Helping Your Eyes with Dr. Riyad Khamis
Show Notes:
One of the most common symptoms of post concussion syndrome is visual disturbances. Talking to us today about how to address these symptoms in such a way that the brain is rehabilitated, is doctor of optometry and specialist in vision therapy and neuro visual rehabilitation, Dr. Riyad Khamis. We dive into the discussion with how he found his niche passion, and how he built his practice from two patients to a thriving community. We discuss what it means to be a developmental optometrist, and how this can help those suffering from post concussion syndrome. Riyad breaks down some of the common visual disturbances he sees in those with post concussion syndrome, and how he rehabilitates them. Each case is unique, and we hear how Bella has used tinted lenses to her benefit. Tune in to hear why it’s so dangerous to push through your symptoms, instead of taking a break, and where you can contact a developmental optometrist today.
Key Points From This Episode:
• Welcome to Dr. Riyad Khamis, doctor of optometry and specialist in vision therapy and neuro visual rehabilitation.
• How Riyad found his passion by combining sports injuries and optometry, and how his practice has grown.
• What it means to be a developmental optometrist.
• Some of the typical eye conditions post concussion sufferers exhibit.
• Why people with post concussion syndrome often don’t remember their symptoms, and how Riyad examines this.
• The glasses and lenses available to treat post concussion symptoms.
• The tints that help Bella’s photosensitivity.
• Why it’s important not to push through post concussion syndrome symptoms.
• Riyad’s tips on how to cope with screens.
• Why Riyad advises against using Visine eye drops.
• How your glasses can be set up to assist your computer position.
• Where you can visit a neuro- or developmental optometrist.
• How glasses can stimulate the rehabilitation of neurons.
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Transcript - Click to Read
[INTRO]
[00:00:05] BP: Hi. I’m your host, Bella Paige. Welcome to the Post-Concussion Podcast; all about life after experiencing a concussion. Help us make the invisible injury become visible.
[DISCLAIMER]
[00:00:21] BP: The Post Concussion Podcast is strictly an information podcast about concussions and post concussion syndrome. It does not provide, nor substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician, or another qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice, or delay in seeking it, because of something you have heard on this podcast. The opinions expressed in this podcast are simply intended to spark discussion about concussions and post-concussion syndrome.
[EPISODE]
[00:01:03] BP: Welcome to today's episode of the Post Concussion Podcast with myself, Bella Paige, and today's guest, Dr. Riyad Khamis. Dr. Riyad received his Doctor of Optometry Degree with honors from the University of Waterloo. He then went on to complete a residency specializing in family practice ocular disease, with an emphasis in vision therapy and neuro-visual rehabilitation at Northeastern State University Oklahoma College of Optometry.
Dr. Khamis obtained his fellowship of both the college vision filament and American Academy of Optometry. Both designations earned by less than 1% of optometrists in North America. In addition to owning two primary care optometry clinics, Dr. Khamis also owns and operates a specialty vision therapy, neuro-visual rehabilitation clinic, both London, Ontario and Sarnia. It's treated over 400 patients with visual symptoms resulting from traumatic brain injuries, including concussions and strokes. Welcome to the show, Dr. Riyad.
[00:02:02] RK: Thank you. Thank you. I'm excited to be here. Thank you for having me.
[00:02:04] BP: To start, do you want to tell everyone a little bit about your background and how you got into concussion recovery?
[00:02:10] RK: Yeah, for sure. Just like a lot of people, initially, you have what you're interested in and what you're passionate about, and you're not completely planned on where you're going to end up. But if you're lucky enough to combine what you're passionate about with your career, I know you end up with the same thing as well then, then that's great. For me, I was always interested in sports, similar to yourself, actually. So both playing and watching sports was always something that was of interest to me.
I really got interested in the field of optometry as well went through undergrad and I thought “If I could combine” — in the back of my mind, it was always “If I can combine optometry with some of my other passions as well, that would be something I'd be very fortunate to do”. So when I graduated optometry school at the University of Waterloo, after eight years in a cubicle and most people were very excited to get to work and start seeing patients, but for me, it was I still wanted to make that connection between optometry and sports and my other passions as well. I obviously had been around concussions, my whole life playing hockey, and other contact sports as well.
After I graduated optometry school, I decided to do a residency. So I went down to Northeastern State University in Oklahoma. It's an Oklahoma College of Optometry and I did a one year residency there. It was in Tahlequah, Oklahoma. I can tell you, I had no idea where Tahlequah was on the map. I basically got in my car and said, “Okay, I guess I'm driving 14 hours south somewhere.” It was at a First Nations Hospital in Tahlequah, Oklahoma. It was probably one of the greatest experiences of my life. I got great mentors. That's where I started to really get interested in the field of developmental optometry, which is basically looking at optometry from a different perspective of rehab and vision training and looking at the visual system and how to get it to where we want it to be.
Well, that's where we started to see some post concussion patients, lots of kids with reading issues, things like that. When I moved back to Ontario, so I'm in London, Ontario, I bought into a private practice and said, “You know what, I'm going to start vision therapy or neuro-visual rehab clinic as well because that's what I'm interested in.” The building we are in had this room upstairs. It was basically pretty small like bigger than a closet, but it wasn't a massive room or anything. It was a storage room. Basically, we had a bunch of old computers there, things like that.
So we cleared it all out, renovated it and said, “Okay, I'm going to start my practice here.” Just anything, when you start something new without much advertising or knowing anyone it started out fairly slow. I would do my eight hours of optometry general eye exams and then I would do this afterwards. I still remember my first two patients. My first two patients that came in they were referred by other practitioners. My first one came in and she said, “I've been dealing with vision issues for this many months or years and I need to get back to work, I need to do this, this and this.” She's like, “No pressure, but I'm really relying on you to help me here.” I was like, “What did I get myself into?”
Then my second patient similar, she was a WSIB patient, like workplace injury, same thing concussion couldn't work, because of their vision issues. I was very invested, so I gave them both at the time, they're my first two patients. I gave them my personal cell phone number and was like, if there’s any issue, give me a call, from your vision perspective and they would. I remember driving to my parents’ house on a Sunday, and all of a sudden, they would call and be like, “This is happening, what do I do?” So but fortunately, both of them did really well with the program. Their original issue started to get better, they were able to get back to work and I was definitely invested.
Fast forward five years now from that time, and we've been fortunate enough to grow quite a bit. We have our own space now, our own building. We have staff, some vision therapists who actually see the patients who are great. I mean, we have about 100 patients a week now coming through here that are post concussion, so we're pretty busy now. I kept that same passion I had for those first couple patients. Now, I don't get my personal cellphone number out anymore. I'll be in [Inaudible 00:06:05] all the time, but I do definitely, if there's any questions, I returned calls, and we are definitely invested in making sure our patients get better as well. That's helped grow our practice quite a bit also.
[00:06:17] BP: I really like your 14 hour drive to nowhere story. I don't really know where I'm going, but I'm going. When you're on a mission, you're just going and I get the phone call thing when I started this. I was like, “Oh, just call me at any time.” I'm like, “Okay, maybe I should stop doing this.” Because how many people are going to start calling me and texting me all day? I was like, “Yeah, I need to separate it a bit.” I think it's great. Can you explain a little bit the difference between developmental optometry and a typical optometrist that a lot of us go to see for an eye checkup?
[00:06:52] RK: Yeah. So we, from a developmental standpoint, we're looking at the visual system from a different lens. We're looking at how the visual system’s developing, and then if there's something that throws that off, whether it's a concussion, or it may be even so we have kids or concussion patients who have healthy eyes, they can see 20/20 a lot of the time, but they're very symptomatic, as you know as well, like we can get eye reading issues, we can get eye tracking issues, light sensitivity.
So it's really, understanding where those come from and then coming up with treatment plans to be able to fix them as well. It's looking at I guess, if you use a pun, but looking at optometry from a different lens in the sense that we're really looking at it from, okay, so let's take a look at how the visual systems developed and what's changed and how we can rehabilitate the brain in order to use the eyes more effectively. A lot of people think of vision therapy is eye training, but it's really training the brain on how to use the eyes more effectively.
[00:07:51] BP: Absolutely. That was a great explanation. You've already mentioned a few of the problems that survivors tend to have. What are some common eye associated problems that a lot of concussions survivors seem to face? I know for me reading was a really big problem.
[00:08:10] RK: Yeah. So it's a great question. Just like anything we say, every patient is different. I would also say just seeing for instance today, I’ll be seeing quite a few patients as well. Some of this stuff ends up being we see in a lot of post concussion patients. From a vision standpoint, usually were looking at or what I'm looking at is post concussion. Now post concussion can have different definitions, but from our aspect, we usually use about two to four weeks post-concussion, if they're still symptoms or now entering that post concussion range.
Now, as Vision plays a huge role in how we take in information and 80% of information is taken in through the eyes. After a brain injury, we can get a lot of visual issues. We use something called the Brain Injury Vision Symptoms Survey, which is a mouthful there, but basically it lets us know how symptomatic or what symptoms our patients have. So things that are on these or things we ask about will be as we mentioned reading, so okay, so are we having trouble with reading? Can are we skipping words when reading? Are we losing our place? Comprehension is a big one. Do you find that you can't really remember exactly how much you read, what you read compared to before the short attention span? Peripheral vision is a big one. So one thing that I always asked about is how do you find when you go into busy places, groceries, I know with locked down, people aren't going to concerts things like that as much anymore, but grocery stores is a good example, right? How do you feel when you go to visually busy places, what tends to happen? A lot of patients have trouble with that as well or survivors have trouble with that, depth perception.
This is the one that people don't necessarily think of as much, but the thing is, okay so when you reach for basically like you reach for your mug, you find you’re little bit off, do you find stairs okay, “I'm a little more hesitant on stairs”, sports wise like catching balls, things like that as well. One that I know we just mentioned here previously that people also don't think of is dry eyes. Dry eyes is pretty common with screen time now, but throw in a concussion and some inflammation that stinging feeling, are we finding our eyes suddenly after our concussion, they're getting a lot more dry and there's definitely treatment for dry eyes.
A big one, light sensitivity, so this one's when we hear quite often is photophobia, both indoor and outdoor. We definitely have some treatment plans for how we do that. Double vision is one I like to point out, because that one's a big one. Even if you don't have the other symptoms, if you have double vision, you definitely need to see someone, because double vision can be different things, and can be a little bit more serious than just because of the post-concussion. We definitely if there's signs of double vision, we need to get that investigated. Then obviously headaches, eyestrain, how quickly can you go on a computer before your eyes start to get really, really tired, night driving, things like that or other issues as well, that can come up also. Those are just some of the ones that we look for as well.
[00:11:02] BP: Yeah. It's so important to like you said, paying attention to what's going on around you. Like you said, going into a grocery store and what changes, I know for myself, I was actually walking into walls on the right side of my body all the time. I walk into the side of a table and I'd walk into the side of a wall or to a doorframe, and I was like, “Okay, I'm doing this way too much. This isn't like once in a while thing was every day.” I am like, off, my perception is off. I keep walking into things. Like that dry an eye, that’s something I dealt with. I spent a lot of time working on that, changing things around. I also do wear glasses and then quite vision problems already. There was all of that on top of it, trying to figure out things.
[00:11:48] RK: Yeah. That's a good point. So just touching on what you were talking about, walking into things. We mentioned depth perception, but there's also something that's called a visual midline shift. We see that here every single day with our patients. Sometimes when they think they're walking straight, or they want to be walking straight, but they're walking all the way to the right, or they're walking all the way to the left. A lot of times that just means our brain and our eyes aren't on the same page. Where our brain thinks is straight, our eyes don't and we almost walk into it. With something called yoked prisms. We can get into this afterwards in a little bit, but then we can correct that or we can look at making sure that our brain and our eyes are on the same page so that we can be straighter when we walk for sure. That's definitely something we test here as well.
[00:12:29] BP: Yeah. There's just so many things about the eyes. I find it really fascinating. It's funny, because I don't always remember all the symptoms I have, until people start mentioning things that they've gone through. I'm like, “Oh, that happened to me.” But it's been 10 years, so it's a long time to remember it all. Do you want to talk about a little bit of some of the treatment plans and things like that go with a lot of those common problems? What are your typical things that you do?
[00:12:56] RK: Yeah, for sure. Yeah, touching on that is just what you said before, we definitely when we do the case history, I won't be like, “Okay, so what are your symptoms?” We’ll actually go through it a lot, because a lot of times patients, they'll try to remember and say “I think headaches”. Then you start asking the other questions and okay, things start to come out. I hear everything, like I've heard before like “I'm seeing black spots similar to —” I remember one time I heard “When I shaved my armpits, I see these black hairs coming back to what I'm seeing” and things like that. So definitely, we see quite different, unique explanations as well.
But yeah, from a treatment standpoint, so how we approach it. Now, again, it can be a little bit different from all when you're looking at a Neuro Optometrist or Optometry specializes in this area. Everyone's a little bit different, I would say from the way we approach it, we found works really, really well. So how we typically do it is first that person comes in for an evaluation. During an evaluation, we're testing a couple things. We're giving them the symptom survey to see where they're at. Typically, we do something called the Binocular Vision Examination. What that means is we're looking at how the visual system is working. In terms of are we seeing double vision? Are the eyes tracking okay? The eye muscle strength were testing, visual midline shift like we mentioned, light sensitivity where they're at with that.
Then the second part of the assessment is Visual Information Processing, which is sometimes overlooked. This is something that typically isn't going to be tested on your general eye exam, but that's how we take in information once it gets past the eyes. So things like memory, how we pick objects out of busy environments like we talked about, we do something like objective tests of eye tracking. Based on all of that we can compare to age norms, so depending on the age of the person coming in, we compare that to what the norms are and then we can have a really good idea of where we need to go, our visual goals. That's the other thing as well.
We also ask the patient or the person what their visual goals are. Is it, we, “I need to get back to work” or “Reading is something I'm super interested in” or if they're retired, sometimes we hear knitting or hobbies or some specific hobby that they want to really get back to. We definitely note those, driving is another one obviously, as well that we look at, and we're careful with as well. That's a whole another evaluation that we do. Yeah. Then we look at when they come in is first thing we look at is therapeutic glasses.
Now, they are therapeutic in nature in the sense that they're not glasses that they're going to wear for the rest of their life. I always reiterate that, because some people are like, “Oh, I want Gucci frames. I want these frames, and I want these. I like it to look perfect and this way.” I say like, “Yeah. That's great, but also remember these are glasses to help you get over your symptoms here as well.” Obviously, you want something that's going to look nice and that you're going to be comfortable in, but that's as important as being comfortable in the glasses. Then we're going to try to get you over your symptoms with the specific glasses. So things we look at and obviously we correct prescription.
Now, some optometrists will look at this differently, but I find like I don't typically do progressive lenses a lot of the time. I find that once we get to invisible bifocals, if there are balance issues that can also create more balance issues. We usually can separate that out a little bit. We also look at prism. Now prism is a big buzzword in optometry right now. That's one thing when people come in, they say okay, “I want prisms.” They don't really understand prisms, but it's I want prisms because my friend got prisms who had a concussion. Prisms are a great tool for optometry, but they have to be used in a specific way for sure. Definitely you need someone experience with fitting prisms before we do, but prisms are a little bit of a crutch. They do help with your symptoms, but we don't want you to be prisons in the rest of your life.
We can prescribe prisms for something like we talked about before, where if someone is tilting or has a visual midline shift, we can correct that. We can also correct things convergence issues and double vision with prisms or a different way depending on where the eyes are aligned, we can correct that. Now typically with prisms, we prescribe it or this is how I do it, I prescribe them, we definitely follow the patient throughout. Eventually we can start to take away prism as they get less symptomatic. Eventually, when they're able to function without them, we take them away completely. They're prescribed to really help with the symptoms, but they're not necessarily a full time thing as well for a lot of patients.
The other thing we look at is tints. So tints can help with indoor light sensitivity. I typically don't like when patients are wearing sunglasses inside all the time, because they can really get used to those and really be reliant upon sunglasses. I prefer doing a specialized tint. We trial tints, there's no one tint that fits everyone. We definitely try them in office, we see how the patient responds. We'll do some tests with them. There are FL-41 is a big one, it's this pinkish red tint a lot of patients really liking it. There are studies where it says it helps with concussions or migraines, headaches, things like that in some patients as well.
We definitely trial them out and see where they are. We could actually put them in the lens specifically with that. Again, being therapeutic in nature, blue another color a lot of people like as well. Depending on what they we prescribe these specialty glasses for them. Just touching on the other part of it there, is so glasses is one portion. Then there's the therapy portion as well. That is the training portion, specifically. I always like to do them with each other never just one or the other. A lot of times with therapy, then at least we can follow the patient and see how they're doing. If they're — as they improve, we can take away, so we can change some of the glasses as well.
The therapy really involves depending on what their symptoms are. It can involve eye tracking, convergence, light sensitivity. We use something called syntonic light therapy to help with their parasympathetic system that helps with some photophobia issues as well, as well as other issues when dealing with a concussion, when really we're just trying to rehab the brain in the eyes and those connections so that we're able to get back to what tasks they really enjoy and where we need them to be there as well.
[00:18:59] BP: Yeah. I think you touched on so many important things. I like how you take a look at what a patient is looking to get, because we talk about that a lot that sometimes our symptoms, certain symptoms matter more to other people because of their lifestyle, if they have kids if they're an athlete depends on what you're doing and that can make a really big difference in what your goals are for recovery. I agree with the prism they are — people here prisms and I think the other thing is, with concussion recovery, a lot of people almost get desperate is a hard road on their recovery and it's quite the roller coaster. When they hear that something might work, they're like, “Okay, I'm going to try that too.” So we cling to it sometimes and it can be hard not to when you're really just looking for anything that will work and so you have to try to find the right people to help you with that.
I like all the different tints. I personally love blue tint in the winter actually. I do a lot of things outside, so all of my goggles that I wear like snowboarding, sledding on an ice bike, all of those have blue tint for the snow. I find it helps I don't get snow blindness. So it's important to see what color tints you like, because I actually green in the summer. It's interesting all of my glasses have different colors for different times. My regular glasses have no tint, so like you said, you don't always want to be under that screen of light all the time, because eventually your eyes get used to it. It's something that happened to me, when I first started 10 years ago. It was like that stay in a dark room kind of thing. Getting out of that gets really difficult. It's like if you wear sunglasses every day, all day, taking the sunglasses off becomes really difficult when your eyes have adjusted to that. It's a wrong process to take, once you've readjusted your brain to always be in the darkness.
[00:20:52] RK: Yeah. The other thing I think is another unique avenue is I know a lot of patients like to wear contact lenses. They are starting to be contact lenses that have specific tints or can go a little bit dark when they go outside, or there's some that start to have the blue blocker a little bit as well. The contact lenses field has also come not — they're not designed specifically for post-concussion, but a lot of these ones are designed for other things like, light sensitivity can be definitely overlapped and used as well. A lot of our, some of our patients are in those contacts and really love them as well. [00:21:25] BP: I think that's really great that they can have tinted contact lenses. I'm so glad things are developing and getting farther. You can reach out to Dr. Riyad at the London Vision Development Center at londonvisiondevelopment.com, which you can also find in our show notes. With that, let's take a break.
[MESSAGE]
[00:21:48] BP: Wow, I can't believe it's been one year. The support from everyone has been truly amazing. Due to reaching our one-year anniversary, you can now book one hour sessions with myself, Bella Paige. I offer help with understanding loved ones, finding your new normal, and finding specialists near you. Find the work with fellow link in our episode description. I am looking forward to another great year.
[INTERVIEW CONTINUED]
[00:22:19] BP: Welcome back to the Post-Concussion Podcast with myself, Bella Paige and today's guest, Dr. Riyad Khamis. So something I always like to get into as a lot of our survivors are at home, what is something that they can do at home in regards to helping their eyes?
[00:22:35] RK: Yeah. So from a home perspective, one is definitely, seek the right treatment. I think is this to make sure that you're under the care of professionals who can definitely help with your symptoms. A lot of times, unfortunately, post time does help heal all things, but in some post concussion areas, and just sometimes it just doesn't get better on its own, unfortunately. We wish it did, but it doesn't all the time. So make sure we're seeking the right treatment portion of it there as well. From a home perspective, from your visual system, you want to make sure that we're not over exerting, which is one thing that I definitely have a conversation with people is different personalities, have different ways to deal with post concussion.
A lot of times people want to just be “Okay, it's fine. It's just any other injury. I can power through it. I’ll just work harder, and I'll be fine”. I think that's something to be well, I do have that conversation, I would say a couple times a week normally with people as well is, is to be just weary of okay, so you want to definitely get better, but at the same time, you don't want to rush back into things that were not at the point of being able to do. For instance, if you work in an environment where it's go, go, go and it's really busy. There's a lot of cognitive overload and then you're still not at that point where you're ready. Sometimes that can actually be detrimental in the sense that can bring back some of your symptoms. It can make you take a few steps back on that direction as well.
We really want to make sure that we're at the point where we're ready to go back to wherever we were. So from a home standpoint, you don't want to push too much stuff, you know, I think everyone's familiar with their own symptoms. They know the days where they've over exerted and the headaches and they can't get out of bed and everything's really fatigued. You know we maybe we over exerted things as well. So really be conscious of your own symptoms type of things as well. Then just home modification.
Again, if you're able to have an occupational therapist, that's great, because they can help you through a lot of this stuff as well, but making sure that the lighting at home is comfortable for you there. We're not in an environment where there's just too much stimulation, which is going to cause some of the symptoms. So just from a vision standpoint, just making your home comfortable so that you're able to function is important as well.
[00:24:48] BP: Yeah. No, there's some great points. I really like how you mentioned that overexerting yourself, because I've talked about a lot on the show before, I wasn't good at that. I was terrible at taking breaks, I never stopped and it prolonged my recovery for a really long time. It can be really hard as an athlete to take a break, it can be really hard to take a break, if you have kids, it can be really hard to take a break, if you have a career. So, in general, sometimes it's really hard to tell yourself to take a step back and focus on your recovery or not over exert yourself.
Then what usually, typically tends to happen is you think you're doing good if you keep going, you keep going, you keep going. Then all of a sudden, there's one day where you take a break, and then you crash really hard, because all of a sudden your brain is overwhelmed, and you're realizing that you've pushed yourself too hard. Then sometimes that crashed last months instead of just a day. It's really important to recognize that you are pushing yourself too hard, and how you can take setbacks in little ways, even if it's not just taking a complete step back from everything. There's always little things you can think of to do.
We help with that as well with Post Concussion Inc, we do one-on-one sessions, where we help people learn how they can readjust their life to still have a successful life, while living with all the symptoms working on their recovery. So something I get asked about a lot is screen tolerance. As a lot of us really our phones and we are on our computers a lot nowadays, especially with social media and things like that. How can we help with our screen tolerance?
[00:26:25] RK: Yeah, for sure. Those are great points you had mentioned as well. I think just having someone to as you guys help with post concussion, that's really important. I would think that it'd be a very valuable resource. One of the things just touching back on that as well is, it's such an important to have — there's not one specific treatment for a concussion. I wish there was, but it is something where there's multiple layers to it. There's different providers, different treatments. I really am a firm believer that everyone has their specific area. There's areas that really help but it's not just one specific like just doing one thing, and that's going to help me.
You do have to reach out to different sources and get help with that as well, because there's a lot of, as you said, a lot of facets, different facets that are working together for post-concussion. The screen question, that's a great question. Yes. So yet that asked that a lot. It's difficult nowadays, because even school is on a screen with COVID and like that. Everything is now on a screen and your social life is on a screen a lot of time. It's Face Timing with family or friends, your work is on a screen, you're working from home. So screens have become a big, big thing.
As we said for a lot of post concussion, people with post concussion is screen sensitivity because it's just the brightness and just the light sensitivity and the strain on a screen. Lots of times if you're in a meeting or things like that there's different things moving around on the screen that can definitely throw people off there, as well. So definitely, we want to be taking breaks when we're on a screen. The other thing we had mentioned was dry eyes. Normally, we blink about 15 times a minute, which means that we're blinking or restoring that front surface tear layer to your eyes and it makes it nice and comfortable, because we're blinking 15 times a minute.
When we look at a screen that typically goes down to five times a minute. Now other than the other symptoms, now you're blinking three times less, just in general, let's take the concussions out of the equation here. People come in and they say they work eight hours on a computer or they're working on a computer, their eyes are already going to be three times drier, because they tend to blink less when they're on a computer. Now concussions can exacerbate that as well. Frequent breaks are important. I may have heard this the 20-20-20 rule, which is basically every 20 minutes, try to take a 20 second break, and let 20 feet in the distance there.
I know it's hard to follow when we get really busy sometimes, it's got to remember every 20, I would even say, for if you have dry eyes or post-concussion that's really affecting that, even making it a little bit sooner like 10 to 15 minutes trying to take a little bit of a break there and looking away from your screen, just trying to remember to blink looking out in the distance there is important as well. Dry eye drops is important as well, so if we are still feeling that burning sensation using artificial tears. One that I'm going to mention is that's not good for your eyes is Visine, because everyone says, “I've been using Visine, so my eyes are good.”
Visine is actually really the opposite effect on the eyes. It just constricts all your blood vessels. It can actually make things a little bit worse. Make sure we're using an artificial tear, preferably a preservative free artificial tier. They'll say preservative free on it. You can get them at the pharmacy or your optometrist office might carry some there as well, but those are really good to use. In fact, here we always prescribe those to our patients while they're going through our program. We tend to say, if you're using the computer because a lot some of their appointments are on a computer or they need they're using the computer for other things as well. We say, “Try to get those in.” Depending on how severe it is, how many times a day we mentioned, but preservative free dry drops is one that we definitely use there as well.
Tints, so tints as we talked about how different tins can help as well, you can also get filters on your computer screens. There are also programs for when you're in school, so high school university, college, wherever you are, there are programs that a lot of your schools will offer that include reading the text, or different filters. I know here in London Western does offer a program for some of this. It's for different reasons, but definitely are a lot of our concussion patients who go to University of Western uses program. It just helps gives them the filter, it also does some of the reading for them, so it can help with that as well also. So definitely lots of options and the big thing is just, soon as we're fatigued or tired make sure we're taking breaks as well.
[00:30:51] BP: Yeah. It's so important to take breaks and make yourself take breaks. I actually have I wear an Apple Watch. My watch tells me to stand up all the time. It helps me because otherwise I will sit and watch and work on my computer all day and not move especially if I have a snack and a drink. I'm good. I'm set for the day. So it's important to take breaks. It's important to try different things like you gave so many options there. Try combination things, change it up, try again. Like we always say, if it doesn't work for you, there can always be something else that works you just have to keep trying and not give up. So is there anything else you would to add after all of your creative advice before we end today's episode?
[00:31:34] RK: Yeah. Just actually touching back on the glasses thing that remind me one more thing is for the computer is, so when we get to our presbyopic patients who are patients who are require progressive lenses, who need it for reading as well. A lot of times they're in need of progressive lenses which basically if you know progressive lenses split into three zones, so you have your distance, your computer, and your reading. A lot of times those patients are already in progressives when they come here and they're already a little bit symptomatic. I find that if you're going to be spending time on a computer to try to find that little computer zone, you're tilting your neck, a lot of times with concussions there can be neck issues as well.
I would say that another thing is definitely consult your optometrist or your neuro optometrist and mention you're on the computer and get just computers or glasses specifically designed for a computer distance, because we can prescribe them if you come in with, okay, my computer sits this far away from me and you bring in that exact measurement, then we can design or your optometrist can design specific glasses exactly for that distance, so you're not having to tilt your neck or shift around to be able to see it which can also elicit some of your symptoms. So just glasses, just like your comfortable, sweatpants, comfortable pair of shoes, if you have glasses that are just that nice and comfortable, that'll help with that as well.
So no, that's great. I think overall, yeah. It's definitely one thing I'd to mention is there our resources to help which is great. We do a lot of from a vision standpoint, a lot of patients will come in and say, “Well, we never heard of this, or we wish we would have heard of this sooner.” So definitely explore your options. Ask where you can get — there are Optometrists who specialize in concussions all over Canada in the United States as well. So definitely find someone and you can look on the College of Vision Development website.
There's also Canadians Optometrists and Vision therapy that you can look up providers or if you just ask your general optometrist, and a lot of times they'll know someone who specializes in concussions. There's a lot of stuff that can help and that's one thing that if patients are coming in and three years later and they haven't been helped before on a lot of this stuff, we wish we would have seen them sooner to help with some of their symptoms. So definitely explore the optometry or the neuro optometry area for sure.
[00:33:53] BP: Absolutely. I really like the different glasses. I'm going to go look into those actually. I'm definitely going to — I live on the computer and I have a lot of vision problems just before concussion. I don't see that well, but actually something that I did at my most recent like eye regular optometrist appointment was we picked glasses that didn't let me see the best, but that felt the best, but it's interesting. We worked off my headache symptoms and things like that and what would work like what prevented too much eye strain and find a balance and it was definitely something different that I hadn't tried before, but it helped me a lot.
[00:34:32] RK: Yeah. When we're prescribing glasses, the thing is, is a lot of times and just in concussion recovery in general we’re building new pathways between the eyes and the brain. So specific glasses can really stimulate those pathways and really start to build and rehabilitate the pathways. It's almost like the analogy of, if you're going down the highway and now after a concussion or a specific highway under construction. Now we got to find the detour and initially the detour might be a gravel road so it might be tough, but eventually that gets paved and starts to improve as well on that area also. So it's a lot of seeing with our brain is the tagline for Neuro-Optometry and that's exactly what it is we're just trying to get our brain rehabilitated, the eyes are just an extension of the brain and we're just working off of that there.
[00:35:15] BP: Yeah. That is a great perspective. I just want to thank you so much for joining us today and sharing your work with post concussion life.
[00:35:23] RK: Yeah, for sure. It's great. Thanks for having us here. Definitely from a standpoint of we do offer FL-41 glasses here at our clinic and I know if sorry, if you aren't able to get them, we do have some fit over ones, so you're welcome to reach out to us on our website. With these, we do get the official ones from, we get them from the states normally here. So we do offer them here in the office. We usually carry some in stock here as well. If you need those and that's something we can always reach out to or if you have any questions feel free to reach out.
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