vital in developing skills such as: Reading,Copying,Hand-eye coordination, social skills.More than 80%  of learning is done through the eyes.

Children with poor vision often find it difficult to focus on their work and may be misdiagnosed as having a learning or behavioural disability.  One in six children has a vision problem significant enough to impair their ability to learn.

Regular eye exams can detect health problems and conditions such as a turned or lazy eye in the early stages. These conditions may be treated successfully if an optometrist diagnoses them early in a child’s life; if they go undetected, they can lead to permanent sight loss.

Often, there are no signs that a child has a vision problem, making regular eye examinations very important. Young children do not have the experience necessary to know what is normal as far as their vision is concerned; they often assume that everyone sees things the way they do.

Vision screening programs are no longer a common practice, and are not a replacement for a comprehensive examination by an optometrist; in fact, as many as 43% of children with vision problems may be able to pass a basic vision screening.

REMEMBER YOUR EYES ARE SCHOOL SUPPLIES…MAKE SURE THEY ARE READY FOR SCHOOL!

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Dr. Patricia Fink

OPTOMETRIST

Millcroft Shopping Centre
2080 Appleby Line, Unit E6
Burlington, Ontario, L7L6M6
Tel: (905) 319-1066

What is computer vision syndrome?

Computer Vision Syndrome (CVS) is an environmental condition caused by extensive computer use; in that the eyes blink less when looking at the screen there can be lasting irritation caused by long periods of computer and monitor use.

As many as 70 -75% of computer users may suffer from CVS but most of these people are unaware that a large part of their discomfort can be fixed.  Symptoms include:

  • Blurred or double vision
  • Burning or watering eyes
  • Headaches

During your eye examination, your optometrist checks

  • Your ability to focus your eyes on close work
  • Check the external surface of the eye for tear layer abnormalities
  • Check the health of internal structures of the eye
  • Inquire about medications that you are taking
  • Discuss the details about your computer workstation set-up

Treatment for CVS can include specialized eyewear such as a business lens or an office lens, changes in contact lenses or solution and adjusting posture to the computer and lighting situations.

Computer users should take regular breaks from viewing the computer screen.  For each hour of computer work, take a 5-10 minute break.  Look back and forth from distance to near to alleviate some of the eyestrain from too much close work.  The ideal distance from your eyes to the screen is about 50-60cm.  You should position yourself so that the computer screen is about 20 degrees below eye level.  Periodically adjust the brightness of the screen and contrast.  This helps with focus for the eyes.  Also adjusting the computer screen to limit glare and reflection will help with keeping the eyes comfortable.  Most of the time lights or windows behind the computer user will cause these issues.

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Dr. Patricia Fink

OPTOMETRIST

Millcroft Shopping Centre
2080 Appleby Line, Unit E6
Burlington, Ontario, L7L6M6
Tel: (905) 319-1066

What type of nutrition is helpful for eyesight?

As much as possible, try to eliminate those things that are known to be toxic. For those who smoke, the most important step is to stop smoking. Smoking can double the risk of developing cataracts and increase the rate of macular degeneration by 500%.

Nutritional supplements can be beneficial to overall health, but before choosing any course of supplements please consult with your optometrist and your physician - sometimes there is no substitute for prescriptive care.

Supplements that may help include bilberry and ginko biloba, which may stimulate retinal blood flow and serve as antioxidants. Glucosamine and chondroitin sulfate may improve tear quality as well as omega-3 fatty acids, while cranberry extract may be active against some chronic eyelid inflammations.

Anti-oxidants such as vitamin A, beta-carotene, vitamin C, vitamin E and selenium absorb excessive free radicals before they damage healthy cells and may reduce risk for cataracts and macular degeneration.

Phyto-chemicals such as lutein (xeaxanthin) help replenish a naturally occurring pigment in the eye and may help reduce the risk of macular degeneration.

Minerals such as chromium, magnesium, selenium, calcium, copper, zinc are used in the production of enzymes & proteins and may slow the progression of macular degeneration.

Overall, lifestyle and nutritional choices that are good for your overall health will of course, be beneficial for the eyes.

Check yearly to see clearly.

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Dr. Patricia Fink

OPTOMETRIST

Millcroft Shopping Centre
2080 Appleby Line, Unit E6
Burlington, Ontario, L7L6M6
Tel: (905) 319-1066

How long should it take to get used to my bifocals?

Q.  I need to fill a new glasses prescription and my doctor says I need bifocals.  I have had discomfort wearing new glasses in the past and I have heard that bifocals are worse.  How long should it take to get used to them?

A. Adaptation to a new prescription or even the same prescription in a different set of frames requires visuomotor adaptation.  Information from the visual system has to be compared with information from the motor system.  The time needed for perceptual adaptation and the remapping of visuomotor space can vary from individual to individual.

Studies showed that the adaptation process is dependent on the number of interactions between the visual and motor system and not on the time spent wearing the prescription.

What all this technical terminology means is that distortions/nausea/dizziness/blurry vision is expected when picking up a new pair of glasses.  Some people adapt quicker than others and this depends on how much of a change in prescription there was, the change in the frame shape and/or size, and how adaptable an individual is.

People that change their prescription eyewear every year, and those that have multiple pairs of glasses, have less adaptation issues than those people that wear the same pair of glasses for 10 years.  The reason for this is that the person is keeping up with smaller prescription changes and is able to switch between different types of frame styles which allows their brain to re-map the visuomotor dynamics much faster.  The longer between prescription changes, the larger the disparity between the old glasses and the new ones, and therefore more difficult to adapt to.

Walking and wearing a new prescription allows for faster visuomotor integration and this explains why sitting down watching TV (no movement) does not allow for proper adaptation.  Switching back to the “old” glasses is also not advisable during the adaptation period as this prolongs getting used to the new glasses.

Certain personality types are more adaptable to change than others.  Some people can adapt to large changes in 2 days and others need 3 months.  Generally the patients with positive attitudes and those determined to make the change in prescription work (for example, those adjusting to invisible bifocals) do much better than the patients that are afraid to try or those that don’t want glasses to begin with.  Patients with a history of motion sickness or fear of heights will also have a more difficult time adapting.

The length of the adaptation period really varies from person to person.  As long as there is improvement from day to day…then the adaptation is working.  I would say a minimum of 2-4 weeks is necessary for most people (especially those adapting to bifocals for the first time).  However, with the proper support from the eyecare professional and encouraging people around you…adapting to your new prescription will be successful!

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Dr. Patricia Fink

OPTOMETRIST

Millcroft Shopping Centre
2080 Appleby Line, Unit E6
Burlington, Ontario, L7L6M6
Tel: (905) 319-1066

Eye testing at age 2?

Q: I understand that children should have their eyes tested at age 2.  Why so young? And what kind of eye conditions can be determined and potentially prevented by getting their eyes tested so young?

A: Yes, children should have their eyes tested by age 2…sooner if an eye turn is noticed by the parents.  Strabismus (an eye turn) is evaluated and can be treated with glasses (in most cases) or surgically (in severe and non-accommodative cases).  Amblyopia (lazy eye) is often a surprise to parents since only one eye can’t see and the other eye is fine.  This child functions normally but is losing visual potential out of the ’lazy eye’ as well as depth perception.  The eyes are not necessarily turned in or out for amblyopia to occur which is a common misconception among parents, who assume that they would have seen that there was something wrong with their child’s eye.  Amblyopia and strabismus are best treated at young ages (before the age of 4) for maximum visual improvement as that is when the visual system is most “plastic” or able to make proper connections from the eye to the brain.

Parents and teachers should be proactive in having their young children evaluated for their vision as learning is 80% visual.  Why do kids not tell us that they are having problems seeing?—They do not have a reference point of what clear vision is and have adapted.

(note:  children ages 19 and under are still OHIP insured for their eye exams)

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Dr. Patricia Fink

OPTOMETRIST

Millcroft Shopping Centre
2080 Appleby Line, Unit E6
Burlington, Ontario, L7L6M6
Tel: (905) 319-1066

Continued Eye Care

Q:  I was recently in for my eye examination and am astonished at all the advancements in technology that have occurred since my last visit.  As the new year is just around the corner, what can I do as a patient to continue to care for my eyes?

A:  What a good question.  Booking your annual eye examination is one of the most important things you can do.  We have found that pre-appointing your appointment helps to keep that annual visit in place.  Most patients are always astonished when they find out it has been 2 or 3 years (or more) since their last visit, even though they had intended to come every year.  Insurance coverage also affects these bookings but please note that there are so many “silent, non painful” eye conditions that checking annually is so important to maintain proper eye health.

If you wear glasses, please, please make sure you have an up-to-date back up pair to wear.  If you can not function without your glasses for either reading or driving, this is imperative.  This also goes for contact lens wearers.  It is your job as a patient to make sure you have a functioning pair of glasses in case you have an infection and/or injury to your eye(s).  This time of year there are many infections and viruses going around, so the risk of infection is higher.  Even if you have “never” had an eye infection, it only needs to happen once for you to see how difficult it is to function without a back up pair of glasses.  Many of you out there that are in this situation also have high prescriptions which can not be made up in 1 hour.  Keep this in mind.

Many post-cataract patients are so pleased with their implants that they manage with over the counter reading glasses.  This is fine for spotting purposes but a pair of prescription glasses to properly correct some of the astigmatism and balance between the eyes is also very important.

Finally, be safe.  Wear safety glasses when doing repairs around the house.  Wear sports goggles for squash, badminton, swimming, etc.  Wear sunglasses to protect from uv rays.

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Dr. Patricia Fink

OPTOMETRIST

Millcroft Shopping Centre
2080 Appleby Line, Unit E6
Burlington, Ontario, L7L6M6
Tel: (905) 319-1066