Eye FAQs

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What am I getting from these places selling complete glasses for $69?

"You get what you pay for". We've all heard this before, and when it comes to your eye care and glasses, it can't be more true. More and more these days we are getting bombarded with ads from large optical chains, whether over Facebook or during the instant replay watching the hockey game. These chains are rapidly expanding across the Canadian market with the general hook: get into complete glasses starting at $69. But what are you getting? Over the past 2 decades there has been an exponential improvement of lens technology, initiated by the invention of "freeform" lenses by researchers at Zeiss in 1996. This technology allows for a significant reduction of peripheral distortion and aberration through the outer aspects of the lens to greatly improve field of view and visual comfort, especially in progressive lenses, high Rx's, or for astigmatism correction. Associated with this technology is a greater cost to manufacture the lenses which then translates to a higher retail price. Companies offering complete glasses for under $100 generally don't employ freeform lens technology and can buy the older technology of low index spherical / aspherical lenses for pennies on the dollar to create huge margins for retail. Add these lenses to frames built in bulk overseas with inferior quality control and no warranty, and selling a pair of glasses for $69 in bulk can still generate profits. A lot of us have quite simple prescriptions, for example low myopia (near-sightedness) without a lot of astigmatism or only need some magnification for reading. The older technology of lens design is adequate (but still not great) for these prescriptions, which is why many offices such as ours offer frame and lens packages similar to the big chains; however, we don't take a blanket approach to selling these lenses because inevitably there is a large proportion of people with more complex prescriptions expecting to see perfectly clear with this outdated technology, leading to high returns and remakes. Just some food for thought when deciding whether to go with the larger chains for your eye care or to support local, where we treat you like family and have every option from the very basic to the very best to suit your style and budget.

Can any certain vitamins help improve eyesight or eye health?

Vitamins are crucial for the health of the eye. As we get older, waste products from our metabolism that float around the blood stream accumulate in the eye, specifically the macula. Over time, these age-related waste products form drusen, a hard substance full of complement proteins, free radicals, cholesterol, and much more. Eventually these waste products cause the retinal tissue at the macula to start dying, leading to central vision loss from age-related macular degeneration (AMD). Current research shows that a mix of antioxidants studied in the Age-related Eye Disease Study 2 (AREDS2) is clinically proven to slow down intermediate and severe forms of dry macular degeneration. This formulation, marketed as Vitalux, includes powerful anti-oxidants such as lutein, zeaxanthine, Zinc, Copper, Vitamin C and Vitamin E. It must be noted that Vitalux is not recommended to be taken unless you have AMD, and what we educate most patients on is to target your diet to include foods that have these anti-oxidants such as green leafy veggies, spinach and kale; and there many other foods such as blueberries that contain powerful antioxidants not on this list. Omega-3 found in fish oil, with a ratio of 200mg DHA / 400mg EPA, is also suspected to greatly protect the eye from the effects of aging. Lastly, and possibly just as important as taking these antioxidants in your diet, it is critical to stay away from foods high in bad cholesterol and pro-inflammatory markers. Basically, anything that is common sense healthy in your diet will be best for your eyes in the long run.

How can I remove a piece of a torn contact lens from the eye (that I cannot locate)?

It is always best to see an Optometrist for an urgent examination if you’ve had trouble removing a contact or piece of contact from your eye. Similarly, if you have any suspected foreign body in the eye such as a piece of metal or wood, call your local Optometrist to have it removed, they are typically better-equipped to do this than if you were to go to the emergency room (that being said, if there are no eye doctors open at the time you get the foreign body in the eye, don’t wait, go to the emergency room). The Optometrist has a slit lamp, which is a microscope used to clearly see the surface of your eye, and will be able to determine where the piece of contact or foreign body is. Struggling to remove this piece yourself may cause you to scratch the eye.

What causes someone to be nearsighted?

Near-sightedness, otherwise known as Myopia, is typically inherited genetically. If both parents are myopic, then the chance of the child becoming myopic is about 40%, this goes down to 25% if one parent is myopic. Myopia is usually due to having steep corneas or more commonly, a longer eye (or both). The ORINDA study shows that children who spend most of their time outdoors tend to have much less near-sightedness than children staying indoors, but the exact mechanism acting by spending time outdoors is unknown. Similarly, in our digital age of spending more time indoors, the incidence of myopia is rising rapidly across the globe. Recent studies have also shown that peripheral defocus is the culprit in progressing near-sightedness. Peripheral defocus occurs when children are corrected with glasses for myopia and the image is focused perfectly at the fovea for clear vision but the peripheral focal points focusing around the macula actually go behind the retina. The eye then wants to grow longer to focus these peripheral points on the retina, causing the myopia to progress. Zeiss currently makes a spectacle lens called Myovision that combats this peripheral defocus. There are also contact lens options from CooperVision called MiSight that works in the same manner.

How valid is it for an eye doctor to do the refractive testing after dilating the eyes? I felt I could not give good answers to "which is better 1 or 2?" with my eyes in distress from the drops.

Most optometrists have historically done the refraction before dilating the pupils, but with the changing paradigm of eye care over the past couple of decades, the eye health check is now becoming the primary focus of the eye exam over the refractive side. Dilating the pupils at the beginning of the exam ensures the optometrist can have clear views to the retina during the health check, but the dilating drops inhibit the natural focusing system and sometimes this can interfere with the subjective refraction (better 1 or 2). That being said, many optometrist who dilate first have tailored their skill-set to account for the change in focus incurred by the drops and are able to provide very accurate prescriptions regardless of the answers provided on the subjective portion, but it can still be frustrating for the patient. Arguably, both the eye health check and refraction should be at an equal level of importance during an eye exam; this is why at our office we rarely dilate before refracting unless it is indicated. There should always be the option to return on a different day to dilate the pupils if there are time / scheduling constraints against doing the dilating drops after the refraction.

I am 18 and have myopia that is -2.00. How worried should I be that my eyes will get worse?

Typically, the most significant refractive shifts occur during childhood and development, especially around large growth spurts. As we grow the eyes tend to grow also, and has the eye gets longer you become more near-sighted (also known as “myopia”). Myopia usually continues to progress until around 24 years old, give or take; however, any progression past the age of 16–18 is usually minor: -0.25 to -0.50 per year, if any. You may become a little more near-sighted over the next few years but the change usually is not very significant. Also important to note is a lot of people with this type of prescription will consider refractive surgery (LASIK or PRK) in their mid-20’s because this is when the prescription starts to stabilize and there shouldn’t be much regression after surgery.

Is it difficult to get used to multifocal lenses?

Multifocal lens options include progressive glasses lenses and multifocal contact lenses. Progressive glasses lenses are often the best glasses option to correct vision in presbyopes. Presbyopia is a process that occurs to every single person on the planet over the age of 40, when the crystaline lens within the eye starts to harden. This is not an all-and-done process, the focusing system slowly deteriorates over the next two decades, where most people in their 60’s have very little ability to clear out objects at near, except for those who are myopic (near-sighted) and remove their glasses for near tasks. Our new digital age has created the need to see clearly at a lot of different focal points (ie. books, phones, desk-work, computer, room’s length, TV, driving). Progressive lenses are manufactured in a way to induce a “progression of power” from the top of the lens (used for distance tasks), to the bottom of the lens (used for near tasks). This is often the most “functional” solution to be able to perform these ever-changing tasks throughout the day, although there is a loss of “real-estate” looking through these lenses that may restrict comfort for each viewing condition. This is where most people who do not adjust well to progressive lenses run into trouble and require a single vision correction for distance and single vision correction for near/computer (2 pairs of glasses); however, there are significantly more people doing well with progressive lenses than without, it just appears that one only hears about the small percentage who do not adjust well versus not hearing at all from those who are happy with the lenses. Cost and quality of the lens is also an issue when adjusting to progressives: you certainly get what you pay for. Progressive lenses from discount glasses retailers typically do not have a lot of technology in the design, creating a very small optical corridor for each visual task, and a lot of peripheral blur or “fishbowl” effect. As you go higher up in quality (for example, lenses made from Zeiss), the corridor becomes much wider, there is more usable lens for each task, and much more visual freedom.

As for multifocal contact lenses, these are not for everyone and are classically difficult to adjust to; however, there are a lot of people who are quite happy with this correction understanding the vision may not be perfect. Compared to progressive lenses in glasses which sit away from the eye, where you can simply move your eyes to look through the appropriate power on the lens, multifocal contact lenses sit on the surface of the eye making this impossible. Multifocal contact lenses employ a special set of optics, that basically create a multitude of focal points that hit the retina, and the brain then needs to sort through and attend to the focal point which is pertinent to each visual task. There is certainly an adjustment phase in wearing these lenses and distance vision and near vision is never perfect like you can achieve with glasses, but the vision isn’t bad, typically equating more to the resolution you would get with a lower-quality television versus the new 4K TV’s. In these instances, we call the patient “20/Happy”, as multifocal contact lenses provide the patient with functional vision to perform tasks around the office, drive to work, etc. without the requirement of glasses.

After hours of sitting at my laptop or phone, I find that my eyesight has become weaker. Is this temporary or will it be permanent? How can I solve it?

Looking at anything within an arm’s length for an extended period of time does not damage the eyes, but can cause transient symptoms of blur, eye strain, and frontal headaches. All near work utilizes the accommodative (or focusing) system of the eye, which is where the ciliary muscles surrounding the crystalline lens within the eye contract to induce a bend in the lens that then shifts the refractive power of the eye to focus on near objects. The eyes also utilize the muscles surrounding it to converge your vision on the target while we focus on near objects. As with any muscle in the body, the ciliary and extraocular muscles are fatigable and prolonged focusing will induce the symptoms noted above, but these are not permanent. If you are over 40, these symptoms typically become more prevalent and it is recommended you see your optometrist for vision correction options to reduce the workload put on the eyes and improve your overall visual comfort throughout the day.

I am getting LASIK soon. I understand that the procedure allows you to return to work the next day, but what should I expect with my eyes for the first day back to work?

LASIK is a procedure that creates an incision/flap within the cornea. Although the cornea is a clear structure without blood vessels, it is still living tissue and as with any surgery on other parts of our body, there will be inflammation after the procedure. Post-LASIK inflammation is typically minor since it is a laser-assisted procedure and does not create a large wound, this is why you can resume most of your daily activities right after the procedure; however, you may find that the eyes feel dry or scratchy and that it may be difficult to sustain focus on the computer for extended periods. Just be careful to keep the eyes well-lubricated and listen to your body while you’re at the computer, don’t force things if you’re starting to feel strain or discomfort and take regular breaks.

What is the difference between 1.61 and 1.67 lens material?

The most common lens materials used for glasses are all a form of plastic, and the number denotes refractive index: 1.50 (CR-39), 1.53 (Trivex), 1.57 (plastic), 1.59 (Polycarbonate) 1.61 (plastic), 1.67 (plastic), and 1.74 (plastic). Glass lenses are rarely used anymore due to weight and safety concerns; conversely, safety frames will have either polycarbonate or Trivex lenses due to impact resistance of the material. The lower the index, the better the optical quality of the lens (known as Abbe value), but the thicker, heavier, and less cosmetically-appealing the lens will be. 1.61 and 1.67 lenses are classified as high-index lenses, most commonly used with higher prescriptions: the higher the prescription, the thicker the lens. It is usually recommended to use higher-index lens materials for prescriptions over +/- 3.00 diopters. A 1.67 lens will ultimately be thinner, lighter, and more cosmetically appealing than a 1.61 lens. For high prescriptions, you also want to a choose a plastic frame because the frame is thick enough to hide most of the edge thickness and optical distortion.

Is it beneficial to massage the orbit of the eyes every day?

Eyelid massage is an effective way to release the build-up of oils from our Meibomian glands, which are found near the base of the eyelashes. Much of the current research on people with dry eye has shown that these glands do not operate properly, causing an imbalance in the tear film chemistry that leads to higher rates of tear evaporation. As a daily hygeine practice, it is beneficial to use a warm washcloth or place a heat mask over the eyelids for about 3 minutes, followed by a vertical massage (up and down) of the upper and lower eyelids to help loosen and secrete excess or thickened oil from the glands. This allows fresh meibom (the oil secreted from the glands) to be secreted onto the eye and coat the aqueous portion of the tear film, leading to reduced tear evaporation, improved comfort, and more stable vision. It is important to note that there are many different forms and causes for dry eye and the heat and massage regimen may not benefit you, so consult your eye care practitioner first.

My left and right eye is -2.00 and -2.25. Is there any correction or cure to it?

Depending on your age, you would be a good candidate for refractive eye surgery (ie. LASIK or PRK). This surgery has its longest-lasting effect when you have demonstrated very-little-to-no change in your refractive error over the past 2–3 years. The minimum age this procedure is performed is 18 years old; however, the eyes typically continue to change until approximately 25 years old. From 25 to 40 there usually is not a lot of change, and if you fall within this age range and demonstrate a stable prescription, then you are a great candidate for refractive surgery. Over the age of 40, we all begin to have focusing issues from an aging process called presbyopia. People with myopic (near-sighted) prescriptions such as a -2.00 must consider if it is more important to see far without glasses or read without glasses, because if you go for the surgery, then you will require some form of reading prescription (ie. your visual function is essentially reversed). When you hit presbyopia and are having a difficult time reading with your regular single vision -2.00 glasses on, simply removing them will clear out anything within 18–20 inches.

Assuming two people have the same eyesight, if someone is sitting in a dark place and the other in a brighter place, which person has clearer vision?

Physiologically-speaking, the person sitting in the bright space should have greater acuity (ie. clearer vision). Our retinas undergo physiological changes when moving from light to dark, called dark adaptation (which takes 30 minutes to fully occur). The retinal cells are essentially “rewired” in the dark-adapted state to pull out as much light and contrast as possible from the environment. This process does however rely mostly on the rod pathway in the retina, which is more light-sensitive than the cone (light-adapted) pathways, but is only able to detect lower levels of contrast. Conversely, the cone photoreceptors in the retina are very tightly packed together at the fovea, the place where most of the light converges on the retina, providing a higher resolution signal to the brain under light-adapted conditions.

If you tried to have Lasik surgery and was denied due to thin corneas 10 years ago, should you try again?

The technology of LASIK and PRK has become much more efficient and safe over the past 10 years; however, the amount of cornea required to be removed to fully correct the refractive error is still roughly the same. Less cornea needs to be removed with PRK than with LASIK, making PRK a better option for higher refractive errors / thinner corneas. That being said, if the prescription is too high (meaning you need have more cornea removed) and/or the corneas are too thin to safely remove the required amount of cornea for the refractive error, refractive surgery often is not pursued. A common misconception is many people think they need to be fully corrected from the surgery, which is definitely most-desirable, but if you have a very large prescription where you can only see a couple inches in front of your nose without glasses, having refractive surgery to a safe endpoint where (for example) you can now read at a comfortable distance without glasses or work on your computer uncorrected, can be worth it! There are also other options for refractive surgery if you’re not eligible for LASIK/PRK, including refractive lens exchange (same as cataract surgery where they replace the natural lens of the eye) or intacts (a contact-lens-like device implanted between the iris and natural lens within the eye).