All About Vision
Is laser eye surgery for everyone?
Below are some guidelines to help you decide if LASIK is a good choice for you.
- Vision stability: Young adults often experience annual changes in their prescription for eyeglasses or contact lenses. A 12-month period of maintaining the same prescription is highly recommended prior to LASIK. Otherwise there is a considerable risk of requiring repeated LASIK surgery in the future.
- Healthy Eyes: Problems, diseases or conditions related to your eyes could cause increased risks to both the actual surgery and the healing process. If you have a condition that can be treated such as dry eyes, pink eye (conjunctivitis) or any eye injury speak to your doctor. It is probably best to wait until the condition is resolved to schedule your LASIK surgery. Conditions like cataracts, glaucoma, and other more serious conditions may disqualify you from LASIK altogether.
- Age: 18 is the minimum age of consent for LASIK. Younger patients may be able to get special exemptions based on certain circumstances.
- Vision prescription range: A very high degree of myopia may require removal of too much corneal tissue. This may exclude your candidacy for LASIK or make another refractive surgery a better option. For example, many surgeons conclude that a phakic IOL procedure provides better results and possesses less risk than LASIK for nearsighted prescriptions higher than -9.00 diopters.
- Pregnancy: Normal hormonal changes of pregnancy may cause swelling of the cornea which can alter vision. Dry eye is also common during pregnancy. Additionally, medications (antibiotics or steroids) which are administered for LASIK could cause risk to the embryo or nursing infant. It is recommended to delay LASIK for several months after childbirth until the eyes stabilize and risks are reduced.
- Systemic and autoimmune diseases such as rheumatoid arthritis, type 1 diabetes, HIV or AIDS may disqualify or delay candidacy for LASIK. If your body has trouble healing, your cornea may not heal properly after LASIK surgery. Opinions vary among professionals as far as which diseases automatically disqualify and which ones pose acceptable risks. Discuss this in depth with your doctor if applicable.
Contact lenses are a great alternative to wearing eyeglasses. An often unknown fact is that not all patients wear contact lenses as their primary source of vision correction. Each patient is different, with some patients wearing contact lenses only on weekends, special occasions or just for sports. That is the beauty of contact lens wear, the flexibility it gives each individual patient and their lifestyle.
If you decide to opt for contact lens wear, it is very important that the lenses fit properly and comfortably and that you understand contact lens safety and hygiene. A contact lens exam will include both a comprehensive eye exam to check your overall eye health, your general vision prescription and then a contact lens consultation and measurement to determine the proper lens fit.
The Importance of a Comprehensive Eye Exam
Whether or not you have vision problems, it is important to have your eyes checked regularly to ensure they are healthy and that there are no signs of a developing eye condition. A comprehensive eye exam will check the general health of your eyes as well as the quality of your vision. During this exam the eye doctor will determine your prescription for eyeglasses, however this prescription alone is not sufficient for contact lenses. The doctor may also check for any eye health issues that could interfere with the comfort and success of contact lens wear.
The Contact Lens Consultation
The contact lens industry is always developing new innovations to make contacts more comfortable, convenient and accessible. Therefore, one of the initial steps in a contact lens consultation is to discuss with your eye doctor some lifestyle and health considerations that could impact the type of contacts that suit you best.
Some of the options to consider are whether you would prefer daily disposables or monthly disposable lenses, as well as soft versus rigid gas permeable (GP) lenses. If you have any particular eye conditions, such as astigmatism or dry eye syndrome, your eye doctor might have specific recommendations for the right type or brand for your optimal comfort and vision needs.
Now is the time to tell your eye doctor if you would like to consider colored contact lenses as well. If you are over 40 and experience problems seeing small print, for which you need bifocals to see close objects, your eye doctor may recommend multifocal lenses or a combination of multifocal and monovision lenses to correct your unique vision needs.
Contact Lens Fitting
One size does not fit all when it comes to contact lenses. Your eye doctor will need to take some measurements to properly fit your contact lenses. Contact lenses that do not fit properly could cause discomfort, blurry vision or even damage the eye. Here are some of the measurements your eye doctor will take for a contact lens fitting:
In order to assure that the fitting curve of the lens properly fits the curve of your eye, your doctor will measure the curvature of the cornea or front surface of the eye. The curvature is measured with an instrument called a keratometer to determine the appropriate curve for your contact lenses. If you have astigmatism, the curvature of your cornea is not perfectly round and therefore a “toric” lens, which is designed specifically for an eye with astigmatism, would be fit to provide the best vision and lens fit. In certain cases your eye doctor may decide to measure your cornea in greater detail with a mapping of the corneal surface called corneal topography.
Pupil or Iris Size
Your eye doctor may measure the size of your pupil or your iris (the colored area of your eye) with an instrument called a biomicroscope or slit lamp or manually with a ruler or card. This measurement is especially important if you are considering specialized lenses such as Gas Permeable (GP) contacts.
Tear Film Evaluation
One of the most common problems affecting contact lens wear is dry eyes. If the lenses are not kept adequately hydrated and moist, they will become uncomfortable and your eyes will feel dry, irritated and itchy. Particularly if you have dry eye syndrome, your doctor will want to make sure that you have a sufficient tear film to keep the lenses moist and comfortable, otherwise, contact lenses may not be a suitable vision option.
A tear film evaluation is performed by the doctor by putting a drop of liquid dye on your eye and then viewing your tears with a slit lamp or by placing a special strip of paper under the lid to absorb the tears to see how much moisture is produced. If your tear film is weak, your eye doctor may recommend certain types of contact lenses that are more successful in maintaining moisture.
Contact Lens Trial and Prescription
After deciding which pair of lenses could work best with your eyes, the eye doctor may have you try on a pair of lenses to confirm the fit and comfort before finalizing and ordering your lenses. The doctor or assistant would insert the lenses and keep them in for 15-20 minutes before the doctor exams the fit, movement and tearing in your eye. If after the fitting, the lenses appear to be a good fit, your eye doctor will order the lenses for you. Your eye doctor will also provide care and hygiene instructions including how to insert and remove your lenses, how long to wear them and how to store them if relevant.
Your eye doctor may request that you schedule a follow-up appointment to check that your contact lenses are fitting properly and that your eyes are adjusting properly. If you are experiencing discomfort or dryness in your eyes you should visit your eye doctor as soon as possible. Your eye doctor may decide to try a different lens, a different contact lens disinfecting solution or to try an adjustment in your wearing schedule.
According to experts, 80% of learning is visual, which means that if your child is having difficulty seeing clearly, his or her learning can be affected. This also goes for infants who develop and learn about the world around them through their sense of sight. To ensure that your children have the visual resources they need to grow and develop normally, their eyes and vision should be checked by an eye doctor at certain stages of their development.
According to the American Optometric Association (AOA) children should have their eyes examined by an eye doctor at 6 months, 3 years, at the start of school, and then at least every 2 years following. If there are any signs that there may be a vision problem or if the child has certain risk factors (such as developmental delays, premature birth, crossed or lazy eyes, family history or previous injuries) more frequent exams are recommended. A child that wears eyeglasses or contact lenses should have his or her eyes examined yearly. Children’s eyes can change rapidly as they grow.
Eye Exams in Infants: Birth – 24 Months
A baby’s visual system develops gradually over the first few months of life. They have to learn to focus and move their eyes, and use them together as a team. The brain also needs to learn how to process the visual information from the eyes to understand and interact with the world. With the development of eyesight, comes also the foundation for motor development such as crawling, walking and hand-eye coordination.
You can ensure that your baby is reaching milestones by keeping an eye on what is happening with your infant’s development and by ensuring that you schedule a comprehensive infant eye exam at 6 months. At this exam, the eye doctor will check that the child is seeing properly and developing on track and look for conditions that could impair eye health or vision (such as strabismus(misalignment or crossing of the eyes), farsightedness, nearsightedness, or astigmatism).
Since there is a higher risk of eye and vision problems if your infant was born premature or is showing signs of developmental delay, your eye doctor may require more frequent visits to keep watch on his or her progress.
Eye Exams in Preschool Children: 2-5
The toddler and preschool age is a period where children experience drastic growth in intellectual and motor skills. During this time they will develop the fine motor skills, hand-eye coordination and perceptual abilities that will prepare them to read and write, play sports and participate in creative activities such as drawing, sculpting or building. This is all dependent upon good vision and visual processes.
This is the age when parents should be on the lookout for signs of lazy eye (amblyopia) – when one eye doesn’t see clearly, or crossed eyes (strabismus) – when one or both eyes turns inward or outward. The earlier these conditions are treated, the higher the success rate.
Parents should also be aware of any developmental delays having to do with object, number or letter recognition, color recognition or coordination, as the root of such problems can often be visual. If you notice your child squinting, rubbing his eyes frequently, sitting very close to the tv or reading material, or generally avoiding activities such as puzzles or coloring, it is worth a trip to the eye doctor.
Eye Exams in School-Aged Children: Ages 6-18
Undetected or uncorrected vision problems can cause children and teens to suffer academically, socially, athletically and personally. If your child is having trouble in school or afterschool activities there could be an underlying vision problem. Proper learning, motor development, reading, and many other skills are dependent upon not only good vision, but also the ability of your eyes to work together. Children that have problems with focusing, reading, teaming their eyes or hand-eye coordination will often experience frustration, and may exhibit behavioral problems as well. Often they don’t know that the vision they are experiencing is abnormal, so they aren’t able to express that they need help.
In addition to the symptoms written above, signs of vision problems in older children include:
- Short attention span
- Frequent blinking
- Avoiding reading
- Tilting the head to one side
- Losing their place often while reading
- Double vision
- Poor reading comprehension
The Eye Exam
In addition to basic visual acuity (distance and near vision) an eye exam may assess the following visual skills that are required for learning and mobility:
- Binocular vision: how the eyes work together as a team
- Peripheral Vision
- Color Vision
- Hand-eye Coordination
The doctor will also examine the area around the eye and inside the eye to check for any eye diseases or health conditions. You should tell the doctor any relevant personal history of your child such as a premature birth, developmental delays, family history of eye problems, eye injuries or medications the child is taking. This would also be the time to address any concerns or issues your child has that might indicate a vision problem.
If the eye doctor does determine that your child has a vision problem, they may discuss a number of therapeutic options such as eyeglasses or contact lenses, an eye patch, vision therapy or Ortho-k, depending on the condition and the doctor’s specialty. Since some conditions are much easier to treat when they are caught early while the eyes are still developing, it is important to diagnose any eye and vision issues as early as possible.
Following the guidelines for children’s eye exams and staying alert to any signs of vision problems can help your child to reach his or her potential.
As a child’s eyes develop, it is not uncommon for a number of problems to occur. Beyond blurred vision due to refractive error including nearsightedness (myopia) and farsightedness (hyperopia), children can develop a number of other visual and perceptual problems that are often not detected by a simple vision exam. Even a child with 20/20 vision, can have underlying vision problems!
Some of these issues are functional vision problems having to do with the actual eyes, how they move individually and as a pair, as well as their ability to focus. Functions such as eye teaming, tracking, focusing, and hand eye coordination, all affect a child’s success in school, sports or general functioning. Often children that have difficulty with these functions will suffer physical symptoms as well such as headaches, eye fatigue or short attention spans. With these critical visual skills lacking, tasks such as reading and writing can be extremely difficult and exhausting which can lead to frustration and behavioral problems.
Just like we are able to train our bodies to build strength, speed and agility, our vision skills can be strengthened. Vision therapy offers a doctor-supervised program to guide children to develop these skills.
What is Vision Therapy?
Vision Therapy is a program of progressive eye exercises individualized for each patient designed to retrain or help the patient develop or improve upon particular visual skills or to improve processing and interpretation of visual information. It is used to treat conditions like strabismus (crossed eyes) and amblyopia (lazy eye) as well as eye movement, focus and coordination problems.
Typically, the sessions take place in the optometrist’s office weekly or bi-weekly and utilize a variety of tools such as therapeutic lenses or prisms. Often the patient will be asked to practice certain exercises or activities at home as well in order to reinforce the skills that are being developed. Through repetition of these tasks, the ultimate goal is to strengthen the skills such as focusing, and improving eye movement and alignment, to the point where the eyes and vision are working efficiently and comfortably. The duration of the therapeutic program usually lasts about 6-9 months.
Vision therapy has been scientifically proven to improve functional vision skills and is approved by the major optometric bodies such as the American Optometric Association and the Canadian Association of Optometrists. It does not improve refractive error and should not be mistaken for some of the alternative self-conducted eye exercises out there that claim to improve your vision.
Vision therapy has also been shown to be effective in adults. If you think that vision therapy could be right for your child or yourself, it is worthwhile to have an assessment by a trained vision therapist to determine whether it could help resolve the vision problems that are present.
Most parents believe that if their child had an eye or vision problem they would know. However, this is far from the truth for a number of reasons. First of all, children often can’t express or don’t realize the difficulty they are having, and often vision problems will be overlooked by the associated behavioral issues that come as a result of frustration. Further, many eye or vision problems don’t show symptoms until they have progressed significantly which often makes the condition harder to treat.
Conditions such as amblyopia (lazy eye) or strabismus (crossed-eyes) can be corrected more effectively when they are diagnosed and treated early at a young age. Further, the sooner you diagnose and correct a vision problem, the sooner your child will be able to achieve his or her potential without struggling with these difficulties. This is why it is critical to have your child’s eyes examined by an eye doctor at regular intervals. Here are some FAQ’s and answers about Children’s Vision that every parent should know:
Q: At what ages should children have their eyes examined?
A: The official recommendations for the American and Canadian Optometric Associations are that infants should have their first eye exams at 6 months. Following that, children with no known vision issues should have another exam at 3 years and then prior to entering kindergarten. Children who do not require vision correction or therapy should have a vision checkup every year or two years and those who use vision correction should have an annual eye exam. Of course if your child is experiencing difficulty in school or after school activities that may be due to a vision problem schedule an eye exam immediately.
Q: My child passed a vision screening by the nurse at school. Does he still need an eye exam?
A: Yes. Many schools implement a basic vision screening test to assess whether the child sees clearly at a distance, however these tests are limited in scope. They do not assess functional vision such as the child’s ability to focus, track words on a page or the eyes’ ability to work in tandem. They also do not look at the health of the eye itself. These tests are essential to know the comprehensive picture of how healthy the eyes are and how well they are doing their job. In fact, studies shown that up to 43% of children with vision problems can pass a vision screening test! A comprehensive eye exam will assess all of these functions as well as color vision, depth perception, and eye coordination.
Q: My child was diagnosed with strabismus and amblyopia. Can this be treated and if so, what are the options?
A: Especially when diagnosed early, chances of a complete correction for strabismus and amblyopia are good when treated properly. The optimal age for this to occur is before 8-10 years old. Depending on the severity of the strabismus (crossed-eye), surgery may be required to straighten and properly align the crossed eyes. Amblyopia (lazy eye) can then be treated using eyeglasses, eye patching, or vision therapy to strengthen the weak eye and train the eyes to work together. A doctor that specializes in pediatric optometry can assess the condition and discuss treatment options on an individual basis.
Q: What is vision therapy?
A: Vision therapy is a doctor-supervised, individualized program of exercises to strengthen the functions of the eye. It is used to correct issues with eye alignment, focusing, coordination, tracking and more. Vision therapy often utilizes tools such as specialized lenses or prisms and involves exercises both during office visits and at home to reinforce the changes. The process usually takes about 6 months to see lasting improvement.
Q: My son’s nearsightedness keeps getting worse – he needs a new prescription every year. Is there a way to stop this?
A: There is research that shows that progressive myopia can be stopped or slowed during the childhood years. There are a number of therapies that are used for what is called “myopia control” including multifocal eyeglasses or contact lenses, orthokeratology (ortho-k) or atropine eye drops. Speak to a pediatric optometry specialist to learn more about the options and what might work best for your child.
Q: Every morning it is a fight to get my child to wear her glasses. What can I do?
A: It may take time for your child to adapt to the feel of the glasses and to be comfortable seeing with them. For little children, you can find glasses that come with integrated headbands that can help to hold the glasses in place. It helps to be consistent in putting them on to allow the child to adapt to the feel of the glasses.
Very often, especially for small children that can’t tell you what is bothering them, the reason for a child’s refusal to wear glasses is that something is not comfortable. It could be that the prescription is not right, that the glasses pinch or that are feeling heavy. It could be worthwhile to take the glasses back to the eye doctor to ensure that they are in fact a proper fit.
Q: At what age is it acceptable for a child to wear contact lenses?
A: Contact lenses can be a great convenience, especially for kids that are active or tend to break or lose their glasses. However, they are a medical device that must be treated with proper care and hygiene. If a child is not responsible enough to take care of them properly he could end up with a serious eye infection, a scratched cornea or worse. Most experts agree that the youngest age that contact lenses should be considered would be between 10-12 depending on the child’s maturity and cleanliness. Consult with your eye doctor about what would be best for your child.
Your baby’s visual system is not fully developed at birth and continues to develop gradually over the first days and months of life. In fact, from your baby’s perspective at birth, the world is black and white, blurry and rather flat. As the days and months go on, they begin to focus, move their eyes and start to see the world around them. While each child will grow and develop on his or her own schedule, knowing an infant’s vision milestones will help you ensure that your infant is on track to achieving good vision and eye health and start treatment early if there is a problem.
Birth – 3 months
Because newborn babies’ eyes and visual system are underdeveloped, they can not focus their eyes on close objects or perceive depth or color. Babies need to learn to move, focus and coordinate eye movements to team the eyes (have them move together as a team). The brain also needs to learn how to process the visual information from the eyes to understand and interact with the world. In fact, until about 3 months, the optimal distance a baby can focus on is about 8 – 10 inches from their face, about the distance their parents face will be during feeding.
Your baby will start to be able to perceive color within the first 2-3 weeks, however it will take a few months to learn how to focus and use the eyes, to track objects, differentiate between two objects and shift from one object to the other. During this time you may notice that the eyes appear crossed and do not work together or team. This is quite common at the early stages of development, however if one eye appears to be constantly turned in or out, seek a doctor’s evaluation.
At around three months, as hand-eye coordination begins to develop, a baby should be able to follow a moving target with their eyes and reach for objects.
By 6 months, your baby will begin to move his eyes with more speed and accuracy, seeing at farther distances and focusing well. Color vision should be fully developed and the eyes should be able to work as a team and follow moving objects with relative ease. Hand-eye coordination and depth perception should be greatly improved as your baby will begin to understand the 3-dimensional world around them.
At six months, you should take your baby for his or her first comprehensive eye exam to ensure that the eyes are developing on track and there are no signs of congenital or infant eye disease.
At this stage of development babies will be coordinating vision and body movements by crawling, grasping, standing and exploring the surrounding world. They should be able judge distances accurately, throw a ball toward a target and pick up a small object with their fingers. Delays in motor development can sometimes indicate a vision problem.
The First Eye Exam
While at 6 months, your baby will not be able to read an eye chart, eye doctors can perform an infant eye exam through non-verbal testing to assess visual acuity (for nearsightedness, farsightedness or astigmatism), eye teaming abilities and eye alignment. The eye doctor will also be able to see inside the eye for any signs of disease or problems that could affect eye or vision health.
InfantSEE® is a public health program in which participating optometrists provide a free comprehensive infant eye exam to babies between 6 and 12 months of age. The program was initiated to provide accessible eye and vision care for infants to ensure they have the best chances for normal development and quality of life.
If your child has any unusual symptoms such as excessive tearing, constant eye misalignment, red or crusty eyes or extreme light sensitivity consult an eye doctor as soon as possible.
Many children who wear glasses want to switch to contact lenses, especially older children who are concerned with their appearance. So, how do you know if and when contact lenses might be an option for your child?
Contact lenses may not only improve a child’s confidence in their appearance but they can also be very convenient for active children who play sports or those who tend to lose or break their glasses.
Yet before you jump to schedule an appointment with the optometrist, it’s important to know that while contact lenses are a great solution for many, they are still medical devices that require care and responsibility. Carelessness with contact lenses can lead to infections, irritation, scratched corneas, pain, and sometimes even vision loss. So if you want to know if contact lenses are a good choice for your child, read below and think about whether your child is mature and responsible enough to take proper care of his or her eyes.
At What Age Can a Child Start Wearing Contact Lenses?
The recommended age for kids to start considering contact lenses varies however it is generally accepted that sometime between 11 and 14 is ideal. Some doctors will recommend them even for children as young as 8 years old who have shown that they are responsible enough to use them. Contact lens use requires good hygiene and cleanliness so if your child shows those traits, she may be ready. Additionally, if he is highly motivated to wear contacts and if he has the support of his parents, this will help in ensuring that the daily regimen is a success.
What is the Process of Getting Fitted for Contacts?
The first step is to schedule an appointment for a contact lens exam with your optometrist. The eye doctor will perform a vision exam and go over the different options for contact lenses, depending on the prescription, the health of the eye and lifestyle and personal preferences. Contact lenses are designed with a number of options including the lens materials used (soft or rigid gas permeable), the replacement schedule (if disposable, how often you replace the pair – daily, weekly, biweekly or monthly) and the wear schedule (daily or extended overnight wear). Often doctors will recommend daily lenses for children because they are thrown away after each use so there is less care involved, less buildup and less risk for infection.
Then the doctor will give a training on inserting and removing the lenses as well as instructions for proper care. Your child will probably be given a schedule for wearing the lenses for the first week or so in order to allow their eyes to adapt. During this time you may have to be in touch with your eye doctor to assess the comfort and fit of the lenses and you may have to try out a couple of options in order to find the best fit.
Purchasing Contact Lenses
As a medical device, contact lenses require a prescription and should only be purchased from a licensed distributor such as an eye doctor. Unauthorized or unmonitored contact lenses can cause severe damage to your eyes that could result in blindness. This is true also for cosmetic lenses such as colored lenses or costume lenses. Any time you are putting a lens in your eye, you must have a proper prescription.
Following are some basic contact lens safety tips. If your child is responsible enough to follow these guidelines, he or she may be ready for contact lens use:
- Always follow the wearing schedule prescribed by your doctor.
- Always wash your hands with soap before applying or removing contact lenses.
- Never use any substance other than contact lens rinse or solution to clean contacts (even tap water is a no-no).
- Never reuse contact lens solution
- Follow the eye doctor’s advice about Don’t swimming or showering in your lenses
- Always remove your lenses if they are bothering you or causing irritation.
- Never sleep in your lenses unless they are extended wear.
- Never use any contact lenses that were not acquired with a prescription at an authorized source. Never purchase c