YOUR EYE HEALTH

WHY ARE EYE EXAMS IMPORTANT?

Regardless of your age or physical health, it's important to have regular eye exams.

During a complete eye exam, your eye doctor will not only determine your prescription for eyeglasses or contact lenses, but will also check your eyes for common eye diseases, assess how your eyes work together as a team and evaluate your eyes as an indicator of your overall health.

WHO SHOULD GET THEIR EYES EXAMINED?

Eye examinations are an important part of health maintenance for everyone. Adults should have their eyes tested to keep their prescriptions

Vision is closely linked to the learning process. Children who have trouble seeing or interpreting what they see will often have trouble with their schoolwork. Many times, children will not complain of vision problems simply because they don't know what "normal" vision looks like. If your child performs poorly at school or exhibits a reading or learning problem, be sure to schedule an eye examination to rule out an underlying visual cause.

WHAT IS THE EYE DOCTOR CHECKING FOR?

In addition to evaluating whether you have nearsightedness, farsightedness or astigmatism, your eye doctor will check your eyes for eye diseases and other problems that could lead to vision loss. Here are some examples of the conditions that your eye doctor will be looking for:

• Amblyopia: This occurs when the eyes are misaligned or when one eye has a much different prescription than the other. The brain will "shut off" the image from the turned or blurry eye. If left untreated, amblyopia can stunt the visual development of the affected eye, resulting in permanent vision impairment. Amblyopia is often treated by patching the stronger eye for periods of time.
• Strabismus: Strabismus is defined as crossed or turned eyes. Your eye doctor will check your eyes' alignment to be sure that they are working together. Strabismus causes problems with depth perception and can lead to amblyopia.
• Eye Diseases: Many eye diseases, such as glaucoma and diabetic eye disease, have no obvious symptoms in their early stages. Your eye doctor will check the health of your eyes inside and out for signs of early problems. In most cases, early detection and treatment of eye diseases can help reduce your risk for permanent vision loss.
• Other Diseases: Your eye doctor can detect early signs of some systemic conditions and diseases by looking at your eye's blood vessels, retina and so forth. They may be able to tell you if you are developing high blood pressure, high cholesterol or other problems.

For example, diabetes can cause small blood vessel leaks or bleeding in the eye, as well as swelling of the macula (the most sensitive part of the retina), which can lead to vision loss. It's estimated that one-third of Americans who have diabetes don't know it; your eye doctor may detect the disease before your primary care physician does, especially if you're overdue for a physical.

WHAT'S THE DIFFERENCE BETWEEN A VISION SCREENING AND A COMPLETE EYE EXAM?

Vision screenings are general eye tests that are meant to help identify people who are at risk for vision problems. Screenings include brief vision tests performed by a school nurse, pediatrician or volunteers. The eye test you take when you get your driver's license renewed is another example of a vision screening.

A vision screening can indicate that you need to get an eye exam, but it does not serve as a substitute for a comprehensive eye exam.

A comprehensive eye examination is performed by an eye doctor and will involve careful testing of all aspects of your vision. Based upon the results of your exam, your doctor will then recommend a treatment plan for your individual needs. Remember, only an eye doctor can provide a comprehensive eye exam. Most family physicians and pediatricians are not fully trained to do this, and studies have shown that they can miss important vision problems that require treatment.

Treatment plans can include eyeglasses or contact lenses, eye exercises or surgery for muscle problems, medical treatment for eye disease or simply a recommendation that you have your eyes examined again in a specified period of time.

No matter who you are, regular eye exams are important for seeing more clearly, learning more easily and preserving your vision for life.

Article by AllAboutVision.com. ©2009 Access Media Group LLC. All rights reserved. Reproduction other than for one-time personal use is strictly prohibited.

↑

PREPARING FOR AN EYE EXAM

Eyecare experts recommend you have a complete eye exam every one to three years, depending on your age, risk factors, and physical condition.

Children. Some experts estimate that approximately 5% to 10% of pre-schoolers and 25% of school-aged children have vision problems. According to the American Optometric Association (AOA), all children should have their eyes examined at 6 months of age, at age 3 and again at the start of school. Children without vision problems or risk factors for eye or vision problems should then continue to have their eyes examined at least every two years throughout school.

Children with existing vision problems or risk factors should have their eyes examined more frequently. Common risk factors for vision problems include:

• premature birth
• developmental delays
• turned or crossed eyes
• family history of eye disease
• history of eye injury
• other physical illness or disease

The AOA recommends that children who wear eyeglasses

Adults. The AOA also recommends an annual eye exam for any adult who wears eyeglasses or contacts. If you don't normally need vision correction, you still need an eye exam every two to three years up to the age of 40, depending on your rate of visual change and overall health. Doctors often recommend more frequent examinations for adults with diabetes, high blood pressure and other disorders, because many diseases can have an impact on vision and eye health.

If you are over 40, it's a good idea to have your eyes examined every one to two years to check for common age-related eye problems such as presbyopia, cataracts and macular degeneration.

Because the risk of eye disease continues to increase with advancing age, everyone over the age of 60 should be examined annually.

WHO SHOULD I SEE FOR MY EYE EXAM?

There are two kinds of eye doctors - ophthalmologists and optometrists. Who you should see depends on your needs and preferences.

Ophthalmologists are medical doctors (MDs or DOs) who specialize in eyecare. In addition to prescribing eyeglasses and contacts, ophthalmologists are licensed to perform eye surgery and treat medical conditions of the eye. Ophthalmologists generally undergo eight or more years of training after college.

Optometrists (ODs) are eye doctors who can prescribe glasses and contacts and treat medical conditions of the eye with eye drops and other medicines. They are not licensed to perform eye surgery. Optometrists generally receive four or more years of training after college.

HOW MUCH DOES AN EYE EXAM COST?

Eye exams are available in many settings, from discount optical stores to surgical offices, so the fees can vary widely. Additionally, fees can vary depending upon whether the exam is performed by an optometrist or an ophthalmologist, and the type of services that are included in the exam.

Generally speaking, contact lens exams cost more than regular eye exams. Likewise, an additional or higher fee may be charged for specialized services such as laser vision correction evaluations.

Many insurance plans cover at least a portion of eye exam services. Check to see what your benefits are and which eye doctors in your area participate in your plan before you make an appointment. Then be sure to give your doctor's office your insurance information to verify coverage.

What information should I take with me to my eye exam? It's important to have some basic information ready at the time of your eye examination. Bring the following items to your exam:

• All eyeglasses and contact lenses you routinely use, including reading glasses.
• A list of any medications you take (including dosages).
• A list of any nutritional supplements you take (including dosages).
• A list of questions to ask the doctor, especially if you are interested in contact lenses or laser vision correction surgery.

Finally, also bring your medical or vision insurance card if you will be using it for a portion of your fees.

Article by AllAboutVision.com. ©2009 Access Media Group LLC. All rights reserved. Reproduction other than for one-time personal use is strictly prohibited.

↑

YOUR COMPREHENSIVE EYE EXAM

A comprehensive eye exam includes a number of tests and procedures to examine and evaluate the health of your eyes and the quality of your vision. These tests range from simple ones, like having you read an eye chart, to complex tests, such as using a high-powered lens to examine the health of the tissues inside of your eyes.

Here are some tests you are likely to encounter during a routine comprehensive eye exam:

RETINOSCOPY

This test helps your doctor get a good approximation of your eyeglasses prescription. For retinoscopy, the room lights are dimmed and an instrument containing wheels of lenses (called a phoropter) is positioned in front of your eyes. You will be asked to look at an object across the room (usually the big "E" on the wall chart or screen) while your doctor shines a light from a hand-held instrument into your eyes from arm's length and flips different lenses in front of your eyes.

Based on the way the light reflects from your eye during this procedure, your doctor can get a very good idea of what your eyeglasses prescription should be. This test is especially useful for children and non-verbal patients who are unable to accurately answer the doctor's questions.

With the widespread use of automated instruments to help determine eyeglass prescriptions today, many doctors forgo performing retinoscopy during comprehensive eye exams. However, this test can provide valuable information about the clarity of the internal lens and other media inside the eye. So doctors who no longer perform this test routinely may still use it when examining someone who may be at risk of cataracts or other internal eye problems.

REFRACTION

This is the test your doctor uses to determine your exact eyeglasses prescription. During a refraction, the doctor puts the phoropter in front of your eyes and shows you a series of lens choices. He or she will then ask you which of the two lenses in each choice ("1 or 2," "A or B," for example) make the letters on the wall chart look clearer.

Based on your answers, your doctor will determine the amount of nearsightedness, farsightedness and/or astigmatism you have, and the eyeglass lenses required to correct these vision problems (which are called refractive errors).

AUTOREFRACTORS AND ABERROMETERS

Your eye doctor also may use an autorefractor or aberrometer to help determine your glasses prescription. With both devices, a chin rest stabilizes your head while you typically look at a pinpoint of light or other image.

An autorefractor evaluates the way an image is focused on the retina, where vision processing takes place, without the need for you to say anything. This makes autorefractors especially useful when examining young children or people who may have difficulty with a regular ("subjective") refraction. Automated refractions and subjective refractions are often used together during a comprehensive exam to determine your eyeglasses prescription.

An aberrometer uses advanced wavefront technology to detect even obscure vision errors based on the way light travels through your eye.

COVER TEST

While there are many ways for your eye doctor to check how your eyes work together, the cover test is the simplest and most common.

During a cover test, the eye doctor will have you focus on a small object at distance and will then cover each of your eyes alternately while you stare at the target. As they do this, eye doctors observe how much each eye has to move when uncovered to pick up the fixation target. The test is then repeated as you focus on a near object.

Cover tests can detect even very subtle misalignments that can interfere with your eyes working together properly (binocular vision) and cause amblyopia or "lazy eye."

SLIT-LAMP EXAMINATION

The slit lamp is an instrument that the eye doctor uses to examine the health of your eyes. Also called a biomicroscope, the slit lamp gives your doctor a highly magnified view of the structures of the eye, including the lens behind the pupil, in order to thoroughly evaluate them for signs of infection or disease.

The slit lamp is basically an illuminated binocular microscope that's mounted on a table and includes a chin rest and head band to position the patient's head properly. With the help of hand-held lenses, your doctor can also use the slit lamp to examine the retina (the light-sensitive inner lining of the back of the eye.)

TONOMETRY (GLAUCOMA TESTING)

Tonometry is the name for a variety of tests that can be performed to determine the pressure inside the eye. Elevated internal eye pressure can cause glaucoma, which is vision loss due to damage to the sensitive optic nerve in the back of the eye.

The most common method used for tonometry is the "air puff" test - where an automated instrument discharges a small burst of air to the surface of your eye. Based on your eye's resistance to the puff of air, the machine calculates the pressure inside your eye - called your intraocular pressure (IOP).

Though the test itself can be startling, nothing but air touches your eye during this measurement and there's no risk of eye injury from the air puff test.

Another popular way to measure eye pressure is with an instrument called an applanation tonometer, which is usually attached to a slit lamp. For this test, a yellow eye drop is placed on your eyes. Your eyes will feel slightly heavy when the drops start working. This is not a dilating drop - it is simply a numbing agent combined with a yellow dye. Then the doctor will have you stare straight ahead in the slit lamp while he or she gently rests the bright-blue glowing probe of the tonometer on the front of each eye and manually measures the intraocular pressure.

Like the air puff test, applanation tonometry is painless and takes just a few seconds.

Since glaucoma is often the result of an increase of pressure inside the eye, these are important tests for ensuring the long-term health of your eyes.

PUPIL DILATION

Your comprehensive exam may include the use of dilating drops. These medicated eye drops enlargen your pupil so your doctor can get a better view of the internal structures in the back of the eye. Dilating drops usually take about 20 minutes to start working. When your pupils are dilated, you will be sensitive to light, because more light is getting into your eye. You may also notice difficulty reading or focusing on close objects. These effects can last for up to several hours, depending on the strength of the drops used.

If you don't have sunglasses to wear after the exam, disposable sunglasses will be provided to help you drive home. Dilation is very important for people with risk factors for eye disease, because it allows for a more thorough evaluation of the health of the inside of your eyes.

SUMMARY

These are the most common tests performed during a standard comprehensive eye exam. Depending on your particular needs, your doctor may perform additional tests or schedule them to be performed at a later date.

Article by AllAboutVision.com. ©2009 Access Media Group LLC. All rights reserved. Reproduction other than for one-time personal use is strictly prohibited.

↑

EYE EXAMS FOR CONTACT LENSES

For many people, contact lenses provide greater convenience and more satisfying vision correction than eyeglasses. Here's what's involved in a typical contact lens exam and fitting:

A COMPREHENSIVE EYE EXAM COMES FIRST

Before being fit with contact lenses, a comprehensive eye exam is performed. In this exam, your eye doctor determines your prescription for corrective lenses (just a glasses prescription at this point) and checks for any eye health problems or other issues that may interfere with successful contact lens wear.

If all looks good during your eye exam, the next step is a contact lens consultation and fitting.

WHAT TO EXPECT DURING A CONTACT LENS FITTING

The first step in a contact lens fitting is a consideration of your lifestyle and your preferences regarding contact lenses, such as whether you might want to change your eye color with color contact lenses or if you're interested in options such as daily disposables or overnight wear. Although most people choose soft contact lenses, the advantages and disadvantages of rigid gas permeable (GP) lenses will likely be discussed as well.

If you are over age 40 and need bifocals, your eye doctor or contact lens specialist will discuss ways to deal with this need, including multifocal contact lenses and monovision (a prescribing technique where one contact lens corrects your distance vision and the other lens corrects your near vision).

CONTACT LENS MEASUREMENTS

Just as one shoe size doesn't fit all feet, one contact lens size doesn't fit all eyes. If the curvature of a contact lens is too flat or too steep for your eye's shape, you may experience discomfort or even damage to your eye. Measurements that will be taken to determine the best contact lens size and design for your eyes include:

Corneal curvature: An instrument called a keratometer is used to measure the curvature of your eye's clear front surface (cornea). This measurement helps your doctor select the best curve and diameter for your contact lenses.

If your eye's surface is found to be somewhat irregular because of astigmatism, you may require a special lens design of lens known as a "toric" contact lens. At one time, only gas permeable contact lenses could correct for astigmatism. But there are now many brands of soft toric lenses, which are available in disposable, multifocal, extended wear and colored versions. In some cases, a detailed mapping of the surface of your cornea (called corneal topography) may be done. Corneal topography provides extremely precise details about surface characteristics of the cornea and creates a surface "map" of your eye, with different contours represented by varying colors.

Pupil and iris size: The size of your pupil and iris (the colored part of your eye) can play an important role in determining the best contact lens design, especially if you are interested in GP contact lenses. These measurements may be taken with a lighted instrument called a biomicroscope (also called a slit lamp) or simply with a hand-held ruler or template card. Tear film evaluation: To be successful wearing contact lenses, you must have an adequate tear film to keep the lenses and your cornea sufficiently moist and hydrated. This test may be performed with a liquid dye placed on your eye so your tears can be seen with a slit lamp, or with a small paper strip placed under your lower lid to see how well your tears moisten the paper. If you have dry eyes, contact lenses may not be right for you. Also, the amount of tears you produce may determine which contact lens material will work best for you.

TRIAL LENSES

In many cases, trial lenses will be used to verify the contact lens selection. Lenses will be placed on your eye and your doctor will use the slit lamp to evaluate the position and movement of the lenses as you blink and look in different directions. You will also be asked how the lenses feel.

You'll typically need to wear these trial lenses at least 15 minutes so that any initial excess tearing of the eye stops and your tear film stabilizes. If all looks good, you will be given instructions on how to care for your lenses and how long to wear them. You will also receive training on how to handle, apply and remove the lenses.

FOLLOW-UP VISITS CONFIRM THE FIT AND SAFETY

Your contact lens fitting will involve a number of follow-up visits so your doctor can confirm the lenses are fitting your eyes properly and that your eyes are able to tolerate contact lens wear. A dye (like the one used to evaluate your tear film) may be used to see if the lenses are causing damage to your cornea or making your eyes become too dry.

Often, your doctor will be able to see warning signs before you are aware a problem with your contact lens wear is developing. If such warning signs are evident in your follow-up visits, a number of things may be recommended, including trying a different lens or lens material, using a different lens care method, or adjusting your contact lens wearing time. In occasional cases, it may be necessary to discontinue contact lens wear altogether.

YOUR CONTACT LENS PRESCRIPTION

After finding a contact lens that fits properly, is comfortable for you, and provides good vision, your doctor will then be able to write a contact lens prescription for you. This prescription will designate the contact lens power, the curvature of the lens (called the base curve), the lens diameter, and the lens name and manufacturer. In the case of GP contact lenses, additional specifications may also be included.

ROUTINE CONTACT LENS EXAMS

Regardless of how often or how long you wear your contact lenses, your eyes should be examined at least once a year to make sure your eyes are continuing to tolerate contact lens wear and show no signs of ill effects from the lenses.

Article by AllAboutVision.com. ©2009 Access Media Group LLC. All rights reserved. Reproduction other than for one-time personal use is strictly prohibited.

↑

EYE EXAMS FOR CHILDREN

As a parent, you may wonder whether your pre-schooler has a vision problem or when a first eye exam should be scheduled.

Eye exams for children are extremely important. Experts say 5 to 10% of pre-schoolers and 25% of school-aged children have vision problems. Early identification of a child's vision problem is crucial because, if left untreated, some childhood vision problems can cause permanent vision loss.

WHEN SHOULD KIDS HAVE THEIR EYES EXAMINED?

According to the American Optometric Association (AOA), 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.

For school-aged children, the AOA recommends an eye exam every two years if no vision correction is required. Children who need eyeglasses or contact lenses should be examined annually or according to their eye doctor's recommendations.

Early eye exams also are important because children need the following basic visual skills for learning:

• Near vision
• Distance vision
• Eye teaming (binocularity) skills
• Eye movement skills
• Focusing skills
• Peripheral awareness
• Eye/hand coordination

Because of the importance of good vision for learning, some states require an eye exam for all children entering school for the first time.

SCHEDULING YOUR CHILD'S EYE EXAM

Your family doctor or pediatrician likely will be the first medical professional to examine your child's eyes. If eye problems are suspected during routine physical examinations, a referral might be made to an ophthalmologist or optometrist for further evaluation. Eye doctors have specific equipment and training to help them detect and diagnose potential vision problems.

When scheduling an eye exam, choose a time when your child is usually alert and happy. Specifics of how eye exams are conducted depend on your child's age, but an exam generally will involve a case history, vision testing, determination of whether eyeglasses are needed, testing of eye alignment, an eye health examination and a consultation with you regarding the findings.

After you've made the appointment, you may be sent a case history form by mail, or you may be given one when you check in at the doctor's office. The case history form will ask about your child's birth history (also called perinatal history), such as birth weight and whether or not the child was full-term. Your eye doctor also may ask whether complications occurred during the pregnancy or delivery. The form will also inquire about your child's medical history, including current medications and past or present allergies.

Be sure to tell your eye doctor if your child has a history of prematurity, has delayed motor development, engages in frequent eye rubbing, blinks excessively, fails to maintain eye contact, cannot seem to maintain a gaze (fixation) while looking at objects, has poor eye tracking skills or has failed a pediatrician or pre-school vision screening.

Your eye doctor will also want to know about previous ocular diagnoses and treatments involving your child, such as possible surgeries and glasses or contact lens wear. Be sure you inform your eye doctor if there is a family history of eye problems requiring vision correction, such as nearsightedness or farsightedness, misaligned eyes (strabismus) or amblyopia ("lazy eye").

EYE TESTING FOR INFANTS

It takes some time for a baby's vision skills to develop. To assess whether your infant's eyes are developing normally, your eye doctor may use one or more of the following tests:

• Tests of pupil responses evaluate whether the eye's pupil opens and closes properly in the presence or absence of light.
• "Fixate and follow" testing determines whether your baby can fixate on an object (such as a light) and follow it as it moves.
• Infants should be able to perform this task quite well by the time they are 3 months old.
• Preferential looking involves using cards that are blank on one side with stripes on the other side to attract the gaze of an infant to the stripes. In this way, vision capabilities can be assessed.

EYE TESTING FOR PRE-SCHOOL CHILDREN

Pre-school children can have their eyes thoroughly tested even if they don't yet know the alphabet or are too young or too shy to answer the doctor's questions. Some common eye tests used specifically for young children include:

• LEA Symbols for young children are similar to regular eye tests using charts with letters, except that special symbols in these tests include an apple, house, square and circle.
• Retinoscopy is a test that involves shining a light into the eye to observing how it reflects from the retina (the light-sensitive inner lining of the back of the eye). This test helps eye doctors determine the child's eyeglass prescription.
• Random Dot Stereopsis uses dot patterns to determine how well the two eyes work as a team.

EYE AND VISION PROBLEMS THAT AFFECT CHILDREN

Besides looking for nearsightedness, farsightedness and astigmatism (refractive errors), your eye doctor will be examining your child's eyes for signs of these eye and vision problems commonly found in young children:

• Amblyopia. Also commonly called "lazy eye," this is decreased vision in one or both eyes despite the absence of any eye health problem or damage. Common causes of amblyopia include strabismus (see below) and a significant difference in the refractive errors of the two eyes. Treatment of amblyopia may include patching the dominant eye to strengthen the weaker eye.
• Strabismus. This is misalignment of the eyes, often caused by a congenital defect in the positioning or strength of muscles that are attached to the eye and which control eye positioning and movement. Left untreated, strabismus can cause amblyopia in the misaligned eye. Depending on its cause and severity, surgery may be required to treat strabismus.
• Convergence insufficiency. This is the inability to keep the eye comfortably aligned for reading and other near tasks. Convergence insufficiency can often be successfully treated with vision therapy, a specific program of eye exercises. Focusing problems. Children with focusing problems (also called accommodation problems) may have trouble changing focus from distance to near and back again (accommodative infacility) or have problems maintaining adequate focus for reading (accommodative insufficiency). These problems often can be successfully treated with vision therapy.
• Eye teaming problems. Many eye teaming (binocularity) problems are more subtle than strabismus. Deficiencies in eye teaming skills can cause problems with depth perception and coordination.

VISION AND LEARNING

Experts say that 80% of what your child learns in school is presented visually. Undetected vision problems can put them at a significant disadvantage. Be sure to schedule a complete eye exam for your child prior to the start of school.

↑

VISION THERAPY FOR CHILDREN

Many children have vision problems other than simple refractive errors such as nearsightedness, farsightedness and astigmatism. These "other" vision problems include amblyopia ("lazy eye"), eye alignment or eye teaming problems, focusing problems, and visual perceptual disorders. Left untreated, these non-refractive vision problems can cause eyestrain, fatigue, headaches, and learning problems.

WHAT IS VISION THERAPY?

Vision therapy (also called orthoptics or vision training) is an individualized program of eye exercises and other methods to treat non-refractive vision problems. The therapy is usually performed in an optometrist's office, but most treatment plans also include daily visual tasks and eye exercises to be performed at home.

Optometrists who specialize in vision therapy and the treatment of learning-related vision problems are sometimes called behavioral optometrists or developmental optometrists.

CAN VISION THERAPY ELIMINATE THE NEED FOR GLASSES?

Vision therapy is NOT the same as self-help programs that claim to reduce refractive errors and the need for glasses. There is no scientific evidence that these "throw away your glasses" programs work, and most eye care specialists agree they are a hoax.

In contrast, vision therapy is approved by the American Optometric Association (AOA) for the treatment of non-refractive vision problems, and there are many studies that demonstrate its effectiveness.

The degree of success achieved with vision therapy, however, depends on a number of factors, including the type and severity of the vision problem, the patient's age and motivation, and whether the patient performs all eye exercises and visual tasks as directed. Not every vision problem can be resolved with vision therapy.

VISION THERAPY IS CUSTOMIZED AND SPECIFIC

The activities and eye exercises prescribed as part of a vision therapy program are tailored to the specific vision problem (or problems) a child has. For example, if a child has amblyopia, the therapy usually includes patching the strong eye, coupled with visual tasks or other stimulation techniques to develop better visual acuity in the weak eye. Once visual acuity is improved in the amblyopic eye, the treatment plan may then include eye teaming exercises to foster the development of clear, comfortable binocular vision to improve depth perception and reading comfort.

VISION THERAPY AND LEARNING DISABILITIES

Vision therapy does not correct learning disabilities. However, children with learning disabilities often have vision problems as well. Vision therapy can correct underlying vision problems that may be contributing to a child's learning problems.

Be sure to tell us if your child has been diagnosed as having a learning disability. If we find vision problems that may be contributing to learning problems, we can communicate with their teachers and other specialists to explain our findings. Often, vision therapy can be a helpful component of a multidisciplinary approach to remediating learning problems.

SCHEDULE A COMPREHENSIVE EYE EXAM

If you suspect your child has a vision problem that may be affecting their performance in school, the first step is to schedule a comprehensive eye exam so we can determine if such a problem exists. If learning-related vision problems are discovered, we can then discuss with you whether a program of vision therapy would be helpful.

If we don't provide the type of vision therapy your child needs, we will refer you to an optometrist who specializes in developmental vision and vision therapy.

Article by AllAboutVision.com. ©2009 Access Media Group LLC. All rights reserved. Reproduction other than for one-time personal use is strictly prohibited.

↑

CHILDREN'S VISION - FAQ'S

Q: HOW OFTEN SHOULD CHILDREN HAVE THEIR EYES EXAMINED?

A:
According to the American Optometric Association (AOA), infants should have their first comprehensive eye exam at 6 months of age. After that, kids should have routine eye exams at age 3 and again at age 5 or 6 (just before they enter kindergarten or the first grade).

For school-aged children, the AOA recommends an eye exam every two years if no vision correction is needed. Children who need eyeglasses or contact lenses should be examined annually.

Q: MY 5-YEAR-OLD DAUGHTER JUST HAD A VISION SCREENING AT SCHOOL AND SHE PASSED. DOES SHE STILL NEED AN EYE EXAM?

A:
Yes. School vision screenings are designed to detect gross vision problems. But kids can pass a screening at school and still have vision problems that can affect their learning and school performance. A comprehensive eye exam by an optometrist can detect vision problems a school screening may miss. Also, a comprehensive eye exam includes an evaluation of your child's eye health, which is not part of a school vision screening.

Q: WHAT IS VISION THERAPY?

A:
Vision therapy (also called vision training) is an individualized program of eye exercises and other methods to correct vision problems other than nearsightedness, farsightedness and astigmatism. Problems treated with vision therapy include amblyopia ('lazy eye"), eye movement and alignment problems, focusing problems, and certain visual-perceptual disorders. Vision therapy is usually performed in an optometrist's office, but most treatment plans also include daily vision exercises to be performed at home.

Q: CAN VISION THERAPY CURE LEARNING DISABILITIES?

A:
No, vision therapy cannot correct learning disabilities. However, children with learning disabilities often have vision problems as well. Vision therapy can correct underlying vision problems that may be contributing to a child's learning problems.

Q: OUR ACTIVE 1-YEAR-OLD BOY NEEDS GLASSES TO CORRECT HIS FARSIGHTEDNESS AND THE TENDENCY FOR HIS EYES TO CROSS. BUT HE PULLS THEM OFF THE SECOND THEY GO ON. WE'VE TRIED AN ELASTIC BAND, HOLDING HIS ARMS, TAPE... HE JUST STRUGGLES AND CRIES. HOW DO WE GET HIM TO WEAR HIS GLASSES?

A:
In most cases, it just takes awhile for a toddler to get used to the sensation of wearing glasses. So persistence is the key. Also, you may want to put his glasses on as soon as he wakes up - this will usually help him adapt to the glasses easier.

But it's also a good idea to recheck the prescription and make sure his glasses were made correctly and are fitting properly. Today, there are many styles of frames for young children, including some that come with an integrated elastic band to help keep them comfortably on the child's head. Bring your son and the eyewear to our office. Even if you didn't purchase the glasses from us, we will be happy to give you our opinion about why your son is having a tough time wearing them and what you can do about it.

Q: OUR 3-YEAR-OLD DAUGHTER WAS JUST DIAGNOSED WITH STRABISMUS AND AMBLYOPIA. WHAT ARE THE PERCENTAGES OF A CURE AT THIS AGE?

A:
With proper treatment, the odds are very good. Many researchers believe the visual system can still develop better visual acuity up to about age 8 to 10. If your daughter's eye turn (strabismus) is constant, it's likely surgery will be necessary to straighten her eyes in order for her therapy for amblyopia (or "lazy eye") to be successful. Strabismus surgery may be needed even if her eyes alternate in their misalignment. See a pediatric ophthalmologist who specializes in strabismus surgery for more information.

Q: MY DAUGHTER (AGE 10) IS FARSIGHTED AND HAS BEEN WEARING GLASSES SINCE AGE TWO. WE THINK SHE MAY HAVE PROBLEMS WITH DEPTH PERCEPTION. HOW CAN SHE BE TESTED FOR THIS, AND IF THERE IS A PROBLEM, CAN IT BE TREATED?

A:
We can perform a very simple stereopsis test to determine if your daughter has normal depth perception. In this test, she wears "3-D glasses" and looks at a number of objects in a special book or on a chart across the room. If she has reduced stereopsis, a program of vision therapy may help improve her depth perception.

Q: WE HAVE AN 11-YEAR-OLD SON WHO FIRST BECAME NEARSIGHTED WHEN HE WAS 7. EVERY YEAR, HIS EYES GET WORSE. IS THERE ANYTHING THAT CAN BE DONE TO PREVENT THIS?

A:
Rigid gas permeable (GP) contact lenses may help. Research shows that, in many cases, fitting myopic youngsters with GP lenses may slow the progression of their nearsightedness. There's also a special fitting technique with GP contacts called orthokeratology (or "ortho-k") that can even reverse certain amounts of myopia. There is also research that suggests bifocals and/or reading glasses may slow down the progression of myopia in some children.

Q: MY 7-YEAR-OLD SON'S TEACHER THINKS HE HAS "CONVERGENCE INSUFFICIENCY." WHAT IS THIS, AND WHAT CAN I DO ABOUT IT?

A:
Convergence insufficiency (CI) is a common learning-related vision problem where a person's eyes don't stay comfortably aligned when they are reading or doing close work. For reading and other close-up tasks, our eyes need to be pointed slightly inward (converged). A person with convergence insufficiency has a tough time doing this, which leads to eyestrain, headaches, fatigue, blurred vision and reading problems. Usually, a program of vision therapy can effectively treat CI and reduce or eliminate these problems. Sometimes, special reading glasses can also help.

Q: MY SON IS 5 YEARS OLD AND HAS 20/40 VISION IN BOTH EYES. SHOULD I BE CONCERNED, OR COULD THIS IMPROVE WITH TIME?

A:
Usually, 5-year-olds can see 20/25 or better. But keep in mind that visual acuity testing is a subjective matter - during the test, your child is being asked to read smaller and smaller letters on a wall chart. Sometimes, kids give up at a certain line on the chart when they can actually read smaller letters. Other times, they may say they can't read smaller letters because they want glasses. (Yes, this happens!) Also, if your son had his vision tested at a school screening (where there can be plenty of distractions), it's a good idea to schedule a comprehensive eye exam to rule out nearsightedness, astigmatism or an eye health problem that may be keeping him from having better visual acuity.

Q: MY DAUGHTER HAS BEEN DIAGNOSED WITH REFRACTIVE AMBLYOPIA DUE TO SEVERE FARSIGHTEDNESS IN ONE EYE. SHE JUST GOT HER GLASSES AND THE LENS FOR HER BAD EYE IS MUCH THICKER THAN THE OTHER LENS. SHE COMPLAINS THAT THE GLASSES MAKE HER DIZZY AND SHE REFUSES TO WEAR THEM. CAN ANYTHING BE DONE ABOUT THIS?

A:
In situations like this, where one eye needs a much stronger correction than the other, contact lenses are a better option. With glasses, the unequal lens powers cause an unequal magnification effect, so the two eyes form images in the brain that are different in size. This can cause nausea and dizziness because the brain may not be able to blend the two separate images into a single, three-dimensional one. And, of course, the glasses will be unattractive because one lens will be much thicker than the other.

Even if your child is quite young, she can probably handle contact lens wear. Contact lenses don't cause the differences in image magnification that glasses do. Continuous wear lenses (worn day and night for up to 30 days, then discarded) or one-day disposable lenses may be good options.

Keep in mind that amblyopia is a condition where one eye doesn't see as well as the other, even with the best possible correction lens in place. Simply wearing the contacts may not improve the vision in her weak eye. Usually a program of vision therapy will also be needed.

Article by AllAboutVision.com. ©2009 Access Media Group LLC. All rights reserved. Reproduction other than for one-time personal use is strictly prohibited.

↑

YOUR INFANT'S VISUAL DEVELOPMENT

One of the greatest moments after the birth of your baby is the first time your newborn daughter or son opens their eyes and makes eye contact with you. But don't be concerned if that doesn't happen right away.

The visual system of a newborn infant takes some time to develop. In the first week of life, your newborn's vision is quite blurry, and they see only in shades of gray. It takes several months for your child's vision to fully develop.

Knowing the expected milestones of your baby's vision development during their first year of life can insure your child is seeing properly and enjoying their world to the fullest.

DURING YOUR PREGNANCY

Your child's vision development begins before birth. How you care for your own body during your pregnancy is extremely important for the development of your baby's body and mind, including their eyes and the vision centers in their brain.

Be sure to follow the instructions your obstetrician (OB/GYN doctor) gives you regarding proper nutrition and the proper amount of rest during your pregnancy. And of course, avoid smoking and consuming alcohol or drugs during pregnancy, as these toxins can cause multiple problems for your baby, including serious vision problems.

AT BIRTH

At birth, your baby sees only in shades of gray. Nerve cells in their eyes and brain that control vision aren't fully developed. Also, their eyes don't have the ability to change focus and see close object clearly. So don't be concerned if your baby doesn't seem to be focusing on objects right away, including your face. It just takes time. (Despite these limitations, studies show that within a few days after birth, infants prefer looking at an image of their mother's face over anyone else's.)

THE FIRST MONTH

Color vision develops in the first few weeks of life, so your baby is starting to see the world in full color. But visual acuity and eye teaming takes a bit longer -- so if your infant's eyes occasionally look unfocused or misaligned, don't worry.

The eyes of infants are not as sensitive to visible light as adult eyes are, but they need protection from the sun's harmful UV rays. Keep your baby's eyes shaded outdoors with a brimmed cap or some other means.

MONTHS 2 AND 3

Your baby's vision is improving and their two eyes are beginning to move better as a team. They should be following moving objects at this stage, and starting to reach for things they see. Also, infants at this stage are learning how to shift their gaze from one object to another without having to move their head.

MONTHS 4 TO 6

By 6 months of age, significant advances take place in the vision centers of the brain, allowing your infant to see more distinctly, move their eyes faster and more accurately, and have a better ability to follow moving objects with their eyes.

Visual acuity develops rapidly, improving from about 20/400 at birth to about 20/25 at six months of age. Your child's color vision should be nearly fully developed at age six months as well, enabling them to see all the colors of the rainbow with ease.

Children also develop better eye-hand coordination at 4 to 6 months of age. They're able to quickly locate and pick up objects, and accurately direct a bottle (and many other things) to their mouth.

MONTHS 7 TO 12

Your child is now mobile, crawling about and covering more distances than you might have expected. They are also better at judging distances and more skilled at locating, grasping and throwing objects, too.

During months 7 to 12, your child is developing a better awareness of their overall body and learning how to coordinate their vision with their body movements. At this time, watch them closely to keep them from harm as they explore their environment. Keep cabinets that contain cleaning supplies locked, and put a barrier in front of stairwells.

WHEN ITS TIME FOR AN EYE EXAM

If you suspect something is seriously wrong with your baby's eyes in their first few months of life (a bulging eye, a red eye, excess tearing, or a constant misalignment of the eyes, for example) take your child to a pediatric ophthalmologist or other eye doctor immediately.

For routine eye care, the American Optometric Association (AOA) recommends you schedule your baby's first eye exam when they are six months old. Though your baby can't yet read letters on a wall chart, your optometrist can perform non-verbal testing to determine visual acuity, detect excessive or unequal amounts of nearsightedness, farsightedness and astigmatism, and evaluate eye teaming and alignment. At this exam, your doctor will also check the health of your baby's eyes, looking for anything that might interfere with normal and continuing vision development.

We welcome providing eye care for even the youngest children. For more information about eye exams for kids or to schedule your child's first eye exam, please call our office.

Article by AllAboutVision.com. ©2009 Access Media Group LLC. All rights reserved. Reproduction other than for one-time personal use is strictly prohibited.

↑

ARE CONTACT LENSES A GOOD CHOICE FOR KIDS?

A common question many parents have about contact lenses and kids is: "When is my child old enough to wear contact lenses?"

Physically, your child's eyes can tolerate contact lenses at a very young age. Some babies are fitted with contact lenses due to eye conditions present at birth. And in a recent study that involved fitting nearsighted children of ages 8-11 with one-day disposable contact lenses, 90% had no trouble applying or removing the contacts without assistance from their parents.

A MATTER OF MATURITY

So the important question is whether or not your child is mature enough to insert, remove and take care of their contact lenses. How they handle other responsibilities at home will give you a clue. If your child has poor grooming habits and needs frequent reminders to perform everyday chores, they may not be ready for the responsibility of wearing and caring for contact lenses. But if they are conscientious and handle these things well, they may be excellent candidates for contact lens wear, regardless of their age.

CONTACT LENSES FOR SPORTS

Many kids are active in sports. Contact lenses offer several advantages over glasses for these activities. Contacts don't fog up, get streaked with perspiration or get knocked off like glasses can. They also provide better peripheral vision than glasses, which is important for nearly every sport. There are even contact lenses with special tints to help your child see the ball easier.

For sports, soft contact lenses are usually the best choice. They are larger and fit closer to the eye than rigid gas permeable (GP) lenses, so there's virtually no chance they will dislodge or get knocked off during competition.

CONTROLLING NEARSIGHTEDNESS

If your young son or daughter is nearsighted, rigid gas permeable (GP) contacts may be the best choice. In some cases, GP contact lenses may slow the progression of myopia in children. (Soft lenses don't offer this potential benefit.) Also, GP lenses are more durable and often provide sharper vision than soft contacts.

BUILDING SELF-ESTEEM WITH CONTACT LENSES

Contact lenses can do wonders for some children's self-esteem. Many kids don't like the way they look in glasses and become overly self-conscious about their appearance because of them. Wearing contact lenses can often elevate how they feel about themselves and improve their self confidence. Sometimes, even their school performance and participation in social activities improves after they switch to contact lenses.

GLASSES ARE STILL REQUIRED

If your child chooses to wear contact lenses, they still need an up-to-date pair of eyeglasses. Contact lenses worn on a daily basis should be removed at least an hour before bedtime to allow the eyes to "breathe." Also, there will be times when your child may want to wear their glasses instead of contact lenses. And contact lenses should be removed immediately any time they cause discomfort or eye redness.

DON'T PUSH CONTACTS ON YOUR KIDS

Motivation is often the most important factor in determining whether your son or daughter will be a successful contact lens wearer. If you wear contact lenses yourself and love them, that still doesn't mean they are the right choice for your child. Some children like wearing glasses and have no desire wear contact lenses.

We can usually tell at your child's contact lens consultation if they really want to wear contact lenses. If it appears that they would rather stay in glasses, we will certainly respect their decision - and you should, too.

Sometimes it's just a matter of timing. Often, a child may feel they don't want contacts, but a year or two later, they do. There's always time to make that decision.

WHEN YOUR CHILD IS READY TO TRY CONTACTS

When you and your child agree it's time for contacts, call our office to schedule a contact lens consultation. We welcome the opportunity to help kids of all ages enjoy wearing contact lenses.

Article by AllAboutVision.com. ©2009 Access Media Group LLC. All rights reserved. Reproduction other than for one-time personal use is strictly prohibited.

↑

LEARNING-RELATED VISION PROBLEMS

There's no question that good vision is important for learning. Experts say more than 80% of what your child is taught in school is presented to them visually.

To make sure your child has the visual skills they need for school, the first step is to make sure your child has 20/20 eyesight and that any nearsightedness, farsightedness and/or astigmatism is fully corrected with glasses or contact lenses. But there are other, less obvious learning-related vision problems you should know about as well.

GOOD VISION IS MORE THAN 20/20 VISUAL ACUITY

Your child can have "20/20" eyesight and still have vision problems that can affect their learning and classroom performance. Visual acuity (how well your child can see letters on a wall chart) is just one aspect of good vision, and it's not even the most important one. Many nearsighted kids may have trouble seeing the board in class, but they read exceptionally well and excel in school.

Other important visual skills needed for learning include:

• Eye movement skills - How smoothly and accurately your child can move their eyes across a printed page in a textbook.
• Eye focusing abilities - How well they can change focus from far to near and back again (for copying information from the board, for example).
• Eye teaming skills - How well your child's eyes work together as a synchronized team (to converge for proper eye alignment for reading, for example).
• Binocular vision skills - How well your child's eyes can blend visual images from both eyes into a single, three-dimensional image.
• Visual perceptual skills - How well your child can identify and understand what they see, judge its importance, and associate it with previous visual information stored in their brain.
• Visual-motor integration - The quality of your child's eye-hand coordination, which is important not only for sports, but also for legible handwriting and the ability to efficiently copy written information from a book or chalkboard.
• Deficiencies in any of these important visual skills can significantly affect your child's learning ability and school performance.

MANY KIDS HAVE VISION PROBLEMS THAT AFFECT LEARNING

Many kids have undetected learning-related vision problems. According to the College of Optometrists in Vision Development (COVD), one study indicates 13% of children between the ages of 9 and 13 suffer from moderate to severe convergence insufficiency (an eye teaming problem that can affect reading performance), and as many as one in four school-age children may have at least one learning-related vision problem.

SIGNS AND SYMPTOMS OF LEARNING-RELATED VISION PROBLEMS

There are many signs and symptoms of learning-related vision disorders, including:

• Blurred distance or near vision, particularly after reading or other close work
• Frequent headaches or eye strain
• Difficulty changing focus from distance to near and back
• Double vision, especially during or after reading
• Avoidance of reading
• Easily distracted when reading
• Poor reading comprehension
• Loss of place, repetition, and/or omission of words while reading
• Letter and word reversals
• Poor handwriting
• Hyperactivity or impulsiveness during class
• Poor overall school performance

If your child exhibits one or more of these signs or symptoms and is having problems in school, call us to schedule a comprehensive children's vision exam.

COMPREHENSIVE CHILDREN'S VISION EXAM

A comprehensive children's vision exam includes tests performed in a routine eye exam, plus additional tests to detect learning-related vision problems. These extra tests may include an assessment of eye focusing, eye teaming, and eye movement abilities (also called accommodation, binocular vision, and ocular motility testing). Also, depending on the type of problems your child is having, we may recommend other testing, either in our office or with a children's vision and/or vision development specialist.

VISION THERAPY

If it turns out your child has a learning-related vision problem that cannot be corrected with regular glasses or contact lenses, then special reading glasses or vision therapy may help. Vision therapy is a program of eye exercises and other activities specifically tailored for each patient to improve their vision skills.

VISION AND LEARNING DISABILITIES

A child who is struggling in school could have a learning-related vision problem, a learning disability or both. Vision therapy is a treatment for vision problems; it does not correct a learning disability. However, children with learning disabilities may also have vision problems that are contributing to their difficulties in the classroom.

After your child's comprehensive vision exam, we will advise you about whether a program of vision therapy would be helpful. If we don't provide the services we believe your child needs, we will refer you to a children's vision specialist or education/learning specialist who does.

Article by AllAboutVision.com. ©2009 Access Media Group LLC. All rights reserved. Reproduction other than for one-time personal use is strictly prohibited.

↑

CONTROLLING NEARSIGHTEDNESS IN CHILDREN

Myopia (nearsightedness) is a common vision problem affecting children who can see well up close, while distant objects are blurred. Nearsighted children tend to squint to see distant objects such as the board at school. They also tend to sit closer to the television to see it more clearly.

Sometimes, childhood myopia can worsen year after year. This change can be disconcerting to both children and their parents, prompting the question: "Will it ever stop? Or, someday will this get so bad that glasses won't help?"

Myopia that develops in childhood nearly always stabilizes by age 20. But by then, some kids have become very nearsighted. Here are three possible ways to slow down the progression of myopia in children:

GAS PERMEABLE CONTACT LENSES

Wearing rigid gas permeable contact lenses (also referred to as "RGP" or "GP" lenses) may slow the progression of nearsightedness in children. It's been proposed that the massaging action of the rigid GP lens on the eye during blinking may keep the eye from lengthening, thereby reducing the tendency for advancing nearsightedness.

In 2001 to 2004, the National Eye Institute (NEI) conducted a controlled study to determine whether wearing GP lenses is effective in slowing the progression of myopia in children. The 116 participants in the study were 8 to 11 years old when the research began.

At the end of the three-year study period, the children who wore GP lenses had only 0.63 diopter (D) less nearsightedness than the kids in the control group who wore soft contact lenses.

The study also found that wearing GP lenses does not slow the growth of the eye, which causes most of the myopia in children. The reduced progression of myopia among those children wearing GP lenses was due only to the effect the lenses had on the front surface of the eye (the cornea). Children who wore the GP lenses had less increase in corneal curvature than those who wore soft contact lenses. The NEI researchers believe these GP lens-induced changes in corneal curvature are not likely to be permanent, and therefore the effect of GP lenses on controlling myopia progression may not be permanent.

ORTHOKERATOLOGY

Orthokeratology, or "ortho-k," is the use of specially-designed gas permeable contact lenses to flatten the shape of the cornea and thereby reduce or correct mild to moderate amounts of nearsightedness. The lenses are worn during sleep and removed in the morning. Though temporary eyeglasses may be required during the early stages of ortho-k, many people with low to moderate amounts of myopia can see well without glasses or contact lenses during the day after wearing the corneal reshaping lenses at night.

Recent research suggests ortho-k may also reduce the lengthening of the eye itself, indicating that wearing ortho-k lenses during childhood may actually cause a permanent reduction in myopia, even if the lenses are discontinued in adulthood.

BIFOCALS

Some evidence suggests wearing eyeglasses with bifocal or progressive multifocal lenses may slow the progression of nearsightedness in some children. The mechanism here appears to be that the added magnifying power in these lenses reduces focusing fatigue during reading and other close work, a problem that may contribute to increasing myopia.

A five-year study published in the February 2007 issue of Investigative Ophthalmology & Visual Science produced an interesting result involving nearsighted children whose mother and father were also nearsighted. These children, who wore eyeglasses with progressive multifocal lenses during the course of the study, had less progression of their myopia than similar children who wore eyeglasses with regular, single vision lenses.

SEE US FOR A CONSULTATION

If you are concerned about your child becoming more nearsighted year-to-year, call us to schedule a comprehensive eye exam and consultation. We can evaluate the progression of their myopia and discuss the best treatment options with you.

Article by AllAboutVision.com. ©2009 Access Media Group LLC. All rights reserved. Reproduction other than for one-time personal use is strictly prohibited.

↑

CORRECTIVE EYE SURGERY BASICS

Tired of wearing glasses or contact lenses? Today, several surgical methods can correct your eyesight and give you the freedom of seeing well without corrective lenses. By far, LASIK is currently the most popular vision-correcting or "refractive" surgery available. But there are other options as well. Here's a brief summary of several refractive surgery options and how they compare to LASIK:

PRK

PRK (photorefractive keratectomy) was the first laser vision correction procedure approved in the United States, receiving FDA approval in 1995. It soon became a popular alternative to radial keratotomy (RK), which was the only viable surgical treatment for nearsightedness available at the time. PRK promised to reduce or eliminate many of the complications of RK, including fluctuating vision, glare, halos around lights, infection, unpredictable outcomes, decreased visual acuity and regression (return of nearsightedness).

Like LASIK, PRK uses an excimer laser to remove corneal tissue to reshape the eye and correct vision. But with PRK, the laser treatment is applied directly to the surface of cornea, rather than under a flap of corneal tissue as in LASIK. Visual outcomes after PRK are comparable to those after LASIK. But the eye is uncomfortable for a couple of weeks after PRK, until the thin outer protective layer of the cornea (the epithelium) grows back. Also, vision can be quite blurred for a week or two after PRK until the eye heals.

The number of PRK procedures declined sharply when LASIK was introduced, because there is usually little or no discomfort after LASIK and vision recovers faster. However, PRK has made a comeback in recent years due to more effective pain management techniques and because it poses less risk of certain complications.

LASIK

LASIK (laser-assisted in situ keratomileusis) is like PRK, except that a thin, hinged flap is made on the cornea prior to the laser treatment. This flap is lifted and folded back, and laser energy is applied to the underlying corneal tissue to reshape the eye. Then the flap is replaced, acting like a natural bandage. LASIK's main advantage over PRK is that there is little or no discomfort immediately after the procedure, and vision is usually clear within hours rather than days.

LASEK

LASEK (laser-assisted sub-epithelial keratomileusis) is a modification of LASIK in which the corneal flap is thinner, containing only epithelial cells. The delicate epithelium is removed by loosening it from the underlying cornea with an alcohol solution. It's then pushed to the side and the laser treatment is applied. The epithelial "flap" is then replaced and covered with a bandage contact lens until it reattaches to the underlying cornea. In most cases, there is less post-operative discomfort with LASEK compared to PRK, and vision recovery may be faster. LASEK is sometimes preferred over LASIK in cases when the patient's cornea is judged to be too thin for a safe LASIK procedure.

EPI-LASIK

Epi-LASIK is very much like LASEK, except a special cutting tool is used to separate the epithelium from the underlying cornea prior to the laser treatment. This eliminates the possibility of an adverse reaction to alcohol placed on the eye and may speed healing after surgery, compared to LASEK. Like LASEK, epi-LASIK is sometimes preferred over LASIK if there are concerns about corneal thickness.

INTRALASIK, ILASIK

IntraLASIK and iLASIK are terms sometimes used to describe a LASIK procedure when the corneal flap is created with an IntraLase brand femtosecond laser instead of a bladed instrument (called a microkeratome) for a blade-free, all-laser surgery. All-laser LASIK eliminates the risk of certain complications that can occur when the flap is created with a microkeratome.

WAVEFRONT LASIK OR PRK

Wavefront (or "custom") LASIK or PRK means the laser treatment is determined by a computerized mapping of the power of your eye called wavefront analysis. Wavefront-guided procedures are more precise than ablations determined by using only an eyeglasses prescription, and they can correct subtle optical imperfections called "higher-order aberrations" that regular ablations can't treat. Several studies show wavefront-guided ablations provide sharper vision than conventional (non-wavefront) LASIK or PRK, and may reduce the risk of nighttime glare and halos.

CK

CK (conductive keratoplasty) is a non-laser refractive surgery that uses a hand-held instrument to deliver low-heat radio waves to a number of spots in the peripheral cornea. This causes the corneal tissue to shrink in these areas, which increases the curvature of the cornea, thereby correcting mild amounts of farsightedness or restoring usable near vision to people over 40 who have presbyopia. CK for presbyopia is called NearVision CK, and it can be used to correct presbyopia for people who previously had LASIK surgery.

PHAKIC IOLS

Phakic IOLs (intraocular lenses) are small lenses inserted inside the eye to correct vision problems. The lenses can be place in front of or behind the pupil. "Phakic" refers to the fact that the eye's natural lens remains in the eye during the procedure. Phakic IOL implantation can correct higher amounts of nearsightedness than LASIK. But because it's an internal eye procedure, there are more risks. Cost of the procedure is also significantly higher.

REFRACTIVE LENS EXCHANGE

Refractive Lens Exchange (or RLE) is another non-laser, internal eye procedure. RLE is much like cataract surgery. But instead of removing the eye's natural lens that has grown cloudy, the surgeon removes a clear natural lens and replaces it with an artificial lens of a different shape, usually to reduce or eliminate high amounts of farsightedness. RLE has a higher risk of complications and is more expensive than LASIK. Also, removing the natural lens of a young patient will eliminate near focusing ability, which means reading glasses are required. For these reasons, RLE typically is used only in cases of severe vision correction needs.

CATARACT SURGERY

Yes, even cataract surgery can be considered a refractive procedure. New lens implants can partially restore a person's near vision in addition to correcting nearsightedness and farsightedness. These lenses, called multifocal IOLs or accommodating IOLs, currently are being used by many cataract surgeons, with promising results.

While Medicare and health insurance will cover basic costs of cataract surgery, you can elect to pay out-of-pocket for the extra costs of these more modern lenses that potentially can restore a full range of vision.

WHICH PROCEDURE IS RIGHT FOR YOU?

If you are interested in LASIK or other vision correction surgery, call our office for a comprehensive eye exam and consultation. We will be happy to discuss whether you are a good candidate for refractive surgery and which procedure may be best for you. We can also recommend an experienced refractive surgeon if you choose to proceed with surgery.

New lens implants developed for cataract surgery can partially restore a person's near vision in addition to correcting nearsightedness and farsightedness. These lenses, called multifocal IOLs or accommodating IOLs, currently are being used by many cataract surgeons, with promising results.

Article by AllAboutVision.com. ©2009 Access Media Group LLC. All rights reserved. Reproduction other than for one-time personal use is strictly prohibited.

↑

LASIK

LASIK, short for laser-assisted in situ keratomileusis, is the most popular refractive surgery available today. Each year, more than one million LASIK procedures are performed in the United States.

LASIK has become the premier surgery for vision correction because it's quick and painless, there is little or no discomfort after the procedure and vision recovery is rapid - some patients already see 20/20 the following day.

LASIK can correct nearsightedness, farsightedness and astigmatism. With a special technique called monovision, it can also reduce the need for reading glasses among patients over age 40 who wear bifocals.

AM I A GOOD CANDIDATE FOR LASIK?

To be a good candidate for LASIK, you should be at least 18 years old, have healthy eyes, and have adequate corneal thickness since LASIK corrects your vision by removing tissue from your cornea to reshape your eye.

Chronic dry eye problems, corneal diseases and other abnormalities may disqualify you from having LASIK surgery. In order to know for sure if you are a good candidate, a comprehensive eye exam is required. For your convenience, we are happy to provide LASIK pre-operative exams and consultations at our office. Call us for details.

Important considerations when deciding whether or not to have LASIK are your expectations and your ability to accept a less-than-perfect outcome. LASIK can reduce your dependence on glasses and almost always gives you the ability to function well without the need for glasses or contact lenses. But there are no guarantees, and LASIK doesn't always create perfect vision. In some cases, your vision after LASIK may be permanently less clear than it was with glasses before the procedure. You have to ask yourself if you're willing to accept the risk of such an outcome before you decide to have LASIK surgery.

Remember: LASIK is an elective procedure, not a required one.

THE LASIK PROCEDURE

LASIK is an ambulatory procedure. You walk in the surgery center, have the procedure and walk out again. The actual surgery usually takes less than 15 minutes for both eyes, but expect to be at the surgery center for an hour or more.

LASIK is a two-step procedure. In the first step, the surgeon creates a thin, hinged flap of tissue on your cornea with an instrument called a microkeratome or with a laser. This flap is folded back and the second step - the laser reshaping of your eye - begins. After the laser treatment, which usually takes less than a minute, the flap is repositioned and the surgeon moves on to your other eye.

WHAT IS WAVEFRONT LASIK?

Wavefront LASIK (also called wavefront-assisted, wavefront-guided or custom LASIK) means the laser treatment (or "ablation") is determined by a computerized mapping of the power of your eye called wavefront analysis. Wavefront-guided procedures are more precise than ablations determined by using only an eyeglasses prescription, and they can correct subtle optical imperfections of the eye called "higher-order aberrations" that regular ablations can't treat. Several studies show wavefront-guided ablations provide sharper vision than conventional, non-wavefront LASIK and may reduce the risk of nighttime glare and halos.

AFTER LASIK SURGERY

After the procedure, your surgeon or an assistant will apply medicated eye drops and clear protective shields over your eyes. You can open your eyes and see well enough to walk without glasses, but you must have someone drive you home.

You will be expected to use medicated eye drops several times a day for a week or so to protect your eyes from infection and help them heal properly. You will also be told to use artificial tears frequently to keep your eyes moist and comfortable.

You should rest and not use your eyes much when you get home from surgery that day. You may also be more comfortable if the lights in your house are dimmed.

The following day, you should be seeing well enough to drive and can resume most activities. Be careful, however, not to rub your eyes until your eye doctor tells you it is safe to do so.

Usually, you will be asked to return to the surgery center the following day so your surgeon or another eye doctor at the center can check your vision and make sure your eyes appear as they should. At this visit, you typically will be given additional instructions about using eye drops and artificial tears, and you will be able to ask the doctor any questions you have.

From this point forward (and sometimes for this "day one" visit as well), your post-operative care may be performed by an eye doctor other than your LASIK surgeon. When your post-operative care is provided by a doctor other than your surgeon or another doctor at the surgery center, it's called co-management. We are happy to provide post-operative care for you at our office through a co-management agreement with your surgeon. Call our office for details.

WHAT IF MY VISION IS STILL BLURRY AFTER LASIK?

Though most patients see quite clearly in a matter of days after LASIK, it can take several months before your eyes are completely stable. Until then, improvements in your vision can still occur. But if several months pass and your vision is still blurred, see your LASIK surgeon. Usually a second LASIK surgery (called an enhancement) can sharpen your eyesight further.

If for some reason an enhancement is not indicated or desired, eyeglasses or contact lenses may help. We will be happy to examine your eyes and discuss the different options with you.

EYEWEAR AFTER LASIK

Keep in mind that, even if your vision seems perfect after LASIK, you still need eyewear.

When outdoors, it's important to protect your eyes from the sun's harmful rays with sunglasses that provide 100% UV protection. If you play sports when wearing sunglasses, make sure the lenses have polycarbonate lenses for extra protection. And any time you're working with power tools or doing anything else when an eye injury is possible, you should wear safety glasses with polycarbonate lenses.

If you're over 40 (or soon will be), it's likely you'll need reading glasses after LASIK. Also, many LASIK patients can benefit from a pair of prescription eyeglasses for night driving. Though these lenses may have only a mild prescription, they often can make your vision sharper for added safety and comfort.

EYE CARE AFTER LASIK

And don't forget to continue to have routine eye exams after LASIK. Even if your vision is perfect, you still need to have your eyes checked for glaucoma and other potential problems on a regular basis. Routine exams also help you make sure your vision stays stable after LASIK. We are happy to serve all your eyewear and eye care needs after your LASIK surgery.

Article by AllAboutVision.com. ©2009 Access Media Group LLC. All rights reserved. Reproduction other than for one-time personal use is strictly prohibited.

↑

LASIK RISKS AND COMPLICATIONS

If you are considering LASIK and worried that something could go wrong, you might take comfort in knowing that it's very rare for complications from this procedure to cause permanent, significant vision loss. Also, many complications can be resolved through laser re-treatment.

Selecting the right eye surgeon probably is the single most important step you can take to decrease any risks associated with LASIK. An experienced, reputable surgeon will make sure you are a good candidate for LASIK before a procedure is recommended. And if problems develop during or after the procedure, the surgeon should work closely with you to resolve them.

HOW COMMON ARE LASIK COMPLICATIONS?

Public confidence in the LASIK procedure has grown in recent years because of a solid success rate involving millions of successful procedures in the United States. With increasingly sophisticated technology used for the procedure, most LASIK outcomes these days are very favorable.

The U.S. military also has adopted the use of refractive surgery including LASIK to decrease reliance of troops on prescription eyewear. In a study of more than 16,000 U.S. Army personnel who underwent refractive surgery from 2000 through 2003, 86% achieved 20/20 or better uncorrected vision and 98% achieved 20/40 or better (the legal requirement for driving without glasses in most states).

"Reports of night vision difficulties, LASIK flap dislocation, and dry eye are infrequent, and do not seem to have a significant negative impact on military operations or individual readiness," researchers who studied these outcomes concluded in the February 2005 issue of Ophthalmology.

LASIK COMPLICATION RATES

Experienced LASIK surgeons report that serious complication rates can be held well below 1% if surgical candidates are screened and carefully selected. You may be eliminated as a candidate, for example, if you are pregnant or have certain conditions such as diabetes that may affect how well your eyes heal after LASIK. Discuss any health conditions you have with your eye doctor during your LASIK consultation or pre-operative exam.

Large pupil sizes also might be risk factors for LASIK complications, because pupils in dark conditions could expand beyond the area of the eye that was treated. Again, make sure you discuss any concerns about these or other matters with your eye surgeon.

OTHER CONSIDERATIONS ABOUT LASIK RISKS

While the great majority of LASIK outcomes are favorable, there is still that fraction of less than 1% of people who experience sometimes serious and ongoing vision problems following LASIK. No surgical procedure is ever risk-free.

Some LASIK patients with excellent vision based on eye chart testing still can have bothersome side effects. For example, it's possible a patient may see 20/20 or better with uncorrected vision after LASIK but still experience glare or halos around lights at night.

When you sign the LASIK consent form prior to surgery, you should do so with a full understanding that, even in the best of circumstances, there is a slight chance something unintended could occur. Even so, most - but not all - problems eventually can be resolved.

COMMON LASIK COMPLICATIONS

When LASIK complications occur, they are sometimes associated with the hinged flap that's created in the cornea (the clear front covering of the eye) in the first step of the LASIK procedure. This flap lifted prior to re-shaping the underlying cornea with a laser, and is then replaced to form a natural bandage.

If the LASIK flap is not made correctly, it may fail to adhere correctly to the eye's surface. The flap also might be cut too thinly or thickly. After the flap is placed back on the eye's surface, it might begin to wrinkle. These types of flap complications can lead to an irregularly-shaped eye surface.

Studies indicate that flap complications occur in from 0.3% to 5.7% of LASIK procedures, according to the April 2006 issue of American Journal of Ophthalmology. But inexperienced surgeons definitely contribute to the higher rates of flap complications. Again, remember that you can improve your odds of avoiding LASIK risks by selecting a reputable, experienced eye surgeon.

• Irregular astigmatism can result from a less than smooth corneal surface. Irregular astigmatism also can occur from laser correction that is not centered properly on the eye. Resulting symptoms may include double vision or "ghost images." In these cases, the eye may need re-treatment (also called an "enhancement").
• Diffuse Lamellar Keratitis (DLK), also nicknamed "Sands of the Sahara," is inflammation that can occur under the LASIK flap after surgery. In rare cases, DLK leads to corneal scarring. Potentially permanent vision loss can occur without prompt treatment with therapies such as antibiotics and topical steroids. The flap also might need to be lifted and rinsed to remove inflammatory cells and prevent tissue damage.
• Ectasia (or keratectasia) is bulging of the cornea that can occur from a flap being cut too deeply, when too much tissue is removed from the cornea during LASIK, or when the cornea was initially weakened as evidenced from cornea topography mapping prior to LASIK. Resulting distorted vision likely cannot be corrected with laser enhancement, and rigid contact lenses or corneal implants (Intacs) may be prescribed to hold the cornea in place.

Other, more commonly reported LASIK complications include:

• Dry Eye: Almost half of all patients report problems with dry eye in the first six months following LASIK, according to the April 2006 issue of American Journal of Ophthalmology. These complaints appear related to reduced sensitivity of the eye's surface immediately following the procedure. If you have this problem, temporary remedies such as artificial tears or prescription dry eye medication may be needed along with oral flaxseed oil capsules. After about six months to a year, however, most of these types of complaints disappear when healing of the eye is complete. People who already have severe dry eye usually are eliminated as LASIK candidates.
• Significant Undercorrection, Overcorrection, or Regression: An overcorrection or undercorrection of your vision problem means your vision may remain slightly blurred from residual nearsightedness, farsightedness or astigmatism. Regression is when your eyesight is optimal at first after LASIK, but then begins to deteriorate over time (due to a return of some nearsightedness, for example). These problems can usually be corrected with an enhancement LASIK procedure.
• Eye Infection or Irritation: In some rare cases, you may develop an eye infection, inflammation, or irritation that requires treatment with eye drops containing antibiotics or anti-inflammatory medication such as steroids.

VISION CHANGES UNRELATED TO LASIK

If you have LASIK in your 20s or 30s, be aware that your reading vision will change as you get older. This has nothing to do with your LASIK surgery - it's caused by a normal age-related loss of focusing ability called presbyopia. Because of presbyopia, most LASIK patients (like anyone else who sees well without glasses in younger years) will need reading glasses after age 40.

Article by AllAboutVision.com. ©2009 Access Media Group LLC. All rights reserved. Reproduction other than for one-time personal use is strictly prohibited.

↑

LASIK - CRITERIA FOR SUCCESS

Laser eye surgery isn't for everyone. Here are six guidelines to help you decide if LASIK is right for you:

• Are your eyes healthy? If you have any condition that can affect how your eyes respond to surgery or heal afterwards, wait until that condition is resolved. Examples include chronic dry eyes, conjunctivitis ("pink eye") and any eye injury. Some conditions, such as cataracts, keratoconus and uncontrolled glaucoma, may disqualify you completely.
• Are you an adult? You need to be at least 18 years of age to have LASIK. (Younger patients can sometimes be treated as an exception. Discuss this with your surgeon.)
• Is your vision stable? Many teenagers and young adults experience changes in their prescription for eyeglasses or contact lenses from year-to-year, especially if they are nearsighted. Make sure your prescription is stable for a 12-month period before having LASIK. If it's not and you proceed anyway, you may need another surgery next year!
• Are you pregnant? Hormonal changes during pregnancy can cause swelling in your corneas, changing your vision. Dry eyes are also common when you're pregnant. Also, eye medications (antibiotics and steroids) used during and after LASIK may be risky for your baby, whether unborn or nursing. Wait a few months after your baby is born before having LASIK.
• Certain systemic and autoimmune diseases may be disqualifiers, too. Examples include rheumatoid arthritis, type 1 diabetes, HIV and AIDS. Basically, if your body has any trouble with healing, your corneas may not heal properly after LASIK. Opinions vary among surgeons as to which diseases are automatic disqualifiers and which ones might pose acceptable risks in certain cases.
• Your prescription must be within certain limits. For example, very high amounts of myopia, which would require removal of too much corneal tissue, may preclude LASIK or make another type of refractive surgery a better option. For example, many surgeons feel a phakic IOL procedure provides a better visual outcome and poses less risk than LASIK for nearsighted prescriptions higher than -9.00 diopters.

To find out if you're a good candidate for LASIK, visit our office for a comprehensive eye exam and refractive surgery consultation.

Article by AllAboutVision.com. ©2009 Access Media Group LLC. All rights reserved. Reproduction other than for one-time personal use is strictly prohibited.

↑

PRK

PRK (or photorefractive keratectomy) is a laser eye surgery that is very similar to LASIK. The primary difference between the two is that in PRK, no flap is created on the cornea prior to reshaping the eye with an excimer laser.

Though you may not be familiar with PRK, it has been around longer than LASIK and once was the most common laser vision correction procedure.

Like LASIK, PRK can correct a wide range of nearsightedness, farsightedness and astigmatism, and many studies indicate PRK provides virtually the same long-term visual outcomes and success rates as LASIK.

ADVANTAGES OF PRK

The primary advantage of PRK over LASIK is that there is no risk of flap problems during or after PRK surgery. This is a particularly important consideration for people whose profession or lifestyle puts them at risk for eye injuries. (Examples include: military personnel, policemen and professional or amateur boxers.)

Another advantage of PRK is that the laser reshaping of the eye takes place closer to the surface of the cornea than in LASIK. Therefore, PRK sometimes can be safely performed on eyes with corneas that may be too thin for LASIK eye surgery.

DISADVANTAGES OF PRK

Vision recovery takes longer after PRK than after LASIK, and there is more discomfort during the first few days after surgery.

In some cases, people who have PRK cannot see well enough to drive safely or perform their normal workday tasks for several days after surgery.

Also, until a new layer of surface cells (called epithelial cells) grows back over the laser-treated portion of the cornea, PRK patients may have a greater risk of eye infections than LASIK patients during the first few days after surgery.

There is also a greater risk of mild or moderate haziness developing in the cornea from PRK surgery. This corneal haze may last a few months or it may be permanent, and it may or may not noticeably affect vision.

In some cases, it may take three to six months to achieve optimum vision after PRK.

BEFORE PRK SURGERY

If you are considering PRK, your first step is to choose a refractive surgeon and schedule a pre-operative exam and consultation. During this visit, your PRK surgeon or another eye doctor will examine your eyes to determine if you are a good candidate for laser vision correction. Be sure to mention any medical conditions you have and any history of previous eye surgery or injuries. Some conditions may disqualify you altogether as a PRK candidate; others may mean a postponement of the procedure or a need for special care afterward.

DURING PRK SURGERY

PRK is an ambulatory procedure - you walk into the surgery center, have the procedure, and walk out again. The entire surgery usually takes less than 15 minutes and you are awake the whole time.

The basic steps of PRK surgery are:

• Your eye is anesthetized with special numbing eye drops. A retainer is placed under your eyelids to keep your eye open throughout the procedure.
• After the surface of your eye is completely numb, the surgeon removes the thin outer layer of the cornea (called the epithelium).
• After the epithelium is removed, the excimer laser is positioned directly over your eye.
• You will be asked to look at a small light within the housing of the laser for a short time while your surgeon watches your eye through an operating microscope.
• The laser is activated and begins reshaping your cornea. It will make a loud clicking sound during the procedure, and you may smell a faint odor.
• After the laser treatment is finished, medicated eye drops and a bandage contact lens will be applied to your eye.

The actual laser treatment during PRK usually takes less than a minute. If you have only a mild eyeglasses prescription prior to surgery, it may take only a few seconds.

If you are having both eyes done the same day, the surgeon generally will proceed immediately to the second eye once the laser treatment of the first eye is finished. If you prefer, you have the option of having PRK surgery performed on your other eye a week or two later, after the vision in your first eye has recovered.

AFTER PRK SURGERY

After PRK, your eye surgeon will instruct you to use medicated eye drops several times a day for a period of time to reduce the risk of infection and inflammation. You may also be given a prescription pain reliever to control discomfort the first few days after surgery.

As with any kind of eye surgery, it's important that you follow your surgeon's instructions to the letter after PRK. Get proper rest, use your medications as directed, and call your eye doctor immediately if you suspect a problem.

Most people achieve 20/20 or better vision after PRK, but results vary from person to person. It's possible you may still need to wear eyeglasses after PRK for specific tasks such as reading and driving at night. In some cases, a second PRK surgery (called an enhancement) may be required for you to achieve acceptable visual acuity without glasses or contact lenses.

PRK RISKS AND COMPLICATIONS

The risks and potential complications of PRK are similar to those associated with LASIK, and include:

• Dry eyes
• Vision problems, such as poor night vision, glare, halos and haze
• Incomplete or inaccurate vision correction
• Infection or inflammation following surgery

Corneal haze may also occur after PRK, reducing the sharpness of vision. In many cases, corneal haze detected shortly after surgery diminishes over time and disappears after six months.

Your eye doctor or refractive surgeon can give you more information about the risks and potential complications of PRK as they apply to your specific situation.

Article by AllAboutVision.com. ©2009 Access Media Group LLC. All rights reserved. Reproduction other than for one-time personal use is ↑

SURGERY FOR PRESBYOPIA

Presbyopia is the normal age-related loss of near focusing ability. If you're over 40 and have to move the newspaper farther away to read it, you are beginning to experience presbyopia.

Even if you've had your vision corrected with LASIK surgery in your 20s or 30s, you'll still experience reading vision problems from presbyopia in your 40s, 50s and beyond.

When the time comes, most people deal with presbyopia by wearing reading glasses or eyeglasses with bifocal or progressive ("no-line bifocal") lenses. But if you want greater freedom from glasses after age 40, there are surgical options for the correction of presbyopia as well.

MONOVISION LASIK

Monovision is a presbyopia-correcting technique where your eye doctor prescribes lens powers for one eye to see clearly across the room (leaving it slightly blurred up close) and the other eye to see well up close (making it slightly blurry far away). The two eyes still work together as a team, but one eye does more of the work for your distance vision, and the other supplies more of your near vision.

Though it may sound odd, monovision contact lens fittings have been done for years, and most presbyopes who try monovision adapt to it quite well. Reading glasses may still be needed for very small print or sustained reading, but a person can usually be glasses-free most of their day with monovision.

Recently, LASIK surgeons have begun using this monovision technique as well, and success rates should be as good as or better than monovision with contact lenses. Before you commit to monovision permanently with LASIK surgery, however, try it with contact lenses first. If it works for you with contacts, you can then proceed with monovision LASIK with greater confidence (provided you meet the other criteria of a good candidate for LASIK).

MONOVISION CK (NEARVISION CK)

CK (conductive keratoplasty) uses a hand-held probe to deliver controlled radio-frequency energy to specific spots in the periphery of the cornea. This shrinks the corneal tissue in these spots and steepens the central cornea, making the eye more nearsighted.

NearVision CK, the version of CK for presbyopia, uses a monovision approach and is performed on one eye only. NearVision CK is less invasive and less expensive than LASIK, and is a good option for someone who only needs reading glasses – that is, someone who is presbyopic but has no nearsightedness, farsightedness or astigmatism.

The effects of CK tend to fade over time. So at some point, additional procedures may be needed. Like with monovision LASIK, it's a good idea to first try monovision with contact lenses to make sure you're comfortable with it before proceeding with NearVision CK surgery.

MULTIFOCAL IOLS AND RLE

Multifocal intraocular lenses (IOLs) are a variation of the lens implants that have been used for years in cataract surgery. But instead of having just one lens power to correct nearsightedness or farsightedness, these new lenses have multiple powers to correct vision at all distances.

Multifocal IOLs can be used in cataract surgery to replace the eye's cloudy natural lens, or they can be used to replace a clear natural lens that has just lost its ability to change shape for reading due to presbyopia. This second procedure is called refractive lens exchange (RLE).

Because both cataract surgery and RLE are intraocular procedures, they have more associated risks than less invasive procedures like LASIK and CK. Possible complications of IOL procedures include glaucoma and retinal detachment.

ACCOMMODATING IOL (CRYSTALENS®)

Another type of IOL that's used in the same manner as a multifocal IOL is the "accommodating" IOL. This intraocular lens has just one lens power, but the central optical portion of the device is supported by structures called haptics that enable the lens to move slightly forward and backward inside the eye in response to focusing effort. In this manner, an accommodating IOL restores some of the eye's ability to change focus on demand.

The accommodating IOL is approved for use in the United States as part of cataract surgery, and has the same risks as other intraocular lens surgeries.

MULTIFOCAL LASIK (PRESBYLASIK)

PresbyLASIK is a multifocal variation of LASIK that is available in Europe and Canada, but is not yet FDA approved in the U.S. In PresbyLASIK, the excimer laser creates concentric rings of different powers on the cornea (much like the alternating powers on a multifocal soft contact lens) to provide good vision at all distances.

Studies show presbyopic patients are quite pleased with the overall performance of PresbyLASIK, though many of them still need to wear eyeglasses for some activities. Also, though near vision after PresbyLASIK is usually good in bright light, reading glasses are usually required in low-light situations.

CORNEAL INLAYS

Corneal inlays are another surgical solution for presbyopia in development and not yet FDA-approved for use in the United States. In this procedure, a small circular device is implanted within the cornea to improve near vision. Corneal inlays will work much like multifocal contact lenses, but with the advantage of never needing removal or ongoing care.

Article by AllAboutVision.com. ©2009 Access Media Group LLC. All rights reserved. Reproduction other than for one-time personal use is strictly prohibited.

↑

CORNEAL INLAYS AND ONLAYS

Corneal inlays and onlays are small lenses or optical devices that can be inserted into the cornea to alter its shape and correct vision problems.

Though these devices and the surgical procedures associated with them are not yet FDA-approved for use in the United States, they are currently in clinical trials and may soon represent a new form of vision correction surgery.

In LASIK and PRK, vision correction is achieved by removing corneal tissue with a laser to reshape the eye. But with corneal inlays or onlays inserted just beneath the surface of the cornea, laser energy some day could be used to sculpt this artificial material instead of the eye itself, and corneal thickness can be preserved.

Corneal inlays and onlays will work much like contact lenses, but with the advantage of never needing removal or ongoing care. And they differ from currently available intraocular lenses, or IOLs, because they are less invasive and aren't placed in the interior of the eye (behind the cornea or iris).

And because corneal inlays and onlays don't require tissue to be removed from the cornea, there may be less risk of ectasia (bulging of the cornea), dry eye and other potential complications of laser vision correction procedures like LASIK and PRK.

THE CORNEAL INLAY PROCEDURE

With corneal inlays, a thin flap is created on the eye's surface with a laser or a microkeratome. In this regard, the procedure is very similar to the first step of LASIK. The inlay is then positioned in the center of the cornea, and the flap is replaced to hold it in place.

The procedure takes less than 15 minutes and can be performed in the eye surgeon's office. Sutures are not required, and only topical anesthesia in the form of eye drops is used.

THE CORNEAL ONLAY PROCEDURE

Unlike corneal inlays, where a flap is created to place the inlay within the body of the cornea (called the stroma), corneal onlays are positioned under the cornea's thin outer layer of cells called the epithelium. An instrument is used to create a pocket between the epithelium and the stroma, and the onlay is inserted in this space. The onlay is secure nearly immediately, and within 48 hours, new epithelial cells grow over the surgical wound to seal it completely.

WHEN WILL THESE PROCEDURES BE AVAILABLE IN THE U.S.?

It's impossible to predict when corneal inlays and onlays will gain FDA approval for use in the United States. Clinical trials have begun for two corneal inlays designed to correct presbyopia, the age-related condition that results in near vision focusing problems.

Article by AllAboutVision.com. ©2009 Access Media Group LLC. All rights reserved. Reproduction other than for one-time personal use is strictly prohibited.

↑

CORNEAL TRANSPLANT

A corneal transplant - also called keratoplasty (KP), penetrating keratoplasty (PKP), or corneal graft - is the surgical removal of the central portion of the cornea (the normally clear front surface of the eye) followed by replacement with a donor "button" of clear corneal tissue from an eye bank.

Corneal transplants are performed when, because of disease or injury, the cornea becomes scarred or damaged in such a way that it causes vision problems that cannot be corrected with eyeglasses, contact lenses, or refractive surgery such as LASIK.

The National Eye Institute estimates that approximately 40,000 corneal transplants are performed each year in the United States. The success rate for keratoplasty is quite high, but up to 20% of patients may reject their donor corneas. When signs of rejection occur, aggressive medical treatment with steroids can often overcome the reaction and save the cornea. Some studies report keratoplasty success rates of 95% to 99% at 5 to 10 years after surgery.

REASONS FOR CORNEAL TRANSPLANTS

A common cause for keratoplasty is keratoconus, a degenerative condition in which the cornea becomes thinner and bulges forward in an irregular cone shape. In mild cases, keratoconus can be treated with rigid gas permeable (GP) contact lenses.

But in advanced stages of the condition, the contact lenses can no longer be tolerated on the eye. Vision with GP lenses also becomes unacceptable due to the high degree of corneal irregularity. According to the National Keratoconus Foundation, 20 to 25% of patients with keratoconus will require corneal transplant surgery to restore vision.

Other indications for keratoplasty include traumatic injuries to the eye and corneal scarring from infections, chemical burns or other causes. A corneal transplant also may be required in cases of corneal degenerative diseases and corneal ectasia (thinning and bulging of the cornea that is similar to keratoconus) after LASIK or other laser vision correction surgery.

THE CORNEAL TRANSPLANT PROCEDURE

Typically, corneal transplants are performed on an outpatient basis, meaning you will not need overnight hospitalization. Local or general anesthesia is used, depending on your health, age and whether or not you prefer to be asleep during the procedure. The surgeon uses a trephine (an instrument like a cookie cutter) or a laser to cut and remove a round area of damaged or diseased tissue in the center of your cornea, and replaces it with the clear donor tissue.

The donor "button" is attached to your remaining cornea with very fine sutures (less than half the thickness of a human hair). These sutures stay in place for months or even years, until the eye is fully healed and stable.

RECOVERING FROM A CORNEAL TRANSPLANT

The total recovery time for a corneal transplant may be up to a year or longer. Initially, your vision will be blurry and the site of your corneal transplant may be swollen and slightly thicker than the rest of your cornea. Eye drops to promote healing and help your body accept the new corneal graft will be needed for several months.

You should keep your eye protected at all times after surgery by wearing a shield or a pair of eyeglasses so that nothing inadvertently bumps your eye. As your vision improves, you will gradually be able to return to your normal daily activities.

VISION AFTER KERATOPLASTY

Some patients notice improvement in their vision the day following surgery. However, large amounts of astigmatism are common after a corneal transplant. Your vision and eyeglasses prescription will fluctuate for several months after surgery, and vision changes may persist for up to a year.

Gas permeable contact lenses usually provide the best vision correction after keratoplasty, as some irregularity of the corneal surface is common. Glasses with polycarbonate lenses should be worn over the contact lenses for eye protection.

After healing is complete and the sutures are removed, it may be possible to have LASIK or some other laser vision correction procedure to reduce astigmatism and enhance your ability to see without glasses or contact lenses.

Article by AllAboutVision.com. ©2009 Access Media Group LLC. All rights reserved. Reproduction other than for one-time personal use is strictly prohibited.

↑

CATARACTS

A cataract is a clouding of the eye's natural lens, which lies behind the iris and the pupil. The lens works much like a camera lens, focusing light onto the retina at the back of the eye. The lens also adjusts the eye's focus, letting us see things clearly both up close and far away.

The lens is mostly made of water and protein. The protein is arranged in a precise way that keeps the lens clear and allows light to pass through it. But as we age, some of the protein may clump together and start to cloud a small area of the lens. This is a cataract, and over time, it may grow larger and cloud more of the lens, making it harder to see.

Most cataracts occur gradually as we age and don't become bothersome until after age 55. However, cataracts can also be present at birth (congenital cataracts) or occur at any age as the result of an injury to the eye (traumatic cataracts). Cataracts can also be caused by diseases such as diabetes or can occur as the result of long-term use of certain medications, such as steroids.

SIGNS AND SYMPTOMS

A cataract starts out small, and at first has little effect on your vision. You may notice that your vision is blurred a little, like looking through a cloudy piece of glass or viewing an impressionist painting. However, as cataracts worsen, you are likely to notice some or all of these problems:

• Blurred vision that cannot be corrected with a change in your glasses prescription.
• Ghost images or double vision in one or both eyes. Glare from sunlight and artificial light, including oncoming headlights when driving at night.
• Colors appear faded and less vibrant.

CAUSES OF CATARACTS

No one knows for sure why the eye's lens changes as we age, forming cataracts. Researchers are gradually identifying factors that may cause cataracts, and gathering information that may help to prevent them.

Many studies suggest that exposure to ultraviolet light is associated with cataract development, so eye care practitioners recommend wearing sunglasses and a wide-brimmed hat to lessen your exposure. Other types of radiation may also be causes. For example, a study conducted in Iceland suggests that airline pilots have a higher risk of developing a nuclear cataract than non-pilots, and that the cause may be exposure to cosmic radiation. A similar theory suggests that astronauts, too, are at greater risk of cataracts due to their higher exposure to cosmic radiation.

Other studies suggest people with diabetes are at risk for developing a cataract. The same goes for users of steroids, diuretics and major tranquilizers, but more studies are needed to distinguish the effect of the disease from the consequences of the drugs themselves.

Some eyecare practitioners believe that a diet high in antioxidants, such as beta-carotene (vitamin A), selenium and vitamins C and E, may forestall cataract development. Meanwhile, eating a lot of salt may increase your risk.

Other risk factors for cataracts include cigarette smoke, air pollution and heavy alcohol consumption.

CATARACT SURGERY AND TREATMENT

When symptoms of cataracts begin to appear, you may be able to improve your vision for a while using new glasses, stronger bifocals and greater light when reading. But when these remedies fail to provide enough benefit, it's time for cataract surgery.

Cataract surgery is very successful in restoring vision. In fact, it is the most frequently performed surgery in the United States, with nearly 3 million cataract surgeries done each year. More than 90% of people who have cataract surgery regain very good vision, somewhere between 20/20 and 20/40, and sight-threatening complications are relatively rare.

During surgery, the surgeon will remove your clouded lens and replace it with a clear, plastic intraocular lens (IOL). New IOLs are being developed all the time to make the surgery less complicated for surgeons and the lenses more helpful to patients. Presbyopia-correcting IOLs not only improve your distance vision, but can decrease your reliance on reading glasses as well.

If you need cataracts removed from both eyes, surgery usually will be done on only one eye at a time. An uncomplicated surgical procedure lasts only about 10 minutes. However, you may be in the outpatient facility for 90 minutes or longer because extra time will be needed for preparation and recovery.

COMMON QUESTIONS ABOUT PRESBYOPIA-CORRECTING IOLS

If you need cataract surgery, you may have the option of paying extra for new presbyopia-correcting IOLs that potentially can restore a full range of vision without eyeglasses.

Presbyopia-correcting IOLs are a relatively new option, so you may have questions such as:

1. WHAT ARE PRESBYOPIA-CORRECTING IOLS?

Presbyopia-correcting intraocular lenses (IOLs) are lens implants that can correct both distance and near vision, giving you greater freedom from glasses after cataract surgery than standard IOLs. They are available in two forms: multifocal lenses and accommodating lenses. Multifocal lenses are similar to multifocal contact lenses - they contain more than one lens power for different viewing distances. Accommodating IOLs have just one lens power, but the lens is mounted on flexible "legs" that allow the lens to move forward or backward within your eye in response to focusing effort to enable you to see clearly at a range of distances.

2. AREN'T PRESBYOPIA-CORRECTING IOLS A LOT MORE EXPENSIVE? HOW MUCH EXTRA DO I HAVE TO PAY?

Yes, presbyopia-correcting IOLs are more expensive than standard IOLs. Costs vary, depending on the lens used, but you can expect to pay up to $2,500 extra per eye. This added amount is usually not covered by Medicare or other health insurance policies, so it would be an "out-of-pocket" expense if you choose this advanced type of IOL for your cataract surgery.

3. WHY WON'T MEDICARE OR HEALTH INSURANCE COVER THE FULL COST OF PRESBYOPIA-CORRECTING IOLS?

A multifocal or accommodating IOL is not considered medically necessary. In other words, Medicare or your insurance will pay only the cost of a basic IOL and accompanying cataract surgery. Use of a more expensive, presbyopia-correcting lens is considered an elective refractive procedure, a type of luxury, just as LASIK and PRK are refractive procedures that also typically are not covered by health insurance.

4. CAN MY LOCAL CATARACT SURGEON PERFORM PRESBYOPIA-CORRECTING SURGERY?

Not all cataract surgeons use presbyopia-correcting IOLs for cataract surgery. Make sure your eye surgeon has experience with these lenses if you choose a multifocal or accommodating IOL. Studies have shown that surgeon experience is a key factor in successful outcomes, particularly in terms of whether you will need to wear eyeglasses following cataract surgery.

5. ARE ANY PROBLEMS ASSOCIATED WITH PRESBYOPIA-CORRECTING IOLS?

At a 2007 American Society of Cataract and Refractive Surgery conference, some reports indicated that even experienced cataract surgeons needed to perform enhancements for 13% to 15% of cases involving use of presbyopia-correcting IOLs. Enhancements don't mean that the procedure itself was a failure, because you likely will see just fine with eyeglasses even if your outcome is less than optimal. But it's possible you may need an additional surgical procedure (such as LASIK) to perfect your uncorrected vision after cataract surgery with a presbyopia-correcting IOL. Depending on the arrangement you make with your eye surgeon, you also may need to pay extra for any needed enhancements.

MORE ABOUT CATARACTS

Though cataracts are often associated with aging—particularly men and women over age 60, people in their 40's and 50's are also more prone to developing cataracts. Research suggests that lifestyle factors like cigarette and alcohol use, diabetes and prolonged exposure to the sun's harmful UV rays could all contribute to lens yellowing with age, and cataracts. Find what eyewear is best for you using our interactive EyeGlass Guide

Other types of cataracts include secondary cataracts from surgery for other eye disorders like glaucoma; cataracts that form as a response to eye trauma or injury; cataracts that develop after exposure to certain forms of radiation; and in some cases, cataracts are congenital—you're born with them.

The point is—with cataract symptoms and treatment, as with all things eyecare-related—there's no substitute for a comprehensive, regularly schedule eye exam to check for vision problems and maintain healthy sight.

Article by AllAboutVision.com. ©2009 Access Media Group LLC. All rights reserved. Reproduction other than for one-time personal use is strictly prohibited.

↑

DIABETES AND EYESIGHT

Diabetes is a disease that affects the way we process food for energy and growth. With all forms of diabetes—type 1, type 2 and gestational diabetes—the body has trouble converting sugar in the blood into energy, resulting in a host of potential health problems.

Diabetes increases the likelihood that common diabetes-related vision problems or diseases might occur:

• Diabetics are prone to developing cataracts (a clouding of the eye's lens) at an earlier age.
• People with diabetes are almost 50% more likely to develop glaucoma, an eye disorder that damages the optic nerve often marked by an increase of internal eye pressure.
• Macular edema (and macular degeneration) are more common in diabetics due to malfunctioning blood vessels in the middle region of the retina responsible for central, sharp vision.
• Most notably, diabetes can result in diabetic retinopathy; an eye disease that affects the blood vessels in the all-important retina. Nearly 45 percent of Americans diagnosed with diabetes have some stage of diabetic retinopathy. That's why there's no separating diabetes and vision. If you have diabetes, then you should understand vision problems that increase in likelihood as a result of the disease.

DIABETES STATISTICS

Over 21 million people in the United States have diabetes, with an estimated additional 6 million people unaware they have a form of the disease. What's more, an estimated 54 million Americans ages 40 to 74 have prediabetes, a condition that puts them at risk for developing type 2 diabetes. According to a recent American Optometric Association survey, diabetes is the leading cause of new cases of blindness among adults ages 20 to 74.

OVERVIEW OF DIABETIC RETINOPATHY

Since the retina is the light-sensitive region of the back of the eye responsible for processing visual images, diabetic retinopathy can affect your vision in mild, moderate or even severe ways.

Diabetic retinopathy involves swelling, leaking or abnormal growth of blood vessels in or near the retina. There are multiple stages to this disease, the earliest of which may not present any symptoms you can see.

Symptoms you can see include dark or black spots in your vision that increase over time, or severely blurred vision due to bleeding within the eye.

That's why comprehensive eye exams are so important when thinking about diabetes and eye sight—both type 1 and type 2 diabetics are at risk for developing diabetic retinopathy, and the longer you have diabetes, the more likely you are to develop some form of the disease.

Treatments for diabetic retinopathy include replacement of the inner gel inside the eye (called a vitrectomy) and different kinds of laser surgery. A recent clinical trial also suggested that better control of blood sugar levels slows the onset and progression of the disease in many patients.

SIGNS AND SYMPTOMS OF DIABETIC RETINOPATHY

If you have diabetes, you probably know that your body can't use or store sugar properly. When your blood sugar gets too high, it can damage the blood vessels in your eyes. This damage may lead to diabetic retinopathy. In fact, the longer someone has diabetes, the more likely they are to have retinopathy (damage to the retina) from the disease.

Anyone who has diabetes is at risk for developing diabetic retinopathy, but not all diabetics will be affected. In the early stages of diabetes, you may not notice any change in your vision. But by the time you notice vision changes from diabetes, your eyes may already be irreparably damaged by the disease.

That's why routine eye exams are so important. Your eye doctor can detect signs of diabetes in your eyes even before you notice any visual symptoms, and early detection and treatment can prevent vision loss.

Floaters are one symptom of diabetic retinopathy. Sometimes, difficulty reading or doing close work can indicate that fluid is collecting in the macula, the most light-sensitive part of the retina. This fluid build-up is called macular edema. Another symptom is double vision, which occurs when the nerves controlling the eye muscles are affected.

If you experience any of these symptoms, see your eye doctor immediately. If you are diabetic, you should see your eye doctor at least once a year for a dilated eye exam, even if you have no visual symptoms.

If your eye doctor suspects diabetic retinopathy, a special test called fluorescein angiography may be performed. In this test, dye is injected into the body and then gradually appears within the retina due to blood flow. Your eyecare practitioner will photograph the retina as the dye passes through the blood vessels in the retina. Evaluating these pictures tells your doctor or a retina specialist if signs of diabetic retinopathy exist, and how far the disease has progressed.

CAUSES OF DIABETIC RETINOPATHY

Changes in blood-sugar levels increase your risk of diabetic retinopathy, as doeslong-term diabetes.

Generally, diabetics don't develop diabetic retinopathy until they have had the disease for at least 10 years. As soon as you've been diagnosed with diabetes, you need to have a dilated eye exam at least once a year.

In the retina, high blood sugar can damage blood vessels that can leak fluid or bleed. This causes the retina to swell and form deposits. This is an early form of diabetic retinopathy called non-proliferative or background retinopathy.

In a later stage, called proliferative retinopathy, new blood vessels grow on the surface of the retina. These new blood vessels can lead to serious vision problems because they can break and bleed into the vitreous, the clear, jelly-like substance that fills the interior of the eye. Proliferative retinopathy is a much more serious form of the disease and can lead to blindness.

Fortunately, you can significantly reduce your risk of developing diabetic retinopathy by using common sense and taking good care of yourself:

• Keep your blood sugar under good control.
• Maintain a healthy diet.
• Exercise regularly.
• Follow your doctor's instructions to the letter.

TREATMENT FOR DIABETIC RETINOPATHY

According to the American Academy of Ophthalmology, 95% of those with diabetic retinopathy can avoid substantial vision loss if they are treated in time.

Diabetic retinopathy can be treated with a laser to seal off leaking blood vessels and inhibit the growth of new vessels. Called laser photocoagulation, this treatment is painless and takes only a few minutes.

In some patients, blood leaks into the vitreous humor and clouds vision. The eye doctor may choose to simply wait to see if the clouding will dissipate on its own, or a procedure called a vitrectomy may be performed to remove blood that has leaked into the vitreous humor.

Small studies using investigational treatments for diabetic retinopathy have demonstrated significant vision improvement for individuals who are in early stages of the disease. Two medications that are closely related, Lucentis and Avastin, may be able to stop or reverse vision loss, similar to very promising results that have been reported when the two drugs have been used as treatments for macular degeneration.

Article by AllAboutVision.com. ©2009 Access Media Group LLC. All rights reserved. Reproduction other than for one-time personal use is strictly prohibited.

↑

GLAUCOMA

Glaucoma is a general name for a group of eye diseases that damage the optic nerve of the eye. Glaucoma prevents the eye from sending accurate visual information to the brain. Usually associated with gradual (and sometimes sudden) increases in pressure within the eyeball itself, glaucoma can result in partial or total blindness over time. The damage caused by glaucoma is irreversible, and it is currently the second-leading cause of blindness in Americans over age 40 in the United States.

GLAUCOMA STATISTICS

Currently, glaucoma affects nearly 2.5 million Americans. And while anyone can develop glaucoma, the disease is most common in people over age 40, particularly African Americans. Glaucoma is five times more likely to affect African Americans than Caucasians, and roughly four times more likely to cause blindness. In addition, people with a family history of glaucoma stand at a higher risk to develop the disease, and anyone over age 60, particularly Mexican Americans, faces an increased risk of glaucoma.

SIGNS AND SYMPTOMS OF GLAUCOMA

Glaucoma is often called "the thief of sight" because glaucoma symptoms either go undetected or develop slowly over time. Glaucoma usually starts by attacking the outside of your vision. Left untreated, glaucoma can lead to complete blindness in one or both eyes. The most common eye problem linked to glaucoma is an increase in internal eye pressure. An increase in internal eye pressure doesn't automatically mean you "have" glaucoma; only that you have a condition that could lead to it—that's why a regular exam is so important. Glaucoma typically affects your peripheral vision first. This is why it is such a sneaky disease: You can lose a great deal of your vision from glaucoma before you are aware anything is happening. If uncontrolled or left untreated, glaucoma can eventually lead to blindness. Glaucoma is currently the second leading cause of blindness in the United States, with an estimated 2.5 million Americans being affected by the disease. Due to the aging of the U.S. population, it's expected that more than 3 million Americans will have glaucoma by the year 2020.

ADDITIONAL SIGNS OF GLAUCOMA

Glaucoma is often referred to as the "silent thief of sight," because most types typically cause no pain and produce no symptoms. For this reason, glaucoma often progresses undetected until the optic nerve already has been irreversibly damaged, with varying degrees of permanent vision loss. But there are other forms of the disease (specifically, acute angle-closure glaucoma), where symptoms of blurry vision, halos around lights, intense eye pain, nausea, and vomiting occur suddenly. If you have these symptoms, make sure you immediately see an eye care practitioner or visit the emergency room so steps can be taken to prevent permanent vision loss.

CAUSES AND TYPES OF GLAUCOMA

The cause of glaucoma is generally a failure of the eye to maintain an appropriate balance between the amount of fluid produced inside the eye and the amount that drains away. Underlying reasons for this imbalance usually relate to the type of glaucoma you have. Just as a basketball or football requires air pressure to maintain its shape, the eyeball needs internal fluid pressure to retain its globe-like shape and ability to see. But when glaucoma damages the ability of internal eye structures to regulate intraocular pressure (IOP), eye pressure can rise to dangerously high levels and vision is lost.

The two major types of glaucoma are chronic or primary open-angle glaucoma (POAG) and acute angle-closure glaucoma. The "angle" refers to the structure inside the eye that is responsible for fluid drainage from the eye, located near the junction between the iris and the front surface of the eye near the periphery of the cornea. Some of the more common types of glaucoma include:

• Primary open-angle glaucoma (POAG): About half of Americans with this form of chronic glaucoma don't know they have it. POAG gradually and painlessly reduces your peripheral vision. But by the time you notice it, permanent damage has already occurred. If your IOP remains high, the destruction can progress until tunnel vision develops, and you will be able to see only objects that are straight ahead.
• Acute angle-closure glaucoma: Angle-closure or narrow angle glaucoma produces sudden symptoms such as eye pain, headaches, halos around lights, dilated pupils, vision loss, red eyes, nausea and vomiting. These signs may last for a few hours, and then return again for another round. Each attack takes with it part of your field of vision.
• Normal-tension glaucoma: Like POAG, normal-tension glaucoma (also termed normal-pressure glaucoma, low-tension glaucoma, or low-pressure glaucoma) is an open-angle type of glaucoma that can cause visual field loss due to optic nerve damage. But in normal-tension glaucoma, the eye's IOP remains in the normal range. Also, pain is unlikely and permanent damage to the eye's optic nerve may not be noticed until symptoms such as tunnel vision occur.

The cause of normal-tension glaucoma is not known. But many doctors believe it is related to poor blood flow to the optic nerve. Normal-tension glaucoma is more common in those who are Japanese, are female and/or have a history of vascular disease.

Congenital glaucoma:
This inherited form of glaucoma is present at birth, with 80% of cases diagnosed by age one. These children are born with narrow angles or some other defect in the drainage system of the eye. It's difficult to spot signs of congenital glaucoma, because children are too young to understand what is happening to them. If you notice a cloudy, white, hazy, enlarged or protruding eye in your child, consult your eye doctor. Congenital glaucoma typically occurs more in boys than in girls.

Pigmentary glaucoma: This rare form of glaucoma is caused by pigment deposited from the iris that clogs the draining angles, preventing aqueous humor from leaving the eye. Over time, the inflammatory response to the blocked angle damages the drainage system. You are unlikely to notice any symptoms with pigmentary glaucoma, though some pain and blurry vision may occur after exercise. Pigmentary glaucoma affects mostly white males in their mid-30s to mid-40s.

Secondary glaucoma: Symptoms of chronic glaucoma following an eye injury could indicate secondary glaucoma, which also may develop with presence of infection, inflammation, a tumor or an enlarged cataract.

HOW IS GLAUCOMA DETECTED?

During routine eye exams, a tonometer is used to measure your intraocular pressure (IOP). Your eye typically is numbed with eye drops, and a small probe gently rests against your eye's surface. Other tonometers direct a puff of air onto your eye's surface to indirectly measure IOP.

An abnormally high IOP reading indicates a problem with the amount of fluid inside the eye. Either the eye is producing too much fluid, or it's not draining properly.

Another method for detecting or monitoring glaucoma is the use of instruments to create images of the eye's optic nerve and then repeating this imaging over time to see if changes to the optic nerve are taking place, which might indicate progressive glaucoma damage. Instruments used for this purpose include scanning laser polarimetry (SLP), optical coherence tomography (OCT), and confocal scanning laser ophthalmoscopy.

Visual field testing is another way to monitor whether blind spots are developing in your field of vision from glaucoma damage to the optic nerve. Visual field testing involves staring straight ahead into a machine and clicking a button when you notice a blinking light in your peripheral vision. The visual field test may be repeated at regular intervals so your eye doctor can determine if there is progressive vision loss.

Instruments such as an ophthalmoscope also may be used to help your eye doctor view internal eye structures, to make sure nothing unusual interferes with the outflow and drainage of eye fluids. Ultrasound biomicroscopy also may be used to evaluate how well fluids flow through the eye's internal structures. Gonioscopy is the use of special lenses that allow your eye doctor to visually inspect internal eye structures that control fluid drainage.

GLAUCOMA TREATMENTS

Depending on the severity of the disease, treatment for glaucoma can involve the use of medications, conventional (bladed) surgery, laser surgery or a combination of these treatments. Medicated eye drops aimed at lowering IOP usually are tried first to control glaucoma.

Because glaucoma is often painless, people may become careless about strict use of eye drops that can control eye pressure and help prevent permanent eye damage. In fact, non-compliance with a program of prescribed glaucoma medication is a major reason for blindness resulting from glaucoma.

If you find that the eye drops you are using for glaucoma are uncomfortable or inconvenient, never discontinue them without first consulting your eye doctor about a possible alternative therapy.

All glaucoma surgery procedures (whether laser or non-laser) are designed to accomplish one of two basic results: decrease the production of intraocular fluid or increase the outflow (drainage) of this same fluid. Occasionally, a procedure will accomplish both.

Currently the goal of glaucoma surgery and other glaucoma therapy is to reduce or stabilize intraocular pressure (IOP). When this goal is accomplished, damage to ocular structures – especially the optic nerve – may be prevented.

EARLY DETECTION IS KEY

No matter the treatment, early diagnosis is the best way to prevent vision loss from glaucoma. See your eye care practitioner routinely for a complete eye examination, including a check of your IOP.

People at high risk for glaucoma due to elevated intraocular pressure, a family history of glaucoma, advanced age or an unusual optic nerve appearance may need more frequent visits to the eye doctor.

Article by AllAboutVision.com. ©2009 Access Media Group LLC. All rights reserved. Reproduction other than for one-time personal use is strictly prohibited.

↑

MACULAR DEGENERATION

As a disease usually associated with aging, macular degeneration is also called age-related macular degeneration (ARMD), though there are other, less common types of macular degeneration.

Macular degeneration symptoms include a gradual loss of central vision needed to perform everyday tasks like driving or reading, and a reduced ability to see small visual details like fine print or patterns.

Age-related macular degeneration is the leading cause of vision loss in Americans over age 60, and presents itself in two forms: dry macular degeneration and wet macular degeneration. Of the two, the "dry" form is far more common. Both affect the center region of the retina, the light-sensitive area in the back of the eye responsible for processing images we see.

MACULAR DEGENERATION STATISTICS

Currently, macular degeneration is the leading cause of vision loss in persons over age 60. Caucasians are far more likely to lose vision from ARMD than African Americans, and studies show that obesity, smoking, and exposure to UV rays may also be risk factors for developing the disease.

Macular degeneration tends to affect women more than men, and has also been linked to heredity. Nearly 90% of all diagnosed ARMD is the dry form

OVERVIEW

Macular degeneration (also called AMD, ARMD, or age-related macular degeneration) is an age-related condition in which the most sensitive part of the retina, called the macula, starts to break down and lose its ability to create clear visual images. The macula is responsible for central vision - the part of our sight we use to read, drive and recognize faces. So although a person's peripheral vision is left unaffected by AMD, the most important aspect of vision is lost.

AMD is the leading cause of vision loss and blindness in Americans of ages 65 and older. And because older people represent an increasingly larger percentage of the general population, vision loss associated with macular degeneration is a growing problem.

It's estimated that more than 1.75 million U.S. residents currently have significant vision loss from AMD, and that number is expected to grow to almost 3 million by 2020.

FORMS OF MACULAR DEGENERATION

Macular degeneration can be classified as either dry (non-neovascular) or wet (neovascular). Neovascular refers to growth of new blood vessels in an area, such as the macula, where they are not supposed to be.

The dry form of AMD is more common - about 85% to 90% of all cases of macular degeneration are the dry variety.

DRY MACULAR DEGENERATION

Dry AMD is an early stage of the disease, and may result from the aging and thinning of macular tissues, depositing of pigment in the macula, or a combination of the two processes.

Dry macular degeneration is diagnosed when yellowish spots called drusen begin to accumulate in the macula. Drusen are believed to be deposits or debris from deteriorating macular tissue. Gradual central vision loss may occur with dry AMD. Vision loss from this form of the disease is usually not as severe as that caused by wet AMD.

A major study conducted by the National Eye Institute (NEI) looked into the risk factors for developing macular degeneration and cataracts. The study, called the Age-Related Eye Disease Study (AREDS), showed that high levels of antioxidants and zinc significantly reduce the risk of advanced dry AMD and its associated vision loss. The AREDS study also indicated that taking high dose formulas containing beta carotene, vitamins C and E and zinc can reduce the risk of early stage AMD progression by 25%.

Early detection of dry macular degeneration is critical to long-term treatment.

WET MACULAR DEGENERATION

Wet AMD is the more advanced and damaging stage of the disease. In about 10% of cases, dry AMD progresses to wet macular degeneration.

With wet AMD, new blood vessels grow beneath the retina and leak blood and fluid. This leakage causes permanent damage to light-sensitive cells in the retina, causing blind spots or a total loss of central vision.

The abnormal blood vessel growth in wet AMD is the body's misguided attempt to create a new network of blood vessels to supply more nutrients and oxygen to the macula. But the process instead creates scarring and central vision loss.

SYMPTOMS & RISK FACTORS OF MACULAR DEGENERATION

Macular degeneration usually produces a slow, painless loss of vision. Early signs of vision loss associated with macular degeneration can include seeing shadowy areas in your central vision or experiencing unusually fuzzy or distorted vision. In rare cases, it may cause a sudden loss of central vision.

An eyecare practitioner usually can detect early signs of macular degeneration before symptoms occur. Usually this is accomplished through a retinal examination.

WHAT CAUSES MACULAR DEGENERATION?

Many forms of macular degeneration appear be linked to aging and related deterioration of eye tissue crucial for good vision. Research also suggests a gene deficiency may be associated with almost half of all potentially blinding cases of macular degeneration.

WHO GETS MACULAR DEGENERATION?

Besides affecting older individuals, macular degeneration appears to occur in whites and females in particular. The disease also can result as a side effect of some drugs, and it appears to run in families.

New evidence strongly suggests that smoking is high on the list of risk factors for macular degeneration. Other risk factors for macular degeneration include having a family member with it, high blood pressure, lighter eye color and obesity. Some researchers believe that over-exposure to sunlight also may be a contributing factor in development of macular degeneration, and a high-fat diet also may be a risk factor.

HOW IS MACULAR DEGENERATION TREATED?

There are no FDA-approved treatments for dry macular degeneration, although nutritional intervention may be valuable in preventing its progression to the more advanced, wet form.

For wet macular degeneration, there are several FDA-approved drugs aimed at stopping abnormal blood vessel growth and vision loss from the disease. In some cases, laser treatment of the retina may be recommended. Ask your eye doctor for details about the latest treatment options for wet macular degeneration.

TESTING AND LOW VISION DEVICES

Although much progress has been made recently in macular degeneration treatment research, complete recovery of vision related vision loss is probably is unlikely. Your eye doctor may ask you to check your vision regularly with an Amsler grid - a small chart of thin black lines arranged in a grid pattern. Macular degeneration causes the line on the grid to appear wavy, distorted or broken. Viewing the Amsler grid separately with each eye helps you monitor your vision loss.

If you have already suffered vision loss from macular degeneration, low vision devices including high magnification reading glasses and hand-held telescopes may help you achieve better vision than regular prescription eyewear.

Article by AllAboutVision.com. ©2009 Access Media Group LLC. All rights reserved. Reproduction other than for one-time personal use is strictly prohibited.

↑

MULTIFOCAL CONTACT LENSES

Once we reach our mid-40s, presbyopia - the normal, age-related loss of flexibility of the lens inside our eye - makes it difficult for us to focus on near objects. In the past, reading glasses were the only option available to contact lens wearers who wanted to read a menu or do other everyday tasks that require good near vision.

But today, a number of multifocal contact lens options are available for you to consider. Multifocal contact lenses offer the best of both worlds: no glasses, along with good near and distance vision.

TYPES OF MULTIFOCAL CONTACT LENSES

Some multifocal contact lenses have a bifocal design with two distinct lens powers - one for your distance vision and one for near. Others have a multifocal design somewhat like progressive eyeglass lenses, with a gradual change in lens power for a natural visual transition from distance to close-up.

Multifocal contacts are available in both soft and rigid gas permeable (RGP or GP) lens materials and are designed for daily wear or extended (overnight) wear. Soft multifocal lenses can be comfortably worn on a part-time basis, so they're great for weekends and other occasions if you prefer not to wear them on an all-day, every day schedule.

For the ultimate in convenience, one-day disposable soft multifocal lenses allow you to discard the lenses at the end of a single day of wear, so there's no hassle with lens care.

In some cases, GP multifocal contact lenses provide sharper vision than soft multifocals. But because of their rigid nature, GP multifocal contacts require some adaptation and are more comfortable if you condition your eyes by wearing the lenses every day.

Hybrid multifocal contacts are an exciting new alternative. These lenses have a GP center and a soft periphery, making it easier to adapt.

ASTIGMATISM? NO PROBLEM.

All types of multifocal contact lenses - GP, soft, and hybrid - are available to correct astigmatism at the same time as presbyopia.

MONOVISION

Until you have a contact lens fitting, there's no way to know for sure if you'll be able to successfully adapt to wearing multifocal contact lenses. If multifocal lenses aren't comfortable or don't give you adequate vision, a monovision contact lens fitting may be a good alternative.

Monovision uses your dominant eye for distance vision and the non-dominant eye for near vision. Right-handed people tend to be right-eye dominant and left-handed folks left-eye dominant. But your eye care professional will perform testing to make that determination.

Usually, single vision contact lenses are used for monovision. One advantage here is that single vision lenses are less costly to replace, lowering your annual contact lens expenses. But in some cases, better results can be achieved using a single vision lens on the dominant eye for distance vision and a multifocal lens on the other eye for intermediate and near vision. Other times, your eyecare professional may choose a distance-biased multifocal on your dominant eye and a near-biased multifocal on the other eye. These techniques are referred to as "modified monovision" fits.

Article by AllAboutVision.com. ©2009 Access Media Group LLC. All rights reserved. Reproduction other than for one-time personal use is strictly prohibited.

↑

MULTIFOCAL EYEGLASS LENSES

Just as eyeglass frames have continually changed to reflect the latest fashions, eyeglass lenses also have evolved. This is particularly true for multifocal lenses - eyeglass lenses with more than one power to help those of us over age 40 deal with the normal, age-related loss of near vision called presbyopia.

HISTORY OF MULTIFOCAL EYEGLASS LENSES

Benjamin Franklin, the early American statesman and inventor, is credited with creating the first multifocal eyeglass lenses. Prior to Franklin's invention, anyone with presbyopia had to carry two pairs of eyeglasses - one for seeing distant objects and one for seeing up close.

Sometime around 1780, Franklin cut two lenses in half (one with a distance correction and one with a correction for near) and glued them together, so the top half of the new lens enabled the wearer to see things far away and the bottom half helped them see up close.

This lens, with a line extending across the entire width of it, was first called the Franklin bifocal and later became known as the Executive bifocal.

MODERN MULTIFOCAL LENSES

Bifocals. There have been many changes to bifocal eyeglass lenses since Franklin's original design, making these two-power lenses thinner, lighter and more attractive. Today, the most popular bifocal for eyeglasses is called a flat-top (FT) or straight-top (ST) design. The part that contains the power for near vision is a D-shaped segment (or "seg") in the lower half of the lens that is rotated 90 degrees so the flat part of the "D" faces upward.

FT or ST bifocals (sometimes also called a D-seg bifocals), are available in different-sized near segments. The most popular version sold in the United States has a near segment that is 28 millimeters wide, and is therefore called the ST-28 (or FT-28 or D-28) bifocal. This design offers a generous field of view for reading, yet keeps the near seg small enough to be cosmetically pleasing.

Other available bifocal designs include lenses with round near segments and bifocals where the near seg extends across the entire width of the lens (Executive bifocals).

All bifocals, however, have a limitation: Though they provide good vision for distance and near, they can leave the wearer's intermediate vision (for distances at arm's length) blurry. Which brings us to...

Trifocals. Trifocal eyeglass lenses have an additional ribbon-shaped lens segment immediately above the near seg for seeing objects in the intermediate zone of vision - approximately 18 to 24 inches away.

This intermediate segment provides 50% of the magnification of the near seg, making it perfect for computer use and for seeing your speedometer and other dashboard gauges when driving.

Trifocals are especially helpful for older presbyopes - those over age 50 - who have less depth of focus than younger presbyopes. (Younger presbyopes may still be able to see objects at arm's length reasonably well through the top part of their bifocals.)

As with bifocals, the most popular trifocals have a flat-top (FT) design, with the near and intermediate segments being 28 mm wide. Trifocals with 35 mm wide segments are also popular.

LIMITATIONS OF BIFOCALS AND TRIFOCALS

Although bifocals and trifocals are very functional, they pose a problem - the visible lines in the lenses. Most people prefer not to advertise their age by wearing multifocal eyeglass lenses with lines in them that everyone can see.

The lines in bifocals and trifocals cause a vision problem as well. Because they mark well-defined changes in power within the lenses, as the wearer's eyes move past the lines, there is an abrupt change in how objects appear. This "image jump" can be difficult for some wearers to adapt to.

Some years ago, these limitations of conventional bifocals and trifocals led to a major breakthrough in multifocal eyeglass lens design: progressive lenses.

PROGRESSIVE MULTIFOCAL LENSES

Progressive multifocal lenses (also called progressives, progressive addition lenses, and PALs) are true "multi-focal" lenses. Instead of having just two or three powers, progressives gradually change in power from the top to the bottom of the lens, offering a large number of powers for clear vision at all distances - distance, intermediate, near and everywhere in between.

And because there are no visible lines or abrupt changes of lens power in progressive lenses, there is no "image jump," so the wearer's vision generally is more comfortable and seems more natural.

Because of these advantages, progressive lenses have become the most popular multifocal lenses sold in the United States.

THE RIGHT MULTIFOCAL LENSES FOR YOU

The right multifocal lenses for you will depend on your age, your visual needs, your budget and other factors. Visit us today for more information about bifocal, trifocal, and progressive lenses and to get a customized solution to your vision and eyewear needs.

Article by AllAboutVision.com. ©2009 Access Media Group LLC. All rights reserved. Reproduction other than for one-time personal use is strictly prohibited.

↑

NEED TO READ ALL DAY AT WORK?

Sometimes, a common multifocal can become an occupational lens simply by changing the position of the intermediate or near segment or the characteristics of the progressive design.

For example, if your job requires you to read much of your day, you may want to consider a separate pair of glasses for work that have the bifocal or trifocal segments placed higher-than-normal in the lens. This would enable you to read or use your computer for extended periods without having to tip your head back in an uncomfortable posture.

Or you may want to try an "office" progressive lens, which has a larger, wider intermediate zone for computer use, and a smaller zone for distance vision. These occupational lenses give your more usable vision for your computer and desk work, yet still provide adequate distance vision for spotting people across the room. However, because the distance zone of occupational progressive lenses is limited, they're not suitable for driving or for other tasks that require a wide field of view in the distance.

WHAT ABOUT ON THE GOLF COURSE?

If you're a golfer and wear multifocal lenses, you know these lenses can be a problem on the course. The near vision zones of bifocal, trifocal and progressive lenses can interfere with your view of the ball, requiring you to tilt your head down in an uncomfortable posture. Everyday multifocals can also make lining up a putt much more difficult.

The solution? Consider trying an occupational multifocal commonly called a "golfer's bifocal." The small (usually round) near segment is placed very low and in the outside corner of just one lens, so it's completely out of the way when you address your ball or line up a putt. But it still gives you enough near vision to read your scorecard or browse a menu for lunch in the clubhouse.

CUSTOMIZED EYEWEAR SOLUTIONS

Nearly all adults - especially anyone over age 40 who needs multifocal lenses - can benefit from having more than one pair of eyeglasses, with the second pair having an occupational design. Visit us today to explore your many options for eyewear solutions that are specifically tailored to your vision needs.

Article by AllAboutVision.com. ©2009 Access Media Group LLC. All rights reserved. Reproduction other than for one-time personal use is strictly prohibited.

↑

HOW PROGRESSIVE LENSES WORK

Progressive addition lenses (also called progressives or PALs) are the most popular multifocal lenses sold in the United States. Sometimes called "no-line bifocals," these line-free multifocals provide a more complete vision solution than bifocals. Instead of having just two lens powers like a bifocal - one for distance vision and one for up close - progressives have a gradual change in power from the top to the bottom of the lens, providing a range of powers for clear vision far away, up close and everywhere in between.

Progressive lenses provide the closest thing to natural vision after the onset of presbyopia - the normal age-related loss of near vision that occurs after age 40. The gradual change of power in progressives allows you to look up to see in the distance, look straight ahead to clearly see your computer or other objects at arm's length, and drop your gaze downward to read and do fine work comfortably close up.

While progressive lenses typically are worn by middle-aged and older adults, a recent study suggests that they may also be able to slow progression of myopia in children whose parents also are nearsighted.

CHOOSING THE RIGHT FRAME FOR PROGRESSIVE LENSES

Because a progressive lens changes in power from top to bottom, these lenses require frames that have a vertical dimension that is tall enough for all powers to be included in the finished eyewear. If the frame is too small, the distance or near zone of the progressive lens may end up too small for comfortable viewing when the lens is cut to fit into the frame.

To solve this problem and to expand options in frame styles, most progressive lens manufacturers now offer "short corridor" lens designs that fit in smaller frames. Today, an experienced optician can usually find a progressive lens that will work well in nearly any frame you choose.

DIFFERENT PROGRESSIVES FOR DIFFERENT PURPOSES

Many different progressive lenses are available on the market today, and each has its own unique design characteristics. There are even progressive lenses designed for specific activities. For example, for the computer user, special "occupational" progressive lenses are available with an extra-wide intermediate zone to maximize comfort when working at the computer for prolonged periods of time. Other designs for office work have a larger reading portion.

ADAPTATION

It may take a few minutes to a few days before you are completely comfortable with your first pair of progressive lenses, or when you change from one progressive lens design to another. You have to learn how to use the lenses, so you are always looking through the best part of the lens for the distance you are viewing. You also may notice a slight sensation of movement when you quickly move your eyes or your head until you get used to the lenses. But for most wearers, progressive lenses are comfortable right from the start.

LET US HELP

With so many options in eyewear today, choosing the right frame and lenses can seem overwhelming. Let us help. Our professional opticians can discuss the advantages of the latest progressive lenses with you and help you find the lenses and frames that best match your needs.

Article by AllAboutVision.com. ©2009 Access Media Group LLC. All rights reserved. Reproduction other than for one-time personal use is strictly prohibited.

↑

READING GLASSES

Are you someone who never needed glasses before, but you now can't read a newspaper without stretching your arms to the limit?

This normal change in our eyes is called presbyopia. As the lens inside our eyes ages, it loses its ability to focus on close-up objects. Most people notice this some time after age 40, when small print starts to blur.

The simple solution to presbyopia is reading glasses. Single vision reading glasses (those that have just one power and are used just for near vision) come in two styles: full-size, in which the reading lens fits in a normal-sized eyeglass frame, and half-eyes - the smaller "Ben Franklin" style glasses that sit low on the nose.

Full-size reading glasses are preferred by people who want a large field of view for reading and other close work, and don't need to see clearly across the room. If you try to look at distant objects through full-size reading glasses, everything beyond arm's length will be blurred.

In contrast, half-eye reading glasses allow you to look down and through the lenses for near work, and up and over them to see across the room.

Another option is bifocal reading glasses. In these, the top part of the lens may or may not contain a mild correction for distance vision, and the bottom portion of the lens contains the reading prescription. These glasses offer the convenience of a comfortable, full-size frame that can be left on for activities requiring good distance and near vision, such as when reading notes during a class lecture.

Bifocal reading glasses are also available with tinted lenses and 100% UV protection for reading outdoors in the sun.

WHY CUSTOM-MADE READING GLASSES ARE BETTER THAN PRE-FABRICATED ONES

Reading glasses can be custom-made and purchased at a doctor's office or optical store, or they can be purchased "ready-made" at a pharmacy, department store or convenience store.

Ready-made readers are less expensive than custom-made reading glasses, making it more affordable to own several pairs. This way, you can keep a pair in different rooms of the house as well as in your car, office, briefcase, purse, boat and so on.

But one drawback of purchasing ready-made reading glasses is that they are essentially "one-size-fits-all" items. The prescription is the same in both lenses, and the location of the optical center of the lenses is not customized for each wearer.

Most people don't have exactly the same eyeglasses prescription in both eyes, and many have at least a small amount of astigmatism. Headaches, eyestrain, and even nausea can result from wearing reading glasses that are too far off from your actual prescription, or that have optical centers too far away from the center of your pupils. If you experience these problems, visit your eye doctor for a customized reading glasses prescription.

Also, the lenses of some ready-made reading glasses contain little bubbles, waves or other defects. Because these readrs are mass-produced, the optical quality of the lenses is often not comparable to that of a custom-made pair of reading glasses.

Another difference: The frames of ready-made reading glasses are often less comfortable, less durable and less stylish than those of custom-made reading glasses.

THE DANGER OF FORGOING EYE EXAMS

A more serious problem associated with pre-made readers has less to do with the glasses than with the reason many people purchase them. Some people head to the drugstore instead of the eye doctor when they feel it's time for a stronger correction. In fact, a recent survey found that 17% of presbyopes purchased pre-made reading glasses because they "didn't want to bother with an eye exam."

Common sense and good eye health dictate that you should consult your eye doctor if you notice a change in your vision.

The need for a new pair of reading glasses may be nothing more than the natural aging process at work. But it might also signal a serious problem with your eyes that needs immediate attention. Glaucoma, for example, is a serious eye disease that has no symptoms at first but can cause permanent vision loss, even blindness, if it's not detected early and controlled with medication. A comprehensive eye exam is the best way to avoid sight-threatening problems and to make sure you keep seeing well for years to come.

Article by AllAboutVision.com. ©2009 Access Media Group LLC. All rights reserved. Reproduction other than for one-time personal use is strictly prohibited.

↑

DRY EYE AFTER MENOPAUSE

Studies show that more than 14% of older Americans have dry eye syndrome, or "dry eye." If you are 50 or older and female, your chance of developing dry eye is even greater. In fact, the American Academy of Ophthalmology says hormonal changes make older women twice as likely as older men to develop dry eye and accompanying symptoms such as eye irritation and blurred vision.

Women who have undergone menopause may experience disrupted chemical signals that help maintain a stable tear film. Resulting inflammation also can lead to decreased tear production and dry eye. Some theories indicate that a decline in a hormone known as androgen could be an underlying cause of dry eye in older women.

What can you do if you are older and develop dry eye? While levels of the female hormone estrogen also decrease following menopause, studies have not shown any beneficial effect of estrogen hormone replacement therapy (HRT) in relieving dry eye.

If you are over age 40 and have been diagnosed with dry eye, you may want to avoid laser vision correction surgery. Procedures such as LASIK and PRK can permanently affect nerve function of your eye's clear surface (cornea) and worsen dry eye problems. If you choose to have a refractive surgery consultation, be sure to tell your examining eye doctor about your dry eye condition. Your doctor can perform special tests to determine if your eyes are moist enough for laser vision correction.

If you have already been diagnosed with dry eyes, make sure you are being appropriately treated for other conditions associated with both aging and dry eye such as rheumatoid arthritis and thyroid autoimmune disease.

Also, keep in mind that many medications required by adults over age 40 may cause or worsen dry eye problems. Examples include diuretics (often prescribed for heart conditions) and antidepressants. If you suspect a medication may be the underlying cause of your dry eye, be sure to discuss this with your doctor. It's possible that changing to a different medical treatment may be equally effective without causing dry eye problems. Also, concurrent treatment of your dry eye may be necessary.

Finally, it's possible that allergies or other problems that cause eye inflammation may be the underlying cause of your dry eye symptoms. Your eye doctor may recommend over-the-counter or prescription eye drops to relieve both your eye allergies and inflammatory dry eye problems.

Article by AllAboutVision.com. ©2009 Access Media Group LLC. All rights reserved. Reproduction other than for one-time personal use is strictly prohibited.

↑

HOW YOUR VISION CHANGES AS YOU AGE

Just as our physical strength decreases with age, our eyes also exhibit an age-related decline in performance - particularly as we reach our 60s and beyond.

Some age-related eye changes, such as presbyopia, are perfectly normal and don't signify any sort of disease process. While cataracts can be considered an age-related disease, they are extremely common among seniors and can be readily corrected with cataract surgery.

Some of us, however, will experience more serious age-related eye diseases that have greater potential for affecting our quality of life as we grow older. These conditions include glaucoma, macular degeneration and diabetic retinopathy.

WHEN DO AGE-RELATED VISION CHANGES OCCUR?

Presbyopia. After you pass the milestone age of 40, you'll notice it's more difficult to focus on objects up close. This normal loss of focusing ability is called presbyopia, and is due to hardening of the lens inside your eye.

For a time, you can compensate for this decline in focusing ability by just holding reading material farther away from your eyes. But eventually, you'll need reading glasses, multifocal contact lenses or multifocal eyeglasses. Some corrective surgery options for presbyopia also are available, such as monovision LASIK and conductive keratoplasty (CK).

Cataracts. Even though cataracts are considered an age-related eye disease, they are so common among seniors that they can also be classified as a normal aging change. According to Mayo Clinic, about half of all 65-year-old Americans have some degree of cataract formation in their eyes. As you enter your 70s, the percentage is even higher. It's estimated that by 2020 more than 30 million Americans will have cataracts.

Thankfully, modern cataract surgery is extremely safe and so effective that 100% of vision lost to cataract formation usually is restored. If you are noticing vision changes due to cataracts, don't hesitate to discuss symptoms with your eye doctor. It's often better to have cataracts removed before they advance too far. Also, multifocal lens implants are now available. These advanced intraocular lenses (IOLs) potentially can restore all ranges of vision, thus reducing your need for reading glasses as well as distance glasses after cataract surgery.

MAJOR AGE-RELATED EYE DISEASES

Macular degeneration. Macular degeneration (also called age-related macular degeneration or AMD) is the leading cause of blindness among American seniors. According to the National Eye Institute (NEI), macular degeneration affects more than 1.75 million people in the United States. The U.S. population is aging rapidly, and this number is expected to increase to almost three million by 2020. Currently, there is no cure for AMD, but medical treatment may slow its progression or stabilize it.

Glaucoma. Your risk of developing glaucoma increases with each decade after age 40 - from around 1% in your 40s to up to 12% in your 80s. The number of Americans with glaucoma is expected to increase by 50% (to 3.6 million) by the year 2020. If detected early enough, glaucoma can often be controlled with medical treatment or surgery and vision loss can be prevented.

Diabetic retinopathy. According to the NEI, approximately 10.2 million Americans over age 40 are known to have diabetes. Many experts believe that up to 30% of people who have diabetes have not yet been diagnosed. Among known diabetics over age 40, NEI estimates that 40% have some degree of diabetic retinopathy, and one of every 12 people with diabetes in this age group has advanced, vision-threatening retinopathy. Controlling the underlying diabetic condition in its early stages is the key to preventing vision loss.

HOW AGING AFFECTS OTHER EYE STRUCTURES

While normally we think of aging as it relates to conditions such as presbyopia and cataracts, more subtle changes in our vision and eye structures also take place as we grow older. These changes include:

• Reduced pupil size. As we age, muscles that control our pupil size and reaction to light lose some strength. This causes the pupil to become smaller and less responsive to changes in ambient lighting. Because of these changes, people in their 60s need three times more ambient light for comfortable reading than those in their 20s. Also, seniors are more likely to be dazzled by bright sunlight and glare when emerging from a dimly lit building such as a movie theater. Eyeglasses with photochromic lenses and anti-reflective coating can help reduce this problem.
• Dry eyes. As we age, our bodies produce fewer tears. This is particularly true for women after menopause. If you begin to experience burning, stinging or other eye discomfort related to dry eyes, use artificial tears as needed throughout the day for comfort, or consult your eye doctor for other options such as prescription dry eye medications.
• Loss of peripheral vision. Aging also causes a normal loss of peripheral vision, with the size of our visual field decreasing by approximately one to three degrees per decade of life. By the time you reach your 70s and 80s, you may have a peripheral visual field loss of 20 to 30 degrees. Because the loss of visual field increases the risk for automobile accidents, make sure you are more cautious when driving. To increase your range of vision, turn your head and look both ways when approaching intersections.
• Decreased color vision. Cells in the retina that are responsible for normal color vision decline in sensitivity as we age, causing colors to become less bright and the contrast between different colors to be less noticeable. In particular, blue colors may appear faded or "washed out." While there is no treatment for this normal, age-related loss of color perception, you should be aware of this loss if your profession (for example, artist, seamstress or electrician) requires fine color discrimination.
• Vitreous detachment. As we age, the gel-like vitreous inside the eye begins to liquefy and pull away from the retina, causing "spots and floaters" and (sometimes) flashes of light. This condition, called vitreous detachment, is usually harmless. But floaters and flashes of light can also signal the beginning of a retinal detachment - a serious problem that can cause blindness if not treated immediately. If you experience flashes and floaters, see your eye doctor immediately to determine the cause.

WHAT YOU CAN DO ABOUT AGE-RELATED VISION CHANGES

A healthy diet and wise lifestyle choices - including exercising regularly, maintaining a healthy weight, reducing stress and not smoking - are your best natural defenses against vision loss as you age. Also, have regular eye exams with a caring and knowledgeable optometrist or ophthalmologist.

Be sure to discuss with your eye doctor all concerns you have about your eyes and vision. Tell them about any history of eye problems in your family and any health problems you may have. Also, let your eye doctor know about any medications you take, including non-prescription vitamins, herbs and supplements.

Article by AllAboutVision.com. ©2009 Access Media Group LLC. All rights reserved. Reproduction other than for one-time personal use is strictly prohibited.

↑

EIGHT WAYS TO PROTECT YOUR EYESIGHT

Sight-threatening eye problems affect one in six adults aged 45 and older. And the risk for vision loss increases with age. In fact, a recent American Academy of Ophthalmology (AAO) report estimates that more than 43 million Americans will develop age-related eye diseases by the year 2020.

TIPS FOR PROTECTING YOUR EYES

To protect your eyesight and keep your eyes healthy as you age, consider these simple guidelines:

• Be aware of your risk for eye diseases. Find out about your family's health history. Do you or any of your family suffer from diabetes or have high blood pressure? Are you over the age of 65? Are you an African-American over the age of 40? Any or all of these traits increase your risk for sight-threatening eye diseases. Regular eye exams can detect problems early and help preserve your eyesight.
• >Have regular exams to check for diabetes and high blood pressure. If left untreated, these diseases can cause eye problems. In particular, diabetes and high blood pressure can lead to diabetic retinopathy, macular degeneration, glaucoma and ocular hypertension.
• Look for changes in your vision. If you start noticing changes in your vision, see your eye doctor immediately. Trouble signs include double vision, hazy vision and difficulty seeing in low light conditions. Other signs to look for are frequent flashes of light, floaters, and eye pain and swelling. All of these signs and symptoms can indicate a potential eye health problem that needs immediate attention.
• Exercise more frequently. According to
• Protect your eyes from the sun's UV rays. You should always wear sunglasses with proper UV protection to shield your eyes from the sun's harmful rays. This may reduce your risk of cataracts and other eye damage.
• Eat a healthy and balanced diet. Numerous studies have shown that antioxidants can possibly reduce the risk of cataracts. These antioxidants are obtained from eating a diet containing plentiful amounts of fruits and colorful or dark green vegetables. Studies have also shown that eating fish rich in omega-3 fatty acids may also prevent macular degeneration.
• Get your eyes checked at least every two years. A thorough eye exam, including dilating your pupils, can detect major eye diseases such as diabetic retinopathy, which has no early warning signs or symptoms. A comprehensive eye exam also can ensure that your prescription for eyeglasses or contact lenses is accurate and up-to-date.
• Don't smoke. The many dangers of smoking have been well documented. When it comes to eye health, people who smoke are at greater risk of developing age-related macular degeneration and cataracts.
• Following these steps is no guarantee of perfect vision throughout your lifetime. But maintaining a healthy lifestyle and having regular eye exams will certainly decrease your risk of sight-stealing eye problems and help you enjoy your precious gift of eyesight to the fullest.

Article by AllAboutVision.com. ©2009 Access Media Group LLC. All rights reserved. Reproduction other than for one-time personal use is strictly prohibited.

↑

TIPS FOR COPING WITH VISION LOSS

Many normal, age-related problems affecting vision can be addressed with practical solutions, such as extra lighting for reading recipes or tinkering with garage projects.

In fact, after about age 60, you may find you need additional illumination for most tasks performed indoors or in darker conditions outdoors. This is because your eye's pupil no longer opens as widely as it once did to allow light to enter. Because less light is reaching your retina where vision processing occurs, images are no longer as sharp as they once were.

To help offset this problem, you might consider extra steps such as:

• Installing task lighting underneath kitchen cabinets or above stoves to help illuminate darker corners.
• Making sure you have enough lighting to brighten work surfaces in your garage, sewing room or other areas where you need to see fine details.
• Asking your employer to install additional lighting, if needed, at your work space.

Also, make sure you have regular eye exams that include critical tests for older eyes to rule out potentially serious age-related eye diseases that may affect vision quality. Your eye doctor also can advise you about the best vision correction options to reduce the effects of normal age-related declines in near vision, color vision and contrast sensitivity.

Cataracts, which are very common in the over-60 age group, also can cause cloudy or hazy vision. Cataracts usually are easily remedied with surgery that removes the eye's cloudy lens and replaces it with an artificial one.

WHAT CAN YOU DO ABOUT PERMANENT VISION LOSS?

Unfortunately, some serious vision losses are due to blind spots caused by age-related eye diseases including glaucoma, advanced macular degeneration and diabetic retinopathy.

Many low vision devices are available for people with permanent vision loss, to assist them with daily living tasks. These devices include:

• Strong magnifying lenses with extra illumination, for reading and other near vision work.
• Audio tapes, specially adapted computer or television screens, and telescopes.
• Lens filters and shields to reduce glare.

VISION LOSS AND THE ELDERLY

One disturbing trend noted in recent years has been an increased tendency in our society to overlook or neglect the vision correction needs of elderly citizens, including those living in nursing homes.

As an example, researchers say almost one third of older Americans diagnosed with glaucoma receive no treatment for this potentially blinding eye disease.

Consequences of delaying vision correction or needed treatment, especially in elderly people, can be severe. Uncorrected vision problems can contribute to falls that seriously injure elderly people and greatly reduce their confidence in their ability to live independently.

If you have older relatives or friends living alone or in a nursing home, consider serving as their advocate to make sure they receive appropriate vision care and treatment of age-related eye diseases, to maximize their quality of life.

Article by AllAboutVision.com. ©2009 Access Media Group LLC. All rights reserved. Reproduction other than for one-time personal use is strictly prohibited.

↑