TRANSCRIPT

0:00

Don't underestimate how good a break can be from doing your work.

0:03

We kind of go, yeah, yeah, whatever, but taking breaks is really,

0:07

really an important strategy for both dry eye and eye strain.

0:11

If you have tried things like lubricants and you're taking breaks and you've still

0:14

got persistent symptoms, don't sit on those.

0:17

Go and get your eyes properly tested.

0:19

Have someone actually work out whether you've got the beginnings of a dry eye

0:22

syndrome or some sort of binocular vision problem that's actually

0:25

creating those things.

0:27

And you know, It might not sound like much, but those small little sort

0:33

of aggravating things, you know, if you're spending 8 hours a day

0:37

on the computer, really important for those things for your

0:39

overall quality of life and stress levels to get on top of it.

0:42

So, you know, so taking breaks and then pursuing care if those sort of home

0:48

strategies aren't working are an important piece.

0:53

If your eyes feel tired, blurry, gritty, or uncomfortable after a day at the

1:00

computer, you're certainly not alone.

1:02

The challenge is that many people assume every screen-related

1:06

symptom has the same cause.

1:08

In reality, digital eye strain and dry eye disease are different conditions, but they

1:14

can produce surprisingly similar symptoms.

1:17

Today I'm joined again by Paul Graham, owner and principal optometrist

1:21

at Harmony Vision Care on the Gold Coast.

1:23

We'll be discussing how to tell the difference between digital eye strain

1:27

and dry eye disease, why the distinction matters,

1:30

and what practical steps people can take to achieve more comfortable

1:34

vision throughout the day.

1:35

For those who are new to the channel, my name is Paul Sallaway

1:38

from Optics Digital Marketing.

1:39

We help eye care professionals to share useful educational information with their

1:43

patient communities through videos like this one.

1:46

So Paul, great to have you back.

1:48

Nick, good to be back, thank you.

1:49

So Paul, to start with, what's the difference between digital

1:53

eye strain and dry eye disease?

1:55

And you might even want to tease out the distinction between digital eye

1:58

strain and the garden variety eye strain.

2:01

If we talk about digital eye strain, obviously the name comes from the ocular

2:05

and visual discomfort that comes from using digital devices versus the eye

2:10

strain that we might get from say reading and writing, those more sort of more

2:14

traditional sources of doing lots of near work.

2:17

The difference between that kind of eye strain and digital eye strain is that when

2:21

we're using things particularly like laptops and desktops,

2:25

your eyes are in an elevated position which makes the opening of your eyelids

2:29

wider, and so there's more surface of your eye to be exposed to be drying out.

2:34

And in any activity where we're concentrating, we don't blink as often,

2:38

and then not only that, and we've spoken on this on some other

2:42

videos, is that we get into doing these little habits of half blinks as well,

2:46

which start to compound the problem.

2:48

And the distinction starts to become a little messy because with digital eye

2:52

strain you can get some of the symptoms that you might get

2:55

from dry eye, so sore gritty eyes, maybe your eyes might water,

2:59

maybe they might sting, and they can be some of the symptoms

3:02

that might indicate that you have a dry eye disease.

3:04

And a dry eye disease is a more chronic condition, and probably, you know,

3:08

our lifestyle of doing lots digital work may actually lead and be one

3:13

of the things that lead to eventual, like, an actual dry eye condition.

3:18

So there's a bit of a spectrum of how this kind of runs.

3:22

You know, you could probably say that digital eye strain might be something

3:24

that you only notice after a session on the computer or a session at work,

3:29

but we need to be careful to kind of tease that out and make sure that you're not

3:32

just putting it off to, oh, it's just a bit of eye strain,

3:34

that's just a, you know, just a consequence of doing lots of near work.

3:38

Versus having some sort of underlying problem like a dry eye

3:41

disease that needs treating.

3:44

Or as we'll discuss, you know, there are other eye teaming or binocular

3:47

vision issues that can create sore eyes and stinging and those sorts of things

3:51

as well while you're doing near work.

3:53

And so we need to sort of tease those sort of things out.

3:55

So just to confirm here, somebody could have dry eye disease

3:59

without doing any kind of digital work at all.

4:01

So, it's a condition in its own right, isn't it?

4:04

So perhaps you might want to just give us a quick explanation of what

4:07

causes dry eye disease.

4:09

Yeah, look, the most common dry eye disease is a, what we call,

4:13

an evaporative dry eye.

4:14

So it's the tear film evaporating a lot more quickly than is ideal.

4:19

Most often it's caused by the meibomian glands, the little oil glands

4:22

that sit in our eyelids.

4:24

And what they're meant to do is every time we blink, it squeezes the gland and we get

4:27

this thin oil film over the top of our tear layer which prevents

4:31

the tears evaporating too quickly.

4:33

So a combination of good complete blinks that refresh

4:37

tear film over the front of the eye, plus those glands actually expressing

4:40

the oils, is what a healthy tear film is.

4:43

So if you start to lack those oils being spread, you then rely on— really relying

4:48

on making sure you've got a very good blink rate, which then gets exacerbated

4:52

obviously when we're not blinking as much on computer screens.

4:54

So, so you've actually got something wrong with the glands that either need support

4:58

through artificial tears, lubricants, those sorts of things,

5:01

or treatments to try and get— decrease inflammation in the eyelids, you know,

5:05

using therapies to try and get the meibomian glands working better

5:07

and producing a better bloody oil.

5:09

And so that's when you're getting into a dry eye disease state where we

5:12

actually need to be doing therapeutic things to improve how

5:15

the tears are actually working.

5:16

So it's the, uh, it's like the, it's the quality of the, the tear film,

5:20

um, mostly that's the, the root cause of dry eyes.

5:23

That's the issue, and that's what we've got to look at in terms of people

5:26

complaining about discomfort when they're using the computer.

5:28

I mean, is it just from the activity itself, and,

5:31

and there are things that you're doing where you're kind of overdoing it?

5:34

Um, and so yes, maybe it's a natural consequence of doing

5:37

that work, and if we recognize that, what are the things that we

5:39

can do to try and reduce that?

5:41

Versus the activity highlighting an underlying problem like an early dry

5:47

eye disease or some sort of binocular vision problem.

5:50

Okay, well, if a patient comes to you and says, 'My eyes feel tired and gritty

5:56

by 3 PM in the afternoon when I'm at the computer,' what clues help you work

6:01

out whether dry eye is the main issue or if it's something else?

6:05

You do a thorough history, and sometimes you can get overlapping symptoms.

6:08

So for example, if someone said, you know, 'Things go blurry and I have to blink

6:11

to keep them clear,' the first thought is, well, that sounds a bit like a dry eye.

6:15

It could also be a sign of binocular visual dysfunction,

6:17

but if you get kind of filmy, cloudy kind of symptoms coming through,

6:22

that's what it kind of looks like when the tear film dries up.

6:24

If you get a watery eye, so what actually happens is if the oily

6:28

part of your tears is not working well, you get some tear evaporation,

6:31

then you get an extra additional response from the watery part of your tear, so you

6:35

end up with an excessively watery eye.

6:37

But if someone was saying they tend to get more double vision and things running

6:41

together, then I'm going to start thinking, okay,

6:43

we've got more of binocular visual dysfunction in this particular situation.

6:47

And where it gets kind of a bit blurred and messy, that's when we have to then

6:50

move on to, you know, obviously doing a full assessment to kind

6:53

of understand what's, you know, what's going on.

6:56

Is the tear film looking good?

6:57

How does the binocular system look?

6:58

Probably another thing is, you know, asking people, you know,

7:01

if you've used an artificial tear or a lubricant, how much

7:03

relief do you get from that?

7:05

And so if it's something where, look, it feels great for the rest of the day

7:09

once I use a drop, then you will be dealing with just some

7:13

mild dryness that's occurring from the activity itself.

7:16

So you ask a lot of questions about the types of environments or situations

7:20

they are in where they feel these, these kinds of symptoms.

7:24

So like, I guess, I guess like office air conditioning could be something

7:27

that plays a part in as well. Absolutely.

7:30

So air conditioning, how many hours a day are you spending,

7:34

is your tasks varied, are you getting up and moving around,

7:36

or are you doing sort of several hours straight, and what sort

7:39

of device are you using?

7:40

Is it something that you look at like an iPad down here,

7:43

or is it up like a desktop?

7:44

We might ask questions around, do you experience the same kind

7:47

of symptoms if you go for a long drive?

7:49

And so if we're driving in the car, then we have similar kind of potentially

7:53

similar environments to the office where on a long drive we've got the air

7:57

conditioning on, we're staring straight ahead.

7:59

If it's a drive where we're really needing to pay attention,

8:02

we're probably not blinking as much.

8:04

And if so, someone's getting similar symptoms in that environment,

8:07

then you start to kind of go, okay, we're dealing with some sort

8:09

dry eye caused by the activity itself, or we've got signs of an underlying dry

8:15

eye disease that we might need to manage.

8:17

So blurred vision could be a symptom of either digital eye strain or

8:22

dry eye disease, is that right?

8:23

Yeah, and if you look at the digital eye strain as a very global term,

8:28

that could cover various things like focusing problems, eye tearing problems,

8:32

and the tear film drying out and being unstable.

8:35

Then both vision problems controlling your focusing and control your eye tearing

8:39

and dryness both end up causing blur.

8:42

And so that's what we need to kind of tease out, is where's

8:44

the blur coming from?

8:45

Is it from the front surface, or is it something around how you're able

8:49

to actually sustain focus and sustain the two eyes working together

8:52

while you're doing that near work?

8:53

I think this is maybe something that a lot of people don't realize,

8:56

is that dry— a dry eye condition can actually cause blurred vision, can't it?

9:02

So it like it impacts the clarity of— it's not just an irritation,

9:07

it's not just feeling like something like you've got a bit of sand in your eye,

9:10

that can actually impact on the quality of your vision as well.

9:13

Oh yeah, and you see that amplified when you've got a contact lens wearer and if

9:16

they experience any dryness, then particularly with certain type

9:20

lenses, it can really drop how clearly you see, so that kind

9:23

of amplifies the problem.

9:25

What I like to do is describe to people the cornea, the front surface of the eye,

9:29

it actually looks like frosted glass effectively.

9:32

And if we, if we take the old way of frosting glass where you're not using

9:36

a film, you're actually etching the surface, and you put water across the,

9:40

across that etched surface, it fills in the gaps, and the water film

9:44

and the glass become one optical surface.

9:46

And you, you start to get clarity through that glass again because you, you've

9:51

sort of provided to fill in the gaps.

9:53

And so the tear film on the front of the eye is very, very similar.

9:55

It provides this really smooth optical surface.

9:59

And so if it evaporates and disappears, you're starting to get this dry,

10:03

kind of relatively rough surface, even though we consider corneas to be

10:06

a lot smoother than the skin on elsewhere on their body.

10:09

Okay, well, you mentioned contact lenses, so that's maybe a good segue to the next

10:13

question, which is like,

10:16

how do contact lens wearers perhaps feel

10:22

more aggravated symptoms from dry eye or digital eye strain for that matter?

10:27

Yeah, well, contact lenses are, depending on the quality of your tear film

10:31

and depending on the actual lens material, they all vary in their ability

10:35

to hold water to the front surface.

10:37

And that's where contact lens manufacturers spend an enormous amount

10:40

of money and time on research in trying to maintain wettability, as they call it,

10:46

across the day, because the contact lenses do actually place more strain, for want

10:52

of a better word, on the tear film itself.

10:54

So it's asking your tear film to be in better condition than it would

10:58

be if you weren't wearing them.

10:59

And so you can have someone who might be relatively symptom-free not wearing

11:03

contact lenses because they've got a dry— like, early signs of dry eye

11:07

that they're not quite aware of.

11:09

You put a contact lens on and now they're starting to sort of feel the symptoms.

11:12

And so that's part of the troubleshooting we go when we're looking at people

11:15

being candidates for contact lens wear.

11:17

And then if you start to get into some of the complicated

11:20

Optics Digital Marketing, you know, you've obviously got

11:22

lens that is designed to hug and sit in front of the eye, but it does move,

11:26

and we want a little bit of movement, but too much movement starts

11:29

to move the optics around.

11:31

It starts to cause buckles and wrinkles in the front surface of the lens,

11:34

and so you get some general sort of aberrations from those sorts of events.

11:39

Some lenses need to sit the right way in terms of being tilted on the eye

11:43

the right way, and so if your eye starts to dry out,

11:45

then your eyelid starts to grab the lens and spin it and turn it, and so you

11:48

can get this kind of variable vision.

11:50

And then finally, you get into the really complex optics of multifocal lenses,

11:54

which is what I wear.

11:56

And, you know, if I've got a particular brand, you know, I have preferred brands,

12:01

brands I do okay, and I've got some brands that I don't wear because for me

12:05

the vision drops off as soon as they get even a little bit dry, whereas other

12:10

brands where not as noticeable.

12:11

And it's because they've got these highly complex optical surfaces in order to give

12:16

you that depth of focus that you might want to enjoy if you're trying

12:20

to avoid wearing glasses like I do.

12:21

I know it's probably a lot less common these days, but

12:24

For anyone who does wear the rigid contact lenses, so-called hard contact lenses,

12:31

is dry eye a much bigger— or does it make wearing those type of lenses

12:35

much more problematic?

12:36

It can be a bit mixed.

12:37

Certainly you can sometimes use soft lenses as an example,

12:41

is almost like a bandage lens where some people might actually get less symptoms

12:45

when they're wearing the lens because there's less of the actual eye itself

12:48

being exposed and there's moisture being held underneath the lens.

12:52

Certainly what will tend to happen with the hard lenses,

12:54

not necessarily that they dry out quicker.

12:57

It's more that they move around a lot more on the eye, and so they're a bit more

13:01

susceptible to issues occurring once you start getting dryness.

13:04

The biggest challenge with the hard lenses is getting people to get comfortable

13:07

initially to wear it, and so any additional factors like dry

13:11

eye, it's more about how well they adapt to the lens in the early stages rather

13:15

than is there a big difference in long-term dryness between one

13:18

and the other, because we can actually use one or the other on a particular

13:22

patient to solve a comfort issue.

13:24

So it's not a sort of black and white you know, hard lenses are better

13:27

or soft lenses are better.

13:29

It really depends on the situation, but a lot of it comes down to what's

13:32

the journey like when you're first, you know, getting used

13:35

to wearing contact lenses.

13:37

And there are things like hybrid contact lenses, aren't there, which maybe, you

13:41

know, give you the best of both worlds?

13:43

Yeah, and so there are again another complex lens where they've got a hard

13:47

center and a soft surround, and they're designed to reduce the feeling

13:51

of that movement that you from a hard lens by having a soft skirt on the outside.

13:56

And they tend to, being a complex lens, they tend to get reserved for complex

14:00

corneal cases rather than a problem solver for everything.

14:04

Okay, well, if you're finding this information useful,

14:08

then please take a moment to like the video and subscribe to the channel.

14:12

It really helps us to continue producing educational content like this one.

14:17

All right, Paul, so For someone working at a screen all day,

14:22

what kind of breaks actually help realistically?

14:25

You know, I hear people talking about the 20-20-20 rule.

14:28

So what's your take on this?

14:30

As my sort of little bit of a bent to kind of go, well, what does the research say?

14:34

And I did look up that 20-20-20 rule because it's a cute thing to say because

14:38

of the American way of saying 20/20, which we call 6/6 sort of vision.

14:42

And certainly, you know, a 15-20, 15 10 to 20-minute bit of work time with a

14:47

micro-break is shown to improve comfort.

14:51

And a micro-break is looking away and blinking.

14:53

Now, the practicalities of whether you remember to do that or

14:56

not is the next question.

14:58

If you're in deep work, then half an hour, 40 minutes can blow by pretty quickly

15:02

before— and you realize that you've missed that break.

15:05

So I think it's much more practical to go into sort of half an hour, 45,

15:10

or even an hour-long break.

15:11

And take a decent 5 or 10 minute break away from the near work.

15:14

That's been shown to be again positive for visual symptoms, and it's also

15:19

a positive thing for your whole body.

15:21

Physically getting up and moving around is a good thing, and it gives you a moment

15:25

to do some proper considerations around what's happening with your tear film.

15:29

And so I think we've discussed before, I had a patient invent a term called

15:33

mindful blinking as we were describing some of the things that we like to do.

15:37

And I've seen some people with some fairly pretty dry, dry looking eyes where our

15:41

only thing thing that we did to help manage it

15:45

and to like reverse what I was seeing on the front surface was get her doing

15:49

decent blinks regularly through the day.

15:53

And so that becomes that be mindful about how well you're blinking

15:56

and how often you're blinking.

15:57

So in those 5 or 10 minute breaks, you, you do, you know, 10 to 12 good blinks.

16:02

And a good blink is making sure that the eyelids come together.

16:04

We're not talking about squeezing the eyes, but making sure that the eyelids

16:07

actually come together, because that's the moment those oil glands are squeezed.

16:11

And that would— and we— and as the eyelid comes up, it spreads those

16:14

nice oils across the tears.

16:16

It also means that the eyelids are coming together and making sure the tear film is

16:19

coating the entire front of the eye, because it tends to be that lower

16:22

half of the eye that dries out.

16:24

Because it's not only that we don't blink fully, is that we do

16:27

these little half blinks.

16:28

So during those breaks, we're making sure we get good 10,

16:32

10 to 12 good blinks as part of that break, you know, get up and moving around.

16:36

So, you know, I think 45 minutes is a good sort of trade-off between needing to get

16:40

the work done and and actually doing a proper job at having a break.

16:44

And that break doesn't mean, uh, turning away from your computer and,

16:47

uh, and looking at your iPhone.

16:49

Yes, your iPhone either, does it?

16:51

Yeah, yeah, that's right, moving from one device to another.

16:53

Yeah, absolutely.

16:55

So, so you'd recommend like actually getting up, moving around the office,

16:58

getting outside if you can, or at least looking out the window if you, if you can?

17:01

Yeah, absolutely.

17:02

Look, the visual system, our whole being, our whole development as we're developing

17:05

as kids, that vision is very much attached to moving through the world..

17:09

And so that's a really important piece, is that we get up and move.

17:12

It's, it's, you know, we know it's part of the whole myopia

17:16

story of people becoming more and more short-sighted is they're

17:18

not outside moving enough.

17:19

And so, you know, on a more minor level, you know, but probably, you know,

17:24

just as chronic, is, is the eye strain that we're getting

17:26

from doing so much computer work and just the basic things of ocular discomfort.

17:30

Well, I'm proud of the fact that I quit smoking decades ago,

17:34

but maybe that was one of the, one of side benefits of being a smoker is

17:38

actually forced to go outside every now and again.

17:41

Trading off lung health for eye health.

17:42

Yeah, yeah, that's right.

17:44

It's, it's a very minor side benefit, maybe.

17:46

Yeah.

17:47

All right, let's talk about blue light glasses.

17:49

So a lot of people may assume that blue light glasses are the answer

17:54

to screen-related eye problems, and how, how much of that is fact and how

17:58

much of it is myth, you think?

18:00

Yeah, look, if we look back at the, my understanding of the original blue

18:03

light kind of, pardon the pun, the energy that got put behind it was

18:09

around cumulative blue light over the years being harmful to retinal

18:13

tissues and things like that.

18:14

And I'm not really convinced that the evidence is going to stand up

18:18

over the longer term that that's actually the case.

18:20

Now, there's certainly people who, when you block blue light,

18:23

do find things more comfortable.

18:25

If you have the kind of blue light lenses that are available through

18:30

a prescription from the optometrist.

18:32

And if I've got a pair of glasses here, which they're not blue light,

18:35

but you wouldn't know because they don't look— these don't look any different.

18:38

If they were blue blocking glasses or regular glasses, you wouldn't notice any

18:42

difference because of the anti-reflection coating.

18:44

And the blue blocking is at the very, very short wavelengths that adds

18:48

a bit of yellowness to the tint.

18:50

But some people generally find that a bit more comfortable,

18:53

and if you do, go for it.

18:54

The challenge is when you're buying stuff online, we don't know if they're TGA

18:58

approved, we don't know if they've been created from a particular body of research

19:02

to sort of demonstrate that they actually have any sort of meaningful impact

19:05

on actually filtering out the harmful, whatever harmful blue

19:08

light's meant to be there.

19:10

From a, you know, minor side benefit, if you are getting dry eye related

19:15

symptoms from digital eye strain, then what a pair of,

19:18

any pair of glasses does is creates a humid environment in front of your eyes,

19:21

so you actually block the tears from escaping more quickly.

19:25

And so, you know, one of we've seen experiments in the past

19:28

when they're looking at dry eye status, actually getting people to wear goggles as

19:31

a way of measuring how much moisture builds up behind the goggles.

19:34

And so glasses can certainly do that to another degree.

19:38

So wearing anything like that does provide a more humid environment for the eyes.

19:42

But in terms of the actual yellow filter, hard to say, particularly when you're

19:46

buying sort of cheap ones online that may not be sort of necessarily approved.

19:50

And then I'd be concerned about them— people wearing them out in the sunlight

19:54

and exposing themselves to more UV.

19:56

That's probably a bigger issue once go outside wearing something like that.

20:00

Whereas, you know, if it's been made and prescribed to you,

20:03

then it's going to have UV filters and, and those sorts of things in them.

20:07

Probably the other aspect of blue light is, you know, what it does

20:10

to your sleep patterns.

20:11

And if you're concerned about that, then there's a couple

20:13

of strategies around that.

20:15

One is that you— most of our devices, we can go into settings and create night

20:19

mode kind of settings, which reduce the amount of blue light.

20:21

And the other thing is get off your device an hour to 1.5 hours before bed.

20:26

There's a great way of making sure that blue light is not impacting on your sleep.

20:30

You mentioned about glasses, there are actually, I think they're called

20:33

moisture chamber frames that you can get that actually kind of like create a sealed

20:39

environment around your eye if you've got extreme dry eye symptoms.

20:44

Yeah, look, it wouldn't surprise me that, it's not something we sort of use in our

20:47

practice, but it wouldn't surprise me those sorts of things are available

20:50

particularly for people who might have more extreme dry eye disease.

20:54

If you've got someone who is dealing with Sjögren's syndrome which you know,

20:57

which is a much more severe dry eye than— and I'm pretty sure from memory I've seen

21:01

things where people can add stuff to frames to help, yeah,

21:04

not quite create a goggle, but that kind of idea where you're just

21:07

trying to reduce the amount of airflow behind so you build up humidity.

21:11

Just to wrap up, Paul, if there's one key message that you'd like

21:15

viewers to take away from today's discussion about dry eye and digital

21:19

eye strain, what would it be?

21:21

Well, I'm going to be greedy, I'm going to say two.

21:24

so don't underestimate how good a break can be from doing your work.

21:29

We kind of go, yeah, yeah, whatever, but taking breaks is really, really a,

21:33

you know, an important strategy for both dry eye and eye strain.

21:36

And the second part is, if you have tried things like lubricants

21:39

and you're taking breaks and you've still got persistent symptoms,

21:42

don't sit on those.

21:43

Go and get your eyes properly tested.

21:45

Have someone actually work out whether you've got the beginnings of a dry eye

21:48

syndrome or some sort of binocular vision problem that's actually

21:52

creating those things.

21:53

And, you know, they might, might not say, might not sound like much,

21:57

but those small little sort of aggravating things, you know,

22:01

if you're spending 8 hours a day on the computer,

22:04

really important for those things, for your overall quality of life

22:06

and stress levels to get on top of it.

22:08

So, you know, so taking breaks and then pursuing care if, um, if the, those

22:14

sort of home strategies aren't working.

22:16

Are an important piece.

22:18

All right, and so for viewers who'd like to learn more or book an appointment,

22:23

how can they get in touch with Harmony Vision Care at Varsity Lakes?

22:28

www.harmonyvisioncare.com.au.

22:29

We're also on Facebook and the other socials.

22:33

If you're in the Gold Coast area, then you can call us on 0755205900,

22:40

and obviously you can look at other links on this channel information.

22:44

And, uh, once again, if you've found this conversation helpful,

22:47

then please subscribe and maybe share it with somebody who spends a little bit too

22:53

much time staring at a computer screen.

22:55

All right, well, thanks for watching.

22:57

Um, thanks, Paul, and we'll see you all next time.

23:00

Bye-bye.

TRANSCRIPT

0:00
It's never too late.

0:01

If you're at any age, we can manage eye teaming and focusing problems.

0:07

And so as an adult, often you think, oh, it's all too late, I'm too old to change.

0:12

No, we can do vision training and vision therapy on any age group.

0:16

If you're able to sort of come into the practice and get an eye exam,

0:20

then you, and we find the right kind of problems that we can sort of deal with,

0:24

then we can do it.

0:28

Many people assume that if an eye test comes back normal,

0:31

then vision can't be contributing to headaches, concentration problems,

0:36

reading fatigue, or difficulty focusing.

0:39

But vision is about far more than just seeing clearly on a chart.

0:43

Sometimes the real issue is how the eyes and the brain work together throughout

0:48

the day, especially during reading, screen use, study, work, or even driving.

0:54

Today I'm joined again by Paul Graham, Principal Optometrist

0:57

at Harmony Vision Care on the Gold Coast, to talk about behavioral

1:00

optometry and vision therapy.

1:02

What these terms actually mean, how they differ from a standard eye test,

1:07

and why both children and adults can experience hidden vision problems

1:11

that affect comfort, focus, and everyday performance.

1:15

For those who are new to the channel, my name is Paul Sallaway from Optics Digital.

1:19

We're an agency that helps eye care professionals to share educational

1:23

information with their communities through videos like this one.

1:27

So, Paul, good to catch up with you again.

1:29

Yes, great to be back. Thank you.

1:31

So, Paul, behavioral optometry

1:35

is a term that I see a lot on the internet,

1:39

but what does it mean in plain language?

1:42

Yeah, look, it's a little of an unusual term, and there's a number of different

1:45

professions that use behavior as part of it.

1:47

And the easiest way that I heard it explained was actually from a teacher who,

1:50

when talking to her parents when she was concerned about a child's sort of progress

1:55

at school, was that we're optometrists who look at visual behaviors.

1:58

And the idea being that, you know, we're looking at more than just sight,

2:02

how you're using your eyes for learning and moving through the world.

2:05

Where the name originally came from was human behavior back in

2:11

the sort of mid-century last year.

2:14

There was that with the emergence of trying to understand how

2:17

people think and psychology and all of those sorts of things.

2:20

They were trying to take a more holistic view that if humans spend a lot of their

2:24

day moving and doing things, and we call those kind of things behaviors.

2:29

How does vision fit within the whole totality of humans

2:35

doing things, so human behavior?

2:36

And so behavioral vision care or behavioral optometry was the term

2:40

that sort of came out of that.

2:42

So, what are some of the everyday signs that someone's

2:47

visual system may not be coping well, even if they can still see clearly.

2:52

Yeah, and that's the thing, a lot of people when they use the word

2:54

vision, they're really just talking about sight.

2:56

When, when we use the word vision, we're really looking at,

2:59

you know, how do you have the two eyes working together well as a team?

3:03

How well is the, the two eyes working together work with your focusing?

3:07

You know, we have two, two channels, but we only hopefully

3:11

only see one perception of the world.

3:13

So, a single world out there that we can see, but we've got two channels.

3:16

So, the brain has to create a single image of the world and keep

3:20

it clear at the same time.

3:21

And so we're looking at how well that sort of happens.

3:24

It's, you know, your eyes have muscles, they need to move, they need to move in

3:28

coordination with the rest of your body.

3:30

So, we loosely call that tracking.

3:31

So, how smoothly have you learned to use your eyes free of your head or your body?

3:36

And then the next phase is, if you are keeping the world single

3:39

and clear and you're able to move your eyes accurately,

3:42

are you able to understand and interpret what your visual input is?

3:46

And you also need to compare that to what your ears are telling you and what

3:49

the rest of your body is telling you through touch and smell

3:52

and those sorts of things.

3:52

And in vision, we look at being kind of a master sense that gathers all

3:57

that information around and attaches it to visual images so that when we see

4:01

something, it's not just the picture we see,

4:04

we have all that understanding about how we interact with it and all the other

4:07

things that go along with that particular object.

4:10

So, what would be some symptoms that somebody,

4:13

somebody might have a functional vision problem as opposed to simply

4:17

just an eyesight problem?

4:19

Yeah, so, you know, at the extreme, uh, you might get double vision,

4:22

so that the breakdown of keeping the world single, you might get

4:26

some blur that comes and goes.

4:28

It could be— and I think I've talked about this in the past— we've got— I would like

4:32

to break it into eye-related symptoms and performance-related symptoms.

4:36

So, an eye-related symptom is that you don't need to be an optometrist to kind

4:40

of think, oh, that kind of sounds like an eye thing.

4:43

So, if you're rubbing your eyes, if you're getting sore eyes,

4:45

if you're getting eye strain, if your eyes are pulling,

4:48

we've talked about blur and double vision.

4:49

Sometimes people will, will make the leap that maybe headache

4:53

could be a vision-related headache because it occurs when they're

4:56

doing a concentrated visual task like bookwork or study or using the computer.

5:00

And then you get into more performance-related headaches.

5:02

And so these are sort of things where you're not concentrating well,

5:05

or you can't— you're finding that you're not paying attention, or

5:08

you're not reading as well as you think you should, or you're losing your place,

5:12

or you're constantly having to go back and read something again

5:15

to retain the information.

5:17

And so they're more of those sort of softer signs that aren't necessarily

5:21

obvious as being a vision problem.

5:23

And, and in kids It can be simply that you've

5:26

got a child who's not performing to their potential, so you as a parent or you as

5:31

a teacher might have a sense the child is capable of a lot more and they're just not

5:34

achieving the kind of scores or output, and, uh, and so vision can be

5:39

a big part of that sort of problem.

5:40

And, and it doesn't take much of a basic eye teaming or focusing problem

5:44

in some cases to really pull apart someone's concentration,

5:47

and that then— those kind of problems extend into adulthood as well.

5:50

So, for something even like a routine daily activity like driving, then, so that's

5:57

if you're suddenly like finding that that's becoming

6:01

like more difficult or you're feeling some discomfort around that,

6:05

is it possible that that could be a functional vision issue?

6:09

Yeah, look, and it can be subtle.

6:11

It can be things like, why don't I feel comfortable driving at night anymore?

6:15

How come I don't feel comfortable driving in wet weather anymore?

6:17

And sometimes you might put it down to just pure confidence.

6:21

If you're getting a bit older, maybe you kind of go, well,

6:23

maybe I'm losing my, my skills and my reaction times are sort of slowing down.

6:28

It could be the person that is constantly taking a bit of, bit of paint off their

6:32

car whenever they park, you know, misjudging where they need to go.

6:35

And I do remember working with a lady who was getting vision-related headaches,

6:40

and partway through her therapy she came in quite excited and said that she no

6:44

longer has to take 10 goes to park a car, she just drives into the spot now.

6:47

And so for her, the, the vision problem

6:51

wasn't just her fighting the vision problem which created a stress-related

6:54

headache, it was impacting on her ability to judge depth in a car.

6:58

And, you know, she hadn't kind of equated it with

7:03

a vision problem, but it's very much about understanding where you are in space.

7:06

And it goes back to that word behavioral optometry,

7:09

the behavior of driving a car being impacted by how well our vision is

7:13

allowing us to do that with skill.

7:16

Okay, well, tell us how

7:19

Does an eye exam at Harmony Vision Care differ from a standard eye test?

7:23

So, what are some of the things that, that you do in your practice?

7:27

Yeah, if we look at what does a standard eye test mean, I mean, the,

7:29

the core things that we test as a profession, as optometrists

7:34

in general, is how clearly can you see.

7:37

So, that's a sight test on, on the chart.

7:39

If you're not seeing the chart clearly, then we do a refraction, which is

7:42

testing what the prescription is.

7:44

We do a— as a profession, we do a sort of fairly basic test of how

7:48

the two eyes are working together and how well the eyes move.

7:50

We eye health and pressures, and so internal eye health and front

7:54

of eye health, as well as pressure checking for things like

7:57

glaucoma and those sorts of things.

7:58

But as an optometrist who has a more holistic

8:03

approach, is how is vision enabling you to have a great life

8:07

and living up to your potential, we really want to then dive a lot more

8:10

deeply into how well do the two eyes work together.

8:13

That's also known as binocular vision or convergence.

8:16

Or eye teaming.

8:17

How well can you focus?

8:19

The technical name for that is accommodation, but we just

8:22

call it focusing skills.

8:23

When we look at eye movements, we're not just looking to make

8:25

sure that the muscles are intact.

8:27

Often a standard test is really about do the muscles work fully, whereas

8:30

we're looking at how well do they work. Do you—

8:33

they're effectively a fine motor system, and so we might understand things like

8:38

fine motor control in hands and fine motor control of speech.

8:41

We want to understand the fine motor control that eyes actually are,

8:45

and so What's the finesse in how you track and follow things?

8:49

And those, those are really critical parts to everyday life.

8:53

And eye teaming, focusing, and tracking problems are a lot more

8:56

common than eye disease, particularly in youth and young adults.

8:59

And so we want to make sure that we're testing all those things.

9:02

And for us, that's a standard.

9:03

We do that comprehensively every single patient that we see.

9:07

And that's a core difference, is we hang so much importance on those

9:10

doing visual skills rather than just whether you can see clearly or not.

9:14

So, we talked before we started about that famous scene from the movie

9:19

Philadelphia where Denzel Washington says to— he's the lawyer and he says to his

9:22

client, explain this to me like I'm an 8-year-old.

9:24

So, I just want to make sure that I understand this, explain this

9:27

to me like I'm an 8-year-old.

9:29

So, eye teaming, this is the ability to focus both eyes

9:33

at an object correctly, is that right?

9:34

Yeah, and if we think about looking along in space, we want to be able to

9:39

point the eyes at the same point in space and allow the brain to easily

9:43

create one image out of two inputs.

9:45

So, I mean, if they're not working well together, then, then at the extreme,

9:49

you might get some problems with keeping the, the two images aligned,

9:53

in which case you might get some double vision or some ghosting

9:55

or sliding of images.

9:57

A lot of people avoid that by putting lots of concentration in, so it could be

10:01

an eye strain or a headache symptom.

10:03

You may not get the double vision, but yes, one of the more obvious signs is

10:07

that you're, you're sort of, you know, you're getting this kind of slip and,

10:10

and double vision something that we hope would normally happen automatically,

10:15

but it's all about having both eyes pointing to the same

10:18

point in space that you're interested in.

10:20

So, somebody who maybe has a— some— I think it's strabismus,

10:24

like some sort of their eyes are not quite aligned as they should be,

10:29

though that would be something that you would pay attention to, or pay

10:33

particular attention to in that case?

10:35

Yeah, so you've got various types of strabismus, so basically we also

10:40

call it People do call them squints.

10:42

It's a relatively old term.

10:43

We call them eye turns because that's a very obvious way of stating it.

10:47

You know, you're trying to point your eyes here,

10:49

but one eye wants to turn in or one eye wants to turn out.

10:52

And, and certainly we want to rule out any sort of rare but serious problems that

10:57

come, that are, that cause an eye turn.

10:59

The vast majority of eye turns we see are from more developmental issues that people

11:03

develop an eye turn at an early age and it carries on through to to adulthood.

11:07

Okay, so that's, that's eye teaming.

11:10

I'm— and you mentioned focusing, so I know, I know it's probably an analogy

11:14

that you don't like, but think of it like focusing a lens of a camera.

11:17

That's really what we're talking about here, isn't it?

11:19

Like the lens, the crystalline lens in, in the eye.

11:22

Yeah, so we've got this, uh, when we're young, uh,

11:24

under 40, we have this, lens that can actually change shape.

11:28

And so we use a muscle to adjust the shape of the lens, which allows us to adjust

11:33

how— where we're how well we're keeping the world clear

11:36

from distance through to near.

11:37

And so that's where the word accommodation comes from.

11:40

We call it sort of focusing.

11:41

And you can have a number of different ways that focusing might

11:44

not be working well. There could be an accuracy issue.

11:47

You may not understand exactly where to position your focusing.

11:50

And again, it either becomes blurry or you're having

11:53

to constantly adjust it, which requires concentration.

11:57

You might have issues readjusting your focus.

11:59

So, you're spending time doing near work, and then when you look up and away,

12:04

it's blurred and it takes some conscious time for your distance

12:07

vision to become clear again.

12:09

And some people might get it in the reverse direction,

12:11

that it takes time to adjust back.

12:13

So, there's a— there's a— not whether you can just simply get things

12:16

clear, but how flexible is your visual system when you keep changing

12:20

where you want to look.

12:21

And then obviously, as we get into sort of aging process, that flexibility gets lost.

12:26

This time it's not completely gone, it's still there.

12:28

So, we still need to manage focusing well into sort of late adulthood as well.

12:33

Yeah, I guess that's what I'm interested in, is that like for all of us, as we,

12:37

as we get older, that accommodative function is going to diminish.

12:43

So, but in like in your practice, if you're seeing those kinds of

12:48

difficulties in younger people, people who shouldn't be experiencing

12:52

presbyopia, not an age-related loss of function, they're usually having

12:56

problems with function that's often lifestyle-based.

12:59

For the vast majority of people, a lot of the focusing issues are just

13:02

from the sheer amount of near work and device use we do nowadays.

13:06

And so a lot of it is helping you manage keeping up with that level

13:10

of near workload.

13:11

And my sort of position that most problems actually do start in the focusing system—

13:15

it's, it's designed to be this dynamic thing where we're constantly

13:18

changing where we're looking.

13:19

And what do we do in modern life is we sit still and we look

13:22

at two-dimensional screens.

13:23

And so our focusing system fatigues.

13:25

So, that's another thing we can add in, is that you've got focusing accuracy,

13:28

focusing flexibility, and simply, do we just get some fatigue

13:32

in the focusing system?

13:33

And tracking here, where, like, in practical terms, we're talking about,

13:37

like, for example, the ability to track a line of text across a page.

13:41

Is that right?

13:42

Yeah, and I'd like to talk to people about— there are two types of

13:46

ways that we use the word tracking.

13:48

The first being is you have a tracking problem, and that is

13:51

you do not move your eyes very well.

13:53

And so that can be something where you never learnt the fine motor skills very

13:56

well as a child, and that carries on through.

13:58

It gets a little better as we age, but there might sometimes be

14:01

a few signs that we see there.

14:02

You might end up with a tracking problem from a concussion or some other sort

14:06

of brain injury or a virus, so that you can actually

14:09

have issues with how smoothly you're able to use your eyes or how,

14:12

how well you do a saccade.

14:14

So, a saccade is, is a jumping eye movement moving from one point to another,

14:18

whereas those smooth eye movements we call pursuits.

14:21

And then you can have tracking symptoms.

14:22

And so yours is a great example of, you know, losing place

14:27

when you're on a screen, losing place when you're trying to read.

14:30

So, you lose track of where you are.

14:32

Now what we do is we then try and work out which part of your visual skill profile

14:38

is leading to the tracking symptom.

14:41

And it could be an eye teaming thing because you're fighting keeping the two

14:44

eyes pointed on the page, and so it's this loss of binocular vision

14:48

that then results in you losing track of where you are.

14:51

It could be a focusing problem, same thing, you start concentrating so

14:54

hard on keeping things single and clear that you lose track of where you are.

14:58

And then finally, maybe you've got a problem in

15:02

how you actually move your eyes.

15:04

So, if you're, so if you're into sports like cricket,

15:08

baseball, something that involves a lot of like hand-eye coordination, then,

15:11

then if you do have tracking problems, that's something that would really,

15:14

you know, be a big, a big deal, I think.

15:18

Yeah, absolutely.

15:19

And a lot of those sports anticipations there, but if you can't follow it up

15:22

with a good eye movement, then yeah, you're going to be not performing

15:25

at your best, that's for sure.

15:27

Okay, so we've talked about, you know, functional vision and what it is.

15:32

Now What exactly is vision therapy?

15:35

So, you know, it comes under lots of different names,

15:38

so vision therapy, vision training, orthoptics,

15:41

neuro-optometric rehabilitation.

15:44

So, vision therapy, I like to say to my patients, it's like

15:47

physiotherapy for your visual system.

15:50

You're being put in a situation where the activities are to highlight how you

15:55

currently do things, and usually it means that we're

15:58

highlighting how well you're not doing them.

16:00

Highlighting the dysfunction and giving a controlled environment

16:04

with someone who's coaching you in the right direction

16:07

on how to learn how to get the two eyes working together better,

16:11

learning how to focus, learning how to combine focusing with eye

16:13

teaming and with tracking, and sometimes visual processing.

16:17

So, it's really building visual skill through eye exercises.

16:22

Obviously, you know, hopefully if you've been watching

16:24

the channel enough, it's not about muscles,

16:26

it's about the brain and the brain's ability to send the right signals and

16:30

combine the information in the right way.

16:32

And so we're just providing an environment where we go through these activities

16:35

that give you feedback on when you're doing it well and when an opportunity to

16:39

do it better if you're not doing it well.

16:40

So, you're— we're setting up a system where you're actually making these little

16:43

mistakes and you're, you're practicing so that those mistakes

16:46

become less and less, and you'll be building visual skill at the same time.

16:49

So, so a vision therapy program then would be something that people do at home,

16:54

but then they, they come into your clinic periodically for follow-up visits

16:58

and additional training, I guess. Is that right?

17:01

Yeah, look, we find the most successful form of vision therapy is

17:05

one that has an office-based component because you really need that skilled

17:08

person giving you one-on-one feedback to how you're doing an activity and

17:13

directing your attention in the right way.

17:14

Sometimes if you've got a vision problem or something, some aspect of your vision's

17:17

not working well, you feel the consequences of it,

17:20

but you might not be aware of what, what is actually happening.

17:23

And it's a bit like a physiotherapist or even a sports coach saying, hey,

17:26

when you swing your racket that way, do you notice what happens to your left foot?

17:30

When you, when you do this particular visual activity,

17:32

this is what we're noticing.

17:34

Can you now do it a different way and pay attention to that?

17:36

So, having that one-on-one coaching is ideal.

17:38

Now we do that directly in the clinic, so people come in and have a one session

17:43

per week with the vision therapist.

17:45

We see people from all over the country and all over the world, so we've got some

17:50

prolonged experience even before COVID of doing a telehealth version of that.

17:53

So, we still have their weekly session, but it's online as opposed to in person.

17:58

And then the critical part is that they're also doing some home activities in between

18:02

to kind of reinforce what they've been learning with the vision therapist.

18:05

And then we didn't need to do it long enough to make those new skills

18:09

something the brain wants to hang on to.

18:11

So, effectively, we want them to become a habit.

18:14

Interesting.

18:15

All right, well, uh, just a quick reminder,

18:17

if you're watching this and getting value from this, uh, interview with Paul,

18:20

then, uh, please do us a big favor and hit the like button because helps us out with

18:25

the YouTube algorithm and means that other people are more likely to benefit as well.

18:30

All right, Paul, so is this all just for kids, or

18:34

can adults have these problems too?

18:37

For example, you know, after concussion, for example, is this something that you,

18:41

that you see many patients who are about, who are also, who are adults?

18:45

Yeah, and I would say probably even though kids can be exposed to sort of having

18:49

concussions, we probably, a lot of our concussion patients are

18:52

adults and And if we look at eye-teaming issues and binocular vision issues—

18:56

and binocular vision dysfunction is a term that's actually gaining

19:02

some sort of presence.

19:04

More and more people are sort of hearing about binocular visual dysfunction.

19:07

And you can have— I'll break it down into sort of three,

19:10

sort of loosely three ways that you can have a binocular visual dysfunction.

19:14

You either developed it when you were young because you didn't learn how to use

19:17

the visual system properly to begin with.

19:20

And the second one is that you developed one by over time through stress

19:25

on the visual system, and that's doing lots of near work.

19:28

And quite often adults I see with a binocular visual dysfunction or eye

19:31

teaming issue have had that problem since primary school.

19:34

And you'll ask, you'll ask some adults and say, uh, did you always find

19:38

reading a bit of a struggle?

19:39

And they kind of go, yes, how did you— why did you ask that question?

19:42

It was like, well, you've got this eye teaming issue that I

19:45

can tell you've probably had for decades and probably had it in school.

19:49

And so it it's— they've shaped their life around what they can and can't do

19:53

because of this binocular vision problem.

19:56

And often it'll pop up again.

19:57

So, someone who might work with their hands gets into a management position where now

20:02

they're doing a lot more office work, and here comes this problem where they're

20:06

having trouble concentrating and getting headaches and eye strain,

20:09

and they think it's the computer when, when in fact it was an underlying

20:13

vision problem they've had sitting there their entire life,

20:15

and they've just perhaps avoided some of the activities that trigger the symptoms.

20:19

And then you have, you know, IT issues that come from injuries,

20:23

brain injury and concussion.

20:24

And concussion's thankfully getting a lot

20:26

more, a sort of common awareness

20:31

around, and we certainly see it in sport.

20:33

I mean, we're seeing 20-something-year-old athletes getting their AFL

20:39

and Rugby League careers cut short, because of multiple concussions.

20:44

And if you, if you look at the stats, you sort of at least 50% of people who

20:50

get what we call a post-concussion syndrome, and that's a— and that's where

20:54

you are still having concussion symptoms past the recovery

20:58

time, 2 weeks for adults, 4 weeks for children.

21:01

And so 50% of those people with PCS, or post-concussion syndrome,

21:04

have vision problems, and typically the kind of visual problems

21:08

that you need to test eye teaming, focusing, and tracking.

21:11

In order to pick them up and then therefore have the means to treat them

21:16

through lenses and vision therapy.

21:18

And that's when we get into the terms like neuro-optometric rehabilitation.

21:22

So,, you know, that's a particular type

21:24

of vision therapy when we're talking about concussions and other forms of brain

21:29

injury where you had— it's presumed you had good visual function before

21:34

the incident, and now we're doing rehab to try

21:37

and restore as much function as we can after afterwards.

21:40

So, this could be something that affects maybe older people who've had falls,

21:43

for example, you know, that's a common type of occurrence.

21:47

So, people who, like, you know,

21:49

maybe they've had that kind of incident and now

21:53

they might feel that they're feeling dizzy, or maybe they're, you know,

21:57

their just general confidence is not up to what it was before.

22:00

That could be a functional vision problem, is that right?

22:04

Yeah, look, you get sensitivity to movement in your

22:06

peripheral vision, you might become sensitive to lights

22:09

and patterns, you start And this is the challenge

22:12

with concussions, is that you have a concussion,

22:14

it puts you at a higher risk of having another one

22:17

because your balance and your ability to judge space and also your

22:21

cognitive processing can be affected.

22:23

And so you're at high risk of having another concussion, which is why when

22:27

athletes have concussions, they take them off the field,

22:29

and sometimes for weeks, because they want to make sure they're not

22:31

put in a position where they're at high risk of getting another one.

22:35

But it can be an innocuous thing.

22:36

So, in the sort of later decades in life when we're at higher risk of having

22:41

cardiovascular incidents, so stroke being one of them.

22:45

You can have your vision impacted by a stroke.

22:49

If we're talking more concussion injury, obviously that's a knock to the head.

22:53

You know, there are obvious things like having a car accident or,

22:57

you know, tripping over and hitting your head heavily, but it can sometimes be

23:00

caused by the most innocuous things.

23:03

Um, you know, a tissue box falling out of the cupboard on your head and just

23:06

hitting your head the wrong way.

23:08

And we've seen concussions from people attending to their push bike

23:12

and the handle hits them in the head when it tips over, and they get this,

23:16

relatively severe symptoms and consequences from what looks

23:19

like a relatively mild event.

23:20

And then you see players and athletes getting these massive

23:24

big belts during the game, and then there's no concussion.

23:27

And so we've got to stop tying the severity of what the accident looks

23:31

like with the severity of the symptoms.

23:33

Sometimes it can be actually quite a small thing.

23:35

And so if you've had a small accident and you don't feel like you're

23:38

seeing as well, or using your vision as well,

23:41

or balancing as well, or judging space as well from even just

23:44

a small accident, then you need to be thinking that there's

23:46

some sort of post-concussion syndrome involved.

23:49

Okay, you mentioned, neuro-optometric rehabilitation.

23:54

Another term which I see used a lot is orthoptics.

23:59

How are these things similar or different to behavioral optometry?

24:04

Yeah, so look, there's a— there's lots of different overlaps between, you know,

24:09

eye exercises, orthoptics, vision training, vision therapy,

24:11

neuro-optometric rehab.

24:13

So, they all use activities to develop skill.

24:17

Some of the labeling comes from the philosophy behind it.

24:20

So, orthoptics and eye exercises take a more mechanical approach to

24:25

what the visual system is doing, so it's about moving the muscles around.

24:30

Vision therapy from a perspective of a behavioral optometrist is you're

24:34

wanting to put the person to learn how to understand where they are in space

24:39

and how they coordinate, and their eye movements are just part

24:43

of that overall understanding where you are in space and when judging where other,

24:47

other things are in space in order to behave and act in the world.

24:50

And so some of the activities on the surface might look the same,

24:54

but the emphasis might be a little different, or how far we take them

24:59

and practice them from an outcome point of view is quite different.

25:04

And so if we're doing a convergence activity to try and train someone

25:08

whose eye teaming becomes uncomfortable here, for us, as

25:13

someone from a behavioral vision care perspective, it's not about just pushing

25:16

and pushing and pushing the muscles.

25:18

Because if we do like an NPC, or if we just want to look at a pencil as

25:22

an example, and we've got the two eyes turning on it,

25:24

there's not a lot of difference between turning that eye by itself that way,

25:28

this eye by itself this way, how come you can't do it together?

25:32

It's not about the muscles being a problem, it's about your brain

25:34

understanding how to do the activity.

25:36

And so it's how we're directing attention to the patient and getting them to really

25:41

understand where they're looking.

25:42

And so that's where there's a much more of a therapy component about it,

25:45

and that's a much more useful, we think, way of, of looking at vision.

25:49

Because ultimately it's got to be good something for something when you train it.

25:53

If you just train someone to kind of push their eyes together, doesn't mean they can

25:56

do it in the real world when they're trying to think of other things.

25:59

And then neuro-optometric rehab

26:04

is vision therapy, but part of what comes

26:06

on when you do additional training in neuro-optometry,

26:11

you need to understand that the way those vision problems might present differently.

26:17

You also need to work with those patients a little differently as well, because

26:21

some of the things— you've got to take things a lot more slowly because often

26:25

movement in their visual, in that peripheral vision is

26:28

quite triggering for them.

26:30

And so it's not a matter of just being good at vision therapy,

26:32

it's also understanding that category of patient and how you have to work

26:35

with them, even though again on the surface

26:37

the activities might be the same, but it's more you change the way you

26:40

execute them for that population of patient.

26:43

Okay, well, just to wrap up, Paul, if there's one

26:48

key message that you'd like viewers to take away from this discussion about

26:52

behavioral optometry and vision therapy, what would it be?

26:56

Look, it's never too late, you know.

26:58

If you're, you know, at any age, we can manage eye teaming and focusing problems.

27:05

And so as an adult, often you think, oh, it's all too late, you know,

27:08

I'm too old to change.

27:10

No, we can do vision training and vision therapy on any age group.

27:14

If you're able to sort of come into the practice and get an eye exam,

27:17

then you— and we find the right kind of problems that we can sort of deal with,

27:21

then we can do it.

27:22

So, you're never too young to benefit from having your, you know,

27:27

eye teaming issues dealt with.

27:28

All right, Paul, well, really helpful information as always

27:31

for people on the Gold Coast who are worried about their vision.

27:35

How can someone get in touch with Harmony Vision Care?

27:38

So, we've got

27:39

www.harmonyvisioncare.com.au

27:41

as our website.

27:42

You can— there's a wealth of information on there.

27:44

You can find booking links to be able to book online.

27:48

You can also call us on

27:50

07 5520 5900.

27:52

If you want to ask questions or email, again, the links are on the website,

27:56

and you can find us on Facebook.

27:58

And if this conversation has been helpful, then please remember to like,

28:05

subscribe to the channel, and share this video with a friend,

28:09

family member, or colleague who you think might benefit from the information.

28:13

All right, well, thanks for watching everyone,

28:14

and, we'll see you next time. Bye, Paul.

28:16

See you next time. Thank you.

TRANSCRIPT

0:00

Yeah, look, you really need to make sure that you know

0:04

how well their master sense is working.

0:07

Is it working for them or is it working against them?

0:09

And so, you've got any child not working to potential, any child in the bottom

0:13

third of the class, you really need to be looking at a comprehensive vision exam

0:18

to make sure that vision's not a piece of the puzzle.

0:25

Many parents worry when a child struggles with reading, concentration,

0:30

or schoolwork.

0:31

It's easy to assume it's behavior, attention, or motivation that's the root

0:35

cause, but sometimes the issue isn't any of those things.

0:39

Sometimes it's vision.

0:41

Today I'm joined again by Paul Graham, Principal Optometrist

0:44

at Harmony Vision Care on the Gold Coast, to talk about the connection between

0:48

vision and learning and how hidden vision problems can affect reading,

0:53

attention, and classroom performance, and what parents should look for.

0:57

For those who are new to the channel, my name is Paul Sallaway from Optics Digital.

1:01

We help eye care professionals share educational information with their

1:05

communities through videos like this one.

1:07

So, Paul, great to speak with you again.

1:08

Yeah, good to see you again.

1:09

So, Paul, so when a child can't concentrate,

1:13

how do you tell if it's behavior, attention, or actually a vision

1:19

problem that's the cause?

1:20

Yeah, look, then Whether it's a vision problem is

1:22

the tricky one, which is why we often say it's a hidden

1:25

vision problem because it's not always something obvious like an eye turn or

1:28

they're not seeing clearly, you know, it's something else going on.

1:32

And often the only way to really find them is to get a proper sort of full vision

1:36

exam of all of their different sort of visual skills.

1:39

So, what's the difference then between a quick sight test and a functional

1:44

vision assessment?

1:45

Yeah, so everyone sort of often when you hear the word vision being used,

1:48

often people are really meaning just sight, and sight is just a small part of,

1:51

you know, the overall visual process, and sight is measured by when we look

1:56

at the letter chart and work out whether you can see 20/20 or not,

1:59

and whether a prescription restores you back to 20/20.

2:01

And when we talk about functional vision, it's more about

2:04

how have you learned to move your eyes smoothly, how well do you coordinate your

2:08

eye movements with your head movements and your body movements,

2:11

how well do you coordinate the two eyes together and coordinate the focusing,

2:16

and all of that going on at the same time.

2:18

And then once you're able to do that, are you able to do it automatically?

2:21

And if you're able to do it automatically, then are you able to actually use

2:24

the information that you're getting in through your visual sense to learn

2:28

and move through the world and those sorts of things?

2:31

So, functional vision is those things around how well you're using

2:34

your eyes as a tool for learning.

2:36

So,, is this why some children might say that reading is hard or tiring,

2:42

even though they've been told that their eyesight's just fine?

2:45

Correct.

2:46

And so, you know, if you do a screening, so are great for picking up, you know,

2:50

obvious vision problems— sorry, those rare but high refractive errors

2:55

where one eye might be seeing clearly but the other one's not,

2:58

or some sort of eye turn.

2:59

But they don't really delve into whether there's actually an issue

3:02

with the coordination of the two eyes or a problem with focusing

3:06

and those sorts of things.

3:07

So, what actually happens in a children's vision and learning assessment

3:11

at Harmony Vision Care.

3:13

Okay, so when you book in, we get you to fill in a questionnaire

3:16

that gives us some background history on development health.

3:20

We do a symptom survey, and the survey is designed to cover those

3:24

more— not only sort of what we call visual symptoms, you know, blurry vision,

3:28

headaches, sore eyes, tired eyes, but also how it might impact on academic

3:32

and learning performance.

3:33

So, we ask questions around how well they're paying attention,

3:35

how well they concentrate, what do they have difficulties with.

3:38

And then when we do a case history, we're asking some very specific questions

3:42

of the kids of, you know, and what what we like to use is open

3:45

questions, so we make sure we're not leading the witness, so we're not asking

3:48

questions that sort of end in yes or no.

3:50

So, getting a sense of the things that the kids like and don't like,

3:53

because that tells us a bit of a hint into things that might be

3:57

visually difficult for them versus those that are easy.

4:00

And once we've done a case history, we then get into testing.

4:02

And, you know, we will test the obvious things like, can you see clearly,

4:05

do you have much in the way of refractive error, which is myopia, astigmatism,

4:08

longsightedness, those sorts of things.

4:10

But we then do a very extensive test of eye movement control.

4:13

We call that ocular motor skills.

4:15

Eye teaming, which is also known as binocular vision, convergence,

4:18

divergence, those sorts of things.

4:20

A detailed test of accommodation, which is the technical word for focusing,

4:25

and we're looking about the relationship of how focusing and eye

4:28

teaming work together.

4:29

And then depending on the age of the child and their presenting concerns,

4:32

we will do a screening of their visual processing skills.

4:35

How well are they able to understand and manipulate mentally

4:39

visual information presented to them?

4:41

And then we'll wrap that up with some eye health screenings and eye health

4:44

checks to sort of round it all out.

4:47

So, it sounds like there's a subjective assessment component to it where you're

4:52

like getting, you know, responses and feedback

4:53

from the patient, but there's also an objective element to it as well.

4:56

So, even if it's a very young child who's not very verbal, you can,

4:59

you can still test for functional vision. Yeah, absolutely.

5:03

And, and we do a lot of objective testing in terms of being able to watch how they

5:07

focus, being able to watch how the two eyes work together.

5:10

People sort of say, oh, look, like young kids, oh,

5:12

they can't read the letter chart yet.

5:14

Well, we rely on a lot of those observational tests, and also we have

5:19

charts that are suitable for kids who are preliterate.

5:21

So, we use LEA symbols, they're called, which are well-normed shapes to get us

5:26

a very good handle on how well they're saying.

5:28

And how long does the assessment usually take?

5:31

We normally book 45 minutes for an initial assessment, and that covers

5:35

a comprehensive history, doing that comprehensive exam,

5:37

and then leaving plenty of time to discuss what we've found, what the alternatives

5:42

of care are, once we've got all that information in front of us.

5:45

And do parents usually stay in the room during the assessment?

5:49

I think it potentially could be a bit intimidating for some young kids.

5:53

Yeah, look, in our practice we always have the parents there.

5:56

There's always questions to be asking as we go along.

5:59

We might observe something that would create a question where we say, hey,

6:04

I've just noticed this, does the child ever do X, Y, and Z?

6:07

So, something we may not have necessarily asked in the case history means we can

6:10

kind of link it to something we're seeing.

6:13

It also allows us to demonstrate some of the difficulties on the spot

6:16

that we might pick up children.

6:18

So, it's a very important educational piece to bring the parents on the journey

6:22

of what's actually happening and how kids use their vision

6:24

and those sorts of things.

6:26

Okay, so in the classroom itself, so what kinds of vision problems often get

6:32

mistaken for, well, they just aren't trying, or they've just got bad behavior?

6:37

What kind of problems get mislabeled that way?

6:40

Yeah, and you're really centering in a lot of, a lot of those kids who have perfect

6:44

sight but then have underlying binocular vision or accommodation

6:48

dysfunction issues.

6:50

They might have some ocular motor dysfunction, so layman's terms,

6:53

they might have issues with tracking, with convergence, and with focusing.

6:57

And for some kids, a smaller proportion, they're going to have difficulties

7:01

with visually processing and integrating that visual information with what

7:04

they're getting from their other senses.

7:05

And so naturally, if kids find something difficult or they're not understanding it,

7:10

then they're going to either have concentration problems,

7:12

or they may learn that those particular tasks are difficult, so they opt out,

7:17

and they start opting out before they've even started.

7:19

So, it becomes this kind of almost like a pattern.

7:23

So, what may look like a motivation problem could actually be a comfort

7:27

problem where kids are just avoiding something that just feels

7:29

uncomfortable for them.

7:31

Yeah,

7:31

and, I'll often talk to parents about that.

7:33

There are two categories of symptoms, and I think we've mentioned this on

7:37

other videos that we've done.

7:38

Loosely, you talk about what we call eye-related symptoms and then

7:41

performance-related symptoms.

7:42

So, eye-related symptoms are those things where I can have a discussion

7:45

to someone who's not an optometrist and go blur,

7:48

double vision, sore eyes, tired eyes, headaches, we would probably agree

7:53

that that makes you a bit suspicious of a vision problem.

7:57

Whereas if we go performance, it's like can't concentrate,

7:59

having problems with attention, losing their place with reading, avoiding,

8:03

not enjoying, those sorts of things.

8:05

And you can start blaming that on lots of other things like attention, behavior,

8:08

interest, those sorts of things, when quite often it can actually be driven by

8:13

a vision problem, uh, wholly or in part.

8:16

So, you mentioned, you mentioned tracking before, so just to clarify, that's,

8:20

that means like kids are struggling to, to read one line to the next,

8:23

is that what you mean?

8:24

Yeah, and I like to break that down, parents, that you've— we can have

8:27

a tracking symptom, which is that losing place, not being able to kind of

8:32

keep check on where you're going with your writing,

8:35

and you can have a tracking problem, which is a measurable issue with how well

8:39

you've developed your eye movements, whether it be what we call pursuit eye

8:42

movements, which is the smooth ones, or a saccadic eye movement,

8:45

which is our jumping eye movements.

8:47

So, you mentioned something important there, I think, is when I'm thinking about is,

8:54

the first thing I think of is reading issues, but you actually mentioned writing as well.

8:59

So, are you saying that these kind of functional vision problems can affect

9:02

kids with their motor skills or their handwriting at least?

9:06

Absolutely.

9:06

I mean, there's a critical link between fine motor skills and your visual system

9:11

and being able to execute.

9:13

And if you think about it, and we do see this sometimes,

9:14

is we'll have kids who have learned to read fairly

9:18

efficiently, and they're really good readers, kind of sampling the text.

9:22

They're looking for the cues that tell them about what the author's

9:24

trying to tell them.

9:25

So, they're not in the decoding phase anymore.

9:27

They're not having to look at all the various parts within a word,

9:30

and then perhaps not even looking at every single word to be able

9:33

to get the author's message.

9:35

But if you shift across to writing, you cannot avoid being interacting

9:39

with every single letter, every single word, spacing, and all the rest of it.

9:43

So, it can be a lot more visually demanding.

9:45

And so you might get this child who has this kind of excellence in reading

9:48

but the spelling doesn't sort of add up to the same degree.

9:52

But you also get into things like spatial awareness, so kids

9:55

who may not really be able to judge space very well,

9:59

don't have an understanding of where to start on the page,

10:02

how much room have I got, and the kids who start too far

10:05

into the page and then run out of space and start writing

10:08

the letters smaller or turning down the margins as they write.

10:12

So, do teachers often notice these signs before parents do?

10:17

Because I imagine, you know, they see a lot more evidence of their

10:20

struggle with reading and writing.

10:22

Yeah, absolutely.

10:23

And sometimes there's also— you'll occasionally get a difference where

10:26

parents will— the teacher will notice something, but the parents haven't seen

10:29

it, because in a one-on-one situation at home, the kids don't have then

10:34

the additional having to filter out noise in the classroom,

10:37

the other sort of distractions.

10:39

And teachers are well-versed obviously on getting a sense of expectations on what

10:43

a child at a certain grade or age level should or shouldn't be able to do.

10:47

And so they can be particularly good observers and will often— those

10:52

questionnaires that we send out to parents,

10:53

we'll often send out a separate one for teachers to fill in so that we can

10:56

kind of get a judgment on, you know, the home situation versus

11:00

the classroom situation.

11:01

I mean, I guess a lot of, you know, kids at home, they're not often reading

11:04

things on a whiteboard or a blackboard across the room, are they?

11:08

So, it's a different kind of environment.

11:10

Yeah, and they're able to sort of work to their own level sometimes rather than

11:14

sort of being stretched like they might be in the classroom.

11:17

Okay, well, just a quick reminder that if you're

11:20

getting value out of this video, do us a big favor please and give us

11:24

a like because it helps us out with the YouTube algorithm

11:28

so other people can benefit as well.

11:30

All right, Paul, so are there any simple things that parents

11:33

and teachers can watch for that suggest it's time for a proper

11:37

eye and vision check?

11:39

Yeah, look, and you've got the obvious things like holding the book close

11:42

to page, getting close to the page when they're writing, closing one eye.

11:47

Even, even it may not even happen in the classroom, there's

11:49

a closing one eye in the sunlight.

11:50

That can be an indication that there's perhaps some eye teaming

11:53

problems going on.

11:54

The, the headache that they get in the car Sometimes headaches can be blamed

11:58

on dehydration when it's an end-of-day headache from stress in the classroom.

12:04

So, you've got those obvious things.

12:05

Then you kind of get into more your performance-related kind of symptoms.

12:09

So, if they're losing their place while reading, especially if you notice

12:11

that they start the first paragraph okay, but then start to fatigue fairly quickly,

12:15

I mean, that's a fairly good sign that there may well be a vision problem.

12:19

But we have a sort of a broad caveat and you kind of go, well, look,

12:23

vision is your master sense.

12:24

If you've got any concerns about your child's progress,

12:27

whether they be in the bottom third of the class or just not working to

12:31

the potential that you can see there, and they've got these kind of parallel

12:35

things where they seem to be able to, you know, intelligent kids be able to talk

12:38

about this sort of stuff but can't put it down in writing and have trouble

12:41

doing this sort of schoolwork.

12:42

So, any concerns over progress with learning really

12:46

for me is a big marker that you need to make sure that you're, you're top 2,

12:51

major senses are checked out, and that's vision being number

12:54

one and number two being hearing.

12:56

And is there any particular age where you see these problems

13:00

start to show up more often?

13:01

Yeah, look, and if you put it into a couple

13:03

of different categories, we've got the— we loosely talk about

13:07

the first couple of years at school being the learning how to read portion,

13:11

and then you move into sort of late grade 2, grade 3, grade 4 in

13:15

using reading for learning.

13:17

And so you're getting into kids with more the maybe issues with vision and auditory

13:22

processing in those younger years.

13:24

Maybe they don't quite have their ocular development, ocular motor development

13:29

quite being where it needs to be based on their age.

13:33

So, not quite ready for certain things.

13:35

And so younger kids will do a bit of a perceptual workup to kind of—

13:39

they're good predictors to kind of flag, hey, be watchful that your child

13:42

might find certain things a struggle.

13:45

Once we get into, like I said, late Grade 2, Grade 3,

13:48

there's a lot more emphasis on a greater volume of print, trying to work

13:53

out what the author's trying to say.

13:55

So, there's a lot more comprehension and cognitive skills going on,

13:58

and the print size jumps smaller.

14:00

So, there's no developmental sort of change to how print size changes.

14:05

It's, um, it goes from being fairly big, remove the pictures,

14:09

make them pretty small. So, there's a lot more demand there.

14:12

And so we'll pick up kids maybe Grade 1 where we can see that there's a little bit

14:16

of a binocular dysfunction brewing away, but they're currently don't have symptoms,

14:21

and then they return to us maybe a year or two time, and now they're getting the

14:24

symptoms because the demand has shifted.

14:26

Is there, is there an age where it becomes too late to intervene?

14:30

I mean, there might be some parents watching this thinking, well,

14:33

I've got like a 15 or a 16-year-old or a 17-year-old, and thinking,

14:36

well, we've missed the boat.

14:37

So, what would you say to them?

14:40

We often say to parents, look, we, if we find a vision problem that we are

14:44

fairly confident has is currently interfering or did interfere

14:48

with optimal learning, then, you know, there is an avenue still to treat

14:52

and manage the vision problem, but that doesn't necessarily give

14:54

the child the love of learning back.

14:56

So, there does need to be some motivation to kind of continue on and get some

15:01

tutoring and do some catch-up sort of work.

15:04

So, that's a challenging age group where, yes, look, we can still

15:08

manage the vision problem.

15:09

I'll often have adults where we're testing them and I can say, oh,

15:13

did you— have you always— have you found reading a bit of a challenge or not

15:16

concentrating well I go, well, how did you know?

15:18

It's like, well, I've seen this binocular vision problem that I know often starts

15:22

in primary school, and the outcome is that it makes reading

15:25

uncomfortable, so people avoid it.

15:27

And so this is this cascading thing.

15:28

So,, you know, these are vision problems that can persist into adulthood.

15:32

So, it's like if somebody, you know, avoids playing sport because of

15:36

whatever reason, they're not going to suddenly develop

15:39

a love of sport necessarily at 15 or 16.

15:42

So, there's not this— it's kind of like ingrained behavior that's a little bit—

15:45

that requires a little bit more effort to turn around.

15:48

Exactly.

15:48

And that's the thing that— and so sort of the sort of overcoming the previous

15:52

sort of barriers and history still requires probably more motivation

15:57

than they have when they were younger.

15:59

And we can provide some of the ways of just

16:02

removing those barriers so that their efforts, you know, you're not getting—

16:05

I call it a comorbid sort of situation.

16:07

You've got this almost double deficit.

16:08

I've got a learning problem and I've got a vision problem on top.

16:11

You know, we remove the vision problem we've still got a learning problem.

16:14

That doesn't mean that the vision problem is unimportant to remove.

16:17

It's very important because the very group who has to put in more work

16:20

and more effort is that group that's having trouble learning,

16:23

and so they deserve to have their vision problems removed and managed as much,

16:27

if not more, than other people.

16:30

Okay, so if a child has already passed an eye screening but they still struggle

16:36

with reading or focus, what should parents do next?

16:40

So, the first point is to investigate getting a full visual exam done, finding

16:46

someone who will do the full workup.

16:48

So, you're asking questions around, do they measure tracking,

16:51

do they measure itining, do they measure focusing, and do they

16:54

measure processing skills where indicated?

16:57

So, it's making sure that whoever practitioner they find

17:02

is going to provide those things.

17:04

One of those measurements can also be that often the people people who,

17:07

like myself, who are engaged in this sort of area of practice will provide

17:10

a report after the exam is done.

17:13

And so the questions are around what sort of things do you assess and do you provide

17:17

a report at the end can be a good interview question if you're

17:21

researching a practice.

17:22

What would you say to a parent who isn't sure whether their child needs this kind

17:27

of assessment, or maybe they're confused about whether

17:31

ADHD or dyslexia is a factor?

17:34

We get referrals from a lot of psychiatrists now,

17:38

and part of the workup for their patients who they're investigating things like

17:43

autism, attention deficit, dyslexia, involves making sure that we've fully

17:47

covered visual skills, sight, those sorts of things.

17:51

Visual skills in particular, because if we have a look at the ADHD

17:54

population in particular, convergence insufficiency is

17:57

a well-researched binocular visual dysfunction.

18:00

It creates ADHD-like symptoms.

18:04

And so it's good to know whether some of those symptoms

18:08

might be as a result of a vision problem as opposed to just purely

18:12

to the attention deficit.

18:13

And there's a bit of an association between those two groups,

18:16

that you have a threefold prevalence of people with convergence insufficiency

18:21

in those who have been identified with ADHD, and vice versa,

18:24

those who have got convergence insufficiency,

18:27

there's a threefold prevalence of attention deficit in that group.

18:30

So,, you know, we've got to be careful not talking cause.

18:33

We don't magically remove the ADHD by treating a convergence insufficiency.

18:37

But again, if we go back to that comorbid things that we talked about,

18:40

we're removing a vision problem in a human being who can then

18:45

have more of their sort of concentration and attention

18:49

and time available to then concentrate on whatever developmental issue

18:53

that they're dealing with at the same All right, Paul, well, your final, uh,

18:57

gold nugget of advice for, for parents who are worried that their

19:00

child is struggling with reading, attention, or schoolwork.

19:04

What would you like them to know before they write off their kids as

19:07

just lacking academic ability?

19:10

Yeah, look, you really need to make sure that you've, you know,

19:14

how well their master sense is working.

19:16

Is it working for them or is it working against them?

19:19

And so any child not working to potential, any child in the bottom third

19:23

of the class, you really need to be looking at a comprehensive vision exam

19:27

to make sure that vision's not a piece of the puzzle.

19:30

All right, well, thanks a lot, Paul.

19:31

It's been great information, I'm sure, for a lot of parents and teachers

19:34

on the Gold Coast who are trying to support children

19:36

with their learning goals.

19:38

So, if a parent's concerned about their child's vision, how can they get

19:42

in touch with Harmony Vision Care?

19:45

We've got www.harmonyvisioncare.com

19:46

au, and they can call us on 07 5520 5900.

19:52

You can book through the website, you can contact us through

19:54

the website if you've got questions.

19:56

We're on Facebook and Instagram, and obviously we've got this

19:58

YouTube channel as well.

19:59

That's right, so please subscribe, like the video, and share with a parent,

20:05

teacher, or friend who you think might benefit from this information.

20:09

All right, well, thanks for watching everyone, and we'll see you next time.

20:12

Bye, Paul.

20:13

All right, thanks.

TRANSCRIPT

0:00

If you follow good hygiene protocols that contact lens wear is relatively low risk.

0:06

6 seconds

You know, there is still a small risk, but it's relatively low on the grand scheme of things. There are so many different brands, so finding and different lenses we can try.

0:15

15 seconds

So, finding something that enables you to see clearly is out there.

0:20

20 seconds

In our practice if someone's unsure if they can actually do that, if we assess you and say, look, you qualify for contact lenses in terms

0:28

28 seconds

of physiologically, your prescription, what you want to use them for, but they're a bit unsure about whether they can actually wear them, then we do. That's part of our trialing process.

0:36

36 seconds

So, there's a way of kind of dipping your toe in the water without fully committing to it.

0:41

41 seconds

Particularly with disposable lenses, we're not having to purchase product or anything like that.

0:45

45 seconds

In the initial stages, your only fees are the consultation sort of chair time fees to at least try it and give it a go and see if you're a good candidate.

0:53

53 seconds

And you might be pleasantly surprised at what the experience is like.

1:01

1 minute, 1 second

Active Australians, whether they are serious athletes or just trying to keep up with the kids on the weekend, often hit a wall when it comes to vision correction and sport.

1:11

1 minute, 11 seconds

Do they put up with glasses fogging up and slipping around or is there a better option?

1:17

1 minute, 17 seconds

Today I'm joined again by Paul Graham, principal optometrist at Harmony Vision Care on the Gold coast, to answer some of the most common questions about contact lenses and physical activity.

1:28

1 minute, 28 seconds

From the real advantages that lenses can offer to how to choose the right type and how to stay safe and what parents of young athletes should understand before making the switch.

1:39

1 minute, 39 seconds

For those who are new to this channel, my name is Paul Sallaway. I am the owner of Optics Digital.

1:43

1 minute, 43 seconds

We're an agency that helps eye care professionals to connect with their community through educational videos like this one. So, Paul, great to have you back.

1:51

1 minute, 51 seconds

Great to be back. Thanks Paul. So, Paul, a lot of people who wear glasses just accept that sport is going to be a bit awkward.

2:00

2 minutes

You know, things slip and vision's compromised or they just go without vision correction altogether and hope for the best.

2:07

2 minutes, 7 seconds

But it doesn't have to be that way, does it? Not at all, not at all.

2:11

2 minutes, 11 seconds

You know, contact lenses are a fantastic way in their various forms for improving your just pleasure of the sport, let alone, you know, know,

2:18

2 minutes, 18 seconds

increasing your ability and particularly if you're starting to play more and more serious sport.

2:22

2 minutes, 22 seconds

I remember like in my early 20s, by that, by that stage I, I realized I was short sighted and I was wearing glasses and I think I was also getting into indoor

2:30

2 minutes, 30 seconds

cricket at the time and I think I was wearing glasses with one of those, like nylon, you know, straps at the back. And I just wish now I'd got into contact lenses a lot, a lot sooner.

2:39

2 minutes, 39 seconds

So, maybe just to start off with, what are some of the ways that contact lenses actually give you some advantage over glasses when, when you're playing sports or being active?

2:48

2 minutes, 48 seconds

Yeah, well, obviously you've already sort of mentioned, you know, the whole slipping, you've got fogging.

2:53

2 minutes, 53 seconds

The problem with slipping obviously is just the distraction and the annoyance of having to adjust your glasses. But it also changes where the optics are relative to your visual system.

3:01

3 minutes, 1 second

So, it can create blur, it can create sort of prismatic effects. So, you lose judgment of where things are at. So, you've got that part of it.

3:09

3 minutes, 9 seconds

If you're in a situation where you want to wear your choice of particularly wrap around sunglasses, then, you know, being able to wear contact lenses

3:16

3 minutes, 16 seconds

underneath really opens up the choice of sunglasses that you've, you've got available.

3:20

3 minutes, 20 seconds

And you know, the best thing about a contact lens from, from a vision point of view is that you're always looking through the best optics.

3:27

3 minutes, 27 seconds

So, because the lens moves with your eye, you know, you're always looking through the dead center of the lens and you're not being distracted by any sort of peripheral issues with the frame kind of getting in the way of your vision.

3:36

3 minutes, 36 seconds

And if we broadly talk about prescriptions being long sightedness, short sightedness or hyperopia, myopia and astigmatism, they all bring some different sort of challenges with glasses and sports.

3:48

3 minutes, 48 seconds

So, you know, things like if you, if you have to wear glasses for hyperopia, they're a plus lens, you actually lose a bit of your visual field.

3:55

3 minutes, 55 seconds

So, if we kind of think of the extreme example of a plus lens being a set of binoculars, we know it makes a small patch of the world out there very big in your vision, but you lose a good deal of peripheral vision.

4:05

4 minutes, 5 seconds

So, that happens on a mind level.

4:07

4 minutes, 7 seconds

And if you're short sighted and wearing glasses, you actually potentially get a bit of doubling things moving outside the field of the glasses, then moving into the glasses stops you being able to judge where things are at.

4:16

4 minutes, 16 seconds

And then the final part is, you know, if you're having to turn your head, and I'm an archer, so this is a common problem with people wearing glasses.

4:24

4 minutes, 24 seconds

If you're having to turn your head, you're looking through not a very good part of the lens. Often there's aberrations and prismatic effects.

4:31

4 minutes, 31 seconds

And perhaps if you are an archer, you can get used to that after a while. But if you shooting in different sort of positions, then it creates issues.

4:38

4 minutes, 38 seconds

And then so obviously someone who's in a more dynamic sport's really going to start to struggle. There's this changing, you know, prism dynamic as they move their head around. Yeah.

4:46

4 minutes, 46 seconds

So, i, you know, like, I can easily understand, like if you're involved in any sort of sport where there's ball tracking involved, you really want to maximize that peripheral vision, don't you?

4:57

4 minutes, 57 seconds

Yeah.

4:58

4 minutes, 58 seconds

And you know, and then you've got peripheral vision and you've got fogging getting in the way, you've got sweat kind of getting in the way, the glass is getting dirty. I mean, all of that reduces how well you potentially could play.

5:06

5 minutes, 6 seconds

And if you're really playing at a, at a very competitive level, you know, you know, every tenth of whatever counts, the difference between you and the next

5:15

5 minutes, 15 seconds

person might be, you know, you both might be great, but that extra little tenth might give you the edge.

5:21

5 minutes, 21 seconds

Yeah, and I think, you know, as we've talked about in the past too, like, when it comes to like tracking things, often you have to keep your head still.

5:30

5 minutes, 30 seconds

So,, you know, that's, that's where I think peripheral vision can really become much more, much more of an issue.

5:35

5 minutes, 35 seconds

So, you mentioned about wraparound glasses, and maybe that's something that a lot of people haven't considered, is that if you do wear glasses,

5:43

5 minutes, 43 seconds

there are some limitations into how you can get those prescriptions built into wraparounds, aren't there? Yeah.

5:48

5 minutes, 48 seconds

And look, there's been some great advances in spectrum, the lens technology that tries to counteract the impact of wrapping a lens.

5:57

5 minutes, 57 seconds

And so when you wrap a lens, then you potentially get additional aberrations and different effects from having such a curved surface.

6:05

6 minutes, 5 seconds

And so the things that you can program into a spectacle lens to try and combat that make the lenses thicker.

6:11

6 minutes, 11 seconds

There's often an upper limit on what description you can do, and that limit sometimes get hit pretty quickly.

6:16

6 minutes, 16 seconds

And then you still have a limitation on the type of frame that you can put that in.

6:19

6 minutes, 19 seconds

So, are there any situation, situations where you'd still recommend glasses instead of contact lenses? I guess there's a contentious one around water sport.

6:28

6 minutes, 28 seconds

You know, the safest thing to do is wear prescription goggles as opposed to wearing contact lenses in the surf. You could potentially consider Orthro-K as your contact lens type there.

6:37

6 minutes, 37 seconds

And we can chat about that in a moment when we discuss the different types, because that Basically removes the lens being on your eye while you're in the water.

6:44

6 minutes, 44 seconds

But you know, we can, we can talk through the water aspect when it comes to sort of hygiene.

6:48

6 minutes, 48 seconds

There are some occasions where people with very high astigmatisms might find glasses just that little bit more stable than a contact lens.

6:57

6 minutes, 57 seconds

But there are so many different lenses available in terms of how we can custom made.

7:03

7 minutes, 3 seconds

You know, if you're really serious about your sport and you want very, very stable vision and you've got either irregular astigmatism or higher degrees of astigmatism,

7:11

7 minutes, 11 seconds

we can even go to something like a large RGP or a, like a minuscular or style lens to really help with that sort of correction.

7:19

7 minutes, 19 seconds

So, there are, there are things possible, so there aren't too many instances where I would say glasses are definitely the way to go.

7:25

7 minutes, 25 seconds

If it's a safety situation, you still might have the advantage of having the contact lens on.

7:31

7 minutes, 31 seconds

But safety glasses over the top, I still think that's going to be a better visual outcome than prescription safety glasses in that sort of sporting sort of situation.

7:38

7 minutes, 38 seconds

You know, if you're playing squash, you know, squash you don't hear about talked about much anymore, but if you're playing that, you still need to be wearing safety glasses.

7:45

7 minutes, 45 seconds

And so I still think some contact lenses with the safety glasses would be better than a prescription in that situation.

7:52

7 minutes, 52 seconds

I've heard that the, like the options on the market now for multifocal soft contact lenses for people with astigmatism, still a bit, a bit limited, but there's more coming on the market, is that right?

8:03

8 minutes, 3 seconds

Like toric, Toric multifocal soft contacts. Yeah. Look, I wear a multifocal contact lens myself.

8:11

8 minutes, 11 seconds

I don't have much in the way of stigmatism, but the brand that I wear does help correct by accident a little bit of astigmatism.

8:19

8 minutes, 19 seconds

But we do have what we call tailor made monthly lenses. So, we've got a couple of different brands that we can, we can use.

8:25

8 minutes, 25 seconds

So, there are, you know, a couple of different options out there.

8:29

8 minutes, 29 seconds

I do believe that they might be bringing out a one day Toric multifocal in the near future.

8:37

8 minutes, 37 seconds

Now, near future on these things, I don't know if that means one year, two years or five years, but the way research goes, near future can be like a five-year kind of plan.

8:45

8 minutes, 45 seconds

But for the companies to be talking about it, it means it's probably not all that far away. All right, so, so Paul, when you're Assessing an active person or an athlete.

8:56

8 minutes, 56 seconds

What are the main things that you look at before deciding whether contact lenses are a good option for them?

9:02

9 minutes, 2 seconds

Yeah, and look, and I think it goes back to that question of when would you recommend glasses?

9:07

9 minutes, 7 seconds

If I find someone has certain types of, you know, strong allergies, problems with dry eye, those sorts of things,

9:15

9 minutes, 15 seconds

any sort of eyelid anomalies that may not work well with contact lenses, then I want to have a careful look at that.

9:21

9 minutes, 21 seconds

Some of those things we can actually deal with through drops or dry eye treatments.

9:25

9 minutes, 25 seconds

So, it may not be a kind of a, a line in the sand for them, but certainly something we want to consider is does the person's sort

9:31

9 minutes, 31 seconds

of physiology stack up to being, to allowing contact lens wear even on a part time basis, being comfortable and possible for them?

9:40

9 minutes, 40 seconds

We would do measurements on eye shape.

9:43

9 minutes, 43 seconds

So, we use what we call a Corneal Topographer, which gives you kind of a very detailed map of the curvature across the whole cornea.

9:51

9 minutes, 51 seconds

So, we can kind of get a sense of, you know, the size of the eye, the shape of the eye, what sort of lenses are likely to fit.

9:58

9 minutes, 58 seconds

And if we're doing, doing more complex contact lens fitting, we really, really use a lot of that information to help us design the initial lenses.

10:05

10 minutes, 5 seconds

And that's a critical part of fitting something like ortho case. So, topography is generally a good part of that.

10:10

10 minutes, 10 seconds

Obviously we're going to want to know what their prescription is and part of it also is, you know, a detailed discussion around what are you going to use these for?

10:17

10 minutes, 17 seconds

Do you only need distance vision? Do you need to be able to read them at the same time?

10:21

10 minutes, 21 seconds

Are you going to be using them just for sport or are there other activities or things in your life where you're going to be using them?

10:28

10 minutes, 28 seconds

So, that'll start to kind of work out which way we might head in the balance of things.

10:34

10 minutes, 34 seconds

And for people who do have really like complex eye conditions, whether that be keratoconus or, you know, severe dry eye, there are other specialist contact lenses out there like scleral lenses which have come a long way.

10:46

10 minutes, 46 seconds

Can you Absolutely. And explain what those are? Yeah. So, a scleral lens is a type of hard lens.

10:52

10 minutes, 52 seconds

So, hard lens is a, been around for literally a century and they, in their traditional smaller designs, they have a little bit more eyelid awareness.

11:04

11 minutes, 4 seconds

So, it requires a bit more dedication to getting used to them.

11:06

11 minutes, 6 seconds

But because you're providing a very good clean surface that keeps its shape while you're wearing it, that's a very good optical surface.

11:16

11 minutes, 16 seconds

So, if your cornea is more oddly shaped, the contact lens in front with the tears in between creates this nice round optical surface that improves clarity.

11:26

11 minutes, 26 seconds

Now if we do it with a scleral lens, it's almost as big, if not bigger than a soft lens, they become very, very stable

11:34

11 minutes, 34 seconds

and the comfort is actually fairly close to a soft lens once you start wearing them.

11:38

11 minutes, 38 seconds

It's not the same as the old smaller RGPs which have a place, but do require a bit more commitment getting used to.

11:46

11 minutes, 46 seconds

So, the scleral wraps right over the cornea and creates a brand new optical surface to look great for irregularities. You're trapping a wet surface.

11:55

11 minutes, 55 seconds

So, for some people with dry eye, it can add that sort of barrier for using it for short periods for sure.

12:01

12 minutes, 1 second

Well, so you mentioned some different types of contact lenses, so maybe this is a good segue to my next question, which is

12:10

12 minutes, 10 seconds

how do you match the right contact lens to someone's sport or their training environment?

12:15

12 minutes, 15 seconds

Like what sort of questions do you ask when you go through that, that fitting process and talk about someone's, you know, lifestyle needs?

12:22

12 minutes, 22 seconds

Yeah, look, generally we're going to lean towards a soft lens of some sort most of the time.

12:29

12 minutes, 29 seconds

There's sort of lots of different ones available, covering a wide range of prescriptions in terms of whether you just need a spherical lens just to correct some hyperopia or myopia, whether you need a Toric lens to correct astigmatism.

12:42

12 minutes, 42 seconds

If someone's in really, really dusty environments, we might lean into more minuscular.

12:47

12 minutes, 47 seconds

But usually a soft lens is well tolerated in those sor situations, particularly if you're wearing sunglasses or some other sort of protection over the top.

12:55

12 minutes, 55 seconds

So generally speaking we lean towards single use lenses a lot of the time, regardless of whether you're a full time

13:02

13 minutes, 2 seconds

wearer or a part time wearer, because they have the convenience of you getting a fresh lens every day.

13:07

13 minutes, 7 seconds

So, it's the most comfortable way of wearing the lens, they have the least complications.

13:12

13 minutes, 12 seconds

Occasionally you might hit a limit somewhere where the prescription is just not available in the one length one day lens.

13:18

13 minutes, 18 seconds

So, we might move to the other forms of frequent replacement, which I'll discuss in a second.

13:23

13 minutes, 23 seconds

The advantage of, of a one day for part time wear is probably even further because

13:31

13 minutes, 31 seconds

you don't have to keep your lens that you've just worn in solution, you don't have to clean it, you don't have to worry about how many times have I worn it, how long has it been since I wore that lens.

13:42

13 minutes, 42 seconds

So, if you're considering Wearing contact lenses just for sport and you're not going to be wearing them during the week, then a one day lens is, is ideal, assuming that it's going to, going to sort of perform well.

13:54

13 minutes, 54 seconds

So, if you're a full time wearer and maybe the cost of one days is you're looking for something a bit more economical or like I said, we're heading down the path

14:04

14 minutes, 4 seconds

of having a lens that we're needing more parameters, we need a different prescription that a one day just can't handle.

14:09

14 minutes, 9 seconds

Then we're moving into say maybe a fortnightly lens or what we call a two weekly lens or more commonly a monthly lens.

14:16

14 minutes, 16 seconds

So, what we mean by those is that if you were wearing them each day, you take them out each night, clean them, put them in a, you know,

14:23

14 minutes, 23 seconds

cleaning solution, what we call a multipurpose solution and at the end of a fortnight for two weekly lens or at the end of a month for a monthly lens, you're throwing them out and then the next day you're opening up a brand new set of lenses.

14:35

14 minutes, 35 seconds

You mentioned that there are different types of one day lenses. I've heard that. I think there's one brand might be Johnson and Johnson (J&J).

14:43

14 minutes, 43 seconds

They've got new contact lenses with well, new type of contact lenses with, with technology built in that makes it makes them much more comfor comfortable for people who suffer from dry eye.

14:54

14 minutes, 54 seconds

So, I think like the, the whole technology behind contact lenses has really improved a lot in the last decade, hasn't it? Yeah. And you'll find that across all the manufacturers.

15:03

15 minutes, 3 seconds

So, you know, Alcon, Coopervision, Johnson and Johnson (J&J) probably the main players, Bausch and Lomb (B+L) in there. So, they're all creating ways of making the lenses more comfortable.

15:12

15 minutes, 12 seconds

I wear a lens called the natural view and they made a change to even just the edge profile and how they coat the lens made a huge difference in the comfort of the lens.

15:23

15 minutes, 23 seconds

And so there are all the manufacturers are finding ways of making contact lens wear more comfortable and achievable for people.

15:32

15 minutes, 32 seconds

All right, so what about swimming then? Swimming and other water act activities.

15:37

15 minutes, 37 seconds

So, why, why is it, you know, why is it something where we have to consider the risks? Yeah.

15:44

15 minutes, 44 seconds

And when I'm talking to patients about contact lens where your top two sources of infections are water and the second one cases.

15:53

15 minutes, 53 seconds

So, you know, if we just eliminate the case story out of the way at the moment, if you're wearing a lens that needs to be cleaned, then we recommend that you replace the claim the case every time you

16:03

16 minutes, 3 seconds

Open a new bottle of multi purpose solution because that takes, that helps control the number two source of eye infections. So, the number one is water.

16:12

16 minutes, 12 seconds

So, in particular acanthamoeba.

16:14

16 minutes, 14 seconds

And if you have someone swim in water with their contact lenses and take the contact lenses out and you, you measure them, then you find bacteria like Acanthamoeba stuck to the lens and so that's where the concern is.

16:27

16 minutes, 27 seconds

The increased risk of getting an eye infection is the contact lens actually, you know, holds on to the bacteria against the eye so it creates, creates more opportunity for an infection to occur.

16:38

16 minutes, 38 seconds

Infections are quite rare, but if you get one from a Acanthamoeba, it can be quite nasty. So, this is where the concern is.

16:43

16 minutes, 43 seconds

So, so if you, the first step is do you really need to be wearing contact lenses while you're in that water activity?

16:50

16 minutes, 50 seconds

Particularly if there are, you know, things like prescription goggles being available and those sorts of things and then we step it down from there.

16:58

16 minutes, 58 seconds

So, this is what I want to be sort of careful is that the advice is don't wear them while you're doing water activities.

17:04

17 minutes, 4 seconds

But if you absolutely must, then wearing goggles over the top adds a reasonable degree of protection.

17:11

17 minutes, 11 seconds

If you happen to get exposed to water, then removing them after you've done the water activity, don't continue to wear them for hours afterwards.

17:19

17 minutes, 19 seconds

Or if they're a lens that you're frequently replacing, make sure you do a thorough clean with a good rubbing step and let them soak.

17:28

17 minutes, 28 seconds

A lot of my one day users, if they wear them in a water situation, will just throw them out.

17:33

17 minutes, 33 seconds

You know, if you're wearing a spherical one day contact lens, it's sort of about half a cup of coffee in terms of cost for a pair of lenses.

17:40

17 minutes, 40 seconds

So,, you know, if you like your water activity and you're going to be wearing contact lenses, then the next best thing to not wearing them at all is throwing them out as soon as you've done it.

17:49

17 minutes, 49 seconds

And I guess Ortho-k is another really good option, isn't it for people who are in and out of the water a lot? Absolutely.

17:58

17 minutes, 58 seconds

As a caveat to everyone, anyone who spends time in the water, whether you're wearing contact lenses or not.

18:02

18 minutes, 2 seconds

I mean it's not a bad idea to put some lubricant in after you get out of the water just to make sure you flush down it out any bacteria in there.

18:09

18 minutes, 9 seconds

The advantage of Ortho-K is that it's a contact lens that you only wear while you sleep.

18:14

18 minutes, 14 seconds

So, it puts some emphasis on some hygiene in that wearing sort of situation because you are sleeping in them.

18:19

18 minutes, 19 seconds

So, you need to be careful around case hygiene, not introducing water washing your hands, but for water activities.

18:25

18 minutes, 25 seconds

You know, with an ortho-k lens, you're basically putting the lens on the eye, going to sleep.

18:29

18 minutes, 29 seconds

It's using tear forces to gently reshape the cornea into a shape that allows you to see when you take the lens off and you can see all day.

18:36

18 minutes, 36 seconds

So, then you can do your water activities and not be worried about having something on the eye that's going to attract and have bacteria stick to it.

18:43

18 minutes, 43 seconds

Okay, well, if you're watching this on YouTube and you're getting value from the discussion so far, could you do us a favor and please hit

18:51

18 minutes, 51 seconds

the like button because it really helps us out with the algorithm and it increases the chances that other people might also benefit from the conversation.

18:58

18 minutes, 58 seconds

Okay, Paul, so we hear a lot of worries about contact lenses falling out or getting stuck behind the eyeball.

19:06

19 minutes, 6 seconds

That's kind of another common myth.

19:09

19 minutes, 9 seconds

So, what are some of the myths that you would like to clear up for people who also play sport?

19:16

19 minutes, 16 seconds

Yeah, look, the eyelids actually form a pocket with the front of the eye, the conjunctiva. So, there's actually not a lot of room there.

19:25

19 minutes, 25 seconds

So, there's. The contact lens may fold and kind of sit in the pocket on or above the eye. So, it's rare for a contact lens to truly, truly get stuck up there.

19:33

19 minutes, 33 seconds

Quite often if I have a patient who's come in and said, I can't get my contact lens out, quite often it's no longer there.

19:39

19 minutes, 39 seconds

And when we look in the pockets underneath the eyelid and down the bottom, well, and truly the lens is not there.

19:45

19 minutes, 45 seconds

So, you hear of those Internet stories of finding 17 contact lenses up under someone else's eyelid.

19:51

19 minutes, 51 seconds

And I don't know about the credibility of them because there's not a lot of room there for that many contact lenses, that some of them would eventually find their way out, you know, and if we think about it, wouldn't be.

20:01

20 minutes, 1 second

It wouldn't be a very good design to have access to the brain through the. Through the eyeball that quickly, all sorts of stuff and get back in there.

20:09

20 minutes, 9 seconds

So, yeah, so lots of protection.

20:10

20 minutes, 10 seconds

You really, you know, yes, you can rub and fold the lens up there, but it's usually easily retrieved.

20:15

20 minutes, 15 seconds

As far as lenses falling out, look, you know, a lot of that came from the very early days.

20:21

20 minutes, 21 seconds

We're talking 1950s, 1960s, where people wore very, very small, basically polycarbonate lenses just about you know, very, very tiny 8 mil lenses

20:30

20 minutes, 30 seconds

and, and obviously manufacturing tolerances in those days are nothing like what we've got now. And so it was very easy for the lens to sort of fall out or get blinked out.

20:40

20 minutes, 40 seconds

And so there's a bit of that that's carried on over the eons. I think a lot of the time lenses come out when you rub your eyes.

20:46

20 minutes, 46 seconds

So, one of our bits of advice is, well, if you're wearing contact lenses, don't rub your eyes.

20:50

20 minutes, 50 seconds

You know, we're not a fan of eye rubbing, irrespective of whether a contact lens wearer or not. Anyway, it's not a good thing to be doing.

20:57

20 minutes, 57 seconds

If you, if you're needing to rub your eyes, you need to be asking why and dealing with whatever sort of irritation or discomforts causing it.

21:04

21 minutes, 4 seconds

So, where you might inadvertently blink a lens out, again, probably one of those

21:10

21 minutes, 10 seconds

more extreme sort of situations where your eyes particularly watery or particularly dry and so the lens is not performing or behaving well.

21:20

21 minutes, 20 seconds

So, again, if they feel particularly watery or feel particularly dry, you really want to be careful about not eye rubbing.

21:27

21 minutes, 27 seconds

So, I think that's a critical piece that contact lenses if fit well and that's the thing that we need to make sure that the lens is fitting well.

21:35

21 minutes, 35 seconds

So, a loose fitting lens is more likely to move around to a point where you might more easily accidentally rub it out. But the big one is just avoid eye rubbing.

21:44

21 minutes, 44 seconds

And I think you get past most of those kind of issues.

21:47

21 minutes, 47 seconds

So, those, those stories about lenses falling out, you know, from, from decades past, I'm assuming that they, they must have been like RGP hard contact lenses because soft contact, lenses are so adhesive.

22:00

22 minutes

I just don't see how that would happen with a soft contact. Yeah.

22:03

22 minutes, 3 seconds

So,, and if we look at even a good fitting, hard lens has, there's a much greater volume of tears underneath.

22:09

22 minutes, 9 seconds

So, they do, they're designed to kind of move around and that's what makes them a very healthy lens actually.

22:14

22 minutes, 14 seconds

It's just that people have trouble getting used to the scent, the feeling of this lens moving around a bit, whereas soft lens drapes or wraps.

22:21

22 minutes, 21 seconds

And so you've got a much finer layer of tear films and that's what causes it to kind of cling.

22:26

22 minutes, 26 seconds

I did have a friend who was into contact sports and, and he wore soft contact lenses.

22:31

22 minutes, 31 seconds

One of the issues he had was that sometimes when the, when the opponent's glove would hit his eye, his contact would stick to their, their glove. Right.

22:40

22 minutes, 40 seconds

So, I don't know I don't know what the solution would be for him. Maybe ortho-k he'd be a good candidate for that perhaps.

22:45

22 minutes, 45 seconds

Yeah, I know if you're talking, if you're talking sort of the contact sports like that, you know, that raises more concerns for me

22:52

22 minutes, 52 seconds

for a whole bunch of other reasons because you know, we deal with concussions and whatnot in our practice and seeing our odd blowout fracture so you start to get

23:00

23 minutes

into a murky water about the whole is that a good sport from a vision point of view anyway.

23:05

23 minutes, 5 seconds

But yeah, look, your fingers in eyes, playing a tackle sport, those sorts of things, they're a risk.

23:09

23 minutes, 9 seconds

You know, I wouldn't promote a contact lens being a safety device but you, you would expect that if they're rubbing the lens out then they haven't yet got to your eye.

23:18

23 minutes, 18 seconds

So, there may be a minor degree of protection.

23:20

23 minutes, 20 seconds

But like I said, I wouldn't be sort of saying hey, let's go and wear contact lenses to protect our eyes.

23:25

23 minutes, 25 seconds

But, but you know, I think it's just one of those things that you take some, if you're wearing one day lenses, take some spare lenses, make sure you're able to keep your hands clean and replace the lens if there's no other injury.

23:35

23 minutes, 35 seconds

Okay, well that's a good follow on for next question which is what does good lens hygiene actually look like in the, in the everyday life of a busy person?

23:46

23 minutes, 46 seconds

Yeah, so making sure the lens is sterile. So, you know, I probably should back that up and say, well, hand hygiene. So, we learned during COVID how to wash our hands properly.

23:54

23 minutes, 54 seconds

Well that's what we should be doing.

23:56

23 minutes, 56 seconds

So, washing your hands with soap, thoroughly paying attention to fingertips and a good 20 to 30 second wash and then drying them,

24:03

24 minutes, 3 seconds

making sure the outside of the blister pack is clean and not got stuff all over it. Making sure that the actual contact lens is still in date.

24:12

24 minutes, 12 seconds

So, they often have an expiry date. Now most of the time expiry dates nowadays are several years down the track.

24:18

24 minutes, 18 seconds

So, if you're a part time wearer and you're buying, you know, maybe three months supply and it's lasting you a year, most of the time the expiry date is going to be fine.

24:26

24 minutes, 26 seconds

But it's a good idea to sort of start checking that.

24:28

24 minutes, 28 seconds

And then so once you pop the lens and you've got clean hands while you're doing that same in reverse, that when you want to remove the lens,

24:35

24 minutes, 35 seconds

you're washing your hands thoroughly again and then removing the lens and disposing of it.

24:40

24 minutes, 40 seconds

If it's a single use lens, if it's a frequent replacement, then you're making sure that you're using the proper contact lens.

24:46

24 minutes, 46 seconds

Cleaning products that your optometrist has recommended to you for your particular style of lens and following things like make sure you do the rubbing step.

24:54

24 minutes, 54 seconds

It's the one step that everyone gets lazy with, but it actually does 90% of your cleaning. And I think we've talked about clean cases.

25:01

25 minutes, 1 second

So, making sure you replace the case every time you get a new bottle of soaking solution, don't top up, make sure you're throwing out the used

25:10

25 minutes, 10 seconds

solution every time you put popular contact lens wear and letting the case dry. So, they're the kind of the critical ones.

25:18

25 minutes, 18 seconds

And again, like we said, you need to avoid getting water on the lens. And so sort of clean cases.

25:26

25 minutes, 26 seconds

Don't be afraid to lubricate your eyes while you're wearing the lens. So, contact lens comforts, very important.

25:32

25 minutes, 32 seconds

So, if you've got constant irritation, constant awareness of the contact lens and lubrication doesn't help, then we have a saying, if in doubt, take them out.

25:40

25 minutes, 40 seconds

So, don't persist with a lens that's uncomfortable because you might potentially either missing a very early infection or providing a pathway to make infection a higher risk kind of sort of situation.

25:52

25 minutes, 52 seconds

And then the final caveat is, you know, if you have a sore red eye that persists after wearing contact lenses, and again, thankfully, this is very rare, but the important thing is you go and get it seen to.

26:02

26 minutes, 2 seconds

Don't wait a couple of days, you know, and it's the same day kind of thing.

26:06

26 minutes, 6 seconds

So, see your optometrist, if you're near a, near a public hospital and you've got a really red, so red eye, then I advise just go to the local public hospital.

26:14

26 minutes, 14 seconds

But I want people to know that's a rare situation, but it's good to know what to do if you're one of the, you know, one in several thousand people

26:23

26 minutes, 23 seconds

that might happen to Normal, normal disclaimers about health advice supply. Right. Yeah. And look, and absolutely this is all general advice.

26:32

26 minutes, 32 seconds

You know, there's nothing like, you know, you really need to have everything set up for your specific situation and needs.

26:39

26 minutes, 39 seconds

And you mentioned about drops and maybe it's worth mentioning that there are, there are specific eye drops for contact lenses.

26:47

26 minutes, 47 seconds

You can't just kind of take any, any old eye drops from the, from the chemist, right? Yeah.

26:52

26 minutes, 52 seconds

Well, you need to be careful with your selection of drops in general, regardless of whether it's contact lenses or no Contact lens wear.

27:01

27 minutes, 1 second

If you've got something that's pretty much a tear supplement or a lubricant, most of those are fine.

27:07

27 minutes, 7 seconds

Generally they'll say on the, on the packaging whether they're safe for contact lens use.

27:13

27 minutes, 13 seconds

I would certainly avoid using something that is a medicated eye drop while you're wearing the lens.

27:19

27 minutes, 19 seconds

So, any allergy, eye drops, any eye whitening, eye drops, I'm not a fan of those in general at all anyway.

27:26

27 minutes, 26 seconds

And, you know, trying to avoid something that's got preservative in it. So, leaning towards something that's preservative free is ideal.

27:34

27 minutes, 34 seconds

And there's different packaging you can get.

27:36

27 minutes, 36 seconds

Now you can get ones that are in a bottle, but they have special kind of lids and sort of valves in them to have the bottle be open for several months despite being preservative free.

27:46

27 minutes, 46 seconds

But if in doubt, the individual doses are always a good one for preservative free. Okay, so last questions.

27:52

27 minutes, 52 seconds

So, for parents of teens who want contact lenses for school sport, what do you want them to know about safety and responsibility and how you support those children to wear their contact lenses comfortably?

28:06

28 minutes, 6 seconds

Look, obviously it's going to need some parental supervision in that sort of insertion, removal and cleaning process until you're confident that your child is following those practices.

28:17

28 minutes, 17 seconds

The argument around, you know, is, is contact lens wear more or less safe in that age group?

28:24

28 minutes, 24 seconds

The research seems to indicate that, that children and teens are at no higher risk than adults when it comes to sort of eye infection.

28:33

28 minutes, 33 seconds

In fact, I've seen a study that Suggested maybe the 19 to 25 year olds are the highest risk category.

28:38

28 minutes, 38 seconds

The new adults, you know, newly minted bulletproof adults, perhaps making some lifestyle choices that don't bode well for contact lens risk.

28:48

28 minutes, 48 seconds

So, you know, certainly you might argue that at one level, kids and teens, well supervised by parents make them safer contact lens wearers than young adults.

28:56

28 minutes, 56 seconds

So, if they're, if they're in the routine of brushing their teeth at night, there's no reason to think they can't get into similar good routines with contact lens wear, right?

29:05

29 minutes, 5 seconds

Absolutely, yeah. So, how do you decide if a teen's ready to handle lenses themselves?

29:12

29 minutes, 12 seconds

Like what, what would you say is a, is a good indicator there?

29:17

29 minutes, 17 seconds

Look, if they're motivated, the team being motivated themselves is an important factor.

29:22

29 minutes, 22 seconds

Sometimes we might go through a process of a little bit of a trial to see if they can get to the point of having someone like myself put a lens on their eye and just that's the.

29:31

29 minutes, 31 seconds

I often say to patients After I've inserted the first lens that you've just done the most difficult thing of contact lens wear and that's getting the first one on.

29:39

29 minutes, 39 seconds

And then when I put the second one on, it's like, well, you've now done the second most difficult thing of contact lens wear and it's getting the other lens on. And so you can get a sense of their readiness in that kind of situation.

29:48

29 minutes, 48 seconds

And so I like to say to parents, you know, there are, there are three people that need to be ready for contact lens wear.

29:54

29 minutes, 54 seconds

I need to be ready, you need to be ready, and your child needs to be ready for it as well. So,, you know, motivation certainly pays the fact factor.

30:01

30 minutes, 1 second

And so when you start getting to 11, 12, 13 years old, the motivation increase because they start to think about their own reasons for, you know, wanting to wear contact lenses versus glasses.

30:12

30 minutes, 12 seconds

And then, then it's a matter of going through a process of just having to watch what the handling skills are like and making some decisions around can they put the lens on themselves, can they take it off themselves?

30:23

30 minutes, 23 seconds

What's their sort of awareness like? Are they doing anything? That's so current risk risky. I mean, eyes are pretty tough.

30:28

30 minutes, 28 seconds

But, you know, there are certain things that we like to sort of see to make sure that someone's not going to hurt themselves.

30:35

30 minutes, 35 seconds

And again, the hurting themselves is not necessarily a risk of serious injury.

30:39

30 minutes, 39 seconds

It's more putting them off contact lens wear because of some early kind of teething issues that just require a bit of time and patience for.

30:46

30 minutes, 46 seconds

What's the youngest patient you've had that's been, you know, able to get to more or less unsupervised contact lens wear?

30:54

30 minutes, 54 seconds

Quite a, quite a lot in the kind of, you know, tweens and teens.

30:59

30 minutes, 59 seconds

But younger than that, I would, I think of one I've seen recently, I think about 10 years old.

31:05

31 minutes, 5 seconds

I'm sure I've probably had an 8 year old, but, you know, when you start getting down to that age, there's a lot more sort of parental assistance.

31:13

31 minutes, 13 seconds

Yeah, all right.

31:15

31 minutes, 15 seconds

Well, for, for someone who's been on the fence about contact lenses and, and sport, maybe they've always just managed with glasses or gone without altogether.

31:24

31 minutes, 24 seconds

What would you want them to know before riding off the idea of contact lenses?

31:30

31 minutes, 30 seconds

So, that if you follow good hygiene protocols, that contact lens wear is relatively low risk?

31:38

31 minutes, 38 seconds

There is still a small risk, but it's relatively low on the grand scheme of things. There are so many different brands, so finding and different lenses we can try.

31:46

31 minutes, 46 seconds

So, finding something that enables you to see clearly is out there in our practice if someone's unsure if they can actually do that.

31:55

31 minutes, 55 seconds

If we assess you and say you qualify for contact lenses in terms of physiologically your prescription, what you want to use them for, but they're a little unsure about whether they can actually wear them, then we do.

32:06

32 minutes, 6 seconds

That's part of our trialing process.

32:08

32 minutes, 8 seconds

So, there's a way of kind of dipping your toe in, in the water without fully committing to it because, you know, particularly with disposable lenses, we're not having to sort of purchase product or anything like that in the initial stages.

32:17

32 minutes, 17 seconds

Your only fees are the consultation sort of chair time fees to at least try it and give it a go and see if you're a good candidate and you might be pleasantly surprised of what the experience is like.

32:27

32 minutes, 27 seconds

All right, well, thanks very much so for, you know, for this information.

32:32

32 minutes, 32 seconds

I think in a very sort of active country like Australia where people are, many people are into sports, I think a lot of people will find this very helpful.

32:40

32 minutes, 40 seconds

So, if someone's on the Gold coast and they're thinking about contact lenses for sport or wants to find out if they're a good candidate, how can they get in touch with you at harmony vision?

32:51

32 minutes, 51 seconds

So, Harmonyvisioncare.com.au you can call the practice on 07-552-05900

32:59

32 minutes, 59 seconds

and we have a Facebook page as well, but the website has a wealth of information.

33:04

33 minutes, 4 seconds

But you can also book through the website as well or contact us if you've got some other questions.

33:08

33 minutes, 8 seconds

And if you've found this conversation helpful again, please, like subscribe and share with someone else who might benefit.

33:18

33 minutes, 18 seconds

Okay, well, thanks for watching. Thanks, Paul. And we'll see you all next time. Thanks again.Sync to video time

TRANSCRIPT

0:00

Well, just as a final question, if someone's been watching this

0:03

and they're living with persistent headaches and they've talked to their GP,

0:07

they've talked to their neurologist, they've ruled out all those more sinister

0:10

potential reasons, but they still haven't found answers yet,

0:14

what would you like them to know?

0:17

Yeah, you need to get a vision exam.

0:19

I mean, that's probably the one workup that hasn't been done yet.

0:24

So getting a thorough vision exam

0:26

that includes site refraction, which is prescription binocular visual

0:31

function, your accommodation function, is to see eye health.

0:33

So making sure you've got all of those sorts of things covered

0:36

would be a great idea.

0:43

Headaches are one of the most Common reasons, adults and teenagers

0:47

seek medical advice.

0:48

Often they have scans which come back clear.

0:51

Eye health checks appear normal, yet the pain continues.

0:54

Today, I'm joined by

0:56

Principal Optometrist

0:57

at Harmony Vision Care on the Gold Coast,

0:59

to explore an often overlooked

1:01

but persistent cause of headaches, binocular vision dysfunction or BVD,

1:05

and what happens when the eyes and the brain aren't coordinating efficiently.

1:09

For those who are new to the channel,

1:10

my name is

1:11

i'm the owner of Optics Digital.

1:12

We're an agency that helps eye care

1:13

professionals to grow their practice

1:14

through connecting with their community.

1:16

So Paul, great to speak with you again. Likewise.

1:19

So Paul, headaches are a pretty common thing and persistent headaches

1:24

can have multiple causes.

1:25

And of course, it's important to rule out what those causes might But I feel like

1:33

binocular vision dysfunction and when your brain and your eyes are out of sync is

1:36

something that doesn't maybe get talked about enough.

1:38

So could you walk us through what's actually happening in someone's head when

1:42

their eyes and brain are out of sync?

1:44

And why does it trigger headaches?

1:46

Yeah.

1:46

And unconscious of your brain is picking up that something's out of balance.

1:50

And when you've got a binocular visual dysfunction, it's a loss of coordination

1:55

or an effortful coordination between the two eyes.

1:57

And it's not just the convergence part of it.

1:59

It's also when you look at something, you need to line up the eyes into the same

2:03

area of space, but you also need to have your focusing line up as well.

2:06

So you've got a couple of systems that have to stay in coordination,

2:09

and they're meant to ebb and flow and flexibly work with each other.

2:13

Now, if they become out of balance, either the two eyes out of balance

2:16

with each other or the convergent system is out of balance with focusing,

2:20

then that creates extra resources.

2:22

You have to start concentrating.

2:24

You have to start concentrating on not making errors, maybe in-depth perception,

2:28

making errors when you're moving your eyes across a page, those sorts of things.

2:31

And that increases internal stress and tension.

2:34

And the way that our brain elevates the warning is through a headache.

2:39

So is it something that people are consciously aware of,

2:43

or is it something that's happening beneath the surface that we

2:45

might not be aware of. Yeah.

2:46

And we can talk about that you voluntarily,

2:49

if you keep going at a particular activity, if you find difficulty with.

2:52

There's a subconscious drive to keep going with it.

2:56

And so it is relatively unconscious, even though there's a a bit of effort involved.

3:01

I don't think people realize what's going on.

3:03

They're pushing themselves, but not realizing it.

3:06

They're actually pushing their visual system.

3:07

And so when we talk about binocular vision dysfunction, that doesn't necessarily mean

3:13

that people might be seeing double vision, does it?

3:15

Yeah.

3:16

And look, that's long been one of those symptoms.

3:19

And I remember when we did our training or you read textbooks on binocular vision,

3:22

and it's like double vision being one of the symptoms.

3:24

And you go, it's one of the really extreme symptoms.

3:27

I think this is the idea that if binocular If your vision breaks down completely,

3:31

then yes, you do get double vision.

3:32

But that's the fight that people are having.

3:34

They're fighting it going double.

3:36

They're fighting it going blurry.

3:37

And it's the fight that creates tension, eye strain, and then the headaches

3:41

that go along with it.

3:42

And so someone coming in with eye strain and headaches means,

3:46

and even blur and double vision means that they're really persisting at a task.

3:49

There's something that they're really trying to get done.

3:51

They're trying really hard to make something happen because other

3:54

people may decide to give up.

3:55

It doesn't feel comfortable to do, and they don't reach a point of headache.

3:57

And so they just give up instead, or they back their performance off to some

4:00

level, it's not quite so stressful.

4:02

But I think you'd have to have a reasonable degree of breakdown

4:05

for it to land at double vision.

4:06

So there's so much happening way before double vision occurs,

4:09

unless you're dealing with the binocular vision dysfunction that comes from having

4:12

an injury, like a brain injury, or a flash concussion,

4:14

where it's a more sudden onset double vision, because that's

4:17

a big shock to the system.

4:18

So the types of binocular vision dysfunction that you see,

4:22

is that something that affects mostly kids, mostly adults, seniors?

4:26

Are there any age patterns where it matches?

4:30

No, it's probably more related to tasks.

4:32

So any task that you spend a long time doing that you find challenging

4:36

to do can result in a headache.

4:37

I mean, you probably more associate it in situations where there's

4:41

a bit more high pressure.

4:41

So it's going to be school-aged through to working-aged.

4:45

Someone who may be retired may not have the same level of

4:50

drive to be doing an activity at a level that creates those symptoms.

4:53

Or they might be doing more pleasurable symptoms.

4:55

And so there's some of the things you need to tease out.

4:57

But you see it clinically, and I've seen it looked at in research,

5:01

is that there is a difference in symptoms between someone doing what we call

5:04

required activities versus pleasure activities.

5:07

So required activities would be studying, having to read a textbook,

5:11

having to do computer work that's related to some time pressure,

5:14

either study or work.

5:15

And then if you go and spend an equal amount of time gaming,

5:19

reading a book for pleasure or doing some other activity that doesn't have the time

5:24

pressures, the stress pressures, the cognitive pressures in the background,

5:26

one will create a headache and the other one won't.

5:29

And so So it can get quite complex and confusing as to why, well,

5:33

they don't get a headache from gaming for 2 hours, but they get a headache

5:36

from 15 minutes of reading.

5:38

And on the surface, you go, well, there's similar distances,

5:40

there's similar levels of attention involved, but the type of task.

5:43

And you can even deep dive into your own self appraisal of the task.

5:48

If you already think it's going to be stressful, then one might argue that might

5:52

increase your chances of getting a headache.

5:54

If you find the task unpleasant, then one might argue you might increase

5:58

your chances of getting a headache. Yeah.

6:00

I know.

6:00

I feel a lot instead of headaches when I think about doing my tax every year.

6:04

So headaches are something that we have to treat seriously, and there

6:10

could be many reasons for it.

6:12

So some are physiological, some related to the eye,

6:17

and some related to the eye in the sense of coordination between

6:20

the eye and the brain.

6:22

A couple of years ago, I was getting these headaches,

6:25

persistent headaches in the back of my head, which was, of course, a concern.

6:28

And I went to the doctor and they did one of those MRIs.

6:31

And he showed me the images and says, look, you're fine.

6:34

I think it's just like a tension headache because maybe you've been sitting

6:37

at a computer a lot recently.

6:38

And yeah, that's exactly what it was.

6:39

So can you talk us through what are some of the things that people should do when

6:43

they're trying to rule out potentially more sinister explanations for headaches.

6:49

Yeah, look, and if you're getting a persistent headache and you haven't able

6:52

to tie it to a particular activity, I mean, diagnostically from the vision

6:56

headaches we're looking for, quite often it's tied to the task If

7:00

you're doing it, it might be more middle of the day, end of the day,

7:02

if it's related to work, study, those sorts of things.

7:04

But any headache that persistent keeps going, you need to think about getting

7:08

some medical attention to that.

7:09

And optometry has a role, even if it's not a vision headache,

7:12

for helping rule out any signs of the more serious pathological

7:17

reasons for a headache.

7:18

We can look inside the eye and make sure the optic nerve looks fine.

7:21

Depending on the presentation, we can look at the visual field test

7:23

to make sure that there's been no visual field loss that might indicate

7:26

something more serious.

7:27

So we have a role to play there, particularly if you start adding in waking

7:30

If you're getting up with headaches, if you're getting nausea,

7:31

if you're getting dizziness, that starts to escalate.

7:33

You really need to be getting medical attention when you start adding

7:36

those other symptoms into it.

7:38

And so there's that place.

7:39

But if you've been through the process of having it medically diagnosed

7:43

and you're still getting these headaches and you haven't had an eye exam,

7:46

then that's a good place to start because it may well be that it's a vision problem,

7:50

whether it just be sometimes a minor prescription problem can create

7:54

headaches in some situations.

7:56

It might be we're looking for dry eye.

7:58

I might create headaches in some situations.

8:00

I certainly experienced that myself, where I'm going through periods of having dry

8:03

eye, and if you're trying to keep working through it, is it the blur

8:07

that the dry eye causes?

8:09

Is it just the discomfort?

8:10

And therefore, over time, you get a headache from just

8:12

the strain of the discomfort?

8:13

Is it the brow ache that you're getting from trying to peer and keep going

8:16

with the work despite the dry eye?

8:18

And you have similar behaviors when you're doing...

8:21

When you get headaches from eye strain from binocular visual dysfunction,

8:25

it could be that you're just doing a lot of ear work and eventually your eyes get

8:28

tired and strained and then you get a headache.

8:29

And so So tension involves all of these things.

8:32

So what we would have a look at is, do you have a sight problem?

8:35

Do you have a binocular vision or accommodation problem that matches

8:38

the headache and the timing of the headache you're getting?

8:40

And then we do a little bit of health checks as well to rule out anything more

8:44

sinister, which are not rare, but the consequences can be quite high.

8:48

And so that's where we want to be alert enough to seek care,

8:52

but don't worry until you get it thing, unless you're getting those up.

8:55

Like I said, you're ready to go more serious roll on symptoms

8:59

that are going on with it.

9:01

So let's say I'm a teenager who gets headaches doing homework or an adult

9:06

who can't get through the workday without pain.

9:09

How do you actually test for this?

9:11

What happens in the exam room that's different from a regular eye exam?

9:15

Well, I'll probably say some of the things that are necessary.

9:19

A good case history is finding out when do you get a headache?

9:22

And I hope that all eye exams have this as a good case history is that when are you

9:26

getting the headache, how often, what part of your head are

9:28

you getting the headache in?

9:29

Because when you deal with headaches a lot because of vision problems,

9:32

you also start to get a bit of a sense when it's not the way the headache is

9:36

being described is not a vision related one.

9:38

And we can make some recommendations, referrals, those things.

9:41

We've talked about getting an occipital headache.

9:44

Some people get a referred pain to behind the eye with something like that.

9:47

And that might be something that might need another professional related,

9:50

some physical examination of neck and jaw and shoulders and those things heading

9:55

through the GP to be sure, but making those suggestions.

9:59

And So time of day, frequency, what other symptoms are you getting?

10:03

What gives you relief from the headache?

10:06

And probably a good point here is to go, we need to differentiate between

10:10

headaches, bad headaches of migraines, which becomes a difference

10:14

of cattle of fish.

10:15

So then we would do your regular things of, do you see well on the letter chart?

10:18

So how well you see down a letter chart is ruling out pathology and ruling out

10:22

whether you've got just a basic refractive problem, whether you've got some

10:25

uncorrected astigmatism or long-sight or short-sight.

10:27

What we concentrate heavily on in our practice is And then doing a very thorough

10:31

assessment of your binocular vision.

10:32

How well are your two eyes working together?

10:34

Do you have good 3D perception?

10:36

Do you have good focusing skills?

10:38

Is it good flexibility between your binocular system and your focusing system?

10:42

Because that's where we're really going to find if a headache

10:47

is related to the eye strain that comes with a binocular visual dysfunction.

10:52

And then after that, then again, we hope this happens in every eye exam is

10:56

that we're going to do a good exam on looking at the back of the eye,

11:00

how healthy does it look?

11:01

Just making sure that there's nothing else that might give off the same symptoms.

11:06

You mentioned a referred pain there.

11:09

I remember I'm disclosing a lot of my medical history here.

11:12

So a few years ago, I had a pain in my leg,

11:14

and I went to a doctor about it, and she said, oh, maybe that's

11:17

an issue with your lower back.

11:18

And I'm like, no, it's in my leg, not my back.

11:20

And then she explained that the nerves are all connected.

11:22

And just because we've got pain in one area, it might be arising

11:25

from something else.

11:26

So from what you're saying, it sounds like the same thing happens

11:29

with our neck, our head, our eyes, all that as well.

11:32

And again, we don't want to take that.

11:33

Anyone taking that as prescriptive advice in their own situations

11:35

to general discussion here.

11:37

But yeah, you can get all sorts of things.

11:38

And I've seen studies in dizziness and vertigo, where sometimes it ends up

11:42

being a binocular vision dysfunction and not something more

11:45

similar or something else.

11:46

So what I talk to my patients about is that I look at this is

11:50

the functional unit of seeing.

11:52

And your visual system, in order to understand what's going out

11:55

there visually, needs to know what parts of you are moving,

11:59

what parts the world are moving to really understand how this light's

12:03

moving across the back of the eye.

12:04

And so if you've got dysfunctions elsewhere, that can then project into

12:08

creating problems in the visual system.

12:09

You got neck tension.

12:11

There's been a fair degree of study over time that when you push hard

12:15

with your focus, you get neck tension.

12:17

And so you get all these associations that you want to be able to tease apart.

12:21

One of the things I look for is someone's getting those, it sounds like neck

12:24

tension, tight neck, tight shoulders.

12:26

Do they have a vision problem that's causing them to change their posture up

12:30

the whole tension while they're doing an activity?

12:33

So there may be a visual element to it, but the physical expression is

12:38

through another part of the body. Right.

12:40

Well, if you're watching this on YouTube and you're getting value

12:43

from the discussion so far, could you do us a favor?

12:45

Would you please hit the like button because it really helps us out

12:48

with the algorithm and increases the chances that other people might

12:51

also benefit from the conversation. All right, Paul.

12:53

So if someone is diagnosed with BVD, binocular vision dysfunction,

12:58

what does treatment actually look like in the day to day sense?

13:01

Are we talking about glasses that they need to wear?

13:04

Are we talking about vision therapy exercises or something else?

13:07

And realistically, what improvements should people expect and on what timeline?

13:12

Yeah, and obviously, we need to have the individual in front

13:15

of us in their individual circumstance and individual findings.

13:19

But if we break it down into what tools do we have available and tools we mean,

13:23

what can we prescribe and what advice can we give?

13:26

And so if we've identified that it's a binocular visual dysfunction or

13:30

an accommodation problem, which implies that it's out of whack

13:33

with the binocular visual system, where we're comfortable that everything

13:36

else about the person's visual system is healthy and everything looks okay,

13:39

then we talk about, okay, well, a lot of the headaches that you might get

13:44

from binocular visual dysfunction is a sheer amount of near

13:47

work that you're doing.

13:47

And so let's have a discussion around simply just that.

13:50

So taking breaks frequently, and we talk about this on other videos,

13:54

is that there's a cute rule, the 20/20/20 rule,

13:57

which is every twenty minutes,

13:58

look away twenty feet for twenty seconds.

14:00

Now it sounds great, and I think it's good advice, but it might have

14:03

its limits on practicalities.

14:05

And so I certainly think that if you wanted to take it a longer period of time

14:09

for getting some work done, if you go forty-five to sixty minutes,

14:13

but then take a decent five or ten five to ten minutes break is some general advice

14:17

around trying to avoid both tension headaches and vision headaches because

14:20

you're getting moving again, basically.

14:22

So that's one of the things we look at is breaks.

14:25

Have you got good lighting?

14:26

How far away is your screen?

14:28

Looking out for How is your workstation set up on those sorts of things?

14:33

So you've got those things that the person can take control of is how much intensity

14:38

of work are you doing in one moment and what adjustments can

14:40

you make to manage that?

14:42

And then we look at what tools are available from a prescription

14:45

point of view.

14:45

So let's assume if you've got a mild refractive error that we think is

14:48

contributing to headaches, then we'll talk about prescribing that.

14:51

We may find that certain types of binocular visual dysfunctions do

14:54

benefit from a mild reading prescription.

14:57

And people worry that that makes their eyes weak and dependent.

14:59

And I simply don't see that happen.

15:02

And the way I look at it, that if you are careful in the way you

15:05

prescribe those lenses, I call them the ergonomic chair for the eye.

15:08

They're basically providing some assistance to make the near task more

15:12

comfortable and that you might only need to use for those intense near tasks.

15:16

So that might be something that we would consider based on the

15:19

individual circumstances.

15:20

And then we would tend to, in our practice, we tend to use vision

15:23

therapy for someone where the dysfunction has gone far enough that

15:28

taking breaks is not not going to work.

15:30

Prescription is really not going to do enough.

15:32

And then we have to effectively rehabilitate and have someone

15:36

develop better visual skills.

15:37

Again, it could be that some people didn't develop them properly to begin with.

15:40

Someone might have had a mild whiplash, mild concussion,

15:43

not realized it's created this.

15:45

Sometimes it's just created from doing lots of near work, and it gets to a point

15:48

where they're stuck and using different analogies for different things.

15:53

I've got an ergonomic chair analogy.

15:54

The other one is that take her personal experience, busted by me at nineteen,

15:59

developed a change in the way I stand and the way I walk because of it.

16:03

The injury is long gone.

16:04

I'm certainly not a nineteen year old anymore, but the patterns of how I move

16:08

and how I stand still persist.

16:10

And so in order to change that and get back to a more balanced way of standing

16:14

and sitting, I've got to do some active rehabilitation.

16:16

And so sometimes what happens in the change in function can

16:20

go too far that we need to do something a lot more active to rebuild it and put

16:23

it back to something more normal.

16:25

Now, are prism lenses also part of your toolkit?

16:29

And I think you've got strong thoughts about prism lenses.

16:31

So first of all, can you explain what they are and then whether

16:33

or you don't use them?

16:35

Actually, I've probably got some samples in a prisms look and sound simple

16:40

in theory or just looking at them.

16:43

And so with We've never prescribed something looking like this.

16:46

And for those of you who are into music or old, you might remember

16:51

the dark side of the moon. Pink Floyd.

16:53

A Pink Floyd cover where you see the prism breaking up light.

16:55

And certainly you can set up a situation with white light's broken, the rainbows.

16:59

But In much smaller amounts, much smaller degrees of prism,

17:03

you don't quite get that impact in effect, particularly if you put

17:06

it within a curved lens.

17:07

But effectively, what a prism does is bend light one direction.

17:10

I don't know if this will work here, but if you can look at the computer

17:14

monitor on this side.

17:16

See if I can get it to work where the direction of the prism,

17:20

I might actually go something smaller, might work a little better where you can

17:23

see the stand has been pushed sideways.

17:25

That little section of stand in there is pushed sideways.

17:29

And so it's bending light in a particular direction.

17:31

So it bends light towards the tip.

17:33

So if we're putting, describing a lens with the thick part

17:36

towards the nose, then the light is being pushed that way.

17:40

And so I have to make a movement of my eyes that way to bring

17:46

the alignment back together again.

17:47

So one of the theories is if your eyes are doing this to begin with,

17:50

we can pop prisms in to match.

17:52

Now, there are certain circumstances where that works quite well.

17:55

And so if you've got a vertical imbalance, we don't have as much movement this way

18:00

Prisms in particular can be quite useful in that situation where

18:04

someone can't bring their eye down.

18:05

So you bring the world down through the prism.

18:07

And now I can get the two eyes working together.

18:09

There's a lot of to-ing and fro-ing in the research about where the horizontal

18:13

prism for eye teeming problems that are more regular, the conversion to excess,

18:17

conversion to insufficiency are all that useful because we often see

18:21

a situation where people eat prism, where we go, well, you come in,

18:25

we prescribe a certain amount of prism.

18:27

It seems good initially, but then you come back later needing more

18:30

because we haven't got to the heart of the problem.

18:32

And then there's other things that go into that.

18:34

Once you start getting up into high prisms amount, they look really simple.

18:38

These flat things got two surfaces.

18:39

They push the light that way, but they bend light in very interesting ways.

18:43

They're one of the most complex lenses you So it's complex

18:47

lenses you could prescribe.

18:47

And so when you start getting into higher powers, you're adding all these other

18:51

things that you're not knowing how to control.

18:53

And so I use them judicious.

18:55

And that's probably the end story.

18:57

We use them a lot for testing, but describing them, I like to be pretty

19:00

careful about what we expect from them.

19:01

So they certainly have a place, but they're not the magic bullet

19:03

that are sometimes made out to be.

19:05

Well, just to get back to vision therapy just briefly.

19:09

Do teenagers and adults respond differently in terms of their adaptation?

19:14

Do younger brains adapt more quickly than, let's say, older adults?

19:21

Good question.

19:23

I think sometimes when we're dealing with an adult, we're dealing with a vision

19:26

problem that may well have started earlier, and they just carried on through.

19:30

So broadly speaking, we don't see age as a barrier

19:33

to benefiting from doing vision therapy when you need it.

19:36

I think my oldest patient would have been eighty-nine.

19:41

So you go, age is not a barrier, then all cliché.

19:46

Certainly things change, though.

19:47

So if you're talking about adults in my vintage, where we're at that age,

19:52

where our focussing flexibility is naturally declining,

19:55

and it's not because of a dysfunction, it's because of just the lens

19:57

inside the eye getting hard.

19:58

And so it doesn't change shape anymore.

20:00

So that altars how someone might be expected to respond to some

20:05

of the activities we do.

20:06

So it means that some of the activities we're using might be,

20:09

it could be just we have to label the instructions a bit differently

20:11

for them or have them pay attention to something a bit different

20:15

as part of the therapy process.

20:18

So I guess the short answer is there are variations, but the overall theme of what

20:22

we're trying to achieve with vision therapy based on ages is fairly similar.

20:27

So the younger kids, you might be working with some general eye

20:31

movements that are part of their binocular visual dysfunction.

20:33

Often, if we're able to catch kids early in the process of going down the path

20:39

of developing some binocular dysfunction, we might avoid needing to do vision

20:43

therapy because we can short circuit what we think of the process is,

20:45

is why they're heading down that way.

20:47

And so I guess that's another aspect that might be different with kids is

20:50

that we get in early, then we might be able to change the path.

20:54

All right. Thank you.

20:55

Well, can you explain why someone's headaches

20:59

might get worse in certain environments?

21:01

For example, are there things like fluorescent lip offices or grocery

21:05

stores or driving at night?

21:07

So what is it about those situations that might trigger particular headaches

21:12

from binocular vision dysfunction? Yeah.

21:14

So it's an interesting one because chicken and the egg is,

21:17

do they have this overarching sensitivity that the binocular vision is just part of?

21:22

And then they're sensitive to movement, they're sensitive

21:24

to changes in visual space.

21:26

There is some research looking at things like fluctuation situations in your

21:30

accommodation system being different in those kinds of circumstances.

21:34

There appears to be some people who have binocular visual dysfunction who have

21:38

this thing called pattern glare.

21:40

And I think that's where the flicker and shopping centers and pattern

21:44

surfaces can be uncomfortable.

21:46

Again, you can have pattern glare without a binocular dysfunction and vice versa.

21:50

So they're not always tied together.

21:51

Not everyone who has patternglare has a binocular visual

21:53

dysfunction and vice versa.

21:54

But people might be sensitive to these kinds of patterns, pattern surfaces,

21:59

and text be a trigger for that.

22:00

And so that's another thing that we are looking for, that if things aren't adding

22:05

up, it sounds like a binocular visual dysfunction, everything seems to be okay,

22:10

then we start to get a sense from those.

22:12

What do you like in shopping centers?

22:13

Do you get a bit of motion sickness? Do you get a bit of car sickness?

22:15

So you find flickering rights annoying that might lead us to go, well,

22:20

maybe it's a pattern glare issue as part of this whole headaches or eye

22:25

cascade that we're looking at.

22:27

And so obviously, we can't just avoid going to shopping centers.

22:31

So are there any practical strategies that patients might use to reduce these

22:36

triggers if there are certain environments that are problematic for them?

22:40

Yeah, look, some people end up finding, if we can manage the binocular

22:45

dysfunction, we think that's part of it.

22:47

And obviously, that's one of the things that we need to deal with.

22:49

So get examined and just see if there are things there.

22:52

There are some people in those situations where they might find certain color tints

22:55

that we test them with make a pack and less glare inducing.

23:00

And so they might find light tints and those sorts of things.

23:03

Again, we need to individually work that out.

23:06

In terms of self strategies, often if you've got some issues around

23:10

shopping centers and things like that, going at quieter times can be useful.

23:14

Perhaps going to shopping centers where the lightings are a little bit more

23:16

natural, ones where the surfaces that are used aren't quite so patterned,

23:21

they're a little bit more bland.

23:22

I do wonder if there are things like how stressed you are making

23:26

it better or worse.

23:26

So just having a little bit of a listen of if I'm feeling pretty peaky

23:29

and stressed at the time, maybe this is not the time to be

23:31

going to the shopping center.

23:33

So in terms of own avoidance strategies, yeah, I would certainly look at

23:38

times when there's more natural light, times when there's less people.

23:41

And that's going to vary, obviously, from wherever you live,

23:45

wherever your local shopping center is. All right.

23:47

Well, just as a final question, if someone's been watching this

23:50

and they're living with persistent headaches and they've talked to their GP,

23:54

they've talked to their neurologist, they've ruled out all those more sinister

23:58

potential reasons, but they still haven't found answers yet,

24:01

what would you like them to know?

24:04

Yeah, you need to get a vision exam.

24:06

I mean, that's probably the one workup that hasn't been done yet.

24:11

So getting a thorough vision exam

24:13

that includes site refraction, which is prescription, binocular visual

24:18

dysfunction, your accommodation function, and obviously, eye health.

24:21

So making sure you've got all of those things come, it would be a great idea.

24:25

Okay, Paul.

24:25

Well, thanks again for a really balanced explanation of a condition that many

24:29

people may be haven't heard of yet, but are experiencing.

24:31

So if someone's on the Gold Coast and they'd like to talk to you more about

24:37

binocular vision dysfunction, how can they contact Harmony Vision Care?

24:41

Okay, so we've got

24:43

as our website.

24:44

We're on Facebook and Instagram.

24:45

You can call the practice on.

24:50

If you're wanting to book an appointment, then again, if you go to the website,

24:53

harmonyvisioncare.com.au

24:54

we've got your ability to book online from there, which will prompt a call

24:59

from the staff to discuss what your needs are and get you all booked in.

25:03

And if this conversation has helped you to have a better understanding of

25:08

one potential cause of persistent headaches, then please like, subscribe,

25:11

and share this with someone else who might benefit.

25:14

Well, thanks for watching, everyone, and we'll see you next time.

25:17

Bye, Paul. Thanks again, Paul.

25:19

Thanks, everyone.

25:20

Bye for now.