Monday, January 30, 2012

Can't recognize faces? You may have a brain-related vision problem.

A study in the new issue of Optometry and Vision Science helps increase our understanding of how people recognize faces and why some people have difficulty with that task.

The authors looked at adults who had one eye removed while they were babies.  The study's results show that face perception is more difficult for adults that developed with the use of only one eye. The authors propose that vision connections in the brain may be reorganized in response to the removal of one eye and suggest that the visual system requires normal binocular vision  (two eyes working together) during development in order for brain areas associated with the perception of faces to fully mature.

The study has important implications for childhood vision care and suggests that vision problems during childhood development can have lasting impacts on brain development.  Optometrists routinely check for and treat conditions that can impact normal binocular vision such as amblyopia, strabismus and convergence insufficiency

It is important, critical even, for parents to have their children's eyes examined every year to ensure that such a condition does not go untreated.  Most of these conditions are easier to treat while the child is very young.  Optometrists can examine a child as young as six months to ensure that their eyes and visual system are developing properly and can then monitor potential problems as the child grows and develops.  If  problems materialize they can be treated effectively if caught early. If you are a parent, click here to review my childrens' vision guidelines. For more information on optometry for children, click here.

Friday, January 27, 2012

The unseen danger of diabetes

More than 20 Canadians are diagnosed with diabetes every hour of every day. I encourage anyone who has, or may be at risk for, diabetes to have an annual eye examination.

Diabetes affects 3 million Canadians, many of whom may not know they have the disease. One of the health problems associated with diabetes is diabetic retinopathy, a disease of the eye which can cause blindness.

Diabetic retinopathy can weaken and cause changes in the blood vessels that nourish the retina. Symptoms may include blurred vision, cloudiness and/or “floaters”.

Diabetes also increases a person’s risk for developing other eye diseases. Persons living with diabetes are 40% more likely to develop glaucoma and 60% more likely to develop cataracts.

The most worrying aspect of diabetes may be the fact that in the early stages diabetic retinopathy may produce no visual symptoms at all. That is why it is so important for anyone who has diabetes or a family history of diabetes to have a yearly comprehensive eye health examination.  Early detection and treatment are essentialbecause once damage has occurred, the effects are usually permanent.

Monday, January 23, 2012

Catch Dr. Randhawa on RJ12OO on Monday January 23, 2011 at 2:00 pm

Dr. Randhawa will be on the radio today - 1200 on the AM dial at 2:00 PM today. 

She will be talking about new developments in eye care  including topics like new and sometimes dangerous ways to change the color of your eyes; healthy sight healthy mind: the connection between vision and Alzheimer's disease; new research into the connection between a common eye movement disorder - convergence insufficiency - and ADHD and academic performance and how vision therapy can help. 

To learn about these and other interesting topics  click here to go to the RJ1200 website and listen live on the web.

Wednesday, January 18, 2012

Woman gets eye color surgery in Panama and goes blind

The "Ask a Doctor of Optometry" facebook page has unearthed another news item concerning the dangers of the risky methods that some people in the globalized Internet age use to access medical care and medical products.  The first was a story of a Toronto man who purchased contact lenses online only to have them peel off a chunk of his cornea.

Now comes the story of Toronto artist, Beatriz Murillo, 36, who went to Panama for medical tourism.  She went to get an iris implant to change the color of her eyes. The surgery is not available in Canada or the United States.  Now she is legally blind and has undergone three followup surgeries including a corneal transplant.  "I'm an artist and I'm afraid I'm never going to be able to paint again," the woman was quoted as saying.

Anyone considering surgery in a foreign country, especially for cosmetic reasons, needs to get the advice of a doctor in their home country before they make a decision.  Obviously, medical tourism can turn out very badly. 

Another issue is the drain on the Canadian medical system caused by this medical tourism tragedy.  This patient had three surgeries one of which was a corneal transplant.  Some other patient could have used that cornea and other patients could have occupied the hospital beds and surgeon's time. This waste of taxpayer money could have been avoided if this patient talked to her eye doctor first.  It seems quite ill-advised to go to a foreign country for a medically unnecessary cosmetic procedure that is not available at home.  Presumably it is not available at home for a good reason.

As for changing the color of your eyes, color contact lenses are the only safe way.  There is a doctor in California who claims to have come up with a 20 second laser surgery that can turn brown eyes blue but I don't think that the procedure's safety and long term effects have been evaluated.  I identified some potential risks and drawbacks to such a surgery in a previous post.

Image courtesy of marin /

Monday, January 16, 2012

Vision therapy for convergence insufficiency improves academic behaviors

We know that in-office optometric vision therapy is the best available treatment for convergence insufficiency.  Convergence insufficiency is a concern for parents, patients and doctors because it causes the eyes to malfunction when doing near work such as reading. And that is a problem because it impacts academic performance. 

We now have a study that confirms that academic behaviours, as measured by the Academic Behavior Survey (ABS), improve following successful treatment of convergence insufficiency.  The study was published in the January 2012 issue of Optometry and Vision Science.

The study's conclusion was that "A successful or improved outcome after CI treatment was associated with a reduction in the frequency of adverse academic behaviors and parental concern associated with reading and school work as reported by parents." 

To the doctors at our Vancouver clinic, the study simply states the obvious.  The whole reason why convergence insufficiency is treated is because it adversely impacts a patient and a successful treatment would improve the patient's life by removing those adverse impacts.  Furthermore, it logically follows that if convergence insufficiency adversely impacts near work, reading and academics will be challenging for the patient.

More importantly, since we treat convergence insufficiency with vision therapy at our office, we have seen academic improvement following treatment many times - often reported to us by the patient's parents.  Nevertheless, it is always useful to have a scientific research paper to refer to. 

For those who want to get into the nitty-gritty of the results and statistics, here they are:
The mean ABS score for the entire group at baseline was 12.85 (SD = 6.3). The mean ABS score decreased (improved) in those categorized as successful, improved, and non-responder by 4.0, 2.9, and 1.3 points, respectively. The improvement in the ABS score was significantly related to treatment outcome (p < 0.0001), with the ABS score being significantly lower (better) for children who were successful or improved after treatment as compared to children who were non-responders (p = 0.002 and 0.043, respectively).
Other vision disorders that impact academics include binocular vision disorders in general (of which convergence insufficiency is one) and visual information processing or visual skills deficits.

Related articles:

Feb 29, 2012
In a study published in 2006 in the journal, Optometry, researchers set out to determine whether there was an association between vision-related quality-of-life factors and academic performance. To answer the question, the ...
Jan 16, 2012
We now have a study that confirms that academic behaviours, as measured by the Academic Behavior Survey (ABS), improve following successful treatment of convergence insufficiency. The study was published in the ...
Jun 16, 2012
between vision problem detection, academic achievement and vision therapy intervention. ... The result is also expected from all the studies that have been done on vision therapy and its impact on academic performance.
Mar 31, 2012
Most developmental optometrists have stories of patients whose academic behaviours and performance have improved following vision therapy treatment of their binocular vision problems. Research studies have shown the ...

Apr 25, 2012
The researchers (consisting of professors of optometry and occupational therapy), set out to compare visual and visual-information processing skills between children with and without mild reading and academic problems and ...

Friday, January 13, 2012

Can astigmatism ever be beneficial?

A member of the public posted an interesting question on the Ask a Doctor of Optometry Facebook page. The question was whether astigmatism is ever beneficial.  My colleague Paul Neumann gave an excellent answer which explains when a vision problem like astigmatism may work to your benefit.  Here is what he said:
"Astigmatism means your eye has two focal points instead of one. This can have some perks in certain circumstances. The one big caveat is how much astigmatism are we talking about? More than 1.00 unit the benefits are very limited. There are two main patient groups that can use small amouts of astigmatism to their advantage. The far-sighted or hyperopic patient, and early presbyopes (early forties age group). For both of these folks the depth of focus is extended by astigmatism, reducing the need for glasses. Your age and pupil size will also play a role. It is the most common refractive error, but you are right, for some folks a little astigmatism is not a bad thing. I like your 'glass half full' attitude."

Tuesday, January 10, 2012

New study supports orthokeratology for myopia control and for astigmatism correction

The Faculty of Health and Social Sciences at Hong Kong's Polytechnic University issued a press release today on the results from two studies on orthokeratology.  One, called the "ROMIO" study, was a single blind, randomized, controlled clinical trial on the effectiveness of orthokeratology for myopia control.  The other, called the "TO SEE" study, looked at the effectiveness of orthokeratology for astigmatism correction.

Brief description of orthokeratology

Patients who wish to receive orthokeratology must have a thorough eye examination to see if they are suitable for the treatment. The optometrist will specially designed and dispense a pair of rigid retainer contact lenses made from high oxygen permeable material to be worn during sleep. The lens will reshape the cornea resulting in perfect vision the next day without the need to wear glasses or contact lenses.

Orthokeratology is the only non-surgical treatment that allows you to be free of corrective lenses like eye-glasses and contact lenses.


Myopia and its progression is a serious problem.  Not only does it cause progressively worsening eyesight, requiring thicker and more expensive lenses, it increases the risk of serious eye diseases such as glaucoma and retinal detachment which can cause permanent vision loss.

After 24 months of research, the ROMIO study found that the increase in eyeball length (also called "axial length" -the progression of myopia is measured by observing the elongation of the eyeball)  in a group of subjects that were treated with orthokeratology was 0.36mm.  In the group that was not treated with orthokeratology and only wore spectacles, the eyeball length was 0.63mm. The results indicate that orthokeratology slowed down the progression of myopia by 43%.


Researchers at the same university also concluded the "TO-SEE" study which looked at 37 children aged 6 to 12 years to study the potential of orthokeratology for the reduction of astigmatism. The team found that toric design orthokeratology lens retainers effectively reduced astigmatism by 79% after one month of wear. At the end of 24 months, the eyeball length of the participants was 0.31mm which indicated that myopia was also being controlled.

Orthokeratology is a reversible treatment and can be stopped anytime. The results of these two studies show that orthokeratology is a safe and effective solution for refractive error correction, myopic control and astigmatism reduction.

I posted about the dangers of the myopia epidemic here.

Monday, January 9, 2012

Larry Fitzgerald "eyes" superbowl victory

I came across a transcript of an interesting story on NPR involving Larry Fitzgerald and a couple of eye doctors who were talking about the superiority of Larry's vision and the role that vision therapy played.  At the end of the story was this comment, which confirms that vision therapy has now become standard in professional sports.

What actually has become routine are the drills that Fitzgerald's grandfather developed [Larry Fitzgerald's grandfather was an optometrist]. Today, aspiring athletes, even those with 20/20 vision, are given a regiment of eye exercises. So, in 15 years, there may well be a generation of wide receivers who can see as well as Larry Fitzgerald. Of course, there will also be a generation of defensive backs to thwart their efforts. 
To read the transcript (which is short and snappy), click here.

Vision therapy helped the most exciting player in the NFL

Recently I met an interesting guy who played professional football in both the National Football League and the Canadian Football League.  Teams in both leagues were using vision therapy to improve the performance of their athletes.  Vision therapy is used, among other things, to improve visual processing, eye tracking and eye-body coordination so its no surprise that it is considered valuable in professional sports.

In fact, "the most exciting receiver in the NFL", according to the wall street journal , credits his success as a star receiver to the vision therapy he had as a child.  To learn more, read the WSJ article linked to above or this story from Marketwire.

Thursday, January 5, 2012

Health warning on eye drops

This is a re-post of a glaucoma related topic I addressed last year. I'm posting it again in honor of glaucoma awareness month.  It highlights just one of the ways that glaucoma can sneak up on an unsuspecting patient.
 I've noticed something troubling lately.  People may be misusing eye drops that contain steriods (usually when prescribed by doctor who is not an eye specialist).  Steriod eye drops need to be carefully regimented and their use needs to be monitored by an eye doctor. They should never be taken "as needed". 
If not used properly, steriods can cause glaucoma - a disease that raises the pressure in the eye, damaging the optic nerve and causing permanent vision loss that starts with the peripheral vision and works its way to the centre.  I've seen this problem in my clinic and it is the last thing that a patient expects.  The only way to catch it before it's too late is to see your optometrist for an eye exam.
There are so many things that can sneak up on your health.  People need to see their doctors (not just optometrists) regularly so that issues like this can be nipped in the bud.  I bet dentists could tell similar stories.  Another point is that doctors shouldn't stray beyond their comfort zone or level and area of expertise.  When in doubt, refer the patient.

Eye drops image courtesy of marin/ 

Online buyer beware - contact lens dangers

A Toronto man bought contact lenses online only to have the lenses peel off the surface of his cornea!

A Toronto Star article reminds people that buying contacts lenses online and without a proper fitting by a Doctor of Optometry can lead to dangerous consequences. Click the link below to read the full article about a young man who developed a corneal abrasion after only four hours of wearing contacts that were purchased online.

Buying contact lenses online can be convenient but now many doctors also offer online buying to their patients following an eye examination and proper contact lens fitting and after the doctor knows that a particular lens is right for the patient.

For example, patients at my office, if they choose, can be registered for our online web-store and log in to order their lenses. Their contact lens brand and prescription are already pre-loaded and linked to their account, so there is no danger of the patient making a mistake and choosing the wrong lenses or inputting the wrong prescription.

Remember that contact lenses are a medical device that can harm you if not prescribed, fitted and used properly.

Another common problem is called neovascularization or the abnormal growth of blood vessels in the eyes of people who are using a lens that is not right for them or over-using their lenses. If left unchecked, this can lead to blindness. Contact lens wearers should have regular eye exams to make sure that their eyes are safe and healthy
A whole host of complications can develop with improperly fitted contact lenses...