Accommodative Disorder
Definition
Accommodative disorder is a nonpresbyopic, nonrefractive, sensory and neuromuscular anomaly of the visual system. It can be characterized by inadequate accommodative accuracy, reduced facility and flexibility, reduced amplitude of accommodation, or the inability to sustain accommodation.
Symptoms
The symptoms and signs associated with an accommodative dysfunction are related to prolonged, visually demanding, near-centered tasks, including the following:
1. Asthenopia (eye strain)
2. Transient blurred vision
3. Photophobia
4. Abnormal fatigue
5. Headaches
6. Difficulty sustaining near visual function
7. Dizziness
8. Abnormal postural adaptation/abnormal working distance
9. Orbital pain
Diagnostic Factors
Accommodative dysfunctions are characterized by one or more of the following diagnostic findings:
1. Low accommodative amplitude relative to age
2. Reduced accommodative facility at near and/or far
3. Reduced ranges of relative accommodation
4. Abnormal lag of accommodation
5. Unstable accommodative findings
NOTE: Additional testing may be appropriate as part of the differential diagnostic workup for accommodative dysfunction to rule out other concurrent medical conditions and differentiate associated visual conditions.
Therapeutic Considerations
A. Management
The doctor of optometry determines appropriate diagnostic and therapeutic modalities and frequency of evaluation and follow-up on
the basis of the urgency and nature of the patient’s condition and unique needs. The management of the case and duration of the treatment are affected by the following factors:
1. The severity of symptoms and diagnostic factors, including onset and duration of the problem
2. Implications of the patient’s general health and associated visual condition
3. Extent of visual demands placed on the individual
4. Patient compliance
5. Prior interventions
B. Treatment
A number of cases are successfully managed by prescription of therapeutic lenses and/or prisms. However, accommodative dysfunctions may also require orthoptics/vision therapy. Optometric vision therapy usually incorporates the prescription of specific treatments to achieve the following:
1. Normalize accommodative amplitude relative to age
2. Normalize the ability to sustain accommodation
3. Normalize relative ranges of accommodation
4. Normalize accommodative facility relative to age
5. Normalize accommodative/convergence relationship
6. Integrate accommodative function with information processing
Duration of Treatment
The following treatment ranges are provided as a guide for third-party claims processing and review purposes. Treatment duration will depend on the particular patient’s condition and associated circumstances. When duration of treatment beyond these ranges is required, documentation of the medical necessity for additional treatment services may be warranted.
1. The most commonly encountered accommodative dysfunction usually requires 24 to 32 hours of office therapy.
2. Uncomplicated accommodative dysfunction characterized by only a transient loss of accommodative function typically requires
up to 8 hours of office therapy.
3. Accommodative dysfunction complicated by:
a. Reduced amplitude or facility for age: up to an additional 12 hours of office therapy.
b. Accommodative/convergence abnormalities: up to an additional 16 hours of office therapy.
c. Other diagnosed visual anomalies may require additional therapy.
d. Associated conditions such as stroke, head trauma, or other systemic diseases may require substantially more office therapy.
Follow-up Care
At the conclusion of the active treatment regimen, periodic follow-up evaluations should be provided at appropriate intervals. Therapeutic lenses may be prescribed at the conclusion of vision therapy for maintenance of long-term stability.
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Amblyopia
Definition
Amblyopia describes poor vision attributable to improper visual development. During childhood, proper visual stimulus is
required for good vision to develop. Amblyopia has three potential causes: out-of-focus vision, a turned eye, and visual deprivation. Out-of-focus vision results when one or both eyes have a substantial degree of myopia, hyperopia, or astigmatism. When a large asymmetry in focusing exists between the two eyes, the most out-of-focus eye can develop amblyopia. When one eye is turned
inward or outward, the brain will suppress vision out of that eye to prevent double vision. However, the turned eye becomes amblyopic. For out-of-focus vision or an eye turn, glasses, eye patches, and sometimes dilating eye drops can strengthen the amblyopic eye when prescribed early. A less-common cause of amblyopia is visual deprivation, which may be caused by a
congenital cataract or a congenitally droopy eyelid. Cataract surgery or eyelid surgery in these cases can minimize the development
of amblyopia.
Symptoms
The symptoms and signs associated with amblyopia include the following:
1. Reduced acuity in affected eye
2. Poor depth judgment
3. Head tilt/turn
4. Incoordination, reduced ability to direct and coordinate movement visually
5. Anisometropia
6. Strabismus
Diagnostic Factors
Amblyopia is characterized by one or more of the following diagnostic findings:
1. Reduced acuity in the affected eye that does not normalize with the appropriate refractive prescription
2. Inability to maintain stable foveal fixation
3. Suppression of binocular vision
4. Spatial distortion
5. Reduced stereopsis
6. Reduced accommodative facility
7. Inaccurate ocular motor efficiency
8. Asymmetry in performance between the two eyes in the areas of ocular motor and visual information processing skills
NOTE: Additional testing may be appropriate as part of the differential diagnostic workup for amblyopia to rule out other concurrent medical conditions and differentiate associated visual conditions.
Therapeutic Considerations
A. Management
The doctor of optometry determines appropriate diagnostic and therapeutic modalities and frequency of evaluation and follow-up on the basis of the urgency and nature of the patient’s condition and unique needs. The management of the case and duration of
treatment are affected by the following factors:
1. The severity of symptoms and diagnostic factors, including onset and duration of the problem
2. Implications of the patient’s general health and associated visual conditions
3. Extent of visual demands placed on the individual
4. Patient compliance
5. Prior interventions
6. Other associated anomalies such as anisometropia or strabismus
B. Treatment
A small percentage of cases are successfully managed by prescription of therapeutic lenses and/or prisms. However, most
amblyopia requires orthoptics/vision therapy. Optometric vision therapy usually incorporates the prescription of specific treatments
to achieve the following:
1. Eliminate any anisometropia
2. Stabilize central foveal fixation
3. Normalize visual acuity
4. Normalize monocular skills, including oculomotor, accommodative, and reaction time
5. Minimize spatial distortion
6. Eliminate suppression
7. Eliminate any strabismus
8. Integrate visual function with appropriate and accurate motor response
9. Normalize binocular function
Duration of Treatment
The following treatment ranges are provided as a guide for third-party claims processing and review purposes. Treatment duration will depend on the particular patient’s condition and associated circumstances. When duration of treatment beyond these ranges is required, documentation of the medical necessity for additional treatment services may be warranted.
1. The most commonly encountered amblyopia usually requires 28 to 40 hours of office therapy.
2. Amblyopia complicated by:
a. Associated visual adaptations (e.g., abnormal retinal correspondence, eccentric fixation, spatial distortion) require additional office therapy.
b. Associated visual anomalies (e.g., strabismus, nystagmus, cataract) require additional office therapy.
c. Associated conditions such as birth defects and strabismus surgery require substantially more office therapy.
Follow-up Care
At the conclusion of the active treatment regimen, periodic follow-up evaluations should be provided at appropriate intervals. Therapeutic lenses may be prescribed at the conclusion of vision therapy for maintenance of long-term stability. Some cases may require additional therapy because of decompensation.
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The Amsler Grid
The Amsler grid was developed by Marc Amsler to allow patients to test their own central (reading) vision for early signs of retinal
disease that may be treatable. The test consists of a grid of vertical and horizontal lines.
Directions
1. Look through your reading glasses or bifocals.
2. Hold the grid approximately 12 inches from the eye.
3. Keep both eyes open and look at the dot in the center of the grid.
4. Cover the left eye. While looking at the dot, answer the following questions. Can you see all four corners of the grid? Are any of the lines blurry, wavy, distorted, bent, gray, or missing?
5. Repeat the previous step with the right eye.
6. If you note any changes in how you see the grid, call your optometrist.
7. We recommend you use the grid two to three times a week.
8. Place the grid in a convenient place to remind you to use it regularly (e.g., the refrigerator door or bathroom mirror).
You can use the grid below to take the test on your computer screen. Download the grid for use as a screen saver. Alternatively, download the black-on-white version for printing.
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Attention Deficit–Hyperactivity Disorder and Vision
Some children with learning difficulties exhibit specific behaviors of impulsivity, hyperactivity, and distractibility. A common term
used to describe children who exhibit such behaviors is attention deficit–hyperactivity disorder (ADHD).
Undetected and untreated vision problems can elicit some of the same signs and symptoms commonly attributed to ADHD. Because of these similarities, some children with vision problems are mislabeled as having ADHD.
A recent study by researchers at the Children’s Eye Center, University of San Diego, uncovered a relation between a common vision disorder, convergence insufficiency, and ADHD. The study “showed that children with convergence insufficiency are three times as likely to be diagnosed with ADHD than children without the disorder.” Dr. Granet of the Children’s Eye Center
commented, “We don’t know if convergence insufficiency makes ADHD worse or if convergence insufficiency is misdiagnosed as
ADHD. What we do know is that more research must be done on this subject and that patients diagnosed with ADHD should also
be evaluated for convergence insufficiency and treated accordingly.”
This new research appears to support what many doctors have known for some time—a significant percentage of children with learning disabilities have some type of vision problem. One study found that 13% of children between 9 and 13 years of age have moderate to marked convergence insufficiency, and as many as one in four, or 25% of school-age children, may have a vision problem that can affect learning.
Vision problems can have a huge impact on academic performance and behavior in the classroom. Parents who suspect a vision
problem may be contributing to their child’s learning or behavior problems should arrange for a complete functional vision examination.
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Blepharitis
Acute infections of the eyelid—those that flare up with little or no warning—are irritating and can affect your vision. You may have
symptoms such as itchy or burning eyes, blurred vision, gritty or granular sensations, or oily tears. These conditions are caused by either blepharitis, a medical term that means inflammation of the eyelid, or meibomianitis, inflammation of the oil-producing glands of the eye.
Blepharitis is usually caused by Staphylococcus bacteria that thrive in excess oil produced by the glands of the eyelid.
Blepharitis sometimes accompanies outbreaks of acne. The inflammation may be worsened by tea or alcohol consumption and may become chronic. The essence of therapy is to prevent the infection from causing chronic symptoms or more serious problems.
Depending on the severity of your symptoms, we may prescribe any or all of the following therapies:
1. Warm or hot moist compresses applied to the eye.
2. Eyelid cleansing procedures. Although neither this nor hot compresses are a cure for infection, both actions help remove debris that has become trapped in the glands and eyelashes.
3. Manual expression of excess oil from the oil glands at the edges of the eyelids. Applying hot compresses before the expression usually helps the glands flow more freely and release trapped bacteria.
4. In more severe cases we may prescribe antibiotic eye drops. These may or may not be in combination with a corticosteroid, an antiinflammatory drug. Sometimes, instead of an antibiotic eye drop, antibiotic topical ointment is prescribed that should be applied along the edge of the eyelids. Oral antibiotics may also be used (a treatment usually reserved for special cases). Blepharitis can recur or remain chronic if not treated completely. Eyelid hygiene procedures are important in removing the
bacteria that remain trapped in your lashes or lid areas of your eyes.
Directions for a Warm Soak of the Eyelids
1. Wash your hands thoroughly.
2. Moisten a clean washcloth with warm water.
3. Close the eyes and place the washcloth on the eyelid for approximately 5 minutes.
4. Repeat several times daily.
Directions for an Eyelid Scrub
1. Wash your hands thoroughly.
2. Mix warm water and a small amount of shampoo that does not irritate the eye (e.g., baby shampoo).*
3. Close one eye and use a clean washcloth (a different one for each eye) to rub the shampoo mixture back and forth across the eyelashes and the edge of the eyelid.
4. Rinse with cool, clear water.
5. Repeat on the other eye.
.* If the eye becomes red or painful, consult an eye care professional immediately.
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Branch Retinal Vein Occlusion
Branch retinal vein occlusion (BRVO) is a cause of painless vision loss in the upper, lower, or central field of vision. It may also
occur with no symptoms. Occlusion occurs when blood flow in a vein is reduced or blocked.
When BRVO occurs, we look for associated conditions. If vision is affected, treatment with a laser may improve vision or reduce the risk of further vision loss. In most cases, we wait for spontaneous improvement. If vision is blurred, treatment is guided by techniques that have been tested in national controlled clinical trials.
In BRVO, an artery crossing over the retinal vein at the point of obstruction is usually present. This can pinch the vein, like
stepping on a garden hose, thereby cutting off blood flow. The area of the retina that drained through this vein may become congested
or swollen. Areas of the retina may bleed or die. Sometimes the obstruction is reversible, and sometimes it is irreversible.
The leading cause of blurred vision in BRVO is macular edema, in which swelling of the central retina is caused when blood cannot flow through the blocked vein, allowing water to leak into the retina.
Causes
The most common cause of BRVO is arteriolosclerosis. However, it may be more likely to occur in people with a history of hypertension, diabetes, glaucoma, ocular inflammation, or carotid artery disease. BRVO may occur in hyperviscosity syndromes, in which the blood is too thick. The conditions associated with BRVO are detected by complete ocular and general examinations and laboratory or blood tests. If a systemic condition is found, treatment reduces risk for the other eye.
Visual Loss: Proliferation and Macular Edema
At its worst, BRVO can rarely cause closure of vessels in the macula and nonfunction. Areas of retina with poor blood flow may sometimes allow new vessels to grow on the back surface of the vitreous gel. When these vessels grow, they are fragile. They can break, bleed, and fill the eye with blood. Symptoms of floaters or cobwebs may be present.
Macular edema is the most common cause of vision loss in BRVO. Cystlike spaces form within the retina, causing swelling and potentially reversible visual loss.
Treatment
Laser is a light focused to a pin point. It can dry swollen retinal tissues or burn retinal tissue that has new vessels. Laser treatment
for macular edema is brief. A grid pattern of laser is used if vision is 20/40 or worse for 2 to 3 months with cystoid macular edema. Laser therapy is a simple outpatient procedure performed in the office. Treatment occasionally must be repeated if swelling is still present 3 months after the initial laser treatment.
An alternative treatment for macular edema instead of, or in addition to, laser is the injection of triamcinolone in the vitreous. This is also performed in the office.
Surgery on the obstructed vein and the overlying artery to relieve the blockage with a vitrectomy shows some promise.
If new vessels grow, scatter laser photocoagulation indirectly treats these vessels, reducing the risk of bleeding.
Prognosis
Many BRVOs are asymptomatic. If vision is affected, laser treatment for macular edema increases the chances of vision improvement by more than 60%. An injection of a steroid may help patients for whom laser alone does not help. If vitreous bleeding occurs, scatter laser reduces the chance of severe visual loss in more than 85% of patients. The blood usually clears spontaneously.
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Cataract
A cataract is an opaque film or cloudiness that occurs in the lens within the eye. It may consist of varying size opacities and/or
water vacuoles. In general, it is an alteration in the normal lens tissue that reduces its normal high degree of transparency. This, in turn, interferes with the degree and quality of light reaching the retina.
Symptoms
Symptoms of cataract include blurred vision at far and near, poor night vision, glare sensitivity, need for more light to see indoors, distorted lights when viewing at night, and halos around lights.
Risk Factors
Risk factors include radiation (sunlight and treatments), smoking, alcohol, medications, and genetics. The main cause of cataract is sunlight radiation. The sunlight tans the lens inside our eye much like it tans our skin. Whereas we get new skin cells on an average
of every 26 days, the lenses inside our eyes have to last our entire lives. The energy in the sunlight, particularly ultraviolet radiation, causes the formation of unstable molecules called free radicals. These free radicals change the lens tissue, causing distortion and darkening.
Cataracts can be directly or indirectly affected by medications and diseases. Many medications cause the opening of the eye to enlarge, allowing more harmful light into the eye. Examples are antidepressants, antihistamines, amphetamines, nitroglycerin, and beta-blockers. Other drugs, such as steroids and tamoxifen, can cause cataracts. Some drugs, like diuretics (water pills), cause the tissue to be photosensitized, which results in increased sensitivity to sunlight. Medical conditions such as diabetes, hypertension, rheumatoid arthritis, and other connective diseases are commonly associated with cataracts.
Treatment
Treatment includes eyeglasses, contact lenses, and surgery. New technologies in eyeglasses and contact lenses allow better vision. Ultraviolet radiation filters, nonglare technology, and the correction of higher-order aberrations with wavefront technology can
result in better vision through cataract changes. The best preventive treatment for the progression of cataracts is polarized sunglasses with the addition of an antireflection coating on the backs of the lenses.
Cataracts are generally not surgically removed until vision cannot be improved to reasonable levels with eyeglasses or contact lenses. The decision for having surgery usually depends on whether you can see well enough to do what you want to do. Phakoemulsification is
a surgical technique used to allow small incisions sometimes not requiring any sutures. An artificial lens is implanted that may provide excellent vision without the need for strong glasses or contact lenses. Prognosis for good vision is excellent.
Cataracts tend to progress at a slow pace and, as a rule, can be monitored on a yearly basis. At the appropriate time we can recommend the best surgeon for your particular type of cataract.
For the near future we should monitor your eye health status and cataract development on a regular basis.
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Lenses for Patients with Developing Cataracts
Our doctors and staff are pleased to be able to provide you the latest technology in eyeglasses. Summarized below are new
improvements in technology and the benefits available to you.
During the course of your examination we discovered that you are showing cataract changes. Today’s lens technology allows us
to prescribe glasses that will slow the development of your cataracts as well as improve your remaining vision. You may recall from the explanation given by the doctor that the lens inside the eye tends to become cloudier with age. This prevents the lens from
properly focusing light on the retina at the back of the eye, resulting in a loss of vision. The clouding results from chemical changes within the lens. Ultraviolet (UV) light and visible light can cause the lens to “tan,” much like tanning your skin. We replace our skin cells every 26 days, but the lens inside the eye must last throughout our lives.
Sun Lenses
The lens technology we have prescribed for you will block 100% of the most damaging light in the atmosphere. The tint recommended for you will block from 60% to 85% of the visible light necessary to see during daylight hours. Some tints are
prescribed to allow normal color perception, and others are designed to increase contrast. The appropriate tint depends on the extent
of your cataract changes and your personal needs. New lens technology also reduces the glare off surfaces such as roadways or reflections off water.
Lenses specifically designed to inhibit the progression of cataracts are manufactured from high-technology polymers, which are the least likely to break in case of an accident. The lens material is lighter, thinner, and the safest available.
Indoor Lenses
The clouding of the lens of the eye causes less light to reach the retina. New lenses allow nearly 10% more light to enter the eye. Thinner lens designs also result in more light reaching your retina. Newer lenses eliminate irritating reflections and improve
contrast with high-technology tints and coatings. The additional light, loss of glare, and improved contrast will allow you to read more comfortably and see better when driving at night.
These indoor lenses and sun lenses have properties that will provide you with better vision as well as protect you from the light rays contributing to the cataracts. Remember to wear your special sunglasses during all outdoor activities in the daylight. Try them
on cloudy days and you may discover after a minute or so that you will adapt and see well with the sun lenses.
Our doctors and staff will continue to monitor new changes in lens technology that will benefit you. With today’s new lens technology and adherence to your doctor’s prescriptions, you can expect to see well the rest of your life. Thank you for the opportunity to provide you with your vision care. We look forward to seeing you in the future.
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Central Retinal Vein Occlusion
Central retinal vein occlusion (CRVO) is a cause of painless vision loss throughout the field of vision, often worst centrally.
It may also occur with minimal symptoms. Blood flow in the main vein draining the retina is blocked or reduced. If vision is poor because of swelling of the central retina, give an injection or surgery may improve vision. If vision is severely affected, laser
therapy to prevent painful glaucoma. Treatment guidelines have been developed by national controlled clinical trials to stop unwanted new blood vessels from growing in the eye.
How the Eye Works
The eye works like a camera. The lens and cornea focus light rays into the back of the eye. The retina works like the photographic film in a camera. The macula is part of the central retina, with which we see fine details and color.
Arteries bring blood to the retina. Veins take blood away from the retina. The main vessel that leads from the retina through the optic nerve to the heart is the central retinal vein.
Obstruction of the Central Retinal Vein
In CRVO an obstruction of the central retinal vein in the optic nerve is usually present. The vein may be pinched, as when stepping
on a garden hose, thereby cutting off the flow. The retina may bleed, die, or become congested and swollen. A leading cause of
blurred vision in CRVO is macular edema. In some cases we treat this to improve vision, especially if vision at presentation is poor.
If vision has dropped to 20/200, there is up to a 20% chance of improving to 20/100 or better without treatment. Only 6% of patients improve by three lines on the visual activity chart. If vision is good to begin with, it often stays good. If the vision is fair, it may worsen in 47% of patients.
Causes of Central Retinal Vein Occlusion
The cause of CRVO is usually unknown. It is more likely to occur in people with a history of hypertension, diabetes, glaucoma, ocular inflammation, or carotid artery disease. It may also occur in hyperviscosity syndromes, in which the blood is too thick.
The conditions associated with CRVO are detected with complete ocular and general examinations and laboratory or blood tests. Their treatment may reduce risks of vein occlusion in the other eye.
Neovascular Glaucoma
The worst complication of CRVO is growth of new blood vessels in the drain for fluid inside the eye, or anterior chamber angle.
If the retina has lost blood flow and vision is quite poor, the retina produces a chemical that calls for vessels to grow, which can cause painful glaucoma.
Eyes with severe CRVO should be monitored every month for 6 months, then every 3 months thereafter. If new vessels are found, laser treatment may stop this vessel growth, control intraocular pressure, and prevent pain in the eye.
Retinal Neovascularization
Rarely, new vessels grow from the surface of the retina. These new vessels may break, bleed, and fill the eye with blood. Retinal detachment is a late cause of vision loss. Laser treatment with focused intense light may cause the blood vessels to disappear and preserve some vision. If the eye fills with blood, surgery is occasionally indicated to restore some vision. However, reading vision is generally poor.
Macular Edema
Swelling of the retina is a common cause of vision loss in CRVO. In eyes that still have blood flow to the macula, intravitreal steroids may lead to visual improvement, but not in all cases. More than one injection may be needed. In others, vitrectomy with radical optic neurotomy may be indicated. Not everyone with CRVO and macular edema is a candidate for treatment with intravitreal steroid injection or radical optic neurotomy. Ask your doctor for details.
Conclusion
CRVO is a significant cause of vision loss and discomfort. Frequent follow-up is often required. We are able to help improve vision
in some eyes, and appropriate laser treatment may prevent severe glaucoma.
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Central Serous Chorioretinopathy
Central serous chorioretinopathy (CSC) is a cause of painless vision loss in the central field of vision. Distortion, a central blind or
gray spot, and color vision changes may be present, and objects may look smaller. In some people the onset of symptoms may be accompanied or preceded by migrainelike headaches.
In most cases we wait for spontaneous improvement, with the majority of patients (80% to 90%) returning to 20/25 or better vision. Patients with classic CSC have a 40% to 50% risk of recurrence in the same eye. If vision is affected, treatment with laser may
improve vision or reduce the risk of further vision loss.
How the Eye Works
The eye works like a camera. The lens and cornea focus light rays. The retina works like the photographic film in a camera.
The retina is transparent. The layer beneath it, the retinal pigment epithelium (RPE), gives an orange color to the inside of the eye. Beneath this is the choroid, a layer of blood vessels thought to be the source of fluid under the retina in CSC.
Fluid under the Central Retina
The hallmark of CSC is fluid under the central retina. This is seen as a leak from one or more spots on a fluorescein angiogram. RPE
detachments and multiple leaking spots may also be present. The other eye will be affected in up to 20% of patients at some point.
Who Gets Central Serous Chorioretinopathy?
Traditionally, CSC has been thought of as a disease affecting young 20- to 45-year-old men. It has recently been diagnosed with increasing frequency among patients older than 50 years. In this age group, the male to female ratio diminishes to 2:1 from the 10:1 ratio seen in younger patients. CSC is uncommon among African Americans but is frequent in whites, Hispanics, and Asians.
Causes
The exact cause of CSC is highly controversial. An imbalance appears to exist in the amount of fluid that enters the subretinal space and the RPE’s ability to remove it. This results in a net accumulation of fluid beneath the retina.
Systemic associations of CSC includes organ transplantation, exogenous steroid use, endogenous hypercortisolism (Cushing’s syndrome), systemic hypertension, systemic lupus erythematosus, pregnancy, and use of some medications.
Finally, type A personalities and major stressful events may be associated with CSC, presumably because of elevated blood cortisol and epinephrine levels.
Laser Treatment for Central Serous Chorioretinopathy
Laser photocoagulation is the application of a bright light to the area of leakage to seal the leak spot found on the fluorescein angiogram. Laser treatment shortens the course of the disease and decreases the risk of recurrence for CSC, but it does not appear
to improve the final visual prognosis.
Laser photocoagulation should be considered under the following circumstances:
1. Persistence of a serous detachment for more than 3 to 4 months
2. Recurrence in a eye with visual deficit from previous CSC
3. Presence of visual deficits in the opposite eye from previous episodes of CSC
4. Occupational or other patient need requiring prompt recovery of vision, such as with police officers or pilots
Laser treatment may be considered in recurrent episodes of serous detachment with a leak located more than 300 ?m from the center of the fovea. Each case must be approached individually.
Rarely patients develop choroidal neovascularization at the site of leakage and laser treatment. If laser treatment is performed
close to the center of vision, a small blind spot may be present that usually fades. Despite treatment and reattachment of the retina, vision may not return to normal.
Prognosis
The prognosis for visual recovery in CSC is generally good. The leaks usually close spontaneously and the detachment resolves
over a period of weeks to months. Most patients (more than 90%) will retain vision of 20/30 or better in the affected eye. However, some patients may still note some mild changes in vision such as decreased contrast, mild distortion, and decreased night visio
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Chalazia and Styes
Your eyelids are quite important. They protect your eyes from approaching objects and irritating particles in the air. When you
blink, your eyelids help remove foreign objects and distribute tears, which lubricate your eyes. But sometimes your eyelids can have problems and need care. Two common conditions that affect your eyelids are chalazia and styes.
A chalazion results from a blockage of one or more of the small oil-producing glands (meibomian glands) found in the upper and
lower eyelids. These blockages trap the oil produced by the glands and cause a lump on the eyelid that is usually about the size of a pea. These are usually relatively painless, although in some cases you may appear to have a black eye. If the chalazion becomes
infected, the eyelid can become swollen, inflamed, and more painful.
Styes are often confused with chalazia. Styes are infections or abscesses of an eyelid gland near an eyelash root or follicle. They generally occur nearer to the edge, or margin, of the eyelid than do chalazia, where they form a red, sore lump similar to
a boil or pimple.
In some cases, both chalazia and styes may come to a head and drain on their own without treatment. However, in most instances they do not.
A chalazion may be treated by applying hot compresses and/or antibiotic eye drops.* In some cases, steroid drugs may be injected into or adjacent to the site of the chalazion. A chalazion may also be treated by surgical incision and drainage when necessary. Sometimes oral medications are prescribed.
Styes may also be treated with hot compresses.* Frequently, antibiotic and/or steroid eye drops or ointments may be needed. Chalazia and styes most often respond well to treatment. If left untreated, however, they can be uncomfortable and unattractive
and can lead to other problems. Chalazia and styes may recur. If this happens too frequently, your doctor of optometry may recommend additional tests to determine if other health problems may be contributing to their development.
Directions for Application of Hot Compresses
1. Wash your hands thoroughly.
2. Moisten a clean washcloth with hot water.*
3. Close your eyes and place the washcloth on the eyelid for approximately 10 to 15 minutes.
4. Remoisten the washcloth as necessary to keep it hot.
5. Repeat at least four times a day.
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Computer Glasses
More than 100 million Americans use computers every day at work, and 70% of them have vision problems. Computer use puts a
great demand on our eyes. The doctor has completed an examination designed to reveal problems that can limit your performance when using a computer. He has determined that you can benefit from wearing glasses designed specifically for computer use.
Focused for the Computer
Glasses designed for the computer have many special features. The prescription will focus your eyes to allow minimal effort when trying to see at computer distances. Focusing your eyes for the computer allows the muscles inside your eyes to relax, reducing the possibility of eye strain and fatigue.
Nonglare Lenses
The lenses prescribed for you are nonglare lenses. Glare is a constant cause of visual disturbance when using computers. Reflections off the surfaces of your lenses can result in loss of nearly 10% of light. This loss of light entering your eye will decrease the contrast of the figures and letters. Loss of contrast can especially be a problem with those who have developing cataracts or macular degeneration. Reflections from the back of the spectacle lenses can also enter directly into the eye, causing
irritating glare and degradation of the optical images. This glare is particularly noticeable in very nearsighted (myopic) individuals. The nonglare lens allows more light to the retina and reduces these reflections.
High-Tech Lens Material
Today’s technology allows lenses to be made from many different materials. Your lenses are composed of polycarbonate, the same material used in the aerospace industry and in compact disks. The benefit of this material is that it is nearly unbreakable. Polycarbonate is the safest lens material and is known as the most break-proof lens fabricated. The lens comes with a high-tech, scratch-resistant coating that allows it to last longer than other lenses.
Thin and Light
Besides being breakage resistant, your lenses are also the thinnest and lightest available. This lower weight allows your glasses to maintain the proper adjustment so all measurements remain in the correct place, allowing you the best vision.
High-Tech Lens Design
The doctor prescribed the lens design that allows you the most use of your vision while using the computer. The design may take several forms. New technology has provided designs specific to computer users. The new high-tech designs allow for normal head postures, relaxing the neck and shoulder muscles. Musculoskeletal symptoms are often the result of improper head postures caused by poor lens design or measurements. The computer glasses manufactured for you are designed to give you maximal vision and maximal comfort.
These glasses have been custom fit to your particular needs. No one else will probably get the same benefits from them as you.
As your eyes change in the future, we will alter your computer glasses to ensure that you have comfort and are able to maximize
your performance. If you have any questions, please give us a call. Remember our theme and our mission are to “provide you with good vision for the rest of your life.”
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Computer Vision Syndrome
Eye Breaks
• Refocus eyes away from the monitor to across the room for 5 seconds every 15 minutes of monitor viewing. Look at objects that are varying distances from your computer.
• Perform several rapid and quick blinks to the eyes several times to rewet and refocus during this eye break. Application of artificial tears or rewetting drops for contact lens wearers at this time would be beneficial.
Workstation Adjustments
• Ambient lighting should be available. Avoid harsh brightness changes from the computer monitor to the room.
• Minimize screen glare by repositioning the computer monitor or source of light to avoid glare and light reflections or consider
an antiglare screen.
• Place the monitor directly in front of you, not off to one side. Adjust monitor sharpness, contrast (adjust to individual
comfort), brightness (match room brightness), distance (20 inches to 26 inches), and viewing angle (approximately 15 degrees from eyes to monitor center).
• A larger monitor with higher resolution and refresh rate (70 Hz or higher) than your current monitor may also be helpful.
• Adjust your chair so that both feet touch the ground with knees approximately 90 degrees to the floor and elbows approximately 90 degrees to the keyboard. Allow for comfortable thigh support.
• Exercise when sitting with various stretches and joint rotation. Standing up and moving about is also helpful to keep your blood circulating.
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Computer Vision Syndrome: Treatment Sheet
Computer vision syndrome (CVS) is a complex optical and musculoskeletal disorder related to near work during computer use. The
most common symptoms of CVS include the following:
• Headache
• Loss of focus, blurred vision
• Double vision
• Dry, burning, tired eyes
• Muscular strain
• Excessive tears
• General fatigue
• Excessive blinking/squinting
• Overall stress
• Neck or shoulder strain/pain
Some individuals react with more difficulty when focusing on characters on a computer screen as opposed to reading printed material on paper.
Treatment is varied and complex, with different solutions for different needs. For optimal patient comfort and performance, a specific computer correction is usually necessary. Your optometrist will assess your optical needs. A wide variety of lens styles are available, ranging from single-vision computer lenses to progressive-add bifocals, which can aid in achieving proper focus. Many different lens materials and treatments are also available (e.g., tints and antireflective coatings) to assist with comfort.
Your doctor will be testing your eyes to help find which solution works best for you. Some of these tests might include the following:
• Detailed refraction: a measurement of your visual system’s focusing power needs.
• Binocular vision testing: an evaluation of your eyes’ efficiency in working together at different distances.
• Dynamic retinoscopy: an evaluation of your eyes’ focusing system function for near tasks.
• Tear assessment: an evaluation of your tear quantity and quality.
Studies show that approximately three quarters of computer users have symptoms of CVS. The good news is that the eye and vision symptoms, as well as other problems of CVS, can usually be alleviated by good eye care and by changes in the work environment.
The doctor has prescribed the following treatment for you at this time:
? Enhancement of tears
? Artificial tears (eye drops or gel)
? Antiinflammatory eye drops
? Punctal occlusion
? Computer glasses (with special computer lenses)
? Vision therapy (specific eye exercises that enhance focusing)
? Eye breaks
? Workstation adjustments
Medications prescribed Dosage and Frequency
___________________ __________________
___________________ __________________
Your Follow-up Visit
Date: ______________ Dr.: _______________
Time: ______________ Phone: ____________
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Conjunctivitis
Conjunctivitis, commonly known as pink eye, is an infection of the thin membrane that lines the inside of the eyelids and the white
part of the eye. The three most common types of conjunctivitis are viral, bacterial, and allergic. Each requires different treatments. With the exception of the allergic type, conjunctivitis is typically contagious.
The viral type is often associated with a cold or sore throat. Bacteria such as Staphylococcus and Streptococcus often cause
bacterial conjunctivitis. The severity of the infection depends on the type of bacteria involved. The allergic type occurs more frequently among those with allergic conditions. When related to allergies, the symptoms are often seasonal. Allergic conjunctivitis may also be caused by intolerance to substances such as cosmetics, perfume, or drugs.
Symptoms
• Watery discharge
• Irritation or gritty feeling
• Itching
• Swollen eyelids
• Swelling of the conjunctiva
• Redness
• Tearing
• Mucous discharge that may cause the lids to stick together, especially after sleeping
Diagnosis
Conjunctivitis is diagnosed during an eye examination with a biomicroscope. In some cases cultures are taken to determine the type
of bacteria causing the infection.
Treatment
Conjunctivitis requires medical attention. The appropriate treatment depends on the cause of the problem. Eye drops are prescribed
in addition to nonsteroidal antiinflammatory medications, antihistamines, cool compresses, and artificial tears. Sometimes an oral antibiotic or ointment is used to treat the condition. Like the common cold, viral conjunctivitis has no cure; however, the symptoms can be relieved. Viral conjunctivitis usually resolves within 3 weeks.
To avoid spreading infection, take the following simple steps:
• Disinfect surfaces such as doorknobs and counters with diluted bleach solution
• Do not swim (some bacteria can be spread in the water)
• Avoid touching the face
• Wash hands frequently
• Do not share towels or washcloths
• Do not reuse handkerchiefs (tissues are best)
• Avoid shaking hands
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Allergic Conjunctivitis
Your eye doctor has given you the following prescription:
Eye drops have been prescribed to alleviate the symptoms of allergic conjunctivitis. An allergen has irritated the thin clear mucous membrane that lines the inside of your eyelids and the white part of your eye, called the conjunctiva. Symptoms vary from person to person. More than 22 million people in the United States suffer from the most common eye allergy: allergic conjunctivitis.
What Is an Allergic Response?
An allergic response is an overreaction of the body’s immune system to foreign substances known as allergens, which the body wrongly perceives as a potential threat. When the eye comes into contact with certain allergens, an allergic response can result. Plant pollens, animal dander, dust mites, mold spores, grass and ragweed, cosmetics and perfumes, skin medicines, and air pollution often cause allergies. Our eyes have millions of mast cells that release chemicals, causing the symptoms.
Common symptoms of allergic conjunctivitis include the following:
• Itchy eyes and eyelids
• Watery eyes
• Dilated vessels in the conjunctiva
• Burning sensation around the eyes
• Redness around the eyes
• Swollen eyelids
• Blurred vision
• Sensation of fullness in the eyes or eyelid
• Sensation of foreign body in the eye
• An urge to rub the eyes
• Lid twitches
• Dry eyes
• Long strings of mucus in the corner of the eye
• Floaters in the tears
The drops prescribed will alleviate the symptoms caused by the release of these chemicals and block the mast cells from releasing more.
Two types of allergic conjunctivitis exist, seasonal and perennial. The former is the more common of the two, occurring in the
majority of people who have this condition. It is associated with seasonal allergies that commonly occur during the spring and summer months and is usually caused by exposure to airborne allergens, such as grass and plant pollens. Perennial allergic conjunctivitis
persists throughout the year and is generally triggered by indoor allergens such as animal dander, dust mites, and mold spores.
Your doctor will evaluate the success of the eye drops and advise you regarding future use. If symptoms seem to worsen, call the office immediately.
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Convergence Insufficiency
Handout to accompany report to school nurse or other professionals
Definition
Convergence insufficiency is a sensory and neuromuscular anomaly of the binocular vision system characterized by an inability to converge or sustain convergence. Convergence occurs when eyes are turned inward so that lines of sight are directed on an object of regard.
Symptoms
The symptoms and signs associated with convergence insufficiency are related to prolonged, visually demanding, near-centered tasks, including the following:
1. Diplopia (double vision)
2. Asthenopia (eye strain)
3. Transient blurred vision
4. Difficulty sustaining near visual function
5. Abnormal fatigue
6. Headache
7. Orbital pain
8. Abnormal postural adaptation
Diagnostic Factors
Convergence insufficiency is characterized by one or more of the following diagnostic findings:
1. High exophoria at near
2. Tight accommodative-convergence/accommodation ratio
3. Receded near point of convergence
4. Low fusional vergence ranges and/or facility
5. Exofixation disparity with steep forced vergence slope
NOTE: Additional testing may be appropriate as part of the differential diagnostic workup for convergence insufficiency to rule out other concurrent medical conditions and to differentiate associated visual conditions.
Therapeutic Considerations
A. Management
The doctor of optometry determines appropriate diagnostic and therapeutic modalities and frequency of evaluation and follow-up on the basis of the urgency and nature of the patient’s condition and unique needs. The management of the case and duration of
treatment are affected by the following:
1. The severity of symptoms and diagnostic factors, including onset and duration of the problem
2. Implications of patient’s general health and associated visual conditions
3. Extent of visual demands placed on the individual
4. Patient compliance
5. Prior interventions
Duration of Treatment
The following treatment ranges are provided as a guide for third-party claims processing and review purposes. Treatment duration will depend on the particular patient’s condition and associated circumstances. When duration of treatment beyond these ranges is required, documentation of the medical necessity for additional treatment services may be warranted.
1. The most commonly encountered convergence insufficiency usually requires 24 to 32 hours of office therapy.
2. Uncomplicated convergence insufficiency characterized by only a remote near point of convergence usually requires up to
12 hours of office therapy.
3. Convergence insufficiency complicated by:
a. Restricted fusional ranges usually require up to an additional 12 hours of office therapy.
b. Suppression usually requires up to an additional 6 hours of office therapy.
c. An accommodative element usually requires up to an additional 12 hours of office therapy.
d. Other diagnosed visual anomalies may require additional office therapy.
e. Associated conditions such as stroke, head trauma, or other systemic conditions may require substantially more office therapy.
Follow-up Care
At the conclusion of the active treatment regimen, periodic follow-up evaluations should be provided at appropriate intervals. Therapeutic lenses
may be prescribed at the conclusion of vision therapy for maintenance of long-term stability.
B. Treatment
A small percentage of cases are successfully managed by prescription of therapeutic prisms and lenses. However, most convergence insufficiencies require orthoptics and/or vision therapy. Optometric vision therapy usually incorporates the prescription of specific treatments to accomplish the following:
1. Normalize the near point of convergence
2. Normalize fusional vergence ranges and facility
3. Eliminate suppression
4. Normalize associated deficiencies in ocular motor control and accommodation
5. Normalize accommodative/convergence relation
6. Normalize depth judgments and/or stereopsis
7. Integrate binocular function with information processing
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Cool Soaks
Cool soaks are useful to relieve ocular itching, lid swelling, and discomfort caused by allergic reactions.
1. Use tap water. Run the tap for approximately 2 minutes to avoid still-standing water that may contain sediment from the pipes. You do not need to use distilled or purified drinking water.
2. Use cool (room temperature) tap water. You should not use refrigerated ice water.
3. Soak a clean washcloth in the water. Close both eyes and lay the washcloth over both closed eyes or as directed:______________
4. Leave the washcloth over your eyes until it warms up, then resoak in the cool water.
5. Attempt to maintain a consistently cool temperature when soaking.
6. Soak for a total of 5 minutes or as directed:_________________
7. Soak three times a day or as directed: _________________
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Corneal Abrasion
A corneal abrasion is an injury to the front surface of the eye. The injury can occur when a foreign object gets in the eye, when the
cornea becomes scratched, or even from rubbing the eyes too hard. The cornea is very sensitive. Depending on the location and depth of the injury, an abrasion can be quite painful and even sight threatening, resulting in permanent visual impairment.
Treatment is important to prevent infection within the injured cornea. The medication that the doctor prescribes will help heal the cornea and prevent infection. Be sure to follow the doctor’s instructions so that the cornea heals properly.
Small abrasions can heal within 24 hours but more severe abrasions can take up to several weeks to heal. This injury can be treated in different ways. The doctor will probably prescribe eye drops and/or ointment. You may need to wear a special contact lens overnight or longer to help with healing. Sometimes a patch may need to be worn on the eye overnight.
The doctor has prescribed the following treatment for you:
Medications/Treatments Prescribed Dosage/Frequency
______________________________ _____________________________
______________________________ _____________________________
Special instructions (follow the instructions that your doctor has checked):
- Fill the prescription today and begin medication as soon as possible.
- Apply eye drops, then close your eye. With one finger, apply mild pressure to the inner corner of the eye. Keep pressure on this area for 90 seconds. This will help the drop stay within the eye.
- Stay indoors and rest your eyes for the first 24 hours. Sunlight will be irritating. If you must go outdoors, wear sunglasses.
- You should notice some improvement in your condition within 24 hours. If the condition worsens, call your doctor’s office immediately at one of the following phone numbers:
Office:_________________________________ Emergency after-hours: ____________________________
Instructions for Contact Lens Wearers
- OK to wear your contact lenses.
- Do not wear your contact lenses until ________________________________
Your Follow-up Visit
Date: ________________________________ Dr.: __________________________
Time: ________________________________ Phone: ________________________
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Diabetic Retinopathy
Diabetes is a condition that can interfere with the body’s ability to use and store sugar. Diabetes can also, over time, weaken and
cause changes in the small blood vessels that nourish the eye’s light-sensitive retina at the back of the eye where images are focused. When this condition occurs, it is called diabetic retinopathy. These changes may include leaking of blood, development of brushlike branches of the vessels, and enlargement of certain portions of these vessels. Diabetic retinopathy can seriously affect vision and,
if left untreated, cause blindness.
Because this disease can cause blindness, early diagnosis and treatment are essential. We recommend having your eyes examined at least annually if you are a diabetic or if you have a family history of diabetes.
To detect diabetic retinopathy, we look inside your eyes with an instrument called an ophthalmoscope, which lights and
magnifies the retinal blood vessels in your eyes. The interior of your eyes may also be photographed to provide more information. The beginning stages of diabetic retinopathy may cause blurriness in your central or peripheral (side) vision, or they may
produce no visual symptoms at all. It mainly depends on where the blood vessel changes are taking place in your eye’s retina.
As diabetic retinopathy progresses you may notice a cloudiness in your vision, blind spots, or floaters, which are usually caused by blood leaking from abnormal new vessels that block light from reaching the retina.
In the advanced stages, connective scar tissue forms in association with new blood vessel growth, causing additional distortion and blurriness. Over time, this tissue can shrink and detach the retina by pulling it toward the center of the eye.
Once diabetic retinopathy has been diagnosed, laser and other surgical treatments can be used to reduce the progression of this disease and decrease the risk of vision loss.
If you have vision loss from diabetic retinopathy, we may prescribe special vision aids to help maximize your vision. Some of the optical aids available include telescopic lenses for distance vision, microscopic lenses, magnifying glasses, and electronic magnifiers for close work.
Not every diabetic patient develops retinopathy, but the chances of getting it increase after having diabetes for several years. Evidence also suggests that factors such as pregnancy, high blood pressure, and smoking may cause diabetic eye disease to develop
or worsen.
As a diabetic or a person at risk for diabetes, you should take steps to help prevent the development of diabetic retinopathy, including the following:
• Take your prescribed medication as instructed.
• Follow a proper diet.
• Exercise regularly.
• Have your eyes examined regularly.
By following these recommendations, chances are good that you can enjoy a lifetime of good vision and health.
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Drugs That Cause Problems with the Eyes
If you are taking any of the following classes of drugs, you could eventually have problems with your eyes. Talk to your eye doctor
about ways you can prevent losing vision when taking these medications. These medications can contribute to the development of cataracts, macular degeneration, and glaucoma or cause irritating symptoms.
Antihistamines Corticosteroids
Antidepressants Oral diabetic agents
Heart/blood pressure agents Nonsteroidal antiinflammatories
Oral contraceptives Allopurinol Antibiotics Statins Antifungals Cancer drugs
Antimalarials Erectile dysfunction agents
Tranquilizers Tetracycline
Sulfa drugs Amphetamines
Isotretinoin Antipsychotic agents
Some of these drugs can cause tissue damage.
Tissue damage occurs when high-energy light rays are absorbed by the body, which change its structure. In the most extreme cases, DNA is altered and cancerous tissue grows. The most common change in eye tissue is cataract, which occurs from the lens inside
the eye absorbing the sun’s rays. Some of the drugs mentioned above cause the pupils of the eyes to dilate, resulting in more than the normal amount of light to entering the eye and causing damage.
In individuals taking these medications, 100% ultraviolet-absorbing eyeglasses are necessary to protect the eyes both indoors and outdoors. The need for protection during or after a variety of medications is crucial to maintaining good vision. Visible light
also has energy and can cause damage, so dark sun lenses will be necessary to protect the vision. Sun lenses that are polarized will reduce uncomfortable glare when driving or from reflections off water. Lenses that change in the sunlight will also provide
protection except when the windshield of a car prevents them from darkening. The effects of cataracts and macular degeneration are increased by the need for time for the lenses to change to different light conditions. Nonglare technology can be used on the backs
of the lenses to prevent reflections going directly into the eyes.
Consult Your Eye Doctor
When taking medications, consult your eye doctor about the best way to protect your eyes. Your eye doctor is dedicated to providing good vision for the rest of your life.
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Drusens
Drusens are seen through the transparent retina as little yellow spots. They are essentially waste products of retinal metabolism that
are present because certain structures surrounding the retina have developed a reduced capacity to process metabolic debris. This seems to be, for the most part, a normal process of growing older.
Drusens generally develop in later years; however, exceptions exist. Drusens may or may not be related to a vision problem. However, they bear close watching because they can be related to some vision loss.
The visual effect, if any, can be appreciated and demonstrated on the Amsler grid.
The first indication that drusens may present a problem is when you note a distortion in the grid pattern. The grid should appear perfect, with all the lines straight and parallel. If you note any distortion, voids, or wavy lines, notify us immediately.
Remember, for the most part drusens are a normal change of growing older and probably will not develop into a problem. However, caution dictates that one should not leave such matters to chance.
Using the Amsler Grid
1. If reading glasses are customarily worn, wear them.
2. Test one eye at a time while closing the other.
3. Look (concentrate) at the central dot and note the surrounding grid pattern. If the pattern is perfect, you have completed the test. If it is not perfect, mark the area of imperfection and notify us.
This daily test only takes a few seconds to administer.
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Dry Eye
The natural tears that your eyes produce are composed of three layers: the outer oily layer, the middle watery layer, and the inner
mucous layer.
Dry eye is the term used to describe eyes that do not produce enough tears or that produce tears without the proper chemical composition in any of these layers. Dry eye is most often a result of the eyes’ natural aging process. Most people’s eyes tend to become drier as they age, but the degree of dryness varies, with some people having more problems than others. In addition to age, dry eye can result from the following:
• Problems with normal blinking
• Certain medications such as antihistamines, oral contraceptives, and antidepressants
• Environmental factors such as a dry climate and exposure to wind
• General health problems such as arthritis or Sj?gren’s disease
• Chemical or thermal burns to the eye
Dry eye symptoms are often different in different people, but the following are commonly experienced by those whose tear production is inadequate:
• Irritated, scratchy, dry, or uncomfortable eyes
• Redness of the eyes
• A burning sensation of the eyes
• A feeling of a foreign body in the eye
• Blurred vision
• Excessive watering as the eyes try to comfort an overly dry eye
• Eyes that seem to have lost the normal clear, glassy luster
If untreated, dry eye can be more than just irritating or uncomfortable. Excessive dry eye can damage eye tissue and possibly
scar the cornea, the transparent front covering of the eye, impairing vision. Contact lens wear may be more difficult because of the possibility of increased irritation and a greater chance of eye infection.
If you have the symptoms of dry eye, your optometrist can perform dry eye tests with diagnostic instruments to give a highly
magnified view and special dyes to evaluate the quality, amount, and distribution of tears. Your optometrist will also need to know about your everyday activities, general health, medications you are taking, and environmental factors that may be causing your symptoms.
In most cases dry eye cannot be cured, but your eyes’ sensitivity can be lessened and treatment prescribed so that your eyes remain healthy and your vision is not affected. Possible treatments include the following:
• Frequent blinking to spread tears over the eye, especially when using a steady focus for an extended period
• Changing environmental factors, such as avoiding wind and dust and increasing the level of humidity
• Using artificial tear solutions
• Using moisturizing ointment, especially at bedtime
• Administering cyclosporine immunomodulator drops
Other forms of treatment include the following:
• Insertion of small plugs in the corners of the eyes to slow drainage and loss of tears
• In rare cases, surgery
Whatever treatment is prescribed, you must follow your doctor of optometry’s instructions carefully. Dry eye does not go away, but by working together, you and your doctor can keep your eyes healthy and protect your vision.
Treatment
The doctor has prescribed the following treatment for you.
Artificial Tears Dosage and Frequency
_________________________________ ____________________________________
_________________________________ ____________________________________
Special Instructions
After applying the drops, close your eye and, with one finger, apply mild pressure to the inner corner of the eye. Keep pressure on this area for 90 seconds. This will help the drop stay within the eye.
Additional Treatment
The doctor is considering the following additional treatments, depending on the results of the artificial tears.
? Medication ? Nutritional supplements ? Punctal occlusion
Your Follow-up Visit
Date:_____________________________ Dr.: ______________________________
Time:_____________________________ Phone: ___________________________
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Eight Reasons Why You Should Purchase Your
Eyewear from Us
1. Fast Service
We have our own optical laboratory and full-time opticians so that your eyeglasses can be made fast. Most prescriptions are ready
in 2 days, and many can be ready the same day.
2. 1-Year Warranty
All eyeglasses carry a 1-year guarantee against breakage at no additional charge. If your eyeglasses break for any reason, return the broken parts and they will be repaired or replaced free.
3. 15-Day Exchange Privilege
After getting your new eyeglasses, if you decide you do not like the frames, you can exchange them for other frames. If new lenses
are required, a small laboratory regrinding fee will be charged. The regrinding fee varies with the type of lens used; check with the receptionist.
4. Huge Selection of Frame Styles
Our dispensary has more than 3,000 frames in stock, several times that of the average office. Our frame stylists will help you find the perfect size, shape, and color in your price range.
5. Competitive Price Guarantee
If you find the same frames priced less within 90 days of your purchase, bring in written confirmation and we will gladly refund the difference.
6. All Plastic Lenses Have Scratch-Resistant Coating at No Extra Charge
This factory-applied coating makes plastic lenses tough. They are guaranteed for 1 year not to scratch, or the lenses will be replaced free (only one replacement pair per year).
7. We Stand Behind Our Prescription
Our doctors are available to review your prescription needs at no charge if you have any difficulties. We want you to love your eyewear!
8. Emergency Repairs and Free Adjustments
Our office is open 6 days a week to best serve our loyal patients. Bring your eyewear in for repairs and free adjustments and cleaning to keep your frames looking good and feeling comfortable.
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Epiretinal Membrane
Macular pucker, or epiretinal membrane (ERM), is a common disorder of the central retina that leads to symptoms of distortion and
central blur. An ERM is excessive scar tissue on the surface of the retina. Most eyes with ERM are without symptoms.
How an Epiretinal Membrane Develops
The vitreous shrinks as we get older and finally separates from the retina. As it peels away from the retina, it roughs up the surface
of the macula. In response, the retina sends out reparative cells to smooth over its surface, like a scab forming over a scraped knee. However, the scar tissue may develop into a permanent structure that does not peel away. If it affects the central retina, it will affect central vision. Most eyes do not require surgery. If vision is poor enough, vitrectomy with membrane peeling may improve vision in
75% to 90% of patients. Surgery can be performed when vision is 20/50 to 20/70 or worse.
The ERM may appear transparent or as a dense, white plaque. It may wrinkle the retina or induce swelling of the macula or central retina. Fluorescein angiography may be performed to assess the possible causes of the membrane and determine specific characteristics. If left untreated, an ERM does not cause blindness. However, once central vision is significantly affected, it rarely spontaneously improves. Fine reading vision may worsen.
If the ERM is the result of previous retinal detachment, central vision may be limited by prior macular detachment. Macular degeneration, cataract, or a preexisting ocular pathologic condition may also limit final visual acuity after surgery.
Vitrectomy for Epiretinal Membrane
Vitrectomy is the surgical removal of the gel in the eye, or vitreous. A bent needle or pick is used to elevate an edge of the ERM, and microforceps then peel the scar tissue away from the retina. The gel is replaced with clear sterile saline. This is an outpatient procedure
that usually takes 35 to 60 minutes. Surgery is most often performed under local anesthesia but can be done under general anesthesia as well. You may go home the same day as surgery.
After vitrectomy, you may feel the self-absorbing sutures for approximately 4 weeks. Eyeglasses may be prescribed
approximately 3 months after surgery to obtain the best acuity. Vitrectomy with membrane peeling can lead to visual improvement
in 75% to 90% of eyes with enough distortion and blur to warrant surgery. The average postoperative acuity is halfway between preoperative vision and 20/20. Vision improves in approximately 3 months but may continue improving for a year after surgery.
Postoperative vision may not be perfect, but 90% of eyes that undergo this surgery have a decrease in distortion. Eyes that have had a prior retinal detachment in the macula are less likely to have return of fine vision.
Complications of Vitreous Surgery
Any time surgery is performed, rare complications may occur. Risks of this surgery include bleeding, infection, retinal tear, and retinal detachment. All these events are quite rare and are listed not to scare you away from surgery, but to let you know that any time you have surgery complications are possible.
More commonly, cataract may advance at a faster pace after vitrectomy. Vision may improve 3 months after vitrectomy, then blur from cataract. This generally takes months to years and will respond to surgery.
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Eye Drops and Ointment
Eye Drop Instillation
1. Wash your hands thoroughly.
2. Read the label and make sure that you are instilling the correct drops.
3. Shake well if directed to do so. Some medications are in suspension and need to be shaken to ensure the correct dosage.
4. Stand in front of a mirror, looking directly forward with the head tipped slightly back.
5. Gently pull the lower lid down with one hand while squeezing 1 to 2 drops from the bottle with the other hand. To avoid contamination, do not allow the dropper to touch the eye or face. Instilling the drops toward the outer corner of the eye is usually easier.
6. After instillation, close the eye gently for 2 minutes or press firmly on the inner corner of the upper and lower lids for
1 minute. Either technique will enhance the result.
Ointment Application to Lid Margins
1. Wash your hands thoroughly.
2. Check the label to verify correct medication and instructions.
3. Apply 1?4 to 1?2 inch of ointment on the tip of the index finger. With the eye closed, apply along the lid margins at the lash line. Cover both the upper and lower lids from inner to outer corner.
4. Alternate technique: squeeze 1?4 to 1?2 inch of ointment onto a cotton-tipped applicator. While looking directly in the mirror, apply along the lid margins at the lash line of both the upper and lower lids.
Ointment Application Inside Lower Lid
1. Wash your hands thoroughly.
2. Check the label to verify correct medication and instructions.
3. Look directly into a mirror and tilt head down slightly. Gently pull lower lid down and squeeze about 1?2 inch of ointment inside the lower lid. Twist tube to separate ointment from tube. Because of the risk of contamination, avoid touching the lid
or the eye with the tube.
4. Alternate technique: squeeze 1?2 inch of ointment onto the index finger and transfer to the inside of the lower lid.
Medications Prescribed Frequency and Duration
__________________________________ ____________________________________
__________________________________ ____________________________________
Your Follow-up Visit
Date:_____________________________ Dr.:__________________________________
Time:_____________________________ Phone: _______________________________
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Eyelid Problems
The doctor has prescribed the following treatment for you.
Warm Compresses
1. Wash your hands thoroughly.
2. Dampen a clean, folded, or rolled washcloth with warm water, or warm it in the microwave on medium for 20 seconds. Make sure the washcloth is warm and not hot.
3. Keeping the eyes closed and the washcloth folded/rolled, apply the washcloth to one or both eyelids. Application of some pressure to the upper lids is acceptable during this process.
4. Apply time(s) a day.
5. Continue for ? 2 weeks ? 1 month ? continuous ? other
Eyelid Scrubs
1. Wash your hands thoroughly.
2. ? Use commercially prepared eyelid cleanser pads in sealed packets.
? Mix a small amount of baby shampoo with warm water and saturate a make-up remover pad with the solution.
3. Close the eyelid and run the cleanser pad back and forth across the upper eyelashes and edge of the eyelid (approximately 15 times). Scrub lower lid by pulling it away from the eye. Avoid getting cleanser into the eye. Repeat for the other eye with a different pad.
4. Rinse excess solution with clear water.
5. Perform time(s) a day.
6. Continue for ? 2 weeks ? 1 month ? continuous ? other
Medications Prescribed Frequency and Duration
_____________________________ ____________________________
_____________________________ ____________________________
Special Instructions
_______________________________________________________________
_______________________________________________________________
Your Follow-up Visit
Date:_________________________ Dr.: _________________________
Time:_________________________ Phone: ______________________
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Eyelid Problems: Treatment Sheet
The eyelids perform many important functions, including protecting and lubricating the eye, producing oil secretions, and helping
drain away tears. The following conditions are usually not serious and can often be easily treated. However, if left untreated, they
can be uncomfortable, unattractive, and lead to more serious problems. Eyelid problems can affect the upper or lower eyelid in one
or both eyes. Your doctor has checked the box(es) that describe(s) your condition.
Blepharitis
Blepharitis is a chronic or long-term inflammation of the eyelid margins (the edges of the eyelids) often caused by bacteria around the lashes and outer tissues of the eye.
Symptoms can include swelling of the lid margin, irritation, sensitivity to light, itching, burning, redness along the lid margin, and redness of the eyeball itself. A crust or roughness along the lid margin and possibly dandruff on the lashes are present. This can be
worse in the morning upon awakening. Patients who wear contact lenses will often have these symptoms to a greater degree because the lenses will seem dry.
Treatment
In most cases, good eyelid hygiene and daily cleaning of the eyelid margins will control blepharitis. Eyelid hygiene is particularly important when awakening because bacteria builds up during the night. In more severe cases, eyelid hygiene and medication may
be combined for good control. In cases in which the conjunctiva (the front surface of the eye) is affected, the doctor may prescribe additional treatment.
Chalazion
A chalazion results from a blockage of one or more of the small oil-producing glands found in the upper and lower eyelids. Symptoms are inflammation and swelling in the form of a round lump within the eyelid that may or may not be painful. If the chalazion becomes infected, the eyelid can become swollen, inflamed, and more painful.
Treatment
A chalazion may be treated by applying warm compresses. At times this condition may require additional treatments that your doctor will prescribe.
Stye
A stye is a bacterial infection of one of the eyelid glands near the lid margins at the base of the lashes. It forms a red, sore lump similar to a boil, causing pain and inflammation.
Treatment
Styes are usually treated with warm compresses. Antibiotic and/or steroid eye drops or ointments may also be needed.
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Eyelid Massage
During your examination today, the doctor found excess oil in the oil-secreting glands of your eyelids. Too much oil disrupts the
normal function of the tear film, and excess oil can become hardened and back up in the glands, causing additional dry eye
problems as well as possible chronically plugged, enlarged glands (chalazion). Massage of the eyelids helps restore a normal flow
of oil and will help prevent backing up of the glands.
1. Use a clean washcloth folded in half.
2. Use warm, not hot, water. Allow the tap to run for 2 minutes. Do not use still-standing water, which may have sediment from the pipes. You do not need to use distilled or purified drinking water.
3. Soak the folded edge of the washcloth in the warm water and wring out the excess. Then close your eyes and lay the
washcloth on your eyelids for approximately 30 seconds. Then resoak the cloth to maintain the warmth. Do this soaking for approximately 2 minutes.
4. After soaking with the cloth, massage the upper eyelids with the edge of the cloth while your eyes are closed. When doing
the lower eyelids, look up slightly before beginning the massage. When massaging, go from side to side with the cloth, with each back and forth motion counting as one time. Massage both lower and upper eyelids approximately 20 times each. Avoid the center part of your eye or any other part while your eyes are open.
5. Massage your eyelids twice a day or as directed:_________________________________________________________________________________________
6. Use artificial tears as recommended:__________________________________________________________________________________________________
Please contact us if you have any questions or problems.
Your Follow-up Visit
Date:________________________ Dr.:_____________________________
Time:________________________ Phone: __________________________
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Eyelid Scrubs
During your examination today, the doctor found crusts on your eyelashes that must be removed. If these crusts are not removed,
the bacteria in the crusts can irritate your eyes. They may cause chronic infections (conjunctivitis, keratitis, blepharitis) or possibly partial loss of eyelashes or scarred eyelids.
1. Use cotton balls or a washcloth folded in half.
2. Make a solution of either:
a. 1?2 teaspoon salt to 1 quart of water, or
b. 1:4 mixture of baby shampoo to water
3. Use room temperature water. Allow the tap to run for 2 minutes. Do not use still-standing water, which may have sediment from the pipes. You do not need to use distilled or purified drinking water.
4. Use one cotton ball per eye, soaking the ball in the solution and squeezing out the excess, or soak the folded edge of the washcloth in the solution.
5. Gently scrub the upper eyelids and eyelashes with your eyes closed. When scrubbing the lower lids and lashes, look up slightly
before scrubbing. When scrubbing, go from side to side with either the cotton ball or washcloth, with each back and forth counting as one time. Scrub both upper and lower eyelids approximately 20 times each. Avoid scrubbing the center part of your eye or any other
part while your eyes are open. Either solution may sting somewhat if it gets into your eyes.
6. Throw away the cotton ball when you are done with one eye and use a new cotton ball for the other eye. If you need to use a second ball on the same eye, use a fresh one. Do not resoak a previously used ball in the same solution, or rinse out the washcloth and resoak when scrubbing the other lids.
7. When you have finished one scrubbing session, throw the solution away and do not save it. Make a fresh solution every time you scrub your lashes and lids.
8. Scrub your eyelids twice a day or as directed __________________________.
Please contact us if you have any questions or problems.
Your Follow-up Visit
Date:________________________ Dr.:_____________________________
Time:________________________ Phone: __________________________
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Floaters and Flashes
Floaters
The small specks, “bugs,” or clouds that you may sometimes see moving in your field of vision are called floaters. They are frequently visible when looking at a plain background, such as a blank wall or blue sky. These visual phenomena have been described for centuries;
the ancient Romans called them muscae volitantes, or “flying flies,” because they can appear like small flies moving around in the air. Floaters are actually tiny clumps of gel or cellular debris within the vitreous, the clear, jellylike fluid that fills the inside cavity of the eye. Although these objects appear to be in front of the eye, they are actually floating in the fluid inside the eye and cast their shadows on the retina (the light-sensing inner layer of the eye). Moving your eyes back and forth and up and down creates currents within the vitreous capable of moving the floater outside your direct line of vision.
Causes
The vitreous gel degenerates in middle age, often forming microscopic clumps or strands within the eye. Vitreous shrinkage or condensation is called posterior vitreous detachment* and is a common cause of floaters. It also occurs frequently in nearsighted people or in those who have undergone cataract operations or YAG laser surgery. Occasionally, floaters result from inflammation within the eye or from crystal-like deposits that form in the vitreous gel. The appearance of floaters, whether in the form of little dots, circles, lines, clouds, or cobwebs, may be alarming, especially if they develop suddenly. However, they are usually nothing
to be concerned about and simply result from the normal aging process.
Are Floaters Serious?
The vitreous covers the retinal surface. Occasionally the retina is torn when degenerating vitreous gel pulls away. This causes a
small amount of bleeding in the eye, which may appear as a group of new floaters. A torn retina can be serious if it develops into a retinal detachment. Any sudden onset of many new floaters or flashes of light should be promptly evaluated by your eye doctor. Additional symptoms, especially loss of peripheral or side vision, require repeat ophthalmic examination.
Flashing Lights
When the vitreous gel, which fills the inside of the eye, rubs or pulls on the retina, it sometimes produces the illusion of flashing lights or lightning streaks. You may have experienced this; it is usually not cause for worry. On rare occasions, however, light
flashes accompany a large number of new floaters and even a partial loss or shadowing of side vision. When this happens, prompt examination by an eye doctor is important to determine if a torn retina or retinal detachment has occurred.
Flashes of light that appear as jagged lines or “heat waves,” often lasting 10 to 20 minutes and present in both eyes, are likely to
be migraine caused by a spasm of blood vessels in the brain. If a headache follows, it is called a migraine headache. However, these jagged lines or “heat waves” commonly occur without a subsequent headache. In this case, the light flashes are referred to as ophthalmic migraine, or migraine without headache.
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Glaucoma
Glaucoma is an eye disease in which the passages that allow fluid in the eye to drain become clogged or blocked. This results in
the amount of fluid in the eye building up and causing increased pressure inside the eye. This increased pressure damages the optic nerve, which connects the eye to the brain. The optic nerve is the main carrier of vision information to the brain. Damage to it
results in less information sent to the brain and a loss of vision.
The exact cause of glaucoma is not known and it cannot currently be prevented. It is one of the leading causes of blindness in
the United States. But, if detected at an early stage and treated promptly, glaucoma can usually be controlled with little or no further vision loss. Regular optometric examinations are therefore important. People of all ages can develop glaucoma, but it most
frequently occurs in the following populations:
• Those older than 40 years
• Those with a family history of glaucoma
• Those who are very nearsighted
• Diabetics
• Blacks
Of the different types of glaucoma, primary open-angle glaucoma often develops gradually and painlessly without warning signs or symptoms. This type of glaucoma is more common among blacks than whites. It can cause damage and lead to blindness more quickly
in blacks, making regular eye examinations, including tests for glaucoma, particularly important for blacks older than 35 years. Another type, acute-angle closure glaucoma, may be accompanied by the following symptoms:
• Blurred vision
• A loss of side vision
• Appearance of colored rings around lights
• Pain or redness in the eyes
Regular eye examinations are an important means of detecting glaucoma in its early stages and include the following:
• Tonometry: a simple and painless measurement of the pressure in the eye
• Ophthalmoscopy: an examination of the back of the eye to observe the health of the optic nerve
• Visual field test: a check for the development of abnormal blind spots
Glaucoma can usually be treated effectively by eye drops or other medicines. In some cases surgery may be necessary. Unfortunately, any loss of vision from glaucoma usually cannot be restored. But, early detection, prompt treatment, and regular monitoring can enable
you to continue living in much the same way as you have always lived.
Protect your eye health and your vision; be sure to visit your doctor of optometry regularly.
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Headaches, The Eyes, and Vision
Headaches are a common symptom associated with the eyes and vision. They can be related to allergies, muscle strain, strained
vision, glare, migraines, and eye disease.
Allergies
The eyes are surrounded by several sinus cavities, which may become congested from colds or allergies. The tissue that lines the eyes is the same as that lining the sinuses. Your doctor will be able to recognize the signs of allergies in your eyes. People with headaches caused by allergies often wake up with them. Nearly 50% of the general population has allergies.
Muscle Strain
The eyes are controlled by six muscles on the outside and additional muscles inside. The outside muscles control eye movements and coordination. Difficulty using the eyes together often causes headaches, particularly during near tasks such as computer work.
The muscles inside the eyes are used for focusing. A computer user changes focus an estimated 10,000 times during a 6-hour day.
Our eyes were not made for this. Problems focusing commonly result in headaches and blurred vision.
Strained Vision
Many individuals can see well enough to get by but may notice a slight blur, or image overlapping the clear image. Even small
amounts of astigmatism can result in strained vision, making discrimination between the numbers 8, 3, and 5 difficult. Other times a person may simply be trying to read print that is too small or of poor contrast. Trying to decipher poor handwriting can result in headaches. The clearer the image, the more comfortable your vision will be.
Glare
Four types of glare make seeing comfortably difficult. Uncomfortable glare is caused by everyday bright light—outdoors even on
cloudy days, indoors with overhead fluorescent lights. Disabling glare is caused by excessive light, as from a window on a bright day. Blinding glare comes from shiny surfaces such as computer screens, glass, metal, water, snow, or concrete. Distracting glare comes
from reflections from eyeglass lenses without nonglare technology. Each of these can cause squinting, eye strain, and headaches.
Migraines
Severe headaches are often thought to be migraine headaches by the general public. True migraine headaches are actually caused by
the dilation of blood vessels in the brain. Usually the blood vessels constrict first, causing the vision part of the brain to get less oxygen and resulting in a strange vision phenomena. After approximately 20 to 30 minutes, the brain calls for more oxygen, dilating the blood vessels and causing the headache. Migraine headaches run in families.
Eye Disease
Many eye diseases may cause headache and discomfort. One type of glaucoma, conjunctivitis, iritis, and other inflammations of the eye can result in headaches. They are often associated with symptoms such as blurred vision, haloes around lights, and extreme sensitivity to light.
Your eye doctor will use several examination techniques to rule out vision and the eyes as a cause of your headaches. Treatment may include lenses, eye drops, oral medications, nonglare technology, eye exercises, or changes in the environment.
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Iritis
Iritis is inflammation predominantly located in the iris, which is the colored part of the eye. The iris controls the size of the pupil, the
opening that allows light into the back of the eye. It is located behind the cornea and just in front of the focusing lens of the eye.
Symptoms
• Pain
• Light sensitivity
• Red eye
• Tearing
• Blurred vision
• Floaters
• Small pupil
Iritis is often associated with an infection or disease of another part of the body, including ankylosing spondylitis, reactive arthritis
(Reiter’s syndrome), psoriatic arthritis, irritable bowel disease, Crohn’s disease, multiple sclerosis (HLA B15), sarcoidosis, systemic lupus erythematosus, Lyme disease, juvenile idiopathic arthritis, “cat scratch” disease, toxoplasmosis, toxocariasis, presumed ocular
histoplasmosis syndrome, Whipple’s disease, valley fever, tuberculosis, leptospirosis, Rocky Mountain spotted fever, and others. Patients known to have these disorders should be examined for chronic mild iritis on a regular basis.
Diagnosis
Iritis is diagnosed during an eye exam with a biomicroscope. Because iritis is associated with other diseases, blood tests, skin tests, and x-rays may be used to determine the cause of the inflammation.
When the iris is inflamed, white blood cells are shed into the anterior chamber of the eye where they can be observed on biomicroscopic examination to be floating in the convection currents of the aqueous humor. These cells can be counted and form the basis for rating the degree of inflammation. This is measured on a scale of 1 to 4, with 4 being the most cells.
Treatment
Initial treatment is through the use of topical corticosteroids. If adhesion is anticipated, then a dilating drop is used to relax the ciliary body to prevent the iris from adhering to the lens in a closed position. Iritis that is stubborn, recurrent, or chronic may require systemic treatment through the use of oral steroids or other immunomodulating drugs.
Some of the consequences to the lack of treatment or undertreatment are epiretinal membrane formation, cystoid macular edema, cataracts, glaucoma, detached retina, vitreous hemorrhage, and vascularization of the retina. Uveitis is the third leading cause of preventable blindness in the developed world.
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Jump Ductions
Purpose
The purpose of this exercise is to improve your ability to change the focus of your eyes (accommodation) smoothly and quickly over a wide range of distances. This exercise will also help you improve your convergence.
Equipment
Postage stamp with fine detail, a window, and a clock with a second hand.
Set-up
Place the postage stamp on a clear window. Pick out a distant target with fine detail that you can see clearly. A street sign or license plate will make a good target.
Procedure 1
Stand as close as you can to the stamp, keeping all its detail clear and single. Jump your gaze (fixation) from the stamp to the distant target and get it clear and single. Quickly return your fixation back to the stamp and once again concentrate on getting it clear and single. Do not change your fixation until the target you are looking at is perfectly clear and single.
Note the time that it takes you to make 20 cycles from distance to near (40 fixation jumps). Do sets of 20 cycles with a short rest period between each. Record your best daily effort and the distance you stood from the stamp.
Your goal is to be able to change your focus from distance to near and back smoothly and quickly while standing as close as possible to the near target.
Procedure 2
Repeat procedure 1 through a special pair of glasses or clip-on lenses that will be supplied by your clinician. Record your best daily effort and distance from the near target as before.
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Keratoconus: Treatment Sheet
Keratoconus (KC) is a condition of the cornea, the “clear window” on the front surface of the eye. The cornea is normally round or
spherical shape. With KC, the cornea bulges, distorts, and assumes more of a cone shape, causing distorted or blurred vision. KC can occur in one or both eyes.
In the early stages, eyeglasses are usually successful in correcting the vision. However, as the disease advances, vision is not adequately corrected and requires rigid contact lenses to aid in flattening the corneal surface and providing optimal visual correction. Your doctor is a specialist at designing a custom contact lens that fits the shape of the cornea.
Contact lens fitting can be difficult in patients with KC, requiring frequent follow-up visits to monitor the corneal health and make adjustments to the design of the contact lenses. The goal is to fit the lenses to maximize comfort, vision, and eye health. For the greatest success, patients will also be required to use eye drops and adhere to a wearing schedule prescribed by the doctor.
When good vision can no longer be attained with contact lenses or when intolerance to the contact lens develops, corneal transplantation may be recommended. This is only necessary in approximately 10% of patients with KC and carries a success rate
of greater than 90%.
The doctor has prescribed the following treatment for you at this time.
? Cold compresses, applied daily.
? Lubrication drops to rewet the surface of your eyes.
? Topical medication (eye drops) to relieve the symptoms of itching.
? Therapeutic management of contact lenses to improve the quality of vision.
? Consultation with a corneal surgeon.
Medications Prescribed Dosage and Frequency
______________________________ _________________________________
Lubrication Drops Prescribed Dosage and Frequency
______________________________ _________________________________
Special Instructions
Do not rub your eyes because this may be one of the factors contributing to the worsening of the condition.
Your Follow-up Visit
Date:________________________ Dr.:_____________________________
Time:________________________ Phone: __________________________
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Lattice Degeneration
Lattice degeneration is a common peripheral retinal degeneration characterized by oval or linear patches of retinal thinning. Atrophic
retinal holes and tractional retinal tears may complicate lattice degeneration and increase the risk of retinal detachment. Patients with lattice degeneration are typically asymptomatic, and the lesions are usually an incidental finding of dilated exam.
The acute onset of floaters, flashes of light, peripheral field loss, or central vision loss may indicate the presence of retinal tear
or retinal detachment, which are complications of lattice lesions. Patients with lattice degeneration should be examined on an annual basis.
The eye works like a camera. The lens and cornea focus light rays. The retina works like the photographic film in a camera. The hollow center of the eye is filled with a gel called vitreous. When this shrinks, it may pull and tear the retina.
Lattice degeneration is characterized by oval or linear patches of atrophic retina with a reddish base and is usually located within the front portion of the retina. Fine vision is in the macula.
Thinning of the Retina
Lesions may be isolated or multifocal, variable in dimension, and usually oriented concentric or slightly oblique to the front edge of
the retina. Condensed vitreous at the margins of the lattice lesions appears as vitreous opacities and represents regions of increased vitreoretinal adhesion. The vitreous over lattice is liquid. Sclerosed vessels appear as crisscrossing, fine, white lines that account for
the term lattice degeneration.
Lattice lesions appear to be caused by dropout of peripheral retinal capillaries, which leads to thinning of all retinal layers. The thinning may become so profound that a full-thickness retinal hole forms at the lattice lesion.
The best and most often used examination to detect lattice degeneration is indirect ophthalmoscopy with pushing on the eye or scleral depression to see it on edge.
Who Has Lattice Degeneration?
Lattice degeneration affects approximately 10% of the population, with 30% to 50% of those affected having it in both eyes. The prevalence peaks by the second decade and is minimally progressive. It may be more common in some families. It is more common
in nearsighted eyes and correlates with increasing axial length, reaching 15% prevalence in the eyes with the greatest axial length. No reported infectious, trauma, gender, or racial differences exist in lattice degeneration.
Clinical Course of Lattice Degeneration
Lattice lesions are believed to develop early in one’s lifetime. Features such as crisscrossing sclerotic vessels, pigmentation, and atrophic retinal holes subsequently may develop over many years.
Retinal detachment is a rare complication of lattice degeneration (less than 1% of patients with lattice). But lattice is associated with as many as 40% of all retinal tear–associated detachments.
An acute posterior vitreous detachment complicated by retinal tear formation usually is signaled by new-onset floaters and/or flashes. Patients with these symptoms constitute a true ocular emergency and need urgent ophthalmic examination.
Laser Treatment for Lattice Degeneration
The presence of uncomplicated lattice does not interfere with visual function and does not constitute a high risk for future development of retinal detachment. Prophylactic treatment is clearly indicated only in the context of specific circumstances.
Lattice degeneration complicated by tractional tears as the result of an acute posterior vitreous detachment represents a high-risk situation for future retinal detachment and is an urgent indication for laser retinopexy. Lattice and atrophic holes complicated by progressively increasing subretinal fluid represent an additional indication for surgical intervention. The presence of lattice lesions
in the other eye of patients who have sustained retinal detachment in the first eye may be treated prophylactically. Subsequent
retinal detachments may also occur as a result of lesions developing in healthy retina, so the protection is not absolute. If a cataract, lens implant, or strong family history of retinal detachment is present, preventative laser treatment may lessen the chance of retinal detachment. In the absence of the aforementioned features, definitive data does not yet exist to clearly indicate prophylactic laser treatment of lattice lesions.
Lattice Degeneration Prognosis
Patients with significant lattice lesions, and those who have had prophylactic treatments, are always at increased risk compared with
the population at large for vision loss caused by retinal detachment. These patients must have routine follow-up examinations. Be aware of the signs and symptoms of retinal and vitreous detachment and the necessity to seek urgent care when needed.
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Macular Degeneration
Macular degeneration is the leading cause of central vision loss among older people. It results from changes to the macula, a
portion of the retina responsible for clear, sharp vision that is located on the inside back wall of the eye.
The macula is many times more sensitive than the rest of the retina; without a healthy macula, seeing detail or vivid color is not possible.
Macular degeneration has several causes. In one type, the tissue of the macula becomes thin and stops working well. This type is thought to be a part of the natural aging process in some people.
In another, fluids from newly formed blood vessels leak into the eye and cause vision loss. If detected early, this condition can
be treated with laser therapy, but early detection and prompt treatment are vital in limiting damage.
Macular degeneration develops differently in each person, so the symptoms may vary. Some of the most common symptoms include the following:
• A gradual loss of ability to see objects clearly
• Distorted vision; objects appear to be the wrong size or shape, or straight lines appear wavy or crooked
• A gradual loss of clear color vision
• A dark or empty area appearing in the center of vision
These symptoms may also indicate other eye health problems, so if you are experiencing any of these, contact your doctor of optometry immediately.
In a comprehensive eye examination, your doctor will perform a variety of tests to determine if you have macular degeneration
or another condition causing your symptoms.
Unfortunately, central vision damaged by macular degeneration cannot be restored. However, because macular degeneration
does not damage side vision, low vision aids such as telescopic and microscopic special lenses, magnifying glasses, and electronic magnifiers for close work can be prescribed to help make the most of remaining vision. With adaptation, people with macular degeneration can often cope well and continue to do most things they were accustomed to doing.
Remember: early detection of macular degeneration is the most important factor in determining if you can be treated effectively. Use an Amsler Grid as directed by your optometrist and maintain a regular schedule of optometric examinations to help protect
your vision.
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Monovision
Monovision is a compromise approach to satisfy visual needs. It compromises, to some degree, both distance and near vision.
However, it does enable one to get by reasonably well for both far and near without the use of eyeglasses. Monovision seems to work best for social occasions, for general all-around situations, and for those patients doing light office work.
One area of concern is driving a motor vehicle, especially at times of low levels of illumination. For example, if light from an oncoming headlight were to strike the distance viewing eye so that it was occluded or partially obstructed, it might compromise distance vision because oncoming vehicles would be mostly viewed through the near vision eye. This is why we recommend a pair
of eyeglasses be worn with contact lenses, or after monovision refractive surgery, enabling you to have binocular distance vision while driving. The eyeglasses would be corrected so that the near eye would now be focused for distance. With both eyes now focused normally for distance, compromise is not necessary.
Another area of concern for those patients who have been doing well for the most part with monovision, but have taken on
added visual demands for near work, is visual discomfort or stress. This situation can also be remedied by wearing eyeglasses that correct the distance viewing eye, thereby focusing both eyes for near vision.
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No Perfect Pair
Our goal as eye care professionals is to provide every patient with the perfect pair of glasses. Unfortunately, in today’s world, when
you look at the range of patients’ needs, it quickly becomes clear that no single pair of glasses can be ideal everywhere, all the time. Each individual patient needs to see well in many different situations. They need good vision in bright sun and while driving at
night. They need to see while playing tennis, working at a computer, and doing needlepoint. Patients also want to look the best they can in these situations and countless others.
One way to look at these needs is to remember that we change clothes at least once each day, and each time we select a specific look or function. You wear one set of clothes to clean the house, another to go to work, and yet another to play tennis or socialize.
You can think of your “eyewear wardrobe” as being like your clothes closet, complete with options for work, leisure, and social occasions.
Glasses are often required for the following:
• Protection from the sun’s damaging rays
• Comfort on the computer
• Sports
• Hobbies
• Social functions
• Safe night driving
• Comfortable reading
• Safety at work or while using power tools
Each pair of glasses the doctor prescribes for you has a specific function. The glasses you wear for working on the computer are not appropriate for playing sports. The sunglasses you use for driving during the day should not be used for watching movies in a darkened theater. One frame may be an excellent shape for your face and will look good in the office, and another may be a sport frame perfect for jogging and tennis.
Today, the average person requires glasses to prevent damage to the eyes from the sun, glasses for seeing indoors and at night, and computer glasses. Many would ideally have additional pairs depending on their desired appearance and recreational needs.
Consult Your Eye Doctor and Optician
Your eye doctor will determine what is best to improve the quality of your life, allow you to perform at the highest level at work and play, and prevent the loss of vision. Your optician will provide a full range of eyewear that will make you look good and feel good.
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Ocular Hypertension
Ocular hypertension is a condition in which the pressure of fluids within the eye is higher than average. When the pressure within
the eye is elevated to an extent that interferes with the normal physiology of the optic nerve, resulting in optic nerve damage, it is referred to as “glaucoma.”
Many people can tolerate higher than average eye pressure without any optic nerve compromise. However, caution dictates that one should not leave such matters to enhance and should monitor eye pressures considered higher than average on a regular basis. Several tests are important to ensure the health of the optic nerve regarding elevated pressure. To ensure the safety of your optic
nerve tissue, we would like to see you again in months to perform the following tests that have been checked.
- Visual field examination
- Dilated fundus examination
- Image of optic nerve (for comparative evaluation over time)
- Eye pressure test
? Morning
? Afternoon
- Retinal nerve fiber layer analysis
- Pachymetry
- Gonioscopy
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Orthokeratology
Orthokeratology (Ortho-K) is a nonsurgical approach to reduce myopia (nearsightedness). A series of rigid contact lenses are used
to flatten the corneal curvature. Because two thirds of the total power of the eye can be explained by the corneal curvature, efforts have been made to alter the cornea to change the overall refractive status. Can corneal tissue be permanently altered by such nonsurgical means? The University of California School of Optometry at Berkeley and the University of California School of Medicine at San Diego both agreed, after substantial time and effort spent on the Ortho-K project, that no significant permanent improvement was noted regarding myopia reduction.
Myopia reduction was noted with the wearing of retainer lenses for a significant portion of time. However, with the permanent cessation of contact lens wear this effect was soon lost.
Many of our patients have had good success with Ortho-K, having qualified for employment that requires improvement in their uncorrected visual acuity or pursuing hobbies (e.g., mountain climbing requiring oxygen) or sports that make wearing eyeglasses or contact lenses impractical. Depending on your vision requirements and type of refractive error, your doctor of optometry can advise you regarding your chance of success with orthokeratology.
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Refractive Error
When considering all the variables that go into the total visual process it is, indeed, a miracle that we see as well as we do. The
visual process is a highly complex one involving cerebral and perceptual aspects that are too involved to describe in one page. The refractive power of the visual system is mostly attributed to the corneal curvature, with the transparent media and the
eyeball length accounting for the remainder. If all these variables coincide nicely so that all light focuses sharply on the retina, one
is said to have perfect vision for distance viewing, or emmetropia. This definition does not consider perceptual, integrative, or binocular vision aspects that, if not in harmony with the refractive state, can result in discomfort, perceptual problems, and reading difficulties.
If light focuses prematurely in front of the retina, the condition is referred to as myopia, or nearsightedness, because near objects are seen more clearly than distant objects. The majority of myopia cases develop before the age of 25 years.
If light passes through the media as if the retina were not there and hypothetically focuses behind the retina, the condition is referred to as hyperopia, or farsightedness, because vision is more adaptable for distance viewing. Farsighted people involuntarily and continually maintain a focusing effort to keep vision clear. A farsighted person will not necessarily have clear distance vision and blurred or fuzzy near vision because these factors can be altered by focusing ability as well as the degree or magnitude of the farsightedness.
Another refractive condition is referred to as astigmatism. In this condition, all the light does not focus on the retina. The portion that does not may focus in front of the retina or behind it. The degree of disparity or difference is related to the amount of the astigmatism, which is the result of the cornea not being perfectly spherical (like a marble) but shaped more like a spoon.
Approximately 20% of what causes blur in the typical eye is from higher-order aberrations. Until recently these could not be measured and corrected by eyeglasses or contact lenses. Even people who have no refractive error (emmetropes) can have many
higher-order aberrations. The effect is usually poor night vision, particularly when driving. Correcting the aberration gives the individual “high-definition” vision similar to high-definition televisions.
Reduction in function is something that is most appreciated or recognized as we grow older. In youth one might be able to run a
4-minute mile, but when one reaches the age of 40 years, a 6- or 7-minute mile is about all that can be achieved. A similar process occurs in the visual process. We refer to this reduction in function or reduced ability to alter or adjust the visual system for clear
near vision as presbyopia.
Near-point asthenopia is a condition that is not necessarily related to a specific refractive error but may be associated with any of them. These patients seem to have difficulty handling near work tasks, such as reading, and note a significant degree of stress.
Because this condition is not related to presbyopia and is often managed or treated in a similar fashion, a different category is
required. This problem is one in which the balance between focusing and turning of the eyes is not in perfect harmony. Appropriate reading lenses (as in presbyopia) generally restore the balance. However, on occasion the eyes may require visual training exercises
to restore harmony.
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Reading Glasses Comparison
People have many different alternatives when choosing how they would like their prescriptions filled for reading and close work.
Each of the choices has advantages and disadvantages. This sheet compares each option to allow you to make an informed decision
to fill your personal needs.
Reading Glasses Only
Reading glasses are focused just for the reading distance or close distance (from 6 to 20 inches). When using these glasses for
reading, doing close work, crafts, hobbies, or your job, things will be clear. The disadvantage of this type of glasses is that any time you have to look at a distance farther than 20 inches and see clearly, you must take your glasses off. You have the inconvenience of putting them on and taking them off. You also need to consider a strong frame because they will get much more abuse than if they were left on continuously.
Half Eyes
This type of glasses has the same prescription as the reading glasses except they are only half the vertical height of normal glasses. This enables you to do your close work yet look over the top of them to see at a greater distance. One of the disadvantages of this system is again that you need a durable frame because your glasses are taken on and off so often.
Bifocals
This is a system in which you have two focuses: far and near. This enables you to read and do close work; then when you look far away, you can see clearly without taking your glasses off. The biggest advantage of bifocal lenses is the convenience of not having
to take glasses on and off constantly.
Trifocals
This lens system has three focuses: far, for viewing something like a clock on a far wall; reading, for objects 6 to 12 inches away;
and the intermediate or in-between range, such as soup cans on a shelf or the dashboard of your car.
Invisible Progressive Multifocals
This lens system is the next extension beyond the trifocal. It has the advantage of not having any lines and has a continuous range
of clear vision from far to intermediate to near. We have printed information and videos on multifocals in the office that discuss
some of the advantages and disadvantages. Also, we have some samples of each type lens for you to see. Please take your time and decide what system works best for you.
Bifocal Contact Lenses
This alternative has merit for individuals who perform minimal close work, such as homemakers or sales clerks, in which the person is not spending several hours at a time reading or studying, for example.
Monovision
This system works with one eye focused for distance and the other eye focused for near. This can be done with any type of contact lens or refractive surgery.
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Reading and Writing
Everyone must visualize what is meant by the words we read and write. Sometimes people with learning-related vision problems
can see the words, but they cannot understand what they mean. If you had that problem, would you find reading and writing easy? Reading and writing are the two most common tasks people perform in school or at a desk job. Every time we read from a book,
a sheet of paper, or a computer monitor, we are performing a visual task.
How We Read
While we read, we need to aim two eyes at the same point simultaneously and accurately as well as the following:
• Focus both eyes to make the reading material clear
• Continue or sustain clear focus
• Move two eyes continually (as a coordinated team) across the line of print
When we move our eyes to the next line of print, we continue with the entire procedure.
Reading Comprehension
To gain comprehension throughout the reading process, we are constantly taking in the visual information and decoding it from the written word into a mental image. Memory and visualization are also constantly used to relate the information to what is already known and help make sense of what is being read.
How We Write
Writing is similar but almost works in the reverse order to reading. We start with an image in our minds and code it into words.
At the same time, we control the movement of the pencil while continually working to keep the written material making sense. Throughout all this, we focus our eyes and move them together just as in the reading process.
Complicated visual procedures are involved in both reading and writing. A problem with any or all of the visual parts of the processes described will present difficulties in some way with reading and/or writing.
Sometimes a visual difficulty that affects reading and writing is easy to recognize; other times it can be quite subtle to detect. Optometrists are able to evaluate all parts of the visual process and, if necessary, prescribe lenses and vision therapy to improve reading and writing skills.
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Retinal Detachment
Retinal detachment occurs when the two layers of the retina become separated from each other and from the wall of the eye.
The retina is like the film in a camera. Nerve cells in the retina detect light entering the eye and convert it into nerve signals to the brain.
Once the two layers of the retina, the sensory retina and the retinal pigment epithelium, lose contact with each other, the retina stops working properly because the eye cannot process what it sees. This causes vision loss in the affected area of the retina. Detachment always results in some vision loss, including severe loss or blindness.
Symptoms
Retinal detachment may occur without warning. Symptoms include floaters in your field of vision and flashes of light or sparks
when you move your eyes or head. Floaters and flashes do not always indicate retinal detachment, but they may be a warning sign and should be evaluated. If a flashing light occurs and does not go away within minutes, you should be examined immediately. The first sign of detachment may be a shadow or curtain effect across part of your visual field that does not go away, or new and sudden
vision loss that gets worse over time.
Retinal detachment affects peripheral (side) vision first. Vision loss tends to get worse over time as more of the retina becomes detached, sometimes within a few hours or days. Once the detachment spreads to the center of the retina, vision loss becomes
severe or even total. Surgery is needed to repair the detached retina to prevent permanent vision loss.
Diagnosis
Retinal detachment is diagnosed by medical history and an examination of the eyes. If you have symptoms of retinal detachment,
your doctor will examine your retina by using ophthalmoscopy. Ophthalmoscopy is a test that allows a doctor to see inside the back
of the eye with a magnifying instrument with a light source. This test enables the doctor to see tears, holes, or detachment of the retina. Pictures may be taken to document the appearance of the retina.
Treatment
Retinal detachment almost always demands urgent care. Without treatment, vision loss from retinal detachment can progress from minor to severe or total within a few hours or days. If discovered within 24 to 48 hours, comparatively simple laser surgery may restore good vision. If allowed to progress, the surgical techniques become much more difficult and the recuperation time longer, with a greater chance for permanent loss of vision.
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Retinitis Pigmentosa
Retinitis pigmentosa (RP) is one of a group of diseases that affect the retina of the eye. Approximately 400,000 Americans are
affected by RP and other RP-like inherited forms of retinal degeneration.
Some of the most common symptoms of RP include night blindness and loss of peripheral (side) vision.
Symptoms of RP often appear for the first time during childhood or adolescence. Stumbling over objects that seem to be in plain sight and clumsiness may be the first indications of a problem. The symptoms of RP generally worsen over a period of years.
Although some patients with RP and advancing age may become blind, most will retain at least some vision and are classified as legally blind. Each individual case differs.
RP develops inside the pigmented layer of the retina. The retina is a delicate layer of cells that acts like the film in a camera.
It picks up a picture and transmits it to the brain, where “seeing” actually occurs. Two types of cells in the retina that participate in sending visual messages to the brain are the rods and cones. The rod-shaped cells are mostly used to help you see “out of the
corners of your eyes” (peripheral vision) and at night. The cone-shaped cells enable you to distinguish colors, see during the day, and help you see with your central vision.
When RP begins, the rod-shaped cells begin to lose their ability to function. As a result, people with this condition frequently have trouble seeing at night or in areas of dim light. Poor or decreased night vision alone is not necessarily an indicator of RP, however.
“Tunnel vision” is also a symptom of RP. The field of vision gradually narrows, giving the effect of constantly looking through a tunnel.
As RP progresses to an advanced stage, you may also have difficulty reading, distinguishing colors, and seeing distant objects clearly. This is caused by the deterioration of the cone-shaped cells.
Your optometrist may be able to help you in maximizing your remaining vision by prescribing special low vision aids. Some of the optical aids available include telescopic lenses for distance vision, microscopic lenses, magnifying glasses, electronic
magnifiers, night vision scopes, special filters, and field enhancers.
Unfortunately, although extensive research is being conducted, no treatment is available at this time to reverse the course of RP. However, early counseling by your optometrist can help you successfully adjust your lifestyle and career goals to this visual impairment. Potential problems can also be identified and forestalled by determining appropriate aids, training, and other job modifications in your chosen career field. When RP is diagnosed early, you can often take full advantage of educational and career guidance.
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Strabismus and Amblyopia
Strabismus is the condition in which a person is unable to align both eyes simultaneously under normal visual conditions (sometimes
appearing as being “cross eyed”). The fovea of each eye is used for distinct vision. When they do not point at an object at the same
time, one eye “turns” in relation to the other. This turning may be in, out, up, down, or in any combination of directions. This turning
also may be constant, in which an eye turns all the time, or it may be intermittent. It may also alternate so that either eye turns. Besides the obvious turning of an eye, the individual has reduced binocular function and stereopsis (depth perception) and may develop
reduced vision in one eye (amblyopia).
Strabismus has many different causes. The specific treatment depends on the specific type and cause. Strabismus can be treated at any age. Some factors favor younger patients, and compliance and motivation are more favorable with adults. Treatment typically consists of prescription lenses and prisms and a program of vision therapy. In certain patients surgery may be recommended in conjunction with vision therapy. Surgery may cosmetically straighten the eyes but does not typically improve visual function. The prognosis for optimal outcome in these cases is enhanced through presurgical and postsurgical vision therapy. Whether constant or intermittent, strabismus always requires treatment. It rarely goes away by itself, and children do not outgrow it.
Amblyopia, more commonly known as “lazy eye,” is a condition manifested by reduced vision not correctable by glasses or contact lenses. It is not attributable to any apparent structural or pathologic condition. It may be related to strabismus because a
turned eye generally loses vision to some extent from disuse. Many patients with amblyopia may be unaware of the condition until they undergo a vision screening or a comprehensive vision examination. Amblyopia has many causes, and the treatment depends on
the cause. In general, the treatment consists of the use of lenses and prisms in conjunction with a vision therapy program. Patching
of the nonamblyopic eye is of limited value unless it is part of an active vision therapy program.
For many years amblyopia was thought only to be amenable to treatment during the critical period, up to age 7 or 8 years. Current research has conclusively demonstrated that effective treatment can take place at any age, but the length of the treatment period increases dramatically the longer the condition has existed before treatment. Research has demonstrated that patients with amblyopia are more likely to sustain injuries resulting in the loss of their good eye than individuals with two good eyes. Early childhood examinations are therefore essential.
Esotropia
1. The most commonly encountered intermittent esotropia usually requires 40 to 52 hours of office therapy.
2. The most commonly encountered constant esotropia usually requires 60 to 75 hours of office therapy.
3. Esotropia complicated by:
a. Associated visual adaptations (e.g., suppression, amblyopia, abnormal retinal correspondence) require additional office therapy.
b. Associated visual anomalies (e.g., cyclotropia, hypertropia) require additional office therapy.
c. Associated conditions such as stroke, head trauma, and strabismus surgery require substantially more office therapy.
Follow-up Care
At the conclusion of the active treatment regimen, periodic follow-up evaluations should be provided at appropriate intervals. Therapeutic lenses may be prescribed at the conclusion of vision therapy for maintenance of long-term stability. Some cases may require additional therapy because of decompensation.
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Subconjunctival Hemorrhage
A subconjunctival hemorrhage occurs on the surface of the eye. It is caused by a rupture of a small blood vessel under the
conjunctiva, the transparent outermost protective covering of the eye. This allows blood to spread under this tissue, often causing
a dramatic presentation. However, in the majority of patients it is of no consequence but may take several weeks to completely resolve or be reabsorbed into the vascular system.
Generally, physical exertion, straining, coughing, or sneezing may be responsible for a rupture of a small blood vessel under the subconjunctival area; however, frequently no cause can be identified.
The standard recommended treatment is to apply cold compresses several times per day for 2 days to reduce any additional blood flow into the area followed by warm compresses to facilitate reabsorption.
If subconjunctival hemorrhages reoccur two or more times in a year, vascular system disease must be ruled out.
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Systemic Disease and Your Eyes
Many diseases in other parts of the body can result in problems with your eyes. Patients with certain systemic diseases should see
their eye doctor on a regular basis to ensure that no vision loss occurs. Likewise, during the course of an eye examination, your eye doctor can often detect changes in the structure of your eyes that indicate a possible systemic disease. An eye doctor can typically detect signs of 400 diseases occurring in other parts of the body, including the following:
Diabetes Anemia
High blood pressure Multiple sclerosis
High cholesterol Autoimmune diseases Heart disease Arthritis Arteriosclerosis Toxoplasmosis Leukemia Histoplasmosis
Stroke Rosacea
Myasthenia gravis Cancer
Because most eye disorders are painless and change gradually, you may not be aware of them until vision loss occurs. At that point it may be too late to recover the lost vision. An example of this is glaucoma or macular degeneration.
Your eye doctor can see signs of systemic disease in many ways by examining your eyes. By looking inside your eyes at the retina, he or she may observe new fragile blood vessels growing, as in diabetes. In hypertension, the arteries first become narrow, then hemorrhage and show leakages called exudates that eventually develop into optic nerve edema, which may indicate that a person is near death. Heart disease can cause a unique hemorrhage called a Roth spot. Plaque in a retinal artery may signal an increased risk for stroke. Scars in the retina may indicate a fungal disease or parasitic disease. Nearly any disease that can affect blood vessels may be seen inside the eye. Inside the eye is the one place your doctor can see the tiny blood vessels magnified
several times without cutting open the skin.
Arthritis can be associated with inflammation of the white part of the eye, the sclera, or the colored part of the eye, the iris. High cholesterol can be detected by looking for a white ring on the back of the clear lens on the front of your eye, the cornea, or yellow deposits of cholesterol on the skin on your eyelids called xanthelasma. Your eye doctor can see the tiny blood vessels inside the eye filling up with cholesterol. If they are getting filled up, you run the risk of the heart vessels becoming clogged, causing a heart
attack, or your carotid vessels becoming clogged, causing a stroke.
Nerve disorders such as multiple sclerosis may affect the optic nerve or the nerves leading to the eye muscles, eyelids, and face. Rosacea may affect the tears and the front of the eye, causing irritation. Melanoma and other cancers can metastasize from the eye
or to the eye.
Regular eye examinations with your eye doctor can minimize the loss of vision from systemic disease. Your eye doctor may also detect signs of a disease you did not know you had.
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Vision Therapy for Adults
Many people think that vision therapy is only for children. This could not be further from the truth. Adults have as much need for
this type of vision care as children do. Vision therapy is often more effective for adults because they are usually more motivated to improve their visual abilities, whereas children may not understand that they have a problem or how that problem may affect their interests or future.
Many people have visual problems sustaining near-centered work (reading, writing, and computer use), and they are not limited
to children in school. When people have trouble using both eyes together or cannot focus for great lengths of time, they do not tend
to grow out of these problems. Children with visual problems often become adults with visual problems.
Adults will figure out many ways to compensate for their visual problems so that they can continue with any strenuous visual work they need to do. Often, adults come home from work extremely tired when all they did was sit at a desk and do paperwork.
Some people will feel as if they had just run a 10-K race! Children, on the other hand, tend to avoid tasks that are difficult or make them feel inadequate.
The right doctor can help reduce the strain of near work as well as work with any other kinds of visual problems. The proper
lenses along with vision therapy make a tremendous difference in an adult’s ability to function at work or play, just as with children
of school age.
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Warm Soaks
Warm soaks help resolve eye infections by speeding up blood supply to the affected area.
1. Use tap water. Run the tap for approximately 2 minutes to avoid still-standing water that may contain sediment from the pipes. You do not need to use distilled or purified drinking water.
2. Use warm, not hot, water. Hot water can damage the delicate skin of the eyelids.
3. Soak a clean washcloth in the warm tap water. Close both eyes and lay the cloth over both eyes or as directed: ______________________
4. Leave the cloth over your eyes until it has cooled down and lost its warmth. Then resoak it in the warm water. You will probably need to resoak the cloth every 30 seconds.
5. Attempt to maintain a consistently warm temperature when soaking.
6. Soak for a total of 5 minutes or as directed:___________________________________
Soak three times a day or as directed:____________________________________
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What is Vision Therapy?
Vision therapy is defined as the following:
• A progressive program of vision “exercises” or procedures
• Performed under doctor supervision
• Individualized to fit the visual needs of each patient
• Generally conducted in the office in once- or twice-weekly sessions of 30 minutes to an hour
• Sometimes supplemented with procedures done at home between office visits (“homework”)
• Prescribed to help patients develop or improve fundamental visual skills and abilities
• Prescribed to improve visual comfort, ease, and efficiency
• Prescribed to change how a patient processes or interprets visual information
Not Just Eye Exercise
Unlike other forms of exercise, the goal of vision therapy is not to strengthen eye muscles. Your eye muscles are already
incredibly strong. Vision therapy should not be confused with any self-directed program of eye exercises that has been marketed
to the public.Vision therapy is supervised by vision care professionals, and many types of specialized and medical equipment can be used, such as the following:
• Therapeutic lenses (regulated medical devices)
• Prisms (regulated medical devices)
• Filters
• Occluders or patches
• Electronic targets with timing mechanisms
• Computer software
• Balance boards
The first step in any vision therapy program is a comprehensive vision examination. After a thorough evaluation, a qualified vision care professional can advise you regarding whether you are a good candidate for vision therapy and whether vision therapy is appropriate treatment for you.
Vision therapy is sometimes referred to as visual therapy or vision training.
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Family Medical History and Risk
If you or a blood relative has a history of the following disorders, you are at risk of losing your sight. Talk to your eye doctor about
how you can prevent the loss of vision caused by such medical conditions.
Medical and Ocular Diseases: A Personal and Family History
In the medical history, specific questions about current or past personal, medical, or ophthalmic diseases may also be of value in
prescribing eyeglass enhancements wisely to help promote healthy sight. The family history is an extension of this. In an individual with
a strong family history of vision-threatening ocular disorders (e.g., cataract and macular degeneration), special care must be taken to minimize the risk of the patient developing similar problems. This same caution holds true for patients with beginning cataracts or those with retinal abnormalities such as drusens, which might progress to the more serious macular degeneration. Also important in the
medical history are other diseases that might have ocular implications, such as diabetes, autoimmune disorders, cancer, and circulatory disease. Early detection, and treatment when indicated, are essential to maintain both good health and good sight over a lifetime.
You run a greater risk for vision loss if you or a blood relative have:
Diabetes Eczema or psoriasis High blood pressure Thyroid disease Leukemia Hypoglycemia
Anemia Autoimmune disease
Multiple sclerosis Glaucoma
Arthritis Cataract
Migraines Macular degeneration
Heart disease Amblyopia
High cholesterol Eye muscle disorder
Epilepsy Allergy or asthma
Protecting Your Eyes
• Wear sunglasses that protect you from ultraviolet radiation.
• Wear a brimmed hat to reduce direct sunlight.
• Eat a diet rich in fruits and leafy green vegetables.
• Watch blood pressure and limit saturated fats and cholesterol.
• Limit alcohol intake.
• Most importantly, stop smoking.
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