May/June 2020 Newsletter
VISITING YOUR OPTOMETRIST DURING LOCK DOWN
Optometrists have now been allowed to open their practices with stringent regulations to ensure the safety of themselves, their staff and you, their patients. Before reopening their doors, optometrists are required to implement protocols and take all the necessary hygienic precautions towards maintaining a clean and sanitised environment. All surfaces are sanitised before and after a consultation, with particular attention given to surfaces with which patients come into direct contact, such as the chair and certain testing equipment. Frames that have been handled by patients and optometric staff are sanitised before being replaced. If the optometrist or a member of his or her staff has symptoms of COVID-19, they will not be allowed to come to work until they have been cleared by the medical authorities.
Patients are required to follow guidelines recommended by the World Health Organisation that will further ensure safety when visiting the optometrist. Before visiting your optometrist for any reason, whether it is an adjustment to a frame, an eye examination or a consultation about an acute visual problem, call the practice to schedule an appointment. If you or a family member has had flu symptoms or have travelled within the two weeks prior to the appointment, it is necessary to reschedule the appointment for two weeks later to allow for a quarantine period. If you or a family member have had contact with a person who has tested positive for COVID-19, inform the optometrist or receptionist immediately so that appropriate action can be taken.
To follow the regulation of social distancing and avoid crowding in the waiting room, arrive for your appointment exactly on time, neither early nor late. You may be screened for COVID-19 before entering the practice. Wearing of a mask is mandatory for optometrists, their staff and patients. Both staff and patients are required to sanitise their hands with sanitiser provided by the practice on entering and leaving. Unless absolutely necessary, for example with children, patients should not be accompanied by others when visiting the optometrist.
During these challenging times, stay safe and stay well!
NOT JUST A BUMP ON THE HEAD
A study published in the Journal of the American Medical Association estimates that as many as 20% of children will be diagnosed with a concussion during their childhood years. Concussions occur more often in children and adolescents because of the sports in which they are involved, and are beginning to be taken more seriously by school coaches and medical staff. Concussion is an injury to the brain caused by a sudden bump or blow to the head which causes the brain to move rapidly back and forth within the skull. The effects are usually temporary, but severe or repeated concussions can have a lasting impact in a number of areas, including on visual functioning.
Signs and symptoms generally appear soon after the injury. However, some symptoms may not show up for hours or days and the severity of the injury may not be evident initially. It is important to continue to check for signs of concussion for a few days after the injury. Physical signs and symptoms of a concussion may include dizziness, headache, ringing in the ears, nausea, vomiting, fatigue or drowsiness, and blurry vision.
Although the eyes may appear to be healthy, a number of functional vision symptoms can occur. Visual symptoms occur more often with near than with distance vision. Blurry vision is a typical vision problem following concussion. There may also be double vision, which can be disorienting and may lead to dizziness, difficulty balancing or walking, and difficulty reading. The individual may experience accommodative dysfunction and struggle with switching focus from near to far and vice versa. A common problem after concussion is convergence insufficiency, a decreased ability to converge the eyes and maintain binocular vision while focusing on a near target such as a book or phone. This may lead to difficulty concentrating when reading and eye fatigue. There may be increased sensitivity to light and glare. Concussion can affect the smooth movement of the eyes, causing rapid jumpy eye movements which may result in problems with hand-eye coordination, eye teaming or eye tracking. Reading speed, fluency and comprehension may be affected.
Fortunately, most of the problems associated with concussion are temporary and will resolve on their own. Research has shown that a break from physical and mental activity will give the brain a chance to recover. Doctors sometimes recommend total rest with no brain stimulation, and a gradual return to normal activity. If symptoms persist, treatment or referral to a specialist may be indicated.
The visual problems resulting from concussion can have an impact on reading and learning activities, and many of these conditions respond well to vision therapy. Vision therapy consists of a unique programme of eye exercises designed by the optometrist for the child's specific difficulties and needs. It helps to retrain eye muscles in order to improve focusing, eye teaming, coordination and reaction time. Sometimes reading glasses, bifocals or progressive addition lenses are prescribed to help remedy and compensate for the effects of concussion.
With the concerns regarding concussions and their associated problems in children and adolescents, the question often asked is whether they can be prevented. Certain steps can be taken to minimise the risks and perhaps the severity of these injuries.
Know the rules - Schools, coaches, community organisations and parents should know the rules so that they can ensure that they are responsibly followed.
Don't put all of your faith in equipment - While a child should wear a helmet or other protective gear, just because a helmet was worn, doesn't mean that a concussion did not occur. Do not ignore injuries, take them seriously.
Talk to your children about symptoms - Keep the lines of communication open, so that the child feels comfortable talking about problems if an injury occurs.
Generally, the impact of concussion is temporary, but being vigilant and aware of problems that may emerge will help to spot these issues and seek timeous professional help.
DIGITAL EYE STRAIN DURING LOCK DOWN
As well as being a potentially fatal disease, COVID-19 has had an enormous impact on numerous aspects of our lives, both global and personal. One of the personal effects of lock down has been on our eyes. While during "normal” circumstances many people spend hours staring at small screens, this has increased dramatically during lockdown, placing strain on the eyes of both adults and children who are spending extended periods of time watching TV, working or engaging in activities on computers and i-pads, and communicating with others via various forms of social media. Limited time is spent outdoors away from screens and artificial light. This may lead to Digital Eye Strain, sometimes referred to as Computer Vision Syndrome. Digital Eye Strain describes a group of eye and vision-related problems that result from prolonged use of computers, tablets, e-readers and cell phones. Rather than being one specific problem, it includes a range of eye strain and discomfort, which seems to increase with the amount of digital screen exposure.
For many reasons, reading text on a digital device is often more demanding for the eyes than reading printed text, which is why reading a book may not cause the same eye problems as staring at a screen. Several factors may contribute to this. These include glare, flicker and contrast from the screen, constantly moving images, poor lighting, poor posture, the incorrect distance or angle of the screen, or a combination of these. The eyes have to focus and refocus from the screen to the keyboard and back again, placing a huge demand on the eye muscles. People often blink less when using a computer than when reading printed text, which may lead to dry eyes and digital eye strain. Changes to underlying vision problems like shortsightedness or farsightedness, inadequate focusing of the eyes or eye coordination problems, and aging eyes can all contribute to an increased risk of strain when using a digital device for a lengthy period of time.
The symptoms of computer vision syndrome may include blurred vision, double vision, red irritated eyes, dry eyes, eye fatigue, itchy eyes, headaches and neck, shoulder or back pain. The severity of symptoms may vary depending on the length of time looking at the screen or underlying eye problems. Most of these symptoms are temporary; there is no evidence to suggest that there is long-term damage to the eyes.
A few simple lifestyle changes and adjustments to workspace can help to improve and prevent the symptoms of digital eye strain. To reduce glare from the screen or environment, use a screen filter, move the monitor away from a nearby window or close curtains or blinds, and adjust the lighting in the room. Adjust the brightness, contrast and font size so that you do not have to strain the eyes to see the screen clearly. Ensure that the computer monitor is slightly below eye level and that handheld devices are at a comfortable angle and distance to avoid poor posture and subsequent neck or back pain.
Give your eyes regular breaks. Follow the 20-20-20 rule. Look away from the screen every 20 minutes or so and look at something about 20 feet away for about 20 seconds. To keep the eyes moist and comfortable, remember to blink often and remind children to do so, too.
If there is an underlying problem with dry eyes, this may be exacerbated by extended use of digital devices. Using lubricating eye drops and creating a more humid home environment may be helpful. Your optometrist can recommend suitable eye drops for your specific difficulties. Be sure to remain hydrated by drinking plenty of fluids. Cotton wool or a cloth soaked in warm water and placed over the eyes for a few minutes can soothe tired strained eyes.
Understandably it has been a challenge during lockdown, but balancing screen time with outdoor time or at least time away from the screen is important for alleviating the symptoms of digital eye strain. Children, particularly, need to use their eyes to focus on objects further away as well as close up. The skills that are critical for visual functioning cannot be adequately developed if children spend too much time in front of a two-dimensional screen.
While you can make the lifestyle changes suggested to help with the symptoms of computer vision syndrome, an examination by your optometrist when the lock down regulations allow would determine if the eye strain is made worse by factors such as the need for a new prescription, an underlying problem with the eyes or a medical condition which requires referral to a doctor.
Your optometrist may recommend glasses specifically for use with digital devices, and specific to your individual visual needs. These typically have anti-reflective and anti-glare coating to reduce screen glare, photochromatic lenses to shield your eyes from high-energy blue light that comes from digital devices, and a subtle tint to reduce other wavelengths of light that may add to fatigue. They improve posture by allowing clearer vision of the screen and reducing the need to strain the neck and back. Your optometrist will discuss this option with you and guide you towards a decision that works best for you.
THE VIEW THAT CHANGED A GAME RANGER'S LIFE
Shaun D'Araujo, a game ranger at Londolozi shared his experience of guiding a blind woman during game drives and how her view changed his life! Going to a private game reserve is a luxury for many. Even self-driving through the Kruger National Park and other reserves scattered around South Africa is a memorable experience. The great privilege is doing these things and being able to see them.
Shaun D'Araujo, a game ranger at Londolozi, was assigned to guide a guest who had lost her eyesight. He was unsure how he would guide her during their drives as he had spent his 15-year career pointing things out to his guests. His stresses were quickly put aside when he learned that the woman didn't need him to talk her through the sightings. She sat and listened to everything and taught Shaun a valuable life lesson.
On their first game drive, he sat there and closed his eyes. He and his guest listened to the animals, the sounds of the birds, the rumble of distant elephants and the boisterous zebra. They listened to the hippos fighting and the fish eagles flying overhead.
Using his eyes, he explained a passing lion's appearance in detail. Shaun described her scars and her missing tail, the colour of her eyes and the detail of her tongue. It was at that moment that Shaun realised how much of nature he was missing using only his eyes. He realised that even using his eyes, he had seen many lions, but he had never really looked. He noted how you could see the life a lion has led by the scars that riddle their bodies.
Shaun learned about the blessings of life, about using everything to immerse yourself in nature. The feeling of the bark on a big tree, the way the sand feels between your toes and the sound of the water slowly rippling over the top of your foot.
Londolozi shared his experience, and it is powerful to watch! Shaun explains how his whole world was opened up, all thanks to how a blind woman experienced a few days in the wild.
Watch the video here
This article is printed with kind permission by Londolozi Game Lodge https://www.londolozi.com & https://londolozi.africa
WHEN SHOULD CHILDREN GET GLASSES?
Parents are often uncertain and confused about when children should have their eyes tested and whether they should wear glasses or not. There are a number of myths around this topic, including if young children wear glasses they will become too dependent on them, or if children wear glasses when they are young they won't need them later, or even children will outgrow their visual problems so they don't need glasses. The truth is that optimal vision is essential for development, and undetected and untreated vision problems can negatively impact numerous areas of the child's functioning. The earlier problems are detected and managed, the better the long-term prognosis.
WHY WOULD CHILDREN NEED TO WEAR GLASSES?
Children need glasses for various reasons, some of which are different than for adults. The visual system is growing and developing during the first 5 – 6 years of life, and in some cases, glasses may be necessary to ensure normal visual development. The eyes may be crossed or misaligned, or one eye may be significantly weaker than the other. Glasses improve the alignment of the eyes, help to strengthen the vision of the weaker eye, or to protect the stronger eye. They provide better vision so that the child may function more effectively in the environment.
There are four basic refractive errors that can affect children. Myopia (shortsightedness) is a condition in which the distance vision is blurred, but a child can usually see well for reading or other near tasks. This occurs most often in school-age children, although occasionally younger children can be affected. Most children have hyperopia (far-sightedness) and need no treatment for this because their own focusing muscles provide clear vision for both distance and near vision. However, when an excessive amount of far-sightedness is present, they may not be able to keep the vision clear, resulting in problems such as crossing of the eyes, blurred vision, or discomfort. This is usually evident by 2 years of age. Astigmatism is caused by a difference in the surface curvature of the eye. Most people have some degree of astigmatism, but if there is significant astigmatism, fine details may look blurred or distorted and glasses may be necessary.
Some children may have a different prescription in each eye, which can create a condition called amblyopia, in which the vision in one eye does not develop normally. Glasses (and sometimes eye drops or patching one eye)or visual training are needed to ensure that each eye can see clearly and that the eyes can work together efficiently.
WHAT SIGNS SHOULD PARENTS BE AWARE OF?
Vision is subjective. A child is unaware that he may be seeing differently from others and that his vision is not as clear as that of his family or friends. Parents, care givers or teachers are usually the people who notice visual problems in children by being alerted to certain signs.
If one eye turns or crosses, that eye may not see as well as the other eye. If an infant shows no interest in faces or age-appropriate toys, or if the eyes constantly move and do not focus on a face or object, a difficulty with vision should be suspected. Squinting may be a sign that the child is not seeing clearly; by squinting, he may be able to temporarily see an object more clearly. The child might cover one eye or tilt his or her head to adjust the angle of vision in an attempt to improve clarity. This might be an indication that the eyes are misaligned or that the child has amblyopia or "lazy eye”. Excessive eye rubbing may indicate eye strain or fatigue.
The older child may sit too close to the television or hold books or other objects too close to his face. He may complain of headaches or eye pain, particularly after reading or doing close work, suggesting that he may be overexerting the eyes in an effort to compensate for blurred vision. Because children need to quickly and accurately adapt their visual focus in the classroom from distant to near, for example from the teacher to the book, vision problems may manifest as a problem with schoolwork.
HOW YOUNG CAN CHILDREN BE TESTED FOR VISION PROBLEMS?
It is important not to delay eye examinations for infants and children because some early eye problems can affect vision for life. Finding a problem early can keep a minor issue from becoming something major (and more difficult to treat). Infants should be examined at about 12 months of age and again before starting school. If your child already has glasses, it is important to have his eyes checked by an optometrist every year or as often as recommended by the optometrist.
An optometrist can detect the need for glasses through a complete eye examination. Accurate prescriptions for glasses can be measured in even the youngest and most uncooperative children by dilating the pupil and analysing the light reflected through the pupil from the back of the eye using a retinoscope. Special vision screeners have been developed to determine an accurate prescription within a fraction of a second. Other tests done will determine eye movements, depth perception, strabismus (crossed eyes) and eye alignment. The optometrist will also examine the back of the eye with an ophthalmoscope or by taking a retinal photograph.
Unlike adults, children who need glasses may develop a second problem, called amblyopia or "lazy eye”. Even with the right prescription, one eye (or sometimes both eyes) does not see normally. Amblyopia is more likely to occur if the prescription needed to correct one eye is stronger than the other. Wearing glasses, vision training or a combination of both can prevent amblyopia from developing in the weaker eye.
At the end of the examination your optometrist will advise you whether the condition can be monitored, if referral is necessary or whether the child needs glasses. Most lenses today, especially for children, are made of plastic, which is stronger and lighter than glass. Because children can be rough with glasses, it is a good idea to have a scratch-resistant coating on plastic lenses. If necessary, colour tints or tints that respond to changes in light can be incorporated into the lenses. For children, the tint should not be so dark that the child has trouble seeing indoors.
WILL WEARING GLASSES MAKE MY CHILD'S EYES WORSE OR MORE DEPENDENT ON THEM?
No. In fact, the opposite may be true. If a child does not wear the glasses prescribed, normal vision development can be adversely affected.
HOW WILL I EVER GET MY CHILD TO WEAR GLASSES?
Many parents are concerned about how they will be able to ensure that their child will comply and wear their glasses. One optometrist commented that "if a child needs glasses, she will wear them because kids like to see their world clearly”. While this may be true for some children, it may not be that simple for others. Initially, some children will demonstrate resistance, but patience, encouragement and a positive attitude should help. With guidance from the optometrist, including the child in the choice of the frame helps him to feel invested in the need for glasses. Frames come in all shapes and sizes. Choose one that fits comfortably but securely. There are devices available to keep glasses in place, a good idea for active children and young children with flat nasal bridges. Cable temples, which wrap around the back of the ears, are good for toddlers. Infants may require a strap across the top and back of the head instead of earpieces. Flexible hinges hold glasses in position, allow the glasses to "grow” with the child, and prevent the side arms from being broken.
With some children, setting a time when they need to wear their glasses and slowly increasing it will allow them to adjust gradually. If the child feels self-conscious or expresses concerns about being teased or bullied, it may help him to identify with a hero who wears glasses, such as a sporting hero or movie star. Harry Potter helped many children to feel comfortable wearing glasses! Most children should adjust to glasses and appreciate their improved vision within two weeks, but if they continue to complain that the glasses feel uncomfortable or they are unable to see clearly, a return visit to the optometrist may be necessary.
SEEING THINGS DIFFERENTLY
The world isn't the same as it was. A lot of things seem unclear and sometimes we can't see the light at the end of the tunnel, or the wood for the trees. It's hard to find clarity, just like when you put on your mask and your glasses get steamed up. (Now there's a new expression for the times we're living in...)
It's true that the past days (weeks, months...) have made us see things a little differently. And not only in negative ways. Spending so much time in your house can be annoying, because you're noticing things you never noticed before. But maybe it's a new and positive experience, because you're... well, you're noticing things you never noticed before. Maybe you're finding new cracks in the walls, but maybe you're also finding new plants in the garden and actually watching them grow. Talk about seeing things through new eyes (and talk about glass half full).
Maybe we're seeing ourselves - and each other - a little differently too. A recent survey revealed that most South Africans miss fried chicken more than just about anything else. Did we know that about ourselves and each other?
True, these days of lockdown can be hard on the eyes. Our moms told us that staring at screens would make our eyes go square. And here we are, sitting through Zoom meeting after Zoom meeting (and yes, Zoom fatigue is a thing). But what if Zoom is helping us to develop X-ray eyes, because we can sit in a meeting and still see what our kids are doing in the next room?
Our peripheral vision is probably developing too. That's how we can see something through the corner of an eye and mute the microphone just in time. You know, like when your three-year-old walks in and makes a toilet-related comment that your clients almost hear. Almost but not quite, thanks to the rapidly-developing reflex of the finger pressing the mute button. Spider-Man may have spider sense, but he's got nothing on us. We've developed excellent skill when it comes to looking through small spaces. That's because we've learned how to peer through the gate when a package arrives - or, more recently, when a food delivery arrives.
So there are always reasons to be positive, not least of which is that we might be developing super-powers and we don't even realise it. But those steamed-up glasses, though. Anybody got a solution for that?
And on that note, stay safe in there and out there. In the words of people everywhere... #StrongerTogether.