Adult onset Myopia- what we know

While myopia control is now considered the standard of care for our young short-sighted patients, it is still a relatively new movement in optometry, hence the science, knowledge and advice is continuing to evolve.

While anecdotally, I have known that some adults continue to progress, myopia control treatment has largely focused on children up until now.

Data shows that at least 10 percent of young adults develop myopia after the age of 20 years. With more than 30 percent of young adults progressing in one eye.

Risk factors for adult-onset Myopia

• East Asian descent- 6x risk vs Europeans

• Parental myopia – 60 percent increased risk of myopia onset and 25 percent increase in speed of  progression  for each myopic parent.

• Women- 80 percent increased risk vs men with increased speed of progression

• Reduced time outdoors

What do we now know about screen time and myopia?

• Television viewing makes no difference to risk of myopia onset or progression

• Computer use and prolonged close work such as writing at a desk increases risk

• No evidence relating to font type, size or contrast.

• Mobile phones- surprisingly due to their small screen size has actually proven to be mildy protective for children age 10 to 18 years! This is due to the varied focal length of the mobile phone versus the blur of the surrounding background. This peripheral blur is a preventative stimulus against the eye elongating and therefore reduces risk of myopia progression.

The latest advice

• For both young children and adults, time outdoors, away from prolonged close work is recommended.

• Have regular eye examinations (6-12 monthly)  if you have the risk factors mentioned

• If you are myopic, adopt a myopia control form of correction such as specialty spectacle lenses or contact lenses.

Contact Lenses

My vision is changing and like the rest of us over the magic age of 40 I am continuing to reach for my glasses more and more. While I love my vision with my glasses and the fashion statement they create, I realise it is not always the most convenient or practical option with my active lifestyle.

As an independent optometry practice we have unlimited access to new contact lens technology as it continues to evolve- allowing  us to treat each patient as an individual  and make the right choice for their precious eyes and their vision.

We want our patient’s eyes to look good, see well and feel great. With the vast range available to us at Eyes of Howick it is very rare to not be able to achieve both clear vision and a comfortable fit. Lens materials are more breathable than ever before so there is simply no need for red, irritable eyes just because you choose to wear contact lenses.

Contact lenses may be worn with a daily replacement schedule- the most hygienic and convenient option; fortnightly or monthly replacement or even monthly extended wear- whereby the lenses are only removed from the eye one night per month.

Prescription availability is extensive with both astigmatic and multifocal prescriptions available. We even have access to the amazing Acuvue Transitions contact lens which has adaptive tint technology- perfect for our glare sensitive patients and even those who have difficulty driving at night.

As part of the contact lens fitting process we spend time with you to teach you not only how to insert and remove your lenses safely but also how to best care for your lenses. We appreciate it can be quite a new experience learning to insert a lens into your eye but we have found with our expert coaching most of our patients become masters in no time!

Feel free to contact us with regard to any queries you may have or book a consultation with one of our Optometrists. We can even offer a free contact lens trial to allow you to experience the world through contact lenses!

Night driving and your Vision

Dark winter months make night driving a challenge. It is a physiological fact that our vision is best in daylight- so our eyes need all the help we can give them while driving at night. Furthermore our eyes require a full 5 minutes to adapt to the dark. While driving at night, light conditions are variable and can change rapidly. This ability to adapt to differing light levels will slow as we get older and some eye conditions impede this process.

How to maximise your night driving experience;

Get your eyes tested- regular eye exams ensure your vision is at its best. Even small focussing errors can have great effect on night vision- so even if you meet the minimum vision requirement to drive without glasses, you may still experience difficulty with night driving. Conditions such as cataract can increase glare sensitivity while driving at night, but also decrease your contrast of vision.

Check your glasses- Visit Eyes of Howick for a free glasses WOF including fit adjustment and ultrasonic cleaning. We can inspect the lenses for any lens defects which may impact  your vision. Clean your lenses daily with cool to luke-warm water and a soft, clean cloth to keep them smudge free. Or better yet, use recommended products such as our lens spray cleaner, wipes of peeps- the carbon lens cleaner. See our online store for our lens cleaning options.

Choose the right lens-Ensure your lenses have an antireflective coating- this improves light transmissibility through the lens and reduces disabling glare while night driving. Crizal Sapphire HR lenses are the most transparent anti-reflective lenses. Furthermore, Crizal Prevencia blue blocking lenses are reported to reduce glare discomfort for night drivers.

Clean your windscreen- on the inside and out! That greasy film can be a real distraction, particularly with oncoming headlights and sun strike through the day. Replace your wiper blades as required and keep the washer bottle topped up.

Clean your headlights- any dirt will reduce their effectiveness at night. Also check for yellowing of any polycarbonate headlamp covers- this can be cleaned off with the appropriate product.

Use your headlights effectively – from 30 minutes before sundown and 30 minutes after sunrise. Don't be hesitant to use high beam while travelling at night except for when approaching and following other vehicles and this can cause disabling glare for other drivers.

Avoid the glare -If you find glare of oncoming traffic a problem- avert your eyes to the left side of the road to avoid this direct glare source while at the same time remain aware of oncoming vehicles. Also don't travel at night with the internal vehicle light on as this will cause extra visual fatigue.

Slow down-Drive at a speed so you can see the road at least 2 seconds ahead.

Remember if you have any queries about your vision difficulties or your eyewear, we are always happy to help at Eyes of Howick. Here's to happy and safe driving!

An Eye on Melanoma

What is melanoma?

Melanoma occurs when Melanocytes- the pigment-producing cells that give colour to the skin become cancerous. Melanomas can occur anywhere on the body, with the eye being the second most common site after the skin.

Signs may include a new, unusual growth or a change in an existing mole or naevus. Treatment may involve surgery, radiation, medication or in some cases, chemotherapy.

Ocular melanoma

As an optometrist, I frequently note pigmented spots and lesions in eyes of my patient’s. These can range from benign iris freckles (small pigmented spots on the surface of the coloured part of the eye), through to large choroidal naevi (large moles situated beneath the retina at the back of the eye).

Posterior uveal melanoma- choroid and ciliary body

Being the most common site for ocular melanoma and occuring inside the eye, they are only detected during an eye examination. Symptoms may include blurred vision or blind spots, new floaters or flashes- however, these usually occur when the melanoma is well advanced.

Conjunctival melanoma

The conjunctiva is the delicate, vascularised tissue that overlays the sclera (white of the eye). Accounting for 10 percent of eye melanomas, treatment outcomes are favourable. However, recurrence is high so regular reviews are important.

Iris melanoma

Generally found during routine eye examinations and often occurring from pre-existing iris naevi- New Zealand has the highest known incidence in the world. If caught early, treatment options are favourable.

Risk factors

·        Fair skin- although 4% of Uveal Melanoma in an Auckland Clinic occurred in Maori patients

·        Light coloured eyes

·        Having a pre-existing mole within the eye

·        Ultraviolet light exposure

·        Older age

Recommendations

Wear sunglasses, ensuring they provide 100 percent UV protection. A hat is also beneficial to further shield ambient light exposure around the eye.

My strongest recommendation would be to those who have never had an eye examination to book one! This enables the Optometrist to screen you for any risk factors of eye cancers and advise a time frame for any further reviews. As mentioned, as many of these lesions are not visible to the naked eye, it is only during a routine eye exam that they may be detected.  

Tips and Tricks for Contact Lens Wearers

Whether it’s your first-time wearing contact lenses or you are a seasoned wearer but you are still trying to find the best techniques, here are some insertion, removal tips and the dos and don’ts of contact lens wear. 

Insertion tips

• Insert the same lens first – this is to avoid confusion and inserting a lens into the wrong eye!.

• Ensure the lens is moist from the contact lens solution – a dehydrated contact lens will not adhere to the eye, will be uncomfortable and may compromise your vision.

• Check the lens is not inside out – look at the side profile of the lens as it balances on the tip of your finger. If it is the correct way the lens will appear spherical as opposed to having a fluted edge like a pudding bowl. Alternatively, gently squeeze the lens between your thumb and forefinger. If it touches, the lens is the correct way. This is known as the ‘taco test’

• Place the contact lens on the tip of your index finger and with with the middle finger of the same hand pull down your lower lid

• Use your free hand to pull the top eye lid up right at the edge of the lid near the lashes – this will help to stop the blink reflex

• Keep looking straight ahead while bringing the lens towards the eye – this helps to centre the lens on the cornea

• Once the lens is on the eye, gently move your eyes around and close them – this helps to displace any air bubbles and makes ensures the lens is centered

Removal tips

If you feel your contact lens is a bit dry apply a lubricating eye drop to the eye – this will help the lens slide of the eye

Pull down your lower eyelid with your middle finger and look either up or to the side

·Using the index finger of the same hand slide the lens to the white part of the eye ( the sclera)

Using your thumb and index finger carefully pinch the lens and remove it from the eye – the contact has remained on your eye for the whole day so don’t be afraid to apply a bit of pressure  

Dos

• Trim your nails- particularly on your thumb and index finger- this reduces the risk of scratching your eye!

• Always wash your hands with soap and water and dry with a lint-free towel or tissue before handling your lenses

• Discontinue contact lens wear if you experience persistent discomfort, redness or blurred vision – contact your optometrist for advice

• Insert and remove your contact lenses before applying or removing your make up

• Clean your lenses thoroughly – follow the instructions given by your optometrist. If you are wearing daily disposable contact lenses, there is no cleaning routine required.

• Clean your contact lens case – this is just as important as cleaning your contact lenses. In fact a dirty lens case is the most common source of eye infections.

• Use contact lens solution to rub and rinse it. Or once per week wash with hot soapy water and allow it to air dry. It is recommended to replace your case every 3 months- a bit like your tooth brush!

• Always purchase your lenses from an eye care professional to ensure your lenses are legitimate and have not been involved in any industry safety recalls. Evidence shows a higher incidence of contact lens related complications in people who simply buy their lenses of the internet.

• Return to your optometrist on an annual basis to ensure your eyes remain healthy and your lenses are still the best option for you and your lifestyle.

Don’ts

• Use tap water to store, clean or rinse your contact lenses – water can have a variety of microorganisms that can cause serious infection to the eye.

• Take care around water based activities such as showering, swimming in pools, hot tubs or saunas. When swimming keep your eyes closed or wear goggles. Daily replacement contact lenses are the safest for water sports.

• ·Wear your lenses sleeping – unless advised by your optometrist. It has been shown to increase the risk of an eye infection by up to 8 times.

• Use the lens if the pack is open or damaged or if the lens itself is damaged

• Use expired lenses or solutions

 No matter what type of contact lens you wear, remember that contact lens care and safety are crucial to maintaining good eye health and an enjoyable contact lens wearing experience.

Complementary therapy for glaucoma patients

When I last attended the International Glaucoma Symposium, one of the presentations which resonated with me was by Professor and Ophthalmologist, Tanuj Dada from the All India Institute of Medical Sciences.

Through his pioneering research on meditation and its impact on glaucoma patients he offers an alternative but complementary therapy for those already on conventional treatment for their eye disease.

His talk offered compelling reasons for all of us to adopt the practice of meditation, yogic or deep nasal breathing.

Physiological benefits 

• Helping to increase cerebral and ocular blood flow 

• Increasing blood oxygenation

• Reduces cortisol (stress hormone ) release

• Increase in nitric oxide-a natural vasodilator which is released by most cells in our body, including the eye

• Activation of the parasympathetic nervous system and reduction in  sympathetic nervous system activity ( therefore, helping to mediate our fight or flight response)

How this helps our physical and mental well-being

• Promotes brain health and neural plasticity along with synthesis of grey and white matter in the cerebral cortex 

• Reduction in intraocular pressure – may be a useful adjunctive therapy for those diagnosed with glaucoma

• Reduction in blood pressure 

• Meditation creates a relaxation response thus helps to reduce stress and anxiety

• Promotes quality sleep

• Helps to activate our pre-frontal cortex (our thinking brain) and deactivates our reptilian (reactive) brain. This helps us return to a mental state of learning 

As an Optometrist who manages glaucoma, I look forward to discussing possible lifestyle changes with my patients which may have a positive effect on their eye condition. For some time I have recommended a healthy diet and moderate exercise but meditation and yogic breathing will now be included in our conversation. 

If you have glaucoma it is important to continue your eye medication as this is the best and most proven way to keep your eye pressure in check. Furthermore, if you have been told you are at risk of glaucoma it is important to always attend your regular eye health reviews with your optometrist or ophthalmologist. Always consult with your eye care professional if you are considering making lifestyle changes which may have an impact on your glaucoma management.