eMagazine
Interview with Lois Strachan Retinopathy of Prematurity How long does it take to adjust to new spectacles? One pair of spectacles cannot fulfil all visual functions
What is Dry Eye Disease and can it be caused by digital devices?
Superior Technology. Superior Views. PolarizedPlus2® Sunglasses
Visual Hygiene
15 Facts about your eyes ENJOY READING. PLEASE DO NOT REMOVE.
and why it matters
JULY 2020
Vo l u m e 1 . N o. 1 2 0 2 0
CONTENTS 1 Editorial CHRIS FAUL
VISION Editorial Board
All Vision Editors & staff can be reached at PO Box 308, Magaliessig, 2067 or email: mdhatter@mweb.co.za
Dr Dirk Booysen Dip. Optom FOA(SA) MCOptom(UK) TMOD(PCO CAS(NECO) DOptom(Aston)
2
15 Facts about your eyes
4
One pair of spectacles cannot fulfil all visual functions
8 How long does it take to adjust to new spectacles? 12
Interview with Lois Strachan
16 Off the hip: with Daleen Visual Hygiene and why it matters 24
Photochromic lenses - how they work
26 Ditch Discomfort with DAILIES Total® Daily Contact Lenses By Marsha Obelholzer (D.Phil Optom)
Dr Clive Novis
Prof Paul Ramkissoon
Dip Optom. MBBCh
BOptom (UDW) CAS (Newenco) MPhil (RAU) ACSpVis (RAU) MOptom (UDW) OD (Newenco) DPhil(RAU) FAAO
(FCS)(Oph)
33
What to know about binoculars
39
Retinopathy of Prematurity
42
What is Dry Eye Disease (DED), and can it be caused by digital devices?
44
Ageing - what it does to the eyes
Publisher & Advertising: Shannon de Klerk 083 260 1036 | mdhatter@mweb.co.za For editorial contributions: Chris Faul - Editor-in-chief 083 469 2222 | email: chris@realvision.co.za Production and design: Marieke Carstens Administration Manager & CPD QUERIES: Ansie de Klerk: 083 450 8294 | ansiedk@mweb.co.za
Prof Tuwane Rasengane
Zena Jacobson
B.Optom (UN) OD
Dip Optom (SA) CAS (SA)
PhD (UHCO)
RESPONSIBILITY: Whilst Vision makes every effort to report news accurately, expressions of opinion, validity of news claims and statements of supposed facts do not necessarily reflect the views of the editors nor do the editors or the publisher accept any responsibility for these and or advertising placed within the magazine. Material submitted for publication is the view of the originator and responsibility for the content consequently resides with the author/s. The publisher will furthermore not accept any responsibility for errors and omissions appearing within. PUBLISHED BY:
Copyright © No part of this publication may be reproduced or reprinted without written permission of the publisher. All rights are reserved and all contributions, images and text remain the property of MD Publications.
Johannesburg office MD Publications, P O Box 308, Magaliessig, 2067, Cell: 083 260 1036 | Admin: 083 450 8294 | email: ansiedk@mweb.co.za
Vision 1
15 Facts
about your eyes
1
2
The only organ more complex than the eye is the brain.
3
Your eyes focus on fifty different objects every second.
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-Ed Did you know that the eyes themselves are not what actually allow you to see? They are simply a conveyance for messages sent to the brain, via the optic nerve. Similarly, did you know that only one-sixth of your eye is even visible to the outside world? Or that your eyes are comprised of more than two million intricately connected working parts? And that’s just the beginning! Here are 15 fascinating facts about the eyes.
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Your eyes can distinguish approximately 10 million different colours.
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Ommatophobia is a fear of the eyes.
Your eyes can detect a candle flame 2.7 km away.
1
2
3
4
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Eighty percent of all learning comes through the eyes.
9 256
2.7km
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Only one sixth of your eyeball is visible.
13
The shark cornea is nearly identical to the human cornea, and has even been used in human eye surgery!
2 Vision
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It is impossible to sneeze with your eyes open.
Your iris (the coloured part of your eye) has 256 unique characteristics; your fingerprint has just 40.
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Your eyes have cells called rods and cones. Rods are responsible for vision at low light levels (scotopic vision). They do not mediate colour vision, and have a low spatial acuity. Cones are active at higher light levels (photopic vision), are capable of colour vision and are responsible for high spatial acuity.
14
The lens in your eye is the fastest contracting muscle in the body, contracting in less than 1/100th of a second.
Heterochromia is the medical term for having two different coloured eyes.
12
The average person blinks 15 -20 times a minute or 1200 times per hour.
15
The optic nerve contains more than one million nerve cells.
From the Editor
V
“ The profession of optometry, within the context of the pandemic, is classified as an enabling service – an essential one. “
chris@realvision.co.za
EDITOR-IN-CHIEF: Chris Faul Chris is an optometrist and businessman, a graduate from the University of Houston School of Optometry, author of ‘Navigating The Business of Optometry’, keen fisherman and bass player.
PUBLISHER: Shannon de Klerk Shannon is actively involved in the optometric profession and industry to make Vision the leading independent magazine. Good music and long Portuguese lunches are good for the soul.
ision Magazine has been serving the optical industry for 27 years. For the past almost 3 years, Vision for the Waiting Room, in print, was available to patients in the optometrist’s waiting room. MD Publications is proud to now publish Vision eMagazine, which will replace the printed version. Vision eMagazine will have the same editorial approach of demystifying visual disorders and ocular disease. In South Africa, only 14,6% of our population wear a visual correction as opposed to the global incidence of around 50%. This points to many people in South Africa being void of eye care. Ocular diseases can cause irreversible damage and loss of sight if not diagnosed early. The importance of regular eye examinations and early diagnosis of eye diseases can therefore not be overemphasized. This is what Vision eMagazine will promote.
VISION online MAGAZINE
for optometrists
The professional version of Vision has gone online.
COVID 19 has put a new spin on all our lives, but our challenge is to find ways to resemble normality. The profession of optometry, within the context of the pandemic, is classified as an enabling service – an essential one. People need to see to work, study, commute and to entertain themselves. Optometrists are well versed in applying adequate safety measures to ensure the wellbeing of their patients. As individuals, each of us carries the responsibility to play our part, and visiting a medical practice also places the onus on us to ensure we are not a risk to others. Sign up to receive your Vision eMagazine every month. CHRIS FAUL Editor in Chief
VISION F O R T H E WA I T I N G R O O M
www.visionmagazineonline.co.za
Vision for the Waiting Room has a print run of 3000 copies and is distributed free-of-charge to the optometric profession.
Vision Online will offer high quality clinical and business content as well as CPD articles. It will also serve as a platform for our advertisers.
Additional copies of Vision are for sale @ R120 per copy. These will be delivered at the regular fee.
Not getting your VISION?
Please email info@visionmagazineonline.co.za or visit www.visionmagazineonline.co.za to purchase your extra copy.
Our mission is to have a Vision for the Waiting Room in every practice in South Africa. If you know of a colleague or fellow enthusiast who is not receiving a copy, please let us know by email: notgetting@visionmagazineonline.co.za Please include the following information: Subject: Request for Vision OP Number Cell Number Email address PO Box address
Disclaimer The information in this publication is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. Do not disregard professional medical advice or delay seeking medical treatment, because of something that you have read here. All content, including text, graphics, images and information, contained in this issue is for general information purposes only. Statements and supposed facts do not necessarily reflect the views of the editors nor do the editors accept the validity of news claims or advertising.
Vision 3
One pair of spectacles cannot fulfil all visual functions
-Ed
When the muscles relax, they pull on and flatten the lens, allowing the eye to see objects that are far away. To see closer objects clearly, the ciliary muscle must contract in order to thicken the lens. Put like that, the function of the lens doesn’t sound that exciting, but consider it like this: Every time a young eye (under 40 yrs) looks at a different distance, from one object to another, everything remains in focus. Every time you look at a different distance the lens has changed shape a lightning fast speed by exactly the right amount of change in its curvature to keep everything in focus. You can’t catch it out because it changes so incredibly fast. An amazing piece of equipment.
T
his is perhaps the most profound statement that can be made about spectacles. Before I elaborate on this statement, let’s take a moment to marvel about our amazing eyes. The retina, which sits at the back of the eye, is a thin layer of tissue that contains millions of tiny light-sensing nerve cells. These nerve cells are called rods and cones because of their distinct shapes, and are primarily responsible for detecting light. They send signals to the brain through retinal ganglion cells (RGCs) so the brain can form our perception of images. But our eyes do more than help create images of our surroundings. Our pupils respond to light intensity, constricting in bright light to reduce the amount of light entering the eye, and dilating when it’s darker to let more light in. Situated behind the pupil is a colourless, transparent structure called the crystalline lens. Ciliary muscles surround this lens. The muscles hold the lens in place, but they also play an important role in vision.
4 Vision
Visual optics is an exact science. Any optical lens will focus light at a particular distance, which is determined by the curvature of the lens, as well as the refractive index (bending power) of the lens material. The crystalline lens in your eye, acts like thousands of lenses in one, because it can change its curves so quickly and accurately. While you are young, you will be able to see at any distance with the same pair of specs regardless of your type of refractive error, because your crystalline lens is still very elastic. However, once you reach your forties, the crystalline lens loses its elasticity and can’t focus as quickly anymore (presbyopia). This is a normal aging process like grey hair and wrinkles, and will get progressively worse as you get older. Now, back to my opening statement; One pair of specs cannot fulfil every visual function. We can now understand why this is so. Since the lens has lost its elasticity, it can only maintain a focus further away.
Reading glasses Reading glasses can be made up to focus at 30 cms or 40 cms or 60 cms, but only one distance at a time. The optical lens has one constant curve which will focus at one point. However, in everyday life we need to continuously look at things at different distances. Your cell phone, computer screen or computer keyboard are all generally at different distances.
“Most patients over forty go to the optometrist with the expectation that one pair of magic specs will fulfil all visual functions. Just like it was when the crystalline lenses were still working their magic. ”
Multifocal Spectacles These continuous focus lenses give a much better range of clear vision within a one meter distance and of course at a far distance. They do go some way in replacing the crystalline lens, but not all the way. For instance, the bottom strongest part of the multifocal is usually set at 40 cms. If you are a goldsmith working for long spells at 30 cms, they are not ideal. Moreover, looking at the computer screen with multifocals, your line of sight is likely to be over the stronger reading section, again not ideal. This is usually compensated for by tilting the head backwards, creating all sorts of muscular fatigue.
Horses for courses Most patients over forty go to the optometrist with the expectation that one pair of magic specs will fulfil all visual functions. Just like it was when the crystalline lenses were still working their magic. What is required is an understanding of the limitations imposed on the visual system by presbyopia and that the solutions lie with more than one pair of glasses. Setting up specs for an executive in an office environment, will not fulfil his visual requirement on the golf course. Specs for driving are not going to be perfect for vision on the canvass while painting. An artisan working on a lathe needs good vision at the right distance as well as visual safety. Here are some of the activities that require specially designed visual corrections:
• • • • • •
Cycling Golf Scuba diving Fitter and turner Musician Lawn bowls
• • • • •
Jogging Hunting Architect Goldsmith Fishing
Apart from deciding on the best lens power for an person, there are many other considerations in terms of choice of lens material, frame design, lens coatings, safety features, lens design and multifocal type. The point is, each activity or visual demand, will require a different design of visual correction.
Go prepared A visit to the optometrist should include an in depth discussion of what your work and recreational visual requirements are. Make a list of all the activities that are important in your daily routine or the activities that you are passionate about. Make a note of any unusual working distances these activities demand, and share all of this with your optometrist. Vision is so important in order to deliver your best performance in work and play, and yet many struggle to come to terms with the fact that you need more that one pair of specs to fulfil all visual functions. It makes little sense to own thirty pairs of shoes, a Ferrari or a R100 000 mountain bike, but only one pair of specs. Vision 5
Enhance Your View With the Right Pair of Shades!
I
f you are in the market for a new pair of sunglasses, you may want to consider more than just the style of the frame during your review and selection process. After all, a pair of sunglasses is arguably only as good as the view they deliver.
To get started, apply a few basic quality checks to ensure your sunglasses not only look good but also offer you adequate protection to keep your peepers safe whilst exposed to sunlight. Critical considerations for safeguarding eye health and eye comfort are glare reduction and UV sun protection. Premium sunglass brands, such as Maui Jim, tick these boxes with ease by offering 99.9% glare elimination and 100% UV sun protection as standard across their PolarizedPlus2® sunglass collection.
Once you start to consider the view through the lens, you will notice that the lens colour starts to play a role in achieving optimal eye comfort, crisp detail and vivid colour contrast. Need a cheat sheet to help you out? Here you go! For varying conditions, overcast to sunny, a versatile lens colour such as Maui Jim’s HCL® Bronze or MauiRose® are recommended. In darker overcast conditions, a lens that allows more light transmission, such as Maui HT® (green), would be the right way to go for improved viewing pleasure. But, when the sun is out and no clouds are around, a darker lens colour, such as Maui Jim’s Neutral Grey, would be the best choice.
Seacliff B831-02D
Southern Cross GM815-54CM
Bowline H557-16M
So, when you pick your next pair of sunglasses, be sure to choose a pair that works to reveal and enhance your view. The overall result you want is a pair of sunglasses that look stylish whilst delivering vivid colour, clarity, crisp detail and added protection for your eyes. Because all is well with the world when you have the right pair of polarised sunglasses! Start hunting for your ideal pair by trying one of these latest releases from the Hawaiian born brand, Maui Jim. Their range delivers an unrivalled through-the-lens view and is available in prescription.
Kalani H818-10
About Maui Jim Maui Jim sunglasses were born on the beaches of Maui and designed to protect eyes from the harsh rays of the island sun. Today, Maui Jim is recognised for unparalleled “Aloha Spirit” and customer service as well as their patented PolarizedPlus2® lens technology, which blocks 100% of UV rays and eliminates 99.9% of glare while enhancing colour, definition and depth perception. Maui Jim sunglasses have earned the Skin Cancer Foundation Seal of Recommendation as an effective UV filter for the eyes and surrounding skin.
6 Vision
For more information, visit MauiJim.com or follow us on Facebook, Twitter or Instagram at @OfficialMauiJim.
Available in prescription STYLE SHOWN: CINDER CONE
#YouDeserveThis Our lightweight PolarizedPlus2ÂŽ lenses are as flexible as you are, adapting to different light conditions while eliminating glare and enhancing colour. Try on a pair and see for yourself. Colour. Clarity. Detail.
How long does it take to
adjust to new spectacles? -Ed
Y
ou may experience some issues during the first few days wearing your new spectacles due to spatial distortion. To get a better understanding, let’s look at some of the underlying factors.
Why do I have to adapt? A change in your prescription, or even a change in the lens material or frame size can cause spatial distortion. For instance, some people are more sensitive to motion sickness than others. Same here - some people are very sensitive to a change in the lens prescription. People with high prescriptions, astigmatism or first time multifocal wearers are more likely to suffer from spatial distortion. A big shift in your prescription can also be a factor. Your optometrist may use a high refractive index material to make your lenses look thinner, and this in itself can require some getting used to. When the prescription is changed, the quality of the retinal image changes. It’s common for your eyes and your brain to take some time to adjust to processing these new images. Maybe it’s been a while since you last had your prescription adjusted, or if it’s your first pair of specs, in which case, your brain may require a day or two to accept the sharp, new image it’s receiving as correct. If you have been compensating for the poor vision for so long it becomes “normal”. Your brain will adjust to the “new normal” as seen through your new specs. Even if the prescription only changes a little, one eye might change more than the other. Different frame styles can also affect your vision and require an adjustment period. Changing from a rectangular shaped frame to a round frame, or vice versa can change the curve of the lens. Changing from a large frame to a smaller frame can change how the frame enters your peripheral vision. While an optometrist can adjust the prescription for the shape, it could require some time to get used to new specs. Even if your new
8 Vision
frames don’t affect your vision, how they feel on your face can require a few days of adjusting.
Some of the adaptation issues include: • • • •
Eye strain – you might experience eye strain during the first few days. Distortion – different parts of your vision might change slightly, depending on how far an object is. Fishbowl – the image may seem “bent” at the edges. The centre of the image may be clear. Depth perception – you may find it hard to discern how far away or how close an object is at first.
Sometimes you may just feel weird and a bit off balance. However, if you are getting headaches with the new specs, you should report back to your optometrist.
Faulty Prescription The biggest potential problem is a faulty prescription because this means your eyes will not adjust to your new specs. Errors during the exam, the measurement process, or the production process can all cause a faulty prescription. Despite all dispensing optician’s diligence in taking measurements correctly, and despite the largely computer-controlled creation of lenses, human errors sometimes occur. You will not adjust to your new specs if the prescription is incorrect. The key indicator is if your vision discomfort does not improve as the days go by. If it feels a little better every day, the cause is likely to be spatial distortion.
Safety while adjusting to new specs For the most part, the adjustment period for new glasses will pass without any real consequences. Take care, however, with driving, walking on stairs or broken ground, working with dangerous machinery, or completing tasks that require concentration and good vision. The adjustment period can take more time if your new specs are multifocal or your prescription has changed dramatically.
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How long will the adjustment take? Most Eye Care Professionals will tell you it will likely take two to three days to adjust to a normal change in prescription, but the adjustment period will be different for each individual and in rare cases it can last up to two weeks. Just be aware that while many people will get used to new specs in two to three days, large changes in prescriptions, a change to progressive lenses, or getting your first spectacle prescription can take longer for your eyes to adjust. Remember, if it does not improve little by little over a few days, you need to go back for a check-up.
How to help your eyes adjust to new glasses The best thing you can do to help your eyes and brain adjust to new specs is to wear them. Put them on and wear them as soon as you get up because that’s when your eyes are fresh. Wear them as much as possible during the day. Don’t wait and put them on later in the day because that shock can cause you to feel spatial distortion. Do not switch back and forth with an old pair. While it’s tempting to go back to your older pair, this can slow the adaptation. Once you have fully adapted, you can resort to intermittent wear if that suits you.
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Pictech Vision PTY (Ltd) Office: +27 11 791 1550 | Cellphone: +27 78 715 7075 Fax: +27 86 506 3206 | E-mail: sales@pictech-vision.com
Interview with
Lois Strachan “Thankfully, I am great at problemsolving, so I took it as a dare to overcome each of the barriers that I encountered.”
Ed: I became interested in your career, not only because you are a blind person, but because of your impressive achievements that any sighted person would be proud of. I quote from your bio: “When Lois became blind at the age of 21, she realised she had a choice – to go home and give up, or to go out and see what was still possible for her as a blind person living in a sighted world.“ Losing one’s sight at that age must have been devastating. What were the toughest challenges you faced during the first year? LS: There were a couple of things that were hard for me. I had to relearn new ways of doing absolutely everything without sight, and I really do mean absolutely everything. And sometimes it was hard for me to accept I had to adjust to such a degree. I also lost a few friends who weren’t able to cope with my new reality, and that was difficult. Thankfully, it was only a very few people who chose to step out of my life, where I believe others who have gone through the same situation have lost far more friends and family members. Finally, I think the most difficult thing for me to accept was my loss of independence – I’d only had my driver’s license for about 18 months and the novelty of being able to go where I wanted, when I wanted hadn’t worn off. So that was the hardest adjustment for me to make.
Ed: I can’t wait to ask you about your rock band – what gigs do you play? LS: Sadly I’m not playing much music at the moment. I simply don’t have time, with so much else happening – my speaking, writing, blogging, and the accessible travel podcast I host. Not to mention the disability advocacy work I’m involved with. The last time I played live on stage was as part of a show at the National Arts Festival in Makana (Grahamstown) last year. While I miss playing live, I still regularly pick up a guitar and play for the fun of it. Ed: As a motivational speaker, can you “feel” the room?
Ed: What was the cause of losing your sight? LS: Diabetic retinopathy. I was diagnosed with Type 1 diabetes when I was 6 years old and had no idea that I was at risk of eye problems until it was far too late.
12 Vision
LS: Yes, to a degree. My speaking style is quite interactive, which helps, but usually I can pick up on the emotional response from my audiences, both as a speaker and as a musician.
Ed: What is the core message you like to bring in your talks? LS: My speeches focus on teaching audiences ways to overcome the challenges they face in their work or personal lives, by sharing some of the techniques I learned after losing my sight. But I also like to raise awareness of some of the tools and techniques I use on a daily basis when accomplishing tasks. Ed: Tell me about; “A different way of seeing” LS - One of the greatest barriers we face as the blind and visually impaired community is that sighted people assume we can’t do things because they don’t know how we do them. In “A Different Way of Seeing” I explain how I accomplish simple, and not-so-simple, tasks and share my personal journey of living life without sight. It’s an easy-reading and lighthearted look at the world from my perspective. Ed: How do you ”read” your emails? LS: I guess the first thing to explain is that I use a standard Windows computer, and a standard iPhone. Both have software on them that convert text to speech. These screen reader apps mean I can access almost anything on my digital devises, including documents, spreadsheets, e-mail, and most PDFs and websites. I also have apps on my mobile phone that mean I can get an idea of what appears in an image, read print documents and use GPS to help me navigate. And, to preempt a follow-up question, I usually type using the keyboard rather than using dictation. Ed: How did the idea of Missy Mouse come about? LS: I originally wrote the stories when I was first learning to use a screen reader. When my teacher told me the best way to learn was to type as much as I could, I started writing poems, songs and short stories. Amongst the short stories were four stories about a blind mouse who was using her other senses to engage with the world around her. I think writing the stories was a way for me to process some of the blindness skills I was learning myself. Ed: In 2015 you received a prestigious award - what was it about? LS: The Tributes Excellence awards are annual awards for women with disabilities who have excelled in their field
of endeavour. The finalists are suggested by members of the public. I was awarded a Tributes Award in the category of literature and education. Ed: And Goodwill Ambassador? LS: I serve as an ambassador for several organisations, assisting them with awareness raising and fundraising efforts. At the moment I am enjoying being an ambassador for the Cape Town Society for the Blind (CTSB) and the South African Guide-Dog Association for the Blind. Both are organisations that do great work facilitating independence for people with visual impairments. Ed: You hold a Bachelor of Arts, majoring in English Literature and Classical Civilisations, an Honours degree in Classical Civilisations from the University of KwaZulu Natal, a diploma in practitioner Coaching Skills, a Certificate in Human Resource Management from UNISA, and is a Distinguished Toastmaster. How on earth did you achieve all of that? Vision 13
LS: One step at a time. There are several challenges that studying can present for a blind student. Thankfully, I am great at problem-solving, so I took it as a dare to overcome each of the barriers that I encountered. I’m also grateful that those running the courses have always been willing to find a workable solution.
Ed: Is he a sighted person?
Ed: Fiji your guide dog must be special – how long have you been together?
“Lois Strachan held our audience spell bound with her eloquent presentation at the Cape Town branch of Fine Women Business Network. Her forthright and honest story of going blind at 21 and yet achieving her life’s dreams, left us astounded and in awe. You are not going to attend a pity party with Lois, you are going to leave feeling inspired, enriched and ready to celebrate life.”
LS: Fiji and I have been working together for four wonderful years. I have enough stories about the amazing experience of working with a guide dog that I could fill an entire book – over and above the chapter about my guide dogs in “A Different Way of Seeing”. Oh, and Fiji writes a guest article on my Beyond Sight Blog once a month.
LS: Yes Ed: Thank you Lois, for inspiring. I want to leave our readers with a testimonial from one of your workshops:
For more information:
Ed: Being a muso – who is your favourate artist?
Website: www.loisstrachan.com
LS: That’s such a tough question. My favourite style of music is modern rock, but my tastes are quite diverse. The music I write is primarily acoustic rock.
Twitter: @LoisStrachanZA Facebook: www.facebook.com/loisstrachanspeaker LinkedIn: www.linkedin.com/in/lstrachan Podcast Feed: https://iono.fm/rss/chan/3715
Ed: How did you meet your husband, Craig? LS: We met through music. We both attended a braai for a local music festival, and he fell in love with my guide dog. Actually, it was a little more complicated than that, but you’ll have to read my book to get the full story!
Be My Eyes Be my eyes is a free app that connect blind and low vision people with sighted volunteers for visual assistance through a live video call. Every day, sighted volunteers lend their eyes to solve tasks big and small to help blind and low-vision people lead more independent lives.
11 Vision
Visual Hygiene and why it matters
Daleen Slabbert – consults to the optometric industry. Her services include: new practice set-up, implementing practice systems, implementing financial check points, staff training, implementing marketing strategies, human resources management, motivating staff, etc. She has amassed an incredible library of information and has vast experience in the running of high performance optometric practices. Daleen offers an on-site service, where she will be at the fore front of implementation of her systems. She has also developed an outstanding online course for optometric staff.
Tel: 082 557 1418 email: dslabbert@mweb.co.za www.daleenslabbert.co.za
“Some people get so absorbed in their online activities and close-up tasks that they do not realise how poor their posture is while doing it. They have never heard of bad visual hygiene. ”
16 Vision
T
here can be no doubt that all of us are doing more close-up focusing more frequently and more intently than ever before. All you have to do is look around any restaurant, in this waiting room and even in traffic to see people of all ages doing it. They are engaged in social media, constantly keeping in touch with friends and family, reading their emails, playing online games and watching movies. In the fifties, D.B. Harmon, an educator, and a kinesiologist, has shown that the ideal reading distance for each individual was elbow distance which became known as Harmon distance. This distance is measured by placing a closed fist under the chin and resting the elbow on the handheld device, book or desk. The interesting fact about Elbow Distance is that as we grow, so do our arms. You would expect a child to hold objects closer to his or her face than an adult. Instead of a “one size fits some” rule of a certain number of centimeters, the Elbow Distance applies to everyone. Try it on yourself now and see if you hold this magazine at Elbow Distance or even a little further. Harmon believed that environmental factors were related to the development of visual problems and had an excellent understanding of the relationship between movement, posture, and vision. Some people get so absorbed in their online activities and close-up tasks that they do not realise how poor their posture is while doing it. They have never heard of bad visual hygiene. The following tips may make you more aware of this crucial matter. • Always keep your working/reading distance in mind. The spontaneous distance at which we read is called the reflex reading distance (RRD). This must always be compared to the Harmon or elbow distance.
• Blink often! The number of times we blink decreases drastically when we are focused on something. The average adult blinks between 10 and 20 times per minute. Each time we blink, a thin layer of tears is spread across the eye surface, keeping them from drying out as well as brushing away any small particles of dust or dirt that could otherwise irritate our eyes or impair our vision. On average we only blink three to eight times per minute when using handheld devices, reading, watching TV, listening to a podcast, working on a computer, or another activity that requires intense focus. That’s roughly 60 percent less than our normal rate of blinking. This lack of blinking over time can lead to eyestrain and dry eyes. Even though a blink only takes one tenth of a second, all those blinks add up to about 10 percent of our waking life! • Poor posture not only causes visual problems, but a postural imbalance requires a greater expenditure of energy, which reduces the effectiveness when performing a task. D.B Harmon also noted that using horizontal surfaces tend to require the student to lean forward to approach his/ her work plan. It is, therefore, preferable to work at a desk with an incline of 20°. Why 20°? Harmon demonstrates that it is the physiological angle that everyone adopts between the horizontal plane passing through the elbows and forearms while reading, in an unconstrained outdoor environment. This position is accompanied by the facial plane parallel to the plane of the forearms. When we bend forward to read, this induces cervical stress, makes digestion more difficult and prevents adequate respiration necessary for the proper functioning of metabolism.
• Active outdoor activity is an essential part of normal and healthy development. Play activities that require seeing beyond arm’s length should be encouraged.
• Have your eyes tested regularly. Many people first learn they have serious health conditions such as diabetes, high blood pressure, high cholesterol, and even cancer from — yes, you guessed it — a routine eye exam. Our eyes have been called “the window to our soul.” It turns out, they also are often a very effective window to our overall health. During a comprehensive eye exam, your optometrist can observe and evaluate the health and condition of the blood vessels in your retina. Conditions such as diabetes and hypertension are visible by changes in the appearance of the retinal blood vessels.
• The chair used when sitting at a desk should be of such size to allow the feet to rest comfortably on the floor. The buttocks should be flat and tucked fully to the back of the seat. The kitchen or dining room tables were not designed for studying or writing. They are usually too high and inappropriate for use by a child. • For proper lighting when reading in a chair, illuminate the entire area using overhead lighting and have another light on your book – one that avoids bright reflection on the task. • Always follow the 20-20-20 rule. When performing any prolonged near work, take breaks if you begin to feel your neck, shoulder, or back muscles beginning to tighten. The 20-20-20 rule was designed by Californian optometrist Jeffrey Anshel. When following this rule, a person takes a 20-second break from looking at a book or screen every 20 minutes. During the break, the person focuses on an object 20 feet (6 meters) away, which relaxes the eye muscles. • Do not sit too close to your television set. A minimum viewing distance is between 2,5 to 3 meters.
Pablo Picasso said: “If only we could pull out our brain and use only our eyes”. But for now, let’s use our brains to take care of our vision. References: Harmon DB. Notes on a Dynamic Theory of Vision, 3rd Revision. Austin TX, Self Published, 1958.
Vision 17
About Essilor and Essilor Instruments
T
he world’s leading ophthalmic optics company, Essilor designs, manufactures and markets a wide range of lenses to improve and protect eyesight. Its mission is to improve lives by improving sight. To support this mission, Essilor allocates more than €200 million to research and innovation every year, in a commitment to continuously bring new, more effective products to market. Its flagship brands are Varilux®, Crizal®, Transitions®, Eyezen™, Xperio®, Foster Grant®, Bolon™ and Costa®. Essilor employs 69,000 people worldwide. It markets its products in more than 100 countries and has 32 plants, 475 prescription laboratories and edging facilities, 14 distribution centers, as well as 4 research and development centers around the world.
It also develops and markets equipment, instruments and services for eye care professionals. Essilor Instruments is a leader in the development of modern solutions and technologies for optometrists throughout the world. Our goal is to provide the equipment and the services that will meet their business needs. With constant innovation, Essilor Instruments has reached a worldwide leading position in several categories such as Finishing, Visual Screening, PD measurement or Tools and Consumables. Below is some information on just some of the phenomenal instruments that Essilor Instruments offers to the optical market:
The VISION-R™ 800 by Essilor Instruments launched in South Africa in 2019. This incredible phoropter offers continuous power changes and reinvents refraction. This machine is transforming eye exams - it is faster and provides highly accurate prescriptions for patients, as well as a much more comfortable testing experience for patients. The VISION-R™ 800 also won a Silmo Award in Paris in 2018.
*R335 000 excl. VAT
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Mr Blue® is at the cutting edge of innovation – serving as a genuine partner to optometrists since its launch. Now featuring a whole range of new functions and even greater flexibility, Mr Blue® is the perfect tracer for a demanding workshop. Mr Blue® Sun & Sport edition goes further with exclusive features for outdoor activities.
*R435 000 excl. VAT
An objective, easy to use and reliable vision impairments assessment solution helping optometrists to set up child screening and evaluate early vision disorders. A new way to assess binocular vision: A digital solution using ActiveGlasses™ and eyetracking technology for optimal vision evaluation Paediatric vision care: A system to help optometrists test children’s eyes & raise awareness of vision impairments. • Fast and automatic protocols • Intuitive & easy to operate • Objective & accurate • Toddler friendly • Clinically proven • Comprehensive reports
For more information, contact us: Tel: 010 202 9300 Instruments Manager: Marais Kotze Cell: 082 929 7668 Email: kotzem@essilor.co.za www.essilor.co.za
*R89 000 excl. VAT
*These are cash prices. Essilor Instruments does Terms if interested.
20 Vision
LIMITED EDITION PACK
THE CONTACT LENS THAT KNOWS LIGHT ™ ACUVUE® OASYS with Transitions™ Light Intelligent Technology™
Ask your eye care professional how you can §,¥ SQUINT LESS. SEE MORE.™
These lenses are not a replacement for sunglasses. § Compared with ACUVUE® OASYS with HYDRACLEAR® PLUS. ¥ JJV Data on File 2018. ACUVUE® OASYS with Transitions™ Light Intelligent Technology™ — Objective Clinical. All ACUVUE® Brand Contact Lenses have Class 1 or Class 2 UV-blocking to help provide protection against transmission of harmful UV radiation to the cornea and into the eye. UV-absorbing contact lenses are NOT substitutes for protective UV-absorbing eyewear such as UV-absorbing goggles or sunglasses because they do not completely cover the eye and surrounding area. ACUVUE® OASYS is a trademark of Johnson & Johnson Vision Care (Ireland) T/A Vision Care Ireland RSC. Transitions™ is a registered trademark, the Transitions™ logo, Transitions™ Light Intelligent Technology™ and Transitions Light Intelligent™ Lenses are trademarks of Transitions Optical, Inc. used under MOS115_19 license by Transitions Optical Limited. ©Johnson & Johnson Medical (Pty) Ltd 2019.
Photochromic lenses: How they work -Ed
P
hotochromic lenses are spectacle lenses that are clear (or nearly clear) indoors and darken automatically when exposed to sunlight. Other terms sometimes used for photochromic lenses include “light-adaptive lenses,” “light intelligent” and “variable tint lenses.” The most popular brand of photochromic lenses sold worldwide is Transitions® Lenses. Because of this, some people, including some Eye Care Practitioners refer to photochromic lenses as “transition lenses.” But there are other brands of photochromic lenses available as well. Contact lenses are also available with photochromic technology. Johnson &
22 Vision
Johnson teamed up with Transitions® Optical to develop Acuvue® Oasys with Transitions®, the first light-adaptive contact lens.
How photochromic lenses work Tiny molecules of silver halide and chloride are embedded within a photochromic lens, which is invisible and clear until exposed to sunlight/UV rays. A chemical process takes place when exposed to sunlight/UV and the molecules effectively move, change shape and absorb the light. This process changes the molecules and they darken to a sunglasses tint.
The photochromic lens will remain in this ‘darkened’ sunglasses state whilst exposed to sunlight/UV and the molecules will reverse the process once the lenses are removed from the sunlight/UV rays returning to the original ‘transparent/ clear’ lens.
“Because a person’s lifetime exposure to sunlight and UV radiation has been associated with cataracts later in life, it’s a good idea to consider photochromic lenses for children’s eyewear as well as for adults.”
Photochromic lenses typically will not darken inside a vehicle because the windshield glass blocks most UV rays. Recent advancements in technology allow some photochromic lenses to activate with both UV and visible light, providing some darkening behind the windshield. Fixed tint sunglasses will al] ways be better for driving. Photochromic lenses are available in nearly all lens materials and designs, including high-index lenses, bifocals, and multifocal lenses. An added benefit of photochromic lenses is that they shield your eyes from 100 percent of the sun’s harmful UVA and UVB rays. Because a person’s lifetime exposure to sunlight and UV radiation has been associated with cataracts later in life, it’s a good idea to consider photochromic lenses for children’s eyewear as well as for adults. Polycarbonate is the safest lens material for kids, providing up to 10 times the impact resistance of other lens materials. Adding an anti-reflective coating to photochromic lenses enhances their performance even further. AR coating allows more light to pass through photochromic lenses for sharper vision in low-light conditions (such as driving at night) and eliminates bothersome reflections of sunlight and other light from the backside of the lenses in bright conditions. Though photochromic lenses cost more than clear lenses, they offer the convenience of reducing the need to carry a pair of prescription sunglasses with you everywhere you go.
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Ditch Discomfort 2020/03/04 14:38
with DAILIES Total1® Daily Contact Lenses
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ontact lenses are a popular choice to correct most refractive problems, whether it is shortsightedness, far-sightedness or astigmatism. A range of contact lenses is available on the market and a good understanding of the choices and benefits of these lenses may enhance your experience. When consulting your optometrist about contact lenses, it is important to note that there is no “one size fits all”. Your optometrist will choose the ideal lens according to your lifestyle and needs. The secret to successful contact lens wear includes good compliance, regular check-ups and voicing any discomfort that you may experience.
Alcon – the Leaders in Contact Lens Innovation Technologies The cornea is an avascular structure and one of the biggest challenges that contact lens manufacturers face, is to ensure the development of a material that allows good oxygen supply to pass through the lens to the cornea from the atmosphere. Alcon Laboratories (PTY) LTD launched one of the first contact lenses consisting of a new generation material, named silicone-hydrogel (AIR OPTIX® Night and Day AQUA, Dk/t=175). This material incorporates silicone into the matrix of the soft contact lens. This breakthrough technology increased the amount of oxygen transported through a contact lens to the cornea due to the affinity that silicone has for oxygen. Silicon-hydrogel material thus enables the cornea to “breathe” better, and hardly reduces the oxygen uptake by the cornea when the contact lens is on the eye. Other advantages of silicone hydrogel contact lens materials include a lower risk of contact lens-related complications, better hydration of the lens during the day and better corneal health. Although silicon-hydrogel was a breakthrough in oxygen transmissibility to the cornea, researchers faced another challenge while developing this material. Silicone repels water and the incorporation of silicone into this new lens material, caused the material to be hydrophobic
24 Vision
By Dr. Marsha Oberholzer D. Phil Optom (water-repelling). To counteract this problem, Alcon’s Smartshield™ Technology was developed, which is a surface treatment on the contact lens that makes the surface hydrophilic (water-loving). Smartshield™ also ensures fewer deposits from tear constituents adhering to the surface of the contact lens.
Water Gradient Daily Contact Lenses Daily replacement lenses, also known as “dailies” are gaining popularity fast. Since these lenses are disposed of daily, no cleaning regimen is required, which makes them “hassle-free”. Moreover, a new lens is a healthy lens on the eye, ensuring long-term corneal health. Alcon leads the development of water gradient lenses through the brand “DAILIES Total1®”. With this brand, Alcon introduced a new-generation silicon-hydrogel material addressing the most important requirements for successful contact lens wear namely, comfort and high oxygen breathability (Dk/t = 156). The material is composed of two different materials fused into one contact lens. The centre consists of silicone (low water content 33%) with a covering on the surface of the lens of a water-loving material creating an ultra-soft gel that ensures comfort of this lens throughout the day (high water content of 80-100%). Water gradient silicone hydrogel offers the best of both worlds in corneal health and comfort. DAILIES Total1®, is the gold standard of daily contact lenses. Expect quality and the best in professional eye care. Wear the lens that feels like nothing, the unique water gradient lens with unsurpassed comfort, superior lubricity and high breathability developed by the leader in contact lens technology innovation, Alcon (PTY) LTD. Consult your optometrist to inquire about DAILIES Total1® contact lenses.
DITCH DISCOMFORT SO COMFORTABLE, NEARLY 90% OF WEARERS FORGOT THEY WERE WEARING THEM.1
*Eye exam may be required. Professional fees may apply. 1.Perez-Gomez I, Giles T. European survey of contact lens wearers and eye care professionals on satisfaction with a new water gradient disposable contact lens. Clin Optom. 2014;6:17-23. Ask your eye care professional for complete wear, care, and safety information. Alcon Laboratories (SA) Pty (Ltd) P.O Box 12257, Vorna Valley, 1686 Office: Magwa Crescent West, Waterfall City, Jukskei View, 2090 Tel: 011 347 6600. Co Reg No. 1977/000460/07. ZA-DT1-1900017.
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26 Vision
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28 Vision
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What to know about binoculars
A lot can be said about the design of binoculars as well as the quality of coatings on the lenses. This is essentially where the money is spent.
-Ed
T
here are lots of very technical issues worth knowing about binoculars. These can relate to the user’s visual status, physical ability, conditions of use, purpose of use etc. Some of these will be explained in this article. However, if I was only allowed to give one piece of advice in general terms, it would be to buy an 8 X 40 model. Higher magnification does not necessarily make for better viewing, because the higher the magnification, the more the residual movement (shake) is magnified when holding the binoculars, and this will corrupt the clarity of the object viewed. In other words, an 8 X magnification will give a sharper image than a 10 X, unless the 10 X is placed on a tripod to eliminate shake. Moreover, as magnification increases, brightness and clarity may diminish, the depth of field may be
shallower and the field of view is usually more restricted. Distortion by heat waves and other effects of atmospheric conditions are also more noticeable at higher powers. Another point worth mentioning upfront, is when buying binoculars, you get what you pay for. Buying the cheapest is not the smart option. However, top-end binoculars can be frightfully expensive (towards R30 000), and one can do very well between R4000 – R7000. A lot can be said about the design of binoculars as well as the quality of coatings on the lenses. This is essentially where the money is spent. The more you pay, the better the performance one can expect. Vision 29
Let’s demystify some of the technical issues of binoculars.
amount of light falling on the retina will be less than that collected with your normal vision.
What do the numbers mean?
The image will appear dim and since resolution and contrast are adversely affected, the image appears less clear. Knowing the exit pupil, can help you choose a binocular that is well-suited to your activities. You may want to use a binocular with a large exit pupil (7 X 50), for activities like boating, during which it is hard to keep a steady hand. It is much easier to keep the smaller pupil of the eye centered in the larger exit pupil of a binocular.
What is the field of view? 7 X 35 – 8 X 40 – 10 X 40. The first number indicates the magnification. The second number denotes the diameter, in millimeters, of the objective lens.
The objective lens The size of the objective lens (the larger end of the binocular) is almost always directly related to the size of the binocular. A larger objective lens will gather more light and, theoretically, allow you to see greater detail and a brighter image. A small difference in aperture will have a greater impact on the light gathering ability of a binocular than you might expect, especially under low light conditions. The apertures of compact models generally range from 20mm to 25mm while “giant binoculars”, used mainly for astronomy, may range from 70mm to 80mm in diameter.
The exit pupil This is calculated by dividing the objective lens number by the magnification number. For example, an 8 X 40, will have an exit pupil of 5mm. You can actually see the exit pupil as a circular image of light in the eyepiece, when you hold the binocular at arm’s length. These exit pupil images should be exactly circular, if not, I would be less confident about the overall quality of the binoculars. When the exit pupil of the binocular is larger than the eye pupil, some of the light coming from the binocular will fall on the iris and go undetected by the observer. When the exit pupil is smaller than the eye pupil, the
30 Vision
When you look through your binoculars, the widest dimension you can see across the circular view is known as the field of view. The field of view is primarily determined by the design of the eyepiece and not the size of the objective lens. As a general rule, the field of view will decrease as magnification increases. For example, a 10 X model will have a smaller field of view than a 7 X model of the same design. The field of view is typically measured at 1000 yards (304,8 m) from the point of viewing. You may find the measurement listed on the binos in either feet or degrees.
Eye Relief Binoculars are essentially designed to be used without spectacles or sunglasses, when the eyes can get close-up to the eye pieces. Wearing spectacles or sunglasses, the eyes will of course be positioned further away from the eye pieces and reduce the field of view. This is not a nice situation, but most binocular designs overcome this dilemma with adjustable eye pods. The eye pods can dial in when wearing specs, or out when not.
Twilight Factor During daylight hours the magnification of a binocular will be the principal factor in image resolution. At night, when the eye pupil is dilated, aperture size is the controlling factor. In twilight conditions, both of these factors affect resolution. The twilight factor compares binocular
performance under these conditions. A higher twilight factor indicates that the binocular will resolve images better under dim light conditions. Calculate the twilight factor of a binocular this way: 1) Multiply the magnification by the aperture 2) Find the square root of this product
MAGNIFICATION X APERTURE
Calculation of the Twilight Factor
According to this indicator, a 10 X 40 model (twilight factor of 20) would resolve better than a 7 X 35 model (twilight factor of 15.4) even though the 10 X 40 has a smaller exit pupil. Note that the twilight factor will primarily indicate performance at dawn or dusk without consideration of the light transmittance or glass quality of the binocular.
Trouble shooting and care Make the effort to understand how to focus your binoculars properly. In my experience, most people don’t. It would be pointless to spend good money and then not get the best performance out of your purchase. Even topend binos will perform poorly unless focused properly. The distance between our eyes (pupils) differs from person to person. It is very important to get the eye pieces to align exactly with our pupils. This can be done by pushing the two sides of the binos together or pulling them apart, while looking through the binos. You can immediately tell, by the quality of the image when alignment is correct. Keep the objective and eye piece lenses clean. Many older people don’t see well at near and often they can’t determine if the bino lenses are clean. Dirty lenses can be very problematic. Do not clean with a dry cloth or tissue paper. Use a micro cleaning cloth with lens spray cleaner. Beware of beach sand in your bino pouch. This will transfer onto the bino lenses and can cause scratches. Always ensure that the eye pods are equally and fully dialed in or out. If you are battling to find a well-focused
image, this is the first thing to check. If there is an imbalance of where they are positioned, it will cause a blur.
Visual correction Good vision with your binos will be a function of the refractive status of your eyes. It makes sense to ensure that you start from the right basis by having a comprehensive visual assessment by an optometrist. The optometrist will have clever options for the keen birder or hunter, such as contact lenses, just for those particular activities.
Buying Purchasing a pair of binoculars can be a life time investment. It is best to spend the money to get the quality. Unfortunately, in my experience, binocular sales people, seldom have the knowledge to advise properly on all the factors that should be taken into account. Someone needs to know the facts to ensure that your purchase will best suit the activity you want to indulge in. To this end, it may be well worth the trouble to familiarise yourself with the key issues. Vision 31
How to focus your binos 1. Turn your main focus knob all the way to the right. 2. Locate your diopter focusing piece. This is either another focus knob or a movable eyepiece, usually the right eyepiece. 3. Choose a distant stationery object on which to focus. 4. Looking through the binoculars, close your right eye (or cover the right lens) and, using the center focus wheel, adjust the focus until a clear image appears. You may need to adjust both wheels slightly to achieve the sharpest degree of focus. 5. Close your left eye (or cover the left objective lens with your hand) and quickly turn the diopter focus piece, so that the image is clear and in sharp focus for your right eye. Lower the binoculars and rest your eyes for a moment. 6. Once you’ve achieved maximum focus, look at the settings for your diopter adjustment (most binos have symbols or number to indicate settings). 7. Lastly, ensure that the eye pieces are aligned with your inter- pupillary distance, by pulling or pushing on the sides of the binos to move the eye pieces in or out. You will be able to tell immediately when this setting is right for your eyes. Remember where your optimal setting is on the diopter knob, so you can automatically readjust your binoculars to that point should the setting be changed by another user.
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Biology of Your Eyes Bausch + Lomb Biotrue® ONEday contact lenses are engineered with a high level of moisture1 and to give your eyes the level of comfort they deserve2. Now you can freely seize the day, comfortably and clearly2. Speak to your Optometrist about Biotrue® ONEday contact lenses
MADE OF WATER1
HOURS OF MOISTURE3
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UV BLOCKING4*
*UV-absorbing contact lenses are NOT substitutes for UV-absorbing sunglasses. You should continue to use UV-absorbing sunglasses as directed. References: 1. ACLM (2019) ACLM Contact Lens Year Book. 2. Data on file. Bausch & Lomb Incorporated. Rochester, NY. Study #700. 3. Data on file. Bausch & Lomb Incorporated. Rochester, NY. Robert b. Steffen. 4. FDA (2012) 510(k) summary, B+L nesofilcon A contact lens. Proprietary name: Bausch + Lomb Biotrue® ONEday (nesofilcon A) Soft (Hydrophilic) Contact Lens. For full prescribing information, refer to the instructions for use. Further information is available on request from Bausch+Lomb. © 2020 Bausch & Lomb Incorporated. ® /™ denote trademarks of Bausch & Lomb Incorporated. Distributed by: Soflens (Pty) Ltd. Reg. No.: 1968/011787/07. 254 Hall Street, Centurion. Tel: +27 10 025 2100. www.bausch.co.za BL465/20
Retinopathy of Prematurity By Daniel Joseph Lattin, MD
R
etinopathy of prematurity (ROP) is an eye disease that can happen in premature babies. It causes abnormal blood vessels to grow in the retina, and can lead to blindness.
What happens in retinopathy of prematurity?
Retinopathy of prematurity makes blood vessels grow abnormally and randomly in the eye. These vessels tend to leak or bleed, leading to scarring of the retina, the layer of nerve tissue in the eye that lets us see. When the scars shrink, they pull on the retina, detaching it from the back of the eye. Because the retina is a vital part of vision, its detachment will cause blindness.
What causes retinopathy of prematurity?
RETINOPATHY OF PREMATURITY
Blood Vessels
Pupil
Iris
During pregnancy, blood vessels grow from the center of a developing baby’s retina 16 weeks into the mother’s pregnancy, and then branch outward and reach the edges of the retina between 8 months into the pregnancy and when the baby is full term. In babies born early, normal retinal vessel growth may be disrupted, and abnormal vessels can develop. This can cause leaking and bleeding into the eye.
Optic Nerve Retina
Retinopathy of prematurity of prematurity causes blood vessels to grow abnormally in the retina. Image: KidsHealth
ROP has no signs or symptoms when it first develops in a newborn. The only way to detect it is through an eye exam by an ophthalmologist.
How is retinopathy of prematurity treated? RETINAL DETACHMENT
Pupil
Iris
Blood Vessels
Optic Nerve Detached Retina
Abnormal blood vessel growth can cause the retina to detach from the back of the eye. Image: KidsHealth
34 Vision
Some cases of ROP are mild and correct themselves. But others progress to scarring, pulling the retina away from the rest of the eye. These cases need surgery to prevent vision loss or blindness. ROP surgery stops the growth of abnormal blood vessels. Treatment focuses on the peripheral retina (the sides of the retina) to preserve the central retina (the most important part of the retina). ROP surgery involves scarring areas on the peripheral retina to stop the abnormal growth and eliminate pulling on the retina. Because surgery focuses on the peripheral retina, some amount of peripheral vision may be lost. However, by preserving the central retina, the eye can still do vital functions like seeing straight ahead, distinguishing colours, reading, etc.
“ROP has no signs or symptoms when it first develops in a newborn. The only way to detect it is through an eye exam by an ophthalmologist.”
SCLERAL BUCKLING Scleral Buckle Blood Vessels
Pupil
Types of retinopathy of prematurity surgery
Iris Laser Scars
The most common methods of ROP surgery are:
Optic Nerve Retina Scleral Buckle Image: KidsHealth
• •
Laser surgery: This is done most often for ROP. Small laser beams scar the peripheral retina. This procedure (also called laser therapy or photocoagulation) lasts about 30–45 minutes for each eye. Injection: A medicine is injected into the eye. This might be done as an alternative to, or along with, laser surgery. This is a newer treatment and results are promising, often allowing the blood vessels to grow more normally. Research is ongoing to determine the long-term side effects of the medicine on premature infants.
For advanced cases of ROP with retinal detachment, these methods are used: •
Scleral buckling: This involves placing a flexible band, usually made of silicone, around the circumference of the eye. The band goes around the sclera, or the white of the eye, causing it to push in, or “buckle.” This, in turn, pushes the torn retina closer to the outer wall of the eye. This surgery takes 1–2 hours. Vision 35
•
Vitrectomy: This complex surgery involves replacing the vitreous (the clear gel in the center of the eye) with a saline (salt) solution. This allows for the removal of scar tissue and eases tugging on the retina, which stops it from pulling away. Vitrectomy can take several hours.
Your baby’s ophthalmologist will talk with you about which ROP surgery method is best.
What happens in retinopathy of prematurity surgery? Your baby’s pediatric ophthalmologist will describe the procedure and answer your questions. ROP surgery is usually done with a child under either general anesthesia (medicine that causes a deep sleep-like state) or sedation (the child is unaware of the procedure, but isn’t as deeply sedated as with general anesthesia). • Laser surgery can be done either at the child’s bedside with sedation and pain medicine or under general anesthesia in an operating room. • Injections usually are done at the bedside with the child under topical (local) anesthesia. • Scleral buckle and vitrectomy surgeries require general anesthesia, so they are done in an operating room. For all procedures, the baby’s breathing and heart rate is closely watched during the surgery. Doctors give the baby eye drops to dilate the pupil(s) before the procedure. During the surgery, a tool called an eyelid speculum is gently inserted under the eyelids to keep them from closing. The eye will be covered with a patch after scleral buckling and vitrectomy, but not after laser surgery or an injection. Whether a hospital stay is needed depends on the child’s medical condition and age at the time of surgery.
What else should I know? If a hospital stay isn’t needed, you can take your child home about an hour after the procedure. Follow-up care for ROP surgery includes
36 Vision
giving your child eye drops (to prevent infection and/or inflammation) for at least a week. To make sure the eyes heal properly and that ROP hasn’t returned, the ophthalmologist will schedule follow-up eye exams. These usually happen every 1–2 weeks. For scleral buckling, the ophthalmologist must examine the buckle every 6 months to account for a child’s growing eye. The goal of ROP surgery is to stop the progression of the disease and prevent blindness. ROP surgery has a good success rate, but not all babies respond to treatment. Up to 25% of babies who have ROP surgery might still lose some or all vision. With all types of ROP surgery, a degree of peripheral (side) vision may be lost. And even if the ROP stops progressing, vision still can be affected. Because some vision loss and complications can happen, any child who has had ROP surgery should have regular, yearly eye exams well into adulthood.
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A FINISHING TOUCH
INFINITY VIEW
THE PERFECT ACCESSORIES TO SPRUCE UP ANY BUSINESS OUTFIT Business fashion has been shaped by many classic designs, from pencil skirts to business suits. These garments have a timeless appeal that has earned them a permanent spot in most of our wardrobes. Chic, stylish accessories are the perfect way to put a personal touch on the classic business outfit. The right accessories can transform your basic business look into a trendy, fashion-forward outfit. An extravagant wristwatch with an eye-catching face or stylish wristband in a striking colour or crocodile leather can put a modern spin on things and let you show off your sophisticated style. Style tip: Forget about contact lenses! Glasses are the ultimate accessory when it comes to rounding out your office look. The Austrian premium eyewear manufacturer’s new Infinity View collection offers an enchanting combination of subtle glamor and one-of-a-kind comfort. Its design embodies the clear, modern visual language for which Silhouette is known and loved. The high-tech production methods and quality materials combine to create one impressive pair of corrective lenses, with timeless appeal. The transparent frames create a seemingly infinite view, also lending them a modern touch. The collection adds the perfect finishing touch to any business look, with an exciting mixture ranging from transparent to classic black. The shapes in the Infinity View collection are the perfect choice for at the office, during a business meeting, having an after-work drink or simply out and about.
NEVERENDING TRENDS FASHION STATEMENTS THAT ARE BUILT TO LAST New fashions come and go with every decade that passes. Yet, some fashion statements stand the test of time, earning themselves a permanent place in our wardrobes. Classics like leather jackets, first designed for pilots in the 1920s, or jean jackets, which made their debut in the 1940s, have gone on to achieve iconic status. It’s hard to imagine what the fashion world would look like today without them. The same goes for colourful ribbons tied playfully in the hair. These were all the rage in the 1950s and, this season, they’re making a well-deserved comeback. And who would have guessed that the ever-popular platform shoe actually dates back to the Baroque era in Venice? This footwear made a big comeback in the 1970s and has enjoyed popularity ever since. What all these styles have in common is that they are continually being reinvented as time goes by to fit within the current fashion universe. Even the 1990s brought us a few fashion gems that keep coming back. The spectacular shapes of the lenses in the new Lite Spirit collections from Austrian premium eyewear manufacturer Silhouette pay homage to the heroes of that era. Classic 90s shapes in small, understated formats lend an allure of timeless chic that never goes out of style. The two different frames look radiant in a choice of hip colours like Cassis Sundown, Indigo and Champagne Jungle. For a more understated colour, you can’t go wrong with Vintage Havana or Soft Grey. The collection features round-shaped and squared models. Created with the utmost attention to detail, the Lite Spirit models are precious accessories that will truly stand the test of time. They’re sure to become a timeless fashion statement that you’ll enjoy wearing for decades to come.
LITE SPIRIT
Ageing What it does to your eyes
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or the past thirty years the improvements in hygiene conditions and medical progress have led to an impressive reduction in morbidity amongst elderly people, many of whom now live without any major incapacity to over 80 years and beyond. Why do we age? The important question that we all ask ourselves still remains. As we age, our past abilities are substituted by new and increasing inabilities that mark every stage on our final journey. Our various organs age in their own specific ways: blood vessels lose their suppleness, the heart is invaded by fibrosis, the brain by neurofibrillar degeneration and the appearance of a senile plate, the kidney function declines, immune defences are down and the frequency of cancer increases with age. The eye itself evolves in its own way. The first obvious sign of its ageing is the difficultly in reading close up, which is known as presbyopia. In reality this is merely the revelation of a long process that affects the accommodative power of the crystalline lens. If one compares this power, at the age of twenty, with that of a four year-old child, it is already clear that a large part of the accommodative power has already been considerably reduced. But at that time it is still of no consequence. It is only around the age of forty-five that someone with no refractive error (emmetropia), begins to experience some difficulties with reading, which will only increase with age. The causes of presbyopia are due to structural changes in the crystalline lens and the ciliary muscles, which are responsible for modifying the
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“It is often during an examination by the Eye Care Professional that a patient is found to have ocular hypertension and glaucoma.�
curves of the lens. Up until the thirteenth century this was a major handicap for intellectuals and was resolved only by the introduction of magnifying lenses. Today we can consider that presbyopia has found its remedy in the remarkable solutions provided by designers of corrective spectacle lenses. Everyone knows that cataract occurs with age. It is the main cause of changes to vision after the age of sixty-five. This gradual change in the crystalline lens leads to modifications in its transparency, which results in a range of visual defects, such as reduced acuity, glare or an alteration in contrast. Thanks to remarkable technical developments, cataract surgery, is now a precise, short, out-patient procedure which restores normal vision.
“Will we be able to write another story one day? The story of humans who could live up to the limits estimated by science, at least thirty years longer than our current averages without any expression of ageing. ” It is in the retina where ageing is the most harmful to vision and the origin of major visual handicaps. Age-related macular degeneration (AMD) is the most common of these handicaps, and is understandably feared amongst the ageing population. With age the retina regularly loses photo-receptor cells (cone and rods) but without affecting vision, since 30% of them are enough to maintain what we consider to be normal vision. AMD affects around 25% to 30% of men and women aged over 80. It is the consequence of a degenerative alteration of the retina, which affects central vision, which is used for reading and seeing colours. It can occur from the age of around sixty, but only in a very low percentage of cases. This percentage increases regularly with age. AMD is expressed in two ways: the most common is a slowprogression, dry form, characterised by the presence of lipid deposits or “drusen” on the macula and, to a lesser extent, a fast-progressing exudative or “wet” form, characterised by major vascular proliferation. It has been clearly established that high-risk factors encourage the appearance of AMD (age, tobacco, oxidative), but also that major genetic factors are involved and these are beginning to be identified with precision. Although AMD is the major retinal complication during the ageing process, added to it are slow degenerative modifications to the retinal periphery. Degeneration of the vitreous humour, may be the cause of retinal tears, which are themselves responsible for retinal detachment. There is a particularly large incidence of these cases in very short-sighted people over the age of fifty. It is often during an examination by an Eye Care Professional that a patient is found to have glaucoma. Patients are usually unaware that they are suffering
from this terrible disease, since at the outset it is entirely without symptoms. If diagnosed early, glaucoma can be treated successfully. Without treatment we know that it leads to optic atrophy and irreversible loss of vision. Although expressions of ageing on the eye mainly affect the clinical forms previously mentioned, there are many other signs. We have all noticed the changes that affect the eyes with age. Those eyes that were so fascinating, lose their sparkle and those previously highly colourful irises have now become dull. De-pigmentation of the iris is the cause of this, the pupil that was previously so black turns greyish in colour and the cornea that was so transparent often bears at its periphery a white ring, known as arcus senilis. The conjunctiva itself can become dull and yellowish because of growths called pingueculas. What to think about the “bags” that hang over or underline the eyelids and which are linked to the failing of an orbital septum, itself the victim of tissue degeneration? Why do old people so often have watery eyes? A condition caused by eyelid distortion and, above all, late onset obliteration of the tear ducts. This is an extremely common and unpleasant handicap, but to a lesser extent than the reverse, the constitution of ocular dryness, which is responsible for chronic keratitis and the need to humidify the eye several times a day. Will we be able to write another story one day? The story of humans who could live up to the limits estimated by science, at least thirty years longer than our current averages without any expression of ageing. Vision 39
MBB X Vogue Eyewear MBB X Vogue Eyewear
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everything Vogue Eyewear stands for. amreal, so excited to be collaborating withtrends Voguewith Eyewear Inspiring, inclusive “I and her unique spirit interprets the latest originalon confidence, inviting women to own their unique vision of life. Plus, the young Time 100-listed multi-hyphenate is a force to be my first eyewear collection. Vogue Eyewear is all about fun, reckoned with in the fashion world. Loved by top brands for her spontaneous, totally personal approach to exciting fashion style – it’s a great match! This designer apparel, Millie’s lookand always keepsforward it 100% real. collection is designed to appeal to every girl, no matter the And if seeing is believing, Millie proves that she has what it takes to transform her super-natural talent into current also be Collection, affordable and accessible” must-have fashion status with trends, her very and own Capsule co-designed with Vogue Eyewear. Defined by her unique ability to connect with a diverse audience, the eclectic selection of trendy sun and optical shapes – Millie Bobby Brown frames the multi-faceted personalities of in-the-now women with expressive style. Designed to fit any mood in anything from feminine pastels on retro-chic metal to bold, stand-out profiles and space age lens shapes, premium quality materials and head-turning style make sure that each and every one of these signature looks makes the cut with irresistible, Millie Bobby Brown-endorsed appeal. As the star of the new Vogue Eyewear campaign, Millie Bobby Brown comes across as both sincere and reassuring, fun-loving and spontaneous, showing us exactly what it means to express our vision of life through the lens of style. Through the six episodes of the campaign, the young star encourages women to be real, to believe in themselves and show the world who they are with pride, defining her ethos with a set of simple rules: Love Yourself, Be Kind, Stand Out, Keep It Real, Laugh Out Loud and most importantly, always Chase Your Dreams. The styling of the campaign echoes the eclectic spirit of the MBB Capsule collection, going from fresh and playful to avant-garde in a blink. This impactful narrative invites us to embrace who we really are in totally fashionable style – and one thing is for sure, Millie Bobby Brown’s take on Vogue Eyewear style is designed to be as unforgettable as her take on life. 2020/03/16 13:59
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“I am so excited to be collaborating with Vogue Eyewear on my first eyewear collection. Vogue Eyewear is all about fun, exciting and fashion forward style – it’s a great match! This collection is designed to appeal to every girl, no matter the current trends, and also be affordable and accessible” – Millie Bobby Brown.
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