BRUCE BUMSTEAD / BRANDON SUN
Born in Sudbury, Dr. Brent Caswell moved to Brandon 17 years ago for what was supposed to be a six-month stint to help a optometry colleague. But love came calling in the person of the woman who would become his wife, Kami-Rae, who hails from Neepawa. The couple now has three children, and Caswell and three other optometrists, Drs. David Ferguson, Andrew Aiken and Matthew Lepage, own and operate Eye Outfitters. With his roots firmly established in the Wheat City, Caswell is happy to call Brandon home.
I’m always interested in how people choose certain professions, especially medical people who specialize in things.
For myself, for optometry, I think when I was younger, I always wanted to do something in the health-care profession. A story that always stands out — when I was a little guy, I was with my mom and we were at an RV show and we were going through the RVs and I was kind of in awe. And my mother said, ‘If you ever want to get one of these, you’re probably going to have to be a dentist.’ So in my head, I always thought a dentist would be great idea! And when I got closer to that time, I had a couple of friends who were a couple of years older than me who were going to optometry school, so I looked into it.
(laughs) Optometry pun, right?
(laughs) No pun intended! So I looked into it, and when I compared dental school to optometry, for me, it just seemed a better fit. So I think I was geared up to be a dentist, but when it came time to apply to schools, I went the optometry route and got accepted.
And what was it about the optometry field that appealed to you?
I don’t know. I always liked the health-care field and I just like to help people and I love interacting with kids — from a young age, I was just kind of driven to do that. So whether I was going to be a dentist or an optometrist or a medical doctor, it just turned out to be optometrist.
Asking as someone who’s worn glasses since I was three years old, how young a person have you ever prescribed glasses for?
We usually recommend having your first eye exam at six months. I think probably between six months to a year would be the youngest child for whom I’ve ever prescribed glasses. There’s quite a critical development period with the eye between birth and six or seven years of age. So if there are some underlying problems and they’re not fixed at a young age, they’ll lose that potential for quality vision later on in life. A lot of times, kids don’t really have the symptoms or they don’t know how to express them, so a lot of kids can get by, and unfortunately, they can get by throughout that critical development time. So we try to get people in when they’re younger and try to promote that.
There’s a new initiative in Manitoba now where they’re trying to get every kindergarten child screened by an optometrist before they get to kindergarten, so that’s been a good program the last few years.
When you say a critical development age, does that mean if you don’t catch them then, then they’ll likely HAVE to wear glasses for the rest of their lives, or just that the eyes deteriorate and then correction is a problem?
It’s just that you can’t maybe achieve your optimal vision, so your potential for vision — we always think of 20/20 as being the greatest — so maybe if you were 20/30, you may lose that potential to get back to 20/20.
So with early intervention, certainly you get the eyes developing at a much younger age and that potential for eye acuity is much more achievable.
And that might mean NOT wearing glasses for the rest of their lives?
Exactly — sometimes that works out, too.
When I was in a few weeks ago for my eye exam, I said, ‘It must be cool to look in people’s eyes!’ And you said you remembered the first time you did it.
I do. I really do. It’s old hat now, but it’s genuinely amazing the stuff you can tell about the health of someone by looking in their eyes. They’re the gateway to a lot of health conditions and there’s a lot of eye health or disease that just tells about the general health of the body.
What do you see when you look in there? Is it red? Is it all floaty weird stuff in there?
The human eye is about the size of a golf ball, so in the very back of the eye, that’s where probably the most important components are — the area of the retina. But there’s a lot of blood vessels — a lot of vasculature — and you’re kind of looking for changes in blood vessels and different types of anatomy in the back part of the eye. But it truly is amazing how much you can see by the back of the eye.
When you had that first glance, did you just kind of go, ‘Whoa! This is cool!’
Yeah! I think it’s neat that you can actually see it, because you’re getting used to the instruments at the time when you’re first starting out, and sometimes it’s hard to get a good picture. I think you’re more happy that you can see what you’re supposed to see! But it’s kind of neat just putting all that stuff that you learned into everyday practice.
Any — and I’m sure they’re different for everybody — guidelines for general eye health for most of us? In the computer age, where we tend to strain our eyes a lot of the time, just take a break?
Absolutely. Computers have really changed a lot of industries, but ours for sure. We’re looking at something for an extended period of time, so the eyes get tired. Looking someplace off in the distance kind of gives a little break to some of the eye muscles. So computers have certainly strained the eyes — not hurt the eyes, but they give the eyes a pretty good workout. And taking breaks is helpful.
Vitamins are great. The biggest thing — probably the most detrimental thing with aging is macular degeneration. We’ve known for several years that vitamin usage is quite important — anti-oxidants vitamins, omega-3 vitamins. Something called lutein is found in these vitamins as well — it’s very helpful in preserving the tissue of the macula. So over-the-counter multi-vitamins with a little bit of an eye component goes a long way for sure. And sunglasses are helpful, too.
Yes. I’m guilty of not wearing them as often as I should. Now I’ve been dying to ask you this — I don’t think you use it anymore, but why the big ‘E’ on the wall test? Just because it stands for ‘Eye?’ Or because people tend to guess and fill in spaces or miss some — like turn the E into a B or an F or something like that?
There’s a couple of letters we have on the charts. The big E is kind of the classic one. But you know what? I don’t know why they started with the E. There are other charts that have big letters, too. We start at that one and to be honest with you, there’s lots of people who can’t see it, unfortunately.
It must be heartbreaking when you have to give bad news, right?
Yeah. I liked that you asked about ‘Why this profession?’ And for the most part, it’s usually pretty good news — it’s a pretty clean profession — people are usually fairly happy. Usually with most people, it’s saying they don’t need glasses or the bad news — they need glasses, which, in the big scheme, isn’t the end of the world. But unfortunately, there is a lot of eye disease out there, too. Sometimes there are some quite devastating eye disorders. So that would probably be the toughest part of the job, having to break the bad news to people who are losing their independence and assume, ‘Maybe I’ll just get some glasses and maybe that’ll make my vision better.’ Unfortunately, some of the time there’s underlying eye conditions where glasses just don’t have any bearing on that.
And we are so dependent on our vision.
Yeah — it’s tough. You seem some elderly people where they’ve lost their independence — they can’t drive anymore and have to rely on people. That’s a pretty delicate and life-altering situation.
Do you wear glasses or contacts?
I don’t. In my optometry class, I think there was just under a hundred students and there was me and another student, a girl, who were the only ones who didn’t wear glasses. So that’s kind of odd. I think a lot of people who got into optometry just had an experience when they were younger and I really didn’t have that and I’m now in my early forties and my reading is catching up to me, so I’m slowly getting into reading glasses.
And I’m betting many people, just like they worry about their hair going grey, fight the need for reading glasses every step of the way. But it’s just normal aging, right?
It is. It truly is. People usually come in in their forties and they’re kind of joking and saying, ‘I knew this was coming’ and chuckle about it, but it certainly is an age-related thing. Our reading goes usually in our early forties and that’s just inevitable.
I’ve had people disagree with me — about a lot of things besides this! — but I’ve often said that severe illness, the incidence of which seems to be on the rise, and the degeneration that happens to us as we age — if you believe in evolution, I don’t think our evolution has caught up to medical science yet, because we’ve made so many advances and really, these bodies of ours weren’t designed to LIVE past 45 or so.
You’re exactly right. For most people, the eye is very predictable — in the forties, most people need reading glasses, in the 60s, people start getting cataracts, in the 70s and so on, a lot of people get macular degeneration. But you’re right — the eyes degenerate. They’re not built for longevity, that’s for sure.
And there’s not really anything we can do about it either.
There really isn’t. The sunglasses, as I said, are important, the vitamins are helping us for sure, there are certainly new surgical techniques that are helping some people with their problems, so things really have improved. But you’re right — evolution-wise, the eye was probably built for about 45 good years, and then there’s a noticeable slide.
I understand there’s been a positive change recently in what optometrists are allowed to do.
As of this past summer, optometrists in Manitoba are now finally allowed to prescribe medication. We’re the last jurisdiction in North America to have done it. So even though everybody’s been qualified and licensed to do it for years, the legislation was just passed this last summer.
So now, coming in for a simple eye infection, diagnosing and treating glaucoma, allergy medications — we’re able to write prescriptions. So it’s been nice. So many times in the past, someone would get referred by a family doctor to us — they’re limited with what they can check with their equipment, so they’re just send those patients to us to verify what it was — and we’d say, ‘Yup — that’s what it is — maybe they need this medication,’ so we’d then send them BACK to the doctor. So they got billed twice by the medical doctor, they got billed by us, so it was kind of a three-billing thing where really, it should just have been one stop. So now people can come to us directly.
The biggest one is glaucoma, too. Up until now, we’ve had to send people to Winnipeg for glaucoma to get the prescription. So people would come into us, we’d say they have glaucoma, but they had to go see a glaucoma specialist in Winnipeg. Now we’re able to do it here in Brandon, so it’s just easier.
So what do you do for fun?
You know what? Probably family’s by far my biggest thing. We have three great kids — 12, 10 and eight — and they all play hockey, so in winters, we’re everywhere, just like a lot of people. So lots of kids’ stuff — we just kind of do family stuff and my social life is following the kids around with their activities, and they do music, too. So I’m pretty much the family guy
Republished from the Brandon Sun print edition February 8, 2014