EYE TALK DOC Chronicles
Hi, I’m Tracy Vo, a local optometrist in the Toronto area.
I have had the privilege of practicing in Toronto for over 9 years now, and I am passionate about eyecare and the many facets of management the eye needs. I cannot be more excited to share my experiences with you!
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I went to York University for my undergraduate studies in Biology, then got accepted to the School of Optometry and Vision Sciences at the University of Waterloo. It was there where I did my studies and graduated with a Doctor of Optometry. During my studies, I was able to intern at the Eye Foundation of Utah, which was a clinic focused on ocular disease treatment and management. I have also participated in outreach missions to Mexico and Jamaica.
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Today, I practice in Toronto and Mississauga, and continually strive to provide the highest quality of eye care to those communities.
Outside of my passion for optometry, I enjoy traveling, and exploring, whether it's in the City of Toronto, or places a little further. And with travelling comes my interest in photography and physical activity! Hikes and trips with friends and family is one of my favourite past times, and that usually includes indulging on delicious meals and snapping photos of all those moments together. There are so many amazing places and things to SEE, and this is what drives me to keep learning and to improve as an optometrist so that my patients can see all the beautiful things the world has to offer!
CASES
Beware of the GLARE
FIGURE 1:
Eye with coloured contact lens being worn in BRIGHT light conditions.
Arrow pointing to pixelated pattern of coloured contact lens
Arrows pointing to pupil size
FIGURE 2:
Eye with coloured contact lens being worn in LOW light conditions.
Ms S has been a patient for a few years now, has been experiencing symptoms of glare for a while and I unfortunately admit that she has been experiencing these symptoms without improvement with treatment. There are some eye cases that leave me scratching my head and those are usually the ones that are the most rewarding!
Ms. S’s main concern was that her vision was weak at night because there was so much GLARE. This glare interfered with her driving and she was not able to comfortably see in the distance. We tried updating her prescription, treating for ocular surface issues, and unfortunately nothing seemed to work! Ms S said it was like she had to wear sunglasses at night! So this sparked the idea to try wearing colour contact lenses, to help shield the eyes from oncoming light! And VOILA! Ms S was able to see at night! She was able to wear colour contact lenses and that helped reduce her glare symptoms because the coloured portions of the lens shielded extra light from entering her eyes! Figure 1 shows Ms S's pupils constricting in bright light conditions, and Figure 2 shows how dilated her pupils get during low light conditions.
The real issue here was not that her prescription wasn't strong enough or whether her eyes were dry at the end of the day, it was because her already large pupils would dilate even further at night. The larger the pupil is, the more light can enter the eye and that also means more light scatter! The coloured contact lenses significantly reduced the light scatter by blocking the light when the pupil dilated at night!
Now Ms S can enjoy her night drives and feels comfortable with her vision at low light levels!
Contact lenses are a great treatment option for patients. Although it is important to always have your contact lenses examined by a professional to ensure the lens is the right fit and are healthy for your eyes! I always tell my patients, “Contact lenses will take care of you, if you take care of them!” So make sure you have a proper fitting and assessment prior to contact lens wear!
Bull's Eye STYE
FIGURE 1:
Right Eye Topographyical Scans:
Tangential Maps (Left), Side Profile (Right)
FIGURE 2:
Left Eye Topographyical Scans:
Tangential Maps (Left), Side Profile with arrow indicating divot (Right)
Ms T came into the office because her left eye just couldn't see normally. She has been patient and tried to wait for her vision to get better. Although it didn't and she couldn't figure out why it was blurred! Her right eye saw great, but the imbalance between the two eyes was very uncomfortable. Seeing clear in one eye, and blurry in the other eye can cause dizziness, nausea, and imbalance because your brain is getting two different images from each eye. The photos above are topography images of her eye (Figure 1 and Figure2). Topography images are specialized imaging optometrists take of the cornea which map out the front surface of their eye, like a map would of land.
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Let’s take a look at Ms T’s coloured topography scans, these are tangential maps. The coloured scans are of a perspective looking at cornea's high and low points, like looking at a mountain from above. For Ms T, her right eye has a pretty even spread of green on the sides, then yellow indicating a slight higher point in the middle. This scan overall suggests a shape like a dome (Figure 1 Left). This is what we expect for normal eyes. The corneal surface should be mostly smooth and look like a dome (Easy way to remember is the Sky Dome!). For her left eye, you can see there is a red ring in the photo, indicating a pattern that has a bowl like shape, where the sides are elevated, as shown in red and the center is not, as shown in green (Figure 2 Left).
Now for the side profile scans. Ms T's right eye you can see a nice dome like shape (Figure 1 Right), although for her left eye, there is a large divot in the center (Figure 2 Right Arrow). This divot distorts the light as it enters the eye, thus in turn causing her vision to blur! Now here’s the plot twist, the divot was created by a new stye she had on her eyelid (Figure 3)! Everynight when Ms T closed her eyes, the stye on her upper eye lid would sit right over top of her cornea along her line of sight, and gradually just made an impression on her cornea while she was sleeping! Thankfully with diligent treatment, the stye resolved, and so did her vision! As you can see below (Figure 4) the divot has resolved and her cornea is starting to return to its dome-like shape! If that stye formed a little to the left or right, her vision wouldn’t have been as affected. Although unfortunately this stye had good aim, and hit a bull’s eye right on Ms T’s line of sight.
FIGURE 3:
Photograph of Stye on Left upper eye lid.
FIGURE 4:
Left Eye Topograpical Scan After Stye has healed
3rd Flip's the Charm!
FIGURE 1:
Eyelid flipped at first presentation.
FIGURE 2:
Eyelid flipped after starting treatment. Hover over image for dye stained photo.
FIGURE 2A:
Flurescein stained photo of eyelid flipped after starting treatment.
FIGURE 3:
Ms K holding the extracted particle.
Tomorrow morning when you wake up, try to see how it feels when you first open your eyes. For Ms K, this was not a pleasant experience. Ms K woke up and she felt a sharp pain the second she opened her eyes! After repeatedly flushing with water, she was still in pain. She made her way to the clinic and greeted me with a lovely hello... while only looking at me with her left eye, because she could not open her right eye. After examining her eyes, what was left was her eyelids. The photo above, Figure 1, is what I saw once I flipped her eyelid.
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Upon flipping the eyelid (Figure 1), I saw this large red lesion that was the source of all her pain and discomfort. This bump was swollen tissue on the underside of her eyelid, so everytime she blinked, the bump would be rubbing her cornea, in turn causing all that discomfort and pain. The location, signs, and of the pain seemed to indicate to me that it was a swollen gland in her eye lid, so I treated her with oral antibiotics, medicated eye drops, and for the pain and discomfort, we placed a bandage contact lens to allow the cornea to be protected from the eyelid bump with every blink. Ms K was able to leave the office with both eyes open now and feeling significantly better!
When she came back to follow up, her pain and discomfort was definitely better, and then I flipped the lid again to assess (Figure 2 & Figure 2A). The swelling and redness of the eye lid had significantly improved! So we decided to continue treatment as planned and removed the bandage lens. After removing the lens, I asked Ms K if I could flip her lid one more time before sending her off. She agreed, and on that final flip, the culprit appeared (Figure 3). Now I was able to see a small shiny particle popping out of the bump on her eyelid!
So here’s what I think happened. Ms K had, from what it looked like, a piece of plastic (Figure 3) that get lodged on her upper lid, which caused alot of irritation and pain. The eye lid responded by swelling around the particle, and thats why it wasnt visible on first presentation! After the antibiotics and medical anti-inflammatory drops were used, the eye lid was able to swell down enough for me to pop the particle out with that final lid flip! Morale of the story, some things are not as they appear… and don't be afraid to keep flipping that lid!
"I can't stop TEARING. It's like I'm always CRYING."
FIGURE 1:
Photo of Cornea before treatment.
Hover for after treatment photo.
FIGURE 1A:
Photo of Cornea after treatment.
FIGURE 2:
Photo of Cornea before treatment.
Hover for after treatment photo.
FIGURE 2A:
Photo of Cornea after treatment.
The photos to the left is of Ms L’s eye illuminated with a blue cobalt light. This light helps highlight the green dye called Fluress, which we place in the patient’s eye to see any abnormalities on the surface. The large glowing green spot you see is a large abrasion on her cornea (Top photo), and the red vessels (Bottom photo) reaching up to the lesion is a sign of chronic, progressive pain to the eye.
Ms L has had eye pain, discomfort, and tearing for years, and by years she means longer than she can remember. With a long line of treatments, nothing has worked. I, being a little competitive in nature, said let me try and see what I can do.
The cornea helps transmit light into the eye, although when it's scratched and damaged like this, the light becomes scattered like a disco ball and the patient’s vision is very smudged and blurred. Also since the cornea is filled with nerves, having abrasions like this one is very painful and irritating. This patient was chronically tearing due to her damaged corneas. One technique done by doctors is to apply a bandage contact lens, which covers the cornea and protects it from external harm while it is healing. I applied the lens, then just stepped out of the room for 15 mins.
When I came back, Ms L bursted out saying“ I AM NOT CRYING?!?!? I want to cry now because I am so happy!” The bandage was able to act as a barrier for her damaged cornea. The bandage protected the cornea from feeling the blinks on her raw eye, which in turn was what was stimulating her eyes to tear and causing the pain. It was amazing that only after a few minutes Ms L was starting to feel better! This treatment coupled with medications has helped this patient’s condition improve and now she can get back to the things she enjoys doing with her eyes.
These conditions require alot of care and time, and thankfully this patient is getting better and I am always happy when she reminds me that “ I can see! And look I’m not tearing!”
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This treatment and management is specific to the patient’s conditions, and may not work for everyone. If you are experiencing any problems, please consult with an eye care professional to curate the right treatment and management for you. If you do not have an eye care professional, and are in the Toronto area, contact us for an appointment and I’ll be happy to offer my services.
My 1st Corneal Abrasion
FIGURE 1:
Photo of Anterior Segment of Eye
I am pretty safe with my eyes, especially because I see some pretty bad cuts at the clinic. Although it can happen to anyone, even if you are super careful!
The cornea is the clear tissue at the front of your eye, and the outtermost layer of the cornea is called the epithelium, it serves as the protective layer for the cornea. Although, like when you accidentally rub your elbow or knee against a hard surface, you can literally skin it and alittle bit of that skin comes off. The cornea is filled with nerves, and once alittle bit of epithelium comes off, it is very sensitive! As you can see in the photo (Figure 1), my eye was pretty red and my eye was not happy with me. All of this trouble from a 1 mm abrasion.
Thankfully, the cornea is pretty resilient, and with diligent treatment it healed up in 48 hours. Sometimes, accidents happen, and in that case, eye got your covered.
Also, can you see the reflection of my laptop on my cornea?