Why You Should See An Optometrist: Your Vision Deserves Professional Care

The Why

Vision is a precious sense, integral to our daily lives and overall well-being. Regular eye exams by a qualified optometrist are essential for maintaining good vision and detecting potential eye conditions early. Despite the importance of eye health, many people overlook the need for regular eye care.

#1 Early Detection of Eye Conditions:

One of the primary reasons to see an optometrist regularly is to detect and manage eye conditions early. Many eye diseases, such as glaucoma, macular degeneration, and diabetic retinopathy, develop gradually and may not present noticeable symptoms in the early stages. A comprehensive eye exam can detect these conditions before they cause significant vision loss, allowing for timely intervention and treatment.

#2 Rx Updates:

If you wear glasses or contact lenses, regular visits to the optometrist are essential to ensure that your prescription is up to date. Vision changes can occur gradually over time, and an outdated prescription can lead to eyestrain, headaches, and difficulty seeing clearly. By visiting an optometrist regularly, you can ensure that your corrective lenses are providing you with the best possible vision.

#3 Monitoring Eye Health:

In addition to checking your vision, optometrists also examine the overall health of your eyes. They can identify signs of eye conditions such as cataracts, retinal detachment, and dry eye syndrome. By monitoring your eye health regularly, optometrists can provide early treatment and management strategies to preserve your vision and prevent complications.

#5 Detecting Systemic Health Conditions:

Believe it or not, your eyes can provide valuable insights into your overall health. During an eye exam, optometrists can detect signs of systemic conditions such as diabetes, hypertension, and high cholesterol. These conditions can affect the blood vessels in the eyes, leading to changes that are visible during an exam. Early detection of these conditions can lead to timely referral to a primary care physician for further evaluation and management. Your eye doctor will put dilation drops into your eyes so they could do a 3D scan to better assess your retina, optic nerve connection, and vasculature.

#6 Children's Eye Health:

Children's eye health is particularly important, as vision problems can affect their learning and development. 80% of our learning is through vision. Regular eye exams can detect issues such as refractive errors, lazy eye (amblyopia), and eye alignment problems (strabismus) early, when they are more easily treated. Early intervention can prevent vision problems from impacting a child's academic performance and quality of life. Myopia control therapy is a new form of treating myopia by preventing the eye from getting worse through therapeutic glasses, contacts, night lenses and eye drops.

schedule an eye exam today

Seeing an optometrist regularly is crucial for maintaining good eye health and overall well-being. From early detection of eye conditions to ensuring that your corrective lenses are up to date, optometrists play a vital role in preserving your vision and quality of life. Don't neglect your eye health—schedule a comprehensive eye exam with an optometrist today. Your vision deserves professional care.

Pandemic and Myopia Progression, Myopia Causes and Control Options

The Problem

COVID-19 has made learning from home the new norm. With schools moving to online learning, that also means children are spending upwards of 8 hours every day in front of a computer screen in a fixed position. In addition, adults working from home for all types of jobs have increased the need to work longer hours in front of screens. I have observed an increase of myopia of upwards of 100% increases (doubling) in my practice for young adults and children.

Myopia Prediction: Now and 2050

Adapted from Holden et al. 2016. Ophthalmology.

Myopia (near-sightedness) is a common eye condition where an individual cannot see far but can see near. Light bends and focuses in front of the retina instead of on the retina, resulting in a blurry image.

WHY?

Myopia increases risk for severe eye diseases

Adapted from Flitcroft DI. The complex interactions of retinal, optical and environmental factors in myopia aetiology. Prog Retin Eye Res. 2012.

You can see from the chart above that having mild myopia (-1.00 to -3.00) can more than double your chances for severe eye diseases. Moderate myopia (-3.00 to -6.00) can 3-9x increase your chances for severe eye diseases. High myopia (over -6.00) can severely increase your chance of severe eye diseases which can cause long-term damage to your vision. Preventing your eyes from increase can have life-changing vision results.

Myopia Risks for Progression

There are several factors that can cause myopia progression including:

1. Genetics (family history, ethnicity),

2. Individual Characteristics (age, eye profile, and health),

3. Eye Efficiency (eye alignment, eye muscles, and eye teaming), and

4. Environmental Factors

We will briefly explore the different factors below.

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Genetics

Studies have shown if one parent is myopic, it increases the risk of their children being myopic by 3x, and if both parents are myopic, it increases the risk by 6x and increases the chance of greater progression to high myopia. In addition, the risk for myopia is also higher for first-born child than for the second.

• 1 Myopic Parent ➤ 3x Risk

• 2 Myopic Parents ➤ 6x Risk + greater progression to HIGH MYOPIA

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ETHNICITY

East /South-East Asian ethnicity has a greater chance of developing myopia, which shows in their prevalence up to 69% by age 15. Particularly Singaporean-Chinese up to 86%. Black Africans had the lowest prevalence of 5.5% by age 15. In general, children of mixed, Hispanic, Asian, and white ethnicity progressed more than African American children.

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Eye Profile

Onset of myopia before 6 years old with less than +0.50 D, and a progression of -0.75 or more in a year is a risk factor. A 0.5mm increase in axial length correlated with 1D of increase of myopia.

• Myopia before 6 years old ➤ 6.6X RISK

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Eye Efficiency

How the eyes work together and positioning of eye muscles can also predict myopia progression. Studies have shown an increased accommodative lag and esophoria / convergence excess may predict myopia progression.

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ENVIRONMENT

Our environment and lifestyle can influence myopia progression as well. Studies have shown that constant near work (3+ hours a day) along with decrease outdoor activity has caused an increase in myopia progression. With lockdowns in place along with online-learning, children are spending more time in front of screens with less time playing outdoors. The risk also increases for families living in urban cities than in rural, up to 2.6x more progression.

• Spending less than 1.6 hours a day outdoors ➤ 2-3X RISK

• Living in urban vs rural ➤ 2.6x risk
  
  
  

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The Solution

Now you know your risk factors and causes of myopia progression. We can start by changing your lifestyle and environment for prevention. Speak to your Optometrist to find out how to slow down myopia.

We know that spending 90 mins of outdoor activity daily is essential for eye and health development. You can break these into two (45 min) or three (30 min) sessions throughout the day.

Take a break every 20 mins of screen time for at least 10 minutes.

Children should study in well light rooms that are larger with natural lighting.

Computer screens should match the brightness of the room and not contrast it. I.e. do not work in a dark room with a bright screen.

Eat healthy diet rich in high antioxidants including lutein and zeaxanthin and omega-3: dark greens (spinach, kale), fruits (blueberries), and omega 3 (eggs and fish).

Consider Myopia Control Therapy

Optometrists now have various tools to control myopia. The risk of high myopia not only changes your child’s life choices but also increases their chance for severe eye diseases later in life that could visually affect their quality of life. Glasses is not the only option now for correction. We can now correct and prevent further progression. Here are some of the options your optometrist may explore with you:

1. Soft Contact Lenses for Kids ➤ up to 59% reduction

2. Myopia Control Eye Drops ➤ up to 30-66% reduction dosage dependent

3. Myopia Control Glasses ➤ up to 20-59% reduction, dependent on lens type

4. OK Lenses ➤ up to 43% reduction

5. Combination Treatment
   

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Studies

• Global variations and time trends in the prevalence of childhood myopia, a systematic review and quantitative meta-analysis: implications for aetiology and early prevention (2016)

• Relationship of age, sex, and ethnicity with myopia progression and axial elongation in the correction of myopia evaluation trial (2005)

• Defocus Incorporated Multiple Segments (DIMS) spectacle lenses slow myopia progression: a 2-year randomised clinical trial (2019)
  
  
  

First Look: AQS Launches Evolve Dry Eye Drops in Canada

First Look

Officially Launching in Feb 2021 in Canada, Aequus Pharmaceuticals Inc. (AQS) with partnership with Medicom Healthcare Inc. are rolling out their two Evolve preservative-free eye drop lines exclusive to Canadian Optometrists and Ophthalmologists: Evolve Daily Intensive and Evolve Intensive Gel. It is great to see new products entering the Canadian market place for dry eye. Dry Eye Disease (DED) affects approximately 6.3 million Canadians, representing approximately 21% of the population. Let’s take a look at the two and how they stack up to the competition:

Evolve Daily Intensive

• 0.2% naturally-sourced hyaluronate (HA) with high molecular weight (HMW)

• Other ingredients: sodium chloride (to adjust pH), boric acid (pH buffer/antiseptic), borax (pH buffer), water

• Borate Buffer

• For Mild-Moderate Dry Eye, 360 drops

Evolve Intensive Gel

• Unique formulation in Canada (branded as Revive in international markets with a different bottle and packaging)

• Triple action formula: 0.2% HA (natural) + 0.2% Carbomer 980 + Glycerol

  • HA promotes healing, improves optical quality and retains moisture.

  • Carbomer 980 has cross-linking ability, retains water and increases viscosity and molecular weight.

  • Glycerol retains moisture, promotes cell growth and blunts high osmolarity

• Buffer-free

• Other ingredients: sorbitol (viscosity agent), sodium chloride (reduces corneal swelling by increasing hypertonicity), sodium hydroxide (to adjust pH), water

• For Moderate-Severe Dry Eye, 350 drops

Both features:

• Preservative-free and Phosphate-free

• 3 month sterility after opening

• Easy squeeze bottle design with antibacterial silver-ion blue tip for aiming and protection

• Contact-lens compatible, Non-blurring

WHICH IS BETTER FOR YOU?

Source: AQS EVOLVE

What’s the difference between GLYCEROL vs GLYCERIN?

Actually, both names are for the same molecule; however, Glyercin is the commercial name of Glycerol, which is not pure and contains at most 95% of glycerol. Evolve’s Intensive Gel uses a pure glycerol and is also buffer-free.

Source:

• https://www.globenewswire.com/news-release/2020/10/19/2110377/0/en/Aequus-Receives-Approval-for-New-Evolve-Intensive-Gel-Lubricating-Eye-Drops-in-Canada.html

3 Steps you should take to treat eyelid bumps: Chalazions & Styes

Chalazion vs Stye

A Chalazion is simply a lump or bump that develops on the eyelids from a blocked eyelid gland. It is generally not infectious. It often starts red and swollen pea-size lump that is painless. A stye (or horodeolum) is infectious. It is often painful and swollen with discharge. If left untreated, a stye can infect surrounding tissues, which is then called preseptal/orbital cellulitis depending on the depth of tissues infected. At this stage, vision is often compromised and oral medication is required. If the infection subsides and contained, a stye can also result as a chalazion.

There are 2 types:

• External hordeola - are acute bacterial infection of the superficial Zeis or Molls

• Internal hordeola - are acute bacterial infection of the deeper meibomian glands

These infections are usually staphylococcal.

Can styes be caused by stress?

There is no scientific evidence to say that stress is directly linked to formation of styes. However, lack of sleep often is linked to stress which makes you more susceptible to infection. If you’re tired or stressed, you may not follow good lid hygiene and proper hand washing.

STEP 1 - At Home Therapy

FOR PATIENTS

You should know that most are self-limiting and should resolve on its own without intervention. However, active intervention can help aid in quicker resolution.

CLEAN EYE LIDS OFTEN

• The best way to do this is to clean infected area with cleansing lid wipes. This will remove any exterior bacteria and keep the wound clean. Keeping the lids clean regularly can also reduce blepharitis - inflammation of the eyelids (aka dandruff of the eye). You can do this by applying some baby shampoo onto cotton rounds and wiping it on your eyelids. Do not use hand soap or any harsh soap with chemicals. Alternatively, you can purchase commercial eyelid wipes that are made to keep the eyes clean. See products below. Systane Lid Wipes are the most common commercially available eye lid wipes. Individually packaged wipes, which you would remove and apply on the eyelid margins and rinse with water afterwards. Preservative-free options include the I-LID' 'N LASH® PLUS wipes and NACLINO™ Lid Wipes.

DAILY HOT COMPRESSES

• Traditionally, you can do this by soaking a clean face cloth under hot water and then applying it to the eyelids. However, the best way is to do hot compresses is with an eye mask for 10-15 minutes, 2-4 times daily. A commercial eye mask will hold the heat 10x longer than traditional face cloths and much easier to use, such as the Bruder Eye Mask or I-RELIEF Eye Mask which you must have a microwave to heat for 10 sec. If you do not have a microwave, can consider the Aroma Season Moist Heated Mask with Flax seed and USB charger or Panasonic Facial Steamer. The facial steamer will apply moisture and heat to warm up the eyelids. Once the eyelids are warm, you can apply a gentle massage over the eyelid margins by using your fingers to massage in a circular or up and down fashion.

Aroma Season Moist Adjustable Heated Mask

STOP CONTACTS WEAR

• Switch to glasses for now. Dispose contact lenses that have been used. When the infection has resolved, you may go back to contact lens wear. Make sure to also clean you contact lens case and avoid any make-up around the eyes for now.

STEP 2 - Seek an Optometrist

FOR PATIENTS

If it’s red and painful, maybe swollen with discharge, then it’s probably an infection. It’s time to seek a professional to take a look and check it out.

Depending on the situation, the doctor may prescribe antibiotic eye drops or in more severe cases oral antibiotics.

FOR DOCTORS

Topical Antibiotic is normally recommended as a prophylactic for external infections.

Consider an oral Antibiotic for recurrent and severe cases that infect internally.

• Erythromycin 250mg PO QID x 7-10 days

• Amoxicillin chewable tablets 250 mg q8h x 7-10d

• Amoxicillin capsules 500 mg q8h x 7-10d

• Clavulin 500 mg q8h x7-10d 

Doxycycline and azithromycin are two additional antibiotics that help reduce swelling and inflammation of the oil glands, which is one of the major causes in the formation of styes and chalazia. Doxycycline is often used to treat chronic blepharitis, meibomian gland dysfunction (MGD), and acne rosacea.

• Apprilon (doxycycline monohydrate) 40 mg

• Periostat (doxycycline hyclate) 20 mg capsules

• Vibramycin (doxycycline hyclate) 100 mg capsules

• Vibra-Tabs (doxycycline hyclate) 100 mg tablets

• Zithromax (azithromycin) tablets: 500 mg qd x 1 day, then 250 mg qd x 4 days

For under 6 years old and < 40lbs consider:

• Amoxicillin Pediatric Suspension 250mg/5mL PO q8h x 7-10d
  
  
  

STEP 3 - Surgical Interventions

FOR DOCTORS

Epilation (removal) of the associated lash follicle may allow spontaneous drainage for external infections only.

Surgical incision and drainage with needle may be needed for chalazions that are recurrent. The surgeon would create a small incision and drain the inner side of the eyelid bump. The entire capsule of the sac is removed so that it does not come back as easily. Antibiotic drops and oral tablets will be required. A full recovery usually takes about a week or two. This is an out-patient procedure, so you can return home after the procedure.

References & Further Readings

• https://www.reviewofoptometry.com/article/take-your-lumps

• https://www.reviewofoptometry.com/article/stye-vs-stye

• https://www.aoa.org/patients-and-public/eye-and-vision-problems/glossary-of-eye-and-vision-conditions/chalazion

• https://www.reviewofoptometry.com/article/options-in-chalazia-management

• https://www.merckmanuals.com/en-ca/professional/eye-disorders/orbital-diseases/preseptal-and-orbital-cellulitis

• https://www.aao.org/eye-health/ask-ophthalmologist-q/how-can-i-treat-my-recurring-styes

• https://opto.ca/health-library/hordeolum-styes#:~:text=For%20this%20to%20occur%2C%20warm,with%20your%20Doctor%20of%20Optometry.

• https://www.college-optometrists.org/guidance/clinical-management-guidelines/hordeolum.html

Free COVID-19 Testing Centres Near Richmond Hill / Markham / Scarborough / GTA

FREE COVID-19 TESTING CENTRES NEAR RICHMOND HILL / MARKHAM / SCARBOROUGH / NORTH YORK / GTA

Disclaimer: Information is subject to change and will be updated accordingly. Please go to site links provided for more up-to-date information should information changes. We will strive to up-date accordingly. This list is to gather important information in one spot and make it easier than looking up several sites to find out.


Update: Starting Oct 6, 2020 - Testing is By-Appointment Only. Some pharmacies will open testing as well.

STEP ONE:

• For those considering getting tested or showing systems of COVID-19. Please use the COVID-19 Government of Ontario Self-Assessment Tool first.

• Free Medical Advice via Ontario Telehealth: A Registered Nurse will take your call 24 hours a day, seven days a week.

  Call Telehealth: +1 866-797-0000

STEP TWO:

• Check your location below for further testing information

• Walk-in availability and swab tests are available at most locations

• Please bring your Health Card and ID to speed up processing

• Family members and visitors are to remain outside, in their cars, or to drop off personal if they are not going for testing

• Note: Some locations may require certain criteria to be met before testing or pre-booking for their appointments.

Shop Kids Face Masks

Adult / Children Face Shields - Made in Canada

JUMP TO:

RICHMOND HILL / GORMLEY

MARKHAM / STOUFFVILLE / UXBRIDGE

NEWMARKET / AURORA / BLOOMINGTON / GWILLIMBURY

NORTH YORK / MID-TOWN

SCARBOROUGH / PICKERING

VAUGHAN / KLEINBURG / KING CITY / NOBLETON

BARRIE

MISSISSAUGA

OAKVILLE / MILTON / GEORGETOWN

BRAMPTON

ETOBICOKE / REXDALE / WOODBRIDGE

TORONTO / DOWNTOWN / YORKVILLE / PARKDALE

ORANGEVILLE

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ARTICLE: CLICK TO LEARN MORE

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RICHMOND HILL:

Mackenzie Health Hospital

✓ Located at Mackenzie Health (10 Trench St). The Assessment Centre is located in A-wing. D-Wing Entrance for patient screenings. See parking for drop-off.

✓ By-appointment only. Walk-ins prohibited.

✓ Hours: Monday to Friday from 10 a.m. to 9:30 p.m. Weekends and holidays from 10 a.m. to 5:30 p.m.

✓ To book an appointment call Mackenzie Health’s scheduling office at 905-883-1212 ext. 2004. The patient scheduling office is open Monday to Friday, 8 a.m. to 5 p.m. and weekends between 8 a.m. and 4 p.m., including holidays. Previous patients can book by logging in to your MyChart account or  download the app on IOS or Android.

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MARKHAM/STOUFFVILLE/UXBRIDGE: 

Markham Stouffville Hospital

✓ Located at Markham Stouffville hospital (381 Church Street). Entrance is located on the south side of the hospital, east of the Emergency Department, see map above.

✓ Park at parking Lot #7 only. Wait times are low. Accompanied visitors should wait in car or in shaded waiting area.

✓ By-Appointment Only

✓ REGISTER via phone by calling: 289-378-2419



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NEWMARKET: 

South Lake Hospital

✓ Located at South Lake Hospital in medical field tents close to East Entrance: 596 Davis Drive in Newmarket (Go to map)

✓ Hours: 9:00 an and 9:00 pm, seven days a week.

✓ By-Appointment Only

Please call 905-895-4521 ext. 2162. between 6:30 a.m. and 9:30 p.m to book.

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North York / Mid-town:

Sunnybrook Health Sciences Centre (U-Wing, Bayview Campus)

✓ 2075 Bayview Avenue, U-Wing, Ground Floor (Go to Map)

✓ By-Appointment Only. Book Online Here or Call Toronto Public Health first (416-338-7600) or main hospital line 416-480-6100. Only one person per household will be tested.

✓ Hours: Monday - Friday: 12 p.m. - 7:30 p.m. Saturday and Sunday: 12 p.m. - 5 p.m.

North York General Hospital (Leslie St. just north of the 401): 

✓ 4001 Leslie St. Enter through Emergency Department (Go to Map)

✓ By-Appointment Only. Book Online Here or Call 416-635-2509 from 8 a.m. to 12 noon to book your appointment over the phone.

North York General Hospital (Branson Site):

✓ Located at 555 Finch Ave. North Entrance immediately after Finch (Go to Map)

✓ By-Appointment Only. Book Online Here or Call 416-635-2509 from 8 a.m. to 12 noon to book your appointment over the phone.

Humber River Hospital Reactivation Care Centre (RCC)

✓ 2111 Finch Avenue West Toronto (Go to Map), West Entrance Only

✓ By-Appointment Only. Book Online Here.

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SCARBOROUGH: 

Scarborough Birchmount Hospital

• Located at 3030 Birchmount Road (Go to Map).

• By-Appointment Only. Hours 9:00 am to 6:00 pm, 7 days a week. 

• Before coming, Book Online here.

Scarborough Health Network – Centenary Hospital: 

• Located at 2867 Ellesmere Rd (Go to Map).

• By-Appointment Only. Hours 10:00 am to 7:00 pm, 7 days a week. 

• Before coming, Book Online Here.

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VAUGHAN:

Mackenzie Health Hospital

• Located at 9401 Jane Street in the same plaza as the Mackenzie Health Urgent Care Centre

• Can be accessed via a dedicated entrance on the main level from the outdoor parking lot. Please follow the directional signage on site.

• By-appointment only. Walk-ins prohibited.

• Hours: Tuesdays and Thursdays from 11:30 a.m. to 6:30 p.m.

• To book an appointment call Mackenzie Health’s scheduling office at 905-883-1212 ext. 2004. The patient scheduling office is open Monday to Friday, 8 a.m. to 5 p.m. and weekends between 8 a.m. and 4 p.m., including holidays. Previous patients can book by logging in to your MyChart account or  download the app on IOS or Android.

Other nearest location:

• Mackenzie Health Hospital

• Humber River Hospital

• Newmarket: South Lake Hospital

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Barrie: 

Eagle Ridge Complex

✓ 490 Huronia Road, Barrie (Rear building of the Eagle Ridge complex and is NOT at the Huronia Urgent Care Clinic) Go to Map

✓ By-Appointment Only. Same day appointments

✓ Monday to Friday 8:30am – 4:30pm. Saturday / Sunday / Holidays Closed

Barrie & Community Family Medicine Clinics
Location:

• Prince William location only

• 829 Big Bay Point Road

• Shoppers Drug Mart Plaza

Hours:

• Monday to Friday 8:00 a.m. to 8:00 p.m.

• Sat/Sun/Holidays 9:00 a.m. to 3:00 p.m.

How to attend:

• Assessment and testing. 

• Booked appointments and walk-in visits available.

• Call ahead for an appointment (705) 722-1199 or visit barriewalkinclinics.ca 

 
RVH Testing Centre - for booked and drive-thru COVID-19 tests
Location:

• 29 Sperling Drive (former Barrie Police headquarters) 

Hours:

• 7 days a week 8:00 a.m. to 8:00 p.m.

 How to attend:

• Click here to book your SAME DAY appointment (pending availability) 

• Click here to book your FUTURE appointment online

• Complete with your name, health card number and date of birth, you will receive an email with instructions about your appointment. 

• If you cannot book an appointment online call 705-797-3120

The drive-thru testing centre on the RVH campus is CLOSED.

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Mississauga:

Credit Valley Hospital / Mississauga Hospital aka Trillium Health Partners

• Drive Thru - Level 1 Main Parking Garage (2200 Erin Mills Parkway)

• Walk-ins - Visit Valley House (2200 Erin Mills Parkway ) or Mississauga Hospital Clinical Administrative Building (15 Bronte College Court)

• Hours 8:30am - 7:30pm

• By Appointment Only. Book online below.

• To reduce wait times PRE-BOOK AHEAD. Fast track with Virtual Physician Assessment.

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OAKVILLE / MILTON / GEORGETOWN:

Oakville Trafalgar Hospital / COVID Assessment Centres in Oakville, Milton, Georgetown

• By-appointment only. No Walk-ins.

• Call 905-203-7963 to book. Press 1. Clearly state your name, date of birth, health card number and contact information. Please only leave one message and someone will call you back within one business day.

• Results will appear after 5 days on the online portal.

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BRAMPTON

OSLER'S Testing Centres

South Fletcher’s Sportsplex north parking lot
500 Ray Lawson Boulevard
Kingsknoll Drive at McLaughlin Road 
(also called Sheridan College Drive)

• Hours 8am - 6pm, 7 days a week

• By-Appointment Only - Drive Thru

• Remain in car at all times. Nasal swabs taken in car.

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ETOBICOKE

Etobicoke's Drive-Thru COVID-19 Assessment Centre

• Humber College overflow parking lot
  2 Janda Court
  Queens Plate Drive west of Highway 27
  (enter via Janda Court)
  Map and directions
  
  Hours 8am - 6pm, 7 days a week

• By Appointment - Drive thru only

• Remain in car at all times. Nasal swabs taken in car.

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TORONTO

UHN Toronto Western COVID-19 Assessment Centre

• 347 Bathurst St., on the northeast corner of Bathurst and Dundas St.

• Hours 12-8pm, 7 days a week

• Walk-ins accepted, no appointment needed

Women's College

• 347 Bathurst St., on the northeast corner of Bathurst and Dundas St.

• Hours 9:00am - 4:45pm, 7 days a week

• By Appointment only please complete the online registration form and a physician from the hospital will call you

Mount Sinai Hospital COVID Assessment Centre

• 600 University Avenue

• Entrance is north of the main entrance

• Hours 8am - 12pm, Monday - Fridays

• By Appointment Only

St. Michael's Hospital COVID Centre

• Li Ka Shing Knowledge Institute, 38 Shuter St. 1st floor

• Hours 8:30-6pm Weekdays, 12-6pm Weekends

• By Appointment Only

St. Joseph Health Centre

• Sunnyside Building, 1st floor – enter through the Sunnyside Avenue entrance

• Hours 8am - 8pm, 7 days a week

• By Appointment Only

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ORANGEVILLE

Headwaters

• 100 Rolling Hills - Map it

• Hours 8:30 am to 4:30 pm daily

• Drive thru centre - By Appointment Only now

• Call to book by phone: 519.941.0001 

• Remain in car at all times. Nasal swabs taken in car.

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Kids Face Masks Disposable

Hylo eye drops vs Hydrasense

HydraSense ADVANCED

Ingredients

Sodium hyaluronate 0.15%, Provitamin B5, sodium chloride, sodium citrate dihydrate, citric buffer, water.

Hyaluronate Acid (HA)

0.15% Short-chain HA (LMW-HA)

Format

10 mL multi-dose squeeze bottle.

More difficult to dispense and not completely sterile since a small amount of air flows back into the bottle through a filter. Due to the nature of the bottle to keep the solution sterile, more pressure is required to be applied to push the fluid out. At the end, it is normal that there will be some remaining not dispensable since some will remain in the chamber of the bottle.

Drop size not controlled since it depends on pressure applied. Light packaging.

Expires 12 months from opening

Preservative-Free?

Yes

Phosphate-Free?

Yes, uses a citrate buffer

Safe for Contacts?

Yes

ADD CART

HYLO

Ingredients

Contains 1mg/mL Sodium Hyaluronate, a citrate buffer, sorbitol and water.

Hyaluronate Acid (HA)

0.10% Long-chain HA (HMW-HA)

High-quality HA promotes healing & each drop lasts longer.

Only HYLO and HYLO GEL are approved by Health Canada for Post-Surgery Use in Canada (LASIK, PRK, Cataracts, Keratoplasty, Severe Dry Eyes).

Format

10 mL multi-dose airless valve pump bottle (does not contact with air/ environment)

Easy, controlled amount dispensed

Can use up entire bottle. Durable.

Expires 6 months from opening

Made in Germany

Preservative-Free?

Yes

Phosphate-Free?

Yes, uses a citrate buffer

Safe for Contacts?

Yes

ADD CART

Top Allergy Eye Drops Safe for Kids and Contact Lens Wear

Preservative-Free Allergy Drops

It’s allergy season. Our eyes get itchy, watery, dry, and red. I will first talk about a few ingredients found in preservative-free allergy drops and why are they important. The next section will talk about medicated eye drops for allergy symptoms.

Disclaimer: Please understand that this is not medical advice so do consult with your optometrist or medical practitioner whether these drops are right for you. Every individual may have a unique response to drops and any eye drop will have side effects.

While we know that certain allergy medications are great at reducing significant allergic symptoms, they can cause adverse effects by drying out the eyes, that is why eye drops are still important in addition with allergy medications or those with only ocular manifestations.

Ecotine is a naturally protective substance produced by bacteria to protect itself in extremely salty water conditions. In medicine, it reduces eye inflammation and irritation by forming a protective layer around proteins, enzymes, and cell membranes in the tear film.

Hyaluronic acid (HA) is a natural occurring glycosaminoglycan. Sodium hyaluronate is the salt form of HA, which is a more stable compound for topical application. It is commonly found in dry eye drops because it binds to water, prevents dehydration, and is highly biocompatible as it is naturally found in high concentrations in the eye. Studies show HA improves optical quality, promotes corneal epithelial wound healing by stimulating epithelial migration, and protects corneal epithelial damage. This is great for those who have dry eyes.

Benzalkonium chloride (BAK) is a preservative that is widely used in eye drops since the 1940s. Almost 70% of all eye drops still use BAK. It is effective as a preservative since its good at killing microorganisms. It acts as a detergent to lysing cell membranes. Recent studies have shown that high concentrations of BAK can be toxic to ocular tissues by causing apoptotic response in corneal tissues. However, there are also many studies that show that BAK at various concentrations does not affect corneal tissues and is no more toxic than other preservatives found in eye drops. Patients who have long standing symptoms of dry eye can consider drops that are preservative-free.

1) Hylo Dual

Contains 0.5mg/ml Sodium Hyaluronate, 20mg/ml Ectoine, a borate buffer and water.

✓ Preservative Free

✓ Good for dry eyes

✓ Natural ingredients

✓ Kid safe ≥ 6 years old

✓ Safe for contact lens use

2) HydraSense Allergy

Contains Sodium hyaluronate 0.15% (naturally sourced), ectoine 2% (20mg/ml), sodium chloride, sodium citrate dihydrate, citric acid anhydrous, water

✓ Preservative Free

✓ Good for dry eyes

✓ Natural ingredients

✓ Kid safe ≥ 6 years old

✓ Safe for contact lens use

✓ Made in Canada

Prescription Allergy Eye Drops

These are the top prescription Dual Activity Agent (Mast cell stabilizer / Anti-histamine) available in Canada. Most over-the-counter (OTC) medications are single activity, meaning they are only act as an anti-histamine or mast cell stabilizer. Dual activity agents will act by relieving symptoms of allergies within half hour and sustain for half a day to whole day before reapplication. Talk to your optometrist if you’re having allergic symptoms at your next appointment to see if these are right for you.

1) Pazeo

0.7% olopatadine hydrochloride | Preservative: BAK ? | 1 drop QD

✓ Dual Activity Agent (Mast cell stabilizer / Anti-histamine)

✓ Safe for kids > 2 years

✕ Pregnancy: Category C

✕ Nursing: Caution

Rx Prescription only in Canada & USA. Ask your optometrist for more details.

Recommendation: Basically a stronger Pataday Once a day / Pataday Twice a day (Patanol). If you have strong allergies and only want to use the drop once for the entire day, this is the one.

2) Pataday / Patanol

0.2% / 0.1% olopatadine | Preservative: BAK ? | 1 drop QD / BID

✓ Dual Activity Agent (Mast cell stabilizer / Anti-histamine)

? Kid safe: not established in <18 years of age

✕ Pregnancy: Category C

? Nursing: Not established

Rx Prescription only in Canada | OTC in USA

In USA, FDA has approved two allergy drugs previously only available via prescription can now be sold as over-the-counter (OTC) medications: Pataday Once a day (aka Pataday) and Pataday Twice a day (Patanol).

Recommendation: One of the most popular drops for allergies. Easily found at the pharmacy with a prescription in Canada or over the counter in USA.

3) Bepreve

bepotastine besilate 1.5% solution | Preservative: BAK 0.005% | 1 drop BID

✓ Dual Activity Agent (Mast cell stabilizer / Anti-histamine)

✓ Safe for kids ≥ 3 years

✕ Pregnancy: Category C

? Nursing: Not established

Rx Prescription only in Canada and USA. Ask your optometrist for more details.

Recommendation: Lowest BAK preservative levels of medicated eye drops in Canada. Good for those who have sensitive eyes or dry eyes.

4) Zaditor

ketotifen fumarate 0.025% | Preservative: BAK 0.01% | 1 drop q8-12h

✓ Dual Activity Agent (Mast cell stabilizer / Anti-histamine)

✓ Safe for kids ≥ 3 years

✕ Pregnancy: Category C

? Nursing: Not established

Rx Prescription only in Canada by Thea | OTC in USA from Systane

Thanks for reading, hope you find this helpful.

Eye Exams after Lock down - All You Need to Know BEFORE you go

Are eye doctors (optometrist) offices open?

The short answer is Yes. In Ontario, optometrists are now allowed to gradually return to work on routine eye exams and are preparing to reopen following the guidance of the College and Ministry of Health. Since March our services were limited by the Ministry of Health to urgent care only. However, as of May 26, we were given the green-light to allow routine eye care visits. We’re starting to re-book our appointments. Please be patient as we ramp up to new working conditions to provide you the best care possible.

Why you should go for an eye exam?

Annual eye exams are important since they help us ensure our eye health is optimal. More frequent health checks allows for earlier detection and treatment of eye diseases. Our eyes are so important to our daily lives, so we want to take good care of them.

Your eye exam will be different from your last visit. But what can you expect when you go for your eye exam after the lock down. Before reopening, your optometrist has invested in countless measures to protect you and their staff from COVID-19. Read more as I dive deep into this topic of what to expect so you can be reassured you’re in good hands.

What can you expect?

1) PPE for everyone

To reduce any viral transmissions, all patients and staff will be wearing personal protective equipment. Face masks or coverings will be mandatory for all. You will also notice several protective barriers on equipment and sneeze guards in reception to help add additional protection.

2) Social distancing guidelines

Patient volume will be reduced by 25-50% to allow for proper social distancing. Waiting chairs will be kept apart with limited patients and stacked patient flow. You may be asked to wait outside or in your car until your appointment is ready. Accompanied family members may be limited to one or asked to come back for pick up. Limited customers in frame try-on area.

3) Increased Deep Cleaning and Sanitation

Routine cleaning of all touch-point surfaces after each patient and nightly deep cleaning will be done. All eye wear products will be disinfected after try-on.

4) Pre-Screening Measures

Be prepared to answer COVID-19 screening questions, observed hand hygiene at hand washing/sanitizer station upon arrival and may require a touch-less temperature screening.

5) Limited talking during your exam

Know questions you want to ask the doctor prior to the exam. Case history will be taken before your visit. More detailed results may be communicated to you over the phone to reduce aerosol droplets inside the clinic.

6) Increased Air Flow & Upgraded HVAC systems

Clinics will be increasing their air flow to allow for more air changes per minute and upgraded HEPA filtration.

7) Eye drops And Eye Imaging

Optometrists will continue to recommend routine dilation of eyes for better viewing of the internal structures. However, to reduce contact time from close proximity of eye examinations, your optometrist may recommend Digital Fundus Photography (DFP) and Optical Coherence Tomography (OCT) imagining. These two powerful imaging tools help optometrists capture an enormous amount of detail within seconds that traditional viewing with a handheld lens would not be able to capture. The data can then be viewed and analyzed at a distance. DFP gives a natural image of the internal retina while OCT uses technology to scan the deeper layers of our retina tissue.

Image source from Lancet Article on Retinal Findings in Patients with COVID-19. All patients with COVID-19 displayed hyper-reflective lesions at the inner plexiform and ganglion layers on OCT imaging. Some patients had cotton wool spots on DFP.

8) Increased wait times

Regular exams and surgical appointments were put on hold since lock down began in March. As doctors catch up on appointment backlogs and adjust to new normal of working, it is likely that non-urgent appointments and referrals will take longer to process.

Thanks for reading. I hope you find this topic helpful and interesting. Share with friends and family. For more eye related content articles, see below.

- Dr. Ng

Reference Studies / Deeper Dives

• Retinal findings in patients with COVID-19 (2020): https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31014-X/fulltext

Top 10 Tips About How to Protect your Eyes during COVID-19

1) Frequent Hand Washing with soap and water for 30 seconds.

Hand washing is the most effective at killing the virus and protecting yourself from spread it.

2) Wearing contacts is safe.

There is no scientific evidence of contracting the virus more with contacts than with glasses or no glasses wear.

3) Avoid rubbing your eyes.

Studies show that we touch our face up to 23 times an hour. We touch everything with our hands and can easily spread the virus to ourselves. It is important to clean your hands frequently.

4) Wearing Contacts do not offer extra protection from COVID-19.

There’s no scientific proof for contacts. Glasses with side-shields may add some protection. However, wearing a face shield or safety googles that cover the eyes may help prevent the spread since the virus can spread through the eyes, mouth, and nose.

5) Wear a face covering & consider a face shield / safety googles / safety glasses for work.

We recommend wearing it especially to your eye exam or any health exam due to the proximity of transmission. During close examinations, optometrists will be wearing enhanced PPE to protect you. You will see breathe shields on testing equipment and plexiglass barriers in waiting rooms. We will dive more on this topic on what to expect at your eye exam next. Go to article: Eye Exams after Pandemic: Everything you need to know before you go.

6) Consider daily disposable contacts

We recommend switching from a bi-weekly or monthly lens to a daily lens. For reusable hard and soft lenses, consider a deeper cleaning solution like CLEAR CARE PLUS with Hydraglyde. It uses 3% hydrogen peroxide, which requires the user to soak it overnight (6 hours). It comes in a special case that will safely neutralize the hydrogen peroxide solution to water. NOTE: Do not use 3% H2O2 directly in the eye before it has had time to neutralize. It has to neutralize to water first after 6 hours. We recommend OPTI-FREE PureMoist for quick cleaning throughout the day if the lenses need to come out and CLEAR CARE PLUS for deep cleaning overnight.

7) Wash your glasses with soap & water daily.

• Simply this is the best way to reduce damage to the frames and lenses.

• Avoid any harsh chemicals like Windex, Dish soap, Alcohol-based products, etc.

• Always rinse under running water for 30 seconds to remove any tiny debris before rubbing.

• Use a microfiber cloth to clean lenses.

• Let it air dry. Store in a case if you’re not using them right away.

Getting into this habit will not only prevent spread while keeping your frames lasting longer and removes any unwanted scent from oil accumulation throughout the day.

8) UVC exposure can damage your eyes. UV devices do not kill viruses effectively.

Due to popularity of UVC devices, we want to make it clear that there is no scientific proof of UVC can kill the virus effectively. Artificially produced UVC is used in hospital settings, sterilizing water, and banks to disinfect money but at high exposure. Sunlight is made of UVA, UVB, and most of the UVC is filtered out by our ozone. It takes hours for UVB to cause sunburn but seconds for UVC to affect our eyes. We know that cumulative exposure to UV radiation can trigger cancer development since UV damages DNA structure.

Recently, scientists have discovered a new type of UVC called far-UVC, which has shown to less damaging to human skill cells and rats. However, this has not been tested on humans yet and almost all UVC devices do not use this wavelength yet.

No one knows what wavelength and at what intensity of UV is needed it takes to deactivate COVID-19. What we do know is that it can be harmful to your eyes and body.

9) Wear YOUR sunglasses.

Sunglasses can act as another barrier. Studies show cumulative UV exposure causes cataracts, macular degeneration, and other aging effects on the eye. One study showed that cumulative exposure of UVB over 8 years can contribute to development of cortical cataracts. More specifically, it affected the lower nasal region of the lenses of both eye more than any other region of the lens. Check for a label on lenses that states UV or UVA/UVB/UVC protection. Most ophthalmic lenses will come with a card stating its authenticity and lens features.

10) If your eyes are dry. use eye drops.

Coronavirus does not cause dry eyes, but dry eyes may be a symptom of prolong work at the computer screen, use of googles, and improper use of masks.

We know that our tears act as a shield to help protect our eyes from bacteria and debris. Evidence show we produce less tears after 50 years old. Asian groups have greater symptoms of dry eye than other ethnicity. In addition, we blink 8-10x less when we are in front of screens. If you’re working from home more now, try to take breaks every 20 minutes for your eyes. Look outside more often, remind yourself to drink more water, and use every drops to keep your eyes feeling great. See my article on what preservative-free eye drops are the best for your eyes.

BONUS) Coronavirus not likely to spread from our tears.

While studies have confirmed spread occurs from AEROSOL droplets released from talking, coughing or sneezing; a new study showed infected patients do not appear to be spreading via tears. No patients in the study had pink eye but health officials report pink eye is seen in 1-3% of coronavirus patients. Therefore, the study concluded coronavirus spreading through tears should be low-risk.

Are your eyes working harder than they have to? Talk to your local optometrist about digital eye strain and dry eyes.

Thanks for reading. I hope you enjoyed it and learned something new. Take safe precautions during these tumultuous times. Share if you liked it. New articles coming out soon.

Studies / Deeper Dives

• Face Touching: A Frequent Habit That Has Implication for Hand Hygiene (2015): https://pubmed.ncbi.nlm.nih.gov/25637115/

• COVID-19 and contact lenses: the facts you need to know (2020): https://core.uwaterloo.ca/covid-19/

• Can you kill coranovirus with UV light?(2020): https://www.bbc.com/future/article/20200327-can-you-kill-coronavirus-with-uv-light

• The Differential Effect of Utraviolet light Exposure on Cataract Rate across regions of the lens (2010) https://iovs.arvojournals.org/article.aspx?articleid=2126317

• Low risk of coronavirus spreading through tears (2020): https://www.sciencedaily.com/releases/2020/03/200325143826.htm

Best Eye Vitamins & Foods to Increase Eye Performance.... Lutein and Zeaxanthin... and MZ

Lemon Kale Salad Recipe: Mix 1 bowl of chopped raw kale, add pine nuts (alternatively pistachios/dried berries), sliced Parmesan cheese, and squeezed fresh lemon juice (or drizzle balsamic vinegar) on top.

The first step to nutritional wellness begins with knowing what to eat. This article is to simply breakdown and gather what we know is good for eye health. 

Aging is simply oxidative-stress build up over time. We can fight oxidative stress by understanding how certain foods can eliminate them through antioxidant properties. The macula is important part of our sight responsible for our central vision, but it also has yellow protective macular pigments (MP) called carotenoids. Carotenoids have antioxidant properties by filtering short-wavelength blue-light by reducing the formation of free radicals. The 3 types of carotenoids are Lutein (L), Meso-zeaxanthin (MZ), and Zeaxanthin (Z) (ratio: 10:10:2).  The highest source of lutein is typically extracted from the marigold petals, while the highest source of zeaxanthin is extracted from red peppers, corn and egg yolks. Most recently, MZ has been demonstrated to be found in marine species, such as skin of trout, sardine and salmon. 

Photo: Marigold Petals. Lutein is extracted from marigold petals through HPLC processing.

Food & Visual Performance

The chart below shows the highest concentration of macular pigment in foods with Kale, Spinach and Swiss Chard ranking the highest. Knowing which foods contain these essential carotenoids can help us create meals that include these items in our diet. It is important to note while diet is the mainstay, supplementation has recently been shown to be beneficial to even normal adults to improve contrast sensitivity and visual performance at work.

Lutein & Zeaxanthin Chart (based on current USDA data)

Based on 1 cup of cooked vegetables. Graph created by Dr. Ng from most recent USDA data.

Contrast sensitivity is most crucial for daily activities where there is low light, rain, fog, or glare. This is especially important for those who do a lot of night driving, athletes who require fine detail orientation, and elderly individuals who have a higher risk of falling due to poor contrast sensitivity. Low contrast sensitivity is often a symptom of cataracts, glaucoma and diabetic retinopathy. It can also affect individuals who have undergone refractive correction like LASIK or PRK. These people often report 20/20 vision but poor night vision. 

While most of us may have trouble reaching or maintaining a well-balanced diet of MP, modern day agricultural methods have been traced to a reduction of nutritional value. Quantity vs Quality: Kale 40 years ago is often many times more nutritious than Kale found today in supermarkets. Modern day farming has limit the gene pool and favored larger more profitable crops over more nutritious varieties. It is important to understand where our food comes from and how it is grown. Therefore, it may be worthwhile to also consider supplementation in addition to our routine diet of greens, fish, and eggs for not only prevention but for visual performance.

AMD

Age-related Macular Degeneration (AMD) is an eye disease affecting the macula resulting in central vision loss, which is important for everyday functional activities like driving, reading and watching TV. Daily supplementation in early AMD with all 3 carotenoids has shown to be most effective in reduction in AMD progression. The daily amounts of intake between the cartenoids require further studies, which is currently undergoing. 

Potential Biomarker for Dementia?

In addition, new studies with macular pigment may lead to greater understanding of detection of Alzhemier's and other dementia affecting the elderly.  Patients with Alzhemier's experience a cognitive decline, tend to have poorer vision and tend to have lower levels of macular pigment.  The intriguing question of whether MP can prevent or push back the onset is in question. Others are looking at whether Alzhemier's and Glaucoma are related conditions since both are neurodegenerative, chronic, and progressive diseases. There are studies looking at the intriguing possibility of whether normal-tension glaucoma increases the risk of developing dementia. There is a lot of excitement in this field of determining a biomarker for early detection such as MP levels, lens changes, and measuring optic nerve fibers. 

Click to shop

List of Supplements on the Market
(Product Links to Amazon)

Source: MacuHealth

With LMZ (non-Plant-based - Beef gelatin capsule):

• MacuHealth with LMZ3

• MacuHealth Plus with LMZ3 + AREDS2 + lower/safe levels of zinc - Soft gels (LMZ:10:10:2) - Made in USA

• MacuShield (MacuVision) - Soft gels (LMZ:10:10:2) - Made in UK

With LMZ (Plant-based):

• Vision Essence Early Defense & Zinc-free (LMZ ratio 10:10:2) - Made in Canada

• Sports Research L+Z Vegan - Soft gels (LMZ ratio: 10mg free L : 4mg MZ +Z) - Made in USA

With L & Z (Plant-based):

• Vitalux Advanced (Alcon) - Caplet - Made in Canada

• Vitalux Advanced Chewable (Alcon) - Chewable tablets - Made in Canada

• EyePromise Zeaxanthin + Lutein (Zeavision) - Soft gels - Made in USA

• PreserVision AREDS 2 (Baush & Lomb) - Soft gels - Made in USA

• Ocuvite Gummies (Valeant) - Gummies - Made in USA

• Mary Ruth’s Eye Care Gummies - Sugar-free Gummies - Made in USA

• Doctor’s Best Lutein & Zeaxanthin Gummies - Gummies - Made in USA

With L & Z & daily vitamins (Plant-based):

• Vitalux Healthy Eyes (Alcon) - Caplet - Made in Canada

• Vitalux Advanced Plus Multi-Vitamins (Alcon) - Chewable - Made in Canada

With L & Z + Omega 3 (Plant-based):

• Ocuvite Eye Vitamins (Baush & Lomb) - Soft gel - Made in USA

• Vitalux Advanced Plus Omega 3 (Alcon) - Soft gel - Made in Canada

STUDIES

• The CREST AMD study (2017) showed that early AMD patients in 35% of trial participants had clinically meaningful improvement in contrast sensitivity and visual function following supplementation of MP in 10:10:2 ratio vs just L & Z over 2 years.

• The CREST study (2016) showed that even healthy subjects with no retinal disease can enhance their contrast sensitivity and meaningful visual performance following supplementation of MP in 10:10:2 ratio over 1 year.

• The MOST study (2015) was to demonstrate the safety profile of taking high concentrations of MZ in addition to L and Z in healthy and early AMD patients, the MP response and serum carotenoid response over a 3 year period.

• The AREDS 2 Study (2013) showed that in early AMD: daily supplementation of 10mg of lutein and 2mg of zeaxanthin (and no beta-carotene and no omega-3) showed a 10-25% risk reduction of AMD progression over 5 years.

• The original AREDS Study (2001) showed that in early and moderate AMD: daily supplementation of beta carotene, vitamin C, vitamin E, zinc and copper showed a 25% risk reduction of AMD progression over 5 years.

Contact Lens Tips every Optometrist wants you to know

Quality over Quantity.

Not all lenses are created the same — some are actually more breathable than others. In fact, you want to know the oxygen transmissibility or Dk/t value of a lens. This tells you how much oxygen can pass through. Often this depends on the material used.

So, lets take a look at some of the best and worst?

Table information complied from Contact Lens Compendium. (https://contactlensupdate.com/compendium/ca/)

As you can see, the higher the DK/t number— the better— or more breathable a lens is. The type of lens is important too: silicon hydrogel lenses out perform hydrogel ones. Studies recommend we should have at least 25 dk/t in a daily lens to prevent cornea edema (or swelling). When we get cornea edema, overtime, our blood vessels in our eyes will start to grow abnormally to find oxygen. This process is called, corneal neovascularization. When we wear bad contacts for too long, this can cause real damage with time. Sometimes, the damage is not reversible without proper treatment. Complications such as corneal ulcers — a painful bacterial infection that eats into our cornea, and GPC (or Giant Papillary Conjuctivitis) — basically, giant bumps on our eyelids that makes contacts uncomfortable to wear are just some examples.

I CAN’T BREATHE!

Imagine placing a plastic bag over your head for an entire day. This is similar to wearing contacts. Some are more breathable and hold more water content so your eyes won’t dry out. So, the longer you plan to wear your contacts, the more important comfort becomes. As a general rule, a maximum of 6-8 hours of wear is recommended. You should always have back-up glasses for when the lenses come out at the end of the day, and for those rainy days when you can’t put them in. Finally, carry dry eye drops for when the eyes get dry.

YOU PAY FOR WHAT YOU GET?

Check out the worse offenders at the bottom of that list. Let’s choose Hubble. Great brand and idea but it’s using one of the worse lenses on the market. Not only does the lens not meet minimum requirements in Dk/t values (scores an 18 vs a 25 for daily wear). This lens material has been discontinued from the market years ago by Cooper Vision. Since then, Copper Vision has created way better lenses such as their Bioinfinity line. So why are they so expensive? It’s actually not, if you factor in what you’re really paying Hubble for… convenience factor (packaging, delivery, subscription idea) over lens technology. It’s R&D — research and development that goes into creating better lenses. Just like how Apple invests millions of dollars to push out a new iPhone yearly, there’s always newer and better lenses to choose from. You don’t want to be using old technology. Why would you do so here for your eyes? Your local optometrist can recommend the best lens for your eyes and take care of them. Keep in mind, Dk/t value is one criteria, there’s more to assessing which would be the best fit for your eyes.

It AIN'T COMFORTABLE

Dk/t value doesn't correlated with comfort. So, just because you get the highest Dk/t lens, doesn't mean it will be the most comfortable either. Comfort depends on a balance of several lens properties: surface, modulus, and lens design. Basically, all the SiH (silicon hydrogel) lenses provide enough oxygen for daily wear. The higher Dk/t, the stiffer the lens. Too stiff can result in unwanted prescription changes or distortion. Too soft a lens can prevent lens movement and tear exchange. Surface treatments on the lenses also important for comfort because it affects lubricity (mechanical rubbing from friction). And finally, lens design-- the way it fits and shape to our cornea.

What about fit?

Not all eyes are created equal, neither are lenses. Some fit better than others. You can buy a great shoe, but if it doesn’t fit, it will never be comfortable, no matter how great they are. When you wear them long enough, it just becomes uncomfortable and won’t allow you to perform well. Just know that lenses come in different sizes: thickness, diameter, curvature, and materials. This is important for an eye care professional dispensing your lenses to check how a lens fits on the eye and check them over time, as your eyes may change.

Lets talk about Underwear…

Lenses have replacement frequencies for a reason. In school, we had a saying that, you wouldn’t wear the same underwear everyday without cleaning them… why would you wear the same contacts every day without cleaning them or replacing them. 1-Day lenses are for 1 day use, then thrown away. They aren’t built to be used repeatedly. Monthly lenses are good for 30-day use. Lenses must come out of the eye every day and be cleaned in disinfecting solution with digital rubbing. This means, just like you need to rub soap on your hands to remove bacteria, you need to actually rub the lenses before dropping them into your case with solution. Contact lens cases should be replaced with each new bottle of solution or every 3 months. If you use make-up, it should be thrown away every 6-9 months since bacteria can grow in them and infect your eye. Always put your lenses in first before any make-up.

Contacts x Sleep a NO-NO

It’s drilled into every one of my patients, but why can’t we wear them? Studies have shown that the highest risk for infection is sleeping with our contacts. Our tears are so important in protecting our eyes from bacteria, dust, allergens. When our eyes are closed, we are no longer are blinking and creating tears to protect the eye. Instead, it becomes a nice warm bed for bacteria to grow quickly. Since our corneas is such a slippery surface, bacteria has a hard time growing big enough to attack our eyes. When we have contact lens in, it provides a great place for bacteria to latch on and is nutrient-rich.

CDC Corneal Infections Case Report Associated with Sleeping with Contacts: https://www.cdc.gov/mmwr/volumes/67/wr/mm6732a2.htm

ENOUGH SAID.

Contact lenses are great tools to help us see. Just remember... don’t sleep with your contacts, follow the tips above, get great comfortable contacts, practice proper contact lens hygiene, use eye drops when your eyes are dry, see your optometrists regularly for check-ups, and you’ll be off to a great start to maintaining healthy eyes for life. Hope you find this helpful, our eyes are so important. Share with others. Thank you for reading.

RECOMMENDED PRODUCTS ON AMAZON

Contact Lens Cleaning Solutions

• CLEAR CARE PLUS WITH HYDRAGLYDE - 3% HYDROGEN PEROXIDE - PRESERVATIVE-FREE. BEST CLEANING FORMULA & FOR SENSITIVE EYES.

• OPTI-FREE PUREMOIST WITH HYDRAGLYDE - DUAL DISINFECTANT - QUICK ON-THE-GO CLEANING. NO NEED TO WAIT OVERNIGHT TO CLEAN.

Contact Lens Cases

• OWL CONTACT LENS CASES

• CUTE BEAR CONTACT LENS CASE + MIRROR
  
  

Comparing Preservative-Free Eye Drop Products in Canada & Looking Beyond

DID YOU KNOW THAT DRY EYE IS SIGNIFICANTLY MORE PREVALENT & EXPERIENCE IN GREATER SEVERITY WITH AGE IN EYES OF ASIAN ETHNICITY THAN CAUCASIAN GROUPS? (See Study By Ji Soo Kim, Dr Michael Wang et al)

FIRST. Why is Preservative-Free Important?

We use eye drops daily for not only comfort, enhanced visual performance, and dry eye relief. Why not choose a drop that helps us most to be active at work, especially with increasing computer strain as we work from home.

Some preservatives can destroy the natural tear film AND cause damage to cell tissues, which makes it intolerable for long-term use.

Most older preservative-containing eye drops recommend disposal after only 30 days from opening. Meanwhile, preservative-free eye drops can last far longer 3, 6 and some up to 12 months from opening due to their nature of their bottle to keep drops clean by using separate compartments to prevent back-flow. This can significantly make your drops last longer while using something more safe for your eyes.

What about buffer systems?

The most common formulations of buffer systems used in eye drops are phosphate, citrate, borate, or Tris-HCL (Tris). Ideally, buffer systems help maintain the pH to help maintain the composition of the formulation to extend shelf life and mimic the natural tear film. The average physiological pH of lacrimal fluid is 7.4 (ranges from 6.5-7.6).

Phosphate buffers are the most widely used buffer since it has excellent capabilities at keeping pH levels neutral. In addition, as phosphate exists naturally on the surface of the eye, it is seen as a safe buffer. Selective case reports in rabbits with corneal abrasions noted that extremely high-levels of phosphate can bind to calcium released from damaged cells (epithelial keratopathy), which can form insoluble calcium deposits on the surface of the eye (corneal calcification). While other studies show risks associated with this is in humans is rather low without pre-existing corneal defects, this is particularly important to consider when using eye drops after corneal injury and post-laser surgery for healing. In a healthy eye, phosphate buffers are safe. Newer eye drops tend to use a citrate, borate, or Tris buffer to maintain a safe pH solution for the eyes; the latter being the least cytotoxic to cellular tissues and shows highest cell viability.

SECOND. The Goal?

This article is a non-bias analysis of preservative-free products available on the Canadian Market to help us better understand product ingredients, their active components, use AND shelf-life.

1. Learn The Basics of Dry Eye

2. Learn about Active Ingredients like Hyaluronic Acid

3. EYE DROP RANKING FOR HA %

4. %HA MAY NOT BE ENOUGH: Molecular weight, osmolarity

5. Discover Non-active Ingredients

6. Additive ingredients: what is Trehalose? HP GUAR?

7. Chart of ingredients of eye drops in Canada & Shelf-life

8. Future Dry Eye Products

9. Studies & Further Reading

“Preservative-free 無防腐劑
frei von Konservierungsstoffen 방부제 무료
sans conservateur 保存料フリー Không chất bảo quản konserveringsmiddel rotvarnarlaust
sin preservativos
ปราศจากสารกันบูด मुफ़्त परिरक्षक без консерванти
Säilöntäaineeton
bebas pengawet koruyucusuz konserveringsmiddel-fri kulondolozekile بدون مواد نگهدارنده χωρίς συντηρητικά
bez konserwantów preserveermiddel vry
senza conservanti”

The BASICS: What is Dry Eye?

Dry eye disease (DED) is a multi-factorial disease characterized by the loss of homeostasis of tear film by tear film instability, hyperosmolarity, and ocular surface inflammation. Artificial tears are the most common topical therapy for DED to supplement or replace our natural tear film.

Hyaluronic Acid (HA)

Why Sodium Hyaluronate / Hyaluronic Acid (HA)?

Hyaluronic acid (HA) is a natural occurring glycosaminoglycan. Sodium hyaluronate is the salt form of HA, which is a more stable compound for topical application. It is commonly found in dry eye drops because it binds to water, prevents dehydration, and is highly biocompatible as it is naturally found in high concentrations in the eye. Studies show HA improves optical quality, promotes corneal epithelial wound healing by stimulating epithelial migration, and protects corneal epithelial damage.

HA vs CMC vs HPMC?

In vitro studies showed that HA preformed slightly better than carboxymethylcellulose (CMC) and hydroxypropyl methylcellulose (HPMC) at water retention and protection of corneal epithelial cells. HA can not only retain water but also slowly release it over time.

WHICH IS BETTER? HA 0.1%, 0.18% or 0.3%?

In In Choen’s 2018 Study, all concentrations helped improve overall DED symptoms. The group with 0.3% HA showed the longest Tear Break Up Time (TBUT) over the 0.18% and 0.1% groups after 21 days. Tear-Break-Up-Time measures tear film instability by measuring the time it takes for the tears to first break up on the surface of the eye from the first complete blink. The study concludes that 0.3% HA is more effective than 0.18% and 0.1% in improving tear film stability, increasing conjunctival goblet cell density, and in protecting corneal epithelial cell damage. In Dorthea’s 2017 Study, 0.2% HA and 0.18% HA were shown to both efficacious and safe for the treatment of moderate to severe DED, with some parameters showing a non-significant trend favouring 0.2% HA over 0.18% HA.

CONCLUSION

~0.2% or less HA seems to be the sweet spot that provides both comfort while also not blur vision. While higher >0.2% HA appears to provide more dry eye relief for those who have more severe dry eye concerns but not afraid of some blur post-instillation. However, %HA may not be enough, scroll down to learn more.

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which DROPS have Hyaluronate acid (HA)?

0.40% HA Ointment

• I-DEFENSE Isotonic Ointment for Eyelids & Dry Eyes

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0.30% HA Drops

• I-DROP PUR GEL (HA + glycerin = 0.3% visoadaptive hyaluronan, phosphate buffer)

• HYDRASENSE NIGHT THERAPY (citrate buffer)

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0.2% HA Drops

• HYLO GEL (high quality 0.2% HA, high molecular weight HA sourced from nature, citrate buffer, approved for Post Eye Surgery in Canada, best for sensitive eyes)

• EVOLVE DAILY INTENSIVE (high quality 0.2% HA, borate buffer, approved in Canada Oct 29, 2020, status: to launch Feb 2021) - New article here

• BIODROP MD PLUS - multi-dose (0.25% HA, 2% trehalose)

• BIODROP MD - multi-dose (0.2% HA)

• BIOTRUE - single dose (0.2% HA, phosphate buffer)

• BIOTRUE - multi-dose (0.24% HA, phosphate buffer)

• BAUCH & LOMB SOOTHE PF Dry Eye Therapy - single dose (0.24% HA, phosphate buffer)

0.2% HA+ Drops

• EVOLVE INTENSIVE GEL (0.2% HA, Carbomer 980, Glycerol, buffer-free, approved in Canada Oct 29, 2020, status: to launch Feb 2021) - New article here

• I-DROP MGD (HA + glycerin = 0.2% visoadaptive hyaluronan, + lipid layer enhancer, phosphate buffer)

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0.18% HA Drops

• I-DROP PUR (HA + glycerin = 0.18% visoadaptive hyaluronan, phosphate buffer)

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0.15% HA Drops

• HYABAK (+Actinquinol: UVB protection, hypotonic, Tris Buffer, Made in France)

• THEALOZ DUO (+Trehalose: Osmoprotectant, hypotonic, Tris Buffer, Made in France)

• THEALOZ DUO GEL (+Trehalose: Osmoprotectant, hypotonic, Tris Buffer, Made in France)

• HYDRASENSE ADVANCED

0.10% HA Drops

• HYLO (high quality HA, citrate buffer, approved for Post Eye Surgery in Canada)

0.03% HA Drops

• HYLO FRESH (high quality HA + Euphrasia officinalis, borate buffer)

Contains HA at unknown%

• SYSTANE ULTRA HYDRATION PRESERVATIVE-FREE SINGLE DOSE and MULTI-DOSE BOTTLES (Canadian Version only, HA + HP-GUAR)

• BIODROP MD SPRAY - micro-emulsion spray bottle (HA + sea buckthorn seed oil)

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For Allergies / Itchy red eyes: contains 2% ecotine

0.15% HA Drops

• HYDRASENSE ALLERGIES (citrate buffer)

0.05% HA Drops

• HYLO DUAL (high quality HA, citrate buffer, Made in Germany)

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HA % alone may not be enough.

Because eye drops have a limited time in contact with the eye before it gets washed away, the time of direct contact is short for absorption. Reapplication is often needed and the number of drops to apply is difficult to recommend for severity of dry eye. Higher viscosity drops tend to allow for higher bioavailability of the drug. The drop size, its composition and molecular weight will also need to be considered.

Molecular Weight: Long vs Short chain HA

The concentration of HA does not always reflect the molecular weight. It is possible to have a high molecular weight HA at a lower concentration in a formulation, which can outperform one with a higher concentration of HA. For example, HYLO (high-MW HA) vs HYABAK & HYDRASENSE (low-MW HA). High-quality HA depends on the molecular weight, which is related to the length of the chain of each molecule.

High molecular weight HA will be more cohesive since it will take more time to breakdown than low molecular weight HA.  It promotes adult regenerative healing. It can sit on the ocular surface longer to draw moisture and continually hydrate the cornea. Low-quality HA is more dispersive due to its light weight, which can bind with other molecules and cascade an inflammatory response. In the future, cross-linked HA may play a role to being more beneficial than non-cross-linked HA (i.e. AEON PROTECT PLUS).

High-molecular weight HA (>1000 kDa)

• HYLO

• HYLO GEL

• HYLO DUAL

Click to article for comparison

OSMOLARITY PLAYS A FACTOR

Since Hyperosmolarity contributes to DED. Hypotonic solutions have been shown to offer greater improvements than isotonic solutions.

A 2008 study showed that by reducing the osmolarity of tear film, the hypotonic solution not only improves the characteristics of tear film and the vitality of the epithelial cells of the cornea and conjunctiva but also proves to be effective in reducing dry eye symptoms.

It compared preservative-free 0.4% HA drops in dry eye patients at 300 mOsm/L and another 150 mOsm/L. At the end of the study, 60.7% of the patients declared that they preferred hypotonic solution and only 10.7% preferred isotonic solution; the remaining 28.6% did not notice any difference between the 2 treatments.

Hyabak, Theolaz Duo and Theolaz Duo Gel eye drops are all hypotonic.

CANDORVISION eye drops around 280 mOsm/L, hypotonic.

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What about The Other Ingredients in Eye Drops?

Table information extrapolated from Artificial Tears Primer (2016). See link below to read more.

What’s the difference between GLYCEROL vs GLYCERIN?

Actually, both names are for the same molecule; however, Glyercin is the commercial name of Glycerol, which is not pure and contains at most 95% of glycerol. Evolve’s Intensive Gel uses a pure glycerol and is also buffer-free. In comparison, I-DROP PUR and PUR GEL uses glycerin.

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What about Trehalose?

Trehalose (TH) is a natural disacchiride that is both a bioprotectant and osmoprotectant. On the eye, it protects corneal and conjunctival cells from desiccation (cell death in absence of water) by:

1. The immobilization theory: Trehalose encases & protects proteins

2. The preferential exclusion theory: Trehalose keeps water out of proteins by becoming more compact

3. The water replacement theory: Trehalose replaces water, increasing its stability

Osmoprotectants protect cells against hyperosmolarity. In Schmidl’s 2015 study, trehalose can increase tear film thickness up to 240 minutes vs drops without trehalose.

The TFOS International Dry Eye Workshop II (DEWS II) recognizes trehalose as an effective ingredient with HA in moderate to severe dry eye.

HA + Trehalose Drops

• THEALOZ DUO Gel - Single Dose

• THEALOZ DUO - Multi-Dose Bottle

CMC + Glycerin + Trehalose Drops

• REFRESH OPTIVE MEGA-3 PF

Click to add to cart

Trehalose + HA vs. Hyaluronic Acid ALONE?

In a 2009 study comparing preservative-free trehalose 3%, hyaluronic acid 0.15%, carbomer 0.25% (TH HA, Thealoz Duo Gel) vs hyaluronic acid 0.3% gel drops (HA). The results showed both groups preformed well for up to 120 minutes for Tear meniscus height (TMH) and tear meniscus depth (TMD). TH HA (Thealoz Duo Gel) mean comfort duration was 115 min and 0.3% HA mean comfort duration was 148 min. Tear osmolarity, Schirmer I test, and TBUT were similar at 240 mins for both groups.

Conclusion: The study concluded that 0.3% HA remains on the ocular surface for longer than TH-HA by about 33 minutes. The longer time seemed to correlated to patient comfort.

WHAT IS HP-GUAR?

HP-GUAR acts as a viscous gel, which is derived from natural guar galactomannan, a water-soluble polysaccharide which has been treated with propylene oxide. HP-GUAR molecules have a high molecular weight (1,000–5,000 kDa), which accounts for the viscous nature of the gel.

HP‑GUAR and HA, appears to adhere to the muco‑aqueous layer of the tear film as well as the cells of the epithelium. An individual 2015 study showed that HA + HP-GUAR had about twice the cell viability after treatment than HA / HP-GUAR alone. The amount of HA concentration was not stated. The protective effect remained on the surface of the eye after 4 hours even after wash.

HP-GUAR and HA can be found in Systane Ultra Hydration PF drops in Canada.

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SUMMARY: COMPARING PRESERVATIVE-FREE EYE DROPS IN CANADA CHART

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Upcoming Novel Ingredients: Two Mucin Secretagogues (Diquafosol vs. Rebamipide) - not available & approved in Canada

Figure 1- created by Shizuka Koh. Study link below.

1) Diquafosol sodium 3%

Diquafosol sodium improves tear film stability by increasing tear volume and mucin secretion. This may inhibit tear hyperosmolarity. More specifically, it stimulates water and mucin secretion by acting on P2Y2 receptors on the conjunctival epithelium and goblet cells and meibomian glands.

DIQUAS

• Diquas became available in December 2010 in asian countries including Korea, Vietnam, Thailand, and Japan (2012).

• USE: Apply 6 times daily regardless of severity of dry eye

Long-term use with Diquas reduces higher-order aberrations (HOAs), increase tear film stability, reduces tear break up time, and reduces corneal epithelial damage better than 0.1% hyaluronate after 4 weeks of use.

Additive effect

There is an additive effect of diquafosol sodium 3% with hyaluronate 0.1%/0.3% showed greater improvement than just hyaluronate therapy alone in dry eye patients. Although more studies need to be conducted.

2) Rebamipide 2%

Rebemipide improves tear film stability by improving epithelial condition. More specifically, it acts by increasing epithelial differentiation.

Rebemipide has also found to have anti-inflammatory effects and promotes epithelial healing in animal models, which may reduce epithelial damage, and provide tear stability.

MUCOSTA ophthalmic suspension

• Launched in Japan 2012

• USE: Apply 4x daily
  
  
  

Which therapy is more effective?

We know that both diquafosol sodium 3% and rebamipide 2% upregulate MUC16, which increases tear stability. Diquafosol sodium improves tear film stability by increasing tear volume and mucin secretion, while Rebemipide improves tear film stability by improving epithelial condition and may have anti-inflammatory effects to promote epithelial healing. Overall, more clinical studies need to be conducted to clarify its long-term effects and use case.

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ACKNOWLEDGEMENTS:

STUDIES / ADDITIONAL READING

• Corneal Calcification (2006): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1856937/

• Comparison of 0.1%, 0.18%, and 0.3% Hyaluronic Acid Eye Drops in the Treatment of Dry Eye (2018): https://www.liebertpub.com/doi/full/10.1089/jop.2018.0032

• Comparison of HA & CMC (2018): https://www.healio.com/ophthalmology/cornea-external-disease/news/online/%7Beac8107e-2636-45fc-b2bb-295b9b2471ae%7D/two-dry-eye-drop-formulations-compared

• Trehalose: A novel treatment for dry eye (2018): https://www.healio.com/ophthalmology/cornea-external-disease/news/print/ocular-surgery-news/%7B6d1f0d15-4321-487b-8aa8-56648bdec2d2%7D/trehalose-a-novel-treatment-for-dry-eye

• Artificial Tears Primer (2016): https://webeye.ophth.uiowa.edu/eyeforum/tutorials/Artificial-Tears.htm

• Effects of Preservative-Free 3% Diquafosol in Patients with Pre-existing Dry Eye Disease After Cataract Surgery (2019): https://www.nature.com/articles/s41598-019-49159-0

• Diquas by Santen Osaka Japan: https://www.santen.com/en/therapeutic-areas/asia/dryeye/diquas/

• Medical Treatment of Dry Eye in Japan (2018): https://iovs.arvojournals.org/article.aspx?articleid=2717221

• Clinical utility of 3% diquafosol ophthalmic solution in treatment of dry eye (2015): https://www.researchgate.net/publication/277602357_Clinical_utility_of_3_diquafosol_ophthalmic_solution_in_the_treatment_of_dry_eyes

• Rebamipide ophthalmic suspension for the treatment of dry eye syndrome: a critical appraisal (2014): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4051796/

• Treatment of Allergic Rhinitis with Ectoine Containing Nasal Spray and Eye Drops (2014): https://www.hindawi.com/journals/ja/2014/176597/#conclusions

• Comparison of 0.2% and 0.18% hyaluronante eye drops in patients with moderate to severe dry eye with keratitis or keratoconjunctivitis (2017): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5388258/

• Dry Eye in Vitamin D deficiency (2015): https://onlinelibrary.wiley.com/doi/full/10.1111/1756-185X.12727

• Optimization of hyaluronan-based eye drop formulations (2016): https://www.sciencedirect.com/science/article/pii/S0144861716309043

• Kim JS, Wang MT, Craig JP. Exploring the Asian ethnic predisposition to dry eye disease in a paediatric population. Ocul Surf. 2018

• Craig JP, Wang MT, Kim D, Lee JM. Exploring the Predisposition of the Asian Eye to Development of Dry Eye. Ocul Surf. 2016 Jul;14(3):385-92.

• Comparison Study of TH HA drops vs 0.3% HA drops (2019): https://www.contactlensjournal.com/article/S1367-0484(19)30218-8/fulltext?dgcid=raven_jbs_etoc_email

• Effect of Hypotonic 0.4% HA drops in Dry Eye Patients (2008): https://pubmed.ncbi.nlm.nih.gov/19034126/

• Sodium Hyaluronate of different osmolarity for treatment of dry eye in Sjorgen’s Syndrome patients (2012): https://www.researchgate.net/publication/11242163_Sodium_hyaluronate_eye_drops_of_different_osmolarity_for_the_treatment_of_dry_eye_in_Sjogren's_syndrome_patients

• HA: No Laughing Matter (2018): https://www.reviewofoptometry.com/article/ha-no-laughing-matter

• Physiochemical Properties of Hyaluronic Acid-Based Lubricant Drops (2019): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6827422/

• Hyaluronic Acid Yes Size Does Matter (2015): http://barefacedtruth.com/2015/03/31/hyaluronic-acid-yes-size-does-matter/

• Indications for Ophthalmic Formulations: Ocular Buffers Showed Varied Cytotoxic Impact (2017): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5421463/

• Biological Production of Hyaluronic Acid: Mini Review (2016): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4754297/

• Effects of a Hyaluronic Acid/Hydroxypropyl Guar Artificial Tear Solution on Protection, Recovery, and Lubricity in Models of Corneal Epithelium (2015): https://pubmed.ncbi.nlm.nih.gov/26067908/

• Impact of polyethylene glycol 400/propylene glycol/hydroxypropyl-guar and 0.1% sodium hyaluronate on postoperative discomfort following cataract extraction surgery: a comparative study (2017): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5424421/

• Tear osmolarity changes after use of hydroxypropyl-guar-based lubricating eye drops (2017): https://www.dovepress.com/tear-osmolarity-changes-after-use-of-hydroxypropyl-guar-based-lubricat-peer-reviewed-fulltext-article-OPTH#:~:text=Hydroxypropyl%2Dguar%20(HP%2Dguar)%20is%20an%20agent%20found,been%20treated%20with%20propylene%20oxide.

Disclosures

• As part of Amazon’s Association Program, we would like to disclose that we use Affiliated Amazon links to not only help you find what you’re looking for, but these product links allow us to generate revenue to support writing great articles for this site.

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WHICH PRESERVATIVE-FREE EYE DROP(S) WORKS BEST FOR YOU?
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5 Steps to Take When You See Flashes and Floaters

"I'm seeing flashes, floaters and spots.
Is it an emergency? What do I do?"

Step 1. Check if it is flashing in one eye or both. How often and where is the flash appearing? Flashes of light in one eye is a sign that the vitreous gel is separating from the retina. It could be separating naturally with age or from trauma, such as a fall or bump to the eye. If it’s both eyes and lasts for several minutes, that looks like lightning and rainbows, you may be experiencing a migarine with aura.

Step 2. Check if you have any *new* floaters, spots, cobwebs or lines in your vision. They are often translucent, grey or colourless, and usually moves with your eyes. Floaters can stay in your vision for many years, so it is important to differentiate new floaters from old. 

Step 3. Check for missing vision or blurred vision. Cover each eye separately, and make sure you can see all four corners. Visual field loss usually occurs in the periphery and will almost always extend to your central vision. Any missing vision is an emergency. 

Step 4. Seek an optometrist. Regardless, if you are experiencing changes with your vision, it is best to seek an optometrist to have your eyes dilated and examined as soon as possible. As symptoms can evolve over time, keeping a record of your findings will help your optometrist determine the cause. Floaters can be a normal occurrence with age, however, new flashes and floaters can be a serious sign of an emergency that can lead to a retinal detachment and permanent loss of vision. 

Step 5. Waiting for an appointment. If immediate referral cannot be made, you should keep head movement to a minimal. Lie down flat with your head facing opposite to the missing field defect (or to the side of the detachment) to prevent it from getting worse. 

So, what is a retinal detachment and how do we repair it? 

If caught in its early stages by an optometrist, an emergency referral is made to an ophthalmologist (surgeon). Treatment can range from sealing the hole or tear by a laser or cryotherapy, which typically, has good visual prognosis and can save your vision from further loss. In late stages, visual recovery is guarded and often surgery is required. Successful reattachment doesn't guarantee your vision will come back. So, don't delay, get it checked early. 

What are my risks?

• I could be completely - Normal, natural vitreous detachment (with or without flashes and floaters) is rare before age of 40 (except for high myopes) but up to 40% will experience it by their 70s... and up 86% by 90 years old.

• 10-15% with symptoms develop retinal breaks.

• Majority of retinal detachments occurs between 50-60 years old.

• Those who have a hole or tear in their retina will almost always develop into a detachment if not treated even if they do not experience any symptoms

• Not all will experience symptoms described above, so its always good to have your eyes checked.

Who are most at risk?

• High myopes (nearsighted)

• Any previous eye surgery or trauma

• Previous retinal detachments (23% more likely to experience it in their other eye)

• Family history of retinal detachments