Eye on vision

When it comes to your eyes, remember the three O’s. Opticians, optometrists and ophthalmologists are your allies in protecting and enhancing your vision. In Canada, a network known as IRIS brings all three of these specialists together for a holistic approach to eye health.

“We’re able to provide all eye care services under one roof, or under one concept, and that’s something that’s unique in the industry,” says Dr. Daryan Angle, vice president professional relations for IRIS. “There’s a continuous level of care happening.”

IRIS, which is headquartered in Laval, Quebec, was conceived in 1989 by a young entrepreneur named Dr. Francis Jean. The University of Montreal School of Optometry graduate travelled the province sharing his vision of a more integrated approach to eye health, and recruiting like-minded professionals to join his growing group of eye care centres. In 2000 IRIS purchased the Fort Group of Optical Companies and cemented its place as the country’s largest eye care centre network. The IRIS team can now be found at 165 locations across the country and comprises more than 500 opticians, optometrists and ophthalmologists.

As your primary eye care provider, the optometrist has a vital role to play in your vision. “Not only is the optometrist there to prescribe options to enhance your vision, whether that be glasses, contact lenses or laser eye surgery, but [we’re] also going to screen you for diseases of the eye such as glaucoma, macular degeneration and cataracts, which can threaten your vision,” says Angle, an optometrist of nine years. “At the same time we are able to, through routine examinations, detect conditions of the general health such as diabetes and high blood pressure, which can show up in the eye.”

People under 19 and over 65 should go for a check-up a minimum of once yearly, as should those who wear contact lenses or have other ongoing issues. Patients with conditions such as diabetes may be seen as often as every three months, depending on whether it’s affecting their eye health. The rest of the population should get their eyes tested every two years.

Aim to have an open dialogue with your optometrist. “What we do at IRIS is we spend the time to have a good conversation with our patients, on not only their family history but their own eye and health history, as well as just what they do with their eyes on a given day,” says Angle. Your hobbies and line of work are some of the things taken into consideration.

If it’s decided that glasses are your best option, Angle says, you should have a conversation with your ophthalmologist and an optician from the same IRIS centre to determine what lens design will work best with your visual needs and prescription. “The technology of eyeglass lenses changes very quickly, and the newer technologies allow for sharper vision through prescription. So the lenses themselves have a huge impact as to how well you’re going to see from the prescription written by your optometrist.”

THINK PREVENTION
BETWEEN REGULAR VISITS TO YOUR OPTOMETRIST, ANGLE SAYS THERE ARE A NUMBER OF THINGS YOU CAN DO TO PROTECT YOUR PEEPERS

SUN UV from the sun has been proven to cause macular degeneration, cataracts and cancers of the eye. Shield yourself with a good quality pair of prescription or non-prescription sunglasses.

SMOKING Cigarettes cause damage to much more than just your lungs and heart.  Smoking is a facilitator of many eye diseases including cataracts and macular degeneration.

NUTRITION You can help keep your eyes healthy in the long term by eating lots of fruits and vegetables with anti-oxidants in them. Also think about reducing the amount of refined carbohydrates in your diet. Some preliminary studies have shown that potentially high carbohydrate diets could be contributing to myopia or near-sightedness.

SURGICAL OPTIONS
Following a check-up, your optometrist may determine that a condition requires more aggressive or specialized medical attention. He or she would then refer you to see an ophthalmologist, who is primarily a surgeon. At IRIS’s two ophthalmology centres, in Langley, B.C. and Laval, Que., patients can choose from treatments including laser eye surgery and intraocular lenses.

Laser eye surgery, in which the surgeon uses a laser device to permanently change the shape of the patient’s cornea, is the most common procedure performed to correct refractive vision problems such as myopia (near-sightedness), hyperopia (far-sightedness) and astigmatism. As of December 2009 IRIS had performed laser refractive surgery on a total of 11,000 patients. “It’s your optometrist that’s going to determine whether you fit all the appropriate parameters in order to go down that route for correction,” says Angle.

In 2004, IRIS’s ophthalmology centres became the first place in Canada to offer presbyopic laser surgery. Presbyopia is a condition that commonly afflicts those over 40, when the eye starts to lose the ability to focus on near objects with age. IRIS’s presbyopic treatments, by giving the non-dominant eye more range of focus, corrects for both near and far vision, and allows the patient to be free from reading glasses 80% of the time. In the past three years, 45% of laser surgeries at IRIS’s Langley ophthalmology centre were to correct both distance and near vision.

If the patient has presbyopia and cataracts, intraocular surgery (lens replacement) may be another option to explore. As of December 2009 IRIS’s Laval ophthalmology centre had performed the procedure, in which the patient’s natural eye lens is removed and replaced with an artificial lens, on 3,000 patients. The procedure is being introduced to IRIS’s Langley ophthalmology centre this spring.

The interconnectedness of the IRIS network makes the process from general eye care to surgery seamless, says Angle. “There’s a huge convenience factor for our patients coming in… The optometrist is able to do all of the pre-operative care, refer you to have the surgery, and then you would come back to do all of your post-operative care at the IRIS centre that’s closest to where you live,” he says. “Everyone has a very specific role and a very important role. By working together under one concept like IRIS we’re able to really provide a high standard of care to our patients by using everyone’s expertise for the patient’s benefit.” •

CLEAR RESULTS
TWO PATIENTS SHARE THEIR EXPERIENCE WITH LASER EYE SURGERY

NIKKI:
Having worn glasses since the age of nine, Nikki Rekman knew her life was going to change when she decided to have laser eye surgery in 2008. “My eyesight was very poor, and I’m a fairly active person in the outdoors,” says the Chilliwack, B.C., woman. “Specifically I'm a paddler, so I kayak and canoe, and I work in that industry. Managing wearing glasses and contacts in that environment is not always easy.”

Because she had thin corneas, Rekman underwent photo-refractive keractectomy (PRK).  In this procedure the surgeon removes the outer layer of the cornea, as opposed to laser-assisted in situ keratomileusis (LASIK), in which the surgeon creates a flap in the cornea. Rekman recalls the cautiously optimistic outlook she was given by the doctors at IRIS’s Langley ophthalmology clinic. “Originally they didn’t think my surgery would be as successful as it was, and it was also a possibility that I wasn’t even going to be a candidate.  So they really encouraged me not to get my hopes up.” Rekman was told she could probably go without glasses for regular everyday living, but would likely have to wear them when watching TV and driving at night.

Then Rekman had the surgery. “I had better than 20/20 vision,” she reports happily. “I’m almost going on two years [from] February, and my vision is still perfect.”

She says her experience following the surgery was quite an emotional one. “I remember when they sat me up after being on the table and my now-fiancé was standing outside,” she says. “I looked through the glass and I could see him and I just started bawling because I would have never been able to do that before.” Rekman couldn’t wait to try out her newly clear vision. “When we were driving home from the procedure all I did was read licence plate numbers and signs.  And you're not supposed to do that; they want you to really relax after.  But I couldn't help it — I was so excited!”

JANICE:
Janice Cotter underwent LASIK in May 2009 after thinking about it on and off for a couple of years. “I never needed glasses up until a few years ago, for anything,” she says. “So it was particularly annoying to me that I had to wear glasses and then had to wear two or three different pairs depending on what I was doing.” The tipping point was when she found out she would need progressive (multi-focal) lenses. “I’d heard so many people telling me how difficult they are to get used to,” she says.

She looked into IRIS’s services and found she could have laser surgery done for both reading and distance vision, otherwise known as presbyopic laser treatment. “It meant having a slight difference in each eye, which seemed kind of scary,” she remembers. Cotter says the IRIS team helped to calm her nerves. “They were very accommodating, and they will come to pick you up and bring you home, whatever you need to do it.”

On the day of the surgery, Cotter was brought into a room and seated on a padded recliner. A piece of machinery came over her head and held her eyes open during the procedure. “It is, literally, each eye, about 15 to 20 seconds,” she says. “It's so easy and there's no pain, no discomfort.” The follow-up process was equally hassle-free, says Cotter. “I went back to the surgery centre for a checkup the next day, but then I could just go to the IRIS optometrist that was quite near my house, so every other checkup that I had to have I went there instead.”

As for the reading correction part of the surgery Cotter was so worried about? “Your eyes adjust automatically,” she says. “If I close each one eye and close the other, they each see just a hair differently.  When they’re open together, they see perfectly, distance and close up.”  Cotter says undergoing the procedure was one of the best decisions she’s ever made. “It’s like getting a little bit of your youth back, being able not to have three pairs of glasses on your head at one time.”