SOAP, Beyond Clean! Part 1

Recording a good history of a patient during an examination is the first step to a proper diagnosis. This is why S.O.A.P notes, an acronym for subjective, objective, assessment, and plan, are so important to all health care professions. First, this essential framework of a medical examination consists of noting subjective elements, such as a chief complaint.  These help paint a picture of why a patient is presenting in my chair and include medical conditions, medications in use, smoking status, family and social history. Often I can formulate a diagnosis based on this essential step.

This may not seem intuitive, but effectively utilizing subjective questions can develop a chief complaint that may be vague. For example, many patients present with a complaint of “my eyes are often red”. Red eyes commonly illicit thought of the viral infection pink eye. However, red can signify allergy, dryness, or a host of other infections. Gathering subjective history allows me to determine when and how the redness began, if it is constant or intermittent, occurring in one or both eyes, or if there is a related medical history.  I can then quickly narrow down potential diagnosis.

Another common example is a chief complaint of blurry vision either at distance, up-close or both. During my subjective course of an examination I will review social issues regarding daily use of vision such as driving, reading, and computer use. I proceed to discuss what patients do for a living, often uncovering a 12-hour day of digital device use!

Discovering such facts about a patient’s daily routine exemplifies how this first piece of my examination help me determine which tests I will need to complete to find a diagnosis and treatment.  Watch for the next part of the series SOAP, Beyond Clean! for a look at the objective examination, or the “O” of SOAP.

Blog written with Moamen Rizk, Optometry Intern, College of Optometry ,Western University of Health Sciences

The Future of Glasses?

In recent years, there have been innovations in eyewear aimed at helping those suffering from presbyopia, the gradual inability of the eyes to focus due to age. Presbyopia usually begins starting at around age 40 and can affect anyone, even if you have never worn glasses before. According to the World Health Organization, more than one billion people in the world were presbyopic as of 2005. Current eyewear treatments include bifocal and Progressive lenses, but advancements in technology offer new solutions.

One example is Superfocus, which is based in California. These glasses have an adjustable slider on the bridge that lets you change the prescription from distance to near or anywhere in between. This is accomplished by a pocket of soft silicone between two lenses that changes the shape of one of the lenses, and therefore the prescription. This mimics the movements of the lens in the pre-presbyopic eye. The other lens is removable and can be switched to a tinted lens, for example.

Another lens innovation was called emPower, a line of electronic eyeglasses offered by Virginia-based company, PixelOptics from 2011 to 2013. These glasses allowed the wearer to switch between two prescriptions, near and distance. They could be programmed to react either to a fingertip pressing the temple of the frame or to a downward tilt of the head, which triggered an accelerometer. The lenses consisted of LCD materials between two layers of plastic and when an electrical charge hit the LCD, the molecules realigned and the prescription changed. The near prescription was made up of an oval-shaped area in the bottom half of the lenses that disappeared instantaneously when the distance prescription was triggered. In terms of price, the glasses retailed from $1,000-$1,500. Besides being a costly investment, there were issues with emPower’s optics, electronics and design, and PixelOptics declared bankruptcy in November 2013. Although these particular glasses are no longer being offered, the technology exists and perhaps with some modifications, a similar concept could revolutionize the presbyopic eyewear industry.

We’ll keep our eyes open and report on it here at the BOG Blog when a new prospect arises!

Blog contribution by Lorraine Lopez, Optometry Intern, College of Optometry ,Western University of Health Sciences

Could going to the movies be an indicator to get your next eye exam?

Could going to the movies be an indicator to get your next eye exam?

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In today’s world, 3D technology has become more popular and common in gaming systems, television, and especially movies. Most people are able to enjoy this thrilling experience through its realistic and close-up features. Nonetheless, there are some who find viewing 3D films gives them discomfort or makes them nauseated. According to the American Optometric Association (AOA), viewers who feel the 3 D’s of 3D viewing (Dizziness, Discomfort, or lack of perceived Depth perception) should get a comprehensive eye exam by an optometrists.

Studies indicate that the problem may arise from eye conditions known as amblyopia (a difference in visual strength between the two eyes) or strabismus (the misalignment of the eyes). However, one of the biggest problems with 3D is the inability to accommodate. When we look at something close, our eyes have a “near reflex”—accommodation, convergence, and miosis (pupils get smaller). Convergence occurs when an object is pointed towards your nose. The muscles that control your eyeballs work in sync by rotating them inwards. You can try this by placing your finger 6 inches away from your friends face—you’ll notice that your friend will now look cross-eyed. Accommodation occurs when you are focusing on near objects. These functions are all completely normal in the real world. In a 3D movie however, when we see objects coming towards us, we converge but don’t accommodate—thus only two of the three “near reflexes” are working normally. This inability to perform all three “near reflexes” may cause eye discomfort or headaches.

If these problems continue to persist, one of the solutions may be to get your eyes checked by an eye doctor. Not only can a strabismus or the inability to accommodate  prevent you from watching 3D movies, it can also cause difficulties in other aspects of your life.

Blog contribution by Jeffrey Dang, Optometry Intern, College of Optometry ,Western University of Health Sciences

What are computer glasses?

Do Computer Glasses Help Reduce Symptoms of Computer Vision Syndrome?

Computer Vision Syndrome (CVS) is a condition where individuals who uses computers for a long period of time or in an unfavorable environment generate symptoms that affect their vision. The distance the eyes focuses when using a computer is different compared to when a person reads or looks at a far distance. When the eyes have to focus for a long time at the computer working distance, CVS symptoms may develop because the visual demands are greater than what the eyes can handle. Symptoms include eyestrain, headaches, dry eyes, neck and shoulder pain, and blurred vision. Some conditions that can contribute to CVS are glare, lighting in the environment, sitting posture, and time spent on the computer. Visual conditions like near-sighted, far-sighted, or astigmatism can also contribute to the development of CVS.

One way to help reduce symptoms of CVS are computer glasses. Computer glasses are designed specifically to alleviate the symptoms of CVS by using different lens power, tints, or coatings. Some frames have smaller amounts of optical power to decrease the demand of accommodation (focusing), thus decreasing the amount of work the eyes must endure. Some designs like the ‘wrap-around’ are made to decrease the amount of air current traveling between the frames and the eyes. The goal of these prescriptions is to achieve maximum visual function and comfort while relieving CVS symptoms. According to a study done by Ohio State University College of Optometry, computer glasses showed an 80.7% decrease in symptoms for patients that were presbyopic.

Because computer glasses can help alleviate symptoms does everyone benefit? It depends on an individuals’ visual demands, occupation, eye health and overall comfort that results from using computer glasses.

Blog contribution by Vally Moua, Optometry Intern, College of Optometry ,Western University of Health Sciences

Can Smoking Cause Cataracts?

Cigarettes can have an adverse effect on our health, but not everyone is aware that smoking cigarettes can have a negative effect on our vision. Research has shown that smoking cigarettes can affect our natural lens, the focusing structure within our eye. Damage to the lens can lead to deterioration or opacification, leading to decreased vision, increased glare at night, and decreased accommodative (focusing) ability. Additionally, smoking can lower the amount of oxygen that is able to reach your eye which can decrease tear production and cause dry eye.

Recently, a study was done by a team of researchers in Sweden who wanted to know if there is a correlation between former smokers and their risk for cataract formation. This study followed an approximate 45,000 subjects. They found that men who currently smoke more than 15 cigarettes a day have a 42% greater risk of having cataract surgery than men who had never smoked. For those who have quit smoking for more than 20 years, it was found that they were at 20% greater risk for cataract formation compared to men who had never smoked. For men who had been light smokers, the increased risk of cataract formation fell more quickly after quitting. Their research has shown that the risk of former smokers developing cataracts had decreased to about half 20 years after quitting. According to this study it takes a longer time for the lens to recover with higher smoking intensity.

Importantly, smoking cigarettes will not only affect the smoker, but anyone living in the same household. Today, second hand smoke is considered a Class A Carcinogen. A person who is exposed to second hand smoke is at a greater risk to be diagnosed with tobacco-cigarette related illnesses such as asthma, lung cancer and cataracts.

Blog contribution by NataliaTemboni , Optometry Intern, College of Optometry ,Western University of Health Sciences

Remember the puff?

Just about everyone who has had an eye exam is familiar with the “puff of air test”. It measures pressure within the eye using a puff of air, which can be startling.  People who dread this test will be happy to know that we have replaced it with a new device; our modern Tono-pen is a handheld device, slightly larger than a pen.  This small piece of equipment only requires one eye drop for a quick and painless measurement of eye pressure. The test aides in screening for glaucoma.

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Glaucoma is a group of eye disorders that cause damage to the optic nerve, leading to progressive, irreversible vision loss if left untreated.  Glaucoma is also the second leading cause of blindness in the U.S. according to the American Optometric Association.  The main signs associated with glaucoma are side vision loss, high eye pressures, and optic nerve damage.

High eye pressure is the most common sign, but can be affected by changes in heart rate and blood pressure.  Unfortunately, feelings of nervousness or anxiousness when sitting in front of the “puff of air” machine can cause eye pressure readings higher than normal.  This is why it is so important to have a device that can get readings quickly and easily. The Tono-pen does just that; more accurate measurements are taken over time to determine if your eye pressure is increasing and potentially causing glaucoma.  For more information on glaucoma please visit glaucoma.org or the American Optometric Association.

Blog contribution by Joseph Gray , Optometry Intern, College of Optometry ,Western University of Health Sciences

Putting lazy eyes into the dark?

An eye is considered lazy when vision is mildly to severely reduced. This can be due to a variety of reasons but the most common causes are high prescriptions and crossed eyes. Interestingly it is not the eye that is “lazy”, rather the brain’s vision center. In my practice I do not use the term lazy eye. Instead I use the more appropriate medical term “amblyopia” to describe the eye condition that is prevalent in 2% of the population.

Amblyopia begins early in childhood during critical developmental years. Neuron pathways are forming during this time and what our eyes see (or do not see) affects how good our vision develops. In fact the amazing thing about human neurological development is the ability of our brain to adapt and change according to environmental stimuli. Early in our lives our brain uses input from the environment to form patterns that allow it to be more efficient. Eventually, it loses plasticity and the ability to adjust to new patterns decreases significantly.  In the case of amblyopia, the brain learns to shut out input from an eye with an uncorrected prescription or crossed eye. Traditionally doctors have considered this to be a permanent reduction in vision when not corrected by age 8.

A new solution?

Researchers Kevin Duffy and Donald Mitchell of Dalhousie University recently conducted a study to return the brain back to its early development stages in an attempt to increase its flexibility. They believe this can serve to reset the brain. The study was conducted on kittens with induced amblyopia who were immersed in a pitch black room for ten days. After the ten days vision significantly improved in all subjects! The positive results of the experiments led researchers to believe the treatment may work on children and young adults with amblyopia. However, in order for this treatment to be effective subjects must be completely isolated from light for long periods of time.

The practicality of this treatment is questionable and I am not yet recommending patients to stay in a pitch dark room for an extended period of time.  I am optimistic about the possibility of a brain “reset” and look forward to further developments. I will still maintain that the key to an amblyopia treatment program is to start at an early age while the brain has great plasticity.

Written with Ian Gao, Optometry Intern, College of Optometry ,Western University of Health Sciences

Birth Control Linked to Glaucoma?

Annual eye examinations are recommended for a variety of reasons including maintaining optimum vision, examining for signs of systemic disease and evaluating the effects of prescription medications on the eyes. The latter of these was emphasized recently with a recent study involving women and birth control. In fact, 10.7 million women used oral contraception in the United States between 2006-2008 according to the Centers for Disease Control.

The study, presented at the American Academy of Ophthalmology Annual Meeting, suggests that there is an increased risk of developing glaucoma in women who have been taking oral contraceptives for three or more years. Researchers from several universities, the closest locally being The University of California, San Francisco used data from a 2005-2008 National Health and Nutrition Examination Survey.

3,406 participants over 40 years old were surveyed on their visual and reproductive health followed by an eye examination. The results showed that women who have been on oral contraceptives for 3 or more years were 2 times more likely to be at risk for being diagnosed with glaucoma compared to women not taking it or for fewer years.

While the study does not show a direct link that long term contraceptive use can cause glaucoma, contraceptive use can be a risk factor that patients and doctors need to monitor. This is especially important if other risk factors for glaucoma such as ethnicity, family history, eye anatomy, or medication are present.  Interestingly, other studies have shown that estrogen is linked to the development of glaucoma, which could be why oral contraceptives, which work by altering estrogen levels, is a risk factor for glaucoma.

Contributed by Peggy Zhu, Optometry Intern, College of Optometry ,Western University of Health Sciences

 

Does computer use damage the eyes?

A recent CNN article examines a question I get asked everyday. Does computer use damage my eyes?  The answer to this question will vary depending on how one defines the word damage. The quick answer is NO.  There has yet to be a case of permanent computer related eye injury. There are however a myriad of symptoms that can result from prolonged computer use.

There is a label that has been assigned to a group of such symptoms and it is comprised of headaches, blurred vision, tired and dry eyes. The American Optometric Association encompasses all of these under Computer Vision Syndrome (CVS).  These irritating symptoms can decrease productivity and increase frustration in the workplace. Certainly we may say this is damaging. Decreased productivity is never good for business.

Damage control

When I examine a patient’s eyes, I am looking to uncover potential obstacles to comfortable vision.  This may include being farsighted or having astigmatism.  In other patients I uncover focusing deficiencies or eye muscle imbalance.  Left uncorrected, a patient may experience headaches or blurred vision, so it is important to correct these issues using glasses or contact lenses.  In some instances surgery may be appropriate.  Use of corrective lenses will relieve many symptoms brought on by prolonged staring at the computer.  By refocusing light, these lenses make the screen more clear and a patient can work more comfortably.

A complete eye health examination has yet to reveal permanent damage in one of my patient’s eyes.  I do find that besides blurred vision the most common complaint of computer users is dry eyes. These include superficial punctate keratitis or dry patches on the cornea and a decreased amount of tears in the eye. I attribute this partially to lower blink rates while using the computer.   Additionally many computer users work in highly air conditioned environments which can dry the eyes.

Damaging or not, using a computer for hours on end warrants careful examination of your eyes and the environment in which you work.

New Multi-focal Contact Lens in Spanish soon….

The term presbyopia refers to changes inside our eyes that affect our near vision beginning around age 40. I am excited to introduce a new multi-focal contact lens that addresses these changes, Purvision 2 For Presbyopia.

This is a brand new design and has shown amazing results in studies and in early introduction this year in Europe. Traditionally, the largest obstacle with multifocal contact lenses is to deliver good near vision while maintaining good distance vision. The Purevision 2 For Presbyopia is the latest lens to address this need. Utilizing a 3 zone progressive design it is 22% thinner than its predecessor and provides remarkable comfort.

Early patient studies make me confident that you will find improvement in your visual experience throughout the day whatever your visual demands include. This is especially apparent with night vision. Email me today to discuss if you may be a good candidate for these lenses. Si.