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Author: Peter Roed

The Low-Down on Digital Eyestrain

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As our digital world expands, we are spending more and moretime glued to our electronic devices, and not surprisingly,Computer Vision Syndrome (CVS) or digital eye strain is on therise. Recent data presented by Kleiner Perkins indicates that,on average, Canadians spend just under 400 minutes per day on electronic devices (two hours being on our smartphones),with one in ten people spending 75% of their waking hours on devices. Approximately 65% of North Americans report symptoms of digital eye strain, with other common related symptoms being headaches, blurred vision, dry eyes and neck and shoulder pain.

Viewing a digital screen often makes eyes work harder. In some cases, the letters on the digital device might not be as sharply defined as on a printed page, the contrast might be too low or there might be too much glare. We also tend to blink 50% less, which can contribute to or worsen pre-existing, dry eye symptoms. As we strain to see details, over time our facial, neck and shoulder muscles can tighten and, in many cases, our poor posture and repetitive movements create musculoskeletal discomfort. In essence, CVS occurs because the demands of the task exceed our abilities, with the risk increasing greatly at two or more hours per day of usage. Our kids are being raised with technology and digital devices integrated into their everyday lives more than any generation before them. With Chromebook use at school and in many cases hours of use once they get home, it is estimated that 65% of children and teens spend two or more hours per day on digital devices. This puts them at risk for not only CVS but now we believe increasing myopia (near sightedness). The prevalence of nearsightedness among North Americans is estimated to have increased over 60% in the last 30 years, and more and more research points towards increasing near work and less time spent outdoors in natural light as being partially responsible. Digital devices can have great value for our kids, but it is important that, as parents, we are aware that they can experience vision problems as well. Kids can also be less self aware of keeping track of the hours they spend on devices or may ignore problems such as glare or neck strain while engrossed playing a video game or watching a show. Luckily there are many strategies and products that can reduce digital eye strain for kids and adults alike.

The first step towards eye-friendly computer use is to have a comprehensive, annual eye examination. That’s because uncorrected vision problems like far sightedness, astigmatism, poor eye focusing or eye coordination abilities can contribute to the development of CVS. In many cases, even the presence of minor vision problems can significantly affect comfort and performance on a digital device, especially over time. Controlling lighting is also very important, both from the display itself and from light sources around you. Glare from nearby windows or from overhead lights make your eyes work harder, so try turning off some surrounding lights or closing the blinds when possible. Ideally your monitor should be about the same brightness as the light around you. You can also try reducing the color temperature of your monitor (to warmer color tones) since blue light scatters more easily in the eye then other visible light, contributing to eye strain. Alternately, try installing an app called f.lux that automatically adjusts your screens color temperature for you (https://justgetflux.com/). Help make your workspace easy on your eyes by keeping your screen arm’s-length away (20–28 inches) and keeping the screen center 15–20 degrees (about 5 inches) below eye height. Your eyes can focus and coordinate on near objects slightly better in down gaze, and it can help with neck and back strain as well. For kids, make sure the computer is adjusted for their body size. Try taking breaks and looking away from the computer for20 seconds every 20 minutes. If possible, take longer five-minute breaks every two hours looking at something at least 20 ft away to reduce focusing strain. Reduced blinking can also make your eyes feel more irritated and strained, so try adding in 10 slow blinks after each break if needed. Additionally, encourage kids to limit their sedentary tasks with digital media to less than two hours a day, and spend some time educating them to respond to any discomfort they experience when using digital devices by taking breaks and seeking care if symptoms persist.

Like many things, moderation is the key. Remember: CVS should be temporary, so if vision for yourself or your child is not returning to normal, book an appointment and share your concerns. Another option is to consider trying computer glasses. In many cases, glasses and contacts prescribed for regular use may not suffice for extended digital device use. As optometrists, we now have new lens designs and coatings/filters that actually help reduce eye strain and allow you to work longer and more efficiently on your devices, even if you do not wear glasses otherwise. As a closing topic, I want to touch on nighttime device usage. For many of us, unwinding from our day does not mean unplugging from technology. In fact, recent studies indicate that about 75% of us look at our devices in the hour before bed. High energy visible light (HEV) or blue light emitted from our devices is very effective at suppressing the sleep hormone melatonin and shifting production towards cortisol (a stress hormone), which can negatively affect our sleep. This can be especially detrimental to our kids whom tend to need more sleep then we do, so try avoiding device usage in the hours before bed. Alternately, we can now make digital lenses that block a portion of the blue light and we can warm the color temperatures of our devices, minimizing their effects. Digital devices are part of our lives and are here to stay. With a bit of knowledge and some strategies for use, we can both enjoy and be productive with them, even the small screens, without any of the big vision problems. If you have any questions or concerns, we are here to help. I look forward to hearing from you.

Dr. Peter Roed

Kids and Concussions in Sports | How does Optometry fit in?

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Sports related concussions, at least the ones that get reported, are on the rise. With three active kids of my own in multiple
different sports, it is a topic that hits close to home. It is very important to realize that a person does not need to be
knocked out – or even hit on the head – to have a concussion. Concussions are a type of traumatic brain injury not usually
seen with MRI or CT scans but are still detectable when certain functions, such as vision, are measured. Science tells us that
repeated concussions (even mild ones) in succession can cause long-term damage, so our goal at the office is to effect change
not only through education but also by screening as many of our young patients as we can. Our office now has a noninvasive
testing system that can help identify concussions when the diagnosis is unclear. It does this by establishing a baseline
assessment and looking for changes post injury.

Sports are still overwhelmingly good for our kids and have benefits such as better self-esteem and improved physical health. But
with the prevalence of concussions on the rise, having a method to help identify even mild concussions is exciting to me both as
a parent and as a clinician. The first and the most important step, however, is identifying the problem. Because when managed
properly, there is usually no cause for concern regarding any long term damage.

A recent online poll by Angus Reid indicated that 1 in 5 Canadians have been concussed while playing sports. There was also a
recent study presented at the American Orthopedic Society of Sports Medicine that cited a sixty percent increase in concussion
incidence between 2007 and 2014, with the greatest change in the 10-19 year old age group. With the passing of Rowan’s Law
concussion legislation in Ontario and with the Liberal Government’s March Federal Budget providing 1.4 million dollars for the
Public health agency of Canada to look at ways to harmonize concussion management guidelines across the country, we are moving
in the right direction. For the moment though outside of Ontario there is no clear legislation mandating a policy on concussion
recognition and management, many times leaving the decisions in the hands of the parents and the coaches. I have included links
to a few great resources which can help us to make educated decisions on when to seek medical care for our children.
(http://www.parachutecanada.org/concussion), (http://www.cdc.gov/headsup/basics/index.html)

It is comforting to know that even if a player is concussed, 80 to 90% are symptom-free in four to six weeks, but for some it persists
for months. This is called post-concussion syndrome. Control of eye movements, focusing and many other aspects of visual system
are particularly vulnerable to concussion and, as such, commonly affected. In fact, vision alone accounts for more than 50% of the
brains pathways. Some common visual complaints include blurred or double vision, eye fatigue, difficulty following objects, light
sensitivity and motion sensitivity. Treatment options can range from a change in glasses prescription and special tints to vision therapy,
which in many cases can greatly speed up visual recovery. Our office now uses the King-Devick Recovery Acceleration Program,
which is a program specifically designed to speed up visual resolution to those suffering lingering symptoms post-concussion.
If a concussion does happen it is very important to realize that returning to play before fully recovered increases the risk of
obtaining another brain injury which can be more significant. It is also important to know that the brain is sometimes still vulnerable
to a repeat injury even after symptoms have resolved. Therefore it is important to follow the official “Return to Play Guidelines” when
attempting to return back to sport (http://www.coach.ca/files/returntoplayguidelines.pdf). If you have any questions in regards
to the screening protocol or treatment options, feel free to contact the office at any time.

The culture of sport is changing in the right direction and will hopefully continue to change. In the mean time, let’s work together
to protect our kids while allowing them to play the sports that they love.

Dr. Peter Roed

Vision Development for Kids: When should they have their Eyes Assessed?

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As a parent of three kids, I know it can be hard to sift through all the information/ misinformation available to make prudent choices for our kids. When it comes to vision care, I get questions all the time, which indicates that we as eye practitioners could be doing a better job at getting the necessary information to the general public. To that end, I have gathered many of the key pieces of information that a parent, grandparent or other caregiver might need to feel comfortable making some of those decisions, such as when to have a first eye exam or how to recognize indications of vision problems at different ages.

Vision development is a great place to start. Here is a timeline to consider:

Birth to 24 months:
Babies are not born with a fully developed visual system, and they actually learn to see over time. They must learn how to focus, use their eyes together as a team and even how to use the visual information they are receiving. Eye and vision problems at this stage, although uncommon, can cause developmental delays, so schedule their first eye exam between 6 and 8 months of age. Initially, an infant’s eyes are not well coordinated, so intermittent wandering/ crossed eyes can be normal for the first few months. If, however, it is constant or still happening frequently by three months, have an assessment.
A few other important signs of visual problems include excessive tearing, extreme light sensitivity and, very rarely, the appearance of a white pupil. The full range of colors and depth perception won’t be available for them until around the fourth to fifth month. A general timeline of visual development might include following high-contrast targets within 8 to12 inches by 2 months, batting nearby targets at 3 months and beginning to reach and grab around 4 months. From 9 to 12 months, they should be able to judge distances fairly well and be grasping things with thumb and forefinger. By 24 months, hand-eye coordination should be well developed, as should depth perception. Remember, most babies’ visual systems develop without complication, but if you notice anything mentioned or something else that concerns you, bring them in immediately to be assessed.

From ages 2 to 5: Visual development continues with ongoing refinement of the abilities gained during infancy. They are developing fine motor skills, hand-eye coordination and perceptual abilities necessary to be able to succeed in school and beyond. Approximately 25% of preschoolers have a vision problem, yet many go undiagnosed—some with long-term consequences. With visual development ongoing, anything that interferes with this process has the potential to create Amblyopia (in which vision is blurry, usually in one eye, and is not correctable with glasses). Eye coordination issues can also present during this period. One of the most common is Crossed eyes— the eyes do not work together and can be constant or intermittent. Amblyopia can develop from crossed eyes but can also develop without noticeable signs, making it harder for a parent to identify.
With no evidence of visual problems, minimum recommended eye exams would be at 3 and 5 years of age. I advocate for annual assessment in my practice through this developmental period since it is such a crucial period in that problems can be elusive and in many cases have better outcomes if managed early. Some important signs for parents to watch for that might indicate a visual problem include frequent eye rubbing, short attention span, light sensitivity, avoidance of detailed visual tasks (i.e. puzzles), frequent head tilting, squinting or consistently sitting too close to the TV or holding books to close. In addition, pay attention for delays in development that may indicate a vision problem (i.e. delays in recognition of numbers, shapes, letters or colors). If any of these signs are present or if you suspect a vision problem might be present, be conservative, and book an appointment. It is also very important to realize that a vision screening is not an eye exam. Screenings done at school or even screenings at the pediatrician/family doctor’s practice can uncover some vision problems, but they can miss more than they find. This is a concern about vision screening programs, which in some cases create a false sense of security and can delay diagnosis. The solution is simple: include regular eye exams by your optometrist or ophthalmologist to protect your kid’s eye health and visual development.

School Aged Vision: age 6 through teens: One of the most important things to remember is that vision is much more than visual acuity (seeing 20/20 on a chart). Your child’s eyes need to track/follow, work as a team and focus at different distances, which in turn leads to visual perception and related hand-eye coordination. Even small deficiencies can affect school performance, especially as the school years pass and visual demand increases. We estimate as much as 80% of learning is visual, let alone our vision’s role in everyday life tasks, sports etc. It is estimated that 25% of school aged children have a visual problem that if left untreated can affect learning ability and so much more. Signs of vision problems for this group can mirror many of those for the preschoolers but should be expanded to include frequent headaches or complaints of tired eyes, poor comprehension/memory of reading material and/or poor reading ability in general (including losing their place when reading). Exam-frequency recommendations for this group without vision problems is every 2 years or as per your eye doctor’s recommendations if an eye problem exists (i.e. annually if your child is near sighted and needs glasses/contacts).


Learning disabilities
are another concern to discuss that tie into visual development. Approximately 4 to 5% of school age kids have a learning disability. Although this is not a vision problem, it has been shown that kids with certain visual problems were significantly more likely to be diagnosed with a learning disability and/or ADHD. Although the exact relationship between the two is unclear, ensuring proper visual development and managing any visual problems if a diagnosis has been given as part a multidisciplinary treatment makes logical sense.
In closing, remember this: if identified early and managed, most eye problems can be solved. The first step is to educate yourself and bring your kids in for routine assessments. If you have questions or concerns, we are always here to help.

Regards,
Dr. Peter Roed

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Dry Eye explained – causes, treatment

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For many people with dry eye, the symptoms are undeniable and ever pervasive, but for others it is not so clear-cut. I see patients adapting and coping not knowing their eyes could work and feel so much better. The prevalence of dry eye varies widely between studies but could be as much as a third of our population. Recent research indicates that the percentage is likely much higher for certain groups such as office workers, with percentages approaching 50%, partially because of their extensive digital-device usage. Furthermore, these numbers are expected to rise in large part due to our aging population, increasing digital-device usage and increasing prevalence of autoimmune diseases such as Type 1 diabetes and Lupus. A number that might be even more surprising is that up to 70% of people polled don’t seek care when experiencing symptoms of dry eye.

So what sort of symptoms or signs might one experience with dry eye? Here are some of the questions I might ask a patient in the chair to confirm what I might see during the exam.

1. Do your eyes bother you while on your phone or computer?
2. Do your eyes get irritated when wearing your contact lenses?
3. Does your vision blur intermittently throughout the day?
4. Do your eyes water intermittently, especially in the wind or the cold?
5. Do your eyes get red, sore, itchy or burn?
6. Do you find you are getting sensitive to certain lighting?
7. Do you ever avoid certain activities due to your eyes?
8. Do you get frequent crusting or mucous in around your eyes?
9. Do you get the intermittent feeling that something is stuck in your eye?
10. Do you ever use or feel the need to use eye drops?

If you answered yes to more than one of these questions, it’s probable that dry eye is involved. So what exactly is dry eye anyways? In most cases, dry eye occurs when the eye does not produce enough tears or when the makeup of the tears changes so they are unstable and evaporate too quickly with the resulting irritation (inflammation) making matters worse. The tears prevent dryness, help keep the cornea smooth so we can see clearly, protect the surface from irritants and infection and so much more. So a poor tear film can result in more than just irritation. Someone with mild dry eye might be tempted to disregard the symptoms, but it’s important to realize that dry eye is usually progressive in nature and, in general, is much easier to
manage in its early stages. It is for this reason that in my practice I focus on a proactive program to maintain a healthy ocular surface, striving for prevention when possible, treatment as needed.

Common causes of decreased tear production include increasing age, certain medications such as antihistamines and antidepressants, or certain medical conditions such as arthritis or diabetes. The main cause of increased evaporation and the main cause of dry eye in general is something called Meibomian Gland Disease (MGD). These meibomian glands in your eyelids produce an oily layer for your tears which helps prevent evaporation, so when they stop functioning properly, a cascade of dry eye can begin.

So how does digital-device usage fit into the mix? Well these oil-producing glands are expressed when we blink, and it turns out if our blink frequency is reduced over extended periods of time, theses glands can get blockages or can be reduced in function. So since we blink approximately 50% less than normal when viewing digital devices, we have our answer. The problem can become chronic since if the blockages are not cleared or function restored for extended periods of time, the glands can be damaged or lost.

So what can be done to prevent and to treat? From the prevention perspective, start with a routine exam, and ask your eye care provider about the state of your tear system. If you are taking medications or have any pre-existing health issues, then ask how they might affect your eyes over time. Since most dry eye is related to MGD, maintaining the function of those oil-producing glands is a critical step in prevention in many cases. In mild cases, a simple eyelid heating and gland expression protocol can be effective prevention.

After diagnosing a patient with dry eye disease, the first step is determining the causative factors, as medications or other health issues may be contributing. Is there a decrease in tear production and/or decreased meibomian gland function? Is contact lens wear or digital-device usage compounding the situation? In some cases, the lid mechanics are part of the problem (the lids might not close properly, or the lower lid turns outwards). If diagnosed properly, the vast majority of patients with dry eye disease can find relief with proper therapy. For mild cases, a regime of eyelid heating/expression, artificial tear usage and specific oral supplements will likely be sufficient. In more recalcitrant cases, anti-inflammatory drugs together with drugs that modulate the immune system locally can help to quell severe irritation and help a person to produce more tears.

If you have dry eye disease and have been living with the symptoms, it is important to know that so much more than just using artificial tears can be done to help. On the other hand if you answered yes to any of the questions prior but have not sought out care as of yet, book an appointment; early treatment and prevention are key. As always, if you have any questions or concerns, we are here to help.

Dr. Peter Roed

Nutrition for your eyes

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The old adage ‘you are what you eat’, although its roots stretch back hundreds of years seems more relevant than ever today. With processed foods, genetically modified ingredients, additives, pesticides and foods shipped the world over, together with our busy lifestyles, eating healthy balanced diet on regular basis can be challenging.

When discussing diet and eye health (and for that matter health in general) it is important to understand that in most cases both nature (your genetics) and nurture (your environment; i.e foods you eat) are important to consider. Most people who develop lung cancer are smokers, but not all smokers get lung cancer. And not everyone who overeats develops diabetes yet they are likely increasing their risk by doing so. Think of a continuum established by your genetics and where you land on that continuum can in many cases be influenced by what we expose our bodies to. So although not all health problems will be influenced by our diet many studies suggest that making smart diet and lifestyle choices can help influence many health outcomes.
For many of my patients the extension of the concept of their diet’s affect on general health to include their diet’s influence on their eye health is difficult. This was the impetus for the article since studies clearly indicate only about 25% of us are meeting our fruit and vegetable intake recommendations, feasibly tipping the nature / nurture continuum in the wrong direction. With rates of chronic diseases such as diabetes continuing to raise in combination with our aging population it is thought that rates of low vision and blindness might double by 2030. Making healthy choices such as changing our diet can help to guard us against disease. The good news in terms of eye nutrition is that many of the choices that are good for the rest of the body are also wise choices for our eyes.

Supplements can fill dietary gaps when necessary but nutrients from food are most important. Real food sources provide nutrients in a wider variety and in combinations that can work synergistically together. For your eyes the Vitamins A, C and E, the mineral zinc, the cartenoids lutein and zeaxanthin and omega 3 fatty acids are some of the most important. It is also critical to realize that although an abundance of these vitamins in a balanced diet is good, there is such a thing as too much, especially in supplement form. Although there is plenty of evidence that eating high-antioxidant foods that contain beta-carotene is good for your health, a clear study from the US of more than 18000 smokers given beta carotene supplements over four years (the CARET study) found a 28% higher risk of lung cancer than those that received a placebo ( a fake supplement).The important message here is that there are benefits to getting vitamins in food that don’t necessarily occur in supplement form.

Two of the best antioxidants for your eyes are lutein and zeaxanthin. The body cannot make either so they have to be eaten. They are found both in your retina (the light sensing tissue at the back of your eye) and the intraocular lens (a biological lens in your eye that helps with focusing light). Dietary intake of these compounds has been shown to improve the pigment density in the important areas of your retina helping to protect these delicate tissues from damaging UV, blue light and free radicals that we get exposed to every day. Dark Leafy greens such as kale and spinach are two great sources but you’ll find them in most fruits and vegetables, especially yellow, orange and other leafy greens. In a lovely example of the above mentioned synergy, fats improve their absorption from our diet, making salads with an oil based dressing or a side of fatty fish the perfect autumn prescription.

Omega 3 fatty acids also play a significant role in eye health and have to be obtained from food or supplement sources. Although all the fatty acids are important for general health the beneficial effects of added omega-3 in our diets seems to be more critical, at least in western society. It is thought that human beings evolved on a diet with an almost even ratio of omega 6 to omega 3 yet present day average Western diets have ratios in the range of 15/1. Although the evidence is far from clear there is mounting evidence that the imbalanced ratio fosters inflammation and chronic health concerns and increasing our omega 3 intake can help to reverse some of these problems. Research and my personal clinical experience clearly indicate omega 3 supplementation has a role in the treatment of dry eye. Although dry eye is complex and usually multifactoral it almost always involves increased inflammation, which the omega 3 supplementation can help to reduce. Another place we see Omega 3 fatty acids in high concentrations in our retina helping to optimize both integrity and function and protect from inflammation and neurotoxicity. Great sources of omega 3 fatty acids are salmon or other coldwater fish, walnuts and flax seeds or oils.

The mineral zinc is highly concentrated in the eye, mostly in the retina and choroid (the vascular tissue layer under the retina). It plays a vital role in bringing vitamin A to the retina in order to produce melanin, a protective pigment in the eyes. The human body does not produce the zinc it needs, so daily intake of zinc through diet or nutritional supplements is important for the maintenance of good eye health. Red meat, seafood, poultry, eggs, mixed nuts, tofu and beans are all good sources of zinc. The most recent research clearly indicates zinc supplementation has a role to play in slowing the progression of advanced age related macular degeneration (AMD) and may benefit those at risk or in the early stages of the disease.
Vitamin A also plays an important role. In order to see properly your eye requires vitamin A to produce certain pigments in your photo sensing cells in your retina. It is also needed to keep the clear covering on your eye lubricated so you can see properly. Current research indicates it also can help slow the progression of advanced AMD when combined with other antioxidants and minerals. Vitamin A can be found in many foods including leafy green vegetables, orange vegetables and eggs.

Vitamin C is an antioxidant found in many fruits and vegetables. Scientific evidence suggests vitamin C lowers the risk of developing cataracts. Risk factors for cataracts include smoking, diabetes and steroid use, which deplete the eye’s lens of vitamin C. Vitamin C helps promote healthy blood vessels and iron absorption and has been proven to be beneficial for AMD also. Good sources of vitamin C include broccoli, brussels sprouts, grapefruit, kiwi, oranges, red peppers and strawberries. Finally, but as important, we have vitamin E. Vitamin E can be found in foods like almonds, broccoli and spinach. It can also protect the cells of the eye from damaging free radicals. If left unchecked the free radicals can break down healthy cells and increase the risk for AMD and cataracts. Studies clearly show that vitamin E has a role to play in both slowing cataract development and in slowing the progression of AMD.

So clearly having adequate intake of these nutrients makes sense from an eye health standpoint but how much do we need for prevention or treatment? In my clinic I approach this question first by understanding each patients eye health and what risks they might have for future problems prior to discussing options for diet or supplementation. Specific eye conditions such as AMD have research based supplementation but more general concerns are not as clear cut. If you are interested in discussing diet and supplementation options specific to your needs I would be happy to help. Look forward to hearing from you.

Dr. Peter Roed

Advanced DIagnostic equipment : OCT and Retinal Imaging

Advanced OCT 3D Eyescan

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Our clinic has an OCT (optical coherence tomography) which delivers a high clarity three dimensional image of the tissues at the back of your eye in real time greatly improving our ability to diagnose, monitor and treat a large variety of eye conditions such as glaucoma. With this equipment our eye doctors can diagnose eye conditions sooner and with more certainty then ever before. Our clinic also has advanced retinal imaging (a specialized camera is able to take pictures of the back of the eye and digitally record them). This allows our doctors to monitor changes in the back of your eye very accurately since we can compare images from previous appointments to current imaging again helping with diagnosis.

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Our clinic also has multiple visual field devices each with specific advantages over the other allowing faster more accurate diagnoses (allows our doctors to test not just central vision but peripheral vision to identify conditions such as glaucoma). The brand new Zeiss HFA3 visual field unit Humphrey HFA3 is the gold standard in field testing allowing us to obtain more accurate results faster than ever before. The second unit is the Zeiss Humphrey Matrix 800 Zeiss Matrix 800. This unit is especially useful as a screening device and for early glaucoma detection. Adding this equipment is part of our ongoing commitment to have the latest technology available helping us give our patients the best care possible. Book an exam today or call the office to discuss this new technology - we are here to help.

Dr. Peter Roed

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Please Read Before Continuing!

Please take note that our clinic is open but we are by appointment for all visit types. Our clinic door will be locked for the near future. We are open 9:30-12:30 & 1:00-5. Closed every second Saturday & every second Monday. 

If you are needing to pick up products such as glasses, contacts, dry eye products, anti-fog solution, if you are needing a frame adjustment or would like to purchase new glasses, please call us to book an appointment.

You can book your eye exams & non emergency medical appointments from our home page. If you are needing dilation drops, contact lens check, a follow up appointment or any other appointment that is not listed online, please call us at 780-460-9673. These appointments cannot be booked online. 

You can also send us a contact lens order request from our homepage. Your contact lenses will be shipped directly to you. Please note that we cannot deliver contacts to PO Box addresses. If you are due for your annual eye exam, we will contact you back to book your eye exam before we order contacts.

We appreciate your time & understanding.

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