Every so often something happens that makes me smile – life gives you an opportunity which is a privilege to experience.  One came my way last week.

A mother brought her little girl into the practice as she had suffered a minor eye injury. We got her all sorted out and recommended a routine eye examination when all was settled. They had recently moved to Belfast from the other side of the world and spoke little English. Following a routine eye examination (with lots of gesturing etc.!), we found that she had a bucketload of astigmatism.  Astigmatism has a habit affecting the visual system in slightly unusual ways -  where you can see objects but the quality of the image is badly affected.

When I put the first lens in, she muttered something to her mum really quietly. I asked her mum to translate – she simply said “I can see.”  From her expression, it was evident that this was news to all concerned.

These lovely people have played on my mind for some time now.  Having recently moved house myself, I can identify with the stress it can cause (and my postcode didn’t even change!).  It is hard to imagine how life would be affected by moving country and having to learn a new language (and maybe alphabet also) – without significant sight impairment.

Any parent reading this can imagine the educational implications of vision loss.  Every day I see patients who during their childhood “slipped the net.” Sometimes they were branded ‘just a bit thick,’ or ‘not the academic type.’ In hindsight, they were working so hard to simply see the blackboard, there was no way that they could concentrate on the content.

Current education regulations state that Primary school children have their sight tested once during their primary school years.  This is usually a test performed in the classroom by a school nurse.  Time and funding implications limit the extent of the test.  So if you do nothing about your child’s vision, no one else will. Additionally, it’s all paid for by the NHS.

Children should be seen by an optometrist who is specifically trained to communicate effectively with those of all ages and abilities. We at  Petticrew Optometrists know that if the child is happy, we get more accurate clinical results. Little ones do not have to know their letters for us to examine their eyes.

A manipulative combination of extreme encouragement, reverse psychology and killer rewards like stickers and being ‘allowed’ to wear the silly glasses, enable us to get good results too.

Parents are consistently amazed that we got so much done and report that their kids really look forward to their next visit. As if kids actually enjoy healthcare examinations.

“Love is in the air” – I can hear you humming, “…just a whisper in the breeze”.

Well, as it happens – not only is it “in the air”, but did you know that it is in your eyes?  Research has shown that our pupils dilate, or get larger when we look at someone we are attracted to – or love.  Despite years of staring into peoples eyes (professionally or otherwise) – it has taken me some time to realise that you need to know what their eyes were like beforehand, in order to see if they are attracted to you.

Some scientists believe that the wide eyes and pupils of babies, puppies or other young animals are part of a Darwinian plan to promote a protective response from bigger and potentially threatening animals.  Even in literature wide eyes are good and narrow are not.

Much has been made of the attractiveness of big, saucer like, pupils over the years and in the last century, it was not unusual for ladies of high society to put Belladonna (the clue is in the title – beautiful lady) drops in their eyes to enhance their beauty.  Also know as deadly nightshade or atropine, optometrists still use it today, if they need to dilate the pupil in order to get a better look at the back of the eye.  The downside is that, while you may look ravishing, you will not be able to see your knight in shining armour. Oh – and don’t eat it – it was also a poison of choice in the Victorian era!

According to many people – the eyes are the winner when it comes to attractive parts of the body. I have to be careful here but the bigger the better – every lash-built, brow highlighted, crow’s feet free part of them!  My father had to return a jar of expensive cream to Anderson McCauley’s (“Pour les yeux fatigue”) after my mother threw it at him – granted it may not have been the most inspired choice for a thirtieth birthday present!  Many brands of ladies mascara, or ‘guyliner’ make a big deal about being ophthalmologically tested.  I have to smile at that – I haven’t seen too many ophthalmologists “in the Royal” or “up the Ulster” wearing eye make-up.

Top tips regarding eye makeup? The chance of eye infection can be reduced by not sharing, discarding frequently, washing your applicator brushes – or using your fingers (clean them first).  Should you get conjunctivitis – throw all eye makeup out.  If you do not – you will be constantly re-infecting your eyes.

Love to all our patients and happy Valentines!

1977 hit for John Paul Young – in case you were interested.

Stop smoking, eat five portions of fruit and veg a day, drink more water, go to the gym three times a week, save some money, stop biting your nails, learn a new language, play a musical instrument and be nicer to your mum.

Heard it all somewhere before? Maybe like this time last year? The doctors are telling you to do it, your nearest and dearest are telling you to do it, and those flipping public health messages on commercial radio are telling you to do it. Along with never return to an uncooked turkey – hang on, that might be fireworks.

It’s the time of year when we are all skulking around, lying to ourselves about why we didn’t make the life changes we promised ourselves last year. I remember some time ago when I personally stopped smoking three times. The first time for one month, the second time for three months and the final time for good. The first two times I told myself that, as I had found it soooo easy to stop smoking, I might as well smoke a bit longer – sure I could give up any time.

All this health stuff is largely to improve the health of our arteries, to reduce the chances of having a heart attack or a stroke but you may not know that it’s really important for your eyes too. The delicate structures in and around the eye are cleverly designed and incorporate a vast web of tiny blood vessels, which perform a very interesting function. The optic nerve and the retina are actually brain tissue and can be irreparably damaged if their needs are not met. They require a plentiful supply of ingredients and efficient removal of waste products, but are actually damaged by the presence of blood itself – we call this web the blood brain barrier.

One of the easiest ways of keeping these vessels super healthy and full of oxygenated blood is to stop smoking. Also, you can help the oxygen on its way by bumping up your intake of iron. A good dietary source of iron (apart from red meat) can be found in dark green leafy vegetables. Popeye relied heavily on spinach but if you are keen to avoid bulging biceps and are not planning to get an anchor tattoo anytime soon (to be fair neither has been scientifically linked to ingesting spinach) you might also want to think about broccoli, cabbage and kale. If it takes the green leafy veg to be tossed around in a pan with a LITTLE dry-fried pancetta, to get your juices flowing, well so be it!

While you are at the shop, why not throw in a bag of carrots? That wartime adage of “helping you see in the dark” is thought to originate from misinformation disseminated by the British Forces to distract the Luftwaffe from the introduction of RADAR. Patients often ask me if carrots are good for your eyes, to which I reply, “Well, have you ever seen a rabbit wearing glasses?” All joking aside, the humble carrot is a rich source of Vitamin A or retinol – a water-soluble vitamin which aids sight, in particular contrast. My new best thing is roast carrots with a dash of light olive oil and some cumin seeds.

My advice is to “Eat a rainbow every day.” It’s a cheesy saying but you might remember it – eat a wide variety of different colours of fruit and vegetables every day. As a spin off benefit, I find that filling up on fruit and veg means I don’t have room to go back for that extra sausage I had my eye on!

Probably more important than all of this is to get some exercise – little and often. Walk to the shop for a pint of milk rather than taking the car, take your grandchildren to the swimming pool or dust off the bike in the shed. Why not recycle all the useless junk in the roof space or get the garden cleared up – two birds with one stone. I think that the idea that we must get x amount of hours of vigorous exercise per week, is entirely unhelpful. Little changes are the thing…just do a bit more than you did last week – you might even enjoy it.

Having said all this, in my opinion, surely January is the worst time to make paradigm shifts in the way we live our lives. We love to think of fresh starts, saying goodbye to our bad habits, and waving cheerio to the events that signify the bad luck of the previous year. Unfortunately seismic changes to our lifestyle are rarely sustainable and January is depressing enough without cutting out all the fun too. If you can make it fun, maybe next year you won’t be skulking when it comes to New Year’s resolutions.

And no, we can’t help you be nicer to your mum.

My Dad used to tell me that he could tell that winter was here when the practice saw an increase in patients needing lenses replaced in their glasses. You could be forgiven for maybe thinking that this was due to trips, slips and falls, but no. Patients would go out for a lovely, long walk in the snow and then toast themselves by the blazing fire, at which point the lenses in their glasses would crack into several pieces. The moral of the story is – warm up slowly, you’ll avoid chill blains also!

At Christmas, most people will see a family member or friend who appears for the first time with a pair of reading glasses – presbyopia (or “old sight”) comes to us all.  You can imagine why us opticians prefer to use the ancient Greek and have moved away from the whole “old sight” thing.

Are you reading the jokes from the crackers just as easily as you did last year? Or are you struggling to see the screw heads on the new toy? It’s not that your eyes are changing, it’s that your arms aren’t quite long enough. The mutterings of ‘why do they print this stuff so small?’ or ‘the quality of print just isn’t what it used to be’ can often be heard.  Or are you one of those people who just reaches for the nearest pair of reading glasses to hand (yours or someone else’s) – in restaurant’s I like to borrow my wife’s false teeth.

When you or your family are back home from foreign parts, why not book them in for an eye examination? We’ll even look after your shopping for you if you want to hit the Boxing Day sales! Seeing a familiar face when getting your eyes tested is not only a lot nicer (usually), but improves the repeatability of results, detects disease sooner and improves clinical outcomes. Lots of our patients buy their loved ones gift vouchers for an eye examination or a set of funky new spectacle frames at Christmas time.

This year has been the busiest ever for us and we would like to say a big thank you to all our patients. We hope you have a really lovely Christmas and very happy New Year.

We have uploaded a new series of ‘Video Logs’ informing you on some of the issues dealt with on a daily basis concerning your vision.  Keep an eye out for more to come!

Night Time Driving

To view more uploaded video logs, simply click on the channel link at the top of the video.

Ensues a moment of unadulterated awkwardness as I wait for them to twig and say that of course that’s not going to affect their own eye care. I end up talking to my patients about glaucoma on a very regular basis because it’s really quite interesting – if you don’t have it yourself.

Glaucoma is a proper pain in the neck to provide care for. Firstly, usually it doesn’t give any symptoms until it’s too late. Secondly it’s common, particularly in those in the more mature bracket. Thirdly, there is no one medical test that gives accurate results regarding whether you do or don’t have it. Finally, it actually isn’t one disease – it’s a family of eye diseases…how very confusing.  This is why half of all glaucoma that exists in our world is undiagnosed.

What is so troubling about all this is that it is a permanently blinding eye condition, for which there is great treatment available, if only you knew to access it. I have heard it referred to as ‘the thief in the night,’ stealing people’s vision without anyone ever knowing. One of our local glaucoma specialists describes it as suddenly someone switches off the lights…for good.

Generally speaking glaucoma can be described as a condition where the optic nerve (the cable that takes the information from the eye to the brain) becomes damaged. This is usually in response to high eye pressure but not always. The particular pattern in which the nerve becomes damaged usually results in a loss of peripheral vision first, the ironic thing being that our brain fills in our peripheral vision with what it already knows to be there – hence we don’t notice a problem.

In my opinion the best way to make sure you don’t have it is surprise surprise…regular eye examinations from someone like me. In seriousness, regular comprehensive eye examinations from the same well-trained optometrist, is a great way to ensure it’s picked up at its earliest point so you can enjoy the fullest functionality of your cabling, whilst we are still above ground to enjoy it.

The optometrist can weight all the results from all the relevant tests over the years and combine them with your known risk factors to give a pretty good sensitivity and specificity. We have an unusually high proportion of glaucomatous patients in our practice because we tend to attract people with ‘unusual’ eyes…we think this has made us pretty good at picking it up as well as helping the specialists monitor it for progression over the years. As an optometrist, but more importantly as a patient who is at an increased risk of developing glaucoma, I can’t see why you wouldn’t.

For more information or to book an appointment, call Ann or Ali on 02890 323 341 or e-mail them at info@petticrewoptometrists.com .

Andrew Petticrew, Optometrist.

What is Keratoconus anyway?

I could write for about three days on what keratoconus is and how it affects people but in short, it is a condition which affects the cornea (the clear structure that lies over the pupil and iris). The cornea acts as the most powerful lens in the eye and consequently, the optical quality of this structure is crucial for good vision.

It is helpful to point out that the normal cornea is utterly incredible to begin with. It is the only living structure in the entire human body that is completely optically clear, the only structure in the entire human body which breaths for itself (from the air around us), and is the most sensitive structure in the entire human body with over 11,000 nerve endings per square millimetre.

I describe the cornea as being like steel reinforced concrete – it has a matrix gel (the concrete) and it has collagen fibres running through it (the steel reinforcement). It is the astounding regularity of the collagen fibres which gives the cornea its amazing optical clarity which is essential for visual function. Anything that causes these collagen fibres to become irregularly arranged causes the cornea to become cloudy. Just one example of this is the very clever pump which regulates the amount of water in the gel to maintain this regularity – to be honest, I find it incredible that it ever works to begin with!

Keratoconus is a condition where the collagen doesn’t work properly and the shape of the cornea becomes irregular resulting in reduced vision.

Do I have keratoconus?

Well, as it turns out, that’s a very good question. Keratoconus has a wide variety of different severities and presentations. There are a lot of people who are asymptomatic – they don’t have any problems at all and without specialist tests, neither they nor their optometrist would ever know.

The first tell-tale sign is often that the irregularity causes a prescription for glasses which changes more rapidly than usual or in an unusual way. But prescriptions for glasses often do this so in itself this doesn’t tell us what we need to know. The diagnosis can really only be made with analysis of the curvatures and thickness of the cornea using a number of specialist instruments and even then, there will be certain incidences where we miss it. There is a not very straightforward family link with keratoconus so if a family member has it, it is worth investigating.

What can be done for keratoconus?

Firstly it can be monitored – often it is not particularly progressive, so we do nothing more than watch it to see if it changes and talk to the patient about how they can manage symptoms and risk factors. Often the irregularity means that glasses do not give good vision and contact lenses are required.

There is a standing joke that the contact lenses we work so hard to design and fit aren’t really doing the work – it’s the tear lens created behind the contact lens, filling in the irregularity in the front surface of the cornea that corrects people’s vision. Designing the back surface of the lens is pretty tricky though – the keratoconic eye is a very very complex shape and all of them are different. And if I get it wrong, it can cause permanent scarring. To give you an idea, the lens which looks like a little clear bit of plastic less than a centimetre across, the back surface is designed, using over twenty different parameters, each of them accurate to five hundredths of a millimetre.

In order to get the very best performance possible, we use one of the widest ranges of contact lens manufacturers, types, materials and designs available anywhere in the UK – and there’s a reason for that. We have found the task isn’t easy and there is a lot to gain. Remember, many of our keratoconic patients can’t really see with glasses so contact lenses which give reliable crisp vision and all day comfort are very helpful.

Thankfully, there are loads of really innovative products and techniques available – and we are always scouring the journals for more. We use standard and specialist RGPs, piggy back with a range of different soft lenses, specialist soft lenses, corneosclerals and sclerals – we find that this gives us the best chance of getting a really good result for you.

More importantly, we stay hugely motivated to find the very best optical products for you. Regularly I find myself asking patients, “Yes, they are good, but are they good enough?” The question here is really whether the patient would like to put the time in to investigate other avenues. I joke that what we lack in skill, we make up for with pure tenacity!

Finally, we put it together with an aftercare package which enables you to pay monthly for everything we do. The aftercare means you can be sure you are looking after your eyes properly and investing in good eye health. Occasionally, the cornea becomes so irregular and thin that the care of a specialist is helpful, so we try to keep really good links with the local specialists who are at the top of the game .

If you would like to book a no-obligation appointment with us to discuss your keratoconus, give Ann/Ali a call on 02890 323 341 to book an appointment.

Local optometrist, Frank Petticrew, has this month been awarded the prestigious Herschel Medal in recognition of his outstanding original contributions to contact lens design and fitting – the first time an optometrist anywhere in Ireland has been given this accolade.

Frank Petticrew, who has practised in Belfast for over 50 years, was overwhelmed by the award commenting: “It’s traditionally a highly guarded secret to whom the medal would be awarded and I was totally taken by surprise. I’m delighted to have the good wishes from so many friends in the contact lens world, right across the spectrum of contact lens designers, manufacturers, scientists, educators and especially clinicians.”

Frank is the third generation of the Petticrew family to work in eye care, his father and grandfather being opticians and jewellers in their practice on Bow Street, Lisburn which was established in 1887. He is succeeded in Petticrew Optometrists by his youngest son Andrew who now fits specialist contact lenses in the family practice in Belfast.

Andrew commented: “When dad started to fit contact lenses, they were a really new technology and there was a lot still to learn. I think one of his greatest contributions was in the field of photography in contact lenses. Nobody really new how to do it and my dad did some fantastic work which enabled contact lens technologies to be developed and optometrists to be better trained.”

Throughout his career, Frank has fitted a huge range of different types of specialist contact lenses both in private practice and in the Royal Victoria Hospital in Belfast. Many of the contact lenses are used for people whose eyes are diseased or scarred. This means that a custom designed lens is necessary to be able to have any vision at all. He has also done some brilliant work fitting artificial eyes for people who have been disfigured in the troubles.

Frank has held a huge variety of different positions throughout his career including Past President of the Northern Ireland Optometric Society; an accolade he shares with his son. He has lectured all over the world including our very own University of Ulster, has been expert witness in many legal cases and has been awarded honorary membership of the Association of Optometrists.

Frank continued, “I have been fortunate to serve the people of Northern Ireland and have been lucky in my choice of specialism. I have enjoyed the work immensely and my patients have appeared very grateful for any help I have been able to give.”

“For many patients, contact lenses have completely transformed their lives, by improving the appearance of an unsightly eye or enabling them clear, undistorted vision where glasses couldn’t help. It has been my privilege to have the opportunity to help these patients work, bring up a family and lead a relatively normal day to day life.”

Andrew commented, “I couldn’t be more proud of my dad – he is an innovator and an excellent optometrist. The recurrent thought amongst our patients continues to be that he is a ‘true gentleman.’”

We think what what do here at Petticrew Optometrists is brilliant but the bit that we feel make the most difference to our patients is the eye examination. To show how determined we are to be better, we mystery shopped ten different optometrists practices, big and small, cheap and expensive, and had a full eye examination in all of them. It is with this knowlege we can say that we give the most comprehensive eye examination of all of them…and by a country mile.

If you want to know a bit more, why not have a look at:

http://petticrewoptometrists.com/eye-write/why-people-come-to-see-us/

http://petticrewoptometrists.com/what-our-patients-think/

Your sight is a very precious thing, book an appointment today by e-mail with Ann or Ali at info@petticrewoptometrists.com or telephone us on 02890 323 341.

Andrew Petticrew BSc(Hons) MCOptom.