I remember the day when I came for the interview at My-iClinic, they told me that as a Marketing Assistant I would have to concentrate mostly all of my energy on marketing. As a person with 20/20 vision, Gosh I probably did not know what 20/20 meant at that time, I just took it for granted. Just the idea of working in healthcare was exciting at that time, however, I did not fully understand or trust lasers at that point.
                                                  
The story is that my ex had laser eye surgery the previous summer and I could see how much happiness and self-confidence laser brought in his life… so I decided to embrace this challenge.
 

In January my introduction to laser started, I had training by a lady from Zeiss, and at the end of February I finally knew how laser worked.

 
After talking with ophthalmologists, optometrists, many patients, and actually seeing results from laser, particularly Smile laser, I was fully convinced that every person that is suitable for laser should definitely have it done. I was a laser brand ambassador, I would attend events, go out with my friends, meet new people and promote laser, I could speak about laser for hours without realising it. I truly believed that Smile is the best… option for anyone that wears contact lenses or glasses and I still believed that…

 

                        but recently something happened that changed my way of looking at this solution drastically. 
 
 Let me explain!
 

I used to think that laser, particulary-Smile is a miracle more than technology, now I truly think that it’s the technology that makes it look like a miracle. As a tech savvy millennial I truly understand that technology nowadays is more developed than most of us can truly understand, however I used to think that the technology for Smile was far beyond what my mind could understand, and somehow in my mind I trusted laser just because I trusted Zeiss and Mr. Bolger.    

 
Last week we had a CET event at the clinic, with a Wet lab for SMILE (a unique experience for optometrist where they can perform surgeries themselves on porcine eyes). After weeks of organisation, the event started at 18:30, everything looked amazing the people, the food, the atmosphere, the information, it seemed to be something new and innovative for them. 
After the nice lecture by Mr. Bolger, the group was divided into smaller groups and I joined one of them to do the Wet Lab.
So here the fun begins:
 
Everyone who truly knows me knows that I have a huge, I mean really huge phobia of blood, I just can’t even talk about it. But after 3 optometrists tried to do the laser on the porcine eyes, I curiously asked: “May I try to do it as well?”.
 
With no hesitation, they put the poor porcine (pig) eye on the laser stand and gave me the control over the laser.
I started moving the joystick to fix the eye in front of the laser. Although, I am a pro at playing Need For Speed on our PlayStation at home, I found it very difficult to move, probably the responsibility of improving the pig’s vision made it so difficult. After moving it back and forth for about two minutes the eye was sitting at the right place. Should mention here that the laser even stopped moving when I was on the right point even though I was pushing the joystick forward?
 
                                                                   “Wow very smart and safe technology”  I thought.
 
I pressed the pedal like when I play formula 1 on the trace in Monaco, and in just 27 seconds the cut was done. Now the important part… they gave me an instrument that I had use to find the cut, in 10 seconds I switched to the other side of the instrument, what I had in my hands looked like a small spatula through the big microscope in front of my eyes. I separated the tissue with it. Switched the instrument for what looked exactly like the one I use to perfect my eyebrows, then inside of the very small cut the laser did and took the small piece of tissue out exclaiming

                                                                   “Is that it? That is what makes a person myopic”

What I was holding with the tweezers looked like a very small piece of skin smaller than the white line from my French manicure, it was so small and it looked dead. I was shocked I just couldn’t believe that this tiny, super small piece of tissue makes people wear glasses, put in contact lenses and cause more trouble to their vision. I was amazed. Amazed with what laser did, amazed with what I did, amazed about the possibilities, amazed about the process in general.
 
That made me realise, that it is not laser that actually performs the surgery, what laser does is just cuts that excess of tissue, the laser is like a very precise knife that magically can separate the tissue. The overall work is done by the surgeon who needs to make the calculations, separate the layers and take out the excess of tissue. And you know it doesn’t look as scary as you imagine!! It is quick, safe and I am sure porcine eye didn’t feel anything.



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As you’re reading the pixelated words projected onto this screen, I regret to inform you that your eyes are losing their childhood suppleness. A downhill slope awaits.

Presbyopia is caused by the loss of elasticity in the lens, typically affecting middle and old age; screens only hurry this process. Perhaps you’ll combat presbyopia by distancing the screen with an extended arm; this is a somewhat reflex act that attempts to combat squinting, by making it easier for the lens to focus. Or you might enlarge the font size to a progressive/regressive (depending on your attitude) level. Both of these measures, however, combat the consequences rather than the root of the issue.




Laser eye surgery combats the root of the problem, as it ensures vision is lastingly corrected.



But we must also look beyond the eye, and into the cause. Screens. Our dependence on them and the addictive nature of brightness. Like morphine, it persuades us to increase the level ad nauseum until we find we are blinded like moths to a bulb.



Perhaps we should change the objects we look at, as well as our perception of them. With the rise in Virtual Reality, are phones becoming our reason for vision?



Where is the ink? Displaced from the physicality of the page, it now exists somewhere upon the screen. But precisely where? The bulbs that create the screen emit light, rather than definitively place it in the realm of the physical. Our eyes now have to do the positioning.



Let us cast our minds back to our ancestors. Before the reign of technology, our eyes dwelt outside, exposed only to the natural elements. Our gaze transitioned from the panoramic highlands to compressed, short-sighted city settings, and we spend more time than ever with our eyes glued to the screen.



Anti-glare technology, rest breaks, blue-filtering lenses and blinking help to reduce eye-strain. 65% of American adults complain of eye-strain.

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Leonardo Da Vinci wrote in his diary “this is the eye, the chief and leader of all others” (1500s). Da Vinci explored the notion of the eye as an optical instrument, and his conceptual search for the science behind sight eventually gathered material momentum with the aid of his various successors: the Camera Obscura came into being a century later, powered by nothing but sunlight and a biconvex lens.





In some sense, this ancient contraption is a scaled-up simplification of the human eye. It is an optical device that projects an image of external surroundings onto an internal blank screen. Light passes through the pinhole, and the biconvex lens flips the image 180 degrees. Colour and perspective is preserved, and in turn, projected onto a screen on the other side of the room. Think of the dark box-room as the interior of an eyeball, and the screen on the back wall as the retina.


Invented by an artist, and used by artists, the camera obscura is essentially a practical extension of the human eye, designed to enhance detail and map reality directly onto paper. Once in circulation, the camera obscura underwent a variety of alterations. In order to aid drawing, it was reduced to the sizeable convenience of a box, in which a mirror re-reversed the image.






Throughout its various stages of development, its slight alterations have given rise to a plethora of charming names: Mozi’s “Locked Treasure Room” or “Collecting Plate” became Gaspar Schott’s “Magic Lantern”, and by the 18th Century, it was known as Conte Algarotti’s “Optic Chamber”.



It persists in Modern Culture; in February earlier this year, a model was installed in the New York Public Library. The Oakes brothers, dubbed “The Perspective Twins”, are conducting an exploratory journey into the origins and mechanisms of sight, specifically bifocal visual perception. Their investigation aims to detail the spherical distortions dictated by the curvature of the eyeball.   



If this hasn’t convinced you enough of the wonders of the human lens and its purposes in the field of photography, go and have a listen to the delightful band “camera obscura”, whose name pays homage to this ancient wonder.


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Our expert paediatric orthoptist Rudrika Joshi-Borrel tells us all about vision development in babies:



Did you know that almost all babies are long sighted when they are born? In most cases the eyes will correct themselves within 2 years, in a process called emmetropization.




As an orthoptist, I am a specialist in helping people with squints and similar eye conditions. If I am examining a 2 year old child, glasses are not always necessary due to the commonality of long-sightedness. On the contrary, short-sightedness in children of this age is much more unusual. Read more about long and short sightedness in our blog: "What are myopia, hypermetropia and astigmatism?”



Emmetropization is when the eye’s process of aligning its axial length to the focal length of its optics; however, imperfect alignment causes short-sightedness, and both genetics and environment can have an impact upon this process. For example, there is strong evidence to suggest that children who less time outside are more at risk. (refer below for the studies). When emmetropization doesn’t happen, light entering the eye isn’t properly focused on the retina and so the brain receives a blurred image. A secondary effect of this is that neural pathways in the brain responsible for sight start to get ‘lazy’, thus working less effectively.



An eye test, called a refraction test, needs to be done in this case as this measures which prescription lenses the child will need in order to correct their sight. If the child is given the right prescription, their vision be immediately corrected whilst wearing the glasses, and refractive adaptation will begin. So wearing glasses can actually exercise the visual system in such a way that the eye and brain eventually adapt to self-correct the child’s sight.


The more often a child wears their glasses the more adaptation occurs.There is a bit of neuroscience behind this; because the brain now receives a clear image from the optical nerves the visual pathways in the brain are stimulated to work properly. This reawakens the neural pathways.






Refractive adaptation does not always completely restore perfect vision, but does much to significantly improve it. Depending on the length of time the child’s vision has been left untouched, treatments such as occlusion may well be needed in order to further stimulate the cells, so the earlier the better. Research shows that a full 18 weeks with glasses is the maximum potential time period for refractive adaptation to have an impact, before occlusion is necessary.


Glasses make up for the miscalculation between the lens and the size of the eye; however, this will only slightly change as a child grows, as long as the prescription is very small. In these cases, the optician may advise them to wear their glasses as teenagers when at school, work, the cinema and whilst driving. For children under the age of 10, however, it is advisable to wear glasses full time.

The coordination of eye movement develops after birth once a baby sees for the first time. Whilst this development progresses it can be normal for babies to look slightly cross eyed up until about 6 months of age.



Naturally if you’re a parent you might be concerned by this, especially if it continues beyond 6 months. If you’re a bit worried, seek medical advice at the GP. If a problem is spotted then the GP may refer your child to a paediatric ophthalmic (children’s eye specialist), like My iClinic. From there a proper diagnosis and treatment plan can be made by a doctor if necessary.



If you are wondering who do you need to see, here is a list of specialists and what they do in the eye world:

Opticians and Optometrist specialise in glasses and eye tests, prescribing glasses and may detect eye diseases.

Orthoptists specialise in the non-surgical diagnosis, such as the management of squints, amblyopia and eye movement disorders, isolated and secondary to systemic disease.? Ophthalmologists are the medically trained doctors and surgeons specialised in the diagnosis and treatment of eye diseases and disorders. They can also perform “refraction tests” and prescribe glasses.


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Often people say ‘I am long-sighted’ or ‘short-sighted’, but for a lot of us who don’t wear glasses sometimes it’s difficult to understand what this means.


Fancy long and complicated words like myopia and hypermetropia make this all the more confusing.



Does short-sighted mean you can see things up close or you can’t? What makes a person long-sighted? How can glasses, lenses or laser eye surgery correct this? We can help you find the answers to these questions!



Short sighted or long sightedness occur when a person’s lens cannot focus light entering the eye in the right way on the back of the eye, also known as the retina.



If you are short-sighted (also known as myopia) you can see things that are up close, but can struggle to see things further away. This is because light entering the eye is focused in front of the retina, when it should focus on the retina. It focuses too soon. This happens for two reasons: either the lens focuses light too strongly or the eye is too ‘long’ meaning the retina is too far away from the lens. To correct this we give short-sighted people lenses that change (diverge) the way light enters the eye so once it is focused by their natural lens it focuses on the right place of the retina. These types of lenses are called minus, hence why short-sighted people get ‘minus prescriptions’.



Long sighted (also known as hypermetropia or hyperopia) is when you cannot see things up close. It’s exactly the opposite problem to short sightedness. This happens when light entering the eye is focused behind the retina; you can think of it like the eye focuses light too late. This happens when either the eye is too short and the retina is too close to the lens, or when the lens focuses light too weakly. To correct this we give long-sighted people lenses that converge the light that enters the eye so once it is focused by their natural lens it focuses on the right place of the retina. These types of lenses are called plus, hence why short-sighted people get plus prescriptions’.



Another term that we hear quite often when talking about disorders of the eye is astigmatism. It is caused by abnormalities in the cornea and the lens. Astigmatism can be described as the condition when the front of the eye is not a perfect round shape like a football, instead it is more oval like a rugby ball. This gives the front of the eye an asymmetric curvature so light scatters as it goes into the eye. This produces a jagged and slightly distorted image.

Some people are unlucky enough to have astigmatism as well as long or short-sightedness. Luckily short-sighted and long sighted don’t often happen together. But some people when getting older may get one eye short sighted and another one long sighted. Optometrists may leave these patients with uncorrected vision if they feel comfortable and would find glasses an inconvenience.



Fortunately, the wonders of modern medicine and technology mean there are many amazing ways to correct long or short sightedness! Glasses can be a low cost and even stylish solution, contact lenses although not always ideal can be a practical one. But there are even more exciting and amazing ways that vision correction can done now.

At My-iClinic our specialists are experts in two types of procedures that can cure long or short sight and astigmatism: laser eye surgery or refractive lens exchange. You can read more about these procedures on our website.


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