Beh Optometry Clinic

这位病人今天来领取眼镜，这是我们为她配制的第三副（见图 1）。

在2022年，她的眼睛出现了一系列问题，已经在这里有报道：https://www.facebook.com/behoptometryclinic/posts/2512398302227038?ref=embed_post

她戴上正确度数的眼镜两年多后，右眼弱视已经完全康复，看东西和左眼一样清楚。两旁眼睛是直的，此外，她还拥有功能齐全的双眼视觉(英文：full binocular vision)。她的母亲对此无比高兴。

现在唯一的问题就是她的眼皮内翻(英文：entropion)，目前通过机械式除毛来治理。现在她只须要定期到我们诊所检查和配戴正确度数的眼镜来维持现状。我的使命也完成了。

This patient came in to collect her spectacles today. This is her third pair of spectacles with us (see image 1).

In 2022, she had a series of eye problems and was reported here: https://www.facebook.com/behoptometryclinic/posts/2512398302227038?ref=embed_post

After wearing our spectacles with correct powers over 2 years, her amblyopic right eye has fully recuperated and sees equally clear as her left eye. Her eyes are straight and in addition, she has a fully functional binocular vision. Her mother is absolutely delighted with her results.

The only thing left is her entropion, which is currently managed by epilation (mechanical hair removal). Now she has to maintain her status quo by regularly visiting us for eye examinations and correct prescriptions.

Please note that my land line 04-227 8291 is currently disconnected because the entire area is being converted to a fiber network.
Please call 018-4686 851. Thank you.

这位 15 岁的病人5 个月前来就诊，左眼患有弱视（英文：amblyopia, 图 1）。 多年来，他一直佩戴从柜台购买（英文：over the counter）的一次性隐形眼镜，右眼视力 6/9（第 7 行），左眼视力 6/24（第 4 行）。 他的父母担忧他的弱视眼并前来寻求意见和治疗。

检查眼睛后，我发现他佩戴的镜片度数不正确。 然而，即使佩上正确的镜片，他的左眼仍然只是看到第4行字母。 在毫无病理或受伤（英文：pathology, trauma）的情况下，这是弱视的经典案例。

弱视是一种视网膜（英文：retina）因长时间模糊而变得功能障碍的疾病（英文：dysfunction）。 尽管戴上了正确的眼镜或隐形眼镜，受影响的眼睛仍然比另一只健康的眼睛少读一行或多行字母。

人类的视网膜在出生时不是固定的。 它在童年时期不断发育和重组，以达到越来越清楚的视力。 到了 7 或 8 岁时，它就会“固定”成永久式的成人模型，发挥和持继一生最强的视力。 所以任何治疗都必须在7、8岁之前进行，过了这个年龄就很难有任何改善，这全都是教科书上写的。

当时这位病人是15岁，显然已错过了最佳的治疗时机。 尽管如此，我还是决定开始治疗。 除了配上一副正确的隐形眼镜之外，我还制定了一套occlussion治疗方案。 这迫使他的大脑用左视网膜看，来激活视网膜上的神经细胞，以获得更清楚的视力（见图 2）。

昨天他来复诊时，他的左眼可以阅读第 7 行的一半的字母，视力明显的已经追赶上右眼了。 他的父母看见这种巨大的进步感到非常高兴。 我们再继续治疗6 个月，观看接下来的还有什么进展。

显然的在正确治疗下，7或 8 岁之后的视网膜也能发育和纠正，不像教科书上所描述。 所以我们决对不能因为病人的年龄而劝阻或放弃治疗。 所有的视网膜，以及视觉，都是珍贵且至关重要的。

待续...

This 15 year old patient came in 5 months back with an amblyopic (lazy) left eye (image 1). For many years, he had been wearing disposable contact lenses bought over the counter and had acuities of right eye 6/9 (7th row) and left eye 6/24 (4th row). His parents were concerned about his amblyopic eye and came for help.

After an eye examination, I discovered that he had been wearing wrongly powered lenses. However, even with correct powers he was only seeing the 4th row of letters. In the absence of any eye pathology or injury, this is a classical case of 𝗮𝗺𝗯𝗹𝘆𝗼𝗽𝗶𝗮-𝗲𝘅-𝗮𝗻𝗼𝗽𝘀𝗶𝗮.

Amblyopia-ex-anopsia (Latin, literally, poor eye sight due to not seeing) is a condition where the retina becomes dysfunctional from a blurry image over a prolonged period of time. Despite optimised corrections either by spectacles or contact lenses, the affected eye reads one or more lines less than its good companion.

The human retina is not fixed at birth. It develops and reorganises to achieve sharper and sharper acuity in childhood. By 7 or 8 years old, it then “fixes” into a permanent adult pattern where the maximum acuity is acquired and this continued throughout adulthood. So all treatment has to be conducted before 7 or 8 years old and any improvement after that age is difficult, this is all according to the text books.

At that time this patient was 15 years old, he had obviously missed the best opportunity for treatment. However, I decided to treat him nonetheless. In addition to prescribing a correct pair of contact lenses, I ordered a regime of occlusion. This forces his left retina to operate as hard as it can to achieve sharper vision (see image 2).

When he visited me yesterday, his left eye was reading half the letters on line 7, evidently catching up with the right eye. This is a tremendous improvement over the course of several months and his parents were absolutely delighted. The treatment is continued and we shall see what happens in another 6 months.

It appears that the human retina is capable of developing and correcting itself even after the age of 7 or 8 as described by the text books. We must not be dissuaded by the age of the patient. All human retina, and therefore vision, is precious and of paramount importance.

𝑇𝑜 𝑏𝑒 𝑐𝑜𝑛𝑡𝑖𝑛𝑢𝑒𝑑…

这位病人（图 1）10天前来检查她眼睛，症状是她戴着现在的眼镜很模糊和经常有复视(英文：diplopia)。 任何时候一边眼睛看时，一切都清楚。 但是两边眼睛看时变模糊和复视。 这些症状她已经体会3年了，而且她刚在其他地方做了一个月的眼镜无法解决她的问题，感到不满。

这是一个双眼抑制(英文：binocular inhibition)的经典案例。 当我们用两只眼睛看东西时，它应该等于或比任何一边眼睛更清楚。 这称为“双眼求和” (英文：binocular summation)，大脑将双眼的视网膜图像组合(英文：binocular fusion) 成更清楚的 3D 图像。 然而，这里的情况恰恰相反，大脑实际上降低了 2 个视网膜图像的质量，因此该患者感觉很模糊。

病人所体会的复视是这个病情管理和治疗的一个重要线索。 覆盖测试（英文：cover test，图 2a）显示病人眼睛有 decompensated esophoria（图 2b、2c）。 Phoria 与斜视（英文：squint, strabismus）不同，它是眼睛的潜在偏差（英文：latent deviation）。 大脑平时会拉直并协调双眼以实现双眼视觉(英文：binocular vision) 。 但是现在 phoria太强，大脑根本无法协调眼睛，因此它自动降低图像的素质，以减少复视引起的混乱。

我给她配了一副新的三棱眼镜（图 3a、3b）来緩解她的复视。 这有助于大脑重新恢复两只眼睛的协调，并恢复双眼视力。 患者现在双眼看得清楚，并且复视不再出现。

这副三棱眼镜只是改正大部份的phoria，不是完全改正。其余的小部份还是需要眼外肌肉操作（英文：extra-occular muscles，图4）把眼睛拉直。这样有助于加强病人的眼外肌肉。我指示患者在一年后回来复诊，以观察她在接受这种治疗的进展。可能一年后我们就可以减少眼镜里的三棱。我的任务也暂时完成了… 😀

这位年轻病人在使用别处配的近视控制镜片(myopia control lenses)时遇上很多问题。她的病例于2021年4月我有写过： https://www.facebook.com/1089753193/posts/10224477548661470/?app=fbl

当时，我为她配了一副高折射率(high index)单光镜片(single vision lenses)，她感觉得很清楚舒服。2022年3月时，她的度数没有变化，所以她继续戴着同一副眼镜。这次2022年11月时，她的散光有所下降，近视保持不变。我再为她配了一副新眼镜。戴了19个月正确的度数后，她的双眼融合储量(fusional reserves)已经恢复正常，不需要任何眼睛协调训练(orthoptic exercises)。所以她不会再经历复视(diplopia)。病人和她的父亲喜出望外。我的责任也暂时完成了...😃

有效控制近视的因素有很多。戴一副正确的眼镜是其中重要因素之一。这里主要的目的是解决患者的问题并满足患者的需求，而不是销售商业产品。

A young patient had a lot of problems using myopia control lenses prescribed elsewhere. Her case was reported in April 2021: https://www.facebook.com/1089753193/posts/10224477548661470/?app=fbl

At that time, I fitted her with a premium pair of high index with multicoat single vision lenses which she found clear and comfortable. Later in March 2022, her powers were unchanged and she continued to wear the same pair of spectacles. This time in November 2022, her astigmatism has come down a little and myopia remained unchanged. We therefore fitted her a second pair of spectacles (Image 1). After 19 months of wearing correct powers and without any eye exercises, her fusional reserves have returned to normal, so she does not experience any diplopia at all. The patient and her father were overjoyed. My responsibility is complete, for now... 😀

There are a number of factors to control myopia effectively. Having a correct pair of spectacles is one of the important factors, amongst others. The crucial point here is to solve the patient's problem and to fit what the patient needs, not to sell a commercial product.

这名10岁的病人上周与她母亲来验眼，妈妈怀疑她有色盲症，因为她经常辨错颜色（图1）。

色盲症在女性中很少见，占总人口的0.5%。在男性中比较普遍，约占8%，是由代代相传的隐性基因(recessive gene)引起的。大多数患者无法区分红色/绿色/紫色（见图2a, 2b）。由于是基因遗传的，所以没有任何治疗方法。一些病症也会导致色盲症，不同的是这些病人不能分辨黄色/蓝色。

眼科检查显示，她的右眼有高度散光和近视，左眼比较低。眼镜矫正后，她的右眼只能看到第5行（6/18）的一半，幸运的是她的左眼看得比较清楚（第6行或6/12）。如果没有戴眼镜，她只是用左眼看到第3行(6/36），右眼非常莫糊，最大字(6/60)都看不见。双眼没有任何病理情况，所以她的"色盲症"极可能只是没有戴眼镜，视力太差的原固。

由于她的弱视(懒惰眼，英文：amblyopia)严重，而且她已经超过黄金年龄（在8岁时，视网膜发育成固定的成人模式），我们必须立即通过眼镜矫正和遮盖左眼(full occlusion)来治疗（见图3），以加速她的视网膜发育。我们将在一年后评估她的情况，看看她进展得如何。

𝕋𝕙𝕖 𝕔𝕦𝕣𝕚𝕠𝕦𝕤 𝕔𝕒𝕤𝕖 𝕠𝕗 𝕥𝕙𝕖 𝕔𝕠𝕝𝕠𝕦𝕣 𝕕𝕖𝕗𝕖𝕔𝕥𝕚𝕧𝕖 𝕒𝕞𝕓𝕝𝕪𝕠𝕡𝕖.

This 10 year old patient was brought in last week by her mother who said that she could not tell colours properly and suspect defective colour vision (image 1).

Defective colour vision is rare in females, about 0.5% of the population. It is much more prevalent in males, about 8%, and is caused by a recessive gene that is transmitted from generation to generation. Most patients cannot distinguish red/green/purple colours (see image 2). As its cause is genetic, there is no treatment. Certain pathologies also cause defective colour vision. But these can be distinguished by the inability to detect yellow/blue colours.

A careful eye examination revealed that she had high astigmatism and myopia in her right eye, much less in her left eye. After correction, her right eye could only see half of line 5 (6/18), luckily better in her left eye (line 6 or 6/12). Without any correction, she was only using her left eye to see (line 3 or 6/36), right eye was very bad. This agreed with my observation that she “squinted” her eyes when she walked in. There was no pathology detected, her “colour deficiency” may just be due to very poor vision.

For her serious amblyopia and her age (above the critical 8 years old where the retina develops into a fixed adult pattern), we have to treat immediately by spectacle correction as well as full occlusion (see image 3) to accelerate development of both her retinae. We will assess her situation in a year’s time to see how she progresses.

这名病人上周一来验眼，她长时间用电脑时感到左边偏头痛（见图 1）。她戴着一副别处做的多焦点镜片(multifocals)

检查眼睛后，她的度数不但不正确，更重要的是，她的多焦点镜片中间部分(intermediate)非常狭窄，不适合电脑工作（见图 2）。

多焦点镜片有多种设计，可以把看远(distance)、看中或看近(near,阅读用）部分放阔。但是，没有任何设计可以把所有部分放阔。
因为她长时间要用电脑看小字体，我为她配了两副对多焦点镜片。一副是通用的，另一副是电脑工作时使用。

那副电脑工作时使用的镜片具有宽阔的看中和看近部分（见图 3）。这样她工作时，头部姿势和角度也很自然，不需要倾斜来看屏幕（见图 4）。她所有的问题和头痛也跟着解决。

We now open on Sunday, per usual hours:

9.30am-12.00pm,
1.00pm -4.30pm.

This patient complaint of a left temporal headache when she worked long hours on the computer (see image 1). She was using a pair of multifocals (progressive lenses) made elsewhere which was supposed to be clear from distance to reading, including intermediate areas for computer work.

After a careful eye examination, I found that her powers are incorrect. More importantly, her multifocals have very narrow intermediate areas not suitable for computer work (see image 2).

Multifocals can be designed in a number of ways to emphasise on the distance, intermediate (computer) or reading part. However, no design can emphasise all parts.

Because of her long hours of computer work looking at small fonts, I separate her prescription into two pairs of multifocals. One for general purpose and the other for computer.

The work multifocal has wide intermediate and reading zones (see image 3). When using this pair for work, her head posture is natural and does not need to tilt to read the screen (see image 4). This will solve all her problems and headaches. Let's see how she gets on with this new multifocal.

哪一只眼睛戴上了隐形眼镜？你看得出吗？

这位病人来拿她的隐形眼镜。她左眼没有近视，右眼近视275度，已经有好几年了。看远时用左眼，看近时用右眼，任何时候只是用一边眼睛看。

因为长期只用一边看，她感到眼睛很吃力（stressful），第二她根本没有立体视觉，打球时常投不入篮。

她两边眼睛的近视相差太多，很难戴眼镜。原因是大脑不能接受两个大小不同的影子(retinal image) 。

我为她右眼配了一边特制很小只的隐形眼镜。外表几乎看不见，不像那些 disposible lenses：
1. 隐形眼镜戴久时不会一边红(慢性发炎) ，
2. 眼睛上还能看到蓝色的镜片。

戴上隐形眼镜，两边眼睛一起看(binocular vision)，她感到清楚得多。不久后就应该有立体视觉了。

这么多的眼镜店，为什么顾客选择我们❓因为

Beh Optometry Clinic
拥有30多年经验的光学博士🎓

Dr GK Beh 是University of Bradford UK Optometry Class of 1989 全科系里唯一的一个华人考生，并且荣获第一级荣誉光学 （Bachelor of Science First Class Honours in Optometry)👍👍👍

Dr GK Beh 考获第一级荣誉学士学位后直接跳级考博士学位，而且还获得了英国政府提供的Overseas Research Scholarship😲😲😲，身为华人子弟要拿英国政府的奖学金，谈何容易啊

但是，我们的马元甲博士做到了

博士学位怎么考到的❓

Dr GK Beh 做了科学研究 （research)，他用了超过500个 references， 写下 9个chapter 250页 的论文 (thesis)。他以最短的时间 ..... 三年之内就完成了他的博士学位👏👏👏

图下是顾客给予 Beh Optometry Clinic 的评语， Customer Reviews

你们知道吗，马来西亚的眼镜店有两种眼镜师

1. 光学师 ( optometrist )
2. 配镜师 （ optician )

1. 光学师 是负责检验度数和检查眼睛，统称 prescribing, 课程比较注重在眼镜护理，眼睛内部健康， clinical practice 和检验方面，是 degree 课程，需要4年的时间完成

2. 配镜师 是负责配镜工作，统称 dispensing, 课程比较简单，比较注重在镜片和配镜方面，是 diploma programme, 2 年就可以毕业

在外国，配镜师是不被批准为病人验眼睛的，他们的工作是为客户选择镜框和佩镜片，只有光学师才能为病人验眼睛

然而在我国，在1991年光学法令 （optical act 1991)下，配镜师被批准为大众检验度数，理由是什么？理由是30多年前我国缺乏光学师

哪我们现在要怎样分辨谁是光学师，谁是配镜师啊？

光学师和配镜师都必须跟大马光学理事会 （Malaysian Optical Council )注册。每一年都必须更新执照 Annual Practice Certificate ( APC ),为了方便区分，光学师的执照是青色的，配镜师是兰色的

所以你们要懂得自己的权利，确保为你验眼睛的人士是合格的

我是马元甲眼科博士，毕业于英国 University of Bradford, 如有任何疑问，欢迎留言或光临本诊所，我将为您解答

Dr GK Beh
Beh Optometry Clinic
88 Lorong Madras
10400 Penang

04-2278291

马博士简介：
1989 年 荣获英国 University of Bradford 第一级荣誉光学学士 ( Bachelor of Science First Class Honours in Optometry)

由于成绩优越，他获得了英国政府颁发的奖学金 (Overseas Research Scholarship ) 继续深造，并于1992年获得了博士学位

An 11 year old patient has been wearing our prescription for a year. This is her second pair of spectacles made with us (see image 1).

A year back, her Mom was complaining about her myopia kept getting worse year after year. A careful eye examination revealed uncorrected astigmatism in both eyes, and after wearing our prescription, her myopia started to come down. Mom and patient are overjoyed.

In an astigmatic eye, the cornea contributes to most of the astigmatism. The ciliary muscles that control the contraction of the crystalline lens are very strong in children (see image 2). When uncorrected, the retinal image is always unfocussed for all distance and near objects (image 3). The ciliary muscles attempt to overcome this blurry image by consistently contracting. This causes the crystalline lens to become more convex and the child accepts more and more myopic powers as the cycle repeats itself year after year.

To break this cycle, we correct the astigmatism and a clear retinal image relaxes the ciliary muscles. Patient sees clearer with lower powers. Let's see how she gets on with this new prescription and if there is any improvement next year.

This patient has thyrotoxicosis for 2 years and came in last Thursday afternoon complained of diplopia (double vision). Her left eye is protruded and has a squint. This squint is worse when looking at her upper left corner (see image 1a & 1b)

In thyrotoxicosis, the thyroid gland produces excessive T3 and T4 hormones which cause inflammation of one or more of our 6 extra-occular muscles (see image 2). When the superior re**us and the medial re**us are inflamed in this case, the left eye cannot turn upwards and leftwards, causing a squint and diplopia. The inflammation also pushed the eye outwards, giving a protruded, staring effect.

A pair of prism spectacles is prescribed to eliminate diplopia when looking forward. Since the squint worsens when she gazes upper leftwards, the patient will still experience some diplopia in this direction. But it is a lot lesser now with the spectacles.

Meanwhile, inflammation of the muscles has put pressure on the eyeball and the eye pressures are higher, but still within normal limits. We will have to re-examine her eye pressure in the morning when it is rhythmically higher during the day. This has been discussed earlier: https://www.facebook.com/693604137439806/posts/2105709122895960/?app=fbl

星期六一位忧心忡忡的母亲带这位小病人来检查眼睛。她右眼皮的向内卷，母亲也发现该眼睛偶尔会向外移如斜视（图1a, 1b）。他们曾去某医院看过，那里建议动手术矫正眼皮。

眼皮的向内卷英文称entropion，导致睫毛经常刷在结膜(conjunctiva)和角膜(cornea)上，引起刺擦的烦扰感觉（图 2）。

检验后，原来右眼有未矫正的散光和弱视，一部分原因可能是上眼皮下垂，遮到视线(amblyopia ex-anopsia)。这只眼睛因为模糊，大脑已经开始压制，而它慢慢的跟着颅骨的角度(axis of orbit)移出去（图 3a, 3b）。

我跟母女讨论了另类的解决方案，例如去除睫毛，或戴上隐形眼镜使睫毛不再和角膜，结膜接触。第二，我为病人配了一副眼镜来改散光，效果不如隐形眼镜那样一石二鸟，因为母亲认为病人目前还不能处理隐形眼镜。

母亲听后轻松得多。由于患者（12岁），已经过了治疗弱视的黄金年龄，我们必须看她6到8个月后进展如何。

This patient was brought in by her worried mother for an eye exam last Saturday. Her right lower lid has turned inwards and her mother mentioned that the eye occasionally swings outwards as a squint (see images 1a, 1b). They were previously advised for surgery by a hospital.

Entropion is a condition where the eye lid turns inwards and the eyelashes brush against the conjunctiva and lower cornea causing irritation and abrasion (see image 2).

Meanwhile, eye examination reveals the same eye has uncorrected astigmatism and amblyopia or “lazy eye“, partly caused by the upper lid dropping down (amblyopia ex-anopsia). This eye swings out because the brain has started to suppress the eye, and it simply drifts out to follow the axis of the orbit in the skull (see images 3a & 3b).

The solution was: (a) I discussed the different alternatives such as removing the eyelashes and wearing a contact lens to segregate the cornea and conjunctiva from the eyelashes, and (b) I prescribed a pair of spectacles for astigmatism, not as good as a contact lens which kills two birds with one stone, because the mother feels the patient cannot manage a contact lens at this stage.

The mother was relieved. As the patient is already 12 years old, we have to monitor how she progresses with the treatment of amblyopia in 6 to 8 months.

This young patient has high astigmatism in both eyes and amblyopia where his vision is below normal for his age. He came in last August and had been wearing our prescription since. (https://www.facebook.com/1089753193/posts/10222635466650571/?app=fbl).

Amblyopia, or lazy eye, is a disorder where the retina is not active and does not convey the image to the brain correctly despite wearing correct spectacles or contact lenses.

It was fortunate that he came in before 8 years old. After that, the retina will set itself into a permanent adult pattern. Treatment is still possible, but chances will reduce quickly as the child grows.

After wearing our prescription for over a year, his right eye has developed nicely, it sees almost all the letters on line 7 (acuity 6/9) from line 5 a year back (acuity 6/18). This is near to normal for an 8 year old. The left eye with higher astigmatism and stronger amblyopia sees line 6 (acuity 6/12), a line below normal. Meanwhile, his ciliary muscles have relaxed further and more astigmatic powers have manifested. A new pair of spectacles is prescribed.

Amblyopia is a treatable disorder of the eye. To achieve maximum results, each case has to be assessed individually and has to be managed in a careful and scientific way. With a new prescription, let’s see what improvements he has next year.

This patient was involved in a traffic accident and his upper right skull was smashed. He underwent constructive surgery where metals plates were secured onto his skull. From picture 1 above, we can see the concaved temple behind his right eye where the plates were placed.

Each human eye is attached by 6 muscles to the orbital skull (see picture 2) and these muscles control every eye movement. The brain coordinates both eyes to move together for binocular vision so that we can appreciate depth and 3D vision.

In this case, the attachment of the muscles was affected during surgery and the patient sees double (diplopia) after the surgery. The right eye sees a lower image and the left sees a higher image (see picture 3). The patient is confused by the 2 images he sees and lost his binocular vision.

We had to design a pair of lenses with prisms so that a single image can be seen by both eyes (see picture 4). With this prescription, the diplopia was alleviated and patient can enjoy comfortable and clear vision. His binocular vision was also restored. My job is done… for now. 😃

这个小病人去年九月和哥哥一起来过(https://www.facebook.com/behoptometryclinic/photos/a.1188424251291123/2052745134859026/)。他散光高，还有懒惰眼，视力低过正常。

懒惰眼或弱视（英文：amblyopia)，是一种视网膜(retina)障碍。尽管戴着正确的眼镜或隐形眼镜，视网膜细胞不活跃，不能正确的将视网膜上的图像(retinal image)传达大脑，所以视力模糊。病原因包括没有戴眼镜或戴错度数，眼睛疾病，斜视等。

在8岁时，视网膜将定型成永久性的成人模式。如果当时视网膜视网膜细胞不活跃，那么以后无论戴正确的眼镜或隐形眼镜，视力永久模糊。因此小孩如果有弱视，8岁之前治疗是非常重要的。过了8岁，还是有机会治疗，但随着孩子成长，机会将迅速减少。

戴了一年正确的眼镜后，他左眼已经发育正常，看到第7行字（6/9）。右眼弱视比较强，看到第6行（6/12）。换了新眼镜，看他明年眼睛发育如何。

我跟他父亲讨论了他的案件，他父亲感到非常满意。

This patient came in with a badly inflamed right eye asking for an eye examination urgently. He has had that red eye for the last 2 weeks and has no medical treatment.

He has a habit of over-using his disposable contact lenses, where he openly admitted that he has been wearing the same pair of monthly lenses for "6 to 7 months".

Disposable lenses are not made in the same way as conventional contact lenses. They are made by injection molding so as to produce in large quantities economically. So their precision and quality are lower than conventional lenses.

Base on their data, disposable lens manufacturers designate their lenses according to the material and design to be "statistically safe" for a certain period, such as 1 week, 1 month or 3 months and so on.

So when a pair of disposable lenses are worn way over its designated safe period, two things happen at the same time:
1. The material degrades badly, and,
2. The lenses get very dirty.

Both factors increase the risk for compromising cornea health as it receives less and less vital oxygen and nutrients. Consequently, corneal cells weaken or die and pathogens attack and cause infection and inflammation.

Another important factor is we do not know how well the lenses fit on his eye as he came in without his lenses. If the lenses are too tight, that worsens the corneal health very rapidly.

The patient was instructed to use a broad-spectrum anti-bacterial ointment along with saline irrigation; and strictly to stop wearing monthly disposable lenses for "6 to 7 months". He was lucky this time his cornea was not infected or scarred, he may not be so next time.

这位病人右眼严重发炎，急着要求检查眼睛。他眼睛已经发炎了两个星期，还没有治疗。

他有超戴一次性隐形眼镜 (disposable lenses) 的习惯，自己承认这"6，7个月"里每天戴同一副每月一次性的隐形眼镜 (monthly disposable lenses)。

一次性镜片的制造方法与传统隐形镜片 (conventional contact lenses) 不同。它是通过注塑成型 (injection-molding) 制成，从而可以经济的大量生产。因此它们的精度和质量都低于传统镜头。

基于其数据，厂方会根据一次性隐形眼镜的材料和设计将其镜片指定为某限期内（例如1周，1个月或3个月等）可以统计上安全 (statistically safe) 使用。超过这种安全限期时，两件事会同时发生：
1.隐形眼镜本身材料严重降解 (degrade) ，而且，
2.镜片很肮脏。

这两个因素都会减少角膜 (cornea) 吸收氧气和重要的营养，而增加损害角膜健康的风险。角膜细胞一旦变弱或死掉，病毒或细菌容易引起感染和发炎。第二，如果病人的镜片如果配戴得太紧，角膜健康也会迅速恶化。

我已发配抗生菌素药膏给病人，同时也教他用生理盐水冲洗。并严格禁止他超戴一次性隐形眼镜。这次他很幸运，他的角膜没有被感染或留下伤痕，下次他可能没有那么幸运。

这病人前星期六来验眼时显现严重的眼睛压力(stress)，畏光(glare)和疲竭(exhausion)等症状。她的症状是两周前戴了别处做近视控制镜片(myopia control lenses)开始的。

我检查她的眼睛后发现她的fusional reserves (FR)异常低，其他眼睛功能在正常范围内。

FR是指大脑在不同压力下能保持双眼视力(binocular vision)的能力。这是一个人的双眼视力有多强的测量。

由于这是我第一次见到她，所有不清楚FR低是由近视控制镜片引起的，或是未戴这种眼镜之前就已经有了。

但是她的那副近视控制镜片正在干扰她的ciliary muscles操作，而导致疲惫和不适。ciliary muscles和虹膜(iris)是大脑第3条神经(third cranial nerve)控制的，因此会影响瞳孔大小和畏光。

换了新的一副眼镜，病人所有的压力，畏光和疲惫症状都消失了。
现在她感到很舒服和清楚。

我将会在6个月后重新验过她的眼睛，看她的低FR进展到如何。同时我们也讨论了一些双眼视力锻炼运动(binocular vision exercises)和其他的控制近视的选择。待续...

This patient came in a week ago with severe symptoms of discomfort, stress, glare and exhaustion. The symptoms started with her elsewhere made new pair of myopia control lenses 2 weeks further back.

A careful eye examination revealed that her fusional reserves are exceptionally low but acuity and other functions are within normal limits.

Fusional reserves refer to the ability of the brain to maintain binocular vision under stress. It is an indication of how strong a person's binocular vision is.

Since it is the first time I saw her, it is unclear if the low fusional reserves were caused by the myopia control lenses, or if they had been low before the lenses were worn.

However, the myopia control lenses are definitely disrupting her ciliary muscle contractions, which is causing the exhaustion and discomfort. It is also linked to her iris muscles and therefore pupil sizes and glare symptoms.

A new pair of spectacles was prescribed and this eliminated almost all symptoms of stress, glare and exhaustion. Patient is seeing clearly and comfortably now.

Her fusional reserves will have to be reassessed 6 months down the road. Options such as binocular vision exercises and complications are discussed so that the patient has an idea of what to expect. My job is done for now. To be continued...