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All About Vision

Corrective Eye Surgery Basics

In recent years there have been tremendous advances in the field of vision correcting eye surgery which is also known as refractive or laser surgery. Corrective eye surgery offers patients clear vision without the use of glasses and contact lenses. There are a number of types of refractive surgeries that are able to correct different vision problems, so if you are considering surgery here are some of the options you should know about.

LASIK

LASIK (laser-assisted in situ keratomileusis) surgery is perhaps the most well-known refractive surgery today. LASIK can help patients with myopia (nearsightedness), hyperopia (farsightedness) and astigmatism. During the procedure, the doctor makes a flap in the outer layer of the corner to reach the underlying tissue and then uses a laser to reshape the tissue which allows the cornea to then focus light properly. The procedure is usually painless and vision is usually clear within a few hours.

Recent advances in the field have developed subcategories of LASIK surgery such as Bladeless LASIK, which uses a laser rather than a mechanical tool to make the initial flap or Wavefront (custom) LASIK which uses computer mapping to guide the reshaping of the cornea and is able to create a much more precise visual correction for very subtle optical imperfections. There is also a procedure called Epi-LASIK in which following the procedure, the doctor applies a soft contact lens to protect the surgical area, holding the flap in place while it heals.

PRK

PRK (photorefractive keratectomy) also uses a laser to correct mild to moderate myopia, hyperopia and astigmatism. PRK was a precursor to LASIK which eliminated many of the complications of prior surgeries such as glare, seeing halos around lights, blurred vision and regression of vision. Unlike LASIK, the procedure only reshapes the surface of the cornea and not the underlying tissue. Consequently, there is often some discomfort for a couple of weeks until the outer layer of the cornea heals. Additionally, the patient may experience blurred vision during this period of healing. PRK does offer an advantage over LASIK in that there is less risk of certain complications. Wavefront technology is also available for PRK surgeries.

Due to the increased comfort of LASIK there was a period that PRK saw a decline. Recent studies show however that LASIK and PRK have similar long-term success for improved visual acuity and with the assistance of newly developed effective pain medications, PRK has become more popular again as an option.

LASEK

In LASEK or laser-assisted sub-epithelial keratomileusis, the doctor creates a flap smaller but similar but to LASIK, and then uses an alcohol solution to loosen the tissue around the cornea which is pushed aside, and then a laser is used to reshape the cornea itself. In an Epi-LASEK procedure, the doctor may apply a soft contact lens to hold the flap in place to assist in reattaching to the cornea as the eye heals. Patients that undergo LASEK generally experience less discomfort and quicker vision recovery than PRK patients. LASEK may be preferred over LASIK as a safer option for patients with a thin cornea.

Cataract Surgery

Cataract Surgery is a very common refractive surgery that removes the clouded natural lens of the eye and replaces it with an artificial lens called an IOL (intraocular lens). Many patients these days will receive a lens that also corrects any refractive error they have such as nearsightedness, farsightedness or presbyopia.

RLE

RLE or refractive lens exchange is a non-laser procedure the replaces the natural lens of the eye. This is the same as the surgery that is used to treat cataracts, ,yet for non-cataract patients, RLE is used to correct severe nearsightedness or farsightedness. The procedure involves the doctor making a small cut in the cornea, removing the natural lens and replacing it with usually a silicon or plastic lens. It is particularly useful for patients with minor corneal problems such as thin corneas or dry eyes.

RLE is more risky than the other procedures mentioned and can affect the patient’s ability to focus on close objects, possibly requiring reading glasses following the procedure. However, in cases of severe vision correction it is often the preferred method.

PRELEX

PRELEX or presbyopic lens exchange is for patients with presbyopia, the age-related condition in which you lose the flexibility of your lens and can no longer focus on close objects. Patients that prefer not to wear reading glasses or multifocals, can opt for a procedure in which the doctor removes the natural lens of your eye and replaces it with a multifocal artificial lens. This procedure is often done in conjunction with cataract surgery.

Phakic Intraocular Lens Implants

Phakic IOLs are implants that are used for individuals with very high nearsightedness who do not qualify for LASIK or PRK. The implant is attached to your iris or inserted behind your pupil, while the natural lens remains intact. Because this is a procedure that involves the inner eye, it is more risky than LASIK or PRK and is therefore also typically more expensive.

Conductive Keratoplasty (CK)

CK uses a hand-held radio wave device to shrink tissue on the cornea to reshape it. The procedure is typically used to treat mild farsightedness and presbyopia, particularly for patients who have already undergone LASIK.

Any surgical procedure has risks and may have some side effects or complications that you should research before you decide to go ahead with the surgery. Nevertheless, as technology advances these complications are being significantly reduced making refractive surgery a great option for vision correction in many patients.

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 Ontario Association of Optometrists, infants should have their first comprehensive eye exam at 6 months of age. Children then should receive additional eye exams at 3 years of age, and every year throughout school thereafter. 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

Children & Vision Therapy

Vision problems in children, other than simple refractive errors such as nearsightedness, farsightedness and astigmatism are not uncommon. Vision problems such as eye alignment, amblyopia (“lazy eye”) or focusing problems, eye teaming problems and visual perceptual disorders require vision therapy. Left untreated, these non-refractive vision problems can cause  learning problems, fatigue, eyestrain and headaches .

What Is Vision Therapy or Vision Training?

Vision Training or Vision Therapy also called orthoptics  is an individualized program for the treatment of non-refractive vision problems. Eye exercises and tasks are tailored to the child's specific vision problem.  The therapy can be performed in an optometrist’s office with additional visual tasks that the child will need to perform daily at home.

Behavioral optometrists or developmental optometrists are optometrists who specialize in vision therapy and the treatment of learning-related vision problems.

Could Vision Therapy Eradicate the Need for Glasses?

Most eye care specialist are in agreement that the self-help programs that claim to reduce refractive errors and the need for glasses are a hoax. There is no scientific evidence that these programs work. These self-help programs are NOT the same as vision therapy.

Many studies confirm the effectiveness of vision therapy.

Not every vision problem can be helped with vision therapy. Children that can be helped must adhere to the established vision program.  The degree of success with vision therapy is determined  by a number of factors.  The patient’s age and his level of motivation are key factors.  As important is the patient's performance of all eye exercises and visual tasks correctly.  Furthermore, the type and severity of the vision problem are taken into account when evaluating the level of improvement with vision therapy.

Vision Therapy is Always Customized

The activities and therapeutic eye exercises prescribed as part of a vision therapy program are customized to the specific vision problem (or problems) a child has.  For amblyopia, for example, the therapy normally includes patching the strong eye, in conjunction with visual activities or other stimulation techniques to develop visual acuity in the weak eye. Once visual acuity is better in the amblyopic eye, eye teaming exercises to further the development of clear, comfortable binocular vision to enhance depth perception and reading comfort, may be added to the treatment plan.

Learning Disabilities and Vision Therapy

Vision therapy is not a corrective procedure for learning disabilities. It is important to note though that children with learning disabilities often have vision problems as well. Vision therapy can correct the underlying vision problems. These may be contributing to the child’s learning problems.

Be sure to explain to your doctor the details of all your child's diagnostics related to any learning disability. If the findings indicate vision problems as contributive factors to the learning problems, your doctor will typically wish to communicate with the child’s teachers and any other specialists to clarify the findings. Vision therapy is often a useful component aspect of multidisciplinary approaches to learning problems and ultimate remedies.

Comprehensive Eye Exam

If you even suspect your child has a vision problem which perhaps is affecting school performance, do not hesitate to schedule a comprehensive eye exam to determine to what extent any problem exists. If learning-related vision problems are discovered your doctor will discuss available vision therapy programs and their relevance as a part of or holistic solution.

Children’s Vision – FAQ’s

When should children have their eyes examined?

According to the Ontario Association of Optometrists, infants should have their first comprehensive eye exam at 6 months of age. Children then should receive additional eye exams at 3 years of age, and every year throughout school thereafter.

If my 5-year-old daughter passed a vision screening at school, does she still need an eye exam?

Yes, she should still have a complete eye exam.

Vision screenings in school are designed to identify gross vision problems. Yet a child can pass this screening and still have an eye condition that affects development, learning and performance in school. Studies have shown that up to 11 percent of kids who pass a school vision test actually have a vision difficulty that requires treatment.

In addition, a comprehensive eye evaluation by a qualified professional checks your child’s eye health, which is not included as a part of vision screening done in school.

What is vision therapy?

Vision therapy or training can be understood as a specialized form of physical therapy for the ocular system. Highly personalized, it involves a customized set of eye exercises that are intended to correct visual problems. Lazy-eye (amblyopia), focusing problems, trouble with eye alignment and movement, and specific visual-perceptual disorders are some of the conditions that may be treated with vision therapy.

Therapy sessions are generally held in an optometrist’s office, but most courses of treatment include daily exercises to be done at home.

Can learning disabilities be cured by vision therapy?

No. Yet children with learning problems often suffer from vision problems too. As the vision therapy corrects underlying ocular conditions, a child’s learning difficulty may be improved or resolved.

How can we get our active one year old son to keep his glasses on? He needs eyeglasses to correct farsightedness and a tendency towards crossed eyes. We’ve tried everything from elastic bands to tape, but he struggles, cries and pulls them off.

Most of the time a child’s resistance to wearing eyeglasses is settled through time and perseverance. Getting used to the feeling of wearing glasses can take some adaptation. It may help to put his glasses on immediately after he wakes up.

However, sometimes the child’s refusal to wear glasses is due to an incorrect prescription or uncomfortable frames. Recheck his prescription and make sure that his glasses fit well. Bring your child into the optometrist for a consultation.

Many frames for children come with an integrated elastic band to help keep the glasses sitting comfortably on your child’s head. Be sure to inquire about this option.

Our 3-year-old daughter was diagnosed with strabismus and amblyopia. What are the chances of a cure at her age?

The odds of a successful cure are very good if she receives proper treatment. Medical research has demonstrated that the visual system can develop stronger visual acuity at up to 8-10 years of age.

Constant strabismus often requires surgery to straighten and align the eyes, and then therapy for amblyopia (“lazy-eye”) follows in order to enhance the success of the surgery. Eye patching and vision therapy are generally implemented as a means to help both eyes team and function together. For more information, discuss treatment options with your Optometrist and a referral to see a pediatric ophthalmologist who specializes in strabismus surgery may be required.

My 10 year old daughter has been wearing eyeglasses since age 2 in order to correct farsightedness. We think her depth perception is weak. Can she be tested for this, and if there’s a problem – can it be treated?

A very simple, straightforward stereopsis test will determine if your daughter has normal depth perception. During this testing, she will put on 3-D glasses and be asked to look at a chart across the room or at a number of objects in a specialized book. If reduced stereopsis is diagnosed, she will be advised to undergo vision therapy.

Our 11-year-old son was first diagnosed with nearsightedness when he was 7 years of age. Since then, his vision has deteriorated every year. Is there any way to prevent this?

Recent studies suggest that myopia progression may be slowed or stopped in childhood. At present, there are four different types of treatment for myopia control: multifocal contact lenses, atropine eye drops, ortho-k and multifocal eyeglasses.

A professional eye doctor will conduct a comprehensive eye exam in order to determine your child’s candidacy for any of these potential treatments.

My son’s teacher thinks he has “convergence insufficiency” at 7 years of age. What is this, and what can be done about it?

When reading or engaging in other close-up tasks, our eyes need to be converged (pointed inwards) slightly. Convergence insufficiency (CI) refers to the eyes’ inability to do this easily and comfortably. Headaches, eyestrain, blurred vision, fatigue and reading problems may result.

Convergence insufficiency is a common learning-related vision problem that’s typically treated well with vision therapy and/or reading glasses.

According to the visual screening done at school, my 5 year old son has 20/40 vision in both eyes. Is this a reason for concern, or could his visual condition improve with time?

In general, 5 year old children can see 20/25 or better. Yet there are a number of possible reasons for his vision diagnosis. Visual acuity testing is highly subjective. Your child is asked to read small letters on a wall chart, and many kids simply give up – even though are able to read some of the smaller lines. Other children may claim that they can’t see the letters because they dream of wearing eyeglasses!

Keep in mind that vision screenings conducted at school are often compromised by many distractions. It’s wise to schedule a comprehensive eye exam with an eye doctor in order to confirm his prescription and rule out any eye health problems that may be affecting his visual acuity.

My daughter has severe farsightedness in one eye and was diagnosed with refractive amblyopia. She just received her glasses, and one lens is much thicker than the other. She is complaining that the glasses make her dizzy and she won’t wear them. Can anything be done about this?

When one eye needs much stronger vision correction than the other eye, contact lenses are sometimes preferable to eyeglasses. Unequal lens powers in glasses can cause an unequal magnification effect, so the eyes transmit images to the brain that are not the same size. The brain may not be able to blend these two images into a single one, which often causes dizziness and nausea. In addition, your child’s eyeglasses may be unattractive and causing her to not give them a real chance to adapt.

Contact lenses obviously grant a nicer appearance, and they don’t cause as many problematic variations in image magnification. Even young children can handle wearing contact lenses, and one-day disposables or continuous wear lenses (worn consistently for up to 30 days) are possible options.

With amblyopia, one eye doesn’t see as clearly as the other eye, even with the best contact lenses in position. Vision in her weak eye may not be drastically improved with contacts, and vision therapy will probably be needed too. Best to discuss all her options with her Eye Doctor.

Your Infant’s Visual Development

Your baby’s visual system is not fully developed at birth and continues to develop gradually over the first days and months of life. In fact, from your baby’s perspective at birth, the world is black and white, blurry and rather flat. As the days and months go on, they begin to focus, move their eyes and start to see the world around them. While each child will grow and develop on his or her own schedule, knowing an infant’s vision milestones will help you ensure that your infant is on track to achieving good vision and eye health and start treatment early if there is a problem.

Birth – 3 months

Because newborn babies’ eyes and visual system are underdeveloped, they can not focus their eyes on close objects or perceive depth or color. Babies need to learn to move, focus and coordinate eye movements to team the eyes (have them move together as a team). The brain also needs to learn how to process the visual information from the eyes to understand and interact with the world. In fact, until about 3 months, the optimal distance a baby can focus on is about 8 – 10 inches from their face, about the distance their parents face will be during feeding.

Your baby will start to be able to perceive color within the first 2-3 weeks, however it will take a few months to learn how to focus and use the eyes, to track objects, differentiate between two objects and shift from one object to the other. During this time you may notice that the eyes appear crossed and do not work together or team. This is quite common at the early stages of development, however if one eye appears to be constantly turned in or out, seek a doctor’s evaluation.

At around three months, as hand-eye coordination begins to develop, a baby should be able to follow a moving target with their eyes and reach for objects.

4-6 Months

By 6 months, your baby will begin to move his eyes with more speed and accuracy, seeing at farther distances and focusing well. Color vision should be fully developed and the eyes should be able to work as a team and follow moving objects with relative ease. Hand-eye coordination and depth perception should be greatly improved as your baby will begin to understand the 3-dimensional world around them.

At six months, you should take your baby for his or her first comprehensive eye exam to ensure that the eyes are developing on track and there are no signs of congenital or infant eye disease.

7-12 Months

At this stage of development babies will be coordinating vision and body movements by crawling, grasping, standing and exploring the surrounding world. They should be able judge distances accurately, throw a ball toward a target and pick up a small object with their fingers. Delays in motor development can sometimes indicate a vision problem.

The First Eye Exam

While at 6 months, your baby will not be able to read an eye chart, eye doctors can perform an infant eye exam through non-verbal testing to assess visual acuity (for nearsightedness, farsightedness or astigmatism), eye teaming abilities and eye alignment. The eye doctor will also be able to see inside the eye for any signs of disease or problems that could affect eye or vision health.

InfantSEE®

InfantSEE® is a public health program in which participating optometrists provide a free comprehensive infant eye exam to babies between 6 and 12 months of age. The program was initiated to provide accessible eye and vision care for infants to ensure they have the best chances for normal development and quality of life.

If your child has any unusual symptoms such as excessive tearing, constant eye misalignment, red or crusty eyes or extreme light sensitivity consult an eye doctor as soon as possible.

Are Contact Lenses a Good Choice for Kids?

Many children who wear glasses want to switch to contact lenses, especially older children who are concerned with their appearance. So, how do you know if and when contact lenses might be an option for your child?

Contact lenses may not only improve a child’s confidence in their appearance but they can also be very convenient for active children who play sports or those who tend to lose or break their glasses.

Yet before you jump to schedule an appointment with the optometrist, it’s important to know that while contact lenses are a great solution for many, they are still medical devices that require care and responsibility. Carelessness with contact lenses can lead to infections, irritation, scratched corneas, pain, and sometimes even vision loss. So if you want to know if contact lenses are a good choice for your child, read below and think about whether your child is mature and responsible enough to take proper care of his or her eyes.

At What Age Can a Child Start Wearing Contact Lenses?

The recommended age for kids to start considering contact lenses varies however it is generally accepted that sometime between 11 and 14 is ideal. Some doctors will recommend them even for children as young as 8 years old who have shown that they are responsible enough to use them. Contact lens use requires good hygiene and cleanliness so if your child shows those traits, she may be ready. Additionally, if he is highly motivated to wear contacts and if he has the support of his parents, this will help in ensuring that the daily regimen is a success.

What is the Process of Getting Fitted for Contacts?

The first step is to schedule an appointment for a contact lens exam with your optometrist. The eye doctor will perform a vision exam and go over the different options for contact lenses, depending on the prescription, the health of the eye and lifestyle and personal preferences. Contact lenses are designed with a number of options including the lens materials used (soft or rigid gas permeable), the replacement schedule (if disposable, how often you replace the pair – daily, weekly, biweekly or monthly) and the wear schedule (daily or extended overnight wear). Often doctors will recommend daily lenses for children because they are thrown away after each use so there is less care involved, less buildup and less risk for infection.

Then the doctor will give a training on inserting and removing the lenses as well as instructions for proper care. Your child will probably be given a schedule for wearing the lenses for the first week or so in order to allow their eyes to adapt. During this time you may have to be in touch with your eye doctor to assess the comfort and fit of the lenses and you may have to try out a couple of options in order to find the best fit.

Purchasing Contact Lenses

As a medical device, contact lenses require a prescription and should only be purchased from a licensed distributor such as an eye doctor. Unauthorized or unmonitored contact lenses can cause severe damage to your eyes that could result in blindness. This is true also for cosmetic lenses such as colored lenses or costume lenses. Any time you are putting a lens in your eye, you must have a proper prescription.

Following are some basic contact lens safety tips. If your child is responsible enough to follow these guidelines, he or she may be ready for contact lens use:

  1. Always follow the wearing schedule prescribed by your doctor.
  2. Always wash your hands with soap before applying or removing contact lenses.
  3. Never use any substance other than contact lens rinse or solution to clean contacts (even tap water is a no-no).
  4. Never reuse contact lens solution
  5. Follow the eye doctor’s advice about Don’t swimming or showering in your lenses
  6. Always remove your lenses if they are bothering you or causing irritation.
  7. Never sleep in your lenses unless they are extended wear.
  8. Never use any contact lenses that were not acquired with a prescription at an authorized source. Never purchase cosmetic lenses without a prescription!

Contact lens use is also an ongoing process. As a child grows, the lens fit may change as well, so it is important to have annual contact lens assessments. Plus, new technology is always being developed to improve comfort and quality of contact lenses.

Contact lenses are a wonderful invention but they must be used with proper care. Before you let your child take the plunge into contact lens use, make sure you review the dangers and safety guidelines.

Controlling Nearsightedness in Children

Childhood myopia or nearsightedness is a common condition that causes blurred distance vision and can usually be easily corrected with either glasses or contact lenses. Unfortunately, simply getting a pair of glasses doesn’t always solve the problem, because often myopia is progressive which means that every year the vision gets worse. This usually continues until sometime around the child’s 20th birthday when his eyes stop growing and eyesight levels off.

It can be worrisome and quite disconcerting for both the parent and the child when each visit to the eye doctor results in a higher prescription. There could be a number of factors involved in progressive myopia, involving hereditary factors as well as possible environmental or behavioral factor such as frequent close-up tasks such as reading or using an electronic device. In fact, studies show that children that spend more time outdoors playing have a lower incidence of myopia. Much research is currently being done into treatments for slowing or stopping myopia progression in children. Here are some of the treatment options currently being offered:

Orthokeratology (Ortho-k)

Ortho-k is a process that uses specially designed rigid gas permeable contact lenses worn at night to gently reshape the cornea, eventually allowing clear vision during the day. The lenses are worn every night or every couple of nights depending on the results of the individual. Ideal for mild to moderate myopia, ortho-k usually takes a few weeks to show results, during which time the patient may need to temporarily continue wearing glasses or contact lenses.

Studies show that the use of ortho-k can permanently reduce the progressive lengthening of the cornea which is responsible for nearsightedness and can therefore slow or stop the childhood progression of the condition. Therefore, in addition to being used for myopia correction, it is now also being offered as a therapeutic treatment to halt myopia progression in children.

Multifocal Eyeglasses or Contact Lenses

Bifocal or multifocal soft contact lenses or glasses have been shown in some studies to slow myopia progression. This therapy is based on the idea that the eye is strained from accommodating to see close up and that by providing multiple focusing powers, this allows the eye to relax when doing near work, which reduces the progression of the refractive error. This treatment has been shown to delay or slow the advancement of myopia in some children.

Atropine Drops

Treatment with atropine drops is another therapy that is used to relax the eye from “focusing fatigue” which may be a culprit in myopia progression. Research is still being done but some studies show that daily use of low doses of atropine drops do slow the progression of myopia. Atropine drops dilate the pupil which temporarily prevents the eye from being able to focus, thereby allowing this mechanism to relax. Research is still being done to determine dosages, but the results are promising.

If your child has progressive myopia, seek out a pediatric optometrist who is knowledgeable about the options available. Finding the right treatment could give your child the gift of better eyesight for life.

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