Pregnancy causes changes to women on many levels, physically and emotionally. One health concern that may go unmentioned during a pregnancy is the visual changes that can occur.

 Systemically there are huge hormone level alterations occurring in pregnant women.  Females experience increases in hormone levels that can cause changes in blood, cardiovascular function, and immunology. In terms of ocular changes, women may experience difficulty in focusing on objects due to increased corneal thickness and curvature.. Commonly, small fluctuations in eyeglass prescriptions occur. Fortunately, the variations experienced are typically transient.  For this reason it is not wise to consider refractive eye surgery while pregnant or breast feeding.  

 There have been a few reported cases of pregnant women who experience minor losses in their peripheral vision for a short period of time.

 Women can also suffer from pregnancy-induced dry eye. This can be intensified with contact lens wear. Artificial tear supplements can be used to minimize these symptoms.  Some women need to be refitted with different contact lenses that are more suited for dry eye conditions.

 Eye pressure in the eye typically decreases in the third trimester. Women who are prone to uveitis (inflammation inside the eye) are more likely to suffer a reoccurrence during pregnancy.

 Pregnant women who are diabetic are of particular concern. Properly maintaining control of blood glucose levels is crucial to the mother and baby. Pregnancy can speed the progression of diabetic retinopathy, which is a type of sight threatening retinal disease that occurs in diabetics. Diabetes that occurs only during pregnancy (gestational diabetes) typically does not cause diabetic retinopathy.

 Women frequently ask if they are able to use prescription eye drops while pregnant.  Over the counter artificial tear supplements are of no concern to pregnant women and the baby. Most prescription topical eye medications such as anti-histamines, anti-inflammatories, anti-virals and antibiotics drops do not pose a serious risk to the fetus. Glaucoma eye drops should be stopped during the first trimester. There are no concerns when your optometrist instills pupil-dilating drops as well. To minimize any potential effect from topical eye medications, gently pressing on the inner corner of the eye after instilling the drop ensures more of the drop absorbs into the eye and less systemically. In fact this is a useful tip for anyone instilling eye drops. There are tear ducts in the inner corner of each eye that drains tears from the eye into the nose and ultimately into the throat. Applying gently pressure onto the inner corner of the eyelids helps reduce the drainage into the nose ensures greater absorption into the eyeball.

 Women who suffer from preeclampsia (gestational hypertension) can experience temporary vision loss from retinal swelling and hemorrhages.

 Not all pregnant women will experience the conditions mentioned above.  Rest assured that in most cases they are temporary. Most changes that occur during pregnancy usually return to normal several months after delivery. Should you have any concerns about the affect your pregnancy is having on your vision, do not hesitate to contact your local optometrist.

The cornea is the clear, dome-shaped covering of the eyeball.  In order to see clearly with or without glasses or contact lenses, the cornea must be clear as well as maintain this dome shape.  For some patients, the cornea becomes thin and eventually bulges forward like a cone.  This disease is called keratoconus.

 What causes keratoconus?  Usually there is no cause but it can be hereditary.  Keratoconus has also been linked to chronic eye rubbing and Down syndrome. It occurs equally between males and females and generally affects both eyes

 Keratoconus usually begins in the late teenage years however it can occur in the twenties or early thirties.  Patients usually notice a very slow progression of distorted vision.  To a patient, objects appear distorted. They will also notice haloes or star bursts around bright lights.  An optometrist or ophthalmologist makes a diagnosis of keratoconus based on the patient’s observations as well as results from a complete eye examination.  Patients usually have an increase in the astigmatism portion of their eyeglass prescription.  The cornea shape is examined manually by a machine called a keratometer.  Computer-generated 3D maps of the cornea can also be performed using a topographer.  These tests will indicate how curved or cone-shaped the cornea has become.

 How is keratoconus treated?  There is no cure for keratoconus.  In the early stages we prescribe new eyeglasses.  As the disease progresses, soft and then hard contact lenses are considered.  Hard contact lenses or rigid gas permeable lens (RGPs) work best since they maintain their shape and can help to mask the corneal irregularity that results from keratoconus.  Some patients find hard contact lenses uncomfortable and need specialty contact lenses.  One type of specialty contact lens has a hard material in the center and a soft material on the periphery.  Another contact lens option available requires wearing a soft contact lens with a hard contact lens over top.

 Scleral contact lenses are another specialty lens option for keratoconic patients who struggle with lens stability. Since the cornea is cone-shaped in keratoconus, some traditional RGP lenses are unstable on the eye. Think of the apex of the cone as the center of a teeter-totter. The RGP can rock over the cone and is prone to falling out of the eye. Scleral contact lenses have a much larger diameter than traditional RGPs and extend on to the sclera (white part of the eyeball) which provides much greater stablitiy.

 For some patients, the keratoconus progresses to the point where contact lens wear does not provide them with adequate vision, or they may simply find the contact lenses too uncomfortable.  These patients are then considered for corneal transplant surgery.  Any patient who has any sign of keratoconus should not have laser eye surgery.

 A surgical procedure available in Canada to prevent the progression of keratoconus. It is called corneal collagen cross-linking with riboflavin and UV-A light (CXL-UVA). In this procedure, the front layer of the cornea is gently removed. Then riboflavin eye drops are applied to the cornea. A safe amount of UV-A light is applied to the cornea. Riboflavin when activated with the UV-A light, increases the corneal cross links within the cornea. This strengthens the links or bonds of neighboring filaments within the cornea making it more rigid and less likely to bulge forward into a cone shape. The goal of CXL-UVA is not to totally reverse the disease but to prevent further progression to enhance spectacle or contact lens wear. It may defer the need for a corneal transplant.

 Keratoconus does not result in blindness.  Improving a keratoconic’s vision requires patience and persistence on the part of the patient and optometrist since no single treatment option works on every patient.

One of the more common emergency conditions patients visit their optometrist occurs when they are experiencing a red or pink eye. The belief that red eye is contagious and is always treated with antibiotics is a very common public misconception. This could not be further from the truth. There are numerous causative factors of red eye. While some cases are treated with antibiotics, others simply do not respond to any type of antibiotic therapy.

 The causes of red eye are extensive. Some of the more common reasons include bacterial infections, viral infections, iritis (inflammation inside the eye), dry eye, acute glaucoma, foreign body in the eye, blepharitis, trauma, episcleritis (inflammation of the upper layer of the whites of the eyes), scleritis (deep inflammation of the whites of the eye), post surgical irritation, etc. Treating a red eye is highly dependent on the cause. Therefore it goes without saying that the proper diagnosis of a red eye is crucial in order for timely and complete resolution.

 A red eye caused by a bacterial infection will produce a yellowish discharge and will resolve itself in time without treatment. It can be contagious. Antibiotic drops will speed up resolution of the red eye.

 Most viral infections will frequently produce a watery discharge and may be associated with an upper respiratory infection. This type of infection can be contagious as well and will resolve without the use of drops however anti-inflammatory drops can speed up the healing. A herpes virus infection of the eye is a much different condition which requires aggressive treatment with strong antiviral and/or anti-inflammatory drops.

 Iritis will also cause a patient to have a red eye. This condition must be treated aggressively with anti-inflammatories and dilating drops. It is not a contagious condition and antibiotic drops will not help to alleviate the red eye. If some cases, oral anti-inflammatories need to be prescribed.

 Dry eye can also cause redness to occur. Treatment usually involves using over the counter artificial tears available at your local pharmacy. The vast variety of different artificial tear brands can be overwhelming when making a treatment choice. A recommendation from your optometrist or ophthalmologist will help in directing you to the correct choice for your treatment. 

 I have seen countless patients who come in with a red, irritated eye that is not getting better with the drops they were given from their general practitioner. In some cases when I examine their eyes, I have found a foreign body stuck in their cornea. Obviously the foreign body needs to be removed.   

 I have not listed all the possible causes and treatments of red eye as time and space does not permit it.  The point I am trying to make is that proper diagnosis is very important when it comes to treating a red eye.  Treatment options depend greatly on the cause of the red eye.  Contact your local optometrist or ophthalmologist should you or anyone in your family suffer from a red eye.

In today’s high tech world, many of us spend several hours per day or week using a computer, tablet or smart phone. Roughly three quarters of all careers involve the use of computers. With video games and the Internet, an increasing number of adults and children are using the computer for entertainment purposes as well.  With this amount of exposure to computers, computer vision syndrome (CVS) is a recognized phenomenon of many patients.

 The symptoms of CVS include eyestrain, headaches, blurred vision, dry or irritated eyes, double vision, excessive squinting, watery eyes, and eye pain. It has been estimated that roughly 80% of the population spend more than 2 hours per day using a computer. With this amount of visual strain, it is not surprising that there has been an increase in symptoms related to computer vision syndrome.

 What can be done to treat CVS? The first step is to have a complete ocular-visual examination with your optometrist. Your optometrist can determine if prescription eye glasses are required to help with the symptoms. Contact lens wearers need to have clean, well-fitted, and hydrated contact lenses to alleviate CVS symptoms. As well the contact lens prescription needs to be accurate.

 For bifocal users, progressive or no-line bifocals work best for computer use. There are new customized progressive lenses available now that allow a larger field of view when looking at a monitor. Traditional lined bifocals create difficulties at the computer since the user needs to lift their head to look thru the bifocal segment.  This could lead to increased neck, upper back, and shoulder strain.

 There are also specific lenses made for computer use. These lenses have a yellow to slightly brown tint that helps reduce the blue reflective light from the computer screen that can cause strain.

 There are several things you can do yourself to treat CVS. First of all, your computer monitor should be positioned roughly two or three inches below your horizontal line of sight. Therefore, you should be able to see just above the top of your monitor. Placing the monitor too high creates unnecessary eye and neck strain.

 Secondly, sit at a distance just far enough away from the monitor so that you can barely touch the monitor without leaning forward.

 Thirdly, make sure you remember to blink. This may sound trivial but studies have shown that our blink rate reduces to roughly one-third of the normal blink rate while we are on the computer. We hydrate our eyes by blinking. Therefore a reduction in the blink rate will dry the eyes out leading to increased eye strain.

 Finally, follow the rule of 20’s. More specifically, every twenty minutes, take a twenty second break by looking twenty feet away.

 Increasing the contrast on your monitor and reducing the overall room lighting can minimize the symptoms of computer vision syndrome.

 If your computer is near an outside window, the reflections from the window can increase computer glare. Positioning the monitor away from a window may help as well.

 Remember that if you suffer from any of the symptoms of computer vision syndrome, something can be done. If you have attempted the above techniques to improve CVS and symptoms remain, it is best to make an appointment with your optometrist to discuss other aids that can be used to help.   

Looking into a mirror, you will easily be able to see your pupils.
They are the round dark centers of the eye or the gap within the
iris, the coloured part of the eye. Health care professionals
assessing a patient’s pupils can provide insight into the health of
not only the eye but also the rest of the body.
The size and shape of the pupil is controlled by nerve impulses
from the brain. There are actually two different classes of nerves.
The first class is responsible for making the pupil larger (dilated),
while the other makes the pupil smaller (constricted).The dilating
group of nerve fibres originates from the lower portion of the
brain. They travel down to the thoracic region of the spinal cord
then back up to the head along the internal carotid artery and
eventually through the back of the eye. The constricting group of
nerve fibres originates from the lower portion of the brain, but
travels into the head and enters through the back of the eye. The
balance between these two types of nerve fibres determines the
size of your pupil.
The amount of light entering the eye can change the size of the
pupil. This is called the light reflex. Increasing the amount of light
will cause the pupil to constrict. In dim light conditions, the pupil
will dilate. When focusing on an object that is close to your face,
the pupils will constrict. This is called the near or accommodative
reflex.
When assessing a patient’s pupils, we look at the pupil size, shape,
reaction to light, and any asymmetry between the pupils.
The normal size of pupils ranges from 3mm to 8mm in diameter.
Normally pupils are round however they can take an oval or
distorted shape due to previous eye inflammation, trauma,
intraocular eye surgery or congenital defects.

Abnormalities in pupils to the reaction of light can be caused by
optic nerve disease due to inflammation or reduce blood flow.
Significant arterial occlusions in the retinal blood vessels can also
cause pupil reaction changes as well.
Usually the pupils have the same diameter between left and right.
On occasion there can be a difference in the size between the eyes.
This is referred to anisocoria. For some people this can be normal.
In other instances this can be caused by certain eye drops, trauma,
intraocular surgery, tumours or blood vessel damage near the
pathways of the nerve fibres responsible for controlling the size of
the pupil.
The next time you look in the mirror, pay particular attention to
both your pupils. If anything should appear out of the ordinary
regarding your pupil size or shape, do not hesitate to consult the
care of your local optometrist or ophthalmologist.