'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 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

The eye examination ... what do you see back there?

One of the greatest privileges of being an optometrist is to be able to look at our patient's eyes in great detail, including right through the pupil to the back of the eye.  The eye is an amazing organ with many intricate details which we routinely examine as part of our eye examinations and so often we take our sight for granted, but many may wonder what are we actually looking at back there when we examine the eyes.

Examining the eyes isn't as scary as some may think, especially given the popular myth in the late 19th and early 20th centuries that the eyes somehow recorded what we saw and that if you photographed the eyes of a dead person you could see the last thing they saw (http://en.wikipedia.org/wiki/Optography and http://www.college-optometrists.org/en/college/museyeum/online_exhibitions/eye/optography.cfm).  This popular concept was used as a plot device in some fiction of the time and was even employed as an investigative technique for some actual forensic investigations.

Our digital retinal camera

At Ocean Optometry we are pleased to include retinal photography as part of our standard comprehensive
eye examination* and we use a Nikon DSLR camera back mounted on a digital retinal camera to capture the images even before you see Dr McGinty or Dr Wilson.  These images are seamlessly integrated into your electronic health record at Ocean and will be reviewed with you by our doctors as part of your eye examination.

Here is an example of one of our digital images:

Digital Retinal Image - Right Eye

You can clearly see some very important structures in the eye, although on first glance it may resemble more the appearance of Mars or the Sun towards sunset.  The salmon pink colour of this photograph shows a nice healthy retina, with the blood vessels overlying the retina.  The lighter/thinner blood vessels are the arteries, which supply oxygenated and nutrient rich blood to the tissues.  The darker/thicker vessels are the veins which take the blood back to the heart.  The vessels branch out from a single point, with smaller and smaller branches, nicely resembling a tree in appearance.

In the lighter pink areas, almost yellow, the retina is light enough that the underlying blood vessel structure is visible.  This is from the white of the eye, right round at the back of the eye!

The point where the blood vessels enter and leave is also the point where the optic nerve leaves the eye to take the information to the brain about what we are seeing.  This is the optic nerve head or the optic disc and creates the natural blind spot in the eye which we all have.  Careful examination of the optic nerve head is very important to help to assess for the presence of glaucoma.  Using digital photographs as part of our eye examination allows for careful comparison in appearance of the optic nerve head between visits to help detect change over time.

Central in the picture is a darker area, called the macula.  The macula is the area of greatest sensitivity of the retina, it has the highest density of light receptive cone cells present, the highest density of pigment underlying the macula and has a very rich supply of nutrients provided through the underlying vessel structure.  Unfortunately, if this area is damaged the impact on our quality of vision can be significant and this is why regular assessment to look for signs of diseases such as Macular Degeneration is important.

One final feature we often get asked about when we are discussing the retinal images is "what is that bump/lump in the top right corner?".  This is a historical feature in retinal photographs and is always in the top right corner as a way of saying "This way up!".  Prior to digital photography, retinal photographs relied upon either 35mm slide film of polaroid film to capture the images, once printed a photograph could be rotated and with slide, flipped even, which could lead to confusion over the area of the eye you were looking at or if you were looking at a right or a left eye.  So don't worry about the bump, we want it to be there!

* There is a $25 co-pay for digital retinal photography for MSI paid eye examinations.

Quality ensured using our Nikon camera