The Good Doctor

Hurray for retinal scans/OCT’s!

Fri, 01 May 2026 01:47:46 GMT

Blog vol 6.40. Hurray for retinal scans/OCT’s!

In 2009, after much research and soul searching, we decided to invest in a new technology: the optical coherence tomographer (OCT). The decision was really made in 2004 when we introduced high-definition fundus photography to the practice and made it mandatory for all our diabetic patients. The wonderful thing about the eye is that it is truly a window into the heart (and blood vessels).

It all started in the late 1980s when two scientists, James Fujimoto and Eric Swanson from MIT, turned their low-coherence interferometer onto the tissue of the eye. This interferometer had limited scanning speed and poor resolution, which were improved over time with the use of broadband light. The 2009 OCT was called spectral-domain, and it had faster scans and clearer images. Learning to use the OCT and interpret findings was a challenge with huge payback in improved patient care.

The OCT improved our ability to diagnose so much that we decided to scan everyone over the age of 18 years for a minimal fee (routine OCT is not usually OHIP covered). The information we receive from the OCT scan allows us to pick up problems early at a tissue level, improving prognosis significantly. This is something that needs to be available to everyone. That was a paradigm shift for the practice.

In 2019, we moved up to the next generation, 3 D-OCT 2000, with higher resolution, wider scans, and now deeper scans. Using different infrared wavelengths and increasing the number of scans has made it possible to do OCT Angiography, a test we use only for specific conditions. This OCT tracks the movement of the red blood cells through the choroid, a fine plexus of capillaries that provides nutrients and oxygen to the retina. So amazing really.

In October of 2025, a local researcher, Dr. Marie E. Pigeyre, in an article from McMaster University, points out the importance of OCT scans in detecting cardiovascular issues and early signs of aging. (Read more here ). With the present OCT technology, genetic data, and blood sample analyses, researchers are doing a study on 74,000 participants. So far, they have found that simpler, less branched blood vessels are at increased risk of cardiovascular diseases and show signs of biological aging. OCT as a diagnostic tool for heart and circulatory problems? There is potential here.

Early, regular testing is key. We can look at a scan of the cells at the back of your eye and compare them to the same area in the previous scan. Abnormalities become quite clear. Please come in and get tested; it really is a great preventative. We have been doing this for 17 years and are quite good at it.

Til next week

The good doctor

The Gut and the Eyes

Wed, 29 Apr 2026 02:58:28 GMT

Blog vol 6.40. The Gut and the Eyes.

One of my biggest jobs is to keep abreast of new research and advances in eye health. Most recently, we have seen new stem cell research, gene therapies, as well as new drugs for dry and wet macular degeneration.

In January of this year, there was an article in the journal, Cell Death and Disease, that looked at cell apoptosis, specifically with the photoreceptors of the eye. (Read the article here ).

Apoptosis is the genetic programming of deliberate and constructive cell death, allowing for the maintenance of healthy structures and systems in the body. Some estimates have the body replacing 50 to 70 billion cells daily by this process. Necrosis, on the other hand, is unplanned cell death caused by injury, toxins, or other negative outside factors; this causes inflammation and disrupts the body’s balance of things.

There are stressors that speed up cell turnover. The study looked at photoreceptors in the retina and were able to demonstrate cellular recovery, even in late stages of apoptosis, recovery not breakdown. When certain stressors were reduced, by working with the mitochondria, there was recovery of the photoreceptor cells. How? Mitophagy, the mitochondria’s own process of programmed breaking down and then repurposing the recycled components for new ones. This mitochondrial repair helps to reverse the sequence of apoptosis for the photoreceptors. Mitochondria, how cool.

How is this helpful for our eyes? Conditions like retinitis pigmentosa or macular degeneration directly involve the photoreceptors and may be slowed or reversed by helping the mitochondria. So, let’s take care of those mitochondria. There is some evidence for nutritional support for the mitochondrial system.

The nutrient, Urolithin A (UA), which is a compound made in our gut from fiber found in pomegranates, berries, and nuts is the only clinically proven substance known to trigger mitophagy, made in the gut no less.

Vitamin B3 is critical for mitochondria function, however vitamin B3 based supplements are still to be clinically tested for their support of cell recovery. Nutrients Coenzyme Q10 and L-carnitine are known to help the mitochondria generate energy, and interestingly, infrared light therapy has also been shown to benefit mitochondrial function.

Again, food for thought. The gut and its function needs a lot of research. How do probiotics and nutrient precursors affect eye tissues? It is so interesting that the gut can be a factor in eye health. Maybe adding Urolithin A as a supplement is wise, along with the antioxidants in Lutein and Zeaxanthin we use to combat photoreceptor degeneration.

Will keep you posted on any new developments.

The good doctor

Paying attention with your eyes

Thu, 16 Apr 2026 19:32:13 GMT

Blog vol 6.39. Paying attention with your eyes.

The conversation around the Artemis II mission highlighted the discrepancies between machine vision and human vision. The processing of visual information, the integrating of cortical input, and the seeing the forest AND the trees, sets human vision apart. The human visual system is very complex and very finely tuned, and not so easily duplicated.

Attention, the focussing of the eyes and mind, is integral to vision. In an on-line article in The Conversation, Dr. Michelle Spear, Professor of Anatomy at the University of Bristol ( Read here ), observes that our brains cannot analyze every object in a scene or space simultaneously. The visual system relies on attention, thereby selecting and filtering.

In my own personal experience, my nemesis is the fridge. I am sent to look for the mayonnaise, and after a careful search of all the shelves, I am befuddled; I cannot see it. The next person to look sees the mayonnaise immediately right in plain sight. Why did I not see it?

Visual searching has a method: a series of spotlight sweeps that go across the visual field. Our fovea, the centre of our vision, can only cover a very small area roughly the size of a thumbnail at arm’s length. This “spotlight” sweeps over a scene gathering detail, sacrificing everything outside its purview. Our eyes will also jump across a scene, by saccades, to cover large areas. These pursuit and saccade movements are constantly and unconsciously being performed by our eyes.

That is not all. It is not just about what information reaches the eye, but also about what the brain expects to find. This is called inattentional blindness or perceptual blindness. It occurs when the brain is so intent on seeing one specific thing that it filters out all other input. A good example of this is a video taken of a group of people passing a basketball around ( Watch here ). In and out of this scene walks a person in a gorilla costume completely unobserved by most viewers. Frankly, somewhat disturbing to find that I did not see something so obvious.

The part of the brain that is crucial to spatial awareness and directing attention is called the parietal lobe. The pathway that runs to this lobe from the eyes is called the dorsal stream. The parietal lobe allows us to see where objects are in space and plays a crucial role in guiding attention during visual search. In the gorilla video, the larger jumps that our eyes perform to track the balls, the saccades, play a part in reducing our attention. This is good when we really want to focus on something yet may be a deadly problem when we are multitasking in say, heavy traffic or when we are texting and driving.

It is important to remember that vision is not only about the eyes but also includes perception and processing. All the more reason to get your eyes and vision checked regularly.

Til next week,

The good doctor

Artemis II and the Dark Side of the Moon

Fri, 10 Apr 2026 01:00:49 GMT

Blog vol 6.38. Artemis II and the Dark Side of the Moon

Last Wednesday, April 1, 2026, we witnessed the launch of the Artemis II rocket from Cape Canaveral at 18:35 hours. The four-person crew is on a 10-day mission to orbit Earth, travel to and orbit the moon, make detailed observations, and then return to Earth.

Day four was fascinating as NASA live-streamed the observations and conversation between the crew on the rocket and the scientists on the ground in Houston. At hour 2:26:52, Victor Glover spoke of his difficulties observing the moon, then being able to see inside the cabin. He was trying to see the dimly lit display of the Personal Computing Device (PCD). He complained that his eyes had changed slightly since being up in space (Day 4 and 20 hours). He was using reading glasses to view his PCD but found it very taxing on his eyes.

The team at the Johnson Space Center stated that the zero gravity of space travel can affect vision, noting that studies of astronauts returning from the International Space Station show that a shift in body fluid from the feet to the head occurs over time, which could be the cause of Victor’s visual difficulties. The condition is called space-flight-associated neuro-ocular syndrome (SANS). It can produce the “water-hammer effect”, which can cause swelling, resulting in optic disc edema, global flattening, choroidal and retinal folds, hyperopic refractive error shifts, and, even more seriously, focal areas of retinal ischemia, all reversible on return to Earth. What Victor was probably experiencing was fluid buildup, which can be helped by wearing prescription glasses, especially for near vision. Astronaut Glover is 50 years old and possibly experiencing early presbyopia, a natural, age-related reduction in reading ability, making it more difficult for him to compensate.

Of great interest is the brightness of the moon, especially the “dark side”. This mission should finally put to rest this misnomer; it is the far side of the moon and certainly not dark. The “far side” still gets light from the sun; we on Earth just do not see it (unless, of course, we send a team of astronauts to observe it or follow a Lunar Reconnaissance Orbiter (LRO), such as NASA’s 17-year-old LRO.) The point is that both sides of the moon are very bright. Furthermore, the moon rotates on its own axis at the same rate at which it orbits the Earth, a fact known for a long time, but still fascinating.

An important goal of the Artemis II mission is to make human observations that interpret and integrate small, detailed observations with the larger picture of the moon. Favourite observations from Artemis II:

“The more I look at the Moon, the browner and browner it looks.”

Victor Glover noted the “magic” seen in the lunar features, calling the illuminated mountains “islands of light”.

They saw impact flashes, bursts of light when tiny meteorites hit the lunar surface.

We cannot negate the human element, seeing these fascinating things with our own eyes.

One sees the moon in a whole new way, so interesting.

Til next week,

The good doctor

A New Treatment for Nystagmus

Fri, 03 Apr 2026 12:45:20 GMT

Blog vol 6.37. A New Treatment for Nystagmus

Nystagmus is an oculomotor condition in which the eyes oscillate back and forth. This eye motion occurs naturally when the vestibular system is stimulated to make compensatory eye movements, such as when the head is tossed around. This is the type of eye movement that ballet dancers have to compensate for when they do multiple successive turns on pointe (fouettés, for example). The dancer uses spotting to keep their vestibular system from overreacting. This is called physiologic nystagmus and is normal and healthy.

Pathological nystagmus, on the other hand, is either congenital or acquired by disease. I have examined many patients with pathologic nystagmus over the years. It is usually the result of an abnormal fundus (retina, the layer on the back of the eye), optic nerve hypoplasia (undeveloped), colobomas (areas of missing tissue), scars, or pigment abnormalities. Pathologic nystagmus can also result from anomalies of the skin around or in the eye.

A number of my patients have a genetic condition called albinism, which causes a lack of pigment in the eye and/or the skin. This lack of pigment leads to abnormal development of the eyes and the binocular vision system. The resulting oscillations occur spontaneously without stimulation, varying in size, speed, and direction, causing reduced visual function.

There are degrees of nystagmus; some cases are worse than others. Research shows that image displacement of more than 5 degrees per second results in a decline in visual acuity and oscillopsia (the perception of visual motion). Treatments for eye oscillations include extraocular muscle surgery, botulinum toxin type A (Botox) injections, various drugs, acupuncture, and contact lenses, all with variable success in different forms of nystagmus.

I have had success fitting contact lenses to increase visual function in nystagmus patients. This is a non-invasive treatment which is easily adjustable. A new treatment gaining much traction in China is much more invasive, though the early results are very promising (Read more here ). This new treatment works on the neuromuscular mechanism that causes the eye oscillations in the first place. The i-NYS device uses microcurrent stimulation to regulate the movement of the extraocular muscles. This stimulation is delivered by a compact, battery-powered implant surgically placed near the extraocular rectus muscle. The device delivers specific microcurrents calibrated to the particular patient. This allows control of neural firing and stabilization of gaze without suppressing natural eye movements.

The device reduces nystagmus amplitude and frequency over time. It is battery-powered and surgically implanted, which does raise questions in my mind. However, in extreme cases, the improvement in vision and quality of life could well be worth the costs/risks.

Unfortunately, there is a stigma to having oscillating eyes. You are not “normal”. This device could help minimize the social impact for people with nystagmus, another important and hard-to-quantify reality. This is a hopeful development, a different approach, a different way of tackling an old problem.

Til next week,

The good doctor

A perspective from the “blind”

Fri, 27 Mar 2026 00:09:49 GMT

Blog vol 6.36. A perspective from the “blind”.

I just finished The Country of the Blind , a book by Andrew Leland. Leland is going blind and he is introduced to a whole new world as he gradually loses his sight.

When Leland was 16, he was diagnosed with retinitis pigmentosa which was caused by a mutated gene named MAK. He was bumping into things a lot when it got dark. After a series of tests, particularly an electroretinography (ERG) which measures the electrical activity of the retina in response to light, the diagnosis was confirmed.

What Leland discovered is a whole new world of people who deal with visual impairment. His struggle for much of the book is still having limited sight but being part of a world and culture that is blind. The reality is that very few people are totally without sight. In Leland’s case, he has lost much of his rod function, hence peripheral vision, but has retained some macular or cone function as he has aged. The fear of totally losing your sight is always present, but as he discovers every gene is different, every situation is different, and in his case, he does retain some vision throughout the time covered in the book.

There is a difference between a visual impairment, a visual disability, and a visual handicap. The author struggles through these differences as he writes. His impairment is his physical condition and the resulting visual functions. For example, as his rods drop out, his field of vision narrows, first having a central tunnel with little islands in his periphery and then the islands “get flooded” and gradually disappear. The MAK mutation also affects cone function, reducing the precious central vision. The visual acuity goes down as well as the contrast sensitivity.

The disability is reduced orientation and mobility (O&M). He cannot see cars and other objects in his periphery, creating a great deal of anxiety when getting around. He has difficulty in distance for T.V. watching or seeing a screen in the classroom and, of course, reading is also a problem, at the least reducing reading speed making higher education a real challenge.

Finally, the handicap is very real. How you are perceived by others, how society, institutions, structures are either negligent or stacked up against you, creating very real barriers to thriving and being part of society. Leland spends a lot of time on these issues. He provides a very thorough history of the politics of blindness, the struggle to remove these barriers to the “blind”.

He does a great job in placing himself in the “blind” world, making use of the resources available to him with several sympathetic agencies. In Canada we have the Canadian National Institute for the Blind (CNIB), but in the USA they have two groups: the National Federation of the Blind (NFB) and the American Council of the blind (ACB). These two groups have a similar mandate to help visually impaired individuals but politically do not align. Who knew?

Leland also looks at the advances in technology such as Kurzweil readers and software and hardware applications that really expand visual worlds. I have found that the most useful aid is an electronic magnifier that is portable and reads text for you, called Seeing AI. Another application recruits online/phone sighted helpers to be there when visual questions arise, called Be My Eyes. Since the printing of Leland’s book, there are new apps like Lazarillo, which helps with GPS, location, and orienting. There is huge potential here.

The hope for Leland is that as the “blind” community has more access, stereotypes disappear, and we can see the visually impaired as regular people (who often have a ton of persistence and drive, enviable qualities).

Leland’s book is worth a read. It is very helpful in describing the experience of visual impairment and he does a great job presenting the technologies and assistance available. I personally found that the political focus was not helpful, there was too much of it. People need to know someone has experienced what they are going through, they need ideas for what to do, and they need encouragement. Leland has achieved this part of the task.

Til next week,

The good doctor

Introducing the Neurolens

Thu, 19 Mar 2026 23:05:22 GMT

Blog vol 6.34. Introducing the Neurolens

At Burlington Eyecare, we have recently added a battery of binocular vision tests to our exams. A company from Dallas, Texas, Newton, has developed a way to measure eye alignment at varying distances and fixation targets. Since 2020, with the Covid pandemic and a significant rise in screen usage, an average of over nine hours a day, we have noticed a lot more computer eyestrain.

In 2012 a company called Eyebrain Medical started developing a way of performing these measurements. They made a device 3 X 3 feet in size and weighing 100 pounds. The patient put their eyes into the attached goggles and performed varying eye movement tasks while the device measured their eyes through a series of infrared sensors and then printed out a report of the patient’s alignment. A lot of people had misaligned eyes and they found a strong correlation between misalignment and headaches, neck strain, and eye fatigue.

Would helping the eyes align relieve these problems? Researchers found that this misalignment was causing a condition called Visually Induced Trigeminal Dysphoria. When this dysphoria occurs, feedback from the extraocular muscles overstimulates the ophthalmic branch of the trigeminal. The constant out-of-phase movements over a long day strain the trigeminal and cause headaches, neck strain, eye fatigue, and even dry eyes. These researchers developed a lens that can realign the eyes at different viewing distances by creating a contoured prism. The size of the prism changes as the fixation distance changes, minimizing prism adaptation and lining up the eyes for variable tasks.

They worked with prototypes and refined the lens design until the patients had comfortable, clear vision. We are now on to the 3 ^rd generation measuring device, called the N3. This device uses a virtual reality headset to measure eye misalignments (Read more about it here ).

Interestingly, studies with the resulting Neurolens have shown a significant increase in reading speed. A retrospective white paper also shows a significant reduction in headache symptoms when using Neurolens.

We are excited to provide this new technology to our patients and are assessing all our patients with the N3 headset (at no extra cost), fitting the lenses when needed. We are learning a lot with this new data available to us and are able to help symptomatic screen users in a new way. Neurolens is an excellent option for people complaining of eyestrain and headaches.

Til next week,

The good doctor

Celebrating Frost

Thu, 12 Mar 2026 21:17:24 GMT

Blog vol 6.34. Celebrating Frost.

Burlington Eyecare hosted Marion and Paris Frost from Germany with their complete frame collection on Tuesday, March 10. We have worked with Frost since the Summer of 2012 and love their designs and quality.

In 2012, our office manager and head optician, Val Haslam, went to Paris for the world’s biggest fashion and optical show, Silmo. We at Burlington Eyecare were getting ready to move to our current location at 3235 Fairview Street and wanted to freshen up our optical frame collection with high-quality frames that were fashion-forward. One of the frame lines Val discovered was Frost, designed and manufactured in the Black Forest.

I met Marion and Paris Frost on Monday for the first time and their enthusiasm and their creative ideas are immediately contagious, no wonder Val took to them back in 2012. They brought in a full lineup of their frames, and the design and quality speak for themselves.

In 1994, Marion, a talented goldsmith and optician, was having difficulties finding spectacle frames that suited her husband. Why not design their own? — Frost is born. This couple has a wonderful synergy. Just like the meeting of form and fashion, they bring these qualities into their work.

Almost 32 years since that beginning, their experience and ideas just keep flowing. When they put out their full lineup of frames for our event, what a display of colours and shapes. Our lab manager, Roger Sales, marvels at the quality, appreciating the workmanship and the ease of glazing spectacle lenses into the frames. Again, that perfect synergy.

In January 2020, before the Covid shutdowns, Val went to Munich for Silmo, and not only saw Marion and Paris again, but went to see the Frost workshop in Sasbach. They handcraft all their frames on sight and demonstrated their frame fabrication while there. Gracious hosts, the Frosts also showed Val and her husband around the lovely world of the Black Forest. Our opticians have since met up with the Frosts and their Frost frames at shows in New York.

No surprise we were excited to have the Frosts and their complete line of frames at Burlington Eyecare this past week. After a successful show in New York, they came through Buffalo to visit us in Burlington. For the past 12 years at Burlington Eyecare their collection has built up a following and many of our patients who love the frames came to peruse the lineup in all its colour and form.

We wish Marion and Paris all the best as they return to Germany and look forward to seeing what new designs they will create in the coming years.

bis nächste Woche (Til next week, in German),

The good doctor

Bolivian Eyecare.

Thu, 05 Mar 2026 22:51:10 GMT

Blog vol 6.33. Bolivian Eyecare.

When referring to Burlington Eyecare we use the acronym BEC, but in the past 10 days BEC has taken on a new meaning. Our office manager, Karen, who speaks Spanish, went on a two-week eye mission to Bolivia with a team representing Medical Missions International (MMI). This team includes surgeons, nurses, optometrists, opticians, and help, ideally with some experience and some Spanish.

This is her “vacation”; a change is as good as a rest?!

The team set up clinic in a brand-new hospital, which means sparkling clean, in the town of Samaipata, which is in the hill country at an elevation of 1700 metres, 120 km south- west of Santa Cruz. It is a regular getaway for Bolivia’s largest city. The name Samaipata comes from the native Quechua and means “elevated place of rest”. This is mostly an agricultural region with fresh fruits and vegetables and wineries, and it is also home to many artisans, with outdoor markets to sell their wares.

This eye mission is co-ordinated with the Province of Florida (the name of the Bolivian province Samaipata is in) and Medical Missions International (MMI). MMI is the same group that operates the Amazon hospital boat we at Burlington Eyecare have supported over the years. The team currently in Bolivia has 50 North Americans and 20 locals and they are running the clinic for two weeks. Karen helps with translation and works in the dispensary, matching glasses for the prescriptions that are produced by the doctors. This is where donated glasses go.

In the first week they saw 1316 patients, did 105 surgeries, dispensed 1029 pairs of prescription glasses, readers, or sunglasses. The numbers are even higher in the second week, so they will be more than double by week’s end. Wow.

A lot goes into such a work: arranging the clinic and facilities through local helpers and officials, bringing surgical supplies, eyedrops, and sorted and rejuvenated glasses. Then there is the setting up into clean but empty rooms, and then the triaging, weaving the many people through the clinic, with language barriers — Spanish and Quechua. Long days and always a lineup to start the day. In my experience, a line that can be up to 3 days long. The needs are huge.

In her texting, Karen really enjoyed the interaction with people in the marketplace, they are so grateful and hospitable. All the team volunteer, pay to get down there, and help with the financial needs of the work. The great discovery when you work on these missions is how much you receive. Not some cliché, it really happens, the people are so gracious and we have so much to learn from them, you come away humbled, changed.

I like to think that the BEC in Burlington works on the same principle. We really want to thank our patients, and we are truly honoured to be able to help the people of Burlington and its surrounds.

Til next week,

The good doctor

Robotic driving and the Eye

Fri, 27 Feb 2026 01:29:28 GMT

Blog vol 6.32. Robotic driving and the Eye.

This past week, there was an interesting article in The Economist on autonomous driving. We have come a long way with digital cameras and their use in a variety of robotic applications. The latest Model S from Tesla has eight exterior cameras to monitor road conditions. That is definitely more angles than we can access with our eyes, so all those cameras must be better than the human eyes? Think again.

The problem lies in the difference between optical flow and the motion field. A camera does not track motion like we do; all it can do is measure the motion of brightness patterns in the image. Even with a highly pixilated image, the camera can only detect these brightness changes as the object moves by. Ideally for the camera, the image velocity would be equal to the scene velocity.

Unfortunately, the delay when cameras process images is more than ½ second, so travelling at 90 kilometres an hour you can travel 12 metres with outdated information. That is definitely not good enough for autonomous driving to safely navigate our highways and streets.

A roboticist, Shuo Gao, from Beihang University in China, looked to the human visual system for help. When studying the pathways for visual processing, the place to start is the eye and the retina where light photons are converted into neural responses, processed by the ganglion cells, leave the eye by the optic nerve, and go to the visual cortex via the LGN.

The Lateral Geniculate Nucleus (LGN) is located in the thalamus of the brain. The LGN acts as a relay station for visual signals, where much processing and feedback occurs. Crazily, 95% of the neural information to the LGN is from the rest of the brain and only 5% comes from the eyes. The cortex provides feedback to the LGN which serves to selectively amplify or suppress visual information. Factors like emotions or stresses on certain stimuli affect the signal, prioritizing them.

In this new device, a LGN-like layer was introduced into the artificial vision system to guide the attention of the optical flow algorithms. This neuromorphic hardware integrates processing storage functions which allow the device to build up a picture of when the motion is occurring. It has increased processing speed by 400% and has actually improved accuracy in some cases (Read more here ).

We must marvel at how well our visual systems work. By mimicking them, this new technology works that much quicker, and yet we can perform these visual pathway decisions in a fraction of a second. For these camera systems to work optimally they need to lose that 12-metre lag. This is a start.

Til next week,

The good doctor

Polarization in lenses, good or bad?

Fri, 20 Feb 2026 00:25:15 GMT

Blog vol 6.31. Polarization in lenses, good or bad?

At Burlington Eyecare, we recommend eye protection from ultraviolet (UV) light and from glare. All sunglasses are required by Canadian law to filter 100% of UVA and UVB light. This is a good thing because a sunglass reduces light to your eyes and causes your pupils to increase in size which results in 2-3 times more UV entering the eye. Protection is a must.

We looked at eye protection for winter sports, UV and glare, specifically ski goggles last week. As a rule, the filters required in the lenses will be condition dependant. Are polarized lenses helpful?

Polarized lenses have a special chemical applied to them to filter light. The chemical’s molecules are lined up specifically to block some of the light from passing through the lens. Think of it like a miniblind hanging in front of a window; only light that passes through the blind’s openings can be seen. On polarized sunglasses, the filter creates vertical openings for light; only light rays that approach your eyes vertically can fit through those openings. The lenses block all the horizontal light waves bouncing off a smooth pond or a shiny car hood. As a result of this filtering, the image you see with polarized lenses is a bit darker than usual, but objects look crisper and clearer, and details are easier to see (Read more here ).

Polarized lenses are great for when you are on the water or driving, so you would think that they would be perfect for skiing. However, they do have their downside —

1. When skiing, ideally you have a way of differentiating snow from ice, more difficult with polarized lenses. Ice is a lot more dangerous and to be avoided.

2. Polarized lenses reduce depth perception and contrast, making the split-second decisions in skiing or surfing more difficult to get right.

3. Skiers also rely on their peripheral vision for extra cues, not optimal with polarized lenses.

4. Golfers use glare from blades of grass to see slopes and judge greens, also affected by polarization.

5. When driving with “Heads up” displays, polarized filters make them hard to see. The same is true for LCD screens.

6. Commercial pilots work with polarized windshields on planes; an extra polarized filter in their sunglasses would be terrible.

Outside of these specific uses, polarized filters are awesome. The key is knowing what you are doing and getting polarization filters when the need arises.

Til next week,

The good doctor

A nice Winter Break

Thu, 12 Feb 2026 22:09:28 GMT

Blog vol 6.30. A nice Winter Break.

Where we live in Southern Ontario, we have experienced a taste of the North since December, lots of snow and polar temperatures, where we find out that -40 is the same in Celsius and Fahrenheit. Wiarton Willy did not see his shadow so apparently, we can expect an early spring. In the meantime, we have the Olympics from Milano/Cortina to our screens any time of the day, lots of sports that you haven’t heard of like the two-man luge and ski mountaineering. Most of the competition on the hills involves the competitors travelling at crazy speed to cross the finish-line first.

The margins in these sports are in the hundredths of seconds and make for great drama with the stakes so high. One thing that you see in almost all the events is the use of some form of eye goggle or cage to protect the eyes and provide ramped-up visual perception.

Downhill skiing goggles protect the eyes from snow, and more importantly, have filters that enhance the contours of the terrain. If it is a sunny day, the skiers will opt for a very dark filter to reduce as much glare as possible. UV rays are a big problem in snow and ice, and filters for UV A and UV B are a must. If the weather is overcast, then the filter is changed to yellow or amber to still filter glare but keep illumination levels high. If you, as a non-Olympic athlete, want a single full purpose lens for all conditions, then a rose-coloured lens is best.

The Olympic athletes have it all down to a science, measuring the light with light meters and crafting the perfect lens. There are also different designs of goggles: some enhance downhill viewing, some allow for a spectacle insert, most are designed to reduce fogging. Then it is a matter of fit and comfort.

The athlete’s vision must be at peak performance, especially in an event like the biathlon, where the athlete must fire a rifle to hit targets, then ski cross country. The required rifle is a .22 calibre with open sights (no scopes) though a dioptric adjustment is allowed on the back sight to correct for your prescription. The targets are at 50 metres and a miss results in a time penalty. The hope is that while skiing the sights are not damaged so that you can also shoot straight at the end. The trick is to fire your rifle flawlessly, control your breathing, and ski like a demon, piece of cake.

Of course, we have to talk about hockey. The women wear a full cage for eye and face protection, and the men wear at least a visor. At high level play, visual demands are intense and processing is split second. It is one thing to deliver a saucer pass (where the puck is lifted at the right height and speed on to a teammate’s stick), and another to see an obstacle in space and get around it. Excellent 3D perception skills, timing, and hand-eye co-ordination are essential. The speed is unreal.

All these moves and visual perception skills are honed and their execution will make the difference between 5th place and a gold medal. (Note, a bit of puck-luck involved here.)

“Go Team Canada!”

Til next week,

The good doctor

The wonder of the Kestrel

Thu, 05 Feb 2026 19:03:47 GMT

Blog vol 6.29. The wonder of the Kestrel.

Countless reels come across my screen. One that stood out this week: a videographer and ornithologist captured a Kestrel in flight. It was hovering, with head rock-solid still, while it soared in a brisk wind. Fascinating and beautiful.

In the 1800’s, the British poet, Gerard Manly Hopkins, captured this image in a poem called The Windhover.

High there, how he rung upon the rein of a wimpling wing

In his ecstasy! then off, off forth on swing,

As a skate's heel sweeps smooth on a bow-bend: the hurl and gliding

Rebuffed the big wind. My heart in hiding

Stirred for a bird, – the achieve of, the mastery of the thing!

The real marvel, from an optometric perspective, is the steadiness which allows the kestrel to maintain fixation on its prey. Raptors have exceptional distance vision. Combine that with steadiness, and it becomes clear why you do not want to be a sparrow within range of this bird.

Another bird with rock-steady fixation is the chicken. Their internal “gyroscope” is so effective that videographers have been using cameras mounted on chickens’ heads to get the most stable images, (see video here ).

Unlike the Kestrel that can move its eyes around, the chicken’s eyes are immobilized, so it must rely mostly on its optokinetic reflex (OKR) to keep the world still. The OKR is an eye reflex that works to keep the world from blurring when the entire visual field moves around you. In humans, this reflex automatically stabilizes the image on the retina by moving the eyes to match the direction and speed of the moving scene. Chickens and other birds maintain a stable head position whatever the rest of the body is doing in order to optimize vision, critical for survival. With all the advances in imaging, we have yet been able to stabilize images as well as a chicken.

I have a number of patients with nystagmus, which is quite common in conditions like albinism. Nystagmus is the roving back and forth of the eye to compensate for reduced visual function. Most people with nystagmus have a null point, a position of the eyes that has the least amount of movement and corresponds to the best position for improved vision. Even with reduced visual function in humans, image stabilization is critical.

The next time you see a Kestrel (or chicken) keeping its head stock-still, marvel at what a feat that is.

Til next week,

The good doctor

Predicting your medical future and Artificial Intelligence

Thu, 29 Jan 2026 21:58:44 GMT

Blog vol 6.28. Predicting your medical future and Artificial Intelligence

In September of 2025, Nature published an article about using Large Language Models (LLMs) to help predict disease in individuals. This model is called Delphi-2M, likely named after the Oracle of Delphi, who in ancient Greece channelled prophecies from Apollo to provide guidance for crucial decisions. After centuries, the oracle at Delphi, on the slopes of Mt Parnassus, made her last prophecy around 323 AD when the practise was banned by the reigning Roman emperor (Ecyclopedia Britannica online). In 2025, we now turn to LLMs, like GPT-5 to provide guidance.

The Delphi model was tasked with analyzing the text in a massive databank, the UK Biobank (400,000 strong), then predicting the next word in sequence. The programmers then added in the passage of time as a factor which resulted in more accurate health predictions. These models must have a huge database to work with and be able to adapt as new data is released. The Delphi-2M developers then ran the model through the Danish health system with over 1.9 million patients.

In the British trials, they found that the model had a prediction rate of 0.76, with 0.5 set as completely random and 1.0 as full proof. One cannot go to the bank with these numbers, so to speak, but it is a good start. As more data, like medical imaging and genome sequencing is added, the accuracy will improve.

One asks the question, why go through all the trouble? As diagnosticians, we have lists of common diagnoses at the ready all the time. We need to see LLMs as another tool in our medical bags. This information can someday help with predicting trends in disease and even help health services and teaching institutions to plan. (Read more here ).

Back in 1990, I decided to take a one-year residency in Low Vision Rehabilitation at Waterloo out of interest, and in anticipation of an upcoming surge in new cases of age-related macular degeneration (ARMD). However, with the decrease in smoking, improved diet, increased use of UV protection, the use of lutein in AREDS formulas, and new treatment modalities, that surge did not happen despite an aging population. This is something that an LLM could likely have predicted.

Will LLMs like Delphi-2M be able to predict our personal health future? No more than knowing that your mother has glaucoma tells you that you are at higher risk for glaucoma or if you smoke, you are at higher risk for many health issues. An LLM can simply analyze more factors, correlate them, and watch current trends. It is the same sort of thing except on a much larger scale. LLMs cannot account for unpredictables like quitting smoking or taking up running or getting in an accident, etc., all of which can have a huge impact on health outcomes.

An LLM like Delphi-2M is a tool for medical professionals to better help their patients, and health care systems better prepare for the future.

Til next week,

The good doctor

Blue light, an ongoing issue

Thu, 22 Jan 2026 00:42:41 GMT

Blog vol 6.27. Blue light, an ongoing issue

During covid, people were spending A LOT of time on screens. Zoom was the thing: distance education, work from home, distance everything (even weddings). Eye strain became a problem. Has our screen time gone down since covid? Hopefully. What is the effect of blue light on the eyes?

There is a connection between the pineal gland, blue light exposure, and melatonin release that is well documented. Some lens suppliers emphasize the link with blue light and eye/retinal damage and push blue filters for protection, but this is unfounded.

The link between blue light, the retina, and possible macular degeneration is not proven. In a great article by Dr. David Sliney out of Johns Hopkins University ( read here ), he points out all the variables that go into measuring blue light exposure and concludes it is almost impossible to control for it, because of variables like pupil size, corneal and lens transmission of the light, pigmentation of the patient’s eyes, the genetic susceptibility to certain wavelengths, the angle of incidence, the actual duration of exposure, and length of waves involved. It is very difficult to set up studies that will conclusively predict possible damage from blue light.

So, what can we work with? And why all the stress on blue light filtration? Our use of screens has gone up exponentially over the last few decades, with average use globally at 6 hours and 40 minutes a day, and with teens, it goes up to over 8 hours. There was a concern about the eyes and LED lights generally which proved to be unnecessary, but this concentrated screen time over a long period is concerning. That much exposure must have some effect on retinal health. The beauty of blue filters, and for that matter, UV filters, is that they can be added to the glasses or contacts you are already wearing.

A blue filter helps with sleep patterns and gives protection for screen exposure. We have a glasses option and a contact lens option:

Nikon lenses for spectacles have been coated with blue filters since 2012, with their camera lenses treated even as early as the 1970’s. In 2021, Nikon introduced Pure Blue UV. Unlike previous coated filters which reflected an unpleasant hue, this new lens material filters and looks great. We have been using this product for close to 5 years and routinely include it in our orders.

We also stock Johnson & Johnson’s Oasys One Day Max with a blue filter for our contact lens wearers.

At this point, we dispense UV filters with all our products. We are coming to see the need for blue filters in the same way.

It is very simple to put on the extra protection and is an excellent preventative, especially with the demands on our eyes and how much we use them. Come in and have a conversation with our optometrists and opticians about the use of blue filters. We even have a promotion on Nikon’s Pure Blue lens, for a limited time we are offering it as a free upgrade.

Til next week,

The good doctor

Shifting Colours and Textures: the Octopus

Fri, 16 Jan 2026 03:36:59 GMT

Blog vol 6.26. Shifting Colours and Textures: the Octopus

A blog about light… colours… texture… how we see, perceive.

Last weekend my son and his friends spent a day at Ripley’s Aquarium in Toronto. If you have not gone, drop everything and go, well worth the trip to Toronto. When I go, I always look for the elusive octopus, a fascinating creature.

Masters of camouflage, they can change their colour, texture, and shape to hide in any environment. Think of the “septopus” (missing one tentacle), Hank, in Finding Dory. Very funny.

How do they do this?

1. Chromophores - octopi have thousands of these tiny sacs that are pigment filled. By stretching or shrinking them, their colour changes.

2. Iridophores - these are tiny cells that act like mirrors to reflect colours and are dependant on the viewing angle.

3. Leucophores - also reflect light but are not viewing angle dependant. They scatter reflecting light to spread it out (this is why polar bears are white: they have leucophores in their fur which spread out the full spectrum light).

4. Papillae - bumps on their skin that can be raised or lowered to create different textures.

Stanford researchers are reporting a major advance: a flexible material that swells into new textures and colours within seconds, forming patterns with details even finer than the human hair. Dr. Doshi et al. came up with this material almost by accident. They were using an electron microscope to examine nanostructures that they had created on a polymer film. The used samples are usually discarded, but on this occasion, the researchers decided to reuse them. To their surprise, they found that the regions of the film that had been previously imaged with electrons were behaving differently and turned a different colour.

Good science requires excellent observation skills and openness to discovering new paths and ways, like Edward Jenner and his observations on cowpox in dairy workers to help develop the small pox vaccine, or Alexander Fleming observing that mold (accidentally planted) on a petri dish culture impeded bacteria growth when he was studying influenza, ultimately leading to the discovery of penicillin.

Back to the Stanford lab. The researchers were able to finely control the electron beams, the polymer, and the amount of water on the layers to create very fine images on the substrate. The colour and even texture of the substrate can be changed by controlling these factors. Read more from Stanford here .

Some fine tuning and we can have “skins” that will blend right in! This concept can also be of use in nanotechnology for changing the texture and the amount of friction in several fluid applications. One door leads to another, and so on…

Keep your eyes open, remember we all are scientists and need to pay attention, ask questions, and think.

The good doctor

The Year in Books

Tue, 06 Jan 2026 03:14:10 GMT

Blog vol 6.25. The Year in Books

Since 2022, I have put out a list of books, highlights of my reading year. Here are four of the best of 2025:

Blaise Pascal by Graham Tomlin.

A 2025 book which looks at Pascal’s life and thought thematically. Pascal lived in the mid 1600’s in France and was a brilliant mathematician, physicist, and philosopher. He grew up in Enlightenment France and deliberately chose the middle ground in ideology, between Descarte’s rational empiricism and Montaigne’s doubting scepticism, and in religion, steering clear of Roman Catholic dogma and the more extreme Jansenists of the time. He did science experiments, inventing the barometer (ever hear of kilopascals?). He also designed elaborate counting machines, public transit for Paris, and very advanced math formulas. His thoughts were posthumously collected and put in a book, Pensées, great food for thought. Fascinating individual.

Dune by George Herbert.

This summer I took on all 6 of Herbert’s 1960s Dune books as part of our reading club at home. What an excellent read. The second book felt like filler between the more epic 1st and 3rd, but filler, especially from Herbert is still very good. The books are based mostly on Paul Atreides, aka Muad’ Dib, his legacy and struggles with the Harkonnens and the Bene Gesserit “Witches”. The main setting is the desert planet Arrakis where giant worms are harvested for spice which seems to keep the Empire rolling. I really appreciate Herbert’s insights and his political wisdom as he weaves together the Dune tapestry. I was really surprised by how much of my other reading and stories have been informed by this world. A must read for anyone.

Silence by Shusaku Endo.

Like Herbert, this was written in the 1960’s. I would also call this a seminal work, opening the door into a lot of other worlds. The story is set in the late 1500s in the Shogunate era of Japan, when the Catholic faith and missionaries were banned from the islands. The story is in the form of a journal kept by a Portugese Jesuit missionary, Father Rodriguez, who is looking for Father Ferreira who it is feared, reached Japan but had since apostatized. The story is about Rodriguez’s struggles as a missionary, his hiding from the authorities, and his final capture by the officials. He too is faced with the ‘silence’ of God. Japanese culture is a ‘swamp’ where the Christian faith struggles to take root. Rodriguez also must decide whether to abandon his faith. What costs are tolerable? personal pain is one thing, pain for others? Heart rending, thought provoking.

The Martian by Andy Weir.

I am partial to science fiction, but I am even more partial to a great story. The Martian is a great story. Imagine that you are on a mission to Mars and you are left there by your crewmates due to some really bad circumstances. This is basically a story of survival, and Andy Weir knows his science, like organic chemistry and physics, and can create sustained tension over a long period. I have not seen the movie, not sure if I will. It does make me hopeful to read his 2021 offering , Project Hail Mary, even though the movie trailers appear a bit hokey with isolation, tension, sentient beings, and space travel. We will see.

Use your eyes responsibly, read a book. Here’s to a great year of reading in 2026! Happy New Year!

The good doctor

Now onto deep space

Thu, 18 Dec 2025 20:45:00 GMT

Blog vol 6.24. Now onto deep space

This blog deals with the eyes, eye health, light, and perception.

A new telescope. This is not your grandma’s telescope from RONCO, this is one the most sophisticated pieces of “optics” ever assembled. Back on December 25th, 2021, the James Webb Space Telescope was launched, and has since sent very deep space images with extra long wave infrared waves. A friend and fellow space enthusiast, Clint, died on that same day.

The journey started in 1998, when people like Clint, with their head (and hearts) in the stars, dreamed of a telescope that could record a lot of pictures of the night sky in detail over a long period of time. Twenty-seven years later and at a cost of $1.9 billion dollars (a bargain compared to Webb’s $10 billion), and with a tonne of ingenuity, hard work, collaboration and perseverance, we now have the Vera C. Rubin Observatory.

Vera C. Rubin (1928-2016) was a renowned astrophysicist who did groundbreaking work with dark matter. ”In a spiral galaxy, the ratio of dark-to-light matter is about a factor of ten;” she found the first direct evidence of dark matter. In her observations on galaxy rotation, she found that it defied Newton’s laws, radical thought. Who better to name a new telescope after?

Location : On the peak of Cerro Pachón, a 2682-metre-high mountain in Northern Chile

Clear skies, low humidity, seismic stability, low light pollution, yet still close enough to an urban centre for access.

Self-sustaining facility: The telescope is housed in a 2500 sq. m facility with dedicated rooms for cleaning the camera and for cleaning and recoating the mirrors when needed, all reducing unwanted down time.

Camera : The size of a SUV weighing 2800 kg, the largest camera ever built having a 3200-megapixel CCD array.

Fastest Slewing Large Telescope : It can move the 243-tonne mount in 5 seconds to the next position, and with minimal vibrations to keep the images constantly clear.

One image: The telescope boasts a wide field, 10 square degrees in size, and yet high resolution in the 330 to 1060 nanometre range, allowing for a wide variety of colours for analysis.

Two mirrors in one : The overall mirror of the telescope is 8.4 m in diameter, not unique, but by combining the primary mirror with the tertiary (the inner 5.0 m), it is easier to shift the whole unit. Like all reflecting telescopes, it can have three reflecting surfaces as this design has the best of both worlds, large and yet compact.

Broad access to data : Pictures are available through a web-based portal, eventually with world-wide access (in 2 years).

This telescope will run for 10 years using timelapse photography and it will produce 60 petabytes of raw image data over that time.

With this new telescope, we have huge astronomical data and universal access. Enjoy the show ( watch here ).

The good doctor

Eye health and the microbiome

Sat, 13 Dec 2025 00:27:27 GMT

Blog vol 6.23. Eye health and the microbiome

What is crazy is that eye tissue is fully exposed to the environment and is not overrun by bacterial colonies. There are protective surfaces, tears that repel and keep bacteria numbers down, as well as an ever-ready immune system. Some ophthalmologists call the eye “paucibacterial”, meaning it has few or little bacteria, only 6 bacteria per 100 eye cells, as compared to the human gut that hosts literally trillions of bacteria in total.

Microbiome – a community of microorganisms (such as bacteria, fungi, and viruses) that inhabit a particular environment and especially the collection of microorganisms living in or on the human body (Meriam-Webster)

We know that the eye has its own microbiome and thrives by balancing these organisms. For example, the latest research on the bacteria, Corynebacterium mastitidis, has shown that this organism helps to recruit white blood cells by encouraging interleukin 17 release from the eye, which causes the release of antimicrobial ’alarmin’ peptides into the tears, which helps put the immune system on alert. We need these helpful bacteria to prevent dysbiosis , the disruption of the eye’s microbiome.

Fungi can also cause dysbiosis. A serious condition like keratomycosis occurs when there is an overgrowth of fungi like Aspergillus or Candida. Too much fungi is obviously a problem, but a lack of fungal diversity on the surface of the eye is also a problem, a symptom of an underlying condition such as Sjögren’s disease.

Sjögren’s syndrome is an interesting condition. It is an autoimmune syndrome that works primarily on the secreting glands of the mouth and the eyes. As a result, people with Sjögren’s usually have extreme dry eye. The latest research from Baylor University, headed up by Dr. Laura Schefer et al., is finding a connection between the gut and Sjögren’s (access the research article here ). Her research with mice is suggesting that gut bacteria release molecular signals which cause the lymphocytes to become overactive, especially targeting the secreting cells of the mouth and eyes.

A connection to gut bacteria? The eyes? It is possible.

So what does this mean? Of course, more research. 1. Researchers are genetically modifying Corynebacterium mastitidis to produce its own interleukin (10) to alert the immune system for protection. 2. They need to find the offending gut bacteria to reduce lymphocyte damage in Sjögren’s. 3. Probiotics is another area of research with much potential. Butyrate (short chain fatty acid) has been shown to reduce eye dryness and a ‘friendly’ strain of Limosilactobacillus reuteri bacteria when ingested, helps to create intact corneal surfaces. Can the consumption of helpful probiotics boost eye health? Again, it is possible.

No doubt a start, it does give one “food for thought”, and for dry eyes.

The good doctor

The Annual Burlington Eyecare Christmas Celebration!

Fri, 05 Dec 2025 14:27:24 GMT

Blog vol 6.22. The Annual Burlington Eyecare Christmas Celebration!

A time to stop and reflect and appreciate. Last night, we had our annual staff Christmas Celebration. I can speak for all present, it was a great time. Yes, we had great food, yes, the wine list was unsurpassed (it is the Edgewater Manor after all) and yes, the company could not be better. Not that we were needing alcohol or food to have a great time. At Burlington Eyecare, everyday is a great time, we just moved the party over from Fairview to Fruitland Road, that’s all.

You realize how important people are, each individual, their personal contributions to our work. Taking care of each other, looking after every person who calls or texts or enters our doors, giving people personal attention and care, that is what it is all about. The beauty of it is that we all get it. No doubt there is room for improvement, and we all have lots of new stuff to learn and take on, but that is the interesting part.

We have been working with the University of Waterloo’s Optometry School since 2018, and the 4th year class for each year has been great, eager to learn, helpful with staff and patients, and very professional. I am hopeful when I consider the future of eyecare in this country. We were able to have our Waterloo intern with us last night; Cara has fit in like a nut in its shell, so to speak.

I am also reminded of the Skinner family, who had an optical store in Hamilton from 1949 to 2004, and with whom I had the pleasure to work with. Great people-persons, their business motto was “People and Products you can trust.“

Those six words say it all. We at Burlington Eyecare carry on that tradition as a culture that we live and breathe each day. That is why the people: patients, staff, suppliers, and ancillary staff, are key. The products that we dispense are one with that commitment.

What does this all look like? It means looking after each other through life’s many adventures; it means desiring the best for each other and for our patients. It means flourishing. That is why Burlington Eyecare also supports initiatives like the Amazon Hospital Boat, or donating to the Burlington Food Bank, or having the City of Burlington beautify the flower bed up front each year. All these daily things matter.

“Do little things with great love.” (St.Therèse of Lisieux)

I thank God for the people and patients that we share our lives with. A privilege.

Merry Christmas, from all of us at Burlington Eyecare, to all of you.

The good doctor

Implants for glaucoma treatment

Fri, 28 Nov 2025 01:36:26 GMT

Blog vol 6.20. Implants for glaucoma treatment.

The midterm results are in on a new implant device for lowering pressures in open angle glaucoma. SpyGlass Pharma has developed an intraocular lens (IOL) implant for cataract surgery that has embedded two drug eluting pads that slowly release an agent that will continuously lower eye pressures to treatable levels over a long period of time.

Elute – to remove (adsorbed materials) from an adsorbent by means of a solvent (Merriam- Webster)

Adsorption – the adhesion in an extremely thin layer of molecules (as of gases, solutes, or liquids) to the surfaces of solid bodies or liquids with which they are in contact (Merriam-Webster): adsorb, adsorbent.

These pads are placed in the eye with the new lens in routine cataract surgery. The pad releases just the right amount of drug to keep the eye pressures continuously at a manageable level. This method takes the drug directly to where it is needed and provides a continuous supply, allowing for more stability in eye pressure.

The difficulty in glaucoma treatment is keeping the eye pressures under control.

The pads are embedded with bimatoprost, a powerful prostaglandin that works on lowering pressures by increasing aqueous outflow. This agent is presently available in a topical eye drop that must enter the eye then get to the site of action, much less direct, much less reliable. The resulting reduction in pressures can be up to 35%. The intracameral (different method) implant, Durysta, has shown promise, lasting for a 6-8 months. This implant on an IOL (cataract surgery) can last up to three years, with a sustained 45% drop in eye pressure over the first 18 months with no adverse reactions (Read the SpyGlass Pharma report here ). More results to follow.

This is encouraging for glaucoma patients because of the long term, chronic nature of the disease. Drops for treatment often have preservatives which negatively affect the tear film and cause inflammation, especially over years of use. The beauty of an implant is that the drug gets directly to the site with less adverse results and no battling with corneal problems (red, sore eyes). Interestingly, three different drug concentrations for the implant had similar results for eye pressures. The implants worked most effectively with low to medium risk patients, providing little relief for late-stage glaucoma patients.

It is also encouraging because it represents a paradigm shift in glaucoma therapy. The patient will still need to be monitored for pressures and for nerve fibre loss, but the clinician can be assured that the patient is taking their medication. Studies show that patient’s consistent use of nightly drops for glaucoma, even with their use monitored, is only 69% of the time. With the implant, there is 100% compliance and a 45% drop in eye pressure. This improves the prognosis significantly.

Prognosis – the prospect of recovery as anticipated from the usual course of disease or peculiarities of the case (Merriam-Webster)

There is no recovery from glaucoma, but it can be controlled, damage prevented, most of the time. Too high eye pressure results in permanent vision loss. There is no pain involved, no warning signs. Again, the difficulty in glaucoma treatment is keeping the eye pressure under control. The continuous release of drug from an implant may provide just the stability in treatment needed.

Future questions: When depleted, can the pads be recharged? or can the eluting pads be improved to release the drug for an even longer period? This preliminary success should encourage other implantable drugs, much potential here.

Keeping abreast on the latest in eyes,

The good doctor

Long-term use of Hydroxychloroquine

Fri, 21 Nov 2025 03:13:02 GMT

Blog vol 6.19. Long-term use of Hydroxychloroquine.

Chloroquine, which was developed in the 1930s to replace quinine as the preventive of choice for malaria, is a great treatment for rheumatoid arthritis. My first introduction to the drug was in 1987, when I had to take it daily during an eye mission in Ecuador. I remember that it tasted terrible.

Chloroquine works against autoimmune diseases like rheumatoid arthritis and systemic lupus erythematosus by increasing the pH within intracellular vacuoles. This interferes with the “antigen (something the body needs to fight) processing” in macrophages and other antigen-presenting cells, since acidic cytoplasmic compartments are required for the body’s immune system to work properly.

The problem in autoimmune disease is that the body is attacking its own cells. This needs to be stopped or at least slowed down. Chloroquine slows the immune system from breaking down its own proteins primarily by decreasing the intracellular acidity and making the environment less conducive to the immune system working well (unfortunately there is no way to differentiate between the body’s own cells and actual threats like viruses, etc.). Most treatments of autoimmune diseases, like Rheumatoid arthritis (RA), work to shut down the immune system.

At Burlington Eyecare, we see patients that take hydroxychloroquine, which is a less toxic version of chloroquine, when under treatment for RA. Over the long haul, the drug can be toxic to the macula and neurons in the eye, causing thinning and atrophy of the ganglion cells and a condition called “bull’s eye maculopathy”. The toxicity can result in loss of acuity, colour vision defects, and central visual field loss; damage which is, unfortunately, irreversible.

The key is to monitor regularly, catch it early, and then jig around dosages and treatments to optimize comfort and minimize damage. This is for the rheumatologist to sort out; we see the patient annually for a complete eye exam. About 7.5% of chloroquine patients will have retinal damage: the longer the exposure, the greater incidence of retinopathy.

It was great to read the September issue of BMC Ophthalmology ( read here ). Early detection is critical. However, macular appearance is hard to detect. Identifying central visual field loss is important, but it shows up later than retinal thinning. The studies in this article were done with optical coherence tomography (OCT) and the researchers found that the ganglion cell complex (GCC), which is quite thick and multilayered at the macula, starts thinning and is affected first in toxicity.

We have been doing OCT’s on all our patients for years and can catch abnormalities very early on. The protocol for detecting toxicity in the eye has been acuities, macular biomicroscopy, and central field testing. Baseline OCT’s should now be at the top of this list.

It is great to have the tools to detect damage and other problems early. The OCT allows us to look at the actual tissues at the back of the eye, which is a really wonderful thing.

‘til next week,

The good doctor

A World Day for Keratoconus

Fri, 14 Nov 2025 04:33:10 GMT

Blog vol 6.18. A World Day for Keratoconus

Monday of this week, in case you missed it, was World Keratoconus Day. Keratoconus, or KC for short, is an eye condition that results from having a very thin cornea. The inner pressure of the eye causes the cornea, in the front of the eye, to bulge forward and change the shape from a dome to a cone.

The condition is progressive, and if left untreated, can result ultimately in loss of the eye, pretty serious. When I first started in optometry, we fit hard contact lenses to help correct major refractive changes in KC patients. Meanwhile the condition could progress, and if the patient developed KC in their teens, they had a whole lifetime to deal with it. If things got real bad, we would have the patient go for a corneal transplant, a very drastic procedure.

In the late 1970’s, two ophthalmologists, Drs. Fleming and Reynolds, came up with the idea of using a corneal implant to change the cornea’s curvature and correct refraction in normal healthy eyes. In 1999, these intrastromal corneal ring segments (INTACS) were approved for correcting mild myopia.

As always, the earth and world did not stand still, and we started using lasers to reshape the corneal stroma. Today this procedure, called LASIK, is the procedure of choice for most myopia corrections. The INTACS procedure, though a viable option, is more invasive than LASIK, so not desirable for a healthy eye, however, it is very helpful in the treatment of keratoconus. Dr. Joseph Colin used two segments of PMMA (a hard contact lens material) for the ring implant and was able to help low to moderate risk KC patients who could not tolerate contact lens correction. INTACS provided a correction to the refraction and allowed everyday function for the patient.

The world did not stand still again, and now there is a procedure called corneal cross-linking, where the eye is saturated with riboflavin and bombarded with ultraviolet light creating “300 year old” corneas and strengthening the collagen bonds, thus slowing down and even halting the progress of KC. Awesome, all we have to do is catch the KC before it progresses and harden the cornea so it doesn’t change. So we now put all children on a corneal mapping device that screens for KC and we are right as rain.

In a perfect world, yes, but… there are a lot of people who were not diagnosed early and KC has done permanent damage. Even if you strengthen the cornea with cross-linking, it doesn’t fix the shape of the cornea and there will still be residual refractive changes. The treatment of choice for refractive problems in KC patients, INTACS, has been improved and is now called Corneal Allogenic Intrastromal Ring Segment, CAIRS for short. Instead of a PMMA ring implant, a donor corneal stroma is used which is more compliant with the host, and allows for a wider pool of candidates to receive the segment. It is also more customizable during the procedure with improved outcomes. The end result is less glare sensitivity, discomfort and scarring, and a better refractive result than INTACS. The procedure is safe to use on KC patients who have received cross-linking and can also help other corneal conditions like Pellucid’s Marginal Degeneration and is safe for high risk KC patients. (Read more here CAIRS Gaining Momentum - Issuu ). CAIRS is about 10 years old and here to stay.

Did you know that lime green or chartreuse ribbons are worn to increase KC awareness?

‘til next week (year),

The good doctor

Not a Dry Eye in the House

Thu, 06 Nov 2025 19:22:52 GMT

Blog vol 6.17. Not a Dry Eye in the House

Last Saturday night, a very sad event happened in our house and all over Canada. We had been following the 2025 version of the Blue Jays to Game 7 of the World Series.

Usually, I do not get too involved in sports or sporting events, usually a casual observer. This edition of the Jays, however, had me hooked. Here was a baseball team that played together, a cohesive unit that seemed to truly enjoy the game, and they had a shot at the Championship, a good shot.

Getting all sentimental, the team reminded me of the days as a kid growing up in Northern Ontario and how we used to show up at the outdoor rink and play hockey all day long with our buddies. My kids do that now, taking their skates and gear over to Jim’s pond in the depths of winter and staying there all afternoon.

Ken Dryden in his book, The Game, states, “Nothing is as good as it used to be and it never was. The ‘golden age of sports,’ the golden age of anything, is the age of everyone’s childhood.”

Over the years, I have become jaded somewhat by professional sport, especially baseball. With players’ strikes, the demise of my beloved Montreal Expos, and the escalation of salaries, the swing and miss of 100 mph fastballs, and the overemphasis on the longball, I have had little room for that version of baseball. By contrast, the Jays were making contact, staying away from the strikeout, moving runners, playing incredible defense and playing together, nice to see.

This is where the wet eyes come in. Our eyes produce tears, in the form of water or aqueous as well as lipids and mucous. The lacrimal glands worked overtime in their production of watery tears when Captain Kirk shattered his bat as it made contact with a Yamamoto fastball and served up to Mookie Betts a game and World Series ending double play. Very sad.

My family and I and many friends went on this incredible ride together and would like to thank the Jays for a wonderful year. Hopefully, this brand of baseball can reverse a lot of the recent trends in the sport. Some teams, like the Dodgers, who have spent a boatload to buy pitchers, or who have spent so much on players that they have the luxury of resting players during a long season and yet remain competitive enough to reach the post season, and who use teams like the Pirates as farm teams to stock their cupboards.

Okay, the Blue Jays spent money, but they had a number of homegrown players and even perennial minor leaguers who rode the team bus for years and finally got a chance to play in the big leagues.

The sadness comes from seeing a team that reminds you of why you love the game, who should have won, lose in extra innings in game 7. And as we say every spring, this is our year and in the spring of 2026, it is my hope that the Jays stay the course and play their game and next fall, there will be tears again, but this time tears of celebration.

Go Jays! ‘til next week (year),

The good doctor

A low vision prosthetic that actually works

Thu, 30 Oct 2025 20:43:21 GMT

Blog vol 6.16. A low vision prosthetic that actually works.

A topic that is very close to my heart and one of my biggest interests: low vision.

Over the past 35 years I have worked with many visually impaired patients. The number one condition that causes vision loss in North America is macular degeneration. Over the years we have done much to prevent and reduce the effects of the disease: reduced incidence of smoking, more balanced diets, as well as improved treatments and diagnostic tools.

There remains a group of patients that have a form of “dry” macular degeneration, called geographic atrophy, that still suffer serious vision loss. An ophthalmologist from Stanford, Dr. Daniel Palanker, wanted to change that. It was back in 2005, when working with ophthalmic lasers, that he began to dream of using light to treat visual impairment.

For some time, ophthalmologists have been experimenting with implant microchips in the back of the eye. The old implants were electrically wired to the visual system from the macula — hard to install, cumbersome, and the resulting vision not great.

Dr. Palanker’s working hypothesis was that macular degeneration did not damage the inner retinal neurons; some diseases (like glaucoma) can destroy all layers of neurons. Consequently, he designed a retinal prosthesis that replaces the damaged outer segment’s photoreceptors. The prosthesis includes a microchip which is implanted in the back of the eye and a pair of glasses that communicates with it.

A microchip was developed that receives photons of light and converts them into electrical signals that are in turn transmitted through the retinal and visual pathways to the visual cortex. Then he developed special glasses that have a built-in camera and a near infrared transmitter that stimulates the embedded microchip at the retina (the back of the eye). The infrared does not stimulate the “healthy” peripheral retina thus reducing confusion when perceiving light.

Installing the microchip involves detaching the inner retina from the damaged outer, sliding the chip in place, then reattaching the inner retina over it. The sensor is photovoltaic, receiving its energy from the incoming infrared, so no wires. There is a considerable learning curve when adapting to the device and the camera on the glasses comes with controls for brightness, contrast, and magnification.

The current prototype uses a black-and-white image, but there are already improvements being made. Software is being developed to create gray-scaled images which help with things like facial recognition. The present microchip has pixels that are 100 microns wide, with 378 pixels per chip. The next generation chip will have pixels that are 20 microns wide, with 10,000 pixels per chip. This new chip will have the potential to get to 20/80 vision and even down to 20/20 with “electronic zoom”. Read some of the latest research at Stanford here .

What a great idea! The years of refining and improving retinal prosthetics is paying off. Time to line up some of my patients that could really benefit from this new technology.

‘til next week,

The good doctor

The Fall Classic, again

Fri, 24 Oct 2025 03:57:00 GMT

Blog vol 6.15. The Fall Classic, again.

This blog is about eyes and light. How does baseball fit? Or am I, in my excitement, stretching it? You can decide.

As Foghorn Leghorn (Looney Tunes) so aptly put it, “You got to keep your eye on the ball. Eye, ball. “ And another renowned Foghorn quip, “I keep pitching them and he keeps missing them!".

The co-ordination of eyes, hands, and body in the motion of hitting a 95 mph heater off of a bat and sending it into the left field bleachers is off the charts.

The eyes. Last year I commented on the Yankees and the Dodgers in the World Series. I looked at velocity and reaction times and the need for excellent vision when playing baseball, especially in the act of hitting a home run.

In 1998, Mark McGwire, a player for St. Louis, hit 70 home runs in one season, smashing the old record of 61 held by Roger Maris of the New York Yankees in the 1961 season. McGwire was so prolific, he had the best ratio of homeruns to at bats in all of baseball history — 1:10.61.

McGuire was a long-time contact lens wearer that suffered from myopia and astigmatism. His optometrist, Dr. Stephen Johnson from San Ramon, California, fit him with contrast-increasing, yellow-tinted contact lenses. These tinted lenses allowed him to see the ball better and that is when his career took off with the Oakland A’s. Coincidence?

Closer to home, the Blue Jays had an excellent catcher, Danny Jansen, who changed his career trajectory in 2016 when he began wearing spectacles to correct astigmatism. The next season his hitting improved so much that he went from playing Single A to playing Triple A. The following year he cracked the Blue Jays line up and is now playing for Milwaukee. He went from Hog Flats to Toronto when a doctor put a pair of spectacles on him and so a hard-luck kid made good when he could finally see straight.

This season’s Blue Jays have Davis Schneider, who wears his glasses because he doesn’t want to touch his eyes with contact lenses and he likes the extra protection they give him. Then there is Vladdy, the star of our American League Champs, who definitely wears contacts and removed them real quick from his eyes just after winning the ALCS against Seattle. You can see him pulling them off as the camera was taking a close-up, hard to miss (at least as an optometrist). Watch the clip here.

We always stress hygiene and good habits for contact lens use, but I guess we’ll let Vladdy go this once considering the rather exceptional circumstances — just don’t do this at home.

Finally, Jansen puts it best when he states, “I mean, being able to see clearly is kind of huge.”

No Kidding! Bold prediction (last year got the Dodgers right) but this year Jays at home in 6. Go Jays!

the good doctor

The Wonders of Gene Therapy

Thu, 16 Oct 2025 22:50:10 GMT

Blog vol 6.14. The Wonders of Gene Therapy.

Back in 2021, we looked at ground-breaking treatments for a very debilitating eye disease, Leber's congenital amaurosis (LCA), a group of inherited disorders in which the retina degenerates and causes severe vision loss in early infancy. The researchers from Pennsylvania used a harmless adeno-associated virus (read cold virus) and programmed it to find retinal cells and insert a healthy version of the involved gene. The virus was then injected into a patient’s eye directly under the retina with good results.

Research leads to more research. The same technique is now being used on another gene, ABCA4, the site where a mutation causes Stargardt’s disease. The body uses vitamin A to make cells in the retina (the light-sensitive layer of tissue at the back of the eye). Then the ABCA4 gene makes a protein to clean up the fatty material that’s left over. In Stargardt’s disease, this gene doesn’t work — so the fatty material builds up in yellowish clumps on the macula. Over time, this fatty material kills the light-sensitive cells and destroys central vision.

Enter gene therapy. The method is quite complex, involving the use of split inteins. These genetic elements work to fuse two separate peptides to finally produce (which is very difficult due to ABCA4’s prohibitive size) large full length proteins. And just as with LCA, the researchers, Tornabene et al. used a carrier, in this case a modified adenovirus, to deliver the correct genetic instructions into the patient's retinal cells, allowing them to produce this necessary protein and restore normal vision function (Read more here ). The process is likened to giving the eye cells a new instruction manual to perform its job correctly.

The beauty of the modified adenovirus is that the recipient’s immune system has minimal response. The procedure has few negative side effects overall, and most exciting, one dose results in long term change of the gene.

It is no wonder that the FDA in the USA is now fast tracking this therapy.

More to come,

The good doctor

The Sun’s UV, a Good Thing?

Thu, 09 Oct 2025 22:46:15 GMT

Blog vol 6.14. The Sun’s UV, a Good Thing?

On many occasions, I have written on protecting your eyes from ultraviolet light. I call it wearing sunblock for the eyes. Still true and very necessary, UV filters in your glasses protect the front and back of the eye and also the lids and adjoining tissues.

However, in the latest issue of The Economist, in the Science & Technology section (which I turn to first when I take it on), they had an article on the benefits of UV light ( Read here ). It does make one ponder. I have been going around the sun long enough to know that ideas and policies swing like a pendulum. In teaching reading, we first had phonetics, then it was whole language, and then back to phonetics… The most sensible approach would be to balance the two. Balance, an interesting concept.

We have been told for a long time that UV is bad, to be avoided at all costs (well almost). We know that it causes skin cancers and ages the skin prematurely.

We also know that we need UV for our bodies to make vitamin D, which helps with bone formation and helps prevent osteoporosis. Vitamin D improves heart health and also reduces the risk of MS and cancer. So, stay away from nasty UV and load up on Vitamin D supplements. The problem is that these supplements don’t entirely do what the sun’s UV does.

UV is beneficial to the body. As early as 2009, German researchers were showing that UV converts chemicals in the skin into nitrous oxide. This substance, known as laughing gas, is used as an anesthetic, an oxidizing agent, or as a fuel additive in high performance vehicles. This UV-produced nitrous oxide in the skin acts as a signalling molecule that helps to relax blood vessels and lower blood pressure. Whole skin exposure to UV causes a substantial drop in blood pressure. Further research has found that the further from the equator, the higher the blood pressure; seasonal changes which vary UV exposure also create the same pattern. Winter has higher blood pressure and summer has lower blood pressure. Does UV play a physical role in seasonal affective disorder? Probably.

Outdoor light slows myopia development in children, too. Is this because of being outdoors? The physical exertion? The use of distance vision? Or is it the UV? A combination of the above? Interesting.

One further advantage from UV exposure is the benefit to the immune system. Current research is showing that even when you take into account the significant increase in skin cancers from UV, the immune system (which in this case is unrelated to Vitamin D) is boosted by UV and enables the body to fight other cancers, to the point that UV exposure reduces your overall cancer risk considerably.

Is the pendulum swinging back to the benefits of UV? Definitely, a time for a rethink. As with the reading wars, we need to be balanced. Please still use UV blockers in your eyewear to protect very sensitive eye tissues. Do not throw out your SPF creams, but use them judiciously. We need to be reminded that the sun is our friend and that there is nothing wrong in getting some R &R at the beach or on the ski slope.

Getting outside for a walk every day is a great place to start.

‘til next week,

The good doctor

Myopia Management Options for Kids

Thu, 02 Oct 2025 20:14:06 GMT

Blog vol 6.13. Myopia Management Options for Kids

As early as 2016, papers were being published about the efficacy of using low dose atropine drops for slowing myopia in children. It revolutionized the field. Prior to this, orthokeratology (overnight hard contact lenses) was the available therapy for the limited few who could work with and tolerate it. Another option, defocus was also known to slow myopia down, and after a two year trial in 2019, it was found that a new spectacle lens, the Defocus Incorporated Multiple Segments (DIMS), was an effective non-invasive therapy. More studies, more availability to a younger and wider group of kids.

We track children with our biometer (a machine that measures the length of the eye) and regular eye exams. Myopia management is part of everyday care.

Combinations of treatments can be helpful for children with more aggressive forms of myopia. For example, DIMS lenses with 0.025% atropine daily, together work better than each separately and because we are regularly tracking axial lengths (length of the eye), we can fine tune treatments.

We have been using 0.05 % atropine drops, taken once nightly, as a monotherapy for the past few years. It is more effective that the initial 0.01% used in the 2016 trials, but unfortunately has more side effects. A recent paper by Shensong Xu et al., ( read here ) shows the efficacy of using 0.01 % twice a day. In their findings, the twice daily dosing was a lot more effective than the once a day. I know you are thinking, but of course, twice as much should work better, however, that is not necessarily how pharmaceuticals and the body work. The trial guessed the double, lower-dose drop would be more effective than the single dose. This was confirmed, though whether it is more effective than a single, higher-dose drop is unclear. The optimal balance of benefit with minimal side effect is yet to be found.

The problem with the low-dose atropine is the difficulty of getting it. As I have stated on many occasions, one trial leads to another; one new technology leads to more trials, and eventually you have some bonafide treatments. A company from San Diego, Sydnexis, has been working on producing low dosage atropine for the market that does not have to be compounded. The only way to get the lower doses is to have the drops made by sterile compounding. This is expensive, the product can degrade over time, and the pH and potency can vary, all bothersome. At the end of October, we should have atropine in a 0.03 % dose and I foresee dosing that twice a day to get maximum benefit.

Interesting developments, as always, we will keep you posted.

‘til next week,

The good doctor

Dry-eye: The latest update

Wed, 24 Sep 2025 17:15:36 GMT

Blog vol 6.12. The report: DEWS III, finally here!

In 2017, the Dry Eye Workshop (DEWS) II Report was published by the Tear Film and Ocular Surface Society (TFOS)(there is a “society” for everything:). This report was a great summary of dry eye disease, embracing the varied nature of the disease and the need for a more nuanced approach, as well as providing helpful algorithms for patient care.

We devoured that report and have based our standard of practice on its findings. Then 2020 hits and a “tiny” inconspicuous virus, COVID 19, flips our world upside down. The COVID epidemic was not pleasant, mostly from a human, social interaction perspective. We had more people on screens than ever before, and a lot of them young (either for Zoom, Facetime, or Hollow Knight), with the end result of a lot of staring at an LED light source with very little blinking. DED, formerly a problem of the elderly and health-compromised, had become ubiquitous.

We have been actively treating Dry Eye Disease (DED) ever since. The DEWS II report recommended using a dry eye questionnaire when patients enter your practice. We found that this was not necessary as many patients were walking in with some degree of Dry Eye Disease and we did our exams with that in mind.

The DEWS II report confirmed that there are essentially two causes of Dry Eye Disease: tear insufficiency and/or poor tear quality. So we have been measuring lacrimal gland production, tear osmolarity (the amount of dissolved solute in your tears), tear break up time, tear volume, as well as analyzing the Meibomian glands in every possible way and manner.

Treatments will vary depending on the cause and severity of the disease, from something as simple as non-preserved eye lubricants and improved daily lid hygiene, to more involved lid treatments like Zest and Ilux, and when necessary, a referral for autologous serum drops with your own growth factors included.

The DEWS III report was released in June, 2025 and is a literature review of over a 1,000 research papers related to Dry Eye Disease. They drew up three algorithms: on tear film deficiency, eyelid anomalies, and ocular surface abnormalities. This breakdown helps the care provider to provide treatment specific to the patient’s case. The report incorporated the findings of the TFOS Lifestyle Report of 2023, reminding us all that what you do with your day, the environment you work in, your daily habits are all critical when it comes to dry eye. Read here .

A great review and reminder to keep at it. As with all chronic conditions, it is mostly a matter of diligence.

Severe dry eye is not pleasant. With the prevalence of the problem and the work being done, relief may be on the way. In the meantime, consider your day, are you helping your eyes?

‘til next week,

The good doctor

The Worst Sport for Eye Injury

Thu, 18 Sep 2025 18:40:11 GMT

Blog vol 6.11. The Worst Sport for Eye Injury.

What is the number one sport for receiving eye injuries?

I was surprised. It was not what I would have thought and I’m a sports fan.

I thought probably a sport where the ball travels super-fast, like squash or baseball, or a sport that is fast and uses sticks, like hockey. Wrong.

By far the highest incidence of eye injuries is in… basketball.

The number one eye injury in basketball is a corneal abrasion from being poked in the eye with a finger. Also common are orbital bone fractures, retinal detachments, or hyphemas (blood in the front of the eye), depending on the type of trauma.

This is where I date myself, but the number one player in the NBA in my time was not Lebron James or Michael Jordan, but it was Kareem Abdul-Jabbar, a very tall center (7 foot 2 inches), who starred with the Los Angeles Lakers for most of his career. While in college in 1968, he received his first major eye injury and then six years later, after another major injury, he donned his trademark goggles. Wearing googles did not stop him from being the all-time point getter in the NBA (King Lebron just surpassed him) and from winning 6 NBA titles. I would even argue that the goggles helped him.

You get afraid of contact, and by the way, basketball is definitely a contact sport. My Dad, who played hockey and signed with the Blackhawks in 1952, always said that basketball was a “sissy” sport, not like hockey. Well, with all due respect, he didn’t play basketball, and he didn’t play under the boards in the NBA. I personally played the four and five position in high school, and I can tell you, even at that level of play, it gets rough under them boards. That is what happened to Kareem; he was one eye injury away from early retirement, so it was affecting his game, increasing his fear of contact, hence the goggles.

Other high profile players in the NBA who donned goggles for the same reason were other LA Lakers, James Worthy and more recently, Anthony Davis. All of them had serious eye injuries and opted for the extra protection. The point is that eye injuries are more common than you would think in basketball.

Wearing safety goggles would be a good start. A player like Horace Grant, former Chicago Bull and LA Laker, who won 4 NBA titles, had Lasik to correct his myopia but still wore goggles after his procedure though he no longer needed them for his vision. After Lasik, your eye is a bit more vulnerable to corneal injuries. Mr. Grant also wanted to give a boost to kids who had to wear glasses to play sports, more or less telling them, “It’s cool to wear goggles”. The biggest deterrent to more ubiquitous eye protection is the uncool factor. Even professionals need to be scared into goggles.

Most sports are risky to the eye: any racquet sports, soccer, hockey, field hockey, football, baseball, and lacrosse. Your full contact sports like boxing or mixed martial arts can cause devastating eye injuries, just because of the heavy contact. Remember, as you raise your compete level, the speed of your game increases, and so do your eye risks. (For more tips and information on sports eye protection click here ).

Come into our office and talk with our optometrists and opticians about the best eye protection options for your sport.

‘til next week,

The good doctor

I have heard of genetics, but what is epigenetics?

Thu, 11 Sep 2025 22:04:41 GMT

Blog vol 6.10. I have heard of genetics, but what is epigenetics?

Epigenetics plays a big role in the aging of the eye.

Genetics is the study of genes and of their component parts particularly deoxyribonucleic acid, DNA. Epigenetics studies changes to DNA through environmental stress, chemical changes from diet, or aging. These changes are usually reversible. Using the analogy of a computer, the DNA is like the fixed hardware, and the changes to the DNA (epigenetics) are like software which is continually “updating”.

A recent paper in Nature (read here ) uses a meta-analysis of 17 different tissues in humans over a lifetime and comes up with some interesting findings. We are focussing on the eyes.

It has been known for some time that surface changes to our DNA affect the retina in aging. Macular degeneration, which is the number one cause of vision loss in North America, is a prime example.

As we age, the DNA in our genes gets methylated: a small chemical tag, most likely a cytosine base, changes the structure of the DNA and alters its expression. At the most extreme, the tag can actually turn off the gene so that it does not get expressed in the tissue. In the “atlas” of epigenetics, retinal tissue is the most likely to be affected as we age. The theory is that the eyes’ high oxidative demands make it more susceptible to this tagging.

That is the hard reality. From changing light photons into neural impulses then into visual images in the cortex, the metabolic requirements of the visual system are staggering. The photoreceptors are constantly being absorbed and replaced as they are used in this all-consuming process. It should not surprise us that all this activity can make the retina very vulnerable to any tweaks in the DNA. Of course, there are the regular genetics of macular degeneration, the ones you inherit, where there are a number of alleles that are directly linked to the disease, like ARMS2 and HTRA1, on chromosome 10. Add the methylation of DNA to pre-existing genetics and the odds are not in your favour.

What to do about methylation? Prevention is key. Our modifiables are cardiovascular fitness, diet, possible therapeutic helps like statins, eliminating smoking, and blocking ultraviolet, along with limiting blue light exposure (jury still out on this, but would not be surprised). On the positive side, use longer wavelengths like red light to boost mitochondria (think oxidation cellular powerhouses), include in your diet leafy greens, blueberries, anything rich in antioxidants, and get some omega 3 fatty acid (fish oils).

Do note that we can do everything right and still end up with macular degeneration. Aging is not preventable or reversible. All we can do is work to minimize our risk factors.

Please have regular eye visits, check-ups with your family doctor, get out for a walk and enjoy the beautiful fall weather, and be deliberate about what you eat.

‘til next week,

The good doctor

BRIGHT RUN 2025: Supporting Hamilton Breast Cancer Research

Thu, 04 Sep 2025 13:18:10 GMT

Blog vol 6.8. BRIGHT RUN 2025: Supporting Hamilton Breast Cancer Research

It is hard to believe that it has been 3 and ½ years since Burlington Eyecare associate, Dr. Jerilee Nyman, died of breast cancer. She was a big supporter of the Bright Run.

Held every year since 2008, every dollar from this event goes to support breast cancer research in Hamilton. All labour is volunteer and all costs are sponsored, ALL the money is used for research.

“Bright Run is a non-competitive, family friendly 1 km/5km walk or run which is held annually on the first Saturday after labour day.”

WHEN: Saturday, September 6, 2025, 9:00-12:00 am (opening ceremonies at 10:00 am)

WHERE: Christie Lake Conservation Area, 1000 Highway 5 West, Dundas

WEATHER: Rain or shine

In 2024, $592,000 was raised for breast cancer research; in total more than $6 million since 2008. More than 1700 people participated in last year`s event! Jerilee’s family, especially her husband and two daughters along with her mother-in-law, Gerri Nyman, a breast cancer survivor herself, continue to be big supporters of the Bright Run. Go to the website and support this good work (link here ).

We all know people affected by cancer of one type or another. Let`s encourage some people who are struggling and at the same time help fund the effort to cure and prevent breast cancer.

So operation ``BRIGHT, PINK FUN``: music, food, games, a walk in the park, encouragement for all.

‘til next week,

The good doctor

One last look at Perception (for now;)

Fri, 29 Aug 2025 02:12:25 GMT

Blog vol 6.8. One last look at Perception (for now;)

I have really enjoyed the book, An Immense World, so one more blog.

I wrote about the chapters on light and colour. This time I am doing a flyover, a look at the forest so to speak. The author, Dr. Yong, points out that all the Umwelts (sensory bubbles) do not work separately but in concert. To write a book with chapters, and to categorize so we understand, we separate things that actually work together and can only work together.

For example, a dog has really good night vision (and some blue/yellow colour vision) and at the same time has a very sensitive sense of smell; or an elephant can trumpet in the infrasound range and communicate over long distances, has an excellent sense of smell and a separate vomero-nasal organ for pheromones, AND has a very sensitive, tactile trunk, AND has an incredible memory to bring all this information together, whew!

One area we haven’t touched on is the sense of echolocation. Bats are the obvious example of this. There is so much that has to happen for a bat to execute the capture of a moth, for instance; it blows my mind. Figuring out background, location, movement, filtering other echoes, dealing with the Doppler effect, and doing this all at high speed is mindboggling. (Varying echo frequency at different times, having directionally sensitive receptors, approaching a target at the right angle, using very short echoes, then having a sensitive nervous system that can speedily process all this).

When it comes to superheroes, I have always been a DC guy, with Superman and Flash at the top. That said, I find Batman lame and now I know why. The coolest thing about a bat is this skill of echolocation. Batman should be able to echolocate, and this is where I say Marvel has an upper hand. Give me a superhero like Daredevil who can echolocate, cool ability. The DC writers are going to have to put that skill in for their next origin story.

Did you know that human beings can actually echolocate? It is rare, but there have been people who are totally blind, especially from a young age, who have learned this skill. One such person, Daniel Kish, has learned to produce clicks with his mouth that are sharper, crisper, and much louder than what you and I can produce. Born with eye cancer which spread to both eyes, he learnt to click early on. Of course he does not just use clicks to get around, he has a mobility cane that he uses to receive tactile information along the ground. The echo he receives back will tell him about soft or hard surfaces, not as much about borders but more about densities and textures. Unlike Daredevil who sees white concentric lines on a black background to delineate objects, Kish sees more variations in the “colour” of echoes. Really interesting.

Research has been done on people like Kish using brain scanners, which show that areas of the “visual” cortex are highly active when hearing echoes. His brain has learnt to organize the information from the echoes to help build a spatial map of his surroundings. Fascinating. Now, do not throw away your cane and just take up echoing. It is an adjunct process, which complements the tactile information of a cane, and not everyone can do it. Just like Dr. Yong is pointing out, we have many sensory bubbles that work together, with the visual bubble still being first in our world.

This is all wonderful food for thought, hopefully helping us to see how important our own sense of vision is, and helping us to see the very different worlds of creatures (and other people, too).

‘til next week,

The good doctor

Colours of a different sort

Thu, 21 Aug 2025 18:55:44 GMT

Blog vol 6.6. Colours of a different sort.

On most business days, I drive past this median as I take a left turn towards Burlington Eyecare. The middle of the median is a garden planted with an assortment of annual flowers — petunias, marigolds, salvia, and coleus. This bed is part of the Adopt-a-Flowerbed program run by the City of Burlington (find out more here ).

It is part of our mandate at Burlington Eyecare to take care of people’s eyes and their eye health and this flowerbed is a small, but important part, of that task. The flowerbed we sponsor sits just south of our office on Fairview, between us and Farm Boy. We requested that the bed “pop” this year in celebration of Burlington Eyecare’s 60th anniversary. Do notice the flowers before fall arrives; they are lovely.

The Adopt-a-Flowerbed program is citywide. There are other sponsors, like Billings Court Manor: Long Term Care, who support a bed further down Fairview, or the Drury Lane Theatre community and many friends who sponsored a smaller bed on Walker’s Line to remember a beloved citizen, Jeanne Montague, who was wardrobe mistress for Drury Lane for years (Read more about Ms. Montague here ).

It is a great idea, a win-win for all involved. We all get a beautiful city to enjoy. The workers do a great job maintaining the beds; they always look good. And, businesses can promote themselves while beautifying the community. Genius.

It really takes a village to raise a child, and it takes a village to encourage each other. Burlington continues to grow, a fact bemoaned by many of my patients, but that does not mean that we do not take care of our little corner of the world.

Enjoy the flowers, walk in the parks and on the trails. Burlington rests on the shore of Lake Ontario, a wonderful location. Then there is Mount Nemo conservation area, so many truly spectacular things to enjoy. And, we have the opportunity to join in making Burlington even more beautiful for each other.

‘til next week,

The good doctor

More colours than you can even imagine

Sun, 17 Aug 2025 13:38:47 GMT

Blog vol 6.5. More colours than you can even imagine.

Louis Armstrong’s song, What A Wonderful World, comes to mind when I think of colour. Two weeks ago I rhapsodized about light and its perception by different animals based on a chapter in Ed Yong’s An Immense World. His chapter on colour is equally fascinating.

We tend to think of colour like the cathode ray tubes we had with the first colour T.V.’s.: red, blue, and green and all their combinations. There is good reason for this. Most humans have three colour receptors (opsins) in their retinas. As Dr. Yong points out, colour is not just about receptors, there is a whole lot more involved. For humans, the real colours come in after the receptors, in the “processing”.

Another cool aspect of colour vision where the power of “processing” becomes clear is constancy, where irrespective of whether the incoming light is bright or dim, the colour will still appear that colour — a red rose is still seen as red whether in twilight or the noonday sun. This we have all experienced, but should this be the case? If we relied solely on receptors, is this what we would see?

The first thing the author states is that colour perception is highly subjective in the eyes, but really in the brain, of the beholder. There was once an artist who suffered a brain injury, with eyes and opsins all intact, yet could only see in blacks and whites. There is more going on here than just receptors.

Receptors do matter, however. There are people, monochromats, that have only one type of receptor and only see in shades of gray. A condition called achromatopsia, where the person only has rod receptors, makes it debilitating to be in bright sunlight. Other people, dichromats, have two types of cones, missing one, and still see colours albeit in a narrower range. Actually, dogs and horses are deuteranopes (lacking medium green cones) but still can see in blacks, whites, blues, and yellows.

Most people are trichromats, with red, green and blue cones which help us to see all the colours in a colour triangle, a thousand times more variations than a dichromat. Now here comes the mind blowing stuff, there are tetrachromats, with four opsins, especially in the animal world, like birds and bees who have an extra UV receptor, such as a Daphnia water flea. This opens another whole world to them, like markings on butterflies or male and female birds or seeing the centres of flowers enhanced. It also allows reflexive responses with little interpretation of data. Just to make things more exciting, the larval zebrafish has variations in the number of opsins in one single eye! The lower retina is black and white, the middle zone is UV sensitive, and the upper region actually has four receptor types.

A very few people, all of them women, also have a fourth opsin between the red and green receptors. The gene is carried on the X chromosome and requires two “fourth opsin gene X chromosomes” for the extra opsin to be present, very rare. This extra opsin increases colour variations by another factor of a thousand, going from a colour triangle, trichromats, to a solid colour prism in tetrachromats.

Now, to appreciate the worlds that these tetrachromats see is very difficult for humans. You cannot just apply a filter to match what they are seeing; it’s just not happening. The world, however, is set up to be appreciated by trichromats. Those extra mutant powers of vision are not going to get you into Xaviers’ special school for X Men/Women, nor are they going to enhance your experience of the beauty of the world. Interestingly, some butterflies, like the Common Bluebottle, have up to 15 different opsins in their eyes (!!), but really only function in the 3-4 colours of most living creatures, humans included.

Colour perception, is in the eye (receptors, we are limited by them), and the brain (processing or not), of the beholder. Enjoy the colours in your life!

‘til next week,

The good doctor

A pitcher with heterochromia iridum!

Thu, 07 Aug 2025 22:35:27 GMT

Blog vol 6.5. A pitcher with heterochromia iridum!

Last weekend my sons and I made the trip down to the Rogers Centre and took in a ball game. The Toronto Blue Jays have been on a tear in the past month and now sit atop the American League East standings, yeah! We got our tickets in way back in May (now a hot item! the place was sold out), seats about 3 rows up on the 3 ^rd base side in the 200’s with a great view of the game. The great view was improved by the recent renovations to Rogers Centre which changed the seating creating more room and better sight lines. We got to see Mad Max pitch, which was awesome! He did not disappoint.

Max Scherzer (Mad Max) is a wily veteran — winner of 3 Cy Young awards, one in at least each league, he has pitched two no-hitters and won two world series. The Blue Jays picked him up in free agency in the winter of 2025 and he did not start until late spring due to injury. On Saturday we saw him win his second win of the season, pitching 6 innings of 5 hit ball, giving up one earned run and striking out 5. He was the star of the game which finished: Jays 4, Royals 2.

What is so special about Max Scherzer, besides his pitching prowess is his eyes. He has a right eye that is blue and a left eye that is brown, a condition called heterochromia iridum. In Max’s case he is completely heterochromic. You can also have partial, sectoral, or circular versions, which I have seen on many occasions. The colour of the iris is directly related to the amount of melanin that the melanocytes deposit in the iris stroma, i.e. more or less pigment. The complete version of heterochromia is quite rare, less than 1 % of the population in North America. Eye colour is usually genetically determined, not by just one gene, but by several genes interacting with each other.

Remember your high school science classes and the old Punnett Square, where you took the dominant brown and the recessive blue genes and you mapped them out for a family or an individual. That works great for demonstration purposes, but the real picture is a lot more complex. Somehow people end up with green eyes, or more “yellow” eyes or even “purple”, and as in the case of Mad Max, one eye of each. If your child has two different coloured eyes, don’t panic, just book your tickets for Cooperstown and the Hall of Fame, where our boy Max is headed.

Seriously, we need to watch our children’s eyes, which in their first year can darken as melanocytes produce and deposit melanin. There are the rare incidences where eye colour can change due to trauma or due to a rare condition called Waardenburg Syndrome, but you will usually know when that happens. With Max, his eye colours may be the result of a gene mutation or they may be autosomal dominant and potentially passed on to his kids.

I would not like to be the batter facing him, for sure, having those multi-coloured eyes baring down on me just waiting for a 95 mph heater to clip the outside corner: another K (strike out) for Mad Max.

Play Ball!

The good doctor

Perception: Human, Jumping Spider, Honey Bees,…

Thu, 31 Jul 2025 14:20:39 GMT

Blog vol 6.4. Perception: Human, Jumping Spider, Honey Bees,…

If you come into our office carrying a book and are interested enough to be reading it when I call you in, be assured I will ask, “So, what are you reading?” No, I am not a ‘Nosy Parker’ nor do I work for CSIS. I am just curious. There are so many fascinating things in this world! Anyone who reads this blog on a weekly basis most likely shares this curiosity.

A patient recently was reading An Immense World by Ed Yong. Right up my alley. It is about how the world is perceived by a multitude of creatures, a potential blog topic??:)

The main premise of the book is a German word, Umwelt, popularized by the Baltic-German zoologist Jakob von Uexküll. Umwelt refers to the animal’s perceptual world. Being an eye doctor, I am interested in the world of light and colours — chapters 2 and 3 in this book! How convenient.

The author emphasizes the diversity of living creatures. In trying to understand each creature’s different world, we become more in tune with them, more sympathetic, and more caring. My job as an optometrist is directly related to the human “umwelt”. Humans are incredibly visual creatures, more now than ever.

Unlike humans, most creatures do not require 20/20 vision, great peripheral vision, and defined colour vision. For example, the Jumping Spider that Dr. Mike Land studied for years, has eight large eyes, huge in comparison to their heads, and they are one of the few spiders that use their vision to catch prey. These eight eyes have different functions: some perceive specific prey, others detect motion, but they all work together to find food. The eyes have different structures depending on their intended use, simplistic and specialized. There can be a lot of different ways to perceive light, even within the same animal.

20/20 is ideal visual acuity for humans. About 98% of the creature world has much less acuity. The only creatures with better vision are the raptors: eagles, falcons, and the like. These predators have more densely packed receptors at the retina and even have two centres, called foveas, for focusing. Most animals do not see the detail that we see. A honeybee’s acuity is really terrible, but they just need to see the centre of the flower, which their UV sensitive receptors pick up quite well. There is a balance achieved with each creature between fine vision, peripheral sensitivity, and the day/night lighting intensity sensitivity. Human densely packed retinas and colour receptors are great for daytime sight but terrible for seeing at twilight and at night, so we leave that to the dogs and the lions who hunt at night.

And did you know that scallops, clam-like creatures that sit on the ocean floor, have “eyes”? They can swim about and it appears that these detectors pick up motion, but their actual purpose is still a mystery. Why does the scallop have them?

Another fascinating creature is the Killer Fly from the Mediterranean that has the unique ability to process visual information superfast. It’s called “critical flicker-fusion frequency” (try saying that five times superfast!). Humans process at 48 frames per second; this fly tops out at close to 400. This speed allows the fly to see regular people motion as a slow slide show, whereas a fly (dinner) buzzing around looks “normal” speed, enabling them to catch fast flies by encaging them with their legs. A similar thing happens in Marvel movies with superheroes like Quicksilver that can slow things right down by moving super-quick.

It makes you wonder, in the “wonder”full sense of the word.

‘til next week,

The good doctor

Just what are MIGS?

Thu, 24 Jul 2025 18:08:44 GMT

Blog vol 6.3. Just what are MIGS?

When I was growing up, in the Cold War era, MiG was an acronym for a Russian Aerospace company. Their jets were called MiGs, the Russian equivalent of the American F-14 (you all remember Tom Cruise and Top Gun).

Now, in 2025, Russia is replacing the MiG-29 with the stealthy Su-57 (Sukhoi, different company) so now we will only hear of MiGs when we watch reruns of MASH or remember the infamous MiG Alley. The new MIGS are here however, and they have nothing to do with planes or war.

MIGS-Minimally Invasive Glaucoma Surgery

MIGS is a surgical procedure that helps reduce the pressure in the eye for glaucoma patients. The only way to reduce the pressure surgically in the past was through a very invasive procedure called a trabeculectomy, where a shunt is implanted to divert aqueous humour into the venous blood system. This is a last resort in glaucoma therapy, after all other methods like drops and laser have been exhausted.

MIGS use micro-shunts that are inserted into the trabecular meshwork during cataract surgery with little extra effort and minimal risk of complications. In a recent review in Eye (journal of the Royal College of Ophthalmologists) on the procedure, the question was not if MIGS work, but how best to adopt them in practice (read review here ). The ophthalmologists of the UK and Ireland have come up with guidelines.

1. Not everyone will qualify for the procedure, only low to midrange risk glaucoma patients (not high risk, they will require the trabeculectomy as previously).

2. MIGS will only be done during a cataract surgery, so is only available to patients requiring cataract surgery, and it can only be done once in each eye.

3. The patient must be under care of a glaucoma ophthalmologist, recognizing the need for individual, specialized care.

Even a “minimally” invasive procedure is still invasive. All surgeries are invasive, only to be done when necessary, as there are always possible negative outcomes. As we learn more, and more advanced imaging is developed, we will be able to make more and more precise installations and continue to reduce risk.

Advantages?

Over the long haul, less eye drops; the procedure buys you time. Glaucoma is a race against time as glaucoma-related deterioration continues even with treatment. The clinician is working to slow the process to maintain the best sight possible over the patient’s life. Sounds morbid, but that is the reality. MIGS reduces eye pressure to slow down the damage caused by glaucoma. It is another “tool” in the clinician’s handbag.

As with any big change in treatment, it takes time to implement. This is a paradigm shift which will be adopted, hopefully sooner as we now have excellent guidelines for its use.

‘til next week,

The good doctor

Back to School Already?!

Thu, 17 Jul 2025 14:16:17 GMT

Blog vol 6.2. Back to School Already?!

Not trying to jump the gun here and spoil your already short summer holidays. But…..

We are booking right now for mid to late August. And guess what? It is that important, the lion’s share of your child’s learning comes through their eyes and visual systems.

We like to see children as early as 6 months and continue to see them on an annual basis through their secondary school years. If there are problems, the key is to catch them early, deal with them, and help your children to flourish in school and in life.

There are screening programs available, which are better than nothing, and can act like triage in Emerg. An optometrist provides an eye exam that is individualized and complete.

This what your child requires:

• Clear vision, at distance and up close

• The ability to maintain focus at any distance

• Good focusing flexibility to allow rapid change from one distance to another

• Eye-teaming skills, including control of eye position, movement and tracking

• Peripheral vision and eye-hand coordination

Problems with one or more of these areas will cause your child difficulties at school and in extracurricular activities, like sports.

Should your child require glasses, Burlington Eyecare is involved in the “Eye See….Eye Learn” Program set up by the Ontario Association of Optometrists: Industry leaders provide complimentary frames and lenses to qualifying children in JK and SK in Ontario. Eye exams for children are OHIP covered.

As part of the exam, the optometrist will discuss the child’s overall situation in light of their eyes such as screen time, school, and diet. They will also suggest simple habits that slow myopia development (difficulty seeing in the distance) like increasing outside time and holding screens at a healthy distance. Sun protection, eye safety, dry eye prevention, allergies, and of course, any parental concerns are all possible conversation topics.

This is all about prevention and setting up good life habits.

‘til next week,

The good doctor

Revisiting the Hippocratic Oath

Thu, 10 Jul 2025 17:42:08 GMT

Blog vol 6.1. Revisiting the Hippocratic Oath

This Oath was written around 400 BC in ancient Greece by (surprise!) Hippocrates (though maybe not?), and has been the guide to medical ethics in the West much of the time since. Now in the year 2025, we would do well to re-familiarize ourselves with its timeless wisdom.

Whenever I think about the Oath, my mind goes immediately to the hot topics related to sanctity of life, like euthanasia or abortion. There is much more in the Hippocratic Oath ( read here ).

The part that impressed me most was the paragraphs on teaching and on the patient-doctor relationship.

Teaching

The Oath refers to medicine as an “art”. Medicine is not just bare facts or cold data, but is a skill set and an art form. Doctors work with human beings not bodies. Teaching this art form takes time, patience, and an overall commitment to the student and the patient.

Since 1991, after my residency year at the University of Waterloo, I have been actively involved in clinical and didactic teaching: first at Waterloo, then later at the Optometry School at University of Missouri, Saint Louis. On my return to Canada in 2002, I took over Dr. Watson’s practice with the idea of setting up a teaching clinic.

When we moved the practice to 3235 Fairview Street in 2012, the office design included space for a student. In 2019, we signed on with the Waterloo Optometry School’s 4 ^th year rotation and have had a student intern ever since. Three students a year rotate into our clinic, one per semester, and see their own patients under supervision. We get the pleasure of walking alongside a new optometrist and the students get practical, real-life patient contact while able to consult with experienced doctors.

Textbook knowledge is not enough.

Confidentiality

When I took a closer look at this section of the oath, I was taken back by how prescient it is.

“Holding such things to be holy secrets,” means that the privacy of patient-doctor conversation is inviolable. How do we reconcile the use of AI scribes in medical exams with this privacy?

Interestingly, the Ontario Ministry of Health is assisting physicians to make use of an Artificial Intelligence (AI) scribe called “Heidi”, which promises to reduce paperwork, since it listens to the exam, puts it into electronic form, and dumps it into medical records. Even if the data stays in house, it has to change the patient-doctor relationship. This concerns me. Are we just so used to the ubiquitousness of being recorded that we do not think about it? What about privacy? The rapport I have with my patients and the confidence that they have in me cannot be recorded verbatim and should not be. That is the beauty of the exam, what is said there, stays there.

I love the conversations I have with my patients. No AI, means we can talk about whatever we like and no one ever needs to know;

Food for thought and practice,

The good doctor

Another “Good Doctor”

Thu, 03 Jul 2025 21:12:16 GMT

Blog vol 5.52. Another “Good Doctor”

What I did not know when I started this blog 5 years ago, was that the title “the good doctor” was not original. There have been other good doctors (my guess there are bad ones too). One I recently discovered is Dr. Vincenzo Arcone, an Italian immigrant from Sicily who arrived in Hamilton with his family in the late 1920’s. Trained at Catania, Italy, he arrived in Canada to start a new life.

I picked up the book, The Good Doctor, by local writer and politician, Vince Agro, (he was related to Dr. Vincenzo Arcone, the “good doctor”) at a used book store because of the title, something familiar about that. What interesting times. The period of the 1920’s and 30’s was very turbulent in Italy, with Benito Mussolini seizing power in 1922 in the midst of pre-Second World War Europe. “Doc Vince” was threatened by the Fascists in Italy and had to flee, and ironically was followed by the same Fascist movement when he got to Hamilton.

He truly was a great doctor, taking care of his patients, helping to build his community at James South, and making a stand for Canada and his fellow Italians. There is plenty of intrigue in the book with the tensions between the new and old world and with the prejudice against Italians in the new homeland. Prejudice is not a new thing at all and it has never been good. In the case of Doc Vince, he was stridently against the triumphalism of Mussolini though not all his fellow Hamilton Italians were of the same mind. There was division in the local Italian community; it came with them from the homeland. Their non-Italian, Hamilton neighbours unfortunately did not make a distinction between the people who sympathized with Fascism and those who opposed it. Also unfortunately, the pro-Fascists were not necessarily very quiet about their views, with parades on James Street celebrating Mussolini’s victories.

When Italy joined the Axis in World War II, the Canadian authorities, in the name of national security, treated all Italian immigrants as Fascists. Read the book, it does end well eventually. These were real people, truly human, with all their foibles and follies. Very heroically, some of them even gave their lives to defend Canada, while still having strong ties to Mother Italy. Like life, not that simple.

This book also speaks to our present times. So many people come to Canada fleeing political turmoil even now. Let’s welcome them. Doc Vince was truly a Good Doctor and Uncle and Community leader for Hamilton. Really interesting local history, so many familiar names and places seen in a different light.

Truly glad to have read this book, especially as we celebrate Canada Day and all the good that Canada stands for. I am also glad to have a blog called “the good doctor” as I try to emulate the many good doctors who have gone before, like Doc Vince,

‘til next time,

The (hope to be as) good doctor

Steps toward acquiring a bioptic driver’s license in Ontario

Thu, 26 Jun 2025 21:28:46 GMT

Blog vol 5.51. Steps toward acquiring a bioptic driver’s license in Ontario

Back in 2020, when we optometrists were celebrating our year (20/20:), and a tiny virus was spreading through the known world, the Ontario government made it possible for visually impaired individuals to drive with telescope assistance. Life altering for many. Who knew that a lightly circulated blog on the inter-webs would reach hundreds of people (yes, that's this blog!), providing hope for a more normal, independent life.

Fast forward five years. The Ontario government is figuring it out. As with any new legislation, the devil is in the details. It is one thing to change five words in an existing piece of legislation and it is another to make it a functional reality.

This is you: you are visually impaired and you have never met or no longer meet the visual requirements for driving in Ontario. There is hope, even though it is involved, it is doable, so here it goes…

Step 1. Contact our office at icare@burlingtoneye.ca or call (905) 639-9595. Describe your situation and arrange a “low vision” assessment, a longer, much more involved appointment. There is a fee for this assessment.

Step 2. You make the trip to Beautiful Burlington, with your trusted family and any visual aids and relevant information about your situation.

Step 3. The good doctor does a low vision assessment which focuses on your visual impairments and your visual capabilities in light of your unique life, vocational, and academic needs.

Step 4. Your main question is driving so we focus on that task. The failure to meet Ontario driving standards may be a visual field problem from glaucoma or a stroke. It may the result of macular degeneration that has advanced in your senior years or it may be a condition like albinism which you were born with and you have worked with all your life.

Step 5. If you qualify, you can apply to the Vision Waiver Program, which assesses your capability to drive with a field restriction. Each claim with the Ministry of Transport is scrutinized and, if allowed, you can have your driving assessed to determine eligibility for a license. This is without bioptic assistance.

Step 6. If your field of vision meets the Ministry’s guidelines, then the door is open for using a bioptic. The bioptic is a telescope that is fitted in the top part of your glasses and when looking through it must get your visual acuity to at least a 20/50 in order to drive. The telescope cannot be more than 4X power and must have a fixed focus. You also should have a contrast acuity of at least 1.30 to help with mobility and a visual acuity of 20/150 or better.

Step 7. You meet all these criteria and now you can be fitted for a telescope. Your glasses prescription is incorporated into the telescope to maximize your vision. You are measured for the bioptic and then it is ordered. There is government financial assistance aid through the ADP program to help with the cost of the device.

Step 8. The government is notified of your intention to pursue a bioptic license and the custom glasses arrive a month later, are fitted, and you are trained in tracking and spotting with the telescope, first sitting then later moving about.

Step 9. You go home with the bioptic and you practice, sitting in the passenger side of the car, walking in your neighbourhood, and watching television. Practice, practice, practice.

Step 10. After three months of practice you return to us and we review the use of the telescope and check the fit and then send the final letter to the ministry to ask for an assessment for driving which must be done in Barrie.

Step 11. The driving assessment involves use of the telescope and driving with it on. Pretty nerve racking; further training is often required to pass. Finally you pass!!! A special license with a bioptic restriction is awarded and you can drive. Every year after that, you must have your vision assessed. The annual assessment is also required for those in the waiver program.

There you have it. It can be done, and we have a good number of licensed bioptic drivers that have come through our doors. We will see you again next year. We also welcome all those who think they might benefit from this special world of bioptics.

Til next week,

The good doctor

New and lovely residents in our birdhouse

Thu, 19 Jun 2025 22:06:51 GMT

Blog vol 5.50. New and lovely residents in our birdhouse

Fantabulous development!

My family has been living on the same property for 23 years actively landscaping and planting trees. Over the years we have attracted more and different birds, Killdeers and Red-Tailed Hawks being two I have highlighted in the past. This winter, a neighbour gave us a birdhouse which we mounted on the post of our backyard pergola. Early in the spring we saw a pair of Eastern Bluebirds, Sialis sialis, trying to get into the house. The hole, made for a wren or chickadee, was too small. They tried, but there was no way they were getting in. I took the house to my workshop, made the hole a quarter inch bigger, and voilà, we now have new and lovely residents.

This pair is busy gathering scraps, grasses, and twigs... you know what that means. We are so excited! These are such beautiful birds.

We have been seeing an increase of paired Bluebirds in our area, likely because one of our neighbours (a different neighbour, we have pretty cool neighbours:) has been feeding them mealworms. They just love worms, especially mealworms. The worms supplement their diet of berries, providing a wonderful source of protein for a young and rapidly growing brood. The Bluebird has bright blue wing feathers and head covering with an orangey chest, with the male more lustrous than the female. Bluebirds also have an easily recognizable musical chur-wi or tru-ly song that is delightful. They apparently prefer free flowing water such as a small fountain or stream though we do not have anything of the sort. And no cats, a feral cat can be a big problem for these worm-eating songbirds.

Eastern Bluebirds are the state bird of Missouri (we lived there 1998 to 2001) and they winter all over the Eastern United States then migrate to Canada during the summer to nest. One pair migrated to our backyard.

We are truly thankful for neighbours and for the opportunity to host these lovely creatures.

How does this connect to eyes you ask. Hmm…

Til Next week,

The good doctor

Eye Protection SO Important

Fri, 13 Jun 2025 00:03:07 GMT

Blog vol 5.49. Eye Protection SO Important

This year’s Stanley Cup playoffs have been very entertaining, with Florida trying to repeat and with Edmonton, being led by Connor McDavid, trying to stop the parade and bring the Cup back to Canada.

It was in the seventh game between the Leafs and the Panthers that the incident occurred. One of the referees, Chris Rooney, was in the corner when an errant stick flew up into his face as a Florida player tried to backhand the puck. There was a lot of blood, and wonderfully, no damage to the eye. All on-ice officials wear helmets and a visor to protect their head and eyes because in hockey, sticks and skates and pucks are moving exceedingly fast in unpredictable directions.

Very Sobering

Food for thought. The cut from the stick was just temporal and superior to his right eye socket. Somehow the end of the stick’s blade came up under his visor and cut him above his eye. In the replay you can see the referee’s head go back as he moved to try to avoid the stick, but his helmet was loose fitting enough that it allowed the stick to reach his forehead. (Watch the clip here ).

As actor Owen Wilson would so aptly say, “Wow!” That was a very close call, with a dramatic show of blood and a residual black eye with some stitches.

What to do?

Vigilance, don’t slack off. This is serious. To start, the helmet strap must be fastened on tight to keep the visor in front of the eyes, less comfortable but important. A deeper visor for referees might be an idea. No one wants to lose an eye; this is a life thing. As an aside, you cannot play professional hockey or referee with one eye. Remember the career of Paul Maurice (who, by the way, is an excellent hockey coach), he permanently damaged an eye during his OHL career.

Remember, protect your eyes.

This is not just for hockey players. All you who play Pickle Ball, get eye protection. Yes, it is a plastic ball, but it travels fast and you play in tight quarters especially when playing doubles. There are goggles/cages like Kitchen Blockers that do not even have lenses but will keep the ball from contacting the eye. And myself, as an avid woodworker, would like to remind anyone out there that is dealing with things that whirl or turn very fast (especially a lathe or a weed-wacker) to wear eye protection. Come on into our office and discuss with our opticians your many options. Just like with the sun, prevention is the key.

Remember, as my Grade 2 teacher used to say, “It’s always fun, until someone loses an eye!” So true.

Til next week,

the good doctor

Sun Protection Now

Thu, 05 Jun 2025 19:29:47 GMT

Blog vol 5.48. Sun Protection Now

As it starts to heat up in Southern Ontario, remember to cover up. We all like the sun (for those in Vancouver, it is that round yellow circle that shows up from time to time over the Burrard Inlet).

The sun brings ultraviolet light, which packs a lot of energy into an afternoon at the beach.

Sun glasses!

Just as you slather the SPF40 on your body, think about SPF for the eyes. I took a course on advanced eye care procedures this year and one of the main talking points was the damage that UV can do to the eyes and the surrounding tissue. Working with vision care and various conditions, especially cataracts and macular degeneration, one gets a real world take on UV’s ravages.

Over the years I have promoted UV protection in spectacle lenses, in contact lenses, and in sunglasses. What I did not fully realize was the huge need for protection of the tissue surrounding the eyes. As optometrists, we look after “zone 3”, the area in and around the eyes. This includes the development of carcinomas, such as basal cell, squamous cell, and sebaceous gland varieties, which are more common than you think, and if left to spread can metastasize to a full body event.

UV is not nice.

Prevention is the key. A full-covering sun lens is essential for protection of your eyes and the surrounding area. The lenses should have full UVA, UVB, and UVC filters that shield your eyes and the delicate skin around them from these damaging rays. Just like with SPF creams, you need to fully cover up and you need to make it a habit. It is the long term exposure to these rays that really creates problems.

Regular eye exams.

Of course, but it is worth repeating, your eye health is a prime concern, but also because some skin types are more prone, some skin tissues just misbehave, so let us take a look at those “bumps” around the eyes and help to keep you in the healthy zone. We have a wide selection of fashion forward and sporty looking frames in many different colours and filters for your specific needs and very capable opticians to help you navigate the options.

Enjoy the summer weather!

Til next week,

the good doctor

A Great 60th Anniversary — Thank you to all!

Sat, 31 May 2025 02:15:25 GMT

Blog vol 5.47. A Great 60 ^th Anniversary — Thank you to all!

Last year in May our church, Jerseyville Baptist, celebrated 200 years. That was awesome! Last weekend we had the opportunity to celebrate 60 years at Burlington Eyecare. That was also awesome!

It takes a lot of people who are really good at what they do and are committed to the same goals for the long haul to make 60 years happen. As with anything done well, it starts small and stays small on a day to day basis: we take care of one patient at a time.

Balance is also key. Care of staff, care of patients, an office environment conducive to making it all happen.

We celebrated Dr. Ron Watson, stepping out on his own, setting up the practice, and being an excellent optometrist. We also celebrated his staff over the years, like Elizabeth Hickey, and later Mary Crans, Shirley Mills, Linda McPhee, Donna Kavcic and Sylvia Tavares, and Brenda Moore. Dr. R.B. assembled a group of very nice people. Last Saturday, we saw many of these people who came for the music, food, and the memories.

The music was great, provided by The Time Machine, a four piece rock band with our own Justine Lachance (Burlington Eyecare optician) on lead vocals. We did find out that we all have to work on our karaoke (next time). The food was provided by the Jonny Blonde Food Truck and Catering Company. Awesome! From the desert displays to the classy presentation and to the help they gave us for our event. World Class. I would also like especially to thank Karen Weisbrod and Nelmari Davidse for all the organizing and the hard work, and everyone who helped out with set up or clean up after, a BIG thank you!

Finally, I would like to thank our platinum sponsor, Nikon Canada. This company, that started in Japan in 1917, has been with us for most of my time in Burlington. They provide us with excellent product and back us up in so many tangible ways, like getting us tents to use for our events, providing the food, sponsoring our photo contest, and providing the giant commemorative ultra-fibre 60 ^th anniversary cleaning cloths. They even took care of the live entertainment. So thank you to Nikon Canada for all their support.

Lastly, but most importantly, to our patients, who have been with us from day 1. We celebrate Clare Abbamont, (patient #2) who at 93 years old, came out on Saturday to celebrate with us. The trust that you have put in us does not go unnoticed and we truly appreciate it. We look to a bright future, with a team of dedicated and talented younger Doctors who hopefully will carry on the work for the next 30 or 40 years (that’s you, Dr. Ryan and Dr. Krystal and Dr. Maya, go get em).

From “Mr. Dressup” (and Casey and Finnegan too), that was my 1960s persona on Saturday complete with drawing easel!

the good doctor

It all started at Wellington Square

Thu, 22 May 2025 20:45:05 GMT

Blog vol 5.46. It all started at Wellington Square.

The book, Vanished Burlington by Gary Evans, describes the early days of Burlington. As we at Burlington Eyecare approach our 60 ^th anniversary celebrations, we look back to Burlington 60 years ago. In 1964, the area bordered by Brant and John Street on the East and West and by James and Pine on the North and South was developed into a modern new mall for downtown Burlington. It was called Wellington Square Mall. (see below, this was state of the art!)

Dr. Ronald Watson, who was practicing with Dr. D.B. Freeman at 490 Brant Street in 1964, decided to step into the future and set up an office in the upper concourse of this new, swankified locale. He practiced successfully there for ten years, but space was at a premium and he needed to take on a new associate. Dr. Watson went east. The town of Burlington had recently expanded out that way with the opening of the Burlington Mall in October, 1968 with large anchor stores Simpson Sears and Dominion. All your shopping needs in one convenient, climate-controlled location AND free parking! The downtown area of Burlington has always been short of parking, and with the latest condo developments (one of which will sit on the same spot as the original Wellington Square Mall), that will continue to be a pressing problem. In 1975, Dr. Watson made the move to 3400 Fairview, purchasing the building with Christopher Breen LL.B..

Dr. Watson attended the School of Optometry when it was in Toronto on St. George Street, graduating in 1962. That same year, the school moved to Waterloo and became part of the University of Waterloo. In 1975 Dr. Nancy Wilson joined the practice. In 1975, Dr. Wilson, who was from Listowel, Ontario, graduated from Waterloo, made the move to Burlington, and met her future husband, Peter Shaver (of the Shaver Pharmacy family business on Brant Street). The practice thrived, with both doctors active in their profession: Dr. Watson taught Optometry at Waterloo and became a Fellow of the American Academy of Optometry, and Dr. Wilson specialized in the new field of contact lenses.

In 1987 I, Dr. Germain, graduated from Waterloo in optometry, actually “walking” across the stage at the same ceremony as Dr. Watson. The School of Optometry in Waterloo granted degrees retroactively to all the graduates from the Toronto School on that same afternoon. In 2002, after a time teaching Optometry in St. Louis, Missouri, and working with Dr. Watson, he asked me to join his practice. I liked it so much, I bought it from him. Generously, Dr. Watson stayed on for two more years to ease the transition. For the next eight years Dr. Wilson and I worked together, and we were still growing. I purchased Skinner Opticians of Hamilton (started in 1949 by Gordon Skinner on John Street North) and in 2007, moved it to Burlington, along with some exceptional staff members. Dr. Wilson retired in 2010 and we made the painful move into the 21 ^st Century installing electronic medical records, a bear of a thing to change. In the meantime, we had taken up more and more space in the building at 3400 Fairview and were busting out at the seams.

With the help from people like Val Haslam, Roger Sales, and others in the industry, we put our heads together and designed a new office to help meet the coming challenges. In November of 2014 we moved, in three days, across the street to our current address at 3235 Fairview. More space, more parking, and room to grow. Since then we have taken on new associates, Dr. Lesley Epstein (who after 6 years moved to Kingston with her family), then Dr. Jerilee Nyman (who was sadly taken from us by breast cancer in 2022), and I am glad to say, we now have Dr. Krystal Chee (since 2018), Dr. Ryan Cavaliere (since 2020), and Dr. Maya Vujicic (since May, 2025!).

Looking back, you see the “humble” beginnings of a local Burlingtonite who committed himself to providing excellent eye care to the people of Burlington. With the support of wonderful associates and staff, this service becomes possible. A special thank you to all that have done great work and those who continue to do great work at Burlington Eyecare. You are what makes it happen.

To commemorate 60 years, we are having a celebration this Saturday from 1-3 pm, with food and live music and fun. All invited.

‘til next week,

the good doctor

Hitting the books! The Importance of Ongoing Education.

Mon, 19 May 2025 15:53:56 GMT

Blog vol 5.45. Hitting the books! The Importance of Ongoing Education.

Part of being a professional is ongoing education, staying current with the developments in your field. No better way than to take an intensive didactic and clinical course on optometry with the professors at the University of Waterloo who are working hard to move our profession to the next level. I have to admit, it is not a quantum leap, like going through wormholes in space and time, but it is very interesting material.

In the USA there are now 20 states that license optometrists to perform laser and minor surgical procedures on the eye and the immediate area around the eye. In the early 1990’s the USA licensed optometrists to prescribe therapeutic medications significantly before those of us north of the border. Ontario optometrists were licensed to treat eye and systemic disease in 2008. With an ever aging and expanding population, there is more need than ever for many types of care.

A fundamental part of my work is learning and education. I have found writing the weekly blogs over the past five years really helpful, always pushing me to stay current and stretching my grey matter. I feel responsible, not only to my patients but also to the fourth year optometry interns that we teach in our clinic, to know what is being researched and what is new in the field of eyecare. Learning is truly one of the joys of life.

This course I just completed was broken up into two modules: the first consisted of foundational online courses in histology, pathology, and lasers; the second consisted of live streamed lectures to apply all this foundational work to the clinical setting. Last weekend we met in person to apply all this head knowledge in a supervised hands-on setting. (I would like to especially thank Drs. Sarah MacIver and Lisa Prokopich for putting together the courses and labs and Dr. Rich Castillo for sharing his knowledge and experience.)

I signed a disclaimer that does not allow me to share the information and trade secrets that I gained over the course. But know this, one can learn a good deal from medical texts and on-line, but the combination of didactic and hands-on was indispensable. We were working with laser procedures like selective laser trabeculoplasty for treating open angle glaucoma, as well as YAG laser capsulotomy, and several surgical procedures for diagnosing and treating lid bumps and growths, including some forms of biopsy. The course was also helpful with procedures that we are already licensed for, like gonioscopy and treatment of open angle glaucomas.

The process and legislation required to make these new procedures a reality may take some time. In the meantime, it is good to know what is available, how it works, and to be able to provide the best care possible to all of our patients.

‘til next week,

the good doctor

Lyme Disease Again!

Thu, 08 May 2025 22:10:08 GMT

Blog vol 5.44. Lyme Disease Again!

If you have been following us for some time, then you saw this coming. Every spring I go on a “rant” about Deer ticks and Lyme disease. I was hoping that with a Northern Ontario kind of winter (when you do not have to convert to Fahrenheit because Celsius and Fahrenheit are the same at -40 degrees), we would see reduced tick numbers. Who knew that ticks do not mind the cold.

Why is an eye doctor so interested in Lyme disease? Chronic Lyme disease can cause inflammation to all your body tissues including the eye, with uveitis, optic neuritis, scleritis, conjunctivitis, and every “itis” you can think of that can affect the eye. Symptoms vary from pain, soreness, redness, blurry vision, double vision, and reduced contrast sensitivity. The key is prevention.

The ticks are out there. I should know, I got one and it burrowed deep and was not noticed until its head was a few layers down into the adipose tissue. We tried to remove the tick with tweezers, but it was holding on fiercely and was buried deep so we only got part of it. It was also quite red around the site. We went to the doctor. The doctor made a small incision and cleaned out the area thoroughly, finishing with a single stitch, then had me take a prophylactic dose of antibiotic. I was given 2 X100 mg doxycycline capsules to prevent infection, but if the site turns to a bull’s eye, time for a full dose of an antibiotic like Azithromycin.

Catching a tick bite early is key, so checking for ticks is important. Hopefully you can catch it before it embeds and then you can check to see if it is a deer tick. Use alcohol wipes to sterilize the site and try to pull it straight out with tweezers. Let a professional remove it if you cannot get it all. The doctor I saw did feel that it was important to remove all the tick. Many of the sites online (even the government of Canada Lyme disease website) suggest leaving whatever parts of the tick you cannot pull out and letting the body work them out. This is not what I was told by the doctor. I would agree that it would seem best to get any potential for infection out of the body.

At the same time at the after-hours clinic, another man came in with a tick embedded in his belly button, fun. So, they are out there. Be careful, no paranoia necessary, just check regularly, and if you are a tick’s lunch get care if necessary.

Now, back to hiking and putting together bird houses before the new migrant birds settle in.

‘til next week,

the good doctor

“We all live in a Yellow Submarine!”

Thu, 01 May 2025 20:31:07 GMT

Blog vol 5.43. “We all live in a Yellow Submarine!”

An iconic song, it was first released as the “B” side of a 45 with Eleanor Rigby in 1966 by the Beatles. It is supposed to be a kid’s song, written and sung by Ringo for his children. An interesting note: it was only a year earlier than this song’s release, in 1965, that Dr. Ron Watson started an optometry practice at Wellington Square, Burlington. Yes, Burlington Eyecare is celebrating 60 years!

My interest in submarines and submersibles goes back a long way to elementary school when I researched Oceanography, wrote a speech, and competed in a public speaking competition. Last weekend, my wife and I stopped in Port Burwell to see the huge submarine that they have dry docked there. It is the HMCS Ojibwa, an Oberon class submarine (sometimes called O boats) that served in the Canadian Navy from the early 1960’s to the late 1990’s. First used to help in anti-sub warfare (ASW) for training, it was later updated to a more strategic military role in the Cold War.

We went for a full tour of the ship, inside and out and there was much to think about. My optometric mind blew its gasket as we explored this ship that survived and thrived on stealth. When engaging with the enemy, the sub has to be very, very quiet: all fluorescent lights turned off, their humming can be detected very easily; the motors turned off, with the diesel motors charging batteries when near surface to snorkel air and get rid of exhaust.

The non-acoustic stealth was really interesting. When in stealth mode, use of only red lights throughout, to enable dark adapting and to eliminate the light that is reflected through the periscopes. These ships had two periscopes, a binocular one for scanning the area, and a monocular version for zeroing in on targets. They were up to 50 feet long and had roof prisms at both ends and optical lenses throughout. (By the way, I love ray diagrams. See below.)

When I was younger, I made my own periscope with a milk carton and two flat mirrors and it really worked.

The submarine was painted a flat black to reduce reflected light. The ship was close to 300 feet in length and almost 5 stories high at the tower. When you go inside you notice right away the smaller than expected inside of the ship. Most of the sides are for ballast and air to assist with buoyancy and pressure changes, leaving the interior decidedly small and cramped. One has to remember the bathyscaphe, Trieste, that went down 7 miles to the bottom of the Marianas Trench. The entire hull was for pressure regulation and the divers were only in the small sphere that was attached to its keel.

You also marvel at the applied science when it comes to submarines, with little to no room for error.

So… if you ever near Port Burwell on a weekend, make a stop at the museum and take a tour of the Ojibwa.

‘til next week,

the good doctor

A New Portable, Affordable, Functional Magnifier.

Thu, 24 Apr 2025 18:30:58 GMT

Blog vol 5.42. A New Portable, Affordable, Functional Magnifier.

This topic is close to my heart: low vision and current technologies in magnification. In the early 1990’s I was introduced to the first electronic magnifiers with closed circuit televisions (CCTVs). “Low vision” works to help a patient to use whatever vision they have left as best possible. Usually it is a degenerative condition like macular degeneration that reduces the person’s ability to see fine detail or to be able to read. To see best in these circumstances, we use a point on the retina that is unaffected by the disease. Unfortunately, this new point cannot see fine detail, thus magnification comes the rescue making it possible for this new retinal point to see more clearly.

Some patients’ vision is so bad that they require a lot of magnification. The CCTV is a TV with a camera underneath that captures an image of an open book and projects it onto an enlarged screen — reading made possible! It really is genius, but not portable. We have hand-held magnifiers that use high powered optics to magnify, but as the power increases the magnifier gets smaller and the field of vision more restricted, not very conducive to reading or much else. The advent of electronic devices, like tablets and smart phones, has changed all that.

In the past two decades portable CCTVs have been available. Really nice devices, but still not really portable (more luggable) and quite expensive.

Eschenbach is a company that has done a lot of research and development in magnification. This past fall, Eschenbach introduced the Optaro, a revolutionary way of getting portable and functional magnification. By the use of an illuminated magnifying stand and a simple app on your Iphone/android, you can turn your smartphone into a really handy magnifier. The controls are very similar to other portable CCTVs with photo capture, reverse polarization, a line marker, data transfer, and even voice reading.

So, if you already have a smart phone and need a magnifier, you can use Optaro. It can come with a universal case to fit all phones or one of the 14 different cases for current models. Because your phone is the major processor, you are not paying big dollars for this magnification system. You can have the best of both worlds: portability, up to 15 X magnification with a larger field of vision, and a decent price. (More information here ).

Really helpful.

‘til next week,

the good doctor

The Remarkable Eyes of the Chameleon

Thu, 17 Apr 2025 23:47:17 GMT

Blog vol 5.41. The Remarkable Eyes of the Chameleon.

This week I want to look at the eyes of a very unique animal, a lizard with asynchronous eyes. The big bulging eyes of the chameleon work quite differently from our eyes.

Asynchronous: the eyes do not work together; they do not do the same thing.

Eyes Front - Eyes front for predator and eyes to the side for prey (usually). The chameleon is mostly predator, but it is also prey when it can be seen! It has the uncanny ability to blend scale colours with its surroundings and so is seen rarely, a great strategy for survival. The chameleon’s eyes are located on the side of its head and can go a full 180 degrees from front to back and a full 180 degrees up and down. The position on the side of the head with a shallower eye socket and very muscular lids for protection, makes it possible for the eye to protrude outside the orbit (the cavity in the skull which houses the eye) giving the eye maximum mobility.

Independence - Human eyes work together; where one eye is looking, the other is too. This is good because we always have input from both eyes being processed by the visual cortex and giving us excellent acuity and depth perception. The chameleon’s eyes, on the other hand, can work totally independent of each other. This reminds me of the funny British actor, Marty Feldman, who had seemingly independent eyes (of note, his eyes were affected by Hyperthyroidism). The independent eye movement of the chameleon allows the lizard to be looking in many different directions at the same time, really bad news for the local flying insects or bugs.

But also Synchronous! - The chameleon actually enjoys the best of both worlds: independent eye movement to scan for food, and switch to yoked mode, eyes working together. This gives it increased acuity and depth perception when it needs it. The eyes switch back and forth between the two modes of vision super fast. A real marvel. (Read more here )

As we admire nature and what the chameleon’s visual system is capable of, we can also marvel at our own visual systems. If you have a child and their eyes are not doing the same thing or seem out of line, that is not cool. They are not chameleons. By 5-6 months, a baby’s eyes should settle into working together. If you suspect that your child’s eyes are not together in some way, please bring them by our office for an eye exam (as early as 6 months). No panic necessary, there is usually some good reason for eyes wandering out of line, and there are several things to do, including eye exercises or glasses.

Til next week,

the good doctor

The Herpes Zoster virus: Shingles

Thu, 10 Apr 2025 20:51:47 GMT

Blog vol 5.39. The Herpes Zoster virus: Shingles.

When we look back at the roaring ‘20s, that is the 2020s, one word that will come to mind will be the five letter word, “VIRUS”. Start your next Wordle with that one, but I get the credit if you get it in one try! We started with the Corona virus, COVID 19, have been watching for the next H5N1 bird flu virus, and continue our wrestling with the age old and ubiquitous Herpes Virus.

I will once again get on my soapbox about Herpes Zoster, or Herpes III, which causes Chicken Pox in children and can reoccur in adults as Shingles. We are all aware of mass immunization to prevent Chicken Pox, a good thing, because this can prevent us from having the Zoster Virus set up shop in our Dorsal Ganglions. Once this virus is in your system, when you least expect it, or want it, when your immune system is lagging, boom, full blown shingles. One side of your body can be tyrannized by lesions that show up on the skin and even the eye. If not treated the nerve damage can be extensive, deep, and chronic.

VERY IMPORTANT : If you have sores on one half of your body, get to your physician right away and start a dose of Valtrex (an antiviral) to get the viral load down. If the sores show up on your nose or around your eye, get to your eye doctor to reduce the effects of these lesions and to check for glaucoma. This is serious stuff, especially around the eye.

Unfortunately, I have a few patients that I follow for this condition that did not get immediate treatment and now have chronic pain and reduced vision as result. Some have had to have a corneal transplant; I actually saw a patient today who had a transplant for this reason.

The key to this virus is prevention. Prevention. Prevention. We use to have the Zostavax vaccine, a single shot that helped to prevent Zoster from reactivating. Introduced in 2006, it is a live attenuated vaccine, a weakened form of the virus, and it is injected subcutaneously. It was not effective over time and did not work as well with the elderly population. Now we have the Shingrix vaccine, which is a recombinant zoster vaccine and contains an inactivated form of the varicella-zoster virus. Shingrix is injected into the muscle and is administered in two doses over six months.

The good news is that Ontario government will pay for your shots if you are 65-70 and have not received the publicly funded Zostavax. More good news, actually very exciting and interesting, recent studies from Wales have found a positive link between getting the Shingrix vaccination and a reduction in cases of dementia (Read more here ). The mechanism is yet to be found but strong causality is noted. (will be watching this)

Another good reason to get the shot.

Hopefully, we can eradicate this one like polio (for those who have never heard, a nasty virus that caused devastating damage to kids and came back to haunt many adults, FDR for one), as well as smallpox, …

Til next week,

the good doctor

Car Technologies that Help Bioptic Drivers (and the rest of us)

Thu, 03 Apr 2025 20:27:36 GMT

Blog vol 5.38. Car Technologies that Help Bioptic Drivers (and the rest of us).

Back in 2020, the Ontario government finally allowed visually impaired people to drive with bioptics. It was done rather quietly, so quietly that as a Low Vision Optometrist (specializing in visual impairment), I didn’t even hear about it until my own association announced it in a newsletter.

Here we are, almost five years later, with over 40 people that I have fit with bioptics, many who were able to drive for the first time. The optics of telescopes and the size of optotypes or letters have not changed during that time, but the technology has. Advancements in phone and car technology have made driving a lot easier for all.

GPS (Global Positioning Satellites) is an aid to most drivers, and most particularly to bioptic drivers. It utilizes existing satellites currently orbiting in space to assist with computerized navigation in real time. GPS has been around for some time, but advancements have made huge gains for the bioptic driver, particularly the use of larger screens and a technology called Voice-Turn-By-Turn, software that allows the user to hear rather than see navigational information. This software is especially helpful when street signs are difficult to be see, and provides early auditory alerts when approaching turns, informing you in advance what direction you will be turning to allow time to get in the right lane. These features are great for all drivers as it keeps the driver focussed on the road not the screen.

Cars themselves have technologies that sound alarms when objects are too near, have back up cameras, emergency braking, adaptive cruise control, blind spot detectors and sensors that allow adjusting of headlights and windshield wipers, etc. These features help all drivers, but make driving with visual impairment more possible.

Another technology is the Dashcam, the mounting of a camera on your dashboard that records the road in front of the car while driving. This technology is more controversial; it does provide a measure of security when driving, keeping track of events as you drive. Important to remember that besides being a camera, it also tracks motion, speed, and lane changes. In the event of a mishap, it can provide much needed data to help with your insurance claim. The down side is that the Dashcam is constantly recording and that data can be used against you (be careful). The device can also be distracting (so can the GPS!) and because they are expensive enough and on display in your car, they can be stolen. Most of the early models only covered the front view but newer ones also have rear views.

All of these technologies provide “sight” for the driver, allowing them to see more than one place at a time whether fully sighted or bioptic. This should make driving safer for us all.

Drive on!

the good doctor

Saw the most beautiful Sundogs.

Thu, 27 Mar 2025 21:12:41 GMT

Blog vol 5.38. Saw the most beautiful Sundogs.

What do dogs have to do with light? The Dog Star comes to mind, otherwise called Sirius, the brightest star in the night sky, a binary star with two parts A and B, in the constellation of Canis Major (Harry Potter fans will appreciate the Sirius Black reference with his animagus form being a dog). But enough digression.

When I pulled into the parking lot at Burlington Eyecare this morning, got out of my car, and paused to look at the now sunny sky, there they were as plain as can be: Sundogs. When growing up in Northern Ontario, we saw them a lot in the frigid winter air and bright sunny days in South Porcupine. When the sun is just above the horizon on a colder morning one can sometimes see two little “suns” (Sundogs) at three and nine o’clock . Not that uncommon, but always breathtaking.

How does it happen? You have to have the right clouds, cirrus at elevation 20,000 feet, cold temperatures, and a clear sky. The sun’s rays pass through plate crystals which float in the air in cold climates. When the light passes through these floating crystals, it is refracted like with a prism (think Pink Floyd and the “Dark Side of the Moon”). The result is a concentration of light at the side positions. If you look closely, you can see a faint rainbow.

When you look at the colours of the Dogs, they start with red on the inner and go through the ROY G. BIV. order of a rainbow. Pure optics and very cool. There are also variations with larger sized crystals producing more “wobble” and subsequently taller Sundogs. The particular crystals and the angles at which they are positioned all affect the resulting Sundogs and where you will see them.

To see Sundogs it is best to look at the sun from a 22 degree angle which is why I could see them so well this morning. They usually appear as bright spots on either side of the sun and are most common in the winter. Sundogs can happen when the sun is higher up in the sky as well though they will be further from the sun (read more here ).

Just stopping to enjoy the show, and then passing it on,

The good doctor

Lasers, what exactly are they?

Thu, 20 Mar 2025 16:07:33 GMT

Blog vol 5.36. Lasers, what exactly are they?

The word LASER is an acronym.

L ight A mplification (by the) S timulated E mission (of) R adiation.

What is crazy, is that you really only need these five letters to explain it.

Light - we all know that light is a form of electromagnetic radiation which has two natures, wave and photon (particle). The laser works with both these natures, with the frequency of the light having coherence (synchronized and in phase) and with the photon being released when energy is applied. Light is the basis of lasers.

Amplification - as energy is applied to atoms, they are excited. As energy is continuously applied, more and more atoms become excited ultimately causing population inversion, i.e. there are more excited atoms than not.

Stimulated - optical or electrical stimulation of atoms causes an existing photon to stimulate an excited atom to release an identical photon. A population inversion leads to a flurry of photons being released.

Emission - the resulting light now travels in a wave form through a “gain” medium and with mirrors which increase amplification and focus emission.

Radiation - the energy builds up in the medium as the coherent waves continue to reflect back and forth in a set wavelength and then are released at a set pulse and length of pulse to unleash a high energy beam.

What makes laser especially important for medical procedures is that different tissues absorb different, specific wavelengths. So, by using a specific laser with a set wavelength, the surgeon can be sure that the laser will only be working on the targeted tissue. The laser can be aimed for a precise spot and can be sharply focused.

The beauty of laser treatment is that it can be very specific, very focused, leading to very little collateral damage.

In eye treatment, we have femtosecond lasers for breaking down cataracts or for creating a precise lasik flap, we have Yag lasers for peripheral iridectomies or lens capsulotomies or for selective laser trabeculoplasties, and argon lasers for retinal blood vessels and for retinopexy. So, you can use a laser to break down a cataract in the eye without affecting the surface of the eye (cornea) at all (it’s a different wavelength), amazing. All these lasers are switched differently and have different wavelengths to work on different tissues. Fascinating stuff.

Til next week,

The good doctor

Lasers and the Treatment of Glaucoma

Thu, 13 Mar 2025 19:05:42 GMT

Blog vol 5.36. Lasers and the Treatment of Glaucoma.

For the next two months, I will be mainly preoccupied with lasers and glaucoma. I am in the throes of a course from Waterloo on this topic. I must keep quiet about the course material so this information is only what is publicly available online in industry journals and websites (signed a nondisclosure, sorry). These are the latest trends in the field.

The latest in selective laser trabeculoplasty (SLT) comes from Alcon. They have purchased the rights to a new way to apply the laser, called Direct SLT. The unit delivering the laser is called the Voyager. In July 2024, Alcon purchased Belkin Vision, a glaucoma surgery company from Israel, and in the fall of this past year introduced the Voyager at the American Academy of Ophthalmology annual meetings.

The Voyager is a Q-switched (pulsed), 532 nanometre-wavelength, frequency-doubled. neodymium-doped yttrium aluminum garnet (Nd:YAG) laser device. Try saying that ten times quickly! The neodymium ions act as a laser gain medium and the ions are “pumped” into excitation from an external source. The pulsing increases in energy and allows great control with phasing, generating 250 megawatts of energy at a pulse duration of 10-to 25 nanoseconds. A lot of controlled energy in a very short burst. Usually the wavelength is at 1064 nanometres but the frequency doubling halves it to 532 nm. LOTS of energy, PRECISELY directed, for NANOSECONDS.

This type of laser has been used for many surgical procedures in the eye, the mouth, and throughout the body. So nothing new here. We know from the Light I and Light II studies that conventional SLT is the new recommended first treatment in primary open angle glaucoma. This is still in its early stages. It takes time to make changes. To perform SLT with the current technology, you need to be an ophthalmologist who is skilled with the mirrored gonisoscopy lens and with a slit lamp. It requires skill and time. The Voyager is Direct SLT and will change that, as it requires no physical contact with the patient, no gonioscopy lens, and the device has an eye tracker that lines up the eye and keeps it lined up during movements to apply the focused energy through the cornea to the trabeculae. Much less skill required. This device needs to be approved for use in Canada as a first step.

From the patient’s point of view, the use of SLT early on in glaucoma should prevent the need for regular eye drops, the standard treatment currently. The prognosis is similar, the treatment much less cumbersome. If SLT could be done with the new machine, i.e. Direct SLT, it could be made more readily available as it would not need to be done by an ophthalmologist.

Once again, exciting times in the Eye Care industry (right up there with an excited Neodymium ion),

The good doctor

Burlington Eyecare 60th Anniversary Photo Contest

Thu, 06 Mar 2025 19:52:26 GMT

Blog vol 5.35. Burlington Eyecare 60 ^th Anniversary Photo Contest.

We have been brainstorming at Burlington Eyecare. We asked the question, “How do we celebrate a diamond jubilee?” When Queen Elizabeth II celebrated, there was quite a party which continued for much of 2012 in London and throughout the Commonwealth. Few British monarchs have had the opportunity to celebrate 60 years, the only other was Queen Victoria in 1897; King George III almost made 60 years, 1760-1820, but died just shy of his diamond jubilee. On a different note, my wife’s parents had their 60 ^th anniversary in 2024, a great time to come together and celebrate.

Burlington Eyecare opened its doors 1965, 60 years ago! WOW!

Let’s celebrate, but how?

We decided to start off with a photography contest. Anyone can enter. The only stipulation is that the photo be of Burlington in some way: the Pier at Spencer Smith Park, a warbler at Paletta Lakefront Park, a trumpeter swan at LaSalle Park, a rose at the Royal Botanical Gardens, or take in the many conservation areas that Burlington is blessed with, or hit the city, what about the skyline or city hall or even an industrial site. There is beauty and interest to be found anywhere. It means you have to get outside and observe the incredible gift that Burlington is, from the heights of Mount Nemo to the shores of Lake Ontario. The contest unites technology, artistry, and a love of Burlington in one celebratory package.

This contest is also inspired by Nikon, makers of excellent camera lenses and cameras for over 100 years. If you get your glasses at Burlington Eyecare, you almost certainly will have Nikon lenses, some of the most advanced spectacle lenses in the industry. Nikon sponsors worldwide photography contests like “Small World in Motion” ( check it out here ). Amazing stuff.

Prizes for the Burlington Eyecare Photography Contest: First place prize is $1,000, 2 ^nd place prize is $500, and 3 ^rd place prize is $300. The winning image will be used as part of our 60 ^th anniversary celebrations.

Details on our website ( link here )

We are excited to see your entries,

The good doctor

Minor Laser Procedures for Optometrists?

Thu, 27 Feb 2025 21:19:31 GMT

Blog vol 5.34. Minor Laser Procedures for Optometrists?

In 2023 I completed a 33 hour certification course: Glaucoma, Oral Therapeutic Prescribing Agents and Lab Testing. It was a great course put together by the Continuing Education Department at the University of Waterloo. It’s now 2025, time for a new certification course: Office-based Laser and Minor Surgical Procedures.

With an ever-aging population and the increased demands on the eyes from screen time, eye care is more needed than ever. The Ophthalmologists of Ontario have their hands full as we witness in the long wait times for cataract surgeries. It would relieve some of the strain on the system and improve accessibility for the patient if optometrists could do some of the more straight forward and routine treatments in their own offices. Who can do what, in this case who can do minor laser procedures, is decided by the provincial government in conjunction with the professional colleges of Physicians and Optometry. These parameters are highly contested for a variety of reasons, one of which is public safety. However, other places have made the proposed changes with no terrible repercussions, notably Oklahoma as early as 1998.

I have always felt it my responsibility (not to mention it is super interesting!) to keep abreast of the latest clinical research and techniques. The School of Optometry and Visual Science in Waterloos has been graduating students the past few years with the knowledge and skills to perform minor surgical procedures using lasers. The School is offering the same training to practicing optometrists, hence the course I am taking.

The old adage still applies: educate, then, legislate. In the 90’s optometrists took certification courses in therapeutic drugs and treatment of disease, and finally, in 2011 were granted licenses to practice with therapeutic drugs. Optometrists need to be thoroughly trained first, and then petition for expanded scope of practice.

I start next week, with on-line modules in anatomy and physiology and a review of procedures like gonioscopy, with necessary quizzes. There will be courses on lasers and their use in glaucoma and capsular opacities, and finally courses on lid lesions, their diagnosis, removal, biopsies, and local anesthesia. All participants in the course take the online portion, then attend a hands-on workshop to put it all together. All culminating in an extensive final exam.

A little daunting at the outset, but lots of really good stuff. I’ll keep you all posted,

The good doctor

Retinoids and your Eyes

Thu, 20 Feb 2025 22:34:27 GMT

Blog vol 5.33. Retinoids and your Eyes

Retinoids: a class of chemical compounds that are natural derivatives of vitamin A or are chemically related to it. These compounds are used in cosmetics, dermatology, and cancer treatment. (Wikipedia).

It has been some time since we had to deal with the side effects of retinoids — specifically 13-cis retinoic acid. From the 1980s into the 2000s, teens challenged with severe acne were prescribed an oral drug called Accutane, a retinoid-based medication that has subsequently been discontinued because of undesirable side effects such as depression, increased blood sugar, problems in pregnancy, high blood pressure, increased cholesterol, and VERY DRY EYES. Aha! The eye connection.

Recently, one of my colleagues was using a cream around her eyes and noticed that her eyes were much more dry than normal. The cream does work, but… you guessed it, it has an active ingredient which is a retinoid. Ironically, she was getting very dry eyes from using the “moisturizer”.

It should be noted that the cream was helping the skin, but research showed that this is a case of “Retinoid-itis”.

Time to review the literature. What is 13-cis retinoic acid (or its equivalents)? and how does it dry the eyes?

The cis form of retinol is changed to the more potent “trans” form that is known to reduce the breakdown of your body’ s own steroids, resulting in a reduction in inflammation. Its main action is the apoptosis (programmed cell death) of sebum-producing cells (sebum: oily substance that hydrates and protects the skin; in acne the sebaceous glands produce too much sebum causing clogged glands…) which then reduces sebum in the skin tissue. This is supposed to reduce acne, but ALSO DRIES the eyes and other tissues.

What is surprising is that these retinoids are included in creams made for use around the eyes. Be very careful, these retinoids don’t just affect the sebaceous glands, they also affect the Meibomian glands responsible for producing stable tears in the eye. Thus, dry eyes.

Be careful, read the label, no retinols in your facial creams. If you have to use a cream with retinol, do not apply it near the eyes. We have enough problems with dry eyes without adding more.

Til next week,

The good doctor

Eyes in Space, a Good Idea?

Fri, 14 Feb 2025 03:11:04 GMT

Blog vol 5.32. Eyes in Space, a Good Idea?

When it comes to the subject of physics and space, I get really interested. You start talking about eyes and space, watch out.

You can imagine what I felt when I read the latest issue of the IEEE Open Journal of Engineering in Medicine and Biology, which had just published an article on the impact of space missions on an astronaut’s eyes!

Prolonged microgravity has a negative effect on the eye and vision. The ocular changes that occur are known as space-flight-associated neuro-ocular syndrome (SANS). It’s postulated that the weightlessness experienced in space causes blood and cerebrospinal fluid (CSF) to travel toward the head (known as the “water-hammer effect”).

40-70% of astronauts traveling to the International Space Station (ISS) experienced some amount of swelling in the back of the eye.

This swelling can cause optic disc edema, global flattening, choroidal and retinal folds, hyperopic refractive error shifts, and even focal areas of retinal ischemia, i.e. problems. Throw in individual genetics, metabolism, and nutrition, and these changes in the eye can be quite serious.

The latest research from Canadian Space Agency in Quebec looked at 13 astronauts that were part of long-duration space missions on the ISS. The study looked at ocular rigidity, intraocular pressure, and ocular pulse amplitude. All three findings showed significant changes in the astronauts’ eyes from pre-space: SANS. In many cases, this shift can be corrected with spectacles during the mission, but some experience significant problems.

The researchers in Quebec have concluded that at-risk astronauts need to be identified in order to prevent exposure and serious damage in a prolonged mission. The good news is that once the astronaut returns to Earth and Earth’s gravity, the eyes return to normal. The changes are not permanent however debilitating SANS was in space ( Read more here ).

All very interesting, but it does make you wonder if Buzz Lightyear can make it to infinity and beyond.

The good doctor

The Ophthalmoscope, Seeing into the Eye

Thu, 06 Feb 2025 19:58:33 GMT

Blog vol 5.31. The Ophthalmoscope, Seeing into the Eye

“We stand on the shoulders of giants”.

You have probably run across that phrase at some point, quoted from Sir Isaac Newton. He was corresponding with another brilliant scholar, Robert Hooke, about the work of their predecessors, like Descartes (and others) in the development of mathematical theorem. This does not grow old, we too have benefitted from the work of these same people and many who have come after. Those of us who look into human eyes for a living owe a debt of gratitude particularly to Hermann von Helmholtz and his invention of the ophthalmoscope.

In 1851, at the age of 29, he developed his Augenspiegel (eye mirror), and started using the first working model in 1854. Prior to that, it was very difficult to see into the eye to detect and treat eye disease. I will always remember the episode in Little House on the Prairie (1970s), where the Ingalls’ oldest daughter, Mary, contracts scarlet fever which results in her going blind. Her visit to the ophthalmologist I will always remember: he took a candle and reflected the light into Mary’s eye to get a look at her optic nerves. He was holding one of the earliest versions of the ophthalmoscope.

Last year, my predecessor, Dr. Ronald Watson, gave me a 1930s cabinet for examining eyes, on which I wrote a dedicated a blog. At that time, he also gave me an ophthalmoscope that was made in the late 1800’s in New York State, which will be one of the many pieces of our soon-to-be museum of optics and eyewear at Burlington Eyecare.

Von Helmholtz wrote many papers on the optics and theory of this instrument and came to realize that three essential elements were required for its design.

1. A source of illumination, thus the candle was used at that time.

2. A method of reflecting light into the eye from the source.

3. An optical means of correcting an unsharp image of the retinal fundus.

These three elements are still essential for today. The unit that I have was the next step in development from von Helmholtz’s original. This unit features a concave mirror with a central hole drilled out to focus the light into the eye in line with the sight of the observer. It also had a rotary wheel of different powered lenses that can sharpen the image of the fundus. Pretty genius.

The greatest improvement in the design came when an incandescent bulb was used as a light source as it stabilized the light. Today we have halogen or LED sources for light, and the energy is supplied by a lithium battery instead of a plug-in unit. Yet the elements remain the same: light and lenses, and all of it lined up for the doctor to see straight onto the visual axis of the patient.

It is only fitting that the Father of Modern Optics, Sir Isaac Newton, would be the one to stand on others shoulders. We benefit greatly from the work of all these people who together brought us such wonderful technology.

A hearty thank you for the ophthalmoscope,

The good doctor

Give us a Call When Stuff Happens, Save a Trip to Emerg.

Thu, 30 Jan 2025 23:58:34 GMT

Blog vol 5.30. Give us a Call When Stuff Happens, Save a Trip to Emerg.

In the past few weeks, I have seen a couple of two year olds for emergency visits. The parents after doing some online research, called our office about their little one’s eye problems. If there has been a minor accident or the sudden onset of eye redness, discharge, or pain, call us right away. The other options are to head to your GP, an after-hours clinic, or the local Hospital Emergency Room (ER). You are not likely to see an eye care professional in any of those places.

I am reminded of the winter of 2020, when all the world was scrambling to deal with Covid 19. With very little to go on as to how contagious or how virulent the bug was, the last place you wanted to be was the ER. If there was any time in my career that I really felt needed, it was at that time. We were fortunate enough to get our hands on the necessary protective gear (N95 masks, gloves, and eye shields) and were able to provide care at that time. That meant that patients could see me at our office. I stayed open on certain days of the week to meet the need, all by my lonesome, with one of my university student children for support.

Not only did we see our own patients, but we saw any patients that needed to be seen. It was tiring and did not pay super well, but it was a much needed help in a difficult situation and was really very rewarding. These people were worried enough about their eyes to come in, we were able to treat and reassure. The same goes for those little ones (or big ones) who need to have their emergency looked after. We have hand- held equipment, like a biomicroscope, for home visits. It works great for a stressed out two year old and not so calm mom or dad. (the ER doesn’t have one of those, btw).

One of my little patients had scratched their eye on something, was having lots of pain, a red eye, and light sensitivity; they needed intervention. Some fluorescein dye with a cobalt blue light under a microscope showed the scratch on the cornea clearly, no question. A prescription for antibiotic eye ointment and in a few days they return as happy as a lark. And you would be surprised what a toilet brush can do when it is used by a two year old on the eye. A quick look, a treatment plan, and a bunch of reassurance and understanding can go a long way. No, you are not a bad parent. Hey, stuff happens.

We have extracted bits of embedded metal and other bits of things from eyes, we have treated pink eye, severe allergies, investigated “flashers and floaters” and sudden vision loss, treated UV and chemical burns, retrieved “lost” contact lenses, and, of course, dealt with many minor scratches or impact to the eye. You really are going straight to where you need to be by seeing your optometrist.

Til next week,

The good doctor

Long-overdue, New Canadian Optometry Schools in the Works

Fri, 24 Jan 2025 19:45:08 GMT

Blog vol 5.29. Long-overdue, New Canadian Optometry Schools in the Works

The Director of the School of Optometry at the University of Waterloo announced in November that Mount Royal University in Calgary is exploring the possibility of setting up an Alberta optometry school ( Read more here ). That has been coming for a while, with Waterloo being the only English language school of optometry in all of Canada. Back in the day, there was much talk about a possible school at Victoria University, a western Canada option has been on the table for a long time.

Since “back in the day”, our population has grown significantly, generally gotten older, and we all have been spending more time on screens and are using our eyes more than ever. The demand for eye doctors has gone way up, and even though Waterloo increased their enrolment from 60 to 90, it is not enough. Many Canadian students go to American optometry schools, which is a great loss to Canadian optometric research and education.

The other problem is that areas outside the “Golden Horseshoe” and the greater Vancouver area have difficulty enticing grads to commit to their communities. When I was in optometry school in the 1980s, there was a quota for each region (a minimum), so every year 2 students from BC, 2 from Alberta, etc. with the Territories and even Northern Ontario having spots on the roster (I am a Northern Ontario lad). The theory was that these students would be most likely to return to these areas, and on the whole in my class this was true (I did not go back, oops). At some point these quotas were abolished, not sure if that’s a good thing or not?

So spread the education around. Western Canada for starters. This past week it was announced that another school is being considered for the Atlantic provinces, at UNB’s St. John Campus (See announcement here ).

Interestingly, the St. John Campus was the home of the first engineering program and the first faculty of computer science in Canada. It does sound a lot like University of Waterloo II, or perhaps it should be the other way around? Back in the sixties, the College of Optometry in Toronto was looking for a new home, and the Senate Committee at Waterloo recommended that the school be established on their new campus. Geographically, east coast makes total sense.

I graduated from Waterloo in 1987 and completed a 1 year residency in Low vision there in 1990; my son, Peter, graduated from Waterloo in 2023. It is our hope that these investigations will result in the actual building of these new schools, and once they are established, all good for optometric care in Canada.

A peak into the future- new frontier in optometry of lasers and treatments, exciting times! More on that later…

Keeping you posted,

The good doctor

A message from the IT department: a new setting for your phone!

Thu, 16 Jan 2025 20:32:44 GMT

Blog vol 5.28. A message from the IT department: a new setting for your phone!

The ubiquitous small screen. How many times a day do we look at it? There are a few things we can do to alleviate the impact on our eyes and vision aside from the obvious, i.e. less screen time.

I have many conversations with patients and their families on a daily basis. Last week a parent told me about a setting on your iPhone that tells you if you are too close to your screen. It made me wonder if Siri has been reading my blogs and reporting back to Apple. What a great idea!

Last blog we were looking at the impact of daylight on slowing myopia development in children (myopia is reduced distance vision); this week we are considering the impact of screen distance. Holding your phone or device close increases the work your eyes have to do to see clearly. This extra work equates to an increase in myopia in children and plain old eye strain in adults.

The people at Apple put a setting in that warns you are too close to your screen. They set it at twelve inches. When it is turned on, the screen will pop up with this alert that you are closer than twelve inches. You just have to tap the screen to continue and move the screen away to start again. This feature is available on other types of phones, of course, and is especially important for children.

On an iPhone, go to “Settings”, then “Screen time”, then go to “Screen Distance” and make sure it is on.

While in Settings…

Take a look at the “Display & Brightness” setting, where you can adjust text size, screen brightness, and set the phone to be on “Night Shift” reducing blue light exposure in the evenings. All these settings make screen time easier on your eyes.

Observe the 20/20/20 rule, not a setting but a general guideline. When you are 20 minutes on a screen, take a 20 second break, looking at 20 feet away. This gives your eyes a break. It wouldn’t be a bad idea to do a screen time assessment. You are the boss of this little device, you decide how it best fits into your life in a way that enhances your well-being.

We are not going to stop using our phones so let’s be smarter in how we use them.

Til next week,

The good doctor

After the Winter Solstice - more and more light

Thu, 09 Jan 2025 14:37:19 GMT

Blog vol 5.27. After the Winter Solstice - more and more light.

December 21 ^st , the shortest day of the year, has come and gone. The days grow longer. Someone at the CBC saw all that light and felt it was high time for a report on day light and its effects on the eye.

We have discussed this relationship on other occasions, (look to June 16, 2022, specifically). The maturing eye needs daylight to properly develop. The Covid Pandemic, put us all at home and on our screens, and since then we have been on our screens and inside more than ever. This threat has increased the number of myopes, those have reduced distance vision, and have also increased the severity of myopia in each individual.

The article posted this week on the CBC ( read here ), brings out the relationship between outdoor time and vision in children. Indoor lighting only provides 500-1000 lux (a unit of light), whereas the outdoors gives us 2000-5000 lux, depending on cloud conditions and the time of day and year. That makes a huge difference. Studies show that an extra 2 hours of outdoor time can help reduce myopia development. Dr. Lisa Christian, from the School of Optometry at Waterloo University, points out that the outdoor time can be done in smaller portions as it is not necessary to have a continuous 2 hours to make a difference. Not the first time that I have prescribed light for a patient.

What is really cool is that it is so easy and as an added perk it gets us off our screens. There is no doubt that the combination of increased light and the reduced screen time all contribute to myopia management ( read more here ). There are other factors to consider, of course, but the main point here is that we all have access to the outdoors, and being Canadians, we do have a lot of space to run around. So get outside, enjoy the outdoors and you parents, get out with your kids. Also remember to get those young eyes checked early and often.

Til next week,

The good doctor

Year in Review: Books of 2024.

Thu, 19 Dec 2024 21:04:31 GMT

Blog vol 5.26. Year in Review: Books of 2024.

It’s a good year when I have a chance to put my feet up and curl up with a good book (or 2 or 3 or…). C.S. Lewis observes that we read “for the enlargement of our being”. We also read because there are so many interesting books and people and things out there, and just for sheer enjoyment! Aren’t eyes a wonderful thing?

Favourites of 2024:

1. The Green Mile , written by an American author of some renown, Stephen King. I have stayed clear of King’s books because I am not into the horror genre, but I was pleasantly surprised by his magical realism. Green Mile was released as a serial, one chapter at a time, and you cannot help but notice King’s choice of chapter lengths and cut offs, truly masterful. It is about a man on death row (the green mile), who is accused of savagely killing two sisters. The supernatural in the story really informs the plot and brings a sense of wonder and enchantment. I have moved on to other books in this genre by King and have not been disappointed.

2 . A History of the Island , by Ukrainian-born author, Eugene Vodolazkin, is unlike anything else I have ever read. Vodolazkin also wrote Laurus , about a medieval Russian monk, and a more modern story, Brisbane, about a Ukrainian-born guitarist struggling with the ravages of time and place. A History of the Island is thought provoking. The history of an island is narrated by a medieval voice and informed by timeless monarchs. Some reviewers have tried to see allegory in this, but that is not the author’s intent. Vodolazkin is bringing a premodern worldview into a time that is struggling with modernity, and these perspectives are intriguing to consider.

3. Sun House , by David James Duncan. I have waited a long time for this author’s next book, I so enjoyed his epic, The Brother’s K (1992). Finally. And remarkably, it did not disappoint. If you are looking for three-dimensional characters, with intricately woven but realistic plotlines, and a wealth of philosophical and religious dialogues, look no further. In general, Duncan shows the reader a world where there is a God, but not a tightly defined God. I love his playfulness; I love his love for humanity; and I love his breadth of knowledge and his ability to communicate these realities in a very readable story. This book is no doubt a critique of our modern milieu and our western materialistic individualism, revealing its trite answers and platitudes. Duncan resists the tendency to stand on high moral ground by staying very aware of our oft times hidden hubris. A long book, but you can hang on his every word (actually, it’s too short:).

4. The Wingfeather Saga by Andrew Peterson, is a four book YA series about the Igiby children and their adventures. The series gets stronger and better with each volume. There are times of great tension, with the threats quite real and foreboding, as well as excellent character development, with each of the children and adults having their moments of struggle and yet persevering through interminable difficulties. There are shortcomings, character flaws, but also hope, restoration. The story, so involved that it is not easily predictable, deals with real issues and yet sees light through the cracks and faults of the world. Song and lore are critical, heart and imagination are key. Really good books. These will be read again, soon.

May you have an opportunity to put your feet up and read a good book this holiday season.

Til next year!! Merry Christmas to all! and a Happy New Year!

The good doctor

Look up! December Meteor Showers

Thu, 12 Dec 2024 18:13:13 GMT

Blog vol 5.25. Look up! December Meteor Showers.

The Geminids are here, a meteor shower radiating from the constellation of Gemini. This is an annual show in the Northern Hemisphere that starts in early December and will peak on the 13 and 14th of this month. The Geminids are special because they start at 7 pm, a convenient time to step out the door and have a look.

The Zenithal Hourly Rate (ZHR) is the hourly rate at which the shower will display meteors entering the atmosphere under ideal conditions: a new moon, clear sky, and the radiant directly overhead. The University of Western Ontario has a neat gage that indicates the ZHR for the next 24 hours ( check it out here ).

Tonight (December 11) the ZHR is 84, which tells us that under ideal conditions the observer can see 84 meteors in an hour. Unfortunately, this year’s display will be washed out by a full moon, reducing that number to half the value (clouds are also a problem, reducing the visibility to 0). At the Geminids’ peak, one can see as many as 150 meteors per hour.

The next shower is the Quadrantids, which will peak on the nights of January 2-3, 2025. The Quadrantids are named after the now defunct constellation, Quadrans Muralis, and will only appear for a couple hours each night most clearly from Northern positions. Its ZHR will peak at 120, but the cool thing is that the moon will just be starting to wax, which means more visible “stars”.

The third major meteor shower is the Perseids which will peak August 12, 2025, but will require a late evening to see them. The Perseids’ radiant is the constellation of Perseus. It has a ZHR of over 100, but this coming year the moon will be just starting to wane, meaning that less meteors will be visible.

The showers happen when the earth’s atmosphere passes through the remains of a comet (sometimes, but rarely, an asteroid) as the earth travels around the sun. The debris enters our atmosphere and burns up, creating a shooting star. You can go out with your own two eyes to watch, a wonderful thing and accessible to everyone. But, if you have a big enough telescope, you can watch the “stars” from the Geminids hit the moon because they do not burn up in its lighter atmosphere, at the rate of about one every 20 minutes, so interesting.

As they say, ”Geminid showers bring Christmas flowers”, just made that up :)

Til next week,

The good doctor

HO HO HO! Merry Christmas!

Thu, 05 Dec 2024 21:47:56 GMT

Blog vol 5.24. HO HO HO! Merry Christmas!

Last night, we at Burlington Eyecare had our annual Christmas get-together, and The Edgewater Manor rose to the occasion once again. Just in case you want to take a special someone out for a nice evening, take the Fruitland Road exit off the QEW and head towards the lake, you can’t miss it. The original house was constructed in 1921 and overlooks Lake Ontario, and at this time of year, the decorations and cozy fireplaces create a festive atmosphere.

I must say I really enjoy being with my staff/friends on any occasion. Our lab manager and his optician wife have been kind enough to host a summer event the past two years at their country property. We take tours of the gardens and have a drink or two while competing in a Bocce tournament. It can get pretty intense, especially when trying to dodge their robotic mower! Did I mention the food? lots of it, and delicious, another great time. Then there are birthday celebrations, baby showers, and just the regular staff meetings.

So last night was a continuation. To make things interesting we played a modified version of the game Taboo on a Christmas theme, which we had a lot of fun with. Once again, Karen, our office manager, did a great job planning, and our suppliers were generous with take-home gifts and Johnson & Johnson (Acuvue) even provided antipasto platters as apps. There is a season for everything, and this is the season to celebrate.

Another highlight was the gift exchange, with presents changing hand many times. And to top it off we discussed some of our favourite Christmas albums to decorate by, an interesting list:

A Gene Autry Christmas

Christmas with Boney M .

Christmas by Michael Buble

A Charlie Brown Christmas

Christmas Album by The Beach Boys

Merry Christmas by Mariah Carey

The Nat King Cole Christmas Album

Christmas is a wonderful time of year, a time to really enjoy each other’s company, and remember what is important. I have a ton to be thankful for, especially the staff and patients that am blessed to work with.

It is with this in mind, I can speak for all of us at Burlington Eyecare,

Have a Very, Merry Christmas,

The good doctor

The eyes of the Red-tailed Hawk

Thu, 28 Nov 2024 20:44:45 GMT

Blog vol 5.23. The eyes of the Red-tailed Hawk.

From red light (last week’s blog was on red light as a potential treatment for macular degeneration) to red tails (this blog is about a Red-tailed Hawk in our back yard). We live on close to two acres just outside the town of Ancaster and keep a list of birds that we have seen on our property, at last count 44 different species. We have seen a Great Horn Owl (Bubo virgianus), that was exciting! and many Chipping Sparrows (Spizella passerina). The last couple months we have been admiring a large female Red-tailed Hawk (Buteo jamaicensis) which seems to have taken up residence. One of our first sightings of this bird was on the ground near our garage with a freshly caught squirrel. This is a very impressive bird, the biggest Red-tailed hawk I have seen.

This species has done well in North America, the most common raptor going. One of the fascinating things about raptors is their eyes.

1. Eyes Front: The American Woodcock (an earlier blog) has eyes mounted on the sides of its head to provide more that 360 degrees of peripheral vision, the prey’s eye position. The Red-tail has eyes front and centre to keep them sharply focused on their prey, the predator’s eye position. This is not a bird that needs to worry about predators, this bird is the predator.

2. Hawk eyes: We call people hawk eyes for a good reason. As humans we can see 20/20, whereas the Red-tail has cone receptors so closely packed together, it allows them to get down to 20/2.5, a factor of eight times stronger. If you’re a mouse that is within 100 feet of a Red-tail, watch out, you are within its sights.

3. Two Fovea: The deep central fovea (centre back of the eye) has high acuity single cones packed in, and there is a second, more temporal (off to the side) fovea with higher density receptors. There is no escaping detection as a mouse or other prey.

4 Third Eyelid: Hawks have a nictitating membrane, a translucent third eyelid, which sweeps across the eyes from their temporal side to protect the eyes from damage. Eye damage would be bad. A Red-tail with eye problems would not last long in nature, no food for them. This membrane closes over the eye in strong winds providing protection from sand and debris, and also closes when drawing close to its prey, again for protection. This membrane also regularly sweeps over the eye to clean it, with the action taking a fraction of a second leaving the eyes open for surveillance.

Who knew that a lone bird on a rural property had such wondrous eyes!

Til next week,

The good doctor

Red light for treatment of dry macular degeneration (PBM)

Thu, 21 Nov 2024 17:21:47 GMT

Blog vol 5.22. Red light for treatment of dry macular degeneration (PBM)

Last weekend, I had the pleasure of attending the annual University of Waterloo School of Optometry and Vision Science, three-day conference on the latest research in eye care.

One topic of conversation was the uses and benefits of photobiomodulation (PBM).

PBM, what is it?

PBM uses low energy light, in LED form at the 670 nanometre(nm) wavelength, as a therapy for retinal problems, primarily dry macular degeneration, but possibly other conditions as well.

How does it work?

As we get older, our retinal cells deteriorate (surprised?) and the key in the deterioration process appears to be the mitochondria (the powerhouse for the cell) in the receptors, rods and cones. The receptors cells are constantly firing, requiring high levels of energy, and placing huge demands on the mitochondria. It has been found that judiciously applied infrared light actually helps restore these cell organelles.

Does PBM work?

The latest study, Lightsite III (see here ) used a clinical instrument called the Valeda, with three different wavelengths, 590 nm, 660 nm and 850 nm. This was the largest and most long-term study to date: 148 eyes over two years. The results were promising. Much more work needs to be done here.

Red light therapy, though still somewhat controversial, also can be used to enhance healing and cell repair as well as reduce inflammation body-wide. The Vielight Rx Plus, for example, was approved in Canada for use with covid-19 patients in May, 2023 (Read more here ).

“Non-invasive, portable, excellent for home and travel use, NOT to replace prescribed treatments and doctor’s recommendations” — exactly.

There, of course, is no guarantee of results, but when your vision is getting worse, it’s worth a try.

Risks?

There are no known long-term adverse risks. The treatment involves the application of low energy light, i.e. red light, to the eyes at regular intervals for relatively short times, that is all. Some negative side effects are always a possibility such as surrounding skin irritation or headache, however, the results are promising and with no other effective treatment on the horizon, the safe use of Infrared light appears to be a viable option.

What does PBM treatment look like practically?

There is in-office treatment with the Valeda, a sophisticated, office-sized machine which applies red light to the eye. This strikes me as impractical, way too cumbersome (and expensive, in money and time) for the regular, long-term application of this treatment. The take-home glasses are approved by Health Canada and make much more sense. You use them every other day for 3 minutes at a time. It is an ongoing treatment like taking your antioxidant supplements (which you should definitely continue to do).

Cost?

Unfortunately, while approved by Health Canada, there is no help from OHIP for this treatment.

I’m interested, what next?

Give us a call, come in for an appointment, and we will assess whether this is a treatment that you may benefit from and what your options are.

It is interesting that blue, high energy, light which we get from screens is potentially damaging to the eyes, especially in large quantity and red, low energy, light can be used to aid healing. Interesting. In light of this thought, blue light filters for people with retinal problems would also seem a good idea.

Continuing to research,

The good doctor

Bifocal Contacts are Worth a Try

Thu, 14 Nov 2024 20:55:19 GMT

Blog vol 5.21. Bifocal Contacts are Worth a Try

If you miss it… you miss it.

These words have been the long-time marketing slogan of Bay Bloor Radio in Toronto, started in 1946 by Sol Mandlsohn, and now operated by his son, Mark. The slogan came on before a big event like an anniversary or president’s sale or an upcoming Black Friday sale. We had our own special event at Burlington Eyecare yesterday and if you missed it, it’s NOT too late. Give us a call.

Bausch and Lomb, the makers of the first soft contact lenses in 1956 for the North American market, have been researching and developing new products for seven decades. All this work has resulted in some fancy new lenses, like the new Ultra Daily Multifocal contact lens. We introduced this lens officially yesterday at the practice, doing trial fittings for interested people. It was a very busy day.

We have had multifocal contacts since the 1980’s, so why all the hub-bub? This new lens has a lot of pluses: high oxygen transmission (healthy), specially formulated lens surface and edge design (all-day comfort), built in UV filters (protection), aspheric optics (clarity), and reading correction (no reading glasses:). Sounds too good to be true. For some people it is, but for some people who have active lives and a lot of visual demands, and eyes that will adapt, it can be a great option.

How does a bifocal work in a contact lens? Bifocals, in glasses, have two different focal points, one for distance and one for near, and the trick to using them is to direct your eyes into different zones for different viewing. The bifocal, or multifocal, contact lens works on a different basis. It relies on the pupil of your eye closing down when you are reading to use the center of the lens which has more near power. For distance, the pupil opens ups and the outer zone comes into play. Not everyone’s eyes are comfortable with this way of seeing; mine, for example, will not cooperate.

Who would benefit from these lenses? Anyone with a reading prescription who is currently wearing reading glasses or progressives can try them out. If they work for you, they can be an excellent way to go. Totally worth a try.

If you missed it… give us a call,

The good doctor

The Mau-Pata, Hospital Boat, in Brazil

Thu, 07 Nov 2024 17:07:52 GMT

Blog vol 5.20. The Mau-Pata, Hospital Boat, in Brazil.

Woke up this morning (Nov. 6) to the reality of a very political world, and unfortunately, at least on the surface, a very divided one (and to be fair, that world was there the morning before too). The hope is that we can work together, in spite of our differences, for the greater good.

This is where the work of Medical Ministry International, MMI, and the Amazon hospital boat, the Mau-Pata, is really bringing hope.

Last week we looked at the clinic they were having in Puerto Nariño, Colombia, with surgeries and dental work, glasses, and doctor’s visits. Again, the refrain: ”Just make it work!” The work of providing care is greater than the individuals, greater than the dividing politics; the boat is providing ongoing care to 325,000 indigenous people in the Amazon basin. The MMI staff could not get the necessary paperwork together for a visit to Peru last week, so it was off to Brazil. The needs are so huge that when they did set up clinic in San Antonio, Brazil, the people came from the nearby villages, and with low water levels in the Amazon, they had quite a walk, but they came.

The boat has been there since Tuesday morning and they have decided to extend their visit because of overwhelming needs, bringing help to at least three different tribes.

The pictures we are getting from Karen (our office manager at Burlington Eyecare who is there helping out on the boat for two weeks) have been breathtaking, a truly beautiful region. The team was treated to a slide show the other day which recapped the making and launching of the Mau-Pata, one year ago! We hope to be able to share that slideshow with you in the coming weeks.

Closer to home, instead of concentrating on what divides us, we should be drawing together to build each other up. I am not talking about a sentimental, ooey-gooey thing, but real, tangible ways of taking care of each other, showing kindness, and working together. I am truly grateful for the team at Burlington Eyecare, who do see the greater cause, who do pitch together to make it work, and who really enjoy doing this together every day. Keep up the great work.

Til next week,

The good doctor

Next stop for the hospital boat: Puerto Nariño, Colombia

Thu, 31 Oct 2024 20:31:36 GMT

Blog vol 5.19. Next stop for the hospital boat: Puerto Nariño, Colombia.

Last Friday the office manager at Burlington Eyecare, Karen, got on a plane for a much needed “vacation”. As they say, a change is as good as a rest. She was going not to Puerto Vallarta, but to Puerto Nariño, not to Mexico, but to the Amazon jungle.

If you have been following, you have heard about the work Medical Missions International has been doing around the world, and specifically the new work with the Mau-pata, (House of Life from the Ticuna language), a “Mercy” ship that travels through the Amazon basin as a mobile hospital clinic with onboard surgical suites.

We have had the privilege of raising awareness and funds for the eye clinic onboard and now Karen is there to help with that clinic. In fact, a whole team of people from across North America have gone to offer their expertise and help for a two-week clinic.

Karen left from Toronto, flew to Bogota, took a connector to Leticia, Colombia, then got on a smaller boat, The Rick Skinner ( named after a good friend who died October, 2015, while in Ethiopia on a medical mission trip), and travelled 75 km up the Amazon to the small village of Puerto Nariño where the Mau-pata was stopped. The only way to get there is by boat. This is in the heart of the indigenous populated Amazon basin with about 80% of the settlement's 6,000 inhabitants being from the Ticuna, Cocama and Yagua ethnic groups. The team set up there for a 3 day clinic.

Two days in, and Karen reports: “So far: Eye exams 275, glasses dispensed 263, Cataract surgeries 17, Pterygia 5, Over 200 prescriptions given out per day by the family doctors. Dental: 120 patients seen.” Tomorrow they will do some post operation checks and then prepare for the next stop.

There are the political realities of the Amazon to negotiate; instead of heading to villages on the Peru side (authorization did not arrive in time), they are going back down the Amazon to Brazil, no shortage of work.

Go Karen! Go team!

The good doctor

Nerding out about Baseball, especially Pitch Speeds and the World Series

Thu, 24 Oct 2024 16:40:31 GMT

Blog vol 5.18. Nerding out about Baseball, especially Pitch Speeds and the World Series

This Friday we will be treated to the Fall Classic, no it is not the venerable Pumpkin Pie, it’s the final matchup between the two best baseball teams in the world: the New York Yankees and the Los Angeles Dodgers. When the world feels like it is a little crazy, it is good to know that you can sit back and enjoy a longstanding rivalry. The players of course have changed, the fields have changed, the cities have changed, and they have put in a pitching clock, but it still is a timeless affair.

I have been a student of baseball for over 45 years, back to the days of the Montreal Expos. I have always been a National League guy, even though the Jays are in the American League. I appreciate the subtleties of the game, the plate count, situational pitching, hitting and fielding, sending runners, hit and run, base movement. Poetry and ballet, strength and speed.

Strength and speed are critical, however high heat on a fastball will only get you so far. No doubt a pitcher needs to have some speed his on fastball to get to the bigs, but after that the radar gun really should be put away (unless you are Nolan Ryan). Here is why:

1. Less interesting game. The distance from the pitching mound to the plate is 60 feet 6 inches and most pitchers’ release point is at around 55 feet away as they lunge into the pitch. At 90 mph, the ball takes 417 millisecond and at 95 mph, 394 millisecs to reach the plate. The average human takes about 250 millisecs to react (you could argue that professional players are not average on this point which is likely true). So there is a small difference between the two pitches (90mph and 95 mph), but the batter can still time the swing and make contact, which provides higher exit velocity. The chances are slimmer with less time, but we are splitting hairs at a certain point. So you end up with more swing and miss, and more home runs when contact is made. Result: Today’s game with lower batting averages, more strike outs, and the possibility of more homeruns when contact is made.

2. Too much damage to pitchers. Bringing the heat comes at the cost of more arm injuries in pitchers, too much throwing hard over 5 or 6 innings. The result is also short outings for pitchers, as pitch velocity is hard to sustain over the length of the game and by the 3 ^rd time through the order, the batters are usually catching up. These intense demands shorten pitching careers.

3. Pitching is an art. It is called pitching, not throwing. The saying goes: “Good pitching always beats good hitting”. The pitcher and catcher have ultimate control, and their job is to keep the batter guessing. The change in speeds, with a really good change up (10 mph down from the heat) will really throw off those heavy hitters who are settled in. The location is crucial, with the ability to locate the pitch and hit the catcher’s glove being key. Last week in the American League finals, the poor Cleveland Guardian pitchers were throwing “mistakes” at the deadliest line up in baseball with late inning homers and losses. High heat is one thing, but that fastball better have some movement, to keep it away from clean contact, the difference between a 3 run homer and an inning ending double play.

So, you may ask what is the connection to eyes? There is out of this world eye hand co-ordination, and just the love of sport.

My bold prediction: Dodgers in 7. Blake Treinen striking out Aaron Judge to finish (not so bold, but highly likely).

Go Blake!

The good doctor

Cataract surgery: the patient’s experience

Thu, 17 Oct 2024 20:38:19 GMT

Blog vol 5.17. Cataract surgery: the patient’s experience.

Last Thursday, one of my colleagues at Burlington Eyecare underwent a procedure that you do twice in your life. No, it was not having your second child or your second hip replacement. It was cataract surgery. Nowadays, almost all people will have the procedure done, one eye at a time. It can be scary, like most surgeries there are risks involved, and when it comes to your eyes and your sight, that is daunting.

The eye doctor will sometimes mention that the cataract is “ripe”. What they mean is that it is now worth the “trouble” of replacing it with an implant lens. It is important to note that this is surgery and it is a serious matter. There is an optimal window of time to have cataracts removed, because the opacity in the eye will become more and more brittle over time, making its removal really tricky.

Fortunately, we have very capable surgeons and hospital staff to refer to in our area.

The process started months ago. My colleague was referred for cataract assessment, and it was determined that the procedure would be beneficial. Next was lens power determination, where the focal length of the eye was measured with a special machine to determine the power of the implant lenses needed. The type of implant lens was decided upon, then the custom lenses were ordered and set aside for the big day. They went with a mono-focal lens to correct distance vision, and upgraded to an aspheric lens to help with night vision.

The worst eye is usually done first (unless visual impairment is present in the worst eye) and in this case, the right eye was done on Thursday. They arrived at the Hamilton Regional Eye Institute which is on the King Campus of St. Joseph’s Healthcare around 11:00 am and were admitted and taken to the Eye Centre where preparation included gel drops and a small IV to enable the administration of fluids and a sedative. Onto the gurney and into the OR, however, after this not much is remembered. During the surgery, light mostly and the whirring of a machine (a phaco machine, a machine used in cataract surgeries).

While the sedation was working, the surgeon prepped the area and made a small incision, about 3 mm in size, and through that port and a widely dilated iris, cut through the front of the capsule, removed it and then with ultrasound and suction broke down the cataract and removed it, careful at all times to not damage the capsule of the lens (the sac) where the lens implant will be centred. The anterior chamber was filled with Healon to assist implantation, then the folded implant lens was inserted through the port and into the capsule, unfolded and centered, and finally the surgeon exited the port and ensured that the eye’s pressure would secure the wound. Pretty brilliant really. (Read more about the procedure here ).

This all took 10-20 minutes, no glitches. My colleague was soon home and able to remove the eye patch. First experience: “Everything is so bright!” The cataract eye is like an incandescent light and the post-surgery eye is like LED, or high definition, which at first is dazzling. The eye looks great, a bit of redness and swelling, but healing nicely. The “patient” is using steroid drops and finishing a round of antibiotics with lots of lubrication drops, and is back to work.

The second eye is scheduled in the next few weeks, then wow! so bright, so clear.

The good doctor

Light Adjustable Cataract Implant Lenses?

Thu, 10 Oct 2024 20:56:03 GMT

Blog vol 5.17. Light Adjustable Cataract Implant Lenses?

We are always talking about protecting ourselves from harmful ultraviolet (UV) rays. We put on SPF 40 or don our sunglasses to shield ourselves because these rays pack a lot of power and can damage tissues by producing free radicals. However there are helpful uses for UV rays such as disinfecting water, curing many types of polymers, contact lens production, curing dental composites, treatment for keratoconus (a corneal disorder), and now, fine-tuning intraocular implant lenses.

In conversation with my wife’s parents this past weekend, they mentioned that Herzig Eye Institute on 96.3 FM (beautiful music for a crazy world) is advertising light adjustable cataract implant (LAL) lenses. What are they, how do they work, will they work for me, and it sounds expensive?

What:

In 1997, some physicians and chemists developed a way of using UV light to change the structure of the polymers making up the implant lenses used in cataract surgery. This makes it possible to customize the power of the implant to better correct the final vision after surgery. The outcomes from routine mono-focal implant surgery are quite good, but even after laser biometric readings and well performed surgery and implant placement, there can still be uncorrected vision. With the advent of refractive surgeries, Lasik and PRK, the bar has been raised to where the refractive outcomes after cataract surgery are now expected to equal or surpass that of corneal laser procedures.

In other words, the usual cataract surgery has good results, the vision is good. However, the final vision could be improved in many cases. We are talking fine tuning.

How:

Light adjustable cataract lenses (LAL) have a polymer that is sensitive to 365 nm wavelength, very strong UV rays, but has a filter in its back side to stop the UV from going to the retina. This UV changes the material, causing the lens to increase or decrease in power and even correct astigmatism. The fine tuning is done with 2-3 treatments of UV within the first 3-4 weeks of surgery. The beauty of LAL is that the eye prescription can be finely tuned, and unlike Lasik or PRK, it is not invasive and there is little to no recovery time.

The patient must be free of macular disease or previous bouts of corneal herpetic disease, must be off of UV sensitive medications, and must wear UV filtering lenses until treatment is finished.

$$$

This new technology requires more visits, UV filters, and more cash. The procedure has been available State side for some time with excellent results. So if you would like your postoperative vision to be as close as possible to 20/20, then this is for you. Like it or not, it is cataract SURGERY, and everybody reacts differently, healing happens differently, so a customizable lens is a great option. (Read more here ).

Definitely sounds good. I have yet to see a patient who has these lenses and I look forward to seeing the results and hearing about the experience. I’ll keep you posted.

The good doctor

From Astronomical to the Microscopic

Thu, 03 Oct 2024 21:57:24 GMT

Blog vol 5.16. From Astronomical to the Microscopic

For a while, we have had our gaze on the heavens with solar and lunar eclipses, and most recently, a new miniature moon (so cool). Moving from the infinitely big to the infinitesimally small. In September, Nikon, a world leader in photography, ophthalmic lenses, and microscopy, announced the 2024 winners of the “Small World in Motion” contest.

Nikon has had a microphotography contest since 1975 and the winning photos over the past 50 years have been nothing short of stunning. With advancements in digital photography and in digital processing and storage, Nikon started a new competition in 2011 for motion videos. My CBC news feed highlighted the top 5 winners in this year’s competition, wow! Amazing! Take a look at this year's winners here .

One of the six judges for the contest, Samantha Yammine, put it best when she stated that this competition is “the perfect merger of art and science.” The still photos are in the same league.

“These things, these things were here and but the beholder,

Wanting;”

— 19 ^th century English poet, Gerard Manley Hopkins, Hurrahing in Harvest

Hopkins’ words are a response to the glories of autumn, but apply equally well to the micro-worlds going on under our very noses as we rush about our days. The things you will see.

Mitotic waves in the embryo of a fruit fly, water droplets evaporating from the wing scales of a peacock butterfly, an oligodendrocyte precursor cell in the spinal cord of a zebrafish,… a baby tardigrade riding a nematode…

What a great contest. Thank you, Nikon.

This fall take time to go outside, enjoy the colours, the smells, the brisk breeze, and don’t lose sight of a world that is incredibly fascinating, so big AND so small.

The good doctor

Birds, Lights, and Windows

Fri, 27 Sep 2024 00:14:00 GMT

Blog vol 5.15. Birds, Lights, and Windows.

They are heading south. In the greater Burlington area, we have a couple of large portals where the migrating birds cross to go south, Long Point and Point Pelee on the North shore of Lake Erie. A busy and dangerous time. Last week, the CBC ran a story about the problem of windows and bird flight ( read here ).

At Burlington Eyecare we write blogs on any topics pertaining to eyes, eye health, and light. Birds are always an interest point, first from a purely aesthetic view, their gorgeous colours and flight, and second they are much affected by our use of light (our construction patterns), with bird populations down by a third since the 1970’s in North America.

Last October in Chicago, there were more than a thousand reported deaths from bird collisions with a single structure, McCormick Place, a 2.6 million-square-foot-glass building built in the 1960’s. ( Read more here ).

It was the perfect storm. A quick turn of the wind to the southeast gave the signal to start the southern flight from Wisconsin. Record numbers of birds crossed through Chicago and the attraction of the lights and the hazardous glass was devastating. In a previous blog we discussed the turning down of lights at night, which happy to say, has been legislated for most major centres in North America, including Toronto.

My family and I live in the country, and during the day, have had birds collide with our large glass window. What can be done? Turning down the lights at night is a great start, but, we need to make the windows more obvious to birds during the day. At our house, the offending window has since been replaced by a window of the same size with multiple panes which does seem to have taken care of the problem (we did not replace it for the birds, alas, but as part of a remodelling).

Acid etching or ceramic frit on the outer sheet of glass can help create a visible barrier. Even something as simple as installing visual markers on the outer pane can be effective. Toronto, in 2007, passed a bill that requires all new larger buildings to have bird-friendly glass installed. Netting, installed in front of the glass, is not recommended because it can still damage the bird and even capture it.

We can all do our part, by making our own windows safe for birds. Think about your windows, are they bird-safe?

The good doctor

The Shadow Knows! A Lunar Eclipse.

Thu, 19 Sep 2024 18:21:21 GMT

Blog vol 5.14. The Shadow Knows! A Lunar Eclipse.

From 1930 to 1954 there was a very popular radio drama called “The Shadow” in which Lamont Cranston, a detective with superpowers, solved crimes and apprehended nefarious criminals. The program began with the question, “Who knows what evil lurks in the hearts of men?” The shadow.

Last night most of the world saw another shadow over a Harvest Super moon, a remarkable event in the celestial calendar. Talk about drama, Marvel Studios could have made an epic movie, The Shadow on the Moon, or Shadowed Harvest. Actually in real life, it was disappointingly undramatic. I think the main reason was the crazy drama of a total solar eclipse in early April, 2024, made this lunar eclipse pale by comparison. There I was last night (September 17), having heard the word “eclipse”, expecting to be wowed by the dance of sun, moon and earth.

The word “partial” was included with “eclipse”, which makes a big difference. In April we had a “total” solar eclipse, in which the moon is perfectly placed to completely shadow the sun during midday. Last night, the lunar eclipse happened when the earth created a shadow that part of the moon passed through.

In a total lunar eclipse, the central shadow of the earth, the umbra (Latin for shadow) covers the entire moon resulting in a darkened moon which turns to red. The light that is reflecting off the moon has come through the earth’s atmosphere, much like a red sunset but a lot dimmer, creating a “blood moon”. Really cool.

In a partial lunar eclipse, part of the moon passes through the umbra, which we saw on the top half of the moon last night, and the rest is in the penumbra (Latin for almost shadow). Still quite dramatic. Over time the moon dances around the umbra emphasizing the moon’s movement through space. One neat shot from Wikipedia with multiple images overlaid with time lapse captures it nicely.

What I could not really see last night was a change in the light that was coming through the penumbra on the rest of the moon’s surface. It was really difficult to pick up any dimming, let alone a colour change. I did see a coloured ring in the clouds around the moon that did have some red tones, but difficult to say. The dimming is only by 10% when it goes through the penumbra, so you would need a light meter to fully appreciate it, I’m not sure it can be detected by the eye.

The really cool thing is that all these celestial bodies are out there moving about all the time and in very predictable regular patterns, so we know what to look for and when. The next total lunar in some parts of the world, including the Americas, is March 13/14 2025. Mark your calendars. (I think I will bring a light meter this time).

The good doctor

Contrast sensitivity to prioritise cataract surgeries?

Thu, 12 Sep 2024 19:17:10 GMT

Blog vol 5.13. Contrast sensitivity to prioritise cataract surgeries?

I read a very interesting article ( see here ) recently in the journal, Eye, that discusses the possible use of mailed contrast sensitivity tests to prioritise cataract patients, in my opinion, a great idea!

The article was a kind reminder of the importance of contrast sensitivity (CS) measurements. What is CS and why the sudden interest? CS is the ability to detect subtle shades of grey in the real-world. To give you an idea of what it is and why it is important: it is a person's ability to see low contrast images, such as a street sign on a dark roadway, a flower pot sitting on the floor of a dimly lit garage, or the step height for a sidewalk at night. Get the idea? You do see how low CS could be a serious problem causing other serious problems. CS has been around for a long time, of course, and is very important in the treatment of visual impairment, so no new development here. What is new is the idea of using CS measurements as a cost effective, accessible way to establish urgency for cataract surgery.

At your optometrist’s office you are measured for visual acuity using high contrast letters, dark black on a white background. This works well for a quick and easy, standardized method of checking a patient’s vision. The visual acuity test, however, is done in optimal lighting conditions with complete focus on the eye chart (no distractions, no movement). Realistically, these are not at all the conditions that we usually operate in; different levels of light or focus affect visual acuity. Couple less than optimal conditions with cataracts, and you have reduced CS. ( Read more here ). Other factors that contribute to a reduced CS as a person ages are smaller pupils, increased hyperopia, and media opacities (cataracts, cloudy cornea, etc.).

Optometrists have been testing CS for a long time. We test CS at different spatial frequencies (loosely this refers to lighting levels) when examining visually impaired patients. The Ministry of Transport for Ontario requires CS numbers for bioptic drivers (drivers who need prescribed telescopes on their glasses).

The mail-in test is a great idea because it is a form of triage to screen for individuals who are higher risk of falls or driving difficulties due to reduced CS. In a perfect world, all eye doctors would be versed in CSF (contrast sensitivity function), include it in their reports, and be versed on interpreting the results. This is not necessarily the case.

I have found that CS testing has even, occasionally, revealed functional problems with patients, difficulties with doing normal tasks. Conditions like glaucoma, macular degeneration, retinitis pigmentosa, and cataracts can really affect function. Fortunately, there are ways to enhance contrast, such as different colour backgrounds for reading (easy to do with e-readers) and special colour filters for glasses.

Contrast is important, very important.

The good doctor

The 17th Annual Bright Run in Support of Breast Cancer Research

Thu, 05 Sep 2024 21:36:00 GMT

Blog vol 5.12. The 17th Annual Bright Run in Support of Breast Cancer Research.

We at Burlington Eyecare support the Bright Run every year. We know, we have seen, what breast cancer can do, and we want to help find treatments, or even better, preventions (wouldn’t that be great!?).

In February of 2000, while the world was waking up to an unknown virus later called Covid, we at Burlington Eyecare had received some terrible news. Sorry Covid, but dealing with a disease as insidious and as close to home as cancer, was a lot worse. We had been walking alongside office manager, Karen, and her husband, Clint, for some time as Clint struggled with cancer, so the news of Dr. Jerilee Nyman being diagnosed that February was very real.

Jerilee, an optometrist in our office much loved by all, had metastaic breast cancer and it had spread to her bones. During a world pandemic, Jerilee and her family and friends walked the cancer journey. On February 20, 2022, 2 years later, Jerilee was taken home to be with her Lord and Saviour.

Cancer is nasty. My mother, at the age of 63 (way too young), died of Non-Hodgkins Lymphoma in 1999. We all have cancer stories.

So the Bright Run, every year on the weekend after Labour Day. September 7, 2024 at Christie’s Conservation area. Registration starts at 9:00. There is a kidzone, live music, Sunni Genesco from 102.9 hosting, food and drinks available for purchase, and, of course, pink, much pink. The walk/run/stroll begins at 10:30 and everything wraps up by 12:00. ( More information here ).

This event and fundraiser was close to the heart of Jerilee. She and her family were/are big supporters.

Come out if you can to show your solidarity with these families in the midst of their cancer struggles. Support any way you can. It is one way we can help.

The good doctor

That time again: Back to School

Thu, 29 Aug 2024 22:13:02 GMT

Blog vol 5.11. That time again: Back to School.

When the flyers and adverts from retailers start appearing in your feeds or in your mailbox, it is that time again. When I was a kid, it was time to go to Sears or Bukovetsky’s ( a local Timmins retailer) to get new, longer pants and new, bigger shoes for school, plus the new math drawing kit complete with pencils and erasers. Some of the more privileged kids got a new lunch box and matching thermos decorated with their favourite cartoon characters. I was back to brown bagging, but hey, we did have food.

Really, the start of our year is September, at least here in Canada. That is when after-school programs start up, the sports leagues, school itself, and so many other programs and events. I was always excited to be getting back to class with friends and new classes. Pretty exciting.

We have been busy seeing a lot of our younger patients for follow ups and checkups before the calendar flips. There is a lot of change in preteen bodies, and unsurprisingly, all that growth causes changes in vision. We have used the optical biometer to measure axial lengths for one year now. We can see even subtle changes and we have seen the many methods to slow myopia down working, very nice.

The research shows that anywhere from a 30-40% reduction in nearsightedness can happen when you apply the current treatment. We are seeing this with our own patients, which is really encouraging. Please get your children checked; we have included this testing with our regular OHIP exam.

We also use the Ontario Association of Optometrists Eye See Eye Learn program that provides free eyeglasses for qualifying JK’s and SK’s.

Good habits have much to do with good eye health:

Moderation in everything,

Reduced screen times (some form of governance is required),

Holding the screen further away to reduce strain,

Getting outside in that precious sunlight,

Eating a balanced diet,

Read real books, a great way to educate and a great workout for your eyes,

Regular eye checkups to catch changes as they happen.

A prosperous year to all!

Til next week

The good doctor

Support: Without it Everything Falls Down

Thu, 22 Aug 2024 20:16:48 GMT

Blog vol 5.10. Support: Without it Everything Falls Down

Last reference to the Olympics for this season, the Games do bring up a lot of interesting ideas. Much is made of Olympic athletes: their commitment, their skills, their tenacity, and their ability to keep focused under incredible pressure, but what about the athlete’s support network? their families, their coaches, classmates, friends, therapists, the salesperson at the sports equipment store, their communities.

We aren’t privy to the MANY people and situations that make up the success of each athlete. This is the part that is not visible in the competition, but without it that athlete is not there, the whole enterprise falls down.

I think that CBC did a great job of bringing this out, the parents and siblings at the games, the shots of the arenas with whole communities joining together to watch their local athlete’s live event. Getting to the Olympics is a huge commitment on the part of the athlete and their whole support network. Most athletes don’t win gold, just being there is an amazing accomplishment.

I want to discuss the reality and the crucial need for excellent support, for just as it takes a community to raise an athlete, it takes a community to take care of each other, especially to take care of those with health and vision challenges.

We saw 3 gold medals from Summer McIntosh. Summer started swimming competitively in 2014, at the age of 8, and her older sister Brooke competed internationally in Pairs figure skating. Just imagine their household routines, the crazy early morning practices, endless pool lengths, the meets, and the exams. Think of all the coaches along the way, the teachers and classmates, neighbours, fellow competitors, Mom and Dad driving and supporting them with their finances and time. All huge. Don’t forget that this is a family that wins on every level, just ratcheted up even more, and don’t forget the long-term commitment from all these people. All relatively unseen.

You get the picture. Many of my visually impaired patients get similar support from family and friends. I work with a good number of people with Low Vision (visual impairment), such as macular degeneration or glaucoma, to help them maximize their residual vision. Low vision is very involved: dealing with devastating loss, a changed life, learning all new skills, retraining, redefining yourself. For the best prognosis, family, counsellors, social workers, rehab workers, employers, and friends would help. All huge. This is long term and heavy lifting. All relatively unseen.

No acclaim here, no gold medals, but so important.

Burlington Eyecare also cannot run without excellent support, the unsung heroes that make our clinic happen. It is like life, the things that go unnoticed are often the most crucial. Every day there is always someone willing to drop whatever they are doing to help with a test or an urgent phone call, someone to get people into the schedule who need to be seen, someone to find a needed crowbar(!) or clean up a spill, and all done pleasantly. A big Thank you to everyone at the office.

“All that is gold does not glitter,” (J.R.R. Tolkien).

The good doctor

Streaming the Games and the Commercials too — Ozempic and your Eyes

Fri, 16 Aug 2024 16:17:14 GMT

Blog vol 5.9. Streaming the Games and the Commercials too — Ozempic and Your Eyes

It was great to have access to the events of the Paris Olympic Games, in spite of the many commercials. One commercial that kept coming up was an ad for Semaglutide, or Ozempic. Ozempic is prescribed as a weekly injection of .25 mg, self-administered, that helps control blood sugar levels for people with type 2 diabetes.

“Just ask your doctor if Ozempic is right for you,” was the slogan.

This drug was first introduced in 2017 by the FDA for the treatment of type 2 diabetes, and in 2021 for weight control under a different name. There has been a 60 % increase in the use of Ozempic in the past two years, with many people not diagnosed with diabetes using it off-label for weight loss. This is a drug. Every drug needs to be treated with respect. Every drug has side effects. There are good reasons why Health Canada does not allow advertising directly to the consumer for a specific drug (the FDA does not have such scruples believing that people have a right to know what is available to them. Interestingly, the FDA has recently tightened the rules about making adverse side effects clear). The relationship between the doctor and patient should not be circumvented. Bottomline, the drug companies want to sell drugs.

Every drug has a safety profile, with unwanted side effects and drug-to-drug interactions. There are several concerns about Ozempic side effects. I, of course, will stick to the eyes. A recent study by Dr. J.T. Hathaway et al. has shown a link between Ozempic and a serious eye condition called Nonarteritic Ischemic Optic Neuropathy (NAION) ( Read more here ).

In NAION, the blood flow to the optic nerve is reduced, resulting in reduced visual acuity and loss of visual field. The acuity can mostly return, but field losses are more permanent. With diabetics, the incidence is more than doubled the average person, and with those taking it for weight loss, the incidence is almost quadrupled. Admittedly, these are relatively small numbers, but this is a serious condition. The study concludes that how and why NAION occurs is unclear and whether Ozempic is the actual cause is not conclusive. More work needed here. Still worrisome.

It is one thing to use a drug with its risks to treat a difficult and serious condition like diabetes or severe obesity, it is a whole other thing to use a drug with these risks in a healthy body where other options are available. Cost-benefit.

So, if you are considering Ozempic, have a really good conversation with your doctor, going over all the risks involved. Weight loss can be facilitated in other healthier ways, again a discussion with your doctor. In the meantime, your eye doctors at Burlington Eyecare are seriously considering a set of baseline tests for visual fields and OCT angiography of the optic nerve for our patients on Ozempic.

Til next week,

The good doctor

The Games of the 33rd Olympiad from an Optometrist’s Perspective

Thu, 08 Aug 2024 13:34:31 GMT

Blog vol 5.8. The Games of the 33rd Olympiad from an Optometrist’s Perspective.

In 2021, I wrote a blog about the Tokyo 2020 Olympic games (it’s a long and sad story the discrepancy in dates, just take my word for it: Tokyo 2020 happened in 2021). That blog, and this one, bring the scintillating perspective of an optometrist to the Games. Oh, the things you would miss…

The Air Pistol competition:

One story that has gone viral at the games is the silver medal won by Yusuf Dikec from Turkey in the Mixed team 10 metre Air Pistol competition. What stood out was his apparently casual approach to the contest. He went to the line, put his hand in his pocket, raised his pistol, and fired; such a contrast to many of the other shooters (Read more here ).

There are special glasses for shooting that help to maximize sight. These were used by many of the competitors. The glasses look very odd as they have an opaque or frosted shield that blocks the non-dominant eye, and a small ring with prescription lenses and/or an iris diaphragm over the dominant eye. This diaphragm reduces your aperture or enlarges your f-stop to increase depth of focus, even having the option of putting in a filter to enhance contrast. This all looks very high tech and brings to mind cyborgs or Arnold Schwarzenegger in The Sixth Day. In contrast, you have the Clint Eastwood type from Turkey, a retired non-commissioned officer, with tons of experience who just walks up and casually, with his own glasses, nothing special, shoots, and captures a Silver Medal.

Great vision is important, but so is a steady hand, precise breathing, nerves of steel, and lots of experience.

Men’s 100 metre final:

This one is about perspective. The men’s 100 metre final was very dramatic and somewhat controversial. We watched with some of the family and all thought that Kishane Thompson of Jamaica had edged out Noah Lyles of the USA for the Gold Medal. It was the camera angle on the finish line from the CBC feed. The angle was a bit in front of the finish and created the illusion that Thompson crossed first. To our surprise, the photo finish had Lyles just ahead by 5/1000 ^th of a second. Of course, the internet blew up when the winner was announced, and the conspiracy theorists went to town. It was so close.

Tennis:

This one is about focus, and just because. I have always admired Novak Djokovic from Serbia for his great tennis playing, especially his ability to focus in on critical points of a match. This Olympics showed, once again, that there is no one better. The match is made up of a lot of points and rallies, but there are points, called break points, that make champions. In the Gold Medal match, Novak was in tough against the next great phenome, Carlos Alcaraz Garcia of Spain, but this time Novak held his serve and relied on two mini-breaks in the tie breakers to get it done. Congratulations to an intensely focussed player.

Til next week,

The good doctor

Optometric Roots and an Antique Cabinet.

Thu, 01 Aug 2024 17:54:40 GMT

Blog vol 5.7. Optometric Roots and an Antique Cabinet.

My predecessor, Dr. Ron Watson, contacted me about a piece of history that he was moving out of his house. If you know Dr. Watson, the first question would be the model and year of the MG that he was moving. But no, it was an antique cabinet that the early optometrists used to do their eye exams. He asked me if I would like to have it. Would I? For sure. I picked it up the next day from his home. Beautiful! I had seen one before at Skinners Optical in Hamilton 20 years ago, where Rick Skinner had a similar cabinet. The cabinet is wood with a tray of lenses (lots) in all different strengths which were manually selected and combined to find the patient’s prescription.

Optometry, as a regulated profession, started with the 1919 passing of The Optometry Act in Ontario. There were 4 optometrists to start, all of whom had completed a one-year course at Toronto’s Central Technical School to get their license. Not quite that far back, I had the pleasure of knowing and learning from a 1935 graduate, Dr. Ben Spence, of Hamilton, who may have used a cabinet like the one I just acquired from Dr. Watson to do his refractions.

In 1962, Dr. Watson graduated from the new school at Waterloo, which now had a four-year program for Optometry. He joined 500 other optometrists in Ontario at the time, of which Burlington had two, Drs. D.B. Freeman and R.B. Watson.

Dr. Watson started with Dr. Freeman and moved out on his own in 1965, anticipating growth in the Burlington area (Wow, was he right!). He purchased the refraction cabinet shortly after, not for use but for interest. I now joke with patients and say that Dr. Watson used that cabinet in his practice. Actually, he used a phoropter as we still do today, which has every possible combination of lenses in one mask-like unit. You know the part where we ask “Which is better? One or two?” The phoropter was invented in the early 1900s and was in common use by the 1930s.

When I graduated in 1987, the University of Waterloo had been granting Optometric degrees for 20 years and we were the first class to finally use diagnostic drops for dilating eyes. In the year 2000, there were 2000 optometrists in Ontario and by 2011, The Optometry Act in Ontario now made it possible for us to prescribe therapeutic drugs for a wide range of conditions.

Fast forward to 2024, 60 years since Dr. Watson opened his practice in Burlington, there are now over 2500 Optometrists practicing in Ontario, and the School at Waterloo graduates 90 new candidates every year. (See more from the College of Optometry here ). For context, there were less than 3 million people in Ontario in 1920 and less than 100,000 people in Burlington in 1960, compared to over 15 million in Ontario in 2024 and almost 200 000 in Burlington.

It is really neat to be part of this history, to have benefitted from many who have come before, and to have personally known a good number of them. When you come in for your next visit at Burlington Eyecare, be sure to check out the “new” cabinet in our waiting area, the first piece in our soon-to-be Optical Museum.

Til next week,

The good doctor

Orthokeratology: One Way to Manage Myopia

Thu, 25 Jul 2024 17:02:17 GMT

Blog vol 5.6. Orthokeratology: One Way to Manage Myopia

Myopia (nearsightedness) in children is on the rise due largely to increased screen time and reduced outdoor time. We can slow it down. Axial length measurements of the eye are key in early detection of myopia. This is done with a special machine called the “Myah”.

There are four known ways to slow myopia down. The one we will be looking at today is orthokeratology.

In the 1960s, contact lens fitters discovered that if they fit a hard lens flatter at the centre it would cause the cornea to “flatten” and thus change its refraction, leading to less nearsightedness. With the development of high oxygen transmission hard lenses, or gas-permeable lenses, safe and effective overnight wear became a reality in the early 2000s.

Orthokeratology lenses are designed to float on top of the eye’s tear film and apply gentle water-based (hydraulic) pressure to the front layer of the cornea, the epithelium. The hydraulic pressure causes the cells of the epithelium to move from the center of the cornea to the periphery. This migration of corneal cells leads to a temporary reshaping of the cornea and correction of the refractive error.

The new corneal periphery creates an off-centre area of defocus that helps in myopia management (actually, the same kind of defocus that other myopia treatments use). The beauty of orthokeratology is that once the nightly treatments take effect you do not have to wear contacts or glasses during the day. (Read more on orthokeratology here ).

For best results, the axial length measurement and the corneal map need to be monitored regularly. The orthokeratology lenses are worn every night as the change in the shape of the cornea is temporary. The lenses are custom fit and therefore not cheap. However, orthokeratology is a one-time fee like orthodontics.

Orthokeratology is not for everyone, not all children are good candidates. The child needs to be 9 or 10 years old for the best results. It is a really good option if you do check all the boxes. Orthokeratology can reduce the development of myopia by up to 50% and allows the child to be glasses and contacts-free during the day. Have a consult to see what works best for you and your child.

Til next week,

The good doctor

The Mau Ipata

Thu, 18 Jul 2024 17:33:00 GMT

Blog vol 5.5. The Mau Ipata

Last winter the Amazon hospital boat, the Mau Ipata, was launched. We at Burlington Eyecare raised the money to equip the eye exam room on the boat. It is very exciting to hear about the good work being done with the people in the communities along the Amazon.

These are photos and videos of the first days and the evening dredging the shore to release the boat to the Amazon.

This past April, Burlington Eyecare was able to raise $3000 through the sale of solar eclipse glasses, and those funds went to support the operating of the boat.

Why is the Mau Ipata so special? Having been on two eye care missions, to Mexico and Ecuador, I have no doubt that these clinics are much needed. I can also attest to the fact that it takes a ton of energy and resources to set up and operate a 2-week clinic. These trips will continue, especially in the remote areas of the Andes and other locales. The idea of having a “Mercy” ship that is not susceptible to the ocean waves and currents, that you can regularly maintain, that is clean and organized, and that can operate year round moving from community to community, is huge. Thus, the Mau Ipata. There are times when the boat can only go so far up the river, then smaller boats go upstream and bring patients down.

Much has to come together to make this happen, including the full cooperation of the national governments involved, which is in itself no small feat.

In the past seven months, the staff and doctors of the Mau Ipata have done many cataract surgeries, as well as pterygium and strabismus surgeries. They have checked many people’s eyes and have fitted many with prescription glasses. And that’s just eyes! They also provide much-needed medical and dental care.

Here are some pictures of patients and staff in the eye clinic and dispensary.

What a great idea! What great work!

Til next week,

The good doctor

Slowing Macular Degeneration, and Back to Melatonin

Thu, 11 Jul 2024 15:50:15 GMT

Blog vol. 5.4. Slowing Macular Degeneration, and Back to Melatonin

Last week, we looked at the possible benefits of taking melatonin. This week we are looking at AREDS —Age-Related Eye Disease Studies, which assess the benefits of different mineral and vitamin supplements.

REMEMBER macular degeneration cannot be prevented or reversed, only slowed down. The goal is to s l o w it right down. So AREDS…

The first AREDS, a six-year study by the National Eye Institute released in 2001, showed moderate benefits in the slowing of macular degeneration when using a prescribed formula including antioxidants like vitamins C and E and beta carotene, as well as copper and zinc.

Another study, AREDS 2 released in 2013, exchanged the beta carotene for lutein and zeaxanthin. A 10-year study followed and the AREDS 2 formula showed promising results in slowing the onset and progression of macular degeneration.

However, there has been some controversy as it was found that some people actually did worse on the AREDS and AREDS 2 formulas, not good. Genetic testing for alleles that are connected with macular degeneration was made available and people with complement factor H (CFH) and age-related maculopathy susceptibility 2 (ARMS 2) genes were found to progress more in their macular degeneration with extra zinc (i.e. people with certain genes did not do well with the zinc).

Genetic testing is a possibility, but now we know what to watch for, we usually start people on the AREDS 2 formula and follow up carefully. If the vision is not stabilizing, we switch to a zinc-less formula like Macuhealth.

PLEASE DO NOT USE VITAMIN SUPPLEMENTS FOR MACULAR DEGENERATION WITHOUT SUPERVISION BY AN OPTOMETRIST.

Hopefully, AREDS 3, when that happens, includes melatonin as part of the formula, since it has been suggested as a potential help.

The pineal gland produces melatonin, a hormone that helps regulate sleep (with less daylight we get more melatonin). Most of the time, our bodies produce sufficient amounts for our daily rhythms in the wake/sleep cycle. Unfortunately, as we age our pineal glands release less hormone, a likely reason for our need for less sleep as we age.

Blue light, so prevalent in LED lighting and video screens, fools the body into thinking that it has had extra daylight and triggers the gland to reduce secretion of the hormone. Thus the importance of blue light filters which Nikon has built into a lens material, a non-invasive way to increase melatonin production, a possible roadblock for macular degeneration.

Til next week,

The good doctor

Does Melatonin Slow Macular Degeneration?

Thu, 04 Jul 2024 18:12:23 GMT

Blog vol 5.3. Does Melatonin Slow Macular Degeneration?

We know vitamins E, C, and A are helpful to the health and integrity of the eye. All of these vitamins have antioxidant properties which are important for the health and healing of the retina, in particular, the macula (the central part of your vision, the 20/20 zone).

Every time a light receptor (rod or cone) is turned on by light, the cell is destabilized creating an action potential. The cell fires off, sending an impulse through the intricate network of axons through the visual system. Receptors require oxygen to perform their role. This whole process releases small amounts of free radicals that can damage the cell and surrounding tissues if in high enough concentration. The body combats these radicals by releasing antioxidants, molecules that neutralize radicals.

So far all good, but factors like UV radiation, stress, nicotine, age, and genetic predisposition are all contributing factors to oxidative stress. This is loosely what happens in macular degeneration: the body does not get rid of the free radicals fast enough and they accumulate messing up the vision. Once messed up, there is no fixing. Macular degeneration cannot be prevented or reversed, only slowed down. So let’s stall, drag our feet, throw up roadblocks…

Take supplements, eat healthy foods high in antioxidant content, protect your eyes from UV rays, stay away from smoking, and, everyone’s favourite, exercise. Could melatonin be another roadblock?

A patient this week asked about melatonin as a macular degeneration preventative. I had not heard of this as an option. Aha! Something to research!

The latest research suggests that melatonin may help slow macular degeneration ( See here ). However, this was a retrospective cohort study which means it was done after the fact with a specific group of people. Melatonin has been popular for sleep and overall health for some time. All the people in this study took a melatonin supplement over a period of time on their own initiative, a very select group (not necessarily representative of the general population), which does put the results of this study in question.

So does extra melatonin help slow macular degeneration? Only a well-constructed, double-blind study with large numbers and lots of time will give us conclusive evidence.

In the meantime, go ahead and take extra melatonin as directed on the package, don’t go crazy. We need all the roadblocks we can get.

Til next week,

The good doctor

The Stanley Cup and Eyes!

Thu, 27 Jun 2024 16:39:20 GMT

Blog vol 5.2. The Stanley Cup and Eyes!

Last November, my sons and I went to the Hockey Hall of Fame. The most impressive room was the “Great Hall”, a 45-foot-high stained-glass dome with all the inductees of the Hall of Fame and all the hardware, including a replica of the Cup. When I was a kid, I had two big dreams: the biggest, being an astronaut and travelling to the moon; the second, being a hockey player and winning the Stanley Cup.

I think Roch Carrier put it best in his memorable story, The Hockey Sweater :

“The winters of my childhood were long, long seasons. We lived in three places - the school, the church, and the skating rink

- but our real life was on the skating rink.”

I would dream of being Guy Lafleur, hair whipping in the breeze, flying down the wing, crossing the blue line, winding up, and blasting a rocket into the top corner. Being from Northern Ontario and having outdoor ice all winter long, we could do this many times. What fun!

The other night, I was really glad for another Northern Ontario boy from Sault Ste. Marie, Paul Maurice, who played junior hockey in Windsor with the Spitfires. During a 1987 preseason game, he was hit in the right eye by a deflected puck. That was a game-finisher for him. He still had sight in his eye, but his peripheral vision was diminished. He finished most of that season but had lost his edge in junior hockey, losing the possibility of an NHL hockey career. The Spitfires, however, recognized his leadership abilities and made him an assistant coach. And, as they say, the rest is history.

Hard to believe, but helmets in the NHL were not mandatory until 1979, after which all new players had to wear a “Bucket”, and goalies had to wear a mask — unbelievable that until then goalies were not required to wear a mask (thank you Jacques Plante). Hockey is partly a game of chance. The puck can bounce around like crazy to the point that there is even such a thing as “Puck Luck.” Unfortunately, it can land in places that cause serious injury, like the eye. Even more dangerous, the end of a stick blade has also ended many a career due to eye injury.

The powers that be decided to join the rest of the world and in 2013, the NHL mandated visors to protect the face and eyes of their players. Close to home, in March of 2000, a Toronto Maple Leaf, Bryan Berard, a top pick defenceman with tons of promise, had his career curtailed with a nasty eye injury. Thankfully, we have mandatory eye protection at all levels of hockey now.

REMINDER: Random stuff happens. ALWAYS wear eye protection around whirring machines (thinking weed whackers here, saw one of these injuries this week) or hockey sticks.

No doubt that Paul Maurice has had a great career as a coach and, after 26 seasons, finally hoisted the Cup. Congratulations!

Til next week, (and next year for Leafs’ fans)

The good doctor

Cataract Surgery and macular degeneration.

Thu, 20 Jun 2024 16:22:27 GMT

Blog vol 5.1. Cataract Surgery and macular degeneration.

What if you have macular degeneration and are receiving Anti-VEGF (anti-vascular endothelial growth factor) injections, can you go ahead with cataract surgery? A unique situation, but one I ran into this past week, and not so uncommon as you would think.

For 90% of patients, Anti-VEGF injections for wet macular degeneration arrest the condition, and up to 33% see some visual improvement, a wonderful thing. This treatment, any effective treatment, is relatively new. When I started practising in the late 1980s, there was no treatment that worked to stop macular degeneration, consequently, we did not worry about cataracts. This is a very good problem we are discussing.

Current cataract surgery, the removal of the cloudy lens from the eye and the replacement with a clear intra-ocular implant is a well-proven treatment for cataracts.

So far so good, but what happens if we mix the two together?

As we go along and develop new procedures we meet with new dilemmas. In the past, most wet macular degeneration patients would lose substantial vision, to the point that cataract surgery would not be done because very little improvement of vision would be attained. Not worth the risk. But with anti-VEGF injections, most patients can be kept at a functional level of vision, so cataract surgery becomes helpful.

Long-term studies, like AREDS2 ( see here ), have found that cataract surgery does not significantly affect the macula. That is good. In 2019 a study was done co-ordinating the two procedures (we are not the only ones wondering about this): anti-VEGF treatments for wet macular degeneration and cataract surgery ( see here ). This study found that the injections did not detrimentally affect the cataract surgery outcomes.

Not surprisingly, the consensus among retinologists (ophthalmologists who specialize in retina issues) is that the wet macular degeneration has to be stable before attempting cataract surgery. The person receiving injections must a have stable retina, as judged by the retinologist, and then be scheduled for surgery.

If you are in this situation, make sure that the injections are working, then look into cataract surgery. We see a lot of people after cataract surgery, and we see a lot of people getting injections. Outcomes have been very promising.

Til next week,

The good doctor

Combining myopia treatments may be the best option

Thu, 13 Jun 2024 16:03:30 GMT

Blog vol 4.52. Combining myopia treatments may be the best option.

The latest study in Eye, the official journal of the Royal College of Ophthalmologists, shows the advantage of combining therapies for myopia, especially in older children. This is great news, especially if the eye doctor needs to get a little more leverage on the myopia. We have known for some time that single therapies such as atropine drops, orthokeratology lenses, or defocus lenses in spectacles or soft contacts each help to significantly reduce myopia development.

Knowing that each of these treatments works in different ways, it has been theorized that a combination could be even more effective. The retrospective study by Tang et al. ( see here ) has shown the effectiveness of putting atropine drops and orthokeratology lenses together. The atropine drops are used once nightly in each eye and the corrective glasses or contacts are worn as prescribed.

As a parent, all you need to do is bring your child for a regular eye exam and we will measure the axial lengths of your child’s eyes, and then track their progress. Early intervention is always best and regular monitoring allows the best results. We see children as early as six months, but myopia treatments are not necessary until at least 5 or 6 years. It is good to watch how your child’s eyes develop over time to see if the changes as they grow are trending toward myopia.

Now, myopia is not the end of the world and if your child has never had their eyes examined you have not done them terrible harm. You are not a bad parent. Myopia (near-sightedness) is on the rise in many parts of the world in a really really significant way. This increase of myopia and the severity of that myopia can be linked to the time we spend on near-work, such as screens and studying, from a young age. Of course, myopia can be corrected by glasses and contacts or laser surgery. So why the fuss? Myopia, especially high myopia, significantly increases the risk of other eye problems. If it can be kept under control at the start, wonderful.

An aside, and a step further back, I strongly suggest to parents, as a preventative measure and to ensure your child’s overall health, that you seriously consider screen time management and, when possible, encourage outdoor play. Time outdoors has the added benefit of building distance vision, an excellent myopia prevention.

SUMMARY FOR PARENTS

FIRST : SCREEN TIME MANAGEMENT.

SECOND : OUTDOOR PLAY.

THIRD : ANNUAL EYE EXAM.

In spite of our best efforts, myopia still happens. With this study confirming our practical experience, we are primed to mix and match treatments. Myopia management requires personalized care taking into account age of onset, rate of progression, and lifestyle. If you want the best results, combo therapies appear to be the way to go.

Til next week,

The good doctor

Maui Jim Day at Burlington Eyecare! Mahalo

Thu, 06 Jun 2024 21:18:26 GMT

Blog vol 4.51. Maui Jim Day at Burlington Eyecare! Mahalo.

It is a Hawaiian word which has a rich meaning, according to Wikipedia, "Mahalo" means thanks, gratitude, admiration, praise, esteem, regards, or respects. One word, much meaning.

When you come to Burlington Eyecare this Saturday, June 8, be ready to be greeted with “Mahalo”. It is our annual Maui Jim Day, the day in which we get every Maui Jim sunglass model, colour, and lens under one roof, and we invite you to take a look. We always have a selection of Maui Jim sunglasses on display and we can always order in whatever colour frame or lenses or style of sunglass you’d like to try. This works well, but Saturday is your chance to try whatever sunglass you like in person, on the spot, in succession. This is a lot of fun and you’d be surprised what looks good when you actually have it on your face. There are some really nice sunglasses in the Maui Jim line — whether your style is cool and with-it, classic and sophisticated, trendy and fun, or uniquely your own.

With summer upon us, this is the time to think about sun protection for your eyes (very important). Some things to remember:

1. Not all sun protection is created equal. A lot of people buy sunglasses at the dollar store, gas station, or drug store. These sunglasses may do in a pinch, but have poor optical quality (you do get what you pay for most of the time). In Canada, all sunglasses must have UVA and UVB protection, but that is all.

2. Optical quality, really good lenses, do make a difference. That is why we appreciate Maui Jim sunglasses. They have crisp optics, even “digital” enhancing in certain wavelengths, complete polarization, and state of the art coatings (blocking UVA, UVB, UVC, and Blue light for when you are on your screen). When we dispense this product, we know we are getting you the best.

3. Service. Maui Jim always comes to the party. On the rare occasion when there is a problem (breakage a possibility), there is full warranty. It makes our job easy, getting parts and ensuring that you are a satisfied customer.

So, when you are out and about on Saturday, stop by Burlington Eyecare for a taste of Hawaii (complete with door prizes, treats, promotions) and a chance to see and try on some great sunglasses.

DESTINATION: SATURDAY, JUNE 8, 2024, 10:00 A.M. - 2:00 P.M. AT BURLINGTON EYECARE, 3235 FAIRVIEW STREET, UNIT 7

And when we say Mahalo, you get ready to answer, “A'ole pilikia” (no problem).

The good doctor

Why a diamond ring effect in a Solar Eclipse? Ask me! Ask me!

Thu, 30 May 2024 18:23:42 GMT

Blog vol 4.50. Why a diamond ring effect in a Solar Eclipse? Ask me! Ask me!

The eclipse was truly awesome. The best part is that we went out our front door and there it was. In our location, Burlington, Ontario the moon started shading around 2:45 and went totality at around 3:20. We watched the whole thing.

1. The overall light got gradually dimmer as the shadow increased, weirdly so, not like evening. For us in Burlington, thankfully, the clouds cleared just in time for the eclipse!

2. As we got closer to totality, we looked for shadow bands, where finer and finer “waves” of light and dark increase in intensity up to totality. Could not see them, but my family at home in Jerseyville, out in the country, did pick them up on the gravel driveway.

3. We watched for Baily’s beads and any diamond ring effect as the corona developed, but no such event on the left side of the moon.

4. Totality. Cannot see the sun with the solar eclipse glasses, so off they go, and voila. Was not total blackness, one likely reason is we had our street lights come on and our overhead sign. The horizon looked like it was on the verge of dusk and it was 360 degrees around. Again, really cool.

5. Speaking of cool, the change in temperature was palpable.

6. Coming out of totality, then we saw it, the diamond ring, at around 2:30, right on the edge, and did it shine. Beautiful.

7. Someone turned on the lights, and we put our eclipse glasses on again to catch the moon’s shadow now finishing its pass.

The shadow bands are not always visible. With snow or concrete on the ground and with less general light, these bands can be seen more readily. However, some people online who have seen multiple eclipses have never seen the bands or only seen them once. My family had never heard of shadow bands but observed the rippling light on either side of totality and thought it was odd. They did not realize how fortunate they were, a little jealous, honestly.

Several theories on what happens here: one is diffraction slits as the light from the corona reaches us, but more likely it is the “twinkling” effect we get when looking at stars, the light, coming from a finer light source, is altered by the earth’s atmosphere as it reaches us. ( Read more here )

In light of all this (no pun intended;), I saw some very interesting things the other night when I got out an 11-inch Celestron reflecting telescope (a really good friend of mine lent it to me) to take a look at the moon. A clear night and 500 X power allowed me to see details on the moon that I did not think possible. I saw a huge “canyon” on the edge of the moon at 10:30 (reversed with Star diagonal, so really at 3:30). The first light that peaked out of the corona during the eclipse was right there, giving us the diamond we saw. The crevice was so huge, it left no doubt that this was our diamond maker. I also found out that the face of the moon rotates on us through the year, always the same side facing us just positioned differently, so full moons look different over a calendar year, did not know this. As a result, the diamond will be in different positions in different eclipses. Breath-taking.

Stay tuned for more astronomy topics as I get into the world of astrophotography, the good people at Nikon, are going to help me make this possible. Now that I am inspired, watch out.

Til next week,

The good doctor

Who knew that the weather has so much to do with our eyes?

Thu, 23 May 2024 06:03:51 GMT

Blog vol 4.49. Who knew that the weather has so much to do with our eyes?

The Weather Network is a great online source for local weather, providing up-to-the-moment weather data. It is like having your own personal meteorologist. It is not like your grandmother’s weather report: temperature, barometric pressure, wind speed and direction, and cloud cover. The Weather Network has daily high and low temperatures, humidex readings, air quality index, UV index, pollen counts, current radar data, daylight hours, phases of the moon, the seven-day forecast, the fourteen-day forecast, and even bug reports.

What does this have to do with eyes and eye health? Everything. Read on.

Poor air quality affects the heart and lungs, pretty important to the body. Body health = eye health. And if you are a naturalist, a birder, or an astronomer, poor air quality will affect visibility even through your Nikon binoculars or telescope.

High UV index means harmful sun rays. Time for SPF 40 sunscreen, sun shades (we like Maui Jim), a wide-brim hat, and conservative amounts of sun exposure to the skin and the eyes.

High pollen counts trigger seasonal histamine production (allergies), requiring anti-histamines, oral and/or eye drops, a mask to screen pollen from your air passages, and other symptom-reducing measures. My sympathies to all of you allergy sufferers out there.

Bug reports tell of mosquito, black fly, and deer fly numbers (for good reason), but they also indicate high insect activity, like deer tick numbers (carriers of Lyme disease). Again, body health = eye health.

Just for fun, the phases of the moon, for night walks, and you more astrological types. The full phase will detrimentally affect your view of the night sky, ironically, though it will make for a lovely nighttime walk.

Impending rain, snow, storms, or fog affect road visibility. This affects your vision though there is not much to do about it except stay off the roads when possible.

All of this eye and vision information, and all from one report.

Til next week,

The good doctor

Artificial Intelligence and Optometry

Thu, 16 May 2024 18:51:07 GMT

Blog vol 4.48. Artificial Intelligence and Optometry.

This week we take a look at Artificial Intelligence and the field of optometry. Our latest student at Burlington Eyecare recently expressed concern about AI making optometrists obsolete. Well-founded, in that AI is developing exponentially, appearing limitless in its potential.

My hope is that you can see that we do not use ChatGPT to generate our essays and blogs. One of my sons is a PhD candidate and helps teach undergrad courses at a local university. The faculty and staff at these institutions can tell pretty quickly if students are using this technology to write their assignments and are devising ways to make it difficult.

The chatbot is built on large language models (LLMs), which recognize and generate text. The LLMs are trained on huge sets of data and are built on machine learning. In the field of optometry, the hope is that these LLMs will analyze large data sets, generate differential diagnosis lists, and provide fairly accurate responses to questions about eye disease. The latest research shows that there are limitations to this technology.

Currently, the LLMs have the propensity to “hallucinate”, or better stated, to confidently generate false information, and they also can perpetuate biases in medicine. AI technology is still developing and these limitations may be overcome in time. ( Read more here ).

As clinicians, we have to remember not to turn off our brains and let technology do our work. The algorithms built into the LLMs have inherent limitations: they have to be setup and programmed by someone, with certain biases in place. We cannot blindly use technology but must see it as a limited tool to help our work. I like to speak of Right and Left brain at this juncture. AI is mainly Left brain, concerned with data and logic, the clinician’s art of caring for human beings is heavily Right-brained, visual, intuitive, and creative.

The ideal clinician has great communication skills and is good at hearing what is being said, not just the words but what the person is actually experiencing. Since we work with human beings who are all unique, every one, as good as AI can get, we will always need the human element to provide the best care.

As Caroline, our Aussie staffer tells us, “No worries”.

The good doctor

Do go outdoors, AND Do a quick tick check.

Fri, 10 May 2024 06:57:09 GMT

Blog vol 4.47. Do go outdoors, AND Do a quick tick check.

Try saying “quick tick check” 10 times fast…

I take a week off at the beginning of May each year. I spend most of the year working inside in a dark room; it is time to get outside. I am positively itching to get out. I clean up flower beds, trim bushes, transplant, dig, clean out the garage and the car, open the pool, outdoor work. In our spare time, we walk at the RBG in Hamilton, around our neighbourhood, or sometimes in a really good year, a special destination (this is a really good year, folks, can’t tell you where we are going, it’s a secret).

So no big blog this week, just a reminder to be on the lookout for deer ticks. This is the annual infomercial on the perils of ticks and Lyme disease. Consider yourself warned. We had a warm winter and that is good for ticks. ( Read more here ).

Be vigilant, but do get outside. It is so lovely this time of year. There is so much to see. Do not let a little tick scare you off, with due respect to the tick.

When you go back inside do a check. Refresh your mind on what you are looking for and what to do. LINK FOR LYME DISEASE CANADA

Then enjoy.

I have seen a “Tick Key” for sale by the cash at the local store. This works for larger ticks, but you will still need tweezers to get the smaller nymphs and ticks.

Have a great week.

The good doctor

Milestones and history

Thu, 02 May 2024 05:31:48 GMT

Blog vol 4.46. Milestones and history

This weekend our Church, Jerseyville Baptist, is celebrating its 200 ^th Anniversary. The lead-up to the event has been involved: organizing a festive dinner, posting festive signs, lining up speakers, inviting guests, finishing off a 200-year history, making cookbooks, preparing for fireworks, stitching quilts, and countless other details. My wife, Mari-Lou, took on the task of updating and expanding the history written for the 150 ^th anniversary in 1974 by Floris Van Sickle, an all-consuming task.

As we look at a history, you really appreciate the work of historians. Donald Creighton, the renowned Canadian historian, once wrote, “History is the record of an encounter between character and circumstance.” Interesting thought.

I am aware that this is a blog about eyes and eye health and anything to do with light and eye science. After countless blogs, one may correctly conclude that this is a wide-ranging topic: from the Webb telescope’s findings in deep space to nanoanalysis of maple syrup, from bird migrations to the ground-breaking work on fizzled receptors for macular repair. The history of all this is fascinating, and as Creighton suggests, there are resourceful and persistent people who stretch the envelope, ask the questions, and look for answers in their time and place.

The last 200 years at Jerseyville Baptist speak of this reality. Many people who, day to day, persisted in living their lives out, doing the work of the Church, sticking together, and holding onto the bigger picture. There is a prize for sticking it out, for showing up, and it is quite attainable — nothing special, just lots of continued care, every day, over many generations.

We are just getting started at Burlington Eyecare. In 1965, Dr. Ron Watson set up his own practice at Wellington Square. He wanted to provide excellent eye care to the people of Burlington. Dr. Nancy Wilson (Shaver) joined him in 1976 when the practice moved to Fairview Street. As I look back at the history, the common thread has been a commitment to providing excellent care. I speak for Drs. Watson and Wilson as well as the current doctors when I say that we are thankful for the trust that people have put in us over the years. It is truly a gift.

You trust us to provide the best possible care and timely, appropriate treatments, to take each and every person seriously and respectfully, to make excellent products available, and to gladly service any needs. It takes a commitment over a long period to make this all happen. A special shout out to my excellent staff, opticians, and doctors who all have this culture of care in their veins.

As we celebrate our 60 ^th year at Burlington Eyecare, we are thankful and encouraged. It may not be the 200 years of Jerseyville Baptist but to get to 60 years takes a lot of continued care, every day, over many years.

Now I had best go see my next patient...

Til next week,

The good doctor

More Results: A Treatment for Severe Dry Eyes, That Works!

Thu, 25 Apr 2024 19:31:33 GMT

Blog vol 4.45. More Results: A Treatment for Severe Dry Eyes, That Works!

In August of 2023 I did a blog on autologous serum, which is when the patient’s own blood is drawn, and the plasma is used to create eye drops. That was cutting edge at the time. This is what I love about the scientific method and the development of new technologies. Sometimes the discoveries are paradigm shifting, they get us out of our ruts and open new horizons of discovery. The using of serum to create patient-specific eye drops was ground-breaking.

The next step: Endoret. The previous autologous drops separated the platelets from the plasma with a centrifuge (think of it like a very fast salad spinner that lets the heavier platelets settle out). These platelets have blood clotting agents, so they were removed, BUT they are also rich in growth factors. These growth factors help promote healing of tissues and repair damaged ones. ( Read more about Endoret here ).

Drum roll, please. You do know what is coming?

In the new process, the blood is drawn, and the platelets isolated and treated so that these growth factors, called cytokines, are now included in the serum. These cytokines bind with receptors on the cell membrane which triggers the cell’s machinery to produce new cells. The result is tissue repair and growth in places where cell damage and death were occurring. This is ground-breaking for severe dry eye conditions like Sjögren’s syndrome, which result from your own immune system attacking the connective tissue of the eye (and other parts of the body, we are just talking eyes here).

In the past, we have thrown everything at these patients: lid treatments, non-preserved lubricants, cyclosporine drops, punctal plugs, scleral contact lenses, but still no relief. The first patient I sent for the Endoret treatment has returned, and the results are dramatic. The patient had 3 months of drops made, which they keep preserved in the cold until opened. The patient then uses the drop three times a day. The drop actually heals the tissue, with a lot less dryness and no dead cells noted on staining. The only drawback is the price which currently (April 2024) is $800 for a three-month supply.

This technology is useful in other areas of medicine as you can imagine. In fact, my daughter was treated for a knee injury in 2017 using her own blood to form PRP (platelet rich plasma) which was then injected into the injured area. The results were disappointing, not being clear whether the injections made any real difference. There is potential here, however, and the eye drops are VERY effective.

This is life changing for people with severely dry eyes. Dry eyes can be debilitating as they interfere with vison especially at night, cause ongoing discomfort, and increase the risk of damage and infection of the cornea. We are very excited to have a treatment that works, and we are excited to see people relieved of this burden, how awesome is that!

Til next week,

The good doctor

Exciting Results: Myopia Management in Children

Thu, 18 Apr 2024 18:50:09 GMT

Blog vol 4.44. Exciting Results: Myopia Management in Children

Myopia: nearsightedness, i.e. near things are clear, far things are not.

The current thought is that, while some children have a genetic predisposition for myopia, this myopia can be reduced by intervening early, the earlier the better. Myopia can also be induced or exacerbated by excessive use of near vision (phones, studying…) and minimal use of far vision (little outdoor time, playing sports…), and this also can be “managed”.

Myopia amongst children has been increasing at enormous rates, both the incidence and the degree of myopia. The idea of managing or controlling the degree of myopia is a response to this situation which, I must say, I was hopeful about but not overly so.

We have seen some excellent results.

In 2015, mounting evidence for myopia management was on the horizon. Along came the pandemic in 2020 and the perfect storm of more indoor time and more screen time boosted the severity and the number of cases of myopia. In the latest issue of Eye (found her e), there is a very telling editorial on this subject.

Even though the evidence has been mounting and researchers have done a great job of providing treatment modalities, eye professionals and the public have been slow to adopt these changes.

We are creatures of habit, for good reason. Taking on new technologies, and adopting new paradigms takes a ton of energy. We also by nature are quite lazy. Look how long it took for the Church to finally agree with Copernicus that the Sun was at the centre of our Solar system and not the Earth (hint-Galileo was finally forgiven by Pope John Paul II in October 1992, 359 years later). An extreme example, but you get the point.

In 2016, we at Burlington Eyecare decided to put all our adult patients on the optical coherence tomographer (OCT). By making it universally available, we changed the way we practice. With all this great data we have collected over the past 8 years, we can key on specific biomarkers that radically improve our ability to detect early disease changes in the eye. We have 4 ^th year optometry students in our clinic and they cannot imagine practicing without the OCT. That was a paradigm shift.

We are experiencing another paradigm shift.

In the case of myopia management, we know that certain environmental conditions increase myopia development. We have some great data that shows that outdoor sunlight, screen time, and even diet all affect vision. The World Council of Optometry in an April 2021 statement has resolved to take the problem head on, encouraging education, providing early detection of myopia, and getting the many available treatment possibilities to the patients.

This past summer, we started measuring the axial lengths of all our youngsters, as early as 3 and 4 years old. Axial lengths are a reliable predictor of myopia risk and are measured using a Myah machine. This test is now part of a regular children’s eye exam, the new standard of care. Almost a year in, and we are already getting data showing the clear slowing down of myopia development when we treat at-risk children. This is very exciting! We have been very impressed with the results so far.

This is a paradigm shift, just like the OCT. I have been in practice and breathed the air long enough to know that anything worth doing takes energy, hard work, perseverance, and patience. I know we are on the right track, and all there is left to do is to see it through, to tweak it as we go, and to find viable and cost-effective ways to help manage the disease.

So, in conclusion, ALL children should get their eyes examined early (entirely covered by OHIP).

Til next week,

The good doctor

WOW!! How AWEsome was that!

Thu, 11 Apr 2024 05:42:28 GMT

Blog vol 4.43 WOW!! How AWEsome was that!

For a solar eclipse to happen and to be experienced many things have to align, literally: the sun, the moon, the clouds, the location, and the proper eye protection. The clouds did disperse in time, just.

On Monday in front of Burlington Eyecare at 3:00 pm EST, we stepped out our front door and donning our solar eclipse glasses, we experienced totality. Overused, but that was totally awesome!

We gave out 7500 pairs of eclipse glasses over the past few weeks to schools and patients and then waited. Instead of payment for the glasses, we collected donations, and we raised $3000 for our Medical Missions International (MMI) hospital boat, the Mau Ipata, ( Learn more here ) another totally awesome. A BIG thank you to the front desk and our patients for your fine and generous support of this cause.

Now the dark underside, eye injuries from looking at the sun unprotected. The internet was deluged with Google searches immediately after the event, see chart. That was fascinating to see. We received several calls and had emergency visits with patients on Tuesday, but thankfully, no permanent damage.

The dilated pupils, from the dim lighting, allow a lot more light in and increase the risk of solar burns. Symptoms, such as eye pain or vision changes, appear within hours or days of the injury, and anyone experiencing symptoms should seek medical attention immediately.

The other dark side is that all these glasses we gave out to shield our eyes end up in landfill sites, not very environmentally responsible. A solution. The good people of Southern Chile and Argentina are going to experience totality on October 2, 2024. My front staff are collecting the used glasses to be sent down to South America for this event.

Stop by the office and drop off your solar eclipse glasses. Do not throw them out, let someone else safely experience totality.

An event like the eclipse gives us a greater appreciation for the outdoors, for nature, for taking care of our planet… just for the wonder of it all.

Again, that was TOTALLY AWEsome!!!

Til next week,

The good doctor

The Eclipse and your Eyes, the facts

Thu, 04 Apr 2024 18:08:41 GMT

Blog vol 4.42. The Eclipse and your Eyes, the facts.

There are a lot of misconceptions about the upcoming Total Solar Eclipse, happening Monday in most parts of central to eastern North America.

Last total solar eclipse visible in Hamilton: January 24, 1925.

Soon: April 8th, 2024.

Next: October 26, 2144.

So don’t miss it!

In our solar system, there are over 200 moons that orbit 6 major planets and the Earth’s moon is the only one that is the right size and the right distance between the sun and Earth to produce a total eclipse. A special shout out to Clint and Karen for showing us, through their telescope, the shadow of Ganymede (largest moon in our solar system), which appeared very small as it transited across Jupiter, amazing, but no total eclipses there.

But is it safe to look at it? Can looking at the eclipse hurt my eyes?

No, it is not safe and yes, it can hurt your eyes.

Since we were little kids, we have always been told to not stare at the sun. For a fleeting second, it is permissible, but actually cannot be helped especially when the sun is on the horizon. But do not stare at the sun. Remember when you were a kid and took a magnifier outside and you put it in the sun and then focused the sun’s rays on some dry leaves or a piece of paper? The ultraviolet (UV) light in the sun’s rays was concentrated on one point and the energy was enough to incinerate paper. The same thing can happen to the eye.

When UV light from the sun enters the eye, it’s focused through the lens and cornea of the eye and onto the retina at the back of the eye. The retina is the light-sensitive tissue lining the inner surface of the eye. Once absorbed into the retina, the UV rays result in the formation of free radicals. These free radicals start to oxidize the surrounding tissues. They ultimately destroy the rod and cone photoreceptors in the retina. The oxidative damage is referred to as solar or photic retinopathy, and unfortunately, it can be permanent.

Solar eclipse glasses are necessary.

Do not look at the sun through binoculars or any other magnifying device. This actually makes the damage worse, because the affected area of burning becomes enlarged.

What you will see on Monday, if we get a sunny sky, is the shadow of the moon coming across the sun and gradually coming to a position of totality with the greenish corona peeking out of the edges of the moon’s umbra. Just before and just after totality you should be able to observe the diamond ring effect, where the corona gets a little brighter at one point and looks remarkably like a diamond. I cannot help but think about my wife’s parents, Hubert and Irene, who are celebrating their Diamond Anniversary right at this time. The heavens are putting on quite a show for a very special couple.

Til next week,

The good doctor

P.S. We still have a limited supply of solar eclipse glasses, come pick up a pair at Burlington Eyecare.

The case for regular eye exams for ALL ages

Thu, 28 Mar 2024 08:02:15 GMT

Blog vol 4.41. The case for regular eye exams for ALL ages.

This past week was a bit sobering. At Burlington Eyecare, we have a regular intern in their 4 ^th year of the University of Waterloo Optometry program. The intern was doing a “routine” eye exam on a 44-year-old patient, no family history of eye problems, no complaints, supposedly normal eye pressures, just very routine.

After a regular exam, test results showed that the patient may have the beginnings of glaucoma, not statistically likely at all. Usually, this condition has some genetic component, not this time. After doing a visual field test, we confirmed the diagnosis and got them an appointment with a glaucoma specialist in Burlington ASAP.

In my conversation with the intern, the question arose, how would we have picked up this early onset of glaucoma in the past? A careful look at the optic nerve, a measure of the pressures, and the corneal thickness would not have detected this one. In 2004 we brought in digital photography of the retina, and then in 2009 we stepped it up and got our first optical coherence tomographer (OCT, which measures the structures of the front and back of the eye). In January 2016, our clinic made the decision to put all our patients, 19 and older, on the OCT. One of the best things we ever did. It picks up early structural changes to the eye, small changes, that help us to detect conditions very early on.

This is very good news.

But it only works if we use it on your eyes.

Regular eye exams, folks.

We knew that the OCT gave us valuable information, but the price was very expensive. We had a dilemma: how do we use this technology with patients without breaking the bank (theirs or ours)? It really is that helpful. We cannot see these early changes any other way. The OCT is not OHIP covered at all, so we decided to charge a minimal fee to do the procedure, spreading the cost, and making the test available and affordable for everyone. The staff and doctors have gotten quite good at working with the OCT and it has paid dividends.

Back in 2004, the government stopped paying for eye exams for 20 to 64-year-olds, and we have seen a huge drop in the number of people in this group getting their eyes checked. The patient this week in this unOHIP-covered group, had their glaucoma caught early. If this person waited for symptoms to show up before coming in for an eye exam, there would be permanent, substantial vision loss. We are so glad they did come in, a really wonderful thing!! It is true that most peoples’ eyes are going to be fine but consider a visit to your optometrist inexpensive insurance. Being able to see well is good.

Get in for a regular eye exam, especially you 30 and 40 years old’s. We see your children; we need to see you too.

Til next week,

The good doctor

P.S. The distribution of solar eclipse glasses is a hit! Mark your calendar: APRIL 8, FULL SOLAR ECLIPSE, right here in Burlington! Need eclipse glasses? Come pick up a pair at Burlington Eyecare anytime.

Drug-releasing Contact Lenses

Thu, 21 Mar 2024 21:10:10 GMT

Blog vol 4.40. Drug-releasing Contact Lenses

Back in 2022, Health Canada approved the use of a revolutionary method of drug delivery to the eye. Johnson & Johnson had developed a contact lens called Theravision which allowed a patient to wear a daily lens that released a reliable antihistamine, ketotefin, slowly over the course of the day. Some of our patients are on them and they do work. Two advantages: no preservatives involved (the usual antihistamine drops have preservatives in them) and the patient gets full-day coverage. Unfortunately, J & J has decided to stop distributing these lenses in Canada.

The idea of using a contact lens for delivering a drug is groundbreaking.

The results from a phase 2b study on a new contact lens with glaucoma therapy have just been released ( available here ).

This lens is a silicone hydrogel, unlike the HEMA material of the J & J product, and it is worn extended-wear for three weeks (24/7). During that time, the drug, bimatoprost, a proven anti-glaucoma agent is gradually released. Results are promising: pressures were the same as when using a drop of 0.01% bimatoprost nightly (the standard treatment for glaucoma), but no nasty preservatives, no missed drops, and no improperly administered drops. The contact lens releases directly on the eye with less potential side effects and even contains a lubricant.

This is very promising. It is just the beginning. Imagine being able to infuse a lens with any number of therapies, be it antibacterial, anti-inflammatory, antiviral, antifungal, or for dry eye therapies, growth factors. The company, Mediprint Ophthalmics, will now be conducting phase 3 studies with the hope of bringing this technology to market.

What a good idea! The tricky part would be to ensure that the drug is released consistently and gradually over the whole period of wear. If this is attainable, these lenses could lead to improved, more consistent treatment results for all patients, a very worthwhile achievement.

Til next week,

The good doctor

P.S. Just received all our pairs of solar eclipse glasses! Mark your calendar: APRIL 8, FULL SOLAR ECLIPSE, right here in Burlington! Need eclipse glasses? Come pick up a pair at Burlington Eyecare anytime.

Getting ready for the big event: Total Eclipse

Thu, 14 Mar 2024 23:37:49 GMT

Blog vol 4.39. Getting ready for the big event: Total Eclipse

Anytime you have a big event, like a wedding or big anniversary, there is a lot of build-up and preparation. Back in spring, 2017, I came across a news feed on a solar eclipse that was going to happen on August 21, 2017. It fired up my imagination. Clint (the husband of our staff, Karen), who wrote software for planetariums and was a big space nut, made it to Tennessee with his oldest son to experience totality. Awesome stuff, in the real sense of “awe”.

Totality is when the moon completely blocks out the sun during the day.

Totality is short-lived and follows a certain path. It happens in your vicinity very rarely. Those of us in Burlington had about 60-65% blockage on that August afternoon back in 2017. The conditions were great and the time of observation was really memorable. In spring, 2017, we invested in 1000 solar eclipse glasses for our patients, sold them for $2 a pair, and raised $1000 for Medical Missions International (MMI, where your used glasses go). So many good things happening at once.

You can imagine our excitement when we found out that on April 8, 2024, we would have totality right here in the Golden Horseshoe, our backyard! Again we have ordered solar eclipse glasses. In the industry, there has been some question about the quality of the glasses from some of the suppliers. Do the lenses actually meet up to the necessary specifications required to protect the eyes? The lenses are supposed to meet the ISO standard 12312-2, which specifies levels of uniform transmittance of ultraviolet, visible, and infrared wavelengths that reach our retinas. We do NOT want to be giving our patients glasses that do not do what they are supposed to do. Despite the quality assurance of the company we are dealing with, we opted to verify the standards ourselves.

I have a colleague at the University of Waterloo, Dr. Jeff Hovis, who has helped me on another occasion, during COVID. I was looking for a way of using UVC to disinfect hard surfaces in my clinic and Dr. Hovis was able to measure UV emission from a commercially made light from the USA. Nothing substantial came of that, a good idea but… still working on that. However, the relationship is ongoing.

I sent 5 new pairs of glasses to him and 2 pairs of leftovers from 2017. All 5 of the new pairs met the ISO standard, yeah! BUT ONE OF THE OLD PAIRS DID NOT, oh no! It would appear that some degeneration occurs over time. The literature coming out supports this.

The moral of this story: Only use new pairs, throw out the old ones so you do not use them .

We should have all the new pairs in our hands next week and if you need a pair, contact our office or drop by. Any money raised from the sale of solar eclipse glasses is going to MMI to fund worldwide eye care. We are having a little party outside our building on April 8, 2024, at 3:18 pm, so if you want to join us, we’d love to see you.

Mark your calendars and THROW OUT ALL OLD PAIRS OF SOLAR ECLIPSE GLASSES.

Til next week,

The good doctor

Now that is “progressive”!

Thu, 07 Mar 2024 20:49:00 GMT

Blog vol 4.38. Now that is “progressive”!

You have to admit that the gurus of “Madison Avenue” in New York City know what they are doing. As Juliet so aptly asked in Act 2 of Romeo and Juliet, “What's in a name? That which we call a rose, by any other name would smell just as sweet.” So when some very bright marketer came up with the name, “progressive”, to describe multifocal spectacle lenses, they struck gold.

Since 1959, the optical industry has been working with “invisible” bifocals. Before that time, (actually, it started in the 1700s with Ben Franklin) we had lined bifocals, which had either a straight line right across, or half-way across the lens, or a round line in the inside corner of each eye. The magic happened when lens makers were able to get rid of the unsightly line.

This is what is called a “progressive” lens: a multifocal lens with no visible lines. From an observer’s point of view, the lens is clear and one piece. The appeal of this is obvious to anyone 40ish and older. Needing a bifocal is often one of the first signs of aging. Now no one needs to know. Sign me up!

In the 1990’s computer numerically-controlled cutting was regularly used in the optics industry. Before this all spectacle lenses were made with a set curve, a base-curve, on the front surface, and the optics were ground onto the back. Advances in software and cutting tools made it possible to cut the lens on the front and back surfaces, allowing for more custom designs of progressives. The Free-form lens was invented.

By 2000, Zeiss and Rodenstock out of Germany launched their versions of Free-form progressives, which made it easier for people to adapt to the optics and to take advantage of the wider zones for viewing. Nikon of Japan has developed software that measures a person’s sensitivity to different designs of progressives, making the lens custom for each person.

For example, there are “soft” and “hard” designs, and each person will work better with one of these. The “soft“ design spreads out the unwanted zones of the lens, giving you wider areas but taking away a bit of clarity, whereas the “hard” designs will give up some zone coverage for enhanced clarity. The algorithms that Nikon developed can tell what design works best for a person and then program this into the CNC cutters.

For the past 3-4 years, we have had great success with Nikon’s “Ultimate” progressive. We have been working closely with Nikon for some years, with their cutting-edge technology, and research and development, and our desire to meet and even exceed the visual needs of our patients, we have found the perfect mix. What is really cool is that Nikon is not stopping there. The past month I have been trying out two new designs for progressives, randomly selected and unknown to me, finishing the month with a questionnaire about my experience, some beta testing for new product.

I am glad that they are always pushing the envelope because our patients have come to expect the best and the latest in prescription eyewear. No doubt there will be a new and improved version of progressive from Nikon in the near future. I am really wondering about its new name — that will be really interesting. Just like with the Avengers “End Game” in the Marvel Universe, where do you go from having the “Ultimate progressive”?

Til next week,

The good doctor

Low Vision Month: Bioptics for the layperson

Thu, 29 Feb 2024 19:50:15 GMT

Blog vol 4.37. Low Vision Month: Bioptics for the layperson

We need some clarity on this topic. This is called “educating the public”!

To begin, a “biopic” is a dramatization of someone’s life, like Freddie Mercury in Bohemian Rhapsody. The letter “T” makes all the difference. Optics have to do with lenses, light, and seeing, and “bi” comes from the Latin for two, so two optics, just like bifocal means two foci.

So how does a person get better distance vision if regular glasses won’t do it? By the use of telescopes that are mounted in a pair of glasses. When we think of telescopes, we automatically think of stars and planets: an instrument that helps us to see into the heavens. They can get up to 120X in power over the naked eye, which equates to 20/0.1667 vision. Pretty out there for driving a car, not a spaceship.

In Ontario, 20/50 vision is the minimum vision requirement for a driver’s license. The driving laws in Ontario allow for a maximum 4 X telescope, so a person with 20/200 vision if everything is working properly, could likely see 20/50.

The process of getting measured and fit for a bioptic is pretty simple. A Low-Vision specialist, who has experience working with people with visual impairments, measures the vision to assess vision level (like 20/100), visual field (like 120 degrees of field), contrast sensitivity, actual physical eye condition, and spectacle prescription. The last one takes special techniques and questions to arrive at an accurate result. Then expectations, motivation, and general support are considered. Bioptics are not the answer for everyone. There is a steep learning curve in learning to use them.

Let’s say that a person comes in with 20/80 vision. We can put a 2.2 X telescope with their spectacle prescription in place and see what their vision is. They should get about 20/30 or 20/40 through the telescope. Then that spectacle prescription is actually built right into the telescope to provide custom vision correction. As long as their visual field is adequate we can fit them for the bioptic.

What you see here is a pair of glasses that have these little black “tubes” sticking out at the top, which are the telescopes. The black “tubes” are fit to sit just above the line of sight at about a 10-15 degree angle upward. The person drives seeing through the bottom or carrier lens, and will regularly drop their head and take a view through the telescope to get a more magnified view of what’s ahead. You can imagine how hard it is to do this while driving, but it is a learned skill, no different than checking your mirrors or your blind spot, which does become second nature.

If the driver requires more power, like 3X or 4X, it does become more challenging. Stronger is not always better. We do not need the Webb telescope in our glasses to drive to the grocery store. I liken it to your shoe size, there is one size that fits you, not too big, not too small, just right. As you get into stronger telescopes, the field of view in the telescope gets smaller and everything seen in the telescope moves that much faster. It makes it harder to spot things and to track or follow them, which is why a 4x telescope is the strongest allowed for driving in Ontario.

Once measured, the device is ordered, it takes about a month because they have to be individually made in the USA. Then the person is fitted and instructed on how to use the device.

This can be an exciting and life-changing process for many people. So if you see someone wearing funny glasses with black things stuck to them driving, you know what you are seeing: a highly motivated and conscientious driver who has worked very hard to have the privilege of being behind the wheel. Kudos to them!

Til next week

The good doctor

Low Vision Month: perspective for the rest of us.

Thu, 22 Feb 2024 14:54:21 GMT

Blog vol 4.36. Low Vision Month: perspective for the rest of us.

It would seem, from a therapist’s perspective, that we can help visually impaired people. A noble notion, but how condescending. The best part of working with visually impaired individuals is perspective.

I have mentioned it in other blogs, it is the indomitable human spirit, the creativity, and the courage of these individuals that is so impressive. Think about the process: getting the news that you are permanently visually impaired, then dealing with the loss of vision and the resulting changes in your life, devastating. Alternatively, those born with a visual impairment, along with their parents, have a long road ahead of them.

By the time this person arrives at my door, they have gone through a lot of adjustment, grieving, anger, and pain. They hopefully are accepting of their situation, which is a lot, and even thriving with the challenge. I marvel at the resourcefulness, and the positive attitude displayed by many of these people.

A bit of history. In the early 1800s in France, a three-year-old boy was playing with a cobbler’s tool and accidently punctured his right eye, and, tragically, the other eye was lost to the resulting infection leaving him completely blind. This boy was Louis Braille, obviously very gifted and resourceful. He was completely blind at the age of five yet he was able to develop, with a system of six dots, raised “text” on a page that the blind could read with their fingers. To this day we still have this system of dots to help the blind even on our currencies.

Later in the 19th century, a little girl from Alabama developed a condition that left her blind and deaf, a double whammy. She was greatly helped by the teacher, Anne Sullivan, at the Perkins Institution for the Blind in Boston. Again the indomitable spirit of a person who thrived, Helen Keller wrote 14 books on varying topics, a prolific reader and writer (both by braille). She lived to the old age of 87 and was instrumental in founding the American Civil Liberties Union (ACLU) and was even nominated for the Nobel Peace Prize.

From the world of fiction, the powerful story by Anthony Doerr, All the Light We Cannot See, won the 2014 Pulitzer and Carnegie Medal and was adapted into a Netflix drama released in late 2023. It is about a blind girl who lives in Saint-Malo, France during the Nazi occupation in the 1940s. This blind girl, Marie-Laure LeBlanc, has an impressive upbringing, heavily influenced by her father. The father makes a model replica of Saint-Malo for his daughter which she uses to help in the resistance and in the many intrigues which she gets involved with over the course of the book. Again, it is her courage and resourcefulness, and the great help from her father, that is wonderful to see.

To all my low vision and visually impaired patients: thank you for sharing your lives with us; thank you, parents, who are unendingly supportive through very difficult situations; and thank you, educators/teachers, for your encouragement and training and for refusing to give up on people.

Til next week

The good doctor

Low Vision Month: Treatment of Macular Degeneration

Thu, 15 Feb 2024 04:06:00 GMT

Blog vol 4.34. Low Vision Month: Treatment of Macular Degeneration

There is much cause for celebration here. In the early 90’s, we were looking at a whole bunch of elderly people having “senile” macular degeneration in the next 20-30 years. I went to Waterloo for a Low Vision Residency to prepare for the deluge. Thankfully the deluge did not happen. A combination of many factors resulted in a milder “version” of what we now call age-related macular degeneration (ARMD). People reduced their smoking, improved their diets, started exercising, started taking antioxidants like lutein, and received cutting-edge diagnosis and treatment.

Now in 2024, we have anti-VGEf treatments that reduce bleeding around the macula. We now also have very precise and complete imaging with optical coherence tomography (OCT) and swept-source tomography to simulate angiography (OCTA) to help detect, track, and treat the disease. In 2009 we got our first OCT machine and have never looked back. In 2016 we started doing OCTs on everyone over 20, a great screening tool for all sorts of conditions. Then in 2019, we donated the original OCT to a clinic in Ghana and moved up to OCTA imaging.

The OCTA is our best tool. We also screen for family history, and other cardiovascular conditions, and encourage people to stop smoking (or Vaping). The numbers have really come down, and the severity of the vision loss has been greatly reduced, with most people continuing to have somewhat “normal” lives even with visual impairment.

With the advancements in Anti-VGEf injections and the introduction of Vabysmo (pronounced Vah-BYES-moh) into Canada, it is possible to extend the space between treatments up to six months instead of every two months. And now with the latest development in the U.S. of injections of Syfovre and Izervay for Geographic Atrophy which, up to this point, was untreatable and devastating, there is hope also on this front. And a ways down the road, there is promise in the Waterloo research into Wnt genes which work with stem cells for wet ARMD.

On the more functional side, the ability to drive with bioptics in Ontario, the development of electronic magnifiers, and Artificial intelligence apps all are new helps for the visually impaired.

Please get your eyes checked, especially if you are in your 30’s and 40’s, to catch problems early. As always, prevention, prevention. Many conditions can be treated. Early detection = better vision for life.

Til next week,

The good doctor

An update on bioptic telescopes and driving

Thu, 08 Feb 2024 08:25:29 GMT

Blog vol 4.34. An update on bioptic telescopes and driving

I have done several blogs on Bioptics and, considering February is low vision month (who knew?), it is time for an update.

As you know, the Ontario government, in 2020, made it possible for visually impaired people to drive with bioptics. The past three and a half years have been an interesting adventure. We now have fit over forty people with bioptic telescopes for the purpose of driving, and are glad to say that the process of getting licensed is becoming more streamlined.

If you are a person who had a driver’s license and developed a visual impairment that resulted in suspension of your license, we have good news. The Ministry of Transport is allowing these individuals to get their vision updated with bioptics, and after three months of working with the device, to be given back their license.

The record shows, and our experience tells us, that prior driving experience is a huge help in driving with bioptics.

We have also worked with people who were born with a visual impairment and never dreamed of driving a vehicle. This is so exciting and crazy!

We fit the bioptic telescope and train them, and then they do driver training, and finally end up with a driver’s license. This is an arduous process. To make things more difficult, not everyone is educated about bioptics so some prejudice needs to be overcome, but these individuals are very motivated and are high functioning when it comes to other areas of life and embracing new technologies. Getting a driver’s license is a huge achievement because they have to go through the bioptic training, then learn how to drive for the first time. We are so impressed by the perseverance and determination of these new drivers. Congratulations.

Unfortunately, not everyone can drive. Do remember that there are limitations on the power of the bioptic telescope, on the requirements for functional visual field (which is critical, especially for driving), and on the amount of visual acuity the patient is starting with. Please call our office to at least start a conversation and do remember that we provide low-vision aids for all sorts of tasks and for everyday life.

The last thing to note is that the Ministry of Transport has created a class G license that is designated for bioptic drivers — now there is an elite group :) When you have this designation, you need to be checked annually to ensure that your vision has not changed and that the device is working and fitting well.

This is challenging work, but so rewarding. AND, even if you cannot drive, there may be devices, technologies, or other options that can help you. DO enquire. (please)

“My Bioptics doth Magnify the Road”, corny but true.

The good doctor

A New Tool for Prevention

Thu, 01 Feb 2024 19:37:20 GMT

Blog vol 4.33. A New Tool for Prevention

My predecessor, Dr. Ronald Watson, would joke that when he started practicing optometry, the earth was just beginning to cool. My come-back is that back then we didn’t have hawk eyes, but Pteradactyl eyes. All joking aside, the profession of Optometry has come a long way. Today we spend a good deal of our day gathering data. We now have electronic medical records, digital imaging devices, and artificial intelligence to help guide our decisions.

However, it still requires “horse” sense and there is a fine art to diagnosing eye problems, matching appropriate remedies, and communicating all this to human beings. Not to be replaced by a robot any time soon, sorry Mr. Asimov.

Our latest gizmo is the Myah, an instrument put out by Topcon, which does biometric readings of the cornea, the axial length of the eye, and the eye glands and tear film. With our highly technical society and the amped-up use of computers and screens in all of life, we need a way of measuring the eye for all the problems that flow from this way of life, specifically dry eyes and myopia.

The Myah is great for dry eye treatment as it allows us to measure the condition of the cornea (the layer on the front of the eye) and the tear film, and it is great for early detection of myopia (near-sightedness, trouble seeing far away) onset in children as it allows us to measure the axial length of the eye, a prime indicator of myopia onset. We put all children on it. This is preventative care which excites me. We can actually slow down myopia in kids and we can help people with dry eyes and we can catch keratoconus at a really early stage in kids.

In a previous blog (see here ) I mentioned keratoconus — a degenerative condition where the cornea is thinner and outpouching, literally forming a cone. In the past two decades, researchers have come up with a technique that hardens the cornea and keeps it from bulging. The key is early detection because it is progressive and irreversible. The Myah has an algorithm that gathers the corneal map data and indicates if the patient is a keratoconus candidate. We have had the odd false positive, but we have also had positive positives, and since we are doing it on all young people, we are preventing (yes, preventing, a big, awesome word) permanent eye damage in these patients.

It does make you wonder what other biomarkers we will be able to use for other conditions in the future. Tell your family, get your kids in for an eye exam. We include the Myah in a regular OHIP visit.

Til next week,

The good doctor

Vaping and the eyes

Thu, 25 Jan 2024 20:39:42 GMT

Blog vol 4.32. Vaping and the eyes

My first blog of 2024, very creatively I might add, was on fitness, diet, and good habits to take care of your eyes (and the rest of you). Smoking is not a good habit, but how about vaping as an alternative? One of my staff, concerned about a young adult in their home, asked about the effects of vaping on the eyes. I thought that this was an interesting question…

It is common knowledge that smoking cigarettes is bad for your eyes, with one of the culprits being nicotine which is highly addictive and causes systemic circulatory problems. There are many chemicals involved in smoking, 7000 in total!! wow, that has to do with the by-products of burning the tobacco. Smoking causes damage to the retina and retinal circulation and significantly increases the risk of other problems such as cataracts, diabetic eye problems, and glaucoma. All parties involved in eye care agree that smoking is bad for the eyes.

What about vaping? It is not traditional cigarette smoke which contains many chemicals some of which are toxic, but it is a vapour made up of nicotine extracted from tobacco, flavours, and other chemicals which are heated up into an aerosol. It is better for your health than cigarettes because there are fewer toxic chemicals involved and you can have some control over your nicotine consumption. The problem is that there are many products out there with many different ingredients, nicotine in varying concentrations, and other chemicals. The long-term effects of some of these chemicals are as yet unknown. (Read more here ).

The use of vaping has increased exponentially. Vaping has become popular because it reduces the stigma of smoking (no smell), you get neat flavours, and it seems healthier. People are presenting with vaping-related lung problems, though at present it does appear that many of these occur when people modify their devices, add substances not suggested by the manufacturer, or use black market products particularly those containing THC. Again, the long-term effects of responsible vaping are unknown. We do know that nicotine is not good.

On a less serious note, interestingly, a great article in Scientific American pointed out the correlation between dry eyes and vaping (click here ). The vaping product messes up the cornea’s ability to metabolize iron products with the result being, the more you vape the more your eyes dry. Dry eyes can be treated, however.

The main point with vaping, it seems, is that nicotine is highly addictive and not good for you. Used responsibly, probably better than smoking, but ideally avoided.

All the best,

The good doctor

Polymeric Beads

Thu, 18 Jan 2024 06:08:48 GMT

Blog vol 4.31. Polymeric Beads

The other day, our current intern from Waterloo University was seeing a patient with an irritated eye. The patient reported a continued sore eye following the removal of an eyelash. After a thorough going-over, the intern found the culprit, a tiny bead embedded under the upper lid.

The intern did not initially recognize the “foreign body”, as we like to call it. It was a polymeric bead that is the base for, in this case, an exfoliate skin cleansing compound, but also shower gels, soaps, and even toothpaste. Actually, microbeads have a wide variety of uses, wow, did not know this. (Read more about it here ).

Anyways, the patient… It was not the first time I had seen one of these. The difficulty is that the beads are tiny and very easily end up in the eye without causing immediate pain. A single bead can “scrub” the cornea without being easily visible. It was like a tiny creature with figure skates went back and forth on the usually smooth surface of the eye. The scratches, though many, were just on the surface and should heal quickly with the regular use of a non-preserved lubricated eye drop as recommended by our very astute intern.

In 2014, the Netherlands banned these products from their shelves and other countries have followed suit. In Canada, since 2019, polyethylene beads smaller than 5 mm in size are banned. The trouble is bigger than eye problems; it is environmental, with the beads mistaken for food by smaller fish and animals in our lakes and rivers. The chemical enters the food chain and can be toxic and cancer-inducing as it moves up the food chain.

The cosmetics industry has been resourceful and has produced exfoliates from ground-up almonds, oatmeal, and even coconut husks, which are environmentally safe. We will be very surprised to see coconut husk under a patient’s lids, but in the meantime, we need to watch for these beads, because they are still out there.

So, get rid of your polymeric bead-based skin cleansers and end-up-down-the-drain products. Throw them in the regular garbage AND definitely don’t use any of them near your eyes.

til next week,

The good doctor

Happy eyes in 2024.

Thu, 11 Jan 2024 07:07:25 GMT

Blog vol 4.30. Happy eyes in 2024.

A new beginning. The holiday season is over, as is the overindulging in eating, drinking, and merry-making. Exercise is no longer on hold. Let’s give our eyes a treat: more oxygen and more nutrients.

Healthy eyes are the goal. Prevention is key. The hope is that our new January habits stay on and get embedded in our daily routines. Being realistic is really helpful; set a one-month goal and stick to it (qualifying for the Boston Marathon isn’t going to work for most of us), something small and doable like no snacks after dinner or parking at the far end of the parking lot at work…

Let’s start with DIET : calories in, calories out. I do a regular workout on an Erg machine, 5 K on the rowing machine equates to 300 calories (it really feels like it should be a lot more). That tells us two things, first that calories take a long time to burn and hey, our bodies are incredibly efficient. By just reducing your calorie intake by 15-20 % you can lose weight if necessary. The type of calories you consume is critical. Eating more antioxidant-rich foods such as green vegetables, peppers, and blueberries helps promote healing and helps prevent damage in the whole body, damage from the free radicals your body produces, and the free radicals you take in by smoking, breathing unclean air, or by being exposed to UV. These nasties damage tissues in your body, eyes included.

NO SMOKING OR VAPING. Please stop.

Gotta love those fatty acids. Omega 3’s are good, that is fish oils and flax seed oil, and help protect your body (good for eyes too!) Omega 6 fatty acids are in vegetable oils and nuts, and can be helpful for conditions like rheumatoid arthritis and heart disease (eyes benefit too:). The Omega 9’s are found in canola oil and olive oil and help with insulin sensitivity and diabetes prevention, great for eyes. The goal is to balance the three fatty acids.

Next is EXERCISE , surprise, surprise. The retina has close to 1.2 million receptors, like rods and cones, that are literally firing all the time. That requires a lot of oxygen and nutrients which are provided courtesy of the circulatory system through a rich bed of capillaries under the rods and cones. Increased circulation is good for the eyes, the heart, and brain, and all the body. Increase cardiovascular output, increase circulation. Aerobic exercise such as walking, jogging, swimming, rowing, or cycling for extended periods of time is great. Start slow, walking in small packets of time, and s l o w l y ramp it up. Do not overdo it the first few times out, you can injure yourself physically, frustrate yourself mentally, or both. Remember that we are in this for the long haul.

Three simple things to consider: diet, smoking, exercise. Make a commitment to change one small thing for the month of January, your eyes will be glad you did.

I have this conversation with all my patients. It is pre-emptive. Let’s prevent what can be prevented, with the bonus of feeling better and feeling better about ourselves.

Happy New Year!

The good doctor

A Year of Books 2023

Thu, 28 Dec 2023 14:29:56 GMT

Blog vol 4.29. A Year of Books 2023.

Looking back on 2023 (it’s that time of year, again), lots of lists of most important events, lists of sports highlights, lists of best films, etc., etc. I’m joining the listing throng with five of my favourite reads from 2023. In December, 2022, I shared a year-end review of books, had a lot of fun doing it, and decided to do it again.

My optometrist-self wants us all to remember what a wonderful gift sight is and, when you can, the gift of leisurely sitting down with a well written and designed book. Enjoy!

Some good reads from 2023:

Mysteries: found a great “new” author!

I discovered Anthony Horowitz for adults this year. My kids, a while back, were into Alex Rider, a teenage spy who works with MI6, a character created by Horowitz, an author of YA novels. Pleasant surprises abound! I stumbled upon Magpie Murders by Anthony Horowitz this year, not a YA book, in which we meet Susan Ryeland, a copy editor, who stumbles on a death which (oops!) turns out to be a murder. Horowitz does a great job with twists and turns and his ability to weave stories together is unparalleled. Not too many details on this one, a real good jaunt and page turner. He has also written a series of Murder Mysteries in a more modern setting with Horowitz himself as an integral part of the story, very interesting. The detective in these is Inspector Daniel Hawthorne.

History: a combination of history and sport, hard to go wrong.

When my wife got The Boys in the Boat out of the library, it was only a book, now it is also a motion picture. It is a biographical account of Joe Rantz, part of the eight-man boat that rows for the USA in the Berlin 1936 Olympic Games. The author, Daniel James Brown, does a masterful job of writing about the boat, the team, and the hard work and the drama leading up to Berlin. I especially appreciate the Zen feel with George Pocock’s contribution to their boat design and his sage wisdom. This crew had an incredible culture of team work. The Boys from Washington were truly in the Zone when they were at their best and, in spite of incredible odds and the political pressure cooker in prewar Germany, they prevail. No spoiler alert here, read the history. The Germans documented on film most of the Games; the Third Reich’s propaganda machine was fully operational. I work out on a Concept2 rowing machine and was inspired, not a bad thing.

Science Fiction: an author we should be hearing more about.

I mentioned Tarkovsky’s incredible movie, Solaris, in a previous blog. The film is based on the book, Solaris, by Stanisław Lem, a Polish writer of Sci-Fi and many essays. We in the West are not that familiar with Lem, but we should be. I read The Truth and Other Stories, which is a collection of shorter stories put out in a new edition by MIT Press. A shout out to all the publishers that go out of their way to get wonderful books and editions into our hands. I also got for Christmas two more newer MIT editions by Lem. What I like best about his writing is his refreshing perspective. He is not totally taken with technology. Seeing the double-edged reality of anything new, he puts a lot of hubris into his tales of aliens and has a very realistic, somewhat cynical view of humans and their endeavours. Again, refreshing, different from the usual Sci-fi stuff.

C.S. Lewis: a C.S. Lewis summer, thoughtful reading.

This was a tough one to pick. I had a C.S. Lewis summer, pretty much most of his writing. I know it sounds like a lot of flexing, but it really happened, and I actually retained and understood much of it. Which book to highlight? The most challenging. Till We Have Faces-A Myth Retold I had read before, but I was encouraged by Peter Kreeft, who teaches philosophy at Boston College, to try it again. He claims that he did not fully understand this book until after his 10 ^th reading and, my goodness, if a philosophy professor needs ten readings... He did give me the key. The story is a retelling of the myth of Cupid and Psyche, with Orual, the Queen, being jealous of her beautiful sister Psyche. Her sister is sacrificed to the gods. Orual cannot accept the reality of this act until the very end when she realizes Psyche’s and her place with God. I am starting to get it, but it does beg another reading. Beautifully written, much to plumb here.

Real Life: best book of the year, easy.

This book, How to Stay Married, by Harrison Scott Key, is a must read for everyone. My wife read it and then handed to me, and I had to read it fast because it was a library book and there was a long line of people wanting our copy. The author is very funny about a very serious topic, marital love and infidelity. This is a real life story which does not have to end well and may still have some major “speed bumps” because it is still being lived out. It is a transparent, funny, heartbreaking account of his wife’s infidelity and his continuing to decide to not give up on her in his anger and grief and confusion and trying to keep his children sane and laundry and work and pain and what is she doing?? and what to give the kids for their lunches??? and what should he do???? He never badmouths anyone; he accepts blame; he has terrible struggles; he perseveres, so hopeful, one of the most hopeful things I have ever read.

til next year!

The good doctor

The boat, it floats!

Thu, 21 Dec 2023 06:39:27 GMT

Blog vol 4.28. The boat, it floats!

The Mau Ipata, The House of Life, is afloat!!! Over the last two years, we at Burlington Eyecare raised the money to equip the eye clinic on this Amazon hospital boat, so it is with great pleasure that we announce that the boat is fully operational.

Floating is not to be taken for granted. Taking on an initiative like a “Mercy” ship for the Amazon basin is not a laissez-faire event, far from it. It takes a lot of planning, a lot of resources, and a huge commitment from all sorts of people. So when the day came for the Mau Ipata to rise in the water from the Amazon’s flood plains, as if by magic, well nature did not cooperate. The Mau Ipata was anchored in Leticia, Colombia for its final fitting and who knew that it would be the stingiest rainy season in 15 years when launch time came? One word comes to mind with this entire project, determination: determination to bring health care to 325,000 underserviced people in the Amazon basin, determination to make sure the care begins and continues for the foreseeable future… so they got out the dredgers and cleaned out the river bed around the boat to make a launch possible.

When we raised the funds for the equipment for the eye clinic, we stipulated that it be purchased locally, through local suppliers, so it can be regularly serviced (and to support the local economy). Just as with our clinic in Burlington, equipment must be maintained and serviced. A shout out to our main equipment supplier, Topcon Canada, and Gary Martin who has been taking care of us for a number of years. I cannot say enough about the level of service and quality of products that they provide.

Administration, planning, organizing, paying attention to all the little things are critical to getting a hospital boat in the water and operational and to keep it running. Just as at Burlington Eyecare, care-full and caring administration is critical. A shout out to my office manager, Karen, and her team who make sure the whole clinic runs smoothly, really great and capable people.

We have felt honoured to partner with the work of Medical Ministry International, and especially Juan Alan Muñoz and his team, in making the hospital boat possible. We would like to take this opportunity to thank everyone who contributed to this awesome project. THANK YOU, THANK YOU, THANK YOU!

We will keep you posted on how the boat fares as it begins to provide care, very exciting. We are so blessed here in southern Ontario in so many ways, if we can share some of that blessing with others in some small way, what a privilege.

From all of us at Burlington Eyecare, a very Merry Christmas!

til next week,

The good doctor

DO. NOT. BUY. PINK EYE DROPS.

Thu, 14 Dec 2023 08:07:47 GMT

Blog vol 4.27. DO. NOT. BUY. PINK EYE DROPS.

It is cold and flu season again and you know what that means at Burlington Eyecare, that’s right, pink eye (conjunctivitis, inflammation of the conjunctiva). In previous blogs, I have gone into detail about this condition: how contagious it is, that it is viral and that it starts in one eye then goes to the other, and that it can be nasty. In the past week, we have seen a number of people coming in with pink eye.

One of my patients was told by family to buy “Pink Eye” drops from the pharmacy to treat their very red, itchy, and runny eyes. Bad advice. My patient used the drops, which are an antibiotic combination of polymyxin B and gramicidin, great for stopping gram-positive bacterial infections. But up to 90% of pink eye is caused by a cold/adenovirus, the only possible benefit of these drops for a pink eye patient is maybe some small anti-inflammatory effect, and the worst it could do is cause secondary problems like contact dermatitis (gramicidin is noted for this) or increased bacterial resistance. Using this drop, for my patient, also delayed the use of something that would actually help. She was not getting better, of course.

I know I am getting on my soapbox again, but Johnson and Johnson (J &J), the makers of this product, have to stop labelling it in bold letters, PINK EYE. I meet regularly with my sales representative from J &J, and I have told him, on multiple occasions that they need to change the packaging as these drops are not an appropriate or helpful treatment for pink eye. The person with pink eye just wants relief, like NOW, and treatment NOW because it can look bad. Their packaging is misleading at best and problem-causing at worst.

A qualification here: not all “pink” eyes are caused by a virus. Bacterial infections are possible, as are burns (chemical or UV), allergic reactions, systemic conditions, extreme dry eye... If in doubt, get it checked out. Viral pink eye tends to be itchy and “gloopy”, as one of my patients described it, like a cold in your eye.

Pink eye spreads by contact, the virus has to get in your eye. Pink eye is usually caused by the cold virus though we have been seeing some cases of “COVID pink eye” – similar symptoms, different virus. Ultimately there is no real treatment for pink eye, like a cold or COVID, we generally try to relieve symptoms and wait out the week or so of the virus’ course.

So, do NOT purchase pink eye drops. You have a virus, not a bacteria, causing your troubles.

til next week,

The good doctor

Christmas cheer! Together!!

Thu, 07 Dec 2023 10:22:16 GMT

Blog vol 4.26. Christmas cheer! Together!!

What a great time! Last night was our annual Christmas Party. I was once again reminded of the wonderful people that I spend my days with throughout the year. I was also reminded what a joy it is to get together in person, real-life people, the best kind. Going through COVID was a great reminder of the importance of people and relationships: vital. The past four years have been a challenge here at Burlington Eyecare with Covid, of course, but even more so, with the illness and death of two dear members of our little community. You do find out a lot about yourself, others, and what matters through such adversity. In my readings of Churchill, he comments on Lord Beaverbrook (Max Aitken) being “a good friend in foul weather.” We have been “good friends”.

We had a lovely evening last night. The Edgewater Manor on Lake Ontario created the setting, with a fully decorated dining room, ample space, and a cozy fireplace. The wine list was unsurpassed, the food delicious, the service attentive (but not obtrusive), and of course the table guests, the most wonderful company. Karen, our office manager/social coordinator, outdid herself in creating a warm and fun environment for all.

The last time we did our Christmas party at the Edgewater was December 2019, on the brink of Covid. We were a different group. Dr. Jerilee Nyman was two months away from the diagnosis that would ultimately take her life; she and her husband were full of good cheer and health. Clint, Karen’s (office manager) husband, though undergoing treatment for his cancer, was able to join us with his usual good humour. We had a lovely evening.

Mixed feelings about going back… but it was good, very good.

We have a gift exchange every year. One of the directions given during the gift exchange was to switch your gift with the person you have known the longest at the table. I looked over at Roger, “the Rog”, who I have known for over 30 years. We first met working at Skinner’s Optical with Barb and Rick Skinner and Val Haslam. That was not so long ago, our relationship like old wine, getting better with time. That was special, to realize the continuity and the camaraderie we have shared over the years. It is times like these that you pause and reflect on just how precious these relationships are. I look forward to spending more time with the Burlington Eyecare team and so many of my patients that I have known for years.

Perspective is so important. At Burlington Eyecare we help people to see better, or keep their sight, or even enhance their sight, and perspective is an integral part of all aspects of this sighted world. I am looking forward to Santa bringing me some newly translated novels and books from MIT Press by Stanislaw Lem. No surprises here, I got my list to the North Pole early on, and Lem is one of my favourite writers. I first began to enjoy his writing years ago with a reading of his novel, Solaris, which I highly recommend. Two movies were made of it, one in 1972 by the Russian director Andrei Tarkovsky, which I am enjoying on YouTube at the present time, and the other a Hollywood version in 2002.

The earlier Russian version is beautiful to watch, with Tarkovsky doing his cinematic magic. The director tells his story, which to the modern viewer, can be a challenge to watch. He provides a perspective that forces you to take a look at life from a different lens, to slow it down, to change angles, to put yourself in someone else’s shoes, so to speak. Without getting too philosophical, we need to have new horizons that help us to Stop. And. Think. and appreciate the life around us. Over this busy Christmas season, let’s slow down and appreciate what we do have, especially the people in our lives. Let’s slow down and actually see them (no prescription possible here, it’s perspective that we need).

Do sleduyushchey nedeli (til next week, in phonetic Russian, I’m pretty sure:)

The good doctor

O Christmas Bird!

Thu, 30 Nov 2023 06:26:00 GMT

Blog vol 4.26. O Christmas bird!

When I was in university, we would jokingly say that we were taking a course in ornithology, a bird course, if it was real easy. I have to admit, after the rigours of our regular optometry program, it was a nice break to take something less demanding. Talking about birds… (what an awesome segue!)… there is a great substack called “ Easy by Nature ” by Bill Davison a bird enthusiast who takes amazing photos of all sorts of birds.

His most recent article was on birding over the Thanksgiving holiday (he is American). November is potentially a challenging time for birding, but the author’s enthusiasm and love for nature are irresistible. His photographs of birds and wildlife in this and his 23 other articles are truly beautiful.

Getting your kids and grandkids involved is so great. Being an optics guy and one who fits and prescribes telescopes and lenses for my patients, I could not agree more that getting some decent “bins” (binoculars) for your budding ornithologists is a good idea. There is so much to see when you are paying attention, right now, right in your backyard, yes, even in November/December.

Just last week in a patient exam, we discussed their recent birding expedition to the rain forests in Brazil. Their group cited 275 different species of birds on that trip, wow! the biodiversity in the tropics is astounding. Yet you can see a remarkable variety in your own backyard or on the many trails in the Hamilton region. Our family keeps a record of any bird that lands or lives or flies over our property. We write down its English name and its genus and species and are up to 50 species at last count, from the very common European Starling (Sturnus vulgaris ) to the more rare White-crowned Sparrow (Zonotrichia leucophrys). Some of our fly byes are the migrating Trumpeter Swan (Cygnus buccinator) and the Canada Goose (Branta canadensis).

The takeaway is that whatever your age, wherever you live, you can find real enjoyment in birding and you can share that with so many others. Resources like Cornell University and their app, Merlin Bird ID, bring the experts along with you on your birding expedition. They can be quite informative. Some of my patients have bird lists that have over a thousand different species!! Obviously, they have gone beyond their backyard.

Do check out the “Easy by Nature” substack. I particularly enjoyed his Goldfinch photos, so lovely.

Do consider birding as a special family activity for the Christmas season. A bird feeder also provides great opportunity for watching your feathered neighbours. What Christmas birds live in your backyard?

Happy Christmas birding,

The good doctor

Eyesight and goaltending

Thu, 23 Nov 2023 07:12:18 GMT

Blog vol 4.25. Eyesight and goaltending.

Last Friday, I had the opportunity to go to the Hockey Hall of Fame with my three sons. All avid hockey fans, two Canuckle Heads and a St. Louis Blues, all donning their jerseys as we took the Go train into Toronto.

I grew up in Northern Ontario, where hockey is (or at least it was) a way of life. My Dad was so good that he signed with the Chicago Blackhawks back in the days of the original six. I mostly played goalie and my hero was a tall, lanky goalie, who wore number 29 on his Montreal Jersey, Ken Dryden. I had the luxury of watching Montreal win many Stanley Cups in the 70’s and 80’s. At the Hockey Hall of Fame, they have the Montreal dressing room with Dryden’s jersey and his gear and mask. Back in the 60’s goalies were still playing without a face mask. Hard to believe that a player like “Gump” Worsley would stand in the net and face Bobby Hull’s 100 mph slap shot. Crazy.

My son sent me a really neat article from the NHL website on goaltending and the eyes. Goalies are not only wearing masks but they are also involved in some sophisticated visual training (see here ).

We watched Jake Oettinger, a Dallas Stars goalie, play the Canucks the other night and his reflexes and the speed of his glove were unbelievable. He and many of the elite goalies are getting extra help with using their eyes. One of the companies helping is True Focus Vision out of Minnesota. They assess your vision, the movement of your eyes in tracking objects (pursuits), in jumping from object to object (saccades), and how well the eye movements are coordinated between the eyes. They use infrared sensors to measure and document.

Once all this data is gathered then the training begins. Using balls of various sizes and colours with and without numbers, they work on increasing eye skills and hand-eye coordination. They also use strobe lights and special goggles and screens to train the eyes. In Optometry we have a whole field of Visual training called Sports Vision that works on improving these skills and keeping them honed.

You can go to YouTube for Conor Hellebuyck’s (Winnipeg Jets) visual warmups; it is something to see. If you or your child are a goalie or just want improved vision for sports, contact us and we can do preliminary testing. I could have used some training when I was at the Hall using the goalie simulator. Thankfully, I will keep my day job and content myself in watching the real stars stop the rubber.

Til next week,

The good doctor

The Eyelash Gecko

Thu, 16 Nov 2023 05:35:16 GMT

Blog vol 4.24. The Eyelash Gecko

One of my son’s friends got a gecko for his birthday. It is really cool; it is a reptile after all. The thing that I am amazed at is its eyes (surprise!). It is called the Crested Gecko, Correlophus ciliatus, with the cilia part of the name coming from the Latin word for eyelashes.

So I got on the web and did some research. This gecko is a native of New Caledonia, a group of islands in the southwest Pacific. They live in the canopy of the rain forests and can live to be 5 to 10 years old in the wild and about 5 years longer in a terrarium. Crested Geckos can grow to be 10 to 15 cm in length with half of that being their tails. They have a prehensile tail that can grab onto branches or fingers, but one must be careful with the tail as it can break off and, unfortunately, it does not grow back.

Among the most distinctive features of these geckos are the hair-like spikes above the eyes which greatly resemble eyelashes. They also have two rows of spines that run from the sides of their wedge-shaped head to the base of their tail. Their padded feet have tiny setae, hundreds of them, which increase surface area and allow them to even climb vertical panes of glass.

The part about their eyes is crazy because these creatures have no eyelids. They have a thin, transparent layer called a nictitating membrane which can be drawn across to protect and moisten the eye. What is really endearing is that they often just sit and lick their eyeballs, especially after eating. Their tongue is very long and soft with a widened spatula-like tip. The nictitating membrane keeps each eye moist, and the geckos use their tongues to clear away debris.

The crested gecko is primarily nocturnal. In the wild, it spends much of the night foraging in shrubs in lower portions of the rainforest canopy. It is also an omnivore, feeding on fruit, nectar, pollen, and a variety of insects. It spends the day resting near the forest floor where it is cooler and less sunny. (Read more here ).

The little fellow that we are getting to know goes by the fierce name of Draco, all he needs is fire-breathing creature powers and then watch out.

Til next week,

the good doctor

”City in danger. Explosion. Conflagration”

Thu, 09 Nov 2023 18:30:20 GMT

Blog vol 4.23. ”City in danger. Explosion. Conflagration.”

This was the telegram message sent to areas around Halifax on the morning of December 6 ^th , 1917. It was the middle of a major war, were the Germans invading? It was possible. Halifax was a thriving naval port shipping munitions, supplies, and soldiers to Europe in support of the Allied war effort. It was not an invasion, however, it was an accident. An uncontrollable fire on board the Mont Blanc, which had collided with another ship in the harbour, led to a violent explosion.

And as a result, many Halifax residents died or were injured. A disturbingly large number lost eyes or were blinded. The large number of eye injuries and face lacerations were the result of the delay between the fire on board the ship and the explosion. Many people were at their windows watching the fire when… kaboom! The explosion was so strong from the picric acid, TNT, and benzol in the Mont Blanc that it blew the ship’s hull 1,000 feet in the air and people watching from their windows were instantly blinded by shards of glass, as the concussion shattered every pane of glass in the district.

Dr. George H. Cox, an eye, ear, nose, and throat (EENT) specialist from nearby New Glasgow arrived on the scene, and with a team of surgeons and nurses, proceeded to remove hundreds of badly damaged eyes. So many people, so many needs, very limited resources. Leaving the eye open to infection, makes loss of the other eye much more likely, a condition called sympathetic ophthalmia. This was to be avoided. As a result, it is estimated that 42% of all the injured eyes were enucleated (removed).

After several days of surgeries, Dr. Cox was finally relieved by Captain T.F. Tooke of the Canadian Army Medical Corps. The final numbers were staggering. Overall, in the explosion 9,000 people were injured and 2,000 died. There were 592 people with eye injuries and 249 enucleations, with 16 people having both eyes removed.

The Halifax Relief Commission tallied numbers and provided help for the injured. Some were given pensions through the newly formed Canadian National Institute for the Blind (CNIB). The CNIB was started in response to the large number of soldiers returning from WW1 with eye injuries. The Halifax explosion significantly expanded the CNIB client base and broadened their scope of care. (Read more here ).

When I read about this event on its 100 ^th anniversary in 2017, I was taken aback by the enormity of the explosion and by the devastation, particularly of people’s eyes.

This Remembrance Day we would do well to remember all the people injured in war and war-related scenarios such as the Halifax explosion, and all the medical professionals who worked so tirelessly on the scene, and unsung over the many years that followed.

Til next week,

the good doctor

Signs, signs, everywhere there’s signs

Thu, 02 Nov 2023 07:50:55 GMT

Blog vol 4.22. Signs, signs, everywhere there’s signs.

We finally did it. After 11 years at our newest location on Fairview in Burlington, we finally got ourselves an overhead sign for the front of the practice. The good people at Burlington Sign made it for us and installed it this past week. Burlington Eyecare is tucked into the elbow of the plaza and is not very visible especially when coming from the east so we had to position the sign carefully. It looks great!

It reminds me of other signs that I have seen over the years, some pretty hilarious. In my hometown of South Porcupine, Ontario we had a local family-run restaurant that had a sign in the window: “Come in and eat, before we both starve”. Here is a list of classics collected over time.

- “We give fast service no matter how long it takes”

- “Septic tanks pumped, swimming pools filled, not same truck”

- At a drive-thru: “Free straw with drink purchase”

- At a drive-thru: “Free tacos yesterday”

- “I could agree but then we both would be wrong”

- At a restaurant: “Now hiring good employees”

- At a paint store: ”Husbands choosing paint colors must have a signed note from their wife”

- For a child’s detective agency, Golden Detectives: “Tiny Detectives Answering Big Crimes”

- At a church: “Too hot to keep changing signs. God good-Sin bad, details inside”

- At another church: “Be the reason someone smiles today”

My favourite for the eye industry is: “If you can’t see what you are looking for, you have come to the right place”

Come and visit us and tell us how much you like the new sign and tell us that there was no way you were going to find us unless that spanking new sign was overhead.

Til next week,

the good doctor

Cannot get away from those Cones and Rods

Thu, 26 Oct 2023 07:11:34 GMT

Blog vol 4.21. Cannot get away from those Cones and Rods

This past week, we had a family in the office whose close relatives have a history of cone-rod dystrophy. The parents were concerned about their child and the possibility of genetic transmission of a potentially blinding condition. Clearly, this condition can be genetically linked as more than one of their relatives has it and these relatives are siblings. So what does this mean for their child?

There are many variations and types of cone-rod dystrophy (and these are different from rod-cone dystrophies, like retinitis pigmentosa, just to keep you on your toes). Dystrophy can affect the cones alone or it can affect both cones and rods. The rods and cones are the light receptors in the outer retina that take in light and convert it into electrical impulses which finally result in sight. They are critical to the seeing process, so one can imagine the devastation to the vision if there is major damage to these receptors. Cone-rod dystrophies are conditions that are inherited (autosomal recessive) and can start affecting the vision at birth but, more often than not, show up in the later teens.

Thus the question from my patient: how do I know if my child has inherited this condition? An eye exam is a great place to start. Then, in their teens, an electroretinogram can be scheduled to rule out cone or rod deterioration. Genetic testing is also a possibility. Are the parents carriers? Does the child have the gene? Both the parents would have to have the recessive gene. As of today, 35 known gene mutations account for 60 % of the cases - with the most common being the ABCA4 gene. (Learn more here ).

The progression of the disease varies, but it does progress and does lead to severe vision loss. There are currently few effective treatments for these dystrophies. The key becomes optimizing existing vision. A low vision assessment and support from a social worker will help. Cone-rod dystrophy occurs only in 1 out of 20, 000 to 100,000 people worldwide. Having it in your family does increase your risk, how much is the question.

Not a lot of surety for this family though there is no evidence for the second parent being a carrier. Both parents need to be carriers for there to be even a possibility of the child developing cone-rod dystrophy. The child looks great now and most likely will continue to do so. Really, we need to know if the parents are carriers while continuing to monitor the child’s eye health. Peace of mind is the goal. Genetic testing will be the best option, potentially eliminating the concern altogether.

Til next week,

the good doctor

Put those Rods and Cones to Work!

Thu, 19 Oct 2023 07:04:51 GMT

Blog vol 4.20. Put those Rods and Cones to Work!

The seasons change, again. One of my children is studying in Vancouver and misses our glorious southern Ontario Falls with all their colour, all the wonderful produce, and the very real sense of hunkering in for a long, cold winter. Fall is much more muted on the West Coast and the contrasts are not so great.

The drama we see every fall is captivating. This fall we have seen a delay in the colour, with it not peaking just yet in our region of Hamilton/Wentworth and Burlington. We get these variations in length of season and colour intensity with early frosts or with warm or wet autumnal weather. Leaves have both yellow and green pigments all the time. The chlorophyll in the leaves starts to break down when the days shorten and the weather cools, then the yellow and orange pigments, called carotenoids, become visible.

Weirdly, many trees are still green. It’s mid-October. I was under the delusion that length of day played a bigger role in colour change but apparently, temperature is critical. Interesting.

The roses are still blooming!!

We do have a red, red Burning Bush in our front flower bed. Clearly, it knows what time of year it is. A technical note: The reds and purples are formed by the accumulation of anthocyanin in the leaves, different process.

To see colour is a great gift, both practically and for the sheer pleasure of it. Those rods and cones in the back of your eye are wonderful things.

Make time to get out and walk one of the many beautiful trails in our area. Look around you. Enjoy!

Til next week,

the good doctor

New drug approved in U.S. for treatment of macular degeneration

Thu, 12 Oct 2023 05:03:38 GMT

Blog vol 4.19. New drug approved in U.S. for treatment of macular degeneration.

One of my patients has been arranging to get a new treatment, an FDA-approved drug which will hopefully slow down his worrisome macular degeneration. Macular degeneration is a disease of the central retina that affects the most crucial part of vision. It can be devastating, with large central vision losses and consequently, life restrictions, the most disturbing being in driving and reading.

There have been many advances in treatments in the last few decades, the most notable being AntiVgef injections for wet macular degeneration. So far there has been very little help for the dry type of the disease, until now. (Simply, there are two types of macular degeneration: “wet” and “dry”.)

We routinely recommend that patients take daily doses of lutein, zeaxanthin, and other carotenoids to slow both types of macular degeneration down. Frustratingly, some patients progress to full-blown macular atrophy in spite of our best efforts. These unfortunate few have “geographic” atrophy: a lot of retinal cells and underlying blood vessels in and around the macula are damaged.

There are approximately 1 to 1.5 million people in the USA who have this condition and as many as 5 million worldwide. In the past year, two new drugs have been approved by the FDA. They are Syfovre and Izervay. These drugs work on the complement system that breaks the retina down.

Syfovre’s drug name is pegcetacoplan and it binds to C3 and slows down compliment activation to C3b. Izervay, or avacincaptad pegol, binds to C5 and blocks the activation to C5a and C5b. Both these drugs must be injected in the eye monthly, nobody’s idea of a good time, but clinical trials for these drugs show a slowing of atrophy progression by as much as 35% in the first year. Very significant.

Patients eligible for the drug must have geographic atrophy and cannot have any subfoveal (an area under the macula) involvement. Do note that these new drugs do NOT reverse existing atrophy, they only slow it down. Health Canada will hopefully approve these new drugs soon.

My patient is very proactive and seeking treatment at an American Retinal clinic as we speak. Cannot blame him. Wonderful news for a nasty condition.

Til next week,

the good doctor

Making a spectacle, a start at a history

Thu, 05 Oct 2023 07:13:54 GMT

Blog vol 4.18. Making a spectacle, a start at a history.

You must have heard about the optometrist who had a couple of glasses and made a spectacle of herself.

Spectacles have a long history. They were first invented to provide focus for aging eyes. Today spectacles correct a wide range of eye conditions.

A few “spectacular” historical facts:

As early as 700 BCE, people in China made spectacles with ground and polished quartz, usually set in a bronze frame. These spectacles were for near vision, essentially magnifiers. As the human eye ages, the lens in the eye hardens and this makes it more difficult to focus the diverging light rays that come from a book or, most likely in that era, a scroll. Lenses for myopia (distance vision) could not be made at that time and few people needed them.

Over the centuries scribes would have had a relatively short career if they could only rely on their own vision to see their writing. The skills and experience required to make the Book of Kells (ca.800 CE), for example, suggest that spectacles must have been accessible.

Last weekend, I was reminded of the writing of John Lukacs who wrote many books on the Second World War, especially focussing on Churchill and Hitler. A patient came in with a pair of glasses that looked eerily familiar. If you can recall, Sir Winston used to wear round tortoise-shell spectacles when he read. A company in Britain has made replicas of these glasses and named them appropriately, Chartwell, after Churchill’s residence in Kent. So for a mere 400 Quid, you can order them with your prescription and have them delivered to your door.

At one point in Lukacs’ book, The Duel, he points out that Hitler had an aversion to wearing spectacles, making sure that propaganda photos did not show him donning them even though he needed them. Perhaps with Hitler’s commitment to Nietzsche’s Übermensch, he wanted to always appear unassailable, not a vulnerable human being. It does make one wonder if the twentieth century would have been less painful if Hitler had decided to gladly wear his glasses. A different perspective may have helped.

The twentieth century was not kind to spectacle wearers in Cambodia, where Pol Pot and the Khmer Rouge ruled. During his four-year reign of terror in the late seventies, the Communist Party’s “cultural revolution” created policies that were against the elite and the educated to the point that even people who wore spectacles were seen as enemies of the state.

As you can see, the history of spectacles is quite fascinating (a topic that has sequel written all over it).

Stay tuned,

the good doctor

Great, very cool, new resource for the visually impaired

Thu, 28 Sep 2023 21:14:44 GMT

Blog vol 4.17. Great, very cool, new resource for the visually impaired.

At last week’s Burlington Eyecare staff meeting, we had the pleasure of hosting Jane McAnally, an independent living skills specialist with the CNIB (Canadian National Institute for the Blind). I worked with several CNIB Low Vision Clinics in the 90’s and it was great to meet up with Jane again and get a CNIB update.

A little history: In 1918, after the Great War and the Halifax explosion, there were a significant number of blind and visually impaired people in Canada. Dr. Baker and a group of men formed the CNIB as a resource and support. As the years went by, they served the blind and, more and more frequently, the visually impaired with rehabilitation, orientation and mobility, and low vision services. Blindness has become less common over time with improvements in the prevention and care of diseases. There was and is still much to do, however, and in order to finance the work a lot of energy has necessarily been put into fundraising. In 2017, the government improved funding for many essential services and the CNIB was divided into two groups: Vision Loss Rehabilitation and the CNIB Foundation.

Jane is working for Vision Loss Rehabilitation. Interesting resources now available. Technology has changed over the years. Back in the day, the CNIB put books on cassette, then mailed these talking books to clients from their vast catalogues, a wonderful thing for the visually impaired; then it was compact discs; then the talking books were made available through public libraries (a great improvement for increased access); and now with streaming, the use of smartphones and some really cool apps, access is even greater.

Jane showed us the best app: Seeing AI (iPhone). It reads text aloud through the camera, really quite amazing. I have since shown this to several patients who were very excited about it, not to mention family and friends… it is just that cool.

The CNIB has helped set up a programme called Phone it Forward which collects used iPhones, cleans them up, and repurposes them for visually impaired clients or individuals. It’s a great idea to donate your old iPhone, the phone isn’t just not ending up in a landfill or recycling, it is helping someone out, a win-win.

This simple device has revolutionized the lives of the visually impaired. It can be used as a camera, as a magnifier, as a talking book, or as a reader with apps for iPhone or Microsoft, like the Seeing AI or Envision AI.

It was great to reconnect with the CNIB and find out what they are up to. We have patients who can benefit greatly from their work. Plus now we all know what to do with our old iPhones.

the good doctor

Sometimes you come across a great article

Thu, 21 Sep 2023 06:26:43 GMT

Blog vol 4.16. Sometimes you come across a great article.

I really appreciate great journalism and great writing. It was a pleasant surprise to discover a magazine that I have not read in the past, Wired, which discusses new technologies and their impact on our culture. In the August issue, there is a very good discussion of the spreading “epidemic” of myopia or nearsightedness. In China and Taiwan, myopia rates are as high as 90% among young people. This is huge. 20-25% of these people have high myopia (greater than 5.00 dioptres of required correction). Read more here .

With the stretched-out retina of myopia, particularly high myopia, conditions like retinal detachments are a problem affecting younger patients.

I was reminded on the weekend, in a course on glaucoma from the University of Waterloo, that the stretching of the eye caused by high myopia also causes weakening of the structures in and around the optic nerve, called the lamina cribrosa. This makes the patient more susceptible to nerve damage from pressure changes in the eye and actually puts the person at higher risk for glaucoma, a degenerative, chronic eye disease that can lead to blindness if not managed. So we have an increased risk of retinal detachments and glaucoma, and we also have macular problems. The stretched eye, if really bad can cause outpouching in the retina and cracks in Bruch’s membrane, all bad.

This course was on glaucoma, a pathology, so, of course, focussed on worst-case scenarios. Many people with high myopia are fine, no need to panic. However, a high myope is at increased risk for a variety of problems so regular eye exams are important. Myopia is a lifelong issue. Corrective eye surgery does not fix these problems, it only changes the lens.

The thing is that much of this myopia can be prevented or at least slowed down.

What is the reason for all this myopia? The short version: too much time on screens or doing near work, screens too close to eyes, not enough time outdoors.

The good news is that we now have ways to detect myopia earlier and slow it down. Part of a child’s eye exam is the measurement of axial length as well as corneal maps to track the possible development of myopia. The first years are when the progression is steepest and it is easiest to manage at this age. There are a variety of options for managing myopia which include glasses, drops, and contact lenses, as well as increasing outdoor time and reducing screen time.

Crazy as it may seem, my first introduction to the causes and development of myopia was in the 80s in the laboratory of the then Director of the School of Optometry, Dr. Jake Sivak. He and his wife, Barbara, were working to crack this myopic code. Once again we all benefit from years of hard work and plugging away at research.

It is our job to take this information and use it. The research is saying conclusively: more daylight, more outside time for our children, less time on screens, hold screens further away from the eyes, and yes, regular eye exams.

the good doctor

The Boat Goes On...

Thu, 14 Sep 2023 03:59:46 GMT

Blog vol 4.15. The Boat Goes On….

In the 60’s Sonny and Cher coined the famous song “The Beat Goes On”, later making it the theme song for their popular variety show. With a slight modification, we have: “The Boat Goes On”, specifically the hospital boat that Medical Ministry International (MMI) is building on the Amazon River. A big dream, to provide sustainable, ongoing care to 280 communities in the Amazon basin — a region of the world that does not have much in the way of ongoing medical care.

How to do this? The Mau Ipata, the House of Life in the Tacuna language, a hospital boat. We are all so excited, the workers are putting the finishing touches on the basic hospital. It is presently being fitted with air conditioning and huge diesel engines. Then the boat will be taken to Leticia, a city in southern Colombia on the Amazon bordering Peru and Brazil where the clinics, surgical suites, exam rooms, and lodgings will be installed.

This past week, the patients and staff at Burlington Eyecare celebrated the reaching of our goal to provide funding for the ophthalmologic equipment necessary for a basic eye clinic: $50,000!

We did it!!!! Yeah!!!! Thank you everyone! So amazing!

It is fitting that Leticia is the final destination for assembly as it is in the centre of the three countries involved. Colombia, Peru, and Brazil have all worked together to make this possible which, in this highly political world, is a miracle in itself. The support for the work has been overwhelming, bringing together lots of people from all over North and South America.

Many of my patients were so happy to be able to support a work where you know that the funds will be put directly to the source, straight to the purchase of equipment for the eye clinic on the hospital boat. The equipment is being purchased in the host countries, and no one involved is benefitting from the purchases.

The projected launch date is October 2024; the Mau Ipata will be fully operational. We look forward to that event, it should be a wonderful christening (hope to get video footage of that one).

So many people will benefit from the services this boat will provide, just basic things we take for granted here in Canada. These services will be funded by Medical Ministries International (MMI) and the local governments. If we can alleviate needless suffering and grief if we can really see people enough to help them… what a gift to be able to share.

Thank you all so much for your excellent support, it’s a lovely thing.

the good doctor

Now, on a “Brighter” note

Thu, 07 Sep 2023 03:50:12 GMT

Blog vol 4.14. Now, on a “Brighter” note.

It is Bright Run time! Saturday, September 9, 2023 is the big day. The Bright Run is a Hamilton walk/run event in support of breast cancer research. This is my week out of the office but I did want to plug this event.

Our very own Dr. Jerilee Nyman was a big supporter of the Bright Run and battled breast cancer for two years. She has been gone for a year and a half; sadly, this will be the second Bright Run without her. Her family and friends continue to support this event, acknowledging all she went through, and just plain missing her, at Burlington Eyecare and in all of our lives. If there is any way to help make it so other people do not have to go through what Jerilee and her family did, we are all for it. Go Bright Run!!!

The Bright Run location changes annually, with the 2023 Run being held at Christie’s Conservation Area. All funds go directly to breast cancer research. The website here gives you all the details.

This is a fun family event that provides great support to families struggling with breast cancer. So if you can donate, great; if you can volunteer, awesome; and if you can run, stupendous.

Til next week, think pink!

the good doctor

On a “lighter” note

Thu, 31 Aug 2023 06:05:08 GMT

Blog vol 4.13. On a “lighter” note.

Last week’s blog on Wnt signalling bent my brain, so this week, a lighter topic.

Light and plants in fact. This time of year, in our area there are fields of sunflowers grown as cut flowers or for the seeds. The sunflower is a fascinating plant whose flower follows the sun across the summer sky, though in actuality it is only the young flower that is heliotropic, attracted to the sun. As the flower matures it locks in on the east as it waits for the sun to rise and stays there. Our family grows them for their beauty and to have the added benefit of free-standing birdfeeders in late summer. Very cheery and hopeful, one cannot help but think of Van Gogh’s beautiful painting of sunflowers.

Sunflowers, moonflowers.

A wonderful picture book, just released in 2023, by author Sarah Mackenzie and illustrator Gabrielle Grimard, called While Everyone is Sleeping tells the story of a little shrew who goes out at night to dance among the moonflowers (ISBN 978-1-956393-02-6). It is worth a read, especially with the grandkids. The concept of moonflowers captures the imagination. Are they like sunflowers, but follow the moon? And why are these flowers open at night when all the pollinators are in bed in their nests?

Moon Flowers, Ipomoea alba, are trumpet-shaped like morning glories, are bright white, and come out only at night. They are a perennial vine in southern climes like Arizona but are grown as annuals in southern Ontario. They do not open by light or moonlight but have photo-sensors that track the length of day. In late summer or early fall, they bloom at sundown and remain in bloom all night. When in bloom they glow and are quite striking, but when dawn arrives the flowers close up.

A night garden is a thing, who knew? Actually the YA book, The Night Gardener, by Jonathan Auxier (another great read! a little creepy, deliciously so) features moonflowers also, though that is not all the gardening the night gardener does (of course).

Bees or wasps or birds can sense and drink from daytime flowers, but what is going on with moonflowers? How are they pollinated? Moonflowers have a lovely fragrance and attract night-flying creatures like moths and bats to their nectar.

The superpower of light, super interesting, the things you learn reading to the grandkids.

the good doctor

New break-through in eye disease treatment from the University of Waterloo

Thu, 24 Aug 2023 09:03:20 GMT

Blog vol 4.12. New break-through in eye disease treatment from the University of Waterloo

In 2018 Donna Strickland at the University of Waterloo won the Nobel Prize in Physics for her work with lasers.

University of Waterloo researchers are breaking ground again, this time in pharmacy, with the development of a new class of drugs for treatment in eye disease. These drugs use a new protein that works with the Wnt-signaling network to help repair damaged blood vessels in the eye.

Off I go to Google and PubMed to research this topic. Not so easy. It is very involved molecular medicine.

“Wnt proteins act as intercellular signals which regulate the proliferation of cells.” This is the definition provided by the Wnt network homepage from Stanford University.

I have read a good number of suspense novels, and I can tell you that one way to solve mysteries is to follow the money. In this case, we need to follow the molecules. Scientists have known about the Wnt signalling network for some time. This system works with stem cells and is involved in the embryonic development of organisms, specifically, how the tissues are developed. Abnormal signals or proteins produced by the signalling network can result in cancers or other malformations.

So, we need to find a way to create proteins that use the Wnt network to signal beneficial changes. Dr. Sachdev Sidhu, working in collaboration with Waterloo’s School of Pharmacy, has developed such as protein. This protein enters a cell through fizzled (yes, fizzled) receptors and by a series of changes results in a new substance, ß-catenin, which enters the nucleus and eventually works with Wnt genes, another part of the network (read more here ). These genes are activated to help build up blood vessel integrity in the eye which is super-important in wet macular degeneration and diabetic retinopathy.

In Wet Macular Degeneration the body produces too much VGEF, Vascular Endothelial Growth Factor, which encourages new vessel growth in the eye. This results in a proliferation of vessels which unfortunately are poor in quality. The best treatment currently is AntiVGEF injections into the eye to control VGEF production and prevent vision loss.

Ideally, we could stop the process further upstream and prevent the over-production of VGEF in the first place. This Wnt-signaling protein is in clinical trials and looks like it just might be able to do that.

‘til next week,

the good doctor

Back to the Books

Thu, 17 Aug 2023 06:54:36 GMT

Blog vol 4.11. Back to the Books

I know this may sound premature, especially for the teachers and students who don’t want to think about it just yet, but school is just around the corner. And I personally am already at the books as I start a University of Waterloo, School of Optometry on-line course.

The population is aging, demand for health care is increasing, how do we provide the care needed? One option is to delegate where possible. Ophthalmologists (eye surgeons) are swamped, some routine care can be passed off to optometrists, leaving the ophthalmologists free for critical care.

The old adage is: educate, then, legislate. The basic principle is that one must know what they are doing before they can be given the responsibility.

Generally, optometrists in the U.S. have added new responsibilities before Canadian optometrists. In the 1990’s many Ontario optometrists took extensive courses through an American University to learn how to treat eye disease with therapeutic drugs. In 2011, legislation was passed making it possible for optometrists in Ontario to prescribe a variety of eye drops and treatments. Fast forward to 2023 and the fourth year optometry students that work with us at Burlington Eyecare are well trained in diagnosing and treating eye disease.

The course that I am currently taking is an in-depth course on treatment and management of glaucoma, on working with oral therapeutics, and on ordering lab tests for various diseases. This is very involved, requiring a thorough knowledge of the eye in all its complexities and how it relates to the entire body.

Glaucoma care is ongoing and mostly routine and can be passed off in most cases from ophthalmologists to optometrists.

Glaucoma is a condition that causes damage to the optic nerve, frequently this is related to high pressure in the eye. Glaucoma does not necessarily present any noticeable symptoms but can lead to significant vision loss if not treated. It is most common in older persons and cannot be cured only managed with medicated eye drops and monitoring for changes. NOTE TO ALL: Regular eye exams are important!!

What I appreciate about the optometric profession and the School of Optometry at Waterloo, is the desire to be the best that we can be, and that means life learning. It is an attitude of serving the public of Ontario to the best of our ability. I also appreciate the School’s commitment to providing a world class facility as they plan and begin building the Waterloo Eye Institute which will integrate the health professions, further eye research, and train up a new generation of optometrists.

In 1987, when I first started practicing, optometrists could use diagnostic drops and local anesthetic, that’s it. The profession has come a long way and it has been a very exciting journey.

I look forward to what the future brings, meantime, back to the books.

‘til next week,

the good doctor

Help for Severe Dry Eyes

Thu, 10 Aug 2023 07:43:10 GMT

Blog vol 4.10. Help for Severe Dry Eyes

There are dry eyes and DRY eyes.

We have several patients that have DRY eyes because their own body is attacking their own tissues, patients with conditions like Sjögren's syndrome, graft-versus-host disease, non- Sjögren's tear deficiency, rheumatoid arthritis, etc. What they all have in common is very reduced tear production and resulting damage to external ocular tissues (the surface of the eye:).

There are many ways to treat this form of DRY eye, but sometimes none of them work leaving a patient virtually visually impaired due to the severity of the eye dryness. An option that has been around for a while but with limited use is autologous serum eye drops. (Read more here ). We recently had a patient who had given up hope of finding relief for their EXTREMELY DRY eyes benefit greatly from these drops which has brought them to our attention in a new way, in a maybe-the-benefits-can-seriously-outway-the-costs way, in a it-may-just-be-worth-a-try way.

The serum is obtained from the patient’s own plasma (hence “autologous”, same donor as recipient), making it very close to the patient’s own tears. To do this a small vial of blood is drawn, allowed to clot, then centrifuged to remove solids. The remaining solution is diluted with a balanced salt solution, preservative-free normal saline, and another sterile, preservative-free, eye-compatible solution. The drops have the patient’s own vitamin A, lysozyme, transforming growth factor‐β (TGF‐β), and fibronectin, a custom-made drop that reduces inflammation and promotes eye healing.

The drawbacks are the process and the price. The process is cumbersome. Being regularly poked with a needle to draw blood is not pleasant, with new batches made every 2-3 months. The procedure needs to be done by referral to an infusion clinic. The patient keeps extra bottles in the freezer, opened bottles in the refrigerator. The drops are used every 2 hours and can take 2-3 weeks to start showing benefits. It is a non-OHIP procedure and a lot of insurances do not cover it. Autologous serum drops can cost $200-300 for the 2-3 month supply.

The good news is that a procedure that was once out of the reach of most patients has become more readily available. More work needs to be done studying the long-term effects of the drops, standardizing the procedures, and making them even more accessible. In the meantime, autologous serum drops just may really help some people (like our patient!) who really need relief from severe dry eye, in which case we need to try it, if at all possible.

Hope for a very trying eye condition.

‘til next week,

the good doctor

The importance of a regular exam

Thu, 03 Aug 2023 04:40:10 GMT

Blog vol 4.9. The importance of a regular exam.

A regular eye exam checks your vision and the health of your eyes. Part of the testing determines what you can and cannot see. It is often hard to tell if your vision has changed because most changes come on very gradually.

Optometrists get regular exams too. The Ontario College of Optometrists has a Quality Assurance Committee whose task it is to ensure that all optometrists maintain excellence in the practice of their profession. Over time it is easy enough to get into habits or practices that do not maintain this standard of excellence, especially since the technologies and standards of care are continually changing.

All optometrists in Ontario are in a pool to be randomly selected for this exam. In June I got selected. The College requires ten new patients’ charts and the completion of a detailed questionnaire. Once submitted (with all names kept confidential and the file properly encrypted), the records are scrutinized.

It is an excellent time to look at your practice and your habits. I was very encouraged with the thoroughness of care we provide our patients. It has been helpful to review best practices in care to make sure we are not missing anything. The process obviously has a teaching component, having you review core documents and highlight the many changes in practicing optometry that have occurred over the years (I was first licensed in 1987 so there have been a few!). The review also helps me see how wonderful my staff and my colleagues at Burlington Eyecare are.

Over four years ago, Burlington Eyecare entered into an agreement with the School of Optometry at the University of Waterloo to supervise students from their 4th-year class in our clinic. I do think that we help the students to grow and thrive, but the reality is that we learn a great deal ourselves. The 4 ^th year students bring an energy and a hunger for knowledge that is contagious. There is so much to learn and so many ways we can help people.

I must say the whole process has made me think and analyze our work, which is the point, but it has also been onerous. There is a lot of work involved in this process. I am almost there and hope to send off the completed document tomorrow. Yeah!!

For the record, one of our doctors was selected in the last few years and, not surprisingly, received excellent results. It is good optometrists are held to high standards and it is good for patients to know that they are.

‘til next week,

the good doctor

Albus is a Latin word

Thu, 27 Jul 2023 05:58:58 GMT

Blog vol 4.8. Albus is a Latin word.

Every second summer our family has a “Harry Potter Festival” where we watch all eight Harry Potter movies. We are big fans of the books and the movies. The headmaster at Hogwarts School of Magic is a wizard named Albus Dumbledore. His name means White Bumblebee, with albus being the Latin word for white. Over the last 3 years, I have had the pleasure of meeting a number of very capable and upbeat people who are keenly aware of the word albus because they were born with albinism.

Albinism is an inherited condition that results in reduced melanin pigment in the skin, hair, and eyes. This is the only thing albinism does, it does not affect cognitive or physical function, it just causes pigmentation issues; that is it. Albinism is not that common in North America, affecting 1 in 20,000. It is a myth that albinism always causes pink eyes, it can but, as with anything, there are varying degrees of albinism. There are 7 known types of albinism, ranging from no pigment at all to hair and skin relatively unaffected and eyes with light pigmentation (ocular albinism). All forms of albinism affect the eyes and vision (read more here ).

Pigmentation in the eye is important as this is what absorbs the incoming light, without the pigment the light just bounces around and doesn’t get absorbed resulting in substantial vision loss at the macula, roving back and forth of the eyes (nystagmus), a significant eye prescription requiring glasses or contacts and sometimes eye turn (strabismus).

With the government’s decision in 2020 to allow bioptic telescopes for drivers with specific visual challenges, many people with albinism have been able to drive for the first time. Albinism is stable, the eyes are not getting worse unlike in many conditions that cause a person to qualify for bioptic assistance. This is good and makes for a very hopeful prognosis.

These patients have been a joy to work with. They have taught me the wide gap between visual impairment and visual disability. These patients are not disabled, not in the least, they have learned to work with their impairment and they do not focus on what they cannot do but on what they can do.

Imagine that you were told from a young age that a driver’s license, which normal-sighted people just take for granted, would be out of your reach. All the people with albinism that I have worked with have been highly motivated, great to work with, great learners, and very resourceful. Seriously, I cannot make this up. I wish all my patients were this enthusiastic.

As always, I look forward to working with whoever sits in my chair and I look forward to helping the few who need that special touch with bioptics to get on the road,

the good doctor

Myopia Management in Children - the Myah

Thu, 20 Jul 2023 08:01:06 GMT

Blog vol 4.7. Myopia Management in Children - the Myah

In earlier blogs, I have discussed myopia, the increase in its prevalence, and its magnitude in our children, an epidemic of sorts. I have written about its early detection and the many ways that we can slow it down. I have also written about the benefits of taking these measures.

To clarify, “myopia” is a fancy word for nearsightedness. Near objects are clear, far-off ones are blurry.

You know the saying “missing the forest for the trees”? Back in June 2020, I wrote a blog on Myopia Control, a lot of the looking at the trees. Myopia Management is the forest, more far reaching, it covers the whole myopia process from the beginning.

The chief editor of the Review of Myopia Management (yes, there is a journal dedicated to this topic), Dr. Dwight Ackerman, points out that the management of myopia is a comprehensive process. He stresses four areas that need attention:

identifying risk factors for myopia and high myopia
providing information, advice, and recommendations to children, parents, and other stakeholders
prescribing appropriate interventions to slow myopia progression and reduce the risk of developing high myopia
being proactive

Prevention, prevention, prevention is the key.

Regular eye checks, a balanced diet, regular exercise, and a variety of activities, especially outdoors (i.e. not too much of any one activity, i.e. screen time, a variety of tasks at a variety of distances from the eye) are the backbone of prevention.

With prevention in mind, we have started measuring axial length of the eyes of our children. Axial length is the distance in millimetres from the front of the cornea to the back of the retina and it is the most accurate and the most pre-emptive way of detecting early myopia. (Read more here ). We use a device called a “Myah” which is an optical biometer that consistently and accurately measures this length. The Myah allows us to detect early myopia up to 2-3 years earlier than previous methods. It also makes it possible to track the progress and success of our interventions. This is all done with light, no drops, no discomfort, just look at the green light, over and done in a matter of seconds; as an added benefit, the machine is quite cool and makes all kinds of R2D2-type noises.

It is not enough to rely on genetics, whether the mom or dad wears glasses because our screen-filled world is creating myopes. The Myah is a great tool that helps us catch myopia early so we can work on minimizing its development.

We have a lot of treatment options, but it is early detection that is critical because caught early means less progress and less myopia.

‘til next week,

the good doctor

Superman has kryptonite. Lenses have heat.

Thu, 13 Jul 2023 02:22:18 GMT

Blog vol 4.5. Superman has kryptonite. Lenses have heat.

Back in November 2020, I wrote a blog on protecting your ophthalmic lenses (your glasses) from extreme heat. I, unfortunately, had firsthand experience with the damage to lens coatings caused by heat and warned my readers to be careful around bonfires and other heat sources.

Well, I did it again. Maybe I should read my blog.

I was careful, really.

On the Canada Day weekend, I was doing some yard work and started a small fire, being mindful of the ongoing danger of wildfires. I had burnt my brush and cleaned up, taking care to not get too close to the flames. Later that weekend, I was having some difficulty getting my lenses clean and did not think about it any further. When back at work I gave my lenses a thorough cleaning, I really was not seeing clearly, and oh no! One of my lenses had cracks all along the front surface.

This time it was only one lens, but they both have to be replaced because antireflection (AR) coats are made in batches to colour match them. These coatings are a scientific marvel. Very thin layers of compound are applied in a controlled environment to create the destructive interference needed to maximize the amount of light getting through the lens. The goal is to provide the clearest vision possible by letting as much light through the lens as possible. The coatings prevent certain wavelengths from reflecting off the lenses and allow them to pass through the lens, the colours not absorbed and allowed to reflect are most frequently in the green to blue to violet range. The coating cannot prevent every wavelength from reflecting, almost impossible to do.

The lenses are first ground or etched with a laser, thoroughly cleaned, then a strong anti-scratch coating is applied to the front and the back. Once this is dried and cleaned again then the lenses are put in a vacuum chamber and the coating compound is heated in a crucible and vapourized and this is evenly applied. It is a very involved process and the newer coatings, like SeeCoat from Nikon, even have blue filters and easy clean coatings built in.

On close examination, and from my research, the heat makes the bottom coating, the anti-scratch, crack apart. The anti-scratch coating is hard, some are so hard that I have seen them crack from a simple flexing of the lens. There needs to be a balance here, but these coatings do prevent minor scratches which can really mess with your vision, and thereby significantly prolong the life of the lens, provided, of course, that you stay away from fires and other hot things.

One of my opticians suggested a pair of gardening glasses for outdoor work. That is definitely one possibility, or another option is a pair of over-safety glasses that I wear for protection from flying objects or in this case, intense heat.

I hope that I do not have to ever write on this topic again.

‘til next week,

the good doctor

Continuing with bugs: after ticks, mites

Thu, 06 Jul 2023 03:23:27 GMT

Blog vol 4.5. Continuing with bugs: after ticks, mites.

I spent a couple weeks on the topic of ticks and preventing Lyme Disease. Now we look at the world of mites, specifically the Demodex folliculorum which takes up residence in the roots of the eyelashes. Two recent articles in ophthalmology journals have focused on this topic.

Demodex folliculorum are very tiny (adults are about 3/10mm), eight-legged parasites that mate then lay eggs in the hair follicles of the eyelashes. These larvae hatch within 3-4 days and reach adulthood after 7 days. This sounds disgusting but is not all bad as mites can be helpful getting rid of dead skin and excess oils, their main source of food. When they die they usually break down inside the follicles. Some estimates have up to 20% of the general population with these critters and up to 65% of the elderly.

The word of the day is “EXCESS”: (1) an amount of something that is more than necessary, permitted, or desirable. (2) lack of moderation in an activity, especially eating or drinking (or in this case hosting too many mites). (3) exceeding a prescribed or desirable amount. (Oxford dictionary)

These mites can live symbiotically in our lashes as long as they do not go crazy. An excess of mites will cause red itchy lids, blurry vision, and even eye lash loss (a nasty form of blepharitis).

One journal article linked cataract surgery to an increase in infestations, reminding surgeons to be on the look-out for this condition after surgery (see article here ).

Another article discussed the results of a double-masked study that looked at the efficacy of a new eye drop: Lotilaner. When used twice a day for 6 weeks it has substantial results against the mite (read article here ).

The traditional method of treatment is to use warm compresses for the swelling and to clean the lids thoroughly and regularly, even scrubbing to get rid of dead skin. More recently, low dose tea tree oil wipes like Blephadex have been used to kill the adults and the growing larvae. This has to be done over a 3 week window because of the mite’s life cycle. My best guess is that the new Lotilaner eye drop will have good results because patient compliance will be higher than for traditional treatments, but that for the best results, cleaning and regular hygiene, though cumbersome, are unavoidable.

So, if you are having irritated, sore eyes and eyelids please come in and see us, we just “mite” be able to help you.

‘til next week,

the good doctor

Water, water, everywhere

Thu, 29 Jun 2023 06:55:18 GMT

Blog vol 4.4. Water, water, everywhere.

And so it seemed. Yesterday, my opening staff was greeted with water all over the floor by the patients’ bathroom. Initially, they looked up at the ceiling; with the recent cloud bursts, did it come through the roof? No (awesome:). The bathroom door was opened to discover that the toilet was overflowing. Fortunately, it was clean water, not sewage, that we were dealing with (again, awesome:). So what happened?

We have had problems with the float in the tank. It must have got stuck and kept the water flowing, which the toilet would usually handle because there is an overflow on the bowl, unless….. the line is blocked further up. We finally discovered that the pump or line further down the pipe was either blocked or not working causing the overflow at the toilet. Stay tuned as we continue the “Saga of the Backed-Up Bowl”.

Why all the hubbub on such a humdrum topic?

The flow of water and its drainage are a great analogy for the condition we call glaucoma. This month is cataract awareness month, but every month is glaucoma awareness month. Glaucoma is sneaky and insidious, just like that slow leak in the toilet bowl and if you are not careful, you can easily have a mess on your hands.

First, a little review of anatomy and physiology. Near the front of the eye, just behind the iris, is a structure called the ciliary body. It produces a clear fluid, called aqueous humour, which is the eye’s way of circulating nutrients and oxygen to all the clear structures of the eye like the cornea and the lens. The circulation of the aqueous also removes waste and debris and maintains the eye’s shape and pressure.

Glaucoma happens when the optic nerve and the neurons in the retina are damaged by high pressure in the eye. The ciliary body is like the tank filling up in the toilet and there is a switch in the eye that stops the water from flowing to achieve a healthy balance. As with the toilet, if the water has no place to go then it overflows or in the case of the eye, the pressure builds.

Catching this process is the problem, much harder than detecting water on the bathroom floor. A regular visit to your optometrist is critical. We now have really neat tools like Optical Coherence Tomography (OCT) and pachymetry that help us detect glaucoma earlier. We have treatments that can reduce the flow or production of aqueous and other treatments that increase the outflow (sort of like pulling the plug on the blockage). The main thing is that you have to catch it, get the pressure down, then do regular maintenance.

By the way, there is a happy ending to the “Saga” as the plumber found a faulty backflow flap. Replace that and get the flusher fixed and we will be right as rain. We have nice clean floors and a great analogy for this blog: the right amount of fluid in the right place is great; too much is bad…

Getting your eyes checked regularly is the surprise moral of the story.

‘til next week,

the good doctor

Cataract Awareness Month

Thu, 22 Jun 2023 07:34:35 GMT

Blog vol 4. 3. Cataract Awareness Month

I see cataracts every day. Most people develop cataracts at some point. A cataract is a blurring of the lens of the eye caused by the breaking down of protein structures. This is usually age-related but can be present at birth, secondary to another medical issue, a result of trauma to the eye, or possibly due to large amounts of sun exposure. Cataract surgery is simply the removal of the cloudy lens and the insertion of a new clear lens. Poof, you can see!

The problem with cataracts is that they sneak up on you. Cataracts usually come on so gradually that you can be visually impaired from them and not even know, our visual systems are that good at adapting. I usually see traces of cataracts starting in a patient’s late 50s, but the average age in Ontario for OHIP cataract surgeries is 73.5 years. That’s a 15-year development. Remember your newborn in diapers then jump forward to your child getting their driver’s license, similar time period, that long (and that short, for you parents out there).

AN ASIDE, as a follower of art history, I always find it fascinating to see when an artist started to develop cataracts (if they lived long enough), the paintings shift to a hazier more brownish tone. Interesting fact.

Cataracts are normal but they can be a serious problem if not treated in a timely manner. In the elderly, the number one cause of falls and subsequent broken hips is visual impairment from cataracts, as you need a lot more light to see through a cataract. There is no reason for this to happen. Get your eyes checked! If caught early, cataracts can be removed before they become debilitating.

Cataracts, today, are very treatable. The most frequently performed surgery in North America is cataract removal. In the past, there was no way to get rid of them, outside of hoping that your lenses were dislocated if you got konked on the head with a club.

I read a wonderful book on an innovative and skilled ophthalmologist from Nepal, Dr. Sanduk Ruit, who has developed new techniques, methods, and materials that make these surgeries more universally accessible. Really life-changing and enabling for so many.

In places in the world where health care is not readily accessible, cataracts are the number one cause of vision loss. Cataracts also happen a lot earlier in many of these places for various reasons, with onset in the early 40s. MMI (Medical Missions International) sends out eyecare teams to remote, health-care-starved regions to provide eyeglasses and surgeries, particularly cataract surgery, to people who do not normally have access. The results can be so dramatic and can mean the difference between being blind and seeing clearly, between poverty, dependence, and a working, active life, so exciting, and a wonderful thing to witness.

The Amazon medical boat, the Mau Ipata, will have, amongst many other things, an eye clinic and surgery. Burlington Eyecare is raising the money for the eye clinic equipment (we are well over half of the way there:). This will make eyecare services available to the people of Peru, Columbia, and Brazil, including cataract surgery. (Follow this link for videos displaying the boat's plans and progress).

So… GET YOUR EYES CHECKED REGULARLY, and if you have cataracts we can refer you to some great surgeons. Also, help other people have the same opportunity and support the efforts of groups like Medical Ministry International.

‘til next week,

the good doctor

Lyme Disease II

Thu, 15 Jun 2023 04:15:30 GMT

Blog vol 4. 2. Lyme Disease II

I feel like I am Harold Crick (Will Ferrell) in the movie Stranger than Fiction. The only difference is that instead of Karen Eiffel (Emma Thompson) doing the writing, it is me. Let me explain. Three weeks ago, I wrote about pink eye, and guess what? I got it real bad the next week. Then last week I wrote on deer ticks and Lyme Disease, and guess what... this past week we had two separate incidences of deer ticks in our house, though this time I’m not personally (bodily) involved, and no Lyme disease thankfully.

No doubt these topics are very relevant. On Saturday my grandson was changing into his pyjamas after dinner at the grandparents’ house. He noticed a black spot on his chest, a tick. We carefully removed it with tweezers and cleaned the site with rubbing alcohol (he was very brave). We have seen ticks before, usually dog ticks, but under the microscope this was a female adult deer tick. Unless you do regular tick checks, hard to tell how long this creature was embedded, and timing is important. So off he goes to his family doctor for a round of antibiotics.

This morning, round two, my daughter was doing her morning routine, and a black spot on her ankle, this time it was not the adult female but the much smaller nymph, about 1/3 of the adult’s size (poppy seed size). I removed it with tweezers and cleaned the site. This is where it gets disturbing, that nymph could be infectious, the problem is that it is a lot smaller and can easily go undetected. The nymph can infect within the 36-48 hour window, like the adult. Question remains- how long was that creature there? Regular checks are a great help. With my daughter, she knew that she was exposed for about 16 hours, so very little chance of infection.

REGULAR TICK CHECKS ARE A MUST. These two incidences were from completely different areas, ticks are out there. Lyme disease can be prevented. The tick needs to be infectious and attached for 36-48 hours, plenty of time to find it and remove it. If you have found a tick and are not sure about the timing see your GP for consultation. Take a real good look, those nymphs are small.

There is a spray called 0.5% permethrin that you can treat your clothes with and there are even clothes you can buy that are pretreated, but do not rely on these things, a quick check is the only really reliable prevention. (See here for preventative measures)

I need to be careful about that next blog topic….

‘til next week,

the good doctor

A great party, no ticks invited.

Thu, 08 Jun 2023 02:51:23 GMT

Blog vol 4. 1. A great party, no ticks invited.

Have I ever told you about the wonderful staff and colleagues that I work with? We get along so well at work that we also like to play together. Burlington Eyecare has an annual Spring outing and this year we went out to Roger and Mary’s (two of our excellent opticians). Their gardens are lovely, the hospitality so warm and welcoming, and the games and food excellent. We had a lovely afternoon and all came, even the toddlers. We had highly competitive Bocce and Spike Ball matches, then sat and enjoyed each other’s company and jokes (still have work to do on my Afrikaans:).

The time in the outdoors reminded me that it is time for my annual tick alert. Lyme disease is preventable. You REALLY. DON’T. WANT. IT. Many myths exist about Lyme disease so beware of what you think you know; for the long list go here .

First, did you know that the deer ticks that carry the spirochete can survive in the cold? Cold, especially extreme cold, does reduce the number of ticks but does not eliminate them.

Second, and this one is concerning, there is no “gold standard” for testing for Lyme disease, meaning that you can have the disease and test negative for it. The signature “bull’s eye” rash of Lyme disease also may not show.

PREVENTION, PREVENTION, PREVENTION. The number of deer ticks and the spirochete are on the rise in southern Ontario, as is the incidence of Lyme disease.

Broken record time, lest I repeat myself, again, but this really matters, so...

1. Bug spray can help, at least 20% DEET, but remember that if a tick is there, it is there, you still have to check.

2. Check, every time you or your little ones go outside: make tick check a habit.

3. If you detect a tick, carefully remove it, getting the mouth, then clean the site with alcohol. If you are not sure when you contracted the tick, better to be safe and get a round of antibiotics from your GP.

Really it boils down to a tick check, there is no other way. And that is it, highly preventable, but make a quick check a habit.

By all means get outside, no worries, when you come in take off your shoes, quick check, done.

‘til next week,

the good doctor

Pink eyes II

Thu, 01 Jun 2023 01:09:46 GMT

Blog vol 3. 52. Pink eyes II

Last week, with pink eye happening in our house, I wrote about… pink eye! Not surprisingly, due to the contagiousness of the virus and the percentage of our household infected, it was also a prescient topic.

Prescient, according to the Cambridge Dictionary is “knowing or suggesting correctly what will happen in the future”. The future being Sunday morning when I woke up with, you guessed it, pink eye, first time ever. Should I let it resolve itself, taking up to eight days to blow over? Meanwhile, my already overloaded schedule gets even more backed up because I cannot expose my patients to this virus.

A while back I took continuing education courses with some doctors in the U.S. who were treating pink eye with Betadine. I also knew of an ophthalmologist, here in the GTA, who contracted pink eye and had done the Betadine treatment.

It really works, because Betadine (iodine) is the compound that we use to disinfect skin and tissues before surgery. It kills everything. Sunday night, I went to the pharmacy and loaded up with Betadine, anesthetic, steroids, non-steroids, and saline, and at 8:30 Monday morning, my colleagues at Burlington Eyecare gave me a Betadine treatment, at this point on both eyes as they were both clearly presenting full-blown pink eye.

It involves getting the Betadine on the eye and the surrounding tissues, like the lids for 60 seconds. No big deal because I was anesthetized, so my world turned yellowish brown as the sterilizer washed over my eyes. I did mention that it kills everything… so gone were the nasty adenoviruses but also gone were my epithelial cells on all the tissue that was washed. After 60 seconds, profuse irrigation with sterile saline.

There is a saying out there (you do not do this to any animal/creature, let alone a cat), that you don’t know what it is like to swing a cat by its tail until you actually have swung a cat by its tail. I can also tell you that the anesthetic lasted exactly 15 minutes because that is when the pain and tearing began and continued for the next hour and a half (seemed like longer). More irrigation with cold drops, and then again more still, lots of cold compresses, some drops of non-steroidal meds, more cold, more irrigation, and an Advil for the pain.

I then lay down with the changing out of cold compresses and the start of steroidal drops and slept, miraculously. Woke at lunch, still irritated and with blurry vision, which with further drops of steroid and lubrication subsided as the day waned.

I am all better now: no more pink eye, no longer contagious. I was able to work the next day, but I wonder about the wisdom of Betadine. It really works but boy oh boy what a miserable affair. My recommendation, unless you really have to, I would stay away. I would also recommend a lot more irrigation to wash out the iodine (Betadine), even going so far as to use a Morgan lens that is used in emergency for chemical burns with a LOT of saline, I mean a LOT, a LOT.

I learned from this whole experience that whatever chemical, etc. that is in the eye, you need to over-the-top irrigate. You do not want to leave a single molecule in there, let alone two… I shudder at the thought.

Instead, pink eye only lasts for so long, put up your feet, read a book, wait for it to go away.

‘til next week,

the good doctor

Pink Eye, a cold in the eye

Thu, 25 May 2023 06:16:24 GMT

Blog vol 3. 51. Pink Eye, a cold in the eye

When we use the word “pink”, we think flowers or “ballet pink” or more recently, the battle against breast cancer.

An eye that is pink is not well. Not all pink eyes are “pink eye”, some are the result of allergies or dryness or other irritants. Pink eyes that come into our office are taken seriously as the condition “pink eye” is highly contagious. All the measures we used to contain COVID are very useful here.

Pink eye is a class of disease that is caused by an infection of the adenovirus. We know that the coronavirus is responsible for COVID and that the coronavirus is now classified as endemic in most parts of the world. The adenovirus has been endemic for a long-time; it is the same virus that is responsible for the common cold. Like the coronavirus, this virus infects other tissues besides our respiratory tracts.

The virus must make actual contact with the eye, where it settles in and produces the classic “pink” eye. The part of the eye that is usually white becomes pink or even red. Usually, the infection will start in one eye and spread to the other eye, usually in a milder form. The infection occurs during cold season, from October to May. If you have a cold and you inadvertently touch your eye with the virus, you can give yourself pink eye. You can also touch a surface that is contaminated, touch the eye, and voila. It is very contagious by contact.

The usual symptoms are extreme light sensitivity, a watery discharge (not pus which comes from a bacterial infection), and blurry vision. It will feel like something is in your eye; it will itch, burn, and be “gloopy” (a direct quote from one of my patientsJ) and usually comes on the heels of a cold or flu.

We use the “rule of 8’s” when it comes to pink eye, technically called epidemic keratoconjunctivitis (EKC). 8’s are wild because it is usually an adenovirus strain 8 that causes 8 days of an infectious red eye, 8 days of immune response, and then 8 days of resolution, a process that can last more than 2-3 weeks.

Treatment is for symptoms with the use of cold compresses and lubricating drops. More severe cases may require steroids to get the inflammation down. Do NOT go to the pharmacy and get Pink Eye drops from Johnson and Johnson as that drop is an antibiotic and pink eye is caused by a virus (read last week’s blog on bacteria and resistance here ). If you suspect pink eye, be very careful to not touch your eyes but if you do touch them then immediately wash your hands with soap and water. Remember: very contagious by contact. The virus must get in your eye.

Prevention is key, so in our office, any suspected case of EKC is quickly isolated, all surfaces washed down thoroughly, use of gloves mandatory, longer disinfection with bleach or alcohol on all instruments, and a report to the office staff and all involved that EKC is in the house.

All this means that you will need to isolate to keep from spreading it. Pink eye is literally a cold in your eye and we all know about colds.

All the best with this one,

‘til next week,

the good doctor

Bacteriophages

Thu, 18 May 2023 07:59:27 GMT

Blog vol 3. 50. Bacteriophages

When studying biology in my undergrad at the University of Western Ontario, we looked at bacteriophages, a class of viruses that help to kill bacteria, something that could be very useful. With all the bad press about viruses that surrounded Covid since 2020, the mention of a beneficial virus sounds like a dream.

This is not a new idea, as early as 1919 Felix d’Herelle, a microbiologist at the Pasteur Institute in Paris, used bacteriophages to treat a patient with a bacterial infection. This was cutting-edge research at the time but the discovery of penicillin in 1928 made phages seem unnecessary and the research dropped off.

Now, 100 years later, we are taking a serious look at them again. The May 6th Economist has an article (see here ), “Battling Superbugs with Viruses”, that discusses the possibilities of this research.

We have been using antibiotics for so long that a number of bacteria have developed a resistance to many of these drugs. Bugs like tuberculosis and gonorrhoea are spreading again and even Staph Aureus has developed some resistance. The drug industry has not developed a new class of antibiotic in 40 years. This is all very worrisome, making us vulnerable to bacterial infections. In fact, as many as 1.2 million deaths globally in 2019 were the result of untreatable bacterial infections.

What is really cool about bacteriophages is that they are incredibly specific to a bacteria even within species. The trick is to isolate and culture the offending bacterium and then have a library of phages available for treatment. The phage binds to a suitable receptor on the bacterial cell wall and injects its genetic material into the cell. The phage is “lytic” which makes it possible to hijack the bacteria cell’s machinery to make copies of itself. The phage proliferates inside the cell, finally killing the bacterium and being released to do more damage.

Specificity is the operative word. Only a small dose is required and there are few side effects. The researchers look for the problem bacterium, usually in human sewage or hospital waste where resistant bacteria can be found, find phages present with it, and then isolate and store them in a library for future use.

Sounds like a great solution, but there are problems. This research is intensive and the phages cannot be patented (not a lot of money to be made here, are governments going to be motivated to fund this work?), as well, large studies need to be done to establish dosing and efficacy. Also, the human immune system can react to the phage as a foreign object, there has to be a way to prevent this.

The application of this technology could be very helpful in medicine and in working with plants and livestock. It will certainly not replace antibiotics but could be a much-needed resource for dealing with a worrying trend in increasing bacterial resistance.

In the meantime, as we look to roll out the phages, we need to be diligent to decrease the development of bacterial resistance by only prescribing antibiotics when required and by using the full dosage when they are.

The fact that bacteriophages were being used 100 years ago is fascinating. Antibiotics have led us down other paths, but in the future, we are likely to benefit from having both in our arsenal.

‘til next week,

the good doctor

Looking back at a legend

Thu, 11 May 2023 03:45:09 GMT

Blog vol 3. 49. Looking back at a legend.

Dr. Eleanor Faye was a wonderful personal mentor. When I was going through Optometry school in the 80s I used a text in Low Vision called Clinical Low Vision, which was written by Dr. Eleanor E. Faye. I was so taken by her care and compassion, it inspired me to specialize in this field.

“Low vision” refers to the care and assistance of people with visual impairment. These people are not blind but have reduced vision to one degree or another.

After two years in private practice, I decided to take a residency in Low Vision at the University of Waterloo, a year-long practicum in the area of visual impairment and disability. Dr. Faye’s book was what inspired me and the wonderful staff and doctors at the Centre for Sight Enhancement in Waterloo were more than eager to share their knowledge and their love of these patients.

Low Vision is a nice blend of Ophthalmology, Optometry, Counselling, and Social work. In the early 90’s the incidence of visual impairments was projected to increase dramatically, especially as our population aged. Thankfully, improvements in treatment and prevention have made these predictions less dire. Yet there is still a large need for this work.

I completed my residency in the fall of ’91 and proceeded to set up a practice devoted to helping the visually impaired and serving long-term care homes in Southwestern Ontario. I worked mostly out of my trunk and had a home office. I continued this work full-time until 1998 and since then have pursued it in conjunction with regular practice.

In the fall of ’93 at the American Academy of Optometry meetings in Boston, I had the pleasure of talking with Dr. Eleanor. She did not disappoint. Dr. Faye was a trained Ophthalmologist with a love for the low-vision patient; the person and the book were all one.

Dr. Faye died in January 2020 at the age of 97. Her groundbreaking work in the field of visual impairment has inspired and helped many. She focussed on using the vision the person has, however little it is, as best possible. This was revolutionary in medicine which wants to fix problems and struggles with what to do with problems that cannot be fixed. Dr. Faye saw the person behind the problem.

Hopefully, we can all be like that.

‘til next week,

the good doctor

The optics of an Infinity Room

Thu, 04 May 2023 04:41:26 GMT

Blog vol 3. 47. The optics of an Infinity Room.

In early May I take a week off from seeing eyes and spend most of my time getting outside, preparing our yard for the warmer weather. A nice and welcome change, we also spend some time at bookstores and, if things are going really well, a visit to the Art Gallery of Ontario (AGO).

The day at the AGO was really interesting. We spent time with the Kurelek collection (a favourite), the European Masters, nineteenth-century into early twentieth-century art (so much going on here), and explored some special exhibits.

In 2018, a Japanese artist, Yayoi Kusama, was featured in a large exhibit at the AGO highlighting her conceptual art particularly her “Infinity mirrored rooms” which generated long wait lists for viewing. The AGO has since purchased one for their collection. We finally were able to visit this mirrored room, called Let’s Survive Forever . You book a time and you get 60 seconds to be in the room. Pictured here is me in infinity mode.

I wanted to experience the space and the geeky side of me wanted to understand how a mirrored room works. Who knows, I might try building my own infinity room, and I probably could do it for a lot less than the 2 million dollars the AGO spent on this one.

The optics are quite basic: you need two mirrors that are parallel to each other which can bounce a beam of light back and forth an indefinite (theoretically infinite) number of times. The reflections appear to recede into the distance because the light actually is traversing the distance it appears to be traveling. The first time I noticed this effect was in a hotel bathroom where there were two mirrors and you could see all the way through the mirror as far back as possible.

In Let’s Survive Forever there were many mirrors and many reflections.

I took some pictures while I was in there and hoped the megapixels in the phone would zoom me out to infinity. To my disappointment, my extra megapixels told me what I should have known from long years of working with optics: even with the best of antireflection coatings, the image starts to diminish very quickly. Every time it bounces off the mirror, the light loses intensity, even if it is only 1% of its brightness, and after an “infinite” number of reflections the brightness goes down. So my infinite images are not appreciated by my megapixels or by my limited eyes and just fade into the distance.

Which is the point.

We all know that when we look into a horizon the colours are muted and less distinct. Looking through an astronomical telescope can get you out to “infinity” too, but not through the horizon, where our thick, murky atmosphere fades the light very quickly. So a painter will desaturate their colours when they paint a horizon and Yayoi Kusama uses many mirrors in a small space to achieve the same “disappearing into the horizon effect”, it’s just you that is disappearing.

Which is the point.

‘til next week,

the good doctor

Response to CBC article on screen time and eyes

Thu, 27 Apr 2023 10:13:40 GMT

Blog vol 3. 47. Response to CBC article on screen time and eyes

This past week CBC posted a story: "Excessive screen time is changing our eyes faster than we can blink." Interesting.

Screen time, whether for work or recreation, has significantly increased since the start of the pandemic. Initially, we were zooming to stay in touch but even as the pandemic has normalized our screen time has not decreased. Anyone surprised?

When on a screen, we do not blink as much. On average a person blinks every 5-6 seconds which can drop to every 10-12 seconds when staring at a screen . A blink has two main functions: first, it cleans the ocular surface of old tears and debris, and second, it puts on a whole new coating of tears.: decreased blinking results in dry eyes.

The glands in the lids, the meibomian glands, secrete an oily mixture that mixes with water to stabilize the tear film and help it spread over the eye. Our blinking activates these glands and aid in its secretion. When we do not blink as much, the meibomian glands start to atrophy reducing their flow and resulting in less stable tears. Studies in children are showing changes in the structure of these glands directly related to increased screen time (see here ).

In adults these glands tend to atrophy over time, leaving as much as 30 % of the Canadian population experiencing some form of dry eye. We at Burlington Eyecare have definitely seen a huge increase in dry eye problems.

The other problem with the extra screen time is increased rates of myopia, or nearsightedness. The World Health Organization (WHO) predicts up to a two fold increase in the worldwide prevalence of myopia from 2010 to 2050. That is huge. Part of that increase can be attributed to the increased screen usage, with a huge spike happening during the pandemic. The long periods of time looking at a near screen causes the eye to adapt to this near environment. Myopia once present needs correction, either by eye glasses or corrective surgery and, unsurprisingly, myopia increases risk of other eye issues.

I would argue that there is a third risk to the eyes. That has to do with the lack of “healthy” activity that usually helps to decrease dry eye and myopia. Whatever affects the health of the body necessarily affects the eyes. Physical activity, time outdoors are very important.

What can we do?

· Reducing screen time is important and getting especially children outside into the daylight.

· Taking breaks on our screens, at least every twenty minutes, a small 20 second break with about 20 extra blinks to get things flowing.

· Start your children on screens at a later age and control the time when they do start.

· Get your children’s eyes checked early on and every year, catching myopia early is important. There are many ways to slow down myopia

development, but is has to be detected early to really be effective.

The CBC article has a point and we should be concerned, but we do not need to be victims. Prevention is possible and well within our grasp.

‘til next week,

the good doctor

The backstory to the government’s change of heart on bioptics

Thu, 20 Apr 2023 04:31:45 GMT

Blog vol 3. 46. The backstory to the government’s change of heart on bioptics

In the fall of 2020, the Ontario government changed the law to allow the use of bioptic telescopes for driving.

I received an email last month that outlined the history of that change, very interesting...

The writer of the email had driven in Ontario with bioptics from 1990 until 2018. The law was not explicitly against using telescopes until 2005 when the Ontario government decided to ban the use of bioptics, so now this driver of 15 years was not legally allowed to drive. In 2018, after 28 years of driving in Ontario with a clean driving record, an optometrist reported them to the Ministry of Transportation and had their license suspended.

Thankfully this person had some pluck and determination and appealed the decision and, finally, after a 2 ½ year-long struggle, won their case because the suspension of their license violated the Canadian Charter of Rights and Freedoms. By October 2020, the Government had changed the law to include bioptics, and their license was restored.

The person’s argument with the authorities was a sparkling driving record, diligence in working at and taking very seriously the difficult task of bioptic driving, and the widespread use of bioptics in so many States in America.

They won their case for themselves and for other people.

At Burlington Eyecare 33 people have been fitted with bioptic telescopes since the 2020 decision. Success in getting a driver’s license is dependent on a few factors: primarily motivation level, previous driving experience, and age.

The Ontario Government is working with driving assessment centres to develop a strategy for dealing with bioptic drivers and, frankly, the process has been frustrating. At this point, it is more clear what the government requires which will hopefully prepare people for getting their license.

Education is also key, of eyecare professionals, of ministry of transportation employees, of law enforcement officers, of visually impaired people, etc…. We have lots of work to do.

Thank you to the person who sent me the email for the story of the bioptic change of heart of the Ontario government and for the groundbreaking work in challenging the status quo. We look forward to helping many more in Ontario experience the reality of driving with a visual impairment.

‘til next week,

the good doctor

An exciting time to be an optometrist

Thu, 13 Apr 2023 11:19:21 GMT

Blog vol 3. 45. An exciting time to be an optometrist.

In May of 1987, a very long time ago, I graduated from Optometry school at the University of Waterloo. It really seems long when your own children are now graduating from the same program. Back in 1987, optometrists were able to use dilating drops to look into the back of the eye; this was a new and exciting development. Until 1985 we could only use anesthetic and fluorescein as drops for diagnosing eye conditions.

Fast forward to 2023, optometrists are now removing foreign bodies from the front of the eye, treating glaucomas with drops, prescribing antibiotics, antivirals, and steroids, and treating chronic dry eyes. All these changes happened gradually over the last 30 or so years but, wow, here we are.

Just last week, I attended the annual Symposium of the Ontario Association of Optometrists. The weekend was packed with courses on current research and clinical advice on a variety of topics. One of my favourites was a 2-hour session on all the latest advances in diagnosis and treatment of a full range of conditions and diseases.

Guess what? If you have been following my blog over the past three years, you have been updated on much of the current research and promising developments in the eye care field.

One topic of research that I have briefly touched on before is the early detection of systemic diseases on the cellular level at the back of the eye. Many diseases affect the whole body and since we can look at actual cells in the back of the eye we can see early changes or irregularities.

I have not been super excited about this so far for two reasons: one, the indicators must be clear, and two, it must be helpful to have an early diagnosis, otherwise we are just getting people upset and anxious when it is not necessary or helpful.

For example, we will be able to catch Alzheimer’s disease at a very early stage by taking photos of the eye. A company out of Toronto called Retispec (read more here ) is using fundus camera technology that is readily available, using specific wavelengths and some sophisticated Artificial Intelligence (AI) to detect early biomarkers, like amyloid plaques, that are present in the retina.

The hope is that this non-invasive screening tool will readily pick up the disease and then spur on further research into early treatment. The time for this technology is almost here; we do know that aerobic exercise, the use of statins, and omega-3 fatty acid supplements can slow down dementia, but we are much in the dark here. The hope is that as we learn more about the condition, we can find more substantial help.

The real usefulness of this technology, at least as related to Alzheimer’s, is still in the future but it does open the way for the possibility of early treatment which, if we are going to get the better of this disease, we are going to need.

I will definitely keep you updated as this is a promising line of research.

‘til next week,

the good doctor

360 degree vision, how is that possible??

Thu, 06 Apr 2023 06:04:59 GMT

Blog vol 3. 44. 360 degree vision, how is that possible??

It is possible, 360 degrees is the field of vision of the American Woodcock, otherwise known as the Timberdoodle (I like this name better). We as humans have at most 200 degrees of vision, however we do have much more binocular vision than the Woodcock. The eyes of the Woodcock are set so far apart that the visual fields of each eye only overlap for 5 degrees, right in front of the bird. A young human can have up to 135 degrees of overlap between the right and left eyes, providing excellent depth perception and enhanced visual acuity.

The bird does not need the depth perception, the wide field of vision is much more useful.

The Woodcock nests on the ground and spends very little time in the air, except when migrating or when seeking a mate in the spring. Predators are a major problem for a ground nesting bird, so literally having eyes in the back of your head (and we thought only human mothers had that) or in this case on top of your head, is a matter of survival as they can see a full 360, no movement necessary.

There is even some suggestion that the brain of the Woodcock can multitask with these wide angle receptors: watching for a Marsh Hawk or a fox with one eye and at the same time detecting a juicy worm for eating with the other (remarkably, humans do this when watching children and making supper, all without 360 degrees of vision).

Spring is the time to be on the lookout, with the males at dusk making a “peenting’ sound and flying upward in a wide spiral getting as high as 75-100 meters, then his wings twitter and he descends in a zig-zag pattern, chirping and then hopefully lands near a female in the grass. You can look for Timberdoodles in fields that are left fallow. They are nocturnal, getting more active at dusk, and then with their long needle-like bills digging in the ground for worms and other juicy invertebrates.

The males will mate with multiple partners. The mothers care for the babies briefly with the chicks leaving the nests after three or four days. The Cornell Lab is an excellent resource for all your birding questions.

So the next time you hear someone tell you that you have eyes like a Timberdoodle, make sure you thank them.

‘til next week,

the good doctor

Resolution of OHIP negotiations: the essentials

Thu, 30 Mar 2023 05:53:19 GMT

Blog vol 3. 43. Resolution of OHIP negotiations: the essentials

Interesting word, “resolution”, the prefix “re”, with the word “solution”. After many years of little to no conversation between the Ontario government and the Optometrists of Ontario, we finally have a workable agreement.

Back in September 2022, we received our first pay raise since 1989. Since then, the billing codes were reworked to reflect changes in health care, and… a final solution!

What does this look like? The changes that affect the public are as follows:

*Partial exams for insured people are no longer unlimited but have been cut back to two visits a year.

*The medical exemptions allowing for OHIP paid eye exams for those between 20 and 64 years have been tightened up. After gathering a lot of billing data, the government found that some conditions do not require coverage. At the same time, conditions like diabetes and glaucoma will be covered more than ever, reflecting Optometry’s growing role in the treatment of these conditions.

*Adults 65 and older are covered for full eye exams every 18 months instead of every 12. The media has highlighted this change and expressed concern about the level of care now available to this age group. We at Burlington Eyecare agree that annual eye care is important for people in this group and will continue to book annually with a full exam every two years and a screening exam in between, but if the patient so desires and if no concerns are present, a full exam every 18 months can be booked.

*The billing for visual field tests has been limited. These are very valuable diagnostic tools for many prevalent eye conditions and may need to be paid for by the patient.

As with any agreement, the final resolution is arrived at when both parties are equally uncomfortable with the end result. The implications and actual effects of the changes will become more clear as we work to implement them.

The pay raise goes into effect April 1 ^st , 2023, and the changes to billing will start Sept.1 ^st , allowing time to reschedule and rethink our lives.

From all of us at Burlington Eyecare, we are committed to providing the best possible care and providing it to all who show up at our door (as always).

‘til next week,

the good doctor

Spring is springing

Thu, 23 Mar 2023 08:03:48 GMT

Blog vol 3. 42. Spring is springing.

This Monday afternoon was the official start of spring. We get to see the first robin, the first crocus, tulips poking through the dirt, forsythia starting to bud, and the running of maple sap on local farms. As Gerard Manley Hopkins so aptly puts it, “There lives the dearest freshness deep down things;”.

With the warmer weather comes…

… pollen and other nasty things that have us itching and rubbing our watery eyes. Allergies are a reality for many, the donning of masks during Covid helped filter these particles when we breathe but they provided little protection for our eyes.

What do you do when the allergy season begins? An isolation chamber, highly portable, is one option, but not very practical. Treatment depends on the severity of your reaction from mild reactions, requiring cold compresses and drops, to the more disabling full-blown reactions requiring strong daily doses of oral Benadryl.

If your eyes are really bothering you, if they are watery, red, itchy and your nose is running, then call us at Burlington Eyecare. We will take a look at your eyes with our bio-microscope, diagnose your problem and give you appropriate treatments. There are some fast-acting dual-purpose medications that hit the histamine system quickly and stop the mast cells from releasing more in the future. This medication is also now available in a contact lens from Acuvue called Theravision which gradually releases the drug over a 12-hour period as you wear the lens.

With the allergies taken care of, enjoy.

Spring brings colour. Take a stroll, admire the spring bulbs, the flowering shrubs, and the many birds that are arriving daily.

Come visit us and make sure that your eyes are fully corrected and that you are benefiting from the advanced coatings and filters we have available. You do not want to miss any of the excitement happening out there.

‘til next week,

the good doctor

A Local Authority Writes on Macular Degeneration

Thu, 16 Mar 2023 05:10:25 GMT

Blog vol 3. 41. A Local Authority Writes on Macular Degeneration.

In the latest issue of Eye, Hamilton’s own Dr. Varun Chaudhary writes an editorial about macular degeneration treatments. Dr. Chaudhary is the Head of Ophthalmology at the Hamilton Regional Eye Institute and the Editor-in-Chief of the Canadian Journal of Ophthalmology. At Burlington Eyecare, we have the good fortune of having Dr. Chaudhary just across the Bay.

In his editorial in Eye, he addresses the need for more custom-tailored treatment regimens with anti-vascular endothelial growth factor (anti-VEGF). (See here for article)

The discovery of anti-VEGF injections has been a dramatic breakthrough in the treatment of neovascular, age-related macular degeneration (nAMD). People used to permanently lose their central vision, there was no way to stop it, and fluid would build up at the macula causing scarring.

Laser grid treatments, then later Visudyne were the only options until anti-VEGF. Anti-VEGF treatments are actually able to reverse the degeneration process and literally clean it up. These treatments involve injecting the drug into the eye and, of course, the fewer treatments the better. What Dr. Chaudhary notes is the gap between the results of clinical trials and the results of real-world clinical practice. The development of the “treat and extend” paradigm has been an attempt to eliminate this gap.

VEGF treatment starts with 3 monthly loading doses, though some research is questioning this dosing for all cases. Future studies will look into variations on this dosing to see if it can be individualized. Presently anti-VEGF is started based on new macular hemorrhages, reduced visual acuity, and/or the presence of intraretinal and subretinal fluid. But as more advanced imaging modes are developed, this could be fine-tuned using less obvious biomarkers to make more accurate predictions. This is what Dr. Chaudhary is proposing.

As we learn more about variations in the disease, we can individualize treatment for each patient, improving effectiveness.

At Burlington Eyecare, we routinely perform optical coherence tomography (OCT) scans on most of our patients. These are the type of scans that, if done more frequently, would benefit our patients under anti-VEGF treatment. It would also be helpful to have a way to make these scans readily accessible to the retinologist.

With anti-VEGF treatments, most people with macular degeneration will not lose substantial vision, a wonderful, wonderful thing. We look forward to working with new treatment regimens as they become available.

til next week,

the good doctor

Three years on

Thu, 09 Mar 2023 09:50:46 GMT

Blog vol 3. 40. Three years on.

There are certain events that stand out in one’s memory. If you are old enough, I bet you can remember when the “O.J” verdict was handed down (October 3, 1995) or when the planes hit the towers (September 11, 2001), or when Doug Ford announced the closing of schools because of COVID (March 12, 2020).

Three years sounds like a long time and it doesn’t. We closed Burlington Eyecare on March 17 ^th , 2020 just after Dr. Cavaliere heroically shaved his beard to fit an N95 mask. At the time we were wondering how we were going to keep things going when we had to be closed down for two weeks. We had no idea. It is a good thing that we do not know what the future holds.

Covid has not gone away, not at all, we have staff still testing positive for the virus, but we are all learning to live with it. Knowing more about the virus helps.

Things learnt these three years:

1. Optometry is a hand’s on profession. We provide in-person care and I must say that Covid has made the importance of this very clear. I really like the person-to-person interaction I have with my patients and this interaction is critical for good care.

2. The crucial importance of a team, all staff and doctors on board working together in a culture of caring. I saw it with my staff, doing the little things, going out of their way, putting themselves in harm’s way. Early on we were not sure about outcomes and the severity of the disease, but here we were.

3. Caring about staff and patients is our top priority. So we repaint the office, put up permanent (and attractive) glass enclosures, social distance, screen patients and staff, manage arrival and flow of patients with new rooms, and flexible scheduling.

4. Support is so encouraging, whether financial support from the government or from understanding suppliers, or moral support from family, friends, some really wonderful patients, and, of course, the awesome Burlington Eyecare team. It really makes all the difference.

5. The importance of dependable people in your life, as Churchill noted, having foul-weather friends. During adversity, we quickly find out who we can depend on, and these last 3 years I found very encouraging, especially when it comes to our team.

During all this, we at Burlington Eyecare lost two dear, dear people to cancer. We also welcomed two new little ones, and sadly, we have had several staff move on for various reasons. Life never stands still.

Tomorrow we are saying goodbye to Angelia Brown, one of my original employees, and a really good one. She went back to school for opticianry while with us and has been a great help to our patients and staff for many years. She is setting up her own store, it’s a dream of hers. We will miss her and wish her all the best in this new endeavour.

‘til next week,

the good doctor

Dry eyes, again

Thu, 02 Mar 2023 05:18:36 GMT

Blog vol 3. 39. Dry eyes, again.

When COVID hit in 2020, the biggest change at Burlington Eyecare was the surge in dry eye patients. It really was the perfect storm: people staring at screens and zooming all day long, an ageing population, in the middle of winter.

Fast-forward to 2023, dry eyes are still here. We have not put our screens away, on the contrary, a lot of us routinely work with two screens at a time. We have actually gotten older AND it is still winter (and never Christmas, borrowed from Narnia).

In my previous dry eye blogs, we looked at tarsal glands, proper hygiene, work habits, and omega-3 fatty acids, all still important and hopefully regular, daily, or weekly habits. A paper in a recent Optometry and Vision Science discusses research on what could be a revolutionary drug for treating dry eyes. It is called Varenicline. (See here to read the paper)

What they found is that the spray, which has a parasympathetic effect on receptors in the nasal cavity, causes the tarsal glands, lacrimal glands, and goblet cells to produce a natural tear film. Basic pharmacology: we have two opposing nervous systems, the cholinergic and the adrenergic, and they are working all the time in concert. In this case, the drug stimulates nicotinic receptors (hence the name Vare-Nicline), which then increase tear production.

What is so cool is that this increase is in both the water component and the fat/oil component which makes for great tears.

This new drug is FDA-approved and hopefully meets Health Canada approval very soon. A word of caution, though, it is not the holy grail, a panacea that will solve all our dry eye problems. If the tarsal glands are blocked up or they are producing really sludgy meibum, this drug will turn on the gland but not much will flow and what does flow won’t be that helpful.

So…you will still need to get the meibum flowing with heat and massage; you will still need to take omega 3’s to fill those glands with helpful oils; in a word, regular maintenance is required.

If you have red, itchy eyes, eyes with a burning sensation, eyes that feel like they have something in them when you know they don’t, you likely have dry eyes. Artificial tears provide immediate, temporary relief but this problem frequently does not just go away. Get some advice from your optometrist, there are things that can help.

til next week,

the good doctor

Exciting research news in auto-immune disease research

Thu, 23 Feb 2023 04:51:33 GMT

Blog vol 3. 38. Exciting research news in auto-immune disease research

A breakthrough in the prevention of Type 1 Diabetes (T1D) was highlighted in the latest issue of Nature. Excitingly, these findings may also apply to other auto-immune disease treatments. Since we care for eyes and vision at Burlington Eyecare, we are always interested in improvements in the treatment of diseases like diabetes, rheumatoid arthritis, and multiple sclerosis.

Ever since the discovery of insulin by Banting and Best, researchers have been working on a way to prevent diabetes. Let’s prevent the islet cells of the pancreas from getting destroyed so the patient’s own body can keep on producing its own insulin, good plan, but how?

Monoclonal antibodies as a treatment have been around for some time. Their strength is their specificity. They are developed to attack or inhibit one point in an enzymatic chain reaction or to work on specific cells. In T1D the body’s own T Lymphocytes attack its own islet cells causing irreparable damage.

Along comes teplizumab, a treatment antibody. Clinical studies using teplizumab (2011 to 2018) show a number of T1D patients having their disease slowed or even halted. The drug is injected over a two-week period and causes the targeted T cells to exhaust themselves. The USDA has approved the drug for the treatment of Stage 2 of T1D which is early in the development of the disease when the blood sugar is affected but no real symptoms are presenting.

Some of the treated patients have been diabetes-free for over 6 years. There are issues with the treatment. It is very expensive, in the range of US $190,000 for one treatment. It requires an early screening process that is not yet developed; early treatment is crucial. For the study patients, siblings, or other family members were previously diagnosed. A problem is that most cases of T1D are not genetically linked. (Read the issue of Nature here )

This new therapy does suggest other possibilities. One researcher is developing an antibody that is even more specific to these problem T cells. The model used in T1D research is being applied to diseases like rheumatoid arthritis and multiple sclerosis.

It is a promising start, there is much potential in this line of research. The commitment to this painstaking work is wonderful and very hopeful.

til next week,

the good doctor

The hull complete of the Mau Ipata, the Amazon hospital boat!

Thu, 16 Feb 2023 03:34:50 GMT

Blog vol 3. 37. The hull complete of the Mau Ipata, the Amazon hospital boat!

On the banks of the Amazon River, the rains start early. While we are firing up Yule logs the December rains in the Amazon basin start to fill in the flood plains of the largest river in the world. The Amazon drains 35% of South America and represents 20% of the world’s river discharge. The Mau Ipata is ready for the floods.

A good part of the 80 tonnes of steel sheets that are supplied for the Mau Ipata, Medical Ministry International’s new hospital boat, has been fabricated into a hull, 9 metres by 36 metres. The next step is the decks for the ship. It is all very fantastic, it hearkens back to the story of Noah building the Ark (which was about 4x bigger and built nowhere near a river), and no doubt, everyone thought he was crazy.

The scale of it, the huge dreaming, the tangible support, and the hands-on work done to create such a boat as the Mau Ipata is mind-boggling. When fully operational it will serve over 280 communities along the Amazon that have little to no access to health care. When you look at the health care issues we are having in Canada, with some communities in remote areas of Newfoundland or Northern Canada having no doctors, we get a little taste of this crisis. (Read more about the Mau Ipata here ).

What is really cool is that Burlington Eyecare gets to be part of this work. We are raising $50,000 CDN to equip the eye clinics on the boat. We were inspired by the scale of the dream and the positive impact it will have on thousands of people. We work hard to provide excellent eye care to our patients here in Burlington and would love to see other people have access to the same type of care wherever they are. If we can help make this happen then we will. (Access Burlington Eyecare's fundraising initiative here ).

We are close to 50% of our goal already raised!!! Thank you to everyone for your support!

We are excited to share progress as it happens.

til next week,

the good doctor

More funding for cataract surgeries

Thu, 09 Feb 2023 07:34:10 GMT

Blog vol 3. 36. More funding for cataract surgeries.

On January 16 ^th of this year, the Ford Government of Ontario announced that it would be paying private clinics to perform cataract surgeries. This decision comes as a result of massive needs and really long wait times. As with any solution, this one comes with its detractors; the potential for private clinics to drain away already depleted staff from publicly funded facilities and the fact that the government is endorsing privately funded health care.

As an optometrist working with the system, it is important to point out that eye surgeons are trying to meet needs as best as they can. The queues for cataract surgeries are way too long.

The government is setting up three centres in Windsor, Kitchener-Waterloo, and Ottawa to help with the current crisis. It is also increasing funding to private clinics in other centres, for example, we have a clinic in Oakville that will be increasing its load.

We can celebrate shorter wait times, but we also need to be aware that these will be bare-bone services. As always if you want laser-guided refractive measurements or if you want to upgrade your implant lens, it will cost you.

The optional upgrades can be a necessity, for example, if you have a lot of astigmatism, or a large prescription, then you should spend the extra money for these services. There are real fancy multifocal implants that are having great outcomes, which require a considerable monetary investment. Many private laser clinics will even combine cataract surgery with refractive laser surgery for optimum results.

When you are talking with your optometrist, go over these options, and do your research before you go for your cataract consult. That way will not be overwhelmed when all the options are presented. It is great to know that many who are waiting for a life-changing surgery will finally not need to wait so long.

til next week,

the good doctor

Diabetes, low blood sugars, and the eye

Thu, 02 Feb 2023 06:35:13 GMT

Blog vol 3. 35. Diabetes, low blood sugars, and the eye

Each week I spend some time combing through the latest research to keep up on new trends and treatments, and …. to have interesting topics for a blog:) This week’s news comes from John Hopkins Medicine: a paper in Cell Reports relating transient hypoglycemia (temporary low blood sugar levels) and eye disease in diabetic patients.

Please note: People with diabetes are at risk for eye issues and should have their eyes examined every year. A third of Americans with diabetes end up with diabetes-related eye problems, a substantial number. This is an OHIP-covered service for all ages.

Keeping your blood sugars under control is the essence of diabetic management. Yet, having a tight rein on your blood sugars can still leave you open to transient episodes of hypoglycemia, which can lead to retinal problems. Why is this the case? What Dr. Chianyo Guo and team wanted to know is what mechanism caused this problem. The mechanism that leads to eye problems during high blood sugar level episodes is known, the mechanism that leads to eye problems during low blood sugar level episodes is (was) not.

Knowing these mechanisms helps greatly in prevention and treatment.

Their research showed that these episodes of low blood sugar levels result in the increase of certain retinal cell proteins which then start a chain of events resulting in the overgrowth of blood vessels.

The challenge is to keep the blood sugars steady.

What happens: When a person has low blood sugars, the retinal cell’s ability to break down glucose for energy is reduced. At the same time, the cells increase their production of proteins that transport glucose into the cells. This increase in glucose to the cell raises levels of Hypoxia-Inducible Factor (HIF-1a), which floods the cell nucleus and finally results in the increased production of VEGF, which promotes abnormal blood vessels, which is the problem and can lead to vision loss. (Find out more here )

Does this same cascade works in other tissues, like the kidneys and the brain? Are treatments that focus on this HIF-1a pathway a possibility? Lots more work to be done.

So keep the blood sugars steady, not too low, not too high. Have your glycosylated hemoglobin (A1C) numbers handy when you come in for your eye exam. For the uninitiated, A1C tells the percentage of red blood cells that have glucose bound to their proteins and gives a three-month window to monitor levels. If you are concerned about diabetes, or if it is in your family, have your GP order an A1C for you, an easy blood test with no fasting required.

til next week,

the good doctor

Snow, snow, snow!

Thu, 26 Jan 2023 04:39:52 GMT

Blog vol 3. 34. Snow, snow, snow!

Growing up in Timmins, we had snow all winter long and then some. When I was a child, stories about the Inuit peoples of the far north building igloos, travelling by dog sled, and taking on polar bears fascinated me. These peoples of the lands of snow frequently (and wisely) wore snow-blindness goggles.

Can snow make you blind? How did the goggles work? Some clever and resourceful person, many moons ago, designed these shields because snow blindness is a real problem. Just imagine being out on ice flows hunting or travelling and suddenly you cannot see. This is life or death in the harsh climate of the north.

The blindness is caused by exposure to ultraviolet light. We have all heard of SPF (Sun Protection Factor) 30 or 50, which is the level of protection that you slather on when you go to the beach. The north, snow, and ice do not make us run for our SPF 30 lotion but should, especially for the exposed face.

The UV reflects off the ice and snow on a bright sunny day and can cause severe UV burn on the skin and the eyes.

The Inuit people took a caribou antler, whale baleen, or a piece of driftwood and carved two narrow slits horizontally where their eyes peeked out and then strapped sinew on the goggles and tied it around their heads. The tiny slits allowed enough light through to see, actually increasing the depth of focus while reducing the eyes’ exposure to UV. (Click here to learn more)

Skiing is another instance where the risk of UV burns is high with the combination of thinner air and the reflection off the snow caps. Prevention is key. A pair of quality ski goggles with UV filters (and a rose tint if you want to really impress through the moguls) with a head strap that fits over your helmet is a must.

Just like with sunburn, you do not feel the burns on your eyes right away but a little time after. These burns can be very painful and can limit your vision. The good news is that they are temporary. Use cold eye drops to lubricate and soothe the eye (keep your eye drops in the fridge, feels really good on a sore eye). If the symptoms worsen seek medical attention.

Now put your feet up, grab a hot cocoa, a great book, and watch the snow gently descend….or hit the hills, but go swooshing with UV-protecting goggles.

til next week,

the good doctor

Dealing with Alzheimer’s Disease: Some Encouragement

Thu, 19 Jan 2023 06:42:33 GMT

Blog vol 3. 33. Dealing with Alzheimer’s Disease, Some Encouragement.

At her recent visit, Paula De Ronde, a patient of mine, brought me a copy of the book she has written, My Bert has Alzheimer’s: Caregiving is Living for Two. From 2011 to 2022, Paula was the caregiver for her late husband, Bert. She wrote down her meanderings and compiled them in a book that really captures the daily demands of being a caregiver.

Two words come to mind as you read Paula’s account: intensive and love.

Intensive - the day-in, day-out demands of being a primary caregiver, and then the community of peers and local day programs helping to share the load. The underlying thoughts throughout the entire account are the preciousness of Bert’s life and his loving relationship with Paula. One of the most beautiful moments in the book is when the day program staff sets up a date night for the couples in their care. Every detail, from invitations, decorations, menus, lighting, music, serving, then, later dancing, was done with such attention and care. Just wonderful, so inspiring.

Love - the relationship between Bert and Paula deepens through the disease. Paula’s desire to learn as much about Bert’s disease as possible in order to help him (and a lot of others) shows the depth of her love. I was especially impressed with Bert’s tender heart and love for his wife, even as inhibitions came down with the development of the disease. Bert, you are my inspiration, I hope I can be that man under similar circumstances. The love of others was expressed in real and tangible ways: the way that the PSWs (an under-appreciated group) helped Bert as he entered the long-term care facility, the daily care of looking after Bert and actively involving him in the daily routines of toiletry, dressing, feeding, and so much more.

Her tone in the book is upbeat, her sense of humour contagious. Paula has done a great service for caregivers in encouraging, educating, and especially, sharing her journey.

So many people are caregivers to spouses with Alzheimer’s or with other health concerns. This work is so important and so difficult. I am continually impressed and humbled by my patients who persevere in caring for their spouses through really heart-breaking situations. The love and care are wonderful to see.

The rest of us need to remember to support the people in these situations. We can make such a difference in even small ways.

If you would like to keep up with Paula, you can follow her meanderings at: https://paulasmeanderings.com/ .

til next week,

the good doctor

Driving simulator and visually impaired drivers

Thu, 12 Jan 2023 05:28:56 GMT

Blog vol 3. 32. Driving simulator and visually impaired drivers.

Research on the correlation between visual fields and driving performance is rare. This research is close to my heart since I help visually impaired people to drive using bioptic telescopes.

A recent study in Sweden asked the question: can a driving simulation be used effectively to help people with visual impairment retrain their driving skills with their new visual limitations? Many of the subjects did function well on the simulator. (Link to study here )

Of particular interest to these researchers was the effect of laser treatment for diabetic retinopathy on driving.

When retinopathy from diabetes is advanced, there is a lack of oxygen to parts of the retina, and there can be substantial vision loss as a result. The body will produce cytokines that encourage new blood vessel growth to provide much-needed oxygen. Problem is that these new vessels are poorly made and leak and eventually produce permanent scarring. The use of lasers to destroy selected visual receptors in order to reduce oxygen demand is an accepted way of reducing further vision loss.

Where you hit the retina with the laser makes a difference in where vision is lost. The study in Sweden showed that it is better to concentrate laser treatment on the superior retina to reduce oxygen demand and to spare the more superior visual field. The driving results were much better in this scenario.

I was impressed with the high-tech simulator (Sim III) they used. It had a real Saab front dash and steering wheel, and real movements and mirrors. No wonder the assessment cost 2000 euros, wow! We now have a driver assessment centre in Barrie for all the bioptic drivers who are seeking to get their “G” license. The legislation passed in 2019 to allow bioptics for driving is finally having “legs” put to it.

If you are visually impaired and would like to see if driving is a possibility, schedule a low-vision bioptic assessment at our office. If you are able to pass the visual field and the visual acuity requirements with the bioptics, then we fit you with a custom pair. Once you are fitted and you practice using them, a temporary license is issued that allows for driver training. Finally, you go to Barrie for a driver’s assessment with the bioptics, and when you pass that, a permanent license is issued. Currently, Barrie is the only option for an assessment. Things keep changing so let’s hope for something on this side of the GTA.

One step at a time, the process takes a lot of patience but it is doable. We have a number of patients with visual impairments who have successfully achieved their “G” license.

til next week,

the good doctor

A year of books

Thu, 22 Dec 2022 15:08:19 GMT

Blog vol 3. 31. A year of books

This is my last blog for 2022. Good vision and seeing clearly is critical for reading. So many of my patients are readers and we have some great conversations about books, so I thought I would do a little reminiscing about the books that I read this year.

A really good series is from the pen of a British author, Richard Osman. It is called The Thursday Murder Club, and it is about a group of seniors who meet every Thursday to solve cold and not-so-cold murder cases. His love for humanity and the quirkiness of the main characters is really endearing. Please do not get on the wrong side of these “gentle” geriatric folk, for you will rue the day you did. There are three books in the series thus far, and I would read them in order. I am eagerly looking forward to his next release.

A science fiction series that came out in the 1950s called the Foundation was originally three books but the author, Isaac Asimov, wrote two prequels that follow the life of Harry Seldon and his final days (it also is quite autobiographical). These two did not disappoint; I always wanted to know more about this genius who could mathematically “predict” what the future would be. The whole series is a great testimony to Asimov’s breadth of knowledge and his understanding of history, politics, culture, and, of course, robots. I have yet to touch on his other many sci-fi stories and I cannot wait to delve in.

I also read two of John Steinbeck’s shorter works: Of Mice and Men and The Moon is Down. The first is about two migrant field workers, George and Lennie, during the Depression. Steinbeck does a great job of depicting the struggles of finding work and of having dreams and shooting for them. The Moon is Down I found fitting during a war between Ukraine and Russia as it is set during the Nazi occupation of WW II, where a village is trying to resist its occupiers. The main character tells the Nazi officer that they will not be able to hold their gains, the villagers will eventually prevail, really prescient in times of conflict (and over and over again).

The literary world was saddened by the death of Hilary Mantel in 2022. Her trilogy on the life of Thomas Cromwell was brilliant, a must-read for anyone interested in history, and also a well-written story. She wrote a book in 1988, Eight Months on Ghazzah Street, which is an insightful observation, from a Londoner’s perspective, of the Saudi regime and all its complexities. It is about a British engineer and his wife who work in Arabia and is based on the author’s real-life experience.

My final book is a history by Barry Strauss called The War that Made the Roman Empire. It is about the rise of Octavius after the death of Julius and describes the main players and the political and military manoeuvres that led up to and prevailed in the Battle of Actium. Strauss does a masterful job highlighting the main characters, especially Octavius, and his naval commander, Marcus Agrippa. When I first read this book I was not aware of all the intricacies involved or of how capable Octavius was at politics or the crucial importance of Agrippa’s leadership. I have other works by Strauss to read and eagerly await his next book.

These were some of my favorite reads from 2022. Would love to hear yours.

All of us at Burlington Eyecare wish all of you a very Merry Christmas and all the best for the New Year.

til next year,

the good doctor

A most interesting patient

Thu, 15 Dec 2022 10:57:29 GMT

Blog vol 3. 30 A most interesting patient.

Yesterday, I saw my most unusual patient. Once a year she comes in with her owner for an eye check. The patient is a dog, a beautiful Golden Lab.

My human patient was hit by a car when younger and lost the vision in one eye and over 90 percent of his visual field in his other. Some visual field impairments can make it very difficult to get around and this is where the visual guide dog is crucial. This pair has been together for 11 years and is always a welcome sight when they come for their annual visit.

The canine eye is similar and yet much different from the human eye. The dog eye has a cornea and lens like the human eye but the dog versions are much larger, and dogs have a third eyelid that comes up between the lower lid and the eye. Their irises, the coloured part of the eye, are usually brown, making some breeds like Samoyed or Husky stand out when you see their piercing blues.

A dog’s retina is quite different from a human’s, having mostly rods and few cones, and these cones only detect two colours instead of three. Humans see the entire spectrum and see best during the day, whereas dogs see more in greys, yellow and blues and see well at night or in the reduced light of dawn or dusk.

Not only do they have more sensitive night receptors, they also have a tapetum. The tapetum is a layer of reflective material that lies just under the retina and serves to reflect the light back to the receptors. That is the coolest part of examining a dog’s eyes; you get this very bright shine coming back when you look inside.

A dog’s visual acuity is usually not as good as a human’s, but their peripheral vision is superb.

Most guide dogs are used for mobility, allowing their owner the freedom to get around with very little anxiety. This requires extensive training for the dog. There is a guide dog training facility in Oakville run by the Lions Foundation. They raise the puppies, train them, and accredit them to serve their many clients. Only some breeds of dogs are eligible, with the Golden Lab very popular; other breeds in use are Golden Retrievers, Labradors, Standard Poodles, Border Collies, Australian Shepherds, Boxers, Airedales, Collies, and Dobermans.

When you see a person with their dog, make a little room for them, and try not to pet or distract the dog. When their harness is on they are working, and that is what they are trained for. If you are interested in helping out, there are many ways you can. (Click here for more information).

By the way, my Golden Lab patient passed her eye exam with flying colours.

Woof! Woof!

the good doctor

Progressive lens: the invisible bifocal

Thu, 08 Dec 2022 08:11:25 GMT

Blog vol 3. 29. Progressive lens, the invisible bifocal

A French lens company, Essilor, started to roll out the first progessive, or no-line bifocal, into the market sixty years ago. An engineer by trade, Bernard Maitenaz, was instrumental in developing the first Varilux lens.

Before that time, all bifocal lenses had some form of line to demarcate the different areas of power in the lens. Ben Franklin, the early American scientist and statesman, developed the first bifocal by cutting in half two lenses of different powers, and putting them to together in one frame. He wanted to have the distance vision clear and then have a larger power in the bottom for reading, so in 1784 he came up with “double spectacles”, a really helpful innovation especially for people with distance prescriptions.

Now, no one needs to know, shhh!, if you are wearing bifocals or not.

No fussing around with reading glasses, or trying to find a pair - where did I put them? Or having to ask the grandkids to read the menu for you.

The no-line bifocal, or progressive lens, has improved dramatically over the years, as lens materials and lens production has changed. The first progressive was a lens that had a set power on the front surface and then the patient’s prescription would be ground on the back. Recent developments in CNC (Computerized Numerical Control) make it possible for the front and back surfaces to both be worked on. Now, custom measurements, like pantoscopic tilt, frame wrap, vertex distance, and variable insets are measured to inform the diamond cutters on the best possible customized progressive. These custom lenses widen out the usable zone for distance, computer, and near viewing.

At Burlington Eyecare, we use a lot of Nikon optical lenses for their excellent quality and state of the art technology. One lens design in particular, the SeeMax Ultimate, is a progressive lens that is completely individualized. In the past, conventional progressives were made with one design concept, whereas this new Nikon progressive is made from 428,793,740 different design possibilities! (Read more about SeeMax Ultimate here ).

All of our bifocal-wearing employees at Burlington Eyecare wear the Ultimate and can attest to the wider zones for all their viewing and the general comfort of the lens. Since it is customized, the Ultimate is more expensive than the standard progressive. The standard progressive is still an excellent choice, but the Ultimate, if you can swing it, is a great way to go.

What a great development the progressive lens is! I love mine, so glad to not have to wear the old lined bifocal. It will be interesting to see where spectacle lens development goes from here.

til next week,

the good doctor

Red, runny eyes, a symptom of RSV

Thu, 01 Dec 2022 06:37:38 GMT

Blog vol 3. 28. Red, runny eyes, a symptom of RSV.

We have seen a number of people with two red and runny eyes the past few weeks.

Every fall the respiratory syncytial virus (RSV) gains access to our noses, bronchial tubes, and lungs. Most children under two years will be infected at some point as well as many of the rest of us. The theory is that we did such a great job of masking, social distancing, and disinfecting in 2021 that the RSV did not spread much. Enter 2022, and with less masks and measures and reduced built-up immunity, we have the perfect RSV storm. (Read more here ).

RSV can really affect children under two, the elderly, and the immunocompromised. People infected with RSV are usually contagious for 3 to 8 days and may become contagious a day or two before they start showing signs of illness. However, some infants, and people with weakened immune systems, can continue to spread the virus even after they stop showing symptoms, for as long as 4 weeks. This extra length of time seems to be the norm for the current version.

RSV can survive for many hours on hard surfaces such as tables and crib rails. It typically lives on soft surfaces such as tissues and hands for shorter amounts of time. Of particular interest to us at Burlington Eyecare, is the eyes as possible doorways for the virus. Usually, the primary infection enters through the respiratory tissues, however, an interesting paper, published in 2007, looks at the eye as a primary site for the entrance of the virus, since the conjunctiva has soft tissue. (Read more about ocular virology here ) Interesting, something to consider.

We have been getting a lot of patients in the door with conjunctivitis (red, runny eye) in both eyes, unlike the adenovirus (aka pink eye) which usually presents in one eye at a time. The eyes are red with matting of the lids in the morning, with watery discharge and some gummy discharge in the nasal corners. The likely cause is RSV, but we are in some cases also treating for opportunistic bacterial infections.

If you find yourself or your children with a flu/cold (potentially RSV) and you develop red, runny eyes there are ways to self-treat. Start out with cold compresses on the eyes, cleaning the lids if matted, and use cold lubricating drops if eyes are swollen; your regular flu medications should also help alleviate the symptoms. These symptoms should resolve in a couple of days. If they persist, are unresponsive to any of the above treatments, or if you are concerned, please call our office.

It is unusual to have so many cases of two red, runny eyes. As we have learned with COVID, viruses are always evolving; they are never quite the same year to year, which is why we keep getting infected with RSV year after year. Red, runny eyes appear to be a potential symptom of the 2022 version.

Prescription: liquids, rest,…

til next week,

the good doctor

Nice to be back

Thu, 24 Nov 2022 07:29:32 GMT

Blog vol 3. 27 Nice to be back.

Last week we looked at the post covid resumption of Medical Ministry International (MMI) eye missions. Another new post-covid experience, this past weekend I had the pleasure of meeting up with my colleagues at a continuing education event hosted by the Waterloo School of Optometry. Really nice to meet up with old friends and learn what is new in eye care.

A local eye surgeon made a presentation on procedures around routine cataract surgeries. The procedure I was most interested in was Descemet Membrane Endothelial Keratoplasty (DMEK). That is a mouthful. This procedure is done when the back layer of the patient’s cornea, the endothelium, has broken down and the surgeon replaces it with a very thin layer of donor cornea.

The DMEK procedure was first successfully done in 2006. Before this, the only way to replace the layer, the corneal endothelium, was to remove the whole cornea and replace it with a whole new donor cornea, very involved, with a large risk of graft rejection and reduced visual outcomes.

The key to the DMEK is the donor tissue preparation, being able to dissect a 10-15 micron thick layer of the cornea from the donor. This kind of precision was just not possible in the past. The surgeon jokingly lamented that they were getting such great results that patient expectations had also risen leaving less room for difficulties.

Now, patients being assessed for cataract surgery get their corneal endothelium measured for integrity as a matter of routine. This is a recent development and a good one. In the past (a year or so ago), the need for a transplant cornea wasn’t discovered until post-cataract surgery when the patient found they were not recovering their vision as they should. Then the patient needed to be reassessed and a separate surgery scheduled, with much more wear and tear on everyone.

Now, if the initial assessment shows that the patient requires the DMEK procedure, it is done right away during the cataract surgery. They call it a triple DMEK. Several of my cataract patients have required DMEK and had good results. For more details on DMEK click here .

This is a wonderful procedure, making clear vision possible for people who would no longer have it, but as with any transplant, the patient needs a steroid drop indefinitely to reduce the possibility of graft rejection. Rejection is a possibility.

When I started to practise in 1987, the only option for these patients was a full corneal graft; this newer procedure is a vast improvement with a lot shorter recovery time and great visual results.

Thank you to the eye surgeons who hone their skills and provide wonderful eye care.

til next week,

the good doctor

Vision Care Team Goes to San Carlos, Bolivia!

Thu, 17 Nov 2022 05:55:04 GMT

Blog vol 3. 26. Vision Care Team Goes to San Carlos, Bolivia!

In February 2020, Medical Ministry International (MMI) went on a Vision Care mission to Bolivia returning March 6, 2020. With the onset of Covid -19 and the uncertainties that arose, it wasn’t until the past month that a Vision Team could set up a full clinic in San Carlos, Bolivia. Two and a half years is a long time, for the people of Bolivia and for MMI. While there providing care, Barb Skinner, optician and former MMI Canada president, dispensed a pair of glasses from Burlington Eyecare, which she captured on her phone.

Valuable work is done on these two-week missions. Barb reported that MMI had a team of 42 people, 31 Canadians and Americans, 10 Bolivians, and one Paraguayan. They were there from October 22 to November 5. The team served 1536 patients, of which 1423 were adults and 113 were children.

As the picture shows, one of the many pairs of glasses donated by our patients at Burlington Eyecare in 2019 was part of a shipment to Bolivia and was finally dispensed to a patient on November 2, 2022. This pair has a Burlington Eyecare case (with our old address) so its source is easy to identify; of course not all glasses are so easy to place.

All totalled, 1374 pairs of glasses were dispensed during the two weeks. Wow!

It all starts with the donation of glasses, your glasses right here in Burlington, which we package in plastic bags to help preserve them. The local Lion’s Club picks up the donations when they start to overflow and delivers them to MMI’s office in Hamilton. From there, they are sorted and verified, with the prescription catalogued in a database. This database with all the glasses is then shipped to the country hosting the next clinic, and the patients receive the closest match in prescription in a frame that works for them.

The Vision Care team also provides eye surgery. 112 patients received surgery: 75 cataract and 17 strabismus. Imagine the logistics of setting up a surgical ward and taking on that kind of volume.

MMI sends a shout-out to Burlington Eyecare and our patients for our support of their work to bring eye care for lasting change in people’s lives. We at Burlington Eyecare also are raising funds towards equipping the eye clinic on the Amazon Hospital Boat, the Mau Ipata, which is scheduled to launch in the spring of 2023. We are currently at 32% of our target!! (See campaign here ). Thank you to all who have supported this effort.

When you come in to see us at Burlington Eyecare, bring in your used eyeglasses, you can make a real difference in someone’s life. If you are interested in volunteering for a two-week clinic, the next vision care missions are January 2023 in Colombia and May 2023 in Rwanda. You can look for upcoming projects here .

Thank you to all,

til next week,

the good doctor

CPR, ABC or CAB? Definitely CCC!

Thu, 10 Nov 2022 07:42:34 GMT

Blog vol 3. 25 CPR, ABC or CAB? Definitely CCC!

Don’t you love all those three-letter acronyms (TLA’s)? No doubt a result of our love of texting and the smartphone’s ability to auto-correct our correspondence. Yesterday, we had a training session (with pizza dinner) at Burlington Eyecare in CPR with AED. We had the Automated External Defibrillator (AED) installed in our clinic in November 2015, and all completed CPR training; time for a refresher.

CPR is key in resuscitating a person in cardiac arrest and/or a person who has stopped breathing and in improving their long-term recovery.

The approach has changed since 2015, interestingly.

Airway-Breathing-Circulation (ABC) was the order of priority for assisting a person in distress that we were taught in 2015. This still is important and a great memory tool, but our teacher from SOS First Aid shifted the order to Circulation first, as the American Heart Association (AHA) recommends Circulation-Airway-Breathing (CAB).

Blood flow to the brain is critical. The compressions of CPR (cardio-pulmonary resuscitation) physically pump the heart and circulate the blood so that the brain can receive up to 20 % of the oxygen it normally receives. And this all buys time, so the TLA I came away with was CCC, Compress-Compress-Compress.

We also had excellent training on co-ordinating the AED with CPR. Unlike what we see in Hollywood, a person with no heart activity, as they say, flat-lined, cannot be resuscitated by a strong shock. Only irregular heart rhythms, like ventricular tachycardia (fast) or ventricular fibrillation (irregular, which can cause the heart to stop), will be aided by the AED.

The rhythm of compressions should be about 100-120 per minute. This is critical because too slow, and not enough oxygen gets circulated. The depth of compression is important, deep enough to again pump the heart and circulate. Our instructor also pointed out variations in pace and depth with smaller people like infants and neonates. All in all, a really good review and practise with the AED, just what we needed.

This Friday we observe Remembrance day, the 11 ^th hour, 11 ^th day, 11 ^th month. Our experience at Burlington Eyecare, preparing for the hour when we may be needed to save someone’s life, calls to mind a book I read, Rush to Danger, an excellent account of war-time medics and the courage they display in saving the wounded while under fire. The author, Ted Barris, a notable Canadian war historian, writes of his own father’s experience as a U.S. army medic during the Battle of the Bulge. It is a good reminder that we can be ready and able to help when someone is in distress.

I strongly recommend taking CPR or updating if you haven’t done it in a while. Do it with a friend or family or your workmates, a lot more fun!

til next week,

the good doctor

Glaucoma Treatments

Thu, 03 Nov 2022 09:26:55 GMT

Blog vol 3. 24. Glaucoma treatments.

In the latest issue of Ophthalmology, a study: which has a better outcome in the treatment of primary open-angle glaucoma? laser treatment? or the traditional eye drops? This study was conducted in Great Britain, following the patients’ outcomes for three years.

In this study, researchers found that up to 75% of patients with open-angle glaucoma who received laser treatment (SLT) were kept below their target eye pressures over a three-year period. These same patients and those who initially took eye drops but then opted for laser treatment were followed a subsequent 3 years and it was found that 70% of them still had target eye pressures or lower.

Glaucoma occurs when the pressure gets high enough in the eye to reduce blood flow to the retina. Pressure usually rises when the fluid in the eye, the aqueous, is either overproduced or does not flow out of the eye fast enough. The usual treatment is to get the pressure down by using glaucoma drops. The trouble is that people do not always take their drops so treatment can be inconsistent.

The original LIGHT study recommended that selective laser trabeculoplasty (SLT) be the first line of treatment with open-angle glaucoma patients instead of eye drops.

The new information in Ophthalmology assures us that SLT is still working well after 6 years. An interesting finding of the study was that pressures were up in some of the laser (SLT) group with very little progression of glaucoma. The author is suggesting that use of eye drops has effects on outflow of the aqueous possibly because of scarring after prolonged use. If this is true, it is another reason to use the laser more often. (Read more here ).

Laser treatment for glaucoma is not new. In the 1980’s clinicians treating glaucoma patients used an argon laser to open up the drainage channels, the trabeculum, in the eye. The idea was to create small holes that would allow the aqueous to flow out easier, thereby reducing pressure. Unfortunately, the laser released too much energy and caused collateral damage resulting in long-term pressure rises.

Lasers have come a long way.

SLT involves a YAG laser that uses up to 10,000 times less energy than the argon variety, allowing for much more control. It uses small pulses of energy that select out only pigmented cells that minimally absorb energy. The idea is to do about 25 tiny holes with the YAG laser per quadrant, with about 100 for a full 360 degrees. There can still be adverse effects, but they are rare and relatively inconsequential. The procedure can be repeated if required and still be helpful.

These recent findings should cause us to rethink our first-time glaucoma treatment plan. At the very least, it should spur on further research. Exciting and potentially revolutionary findings, stay tuned!

til next week,

the good doctor

Pirates and patches

Thu, 27 Oct 2022 06:39:11 GMT

Blog vol 3. 23. Pirates and patches.

Favourite Halloween costumes: witches, ghosts, cats, Batman, pirates. Pirates complete with a red bandana, a stuffed parrot on the shoulder, a wooden leg, a tattoo or two, an eye patch…

There it is, the eye connection.

One gets thinking that there were a lot of eye accidents in the pirate population. Kids taking classes in cannonry and swashbuckling would have to watch those flying projectiles. As the instructors invariably would say, “It’s always fun until someone loses an eye.”

But, and this is very ingenious…

Scientists studying the brain and the retina have concluded that the patch had a practical purpose, and was not worn because of injury or just for a fashion statement.

The life of a pirate and even an able seaman involves going from on top of the deck to underneath it, from blinding daylight to a dark hold. This requires time to adjust, up to 10- 30 minutes depending on your age and your daily intake of carrots. A very clever buccaneer found that if he patched his eye on top, he would be able to keep on seeing down below by removing the patch over the unbleached eye. (Read more here ).

This use of patching could mean the difference between a successful raid or capture and death. One thing for certain, to pillage and survive, pirates will take every advantage they can get. A note to the developers of the video game, ”Sea of Thieves,” definitely add this realistic component, of patching and unpatching, to the day-to-day lives of the sailors.

In my days in the military reserve, Algonquins, B Company, we learned about night warfare. The military uses para-flares that are launched to light up an area, but quickly fade out and drop to the ground. During training, we were always told to close one eye and keep it closed as soon as the flare went up so that when the light died down you could continue to see with the unbleached eye. Again, potentially a matter of life and death, and by the way, it does work.

The rods in the retina are receptors that receive light which starts a chemical reaction in the retinal. Problem is that this reaction takes time to recover, getting bleached out. When you get into dark conditions you rely on these rods a lot more but it takes time to shift to the darker environment. If you are deficient in Vitamin A or you are older, that shift takes longer.

As optometrists, we use patches when we want to encourage a “lazy” eye to develop, we will patch the good eye to make the “lazy” eye work. A few hours a day at home with a patch and some sessions with Minecraft with a patch and we get great results.

You know the favourite letter of a pirate on the eye chart, right?

“RRRRRRRRRR”

til next week,

the good doctor

Wait a second

Thu, 20 Oct 2022 05:57:58 GMT

Image source

Blog vol 3. 22. Wait a second.

Again, I am thankful to Nature for their regular news feed. I comb through it and pick out advances in eye care and optics. We have discussed nanophotonic sensors, 3-dimensional photonic crystals, chirped-pulse amplifiers, and today, optical clocks. Fascinating stuff.

We have had atomic clocks since the 1950s. Atomic clocks use caesium-133; a second is the time it takes to cycle through 9,192,631,770 oscillations of the microwave radiation the caesium atoms absorb and emit when they switch between certain states.

Optical clocks use strontium and ytterbium, which have up to 100,000 times faster frequencies, to cut the second even finer. Remarkably, optical clocks are 100 times more accurate than atomic clocks, which since the 1960s have defined Coordinated Universal Time (UTC).

Why do we need more precise chronometers? Do we really need to slice up time that finely?

For everyday life, no. For scientific research, this is useful.

With really fine slices of time scientists can even test the general theory of relativity which says that time should pass more slowly in places where gravity is stronger such as at low altitudes. Comparing the ticking frequency of two optical clocks could even reveal subtle changes in gravitational fields caused by the movement of masses, for example, by shifting tectonic plates.

The key is not only finer slicing of time but also more precise synchronizing of timepieces so even small (we’re talking REALLY small) differences can be observed. This is where the latest research from Dr. Pan, a physicist at the University of Science and Technology of China in Hefei, comes in. His team was able to transmit, optically, instead of with the previously used low-frequency microwaves, pulses as far as 113 km which is a new record. (Read more here ).

The optical clocks need to be able to communicate with each other precisely before they can become the new standard for the measurement of the second as a unit of time.

The plan is to transmit to satellites and then relay to other earth-bound clocks (also making it eventually possible to hunt for dark matter and detect gravitational waves in space, my editor says this is extraneous, but it is so interesting I asked to keep it in:)

Wait a second! Or should I say, wait 919,200,000,000,000 oscillations of an ytterbium atom!

til next week,

the good doctor

The Harvest Moon

Thu, 13 Oct 2022 01:52:36 GMT

Blog vol 3. 21. The Harvest Moon.

On October 9 ^th , we enjoyed the full moon that is traditionally called the “Harvest” moon. It occurs around the Autumnal Equinox, so either in September or October, and it happens at harvest time in the northern hemisphere.

What I marvel at is the size of the harvest moon; it appears twice as large when it starts to come up over the horizon. Sorry to burst your bubble or remove a little magic from your lives, but it really is no bigger, it just looks that way.

Scientists have scratched their heads on this one.

There is the long-known Ponzo illusion, where we have converging perspective lines and two horizontal lines above each other, the one further back looks longer even though they are actually the same length.

This goes a long way to explaining our larger moon. When the moon is near the horizon, our brain perceives it as closer to us and adjusts the perceived size. There are many ways to tell that this is happening. One way is to take a picture of the moon on the horizon and then with the same settings take a shot of it up in the sky, and you will find that the moon is the same size. Another way, which is less technical, is to just turn around and bend over and peek between your legs, upside down, and a smaller moon ensues.

What is really cool, is that astronauts out in space still experience this same moon illusion, even though there are no background clues to help make it happen. (Read more about this moon illusion here ). My best guess is that we have learned perspective patterns that just kick in whatever the circumstances.

The Harvest moon is also named for its time of rising. Usually, there is a ½ hour difference from day to day on the time of moonrise, but the Harvest moon rises at about the same time every evening. It gives the perception that we have more days of full moon at this time of year to help in the harvesting.

The reason for this timing is the angle from the elliptic, which is the path that the planets and the moon follow as we track them in the night sky. During September and October, we have a shallower angle in the east for this path resulting in less variation in the time of moonrise.

All this to say that it is a great time of year to go out and enjoy a moon on full display.

Til next week,

the good doctor

On giving thanks

Thu, 06 Oct 2022 06:04:49 GMT

Blog vol 3. 20 On giving thanks.

I started this blog during the quiet times of early 2020 (read early COVID) and shockingly, or perhaps more sadly, have not yet done a blog on Thanksgiving. We, at Burlington Eyecare, have much to be thankful for.

I am most thankful for people.

First, those I work alongside every day: my colleagues in Optometry and Opticianry, who truly get it. It is about taking care of people, about putting the needs of the patient first and foremost. It is the so-called little things like explaining a hard-to-understand process of the eye or an intricate lenswear design or helping someone out of their chair and down the hall. It is about respecting our patients, treating them as human beings, giving them the time of day.

Thank you.

Second, my staff. I have had staff leave this year for personal reasons, mostly academic, and I would like them to know that they are much missed. My present staff is wonderful, and they more than get it, or more to the point, I am getting it from them. They care. They are the ones that make sure every interaction is meaningful. They do the little things to ensure that your time with us, whether on the phone or by text, or in person, is special.

Thank you.

Thirdly, the University of Waterloo student interns who bring their enthusiasm and energy to our practice. I have been very impressed with their level of knowledge and compassion. It is an honour and a joy to help prepare the next generation of Optometrists.

Thank you.

Fourthly, the unsung ones who deliver excellent service to us: the people working in the eyewear, lenswear, contact lens, and optical equipment industries, and, of course, our IT team. We have a wonderful relationship with every one of these people and they help us to provide the excellent care that our patients have come to know.

Thank you.

Fifthly, I owe a huge debt to those who have come before us: Dr. Ron Watson, Dr. Nancy Wilson, and Dr. Jerilee Nyman, who set the bar very high in providing unsurpassed care. I know that their example and legacy will continue at Burlington Eyecare.

Thank you.

Lastly, and most importantly, our patients. You are why we are here on Fairview Street striving to provide the best care possible. I am most thankful for the trust that you put in us. I so enjoy getting to know you all, we have so many really wonderful patients.

Thank you.

Til next week,

the good doctor

Coming full circle

Thu, 29 Sep 2022 03:30:57 GMT

Blog vol 3. 19 Coming full circle.

In 1991 I completed my one-year residency in Low Vision at the University of Waterloo. During the nineties, I would carry my mobile equipment into various long-term care homes and provide much-needed care to those who could not get out for an eye exam. I travelled to homes in Hamilton, Stoney Creek, Ancaster, Brantford, Kitchener, Cambridge, Waterloo, New Hamburg, Paris, and Simcoe. I also worked at the Low Vision Clinic at the CNIBs in Hamilton, Mississauga, and Brantford. It was very rewarding work.

Working out of my trunk and using my home office as a base, I could provide services to an often overlooked population. I can tell you that I did not grow rich financially but I definitely grew rich in experience and compassion.

I had hoped to also provide Low Vision Care to the people in the long-term care homes. Research showed high levels of visual impairment in these homes. No doubt it was there, and there were some people who could be really helped, but on the whole, these people had so many other concerns that visual impairment was level 6 on Maslow’s Hierarchy of Needs (not very pressing). Somewhat discouraging for my young, idealistic self.

After my first year, I noticed close to a 30% attrition in some of the homes I visited, either from death or from transfer. That was also very depressing. It was also hard to deal with the high level of medication, especially in the area of antipsychotics among the residents in these facilities. I had a lot to learn.

There were highlights, meeting people who were born in the 1880s that flew with the Wright brothers or flew biplanes in the First World War. Or people that saw the advent of the telephone, or electricity, or cars and tractors. I even had one couple who had been married at the age of 20 and were celebrating their 80 ^th year together. Remarkable. And such a pleasure.

The staff and workers in these homes were wonderful, caring, and dedicated, doing the best they could with the resources they had.

Even before optometrists in Ontario could prescribe medications for their patients, the needs in these homes required that I recommend antibiotics or anti-glaucoma medications with the house doctor signing off. Needless to say, a great learning experience both professionally and personally. I got to know a number of the residents on a personal level, and they were a great encouragement.

On a full-time basis, this work was physically, emotionally, and mentally demanding so I balanced the work with doing “normal” eye exams with Skinners Optical and an ophthalmologist in Dundas. I got my license to practice in Missouri, took the family to St. Louis to do my Masters, and then returned in 2002 to take on Dr. Watson’s practice in Burlington.

Twenty years later…

I provide lots of regular everyday eye care. I still do provide Low Vision Care and still do visit shut-ins in their homes. Today I embark on a new phase, a regularly scheduled clinic in a long-term care home. Our current optometry intern will be accompanying me. This is very satisfying and a good thing, a really good thing.

This Covid experience has reinforced what I have learned from all my years of practice, I am here to provide eye care and a human touch to the people of Ontario, in spite of hurdles and circumstances.

We will continue to give a helping hand to those who need it. As Gregory Porter so aptly sings, “There will be No Love Dying”.

Til next week,

the good doctor

House of Life

Thu, 22 Sep 2022 02:58:31 GMT

Blog vol 3. 18 House of Life

Back in 2020, before the pandemic, we decided to raise funds for Medical Ministry International, MMI, which provides medical services to the less fortunate around the world. Some of our doctors have been on MMI’s short-term eye care missions to Ecuador, Peru, and Mexico. We saw the need firsthand and wanted to continue to support the work from our practice in Burlington, Ontario. In spite of a rather turbulent 2020-2021, with the pandemic and all, we raised a lot of funds and awareness for this important work.

Fast-forward, two years later, we continue to want to make good eye care available to people everywhere. MMI meanwhile has been dreaming, planning, and praying. Thus were started plans for a hospital boat: “House of Life”, the Mau Ipata, a Ticuna phrase from one of the indigenous tribes that live in the Amazon region. Amazingly, there is full cooperation in this project from the three nations that share this zone: Columbia, Peru, and Brazil.

Leanne Ferris (director MMI International) and the team from MMI want to provide a permanent hospital that is a large boat that will go up and down the rivers of the Amazon basin. An excellent idea. (click here for more information).

We, at Burlington Eyecare, wanted to do something big, and here it is. We have committed over the next year to raise $50,000 to equip an eye exam lane for the boat. So far we have reached the 32 % mark, a third of the way. We have had support from generous patients (thank you!!) and Burlington Eyecare has committed a portion of our regular sale of glasses.

We have worked with MMI for many years. I personally went to Mexico and Ecuador with them in the late 1980s as part of my optometry training, a very educational and eye-opening experience.

We have also known Leanne and her family (the Skinners of the former Skinner Optical on John Street North in Hamilton, 1949-2004) for years. We have great confidence in the MMI team.

The construction team is locally sourced (as you can see on the video), as will be the equipment for the exam room. This local sourcing ensures continued support, a must for a long-term commitment, and ensures that the local people benefit from the business.

Who knows? One of our Burlington Eyecare team may go down and work on the boat someday in the not-so-distant future. This is all very exciting and actually happening! Here is a link to our initiative and a video on the building of the boat.

Thoughts of Noah’s Ark and building a boat on dry land come to mind, it really captures the imagination...

til next week,

the good doctor

"Huh, Huh, so what's new today?"

Thu, 15 Sep 2022 05:00:36 GMT

Blog vol 3. 17 "Huh, Huh, so what's new today?"

He had just retired as head of the University of Bern’s Eye Clinic, where he presided from 1935 to 1968, when in 1969 he spent a year sabbatical at Washington University’s Eye Clinic in St. Louis Missouri. Dr. Hans Goldmann, who was born in 1899 in Bohemia, would appear in the mornings and greet the faculty and students with, "Huh, Huh, so what's new today?"

His work in glaucoma research and in developing new eye testing techniques are lauded to this day. We still use the Goldmann tonometer, which is the gold standard in measuring eye pressure, and the Goldmann field perimeter, which measures visual field.

I have written several articles on bioptic driving and telescopes. Many of my patients who have presented for possible bioptic use have an eye condition called nystagmus, where the eyes weave back and forth searching for a better reference point.

In the 1970s automatic perimeters replaced the manual Goldmann variety. Problem is that the automatic variety cannot account for the eye movement of my nystagmus patients, and that is real trouble when a reliable and accurate measure of a potential driver’s peripheral vision is required.

Dr. Tabone, who practices with us, suggested that we look into getting a Goldmann perimeter for these patients. That was early July, and I found one that, originally made and designed in Switzerland, was sitting on a hospital bed in Vernon Hills, Illinois, and not in a museum for ophthalmology. I purchased it and had it shipped to a family friend in East Aurora, New York because the supplier could not ship outside the USA. It then sat in a warehouse, for about a month as I figured out how to get it across the border to my office in Burlington. It was with much elation when, on an August morn, I received my Goldmann perimeter and have been working on getting it operational since.

As the emperor in Star Wars says, “Now witness the firepower of this fully armed and operational battle station!”

It feels like that, now that we have the Goldmann perimeter operational. It has been a long process but much needed. The bioptic telescope makes it possible to see at least the 20/50 line on the eye chart, but that is not the most important visual task when it comes to getting around. It is your peripheral vision, and unless the driver has at least 120 degrees of visual field in the horizontal, they cannot responsibly drive a motor vehicle. The Goldmann perimeter measures the degree of field definitively for all patients.

So as Dr. Goldmann, used to say when he was doing his rounds at Wash U, "Huh, Huh, so what's new today?"

The answer is something that has been brought back and made new once again, the Goldmann perimeter for the patients and potential bioptic drivers that make it to Burlington Eyecare.

til next week,

the good doctor

BRIGHT RUN 2022: Saturday, September 10

Thu, 08 Sep 2022 04:10:15 GMT

Jerilee with her parents at Bright Run 2021

Blog vol 3.16. BRIGHT RUN 2022: Saturday, September 10, 15th Anniversary

In February, 2022, one of our doctors at Burlington Eyecare, Jerilee Nyman, tragically lost her 2 year battle with breast cancer. During that time Jerilee, her family, and friends pored their energy and enthusiasm into record-breaking fundraising for the Bright Run, an event that raises awareness and funds for cancer research.

Jerilee was scheduled to speak at this year’s event Saturday, September 10th, at the Dundas Conservation area. Gerri Nyman, Jerilee’s mother-in-law, a cancer survivor herself, will be speaking on her behalf. This will be a very emotional event for team Nyman.

We all miss her.

So think pink, put on your walking shoes, put the kids in the stroller or carrier and offer your encouragement and support for the many families struggling with cancer. This is a fun, outdoor, family-friendly event. For more info click here .

With sadness,
September 2nd, local ophthalmologist, Dr. Patricia Harvey, died after a 6 month illness. She is the sister of Hamilton ophthalmologist, Dr. John Harvey and Hamilton sports medicine doctor, Dr. David Harvey. I had the pleasure of working with her and sharing patients with her over the years. She will be missed by her patients and by the eye care community.

til next week,

the good doctor

Of Carrots and Cones

Thu, 01 Sep 2022 04:29:14 GMT

Blog vol 3. 15. Of Carrots and Cones

This past summer, which was way too short and way too dry, we had our annual summer reading club at the Germain household. We all read as many books as possible in the summer. Then we tally the books and give out gift cards (the amount varies depending on how many books a person reads) so we can buy more books.

One of my summer reads was Steinbeck’s Of Mice and Men. The more cynical members of my family accuse me of reading smaller books to inflate my numbers. It is a shorter book and covers the span of four days in the life of two wandering farm labourers in 1930s California. Thus, the title Of Carrots and Cones mirrors Steinbeck’s title, but all this, while very interesting, has nothing to do with the actual blog topic….

Which is really an eye condition called keratoconus. It is a condition that results from having a thinner section of cornea (the outer layer on the front of the eye). When the conditions are right (or wrong really), the internal pressure of the eye will push forward at this thin spot and produce a cone in that region. It can be caused by environmental conditions, in some cases, there is some autosomal dominant genetic transmission, and certain behaviours, like excessive eye rubbing, can contribute (read more here ). If left too long, a corneal transplant or a procedure called Intacs may be needed.

The key is to catch it early.

This past week I had a patient in his early 30s who came in with a floater in his eye and reduced vision - keratoconus.

If there is a family member that you know who has it, or if you rub your eyes a lot, or if you are not seeing quite right, these are all excellent reasons to get an eye check.

When I first started practice, we treated this condition by helping the vision with rigid contacts that vaulted over the cone. Since the turn of the century, scientists have discovered that an older cornea from a life of exposure to ultraviolet light is a lot more rigid and not as susceptible to forming a cone. Some creative researcher said, “Let’s bombard the cornea with enough UV to make it a bazillion years old and make it rock hard.”

That is where the procedure called corneal cross-linking came from. The surgeon usually scrapes off the cornea’s epithelium and exposes the thick collagen layer called the stroma and then pours on riboflavin and a huge amount of UV to create an aged cornea.

Cross-linking is now standard of practice for keratoconus. The earlier the patient is diagnosed, the better the result, and studies show that it does not regress, the procedure actually arrests the cone development. Of course, we still work with the results of cone formation but that can be handled with special contact lenses.

Keys to remember: if you are rubbing your eyes a lot, something is wrong. It can be dryness of the eyes, it can be allergies, or it can be a bad habit. Get your eyes checked to see what the problem is, and also make sure your children get regular eye examinations.

As one famous rabbit says, with carrot in hand, “What’s up Doc?”

til next week,

the good doctor

“My child’s eyesight is just fine.”

Thu, 25 Aug 2022 06:45:41 GMT

Blog vol 3. 14. “My child’s eyesight is just fine.”

I have heard this statement way too many times. In 2018, McMaster University released a paper about the need and validity of vision screening for elementary school children (read here ).

What the paper did not discuss is that this screening process is the lowest possible level of care. To their credit, the researchers were addressing a huge need in the community, but there are more thorough, effective ways of catching visual problems in children.

One of the physicians on the research team had a child with amblyopia, or a lazy eye, into their first years of school before it was diagnosed. Unfortunately, this happens way too often. Why? Government-funded eye exams are available for all Ontario children.

How did this physician’s child get missed? The false assumption that the child’s screening at baby wellness visits is sufficient care.

The Canadian Association of Optometrists recommends a child’s first eye exam be at 6 months of age. Even I was skeptical, this sounds over the top, but the earlier problems are caught, the better the prognosis. Children develop so much, so fast, you want to assure a solid foundation. Good vision is part of that foundation.

In 2019, Burlington Eyecare started seeing children at 6 months and annually after that. We have made a concerted effort to inform parents and grandparents about the importance of this preventative care.

Now, we get little ones at 6 months, we can objectively check their eye prescription, check how their eyes work together, and on most occasions, with a little creativity, can get a good look inside their eyes to check health.

Yes, we have picked up those children that require more attention, and picked it up real early. If the child is doing well, we counsel the parents on what things to look for, how to protect their child’s eyes, and also stress the need for regular eye exams. We suggest scheduling their next visit before they leave.

In a perfect world, every child will go through this process. This is where the vision screening process will help, to prevent children falling through the cracks. If you have not had your child’s eyes checked, do not fret, get them into an optometrist’s office. No better time than just before school.

til next week,

the good doctor

Visual impairment, reading, and the village

Thu, 18 Aug 2022 02:44:32 GMT

Blog vol 3. 13. Visual impairment, reading, and the village

In 1990-91, I did a residency in Low Vision at the University of Waterloo’s Centre for Sight Enhancement. “Low vision” occurs when a person has reduced vision as a result of an eye disease or condition resulting in a visual impairment, which makes it difficult to do tasks like reading, driving, or the activities of daily living.

The low vision optometrist measures the patient’s vision and helps them to maximize their existing vision by using sources of magnification and/or contrast enhancement. There are so many ways to do this.

Last week, my wife finished an autobiographical work by physician Oliver Sacks. He was a world-renowned neurologist who is probably best known for his 1973 book, Awakenings, which was adapted into an Academy award nominated movie.

He lived with reduced vision for the last nine years of his life.

He loved to read so much that he adapted to using a myriad of magnifiers so that he could still access his journals and other texts. He loved physical, paper books and was determined to keep reading them. It is inspiring to see his motivation.

This past week, I was reminded of why I love to do low vision.

An elderly lady presented with her niece, who had seen on our website that we help people with visual impairment.

For a person to do well, it really takes a village, as the saying goes.

The patient’s niece knew of her visual impairment and continued to get her large print books so that she could keep reading. This patient has macular degeneration and needed to learn to use another part of her retina to see again. We were able to get a +6.00 dioptre lens over her spectacles at the right distance and lighting which got her to see newsprint “comfortably”.

Three things need to be present: the patient’s desire to continue reading, the ability to do so, and the help to make it happen.

I cannot emphasize enough the help that a social network can give to a low vision patient. It is critical. I have simplified the process here, not going into the heartache and adjustments that must occur to reach the point of accepting a visual impairment. Another thing to remember is the ongoing care with an ophthalmologist.

If you are a caregiver, please be patient and encouraging, and if you have an impairment, do not despair, there is help and hope.

til next week,

the good doctor

EGNDH

Thu, 11 Aug 2022 04:38:57 GMT

Blog vol 3. 12 EGNDH

No that is not a word, those are 5 letters on the Snellen eye chart for vision testing. Late 2019, the Ontario government changed the regulations for drivers, making it possible for people who could not see this line of letters to drive.

To drive a car in Ontario, the most important visual component is the field of vision, which has to be at least 120 degrees. The visual acuity needs to be 20/50, that is the person needs to see at 20 feet what the “normal” observer can see at 50 feet.

The Ontario government has allowed the use of bioptic telescopes, telescopes mounted on a pair of spectacles, set at a different angle from looking straight ahead, to enable visually impaired people to get behind the wheel. Since that time we have been busy at Burlington Eyecare, fitting and training people on the use of these telescopes: new drivers, reinstated drivers, or drivers with visual problems who are able to keep their licenses.

If you are not able to drive because of vision limitations, please give us a call.

A good low vision refraction is a must to get the best possible spectacle correction.

The answer is not always a bioptic. Two examples of note, both these patients wanted to drive, but we are not fitting them with a telescope.

Sometimes special contact lenses can be the best solution for visually impaired patients. One patient had a high myopic prescription and was just not making the 20/50 line. A gas permeable contact lens will improve the optics and increase the size of the objects just enough to pass.

Another patient has nystagmus, the eyes weave back and forth, and when this happens, vision is reduced when using spectacles. Scleral contact lenses will help in two ways, by providing a more stable image and by helping to slow down the nystagmus. We are hoping to achieve 20/50 also.

A low vision assessment is a thorough eye exam specifically aimed at finding the best visual ability in the midst of impairment of whatever degree. It aims to help the patient use the vision they do have as well as possible. The low vision assessment considers the patient’s life and needs and tries to make things work.

Get a good low vision assessment.

Realistically, some people are not going to be able to meet MTO standards period. There are options and resources for these people also.

Call 905 639 9595 or email icare@burlingtoneye.ca .

til next week,

the good doctor

How I spent my long weekend

Thu, 04 Aug 2022 04:06:44 GMT

Blog vol 3. 11. How I spent my long weekend.

Each week you, the reader, have come to expect fast-paced drama (right?), and this week… well, not so fast-paced, but oh so necessary.

Every civic holiday, my wife and I rent a commercial carpet cleaner (they’re always available, strange, and on a long weekend too; what is everyone doing?) and clean all our carpets. No exceptions this year, we spent the better part of two days moving furniture (and other things, it’s the other things that get you) and going over the carpets, repeating in high traffic areas. Why?

Dirt and sand, which are very gritty, get ground into the fabric of the carpet and actually wear out the fabric. It is also a pleasure to walk on clean carpet with pile refreshed and to be on clean carpet enjoying grandkids (this is where they hang out).

Then there is the pool, which has never looked better. A pool requires going out every morning and cleaning out the basket of leaves and checking the pH, chlorine and free chlorine levels. When the balance starts to go, and it will, you are on top of it. It also helps to have a good pool store that can analyze your water and “prescribe” the right mixture of chlorine, no-phos, or stabilizer.

You can see a picture coming into view, as we bring the pixels together, a life message appears. Regular maintenance is critical.

As with carpets and pools (not to mention aquariums, pets, cars, bicycles, furnaces,…) , maintenance is not optional. As one sage, entering his 71 ^st year once said , “If I had known I was going to live so long, I’d have taken better care of myself.”

Consider it an investment.

Or a responsibility.

Good stewardship.

Taking care of the people you care about.

Eyes are no different. If you have not had an eye exam within the past two years, schedule one. Many things can be prevented or minimized if caught early. Some serious conditions have no obvious symptoms in their early stages, such as glaucoma.

If you have kids, schedule them for eye exams before school; again, caught early many problems can be prevented.

Have you refreshed your contact lens supply? Your solutions? Had a check-up? What about protective eyewear?

You get the idea: regular maintenance.

Our phone, 905-639-9595 or email, icare@burlingtoneye.ca

til next week,

the good doctor

Going small, really small: Nanophotonic biosensors.

Thu, 28 Jul 2022 05:28:27 GMT

Blog vol 3. 10. Going small, really small: Nanophotonic biosensors.

In the past weeks, we received our first images from the Webb telescope. We are able to identify elements in and around exoplanets thousands of light years away.

This week we turn in on the larger universe and look at the “nano” verse.

In the latest edition of Nature , a research team from the University of Montreal uses nanophotonic sensors for analyzing maple syrup. Only in Canada, eh?

Sometimes a batch of syrup tastes a bit off and even trained tasters cannot pin-point the cause. Jean-Francois Masson and his team decided to apply the technology of biosensors to the problem.

The researchers took some samples of off-flavoured syrup and devised a nanophotonic sensor that contained very fine gold particles which then bound to the amino acids and amines that were suspected of distorting the flavour. When the proteins aggregated with the gold, the colour of the syrup changed alerting the tester to their presence. Once the team knew what they were looking for, they could back up a step and test sap samples before processing.

Harnessing the light-changing qualities of a nanoprocess has huge implications…

…not only for maple syrup quality control, but also in areas of medicine. This has potential applications in cancer detection, catching early changes in neurogenerative diseases like Parkinson’s, or screening for autoimmune diseases. It would also be valuable in the area of monitoring environmental toxins.

The key is the very small scale and specificity of the sensors.

When the molecule in question joins with the substrate there is a change in the discharge of light, very similar to how light is emitted from stained glass, this change is detected and quantified. For a more detailed explanation refer to the article in Nature .

On the one hand, we are observing objects thousands of light years away with the Webb telescope, on the other, molecules right under our noses and all around us with nanophotonic sensors.

Til next week,

the good doctor

It all started in 1962, with Dr. Ron Watson

Thu, 21 Jul 2022 02:55:26 GMT

Brant Street looking South

Blog vol 3. 9. It all started in 1962, with Dr. Ron Watson

Dr. Ronald B. Watson, an alumnus of Burlington Central High School, graduated in 1962 from the College of Optometry, which was situated on St. George Street in Toronto. He started practice in his hometown with Dr. D.B. Freeman on 490 Brant Street. In the early sixties, they were the town’s only two optometrists.

In 1964, Dr. Watson went out on his own and started a practice at 377 Brant Street at Wellington Square Mall. Burlington in the sixties and seventies was a small town surrounded by market gardens and orchards.

In 1975 he decided to make the huge move out near Walker’s Line on Fairview Street, where there were still dirt roads and as Dr. Watson calls it, “cowpaths”. He stayed there for the next 27 years.

In 1976 Dr. Nancy Wilson joined him in the practice on the corner of Woodview Avenue and Fairview. Meanwhile, the town, once called Port Nelson, was slowly becoming a city. With the Fisher family orchards turned into a new Burlington Mall, paved roads turned into Fairview Street which now went out past Walker’s Line.

Dr. Watson practiced optometry and taught part-time at the optometry school which had relocated to the University of Waterloo. He also became a Fellow of the American Academy of Optometry, as he developed his clinical skills.

He did a great job of keeping up with the changing technologies and methods of practice. Many changes happened in eye care during the ’70s, ’80s, and ’90s. When I took over in 2002, no big update was necessary, the practice was up to speed and running beautifully. This is no small achievement. Kudos to Dr. Watson.

In 1987 he received his Optometric Doctor’s degree from Waterloo (and I might add, on that day, May 30 ^th , I received my degree also from Waterloo, we like to joke that Dr. Watson and I walked on the same day).

That is where the story takes us, I met up with him through his Waterloo connections, and the rest is history.

Dr. Watson's retirement party

Dr. Watson has been retired for 18 years now and continues to be a great source of encouragement.

Till next week,

the good doctor

Stunning!

Thu, 14 Jul 2022 01:46:03 GMT

Blog vol 3. 8 Stunning!

The Webb telescope sent its first photos this week.

NASA and the European Space Agency and our own Canadian Space Agency have collaborated to produce something special. On Monday and Tuesday, July 11 and 12, the first five images were released to the media and, wow!

Some of us remember the first amazing images coming from Hubble in 1990. Many of these images produced by Hubble over the years are archived and still accessible. NASA has taken some of these same Hubble images side by side with the new Webb images. What a difference, like going from analog T.V. to 5 K (see images here ).

With these new images we will be able to see deeper into space and into time than ever before. Scientists estimate that the universe is around 13.7 billion years old, so the Webb can pick up infrared that was released close to 13.7 billion light years away. Hang on to your grey matter, that light may be coming from objects that no longer exist, or are no longer in the form that sent the light.

Not only that, but the sensitivity of the telescope makes it possible to analyze the composition of galaxies, stars, and even planets. All those exoplanets out there can now be checked to see if they have water, oxygen, and other elements that can support life as we know it. With space so vast, the universe being mostly empty space and constantly expanding, it’s exciting for us to have a device that can reach the farthest corners of the universe.

In 1969, NASA captured our imaginations by landing a man on the moon.

Then it was driving a moon buggy and even driving a golf ball (take that, Mr.DeChambeau).

Space and all its vastness gives us lots of fuel for our imaginations. Even Elon Musk inspires with launching Tesla Hot Rods in orbit.

In 1990 Hubble sent us pictures clear of the fog of our atmosphere, and now in 2022, the Webb.

We stand on the shoulders of scientific geniuses who have made it possible to see far far into space, and similarly possible to see detailed images of the inside of the eye.

Looking forward to more images...

Til next week,

the good doctor

20 years at Burlington Eyecare!!

Thu, 07 Jul 2022 04:49:05 GMT

Blog vol 3. 7. 20 years at Burlington Eyecare!!

I purchased the practice from Dr. Ronald Watson in June, 2002. That was a quick 20 years.

Back in the 1990’s I had a practice that focussed on nursing home care and CNIB low vision clinics, alongside the usual general optometric care. I took a three and a half year leave at the turn of the century, worked on a Master’s degree, and taught clinical optometry at the University of Missouri school of optometry in St. Louis.

In the 1990’s I had the pleasure of filling in for Dr. Watson at his practice in Burlington while he had some surgery, and upon my return to Canada in 2002, he was ready to retire.

So in June of 2002, Dr. Watson handed over the reins of the practice and graciously stayed on for two more years to help smooth the transition for patients. Dr. R.B. (as I call him) was wonderful, introducing me to all his patients and really helping to make it work. It wasn’t until after he retired that I realized just how good he was at running the practice.

Dr. Watson raced MG’s at Mosport and Shannonville as a hobby. He knew how to drive finely tuned race cars just as he knew how to run a finely tuned practice. He just had to hand me the keys with little to no tinkering.

I also had wonderful support from Dr. Nancy Wilson who had worked with Dr. Watson for 28 years and stayed on with me for another 6 years, retiring in 2010, a great optometrist and truly helpful person.

The following year we went through the onerous task of digitizing all our paper records, going back to 1964, and went completely paperless. Then, with the practice growing, we needed more space so we moved down Fairview Street, from the corner of Woodview to Cumberland, into a larger office with more parking.

We now have four optometrists on board and three opticians, and all this was done very organically over time. The practice is a testimony to the great start that Dr. Watson gave us, and to the ongoing dedication of excellent doctors and staff and suppliers. I would be amiss if I did not give a huge shout out to all the patients we have seen over the years that have made our job such a pleasure.

Til next week,

the good doctor

Alzheimer’s and the eye

Thu, 30 Jun 2022 03:41:17 GMT

Blog vol 3. 6. Alzheimer’s and the eye.

This past year a paper was published that found a possible and hopeful association between optical coherence tomography angiography (OCTA) retinal measurements and Alzheimer’s disease.

We have the ability to take in-depth pictures of the inside of the eye (OCTA), and that could allow us to detect the beginnings of Alzheimer’s.

I have mentioned the OCT before. It is a valuable tool in detecting and treating retinal and optic nerve conditions because we can see the layers of tissue at the back of the eye and what they are doing.

In 2019, our clinic acquired the ability to do a form of angiography with the OCT. By using a different wavelength of infrared light and performing multiple scans it can track the movement of the red blood cells through the choroid vessels, the layer beneath the retina. We now can pick up changes in the circulation underlying the retina, a valuable tool in detecting sight-threatening conditions like Giant Cell Arteritis or Wet Macular Degeneration.

The retina of the eye is a developmental extension of the brain, so our ability to see into the eye with high magnification and to see the varied layers of the retina gives us a “window” into looking at brain tissue.

There are other ways to look at brain tissue, like Positive Emission Tomography (PET), but they are a lot more costly and invasive. With OCTA you can do a scan of the eye in seconds and use biomarkers that can help in detecting early Alzheimer’s. This has driven research into measuring the retina to determine a possible link between Alzheimer’s disease. (See study here ).

What they have found so far is that the structures at the choroid appear to be diminished in Alzheimer’s patients.

What they have concluded is that a lot more studies and lot more subjects need to be looked at to make sure that we have predictive values. Hopefully, one day we can do a 20 second scan and detect this dreaded disease early, then with the same technology analyze treatment paradigms and come up with a cure once and for all.

Til next week,

the good doctor

Can I have my prescription, please?

Thu, 23 Jun 2022 03:29:36 GMT

Blog vol 3. 5. Can I have my prescription, please?

It was only a few years ago that some enterprising companies started providing spectacles online. At the time the industry experts predicted that online ordering would not amount to much.

Fast forward to 2022, with a gentle nudge from a worldwide pandemic, the number of online prescriptions being filled is legion. The fact remains, people want to order online, and the fact remains that you can get almost everything online.

There are certain services that cannot be done online, such as a brake job on your car, or a root canal on your tooth.

What these have in common is timely intervention, custom procedure, and personal care.

Healthcare should ideally not be done online. Professional, experienced, real person observation of real person patient who can voice concerns and complaints…

Custom measurements, personal care, education about your options and what would work best for you, and counselling and support after the fact, are so important to successful treatment.

Go to a professional health care provider, in person. For eyes and eyeglasses, see an optometrist.

Just yesterday, I had a patient who wanted to order online. The prescription was quite high and would require much attention to details about the frame, its size and shape, and how it fits the patient, with parameters like pantoscopic tilt, vertex distance, and frame wrap being important; and then attention to the right spectacle lens, with lens material, coating, and lens design to be considered.

The patient wanted the prescription and pupillary distance (P.D.) and is ordering online. This will not go well.

Some prescriptions do lend themselves better to online ordering, to be fair.

You use your eyes all the time; you rely on them. You wear your glasses all the time; you want to look good and feel good. Unless you try the frame on, how are you to know if it feels comfortable or really looks WOW!? For sure? What about adjustments and support? And someone to answer your questions? And fix your problems?

I rest my case.

Til next week,

the good doctor

Are we being a bit short-sighted here?

Thu, 16 Jun 2022 02:33:12 GMT

Blog vol 3. 4. Are we being a bit short-sighted here?

“Short sightedness has become an epidemic.” That is the title to a recent article in The Economist.

As I was growing up, all my older siblings wore glasses, so I wasn’t too surprised when, at 14 years old, a kindly optometrist asked, “which is better, one or two?, ”and I came away with a different perspective…

Trees have leaves, there are blades of grass, wow.

Research shows that there is a large genetic component to myopia, as my family will attest.

Research also shows that environment also plays a key role in myopia. Nature or nurture?

Both. The problem with myopia is more than just having to wear glasses or contacts, but increased risk of retinal detachment and maculopathy (problems, especially as you age).

Changing our genetic code is very difficult and not necessarily desirable; modifying our environment is somewhat easier. An Economist article on myopia (see here ) points out that the emphasis in a lot of Southeast Asian countries has been on the environmental component of myopia development in children. This is something to consider.

Some tips:

Get your child’s eyes checked, a full eye exam, as early as 6 months of age.

Watch for symptoms: squinting, eye turns, or headaches.

Reduce screen time; have your children hold their screens out further.

Get them outside.

Regular eye exams to track possible myopia development. There is a window of time, from about 6 to 15 years of age where myopia can be slowed down.

If myopia is developing quickly, then myopia control is available in the form of atropine drops, or specialty spectacle lenses and contact lenses. Your optometrist will discuss options and the best fit for your child and family.

As the Economist article states, daylight and outdoor light play more of a role in keeping myopia under control than previously thought. So put the screens down, and enjoy the great outdoors (with UV block, of course).

Have a myopia arresting summer.

Til next week,

the good doctor

Visual impairment to be avoided, get eyes checked regularly!

Thu, 09 Jun 2022 06:20:41 GMT

Blog vol 3. 3. Visual impairment to be avoided, get eyes checked regularly!

Of course, I would say this, after all eye exams are our thing…

In the past week a paper was published in the Journal of Alzheimer’s Disease Reports by a U of Toronto professor, Esma Fuller-Thomson. In an analysis of 5.4 million seniors in the American Community Survey from 2008 to 2017 the results revealed some interesting findings on the link between hearing and visual impairment and cognitive decline.

This link has been known for some time, but the numbers here are startling.

The researchers found that older adults with only visual impairment had more than three times the occurrence of cognitive impairment (mental decline) than people with no impairment. Older adults with only hearing impairment had more than twice the occurrence of cognitive impairment. The risk increased eightfold for those with both hearing and visual impairment. (Read full article here )

Being an optometrist, I have seen this first hand.

Moral of the story: Get your eyes checked regularly.

Ask your parents or other seniors in your life whether they are getting routine eye checks, and, of course, hearing checks too. The eightfold increase is the really staggering number.

The societal problems and family pressures of dealing with decline are unmeasurable, not to mention the reduction in quality of life for seniors.

Most of this is preventable with the treatment options available to us today.

Once again, I know that we can make a difference. At Burlington Eyecare we can take care of you and your eyes, but we have to see you to do that. Book an appointment.

We also do home visits for people who really cannot get out. There is a fee for this as OHIP does not cover it.

Til next week,

the good doctor

My annual tirade on Herpes Zoster (shingles)

Thu, 02 Jun 2022 23:49:49 GMT

Blog vol 3. 2. My annual tirade on Herpes Zoster (shingles).

I was reminded this week why I go on about this condition, shingles, the reoccurrence of Herpes Zoster or chicken pox, which once in your system stays there.

10% of chicken pox survivors go on to get shingles. It is more common in older people, but also does affect the under-50 crowd. Causes are unclear though anything that compromises the immune system is suspect.

Anecdotally, it does seem to hit people when they are already stressed: a big life change, a nasty diagnosis…

One of my patients came in for her annual visit this week. In 2019, she had a bout of shingles, and as with 25% of people with shingles, it affected her eye. Shingles can start on the eye brow, go down the nose, and get into the cornea of the eye.

After three years and much treatment with steroids to keep inflammation down, she still struggles with the results. She now has a permanent scar at the centre of her cornea that has dropped her vision to 20/80. The end result will be a corneal transplant to replace this damaged tissue.

There is antiviral treatment which if given in the first 72 hours of a bout of Shingles, can help to control the attack, but the neuralgia, pain, often persists long after. As with this patient the virus can cause chronic eye pain and even vision loss.

Shingles can be usually prevented with vaccination.

The chicken pox vaccine is routinely available for children and is part of standard care at this point. For those of us who had chicken pox as children, there is a vaccine, Shingrix, which is able to prevent shingles in 90-97% of people 50 years of age or older, and in 89.1% of 80-year-olds.

Shingrix is given intramuscularly in two doses two to six months apart, and is covered by OHIP, if you are between 65-70 years of age and have not received Zostavax (the original shingles vaccine) from the government. These are the current parameters, which will hopefully change.

Shingrix is available to people outside this age bracket but is costly. If possible, I would highly recommend the expense and trouble.

The doctors and staff here at Burlington Eyecare continue to educate and ensure that all our patients get their zoster shots. I know I can speak for all health practitioners out there, get your vaccine and let’s make this bug history.

Til next week,

the good doctor

Here comes the Sun, doo-doo-doo-doo……it’s all right!

Thu, 26 May 2022 04:07:10 GMT

Blog vol 3. 1. Here comes the Sun, doo-doo-doo-doo……it’s all right!

That famous Beatles tune reminds us of the coming summer months, three cheers for the sun! Well almost… how about two cheers and bottle of SPF 40. When the UV index climbs, we need to think of protecting ourselves from overexposure.

We all know about SPF, the sun protection factor, the rating given to lotions that we use to protect our skin. We also know to slather it on our children during the hot summer days.

We also need to put “sunscreen”, also known as sunglasses, on our eyes and our children’s eyes.

All sunglasses must have UVA and UVB coverage. There was a time when you could buy cool shades and actually be causing damage to your eyes, especially your lens and retina. The dimming effects of the lenses caused the pupils to dilate and actually permitted more light into the eyes and consequently, more UV. Thank goodness that these glasses can no longer be sold in Canada.

Children have much larger pupils than adults, actually allowing up to 2X more light into the eye, which means 2X more UV. Just like the skin, the eye ages prematurely when exposed to UV, getting earlier cataracts, possibly developing macular degeneration, at a younger age and more severely. Ideally you should also wear a wide brim hat to reduce your exposure during high UV indices, especially early afternoon.

When you are shopping and planning for your summer, put sunscreen for the eyes on your list: sunglasses.

You do not have to invest in Prada to get protection, all product out there will help. The best sunglasses reduce glare from water and sand, and have polarization features. Our favorite sunglasses are Maui Jims which even “digitally” enhance the light coming through.

The main message is protection.

til next week,

the good doctor

Bioptics, two years later

Thu, 19 May 2022 05:27:51 GMT

Blog vol 2. 52. Bioptics, two years later.

Back in 2020, I wrote a blog about changes in Ontario ministry of transport guidelines which now allow people to drive with bioptic telescopes. It was an exciting change for many people.

My 2020 blog focused on macular degeneration and the help these new glasses would bring to people with this devastating condition. This is the group I had anticipated would benefit the most from these changes, but…

Little did I know that there were a number of young people in Ontario with albinism that were just waiting to be able to drive. We have had the privilege at Burlington Eyecare of helping a number of these talented, motivated young people go from no license to a full G license, very exciting, and dare I say, life changing.

The power of a bioptic telescope usually does not exceed 4X, due to limitations like movement and field of vision. Yet it is worth stating that it is not impossible to use a 6 or even 7X telescope. The only way to know if it will work is to have a low vision assessment. One thing I have learned over the years is that the motivation of the patient is the main determinant of success.

One frustrating thing, over the last two years we have found that the licensing process is hit and miss. We have sent documentation with the patient for the MTO and some offices have accepted it, and others have wanted more information or have sent it for review. The system is not fully aware of the changes and the requirements that are now in place. Some perseverance may be necessary here.

That said, it has been a wonderful ride, helping drivers with bioptics already fitted from the USA or other places that already license bioptic drivers, helping new drivers, helping drivers who had their licenses suspended and then restored.

I look forward to the next year, its challenges, and the people we can help get on the road.

til next week,

the good doctor

That is one mighty big lens

Thu, 12 May 2022 05:52:55 GMT

Blog vol 2. 51. That is one mighty big lens.

After 35 years of being an optometrist, the world of lenses and refraction of light are second nature. However, I am still continually amazed by the work being done with lenses of all different sorts.

In the news today, there was an article on the Supermassive Black Hole (SMBH) at the centre of our galaxy called Sagittarius A.

Back in 2019, a composite image put together by eight different telescopes around the world called the Event Horizon Telescope or EHT, showed the first actual photos of a black hole. Now the EHT has set its sights on the Sag A hole which is only 90 million miles in size but massive, four million times the mass of our Sun.

Black holes were first discovered by observing how light bends as it passes through the hole, with the huge mass of the hole bending any light that passes near, resulting in a lens affect, called a gravitational lens.

As early as 1912, when Einstein was formulating his theory of relativity, he reasoned that there must be black holes and that light would bend around them. Astronomers, in 1979, noticed that objects seen through these holes are either distorted or “doubled” in appearance.

Figure 1: An illustration of the image of a star behind a black hole getting split into two as seen by a telescope on the other side. Image credit: NASA Roman Space Telescope

The larger the celestial body you are looking at, the more doubling you will see. In the case of Sag A, the doubling is relatively small, due to its distance from us (26 000 light years away). To get a noticeable gravitational lens affect from this hole would require larger and more sensitive telescopes, and that is what the EHT group will be announcing on May 12. Stay tuned.

Just a small side note, for this is all mind blowing stuff, to get to Sag A travelling at Warp 9.975 (Star Trek convention) it would take 26 earth years just to get there, making you realize that any of the Sci-Fi books or movies we enjoy have the travellers go as fast as the speed of the plot (no more questions, anyone).

Just to put the wide cosmos into perspective.

til next week,

the good doctor

A week off and start of hiking season.

Thu, 05 May 2022 05:26:43 GMT

Blog vol 2. 49 A week off and start of hiking season.

I took my own advice yesterday, and I must say it was good advice. My wife, the kids, and I went on an excursion to the Royal Botanical Gardens (RBG), one of the gems of Hamilton and Burlington. We spent the morning at the Arboretum, which has a lovely collection of magnolias in bloom, as well as a series of trails to varied ecosystems. The lake, the trees, the daffodils, all so lovely…

We met up with many species of birds; we even met a person who was volunteering for the RBG counting bird species. And so many of my favourite bird, the Red-winged Blackbird. There is a boardwalk that has been built into a marshy area, called the (you guessed it!) Marsh Walk that has lots of Red-wings.

The male appears quite plain, then he calls, puffs out, and shows off his coloured shoulders, quite striking. Plucky birds, it is heartening to see them come together in groups to badger larger birds that fly into their territory.

Another highlight was the Grey Doe Trail that cuts through the centre of the sanctuary with some of the tallest and biggest white pines that I have seen in this region. You feel like you have stepped back in time while in their majestic presence. The very hilly terrain creates a beautiful backdrop for these giants.

It is so wonderful that a group like the RBG has gone through the trouble and has had the foresight to establish these reserves, maintain them, and make them accessible to the public.

On our way back to the car we walked through one of the Magnolia gardens, so refreshing and therapeutic.

We drove home, did our Deer Tick check, and started planning for our next hike.

I won’t bore you with a lecture on the health benefits of exercise and the great outdoors, neither will I extoll the wonders and gift of sight…

til next week,

the good doctor

Lyme Disease prevention: the Tick Check

Thu, 28 Apr 2022 04:32:46 GMT

Blog vol 2. 49. Lyme Disease prevention: the Tick Check.

This is our third spring since starting the blog on a drafty April morning during the start of a global epidemic. Time to get out of the house, breathe in the fresh air, and enjoy the great outdoors.

Only one caveat: be careful, those nasty spirochetes that carry Lyme Disease are still out there.

The incidence of Lyme disease continues to increase. Bear with me as I go through my annual rant on prevention. It really is important. This is a potentially devastating disease which can be prevented with a few simple precautions.

How do we get Lyme Disease?

You catch it usually from a Deer Tick that is carrying the spirochete, Borrelia burgdorferi .

What to do?

1. When outdoors, especially in wooded areas, use bug spray with at least 20% DEET.

2. After outdoor activity, check your body for any clinging ticks. Make a “tick check” part of your routine when coming inside.

The chance of contracting the disease increases the longer the tick is attached to the body. When you find a tick attached to your skin, there’s no need to panic—calmly remove the tick as soon as possible by pulling gently with a set of fine-tipped tweezers trying to get the whole tick including the mouth, then clean the site with alcohol. If you suspect exposure, contact your physician for a consult.

There is much information online; look particularly at the Canadian Lyme Disease Foundation website.

Do get outside, just do a tick check when the day is done. Save yourself and your loved ones a lot of heartache.

til next week,

the good doctor

Improved Treatment of Wet Macular Degeneration

Thu, 21 Apr 2022 05:28:35 GMT

Blog vol 2. 48 Improved treatment of Wet Macular Degeneration

The macula is the center of your vision at the back of the eye. Macular degeneration is a largely hereditary condition associated with aging. There are two kinds: dry and wet.

Wet macular degeneration is when the choroidal vessels near the macula start to leak and the eye starts to form new vessels to compensate, the result, if untreated, is very leaky new vessels and permanent scarring. This used to mean devastating vision loss.

Before the 1990’s this condition was treated with laser and with some improvements, with visudyne and lasers. Then along came a class of drug that works against this new vessel growth and subsequent scarring.

Today, this is the gold standard for treating wet macular degeneration. Drugs like Lucentis or a more recent development, Eylea, are injected into the vitreous of the eye. The first few treatments are monthly, and then if results are good, the injection interval gets extended to as much as 3 months. Drawbacks are the risk of infection and the possibility of endophthalmitis (inflammation of the inside of the eye), as well as the general unpleasantness of the treatment.

A reduction in the number of injections necessary would be good.

A company called Genentech has developed a new drug that is extending this treatment interval. It is called faricimab, and goes by the trade name Vabysmo. The secret in its extensions is its dual action. Unlike its predecessors, that only neutralize the vascular endothelial growth factor-A , faricimab has a complimentary action that neutralizes angiopoietin-2 which also helps to produce these new “leaky” vessels. The additive effect of these two functions equates to less injections. (Read more here ).

This is promising for patients and for the health system, making it possible to extend the interval between treatments to at least 4 months.

New methods of delivery are being developed for a current treatment drug, Lucentis. It is called Susvimo by Roche, and uses an implant that releases the drug slowly so that treatments can be done every six months. Down the road, the use of Vabysmo with an implant may get us to an annual treatment. It is all very exciting.

til next week,

the good doctor, Dr. Mark Germain, Burlington optometrist

Happy Spring!

Thu, 14 Apr 2022 04:54:27 GMT

Blog vol 2. 47. Happy Spring!

Spring. With the warmer weather and more sun, comes the return of the birds and the greening of our backyards and parks. And, if you are an allergy sufferer, you start breaking out in sneezes and itchy eyes in anticipation.

Just new to the eye care industry is a contact lens that is drug-eluted with an antihistamine. The good people at Johnson & Johnson have developed the first and only contact lens that has an embedded, slow-releasing drug that helps with allergies.

The lens is called Theravision; it is a daily contact lens that has ketotifen, a combination antihistamine and mast cell stabilizer, that works immediately to alleviate seasonal allergy symptoms. The eluted lens releases the drug over the day lasting up to 12 hours, and as an added benefit, it has no preservatives.

This is a paradigm shift in allergy treatment.

As I discuss the lens with people that have allergies, they are initially reluctant to wear these lenses. Too good to be true? Like, what do you mean, I can have my cake and eat it too? The answer is yes. Currently if a person wants relief from allergies, they use an eye drop and stay away from contact lenses. The drop lasts for much of the day, but not all day, and has a preservative that can irritate the eye. The result is tolerable relief, the patient needs to wear their glasses, no contacts, and repeat the eye drops as needed.

If you are an allergy sufferer and want to wear your contact lenses, the Theravision lens is worth a try. Finally, a solution to the itchy, irritated eyes of spring (and just around the corner, summer and late summer…).

til next week,

the good doctor, Dr. Mark Germain, Burlington optometrist

Lenses for Migraine Relief?

Thu, 07 Apr 2022 04:09:51 GMT

Blog vol 2. 46. Lenses for Migraine Relief?

Is this possible? Or too good to be true?

A patient this week asked about special glasses they had heard provide relief when having a migraine headache. The lens in question is a type of light filter called a FL-41.

These lenses have been around since the 1980’s. They were developed by Dr. Arnold Wilkins of Cambridge University. As a result of the 70’s energy crisis, fluorescent light bulbs were used in a lot of settings. The light from these bulbs was annoying, and could trigger or worsen migraines. This is how the FL-41 came to be; FL is short for fluorescent, and a darker brown-red lens, the 41, was used to help with this lighting.

Fast-forward to the 2000’s when Dr. Bradley Katz from the University of Utah found that the colour range and saturation of the lens could be refined to produce even better results. His lens took on a lighter, more rose appearance. In 2010, researchers at Harvard University were looking at the effect of light on migraines and light sensitivity and concurred with Dr. Kazt’s earlier findings: these lenses do in fact help provide relief from light-induced migraine pain. (Read article here ).

Just exactly how does it work? There are retinal receptors, and brain centres in the thalamus, that are more sensitive to certain colours in the blue and red wavelengths and cause more intense pain and symptoms, while certain wavelengths of green reduce these symptoms.

Does this mean that you get yourself a pair of FL-41’s and all your migraine issues are gone? That would be wonderful, but not true. For the frequent migraine sufferer, however, they definitely are worth a try.

When it comes to migraines, try to keep track of possible triggering factors, you never know you might find a commonality. And, of course, regular, balanced eating, drinking of water, exercise, and rest are critical, as well as avoiding unnecessary stress. However, you can do all the right things and still have the worst migraines.

FL-41 lenses can be made in your prescription, and for the migraine sufferer may provide some small relief, and, frankly, any relief would be awesome.

til next week,

the good doctor, Dr. Mark Germain, Burlington optometrist

Light and Birds, Prisms and Refraction.

Thu, 31 Mar 2022 06:55:02 GMT

Blog vol 2. 45. Light and Birds, Prisms and Refraction.

Spring is a great time for seeing unusual birds, as they are on the move, and binoculars are a great tool for up-close observation of these migrating marvels.

Magnification, I have a keen interest in Low Vision, which is when a patient has reduced vision from an eye disease and requires some form of magnification such as a telescope. (Bioptic telescopes have recently been approved for drivers in Ontario!) Telescopes and binoculars use the same elements of magnification.

A lot of times, bigger is better, but not always. When using binoculars, a fancy form of telescope, the numbers that describe it are 7 X 30 or 8 X 40, for instance. The 7 X is just what it states, the binocular has 7X strength, making everything 7 times larger through the system. So if you are looking at a bird that is 70 metres away from you, it makes it look like it now 10 metres away, a lot closer and bigger.

The 30 is the size in millimetres of the objective lens, the front lens of the system. This number, when it is larger provides more light for the system and increases the field of vision for wider viewing. So why not have a 100 X power and a 200 mm objective lens? then theoretically you could see so much more. We do not need to see Alpha Centauri, but a Downy Woodpecker…

With a 7 X binocular, everything is not only 7 X closer, but also moves 7 X faster in the lens. This can be very disorienting, as any movement of your hand when holding the binocular is magnified by 7 X. This is a limiting factor. Telephoto lenses can be mounted on a monopod to overcome these limits, but they are not very portable.

Then along comes my patient, world renowned ornithologist, Bob Curry, with his new 12 X binoculars.

Over the years, I have come to appreciate the world of birds, because of people like Bob, and when he got his new binoculars, he brought them in so I could have a look. This is very exciting stuff for us optical people. The numbers, 12 X 42, 12 times power and a large 42 mm objective. That kind of power is a problem even with a very steady hand.

Bob’s binoculars are made by Kite Optics out of Belgium, and Kite has perfected technology that compensates for movement when looking through the system (there is even a 16X 42 model available now). They use self- adjusting prisms built into the system to counteract movement. We took the binoculars outside and had a look through them at the back of the office, and wow! very clear optics, 12 X power, AND a steady image.

This technology comes with a hefty price tag, of course. The binoculars also require rechargeable batteries. For most of us, the 7X and 8 X versions will work just fine. You can get hours of enjoyment with a pair of these at hand. But the new technology is pretty cool and works really well…

Enjoying the approach of spring,

the good doctor, Dr. Mark Germain, Burlington optometrist

Light and Bird Migration

Thu, 24 Mar 2022 06:57:14 GMT

Blog vol 2. 44. Light and Bird Migration.

Two weeks back I discussed research into use of green lights to help with fishing. This time of year, in the Northern hemisphere we are beginning to enjoy the return of our feathered friends from the south.

As I look outside and see sleet and snow falling, I also see our first American robins. What are they doing here in this cold, miserable weather? Maybe their travel agent should have looked into weather maps and northern conditions before they flew up here.

Bird migration is not motivated by weather, but by light, daylight.

Research has shown that the main cue for migration is the changes in the length of day. As we pass the vernal equinox (the day in spring when there is an equal amount of light and dark), we start to have more daylight than night. This shift in light causes the birds to undergo hormonal changes that make them more restless and prepares them for the long trip.

In the Hamilton area, the first birds start returning in January(!), some owls and about thirty different waterfowl.

In February, the red-winged blackbirds, a few robins and grackles, along with ducks and geese.

Now in March, we begin to see eastern phoebes, tree swallows, and lots of robins.

The peak is Mid-May with the arrival of the warblers and flycatchers and the orioles. Spring is a great time to be a birder, at home, or in parks and migration hot spots.

Light triggers the migration journey, but light can also be a problem. Most birds travel at night when there are fewer predators, fairer winds, and cool damp air to reduce water loss. But man-made lights, especially in the red and white colour temperatures, are distracting to them. Disoriented birds can actually fly into buildings, crash-land onto hard surfaces, or hit communication towers.

Being drawn to cities by the light, migrators are having stopovers in environs that are far from optimal for cover and food, and are lengthening their time of migration which can have devastating effects. To fix this pressing problem: dim the lights, turn them off, or change the light colour to less-distracting green or blue.

Light, daylight, the ongoing shift of the earth relative to the sun, puts many things in motion; birds, vast numbers of such variety in shape, size, colour, and habits; birds, “wonder”ful, endlessly interesting, and so hopeful...

Spring.

Enjoying the return of our fine feathered friends,

Til next week,

the good doctor, Dr. Mark Germain, Burlington optometrist

An Enjoyable Evening

Thu, 17 Mar 2022 04:44:24 GMT

Blog vol 2. 43. An enjoyable evening.

Back before covid (B.C.), spring, 2019, to be precise, my wife and I purchased tickets to go see our favourite classical pianist, the incomparable Lang Lang who was coming to Toronto in May, 2020. We would have to wait close to three years. This past Monday, we finally went to enjoy a long anticipated evening.

He did not disappoint; his enthusiasm, showmanship, and artistry are brilliant. Even when it comes to putting in eye drops, he’s got it down, yes, even eye drops. After finishing a variation, in the middle of Bach’s Goldberg Variations, he pulled out a bottle of eye drops, one eye, the other eye, quick wipe, done, next variation on the beat. The appreciative audience chuckled at his skill, and his humanness.

It got me thinking about eye drops. Lang Lang must have practised that procedure many times, it was so automatic, it flowed. We can learn many lessons from that simple act. Putting something in our eye does not come naturally. Our natural reflex is to protect our eyes. How do we acquire this skill? Practise.

Step 1: Read your doctor's instructions for timing and dosage. If you need to take more than one type of eye drop at the same time, wait 3 to 5 minutes between the different kinds of medication.

Step 2: Get prepared. Always wash your hands before handling your eye drops or touching your eyes. Shake the drops vigorously before using them. Remove the cap of the eye drop medication but do not touch the dropper tip.

Step 3: Place the drops into your eye. Tilt your head back slightly and look up. Some people find it helpful to focus on a specific point on the ceiling. Use one hand to pull your lower eyelid down, away from the eye. This forms a pocket to catch the drop. Hold the dropper tip directly over the eyelid pocket. Don’t touch the bottle to your eye or eyelid. Squeeze the bottle gently and let the eye drop fall into the pocket.

Too anxious to insert eye drops? You are not alone. Try this method: lean your head back as far as is comfortable, or lay down on a bed or couch. Keep your eyes closed. Hold the eye drop bottle with your thumb and first two fingers. Put the other two fingers of the same hand on your nose for stability. Without touching the bottle to your eyelid, put an eye drop in the corner of your eye near your nose. While your head is still tilted back, open your eyes and blink several times until the drop rolls into the eye. If you're still having trouble, ask a family member, neighbor or friend to help you. Ask your doctor about eye drop assistance devices. These devices can help you aim the drop, squeeze the bottle and keep your eye open.

Step 4: Close your eyes and don't blink! Apply gentle pressure to your tear ducts, where the eyelid meets the nose. Hold the tear ducts closed for a minute or two—or as long as your eye doctor recommends—before opening your eyes. This will give the drop time to be absorbed by the eye, instead of draining into your nose. If any drops leaked out, use a tissue to wipe them from your closed eyelids.

Step 5: Wash your hands. It's important to wash your hands with soap and water after handling medication and touching your face.

Lang Lang streamlined this process, but what skill! Wow!

Til next week,

the good doctor

Now on to a lighter topic...

Thu, 10 Mar 2022 06:00:58 GMT

Blog vol 2. 42. Now on to a lighter topic…

Oh, Dad! is the cry, once again, of my children - another bad pun. There has been a lot going on at Burlington Eyecare, so when these results came out in early February, I had to wait to share.

Who knew that the use of green LED diodes could be helpful in fishing? Over the past decade, illuminating gillnets with LED lights has emerged as an effective tool to reduce bycatch of endangered sea turtles, up to 64%, in coastal gillnet fisheries. Ecologist, John Wang, and his team in California have pursued this idea and have discovered some cool stuff.

The gillnets, when equipped with green diode LED lights every 10 metres along the net’s length, not only helped keep sea turtles away but also other species. Gillnetting is an inexpensive way of catching fish, but the problem is that unwanted organisms also get caught in the netting. To the researchers’ surprise, not only did less sea turtles get caught, but 81% fewer squid, and a whopping 95% less sharks. Good news, for the sea creatures: less trauma and damage, and for the fishing industry: less time and energy spent in safely removal of unwanted species from the nets. Just imagine trying to catch and release a Mako shark, it could get a little dicey. (Read more here ).

Just why elasmobranchs, like sharks and rays, stay away when green lights are used is still to be investigated. They do have more sophisticated eyesight than halibut, and also creatures like squids do have rather large eyes that could possibly alert them to the green netting. A great and simple idea, now we need to find a way to make these lights affordable, and develop a solar-powered version. Further research may look at different wavelengths of light to see if better results are possible.

Very exciting, a win-win situation……definitely a move in the light direction.

Til next week,

the good doctor , Dr. Mark Germain, Burlington optometrist

With a Heavy Heart

Thu, 03 Mar 2022 07:02:29 GMT

Blog vol 2. 41. With a heavy heart.

The past two months at Burlington Eyecare have been difficult. We lost two very dear people in our practice. On Christmas day, Clint Weisbrod, life partner of Karen, our office manager, died after a five year struggle with cancer. On February 20, one of our doctors, Jerilee Nyman, died after a two year battle with cancer.

One word to describe what we just witnessed: courage. In spite of countless procedures and treatments, and times of hope and possible recovery, then again, setbacks; they carried on, lived , and even “thrived”. Both Clint and Jerilee shared a Christian faith which grew and flourished, even in the driest and most inhospitable of conditions. I marvel at the support and tangible helps that my staff and colleagues expressed and lived out during this period. You have no idea how critical and encouraging your love to them and their families was and still is.

Karen joined our office a few years back and quickly became a key help in the running of the office, and has especially risen to the occasion during this administratively challenging pandemic (don’t know what we would have done without her). With any great person, you usually find a great spouse: Clint. All I can say is that it was a privilege to have shared a few miles of road with him. His inquisitive mind, great sense of humour, and uncanny down-to-earthiness were just a few of his much-appreciated attributes and qualities. At his Celebration of Life, his family quoted from Psalm 8, “When I consider your heavens, the work of your fingers, the moon and the stars, which you have set in place…” Clint was an astronomer and space cartographer and wrote software for planetariums. It was these stars and planets that were also instrumental in pointing him to God. On a clear, starry night, I can’t help but gaze at the heavens and also think of my buddy. Thank you for the time we shared.

Jerilee, Dr. Nyman, was literally family. Her youngest brother married my daughter, and through association and wonderful timing, we gained a great doctor for the practice, and later an aunt for my grandchildren, and a good friend. Dr. Nyman had a significant following at Burlington Eyecare, and it is not difficult to see why, as she was a compassionate and very conscientious practitioner; the work was her wind song. In February, 2020, we got the heart-breaking news from Jerilee that she was diagnosed with metastatic breast cancer. In March, cancer was found in her bones, and a pandemic started. Jerilee, Mark, her husband, and her very supportive family, resolved to fight this thing. And they did just that. Treatments, appointments, tests, lots of prayers, more treatments, struggle. She threw herself into the Bright Run, fundraising for cancer research. It was her hope that she would get back to her patients and her family at Burlington Eyecare, but the disease would not be stopped. At her Celebration of Life, her husband read a Bible verse very close to Jerilee, Phillipians 2:5-6, “In your relationships with one another, have the same mindset as Christ Jesus: Who being in very nature God, did not consider equality with God something to be used to his own advantage;”. Here was gentle Jerilee, lovely Jerilee, needing encouragement to be more humble, more serving. There is not more I can say.

We miss you both dearly. We are inspired by your courage. With courage, we press on.

Til next week,

the good doctor, Dr. Mark Germain, Burlington optometrist

Cataracts, Post-surgery.

Thu, 24 Feb 2022 06:07:38 GMT

Blog vol 2. 40. Cataracts, Post-surgery.

Your surgeon has done a wonderful job, and you are getting back to living, with clear vision. There is much to do and consider. First, drops, and lots of them for up to a month post-surgery: usually steroids for getting inflammation down, antibiotics to reduce risk of infection, and lots of lubricants to keep the eye from drying. Second, problems to watch out for are an increase in floaters or flashing lights, or any sustained reduction of vision. See your surgeon as soon as possible.

All those drops.

There has been much research on ways to reduce the number of eye drops necessary. The drops can be hard to get in, take up a lot of time, can get costly, and their preservatives can irritate the eye. Some surgeons have been injecting a diluted antibiotic into the eye before finishing up. This eliminates the need for an antibiotic after the surgery. In places where insurance covers it, some surgeons insert a steroid plug into the canaliculus which releases a mild steroid over a month period: no drops, no preservatives. It is worth asking your surgeon about.

Post-surgery problems

There is an increased risk of retinal detachment after cataract surgery, about 5.5 X higher than untreated people. If you have high myopia (nearsightedness), your risk is also higher. These changes usually occur within the first year after the operation, so watch for any new floaters or flashes or changes in vision and be seen as soon as possible. Your optometrist will be watching for these changes at your next visit.

The cells that make up the cataract can sometimes grow back and make a “film” of tissue that covers the line of sight and results in sustained blur. This capsular cataract can be easily removed with a YAG laser, a procedure that takes about a minute to perform and is only done once. The key for you, is that if you notice blur, and this time it can take up to 5 years or more to develop, then report it to your eye doctor. Your optometrist will be checking for this at every visit.

Glasses?

Lastly, remember that you can wear glasses, again, after surgery. Too often, the patient feels like the surgery has healed them and glasses, especially for distance, should not be needed. I have this conversation with most of my patients and gently suggest that a pair of progressive glasses is a really nice and convenient way to see really well for all situations. As we all know, we have many and varied interests that require all sorts of viewing distances and head positions, which a well-fitted pair of glasses can make easier and clearer.

Next week the blog will have different focus, I promise, (and the pun was totally intended).

the good doctor, Dr. Mark Germain, Burlington optometrist

Cataracts, continued…

Thu, 17 Feb 2022 06:43:52 GMT

Blog vol 2. 39. Cataracts, continued…

Step 1: Your optometrist has determined that you have cataracts and they appear ready for surgery.

Step 2: A referral is made to a local ophthalmologist and you are scheduled for a cataract consult.

Step 3: At the consult, the ophthalmologist determines that you will greatly benefit from cataract surgery. At this point it can appear to get very complicated, as many options or “top-ups” are offered for this procedure.

Here is an overview of the options that you will have:

Implant lens power.

There is a fee for this. Pay for it. Biometric measurements calculate the power of the lens you need to see as well as possible, through the use of infrared light, lasers, and a lot of fancy mathematics. Since the dawn of refractive surgery and the increase in expectations for visual outcomes after surgery, these procedures have become essential. We want to see well after surgery, so advanced biometric measurements for determining implant power is a must.

Types of implant lenses.

Mono-focal lenses: OHIP provided, no extra cost. This lens is used to correct your distance vision, very serviceable, tried and true.

Aspheric lenses: extra cost. This lens gives you greater depth of focus, corrects distance vision, tried and true.

Toric lenses: extra cost. This lens corrects astigmatism, corrects distance vision, tried and true.

Multi-focal implant lenses: extra cost. This lens corrects distance and near vision at the same time with rings or zones of power, and has been on the market for some time with mixed results. Do your research on this one.

Latest research: extra cost. This lens implant is actually focusable, and changes its power depending on what you are doing. Hopeful.

The actual surgical procedure.

Routine cataract surgery: OHIP covered, tried and true. The surgery is usually done in a local hospital with pre- and post-surgery appointments at the ophthalmologist’s own office.

Private clinic, routine cataract surgery: your cost, much variability here. Private clinics for cataract surgery are permitted in Ontario. This is an excellent way to go if you wish to avoid the hospital, or if time is a factor and money not a concern, as the wait time for cataract surgery in Hamilton/Burlington can be longer than desired, with most people getting surgery within six months.

Femto-laser cataract surgery: your cost, done in select private clinics. After the initial incision into the eye, the front of the capsule of the lens is cut out, and the cataract broken up with the femto-laser. This is more exact than the traditional methods and surgical outcomes have been excellent.

Post-operative lasik or PRK: your cost, as any lasik. This can be done to refine your vision after your cataract surgery, should it be necessary.

Any questions? Give us a call.

Til next week,

the good doctor, Dr. Mark Germain, Burlington optometrist

Cataracts

Thu, 10 Feb 2022 05:52:30 GMT

Blog vol 2. 38. Cataracts

A few weeks ago, I discussed a patient who was left untreated for cataracts way too long. I wanted to go into more detail about cataracts in that blog, but only so much time and pixels, so here we are…

Cataracts are the number one condition I deal with on a daily basis. Cataracts usually come with aging.

What is a cataract, and how can we tell when we have one?

Cataracts are essentially a clouding of the lens that is in the eye. They are usually in one of three locations in the lens: the nucleus or centre of the lens, the cortex or side, and the posterior or back-centre of the lens. They also can be of varying sizes and densities.

Since they are usually slow growing, they can be difficult to detect from the patient’s perspective. Very gradually they cloud the vision, change colours to a muted brown, and even cause ghosting of the vision, but you don’t wake up one day and deduce that you have a cataract.

What causes cataracts?

Cataracts are a result of the aging process, and more specifically of oxidation. The lens is made up of cells which are mostly water and protein. Free radicals in our body cause damage to these proteins and this breakdown results in changes to the lens structure.

Exposure to ultraviolet (which will release more free radicals), or the reduction in antioxidants in our diet (like vitamin C), or metabolic changes from diabetes, or taking medications like steroids or phenothiazines, will accelerate these changes.

The nucleus of the lens will start to harden and become brown, which will cause damaging of the softer cortex creating spokes that grow to the centre of the lens.

A posterior cataract usually results from diabetic or steroid changes. An excellent article on this is available at, https://pubmed.ncbi.nlm.nih.gov/20829639/. From this paper we learn of the role of oxygen in cataract development and the tie in with vitrectomies, when the vitreous behind the lens is removed. The vitreous is a barrier to oxygen, and even has vitamin C that reacts with oxygen, that slows this aging process. All very fascinating.

Can cataracts be prevented? How?

Wear UV filters, sunglasses, a wide-brim hat.

Eat a balanced diet with lots of antioxidants, that means fruits and vegetables.

No diabetes and no vitrectomies and no nasty steroids. Seriously, if you have a medical condition that exposes you to these risks, just be aware and get your eyes checked.

What is the treatment?

Of course, if you are experiencing blur or double vision, or “ghosting”, or have any other eye concerns, please call us right away and make an appointment. Regular eye exams catch problems early, a good plan.

Cataracts must be surgically removed, there is no other treatment. For surgery, you need a referral, and at Burlington Eyecare we have good relationships with many very skilled surgeons. Cataract surgery, where the lens capsule is cleaned out and a new implant lens is inserted, has excellent success rates, and though not anyone’s idea of fun, will ensure that you see clearly well into the future.

Til next week,

the good doctor, Dr. Mark Germain, Burlington optometrist

Groundhog Day. Groundhog Day. Groundhog Day...

Thu, 03 Feb 2022 07:28:34 GMT

Blog vol 2. 37. Groundhog Day. Groundhog Day. Groundhog Day…..

Every year, about halfway between the winter solstice and the equinox, we have this odd day called Groundhog Day. Supposedly the tradition came over from Germany to Pennsylvania and morphed into a myth that if the sun came out on Candlemas, a hedgehog would cast its shadow, predicting snow all the way into May. As a hedgehog was hard to find in North America, it was replaced over time with the ubiquitous groundhog.

I would like to spend some time on groundhogs. Just how well do these prognosticators see? They are part of a larger rodent genus called Marmots. Groundhogs spend a lot of their life in their holes, hibernating for the winter and sleeping and having their families.

They are diurnal in habit, so they can be out by day or night. Their field of vision is excellent. Humans have up to 180 degrees of visual field; groundhogs can have closer to 215 degrees because of their wider set eyes. They have more sensitive peripheral vision because most of their retinal receptors are rods, about 85%, compared to cones at 15%.

They also have vertical slits for pupils which give them greater depth of focus in the horizontal field. A key survival skill is to get out of their hole, sit up, look around, and detect predator threats. Their vision works great for this. No doubt, our little friend will have no trouble seeing his shadow if it is present on the big day.

With only 15% of their receptors as cones, their colour vision is not as developed as that of humans or primates, which have predominantly cone receptors and excellent colour vision. The cone receptors of the groundhog tend to be in the green part of the spectrum, so they see mostly greens and blues, which is great for picking out herbaceous food sources.

NEWSFLASH!! Punxsutawney Phil did see his shadow, six more weeks of winter (sigh).

There you have it. A creature that tells us the future with its superb creature powers (borrowed from Wild Kratts).

Til next week,

the good doctor, Dr. Mark Germain, Burlington optometrist

Just another day at Burlington Eyecare

Thu, 27 Jan 2022 07:08:17 GMT

Blog vol 2. 36. Just another day at Burlington Eyecare.

I am really glad to have that snow behind us. Now we just have to deal with freezing cold temperatures. My sister from Timmins reported a chilly -48 degrees today, and when it is that cold you do not have to state whether it is Centigrade or Fahrenheit.

One of our doctors this week had the disheartening experience of seeing a patient in their early 60’s who had not had eye care for a long time and in that time had developed serious cataracts.

Through a series of unfortunate events, they failed to get eye care until this week, and actually had their driver’s license revoked because of poor vision about two years ago. During this time, the patient has suffered several serious falls and broken both hips. The link between visual impairment and falling is well documented. https://www.sciencedirect.com/science/article/abs/pii/S0378512213000285

Unfortunately this patient was a multiple casualty. How did this happen? We determined that they had very dense cataracts, and an intact retina and optic nerve. The problem is, when a cataract gets this dense it is a lot more difficult to remove. A cataract caught early can be removed with excellent results in most cases.

Please, if you are having any vision problems, see an optometrist. In this case, early intervention could have kept the patient driving, could have got them to a surgeon in time for surgery to be successful. The really sad part is that all of this was entirely preventable. Your local optometrist should be able to see you within a week. Our job is to see people as soon as possible and be gatekeepers to the healthcare system.

It is my hope that I do not have to write on this subject again, so I repeat, call your eye doctor right away when you have problems with your vision, any problem at all, and if you know anyone with eye concerns send them to an optometrist right away, NOW, really.

Til next week,

the good doctor, Dr. Mark Germain, Burlington optometrist

Let it snow, let it snow.

Thu, 20 Jan 2022 04:58:45 GMT

Blog vol 2. 35. Let it snow, let it snow.

Boy, the people in the GTA (Greater Toronto Area) got walloped with a tonne of snow this past Monday. In Toronto, major highways were totally closed as 36 cm dropped on the city in a 24 hour period. The last time we saw that much snow was 23 years ago on January 2 ^nd , 1999, when 40 cm fell and the mayor, Mel Lastman, called in the Canadian Forces to help with the clean-up. Closer to home, Redeemer University’s Soccer Dome collapsed under the unprecedented weight, fortunately no casualties.

So….today’s topic is snow: snow in the eye. How can it snow in the eye? There is a rare condition that can occur to the eye called snowbanking and snowball formation. It has nothing to do with winter and the cold, but results from inflammation of the Pars Plana, as pictured:

Pars plana is a layer just behind the ciliary body that sits between the sclera and the retina. When this area and the overlying vitreous gets inflamed, proteins or cells leak out and form what looks like snow in the eye. The patient will experience a variety of floaters in their vision and will also have a sore red eye. The resulting snow is not dangerous, but the disease process can result in optic nerve swelling, macular edema and/or even glaucoma, which can be devastating. Pars planitis usually occurs in children or adolescents. So, as a parent, watch for eye redness and pain and development of floaters. Have them seen immediately at your optometrist or the local emergency department.

The other condition that reminds me of snow is your more routine floaters, which most people have. For lots of people the eye is like a snow globe. Try standing on your head and then quickly turning your head back up straight, and you will see the most fantastic floating formations. Closing your eyes and moving the eye from side to side will get you the effect you are looking for. These floaters, unless they are new or unusually visible, are quite routine, and result from the normal process of vitreous change over time.

Have fun shovelling out, and spend some time with your kids and grandkids playing in the snow,

the good doctor, Dr. Mark Germain, Burlington optometrist

Guess what happened this Christmas morn?

Thu, 13 Jan 2022 06:25:38 GMT

Blog vol 2. 34. Guess what happened this Christmas morn?

My last blog was on Santa’s big night... then Christmas morning, from French Guiana, the highly anticipated launch of an Ariane 5 rocket, with a special scientific instrument on board: the James Webb Space Telescope. A joint project between NASA, the ESA, and our own Canadian Space Agency has successfully deployed the most powerful telescope ever built, https://jwst.nasa.gov/index.html .

We have all heard of the Hubble telescope which is also in space; the Webb is a lot more advanced. The Webb has several near and mid-infrared sensors, cameras and spectrographs that will be able to detect radiation from the deepest and oldest parts of the universe. I have always marvelled at the images that the Hubble is able to obtain orbiting the Earth, clear of its cloudy atmosphere. Hubble has sensors for visible light, ultraviolet and some infrared. The Webb telescope will work only with infrared which allows it to pick up radiation from greater distances, and through space clouds and dust. The Webb telescope’s mirror, at 6.5 metres diameter, is a lot larger than Hubble’s, at 2.5 metres, which gives it a wider field and more sensitivity.

The infrared sensors are so sensitive that any radiation coming off the telescope would “blanche” them out. The telescope will be able to start gathering data only after a 4-5 month cool down. Webb has a huge solar shield that will gather energy for operations and it will shield the sensitive sensors from damage and stray energy. The resting temperature for the device will be -225 degrees Celsius to ensure that the telescope will not emit its own infrared. That is how sensitive the sensors are.

The telescope has now unfolded like origami and is travelling to its final orbital, at Lagrange point 2. The final location is about 1.5 million kilometres from Earth and is exactly where the gravitational pull of the Earth and the Sun are equal, so the telescope will perpetually orbit in that locale. This position also helps to shield the device from the sun’s radiation. It will arrive there after a month of travel.

The telescope was built over a 20 year period at a cost of close to 10 billion U.S. dollars. The data it will gather will be invaluable in learning about the origins of the universe as it will receive infrared from the farthest corners of space. The Webb is an incredible technological feat that makes use of electromagnetic radiation that is so incredibly far from visible light. It does remind me once again how we have made use of infrared light in health sciences and especially in the area of visual science, how it aids diagnosis of disease and potential treatments: awesome.

Go to the link that I gave earlier on to the NASA site, make sure you get on it for all sorts of interesting resources.

Looking forward to those first images from Webb,

the good doctor, Dr. Mark Germain, Burlington optometrist

Rudolph the Yellow-Nosed Reindeer??

Thu, 23 Dec 2021 16:18:05 GMT

Blog vol 2. 33. Rudolph the Yellow-Nosed Reindeer??

On Dasher and Dancer and Prancer and Vixen…. the start of the ode to Rudolph is known by all, especially, at this time of year. Did you ever wonder whether his red nose really worked on all those Christmas Eves? It was on that foggy Christmas Eve so many years ago that Santa had the bright idea to have Rudolph lead his sleigh through all that pea-soup. Are there not better colours for helping with fog than red? After all most fog lights we have for cars today are one of two colours, yellow or amber, not red. Rudolph the yellow-nosed reindeer? it could work. Who is right?

So I took off my night cap and donned my thinking cap. Maybe, it is the wavelength of the light that makes yellow better, with yellow in the 570-590 nanometre range and red being quite a bit longer at 620-750. Some have thought that the shorter wavelength helps to penetrate the small water droplets present in fog, but there is no credence to this theory. The water droplets are a lot larger than the wavelength of either yellow or red, so wavelength makes very little difference. The most likely explanation is that the vast majority of our cone receptors are more sensitive to the yellow wavelength than the red.

But Santa cannot be stupid (we can all agree on this point, since I still am hoping for a big haul on Santa’s big night). On goes the thinking cap again, and the answer is plain to see. The red colour works with Santa’s dark adaptation at night so he can see to land the sleigh and find your house and your chimney. We all know that as we get older it takes longer to dark adapt, and guess how old Santa is, of course, then red for dark adaptation. Everybody knows that Santa is very clever (here’s hoping), so even the designers of airplanes and towers and skyscrapers also use red light as a beacon to make sure that nobody collides with them.

So what can we conclude from this, besides Santa being extremely astute and bright? We should stick to yellow or amber for our fog lights and leave the flying and sleighing to Santa with Rudolph and his very bright red proboscis leading the way.

Merry Christmas to all, and to all, a good night,

the good doctor, Dr. Mark Germain, Burlington Optometrist

Raise A Glass Of Cheer

Thu, 09 Dec 2021 20:44:05 GMT

Blog Vol 2. 32. Raise A Glass Of Cheer.

You heard about the optometrist who was at a party and had a couple of glasses and made a spectacle of himself. Fortunately that was not the case last night at our staff Christmas party. It was so nice to be together in a fancy restaurant again, and I won’t mention its name but it rhymes with “Marriage Mouse” and is on Old Lakeshore in Burlington where the steaks are always superb and the wine list is unsurpassed, thank you for a wonderful time. We had a guessing game where the name of a character from a Christmas movie or show is taped on your back and you have to guess who you are based on questions people ask you. I ended up being Kevin McCallister from Home Alone fame, it could have been worse, I could have ended up as Clark Griswold of National Lampoon’s Christmas Vacation.

As I sat there last night, I had chance to look around and reflect on everybody at the table. It was wonderful to see all present, enjoying themselves and each other’s company. I have a really great team. I can say that, because I have been able to see through the lens of a Covid pandemic and an OHIP job action, a group of people that truly get it. You know the saying, “that it takes a village to raise a child”. I would like to say that it also takes a village to take care of others and their eyes and vision, and each other in the process.

The opportunity to take some time out to play together and a have a few laughs was so precious. What do you get the optometrist that has everything already? How’s about a Red Ryder BB Gun, the “official Red Ryder, carbine action, 200-shot, range model air rifle, with a compass in the stock and this thing that tells time”? one can still dream. Seriously, a nice ratified deal with the Ontario government and a swell long term relationship with the Ministry of Health would look great in my Christmas stocking.

Much to be thankful for,

Til next week,

the good doctor, Dr. Mark Germain, Burlington Optometrist

Your Optician vs Online Ordering: What Is The Difference?

Mon, 06 Dec 2021 18:01:42 GMT

What is the difference between ordering your glasses online and ordering with an Optician? More than you think! In this episode, Dr. Tabone talks with Angelia, Burlington Eyecare Optician/Optical Manager. Together they outline the role of the Optician and talk in-depth about the difference between ordering online and ordering with a professional.

Trim Up The Tree

Thu, 02 Dec 2021 19:46:48 GMT

Blog vol II. 31, Trim Up The Tree.

As the Christmas season begins, with visions of sugar plums dancing in our heads, watching “The Grinch Who Stole Christmas” and all those other Christmas things, it is time to go tree hunting. Being already out in the country, we find the source of all the cars with trees tied to their roofs, head to the closest tree farm, and get in line to cut a tree and bring it home.

As I stood there in line, my thoughts drifted into optometrist mode. With all those pokey needles, my memory goes back to the many occasions when overactive pine boughs or spruce needles decided to charge at someone’s eye and insist on scratching a once healthy cornea. PLEASE BE CAREFUL with those pesky herbaceous eye abraders. Wearing safety glasses would not be inappropriate though not much in keeping with the Christmas theme. I have seen many of these abrasions, and it is important to get them looked at and treated.

WARNING: Any substance that has “vegetable” matter like a pine needle or a branch can cause a fungal infection. So, let’s say you decide to wash out a scratched eye and put on some antibiotic drops from the pharmacy, but it is getting worse, YOU MUST GET IMMEDIATE ATTENTION, do not play with a fungus.

We also turned on our outside Christmas lights for the first time and enjoyed all the variety of colours. It is great to have shorter days at this time of year so that we can appreciate the many seasonal light shows. What a gift sight is, and clear vision. In our practice, we have many patients that are coming into the cataract season of their lives. When cataracts are bad, they change our colour perception. Patients who have had one eye operated on notice right away that the colours are more vivid and whiter in the “new” eye compared to the old. Cataracts also affect your night vision, often giving a form of double vision or “ghosting” which can be disconcerting, especially when driving.

The last thing I noticed was the number of families, from little tots in carriers to grandparents, all coming together to share a memory. It reminds me of why I like being an optometrist. I see whole families, from six months old to palliative care and everything in between, and often together. We have lots of families with three, and even four, generations that come to see us. What a privilege.

Ah, a wonderful time of the year.

Merry Christmas,

the good doctor, Dr. Mark Germain, Burlington Optometrist

Press The Pause Button (On The Job Action)

Thu, 25 Nov 2021 16:29:17 GMT

Blog Vol II. 30, Press The Pause Button II

Since September 1 ^st , optometrists in Ontario have been in job action, withholding OHIP covered eye exams. That was paused on Tuesday, November 23 as the Ontario Association of Optometrists has finally entered into formal negotiations with the provincial government. Yeah!!!!!

It is really nice to see my long-time patients again and it is nice to have a full appointment book. It is our hope that, with the help of a mediator, the optometrists can bridge the funding gap that has built up over the past 32 years and lay the foundation for future rounds of talks. The deadline is January 31, 2022 for having an agreeable offer in place. The only problem for the rest of us is that a blackout is in effect during this process; nothing can be discussed outside of the ongoing meetings. Here is hoping that there is a meeting of minds and that a new contract can be ratified quickly.

At Burlington Eyecare we provide eye care to all people who seek it. We provide equal access to OHIP patients and private-pay patients, no blocking out OHIP patients or discriminating against them. Sadly, this practice has been happening in our profession, mostly out of financial necessity, as OHIP fees cover only a small portion of the costs of an eye exam (which is why the Association of Optometrists is currently in negotiations with the Ontario government). We want you to know that our mandate, and our pleasure!, is to take care of you, your eyes and your family’s eyes. Period.

Here is hoping for a quick and equitable resolution,

the good doctor, Dr. Mark Germain, Burlington Optometrist

Photonic Crystals

Thu, 18 Nov 2021 20:41:52 GMT

Blog vol II. 29, Photonic Crystals

A photonic crystal is a periodic optical nanostructure that affects the motion of photons in much the same way that ionic lattices affect electrons in solids. Wikipedia

What is that? Sounds like something out of Sci-Fi. The idea actually comes to us from nature in the form of iridescent butterfly or dragonfly wings or from minerals like opals. The colours will shift on the object because of these nanostructures, depending on the angle of viewing.

This week we congratulate Dr. Sajeev John and his team at U of T for being awarded the 2021 $1 Million Herzberg Medal for their ground-breaking research with light.

For the past century many scientists have worked on unlocking the secrets of these crystals. Interestingly, we have been using PC’s in industry and science for some time, without even realizing it.

The multi- layer anti-reflection coatings that we have on our optical lenses are a form of one dimensional photonic crystal.

The fibre optic cables that we use for lasers and for transmitting data are a complex form of two dimensional photonic crystal.

Recent advances in engineering have made it possible to create these photonic crystals in three dimensions, making it possible to precisely manipulate the flow of light for medical laser applications, for advanced computers, and for solar cell technology.

Dr. John’s has been doing research in the area of light since he finished his Ph.D. at Harvard in the 80’s. With the advance in 3D PC’s, the door has been opened to innovative solar cells. Hence the big grant money, in the hope that solar cell technology being everywhere and on everything would be a climate game changer. I want to acknowledge the ingenuity of the engineers who designed these crystals and the hard work yet to be done by them to bring them to market.

Congratulations to Dr. John and his team,

the good doctor, Dr. Mark Germain, Burlington Optometrist

Let us Remember: Dr. Cluny Macpherson

Thu, 11 Nov 2021 13:02:15 GMT

Blog Vol II. 28, Let us Remember: Dr. Cluny Macpherson

On November 11, we remember all those who gave and sacrificed for this country and for our freedoms. In the past week I have been reading a great book by Ted Barris, a Canadian Military Historian, called Rush to Danger. Barris dedicates a whole chapter to a physician who served with the 1 ^st Newfoundland Regiment in WWI.

Dr. Cluny Macpherson, was from Newfoundland, and served in the war as a field physician. He was instrumental in developing an effective gas mask after the Germans used chlorine gas at Ypres for the first time on April 22, 1915. The gas devastated the French and Algerian lines, and the Allies had to come up with a solution to this noxious weapon, real quick.

Really terrible, chlorine gas is nasty, causing major damage to the lungs and leading the victim to drown in their own fluids. The gas when mixed with tears produces hydrochloric acid, resulting in burns and blindness. Protection is absolutely necessary.

The initial protective mask that was used mimicked a surgical mask, like the one we wear today for Covid. It was pressed over the mouth and nose, but gave no protection to the eyes. Two scientists, Baker and Watson, worked with Dr. Macpherson to revise this design. The doctor drew up a design that covered the whole head, and he then made it out of Viyella cloth with a mica window to see through and a breathing tube to exhale from.

After a near fatal exposure, an upgraded design was needed. A secret ingredient, hyposulphite of soda was used to douse the new mask. Eureka, the soldier could carry on with no adverse effects from the gas.

Dr. Macpherson found that mica was too brittle and prone to cracking, allowing deadly gas through. As an alternative, at the time there was a photographic film in use that was flexible and allowed light to pass through, only drawback, the film was explosive! Dr. Macpherson discovered that there was a new material, triacetyl cellulose, which could be made into film that was non-flammable. He was able to procure a large amount from a French supplier, and produced the first gas mask, with protection for the lungs and for the eyes, that worked.

Over the course of the war, 22 million Macpherson masks were made. Dr. Cluny Macpherson never sought royalties, “I belong to a profession which does not register patent discoveries, but gives them freely to humanity.”

Great story. Inspiring. I highly recommend any of Ted Barris’s books.

On this day let us remember,

the good doctor, Dr. Mark Germain, Burlington Optometrist

Podcast: Dry Eye

Fri, 05 Nov 2021 15:29:20 GMT

In this week's episode, Dr. Germain and Dr. Lauren Tabone explore dry eye, the connection to screen use, and what you can do about it.

Gene Therapy

Thu, 04 Nov 2021 14:29:19 GMT

Blog Vol II , 27, Gene Therapy

I always marvel at the work and research that is going on every day, especially when it comes to treating the eye. We only hear about the successes; there is a lot of unsung work that goes into every therapy or treatment that is discovered. Gene therapy is one of those fields of research. It has a Sci-Fi feel to it, like something from a Michael Crichton novel - that is way out there. In the past two decades there have been some remarkable advancements in the field. The eye disorder, Leber’s congenital amaurosis(LCA), has been the focus of some of this study.

Leber's congenital amaurosis (LCA) is a group of inherited disorders in which the retina degenerates leading to severe vision loss in early infancy. This condition is usually noticed by parents as unusual behaviour, such as abnormal roving-eye movements (nystagmus). The diagnosis is confirmed by both abnormal electroretinographic responses and pupillary light reflexes. Most patients with LCA have severe visual impairment throughout childhood with the vision deteriorating over time, resulting in total blindness by middle age. Until recently there has been no treatment for LCA.

Researchers have linked the disease to mutations or deletions in any one of 27 genes associated with retinal development and function. One of these genes, RPE65, when mutated can cause LCA. Two ophthalmologists who are now at the University of Pennsylvania, Jean Bennett and Albert Maguire, used a harmless adeno-associated virus and programmed it to find retinal cells and insert a healthy version of the gene. The virus was injected into a patient’s eye directly under the retina with good results. In 2017, after a series of clinical trials the FDA approved this new drug, Luxturna, for the treatment of inheritable retinal dystrophies caused by this gene mutation. The treatment, at this time, is quite expensive, at $425,000 US per eye, but people have been treated with funding coming from a variety of sources.

Those treated showed significant improvement, with patients who were once unable to see clearly having their vision restored, and very quickly. Very promising and hopeful, for it opens the door to isolating other genes and…

T’il next week,

the good doctor, Dr. Mark Germain, Burlington Optometrist

the good doctor on: The Father of the Soft Contact Lens

Thu, 28 Oct 2021 21:25:49 GMT

Blog Vol. II , 26, The Father of the Soft Contact Lens

Every day the Google browser has a picture for the day. This was today’s.

When I saw this come up, I knew what this week’s blog would be about.

On October 27th, 1913, Otto Wichterle was born in Protejov, Moravia. He studied chemistry in Czechoslovakia and graduated from the Czech Technical University in 1936. He went to the Bata’s Institute, where he began working with polymers. During the Second World War he was imprisoned by the Gestapo for a few months and after the war he returned to his studies in organic chemistry. Otto became the dean of the Institute of Chemical Technology in Prague. It was there that he and Drahoslav Lim developed a cross-linking gel called pHEMA (Poly[2-hydroxyethyl methacrylate]). They patented the material in 1953. Otto was at first unsuccessful in shaping the polymer using molds. In 1958 the Communists, through a political purge, forced Otto and others to leave the Institute, so it wasn’t until late 1961 that the first soft contact lens was successfully developed.

Otto used a home-made apparatus, using a children’s building kit (Merkur), which is pictured in the Google image above. He hooked up a bicycle dynamo which belonged to one of his sons and a bell transformer. So, on Christmas Day, 1961 Otto and his wife, on their kitchen table, for the first time were able to centrifugally spin the polymer into a lens, thus inventing the spin-casting method of lens fabrication. His earliest experimental lenses were first called Geltakt and were later named after it’s manufacturer the Spofalens. In 1965 the Bausch and Lomb Company of Rochester, New York, started making spun-cast lenses for the American market.

The lens was so successful, even I had an opportunity to fit spun-cast lenses in the form of the U3 and U4 lenses, in the late 80’s and early 90’s. We have come a ways with newer materials, like silicon hydrogels and more advanced molding procedures, but the first advancements in soft contact lens wear was due to the ingenious work of Otto Wichterle.

Happy Birthday Otto!

Til next week,

the good doctor, Dr. Mark Germain, Burlington Optometrist

the good doctor on: Not all Macular Degenerations are Alike

Thu, 21 Oct 2021 13:33:46 GMT

Blog Vol. II.25, Not all Macular Degenerations are Alike.

In previous blogs I have discussed vision loss, a topic close to my heart. One of the biggest causes of vision loss in North America is macular degeneration. Back in the late ’80s, there were staggering projections for the incidence of macular degeneration with the aging population. That was one of the main reasons why I completed a one-year residency on Low Vision at Waterloo University, to help with the oncoming wave. Thankfully, new research and treatments reduced the number of people losing sight. Changes in behaviour like eliminating smoking, wearing UV protection, and taking antioxidants, as well as new treatments with Anti-VGEF injections, were critical in this trend. I still practiced low vision, but fortunately, with far fewer patients.

So now we can slow down the progress of “Dry” macular degeneration and we can stop the devastating effects of the “Wet” form of the disease, but there is one type that still has eluded us and continued to wreak havoc: the “Geographic” form. It is called geographic atrophy and it is a devastating form of macular degeneration. Changes in diet and behaviour do not seem to help this form of atrophy. Recently, details from research at the University of Virginia with Dr. Jayakrishna Ambati and his collaborators have found a possible help for this condition, which is so hopeful.

The atrophy is devastating because it continues to spread and affect a large area of the central retina (essential for sight), making visual aids such as magnifiers difficult if not impossible to use. Dr. Ambati discovered that the cells at the retinal level had a large buildup of a toxic substance called Alu DNA. It came as a surprise to him that this substance was being manufactured in the cell’s cytoplasm, unlike most DNA that is only made in the cell’s nucleus; this was not expected and may be the key, or a key, to finding an effective treatment. This high concentration of Alu DNA triggers harmful inflammation and eventual death of the cells, all bad.

The good news is that studies with HIV drugs showed a reduction in the development of existing dry macular degeneration by up to 40 %. A class of these HIV drugs, Kamuvudines, could block the harmful inflammation in geographic macular degeneration and protect against retinal cell death. Fantastic. He hopes that clinical trials with this drug start soon.

In the meantime, studies are showing a reduction in dry macular degeneration when taking high doses of omega 3 supplements. Could there be a possible tie-in with the inflammatory process in the retinal cells and the protection that these fatty acids can bring?

Let the trials begin,

Til Next Week,

the good doctor, Dr. Mark Germain, Burlington Optometrist

the good doctor on: Are All Optical Lenses Created Equal?

Thu, 14 Oct 2021 19:08:37 GMT

Blog.Vol.II.24. Are All Optical Lenses Created Equal?

In the past week I had two people visit me, one a long-time patient and another a new territory rep for Nikon, and this was the question. My patient needed a pair of “beater” glasses that he could wear when he was home at night after he took out his contact lenses. So he went on-line and ordered a pair of glasses from an on-line service. The territory rep is a licensed optician since 1994, who knows a lot about optical lenses.

Here is an imaginary conversation between Bob, the patient, and Joan, the optician.

Joan - optician - you sent the web site your prescription and they put together a pair of glasses for you?

Bob - patient - yes, it was that easy, it took some figuring to get the pupillary distance for them, but I got it.

Joan - how are you doing with them, are you satisfied?

Bob - they recommended thinner lens materials and antireflection coating and a thicker frame because of my prescription. They look alright, hey the price was right, but they do need some adjusting, though.

Joan -(takes a look at the spectacles on him, they are sized properly) see how the arms spread out, that was not the best edging job, and the lens is polycarbonate, thin but not the best for seeing, it’s alright for making DVD’s. The centering of the lenses is a bit off but within tolerance and the coating is basic. Hey you did not pay much for these, and they are only like you say, “beater” glasses, so you did alright. (She warms the frame and adjusts the front end pieces inward and bows the arms in and curves the temple ends rounder to conform to the back of his ears).

Bob - hey that feels great, they really fit me now.

Joan - just for future reference, your seeing experience would have been a whole lot better if you had taken the time and money and invested it in a more customized product. Think of what we do here as like getting a bespoke suit. Did you know that the bespoke suit is made on over 20 different measurements that are custom for you, and yes there is a big difference between that and a “made to measure” that is adjusted to fit. Now, Bob, you didn’t go into it wanting a custom tailored pair of glasses. But you should have. Yes, a bespoke suit looks and feels great. With Nikon’s Seemax lenses, either in the Infinite series for single vision lenses, or the Ultimate series for progressives you get this experience.

Bob- sounds expensive.

Joan- Admittedly more expensive, yes, but remember, this a very practical decision too, you use your eyes for everything and all day long. With your larger prescription you would benefit even more from this customization. Then have these crafted lenses mounted in a proper fitting and great looking frame, with all the unique measurements taken, and voila, a person who sees great and is comfortable in his spectacles and will be more inclined to wear them, giving some rest from contact lens wearing.

Just food for thought, thanks Bob and Joan,

the good doctor, Dr. Mark Germain, Burlington Eyecare

the good doctor on: Last Week: Spurge, ThePlant; This Week: Stems…

Thu, 07 Oct 2021 18:43:58 GMT

Blog.Vol.II.23 Last Week: Spurge, The Plant; This Week: Stems…

… actually, stem cells. I receive a weekly news feed from the journal, Nature, that keeps me informed on the latest research, especially when it comes to eyes. This week featured regenerative therapy in which researchers are using stem cells to “regrow” vital tissues in the eye. The most recent research has been in replacing damaged corneal epithelial cells, photoreceptors like cones, retinal pigment cells, and ganglion cells, different parts of the eye.

Stem cells have been the source of much research in the past few decades. They are body cells that have not differentiated into specific tissues. The research related to the eye has been with a class of cells called induced pluripotent stem cells, or iPS cells, which are harvested from the donor, coaxed into becoming stem cells, then into more specific tissues like retinal epithelial cells. The researchers harvest these cells from the donor’s own tissue which makes rejection of the newly grown tissue unlikely, a huge advantage.

When the cornea is severely damaged by a chemical burn, intense UV burn, or an explosive, it must be replaced. The donor cornea replaces the central 8 mm of cornea in these cases. The corneal epithelium regenerates from stem cells that are at the limbal area, just next to the cornea. But if damage is extensive, then these cells cannot be produced and migrate to replace old corneal cells. The unfortunate result is a short-lived transplant. With stem cells obtained from a healthier limbus and cultured, these stem cells can be implanted into the damaged eye and help sustain the transplant.

A similar procedure is used when restoring the retina. Researchers are finding ways to coax stem cells into more specialized tissues like retinal pigment epithelium and photoreceptors, which are damaged in macular degeneration, diabetes, or retinitis pigmentosa. Stem cells are also being used to develop new ganglion cells, which are damaged in glaucoma. In the past, stems cell were injected into the affected retina, in the hope that they would organize into functional tissue. This strategy was not very successful, with more promising results from the production of “sheets" of stem cells that are then mounted into the retina. Much work still needs to be done, but this is very hopeful.

These are exciting times. All of this means that there are possible treatments for previously devastating eye conditions hopefully just around the corner.

Keeping you posted, til next week,

the good doctor, Dr. Mark Germain, Burlington Optometrist

the good doctor On: A Nice Day For A ….Fall…Wedding.

Thu, 30 Sep 2021 22:05:37 GMT

Blog Vol.2, # 21. A Nice Day For A ….Fall…Wedding.

This past weekend, my daughter and her fiancé, hosted us at their much anticipated and much planned wedding. They have a wonderful garden and grew most of the flowers for the event. The table settings, the bouquets, the decorations for the ceremony and the reception were all adorned with an abundance of beautiful fall flowers. One of the plants they used was a very decorative filler called Euphorbia, better known as Spurge. Two of her bridesmaids, very gifted with flowers and with flower arranging, spent Friday cutting and arranging for the big day. Saturday morning, the wedding day, AHHHHH!!!, the bride and one of the bridesmaids woke up with a nasty rash on their faces and around their eyes. Redness, swelling and itching ensued, and a call to the bride’s father, namely me self, to see what to do. The bridesmaid had a much more dramatic reaction and went to urgent care. The bride’s reaction was milder, the diagnosis: contact dermatitis.

Who knew that Euphorbia, such a lovely, easy-to-grow plant is so notorious? We learn something every day, sometimes, unfortunately, the hard way. When the plant is cut, it releases a sap that is a milky latex-like liquid which is quite caustic. The sap contains diterpene esters which are toxic when ingested and an irritant to the eyes and skin after contact.

The mechanism of contact dermatitis, or delayed hypersensitivity reaction, involves the immune system. Since Euphorbia is everywhere, up-to 8000 species in the genus, it is very likely that a person has been previously exposed. The initial exposure to the esters causes a build-up of T lymphocytes in the lymph nodes, and when this person makes contact with the Euphorbia sap again, then the body sets up the delayed immune response. Unlike a normal allergy, where the mast cells release histamines, in this case the lymphocytes start a cascade of immune reactions.

Treatment will depend on the exposure and severity and will also depend on the person’s individual response. In this case, the severity of the bridesmaid’s reaction required an oral corticosteroid, which fortunately aided in reducing symptoms very quickly. The bride was able to manage her reaction with cold compresses and eye drops. If the sap gets into the eye, it can cause severe conjunctivitis and even uveitis (very bad). Immediate attention must be sought.

If you suspect the possibility of being exposed, time for PPE: gloves and goggles to keep from contacting the sap.

By the way, there was a happy ending to this story. Everyone was on the mend by the time of the ceremony, the flowers were stunning, and the wedding was lovely! Congratulations Emily and Michael!

til next week,

the good doctor, Dr. Mark Germain, Burlington Optometrist

the good doctor On: It Is With A Sad Heart…..

Thu, 23 Sep 2021 20:26:30 GMT

Blog Vol.II, # 20. It Is With A Sad Heart…..

Back in the spring of 1983, I applied to Optometry School at Waterloo, hoping that I could get into the four year program for the fall. There were many reasons for wanting to become an optometrist, some of them altruistic. I wanted to be in a helping profession and I knew a bit about eyes, being a spectacle and contact lens wearer for some time. I was also inspired by my optometrist in London, Dr. Brian Garnett, who was very enthusiastic about eye care and quite frankly, was tops in his field of contact lenses (not to mention being a top flight curler -- he could see the broom and hit it every time, as the saying goes). I did get into the optometry program and have thoroughly enjoyed the work, especially the people. Right now is the first time in my career that I have had to volitionally deny services to patients. As of September 1st, the optometrists of Ontario have come together in job action to make sure Ontarians will receive quality eye care into the distant future.

I miss my patients. They are the reason I go to work every day. After being in practice for over 34 years, you have spent a good deal of time with your patients. Nothing against my younger patients, thank you for coming in during September. Like they say, new friends are silver but old friends are gold. I would like to apologize to my older patients for having to take this course. I have been known to say that I would show up for work, even I did not get paid. Little did I know that the government would take me at my word. An 18% increase in OHIP funding over 32 years is inadequate. Unfortunately, the negotiations go on and on or not….

My hope is that this action will be short lived. The best way to do this is to put pressure on the Ford government. We have collected over 300,000 signatures and letters and have submitted them to Queen’s Park. We have to keep the pressure up. That means getting every Ontarian possible to send a letter to their MPP or to Premier Ford. Here is the link.

As a people, we need to be looking to the future of eye care.

As an office, especially my front staff, we are determined to see it through.

As a doctor, I can’t wait to get back to seeing my patients.

Til next week,

The Good Doctor, Dr. Mark Germain, Burlington Optometrist.

the good doctor on: Cannabis and Glaucoma

Thu, 16 Sep 2021 22:24:58 GMT

Blog Vol.II, # 19. Cannabis and Glaucoma

When I was back in the office this week, I was reminded of the connection between cannabis and eye pressures. I asked one of my patients (as I do all my patients) if they smoke and their answer was: “only marijuana”. That got me thinking that I need to ask patients directly if they are smoking or taking THC ( tetrahydrocannabinol) because this has an effect on eye pressures and does alter the risk for glaucoma.

The active ingredient in cannabis will reduce the eye pressure when it is in high enough concentration. The problem with THC is that it is difficult to tell what concentration is in the system, how the concentration affects each individual, and how that dose affects the eye pressure. With alcohol consumption, we know that a standard drink has 14 grams of alcohol (equal to 12 ounces of 5% beer or 5 ounces of 12% wine or 1 ½ ounces of 40% whiskey). We know the concentrations and have a good idea about how that will affect a person. This is not so clear with THC.

I would like to point out that THC is not a way to treat glaucoma if you have it or even if you are at risk for it. In order to have a therapeutic effect, enough THC to lower the eye pressure significantly, a person would have to take anywhere from 18-20 mg of THC every 4 hours. The person would be permanently sidelined under such circumstances, not to mention the high cost of maintaining that concentration. Also of note is that the pressure-lowering benefit is countered by the blood-pressure-lowering effect of the drug. So THC’s effects on eye pressure gets cancelled out for the most part.

Further complicating factors are that there are also inconsistencies with licensed vendors and their stated concentrations and home grown or street purchased cannabis, then there are the differences in individual responses to the drug. There are just way too many variables.

In the future I will ask about THC use but it will have pertinence only if the drug has been taken within 3-4 hours of taking eye pressures during the eye exam as it will mess with the results and could mask glaucoma which is a problem.

In summary, do not depend on THC use to help with glaucoma, if possible, do not take it before your eye exam and be forthright with your optometrist about usage, especially around eye exam time.

til next week,

The good doctor, Dr. Mark Germain, Burlington Eyecare

the good doctor On: Restful Respite

Thu, 09 Sep 2021 21:16:30 GMT

Blog Vol.II, # 18. Restful Respite.

Every fall I take a week off to regroup. It has been quite a week so far. With school starting up again, there are all the tensions of coming together as a society, agreeing to be kind and thoughtful with each other, and trying to make this work. Amidst hyperventilating and trying to calm down as our anxiety levels rise, we are reminded of all the stresses of the COVID era. Some observations:

People are pretty resilient and willing to give this grand experiment another go. My week off is as an observer, trying to dissociate myself from all that is going on around. I need perspective. I turn to nature at times like this: the flowering sedums that are full-out now, teeming with honey bees as they give their nectar and pollen to the ever filling combs. We spent the lunch hour yesterday having a picnic at Minet’s Point in Barrie with refreshing breezes off the bay, the sun peeping out among the slow-moving cumulus clouds, the red pines, oaks and maples gently swaying their leaves and limbs in time to the moving air, and fresh food a la fresco. Perspective, making it possible to be in that moment in the midst of all the white noise, then capturing those moments for the long haul, a repository of sanity as the water levels rise around you.

I definitely need the break.

Take time to create and hold on to those moments.

til next week,

The good doctor

Dr. Mark Germain, Burlington Optometrist

the good doctor on: More Vivid Colours

Thu, 02 Sep 2021 13:41:35 GMT

Blog Vol.II, # 17. More Vivid Colours.

Every summer we “rescue” monarch caterpillars and raise them to form adult butterflies. The day that they eclose (emerge from the Chrysalis) is very spectacular. Especially when the wings start to fill out; they become iridescent with black, orange and white spots. Definitely, a sight to behold. There is no camera lens that can even begin to capture the vividness of these colours. One more excellent reason to have 20/20 eyesight.

A few words on rescuing monarchs. The survival rate is higher for a monarch caterpillar in a well ventilated and spacious container with ample milkweed for food than it is in nature. Contrary to popular belief, monarchs do have natural predators. We were always told that they taste awful, so birds, like blue jays, may experience the taste of monarch once, but Yuck! The main predators are insects and spiders, which do not mind the flavour and will eat the caterpillar as a food source. Monarchs can also be infested with a parasite called OE (Ophryocystis elektoscirrha) which can deform the butterfly and spread more of their spores to other monarchs. A word of caution when putting a caterpillar in a container: make sure it has been thoroughly cleaned with chlorine and rinsed beforehand and only one caterpillar per container.

Keep the caterpillar well fed. They will eat a tonne of milkweed leaves, and when they are ready, will climb to the top, hang upside down and make a “J”. Then it is chrysalis time, a green covering will form and it will hang there. Wait about 10-15 days and watch for the colour to change to orange and black. Emerging from the chrysalis takes 3 hours, for proper drying. The vivid colours emerge when the monarch starts pumping hemolymph into its wings. The pumping fills out the wings and also starts the drying process, in which the adult must hang until they are fully dry. Another good reason to rescue them is this long duration of drying, when they are vulnerable to attack from other insects like a mantis or spiders.

As I am writing this article our monarch has just enclosed, and is hanging upside down and pumping hemolymph. Awesome. Once again, having the eyesight to take this in, is really something else.

til next week,

The good doctor, Dr. Mark Germain, Burlington Optometrist

the good doctor On: A Bountiful Harvest

Thu, 26 Aug 2021 21:48:32 GMT

Blog Vol.II, # 16. A Bountiful Harvest

I cannot remember a summer that has been so kind to all the fruits and vegetables grown in our area. The Niagara Peninsula and surrounding area farms all sorts of delicious fruits and vegetables. This year, the combination of sun and nicely timed rains has produced a bumper crop. Our apple tree is loaded with fresh fruit, and the farmers’ markets are full and overflowing.

This is a happy time for our eyes. Think orange: this colour is usually an indicator of vitamin A , which is essential for retinal health and moist corneas (i.e. good for your eyes). Think: fresh carrots, sweet potatoes, which have high vitamin A content, Ontario cantaloupes and apricots.

Of course there is vitamin C , a widely available antioxidant that protects us from free radicals (i.e. good for our overall health); we have peaches, nectarines, red bell peppers, apples, and my favourite, the humble tomato. Tonight is pizza night for us and we are making Margarita pizza with fresh grown tomatoes and basil, yummy.

We cannot forget vitamin E which is important for overall cell health, and is found in almonds, sunflower seeds, and avocadoes which unfortunately do not grow around here .

The summer also produces leafy greens, like spinach, kale, romaine lettuce, collards, turnip greens, broccoli and peas (we had a bountiful harvest of snap peas this year). These greens have lutein and zeaxanthin , which are macular protective pigments that help prevent macular degeneration and improve overall retinal health (i.e. good for your eyes).

Last but not least, our harvest also produces minerals like zinc , which are important in helping Vitamin A and E get from the liver to the eyes. Whole grains and nuts are great sources of zinc.

As you can see, all these locally grown foods in such abundance are great news for our eyes, not to mention being delicious! The harvest is also a beautiful visual feast for our eyes with its panopoly of shapes, textures, and colours.

Enjoy!

Til next week,

The good doctor, Dr. Mark Germain, Burlington Optometrist

the good doctor On: Back to School

Thu, 19 Aug 2021 15:15:10 GMT

Blog Vol.2, # 15. Back to school.

The summer seems to go by so fast, with the start of school just around the corner. Again, another Covid-fraught September. The details need to be worked out, but we are back in the classroom much to the relief of all involved. Back-to-school time is a good time to consider your child’s vision. Has your child had their eyes checked? Because they are growing and changing so much, children need to have their eyes examined regularly. Furthermore…

..the increased screen time of the pandemic has an impact on our children’s eyes. I am particularly talking about myopia development or increased nearsightedness (cannot see the distance clearly, sees well up close). The decrease in outdoor activity and the increase in screen time have created the “perfect storm”. The studies done during the past year have concentrated on the impact of this “perfect storm” on school age children. Here are two of many studies:

Progression of Myopia in School-Aged Children After COVID-19 Home Confinement

Myopia incidence and lifestyle changes among school children during the COVID-19 pandemic

The upshot is that when children get back to the classroom there will be some squinting of eyes and extra eye strain. Teachers, parents and students have to be on the watch for these symptoms. Nearsightedness can result from the eyes adapting to a near environment, the visual system actually changes to make work up close easier. While we have been at home for much of the last 20 months, our eyes have been “happily” doing our near work, not needing to do our pre-Covid distance work.

REMINDER: Eye exams for the kids.

Glasses are not the only solution. There are many new treatments to slow down myopia development, not to mention habits that we can develop in our children, like getting outside as much as possible, spending less time on our screens, and moving our screens further away from our eyes.

Remember, watch for squinting in the classroom this fall.

Til next week,

the good doctor, Dr. Mark Germain, Burlington Optometrist

the good doctor On: I See! I won!

Thu, 12 Aug 2021 14:39:00 GMT

Blog Vol.II, # 14. Olympics: I see! I won!

I can remember back in 2016 at the closing ceremonies of the Rio Games, the Prime Minister of Japan, Shinzo Abe, led us through a spectacular animé production that transported us to Tokyo, home of the 2020 games. It was definitely something to look forward to. Fast-forward five years… and the world just witnessed the most digitally streamed Olympics ever. The Covid pandemic had a lot to do with this, of course, as there were no spectators allowed at the events. As always, the level of athletic achievement was amazing.

As an optometrist, I was impressed with the visual accuracy and the eye-hand co-ordination that was on display over the 16 days. I was streaming a volleyball match in the preliminary round between the men of Brazil and Argentina, always excellent drama when these two sides meet. During the game, one of the players had to take a time out for a trainer/eye doctor to remove, clean, and re-insert a contact lens. Sports like volleyball, table tennis, tennis, baseball, archery, shooting (ten different events at this games), and countless others require superb vision and co-ordination. When it comes to the games, there is much mention of the dedication of coaches, parents, and support staff; I would like to give a special shout out to all the sports vision optometrists who make this level of excellence possible.

Eye protection was also in much use at the games. I could not help but notice that our own André De Grasse, who took home medals in three different sprinting events, was sporting a pair of pretty nice sunglasses in his races. How cool was that? Not only did he look good, but he also had glare control and sun protection. How about the swimmers with their tiny goggles? I could not help but notice that Canadian, Maggie MacNeil, was wearing goggles when she won gold in the 100 metre butterfly. Did you notice that when she finished her race, she removed her goggles and had to really scrunch up her eyes to see if she won? She was wearing prescription goggles. (Contacts lenses should not be worn under goggles.) Then, when she was receiving her medal on the podium, she showed up wearing glasses for her nearsightedness. The games through an optometrist’s eyes.

Even us regular people need eye protection when participating in athletic activities. Swimming and protective goggles all are available with prescription lenses as are sunglasses. In fact my wife and I are getting my son a pair of prescription swim goggles for his birthday, shh! Don’t tell.

Til next week,

the good doctor, Dr. Mark Germain, Burlington Optometrist

the good doctor On: OHIP patients lose access to eye care? What is going on?

Thu, 05 Aug 2021 15:08:37 GMT

Blog Vol.II, # 13. OHIP patients lose access to eye care? What is going on?

Back in the spring, the optometrists of Ontario got together (online, of course) to discuss what was necessary to continue to provide excellent eye care to Ontarians. The OHIP fees for eye exams do not even begin to cover the current costs. This is a problem. I personally have been seeing patients for more than 30 years, and in that time optometrists have received little to no increase in OHIP fees. Job action during a pandemic is not ideal, hence the postponement until fall, more precisely, September 1, 2021.

What are optometrists asking for?

- to have some form of negotiating process in place, as other health professionals have

- to be able to cover the costs of providing eye care.

What form is this job action going to take?

As of September 1, 2021 optometrists in Ontario are not going to see any OHIP-billed patients until the government has addressed this issue. We will continue to see non-OHIP patients and problems, and any emergencies.

What can you do to help speed this up?

- sign a petition to send to our local MPP

- send an email to Premier Ford and the Ministry of Health.

Close to 100,000 emails have been sent thus far and over 70,000 signatures have been submitted. Unfortunately, putting pressure on the government seems to be the only way to get them to the table.

What are optometrists hoping for?

The best case scenario is a bilateral agreement that is ratified before the end of August so that no care is affected. That would be wonderful.

A note for the patient:

We really don’t like inconveniencing our patients or making them anxious about their eye care especially since the last year and a half has been hard enough on many of you. We apologize for any trouble this causes anyone, and ask for your patience.

A tribute to the unsung heroes:

Our staff: who have been providing front-line care through a pandemic, who have been fielding calls and emails from concerned and even disgruntled patients regarding these impending OHIP reductions, who have been scheduling and re-scheduling patients in light of the possible job action, and who are wholeheartedly committed to providing Ontarians with the best in eye care.

If you would like more information, would like to sign a petition, or would like to send an email, go the web site, www.saveeyecare.ca . If you still have questions or concerns, please feel free to contact our office at Burlington Eyecare.

Til next week,

the good doctor, Dr. Mark Germain, Burlington Optometrist

the good doctor On: Vitamin A In The World At Large

Thu, 29 Jul 2021 17:08:45 GMT

Blog Vol.II, # 12. Vitamin A In The World At Large

Beta carotene is a carotenoid that the body converts into vitamin A. It is very important for overall health, especially for eye health. Vitamin A helps prevent eye dryness and macular degeneration, and helps maintain general retinal health. Excellent sources of vitamin A are carrots and sweet potatoes; the Daily Value needed is 5000 IU.

In developed countries there is little difficulty in consuming the daily vitamin A requirement, but in 2/3 world zones it is a lot more difficult. Vitamin A deficiency can cause childhood blindness, with 250,000 to 500,000 children affected annually. Blindness is not the only danger, numbers of immune-suppressed children also die from lack of vitamin A.

In the last two decades, scientists have been developing a genetically modified form of rice that has Beta carotene as part of its grain. Vitamin A deficiency has been a problem for a long time in many countries and public health administrators have tried various things including distributing capsules to the vulnerable which has helped to reduce cases, but the logistics are difficult and costly. As a solution available and affordable to all, the Philippines has passed legislation to allow the growing of this genetically modified, vitamin A-rich rice on its fields. It is called Golden Rice and a cup of it taken daily will provide up to half of the needed vitamin A for a child.

This technology has not been embraced in a large portion of the world. Genetically modified organisms are controversial. With any new technology, there are good and bad consequences and these can be hard to discern especially the longterm consequences. With GMO’s, one big concern is the reducing of our biodiversity by promoting narrower ranges of cultivars, and thus making us more susceptible to crop failure or disease on a large scale. Further concerns include the ownership of seeds, raising questions about corporate responsibility and copyright, as well as the possible risks of introducing a “foreign” component into already stressed ecosystems. If the last year and a half has taught us anything, we need to try to keep healthcare from becoming too political. The endless cycle of polarizations has to stop, there are millions of lives involved, while media outlets, interest groups, and legislators play a dangerous game of political chess.

Ideally, we can all come together and take a real hard look at each new advancement as it is introduced and debate each one on its own merits, addressing the possible fallout and ramifications. What the Philippine’s government has done here is to be lauded. After much consideration and research, they have taken a viable food crop and are using it to help save countless lives and prevent blindness.

Til next week,

the good doctor, Dr. Mark Germain, Burlington Optometrist

the good doctor on: The Virtual Eye Exam?

Thu, 22 Jul 2021 19:20:12 GMT

Blog Vol.2, # 11. The Virtual Eye Exam?

It is finally here, the on-line eye exam. In the convenience of your own home you can download an app that will perform an on-line eye test on you. In order to cover the legalities of this, the companies involved have included screening questions for eye health conditions. While this could provide an adequate prescription, few people would be well served by the stay-at-home prescription check.

From the perspective of eye care professionals, this is far from adequate eye care. If a patient cannot get out, or does not have access to an eye care professional, on-line care is better than nothing in a pinch (though there are in-home eye care options). There is no substitute for a person-to-person, real reality eye exam. The eye health and overall health of the patient are reviewed, as well as the interaction between the prescription of the eyes and how well they work together. The eye care professional takes a history of overall and eye health and does a thorough examination of the structures of the eye. Preventive care is a priority. We frequently discuss healthy life habits.

It is very surreal that we are even having this discussion. My guess is that people have gotten used to on-line shopping and on-line family get-togethers and on-line everything, so why not on-line eye exams? There is no doubt that there have been undocumented casualties during Covid due to the reliance on on-line medical care, diagnosing and treating patients without actually seeing them is not ideal. There is serious risk of misdiagnosis. If there is no other way, then we must carry on virtually, but accessibility, at least at Burlington Eyecare, has not been a problem, except for a couple of months at the beginning of the pandemic when we were only able to see emergencies, though this was still in person.

My fear is that people will have their eyes tested on-line, thinking that they have had their eyes checked, when that has not happened. There is risk of undiagnosed, treatable conditions with long-term consequences, not to mention I know we can do a better job with the prescription in a real-life eye exam. Preventive care is key; the health system works best when we are doing our part to live healthily. This includes regular eye exams and education on underlying conditions, risk factors, and what to do about it.

Feel free to contact us and start a conversation in your ongoing pursuit of a healthy life.

Til next week,

the good doctor, Dr. Mark Germain, Burlington Optometrist

the good doctor on: The Heart of the Matter

Thu, 15 Jul 2021 16:50:41 GMT

Blog Vol.II, # 10. The Heart of the Matter

First, a couple of house-keeping matters, it is now two weeks past my second Pfizer shot: fully vaccinated. Now, I can sit in a throng of 50,000 screaming Blue Jay fans at the Roger Centre. Not yet, but one step closer…

As we have been opening up, I have been able to receive some routine medical care. Today was a cardiovascular stress test. My family’s gene pool has issues with providing enough oxygen to the heart muscles, especially later in life, hence the preventive care. This got me thinking about the eye’s huge demands for oxygen. The over one million receptors in the retina especially require oxygen every time they fire away. That is how we see: a photon hits a receptor, a rod or cone, and causes a chain reaction that sends a neural impulse along the pathway to the visual cortex.

This sounds tedious, but one of the best ways to ensure that you keep your sight is a healthy diet and exercise. It would be nice be able to take a pill that would take care of our oxygen demands. Not so easy, these are habits, they take time to establish. If you were raised in a super-size-me home or if you live in one of those right now (I exaggerate), your diet needs to be rethought. Or if you haven’t gotten your heart rate up for any prolonged period in the past while, some exercise is in the plans. The key to getting rid of “bad” habits is to replace them with “good” ones. You do not have to go crazy, do not overdo it, start slow and slowly ramp up. The goal is for the duration, the long haul.

Diet. Exercise. Preventive care, especially if there is a family history of cardiovascular problems.

There are some wanted side effects to providing oxygen to your eyes, not to mention that your brain, your heart, and the rest of your body will love the new hyperbaric digs. There is no guarantee that you will have perfect health, but you will have a sense of satisfaction in knowing that you have done your part, and a general sense of well-being that comes with a balanced and healthy lifestyle .

And, by the way, come in for an eye check-up, especially if you are younger so we can get you building those healthy habits sooner.

Til next week,

the good doctor, Dr. Mark Germain, Burlington Optometrist

the good doctor on: When No Light is the Best Light

Thu, 08 Jul 2021 19:57:19 GMT

Blog Vol.II, # 9. When No Light is the Best Light

This is the time of year to be outside, whether in your backyard or out camping. And this weekend, on the 9th of July, there will be what is called a New Moon, when the sun and the moon are aligned. That means there will be a dark sky, the garish light of the moon will not disturb stargazing.

The gift of sight is really evident when you get out in nature, with the dark sky a lot can be seen at night, especially when camping away from the light pollution that we usually experience in Southern Ontario. Take along a telescope for even more excitement.,

Just what will you see this time of year? You will see, of course, the Milky Way, the galaxy that we reside in. You should be able to get really good views of constellations like Sagittarius, Hercules and Draco. If you have a more powerful telescope you can get a good view of Mars and Venus in our locale. Also you can obtain apps like Star Tracker that not only locate celestial bodies in the night sky but also accompany them with Sci-Fi music. There are a number of really interesting websites to help in your space exploration, such as www.space.com or www.earthsky.org and of course there is always www.nasa.org . And, with the current high pressure system upon us, we should have reduced cloud cover and clear views.

I will be getting my telescope out this weekend. Enjoy.

Til next week,

the good doctor, Dr. Mark Germain, Burlington Optometrist