Lenses for the smallest of eyes

Many of my patients will know contact lenses are a passion of mine. Most of my patients have straightforward prescriptions with some requiring more specialist products. However a small number of our patients are a little more complex still.

We are fortunate to work closely with the Princess Alexandra Eye Pavilion and St John’s Hospital, taking referrals from them to provide specialist expertise in dealing with even the youngest of patients including newborns with congenital cataracts.

Babies who are born with cataracts (the clouding of the eye’s lens) are usually operated on within the first few weeks of their lives. For adults, following surgery the normal course is to be fitted with lens implants or where this isn’t possible they can wear high prescription glasses (around +15.00 or so)

Babies are different. After surgery to remove the cloudy lens they have been born with the eye is usually too small to support an implant until they are at least 2 years old. They can’t be expected to wear glasses as the prescription is as high at +35.00 and changes every few weeks as it reduces towards the usual +15.00 over the first year of life.

In fact a new study has found that wearing contact lenses for a few years before having implants fitted also gives better eventual outcomes. This is an area myself and my colleagues have a lot of experience in and it is encouraging to see further study supporting the treatment. For surgeons to get the prescription spot on for a small baby is very difficult. It is hard to judge the focusing power of the baby and the infant years are a period of rapid growth so the chance of the surgeon getting their lenses as near perfection as possible increases as the baby becomes a toddler. At this time testing is far more straightforward. The eyes have developed substantially and the child’s ability to communicate makes it easier to select the right permanent lens.

As you can imagine, it isn’t easy getting a baby to wear contact lenses, perhaps even harder a toddler, but like anything, they do get used to it and as this research reiterates, the long-term benefits are worth the short-term angst.

China raising the bar to improve eyesight

I’ve had quite a few short-sighted children come through the doors this month and it reminded me of an image of Chinese school children.

In China, some 41 per cent of children need glasses, whilst another study from 2011 found that 85 per cent of university students were short-sighted. This compares to around 20-30 per cent in the UK. Some Chinese schools have taken an interesting step to try to halt the increased incidence of short-sightedness in the country, putting bars on desks to prevent children getting too close to their books.

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Short-sightedness or myopia is known to run in families so genetics always play a part. However there are environmental factors such as intensive close work that are also known to impact on eye development. The Chinese continue to top the international educational rankings however the long hours spent studying could well be a contributing factor to their declining sight. Spending around 13 hours a day studying at school plus extra tutoring and homework, going to bed late and getting up early, could well be taking its toll.

Obviously we all want our children to learn but eyes need rest like all parts of our bodies. So, far from discouraging your studious child, do encourage them to take breaks, get them outside to give their eyes a rest. It could well help their sight in the longterm.

No Smoking Day

Tomorrow (12 March 2014) is No Smoking Day. Smokers across the country are being encouraged to give up cigarettes for numerous health reasons. Many of the negative effects smoking has on the body are well publicised; heart, lung and mouth disease being some of the most common. However, few appreciate the effect smoking has on the eyes.

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Smoking is by far and away the most important modifiable factor in age-related macular degeneration (AMD), the loss of central vision. ‘Modifiable’ means it’s something you can do something about about – i.e. by stopping smoking. There are other risk factors of some of which are modifiable (e.g. UV light exposure and diet) and others which are non-modifiable (e.g. family history). A series of studies have found a significant link between smoking and this form of eye disease.

Cataracts are another eye condition associated with smoking. Cataracts are cloudy patches in the lens which cause visual impairment and various studies have found a link between smokers and the chance of developing cataracts. Although most people get cataracts as the get older, smokers get them younger and they develop faster.

Less seriously, smoking can make your eyes dry and uncomfortable by affecting your tear film, the layer of liquid constantly covering the eyes. You should very quickly notice an improvement in dry eye symptoms if you give up smoking.

So when you’re considering quitting, give a thought to your eyes.

Spritz: transforming the way we read?

Earlier this month a new piece of technology was launched by Spritz which aims to dramatically change the way we consume printed content. The Spritz system basically fast-streams one word at a time so your eyes don’t have to flicker back-and-forth (movements called saccades) to find the point where your brain can properly process them. The app, which will be available on some smartphones, can be customised to suit your own pace displaying from 250 to 1000 words per minute.

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The key to the success of Spritz is to stop the eye wandering on the page. When you read, your eyes seek out the Optimal Recognition Point of each word (OPR). This technology works out the OPR and highlights this letter in red further assisting the word recognition process. According to Spritz, only 20 percent of our time ‘reading’ actually involves taking in content and during the other 80 percent our eyes wander around the page.

There are definitely downsides. Sneeze and you might miss five words! And it definitely takes some of the leisurely enjoyment out of reading. But I think it could well have a place and I could have probably used it to good effect in my student days. Imagine if you’ve got an English literature assignment due and need to read War and Peace in 10 hours? Spritz could make that happen.

Have a go and see what you think. www.spritzinc.com

Dame Judi Dench’s fading eyesight

I was very sorry to read of Dame Judi Dench’s declining vision. Up for an Oscar this Sunday, the 79 year old is suffering with age-related macular degeneration (AMD). She has said she can no longer read and struggles to paint and watch films.

Judi Dench

Sadly the condition affects over 500,000 people in the UK to varying degrees, most of those being over the age of 60. The genetic element of the condition is well known and in Dame Judi’s case her mother also suffered from AMD. Visiting your optometrist regularly will ensure early signs are detected allowing the condition to be most effectively managed. Early signs can include blurred and distorted vision and straight lines looking wavy. Using our latest OCT scanners we are able to see cross-sections of the retina to find the earliest signs of AMD which helps us get you access to treatments as soon as possible.

Lenses and glasses will help, certainly in the early stages, and there are some medications and nutrients available that can also slow the degeneration, depending on which variety you have (wet or dry). Because the disease only affects the middle of the eye, sufferers will never experience total blindness. Dame Judi has said she has no plans of retiring, showing that even at its more advanced stages, the disease should not mean a complete change to current lifestyle.

Encouragingly there are many ongoing studies into the disease so we hope that some day soon a cure will be found.

www.macularsociety.org

A vending machine for lenses? No thank you.

Vending machines are great. You’re thirsty or desperate for a quick snack in the middle of a busy day and there in the corner of your eye is a vending machine. Ideal. A pound coin in, a can of juice out, problem solved. They are fit for this purpose. However, when Gillian was recently on holiday in Russia, she spotted a vending machine spouting out contact lenses.

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The first emotion is amusement – we’ve seen some other funny Russian customs in Sochi hitting the news recently. But the second emotion is worry. Eye care should not be dealt with on-the-go and I really hope never to see these machines in the UK. The concern is people will rely on these kinds of dispensers and forego a proper eye examination.

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CamOpt patients will know, the first half of your check up is spent looking at the suitability of your lenses. We look for any changes from your last appointment, talk about your lenses and whether they are still the best option for you, after all there are so many excellent options out there for each different individual. When it comes to eyes we are very individual so off-the-shelf and eye care shouldn’t even share the same sentence.

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After that section, we whip you off to check the health of your eyes with the scanner and the biomicroscope, then off to another machine to check your peripheral vision. All the while we are looking for any signs of disease and damage. Our technology allows us to spot issues early so we can devise a plan to hopefully cure and certainly manage the problem. If you forgo your appointment with us, you risk not only wearing the wrong lenses, but missing vital signs of eye ill health.

Lensplates now available in the UK

This is a one for all our optometrist readers. It’s one of those times when you think “why hasn’t anyone thought of this before now?”

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During contact lens exams when patients remove their contacts, where do you put them? Chances are they’ve forgotten their case (not Cameron Optometry patients of course.) so you open a trial pack of solutions, chucking away all the bits you don’t need or you buy a whole bunch of cases from a supplier for an extortionate price.

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I wanted a way to do it quicker, cheaper and better and came up with Lens Plate – single use disposable trays for temporary contact lens storage.

Take one off the stack, use it once and dispose of it – totally hygienic for patients. But remember you don’t have to be an optometrist to use them.

They are now available online at www.lensplate.co.uk

Gene therapy breakthrough could improve sight

After years of exploration, I was delighted to read that scientists at Oxford Uni have succeeded in restoring the sight in people with a form of degenerative eye disease.

Choroideremia affects about 1 in 50,000 people who see their eye sight deteriorating as the light-detecting cells in their eyes die, usually becoming completely blind during their mid-life – a disease not dissimilar to the more widely known retinitis pigmentosa. There has been lots of research in this area but this is the first real world example of success.

Whilst the long-term effects are still unknown, the fact that the trial has had such early successes is a huge step forward and will give real hope to those suffering from various genetic eye diseases.

And it doesn’t stop there. There are many diseases with genetic components that affect eyesight, such as glaucoma which a number of my patients suffer from, and I am hopeful that the same principle could be used to treat a raft of similar diseases in the future.

What is especially heart-warming, is that the research was funded by the Tommy Salisbury Choroideremia Fund set up by the parents of Tommy, a 13-year-old boy from Kent who was diagnosed with the disease eight years ago. Wouldn’t it be great if he reaped the rewards of the research?

Read more about it here

Smartphone app for eye tests

My first mobile phone made calls, sent about 200 characters of text and weighed enough that to use the term mobile was a slight exaggeration. My most recent phone looks like it might be able to download an app that can do my job for me!

The app is currently being trialled in parts of Africa devoid of optometrists.Having had the opportunity myself to visit Africa as part of a Vision Aid Overseas team I met many people who were effectively blind due to not having spectacles. The statistics are quite staggering. Of the 285million people worldwide that the World Health Organisation suggests are visually impaired almost 230 million could be cured by spectacles alone.  

 Recently Vision Aid Overseas has realised the enormity of the problem and has focussed more of its work on educating and training local people to provide their own eye care services.

 Perhaps a tool for this in the future could be the PEEK mobile phone app recently reported on by the BBC. The app uses the phone camera to scan the lens of the eye looking for cataract, and by illuminating the retina with the camera flash it can look for disease at the back of the eye. A shrinking letter on the screen is used as a very basic vision test. The patients record and their exact GPS location is stored on the phone allowing the images to be e-mailed to doctors and the patients to be located should follow up be required.

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At the moment the app is being trialled on 5000 people in Kenya. With the image of their eye being taken by both the phone and standard retinal cameras that are being transported in the back of a van. Doctors at Moorfields eye hospital in London are comparing the ocular images to see how good a job the phone can do.

 While we are hoping to start sending out more communication to our patients via e-mails and mobile phones, we will not be using them for your annual eye exams ……. quite yet!

Hidden benefits of contact lenses

With yesterday officially being the hottest day of the year so far, and dare I say it, the good weather predicted to last into August, It is perhaps the first summer in many that we have had to think about the effects of Ultra violet (UV) light on our body.

It is commonplace now to protect our skin with sun creams but what about protection for our eyes?

While our bodies are wonderful at repairing and replacing some damaged cells, the crystalline lens of the eye is an exception that is never replaced. Therefore gradual UV exposure over the years can lead to the early development of cataract, causing reduced vision.  Ocular UV related changes are not limited to cataract but have a role in the development of age related macular degeneration , photo keratitis, pterygium and can cause melanomas of the skin around the eye and eyelids.

Most sun damage is accrued during the early developmental years of life, perhaps only showing itself later in life. Therefore sun protection for children is vital.

So how do we protect our eyes from the harmful UV exposure? A good pair of sunglasses is a great start. These should offer protection to the level of UV 400. This means that 99-100% of harmful UVA and UVB wavelengths are blocked out. The style and fit of the spectacles can also make a difference. The larger the lens, or the more wrap around the style then the more UV light is blocked out.  Be very wary of cheap sunglasses without the UV400 protection. The dark nature of these lenses causes the pupil to get bigger behind the lens, allowing even more harmful light into the eye. Standard spectacle lenses do not offer UV protection.

A great benefit of many modern soft contact lenses and some RGP lenses is that they have a built in level of UV protection. This means the added benefit of year round UV protection as well as coverage of the whole eye.

Good nutrition is another way of protecting the retina from potential UV damage. Lutein is an antioxidant that protects the delicate cells at the macula. It can be found in many of the ocular supplements you find at the chemist or in health food shops and naturally in dark green leafy veg such as Kale, spinach and broccoli.

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