What is dry eye disease? Like many other medical diseases, the definition for dry eye disease continues to evolve as we gain more medical knowledge on the subject. Simply put, dry eye disease is an imbalance of the delicate tear layer that coats the front of our eye. This tear layer is not only responsible for keeping our eyes feeling comfortable and happy, it is also responsible for us maintaining clear and consistent vision throughout the day. Have you ever noticed that your vision fluctuates during the day? For example, is it better an hour or two after first waking up, or does it become worse after a session of screen time? If so, this is likely at least partially related to dry eye.

Dry eye can cause visual fluctuations up to a whopping 70%, and can lead to a huge range of ocular symptoms such as burning, stinging, redness, pain or a foreign body sensation, watery eyes, inconsistent or filmy vision, irritated and tired eyes, sensitivity to light, increased glare with lights at night time, etc.! How can one disease have such a varied range of symptoms you might ask? Well, dry eye disease is actually quite complex and has a multitude of different causes.

Like many other types of eye disease, dry eye disease does not only come from within our eyes, it can also come from an imbalance within our whole body. Dry eye specifically can come from an imbalance of different components within our body, from environmental disruptors, or from improper functioning of our eyelids or lacrimal gland. If something is causing damage to our eyes from within our whole body, this means the causation can be from our diet, our medications, our stress and inflammation levels, our hormones, etc. Environmental factors point to factors such as smoke or other allergens, dust, artificial heating/cooling, wind, etc. Lastly and more specifically with our eyes, inflammation on the eyelids, contact lens wear, blockage of our delicate meibomian glands in our eyelids (often from excessive screen time), or make-up (false eyelashes, tattooed eyeliner, cosmetic products with preservatives/chemicals) will lead to a fall out of homeostasis that causes dry eye.

Now that we have an idea of what dry eye is and where it comes from, it makes sense to realize that the treatment will vary by individual. In the past, this disease was often treated by artificial tears alone. However, we now know that we need to have multi-targeted treatment in order to address the individual’s specific cause of dry eye. Even artificial tears vary greatly in composition and function, and while you could haphazardly pick one for yourself out of the many choices on the pharmacy shelf, the best option would be to inquire with your Doctor of Optometry about the best one for you, along with an individualized dry eye treatment plan.

Please note that blurry vision can also be related to your prescription or other important eye conditions that should be addressed with annual or bi-annual comprehensive eye exams. For more information on dry eye, please consult your Doctor of Optometry and watch out for our continued dry eye information series with Armstrong Optometry!

Dr. Talisa Dennis

The COVID 19 global pandemic has created many challenges. Among them is an increase in dry eye related symptoms and complaints that have become known as “mask-associated dry eye”. This condition tends to affect those who are required to (or chooses to) wear a mask regularly and for extended periods of time.

The definition of dry eye describes a condition where the amount or quality of the tears is not sufficient. Dry eye symptoms can include stinging or burning, redness, light sensitivity, blurred vision, and scratchy or gritty feeling among others.

There are many causes for dry eyes – taking certain medications, previous laser refractive surgery, advancing age, and excessive screen time are some examples. Mask-associated dry eye is a relatively new condition, and subsequently there is no scientific literature on this subject.

Theories as to the cause of mask-associated dry eye suggest that some face masks can allow exhaled breath to flow up and across the surface of the eyes, causing increased evaporation of the tear film and ultimately dry eye irritation. To prevent this some people have turned to taping their mask to their face across the bridge of the nose. In this case the tape itself may interfere with the lower eyelid’s normal functioning, thus impairing normal blinking and leading to dry eyes. Improperly fitting masks can also pull down the lower eyelid, with a similar end result. If you choose to tape your mask to your cheeks, ensure you are using an appropriate tape to prevent skin irritation.

Managing symptoms of mask-associated dry eye starts with looking for a mask with a moldable upper rim that can be formed over the bridge of the nose, providing limited gaps for air to move upward from under the mask. Adjustable ear loops can be helpful to tighten the mask to the face. Folding a tissue and tucking it under the top of the mask can also reduce air flow coming up and over the eyes. If you choose to try taping the upper rim of the mask, apply tape to the cheeks taking care not to displace the lower eyelid to maintain healthy blinking.

Additional measures to alleviate dry eye symptoms can include regular and frequent blinking, using lubricating eye drops, hot compress of the eyes with closed eyelids, minimizing contact lens wearing time, and managing seasonal allergies that can involve the eyes and increase symptoms of dryness.

Your optometrist will be happy to discuss mask-associated dry eyes with you and recommend customized solutions that will be helpful for your specific circumstances.

Dr. Tim Styles

The Omega 3’s are essential fatty acids that we do not want to go without! I hope we have all moved on from the ill-advised low-fat diet craze of the 80’s and 90’s, but we may still hang on to some mental adversity at adding fats into our diet on purpose. However, this is exactly what we should be doing! If you are not eating at least 2-3 servings of fatty fish per week, you should consider taking a supplement. Our bodies need Omega 3 essential fatty acids to function and they deliver some big health benefits:

Omega 3’s have been shown to lower the triglyceride levels in our blood, reducing the risk of heart disease and stroke.

A diet high in omega-3s lowers inflammation, which can be helpful in conditions such as arthritis and asthma. It is also good for dry skin, and dry eyes and macular degeneration.

High levels of omega 3 oils may help with mood stabilization, depression and even help prevent dementia (more research needed on this).

Omega 3 oils are made up of two crucial fatty acids — EPA and DHA – and these are primarily found in certain fish. ALA (alpha-linolenic acid), another omega-3 fatty acid, is found in plant sources such as nuts and seeds and grains. ALA is less useful than EPA.

There is a massive wall of vitamins and dietary supplements at every pharmacy, grocery store and health food store. How does one figure out which Omega 3 supplement to take?? The basic rules are: look for high levels of DHA and EPA, not ALA. The DHA and EPA can be in an ethyl ester form or a triglyceride form. Ethyl ester is cheaper to produce, but your body does not absorb this form well. Triglyceride form is the one you want. It mimics the form of the Omega 3 as it is found in fish flesh, and has better bioavailability.

Supplements come in capsules or liquid form. Good quality products should not taste fishy, even in the liquid form. If you cannot have fish, there are Vegan products made from plankton that have DHA and EPA, and this is a great alternative. Armstrong Optometry has sourced both the capsules and the liquid and found excellent quality products to offer our patients. Contact us if you have any questions or to purchase these important supplements!

Dr. Lisa Scharf

Sense of Smell

Why is an eye doctor writing about our sense of smell?? Because it is fascinating! Smell is an under-rated and under-appreciated sense in humans. People can easily imagine how devastating it would be to lose our vision, but we tend to think that losing our sense of smell would have little impact on our lives. In fact, a survey of young people indicated that most would rather lose their sense of smell than live without their smartphones!

Covid-19 has brought new attention to a condition called anosmia – the loss of smell. Anosmia is a common symptom of COVID-19 – up to 86% of people infected with the virus may partially or fully lose their sense of smell. Anosmia can be the first or only symptom of mild COVID-19 infection. Most people recover their sense of smell within days or weeks, but a small percentage of people are experiencing long-term losses.

When we stop to appreciate it, our sense of smell is wondrous. Our sense of smell enhances and broadens our taste and appreciation of food. But think too of the information that smell gives us… we can deduce that a lawn has been mowed just from the whiff of fresh-cut grass, or know that bread has been baked the moment you open your front door. Smell also provides essential information on dangers in our environment – the smell of smoke, gas leaks, or rancid food. Humans can even distinguish between the smells of sweat from exercise versus sweat from fear. We gain all this information almost instantly from breathing in some chemical molecules floating on airwaves – it is amazing!

Our visual system has been well studied and we know a lot about the structure and function of the photoreceptors (rods and cones) that provide us with sight. Our smell receptor cells (olfactory sensory neurons) were only discovered in the 1990’s, and there is a great deal to be learned about them. Viruses have been known to affect our sense of smell, but it was previously assumed that this was due to congestion in the nasal passages. With COVID-19, many patients with anosmia have no nasal congestion to account for their loss of smell. Researchers are now thinking that the COVID-19 virus may cause damage to the supporting cells to the olfactory sensory neurons, which in turn causes a loss of function of the actual nerves responsible for smell.

As this pandemic continues, please be alert to any changes to your sense of smell. A loss of smell and/or taste indicates a need to get COVID tested and isolate while awaiting results. So take a moment today to appreciate your amazing sense of smell (and don’t forget your vision too! – book an appointment for an eye examination if it’s been more than two years).

Dr. Lisa Scharf

IRITIS – An inflammation affecting the eye.

The iris is the colored portion of the eye. It contains muscles that contract and relax in response to light and other stimuli including emotional states. Muscle activity in the iris changes the size of the pupil, thus regulating the amount of light entering the eye.

Inflammation of the iris and other nearby structures is called iritis, also known as anterior uveitis or iridocyclitis.

Iritis has many causes including but not limited to eye trauma, following eye surgery, some medications, malignancy, infection, adverse reaction to contact lenses, and association with general health problems that often have an autoimmune component (for example inflammatory bowel disease, ankylosing spondylitis, juvenile rheumatoid arthritis among others).

Iritis may be acute or chronic. Nearly half of acute iritis is idiopathic, meaning that there is no cause found for it. Recurrent episodes of acute iritis, iritis involving both eyes, or chronic iritis often indicate a need for medical testing to search for an associated underlying general health condition.

Recurrent episodes of iritis and chronic iritis can be associated with development of glaucoma and premature development of cataracts, and may affect structures deeper within the eye thus compromising vision.

Symptoms of iritis include blurred vision, tearing, light sensitivity (also called “photophobia”), eye pain that often radiates into the brow or forehead, pain upon focusing for near vision, and redness of the eye that often increases towards the limbus (which is the junction of the white of the eye with the cornea). However, some patients with iritis have no symptoms.

Treatment of iritis typically involves the use of anti-inflammatory steroid eye drops coupled with drops that dilate the pupil of the eye. The frequency of these drops is adjusted based on how the inflammation responds. Medical treatment of any underlying general health conditions may also contribute to managing iritis.

Any time you have a new onset, red eye with aching pain and light sensitivity, you should contact your Doctor of Optometry immediately for diagnosis and treatment.

Dr. Tim Styles, OD

I have always enjoyed school and learning – as evidenced by my nine years of university completing my Bachelor of Science (Psychology) and doctorate degree (Optometry), plus a few extra meandering courses along the way! One of the things that I love about practicing optometry is the ongoing opportunity for continued learning and development of professional knowledge and skills.

Many regulated healthcare professionals are required to complete continuing education hours in order to maintain professional licensing. Optometry mandates a minimum of twenty hours of continuing education per year, with at least half of these hours dedicated to ocular disease courses. The remaining hours may be used to learn about product knowledge, business management, communication, and leadership.

This year brought a number of changes to the way I completed my continuing education requirements. Gone were the weekend conference “getaways” to the city, and instead courses were completed via online platforms at my kitchen table. I focused on glaucoma, diabetes, and retinal pathology topics this year. I also spent an inordinate amount of time learning about Covid-19 and all the associated protective and sanitization protocols.

I read a number of fascinating books about the effects of insulin resistance and type 2 diabetes on our overall health and wellness. A few excellent books on this topic:

The Diabetes Code and The Obesity Code by Dr. Jason Fung

Why We Get Sick by Dr. Benjamin Bikman

(You can also find YouTube talks by these authors if you prefer video content to reading!)

On personal values, communication, and leadership, I enjoyed the book Dare to Lead by Brene Brown. And this year was a great time to re-read the classic book Man’s Search for Meaning by Viktor Frankl, with its reminder that each of us have the freedom to find purpose and meaning in even the most difficult circumstances.

Dr. Lisa Scharf

Most of us now spend an appreciable amount of time using a computer, tablet, or smart phone for work or recreation. Computer vision syndrome is a term that was coined to describe eye and vision discomfort resulting from screen time.

Symptoms of computer vision syndrome include headaches, blurred vision, sore burning eyes, watery eyes, and ocular and general fatigue.

Many of these symptoms are related to the fact that the human eye is not well adapted to hold focus at one distance for extended periods of time. In addition, reduction in blink rates and widening of the eye as we stare at the screen can create surface dryness on the eye. Variations in the screen brightness as the image changes cause the iris musculature of the eye to work overtime to regulate light getting into the eye thru the pupil, thus causing fatigue.

Help and relief from computer vision syndrome may involve optical correction with glasses for computer work, often incorporating antireflection and blue light blocking filters to optimize vision. Adjusting workstation lighting and screen position can also be helpful. Increased awareness of blinking and taking regular breaks from the screen to look to a farther distance relaxes focusing muscles momentarily and can help avoid eye muscle fatigue.

If you suffer from computer vision syndrome, discuss it with your eyecare professional to help find a personalized solution to your symptoms.

–Dr. Lisa Scharf, BSc, OD

We all know someone who had perfect vision all their life, but then began to need reading glasses as they entered their mid-40’s. Why does this happen?

First – a short explanation of how the human eye focuses for near vision. Behind the pupil of the eye is the lens. The lens is attached via small ligaments (called zonules) to the ciliary muscle. As the muscle contracts the lens changes shape and we are able to “accommodate”, or adjust our focus to different distances.

As we go thru life the lens is constantly bombarded by light energy and UV radiation. This causes stiffening of the lens, much the same as how plastic left outdoors will stiffen and go cloudy over time. Throughout our life the lens also grows constantly like our hair and our fingernails, gradually becoming larger and rounder. These joint processes of hardening and growing create a situation where the lens gradually looses it’s ability to change shape, resulting in the loss of near vision that we call presbyopia.

In our climate people often start to notice their near vision changing in the decade between age 40 and 50. In other parts of the world, the Caribbean for example, where the locals may not wear sunglasses much and are exposed to high levels of UV from the intense sun, hardening of the lens can be accelerated and the onset of presbyopia can be earlier in life.

–Dr. Lisa Scharf, BSc, OD

Astigmatism sounds bad, but really it is just a type of blurry vision that is caused by the focussing parts of the eye (the cornea and the lens) not being perfectly round. Since the eye is a biological structure, it is common for some imperfection like this to be present. Subsequently, many people have some degree of astigmatism.

Along with nearsightedness and farsightedness, astigmatism is lumped into what are known as “refractive errors”. Refractive error means that the light entering the eye does not get focussed accurately onto the retina, and the result is blurry vision.

Astigmatism may occur together with nearsightedness or farsightedness, or may be present on it’s own. The blurry vision caused by astigmatism is usually easily rendered clear by the use of glasses, special “toric” contact lenses, or even laser eye surgery in some cases.

People with uncorrected astigmatism often complain of headaches and eyestrain when doing visually concentrated activities like long drives or computer work. They may note that the scenery looks pretty clear, but are unable to accurately read a road sign an appropriate distance away. People with uncorrected astigmatism may tire easily when doing visually concentrated tasks, and this can result in the inability to complete tasks and poor school performance.

Astigmatism is easy for your eye care professional to detect, measure and correct. If these symptoms are familiar to you, an eye exam is a good idea!

–Dr. Tim Styles, OD

Canadians planning their Halloween costumes should be wary of decorative contact lenses, according to health officials.

Health Canada warned in a recent release that while such decorative lenses are popular additions to Halloween attire, they can pose risks such as cuts or scratches on corneas, allergic reactions, impaired vision, infections and even blindness.

Decorative contact lenses, also referred to by other names such as “fashion,” “costume” or “cosmetic” lenses, don’t correct vision but change how eyes look.

The public health agency warned that such lenses can be sold at unlicensed novelty stores, flea markets or online, which means they could contain harmful ingredients such as toxic dyes.

Health Canada advises those who want decorative lenses to stick to companies licensed by the public health agency. These companies have products that are tested for safety and quality.

The following companies are licensed by sellers of decorative contact lenses in Canada: Alcon Laboratories Inc., Bausch & Lomb Inc., Ciba Vision Corporation, Coopervision Inc., Geo Medical Co., Ltd., Les Lesieur Enterprises Inc., Neo Vision Co. Ltd., Unicon Optical Co., Ltd.

The health agency also has a myriad of other tips for those using the lenses this Halloween, including properly cleaning and disinfecting them, never sleeping with them on, never sharing them with others, and talking to licensed eye-care professionals if there is any discomfort. Some forms of discomfort may include itchy, watery or red eyes and blurriness.

Several eye-care organizations in Canada have issued similar warnings urging consumers to stay away from such contact lenses.

The Canadian Ophthalmological Society (COS) said in a news release that these lenses can cause corneal ulcers, which can “quickly lead to permanent loss of vision if left untreated.”

“No one should purchase, and then wear, cosmetic lenses directly from a retail outlet without a prescription and professional oversight. The risks are far too high,” Dr. Allan Slomovic, who works with the COS, said in the release.

The Canadian Association of Optometrists added that those dressing up for Halloween should also stay away from applying makeup products near the lid or lash line that are not specifically designed for the area.

It noted that some people use blush or red lip liner around the eye, which could transfer bacteria from other parts of the face to inside the eye and cause an infection.

“Vision is precious. If novelty contact lenses are the finishing touch for your Halloween costume, see your doctor of optometry first,” a statement from the organization read.