Tips for eye health with Dr. Alejandro Oliver, Timmins and District Hospital ophthalmologist

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Canadians have a lot of questions about the health of their eyes.

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That was the conclusion of a survey conducted between March 20 and 23 whose findings were released in May to mark National Vision Health Month.

The Ipsos poll interviewed 1,501 people online on behalf of the Canadian Ophthalmological Society, and found that eighty-three per cent of Canadians say they vision health is important to them, yet half feel informed about treatments for serious eye conditions like cataracts.

Your reporter asked Timmins and District Hospital ophthalmologist Dr. Alejandro Oliver to unravel some of the mystery behind these complex little orbs, and how TADH is contributing to eye health in the region.

Dr. Oliver made local headlines in 2023, when he led the establishment of a locum ophthalmology clinic at the hospital to reduce wait times. He recounts that story in the following interview.

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(This interview has been edited for readability)

Q: What does an ophthalmologist do?

A: Ophthalmologists are eye physicians and surgeons. After university, we go to medical school and after medical school, as licensed physicians, we specialize in diseases of the eye, in particular how to diagnose and treat them medically and surgically.

Often people get us confused with optometrists. Optometrists will go to university and then directly to optometry school. So they are not physicians, but we all work together very closely looking after people’s eye health.

Ophthalmologists are responsible for screening of eye conditions, a little bit of treatment now since their scope has increased, but we’re responsible for any surgical treatment.

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Q: I understand you also teach at the University of Toronto. Do you do that virtually, or do you have to travel?

A: I’ve been teaching medical students and residents at NOSM (Northern Ontario School of Medicine) for many years. Very recently we started a collaboration with the University of Toronto where we get their residents —doctors who are training to be ophthalmologists in Toronto—to come and visit us once a month in Timmins. They come and help us with cataract surgery patients.

It’s a collaboration between their staff and me. They’re here for a full week: half a week with me and the other half with a doctor from Toronto that flies into Timmins with the residents. In fact we have one with us today. This is U of T week.

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It’s like a transition to practice. They are senior residents almost ready to graduate. The hospital built a clinic for them that they share with other locums. They get to run the clinic, schedule patients, make surgical decisions and follow-ups in collaboration with me.

Q: Are there residents coming from NOSM too?

A: NOSM does not have an ophthalmology program, unfortunately. It would be great, because I think that there’s a need. But it’s a senior resident from Toronto. Ophthalmology is a five-year program so they’re in their late fourth or fifth year. They’re basically fully trained, but up here they’re trained in rural medicine, and they provide service, because I cannot keep up with everyone who needs surgery. They and their team of doctors come and help us. They are based in Toronto at the Kensington Eye Institute, which is the biggest eye hospital in Canada.

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Q: Tell me about your background.

A: I’m from Mexico, originally. I trained all over the place— in the States and Europe. When I finished my training, as part of my agreement in Canada I had to do what’s called a return of service. I trained one year in Canada so I was asked to serve in an underserved area for a year, but Timmins convinced us, and a year became 16 now. We’ve enjoyed it. People are very nice, very welcoming.

Q: What are the biggest eye health issues you come across in Timmins and the surrounding area?

A: There’s plenty, it’s hard to pick one. One of the things is preventable diseases like diabetes and high blood pressure and smoking. As you know, we’re extremely short of family doctors and that trickles down into chronic diseases and worse health for the population.

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The eyes are not alone. They are connected to your body, so any disease of the body affects your eyes. If you have diabetes, and you don’t have a family doctor or nurse practitioner to help you control it, eventually it takes a toll on the eyes, and they can be devastating, especially for the homeless or who those have poor access to health. That is very frustrating because it’s so preventable.

You could go blind from a retinal detachment through no fault of your own. But with diabetes, you could have perfect vision your whole life with proper treatment.

Q: What should people with those conditions and smokers know about prevention when it comes to eye health?

A: If you could get a family doctor— though that’s very difficult these days. Do anything in your power to try to optimize your health. Stay active. Find ways to stay active in the winter. Stop smoking. It’s not easy, it’s a big addiction. Try to watch your blood pressure. If you have access to a family doctor or a nurse practitioner, make sure you are seen regularly. Measure your own blood pressure at home. If you don’t have a blood pressure metre, you can go to the pharmacy and measure it there. You kind of have to be your own family doctor in some ways if you don’t have access to one.

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Q: What advice do you have on how screen time affects children’s eye health?

A: There’s a proven link between near work and certain diseases. The main one would be myopia. Myopia means as you get older you start to need glasses to see far away because your eye elongates, it gets bigger. We think that kids that spend a lot of time on their devices trying to focus up close are at risk of developing myopia.

We would like to prevent that. The best way to do it is by cutting on screen time and spending time outdoors. When your eyes focus far away it relaxes those muscles inside the eye and prevents that development of myopia. People with myopia that are very near sighted have a lifetime risk of many other diseases like retinal detachment, bleeding inside the eye, so anything we can do to prevent myopia in children is going to pay off for decades.

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Have an agreement with your kid as to how much screen time is allowed every day and kick him out of the house— play road hockey, ride your bike— spend as much time outside as possible.

Q: What about the 20-20-20 rule to reduce digital eye strain for adults? Do you have a similar suggestion for kids?

A: I think in general, kids need to be kids and be outside. That rule is more for adults, who can set a timer for when to look out the window. But for kids, they just need to play, not just for the eyes but for their general health—make believe and coming up with scenarios.

Q: The Canadian Ophthalmological Society survey found that only 41 per cent of Canadians aged 18 to 34 were knowledgeable about the symptoms and early signs of cataracts, though cataracts, a leading cause of blindness, can occur at any age. What should this age group know?

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A: The truth is that the chances of eye disease at those ages are small. When you’re young, most things work. Eye injuries—often work-related— in that group would be the most common cause of eye disease.  We recommend that working-age people always wear protective glasses, also during recreation. When you’re hammering, cutting down a tree, fishing— be mindful of that. Cataracts at a young age are rare. If anything, we see them congenitally, which means that you’re born with them. We have very good screening programs for that with a nurse practitioner and family doctor.

Most workplaces have good policies in place. Protective eyewear gets in the way in certain situations— if it’s cold, you can fog up or if it’s hot you can be sweating and it’s tempting to take off the shield, but it’s important to stick to it. When you’re young, if you have a bad eye injury, it follows you for the rest of your life.  What you can do with one eye versus two can hamper your livelihood. It just takes a second to have a really devastating injury.

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Q: What should adults know about cataract prevention?

A: Typically, we start worrying about cataracts after age 65 when we recommend yearly exams, even if you have no symptoms (You can get cataracts at a younger age if you have certain risk factors such as diabetes). Before that, an exam every two years is usually adequate.

Be mindful of eye symptoms. If you experience a new eye symptom at any age, seek help. That’s important. It could be something like floaters, but it could be something serious, like a detached retina. Screenings will pick up any problems.

Q: What kinds of eye health services does the Timmins and District Hospital offer?

A: Timmins is very special because it’s a community hospital but it acts as a district hospital. Even though our funding is for a little hospital, we take on cases and serve populations that a much bigger hospital would. In ophthalmology in particular, our scope is very broad, much broader than Sudbury and North Bay.

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We look after diseases that are complex and challenging that normally Sudbury would bypass and say ‘Go to Toronto,’ or North Bay. Timmins punches above its weight that way, so it’s quite unique. We treat common conditions like cataracts or glaucoma to something very advanced like a detached retina or severe glaucoma.

We’re lucky that the hospital is very forward-thinking and very supportive. Like the locum clinic, it’s one of a kind. It’s never been done before in Ontario, perhaps even in Canada, so we’re very proud of it.

Ideally we’d be able to recruit someone like me that would want to live in Timmins and practice full time, but it’s been very challenging.

Q: The Canadian Ophthalmological Society also found that 38 percent of those surveyed say extreme weather negatively impacted their eye health in the past year. Do you see this in your practice and what are your tips for protecting our eyes from extreme weather here in Timmins and the surrounding area?

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A: In our area, I think the biggest direct impact would be effects of forest fire smoke on people’s eyes. This would be especially detrimental for those with allergies, dry eyes, those who use glaucoma drops or have had previous eye surgeries.

An indirect effect would be that of population displacements, from fires, floods, and so on, which adversely affect the social determinants of health.

Q: The survey also said that 75 per cent of Canadians feel it’s important to have access to the latest innovations in eye care but 52 per cent feel comfortable with AI-assisted diagnostics. What is your view?

A: It’s still to be determined what the value of AI is. Certainly, any discipline where there’s a lot of data being generated can be supported by AI. From my understanding, if you can give these computer models a lot of data, a lot of information, the computer can find patterns.

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In ophthalmology, we generate a lot of data, we see a lot of patients often, so AI companies have an interest in imaging. For example, we could take pictures of the back of the eyes of patients with diabetes. Without a human involved, AI could say ‘this person is starting to have problems, let’s find them an eye doctor.’

As far as I’m concerned, it’s still early days. It’s not fully clear what the role of AI will be. It’s hard to see a point where you won’t need an eye doctor anymore, you just see the AI and that’s it. I think that might be a decade or so away.

Q: I recently wrote about the hospital auxiliary, who decide who to fundraise for by sending a letter to every department and asking what their needs are. If I were the auxiliary, what would you say some of your departmental needs are going forward?

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A: First of all, I would say thank you, because the auxiliary has been supporting ophthalmology from the beginning, they’re amazing. Talk about punching above your weight.

Right now, we’re looking at renovating our lasers. A lot of the surgery we do in ophthalmology is through lasers, which is just a very special type of light. We can use lasers to deliver treatment to the eye because the eye is transparent. A laser can get into the important areas of the eye and deliver treatment.

Our lasers are now 14 years old so the companies that service them are telling us there’s no more parts and we need to think about buying new ones. So that’s the stage we’re at now, of renewing our two lasers that we have. So that would be our next capital project.

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