Unlock The Secrets To Great Vision: From Child Eye Exams To Ditching Glasses After 40

In this in-depth interview, we cover essential topics including the differences between basic sight screenings and comprehensive eye exams for children, when to schedule your child’s first eye test, and how adults over 40 can reduce their dependence on glasses with innovative contact lens options.

In addition, learn practical tips for mastering contact lens insertion and managing conditions like keratoconus.

Whether you're a parent concerned about your child’s vision or someone looking to enhance your own eye health, this video offers crucial guidance to keep your vision sharp and healthy.

Don’t miss out—watch now and take the first step towards better vision for life!

Disclaimer:
The content provided in this video is for educational and informational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of a qualified healthcare professional with any questions you may have regarding a medical condition or treatment. Never disregard professional medical advice or delay seeking it because of something you have seen or heard in this video. The information shared is based on personal experience and general knowledge and should not be considered actionable health advice. Reliance on any information provided in this video is solely at your own risk.

KEY TAKEAWAYS

TRANSCRIPT

0:02

Are you curious about how to ensure the best vision for yourself and your

0:08

family at every stage of life? Today, I'm once again chatting with Paul Graham,

0:13

a leading Gold Coast optometrist with over 30 years of experience, who's the owner

0:20

of Harmony Vision Care. From understanding when to get your child's eyes checked,

0:25

to looking at why young adults might experience deteriorating vision

0:31

to exploring how adults over 40 can ditch their glasses. Paul is about to share his expert insights regarding all these and more.

0:40

But first, who am I? My name is Paul Sallaway, owner of Optics Digital Marketing,

0:45

an agency that helps independent optometrists to grow their practice. So hello, Paul.

0:51

Thank you for making time for this interview again. Hey, Paul. Thank you.

0:56

So in the last video we did, you gave us the background of Harmony Vision Care.

1:03

So if anyone's interested, they can go back and watch that. So what's new on the Gold Coast there since we last talked?

1:09

What have you been up to? Probably the biggest thing is we just had the

1:15

International Cornea and Contact Lens Congress. That is hosted quite often on the Gold Coast in our own backyard,

1:22

which is nice, but it brings in practitioners from all over the world to discuss all things cornea, contact lenses, dry eye.

1:31

I gather that there were some good discussions around keratoconus,

1:39

which is a topic that we're going to touch on later as well. So it's good timing there.

1:45

Absolutely. So the top four things, probably at these conferences are how we manage keratoconus

1:53

and how we bring back good vision to people who suffer that condition, what we're doing with regards to ortho-k, what we're doing with multifocal contact

2:03

lenses, and dry eye is a really big developing field as well.

2:09

All right. Excellent. Well, last time we talked a little bit

2:15

about sight screening in schools and early childhood eye examinations.

2:24

So can you just go over again, what are the key differences between

2:29

the basic site screening that kids might have in a school environment

2:35

versus a full child examination that they might have in an eye care practice like yours?

2:40

What are some differences there? It's a really important discussion because most

2:48

families will, certainly in Queensland, they have a programme where kids go through a site screening in their prep year of school.

2:58

And it's nice to talk about how the different terms like sight versus vision are used.

3:05

And a lot of the time people might be using the word vision, but they really mean sight. It leads us into a lot of vision screenings are really

3:18

concentrate on the sight side of things. So sight is how clearly we can see it, and that's typically measured by what

3:26

you can see on a letter chart. And when you're dealing with kids, they to use pictures instead.

3:32

And site screenings have a really important role for picking up those types of eye and major eye and vision problems that develop before the age of four.

3:43

And things where because the kids develop those things young,

3:48

they may not necessarily outwardly show any issues because they just learn and develop with the vision problem in place.

3:56

But it then can cause some issues later on. A lot of the testing centres around whether they've got a high prescription,

4:06

so that's whether they've got astigmatism or long sight or short sight, how well they can see on a letter chart,

4:13

and whether there's any difference between the two eyes. And that's just there are very important parts of vision, but they're only

4:21

a small part of the whole visual process. And the nature of screenings is that they've got to get through a lot

4:28

of kids in a a fairly short space of time. So they're going to be picking on the more major eye and vision problems,

4:36

things like eye turns, lazy eyes, and high prescriptions that you want to get on to early.

4:41

And that's different from, well, one, if we're seeing a child of that age, there's so much more that we'd be testing because we're interested in how they

4:49

process and perceive information, in addition to doing more extensive tests of their eye health.

4:55

But I think the important thing to understand is that If we're talking about the vision problems that are going to affect

5:03

learning, then many of those kids will pass a sight screening. And so the vision problems that they get are a lot more subtle.

5:13

And so that's where it needs more extensive comprehensive testing. And the other thing that can also happen is that the vision problems may start

5:23

to develop once they're at school. So we need to be looking at the things where they have genuinely

5:28

passed a sight screening. They may even pass a full visual exam at four years old, but things

5:34

can change and do change. They can start to develop eye-teaming problems, they can start to develop by teaming problems. They can start to develop focussing problems and they can

5:40

start to develop myopia. And those are things that occur well after a sight screening has already been conducted.

5:46

It might happen two or three years down the track. So it's easy to fall into the trap of my child passed

5:55

the screening and everything's okay. I think we need to recognise that one, it is just a screening and things change.

6:02

Those kinds of screenings, so they don't necessarily

6:08

check what's going on inside the eyeball or at the back of the eyeball, that those are the examinations that you'd really need proper diagnostic tools for,

6:17

which they wouldn't have, I guess. Absolutely. So the modern screening now with instrumentation,

6:25

they're a little bit more sophisticated than they were, say, 20 years ago, where they can use instruments to pick up difference in the prescription

6:34

between two eyes. So you might have a child who's very long-sided in one eye, but you won't know about it because they see well with the other and they're

6:42

not showing any outward signs. Or they have instruments for picking up those differences. But again, we're talking about picking up the 5 to 10% of kids who have

6:51

more obvious developmentally-based eye problems. But yeah, it doesn't look at eye health and doesn't look at those subtle things

6:58

around eye teaming and tracking and things like that. And I guess often the children themselves don't know if they have vision problems,

7:07

so they're not going to stick their hand up and say, Mum, take me to the optometrist, are they?

7:13

Yeah. And look, they don't know what blur is.

7:18

And if they've been seeing that way since they were younger, then that's their normal. I still remember having a young boy come in at seven.

7:27

And this is back in the days where sometimes screening programmes would come and go.

7:32

They've been a lot more regular now. And he came in and he seriously couldn't see letters

7:40

on the chart that were this big. And looking at him, he looked perfectly normal.

7:46

He rode motorbikes. And he was not able to see things this big and had no issues riding motorbikes.

7:54

And so he was obviously, I think we saw him at seven or eight years old because he was starting to notice that he wasn't seeing what the other

8:01

kids were seeing in the classroom. But there was nothing about his behaviour away from school that

8:09

would indicate anything because he was so used to seeing like that. That was his normal.

8:14

It's not even just kids, is it? I got my first set of glasses as an adult, and I think everyone who wears glasses

8:22

probably has a story like this. When I put my glasses on for the first time, I remember I was at the optometrist office and it was 5:30 in the afternoon or

8:32

something, and I walked outside and I could see the sunset in vivid colours. I thought to myself, Is this what a sunset looks like?

8:39

I've been missing out on it all these years. So sometimes you just don't know you've got a problem until it's properly tested.

8:47

That's right. Obviously, if something suddenly shifts, you've got a reason to your brain picks up on it.

8:53

But if you get these slow changes over time, then you just adapt. It's not until you're confronted something that you're performing

9:01

differently to somebody else. And I got a similar story with seeing the leaves on trees that I didn't

9:06

realise you went to until I got my glasses as a teenager and went, okay, I am meant to see that from this far away.

9:13

Well, that maybe leads us to the next topic, which is children's eyesight.

9:21

So when children are born, they're not blind, I have to assume,

9:27

at least in most cases. But their eyes aren't fully developed either. So there are some developmental milestones that they go through.

9:36

And so in those early years when our eyes are developing,

9:42

and even perhaps later in the teenage years, how often do you recommend that

9:49

kids get their eyes checked? What are some of the key milestones there?

9:55

It's really about, and again, if we move away from eyes and talk about vision, you basically, our eyes are tools that our brain

10:02

uses to understand the world. It's really the brain learning how to move the eyes and how

10:08

to interpret the information. One of the first common critical points that we look at is

10:14

by six months old, an infant has started to really organise how the two eyes work together.

10:20

So you're wanting to check that they've hit that first developmental milestone, that there's no sign of what they call infantile strabismus.

10:29

And again, we're talking about a few % of do that, but you still want to check. You may want to get a sense, particularly if there's a family history

10:37

of eye turns or high prescriptions, that's a good time to start getting a sense of, are these kids in where do they sit on the normal range?

10:46

At that age, there is a very, very broad range. So you're looking for overall global signs that they're using the two

10:54

eyes together and that they're able to shift their focus and everything's looking healthy at that stage.

11:01

So it's a first marker. And certainly, if there's a family history of high prescriptions from an early age or

11:07

a family history of eye turns or lazy eyes or eye surgery, someone's grandparent had an eye surgery when they were little,

11:14

then I would be saying, look, you probably, that marks you as someone where having a general checkup is a probably good idea at

11:22

six months old to get that first bar set. Then the next phase is around the

11:30

two to four year old age group where they're starting to be more mobile.

11:36

They're getting more control over being able to separate their eyes from their head and body movements.

11:42

They're starting to pay attention to find a detail. You're able to get, sometimes in that age,

11:51

almost an adult test done. But if you're using the appropriate kid's symbol chart rather than letters,

11:57

you can quite often get a fairly good complete visual exam done.

12:04

But you're starting to look at that more finesse in how they're using the two eyes together.

12:09

You may even start when they're getting at a four-year-old and start looking at visual processing. Are they starting to interpret things at an age expected level because you're

12:18

starting to get into that free literacy skills that you're looking for.

12:25

And again, looking for any deviations from normal visual

12:31

development that the kid might not outwardly show. And then you move on to your real getting

12:39

into your school readiness testing. And that's where we more heavily look at focusing, eye teaming, visual processing.

12:48

We really want that happening around that prep Grade 1 marker.

12:55

And then it depends on the child's progress through school.

13:01

If there's any concerns about how they're progressing, you may want to get them checked annually, particularly if there's a family history of some issues.

13:09

But after that point, then probably a couple of years later, you want to be looking into

13:16

we tend to loosely break them up into what are the learning how to read skills, and then there's using

13:26

reading for learning skills. So when the kids are entering late grade 2, grade 3, there's a change

13:34

in what's expected of them reading. They've been transitioning from learning how to decode words

13:41

to then starting to actually extract a lot more meaning from what they've read. So the print size gets smaller, the amount of work that they have to read

13:51

gets bigger, and they're having to comprehend a lot more. And so that places a lot more demand on finer eye teaming and focusing skills.

13:59

And so we're starting to look out for those common binocular visual dysfunctions and accommodation dysfunctions,

14:07

which is the technical words for eye teaming and focussing issues.

14:13

And then after that, it's you want to patch in every couple of years because things change, and then you're also starting to look

14:18

for signs of myopia development. Again, that's where you start to lose your distance vision.

14:23

That's particularly important. It used to be that if you have a family history, obviously that

14:30

predisposes you even more, but it tends to be a modern life problem. I think we discussed last time that the prevalence is

14:36

increasing in that one as well. So it loosely comes around every 2-3 years is what you want to be looking at.

14:44

Right. So just to clarify what age is a good age to be thinking about myopia control.

14:53

Is it five, six around there or even earlier? Yeah. Look, it's a changing

15:02

face that depends on your demographics sometime,

15:07

but certainly 5 years old is where you get your first marker of being able to understand the likely risk of a particular individual,

15:14

maybe progressing towards some myopia. So we look at their family history, we look at what activities they're into,

15:21

how much time they're spending outdoors, and we're able to get also an idea from what their current level of prescription is.

15:28

So even if they're not short-sighted yet, there can be sometimes some signs that they might be moving in that direction and be able to counsel

15:36

the family on how often we need to check them, it might become more regularly, and what activities and

15:44

changes to their lifestyle that they should be looking at doing as a safety valve. Well, one of the common treatments that I

15:54

know that you recommend for myopia control is contact lenses, like ortho-k contact lenses,

16:04

and even some of the other soft contacts, like the MiSight lenses,

16:10

because they have certain special technology built into them that

16:15

reduces stimulus for eyeball elongation, which causes myopia.

16:21

Now, I guess for a lot of people, contact lenses sound good in theory

16:28

until it comes time for them to actually insert them. And that's where we run into some challenges.

16:36

So can you give us some tips? What are some of the things to think about when we're learning how

16:44

to use contact lenses or when our kids are learning how to use contact lenses, if, for example, they have myopia?

16:50

Yeah, look, the kids can be a... It's a very much individual...

16:55

You take each case as they come. I don't have any strict cut offs when it comes to the kids

17:01

but generally moving into contact lens wear, regardless of whether you're a child or an adult, the number one thing is it is a process.

17:09

It does require some learning. It is actually a quite a fine motor skill. It requires some patience.

17:16

You have to get used to the idea of putting something on your eye.

17:22

Sometimes, particularly for adults, it's sometimes it might be a bit challenging to actually see the contact lens.

17:29

So we've got to work on text techniques and learning how I get this thing lined up on my eye if I have trouble seeing it.

17:35

So the number one thing is just understand that it is a process and takes time. I don't like any of my patients feeling like

17:44

they're failed if they don't get it the first time. And I always say to them, the last thing I want to see is that you've given up way too early or you felt like you were not good enough.

17:53

And so I say, I'll keep going while you're motivated to get you there. And my I wear contact lenses regularly.

18:02

My own journey was a little bit up and down. So I understand that I'm one of those people that took more time.

18:10

We can't get it first go. And so probably the number one thing is just being patient with the process.

18:16

And I don't measure chair time in my practice from a success rate.

18:21

If you're motivated, I don't see any difference between getting

18:26

the lenses in and off the first time versus taking 10 goes to get it done. It's all part of the differences in everyone's journey.

18:33

That brings us to the other speed thing. A lot of people, they get nervous and they start to rush.

18:39

One of the number one rules when we're learning how to take lenses on our off is just take your time, go slow.

18:46

People are fearful of hurting themselves. And the eyeballs, yes, look, they're our precious sense and we treat

18:53

them as they're delicate as we should do, but they are actually reasonably robust. But we do need to take time and if you're obviously concerned about hurting

19:02

yourself, then going fast is not the answer. Doing everything slowly is the key one.

19:09

And I find that once people are able to calm themselves and just take time

19:16

in the insertion-removal process, that's when they start to become a lot more successful.

19:21

And probably the final part of that is if you're taking time, you become a lot more aware of where your eyelids are and how to manage those.

19:32

That's probably one of the biggest factors of trying to get a lens on is just managing how wide your eyes are, managing the control of your eyelids.

19:42

And so once you get your eyelids in control, once you're going slow, then

19:47

the whole process becomes a lot easier. Okay. I got to admit, I'm one of the biggest chickens in the world when it comes

19:56

to anything, like putting anything near my eye, like if, whether it's, whether it's knives,

20:03

scissors or knitting needles, if anyone in the room got those, I'm giving them lots of space.

20:08

But still, I got used to putting contact lenses in my eyes so if I can do it, anyone can do it.

20:14

And I think that a lot of people have that initial, recoil about touching

20:19

their eyes, don't they? Yeah, look, and it's there for a reason. We have these protective reflexes,

20:26

and you've got the logical part of your brain has to override the reactionary part of your brain to get there.

20:36

And that's again, that's where it's a time and requires patience

20:41

to chip away at that. And I guess hygiene is important as well, making sure your hands are

20:47

properly washed, that thing. That's important. Clean hands, clean lenses, clean cases. Absolutely.

20:53

And we talk a lot about water being a risk factor for the contact lenses and being

21:00

very careful around water activities and getting water on the lens when you're inserting it. But the second biggest source of infections is actually dirty cases.

21:10

So it's really important to keep your cases clean, replace them as you've been advised to do.

21:16

And I think this is where kids often do really well is that the parents being in charge and supervising, typically the infection risks

21:27

are very well managed by the parents compared to maybe some young adults out there looking after themselves.

21:33

So my experience with contact lenses was only the soft variety. I never actually even tried the RGP, the so-called hard contact lenses.

21:43

Do you get many patients who wear hard contact lenses? And if so, is it more of a challenge, or do you find that it's just much

21:51

of a muchness between using RGP lenses versus soft contact lenses? Yeah, look, when I first started my training,

21:58

soft lenses were not new, But certainly newer. Back then, hard lenses were still the healthiest lens for your eye.

22:06

One of my mentors, and we talked about his son off camera, Damon Ezekiel, his father

22:13

was one of the pioneers internationally. Australians have got a very long history of being pioneers in various forms

22:23

of the contact lens and ortho-k space, which is something we can be quite proud of. A lot of the instruments that we use that are some of the top in the world are

22:29

actually created I'm looking at purchasing another one after being at the conference, and there's some great technology coming out of this country.

22:36

But what Don used to say was that hard contact lenses are hard on you mentally initially to get used to wearing them, but they're very soft on your eyes.

22:45

They still do have one of the lowest complication rates, but they are a challenging lens to get

22:51

used to in the Australian environment and what I find in Queensland because of

22:56

the heat and our outdoor lifestyle means we're out in the dust

23:01

and the sand and things like that. The old soft lenses used to be, Don used to say, soft on you mentally,

23:09

easier to get used to, but harder on your eyes. But with the advent of newer materials, single-use wearing modalities,

23:18

then a single-use lens is getting pretty close to the low complication

23:25

rates of a hard lens. But they still have a place. Hard lenses have their place for certain things. Without hard lenses, we wouldn't do ortho-k.

23:34

Without hard lenses, we wouldn't be able to restore good vision back to people with keratoconus.

23:40

I have to say that if I have someone sitting in my chair who's worn contact lenses for 40 or 50 years of their life, they're usually a hard lens wearer.

23:49

So they're still out there. Absolutely. And so there's still a place for practices like mine where you still want to have

23:56

a skill set and being able to fit them because those people are out there wearing them.

24:02

And there's no good reason to necessarily move them into anything else while they're still doing well. Well, to keep it personal for me.

24:12

So I told you, I started wearing contact lenses years ago. Then I stopped and I went to glasses.

24:17

And I'm actually now thinking about going back to contact lenses for various reasons.

24:23

And I know this will come as a shock to you, Paul, but I am over 40 years old. And I guess that's fitting someone with contact lenses

24:31

who is middle-aged or older is somewhat different to fitting a young adult or a teenager.

24:37

So are there differences in that whole process? And how would ortho-k or other types of contact lenses suit

24:48

somebody like me, for example? Yeah. Look, probably the two things that we deal with once we have

24:55

anniversaries of our 39th birthday is probably the prevalence

25:00

of dry eye is a bit higher. We have to be looking at managing that as part of

25:07

our entry into contact lens wear because contact lenses do demand more of your tear film. We want to make sure that you're able to be comfortable.

25:15

Maybe even just choosing the right lens material can help with that.

25:21

Probably the second biggest factor is that if you were someone who wore a distance

25:28

correction for, say, astigmatism or for myopia when you were younger, when you were short-sighted, you would find that you had a single

25:36

vision lens, corrected your distance, and it didn't matter what you picked up. You could look at something close, you look at something further away,

25:43

and you could see clearly at all distances because you're, and I'll use the model from last time, a crystalline lens inside

25:52

our eye changes shape when we're younger. And that's what defines what happens when you are in your 40s and 50s, that this

26:01

lens starts to become less flexible. The prescription you have to maintain good distance vision is

26:08

different to the prescription you need to read. That's when people start talking about wearing multifocals or bifocals or having

26:16

to take reading glasses on and off and all of that frustration. That's something that we're dealing

26:22

with when we look at what are the alternatives to wearing glasses.

26:31

We have to do effectively what we call a provided depth of focus or simultaneous vision.

26:38

Rather than being a multifocal situation, which is different to the whole finding

26:44

the spot in the glasses to wear, is that we set you up where you've got

26:49

focusing available at all distances and your brain has to learn how to use them. There's a little bit of getting the brain to learn how to do it,

26:57

and that is entirely possible. We're not too old to learn.

27:03

Again, it goes back to the patience discussion. We need to be patient to understand that if we're really motivated to get some

27:09

freedom away from glasses, then the brain needs to learn how to use these depth of focus lenses. There's a couple of ways we can do that.

27:17

One of the old methods was called Monovision. We had one eye corrected for distance, one eye corrected for near.

27:24

The brain was able to use the peripheral vision from both eyes together, but then it would select I'd actively choose which eye it was using for, say,

27:32

the detail at near versus the detail at far. If we're going to do that correction, we can do that in a contact

27:41

lens or ortho-k the overnight lenses that you sleep in, we can set up someone with

27:47

a monovision situation. It's a little trickier in ortho-k than fitting just distance only.

27:57

We need to carefully choose who's going to be a good candidate or not. If someone's a good candidate for that, the advantage is that you're not

28:05

wearing any lenses during the day. So it somehow negates those mild dry eye situations.

28:13

And we obviously check that as a case by case basis.

28:19

Probably the thing that we're doing more of is the multifocal. So multifocal, and again, we prefer to use the word depth

28:26

of focus, where you're wearing a contact on each eye that has both distance and near vision available.

28:33

And your brain, over time, learns to use which part of that focal

28:40

length for various distances. So the magic of ortho-k is that it reshapes, at least temporarily,

28:47

it reshapes the cornea, the front surface of your eye, doesn't it? Correct. I was going to say, and that's something where

28:54

with short-sightedness, it's been very commonly used, and there's a few of us who are using it for that more long-sightedness treatment.

29:02

We have to be a bit more selective about who it works for, but if you got someone who's motivated and getting a little bit of dry eye with contact lenses, that's

29:10

certainly an option we might look at. Well, so I was just going to say that that whole front of your eye, the cornea.

29:18

So there's a lot of... Feel free to use your model there, if you like. There's a whole complex physiology in how our eyes work.

29:27

And the cornea is an important part of that. And so before we started this interview, we were talking about keratoconus

29:35

and how you talked about that with your colleagues at the recent conference on the Gold Coast.

29:41

So maybe this is something that a lot of people don't know about. I wonder if you can just give us an introduction to what is keratoconus?

29:48

What does it mean? What are some of the things that we're learning about it now?

29:54

Yeah. Look, so keratoconus is quite common on the Gold Coast.

30:00

We've got a fair bit of experience dealing with how we restore sight to someone who's got Kera Taconis.

30:07

We have the cornea, which is the clear window

30:12

on the front of the eye. It's the first really part of the lens system that the eye is. We generally talk about it being a fairly spherical regular shape.

30:23

Technically not true, but for our intents and purposes, it is. With keratoconus what ends up happening is that you

30:30

end up getting irregularities in the shape of that cornea because it starts to bulge.

30:38

Now, back when I was first learning about keratoconus, we would have said it's

30:44

probably one in 2000 people who had it but there's probably more like one in a 100.

30:49

It's not because there's more people now with keratoconus, it's that our equipment that we can use now, and that's some of the Australian made

30:58

equipment that I was talking to, where we can get very good electronic shape maps

31:05

of the front of the eye. They're very, very sophisticated. Even mild cases we're able to identify.

31:10

Now, they may or may not be people who progress to needing specialty contact lenses. They may get away with regular glasses or regular soft lenses.

31:18

But we do think the prevalence is a lot higher. They talk about it being a combination of nature versus nurture,

31:28

like a lot of things. The nature nature being that, yes, it is inherited, but it's not like your dad had it, so therefore you'll have it and therefore your kids will have it.

31:38

I think the hereditary is like one in 10 and not necessarily

31:44

directly in that generation. Atopy or allergy seems to be a big component.

31:52

One of the number one bits of advice out there is that if you have

31:57

itchy eyes, do not rub them If you're the one in 100 who has

32:04

the predisposition to having keratoconus, the last thing you want to be doing is rubbing the eye, because what happens is the cornea is made up of collagen

32:14

fibres that are lined up over each other. In keratoconus they're not well stuck together.

32:21

So you have the natural pressure from inside the eye pushing against the back of the cornea. Well, if you then go and rub the front, you've got pressure in both directions

32:32

and those fibres start to slide. And if they start to slide, then the cornea becomes

32:37

thinner and it starts to bulge out. Now, if it bulges, it's not a spherical shape anymore and we can't use a regular lens to correct your vision.

32:44

The number one thing is, like anything, prevention is better than cure. Avoid the eye rubbing at all costs.

32:51

And if you have itchy eyes, go and see an optometrist to get some assistance in treating that allergy.

32:58

It's probably the number one first step. And keratoconus is not super common in nine-year-olds, but

33:06

that's certainly the youngest I've seen. And so we need to be mindful of it even in our kids and teenagers.

33:12

And it's typically most progressive between teenage years and 30 years old.

33:18

That's the key time where you really see the progression. Yeah, so eye rubbing is the number one thing to avoid.

33:25

If you are unfortunate enough to then develop keratoconus,

33:31

then you might find that it starts out that you have a little bit of blurred vision. You get some glasses, it makes it a bit better.

33:38

But down the track, your eyes are changing very rapidly. It may get to a point where you find that even with glasses on, you're

33:46

just not getting satisfactory vision. It's always blurred. You might get stariness and flair at night around lights.

33:52

You might have tried some contact lenses, but you're just not getting satisfactory vision with it because, like I said, that shape shape is no longer

34:01

what we consider regular. It's out of shape now. I've heard some optometrists described as being the pointy

34:09

end of a football, whereas instead of being more like a soccer ball and regular, it's more elongated, isn't it?

34:16

Yeah. Probably the one example is that they talk about we give different names

34:24

to different types of keratoconus. The two common ones are what we call a nipple cone, and one's called oval cone.

34:30

And it's called a nipple cone because it's like a little bump popping out of a round surface.

34:35

And so it's almost like a peak rather than...

34:42

The key part is that the centre is a completely different shape to the tissue just beside it.

34:48

It's very, very steep in the centre, and then it becomes... And there are some surgical remedies and also non-surgical

34:57

remedies for keratoconus, aren't there? So can you tell us a little about those? Yeah. And so a particular treatment that's become

35:06

a very important part of progression control is a thing called cross-linking. So this is where if we pick up keratoconus in someone

35:15

Then we're going to work with eye specialists, refer them to eye specialists who have the skills to provide the cross-linking, where

35:24

what they're trying to do is get those collagen fibres to stop slipping and freeze them together.

35:31

And now, unfortunately, that if you've had some reasonable change in your corneal shape, it doesn't necessarily put it back to normal anymore.

35:40

The whole idea is to stop it from progressing. So we still may need to use special types of contact lenses

35:49

to get you clear vision again. But the key part is we want to be able to try and stop that eye from changing as well.

35:55

There are other forms of surgery that once you've had cross-linking, they might look

36:01

at certain types of corneal implants. I've seen those come and go.

36:08

Some surgeons use them, some surgeons don't. Probably the critical part is getting an opinion for cross-linking,

36:14

though, in the early phases of finding out that you've got a kerotoconus. I guess the non-surgical solutions would be like specialised contact lenses,

36:24

for example, scleral lenses. Can you tell us what they are? Yeah. Again, if we Thinking back to this discussion around

36:32

hard lenses, what is a hard lens? Well, it's a hard plastic, and the advantage of that is it

36:37

provides a round surface again. If we have a look at the way a hard lens bends light.

36:45

So we look at the cornea bend light, water bend light, and the tear film is effectively water, and the hard contact bend light.

36:54

So when you put them all together and the tear film fills up the gap behind the cornea and the lens, it all becomes a brand new lens,

37:03

and now the contact lens provides that smooth, round surface to look through again.

37:08

Whereas a soft lens, if we've got a bumpy cornea, soft one goes on and then just wraps to it.

37:13

So that's why they're not very successful at correcting it. We want something that's going to clear over that bumpy part and provide

37:22

a nice round surface again. And that can vary anything from a

37:30

special version of the traditional small hard lens.

37:35

And it might go to something that's as big, if not a little bigger than a soft

37:41

lens, depending on the needs of the particular patient. It does require some special equipment and trial sets to be able to do that.

37:47

So one of the things we invested in early in the practise was a topographer, and that's where we can get some very good shape maps.

37:55

But usually we're then using a combination of software programmes to design lenses

38:02

and actual fitting sets to be able to find out an individualised lens for a patient.

38:08

All right, Paul. I think there's been a lot of really good information coming out of this interview,

38:13

something in there about something of value for young kids, for teenagers, for young adults, and even us greyhairs.

38:20

I think that we got some good tips from that. Just remind people how they can get in contact with you and your practise.

38:27

Okay, so it's HarmonyVisionCare.com.au our phone number is 07-5520-5900

38:35

we're on the Gold Coast in Varsity Lakes, and you can find out more about our services on the website, and you can even book appointments through there.

38:43

Like I said, the phone number is there if you feel like you wanted to discuss your situation a little further with us. All right.

38:49

Well, so if you are watching this and you found this content valuable, don't forget to hit the LIKE button because it really helps us

38:58

out in the YouTube algorithm. And also hit the SUBSCRIBE button if you'd like to be notified when Paul releases

39:05

more highly valuable YouTube videos like this one. All right, Paul. Well, thanks a lot once again.

39:12

Appreciate the opportunity. Thanks, Paul. Okay. Goodbye, everyone. Have a great day.