There are many urban legends surrounding eye health, but are any of them actually true?

As we mark Vision Month this May, we asked Dr. Kenneth Eng, chief of the Department of Ophthalmology and Vision Sciences at Sunnybrook, to answer some “old wives’ tales” and common questions about eye health.

“Eating carrots will improve my eyesight”

While carrots contain beta-carotene, a substance closely related to vitamin A which is essential to the metabolic function of the retina, there is nothing magical in consuming carrots that would result in improved eyesight or a reduced need for glasses.

It’s important for people to try to maintain a healthy diet rich in many nutrients. This can be protective in terms of reducing the risk of certain conditions, like age-related macular degeneration, but it is unlikely that mega-doses are beneficial for otherwise healthy individuals.

“Don’t sit too close to screens”

There is no evidence that sitting very close to screens causes any permanent injury to your eyes. However, prolonged screen time can result in eye strain or discomfort and can result in more dry eye symptoms. In children, there is some evidence that increased screen time may lead to greater myopia, or nearsightedness, and that increasing outdoor activities may be protective.

It is good to keep in mind the 20-20-20 rule: take a 20 second break every 20 minutes to look at something at least 20 feet away.

“Reading in poor lighting will hurt my eyes”

Much like sitting close to a screen, reading in poor light will not result in harm to eyesight but can be a cause for symptoms of eye strain and can exacerbate dry eye symptoms. Especially in older adults needing reading glasses or bifocals, reading in dim light will makes it significantly more difficult to read efficiently given the reduced contrast of print. It’s always sensible to read in well-lit areas and/or adjust the brightness on a screen to optimize reading comfort.

“Wearing glasses make your eyes weaker”

It is important that, if you need corrective prescription glasses, that you wear them regularly. Eyes do not become more dependent when wearing glasses or contact lenses. On the contrary, there is evidence that for children with myopia, maintaining a clear image on the retina with their full prescription reduces the likelihood of as much progression of their nearsightedness. People with hyperopia, or farsightedness, can develop eye strain and headaches without their glasses.

You should always avoid wearing someone else’s glasses as an incorrect prescription can lead to eye strain and discomfort. If you are not comfortable with your glasses (old or new), you should see your eye care professional to ensure that they have the correct prescription.

“Eye exams can only tell me about my vision”

There are many ocular conditions like cataracts, glaucoma, and macular degeneration that are screened and diagnosed by regular eye exams, but many systemic conditions may appear during these exams too!

Even in patients without visual symptoms, common conditions such as diabetes, hypertension, and high cholesterol can be detected. Much more rare conditions such as metabolic and inflammatory diseases and even cancers can occasionally be detected and diagnosed in the course of a routine eye exam.

Eyes are a window not only to the soul but an important way for doctors to screen for other systemic conditions!

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Vitreous hemorrhage is a leading cause of severe vision loss worldwide. This condition, commonly caused by diabetic retinopathy, occurs when diseased retinal blood vessels rupture, rapidly filling the eye with blood and rendering someone blind within minutes. The traditional treatment for this condition involves a period of watchful waiting to allow for natural resolution, which can take many months. Patients suffer while waiting, facing limitations in physical activity, reduced work productivity and the fear of impending surgery or permanent blindness. If the hemorrhage does not clear, surgery is the only alternative.

Dr. Gary Yau, ophthalmologist and affiliate scientist in Physical Sciences and the Hurvitz Brain Sciences Program at Sunnybrook, is developing a non-surgical, office-based solution that uses the power of sound to restore vision loss caused by vitreous hemorrhage. The technology applies focused ultrasound waves deep within the eye to fragment the hemorrhage and accelerate its clearance, all without the need for incisions.

Partnering with SRI, Dr. Yau founded Vitreosonic, to accelerate the technology and its potential to transform the current treatment paradigm, having a significant impact on how patients may recover from this blinding condition in the future.

Dr. Yau sits with the Vitreosonic technology, which applies focused ultrasound waves to the eye non-invasively.

How did your training as a physician help you as an inventor?

Medical training is, understandably, centred around learning the craft of clinical care. While it may not explicitly focus on invention or product development, health-care professionals are uniquely positioned to contribute to innovation. We work on the front lines, encountering real-world clinical challenges and observe firsthand where current solutions fall short. Our research background trains us to think critically about evidence and improvement, and as end-users of medical technologies, we bring valuable insight into what works in practice, not just in theory.

What knowledge or skills do you need to become an inventor?

Perhaps the most essential skill I’ve observed in successful inventors is simply the ability to get things done.

Invention is about bringing an idea to life. It requires you to be both a dreamer and a doer.

As an inventor, you’re stepping into new territory, so you’ll inevitably hear phrases such as “this isn’t how things are usually done.” The ability to push forward despite those barriers is a necessity.

I certainly am early in this journey, and still have many walls to navigate, but this pursuit has been one of the highlights of my professional life. True invention doesn’t just advance care—it has the power to redefine it. I would encourage those that have a compelling idea to take this less travelled path, as its impact on patients can be profound.

What advice would you give to someone interested in launching a health-care company to commercialize their discoveries?

Absolutely go for it. Inventing and entrepreneurship aren’t the most common paths for health-care professionals, but they offer an incredible opportunity to make a lasting impact on patients’ lives.

I didn’t initially set out to start a company. It began with identifying a compelling clinical need, one that resonated deeply with me. Over time, it became clear that the only viable path to bring this solution to patients was through commercialization.

In that sense, forming a company wasn’t the goal, rather it was the necessary vehicle to move the solution forward.

Translating an idea into a real-world solution often requires knowledge beyond traditional medical training, such as intellectual property, regulatory strategy, and product development. For clinicians interested in innovation, being involved more upstream in the invention process not only broadens our perspective but also allows us to shape the direction and real-world impact of new solutions from the start.

As a health-care professional, your unique clinical insight is a major advantage that can help propel an idea forward.  Just as important, though, is knowing where your expertise ends and being resourceful in filling those gaps. It’s rare these days, especially in health care, to develop an impactful invention entirely on your own. I’ve been fortunate to collaborate at SRI with Dr. Kullervo Hynynen and an outstanding engineering team, Bohao Ning PhD and Christopher Hu MSc, whose expertise and partnership continue to be essential in moving this technology ever closer to the bedside.

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What damage can looking directly at the solar eclipse cause to the eyes?

“Looking at the sun directly is never a safe thing to do as it can cause permanent damage to the retina called solar retinopathy,” says Dr. Eng. “This can cause permanent blindness in one or both eyes.

What should someone do if they don’t have the special protective eyewear to watch the eclipse? Are there are any specifications people should look for when it comes to protective eyewear to watch the eclipse?

“The only way to avoid the risk of damage to the eyes is to wear approved, special-purpose glasses, also known as solar filters,” Dr. Eng says. “Approved glasses meet a special international standard that is called ISO 12312-2.”

Visit the  American Astronomical Society for more information on approved glasses.

According to Dr. Eng, very dark sunglasses, homemade filters, squinting, or looking through a tinted window are not safe methods to look at the sun.

For those without access to approved eclipse glasses, the other options to view the eclipse include using a pinhole projector or watching the livestream of the eclipse. These options are safe and can be just as exciting!

Can someone watch the solar eclipse if they have pre-existing eye health concerns?

“As long as the eclipse glasses or solar filters are used, a person with pre-existing eye condition can still safely enjoy watching the solar eclipse.”, says Dr. Eng.

The key takeaway is that yes – today’s solar eclipse is a rare and exciting experience, but make sure you keep your eyes safe!

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Retinitis Pigmentosa is a genetic form of vision loss. While rare, its impact on day-to-day living can be devastating, especially as symptoms usually start in early childhood. Now, an important advance in gene-based treatment is offering new hope to many patients.

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“I have always had trouble seeing at night but I thought it was normal — that everyone would find everything black,” says Michael. “I would be thinking, how do people navigate through this? They must be really good at it. Then when I was diagnosed, I realized okay, this is not normal.”

Michael, 21, has a rare and aggressive form of retinitis pigmentosa — a genetic disease which causes progressive vision loss. His sister Cassidy, 19, has also been living with the same condition since birth.

Both Michael and Cassidy have what doctors describe as poor vision. This makes everything from seeing at night, to crossing the street unassisted, to recognizing people’s faces extremely difficult.

“It’s a devastating disease for patients and their families,” says Sunnybrook ophthalmologist and vitreoretinal surgeon Dr. Peter Kertes. “They typically have an onset of symptoms early in childhood and usually by young adulthood they’re pretty disabled.”

Today, however, Michael and Cassidy are turning over a new page thanks to a ground-breaking gene therapy treatment called Luxturna, offered for the first time at Sunnybrook.

Luxturna is designed to treat a type of retinitis pigmentosa known as Leber’s congenital amaurosis, specifically one that is caused by mutations in the RPE65 gene. The drug helps replace the faulty gene with a healthy one to slow vision loss and restore some vision.

“It’s transformative,” says Dr. Kertes.

For Michael and Cassidy, it has been a long and difficult road to get to this point.

It took several years for doctors to diagnose the siblings. Even then, Cassidy says, as a child it was hard to comprehend the impact the disease was having on her.

“I just remember being frustrated because I couldn’t do things as well as other kids,” she says. “Something could take me a year to get good at whereas it could take someone else a month.”

Cassidy says it was challenging to get adequate support and understanding from some members of her community in Cornwall, Ontario. For instance, while teachers provided accommodations to help with things like reading and writing, she says they sometimes seemed to do so reluctantly.

“If they found out they had to make larger print they would kind of sigh and roll their eyes,” she says. “The thing with (this condition) is I don’t look disabled. I look like I can see just fine.”

For Michael, the challenges continued in college when he enrolled to study game development. Having to attend classes online due to the pandemic, combined with having to advocate for accommodations, meant it was a constant uphill battle.

“I failed a lot more courses than I am proud to admit,” he says.

Knowing the toll retinitis pigmentosa takes on people is what motivates Sunnybrook’s team of pharmacists involved in providing the unique gene therapy treatment.

“It’s life-changing therapy,” says Pharmacist Jonathan Shloush.

It’s also, he says, one that requires a military-like approach to logistics coordination. More than a dozen pharmacists, pharmacy technicians and other staff spent months working to ensure the drug would be ready for patients like Michael and Cassidy when the time came.

“Literally mapping out things A to Z — all these processes needed to be worked out,” Shloush says.

The drug had to be kept at a temperature of at least -65C during shipment from Germany. Once it reached Sunnybrook, special arrangements were made to keep it in cold storage until one hour before surgery. Only then could Jodi Wood, a registered Pharmacy Technician specially trained in handling Luxturna, take it out of storage and wait for it to thaw in a sterile ‘clean’ room, before preparing it for Dr. Kertes to administer.

“It’s definitely unique,” Wood says of the process. “It was exciting because gene therapy is new for us to be handling so that was actually quite interesting.”

For Shloush, the team effort involved in this kind of treatment goes to the heart of what Sunnybrook does best.

“It’s truly a collaborative effort,” he says. “It really does align fully with what Sunnybrook stands for in terms of teams coming together to care for patients.”

Dr. Kertes echoes that sentiment, pointing out that collaboration across Sunnybrook’s various departments as well as with colleagues at SickKids Hospital was key.

In February, the Ontario government said it would fund Luxturna treatment — which costs more than $1 million for both eyes — for a number of patients at SickKids and Sunnybrook. The announcement was welcomed by patients and their families, as well as groups such as Fighting Blindness Canada.

Michael and Cassidy say they are grateful the treatment is now available to them. They will continue to receive follow-up care in the coming months from Dr. Kertes and their care team. And they are hopeful about what the future now holds.

“I’m hoping I can get a part-time job and maybe see better at night so I can hang out with friends past five p.m.,” says Cassidy. She adds she would like to pursue a career as a therapist one day.

And for Michael?

“I am looking forward to becoming more independent,” he says. “Being able to go into a bank or a store and actually see what’s in the building, shop for myself, do my own banking. My ultimate goal is to be able to start my own game development studio.”

Dr. Kertes, for his part, hopes this kind of gene therapy will soon become more commonplace.

“I feel like I’ve been waiting my whole professional lifetime for something like this,” he says. “This is the most exciting thing to come along in a generation. To talk to these patients after they’ve had their treatment and to hear their stories, it’s hard not to get emotional.”

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What effects of the pandemic have you seen?

Since the onset of the pandemic, there has been a dramatic rise in the rate of screen time for both children and adults. Whether or not that has led to a specific increase in certain conditions is being monitored, and more time will be needed to answer that conclusively.

What we do know across the profession is that many patients have been avoiding care for their eyes, and that includes routine exams and assessment of acute and chronic eye symptoms. Some patients missed appointments early on because they were deferred. While community and hospital clinics are now fully open again, the number of patients seeking care still appears to be down.

Some patients may feel nervous to come into a clinic or hospital setting, but it’s important for them to know that there are many layers of safety protocols in place to keep everyone safe.

How often are eye exams needed?

For most healthy children and adults, they should continue seeing their community eye specialist every 1-2 years for screening and to assess the need for glasses. Here at Sunnybrook, where we see patients needing more specialized care, we know that there are many conditions that can progress and threaten vision if people don’t seek timely care. Some of those include age-related macular degeneration, diabetic retinopathy, glaucoma, retinal detachment and tumours of the eyelids.

How has increased screen time impacted our eyes?

When people spend time in front of screens, they tend to blink less, meaning the eye tends to dry out faster. Dry eyes can feel itchy and irritated and are a common problem. Thankfully, this condition is relatively mild and reversible in most people.

If this is something you are experiencing, take frequent breaks from your screen whenever possible. Artificial tear drops, available at your pharmacy, can also help. For people who wear contact lenses, some may find some comfort in removing them and wearing glasses more often if a significant amount of screen time is required. If these approaches don’t offer any relief, your eye doctor may recommend an approach that’s done in clinic called punctal occlusion. During this procedure, small plugs are implanted into the tear duct openings to prevent tears from draining away from the eye as quickly.

It’s important to note that some medications, like anti-depressants, can also increase dry eye symptoms. Talk to your doctor or pharmacist if you need more information.

Have masks affected our eye health?

The biggest effect appears to be an increased risk of dry eyes. To minimize air flow from coming up from your mask into your eyes, be sure your mask fits properly. That means the wire should conform snugly to the bridge of your nose.

Any other advice on balancing eye health with screen time?

While screens are a reality in our lives, try to limit the amount of time you spend in front of them. Also, take frequent breaks when doing any screen work. We often talk about the 20-20-20 rule, where you should look away from your screen every 20 minutes, focusing on something that is 20 feet away for 20 seconds.

Cutting down on the glare of your screen may help, by either lowering the brightness on your device or using a filter. Also, make sure the screen you are working on is a safe distance away from your face, which should be about an arm’s length away.

No matter how much time you spend on screens, pay attention to how your eyes are feeling. You don’t want to risk permanent damage to your vision by not getting timely care.

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Dr. Eng shares findings and insight from his study, the first to examine the impact of the COVID-19 pandemic on patients with retinal detachments, recently published in the Canadian Journal of Ophthalmology.

Are patients delaying seeking treatment due to the pandemic?

Dr. Eng: Throughout the pandemic, individuals have been presenting late or delayed going to see their doctors with serious eye conditions.

In the early months of the pandemic, there was a drop in the number of patients coming in with retinal detachments. We learned through the study that this was due to the uncertainty around the coronavirus. Fear and anxiety around hospital visits led some patients to hold off on the medical treatment they needed.

The hospital is safe and has remained open to patients throughout the pandemic. In recent months more patients have been returning for routine examinations. If people have pre-existing conditions and they’re having difficulty, it’s best to reach out to their physician in the earliest stage and not put off receiving treatment.

Is a retinal detachment painful?

Dr. Eng: Typically with a retinal detachment, patients do not feel any pain. There aren’t visible signs, for example, redness around the eye.

Often what happens before it detaches, is that patients will see flashes of light in one or both eyes, or “floaters” which are tiny dark spots or specks that seem to float away when individuals try to look right at them.

It is important that patients contact their ophthalmologist when they notice new “flashing” or “floaters.” Their physician can determine if there is a tear or hole in the retina and help treat it before it leads to a full retinal detachment.

What can happen when treatment is delayed for retinal detachments?

Dr. Eng: Retinal detachment can lead to permanent vision loss if not treated in time.

When patients experience a detachment, they may feel like there’s a shadow or curtain or veil over their vision and it becomes more difficult to see things. Sometimes it grows over a few hours or over the course of several days, and it progresses until that shadow covers your central vision. When that happens, it can be an indicator that the central retina has detached.

Individuals can progress from being able to read and recognize faces to seeing next to nothing. Sometimes they’ll only see fingers in front of their face or movement at the sides, or even perhaps only light.

In general, the longer patients wait to seek treatment, the less they can recover.

Patients that come to us with a retinal detachment after many weeks or many months may never regain very useful vision in that eye.

The eye is not very forgiving. When you have a retinal detachment and that part is injured or damaged, it never recovers function like it used to. The retina can be reattached months or years later, but by then the damage is done.

What signs or symptoms should patients watch out for?

Dr. Eng: Patients will often see warning signs before a retinal detachment actually occurs.

Patients should pay close attention to the “flashes” and “floaters” mentioned earlier, blurred vision, or feeling like there is a curtain or shadow affecting your vision.

Delaying treatment for a retinal detachment can have serious implications in terms of how much vision you can recover, so it is best to reach out to your ophthalmologist at the onset of symptoms.

Read the full study: Impact of the COVID-19 pandemic on characteristics of retinal detachments: the Canadian experience

Learn more about Ophthalmology & Vision Sciences at Sunnybrook

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“Before the pandemic, I was in the gym almost every day,” says the 21-year-old. “It became the best part of my day.”

When Richard’s local gym closed due to the COVID-19 pandemic, he started working out at home using a resistance band, a large band made of synthetic rubber that can be used for strength training or rehabilitation. The bands provide resistance so muscles are working against its force to help build strength.

The band that Richard used was weighted to 50 pounds, almost 23 kilograms, which means using it was like working out with a 50-pound hand weight.

“After a couple of pulls, the band snapped out of nowhere,” says Richard. “One end hit my left eye and I couldn’t see anything for about 10 minutes. After awhile, my vision started coming back, but was a little blurry. At first, I thought it was just a little injury and wasn’t a big deal.”

Richard says the initial force on his eye caused some pain, but it eventually subsided.

“My eye just looked really bloodshot and red,” he says.

Later in the day, he noticed some changes to his vision.

“I would look left to right and started noticing darker spots, and that’s when I started thinking it might be more serious.”

Impact of retinal detachment

After seeing his optometrist who suspected Richard had suffered a detached retina, he was referred to Sunnybrook where it was determined there was more damage than first thought.

“Richard had an unusual retinal detachment. His retina was damaged in three separate areas,” explains Dr. Kenneth Eng, chief of ophthalmology and vision sciences in the Hurvitz Brain Science Program at Sunnybrook. “There was a large tear in his retina as well as extensive bleeding and bruising. The retina had detached in two places, and there was also a hole in his macula, which is the central part of the retina. He lost a lot of vision. Enough to be considered legally blind in that eye.”

The operation was extensive. Dr. Eng and his team used special surgical tools to do precision work on the fine membrane inside the eye, measuring only one micron thick (or 1/1000^th of a millimetre). The surgery also involved laser treatment to help repair the retinal tears. The team also applied a special silicone solution to help the holes in Richard’s eye heal.

After a few weeks, the bleeding and bruising subsided. After another surgery to remove the silicone, the holes eventually closed and his retina remained attached with improvement in his vision.

Unique case study

The case was so unusual that a photo essay case study was recently published in The Canadian Journal of Ophthalmology.

Dr. Eng says within a couple of weeks of Richard’s eye injury, another patient experienced a similar injury after working out with a resistance band at home during COVID. Dr. Eng says while these exercise band injuries seem to be rare, there is the possibility for more cases as more people are exercising at home over the course of the pandemic. Dr. Eng says safety during physical activity is imperative.

“It’s important to exercise with caution and not be cavalier with any workout equipment that is used,” recommends Dr. Eng. “Accidents can happen that could impact vision or lead to serious complications.”

Recovering after retinal detachment

“The first time I had surgery I thought, ‘I won’t be able to see anymore,’” says Richard. “But Dr. Eng had put his whole effort to helping me and the best I could do was move forward and just recover one day at a time with the help of people around me. Throughout my recovery, my family has been there to support me.”

Dr. Eng says about 80 per cent of Richard’s vision has returned over a couple of months.

“Richard has come a long way,” adds Dr. Eng. “Time will tell how much of his vision will return, but he has made some positive progress after his ocular trauma.”

“Before this injury, I had 20/20 vision and I saw everything crystal clear,” says Richard. “But now, if I read with my left eye, I am not able to read small-font books, so I rely on my right eye. I might not get all my vision back, but I just have to get used to it and I am adapting.”

“While exercise is important to maintaining mental health and physical conditioning during the pandemic, care and attention is needed whenever new activities or equipment are being used. Individuals should familiarize themselves with the use and warnings of all equipment being used. Some equipment, like exercise bands, can store significant amounts of energy,” emphasizes Dr. Eng, “so ensuring that they are installed properly and securely is of the utmost importance to help avoid serious accidents.”

In the meantime, Richard says he is remaining positive and when using the bands in the future, he plans to wear protective glasses. “It may look strange to be wearing safety glasses, but I’m not taking any chances. This injury won’t prevent me from going to the gym in the future. I’m going to be more careful and am looking forward to going back when it is safe to do so.”

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How does spending time on screens affect our eyes?

We know that doing prolonged near work, where you are sitting close to a screen, can promote the development of myopia (nearsightedness) in the growing eyes of young children. This is also true of books or other activities that require close-up work.

Prolonged screen use can also lead to tired or dry eyes. This is because when we concentrate on something, we tend to not blink enough. Blinking is important because it spreads tears evenly over our eyes, and it should happen on average 15 times per minute.

What symptoms indicate there may be reason for concern?

There is nothing inherently dangerous about looking at screens, but if you are noticing changes in your vision, reach out to your doctor. Any loss of vision or significant visual symptoms should be investigated.

Generally, for tired or dry eyes, rest and lubricating eye drops can offer some relief. Using a humidifier in the space where you do most of your online work can also be helpful.

Does the type or size of screen matter?

No. Just make sure the font size is at a comfortable setting to read without straining.

Are there recommendations for the amount of time children or adults should be online every day?

In terms of your eye health, there are no formal recommendations. You may have heard of the 20-20-20 rule, which will definitely help give your eyes a rest: every 20 minutes, look at something that is at least 20 feet away for 20 seconds. If you are spending significant amounts of time online, you might find that frequent breaks will help give your eyes, and body, a good rest and stretch.

Are certain screen settings better than others?

Some people prefer cutting the glare on their screens by using a filter or choosing settings like night mode, which eliminates blue light. There is no specific setting I recommend to my patients as this is really all about personal preference.

Any other tips?

For everyone, including children as they grow and develop, remember that regular eye exams are important. They are an opportunity to discuss any concerns or changes and to examine the eye for more serious problems.

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Flashes or arcs of light

“Flashes or arcs of light get us worried,” said Dr. Peter Kertes, chief of ophthalmology at Sunnybrook. “It might mean that the vitreous – the gel-like substance that makes up the bulk of the volume of the eye – is pulling on the retina.” If you move your eye quickly and there’s a flash briefly, see an eye doctor. Over time the vitreous gets pockets of fluid in it. The fluid comes together and the gel collapses forwards and can pull on the retina and tear the retina. This can lead to retinal detachment and other issues.

Floaters

“Floaters” happens when the vitreous becomes liquefied. “People report seeing spiderwebs or a seeing a bug that’s not there,” Dr. Kertes said. What you are actually seeing is the shadow of coalesced material in the vitreous. These floaters can be a normal part of aging, and for some, are just a nuisance. But, they can be a sign of other issues and can lead to complications, so best to get it checked out.

Aura Light from Migraines

Aura light from migraines can be disturbing and difficult to see through. “These are usually accompanied by a headache and last a few minutes,” Dr. Kertes said. “In the elderly in particular, these can be visual migraines.” But these differ from flashes and arcs of light in that they aren’t just when you move your eye as mentioned above. If you suffer from migraines, speak to your family doctor who can help with treatment.

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