The eye examination photo series - Part 1

We are always looking for new ways to share what we do at Ocean through our social media.  To kick off 2015 with a blend of style and information, one of our optometrists and owners, Dr. John Wilson, decided to create a series of Instagram images showing the eye examination in 10 steps.

We've already talked about what a comprehensive eye examination involves (see blog here), bringing it to life with pictures is lets us share it in a whole new fashion!  Great thinking, John.

Let's take a look at the pictures and give a little more detail as to what is going on.  This first series of pictures involves the steps that go together for our preliminary assessments.

Auto-refractor/keratometer

This machine may appear a little scary, however, there's really nothing to it.  We get you all lined up, one eye at a time, so that you see a picture.  The picture helps the eye to focus into the far distance, so usually they have images with items on the horizon, like hot air balloons or houses.  Once it is completely aligned you may see the image go in and out of focus as the instrument goes through a series of steps to gain a complete reading.

The information the instrument provides is an estimate of the focus of the eye and a measurement of the curvature of the front surface of the cornea.

The next instrument, the tonometer, is perhaps the one most people have concern over.  The tonometer measures the pressure of the fluid in the eye using a gentle puff of air.  It is definitely not sore or uncomfortable, however, our natural reflexes make the air-puff seem like quite the surprise.

Non-contact tonometer

It is important for us to measure the pressure of the eyes as part of providing a comprehensive assessment of the overall eye health.  For those that are really squeamish, however, we do have another technique for assessing eye pressure - just let us know.

The last of the trio of instruments used in our preliminary assessments is the digital fundus camera.

Digital Fundus Camera

This last step is very straightforward, just keep looking straight at the flashing light, keep your eyes nice and wide open and we'll take photographs of your retinas.  These pictures provide a great way to both initially  view the retina and also to monitor the health of the retina over time.

At each eye examination we can compare the newest retinal photographs with previous ones on file, either side-by-side or even overlaying them one on top of the other.  We also have filters and effects which can be used to enhance the images to assist with interpretation.

One last great feature of taking retinal images, that we love, is that it gives our optometrists the ability to show you exactly what they are looking at when they are examining the back of your eyes.

If you have any questions about any of these steps during the eye examination, do not hesitate to ask.  Both Dr. John Wilson and Dr. Euan McGinty are very keen to make sure that you have an excellent experience when you come in to Ocean Optometry.  Taking time during their eye examinations is definitely something that they will do.

If you are reading our blog and thinking, "Hey, I need an eye exam." then we would be honoured to take good care of your eyes.  You can call us directly on (902) 446-4470 or use this link.

To check out our Instagram feed, just click on the logo!

Ocean's Instagram

'Tis the season!

Seasonally named eye conditions!

We're sure that you've come to recognise our optometrists, Dr. Euan McGinty and Dr. John Wilson, are eye geeks through and through.  So for this holiday season, our eye guys thought they'd share some seasonal naming quirks for eye conditions!

All of these are real eye conditions ... well ... almost all, for a bit of Christmas fun we're throwing in a fake one - let's see if you can pick out the fake one.

1- Christmas Tree Cataract

Usually cataracts are a haziness or discolouration of the natural lens inside the eye, which sits just

Christmas Tree Cataract - (image Medscape)

behind the iris.  They can look foggy or smokey to look at and can cause a similar effect on our vision.  Christmas Tree Cataracts are slightly different, this cataract tends to form highly reflective particles in the eye, which significantly bend the light or refract it.  These refractive and reflective properties give the cataract a highly coloured, iridescent and sparkly appearance which is where it gets its name from.

Similar to other cataracts, we would monitor this for its affect on your vision and look for associations with medical conditions.  While it is very pretty to look at, its affect on your vision would depend upon how significant it was in size and its location in the lens.

2 - Frosted Angiitis

This uncommon condition gives an distinct appearance to the blood vessels at the back of the eye and can unfortunately lead to significant degradation in the quality of vision.  Perhaps due to its rareness, the cause can sometimes be a mystery (idiopathic); however it is thought to be associated with an immune response from the body.

Frosted blood vessel appearance

3 - Rudolph Vasculature

A normal and healthy eye, which has a slightly unusual presentation in the blood vessels entering and

Classic Rudolph Vasculature presentation

leaving the optic disc at the back of the eye.  The optic disc is the natural blind spot at the back of the eye, where there are no light receptor cells.  At this point the optic nerve leaves the eye to carry the nerve pulse signals to the brain and where the blood vessels enter and leave the eye.

In Rudolph Vasculature the blood vessels all leave going upwards, giving the appearance likened to the antlers of a reindeer, and due to the twisting of the blood vessels there appears to be a "red nose" in the center of the optic nerve.  No known side effects are associated with this condition.

4 - Snowball Vitreous Floaters

Snowball floaters (bottom-left) - (image Optos.com)

Floaters are not an uncommon finding and often we can be aware of them in particular lighting conditions or against blank backgrounds - a white wall or a blue sky.  As floaters can also be a sign of activity in the eye, they definitely should not be ignored and if you experience new floaters always arrange an appointment for assessment without delay.

Snowball floaters are usually inflammatory cells, which are white in appearance, and occur in a condition called Pars Planitis.  The presence of floaters may actually be the only symptom of this condition, which is generally benign and may only cause a small effect on vision, if at all.

5 - Macular Star

Macular Star (yellow star to the right) - (photo EyeWiki)

The macula is the central part of the retina, which is the most sensitive area responsible for fine detail and colour vision.  When we talk about seeing 20/20 vision, it is this part of the retina which is working for us.

A Macular Star forms due to leakage of lipid rich fluid leaking from the blood vessels into the tissues of the retina, often forming a classic star pattern around the macula. 

If seen, it is important to try to identify the cause, although sometimes the cause is unknown.  It can be related to hypertension or to nerve inflammation.  The nerve inflammation, when caused by infection, is most commonly related to cat-scratch disease.

Thankfully, for most of these conditions, they are quite rare to see!

Click here to give your choice as to which condition is our "Christmas Cracker"

This will be our last blog until 2015, we do hope you are enjoying them.

Many thanks to all our friends, followers, supporters, customers, patients who have made 2014 such a fantastic year for Ocean Optometry - we can't wait for 2015!

Happy Holidays from all at Ocean!

What's scary about choosing eyewear?

We have many wonderful interactions with people coming in to Ocean Optometry to look for eyewear, but in the eighteen months since we have opened we have come to realise that perhaps we do things a little differently!  I'm not sure if it's right or wrong; better or worse ... it's just how we do things!

Then I remembered - we have a blog!  What a perfect vehicle to explain how we do things here at Ocean!

So here's some things to be aware of:

1 - We don't bite!

Seriously, we don't!  I know some people are concerned about asking for help - perhaps we will pounce on them?  We won't!

Mike, our optician, going through frame options with Stuart

We always try to make sure that when you come in to Ocean you are acknowledged, even if we are busy.  It's nice to be acknowledged.  We may even strike up a conversation, and that's just being polite.

If this is your first time visiting Ocean, we will explain a little about the collections of eyewear that we carry and give you a brief idea of the layout.  This lets you get a feel for the lie of the land.  Some people at this stage will want to then have a look unaccompanied, and we will always respect this.

It's fun to be able to try on different frames, without feeling that you are being watched.  One thing to be aware of, though, is we have hundreds of frames to choose from and it can all get somewhat overwhelming.  This is when having expert assistance in selecting eyewear comes in to its own, and that may not be the family or friends that are with you!

Hana falling in love with an Activist frame

At Ocean we are expert in choosing the right frames for you both in terms of form and function.

The frames have to look fantastic and be just what you are looking for, but they also have to work with your prescription.

Especially with frame ranges like TD Tom Davies where we can make a one-off frame completely from scratch just for you, having expert advice is invaluable.

We are sure you won't regret letting us help you choose your eyewear!

2 - There are no boys and girls!

We don't have our frames displayed by "gents" and "ladies" or male/female; boys/girls ... however you want phrase it!  These are collections of fine eyewear, not washroom selections!

The collections of eyewear that we carry all have unique characteristics - this is one of the advantages of working with independent eyewear manufacturers.

The frames selections that we have are not mass-produced homogenized product with a brand label stuck on it through a licensing agreement.  The eyewear collections are all hand made, often in small production runs, by artisan craftsmen with years of skill, knowledge and tradition.  They are producing styles created by designers who are the very cutting edge of eyewear fashion and the creators of the trends that others follow.

Eyewear by collection

Often you may hear terms like "designer eyewear" and it has become, in many ways, an overused and somewhat meaningless phrase.  What would perhaps be more correct would be "brand eyewear" or "label eyewear", where an eyewear manufacturing company has either bought a company for its brand, or has bought the licensing rights for a well known brand.

These frames are then designed in house, produced by that manufacturer and using the added strength of the brand attraction.  In many ways, what was originally attractive, inspirational or unique about a particular brand may no longer be true.  Eyewear brands such as Oakley and Ray-ban are no longer manufactured by the original makers, but produced by the same company.  If all that is important is the brand, and this may indeed be the key feature you are looking for, then you will be satisfied with your purchase.  At Ocean, however, we would rather pay for quality than a name!

Having definite collections to choose between allows you to really get a feel for the different eyewear ranges, so have fun exploring to find out what appeals to your senses.

3 - Is your eyewear exclusive or one-off?

Well, yes and no!

Hand made, embedded with French lace

If we design a Couture TD Tom Davies frame then it's definitely a one-off frame. Some of our frames are made from or incorporate natural materials, so they are definitely one-off frames, you will never find exactly the same colouration or patterning again.

When we choose our frame ranges, we like to offer something different.  Generally we are the only office within the Maritimes to carry any of the frame lines we do, in fact, there may not be anyone east of Toronto with the frame collection, perhaps even all of Canada!

SALT. are handcrafted in Japan

As the frame collections are hand made in limited production runs it is also important to remember that it may not be possible for us to order in a frame again.  When we do order eyewear, we don't like to repeat frames models and colours, we always like to have fresh and new selections to pick from.

We do advise people looking at our collections of this, and perhaps some think this is just a sales gimmick, but we can assure you it's not.  If someone comes back in and asks us for a frame which has already been chosen, there is nothing that we would love to do more than sell it again - that makes our lives so much easier!  There can be huge element of disappointment, though, to find out that the frame you set your heart upon last week has now gone.

Our best advice is if you find something you like, go for it!

This way you avoid any chance of disappointment.  It is not feasible for us to put frames aside, this would not be fair on other people coming in to look for their new eyewear.

Drift - handmade with reclaimed wood from sailing ships

If we are able to order in a frame which has gone, it is useful to remember there may be additional costs due to single piece shipping/customs charges.  With hand made products, we also find that there can be slight variations even when we receive the same model/colour again - this is part of their beauty.  If a patient has also requested that we do not re-order a particular frame we will also always respect that.

What's the take home message?

1. Choosing new eyewear should be a fun experience, let us help you and it definitely will be!
2. Find out about the different collections, knowing the history behind them make appreciating the design elements all the more significant.
3. Don't be a commitment-phobe!  If you find eyewear that you like, then make that decision and order them.

We will always give our honest opinion when you are choosing eyewear as we want people to love you in your new glasses - that way they will ask you where you got them from!  It's not all about you, after all ;-) !

Mark coming down to his final choice!

What exactly is a comprehensive eye examination?

When you schedule your eye examination at Ocean Optometry, you can be sure that we are going to take very good care of you and your eyes.  Many people may wonder what is involved in an eye examination and may even be a little nervous about it, so let's try to demystify it a little.

We have designed our comprehensive eye examination to be a flexible approach to gathering a range of baseline measurements to best assess the health of your eyes, the best focus for your eyesight and lifestyle and to provide an opportunity to address any concerns that you may have.

To begin with we will ensure all of the basic information that we have for you is correct, for example your address and contact information and then we will take preliminary assessments prior to your time with one of our optometrists.

There are three main instruments that we currently use for our preliminaries: auto-refractor/keratometer; non-contact tonometer and the digital retinal camera.  This gives a range of information which is useful to gather for most people.  We tend not to use the auto-refractor/keratometer and the non-contact tonometer on people less than 20 years of age as it is not the most reliable way to gather this information on younger eyes.

When we gather any information as part of our eye examinations we want to ensure that the information is good quality information and we want to ensure that there is a real need/reason to gather this information.  Perhaps this is a good example, at a simple level, of what we mean by having a flexible approach.  There is little benefit in doing tests for the sake of doing tests, we are not interested in merely performing the test, but in the information that we gain.

Once the preliminary assessments are carried out, you will be introduced to whichever optometrist is scheduled to see you.  Optometrists Dr. Euan McGinty and Dr. John Wilson are not only our optometrists, but also the owners of Ocean Optometry.  With over 30 years experience in the whole "testing eyes thing", they both have a wealth of experience and knowledge to draw on, however, they are not your stuffy/bossy doctors, so feel free to call them Euan and John.  We're pretty relaxed here!

The first thing our docs will do is review all of the information so far and then have a chat about why you have come in for the eye examination, finding out if you had any specific issues needing addressed or have any specific goals that you'd like to achieve.

From here on in, things are really going to get personal!  We will generally ensure that we assess the quality of your vision and find the optimum focusing requirements for any spectacle lenses you may need. (refraction) We will assess the alignment of the eyes, the way they work individually and as a pair (binocular vision).  At times, however, this may not be appropriate to do at this visit and we will discuss this with you as well.

During your appointment we will also carefully assess the health of your eyes.  We will look at the front of the eyes under high magnification, all the time asking ourselves questions about how healthy they look? Are the eyelids working properly? Are the front tissues quiet and clear?

We will then carefully review the internal health of your eyes, looking at the crystalline lens, the fluids inside the eye and right back to the retina and the optic nerve head.  If this is your first eye examination with us we will be looking to establish baseline assessments for all of these features and considering if the appearance falls within the expected normal variations found within healthy eyes.

If it is not the first eye examination we will further consider how this compares to previous visits and look for any signs of change which could indicate any abnormalities with the eyes or even with your overall general health.  There are also indicators linked to neurological assessments which will be reviewed when we are examining your eyes - for example do the pupil reactions function normally?

Once we are satisfied with all of our findings, we will make appropriate notes and then discuss all of our findings with you, where possible sharing the findings with you when we can review it with our digital instrumentation.

We will make sure that any concerns that you came in with are addressed, that we have discussed any issues that we may have found during our examination and answered any questions which you may have.

Once we are sure that all of the i's are dotted and the t's are crossed, all concerns and questions are covered we will then conclude the eye examination and advise when your next eye examination is recommended.  If it is within a reasonable time we will in fact schedule the appointment there and then, so we know that the clinical time has been set aside for you (don't worry, we can always re-schedule down the line if we need to).

What many find surprising, however, is that John and Euan will then accompany you either to help you choose frames, or to discuss your spectacle requirements with our optician, Mike, or to make sure all matters are taken care of with our front desk.

Even beyond this, though, if you go home and think "Oh, I wish I had asked this ..." then please send us an e-mail, contact us through our website, call us or drop in.

We like to consider that once you choose Ocean Optometry to take care of your eyes, then we're going to take care of them exceptionally well and for a long time.  It's not just about a quick "one/two"; "better/worse" rapid appointment every couple of years, or whenever you remember!  We'll be your go to resource for all things eyes and eye-related!

For further information about our eye examinations, please visit this section of our website: http://www.oceanoptometry.ca/index.php/the-collections/the-examinations

Dry Eye - an interview with our optometrists

Dry eye complaints are something both our optometrists, Dr. John Wilson and Dr. Euan McGinty are seeing more and more of in their day to day consultations.

With people spending more time doing visually intensive tasks, working on computer screens for extended periods and working in environments with controlled atmospheres which are often dry, it is perhaps not surprising that it is becoming an increasingly common complaint.

Therefore, we decided to quiz our doctors a little further about dry eyes.

"While the symptoms of dry eyes can be very frustrating", John says, "the clinical issues associated with it can be equally significant.  A dry eye can often be a compromised eye and therefore more vulnerable to infections or even scar tissue formation.  These both can further complicate the picture and early intervention to provide long term management really is key."

"If you suffer from dry eyes, which can often be recognised through its signs and symptoms, then it is important to have it properly assessed so that we can give you the correct advice specific to your condition."

"This is important", Euan adds, "not all dry eyes are the same.  From that point of view we often have people whose symptoms can range from a burning/gritty sensation, an itchy sensation, to just some discomfort.  What is surprising is we also have patients whose eyes are watering, they can find it strange when we start to talk about 'dry eyes'."

"Looking at the eyes, patients can present with red eyes or inflammation of the tissues of the eye and eyelids, at other times the eye looks quiet and healthy, but the symptoms are all there.  From this point of view dry eyes can be an incorrect label, really we are talking about the tear film not functioning properly."

"When we are performing a dry eye assessment we will be looking at all of these factors, taking into account the symptoms, the appearance of the eye and the tear film and the quality and quantity of tears present.  This will help us to arrive at a care plan which is individual and appropriate for each patient."

"I can't agree more", adds John.  "This really isn't a one-size-fits-all type condition.  With an appropriate manage plan, the condition can often be turned completely around.  It does take effort and commitment from both the patient and ourselves, especially in the early days and weeks.  When we review patients and compare their initial metrics to those after appropriate management, the improvements can be marked."

"This can translate into real world differences, not just in their comfort, but also in their quality of vision."

We asked, is there any general advice which could be helpful?

Euan replied, "It's hard to be general, but there are some things which I do keep going back to.
 Firstly, not all artificial tears are the same.  It is important to find one which works well for you, although I would say that preservative free artificial tears are generally all better than others."

"There may be an element of trial and error to begin with, however, my go-to artificial tear at the moment is one called "Hylo".  This contains an excellent agent for nourishing and protecting the eye, Sodium Hyaluronate, which is found naturally in the tear film.  It comes in unique bottle allowing it to be both preservative free and usable for up to six months from first opening."

We have found this to be so successful we have decided to stock it in our office to make it easier to find, it is available at pharmacies and drug stores, however, some patients did comment that it was difficult to find.

As Hylo is preservative free it is also suitable for contact lens wearers to use, even with their contact lenses in.  So if you find that your contact lenses dry out your eyes or have difficulty in handling your lenses at the end of the day, this may just be the solution you are looking for.

"There are two things I keep coming back to as well," responds John, "Omega-3 fish oils and an eye mask"

Dr. John Wilson using a Thera Pearl Eye Mask

"The Omega-3 supplements have been shown to be useful in helping manage dry eye conditions, it is important to choose the fish oil, however, and not the flax seed oil (which may have other benefits).  There are certain things to look for, so a little research is definitely useful to ensure it will fit in with your needs and lifestyle."

"Eye masks are a great resource for patients with dry eyes.  We recommend the Thera Pearl eye mask and again have decided to always have it available here at Ocean, as we were so impressed.  It can be used for both warm compresses, to help open up the meibomian glands and improve their function, and cold compresses, to help calm down an angry and inflamed eye.  I have been so impressed with this simple product that I have one at home for myself to use!"

John concludes, "While this advice may not be for every patient, it may be beneficial for many patients and, at times, I do wonder if we should all be performing eye-lid cleaning and warm compresses as part of our daily routine, like brushing and flossing our teeth."

One final piece of advice from both or our optometrists: Don't forget the 20/20/20 rule - for every 20 minutes you are using your computer (or tablet/smartphone) you need to look at something 20 feet away for at least 20 seconds.

If you have any concerns about dry eye, please feel free to make an appointment.  The first step is a comprehensive eye examination to rule out other factors and then, if appropriate, we can schedule a dry eye assessment appointment.