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

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