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Having eye problems? Why not ask an Ophthalmologist – the MD of the eye world.
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Dr. Setareh Ziai
University of Ottawa Eye Institute, Ottawa, ON
Dr. Setareh Ziai is an academic ophthalmologist at The Ottawa Hospital, specializing in cornea, anterior segment, external disease, and refractive surgery. As a clinician at a teaching hospital, she provides patient care while training the next generation of ophthalmologists. Dr. Ziai serves on the board of directors of the Canadian Ophthalmological Society and is a cofounder of Canadian Women in Medicine, an organization advocating for women doctors.
Do you know the 3 Os of the eye care team?
Dr. Ziai explains the connection between our eye health and our overall health, and answers your questions about all the ways in which we can love our eyes to keep them healthy and happy.
What are some steps I can take to help maintain healthy eyes throughout my life?
Anything you do to improve your overall health will also contribute to better ocular health. Things like exercise, not smoking, and eating a balanced diet can all help. Dark leafy greens, in particular, are really good for eye health, and studies have shown that certain vitamins can help with macular health in some patients.
Protecting the eyes from the sun is another big one. We’ve become so good at putting on sunscreen every time we go outside, but we often forget about our eyes. I find we’re still living in a society where sunglasses are more of a fashion statement than a necessity. We can’t forget the importance of UV protection, not just for our eyes, but also the structures around the eyes, including the eyelids.
What can an eye exam reveal about our overall health?
Our eyes are truly a “window into the soul” – we can get a lot of insight into a patient’s health simply by looking into their eyes. Some eye diseases are associated with systemic diseases, which are diseases that can affect the entire body. Sometimes when ocular signs are detected, it will prompt us to look for associated medical conditions elsewhere in the body.
One of the most common systemic conditions that we sometimes first find in the eyes, before a patient is even aware they have it, is high blood pressure. Long- or short-term high blood pressure can lead to changes in the structure of the blood vessels in the back of the eye. Diabetes is another condition that is sometimes first diagnosed by an ophthalmologist based on the appearance of the retina. Ophthalmologists can also help diagnose and monitor multiple sclerosis and other neurological diseases based on what’s happening with the patient’s eyes.
The opposite scenario is also true – oftentimes, a patient is diagnosed with a systemic condition, and then sent to an ophthalmologist to see if there are any associated changes in the eye.
I’ve never been to an ophthalmologist. What exactly is an ophthalmologist and why would I see one?
The first step in looking after your eyes is understanding the difference between an optician, an optometrist, and an ophthalmologist, or what we refer to as the 3 Os of the eye care team. While each of the 3 Os has a specific role in eye care, we work together to monitor and manage your eye health.
An optician is trained to help you see better; they will fit and dispense eyeglasses, contacts, and low vision aids and devices. As a primary eye care provider, an optometrist is who you’ll most likely routinely encounter. An optometrist has completed optometry school and is well qualified to provide screening exams and identify ocular conditions. If an eye disease is diagnosed, an optometrist can monitor you until you need further treatment. They can also prescribe certain eye drops.
If you and your optometrist feel that additional consult is needed (for example, to confirm a diagnosis), or if your eye condition requires management beyond prescription drops, then you would be referred to an ophthalmologist like me. Ophthalmologists have gone through a minimum of 4 years of medical school and 5 years of surgical training, so we have the unique, specialized expertise to diagnose and treat all eye diseases, including with surgical or laser procedures if needed.
I haven’t been to an eye doctor in several years, but my vision seems fine. Should I get an eye exam?
It’s important to be aware that a lot of eye diseases are silent and can progress without causing many, or any, symptoms. Take glaucoma for example. You wouldn’t necessarily know you had it unless an eye care professional detected it during an eye exam, or until it became very advanced. For many eye diseases, early detection and treatment can lead to better outcomes and can prevent vision loss. So just like you have your teeth checked regularly by a dentist, you should have your eyes checked every couple of years by an optometrist or ophthalmologist to make sure you don’t have a condition that might need treatment or monitoring.
I have a healthy 6-month-old baby. When should she have her first eye exam?
It’s great that you’re already thinking about your child’s eye health. Most babies will have a quick eye exam performed by their primary care provider within the first week or two of life, during the routine well-baby exam. It’s recommended that all kids have at least one comprehensive eye exam before they’re 5 years old.
There are some conditions in children, like amblyopia or “lazy eye”, that can affect vision into adulthood if not caught early enough. There’s this magic window of time in which we can help both eyes see at their best potential, but only if we treat the condition early enough. After the age of about 10-12, if you discover that one eye is weaker than the other and try to strengthen it, the success rate of improving visual potential in that eye drops dramatically. What breaks my heart is when children aren’t seen until they are teenagers, and only then discover that they have a condition like amblyopia. If we had caught it when they were younger, both eyes could have been “normal-seeing eyes”. Some of these problems are so preventable – they can often be fixed if treated in a timely fashion.
How often should I get my eyes checked? What about my kids?
If you don’t remember the last time you had your eyes checked, go get a comprehensive eye exam. If the optometrist or ophthalmologist says your eyes look healthy and doesn’t have any concerns, try to stick to the recommended schedule of an eye exam every 2 years (or yearly, if you’re over 65).
Your eye care professional might recommend more frequent follow-ups and will advise on the appropriate interval if:
• You have any family history of ocular disease
• You have high blood pressure or diabetes
• You’re pregnant or nursing and notice any changes in vision
For kids, make sure they’ve had at least one comprehensive eye exam by age 5. If everything is normal, periodic eye exams are recommended thereafter. Young children will often not complain of vision changes, especially if only one eye is affected, so it’s a good idea for them to get an eye exam every year to make sure they’re seeing clearly.
My eyes are extremely dry and irritated, especially in the winter months. Do you have any simple tips that can help my eyes feel more comfortable?
Dry eye is extremely common, especially given our harsh Canadian climate, and dry eye can be debilitating. There are steps you can take on your own to help relieve the symptoms.
Screen time is one of the main culprits for dry eye. In fact, any focused work, including screen time or even reading a book, causes you to blink less often than you normally would, so it’s important to take a break every 20-30 minutes. Just look away, focus on something in the distance, and blink your eyes. You can increase the humidity in your home or office space using a humidifier. Artificial tears or lubricating drops can help improve the quality of the tear film. An oilier tear film stays on the surface of the eye longer. Some studies have shown that omega-3 supplements, like fish or flax oils, can help produce oilier tears. Hot compresses can help too. For many people with mild dry eye, these tips can help. If you’ve tried all of these and still haven’t found sufficient relief, speak to your eye doctor because other treatment options are available.
I work on a computer all day. Should I be wearing blue light–blocking glasses?
Blue light–blocking glasses have recently become trendy and are advertised to reduce digital eyestrain. While they won’t cause harm, there’s no evidence to support their use. The best way to find relief from digital eye-strain is to take regular breaks, position the screen at about arm’s length, and reduce glare by adjusting the ambient light in the room.
So instead of splurging on blue light–blocking glasses, you’re better off putting the money towards a pair of sunglasses to protect your eyes from UV – which is known to cause eye damage.
Dr. Hady Saheb
McGill University Health Centre, Montreal, QC
Dr. Hady Saheb is a glaucoma surgeon whose ophthalmology practice is focused on medical and surgical glaucoma care, as well as cataract and complex anterior segment surgery. He’s also the Director of the Glaucoma Fellowship at McGill University and is on the Board of Directors at the Canadian Ophthalmological Society (COS). For Dr. Saheb, the most rewarding part about treating glaucoma is helping patients understand their disease and engaging them in their treatment to help preserve their vision.
Ready to learn more?
Watch our glaucoma video and read about common risk factors, diagnosis and treatment.
Ahead of World Glaucoma Week, we asked Dr. Saheb some of your questions about glaucoma to help bring awareness to this leading cause of blindness, provide tips to those living with glaucoma, and educate Canadians about ways we can lower our risk of vision loss from this serious eye disease.
What exactly is glaucoma?
Glaucoma refers to a group of eye diseases that affect the optic nerve, which connects your eye to your brain. Glaucoma is often related to the pressure inside the eye, known as intraocular pressure. When the eye fluid doesn’t drain properly, pressure builds up in the eye. This increased pressure can damage the optic nerve fibers, leading to a loss of peripheral vision and sometimes even complete vision loss.
I’m in my 40s and have never really given glaucoma much thought. What should I know?
I think it’s really important for everyone to know that glaucoma can lead to blindness if not treated early. In fact, it’s one of the most common causes of blindness both in Canada and worldwide. It’s equally important to remember that vision loss from glaucoma is preventable with early diagnosis and treatment. The best thing that you can do to protect yourself from glaucoma-related vision loss is to be screened regularly for glaucoma. Every adult should have a comprehensive eye exam with an eyecare provider every 1-2 years.
I’d urge Canadians to be aware of the risk factors for developing glaucoma. People over 50 years of age, who have a family history of glaucoma, or from certain ethnic groups (e.g., those of African descent) are at higher risk of developing glaucoma. Those individuals should be screened earlier and more often, at a minimum of once a year.
I’ve just been diagnosed with glaucoma. Does that mean I’m going to go blind?
Recognizing how highly most people value their sense of sight, the thought of going blind is scary, so your question is common and an important one to ask. Glaucoma is a serious eye disease and remains one of the most common causes of blindness. What’s helpful to keep in mind is that in looking at studies of glaucoma around the world, most patients who go blind either started treatment when their glaucoma was already at a severe stage, or they struggle with adhering to treatment and follow-up. In many cases, if patients are engaged in their treatment and follow-up, the chances are very good that we’ll be able to maintain their vision throughout their lifetime.
I have glaucoma but I’ve never seen an ophthalmologist. What role does an ophthalmologist play and when should I be referred to one?
Glaucoma care is complex and may involve an optometrist, ophthalmologist, or sometimes both working together. As medical doctors with extensive training, ophthalmologists have a unique and specialized expertise in managing patients with glaucoma. We also have the training required to perform laser and surgical procedures as well as manage any potential complications safely and quickly. In general, if they are not already seeing an ophthalmologist, patients with glaucoma should be referred for evaluation or treatment in the following cases:
- Worsening glaucoma despite treatment
- Difficulty lowering eye pressure despite treatment
- Difficulty tolerating current treatment
- High risk for glaucoma deterioration (e.g., younger age, strong family history of glaucoma-related vision loss, other eye conditions, etc.)
I’ve been on prescription eye drops for glaucoma for over a year. I know I need to use them regularly, but I really don’t like them. Is there anything else that can be done?
The short answer is yes – something else can almost always be done so it’s really important to share this feedback with your eye care provider. Prescription drops can be extremely effective for managing glaucoma, but some have side effects, such as increased dryness or irritation of the eyes. We know that patients who are bothered by their drops are less likely to take them regularly, so we want to work with you to help you find a treatment option you’re comfortable with. That could mean switching to a different kind of eye drop or considering other treatment options like laser or surgery. The key is to keep those lines of communication open with your eye care provider so they can find an option you’re likely to stick with.
Looking ahead to the next 5-10 years, what new advancements are on the horizon that will improve glaucoma care in Canada?
Ophthalmology is a medical discipline that’s constantly evolving and within glaucoma care specifically, there is a lot to look forward to in the next few years. The surgical space in glaucoma is continuing to evolve and there are new procedures expected to become available to patients that will improve surgical outcomes and safety. We’re also seeing laser treatment playing an increasing role as patients are looking for alternatives to eye drops to lower eye pressure. There’s also some exciting innovation still in the research phase looking at reversing glaucoma, rather than the current approach of preventing or stabilizing damage from the disease. Lastly, the COVID-19 pandemic has really accelerated the uptake of virtual glaucoma care and moving forward we’re likely to see more telehealth options available to make glaucoma care more accessible and convenient to patients.
Dr. Phil Hooper
Ivey Eye Institute, London, ON
Dr. Phil Hooper is a leading Canadian ophthalmologist with a clinical focus on uveitis and retinal diseases. He currently serves as the President of the Canadian Ophthalmological Society (COS).
We asked Dr. Hooper your questions about eye injuries to help us better understand how they happen and steps we can take to help keep our eyes safe as we work and play.
What are some of the most common causes of eye injuries?
A lot of the eye injuries I see in my practice are sports related; they’re usually the result of a blow to the eye from a ball, elbows, or hands. Contact sports like basketball and boxing pose a particularly high risk of injury. Workplace eye injuries are also quite common. People who work with chemicals or in construction, carpentry, or other industrial settings are at the greatest risk. Weekend chores like yard work and home repair projects are another major cause of eye injuries – hammers and power tools like drills and saws can send sharp objects or debris flying up toward the eyes.
The good news is that the vast majority of these injuries can be prevented by wearing the right protective eyewear. Look for CSA-certified glasses or goggles and wear them in any potentially risky situations.
What types of eye injuries are most likely to occur when playing sports? Which sports cause the most eye injuries?
Sports-related eye injuries can range from corneal scratches and eyelid lacerations to more severe blunt-force trauma that can cause orbital fractures or even retinal detachment, which can result in complete vision loss. Most sports-related eye injuries occur in basketball, baseball, and racquet sports – but any activity with a high-velocity projectile (like paintball) can be dangerous. Combat sports like boxing and martial arts are more likely to cause a serious or even blinding eye injury.
To protect your eyes, ensure both you and your kids wear the right kind of eye protection for the sport you’re playing. Often, that means glasses or goggles with impact-resistant, shatterproof polycarbonate lenses. Sports like hockey or lacrosse require helmets with polycarbonate face masks or wire shields. And if you’re on snow or water, wear protective glasses or goggles with UV protection to shield your eyes from harmful UV rays and reduce glare.
Our family loves celebrating holidays with fireworks! What should I know about fireworks and eye safety?
Fireworks are a fun way to celebrate with family and friends but it’s important to be aware of the risks and take recommended safety precautions. When not handled properly, fireworks can cause burns and injuries, including serious eye injuries. Firework-related eye injuries tend to be especially severe because fireworks combine force, heat, and chemical exposure – they can cause anything from burns to ruptured eyeball and retinal detachment. Even sparklers, which many people assume to be safe for kids to play with, burn hot enough to cause serious burns.
The best way to avoid a potentially serious injury is by attending a professional, public fireworks show rather than buying fireworks for home use. If you decide to use fireworks at home, there are some safety precautions you can follow to help ensure your fireworks displays are fun and memorable (for the right reasons!):
- Keep your distance – even bystanders can be injured by fireworks
- Wear safety glasses when handling and lighting fireworks
- Make sure everyone holding a sparkler is at least 5 years old and kids are closely supervised
- Hold lit sparklers at arm’s length and away from other people
If you do experience an eye injury from fireworks or a sparkler, get medical attention right away.
A stone got kicked up from my lawn mower and hit my eye. Now the eye is bloodshot, but my vision seems normal. Should I see a doctor?
Eye injuries can sometimes be more serious than they appear, and serious injuries can lead to vision loss or even blindness. In general, any eye injury other than small scratches or grit in the eye may be potentially serious.
If you’ve damaged some of the structures inside your eye, you might be more likely to experience severe consequences such as glaucoma, retinal detachment, or development of cataracts. Even if you think an injury is minor or you aren’t sure you’ve injured your eye, it’s a good idea to get checked out by an eye care professional or other medical doctor. They can assess the severity of the injury and provide the appropriate treatment to help reduce the risk of long-term vision loss.
I’m shopping for toys for my kids’ upcoming birthdays. What should I look out for from an eye safety perspective?
It’s great that you’re considering eye safety when shopping for gifts for kids. Eye injuries among children are one of the major causes of visual impairment. Many kids end up in the ER with toy-related eye trauma each year, so it’s important to take precautions.
Here are a few tips to help prevent eye injuries when it comes to toys:
- Be sure to confirm toys are age appropriate - look for minimum age requirements on the toy’s packaging
- Avoid toys that pose a high risk of injuries - lasers, sharp toys, aerosols like silly string, and flying or projectile toys come to mind
- Show kids how to properly play with the toys in a safe manner
- Keep toys that pose a potential eye injury risk away from children unless supervised by an adult
- If you’re giving sports equipment as a gift, make sure to include the appropriate protective eyewear
Ever since using a power sander yesterday, it’s felt like there’s something in my eye. Should I be worried and what should I do?
The feeling you describe, of something rubbing against your eye when you blink, is called foreign body sensation. While it can be caused by a number of eye conditions, it’s also possible you’ve scratched your eye. If you have, you might also be noticing redness, irritation, and excessive tearing. Eye scratches and corneal abrasions are common and can be caused by anything from sand or sawdust in your eye to your pet’s claws. The good news is that most are minor and will heal on their own within a few days. It’s a good idea to get your eye examined if the sensation is severe or doesn’t settle in a few hours. It is possible that the foreign body is embedded in the cornea or stuck to the lid and causing continued irritation. Using the slit lamp and high magnification, the eye can be examined and any remaining material removed. If severe scratches are present, your eye care professional can then advise you on the best approach to speed up healing. They might prescribe an antibiotic eye drop to help prevent infection and steroid eye drops to reduce inflammation and lower the chance of scarring. You might also be given lubricating eye drops to help reduce discomfort.
There are things you can do to help provide some relief while the injury is healing. Blink often and rinse your eye with saline solution or clean water. You might notice that your eye is sensitive to light, so wear sunglasses when heading outdoors. Try not to rub or touch your eye and avoid wearing contact lenses until your eye is fully healed. If you notice persistent or worsening pain, vision changes, or are worried about your eye, head to the emergency room.
What can I do to help keep my family’s eyes safe from injury?
Eye injuries are common and while accidents happen, the reality is that most of these injuries are preventable. The easiest step you can take to reduce your risk of eye injury is to wear proper protective eyewear. It can prevent up to 90% of all eye injuries! Look for CSA-certified safety glasses and use them whenever you’re doing anything risky around your home – yard work, home repairs, or even using chemical cleaning products. Not only will you help keep your eyes safe, but you’ll also be acting as a good role model for your kids and instilling safety habits in them.
Ensure both you and your kids wear sports eye protection – especially for high-risk sports and recreation like baseball, basketball, racquet sports, hockey, and paintball. Keep eye safety top of mind when choosing toys for your kids. Remember that the sun can cause injury to your eyes, too. Shade your family’s eyes from harmful UV rays with sunglasses that offer 100% UVA/UVB protection – that goes for kids and babies, too. Protecting your eyes from injury is one of the simplest things you can do to maintain lifelong healthy vision.
