What you need to know about double vision symptoms

Double vision, or diplopia, is one of the most common symptoms that are presented to an optometrist’s office. Not all double vision symptoms are the same though; “double vision” can mean many different things and can come in a variety of forms.  Binocular double vision means both eyes have to be opened for diplopia to be present.  In true binocular diplopia cases, covering one eye would resolve the doubling effect. Monocular diplopia would occur through one eye only and covering one of the two eyes would not resolve the diplopia.  

Binocular diplopia can present in a horizontal or vertical fashion and can be caused by a variety of reasons.  Muscle misaligned is often a leading cause for diplopia.  Depending on which ocular muscle is affected will dictate the resulting doubling in vision; diagnostic tests are performed to infer and identify the affected muscle and thus help with diagnosing the condition that may be involved.  

Unlike binocular double vision, monocular diplopia is usually due to media opacity or refractive error.  “Shadowing” or “overlapping effect” are some of the common ways patients describe this monocular diplopia.  Other common causes for such symptoms include, cataracts, regular astigmatism, or Keratoconus (corneal disease causing irregular astigmatism).

Once the type and nature of diplopia is identified by your optometrist a treatment plan and a course of action is outlined. Certain binocular double vision presentations are serious and the underlying cause should be addressed urgently.  Acute presentations of vertical diplopia, for example, can be caused by serious conditions and should be investigated immediately.  Monocular cases of diplopia are often resolved by addressing the causing factor.  For example, when cataract is the offending factor, removing it would usually resolve the symptoms, other times the symptoms are due to uncorrected refractive error.  Correcting the refractive error with spectacles, contract lens therapy, or laser refractive surgery, can oftentimes remedy those conditions.  However, it is imperative that an accurate diagnosis for the cause of diplopia is made before treatment options are discussed.

Many forms of binocular diplopia are corrected with prism therapy and/or vision therapy.  Prism therapy in spectacles can vary in nature and could include Base Out and Base In prism for vertical deviations or Base Up and Base Down for vertical diplopic presentations.  Vision therapy is also indicated in certain cases when certain intraocular muscles are weakened and need strengthening for better alignment; the eye muscles ability to converge or diverge is improved through vision therapy.  Depending on the severity and type of each case, some conditions can be treated with in-home vision therapy programs such as HTS (Home Therapy System).  Other patients might require office based vision therapy and more sessions with a vision therapist in the office for better outcome.

If you are experiencing double vision contact one of our 360 Eyecare clinics today to see one of our optometrists or go to your nearest emergency room for immediate care.

Ocular Emergencies and Examinations

Ocular emergencies are some of the most frequent type of visits seen at an optometrist’s office.  Many types of emergencies present to an eye doctor’s office on a daily basis.  Many are acute and serious conditions that require immediate attention.  This article will outline some of those common emergencies and what should be done when you are concerned that you might be experiencing them.

eye emergency

Q: I just started seeing floaters and flashes in my vision. What should I do about them?

The symptoms of recent onset floaters are often associated with a detachment in the eye’s vitreous (the gel inside the eye ball).  Often times this detachment is described as PVD or posterior vitreous detachment.  However, those symptoms are also sometimes associated with flashes that accompany them and could represent a real emergency if the retina is involved.  If you experience any of those symptoms you must see your optometrist immediately or report to the nearest hospital emergency room for a dilated fundus exam to rule out signs of retinal breaks, tears or detachments.

Q: I have a sudden sensation that sometime is in my eye and I can’t wash it away. What should I do?

Foreign body sensation symptoms are a common presentation at an optometrist office.  Many times this occurs while people are working with tools or in their backyard gardening and a small foreign body hits their eye.  These cases can vary widely depending on the type of foreign body, the size of it and the part of the eye that it hits.  Corneal foreign bodies are the most common and the most painful and are considered vision threatening if they are lodged in the patient’s visual axis.  Corneal foreign bodies should be examined immediately and removed to prevent further damage and complications. Depending on the location of the foreign body and how deep it has penetrated the eye, different tools are used by the optometrist to remove it.

Q: I woke up with a pink eye with watery and yellow discharge.  What should I do?

Pink eye presentations are quite common and they can be caused by a variety of reasons.  Some are more serious than others.  Causes can be inflammatory in nature or infectious and can be bacterial, viral or allergic.  Patients with pink eye presentation are instructed to practice caution, as the nature of some conditions can be contagious.  If you are experiencing any signs of pink eyes see your optometrists immediately for treatment and management.

Q: My vision is suddenly blurry. What should I do about it?

Blurry vision is another symptom that can be caused by serious ocular conditions or as a result of refractive change over time.  Blurry vision can occur suddenly or over time and can occur in both eyes or just one eye.  Many reasons can be attributed to blurry vision and only through a thorough eye examination by an eye doctor can they be assessed and managed.  If you are experiencing blurry vision you should see your optometrist for a full assessment to determine the cause and treat the condition.

Ocular emergencies should be addressed as soon as possible to prevent any potential damage and to get you back to feeling your best. For more general questions and answers, feel free to review our other FAQ section. If you have an ocular emergency and wish to get in touch with us to receive fast, compassionate, and informative care, contact us today!

What is Dry Eye disease and how is it diagnosed?

What is dry eye disease?

Dry eye is a medical condition in which the eyes do not produce enough tears. You may wonder why that is a problem. The human eye needs to produce a certain amount of tears to remain healthy and comfortable so if the eye does not produce enough tears, it is a problem. A common type of dry eye disease is when the eye does not produce the right type of tears and tear film.

Understanding the importance of tears

Dry and cracked eye

Each time you blink, a film of tears spreads over your eyes to keep their surface clear and smooth. In other words, your tear film promotes clear vision. There are three layers of tear film and they are the mucus layer, watery layer, and oily layer.

The oily layer is outside the tear film and its purpose is to make the eyes’ surface smooth. It also prevents the tears from drying up too quickly. The oily layer is produced in the Meibomian glands. The watery layer is the middle of the tear film and it makes up most part of the visible tears. Its major function is to clean the eyes by washing away dirt or particles from the eyes. This layer comes from the Lacrimal glands right in the eyelids.

The mucus layer is the inner layer of the film and it ensures that the surface of the eyes is always moist by spreading the water layer over the eyes’ surface. This layer comes from Conjunctiva. Sometimes the eyes do not produce enough tears or one or more of the three layers become dysfunctional. Either case will lead to what is known as dry eyes. Dry eye can be diagnosed through three major tests that have been outlined below.

Common tests used during a dry eye assessment

Osmolarity Test

This test can be carried out using various osmolarity instruments. The osmolarity test assesses the quality of tears with results displayed in most/l. An elevated reading, >300 mOsm/L, indicates loss of tear film homeostasis. When the inter-eye difference is >8 mOsm/L, it indicates instability of the tear film. The iPen and Tearlab are two common examples.

Schirmer’s Test

To perform this test, a patient is first given numbing drops to reduce the discomfort that the test may cause. The optometrist will then pull down the lower eyelid and place a strip of paper beneath it. After that, the patient will close their eyes and leave it closed for 5 minutes. The strip is removed thereafter and the amount of moisture in it is measured. Dry eye disease is diagnosed if the amount of moisture is insufficient.

Red Thread Test

This is a very similar version of the Schirmer’s test. The main difference is that the strip is replaced with a red thread in this test.

Oculus Keratograph 5M

This is an advanced form of corneal topography coupled with specific dry eye tools. It consists of a keratometer, topographer and a color camera that has been optimized for external imaging. Apart from topography and external imaging, the equipment helps to evaluate the lipid layer, measure the tear meniscus height and performs a non-invasive tear film break-up time. Optometrists use this tool to diagnose the specific type(s) of dry eye disease involved. It also helps provide comparative pre and post treatment analysis.


This is an imaging study of the morphology of meibomian glands in vivo. The test is for the purpose of examine the upper and lower meibomian glands and to assist in diagnosing Meibomian gland dysfunction (MGD).

Patients with dry eye syndrome are advised to see an optometrist with the right equipment to run a comprehensive diagnostic battery of tests. Specific tests tailored for the diagnosis of dry eyes will help narrow the diagnosis and the root cause of the condition and ultimately helps in providing a guide for a targeted treatment.

360 Eyecare is proud to offer a specialized dry eye clinic located at our Queen St office. If you're experiencing dry eye please contact our dry eye clinic or fill in this dry eye assessment request form.

What takes place during pre-testing for your routine Eye Exam?

Many people are used to going through the motion of the different tests done during their eye exam visit, but many don’t know what is actually being tested. We would like to use this article to highlight some of the common tests done during pretesting.  Pretesting is usually done in a different room before the patient is ready to see the optometrist by an optometric assitant, ophthalmic technician or an optician.  Here are few of the most common eye tests done during the pretesting stage of your eye exam:

Advanced Diagnostics in Downtown Toronto

NCT (Non-contact Tonometry)

 Non-Contact Tonometry is used by eye care professionals to measure the intraocular pressure in an individual's eye. Intraocular pressure is the fluid pressure within the eye. Intraocular pressure is useful to measure because it can determine if the patient is more likely to develop glaucoma. Glaucoma is when there is damage to the optic nerve and be caused by an increased intraocular pressure. The optic nerve is responsible for transmitting images to the brain. A Non-Contact Tonometer uses a puff into the individual’s eye. It measures the intraocular pressure by the eye’s resistance to the puff.


             An auto-refractor is a computer-controlled machine that is used to provided an objective measurement of a person's refractive error and a starting point for prescription for glasses or contact lenses. Refractive error is a problem with focusing light properly onto the retina due to the shape of an individual's eye. Common types of refractive error are near-sightedness, which is when you can see objects near you clearly but object far away are not clear, and farsightedness, is when you are able to see objects far away clearly but are not able to see objects up close clearly. An autorefractor works by shining light into the eye and measuring how it changes as it bounces off the ocular fundus, which includes the retina, optic disc, macula, and fovea. An image of an object is shown to the patient moving in and out of focus and a number of measurements are taken of the reflection to determine when the eye is properly focused. When these figures are put together a level of correction needed for the patient is formed.


            Auto-keratometry measures the anterior curvature of the cornea, which is the front of the eye. This test can be taken at the same time as the auto-refractor in some cases. An image is reflected off of two points in the cornea, and the relationship between object size, size of the image reflected and distance between the object and keratometer are all utilized to get the result of a minimum and maximum curvature valued for the cornea. This measurement helps with contact lens fittings.


            Pachymetry is the process of measuring the thickness of an individual’s cornea. This measurement is taken just before the NCT is preformed. This is useful in regards to refractive surgery candidacy and certain corneal diseases.

Retinal Imaging

            Retinal imaging is an image that is taken of the inside of an individual's eye. It uses high-resolution imaging is used for the picture. This is used to assess the health of an individual’s retina. Within the picture an individual's retina, optic disk, and blood vessels can be seen. Retinal imaging is highly recommended when an individual has diabetes, since it can cause damage to the blood vessels in the retina.

To book your Eye Exam today with one of our optometrists in the Toronto Downtown area contact us at metro@360eyecare.ca.

What’s new in the eyecare world?

Eyecare and Technology

Technology plays a tremendous role in every industry and the eyecare industry is no exception. We see advancements in technology impacting all aspects of the eyecare practice. From new revolutionary diagnostic equipment that help optometrists pick up settle ocular changes that were missed in the past to new advancements in contact lenses and glasses, the future of eyecare is bright.

eye-technology, Metro Eye Care


The OCT (optical coherence tomography) is one of the diagnostic tools that have revolutionized the way optometrists and ophthalmologists practice over the last several years. OCT is a non-invasive technology that’s able to take a cross section of internal ocular structures including the optic nerve, macula and other sections of the retina. This advanced technology allows the eye care professional to see beyond what could be discovered on a standard clinical examination through biomicroscopy or retinal imaging. This tool is specially important for patients with family history of macular degeneration or glaucoma. It’s also great for monitoring disease progression in patients who have already been diagnosed with the disease and would need to be monitored closely for change.

Contact lens inovation

Another eyecare area that has been tremendously transformed by technology over the last several years is the contact lens market. The technology in this arena has come a long way over the years. Daily lenses now come in silicone hydrogel material that allows for greater oxygen transmission through the lens and better comfort. Given that these lenses are now manufactured at a larger scale the cost of the lenses has also come down significantly, so wearing these lenses has become much more affordable as well. The custom rigid gas permeable lenses and scleral lenses advancements have also been instrumental in allowing optometrists to help more patients who otherwise would have not been able to help in the past. Example of such cases include those with dry eye disease who had developed intolerance to soft contact lenses or those with corneal disease such as keratoconus, and post surgical patients.


On the glasses front, digitally manufactured spectacle lenses now allow for more customization than ever. Such level of accuracy and customization now allows for most optimized vision. The days of having only generic stock lens options are long gone. Thanks to digital lens surfacing, we’re now able to specify how a patient chooses to wear a frame to the fabrication of the lenses for most optimized clarity and comfort.

Surgical front

On the surgical front, we have seen many technological advancements that have increased the options available to patients in need of ocular surgeries. In refractive surgery for example, new laser technology such as the custom all-laser wavefront Lasik or transepithelial PRK has allowed corneal surgeons to deliver more accurate and safer outcomes for their patients.

Emerging Technologies

One of the most exciting technologies that are starting to emerge now is the wearable technology. We are seeing small launches in the eyewear arena but likely there will be much more to come in the near future.

To learn more about eye health, eyewear or to book an Eye Exam or a consultation with one of our Optometrists call or email us at our Downtown Toronto University Avenue location and we’ll be more than happy to assist.



Diabetes and our Eyes

diabetes and your eyes

Diabetes is a metabolic disorder that interferes with the body’s ability to use and store sugar. The food we eat is converted into glucose, or sugar, and used for energy. Diabetes impairs the ability to produce and respond to a hormone called insulin which helps the body process sugar. This causes a buildup in the body and can lead to serious health problems like heart disease, kidney failure, lower extremity amputation and blindness.

There are two types of diabetes. In Type 1 diabetes you are considered insulin-dependent because injections or other medications are required to supply the insulin your body is unable to produce on its own. Type 1 diabetes is usually diagnosed in children and young adults. In Type 2 diabetes, the most common type, the body becomes insulin-resistant. Although you produce insulin your body is unable to make proper use of it. The percentage of adults with Type 2 diabetes increases in people 65 years or older.

Diabetic Retinopathy (DR) is the most common form of diabetic eye disease. It occurs when high levels of blood sugar cause changes that damage the tiny blood vessels in the retina, which makes them leak fluid or hemorrhage (bleed). Without proper blood flow the retina can become damaged and lead to permanent vision loss. Diabetes can also cause new growth of abnormal blood vessels in the retina which can break and bleed into the clear gel filling the middle of the eye, the vitreous, causing sudden vision loss.

Diabetic Macular Edema (DME) is a complication of DR. In DME, the fluid leaked from the damaged blood vessels causes swelling in the center of the retina, the macula. The macula is the most sensitive part of the retina that is responsible for central vision. DME is the primary cause of vision loss associated with DR and is the leading cause of new cases of blindness in adults.

In the early stages of DR there are often no symptoms, but as it progresses it can cause spots or floaters in your vision, blurred and/or distorted vision, fluctuating vision, double vision and cataracts. In the early stages it is important to monitor the condition with an eye exam every six months and control the blood sugar with diet and exercise. Treatment in advanced stages includes eye injections and laser surgery. People with both Type 1 and Type 2 diabetes are at risk for DR and vision loss. Additional risk factors include race (Hispanics and African Americans are at higher risk), high blood pressure, high cholesterol, and pregnancy.

Because Diabetic Retinopathy can go undiagnosed until it causes vision loss, an annual eye exam is recommended for all diabetics. Early detection and treatment are key in the management and control of diabetes and diabetic eye disease so schedule your appointment with 360 Eyecare - Metro today.

What is Chronic Dry Eye

chronic dry eye

Chronic Dry Eye

A healthy eye produces an adequate amount of tears to keep the eyeball moisturized. Tears are made up of oil, water and mucus. Each of these is an important component in protecting the front of our eyes and keeping them comfortable. An oil layer helps prevent evaporation of water, while the mucin layer spreads the tears evenly over the eye. If the tears evaporate too quickly or do not spread evenly over the cornea due to issues with any of the tear layers, you will begin experiencing dry eye symptoms. Most people at some point will experience these symptoms, but people with chronic dry eyes experience symptoms almost daily.

What Causes Chronic Dry Eyes?

Causes of chronic dry eye depend on a variety of factors such as living in a dry climate, exposure to smoke and wind which increase the rate in which tears are evaporated. Women are also more likely to experience chornic dry eyes due to hormonal fluctuations during pregnancy and menopause. Medications such as antidepressants and high blood pressure medications are known to aggravate dry eyes. Age is another cause of dry eyes, most people over the age of 65 experience symptoms.

What are the Symptoms of Chronic Dry eyes?

If you’re experience chronic dry eyes you most likely feel your eyes heavy and out of focus most of the time. Additional symptoms are as follows:

  • Difficulty driving at night
  • Sore Eyes
  • Sensitivity to light
  • Itching, burning
  • Gritty feeling, like there is sand in your eyes
  • Eye redness and eyelid soreness

How is Chronic Dry Eye diagnosed?
The only way to obtain a proper diagnosis is to be evaluated by a reputable eye doctor. It is important to find an eye care provider with the proper technology to make the most accurate diagnosis and match you with the best treatment for your specific condition.

What treatments are available?
Once your eye doctor has examined you, the best course of treatment will be determined. Fortunately, you have plenty of options on how to treat Chronic Dry Eye depending on the severity of the discomfort:

  • Steroid Eye Drops
  • Restasis
  • Xiidra
  • Meibomian Gland Expression
  • Punctal Plugs

Contact Us here at 360 Eyecare - Metro for more information.

Child Eye Exam – Why Should I Get My Child’s Vision Checked?

Child Eye Exam

child eye examUnless a child is showing obvious signs of vision impairment or poor eye health, many parents and guardians assume they don’t need to schedule an eye exam. Some even think their children’s eyes will be examined in school as a part of regular health screenings. Both of these are mistaken assumptions. At 360 Eyecare - Metro, we agree with the the Canadian Association of Optometrists’ recommendations that children have at least one comprehensive eye exam before they start school and once a year thereafter.

Children often don’t complain about vision impairments because they don’t know whether their vision is abnormal. To them, blurry vision, not being able to follow words on a page, or straining to see a blackboard (or whiteboard) may seem perfectly normal. As they say, a fish doesn’t question how it swims, it just swims! Many vision impairments are only discovered once a child begins school or starts playing organized sports. Both situations require clear sight. But a comprehensive vision examination isn’t just a test of sight. It’s an examination of eye health. And for children, it can be one of the first steps in diagnosing an eye disorder.

Why Should I Get My Child's Vision Checked

At 360 Eyecare - Metro, our pediatric eye exam includes a full review of a child’s health and vision history as well as tests for farsightedness, nearsightedness, color perception, astigmatism, and other common vision conditions. Identifying an eye impairment or disorder early greatly aids a child’s ability to learn and feel comfortable in a classroom, or on a playing field.

360 Eyecare - Metro’s comprehensive eye exams also look at eye function such as how well the eyes focus and work together, as well as overall health screenings. Did you know that in children, some binocular vision disorders are mistaken for behavioural disorders such as ADHD? Many family doctors treating children for ADHD often don’t detect or even consider that an ocular disorder, or malfunction, is the cause. Disorders such as convergence insufficiency, where the eye do not work in unison, may not be apparent in simple vision checks. Only optometrists with expertise in eye-teaming abnormalities, would be able to diagnose—and properly treat—these issues in children.

In today’s fast-paced digital world, it is also important for children to learn early about eye care and protection. Who better to impart this knowledge than the trained professionals at 360 Eyecare - Metro? We know that too much screen time, or time spend in front of Ipads, tablets, computers, smartphones, and TVs can harm a child’s eyesight. Since the eyes of children and teens continue developing until they are about 20, many eye care professionals believe long hours spend in front of electronic devices can cause myopia, or near-sightedness. Both the Canadian Ophthalmological Society and the Canadian Association of Optometrists agree that the strain of “near work”— or looking at things close up—effects vision and can lead to conditions such as dry eye. Many experts are now recommending that children spend more time outdoors looking at things far away and absorbing beneficial sunlight and vitamin D.

Vision can be so important to learning and behaviour. A comprehensive eye exam will start your child’s school years off right. Call 360 Eyecare - Metro today to book an appointment today.

Dry Eye Disease

dry eye diseaseYou may have seen the commercial on TV. An attractive doctor diagnoses her patient with chronic dry eyes, prescribes a drug to alleviate the symptoms, and announces that the drug helped her too. It was one of the most memorable American TV ads of 2013—making it to the Neilson top ten in advertising. One reason for its top-ten status was that it skillfully announced to the public how dry eye disease or dry eye syndrome (DES) is actually a disease, and not just an annoying temporary symptom.

It’s not often that eye disorders get such public attention, but dry eye disease confirms how important regular comprehensive exams are in treating conditions that patients sometimes brush off. Your optometrist can diagnose dry eye disease and set you on a path to better, more comfortable vision.

Dry eye disease is a chronic, or long-lasting condition. It happens when your eyes do not produce, or maintain enough tears to adequately lubricate the surface of the eye. Sometimes this is because of reduced tear production. In other cases, it arises as a result of the lack of lipid in tears. As medical professionals, we learn from current research—and dry eye is one condition where research and corresponding treatment is ongoing.

Dry eye symptoms run the gamut from dry and itchy, to burning and watering. They can also be painful, stinging, and irritated. It can even feel like you have a grain of sand in your eye. Dry eye effects different people in different ways, and treatment depends on the severity of the symptoms.

As for the contributing factors and causes? Dry eye can happen as a result of normal aging or hormonal change, environmental factors such as living or working in dry or dusty conditions. Air conditioning in summer and heating in winter can exacerbate the condition, as can staring at a computer or television screen for long periods of time. Researchers know that age and gender are factors in who gets dry eye. Women over 50 have a greater risk than men of the same age. Certain medications for blood pressure, allergies, and depression, can contribute, as well as having medical conditions such as diabetes, arthritis, and thyroid disease.

Optometrists have a number of weapons in their arsenal for treating dry eyes. Treatment depends on isolating the cause and determining the severity. Often, we examine the effects of lifestyle with an eye on alleviating major contributors to discomfort. If the cause is environmental, you may be able to eliminate or avoid it—such as wearing wrap-around glasses or goggles in dusty environments, or making sure you blink often while staring at a computer, video, or television screen.

Dry eye treatment could also include using over the counter eye drops, prescription drops, or even prescription drugs (such as the one promoted in the television commercial). Many people find the limiting their use of contact lenses, and warm compresses on the eyes, can help, as well as eye scrubs. Long term treatment plans include eating a diet rich in omega-3 fatty acids, keeping hydrated with water and blinking fully and consistently.

If you believe you have been suffering from dry eyes, give us a call, we have a number of treatment options that can help replenish moisture on the surface of your eyes and help you feel better.

Glasses or Contact Lenses

Glasses or Contact Lenses

glasses or contact lensesSome people are contact lovers, some people are glasses fans. And some love both. The contacts vs glasses debate has a lot to do with personal style, usage, and comfort. Luckily, with the array of contacts and eyeglass lenses now available through our optical shop and a little knowledge of the pros and cons, you don’t have to sacrifice aesthetics for comfort or convenience. You can choose what works for you when it works for you.

Eyeglasses Make a Statement

Most people begin their vision correction journey with glasses. Eyeglasses allow wearers to define their personal style and make a statement. Maybe you want to assert yourself like Clark Kent, or show the world your eccentric or artistic side like Andy Warhol. Eyeglasses will convey your message whatever your tastes. In addition, glasses are generally cheaper than contacts over the long run, and they offer some protection from dust, wind, and light. Glasses are easy to pop on and off for tasks and naps. In addition, if you have sensitive or dry eyes, glasses are also gentler on your peepers.

Convenience for Active Lifestyles

Contact lenses are great for people with active lifestyles who don’t like the feel of an appliance on their face when they play sports, hike, or run. Because they fit to the curvature of your eye, contacts give a wider field of vision than eyeglasses and won’t distort or reflect your view. As an added bonus, contacts don’t steam up when it is muggy out or fog up in freezing weather. There are also contacts available now that fit specific prescription issues such as astigmatism, as well as multiple prescriptions, far sightedness, and near sightedness.

The optometrists at 360 Eyecare - Metro would be happy to advise you on the proper fit for your eyeglass prescription, or the right contact lenses for you. We are conveniently located in downtown Toronto and are accepting new patients.