Eye Health Archives | Peter D'Arcy Optometrist Bega

Covid -19 and your eye exam

Tue, 24 Mar 2020 14:26:47 +0000

Covid 19 symptoms can be avoided by wearing face masks. An N95 mask is ideal.

The outbreak of SARS-CoV-2 causing the disease COVID-19 was declared by the World Health Organization as a global pandemic on 11 March 2020.
Infection control by healthcare institutions is one of the key factors limiting the spread of COVID-19 and other nosocomial diseases.

The World Health Organization (WHO) and the Australian Department of Health maintain that wearing a face mask while seeing healthy, asymptomatic, low-risk patients is unnecessary. Nevertheless, wearing a medical mask is one of the prevention measures limiting the spread of certain respiratory viral diseases, including COVID-19. However, using a mask alone is insufficient to provide an adequate level of protection, and other measures should also be adopted. Patients sometimes would wear masks during testing of the visual field in automatic perimetry bowls. There has been some concern about uveitis and Covid 19 regarding the suspected adverse drug reaction of AZD1222 vaccination.

COVID-19 (SARS-CoV-2) is a novel coronavirus that is an enveloped, single-stranded RNA virus believed to spread from person to person via respiratory droplets. This occurs when an infected person coughs or sneezes or touches a surface with the virus present from an infected person, then touches their eyes, mouth, or nose.
Patients may be asymptomatic and infected and potentially have viral shedding for 20 days. Symptomatic patients typically present with a respiratory illness such as cough, shortness of breath and fever. Other patients may have eye pain, headaches and fatigue. The incubation period averages 5-7 days.
We are still open to looking after your eye health needs. We are taking every possible precaution to protect your health. We are sanitising all equipment each time it is used and prescreening before each patient attending to ensure that no one is displaying any symptoms associated with coronavirus.
• We use infection control methods, including face shields and goggles, P2, N95, and surgical masks, cleaning our practice, testing equipment, and consultation rooms before and after every patient use. We are being diligent with cleaning and disinfecting these areas for patient and staff safety.
• All staff are regularly using hand sanitiser and washing their hands thoroughly throughout the day. All staff are vaccinated against Covid 19
• We use the Visi2 centration system to take all our biometric measurements for spectacles, a contactless method.
• If you need to replenish contact lenses, fill solutions or collect spectacles and cannot come in, we will happily arrange for these to be posted to you.
If you have concerns about the health of your eyes and are unable to attend the practice, we can provide advice to you over the phone.
We are closely monitoring the current COVID-19 situation and following the guidelines released by both the Department of Health and Human Services and Optometry Australia to help prevent the spread of the virus.
• If you, or someone you have had close contact with, is diagnosed with COVID-19 and you have visited the practice within the last 14 days, we ask that you notify us as soon as possible to take appropriate and necessary measures. If you have any questions or concerns, please phone us on 64921999 or email us at peterdarcy.com
There is no requirement to cancel or postpone your appointment if:
• You are feeling well as we enforce social distancing and density requirements.
• HAVE NOT travelled outside Australia in the last 14 days
• HAVE NOT been in contact with any individual who has travelled outside Australia in the last 14 days.
However, courtesy to our staff and other patients, we ask that you have a cold, fever, sore throat, etc., to ring us before coming for advice.
The most common symptoms of COVID-19 are:
• fever
• flu-like symptoms such as coughing, sore throat and fatigue
• shortness of breath.
• Not everyone who has symptoms like these has COVID-19 as several other illnesses can cause these symptoms.

Fever above 38 degrees, cough, difficulty breathing, close contact, droplets
Isolate early, safety equipment, disposable tissues, hand cleaning, surface decontamination
Higher Risk Populations Some people at higher risk for developing severe illness from COVID-19 including:
• older people
• those with underlying medical problems, including high blood pressure, heart problems, diabetes, respiratory disease or immune deficiencies (low immunity).
• experience higher rates of chronic diseases than other Australians and may be at higher risk of serious illness.

What safeguards are in place if I am examined?

Patients are triaged over the phone or offered via a safe. Telehealth consultation, if appropriate.

Discretionary rescheduling of certain non-urgent appointments. Make tissues, face masks and alcohol-based hand sanitiser available in waiting areas. Perform frequent hand hygiene after contact with respiratory secretions and contaminated objects or materials
Follow respiratory hygiene techniques (i.e.. covering mouth or nose during coughing or sneezing with a medical mask, tissues or sleeve or flexed elbow, followed by hand hygiene). Immediately dispose of tissues into a hands-free waste receptacle.
Use appropriate PPE, such as surgical masks, P2/N95 masks, gloves, eye protection and breath shields for the slit-lamp
Use disposable equipment where possible. Perform systematic and enhanced decontamination of work surfaces after each patient
Staff not to attend work when unwell and also to have vaccinations as part of the employment. Encourage home delivery of spectacle/contact lenses to reduce the number of potentially infectious people visiting the practice.

Coronavirus causes and symptoms. What we can do

As well as employing Winix hospital-grade air purification, we receive daily updates from the relevant government bodies, infectious control medical experts. We are prepared and aware of the risks.
As health professionals, we have strict infection control protocols and sterilisation.
We clean all touchable surfaces between patients, including disinfecting frames after being handled.
We have all patients use our hand sanitiser upon arrival and when leaving the clinic.
If you feel unwell or have been in contact with someone who has, isolating yourself until you are all clear given the all-clear is the right thing to do!

TRISTEL DISINFECTION

Tristel Duo OPH is an approved Instrument Grade – High-Level Disinfectant.
Tristel Duo OPH is chlorine dioxide in a foam, designed specifically for the high-level disinfection of ophthalmic and optical medical devices. Tristel Duo is more compatible than alternative disinfectants such as sodium hypochlorite, aldehydes, peracetic acid or alcohol.

Tristel human healthcare products utilise chlorine dioxide for disinfection. Chlorine dioxide is a fast and effective disinfection agent activated at the point of use and does not carry many drawbacks of conventional disinfection chemistries. It has both a strong OH&S profile for staff and patients and material compatibility. The products are bactericidal, viricidal, fungicidal, mycobactericidal and sporicidal.

We use a Germidcidal lamp to sterilise frames that is powered with 253.7 nm UV rays that quickly remove every single micro-organism. The treatment does not generate heat. Frames and tools once sterilized can be kept for a long time, enabling them to be stored and ready for use.
The inside shelf keeps the items away from the reflecting surface in order that the rays uniformly coat the products, so as to optomise germicidal action.
For a better result we do not place items on top of each other. For frames with ophthalmic and special treatment lenses we remove the lenses first as
continuous treatment can cause the lenses to yellow. Sterilization time:
From 60 seconds to a maximum 90 seconds.

For devices that contact the surface of the eye or secretions, Tristel Duo OPH is used as is TGA approved specifically for high-level disinfection of small devices such as tonometer prisms and gonioscope lenses, pachymeters, ultrasound A- and B-scanners, etc.

For all clinic surfaces (whether treatment room, medical surfaces such as headrests, reception desks or cabinetry), Tristel Jet Gel is effective against all organisms of concern in 30-seconds of contact.

EFFICACY AND SAFETY COMPARISON TRISTEL DUO OPH AND 70% IPA

Hazard Statements DUO OPH has no hazardous classifications according to CLP, whereas IPA is a highly flammable liquid and vapour and can cause serious eye irritation, drowsiness and dizziness.

	TRISTEL DUO OPH	70% IPA
Gram-negative bacteria (e.g. Pseudomonas aeruginosa)	30 secs	5 mins
Gram-positive bacteria (e.g. Staphylococcus aureus)	30 secs	5mins
Yeast (e.g. Candida albicans)	30secs	5mins
Fungi (e.g. Aspergillus brasiliensis)	30 secs	5mins
Viruses (e.g. Adenovirus, Herpes simplex virus)	30 secs	NA
Mycobacteria (e.g. Mycobacterium terrae)	2 mins	NA
Bacterial spores (e.g. Clostridium sporogenes)	2 mins	NA

Duo Wipes are low-linting, non-scratching, and non-absorbent. This means they apply the chemistry effectively and efficiently (rather than absorbing it) and leave surfaces pristine and clean.

Studies comparing the ‘absolute risk’ of viral infection or transmission for people with eye protection – such as a face shield or goggles – compared to those without – found those with no eye protection faced a 16% likelihood of contracting the virus. In comparison, those adopting the protective measure reduced their chances to 5.5%, equating to a 10.5% difference or a 3x decrease in risk.

What safeguards are in place if I am examined?

Patients are triaged over the phone or offered via a safe. Telehealth consultation, if appropriate.

COVID-19: Background
• Coronaviruses are a family of viruses that can make humans sick
• The new coronavirus disease, officially known as COVID-19, originated in China in 2019 and has since spread around the world
• Most people, around 80% who become infected with COVID-19, will experience only mild symptoms and fully recover without any special treatment
• Some people, around 15% of those who become infected with COVID-19, will experience moderate symptoms
• A small number of people who become infected with COVID-19, approximately 5%, may experience severe symptoms and get very sick
• It is important to know how to protect yourself, your family and your community

Protecting yourself and others in the workplace

You can help keep yourself and others safe by practising good infection and prevention and control in your workplace.
You can use the same principles at work and home:
Clean your hands regularly
Practice social distancing
Practice respiratory etiquette Practical tips for protecting yourself and others in the workplace
Put marks on the floor to ensure customers stand at least 1.5 metres away from the counter and each other.
Practise hand hygiene between customers
If you are in an open plan office
Make sure there is at least 1.5 metres between yourself and the next workstation.

Social Distancing

• Maintain at least 1.5 metres distance between yourself and anyone who is coughing or sneezing
• This is important because if you are too close to someone, you might breathe in droplets they cough or sneeze

Use good respiratory hygiene.
• Make sure you and the people around you follow good respiratory hygiene.

This means covering your mouth and nose when you cough and/or sneeze with:
You put a tissue you put in the bin straight after use, your bent elbow, and maintain social distancing.
Respiratory hygiene is important because droplets spread the virus. By following good respiratory hygiene, you ‘catch’ any droplets that might be produced, and this protects the people around you from viruses, including COVID-19.
Remind those in your care to use good respiratory hygiene
Make sure that when you are out and about, you carry tissues for yourself and others to use
Remind those in your care to clean their hands after coughing or sneezing

• If you are further away than 1.5 metres, it is improbable that you will breathe in droplets that might contain COVID-19
• Help those that you care for by keeping 1.5 metres between themselves and others
• This is especially important if you’re out and about
• Avoid large public gatherings, unless essential
• Remember that COVID-19 can be transmitted by droplets that can be passed from hand to hand, including handshakes

Centres for disease control and prevention advise the n95 mask with ear loops to protect the wearer. Disposable masks can be utilised depending upon the respiratory need.
Click here to see how vaccines work.
Australia has secured 10 million doses of the Pfizer vaccine and 53.8 million of the AstraZeneca vaccine produced onshore by CSL in Victoria.
People will need two doses of the Pfizer vaccine, meaning it will cover five million Australians when it is distributed.
The World Health Organization (WHO) stipulates the doses should be given within 21 to 28 days.

Food Safety

• From the information we know at present, COVID-19 doesn’t seem to be spread by food
• However, you should still make sure you prepare food safely to make sure that you and others don’t get sick from other diseases
• This is important when you are preparing food for yourself and those in your care, washing hands between handling raw and cooked foods

• using different chopping boards for raw meats and cooked foods, ensuring all meats are cooked thoroughly. When you are preparing food, you should always practise good respiratory etiquette, and if you have symptoms of a respiratory illness, you should avoid preparing food for other people.

Managing visitors
• Keeping safe from COVID-19 does not mean having any social life for yourself or those in your care
• It is important to maintain relationships
• People who are unwell should be advised to stay in their own homes and not visit others
• This is particularly important to enforce in residential settings where people should stay in their own room
• Visitors to residential facilities should be encouraged to wash their hands on entering and exiting the facility and before and after visiting any resident

Taking people in your care out in public
• Regular hand hygiene, social distancing, and respiratory etiquette are essential in public settings
• Practice hand hygiene after touching shared surfaces (e.g. in shops, cafes or on public transport)
• To maintain social distancing, you should avoid large public gatherings unless essential

Protecting yourself and others in the workplace

You can help keep yourself and others safe by practising good infection and prevention and control in your workplace.
You can use the same principles at work and home:
Clean your hands regularly
Practice social distancing
Practice respiratory etiquette Practical tips for protecting yourself and others in the workplace
Put marks on the floor to ensure customers stand at least 1.5 metres away from the counter and each other.
Practise hand hygiene between customers
If you are in an open plan office
Make sure there is at least 1.5 metres between yourself and the next workstation.
Have meetings in large enough rooms for everyone to sit 1.5 metres apart (mark the desks with tape)
Ensure you wipe down surfaces in your work area regularly
If you are doing household deliveries:
If possible, avoid face to face contact with those inside the house, e.g. leave goods at the front door and call the house occupants to let them know their delivery has arrived.
If you need to have face to face contact with those inside the house, then stand at least 1.5 metres back from the door when it is answered.
Practice hand hygiene when you get back in the car after every delivery
Wipe down surfaces in your car (including the steering wheel and door handles) regularly
Practice regular hand hygiene
Practice social distancing
Practice respiratory etiquette
Seek medical advice, remember to call first, and inform your workplace if you have symptoms. Keep yourself and others safe.
Remember, whilst COVID-19 can seem scary, you can help stop it from spreading and protect yourself and those in your care.
Most importantly, wash your hands and make sure those in your care do the same.
Practice respiratory etiquette and make sure those in your care do the same
Practice social distancing and make sure those in your care do the same

Masks and Covoid-19

Those who are sick should wear a mask if they went out. (Ideally, however, those who are sick should stay at home and those confirmed to have COVID-19 should be isolated and cared for in a health facility and their contacts quarantined).
Home caregivers should wear a mask to protect themselves and prevent further transmission.
Health workers should wear medical masks and use other protective equipment when dealing with suspected or confirmed COVID-19 patients.

Wearing a facemask in public won’t help to protect you from infection
• Only wear a mask if you are sick with symptoms that might be due to COVID-19 (especially coughing) or looking after someone who may have COVID-19
• There is a shortage of masks and we need to save them for use when they are needed for sick people or those looking after them
• Remember the best ways to protect yourself and others against COVID-19 are: Regularly wash your hands, Use respiratory etiquette to catch your cough or sneeze

In areas with the widespread transmission, medical masks for all people working in clinical areas of a health facility should be worn. In areas with community transmission, members of the general public aged 60 and older and those with underlying conditions should wear a medical mask when physical distancing is not possible. The general public should wear non-medical masks where there is widespread transmission and when physical distancing is difficult, such as on public transport, shops, or other confined or crowded environments.

Cloth masks should consist of at least three layers of different materials: an inner layer being an absorbent material like cotton, a middle layer of non-woven materials such as polypropylene (for the filter) and an outer layer, which is a non-absorbent material such as a polyester or a polyester blend. Masks sometimes can create mask associated with dry eye.

Fogging happens because of the phase change of matter. Water vapour (from exhaled breath and sweat from your forehead) cools down when it touches the lenses. The cold lenses cause a phase change as the warm vapour touches them and turns into a liquid. There is a controlled temperature that each coating is based on. This means there is an optimum temp that the coating will work at, and as the temp gets further away from his, the less likely to work efficiently.

Ant Fog cloths and sprays work by placing another layer over the lens, which in time will wear off! This is also temperature dependant. Most products designed with face masks, so they would work more for steam/ heat. This means the fogging you get on a cold morning putting on your glasses may still occur depending upon the treatment. Airflow between the lens and the wearers face is a major determinant in the fogging factor.

Travel and COVID-19

• Currently, many cases of coronavirus in Australia are imported from overseas
• Therefore, if you are a frontline healthcare worker, carer, volunteer or have close contact with high-risk persons and you have recently travelled overseas, you may be asked to stay away from work for a certain period after your return

Contact lens disinfection protocols

A review of the evidence, published in July’s Clinical and Experimental Optometry, indicates the eye is an unlikely site for SARS‐CoV‐2 infection. However, ocular manifestations such as conjunctivitis and the presence of SARS‐CoV‐2 in tears had so far only been found rarely in people with confirmed, symptomatic COVID‐19.

Migraines and Eyes

Sat, 30 Nov 2019 04:44:27 +0000

WHAT IS A MIGRAINE?

Migraine headaches, sometimes preceded by warning symptoms, can have specific triggers but also can vary in severity and type.

As distinct from the tight band type tension headache and the cluster headache often around one eye, the classic migraine is on one side of the head with the vision effected. Migraine is a common headache disorder with no conclusive cures, of many types affecting about 15 per cent of the population, but much is underdiagnosed and can have serious health risk warnings eg women suffering from migraine with aura at any age should never use oral contraceptives accordingly.

A diagnosis of migraine is one of exclusion. especially in recent onset cases, increasing severity/frequency, neurological symptoms of pins and needles and visual field defects all indicate further work up is indicated eg MRI with a neurologist or neuro-ophthalmologist

Migraine can be triggered by many factors such as food, medication,weather, stress, lack of sleep, skipping meals, dehydration. Triggers need to be kept in a diary,ideally.

WHAT CAUSES MIGRAINES ?

WHAT CAUSES MIGRAINE PAIN ?

Researchers have identified more than 20 irregular chromosome segments associated with migraine. Each potential genetic error affects how nerve cells work in a different way. The most effective treatments control the individuals triggers for migraines often called predisposing and precipitaing factors.
The brainstem is a complex intersection of nervous system wiring at the base of our brain in clusters of cell bodies called nuclei. From these nuclei, new signals are rerouted to other parts of the brainstem and the rest of the brain.These nuclei control pain, stress, balance, mood, sleep and the autonomic nervous system.

MEDICAL FILTERS

The FL-41 tint has been used successfully for migraine sufferers and in certain neurological conditions.

At 75% luminous transmittance or 25% absorption as an over the counter sunglass category 2 (43% to 80% luminous transmittance) it would have to be marked
“Not suitable for driving at twilight or night” or “Not suitable for drivng at night or under conditions of dull light”

Traffic signal visibility requirement must also be met for OTC and prescription. If they don’t then they must be marked “Notsuitable for driving and road use”

If they are considered precription, then AS/NZS ISO 8980-3 applies,

6.3.4 Driving in twilight or at night refers spectacle lenses with a luminous transmittance less than 75% shall not be used for driving in twilight or at night.

Medical filters are dyed according to the transmission curve
MEDICAL FILTER LENSES can be used for

• Age-related macular degeneration
• Albinism
• Diabetic retinopathy
• Retinitis pigmentosa
• Achromatopsia (colour blindness) Migraines
• Cone-rod-dystrophy
• Iris coloboma
• UV protection for pseudophakia and aphakia
• Photochemotherapy,

Medical filter lenses absorb short-wave blue light components more strongly than conventional sun protection lenses or contrast-enhancing lenses. Medical filters lenses can restrict peripheral vision due to the (almost) complete absorption of short-wave blue and violet light – which is extremely important in sports.

The short-wave violet and blue light causes scattering in the eye, which leads to glare and a reduction in acuteness of vision.
The contrast is increased by the difference between the strongly and less strongly exposed receptors.

Visual symptoms such as blurred vision, visual aura and photophobia can occur during migraine attacks, but not necessarily always.

Less than half of current migraine sufferers have been formally diagnosed, and about one-third are thought to receive appropriate treatment with prescription medications.

Colourimeter research data determines certain specific tints can help migraine sufferers whose migraines are triggered by pattern glare.

BPI manufactures the pink FL-41 dye is a mixture of colours that blocks the blue-green wavelengths.
BPI is the world’s largest manufacturer of optical tints.
Though the efficacy of Blue Light Blockers can vary, environmental exposure to blue light, including those from digital screen technology, does not cause significant damage to eyesight. Therefore, filtering out the blue light from screens is not essential but can be helpful.

The FL-41 tints in 25, 50 and 75% transmissions. (The % related to how dark the tint saturation is.) are sometimes prescribed for patients with migraine or brain trauma.

Research shows that there is not one specific colour to treat migraine (or any condition) as peoples vision and brains react differently and need to be treated individually. This is the reason the Colorimeter has 110,000 different colour combinations.
Pattern glare tests involve tints (that later can be prescribed) often but not always blue or yellow to reduce nausea that can arise from stripe patterns for some people by reducing or changing the contrast between black and white.

The theory is some people have a hyperactivity imbalance between their central and peripheral vision for light, flicker and specific spatial frequencies in stripes and patterns and can make reading difficult.

Optometrists do not treat “dyslexia” or even learning difficulties, but learning-related vision problems, and in the above cases treat people with pattern glare with tints when it affects reading.

Migraine is a complex and the most common neurological condition and classified by the World Health Organisation as the 7th most disabling disease worldwide, the 4th for women. It is three times more common in women than it is in men and is usually inherited. It is a very individual condition. Some people experience only an odd attack, while others suffer them regularly

TYPES OF MIGRAINES

RETINAL MIGRAINE

A retinal migraine (aka ophthalmic, migraine, visual, ocular ) has the temporary loss of vision effect by definition. (A headache that lasts from 4 -72 hours.)

An aura usually appears in both eyes.

Retinal migraines involve episodes of temporary vision loss or blindness in one eye only.

A retinal migraine often comes on suddenly in concert with head pain and nausea from a vascular spasm in or behind an eye.

Retinal migraines are apparent in 1 in 200 migraine sufferers with short-term loss of vision in one eye only.
• flashing lights or haloes
• blind spots in your field of vision
• partial or complete blindness
• affect one side of the head
•painful
• aggravated by activity
• nausea and vomiting
• sensitivity to light/sound

MIGRAINE WITH AURA

Aura :

Blind spots
Flashing lights
Zig-zag patterns
Pins and needles on one side usually starting in the fingers/ arm, sometimes spreading up into the face.
Slurring of speech
Muscular weakness
Loss of co-ordination
Confusion) up to an hour duration can occur in about 20% of cases before the actual headache.

The actual headache:

Intense throbbing headache, usually on one side of the head, worsened by movement and lasting from 4-72 hours.
Nausea, sometimes vomiting.
Sensitivity to light, noise, smells, Stiffness of the neck and shoulders, Blurred vision.

MIGRAINE WITHOUT AURA

Most commonly, migraine occurs without the aura but with the headache
The intense throbbing headache, usually on one side of the head, worsened by movement and lasting from 4-72 hours.

Nausea, sometimes vomiting
Sensitivity to light, noise, smells
Stiffness of the neck and shoulders.
Blurred vision

MIGRAINE WITHOUT HEADACHE

Occasionally migraineurs can experience only the aura of
Blind spots
Flashing lights
Zig-zag patterns
Pins and needles on one side usually starting in the fingers/ arm, sometimes spreading up into the face.
Slurring of speech
Muscular weakness
Loss of co-ordination
Confusion

OPTHALMOPLEGIC

As well as the headache occurring mainly in young people, there is the weakness of one or more of the muscles that move the eye, dilate the pupil and control the eyelids.

BASILAR

Rarely in young women, mainly loss of balance, double vision, blurred vision, difficulty in speaking and fainting.
Headache, loss of consciousness. Basilar migraine occurs when the circulation in the back of the brain or neck is affected.

HEMIPLEGIC

It is rarely headache but with temporary numbness, weakness, or even paralysis on one side of their body up to a few days in duration.
MRIs, CT scans and other neurological tests are required to rule out stroke, blood clot stroke, pituitary tumour, detached retina, or drug abuse.

Treatment causes etc

Acute medications used include the normal NSAIDs such as Ibuprofen,anti-nausea medication as well as preventative medications.

VESTIBULAR

Many migraine sufferers experience some vestibular symptoms during their lifetime, such as dizziness, sensitivity to light/sound and stiffness of the neck

but severe vestibular migraine can encompass
Severe dizziness
Vertigo
Sensitivity to light, sound, smell
Nausea and vomiting
Ataxia (loss of control over bodily movement)
Neck pain
Muscle spasms in the upper spine area
Confusion