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Physical, school, health fair, or drivers vision screenings cannot substitute for routine exams with your eye doctor. Your eye doctor will perform a comprehensive examination of your vision and eye health to include testing of:
Far and Near Visual Acuity
Eye Muscle Coordination
Side or Peripheral Vision – to screen for problems affecting the visual pathway from the eyes to the back of the brain including glaucoma, strokes, and tumors
Pupil Response to Light
Refraction – to detect nearsightedness, farsightedness, astigmatism, and presbyopia
Intraocular Pressure – to measure the pressure inside the eye, which is part of glaucoma testing
Anterior Segment of the Eye – to check for conditions affecting the front of the eye including the eyelid area, conjunctiva, cornea, and iris
Posterior Segment of the Eye – to check for conditions toward the back of the eye such as cataracts, floaters, glaucoma, macular degeneration, and diabetic retinopathy
Symptoms of diabetic retinopathy include:
- Seeing spots or floating strings
- Blurred vision
- Having a dark or empty spot in the center of your vision
- Difficulty seeing well at night
Often there are no visual symptoms in the early stages of diabetic retinopathy. That is why it is recommended that everyone with diabetes have a comprehensive dilated eye examination at least once a year. Early detection and treatment can limit the potential for significant vision loss from diabetic retinopathy.
A cataract is a cloudy area in the normally clear lens of the eye. The lens is located behind the iris, the colored part of the eye. The lens focuses light on the back of the eye, the retina, which sends the image through the optic nerve to the brain. If a cataract clouds the lens, the lens can no longer focus it properly. Depending upon its size and location, a cataract can interfere with normal vision.
Signs and symptoms of a cataract may include:
- Blurred or dim vision
- Increased sensitivity to glare from lights, particularly when driving at night
- Increased difficulty seeing at night or in dim light
- Most cataracts are due to age-related changes in the lens
Other factors that can contribute to their development include:
- Extensive exposure to sunlight
- Steroid medicines
- Previous eye trauma, swelling or surgery
If you have any of these risks factors for cataract, you should schedule an appointment with your eye doctor.
The treatment of cataracts is based on the level of visual impairment they cause. If a cataract affects vision only minimally or not at all, you may be advised to follow a regular check-up schedule. In some cases, a change in eyeglass prescription may improve your vision. The use of non-glare lenses can help reduce glare for night driving. When a cataract progresses to the point that it affects your ability to do normal everyday tasks, surgery may be recommended.
Glaucoma is the second leading cause of blindness in the United States and is the leading cause of blindness in Hispanics. It is a group of eye disorders, sometimes related to increased pressure inside the eye, leading to progressive damage to the optic nerve resulting in permanent vision loss. Since there is usually no symptom, many people do not become aware they have the condition until significant vision loss has occurred.
Medication or surgery can slow or prevent further vision loss. However, vision already lost to glaucoma cannot be restored. That is why an annual dilated eye examination is recommended for people at risk for glaucoma. Depending on your specific condition, your doctor may recommend more frequent examinations.
Certain factors can increase the risk for developing glaucoma, including:
- Family history of glaucoma
- Medical conditions – Some studies indicate that diabetes may increase the risk of developing glaucoma, as do high blood pressure and heart disease.
- Age – People over age 60 are at increased risk for the disease. For African Americans, the increase in risk begins after age 40.
- Race – African Americans are significantly more likely to get glaucoma than are Caucasians, and they are much more likely to suffer permanent vision loss as a result. People of Asian descent are at higher risk of certain types of glaucoma.
- Physical injuries to the eye – Severe trauma, such as being hit in the eye, can result in immediate increased eye pressure and future increases in pressure due to internal damage. Injury can also dislocate the lens, closing the drainage angle, and increasing pressure.
- Other eye-related risk factors – Eye anatomy, namely corneal thickness and optic nerve appearance indicate risk for development of glaucoma. Conditions such as retinal detachment, eye tumors, and eye inflammations may also induce glaucoma. Some studies suggest that high amounts of nearsightedness may also be a risk factor for the development of glaucoma.
- Use of steroid-containing medication
- Previous eye trauma, swelling or surgery
Age-related macular degeneration is the leading cause of severe vision loss in adults over age 50. This eye disease occurs when the macula deteriorates. The macula is the small part of the inside back layer of the eye that is responsible for your central vision and allows you to see fine details clearly. Although there may be no symptoms in the early stages, symptoms may occur as the disease progresses, which may include:
- Dark or blank areas or distortion in your central vision
- Need for increasing bright light to see up close
- Colors appear less bright
- Difficulty seeing when going from bright light to low light
- Trouble recognizing people’s faces
Treatment may include sunglasses, special vitamins, medications, laser surgery, low vision aids, and vision rehabilitation. Any vision loss cannot be restored.
The following individuals who are at risk should be examined at least yearly:
- Age 50 or over
- Family history of macular degeneration or blindness of unknown cause
- High blood pressure, abnormal cholesterol levels
Additional Tests include:
Color Vision – to detect type and extent of any color vision deficiency
Depth Perception – to determine the ability to see in 3D and perceive the distance of an object
OCT (Optical Coherence Tomography) – non-invasive optical signal method to obtain high resolution 3-D images within and posterior to the retina and optic nerve, very useful in the diagnosis and management of conditions such as glaucoma, diabetic retinopathy, and macular degeneration
Posterior or Anterior Segment Digital Photography – detailed digital images of the back or front of the eye useful in the management of conditions such as glaucoma, diabetic retinopathy, and macular degeneration
A-Scan Ultrasound – to determine the length of the eye for calculation of the intraocular lens implant used after removing a cataract
Keratometry – to measure the curvature of the cornea to help select proper contact lens or intraocular lens implant
Automated Perimetry (Visual Field Testing) – use of a computer-based program to detect defects in the field of vision that may indicate conditions affecting the visual pathway from the back of the eye to the back of the brain such as glaucoma, brain tumors, and strokes
Gonioscopy – use of a gonio lens and a slit lamp microscope to view the area between the cornea and iris to diagnose and monitor various eye conditions including glaucoma
Pachymetry – to measure the thickness of the cornea using ultrasound, an important test for glaucoma detection
- What causes dry eyes?
- How is dry eye diagnosed?
- How is dry eye treated?
Dry eye is a condition in which there are insufficient tears to lubricate and nourish the eye. Tears are necessary for maintaining the health of the front surface of the eye and for providing clear vision. People with dry eyes either do not produce enough tears or have a poor quality of tears. Dry eye is a common and often chronic problem, particularly in older adults.
With each blink of the eyelids, tears are spread across the front surface of the eye, known as the cornea. Tears provide lubrication, reduce the risk of eye infection, wash away foreign matter in the eye, and keep the surface of the eyes smooth and clear. Excess tears in the eyes flow into small drainage ducts, in the inner corners of the eyelids, which drain in the back of the nose.
Dry eyes can result from an improper balance of tear production and drainage.
- Inadequate amount of tears – Tears are produced by several glands in and around the eyelids. Tear production tends to diminish with age, with various medical conditions, or as a side effect of certain medicines. Environmental conditions such as wind and dry climates can also affect tear volume by increasing tear evaporation. When the normal amount of tear production decreases or tears evaporate too quickly from the eyes, symptoms of dry eye can develop.
- Poor quality of tears – Tears are made up of three layers: oil, water, and mucus. Each component serves a function in protecting and nourishing the front surface of the eye. A smooth oil layer helps to prevent evaporation of the water layer, while the mucin layer functions in spreading the tears evenly over the surface of the eye. If the tears evaporate too quickly or do not spread evenly over the cornea due to deficiencies with any of the three tear layers, dry eye symptoms can develop.
People with dry eyes may experience symptoms of irritated, gritty, scratchy, or burning eyes, a feeling of something in their eyes, excess watering, and blurred vision. Advanced dry eyes may damage the front surface of the eye and impair vision.Treatments for dry eyes aim to restore or maintain the normal amount of tears in the eye to minimize dryness and related discomfort and to maintain eye health.
What causes dry eyes?
The majority of people over the age of 65 experience some symptoms of dry eyes. The development of dry eyes can have many causes. They include:
- Age – dry eye is a part of the natural aging process. The majority of people over age 65 experience some symptoms of dry eyes.
- Gender – women are more likely to develop dry eyes due to hormonal changes caused by pregnancy, the use of oral contraceptives, and menopause.
- Medications – certain medicines, including antihistamines, decongestants, blood pressure medications and antidepressants, can reduce the amount of tears produced in the eyes.
- Medical conditions – persons with rheumatoid arthritis, diabetes and thyroid problems are more likely to have symptoms of dry eyes. Also, problems with inflammation of the eyelids (blepharitis), inflammation of the surfaces of the eye, or the inward or outward turning of eyelids can cause dry eyes to develop.
- Environmental conditions – exposure to smoke, wind and dry climates can increase tear evaporation resulting in dry eye symptoms. Failure to blink regularly, such as when staring at a computer screen for long periods of time, can also contribute to drying of the eyes.
- Other factors – long term use of contact lenses can be a factor in the development of dry eyes. Refractive eye surgeries, such as LASIK, can cause decreased tear production and dry eyes.
How are dry eyes diagnosed?
Dry eyes can be diagnosed through a comprehensive eye examination.
Testing, with special emphasis on the evaluation of the quantity and quality of tears produced by the eyes, may include:
- Patient history to determine any symptoms the patient is experiencing and the presence of any general health problems, medications taken, or environmental factors that may be contributing to the dry eye problem.
- External examination of the eye, including lid structure and blink dynamics.
- Evaluation of the eyelids and cornea using bright light and magnification.
- Measurement of the quantity and quality of tears for any abnormalities. Special dyes may be instilled in the eyes to better observe tear flow and to highlight any changes to the outer surface of the eye caused by insufficient tears.
Using the information obtained from testing, your optometrist can determine if you have dry eyes and advise you on treatment options.
How are dry eyes treated?
One of the primary approaches used to manage and treat mild cases of dry eyes is adding tears using over-the-counter artificial tear solutions.
Dry eyes can be a chronic condition, but your optometrist can prescribe treatment to keep your eyes healthy, more comfortable, and prevent your vision from being affected. The primary approaches used to manage and treat dry eyes include adding tears, conserving tears, increasing tear production, and treating the inflammation of the eyelids or eye surface that contributes to the dry eyes.
- Adding tears – Mild cases of dry eyes can often be managed using over-the-counter artificial tear solutions. These can be used as often as needed to supplement natural tear production. Preservative-free artificial tear solutions are recommended because they contain fewer additives that could further irritate the eyes. However, some people may have persistent dry eyes that don’t respond to artificial tears alone. Additional steps need to be taken to treat their dry eyes.
- Conserving tears – An additional approach to reducing the symptoms of dry eyes is to keep natural tears in the eyes longer. This can be done by blocking the tear ducts through which the tears normally drain. The tear ducts can be blocked with tiny silicone or gel-like plugs that can be removed, if needed. A surgical procedure to permanently close tear ducts can also be used. In either case, the goal is to keep the available tears in the eye longer to reduce problems related to dry eyes.
- Increasing tear production – Prescription eye drops that help to increase production of tears can be recommended by your optometrist, as well as omega-3 fatty acid nutritional supplements.
Treatment of the contributing eyelid or ocular surface inflammation – Prescription eye drops or ointments, warm compresses and lid massage, or eyelid cleaners may be recommended to help decrease inflammation around the surface of the eyes.
Steps you can take to reduce symptoms of dry eyes include:
- Remembering to blink regularly when reading or staring at a computer screen for long periods of time.
- Increasing the level of humidity in the air at work and at home.
- Wearing sunglasses outdoors, particularly those with wrap around frame design, to reduce exposure to drying winds and sun.
- Using nutritional supplements containing essential fatty acids may help decrease dry eye symptoms in some people. Ask your optometrist if the use of dietary supplements could be of help for your dry eye problems.
- Avoiding becoming dehydrated by drinking plenty of water (8 to 10 glasses) each day.