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Pediatric eye exams

Regular eye exams are important for children because their eyes can change significantly in as little as a year as the muscles and tissue develop. Good eyesight is critical for a child’s life and achievements since success in school is closely tied to eye health. School demands intense visual involvement, including reading, writing, using computers, and blackboard/smartboard work. Even physical activities and sports require strong vision. If their eyes aren’t up to the task, a child may feel tired, have trouble concentrating, have problems in school or have difficulty playing their favorite games which may affect their overall quality of life.
 

When to Perform a Pediatric Eye Exam?

According to the recommendations of the American Academy of Ophthalmology and the American Association for Pediatric Ophthalmology and Strabismus, a child should have initial screening between 6 and 12 months of age. After that, routine eye health and vision screenings throughout childhood should be performed in order to help detect any abnormalities as their eyes develop. Then, unless otherwise recommended, every two years thereafter until the age of 18.

For a newborn, an ophthalmologist should examine the baby’s eyes and perform a test called “red reflex test” which is a basic indicator that the eyes are normal. In a case that the baby is premature or at high risk for medical problems for other reasons, has signs of abnormalities, or has a family history of serious vision disorders in childhood, the ophthalmologist should perform a comprehensive exam.

A second eye health examination should be done to infants between six months and the first birthday. This examination includes tests of pupil responses to evaluate whether the pupil opens and closes properly in the presence or absence of light, a fixate and follow test to determine whether the baby can fixate on an object such as a light and follow it as it moves, and a preferential looking test which uses cards that are blank on one side with stripes on the other side to attract the gaze of an infant to the stripes and thus vision capabilities can be assessed. Infants should be able to perform this task well by the time they are 3 months old.

For a Preschooler, between the ages of 3 and 3½, a child’s visual acuity and eye alignment should be assessed. If the child is diagnosed with misaligned eyes (strabismus), "lazy eye” (amblyopia), refractive errors (astigmatism, myopia, hyperopia) or any other focusing problems, it’s important to begin treatment as soon as possible to ensure successful vision correction and life-long benefits.

At School age or upon entering school, the child’s eyes should be screened for visual acuity and alignment. In this age group, nearsightedness (myopia) is the most common refractive error and can be corrected with eyeglasses.


Overview of Visian ICL

Visian ICL, or “implantable Collamer lens” is an alternative procedure for patients who may not be ideal candidates for Lasik or other alternative corrective eye surgery. Visian ICL is typically used for patients who do not want to remove portions of their cornea, have thin corneas, or that have excessively high levels of nearsightedness (myopia).

This procedure makes a small incision and then implants a personalized prescription lens over the cornea to allow for corrected vision. If your vision then changes due to aging or other natural processes, the lens can be replaced by another lens with an updated prescription.
 

Who is a Good Candidate for ICL?

Typically, patients that would benefit from ICL are between the ages of 21-45. This age represents a slight increase from the base age of 18 for Lasik. This procedure is also not well suited for geriatric or elderly individuals. Patients may also have mild or severe myopia, and they have a prescription that has been relatively unchanged. While the age requirements are more stringent for ICL than Lasik, there are other less stringent qualifications. This means that even if you aren’t an ideal candidate for Lasik, ICL could be a good option for you.
 

Performing the Operation

ICL is considered an outpatient operation and only takes about 30 minutes to complete. This means that you will be in and out of your chosen facility on the same day. Patients are given some numbing drops for their eyes and individuals that are more hesitant or uncomfortable may also be given a sedative. 

The surgeon will make several micro-incisions in the eye to insert and place the lens. When the lens has been inserted, it will be unfolded, and the edges of the lens will be placed behind the iris. After this is completed, the operation is considered complete. Your physician may give you some eye drops for postoperative care and then send you home. There may be a follow-up appointment scheduled 24 hours later.
 

Post-Operation

After your operation, you will be required to have somebody else drive you home. Anytime that you have an operation that may impair your vision or ability to operate a vehicle, you should plan to have somebody else drive you home. Surgery results are typically noticeable 24 hours after the operation.

Recovery time is minimal, and some patients experience mild discomfort or a gritty feeling in their eyes. Your doctor may require you to stay out of the swimming pool and avoid activities that make you heavily perspire because when sweat gets into your eyes, it may aggravate the micro incisions and cause additional discomfort.

While there are some potential complications both during and after the operation, they are typically minimal. The chances of impairing your vision or causing long-term damage are very low with this operation, however, you should make sure to talk about potential side effects with your physician. If you experience any abnormality, you should seek medical attention immediately.
 


LASIK Surgery

LASIK (laser-assisted in situ keratomileusis), is the most popular refractive surgical procedure. In this procedure, a laser is used to permanently change the shape of the cornea (the clear covering on the front of the eye) to correct common vision problems such as nearsightedness, farsightedness, astigmatism, and presbyopia. This improves vision and reduces a person's need for glasses or contact lenses.

LASIK uses an excimer laser (an ultraviolet laser) to remove a thin layer of corneal tissue, giving the cornea a new shape, so that light rays are focused clearly on the retina.

In the case of a nearsighted person, the goal of LASIK is to flatten the too-steep cornea; with farsighted people, a steeper cornea is desired. LASIK can also correct astigmatism by smoothing an irregular cornea into a more normal shape.

LASIK is an outpatient surgical procedure with no need to stay at the surgery center overnight as it will take 10 to 15 minutes to perform for each eye.

The procedure is done while the patient is awake, but the patient may request mild sedation. The only anesthetic used is eye drops that numb the surface of the eye. LASIK can be done on one or both eyes during the same session.

 

How to Prepare for LASIK Eye Surgery?

Before LASIK eye surgery, the eye surgeon will evaluate the patient’s medical history and perform a full eye examination, including measuring corneal thickness, refraction, corneal mapping, eye pressure, and pupil dilation. Afterward, the surgeon will discuss what to expect during and after the procedure.

On the day of the surgery, eat a light meal before going to the doctor and take all prescribed medications, if any. Do not wear eye makeup, creams, perfumes or lotions on the day before and the day of surgery, or have any bulky hair accessories that will interfere with positioning head under the laser.

Contact lenses shouldn't be worn for at least three days prior to the evaluation. In the case of, rigid gas permeable contact lenses, they should not be worn for at least three weeks before. Patients should arrange for a ride home from the place of surgery, as their vision might be blurry.
 


Dry Eye Treatment

While dry eye isn’t a serious condition, it can have a major impact on your quality of life. You may find your eyes get tired faster or you have difficulty reading. Not to mention the discomfort of a burning sensation or blurry vision. Let’s take a look at dry eye treatments – from simple self-care to innovative prescriptions and therapies – to help you see clearly and comfortably.
 

What is Dry Eye?

Understanding dry eye will help you determine the best treatment option. Dry eye occurs when a person doesn't have enough quality tears to lubricate and nourish the eye. Tears reduce eye infections, wash away foreign matter, and keep the eye’s surface smooth and clear. People with dry eyes either do not produce enough tears or their tears are poor quality. It’s a common and often chronic problem, especially in older adults.
 

Preventive Self-Care

Before we delve into more serious dry eye treatment options, here are a few simple self-care options that can manage minor cases of dry eye.

  • Blink regularly when reading or staring at a computer screen for a long time.

  • Make sure there’s adequate humidity in the air at work and at home.

  • Wear sunglasses outside to reduce sun and wind exposure. Wraparound glasses are best.

  • Take supplements with essential fatty acids as these may decrease dry eye symptoms.

  • Drink 8 to 10 glasses of water each day to avoid dehydration.

  • Find out if any of your prescriptions have dry eye as a side effect and if so, see if you can take an alternative.
     

Artificial Tears

For mild cases of dry eyes, the best option is over-the-counter eye drops. Here are a few tips for selecting the right one:

  • Low viscosity – These artificial tears are watery. They often provide quick relief with little or no blurring of your vision, but their effect can be brief, and sometimes you must use these drops frequently to get adequate relief.

  • High viscosity – These are more gel-like and provide longer-lasting lubrication. However, these drops can cause significant blurring of your vision for several minutes. For this reason, high-viscosity artificial tears are recommended at bedtime.
     

Prescription Dry Eye Treatments

There are several prescriptions that treat dry eye differently. Your eye doctor can advise the best option for your situation.

  • Contact Lenses – There are specialty contact lenses that deliver moisture to the surface of the eye. They’re called scleral lenses or bandage lenses.

  • Antibiotics– If your eyelids are inflamed, this can prevent oil glands from secreting oil into your tears. Your doctor may recommend antibiotics to reduce inflammation.


Comprehensive Eye Exam

If you’ve had a vision screening recently, you might say, “My vision is fine! I don’t need a comprehensive eye exam.”

But a vision screening provides a limited perspective on the overall health of your eyes. It’s a bit like getting your blood pressure checked and not getting the rest of your annual physical. You’ll have useful information, but it’s not the whole picture.
 

What are the Limitations of a Vision Screening?

Vision screenings only test your ability to see clearly in the distance. This is called visual acuity and is just one factor in your overall vision. Others include color vision, peripheral vision, and depth perception. The screening also doesn’t evaluate how well the eyes focus up close or work together. Most importantly, it doesn’t give any information about the health of the eyes.
 

Vision screenings are conducted by individuals untrained in eye health.

Vision screenings are offered in many places – schools, health fairs, as part of a work physical or for a driver’s license. Even if your physician conducts the screening, he/she is a generalist and only has access to a certain amount of eye health training. Most individuals don’t have the tools or knowledge to give you a complete assessment of your vision or eye health.

Vision screenings use inadequate testing equipment.
In some cases, a vision screening is limited to an eye chart across the room. Even when conducted in a physician's office, they won’t have the extensive testing equipment of an eye doctor. They also won’t be aware of nuances such as room lighting and testing distances all of which are factors that can affect test results.
 

What are the Benefits of a Comprehensive Eye Exam?

Comprehensive eye exams evaluate all aspects of your vision and eye health.
The comprehensive eye exam looks at your eye externally and internally for any signs of eye disease, then tests your vision in a variety of ways.


Contact Lens Exam

If you’ve never worn contact lenses before, it can seem a bit intimidating. After all, you’re inserting something into your eye! Let’s ease your mind about the first step – your contact lens exam. This post will walk you through what’s involved in a contact lens exam and what you can expect every step of the way.
 

It begins with a comprehensive eye exam.

Your eye doctor will first determine your overall eye health and vision. This includes a discussion of your health history and then a series of standard eye tests. These tests will evaluate eye focusing, eye teaming, depth perception, color vision, peripheral vision, and the response of your pupils to light. The doctor will also measure your eye’s fluid pressure to check for glaucoma, evaluate your retina and optic nerve, and test your vision with different lenses to assess whether contact lenses can improve your vision.
 

Then, a discussion about your contact lens preferences.

If contact lenses are appropriate for you, it’s time to talk about your contact lens preferences. For example, do you want to enhance or change your eye color? Would you prefer daily disposable lenses or overnight contacts? Ask about the benefits or drawbacks of each, so that you make the best decision. If you’re over 40, your doctor will likely discuss age-related vision changes and how contact lenses can address these issues.
 

Next, the eye doctor will conduct eye surface measurements.

Contact lenses require precise measurements of your eyes to fit properly. Using an instrument called a keratometer, your doctor will measure the curvature of your eye's cornea, the clear front surface of your eye. Next, the size of your eyes pupil is measured using a card or ruler showing different pupil sizes which is held next to your eye to determine the best match.
 

You may also need a tear film evaluation.

If you have dry eyes, your eye doctor will perform a tear film evaluation to measure the amount of tear film on the surface of your eye. If your tear film is insufficient or you have chronic dry eyes, contact lenses may not be a good option for you. However, some newer contact lenses deliver moisture to the surface of the eye, making them a better choice for individuals with dry eye issues.
 

Its time for the contact lens fitting.

The final step is to fit you with a trial pair of contact lenses. Once inserted, your eye doctor will examine the lenses in your eyes to ensure a good fit. He/she will check the alignment and movement of the lenses on the surface of your eye and if the fit looks good, the last step is to ensure the prescription is correct with a few more tests.
 

Now it’s your turn to test it out.

Your contact lens exam is over, but you’ll need to come back. Your doctor will usually have you wear the trial lenses for a week. After that, you’ll have a short follow-up exam to confirm that the lenses are working well for you and you can then order a supply of contact lenses.


Cataract Surgery

Although you’re probably not looking forward to cataract surgery, keep in mind that modern cataract surgery is one of the safest and most effective surgeries performed today. There are over three million cataract surgeries in the United States every year and the vast majority have excellent outcomes which greatly improve quality of life.

Being prepared for your upcoming surgery by knowing what to ask your eye doctor and understanding your options will ease your mind and be sure you’re ready for recovery.
 

Find an Ophthalmologist

First, you’ll need an ophthalmologist to perform the cataract surgery. Ophthalmologists treat eye diseases, prescribe medications, and perform surgeries to improve eye and vision-related conditions. In addition to four years of medical school and one year of internship, all ophthalmologists have three years of residency. Here are some ways to identify the best provider for your needs:
 

  • Your Regular Eye Doctor – Even if your eye doctor is an optometrist, he/she will be knowledgeable about ophthalmologists in the region and can advise on their specialties.

  • Family and Friends – If they had a positive experience, you can hear personal stories to really know if the doctor is right for you.

  • Go Online – Find eye surgeons in your area by using the American Academy of Ophthalmology’s Find an Ophthalmologist tool.
     

Consult with the Ophthalmologist

Once you find the right doctor, you’ll have a consultation before proceeding. You'll undergo a comprehensive eye exam and a preoperative exam to determine the level of correction needed and confirm you're healthy enough for surgery.

Your doctor will also need to take measurements of your eyes before the procedure. This will determine the curvature of your cornea and the length of your eye. They need this information to choose the right size and power of the intraocular lens (IOL). This artificial lens will replace the cloudy lens inside your eye.

There are a variety of IOLs with different features available. Before surgery, you and your eye surgeon will discuss which type might work best for you and your lifestyle, but bear in mind that insurance companies may not pay for all types of lenses. Some of the types of lenses available include:


Why Should You Consider Eyelid Rejuvenation

Eyelid rejuvenation surgery is a medical procedure that is designed to reduce the appearance of bagginess from the lower eyelids and sagging from the upper eyelids. This operation is often used for cosmetic surgery to reduce the appearance of aging.

This surgery can also be considered when the eyelids are interfering with a patient’s ability to see. Sometimes a sagging upper eyelid can partially obscure the eyeball, interfere with a person’s ability to look in certain directions or interfere with their peripheral vision.
 

Why Do My Eyelids Sag?

As our skin ages, it often loses its elasticity. This doesn’t allow the skin to rebound back to its original shape and we see the appearance of wrinkles and bulges that aren’t due to weight gain. While these wrinkles can occur all over the body, they typically first appear in the face and eyes. Any additional skin on or near the eyelids can cause the eyelid to sag or droop over the eyelashes and into the frame of vision.

The eyelids also contain some fat to protect and cushion the eyeball. The fat is held in place by a thin membrane. As we age, the membrane can weaken and will no longer keep the fat in place. This fat can create bulges in the upper and lower eyelids.
 

What Can I Do About Eyelid Sag or Bulging?

There are several non-surgical treatments on the market to help treat sagging skin or reduce the appearance of wrinkles, but it is important to use additional caution when applying any product near the eyes. Always make sure that the product is designed to be used in the predetermined area. If you have questions about a specific product, you should contact your health care provider.

Many individuals find that non-surgical options don’t have enough or any effect on their eyelids. In these instances, they can consider working with a licensed medical professional to weigh their options. Eyelid rejuvenation (blepharoplasty) is also commonly called an eye lift.

There are several different methods for achieving your desired results. Typically, an incision is made into the eyelid, and then the excess skin or fat cells are removed by laser or scalpel. Additionally, your surgeon may suggest that you also get laser resurfacing done in combination with your surgery.

 

What to Expect

Eyelid surgery can be done in a local office or a surgery center. If you are completing the operation in an office environment, you can probably expect that you will be treated with a local anesthetic and an oral sedative. If you are in a surgery center, it’s likely that you will receive an intravenous anesthetic. The surgery takes about two hours to complete if you are getting all four eyelids done (upper and lower lids). When you are getting all four eyelids corrected, the surgeon will likely opt to work on both upper eyelids first and then move to the lower eyelids. While the upper eyelids will have three to six stitches, the lower eyelids may not have any. The stitches should remain in place for three to six days.
 


Importance of Routine Eye Exams

Routine eye exams are an important aspect of maintaining one's overall health. As with an annual physical or dental exam, it is extremely important to have your eyes examined regularly. Regardless of how great your eyesight is, scheduling regular eye exams according to the American Association of Ophthalmology recommendations is a great way to stay on top of your overall health.

Adults should have an eye exam every 1-2 years, depending on any existing vision problems, eye conditions or being diagnosed with significant risk factors, such as diabetes, high blood pressure, thyroid disease, previous eye injuries or family history. The doctor will recommend a frequency for routine follow-up exams based on the patient’s medical history. For instance, a diabetic person needs a dilated eye exam every year while contact lens wearers need exams every year in order to look for changes that might affect lens fit and eye health.

Regular eye exams will also ensure that prescriptions for glasses or contact lenses are current as well as offer an opportunity to check for early signs of diseases. Adults older than 60 years, should have an eye exam each year, as age-related eye problems are more common.

It may be important to see a doctor more frequently if one is experiencing any of the following:
 

  • Blurry vision or loss of vision.
  • Difficulty seeing things near and/or far away and perform basic tasks.
  • Flashing light in the eye.
  • Eye floaters, or small spots that appear in vision.

Why Should You Have Regular Eye Exams?

While eye exams are important for one's vision, routine eye exams can also help to identify a variety of problems ranging from cognitive decline to diabetes. Since the eye is an extension of the brain and the only part of the body where blood vessels and tissue are visible, it allows an eye doctor to detect warning signs of the early stages of different health problems, such as diabetes which can present as bleeding in the eye or swelling in parts of the retina.

Besides diabetes, there are several other health problems that may be detected during a routine eye exam that include brain tumors which may cause swelling of the optic nerve and rheumatoid arthritis or other autoimmune disorders which may be the reason behind dry eyes.

Skin cancer on the eyelid is another health risk as the eyelid is very sensitive to ultraviolet rays and may be one of the first places affected by different types of skin cancers. Any spots or affected areas may be detected before skin cancer can spread to other parts of the body.

In addition, high blood pressure which would show as blood vessels in the back of the eye appearing bent or leaking, the narrowing of the vessels in the retina, swelling of the optic nerve, and hypertensive retinopathy in its earliest stages can be looked for during the exam.

There are some progressive eye diseases that are not immediately apparent and should be tested for during regular eye examinations. These include:
 

  • Glaucoma; the buildup of pressure within the eye which causes damage to the optic nerve and can lead to a loss of peripheral vision or a complete loss of vision. Glaucoma is a chronic, progressive eye disease that doesn't show any symptoms or pain in the initial stages.

  • Macular degeneration; an eye condition that causes damage to the retina.

  • Cataracts; the most common cause of blindness in the world. Cataracts occur when the lens of the eye becomes less flexible with age. Blurred or foggy vision and sensitivity to light are common symptoms. Cataracts are easily corrected with outpatient surgery.


Vision changes can have a profound effect on a person’s day-to-day life, but early treatments can help to slow or stop vision loss and regular eye exams can help ensure a lifetime of clear sight.


How Your Eyes Change with Age

As our bodies age, it is normal to notice that there are decreases in our ability to complete certain functions that may have been natural for us in our youth. Just like our physical strength, the strength of your eyes can also weaken over time.

Several different factors influence how each of us will experience aging. Your genetics can play a pivotal role. Understanding your family history and making sure to communicate this with your health professional can be a great way to monitor changes and spot early signs and symptoms. Exposure to certain chemicals or environments or specific trauma to our eyes can also have an impact on how our eyes age. While the eyes can often recover from traumatic injury or exposure, they may still have a detrimental effect on your vision as you age.

Knowing what age you start to have an increased risk of certain diseases or eye conditions can help you to be prepared when you meet with your optometrist or ophthalmologist. Here are some of the most common ailments that people experience when they age.
 

Presbyopia

Once you are over 40 years old you may experience a loss in vision at close range. Presbyopia is a normal condition that occurs due to the hardening of the lens in your eye. In the early stages, you can often compensate for small changes to your vision, but as the condition progresses, you will likely need a corrective lens, or choose a surgical procedure. such as Lasik, corneal inlays, refractive lens exchange, and conductive keratoplasty.
 

Cataracts

Cataracts are technically a disease of the eye. However, they are so frequently seen in patients as they age, that they are classified as a normal part of aging. While almost half of the population over 65 have cataracts, that number increases even more by age 70. While it can be frightening to begin losing your vision, cataract surgery is extremely successful and can restore up to 100% of the lost vision. If you notice even small changes to your vision, it is smart to talk to your doctor. Cataract surgery is best performed when the cataracts are small and can be more easily removed.
 

Macular Degeneration

This disease is the leading cause of blindness in senior citizens in the United States.
 

Glaucoma

The risk of developing glaucoma generally begins when you are in your 40’s with a near one percent chance and increases throughout the decades with a twelve percent by the time you are in your 80’s.
 

Diabetic Retinopathy

Individuals who have diabetes may be affected by diabetic retinopathy. This disease occurs when blood sugar levels are elevated for an extended period that causes damage to the eye. This damage may lead to permanent vision loss. Americans with diabetes over the age of 40 are at an increased risk, with about 40 percent of people with diabetes over this age displaying some degree of diabetic retinopathy.