April 2018


SEE YOUR WHOLE WORLD, NOT JUST PART OF IT!

The annual World Glaucoma Week in March may have come and gone but unfortunately glaucoma is here to stay! Glaucoma is an irreversible progressive condition of the eyes caused by damage to the optic nerve at the back of the eye. After diabetic eye disease, it is the most common cause of blindness in the Western world if left untreated. The 2018 theme for World Glaucoma Week was B-I-G, Beat Invisible Glaucoma. This is an excellent incentive to visit your optometrist for a glaucoma screening, which is a quick and painless measurement of the pressure inside the eyes.
 
Most cases of glaucoma are due to a build-up of pressure within the eye, gradually causing damage to the optic nerve which connects the eyes to the brain. However, some people who have optic nerve damage have relatively normal intra-ocular pressure but may have poor or compromised blood supply to the optic nerve and the retina at the back of the eye. For this reason, it is important to have a regular comprehensive eye examination of the internal structures of the eyes as well.
 
Glaucoma is most prevalent in people over the age of 60 but can occur in younger people. Some experts recommend glaucoma screening every 5 years from the age of 40, or earlier and more frequently if there are risk factors for the development of the condition. Risk factors include a family history of glaucoma, a high degree of shortsightedness or farsightedness, diabetes, trauma to the eye (even many years ago), or ocular inflammation. The earlier the onset of glaucoma, the more aggressive it is, and the more damage will occur sooner. Although glaucoma is usually due to increased pressure in the eye, it is not associated with high blood pressure.
 
Frequently referred to as the "silent thief of vision", most cases of glaucoma only manifest visual symptoms late in the disease process, so that people who have it are usually unaware of it initially. It develops slowly and without symptoms, gradually damaging the optic nerve and causing progressive loss of peripheral vision until one notices a certain degree of tunnel vision. By then it is too late to reverse the damage. Very occasionally, glaucoma can develop suddenly. Acute symptoms may include intense eye pain, headache, blurred vision, nausea and vomiting, or redness of the eyes. Immediate medical intervention is essential.
 
While damage to the optic nerve cannot be repaired and lost vision cannot be recovered, glaucoma can be controlled. Early detection and treatment of glaucoma is vital in order to arrest or slow down the damage process. The aims of treatment are to decrease intraocular pressure and prevent further damage and vision loss. Different treatment options are recommended depending on the type and extent of the glaucoma. It is important to realise that glaucoma is a chronic disease which needs lifelong treatment to prevent ongoing optic nerve damage and further vision loss. An important aspect of the management of the condition includes regular monitoring by your optometrist.


GATEWAY TO LEARNING

School Health Week in March served as a reminder of the need to be aware, not only of general health, but of eye health and the essential role vision plays in the classroom. Learning is a complex process which requires integration and coordination between a number of modalities, including hearing, vision, language, and physical and cognitive abilities. We all have different learning styles and strengths. Some people learn most effectively by looking, others by listening, and still others by doing. The large majority of the demand in the classroom is on the visual system, increasing as children progress through school, when more study materials need to be read, print in books becomes smaller, and more time is spent studying and working on the computer. Optimal vision for learning is not simply being able to see clearly but involves visual processing skills and the ability to make sense of what is seen. Less than optimal visual skills may lead to poor academic and sporting performance, a negative attitude towards school, and emotional and social problems.
 
Although visual processing skills can be broken down for the sake of definition, they do not function independently of each other. They are an integrated system of processes that work together to facilitate effective learning and interpretation of information coming in through the eyes.

Visual Acuity

Visual acuity is a measure of the sharpness of vision or how clearly one is able to see at various distances. Problems that could impact school performance include difficulty with distance vision (shortsightedness), close vision (farsightedness) or blurred vision due to an irregularly shaped cornea (astigmatism). Generally, a child will not report a visual acuity problem because he is unaware that he sees differently from others. Your optometrist will detect and manage problems in this area.

Eye Tracking

This is the ability to keep the eyes on target when looking from one object to another, moving the eyes from word to word in a book or following a moving object like a thrown ball. The child should be able to track with the eyes without moving the head.

Eye Focusing

This ability allows the child to quickly and accurately maintain clear vision while changing focus at different distances. Activities such as reading and writing require sustained focus for prolonged periods of time, while copying from one place to another requires a rapid and efficient change of focus.

Eye Teaming

Eye teaming is the ability of the eyes to coordinate and work together smoothly, simultaneously and accurately. Each eye actually sees a slightly different image, which the brain puts together to create a fused 3-D picture, enabling the child to judge depth, distances and spatial relationships.

Eye-hand Coordination

This is the vital ability to use visual information to monitor and direct movement of the hands when doing both close work like writing or larger movements such as catching a ball.

Visual Discrimination

By comparing visual features, the child is required to identify differences and similarities between colours, shapes and patterns. This is an essential skill in differentiating letters, numbers and words.

Figure Ground

Figure ground refers to the child's ability to perceive the foreground from the background in a visual presentation, for example locating a specific word on a page or area on a map.

Visual Closure

Visual closure is the ability to identify forms or objects from incomplete presentations. The child with adequate visual closure skills does not have to read each letter in a word or each word in a sentence but is able to read the word or sentence as a whole.

Visual Memory

With good visual memory the child is able to recall what has been previously seen, for example letters, numbers and reading passages. Closely allied with this is visual sequential memory which requires the recall of items in the correct order, e.g. letters in a word. It is a skill which has an impact on daily activities such as dressing.

Sequencing

Sequencing is an important foundation for reading, writing and comprehension, as it involves putting letters, words, numbers and ideas in a logical consecutive order.

Spatial Relations

Spatial relations skills involve the ability to perceive and understand the position of one's body in space in relation to itself and others, to identify left and right, top and bottom, and the direction in which the body is turned. It has an impact on written work as well as on the sports field.

Form Constancy

Form constancy refers to the child's ability to identify objects, shapes, letters, and words, despite differences in their size or position. The form remains constant but the orientation changes.

Reading Comprehension

The main purpose of reading is to understand what has been read. Although not strictly a visual skill, it is essential that the child has adequate reading proficiency so as not to concentrate solely on the process of decoding words, but to be able to make sense of what he is reading.

Signs of Visual Problems

Visual skills can be influenced by many physiological, environmental and psychological factors, including development, illness, nutrition, medication, fatigue, environmental stress, emotional stress, attention and attitude. Some children are able to compensate for some of these factors reasonably well in the lower grades but may demonstrate difficulties as schoolwork becomes more demanding. Parents and teachers need to be aware of the signs that indicate that problems may exist. Among others, these are:
    Frequent eye rubbing or blinking
    Avoiding reading and other close activities
    Frequent headaches or fatigue especially after near work
    Covering one eye or squinting
    Tilting the head to one side
    Holding reading materials close to the face
    Blurred or double vision
    Losing the place when reading, writing or copying
    Difficulty remembering what was read
    Excessive time completing assignments
    Excessive time copying from the board
    Daydreaming
    Slow laboured reading
    Short attention span
    Difficulty catching or hitting a ball
    Decreased depth perception
    Inefficient eye-hand or eye-body coordination
    Poor handwriting
    Use of a finger or marker when reading
    Difficulty copying from the board
    Skipping or repeating words while reading
    Head movement side to side while reading
    Difficulty discriminating between letters or numbers
    Confusing similar words
    Difficulty recognising words or letters presented in a different font
    Confusion or fatigue looking at a "busy" page
    Difficulty recalling what was previously seen
    Reversal or transposition of words, numbers or letters
    Spelling problems
    Struggling with spacing within and between words when writing
    Poor organisation of a written page
    Limited understanding of spatial terms (up, down, left, right, etc.)
If any of these symptoms are noticed, visit your optometrist for a comprehensive assessment. Glasses or contact lenses may provide the necessary correction of certain vision problems, or a programme of vision therapy may be indicated to help develop or improve visual processing skills. Because vision may change frequently and demands on the visual system increase during the school years, regular eye and vision care is important, whether problems are evident or not.


A TWITCH IN TIME ....

Everyone has them from time to time. Everyone finds them irritating. No-one knows exactly what causes them. But they usually don't last long and are seldom a cause for concern. Eyelid twitches or myokymia are painless repetitive involuntary spasms of the muscles of the eyelids. They usually occur in the upper eyelid but can occur in both the upper and lower lids and are more prevalent during the day than at night. Episodes of eyelid twitching are unpredictable, typically occurring every few seconds for a minute or two. They may appear on and off for a day or two and then disappear for weeks or months. While most twitches resolve on their own, in rare cases they may be early warning signs of an underlying disorder which requires medical intervention.

CAUSES

The specific causes of eyelid twitching are usually unknown, although certain factors may be identifiable as triggering them or making them worse. These are usually related to life style.
 
Stress - Stress is often a reason for eye twitching. If associated with a particular stressful situation such as exams, it usually resolves once the stressful situation comes to an end. Meditation or just sitting quietly with closed eyes for a few minutes can help reduce stress and eye twitching, if not alleviate them completely.
 
Caffeine or alcohol - It is thought that the stimulants in caffeine and/or the relaxant effects of alcohol can bring on a twitchy eyelid, especially when used in excess. It is often difficult to eliminate or reduce caffeine intake, but it is important to remain hydrated by drinking lots of water.
 
Mineral deficiencies - According to some experts, a magnesium deficiency is the most common nutritional imbalance that may lead to eye twitches. Taking a magnesium supplement or eating magnesium-rich foods such as almonds, oatmeal and spinach, can help restore the balance.
 
Dry eyes - Dry eyes are a common condition, particularly in older people, and are frequently a precipitating factor in eye twitching. Artificial tears are an effective remedy. Discuss with your optometrist which in the available range would be most appropriate for you.
 
Eye strain - Whether from overuse of computers or tablets, or not wearing sunglasses when there is bright sun or glare, we all suffer from eye strain at some time or another. This can cause the eyelids to twitch. The obvious solution is to limit time or at least have a break from LED screens, and wear sunglasses in bright sunshine. The 20-20-20 rule helps to relieve eye strain - every 20 minutes look at least 20 feet away from the screen for 20 seconds.
 
Jaw clenching and teeth grinding - Without being aware of it, many people clench their jaws or grind their teeth, often in their sleep. This type of muscle tension can exacerbate eye twitching. A dentist can fit a mouth guard to be worn at night which will reduce the grinding of the teeth. A gentle self-massage of the jaw will have a similar effect.
 
Blepharospasm - While for most people eyelid twitching is mild and intermittent, for people with blepharospasm the spasm may be strong enough to force both eyes shut. Although generally not serious, this is a chronic condition which may become progressively worse over time. As it worsens it may lead to an increased sensitivity to light, blurry vision and facial spasms. The exact cause is unknown, but it is thought to be the result of a combination of genetic and environmental factors. If spasms become severe and interfere with daily living, consult your optometrist about their management.
 
Chronic disorders - In very rare cases eyelid twitching may be a sign of an underlying chronic nerve condition such as multiple sclerosis or Parkinson's disease. In these cases, the eye twitching is usually accompanied by facial twitches, muscle spasms and other symptoms in other parts of the body. These cases need to be managed by a medical practitioner.

TREATMENT

Most eyelid spasms disappear without treatment in a few days or weeks. If they are triggered by stress, fatigue or excess caffeine, try to eliminate or decrease these factors. Keeping the eyes lubricated with artificial tears or applying a warm compress to the eyes may ease the spasm. In cases of chronic blepharospasm Botox injections or surgery may be necessary. If an underlying health condition is the cause, treating this condition is the obvious solution.

WHEN TO SEE A DOCTOR

Eyelid twitches are seldom serious enough to require medical treatment. However, in rare cases chronic eyelid spasms may be a symptom of a more serious nervous system disorder. You may need to see your doctor if you're having chronic eyelid spasms accompanied by:
    Red or swollen eyes
    An unusual discharge from the eyes
    Drooping of the upper eyelid
    Complete closing of the eye when it twitches
    Continued or worsening twitching over several weeks
    Other parts of the face being affected


SEEING THE WORLD THROUGH ROSE-COLOURED LENSES?

Contact lenses have a rich history that dates back to the 1500s, when Italian artist and inventor Leonardo da Vinci first conceived of them. While his idea was only a sketch and was highly impractical, it was the beginning of centuries of contact lens innovation which continues to develop. Today contact lenses are a part of everyday life for millions of people around the world. With the rapid advances in technology, not only have the materials evolved for better comfort and durability, but the availability of colours and patterns has grown, making coloured contact lenses an important feature in the world of movies and a cosmetic accessory in the wardrobes of many people.
 
Human eye colour is determined by two factors, the pigmentation of the iris (the coloured part of the eye) and the way the iris scatters the light passing through it. The amount of melanin in the iris is genetically determined; the more melanin, the darker the eye. Sometimes eye colour appears to change depending on variations in light and the way in which this is reflected by the iris.
 
Coloured contact lenses fall into three basic categories, each of which serves a slightly different purpose and has a different role to play in modifying the colour of the eyes.
 
As their name implies, enhancer contact lenses are designed to highlight the natural beauty of the eye colour, boosting it or subtly changing its tint. They are particularly meant for people who have light coloured eyes and who want to enhance their natural look rather than actually change the colour of the eyes. Enhancer lenses give the eye a greater sense of depth and dimension. A new concept in eye colour enhancement is a lens which simply has a black ring around the outside of the iris. This simple feature adds a mesmerising effect to the existing eye colour and usually looks completely natural.
 
Opaque lenses are intended to change the eye colour completely. They come in a variety of colours ranging from a natural look to something more striking such as bright green or violet. They usually have a clear opening for the pupil in the centre of the lens and a heavy colour over the iris area.
 
Some coloured contact lenses are designed specifically as a fun accessory. These theatrical lenses have designs ranging from unusual colour combinations and patterns to matching fancy dress outfits and even the logos of sports teams.
 
Coloured contact lenses are available in both prescription and non-prescription lenses. Whether they are worn for vision correction or cosmetic purposes, it is essential that they are fitted by an optometrist who will ensure that the lenses are correct and comfortable. With the increase in their popularity, unregulated lenses are freely available in markets and party shops, and their use could pose a danger to the eyes due to inferior materials, poor fitting and lack of hygienic care.
 
When buying coloured contact lenses think of them in medical rather than cosmetic terms and shop accordingly. Make an informed choice by visiting your optometrist who will take into account your history, general health and the health of your eyes, and recommend suitable lenses. They may be more expensive, but it is worth investing in coloured contact lenses that are made from the right material for the eyes, fit well and will not lead to irritation or infection of the eyes.
 
Choose coloured contact lenses based on your skin and hair colour. If you have darker skin or warmer skin tones with yellow or golden undertones, then the most suitable coloured contact lenses are hazel, honey, green or light brown. Alternatively, for people with cooler skin tones that have bluish undertones, the most popular coloured contact lenses are violet and blue. Similarly, people with black hair will look good with blue contact lenses whereas those with blonde or red hair could opt for blue or green eyes.
 
Follow your optometrist's instructions regarding the care of your coloured contact lenses. Wash your hands before inserting or removing the lenses. Use the recommended contact lens solution; do not clean your lenses with water or saliva. Clean the lenses after each use, and store in a clean case. Carry contact lens solution and a clean case with you in case you need to remove your lenses. Don't over-wear the lenses; check their expiry date and dispose of them as and when recommended. Never share contact lenses! It may seem like fun to try each other's lenses when going to a fancy-dress party, but it can lead to eye infection. Remove your lenses if your eyes feel uncomfortable and schedule an appointment with your optometrist if the discomfort persists.
 
Wearing coloured contact lenses as a fashion accessory is common amongst many celebrities. Tom Cruise wears them to enhance his natural brown eyes, while stars such as Orlando Bloom, Kanye West and Jennifer Aniston prefer to change the colour of their eyes from brown to blue or green. Super model Naomi Campbell wears either green or blue lenses on the catwalk. Lady Gaga makes use of both eye make-up and coloured contact lenses to complement her unusual outfits on stage. What would fantasy films like "Avatar" and "Twilight" be like without the dramatic effect of coloured contact lenses?


LOOK ME IN THE EYE

Eye contact has been compared to the fairy tale of "Goldilocks and the Three Bears" - too much may be interpreted as rude, too little may make a person appear uneasy or disinterested, while just the right amount produces feelings of mutual trust and interest. Eye contact is an integral and powerful part of non-verbal communication, is often linked to facial expression and sends out messages that are not always picked up with words alone. However, it is not as simple as the Goldilocks theory would suggest. There are different types of eye contact, and the interpretation of acceptable eye contact differs from culture to culture, situation to situation, personality to personality, gender to gender and even extends to the eyes in photographs and paintings.

Making and Breaking Eye Contact

Making eye contact with someone acknowledges that person and shows that you are interested in them. In some cultures, however, it is interpreted as rude to make eye contact with people in authority or of the opposite sex. Breaking eye contact can indicate that the person has lost interest, disagrees with what has been said or feels threatened. During conversation we frequently look away and back again, to prevent the discomfort of prolonged eye contact. When a person is feeling uncomfortable, he may rub one eye or pretend to have something in his eye, giving him an opportunity to break eye contact by turning his head away.

Avoiding Eye contact

We tend to avoid eye contact when we feel that our personal space may be threatened, for example in lifts, when everyone faces forward, or in crowded places where people look out of a window or at their phones. In some cultures eye contact is avoided as a sign of respect. There is a universal myth that when someone is lying he will avoid eye contact, but some experts feel that he may overcompensate by holding eye contact too long. Still others believe that by closely watching the listener's eyes he may be able to detect if the listener has seen through his lie. Employees or children at school may avoid eye contact when they know that the boss or teacher is seeking volunteers and are thinking: "PLEASE DON'T PICK ME!" People who avoid eye contact by wearing sunglasses indoors can make those around them feel ill at ease which is often their intention.

"Just Right" Eye Contact

Too much eye contact is instinctively felt to be rude, hostile and condescending. In a business context, it may be perceived as a deliberate intent to dominate or intimidate or to place others at a disadvantage. Too little, on the other hand, can make a person appear uneasy, insincere, or lacking confidence. "Just the right" amount of eye contact, the amount that produces a feeling of mutual likability and trustworthiness, will vary in different settings. As a general rule, direct eye contact during conversation, more when listening, less when speaking, makes for a comfortable atmosphere. Females typically look more at the person they are talking to than males do.

Gazing

Gazing can have either positive or negative implications. The acceptable duration of eye contact is situation and culture specific; sometimes even a slight glance is regarded as disrespectful. Looking at something indicates an interest in it, and others often follow our gaze to share what we are looking at. The gaze that is short but intense is sometimes used to impose one's will on another, showing power without aggression. It is usually accompanied by a facial expression that conveys the same message.

Glancing

Glancing at something can betray a desire for that object. Glancing at a person can indicate a desire to talk with them. It can also indicate a concern for that person's feelings. Glancing may indicate a desire to gaze at something or someone when it is forbidden or uncomfortable to look for a prolonged period. Glancing sideways at a person can be viewed as a sign of attraction or sometimes disapproval, depending on the situation.

Prolonged Eye Contact

Eye contact longer than normal can have several different meanings. Eye contact often increases significantly when we are listening, and especially when we are paying close attention to what the other person is saying. In more intense or intimate conversations, we naturally look at one another more often and for longer periods of time. We look more at people we like and like people who look at us more. Prolonged eye contact without blinking, contracted pupils and an immobile face can indicate domination, aggression and use of power. Prolonged eye contact can be disconcerting; to reduce stress from this look at the bridge of the other person's nose - he will think you are still looking at his eyes!
 

Limited Eye Contact

We generally reduce eye contact when we are talking about something shameful or embarrassing, or when we are sad or depressed. Less eye contact is used in conversation when people who are visual thinkers stare into the distance or look upwards as they access internal thoughts or emotions.

Eye Contact and Persuasion

A public speaker wanting to convey his message strongly seeks out eye contact with audience members and continues to sustain it with reconnection as he speaks. This makes him appear confident, believable and competent. If people in the audience are listening but are not making eye contact with the speaker, the personal connection is reduced.
 
 
 

Staring

Staring is generally done with eyes wider than usual and with reduced blinking. It generally indicates particular interest in something or someone. Staring is often indicative of aggression. A short stare, with eyes wide open and then back to normal indicates surprise, shock or disbelief. The length of an acceptable stare varies across cultures, as does who is allowed to stare, and at what. Babies and young children stare more, until they have learned the cultural rules.

Squinting

Squinting or narrowing of the eyes can indicate judgement, uncertainty or not necessarily believing what one has heard.
 
 
 

Blinking

Blinking is a natural process to lubricate the eyes but it can also convey nonverbal cues. Blink rate tends to increase when people are feeling stressed and it can be an indication of lying. In a conversation between two people it may reflect their rapport as they tend to blink at the same rate as they listen carefully to one another. A single slow blink can be a reaction to surprise - "I do not believe what I am seeing!"

Pupil Size

Pupil size, contraction or dilation, sends a subtle subconscious message which is often missed by the sender. Not very different in meaning to squinting, the pupils often constrict in disgust or distaste, while they dilate in situations of attraction. In general, dilated pupils are positive while constricted pupils are negative.

Eye Contact and Learning

Some studies have suggested that eye contact has a positive impact on retention and recall of information and may facilitate learning. Most teachers are aware of engaged eye contact versus the blank stare of the child who is daydreaming or does not understand what is being said. One study reports that while maintaining eye contact when listening enhances retention of information, avoiding eye contact when processing information is helpful. This could be one explanation why children tend to look away while thinking.

Animals and Eye Contact

In general, most animals perceive direct eye contact as a threat and a means of establishing dominance. Prey animals, such as horses will run away, while predators are likely to attack. Chimpanzees use eye contact to signal aggression in hostile encounters and staring at them can induce agitated behavior. With domesticated animals, particularly dogs and cats eye contact depends on the situation. The slow blink of a cat is often interpreted as friendly. Some people believe that dogs are the only animals who look humans directly in the eye, read facial expressions and understand human emotions. Others say that their response to the feelings of their owners has more to do with body language and tone of voice than eye contact.


SEEING IN COLOUR

April is that time of year when the mornings are chillier, the evenings are darker, and the leaves on the trees turn spectacular shades of... I don't know. Orange and red. I know I was about to get poetic there, but then I remembered I'm no poet. I'm just an old pair of glasses going on about the way I see the world.
 
But yeah... colours of leaves. Green turns to red. That's what April is all about in its autumn glory and all. But if you think about it, April is a time for other colours too.
 
On April 27 we'll remember how a major change swept across our country, and we found ourselves living in what became known as the very colourful Rainbow Nation.
 
Now, my friend Rose is a... well, no surprises here... a pair of rose-tinted glasses. And she says everything's been perfect since 1994. Me? I'm a little less rose-tinted myself, and I gotta say we have a lot of work to do. But even I can admit that we've come a long way. And this is the month where we stop and remember that.
 
Plus, our new democracy also gave us a new flag. Talk about colours... it probably contains more colours than any other flag in the world. Sure, there were people at the time who said it looked like a beach towel. Others said they'd never get used to it. But - as the millennials would say - those people are "haters", and "haters gonna hate". (That last one comes from Taylor Swift...)
 
In other words, people said what they said and they'll say what they say. But that flag has flown proudly at rugby matches, athletic events and Miss Universe pageants - all of which we've won, by the way. ("Hashtag just saying", if I may quote the millennials again.)
 
Anyway, I'm not here to preach. Just like I'm not here to recite poetry about the colours of the autumn leaves. All I'm saying is this is a month to stop and look. It's a time to appreciate and celebrate. There are colours of different kinds all around us. Let's stop for a minute and take in the view.
 
But again, I'm just an old pair of glasses, so what do I know? Just telling it like I see it... or like I want to see it. Maybe my friend Rose is sometimes on the money... just sometimes.