Saturday, December 14, 2013

When changing or replacing contact lenses part way through the day does not improve discomfort - a new study explains why

Contact Lens Discomfort - Vision Source Vancouver Optometrists, Dr. M.K. Randhawa, OD
An interesting study was published in the October 2013 issue of Optometry & Vision Science.  It addresses a situation well known to many contact lens-wearers. Over the course of a day of contact lens wear, discomfort increases for some people.  And for some of these people, changing or replacing the lens to a fresh lens part way through the day does not help. Why is that?  This study may have an answer and suggests that it is not the lens, it's physical changes happening on the surface of your eyes.

Thursday, December 12, 2013

Long-Term Orthokeratology Patient Satisfaction


Orthokeratology satisfaction (Vancouver Optometrists - Vision Source)
Yet another study supporting the use of orthokeratology (also known as corneal reshaping) appeared in the November 2013 issue of the scientific journal Contact Lens.  The new study found that long-term satisfaction rates with orthokeratology treatment were high.  We have provided orthokeratology at our Vancouver eye clinic since we opened.

Orthokeratology is a safe and effective vision correction method where patient wears a lens retainer at night that reshapes the cornea of the eye.  The result is clear vision the next day without the need to wear corrective lenses during waking hours.  A number of studies have also shown that orthokeratology is effective in slowing or stopping myopia progression and that is save and effective in children.

The researchers who conducted the new study used a questionnaire where patients rated their visual experience and satisfaction levels with orthokeratology on a scale of 0-10.

orthokeratology and corneal reshaping therapy in Vancouver, BC.
The results of the study showed that light distortion in low light conditions decreases over time and decreases more quickly in younger patients and in patients with lower amounts of myopia. Predictably, visual performance declined after a patient skipped a night of lens retainer wear but this was usually tolerated.  In addition, the majority of patients report that they skipped overnight wear at least 1 night per week, but tolerate the resulting transient decrease in vision. Overall satisfaction was high, even after skipping a night of lens wear.

Here are the results in the study's own words:

More than 50% of patients skipped lens wear at least 1 night per week. The most common wearing pattern was 6-8 hours a day for 72.7% with 54.5% of patients wearing lenses every 2-3 nights only. Subjective vision scores after lens removal was 9.1 ± 1.1 after having worn the lenses and 8.1 ± 1.4 after skipping lens wear for 1 night. Subjective vision scores before lens insertion at the end of the day was 6.9 ± 2.0 and 5.8 ± 2.4, respectively. The number of hours until noticeable blur reduced with increased level of baseline myopia (r = 0.396; P < 0.001). 
Source:

Eye & Contact Lens
Subjective Satisfaction in Long-Term Orthokeratology Patients Eye Contact Lens 2013 Nov 01;39(6)388-393, E Santolaria, A Cerviño, A Queirós, R Brautaset, JM González-Méijome

Related Articles

Wednesday, December 11, 2013

Oral contraceptives double the risk of glaucoma, a leading cause of blindess


Glaucoma risk and contraceptives
Research presented recently at the 2013 Meeting of the American Academy of Ophthalmology in New Orleans, shows that women who have taken oral contraceptives for three or more years are twice as likely to suffer from glaucoma.  Glaucoma is one of the leading causes of blindness and vision lost to glaucoma is lost permanently. Glaucoma slowly takes your vision, starting at the periphery and working its way to the center.  Many people with glaucoma don't know that they have it until it is too late. The only way to detect glaucoma early enough for effective treatment is through a regular eye exam.

This is normal vision:

Normal vision compared with vision with glaucoma










This is vision with glaucoma in its advanced stages:

Normal vision compared with vision with glaucoma













The study looked at 3,406 American women aged 40 years or older who completed a vision and reproductive health questionnaire and underwent eye exams. The researchers found that females who had used oral contraceptives, no matter which kind, for more then three years were 2.05 times more likely to also report that they had also been diagnosed with glaucoma.

The study means that women who have taken oral contraceptives for more than three years should have a regular eye exam to screen for the early onset of glaucoma.  Other risk factors for glaucoma include elevated pressure inside the eye, visual field deficits, family history, South Asian or African ancestry, a history of myopia and other risk factors.  See your eye doctor if you are concerned.

Women's glaucoma treatment in Vancouver.  We take women's eye health seriously.
The study rings another note of caution for women when it comes to eye health. Women are at significantly higher risk than men for many eye diseases and must therefore ensure that they are vigilant about their eye health.  Read about women's eye health at the link below:

Saturday, December 7, 2013

Nutrition to prevent Macular Degeneration: The AREDS2 Study

Macular degeneration treatment in Vancouver, BC.


















AMD (age-related macular degeneration) is the leading cause of blindness in those over 50.  AMD breaks down cells in the layer of tissue called the retina in the back of the eye that provide
sharp central vision.  This is the type of vision that is necessary for tasks such as reading, driving, and recognizing faces.  Advanced AMD can lead to significant vision loss and is the leading cause of blindness in North America.




This is normal vision:


This is vision people with AMD:

Vision with macular degeneration

Optimal nutrition has been shown to be effective in slowing or preventing the advanced stages of AMD, allowing patients to keep their vision for much longer than would otherwise be the case.  The most highly regard studies are known as the AREDS studies.  There are now two studies, known as AREDS and, the latest study (published in 2013), AREDS2.

AREDS 2 formula based AMD treatment in Vancouver, BC.








The purpose of the AREDS2 study was to evaluate the efficacy and safety of particular nutrient supplementation: lutein plus zeaxanthin and/or omega-3 long-chain polyunsaturated fatty acid supplements in reducing the risk of developing AMD. The study also assessed the effect of reducing the amount of zinc and of omitting beta carotene from the original AREDS formula.

This was the original AREDS formulation:
  • 500 milligrams (mg) of vitamin C
  • 400 international units of vitamin E
  • 15 mg beta-carotene
  • 80 mg zinc as zinc oxide
  • 2 mg copper as cupric oxide

These were the modifications that were tested in AREDS2?
  • 10 mg lutein and 2 mg zeaxanthin
  • 1000 mg of omega-3 fatty acids (350 mg DHA and 650 mg EPA)
  • No beta-carotene
  • 25 mg zinc

The results of AREDS2 were summarized by Stuart P Richer OD, PhD as follows:

The AREDS2 results for the average American with a suboptimal daily intake of lutein/zeaxanthin showed a statistically significant prevention of catastrophic vision loss, primarily neovascularization. That was an incredible result, favoring a new AREDS2 formulation minus beta carotene but with lutein plus zeaxanthin. 

AREDS2 showed that there was an approximate 34% reduction overall in the risk of premanent vision loss. This means that with optimal nutrition many hundreds of thousands of people could have avoided vision disability that has made them illegal to drive and that requires them to take injections that costs hundreds of dollars each time.

Not only does optimal nutrition prevent serious eye disease, nutrients such as carotenoids have been shown to improve visual performance by providing patients with better contrast sensitivity and shortened glare recovery and better visual processing.  The carotenoids lutein and zeaxanthin have also been shown to improve cognitive function in the elderly.

NEI Press Release

Below is an excerpt from the press release issued by the National Eye Institute on the results of the AREDS 2 sudy explaining that adding lutein and zeaxanthin to the original AREDS formulation had the beneficial result of a greater reduction in the risk of developing AMD when beta-carotene is removed from the formulation because beta-carotene blocks the absorption of lutein and zeaxanthin.  Therefore the optimal formulation is the include lutein and zeaxanthin but to remove beta-caroteine.  Beta-caroteine also increases the risk of lung cancer in smokers or former smokers. This is a formulation that is good for everyone, as pointed out by one of the researchers quoted below.

In the first AREDS trial, participants with AMD who took the AREDS formulation were 25 percent less likely to progress to advanced AMD over the five-year study period, compared with participants who took a placebo. In AREDS2, there was no overall additional benefit from adding omega-3 fatty acids or a 5-to-1 mixture of lutein and zeaxanthin to the formulation. However, the investigators did find some benefits when they analyzed two subgroups of participants: those not given beta-carotene, and those who had very little lutein and zeaxanthin in their diets.

When we looked at just those participants in the study who took an AREDS formulation with lutein and zeaxanthin but no beta-carotene, their risk of developing advanced AMD over the five years of the study was reduced by about 18 percent, compared with participants who took an AREDS formulation with beta-carotene but no lutein or zeaxanthin,” said Emily Chew, M.D., deputy director of the NEI Division of Epidemiology and Clinical Applications and the NEI deputy clinical director. “Further analysis showed that participants with low dietary intake of lutein and zeaxanthin at the start of the study, but who took an AREDS formulation with lutein and zeaxanthin during the study, were about 25 percent less likely to develop advanced AMD compared with participants with similar dietary intake who did not take lutein and zeaxanthin.” 
Because carotenoids can compete with each other for absorption in the body, beta-carotene may have masked the effect of the lutein and zeaxanthin in the overall analysis, Chew said. Indeed, participants who took all three nutrients had lower levels of lutein and zeaxanthin in their blood compared to participants who took lutein and zeaxanthin without beta-carotene Removing beta-carotene from the AREDS formulation did not curb the formulation’s protective effect against developing advanced AMD, an important finding because several studies have linked taking high doses of beta-carotene with a higher risk of lung cancer in smokers. Although smokers were not given a formulation with beta-carotene in AREDS2, the study showed an
association between beta-carotene and risk of lung cancer among former smokers. About half of AREDS2 participants were former smokers. “Removing beta-carotene simplifies things,” said Wai T. Wong, M.D., Ph.D., chief of the NEI Neuron-Glia Interactions in Retinal Disease Unit and a co-author of the report. “We have identified a formulation that should be good for everyone regardless of smoking status,” he said. Adding omega-3 fatty acids or lowering zinc to the AREDS formulation also had no effect on AMD progression.

More than 4,000 people, ages 50 to 85 years, who were at risk for advanced AMD participated in AREDS2 at 82 clinical sites across the country. Eye care professionals assess risk of developing advanced AMD in part by looking for yellow deposits called drusen in the retina. The appearance of small drusen is a normal part of aging, but the presence of larger drusen indicates AMD and a risk of associated vision loss. Over time, the retina begins to break down in areas where large drusen are present during a process called geographic atrophy. AMD can also spur the growth of new blood vessels beneath the retina, which can leak blood and fluid, resulting in sudden vision loss. These two forms of AMD are often referred to as dry AMD and wet AMD respectively. 

Frequently asked quesitons

Click here for the FAQ page on AREDS2 from the National Eye Institute.

Here are two questions that we frequently get asked at our Vancouver eye clinic:
Can a daily multivitamin alone provide the same vision benefits as an AREDS formulation?
No. The vitamins and minerals tested in the AREDS and AREDS2 trials were provided in much higher doses than what is found in multivitamins. Also, it is important to remember that most of the trial participants took multivitamins. Taking an AREDS formulation clearly provided a benefit over and above multivitamins.
Can diet alone provide the same high levels of antioxidants and zinc as the AREDS formulations?
No. The high levels of vitamins and minerals are difficult to achieve from diet alone. However, previous studies have suggested that people who have diets rich in green, leafy vegetables—a good source of lutein/zeaxanthin—have a lower risk of developing AMD. In the AREDS2 trial, the people who seemed to benefit most from taking lutein/zeaxanthin were those who did not get much of these nutrients in their diet. Within this group, those who received lutein/zeaxanthin supplements had a 26 percent reduced risk of developing advanced AMD compared with those who did not receive the supplements.

Wednesday, November 27, 2013

Optometric care of the struggling student

Vision disorders can impact learning
The American Academy of Optometry has issued a position paper on the connection between vision and learning.  There is a large body of scientific evidence on the connection between vision and learning and how vision therapy treatment of eye movement and eye teaming disorders can improve academic behaviours.  A discussion of the research and reference to scientific studies is available here.

However, the position paper summaries some key studies in easy to understand language.  The summary provided at the end of the position paper states the following:

In summary, recent research has clearly shown that problems in eye focusing and eye teaming are common in students and should be evaluated, especially in children who are struggling in school. If a problem is found, then effective treatment should be prescribed. Timely identification and treatment of eye focusing and teaming problems can remove a potential obstacle that may restrict a child from performing at his or her full potential.

Monday, October 21, 2013

Life demands more than 20/20

In order for children to learn well, they need to see well. Parents may not realize there is more to good vision than 20/20 and that there are conditions that vision screenings can miss. Two optometrists conducted a visual experiment where common visual problems known to affect learning in kids are simulated in 4 adult teachers, and their experience and reaction are discussed.

 

Related Articles


Behaviors in children that indicate a visual-perceptual problem requiring a visit to a developmental optometrists

Saturday July 27, 2013


Research confirms vision therapy can Improve reading comprehension and improve a child's overall attention in the classroom
Friday, July 5, 2013

Visual Input Important in Developmental Dyslexia
Tuesday, July 2, 2013

If your child has reading problems, treatable vision and eye movement disorders may be the reason
Sunday, June 9, 2013

Visual processing and learning disorders 
Apr 17, 2013

60% of learning disabled students failed two or more binocular vision tests
Oct 20, 2012

More visual symptoms means lower academic performance
Feb 29, 2012

Vision therapy for convergence insufficiency improves academic performance ...
Jan 16, 2012

82% of teachers report an improvement in students after vision therapy 
Jun 16, 2012

Binocular vision dysfunctions ate my homework 
Mar 31, 2012

Study proves that vision problems interfere with learning

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Sunday, October 20, 2013

This is what convergence insufficiency looks like

This is what convergence insufficiency looks like (thanks to the VisionHelp Blog):

People with convergence insufficiency may still see 20/20 when measured using a standard eye chart and basic vision screenings that are done in schools and pediatrician offices.  

However, what the eye chart does not measure is how their eyes move and work together when doing work close up.  That's why convergence insufficiency is so often missed -  until a patients goes to a developmental optometrist. 

For more information on convergence insufficiency, visit www.convergenceinsufficiency.ca

To find a developmental optometrist near your, visit www.covd.org.

Tuesday, October 8, 2013

Are school vision screenings enough?

School vision screenings are not enough and often give parents a false sense of security about the health of your child's vision and eye health. A comprehensive eye exam provides the full assurance of vision and eye health that a simple eye chart test or a school vision screening cannot. 

Eye diseases, many that can cause blindness, eye movement problems such as convergence insufficiency and binocular vision disorders, eye muscle control disorders and visual information processing deficits all go undetected in a rudimentary vision screening.  Many of these disorders can impact a child's school performance, their personality and their self esteem. Undiagnosed diseases can cause permanent vision loss.

Dr. M.K. Randhawa explains:




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Monday, September 30, 2013

Kids' eyeglass frames - the top three features to look for

Did you know? Only 10% of all eyeglass frames are made for children.

There are a number of child friendly features to look for in children's frames.  Here are the top three.  Read more...


Sunday, September 29, 2013

Which children benefit most from orthokeratology myopia treatment?

Myopia treatment in Vancouver, BC.
Orthokeratology is effective in slowing or stopping myopia in children. A new study helps doctors determiner which patients will benefit the most from orthokeratology treatment.

A new study published in the journal Optometry & Vision Science sought to determine which children would benefit the most from the orthokeratology to slow or stop their myopia progression.

Here is our definition of orthokeratology:

Orthokeratology is a vision correction treatment that reshapes your cornea while you sleep so that you have perfect vision during the day. No glasses, no contacts, no surgery. Orthokeratology is also sometimes caled "corneal reshaping", "corneal molding", "overnight vision correction" or "ortho-K". Orthokeratology is most effective for near sightedness and astigmatism. Lens designs for farsightedness are under development. - See more at: http://www.orthokeratology.ca/what-is-orthokeratology.html#sthash.BJiPJf5m.dpuf

There are many studies that support orthokeratology to slow or stop the progression of myopia. This study wanted to find out which children would benefit the most from ortho-k.

Orthokeratology (OrthoK) in Vancouver BCThe researchers evaluated baseline measurements in myopic children fitted with overnight orthokeratology retainer lenses and compared these to measurements in a  group who wore glasses.  The authors then analyzed their data to figure out which measurements predicted myopia progression.  The standard measurement of myopia progression is to measure the axial length of the eye.  In myopia, the eye grows longer and if this effect is slowed or halted altogether, a child's eyes will stop getting worse.

The study identified number of factors that can help eye doctors predict which myopic children might benefit from overnight orthokeratology retainer lenses to control axial length growth and hence myopia progression.

The study found that the children who experienced the greatest myopia slowing effect were those who were older, had earlier onset of myopia, were female, had lower rate of myopia progression before baseline, had less myopia at baseline, had longer anterior chamber depth, had greater corneal power, had more prolate corneal shape, had larger iris diameter, had larger pupil sizes, and had lower levels of parental myopia.

The study also highlights the need to see a doctor who is highly trained in ortokeratology. A great deal of knowledge is required to ensure that the right patients are selected and that orthokeratology is not prescribed indiscriminately.

Related articles

Orthokeratology slows or stops the progression of myopia in children
July 6, 2013

Study suggests that young children may benefit from orthokeratology
February 14, 2013

New study confirms orthokeratology for slowing myopia progression
January 30, 2013

Orthokeratology is shown to be safe for correcting myopia in chidlren
Aug 11, 2012

Orthokeratology is shown to be effective in correcting astigmatism and myopia
Jun 18, 2012

New study supports orthokeratology for myopia control and for astigmatism correction
Jan 10, 2012

Laser eye sugery makes you queasy? Orthokeratology is a safe and effective alternative
Jun 09, 2011



Saturday, September 28, 2013

Why Apple's iphone 5s and iOS7 make people dizzy, motion-sick and nauseous - you may have Neuro-Ocular-Vestibular Dysfunction



Motion sickness, dizziness, vestibular treatment in Vancouver, BC
Many Apple iPhone users are complaining that the new iOS7 operating system makes them dizzy, sick and nauseous.  In one article from ABC News, users are reported as experiencing the following symptoms:

One user says "It hurts my eyes and makes me dizzy. So annoying that we can't downgrade!!!!" Another writes, "I had severe vertigo the minute I started using my ipad with ios 7. Lost the rest of the day to it... And not happy at all. It's the transition between the apps flying in and out."
People are experiencing a form of motion sickness caused by the transition animations in iOS7. They may have unwittingly diagnosed themselves with a vision or eye movement problem.  

We treat many patients for a problem called Neuro-Ocular-Vestibular Dysfunction (also known as "see-sick syndrome" or "supermarket syndrome") where they experience motion sickness like symptoms arising from dynamic visual stimuli, even when they are not in a vehicle.  The visual stimulus of a super-market, stripes on a shirt and now perhaps even the iPhones iOS7 operating system can trigger motion sickness type symptoms. 

The problems often arises from binocular vision disorders - eye movement problems where the eyes do not work together as a team properly. Studies have shown thatvertigo and dizziness is an underestimated symptom of eye and vision disorders.

The fact that vision and eyes are an under-recognized cause of dizziness, vertigo and motion sickness means that many people spend a year or more seeking help from various doctors who fail to diagnose the problem before finding an eye doctor who can zero in on the cause. One recent case found us one when she went to her optometrist after consulting various doctors for over a year. The optometrist found that the patient's eyes were misaligned, a condition that commonly causes the dizziness and vertigo-like symptoms she was experiencing. The patient was referred to our Vancouver eye clinic for treatment.

Dynamic adaptive vision therapy is an effective treatment for see-sick syndrome. Vision therapy relies on the principle of neuroplacticity and involves a doctor and therapist treating the patient with exercises and special equipment to "re-wire" the eye-brain connection and improve visual skills. In this way, vision therapy is similar to speech therapy or occupational therapy but focused, of course, on the eyes and visual system.

Related Articles

See sick syndrome
Jul 29, 2013
See Sick Syndrome, also known as Neuro-Ocular-Vestibular Dysfunction (NOVD), is a combination of motion sickness and photophobia that negatively affects quality of life, but is almost always unrecognized by medical ...


Motion sickness and vision therapy - See for Life
Apr 18, 2012
MSNBC recently did a story on adult onset motion sickness. One of the doctors interviewed for the article was optometrist, Dan L. Fortenbacher, O.D., FCOVD, who treats motion sickness using vision therapy. Here is an ...

Vertigo is often a symptom of eye disorders - See for Life
Apr 20, 2013
As we see more and more patients in our Vancouver optometry clinic with vertigo caused by eye disorders, we are reminded of an important study that was published on the topic over a decade ago by researchers from France ...


More articles on iOS 7 and motion sickness

New iOS 7 update making some users dizzy
Detroit Free Press
Apple customers have taken to Apple message boards and Twitter to complain that the flashy graphics in the new operating system for the ...

Apple iOS 7 Literally Making Some Users Sick
ABC News‎

Make iOS 7 less nausea-inducing
  1. Macworld (blog)



Monday, September 23, 2013

Can pet hair harm your eyes?

Eye health tip. If you have a pet, keep their hair off areas where you lie your head down.
If you love to cuddle your pet just be sure to keep the pillows on your couches and your bed clear of pet hair. Along with shedding dander, pets can also track in other irritants from outside that can cause inflammation in human eyes.


Which treatments are better than patching for amblyopia?

Patching is often the worst treatment for amblyopia for a number of reasons, including loss of self-esteem and exposure to bullying.  There are more effective and pleasant treatments available.  Read more...

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Wednesday, September 18, 2013

Eye tracking problems and reading - pursuits and saccades

Some students have reading problems because their eyes cannot properly track the words on the page.

There are two types of basic movements that eyes make when reading.  The first type is called a pursuit.  Imagine a baseball field, imagine the pitcher throwing the ball to the batter.  As the batter's eye follows the ball, the eye is performing a pursuit.

The second type of eye movement that is critical to reading is a saccade.  In baseball, if you quickly look from fist base to second base to third base, that is a saccadic eye movement.  To read properly, your eyes must have very precise and accurate pursuit and saccadic eye movements.  People with problems with pursuits and saccades often miss words, loose their place when reading and have to re-read sentences.

Problems with pursuits and saccades can be effectively treated with vision therapy.


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Monday, September 16, 2013

Free prescription eye-glasses and free sunglasses

End of summer promotion: FREE prescription eyeglasses + FREE sunglasses.  Visit www.freeglasses.ca for more information.



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Listen to RJ 1200 radio at 2:00 p.m. to catch Dr. Randhawa

Catch Dr. Randhawa on the radio today on  RJ 1200 at 2:00 p.m. (1200 on the am dial)

Saturday, September 14, 2013

Childhood Glaucoma - even kids can go blind from it

Glaucoma is most often associated with adults but childhood glaucoma also exists.  A new study from the August 2013 issue of the journal Clinical Ophthalmology found that most childhood glaucoma is found in three categories of kids.  Read more.

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Sunday, September 8, 2013

Vision problems resulting from head and brain injuries - what we can learn from the way the US Army uses vision therapy

Recently an interview appeared between Dr. Kathy Freeman and Dr. Randall Beatty, an assistant professor in ophthalmology at the University of Pittsburgh School of Medicine in Pittsburgh, Pennsylvania, about his experience treating combat eye injuries.

Dr. Beatty served as a colonel in the US Air Force Reserve Medical Service in Irag and Afghanistan, where he treated American service members and Iraqi and Afghan military and police personnel, as well as civilians, who experienced traumatic eye injuries during the course of the wars.

Below is the portion of the interview where the doctors talk about vision problems that arise from brain injuries. Dr. Freeman specifically mentions vision training (vision therapy) as a treatment. There is tons of evidence on the effectiveness of vision therapy in treating vision problems that result form brain injuries.  We have had considerable success in our Vancouver eye clinic treating vision problems that result form brain injuries sustained in car accidents, sports and falls.

Dr. Freeman: What are your thoughts on the traumatic brain injury that might be associated with these injuries?
Dr. Beatty: Well, traumatic brain injury was one of the things that kept us busy. A recent review of the VA literature reports that over 250,000 US service people have been diagnosed with some form of traumatic brain injury.2 The symptoms of those patients who have suffered traumatic brain injury are very similar to those associated with migraine headache—visual distortion, headaches, and extreme photosensitivity, not only to sunlight but even to lights inside. Some patients are very sensitive to the flickering of fluorescent lights. These are some visual disturbances that you won’t pick up just by having someone read an eye chart. The symptoms may be episodic, depending on how the patient is recovering from the post-concussive events, which can take quite a while; some may not really ever recover.
Dr. Freeman: How do you think eye care practitioners can best serve these veterans?
Dr. Beatty: I think that, overall, anyone who has been in a combat zone, and especially anybody who has had a concussion or suffered a concussive force by a nearby IED, will need to have very complete eye examinations on an ongoing basis. Dr. Glen Cockerham, at the VA Hospital in Palo Alto, California, did a study of returning veterans3 and, although the number was small, he found that a very high percentage of those veterans had some sort of ocular abnormality that could be attributable to their time in the combat zone. And that’s where we think that there may be problems with late-onset glaucoma as the years go by and as these veterans get older. In summary, very careful and complete eye examinations are necessary, and the emphasis cannot only be on detecting ocular pathology. It is essential to talk with these patients to determine what bothers them about their visual system—for example, do they experience photophobia or double vision? And, then, institute not only medical treatment but nonmedical as well—such as different types of eyewear that have tints, prism; low-vision devices that address the visual impairment; non-optical aids that can help with the distortion. In addition, there may be some need for different types of visual training. There should be attention to visual field analysis, detecting areas where there may be scotomas or blind spots.
And all of these things may be complicated by the fact that these patients also have cognition problems, deficits of short-term and long-term memory, which impacts their ability to handle low vision devices. Some of them have lost limbs or have other limitations that make it difficult to hold things and that complicate their visual rehabilitation. We’re now saving people on the battlefield with brain injuries and other types of trauma who, in the past, did not make it back to the trauma centers, and they are surviving and undergoing rehabilitation. This will result in more challenging long-term rehabilitative care, which is going to involve extensive physical and occupational therapy. And, in addition to those therapies, there should be visual rehabilitation.
The US army uses doctors of optometry to provide vision therapy to soldiers who have sustained brain injuries.  Here is a video:

video


RELATED ARTICLES
Traumatic brain injury often results in convergence insufficiency
Dec 11, 2012

Brain injuries and vision problems 
Nov 04, 2012

Vision problems after car accident are caused by brain injury
Nov 07, 2012

Motion sickness and vision therapy - see sickness syndrome
Apr 18, 2012

Image courtesy of koratmember / FreeDigitalPhotos.net

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Monday, September 2, 2013

Patient stories from the optometrist's office - meningioma diagnosed during a routine eye exam

Patient stories from the optometrists office from the BC Doctor's of Optometry:

Find out how a Doctor of Optometry helped diagnose Shrie with meningioma during a routine eye exam by watching the video below.

According to the Mayo Clinic:

A meningioma is a tumor that arises from the meninges — the membranes that surround your brain and spinal cord. Most meningiomas are noncancerous (benign), though, rarely, a meningioma may be cancerous (malignant). Some meningiomas are classified as atypical, meaning they're neither benign nor malignant, but rather something in between.
Meningiomas occur most commonly in older women. But a meningioma can occur in males and at any age, including childhood.
A meningioma doesn't always require immediate treatment. A meningioma that causes no significant signs and symptoms may be monitored over time.


Saturday, August 31, 2013

Visual processing speed slows down as we age, making driving less safe - how to measure it and how to improve it


We slow down as we age.  But can we get some of our youthful speed back, at least with respect to visual processing?  Will treating visual processing weakness make older adults safer drivers? A new article in the September 2013 issue of the journal Vision Research suggests that the answers to these questions is "yes".

With respect to eyes and vision, the need for reading glasses is a common vision change that few manage to escape as they age. Another change, that is not as well known is changes in our visual processing speed.  

Changes in visual processing speed affect all aspects of our daily life.  Slower visual processing can make us generally inefficient as we are slow to take in and react to our visual world.  It can also make us prone to accidents.  

What can we do about declining visual processing speed? There is research that suggests that with the appropriate training, therapy and practice, visual processing speed can be improved for for many activities of daily living such as driving.  

One way to test visual processing speed is a protocol developed by doctors of optometry called Useful Field of View (UFOV).  It consists of a computer-generated series of three tests. The results are categorized into areas of visual processing weakness:

  • rapid visual processing, 
  • selective visual processing, and 
  • divided attention. 
If weaknesses are found, they can then be addressed with specific vision therapy or training based on the protocol for the UFOV.  The results can then be measured and they usually affect the speed with which older adults can perform everyday visual tasks, with the result of, hopefully, decreasing the risk of accidents.

The results of UFOV illustrate the difference between legal driving and safe driving.  Legal driving requirements are based on visual acuity - how clearly you see at various distances and whether you have the necessary peripheral vision.  Legal driving tests do not assess how useful your vision is to the task of driving. Safe driving is impacted by the driver's speed of visual information processing. The law has not caught up to vision science yet, but it is only a matter of time.

For people that have weak visual processing speed and who want to improve, developmental optometrists at our Vancouver eye clinic such as Dr. M.K. Randhawa, offer therapy programs to improve visual processing speed.  Car accidents can radically change your life for the worse, anything that can be done to avoid them is welcome.

Related articles:

Monday, August 26, 2013

Macular degeneration and depression

A new study published in the Canadian Journal of Ophthalmology found that a 21.3% patients with a macular degeneration demonstrated severe symptoms of depression. The study also found that patients who lived with others had a lower prevalence of depression, which suggests the need to help ensure that patients with macular degeneration have adequate support and live in an environment that mitigates the risk of depression.

It is not surprising that severe depression is common among patients with macular degeneration, as the disease impairs vision to an extent that it reduces a person's quality of life.

This is normal vision:

Depression and age related macular degneration

 This is vision with macular degeneration:

Macular degeneration treatment in Vancouver, BC.

At our Vancouver eye clinic, we find that maximizing a patient's remaining vision can improve quality of life and reduce depression.  Visit www.lowvisionvancouver.com for more information on how low vision devices can help the visually impaired.

This is not the first study to link vision and mental health. See the following related articles:

Sharp Vision Sharp Mind 
Feb 09, 2012

Depressed? Anxious? Maybe your eyes are too dry
Apr 20, 2012

Citation

Can J Ophthalmol 2013 Aug 01;48(4)269-273, J Jivraj, I Jivraj, M Tennant, C Rudnisky