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All About Vision

Orthokeratology CRT & VST


Imagine freedom from daytime eyewear! Orthokeratology, best known as Ortho-K, are contact lenses which are only worn at night while you sleep, so that you don't need contacts or eyeglasses during the day.

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What is Ortho-K?

Orthokeratology, commonly called ortho-k, is a method used to correct myopia (nearsightedness) or astigmatism by wearing rigid gas permeable contact lenses overnight, so that no corrective lenses are needed during daytime hours.

Gas permeable (GP) lenses specialized for ortho-k are inserted at bedtime and worn as you sleep. Throughout the night, the lenses reshape your cornea gently so that your vision becomes clear on the following morning. The correction is temporary, and ideally no eyeglasses or contact lenses will be needed on the next day or two. In order to maintain sharp visual acuity on a daily basis, you need to wear the ortho-k reshaping lenses every night.

At present, three brands of orthokeratology contact lenses are approved for use by the FDA. Euclid Emerald, usually prescribed for myopia control, Paragon Vision Sciences, who produces “Corneal Refractive Therapy” (CRT), and Bausch and Lomb, who manufactures “Vision Shaping Treatment” (VST).

Best Candidates for Ortho-K

Ortho-k is very suitable for nearsighted people who are not appropriate candidates for vision correction surgery, such as children. Individuals of all ages with healthy eyes can try ortho-k, namely because it can be discontinued at any point without permanent effects to the eyes.

People who require vision correction and engage regularly in sports or work in extremely dusty, dirty environments will also appreciate the convenience of ortho-k.

How Does Ortho-k Feel?

Although some people have trouble wearing regular gas permeable contact lenses during the day, ortho-k GP lenses are worn while sleeping – so discomfort and awareness of the lenses in your eyes is generally not an issue.

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Vision Results from Orthokeratology

Success rates for ortho-k are generally higher for more mild vision prescriptions. The ideal goal is to provide 20/20 vision without any need for eyeglasses or contacts during the day.

According to FDA trials conducted on both CRT and VST lenses, more than 65% of ortho-k patients achieved 20/20 visual acuity. A whopping number of more than 90% of ortho-k patients achieved 20/40 vision or better (this is the legal requirement for driving without vision correction in most states). Consult with your eye doctor to find out if your vision prescription is within range for successful ortho-k treatment.

Note that although improvement in vision is generally reported within a day or two of wearing ortho-k overnight, the full effects may not be experienced until the lenses are worn for a few weeks. During this transition period, your vision will probably not be as crisp as it was with regular contacts or eyeglasses, and glare or halos around lights may be visible. Until ortho-k works fully, a temporary pair of eyeglasses may be required for specific actions, such as driving at night.

Is Ortho-k expensive?

Professional fitting for ortho-k requires a series of visits to your eye doctor. A number of pairs of contact lenses are also generally needed. GP lenses that are special for ortho-k are more costly than standard contacts. In sum, the fees for ortho-k add up to a higher total than regular contact lenses.

LASIK after Ortho-k

Some consider Ortho-K to be a non-surgical alternative to LASIK. Nonetheless, refractive surgeries, such as LASIK, are possible after treatment with ortho-k lenses. Yet because ortho-k works to reshape your cornea, you are required to stop wearing the lenses for approximately several months before undergoing LASIK. This allows your eyes to return to their original shape.

It’s important to inform your LASIK surgeon if you’ve been wearing ortho-k lenses, and you will be advised as to how long of a wait is necessary before having the laser procedure.

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Children's Vision & Learning


According to experts, 80% of learning is visual, which means that if your child is having difficulty seeing clearly, his or her learning can be affected.

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There's More To Children's Learning Than Just 20/20 Vision

Even if your child doesn't need corrective lenses, he or she may be experiencing vision problems. These eye conditions can cause learning problems and substandard educational results.

A child's visual acuity (how well s/he can see the wall chart) is an essential aspect of good vision but there are other factors which may prove more important.

You may already be aware that a nearsighted child has little trouble reading or that good grades in school can be acquired even if much of the teacher's board cannot be seen by the student.

Questions Related to Eyesight and Learning

Eye movement skills:

Do your child’s eyes move across the page in a book smoothly and accurately?

Eye focusing abilities:

Does your child change focus from near to far and back again – between reading text from a far-away white or black-board and writing on paper?

Eye teaming skills:

Are your child’s eyes working together as a focus unit – do they come together for proper eye alignment for reading?

Binocular vision skills:

Are your child’s eyes blending visual images from both eyes into a single, three-dimensional image?

Visual perceptual skills:

Does your child identify and understand what s/he sees, co-relating importance, connecting with previous visual memorized information?

Visual-motor integration:

Is the quality of your child’s eye-hand coordination balanced? Visual-motor integration is important not only for legible handwriting and the ability to efficiently copy written information from a book or board but also for sports. Deficiencies in any of these can be detrimental to a child’s learning ability and/or school performance.

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Vision Problems Do Affect Kids Learning

Undetected learning-related vision problems in children are common. A child with an untreated vision problem may be misdiagnosed with behavior problems or ADHD/ADD when in reality they have a vision problem.

Vision problems, in extreme cases, ignored or misdiagnosed, can become the true root cause of a child becoming the victim or aggressor in a school bullying tragedy.

Left untreated, vision problems will hinder your child’s learning in school. Studies have shown that at least 13% of children between the ages of nine-thirteen suffer from moderate to severe convergence insufficiency, the ability to bring one’s eyes together, which is crucial for good reading.

Studies demonstrate clearly that 1 out of 4 school-age children suffer from at least one learning related vision problem.

Learning-Related Vision Problems

Signs and Symptoms

Some of the most common roadmap symptoms of learning-related vision disorders are:

  • Double vision, particularly during or after reading
  • Poor handwriting
  • Hyperactivity or recklessness during class
  • Word and letter reversals
  • Easily distracted during reading
  • Poor reading comprehension
  • Poor overall school performance
  • Circumventing of reading
  • Blurred vision, especially after reading or working closely
  • Eye Strain or frequent headaches

Call us to schedule a comprehensive child’s vision exam if your child exhibits one or more of these signs or symptoms and is exhibiting these types of problems in school.

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Comprehensive Child Vision Exam

A comprehensive child's vision exam includes tests performed in a routine eye exam, plus specific additional tests for detecting learning-related vision problems.

Extra tests would include accommodation, binocular vision, and ocular motility testing. In addition to these, depending on the type of problems your child is displaying, we may recommend other testing, either in our office or with a child’s vision and/or vision development specialist.

Vision Therapy

Special reading glasses or vision therapy may help your child if s/he has a learning-related vision problem that cannot be corrected with regular glasses or contact lenses. Vision therapy entails eye exercises and other activities specifically tailored for each patient to improve vision skills.

Learning Disabilities and Vision

Although children with learning disabilities may also have vision problems that are contributing to their difficulties in the classroom, vision therapy is a treatment for vision problems; it does not correct a learning disability. A child's learning ability and school performance may indicate learning disabilities and/or vision problems.

Once your child’s comprehensive vision exam is completed, our doctor will advise you about whether a program of vision therapy could be helpful. We will refer you to a children's vision or education/learning specialist if we do not provide the specified additional services your child needs.

How to Cope with Low Vision

Reduced vision is defined as vision that can not be corrected completely using either contact lenses, eyeglasses, or surgery, and is blurry (at the level of at least 20/70), or limited in its view field. Low vision is sometimes caused by injury to the eye or brain, and it can be inherited. However the main cause of low vision is eye disease, including diabetic retinopathy, glaucoma and macular degeneration.

If you have low vision you have some sight. However completing normal activities, including driving and reading, can be hard or even impossible.

Low vision is a condition that the elderly suffer from, although it is possible for children and adults to have low vision. After a life of seeing normally, losing your vision can be hard, or even traumatic, and can potentially lead to frustration, or even depression.

What is especially hard about low vision is that many people are unable to work, and lose their existing jobs. In 2010 the U.S. Census Bureau’s American Community Survey showed that the employment rate for Americans with low vision was 24 percent.

If you have low vision, you probably feel disconnected from the rest of the world. With low vision, it’s hard to read, see images on television or a computer screen, and impossible to drive. You may not be able to be independant and run your own errands, shop for food, or visit friends and family. Sometimes people with a vision impairment suffer with this burden alone, while others must rely completely on friends and relatives on a daily basis.

There are many devices and ways to manage low vision, which can help people suffering with low vision to continue leading productive and independent lives. Some of the devices that can help make the most out of remaining vision are magnifiers, both handheld and mounted on eyeglasses, and telescopes.

Signs that it is time to see an eye doctor include loss of peripheral vision, blurry vision, sensitivity to light, night blindness, needing more light to see, spots or floaters, and reading difficulty. This symptoms could indicate that a cataract is beginning in your eye. Or these problems could be signs of an eye condition such as glaucoma, retinitis pigmentosa, or macular degeneration. Make sure to see your eye doctor before any eye condition becomes so serious that vision loss occurs.

If it’s not possible to correct your vision loss with surgery, medical treatment, or eyewear, your eye doctor will send you to a specialist in low vision care. A low vision specialist, who is usually an optometrist, will evaluate your vision loss. Once he or she determines the type and degree of vision loss you are suffering from, this specialist can create a treatment plan including low vision aids, and guidance in using devices that help you to live with vision loss.

Additionally, a low vision specialist has knowledge of many different types of aids for low vision, including large-print and audio books, specially-designed lights, and signature guides that are used to sign checks and other documents. Sometimes eye care professionals that are treating vision loss recommend counseling to help their patients learn to live with the changes that low vision brings.

Safety and Sports Glasses


Nowadays, sports eyewear tells the world that you are a serious player. It doesn’t matter whether you bat in Little League or skate with the pros, eye gear for sports offers a long list of benefits.

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Protective eyewear, such as specialized goggles and wraparound frames with polycarbonate lenses, helps to reduce or eliminate your risk of eye damage. An added bonus is that performance is often enhanced, due to the high quality vision provided from eyewear made for wearing on the playing field.

Eye gear for sports is not merely recommended, but now mandated by many clubs. Members are required to wear proper protective eyewear in order to participate in activities. Once upon a time, kids used to cringe at the concept of wearing goggles, but just like bike helmets have become the norm – sports goggles are now accepted as part of the uniform and regarded as ultra-cool.

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Protect Your Eyes from Fast and Furious Sports Action

If you’re still unconvinced about your need to wear protective eyewear for sports, take a look at these scary statistics:

Hospital emergency rooms treat 40,000 eye injuries annually, which are sports-related
Tennis and badminton are played with objects that zoom at 60 mile per hour or faster. With racquetball, the ball can whizz by at 60 to 200 miles per hours.

Activities such as racquetball involve racquets that swing at lightning speed in a confined space where crashes are inevitable.

Many sports are filled with pokes and jabs from elbows or fingers. Even basketball is associated with a high incidence of injuries to the eye.

Up Your Performance with Sports Eyewear

Until recently, people with mild to moderate vision correction used to play their games without wearing eyeglasses or contacts. Yet top performance in any sport is dependent upon sharp vision. Eye gear and goggles for sports allow you to compete at your best, with 20/20 eyesight.

Key Features of Sports Glasses

Sports eyewear does not share the same characteristics as regular eyeglasses, sunglasses or industrial safety glasses. Crafted in a variety of shapes, sports eye gear is specialized to suit the specific needs of each respective sport. Many types of eyewear are even designed to fit into helmets worn when playing football, baseball or hockey.

Protective lenses are generally made from polycarbonate, a durable and impact-resistant material that boasts full UV protection for outdoor action. Polycarbonate lenses are also scratch-resistant, which is a valuable feature for many rough sports.

The frames are typically designed from highly-impact resistant plastic or polycarbonate, and they are coated with rubber padding at every point that connects with your face. Some frame styles are contoured to wrap around your face, which provides secure coverage for activities such as hang-gliding, sailing and biking. Non-prescription wraparound shapes are useful for contact lens wearers, as they block your eyes from dust or wind.

Classic handball goggles used to be fashioned as plain goggles with small openings instead of lenses. That style was abandoned once it was realized that the high speed of handballs actually compressed the balls enough to penetrate through the goggle opening and seriously damage the orbital bones around your eye. Modern and effective goggles for handball and racquetball include polycarbonate lenses that protect your eyes.

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Importance of a Good Fit

There’s no such thing as one-size-fits-all when it comes to sports goggles. Proper sizing is critical for top-notch function. For kids, many parents may be tempted to purchase larger goggles so that they’ll be long-lasting with room to grow. Yet if the frames are truly oversized, they won’t protect the child’s eyes adequately. Impact or blows to the face or head won’t be cushioned properly.

On the flipside, wearing sports goggles that are too small is just as hazardous. Not only will the child be constantly tempted to take them off due to discomfort, but the eyewear will also disturb peripheral vision. Without a good view of all that’s happening around your child, sports performance will be compromised. Hits from unseen sources on the sidelines are another risk factor.

The fit of sports goggles should be reassessed each year. The eyewear should still feel comfortable and provide proper eye protection. The padding on the interior of the goggles must rest flush with your or your child’s face, and eyes should be centered in the lens zone.

Low Vision Aids for Computer Users

Low vision is a condition, often caused by a number of eye diseases which damage parts of the eye, in which individuals have significantly reduced vision. Individuals with low vision have some sight, but usually it is not sufficient to get by in daily life without some assistance. Often they are not able to read, drive, cook or work on a computer without a visual aid. Today there are many low vision aids available on the market to help those with low vision to function independently in performing daily tasks.

Computer use is one activity that often requires assistance and the good news is the technology to aid computer users with low vision is always improving.

Here are some devices and programs on the market to help:

Text Magnifying:

There are a number of ways to enlarge the text on your computer screen in addition to handheld magnifiers.

Via Your Computer Operating System: Both newer generation Windows and Mac operating systems have screen magnifiers built in. These do not have as many capabilities as purchased screen reader programs but for many with mild low vision, they may be sufficient.

Via Browser: When using the Internet most browsers (Chrome, Safari, Firefox and Internet Explorer) allow you to change the size of the page or text on the screen to suit your needs. To enlarge the text on a PC simply hold down the Control (“Ctrl”) key on your keyboard and either tap the “+” key or roll the wheel on your mouse. To reduce the size tap the “-” key or turn the mouse wheel in the opposite direction. On a MAC, you press command and shift at the same time along with the “+” or “-” keys.

Additionally, the browser might have a drop down option under the “view” tab that allows you to Zoom the screen in or out or make the text larger or smaller. Keep in mind that if you are using a larger higher quality screen, this will enable you to see bigger and more clearly as well.

Screen magnification programs: there are a number of free and paid software programs that will enlarge the text, picture and images on your computer screen.

Screen Readers and Text to Speech Programs:

There are a number of programs that enable you to “read” what is on the computer without needing to see it – these are designed for people that are totally blind as well. These programs work by scanning the text and icons on a page and converting it to speech which is read aloud. Some of these programs also have a cursor on the page that moves along with the voice.

Up to date Microsoft and Apple operating systems do have simple, built in screen readers but they may be limited. The Chrome browser and Android devices do as well. Nevertheless depending on your abilities, you may prefer to purchase a program with more comprehensive options and usability.

If you are looking for something simpler, text-to-speech programs exist in which you select a portion of the text you want to read and the program reads it for you.

Screen Contrast

Adjusting your screen to the highest contrast will enable the letters and images on the monitor to stand out. Font should be adjusted to achieve a dark text on a light background. Further it is advisable to reduce glare as much as possible. This may require adjusting window shades and indoor lights or even purchasing an anti-glare screen to reduce glare that can’t be eliminated.

Hardware

You can purchase special keyboards, mice and monitor magnifiers made specifically to enhance usability for those with low vision. Purchasing a large LCD screen for your monitor will also help to enhance visibility.
Computers can be a window to open our world to information, connections, work and play. Individuals with low vision can access all of this as well with the assistance of specialized software, devices and programs using the strengths and senses that they do possess.

Why are Eye Exams Important?

For both adults and children alike, eye exams are an important part of one’s general health maintenance and assessment. Your eyes should be checked regularly to ensure that you are able to see as best as possible. Regular eye health exams will also check for signs of eye disease or conditions that can affect not only your vision but your overall health. Vision and eye health is such a critical part in learning and development, therefore, we highly recommend eye exams for infants and children.

Vision Screening vs. an Eye Exam

When we recommend regular eye exams, this should not be confused with a vision screening. A vision screening is a basic test that indicates if you have difficulty seeing and require further assessment and corrective measures. It can be performed by anyone, whether it is a school nurse, a pediatrician or even a volunteer at a vision clinic. A vision screening usually only checks vision, it does not check eye health. Also, most vision screenings for kids only check for nearsightedness (when you can not see far), but what happens when the majority of children are farsighted? Most of the time many of these kids get overlooked.

A comprehensive eye exam on the other hand, can only be performed by an eye doctor as it requires special knowledge and equipment to look around and into your eye to check your eye and vision health. Such an exam can assess whether there are underlying causes for vision problems and whether there are any signs of disease which can threaten your site and the health of your eye. A comprehensive eye examination can also diagnose symptoms of diabetes, high blood pressure, high cholesterol, tumors, cancer, autoimmune disorders, and thyroid disorders. A comprehensive eye examination will also provide an accurate prescription for eyeglasses or contact lenses.

Eye Exams for Eye Health

Eye exams are critical because many vision threatening eye diseases such as glaucoma, macular degeneration, cataracts, or diabetic retinopathy have no or minimal symptoms until the disease has progressed. In these cases, early detection and treatment is essential to halting or slowing down the progression of the disease and saving eyesight. During a comprehensive eye examination, your eye doctor will be looking for initial signs of these diseases. If a problem with your eyes arises such as red eyes, eye allergies, dry eyes, eye swelling,eye pain, always seek an eye doctor as your first doctor to call since they are specifically trained to treat eye diseases.

Eye Exams and Children

If your child is having developmental delays or trouble in school there could be an underlying vision problem. Proper learning, motor development, reading, and many other skills are dependent upon not only good vision, but your eyes functioning together. Children that have problems with focusing or hand-eye coordination will often experience frustration and may exhibit behavioral problems as well. Often they don’t know that the vision they are experiencing is abnormal so they aren’t able to express that they need help. Many conditions are much easier to treat when they are caught early while the eyes are still developing, so it is important to diagnose any eye health and vision issues as early as possible.

Eye Exams Over 40

Just like the rest of our bodies, our eyes begin to weaken as we age. There are a number of common age-related eye conditions such as presbyopia, cataracts, and age-related macular degeneration that can begin to affect your vision and your daily life. While some of these conditions are more of an inconvenience, others could lead to vision loss and dependency.

In addition to regular yearly eye exams, it is important to be aware of any changes in your eye health and vision. Also know your potential risk factors as well as your family ocular and medical history. Over half of the vision loss worldwide is preventable with proper treatment and care.

Preparing for an Eye Exam

For both adults and children, an eye exam is a critical part in maintaining your overall health and well-being, and therefore, regular eye exams should be incorporated into your health routine. Comprehensive eye exams assess your vision and the health of your eye, looking for early signs of disease that may not have obvious symptoms. You should not wait until you experience a vision problem or symptoms of an eye condition to schedule a routine exam.

Depending on your age, family history, general health and eye health, it is recommended to have an eye exam every one to two years. Of course if you experience any serious symptoms that affect your eyes or your vision, you should contact your eye doctor immediately.

The Difference Between an Optometrist (OD) and an Ophthalmologist (MD or DO)

Confusion about the difference between optometrists and ophthalmologists is common, and many people are not aware of how the two eye care professionals differ.

Optometrists

Optometrists or Doctors of Optometry attend optometry school which is usually at least four years of graduate level training. They are able to perform eye exams, provide prescriptions for eyeglasses and contact lenses, and diagnose and treat eye diseases as as glaucoma, dry eyes, or eye infections that may require medication or drops. They can consult with and co-manage patients in pre- or post-op surgical care, however they do not perform surgery.

Ophthalmologists

Ophthalmologists are medical doctors that attend medical school and later specialize in ophthalmology. They are able to do all of the services mentioned above but also perform eye surgeries such as cataract surgery, refractive surgery such as LASIK and deal with more urgent eye conditions such as retinal detachment.

Infant and Child Eye Exams

According to the American Optometric Association (AOA) children should have their eyes examined by an eye doctor at 6 months, 3 years, at the start of school and then at least every 2 years following. If there are any signs that there may be a vision problem or if the child has certain risk factors (such as developmental delays, premature birth, crossed eyes, family history or previous injuries) more frequent exams are recommended. A child that wears eyeglasses or contact lenses should have his or her eyes examined yearly.

Adult Eye Exams

Healthy adults under 40 with good vision and who do not wear eyeglasses or contact lenses are recommended to have an eye exam at least every two years. Those that do use vision correction or have a health issue such as diabetes, high blood pressure or another health condition that can have an impact on your eye health should schedule a yearly exam, unless the eye doctor recommends more frequent visits.

Once you reach 40, you become susceptible to a number of age-related eye conditions such as presbyopia, cataracts or macular degeneration, therefore annual or bi-annual exams are strongly recommended.

As you continue to age, particularly after age 55, the risks of eye disease increase, and early detection can be critical to preventing significant vision loss or blindness. Scheduling a yearly eye exam can make all the difference in maintaining your independence and quality of life.

How to Prepare for Your Exam

Prior to your exam you should decide whether you will be seeking special services such as a contact lens exam or LASIK consultation. These services may cost extra. Check with the doctor’s office or your insurance provider to see if they cover any of the exam expenses.

You need to know if you have medical insurance, vision plan coverage or both. Medical insurance usually does not cover “wellness/refractive” exams for glasses or contact lenses. Vision plans will cover exams for glasses or contacts, but usually cannot be used for red eyes, floaters, or other medical eye health problems. Please bring your insurance cards with you.

In addition to bringing your current pair of glasses or contacts if applicable, it is important to be aware of your personal and family history and to have a list of medications or supplements you are currently taking. Your pupils will probably be dilated as apart of your exam, so plan accordingly.

Your Comprehensive Eye Exam

Your eyes are one of the most complex organs in your body. A comprehensive eye exam to assess your visual system and eye health involves a number of different of tests. Unlike a simple vision screening, which only assesses your vision, a comprehensive eye exam includes a battery of tests in order to do a complete evaluation of the health of your eyes and your vision.

The tests that you will undergo in a comprehensive eye examination may vary from eye doctor to eye doctor but here are are some common exams that you may encounter:

Patient Background and History

One of the most important parts in a comprehensive eye exam is your patient health history. This information will alert your doctor to any conditions that should be monitored closely, such as an allergy to any medications, current or family history of systemic or eye pathology or environmental conditions that could be affecting your vision or eye health. This will also help your doctor to determine any preventative eye care measures that are relevant to keep your eyes healthy for years to come.

Visual Acuity

Visual acuity is a measurement of your vision using an eye chart, the Snellen Eye Chart. In this test the patient is seated at a standard distance and is asked to read letters or symbols of various sizes, which get smaller as you move down the chart. The results are the familiar ratio of 20/20, 20/40 etc. which is a comparison of your vision compared to the average person with good vision, which is typically 20/20. For example, a patient that has 20/40 vision, can only see at 20 feet what the normal person can see from a distance of 40 feet. This test is a preliminary test of how clearly you are seeing in each eye but it does not give you a prescription for corrective lenses.

Refraction

Those who don’t have 20/20 vision have what is referred to in most cases as a “Refractive Error.” The patient may have nearsightedness, farsightedness, astigmatism or other eye conditions that prevent the patient from seeing 20/20. A refraction will tell the doctor which prescription lenses will correct your eyesight to achieve 20/20 vision or whichever amount your vision is correctable to.

A refraction may include a couple of steps.

Retinoscopy

Retinoscopy is a test that allows the doctor to obtain an approximate prescription for eyeglasses. In this test the doctor uses a hand-held instrument called a retinoscope that shines a light into the patient’s eye. The doctor then analyzes the reflex of the light from the patient’s eye to determine the patient’s prescription for glasses.

An instrument called a phoropter is something most patients associate with an eye exam. This space age appearing instrument, positioned in front of the patient’s face during the eye exam, gives the doctor the ability to determine the patient’s focusing ability as well as their eye alignment. The phoropter also determines which, out of the hundreds and hundreds of potential eyeglass prescriptions, will help the patient see as clear as possible. Using the phoropter, the doctor will ask the patient which series of lenses makes their vision the clearest.

While retinoscopy is quite effective for children and nonverbal patients, there are now a number of computerized or automated instruments available today to help doctors accurately determine a patient’s eyeglass prescription.

Autorefractors and Aberrometers

Autorefractors and aberrometers are computerized machines that are able to measure your refractive error to determine your prescription for glasses or contact lenses. These instruments are usually used in addition to testing described earlier:

– An autorefractor is similar to retinoscopy, which electronically analyses the light reflex from the patient’s eye.

– An aberrometer measures distortions or aberrations in the cornea and lens of the eye that disrupt proper focus of light on the retina. Using wavefront technology, the instrument measures the rays of light as they pass through your eye to look for imperfections which may indicate a refractive error.

Eye Focusing and Eye Teaming Tests

During the comprehensive eye exam, your eye doctor will also want to test how your eyes function individually and together from a mechanical perspective. In order to see clearly and comfortably, your eyes need to work together as a team.

Eye Health

The final and most important aspect of a comprehensive eye exam is a check of your overall eye health. These tests (below) are done to identify any eye conditions or diseases, both inside the eye as well as the external parts of the eye, that could affect your vision and general health.

Slit Lamp Test

The slit lamp or biomicroscope is an instrument that allows the doctor to examine the internal and external parts of the eye in detail, such as the conjunctiva, iris, lens, cornea, retina and the optic nerve. The patient rests their forehead and chin on a headrest to stabilize the head, while the doctor looks into the eye with the slit lamp microscope, which is magnified with a high-intensity light. A slit lamp test enables the doctor to evaluate the eyes for signs of normal aging and eye pathology, such as conjunctivitis, cataracts, macular degeneration or retinal detachment. Early diagnosis and treatment of eye diseases are essential for preventing vision loss.

Tonometry

Tonometry is a test to detect glaucoma by measuring the pressure inside your eye or IOP (intraocular pressure). Glaucoma can cause vision loss and even blindness if the IOP in the eye is too high and damages the optic nerve.

The applanation tonometer, typically attached to a slit lamp, is one of the most common instruments used to measure the pressure in the eye. Prior to doing this test the doctor will numb the patient’s eyes using an anesthetic, before gently applanating (putting pressure on) the patient’s cornea to measure the pressure in the eye.

Pupil Dilation

During your comprehensive eye exam, your doctor may decide to do a dilated eye exam. In this test, your doctor will instill dilating drops in each eye, which would enlarge your pupils to give the doctor a better view of certain parts of the back of the eye. Dilation is done at the discretion of the doctor, with some patients dilated every year and others at specified intervals; the frequency of dilation will vary for each patient.

Typically the drops take around 20 to 30 minutes to take effect and may last up to several hours following the exam; each patient is different. Since more light enters your eyes when your pupils are dilated, you will be more sensitive to bright light, especially sunlight. Although your doctor may provide disposable sunglasses, you may want to bring a pair of sunglasses to wear after the exam to make it more comfortable until the drops wear off.

A comprehensive eye exam is an important part of your overall general health maintenance and should be scheduled on a regular basis. The findings from your comprehensive eye exam can give your doctor important information about your overall health, particularly diabetes and high blood pressure.

Vision Therapy for Children

As a child’s eyes develop, it is not uncommon for a number of problems to occur. Beyond blurred vision due to refractive error including nearsightedness (myopia) and farsightedness (hyperopia), children can develop a number of other visual and perceptual problems that are often not detected by a simple vision exam. Even a child with 20/20 vision, can have underlying vision problems!

Some of these issues are functional vision problems having to do with the actual eyes, how they move individually and as a pair, as well as their ability to focus. Functions such as eye teaming, tracking, focusing, and hand eye coordination, all affect a child’s success in school, sports or general functioning. Often children that have difficulty with these functions will suffer physical symptoms as well such as headaches, eye fatigue or short attention spans. With these critical visual skills lacking, tasks such as reading and writing can be extremely difficult and exhausting which can lead to frustration and behavioral problems.

Just like we are able to train our bodies to build strength, speed and agility, our vision skills can be strengthened. Vision therapy offers a doctor-supervised program to guide children to develop these skills.

What is Vision Therapy?

Vision Therapy is a program of progressive eye exercises individualized for each patient designed to retrain or help the patient develop or improve upon particular visual skills or to improve processing and interpretation of visual information. It is used to treat conditions like strabismus (crossed eyes) and amblyopia (lazy eye) as well as eye movement, focus and coordination problems.

Typically, the sessions take place in the optometrist’s office weekly or bi-weekly and utilize a variety of tools such as therapeutic lenses or prisms. Often the patient will be asked to practice certain exercises or activities at home as well in order to reinforce the skills that are being developed. Through repetition of these tasks, the ultimate goal is to strengthen the skills such as focusing, and improving eye movement and alignment, to the point where the eyes and vision are working efficiently and comfortably. The duration of the therapeutic program usually lasts about 6-9 months.

Vision therapy has been scientifically proven to improve functional vision skills and is approved by the major optometric bodies such as the American Optometric Association and the Canadian Association of Optometrists. It does not improve refractive error and should not be mistaken for some of the alternative self-conducted eye exercises out there that claim to improve your vision.

Vision therapy has also been shown to be effective in adults. If you think that vision therapy could be right for your child or yourself, it is worthwhile to have an assessment by a trained vision therapist to determine whether it could help resolve the vision problems that are present.

Children’s Vision – FAQ’s

Most parents believe that if their child had an eye or vision problem they would know. However, this is far from the truth for a number of reasons. First of all, children often can’t express or don’t realize the difficulty they are having, and often vision problems will be overlooked by the associated behavioral issues that come as a result of frustration. Further, many eye or vision problems don’t show symptoms until they have progressed significantly which often makes the condition harder to treat.

Conditions such as amblyopia (lazy eye) or strabismus (crossed-eyes) can be corrected more effectively when they are diagnosed and treated early at a young age. Further, the sooner you diagnose and correct a vision problem, the sooner your child will be able to achieve his or her potential without struggling with these difficulties. This is why it is critical to have your child’s eyes examined by an eye doctor at regular intervals. Here are some FAQ’s and answers about Children’s Vision that every parent should know:

Q: At what ages should children have their eyes examined?

A: The official recommendations for the American and Canadian Optometric Associations are that infants should have their first eye exams at 6 months. Following that, children with no known vision issues should have another exam at 3 years and then prior to entering kindergarten. Children who do not require vision correction or therapy should have a vision checkup every year or two years and those who use vision correction should have an annual eye exam. Of course if your child is experiencing difficulty in school or after school activities that may be due to a vision problem schedule an eye exam immediately.

Q: My child passed a vision screening by the nurse at school. Does he still need an eye exam?

A: Yes. Many schools implement a basic vision screening test to assess whether the child sees clearly at a distance, however these tests are limited in scope. They do not assess functional vision such as the child’s ability to focus, track words on a page or the eyes’ ability to work in tandem. They also do not look at the health of the eye itself. These tests are essential to know the comprehensive picture of how healthy the eyes are and how well they are doing their job. In fact, studies shown that up to 43% of children with vision problems can pass a vision screening test! A comprehensive eye exam will assess all of these functions as well as color vision, depth perception, and eye coordination.

Q: My child was diagnosed with strabismus and amblyopia. Can this be treated and if so, what are the options?

A: Especially when diagnosed early, chances of a complete correction for strabismus and amblyopia are good when treated properly. The optimal age for this to occur is before 8-10 years old. Depending on the severity of the strabismus (crossed-eye), surgery may be required to straighten and properly align the crossed eyes. Amblyopia (lazy eye) can then be treated using eyeglasses, eye patching, or vision therapy to strengthen the weak eye and train the eyes to work together. A doctor that specializes in pediatric optometry can assess the condition and discuss treatment options on an individual basis.

Q: What is vision therapy?

A: Vision therapy is a doctor-supervised, individualized program of exercises to strengthen the functions of the eye. It is used to correct issues with eye alignment, focusing, coordination, tracking and more. Vision therapy often utilizes tools such as specialized lenses or prisms and involves exercises both during office visits and at home to reinforce the changes. The process usually takes about 6 months to see lasting improvement.

Q: My son’s nearsightedness keeps getting worse – he needs a new prescription every year. Is there a way to stop this?

A: There is research that shows that progressive myopia can be stopped or slowed during the childhood years. There are a number of therapies that are used for what is called “myopia control” including multifocal eyeglasses or contact lenses, orthokeratology (ortho-k) or atropine eye drops. Speak to a pediatric optometry specialist to learn more about the options and what might work best for your child.

Q: Every morning it is a fight to get my child to wear her glasses. What can I do?

A: It may take time for your child to adapt to the feel of the glasses and to be comfortable seeing with them. For little children, you can find glasses that come with integrated headbands that can help to hold the glasses in place. It helps to be consistent in putting them on to allow the child to adapt to the feel of the glasses.

Very often, especially for small children that can’t tell you what is bothering them, the reason for a child’s refusal to wear glasses is that something is not comfortable. It could be that the prescription is not right, that the glasses pinch or that are feeling heavy. It could be worthwhile to take the glasses back to the eye doctor to ensure that they are in fact a proper fit.

Q: At what age is it acceptable for a child to wear contact lenses?

A: Contact lenses can be a great convenience, especially for kids that are active or tend to break or lose their glasses. However, they are a medical device that must be treated with proper care and hygiene. If a child is not responsible enough to take care of them properly he could end up with a serious eye infection, a scratched cornea or worse. Most experts agree that the youngest age that contact lenses should be considered would be between 10-12 depending on the child’s maturity and cleanliness. Consult with your eye doctor about what would be best for your child.