Ask the Doctor

Here are some frequently asked questions about eyes.

If you have more questions or would like to leave a comment please feel free to contact us.




Glasses

Will everyone need reading glasses eventually?

Yes! Presbyopia is the term used to describe the loss of the eyes ability to change focus to see objects close up. This ability starts to deteriorate from the time we are born, but usually doesn't start to bother in every day life until early to mid 40’s.

The mechanism is still not clearly understood, but one of the hypothesis is that the lens inside your eye gradually gets stiffer and therefore, the ability to flex and focus decreases. It is not uncommon to have changes starting in late 30’s and continue to change throughout that decade into early 50's.

The first sign may be a difficulty in changing focus from near to far distances. Depending on your prescription, the needs will vary. Most people will feel the most comfortable going with a progressive lens that is also known as a no-line bifocal. This lens starts out with the distance prescription at the top and progressively gets stronger for reading as you look down the lens. At the bottom would be the most power for reading. This lens works well for computer distances also.

Other options include separate pair of glasses for reading or simply taking the glasses off to read. In some cases, over-the-counter reading glasses may be an option for you. It's important to have a yearly comprehensive exam to see what option would be best for your eyes.

Is more than one pair of glasses ever necessary?

Yes, there are many reasons why more than one pair of glasses is necessary. Think about all the different things you do in a day. You may work at a computer, go for a bike ride, mow the lawn, attend a social function, watch TV and read in bed before going to sleep, all in one day. All of those activities require your eyes to be used in different capacities.

If you are over 40 years old, these activities can become even more difficult to do with only one pair of glasses. Many people, at any age, find that a separate pair of reading or computer glasses reduces the strain on the eyes when they spend all day at the computer or doing paperwork. Those doing activities outside need a quality pair of sunglasses with safety lenses in them to protect the eyes and prevent UV light from damaging them. For a social function, a fun pair of glasses may be just the look you need with that new outfit.

Many people who use progressive lenses feel a single vision pair of either distance or reading glasses is more comfortable for watching TV while reclining or reading in bed. For those who depend on glasses or contact lenses to see, a back up pair of glasses is helpful if the current pair would break unexpectedly or when contact lenses cannot be worn.

Just as you wouldn’t dream of exercising in heels or attending a formal event in your tennis shoes, glasses have many different uses that will require more than one pair for comfort, safety and fashion.

Why are sunglasses important?

Sunglasses protect the eyes from harmful UV rays. They protect the delicate skin around the eyes preventing wrinkles and benign or malignant skin cancers on the eyelids. UV light exposure also increases the risk of cataracts and macular degeneration.

Polarized sunglasses decrease the glare caused from the sun reflecting off surfaces and are used for general use and especially for driving, boating, skiing and fishing.

A good quality pair of sunglasses will have total UV protection, be made of impact resistant materials for outdoor activity use, reduce glare with polarized lenses and come in the proper tint to enhance contrast for specific activities.

Sunglasses should be worn year round for UV protection and comfort in bright conditions.

Are sunglasses necessary in the winter?

As winter approaches, we make sure we have a hat, gloves and boots ready, but are we looking for our sunglasses? Even though the sun seems less intense during the winter, the reflection off the snow can still cause eye damage.

New snow can reflect up to 80% of UV rays while normal ground surfaces and water tend to reflect less than 10%. Polarized sunwear decreases the glare more than a tint by itself does.

While some contact lenses have UV protection, sunglasses are still needed to protect the eye tissues and lids that are not covered by the contact lenses. UV damage can cause cataracts, macular degeneration and melanomas on the lids and white part of the eyes along with wrinkles around the eyes.

What is an anti-reflective coating?

An anti-reflective coating is a clear coating that is put on both sides of the lenses which allows light to pass through the lens, eliminating reflections off the surface of the lens. Reflections can cause eye strain and fatigue, especially when under fluorescent lighting and while using computers.

Anti-reflective coatings also help with reducing the starburst effects of lights, making night driving easier. Cosmetically, glasses look nicer without the reflections, as the anti-reflective coating allows the eyes to be seen easier.

Many improvements have been made to anti-reflective coatings over the years. Good quality anti-reflective coatings have scratch resistance built in and are easier to clean. Consider an anti-reflective coating on your lenses to make your glasses look better and your eyes feel better.

What is a Progressive Lens?

A progressive lens, also known as a no-line bifocal, allows vision at all distances.

The top portion gives distance vision past 5 feet; the middle of the lens is for intermediate vision, usually past arm’s length to 5 feet and at the bottom of the lens, areas that you can touch within arm’s reach.

This lens technology has constantly changed since they first came out many years ago, to allow more usable vision in all areas. There is still a “channel” down the center that allows the clearest vision.

Since many powers are being blended together without lines, there is some distortion off to the sides. As the lens technology improves, the ability for people to adjust to progressive lenses increases. Those who may have tried an older lens design and were unable to wear it, may find it much easier now.

Overall, a progressive lens will give the best vision, as it allows focus at multiple distances, instead of just two (bifocal) or three (trifocal).




Contact Lenses

Why does a contact lens exam cost more than one for glasses?

A comprehensive eye examination includes a full health evaluation and a refraction, which determines the prescription for glasses. Contact lenses have a fitting and evaluation process.

We start out by finding out the needs and wants of the contact lens wearer. For example, are the contact lenses comfortable for as long as you would like to be able to wear them each day? Does vision stay clear throughout the day and for the life of the lens? After finding out information on how the lenses are working currently and also checking for a new prescription, we can find a contact lens that would be the best for your situation and lifestyle.

There are hundreds of different brands to choose from and each has their own unique qualities and benefits. We need to do extra measurements, such as looking at the curvature of the front surface where the contact lens will be sitting and also looking at the fitting of the contact on your eye. It needs to move enough to allow oxygen exchange, but not too much that it will cause discomfort.

Most fittings include follow up appointments to ensure that the lenses are comfortable and the fit is still adequate after wearing the lenses for an extended period of time. A contact lens prescription is found based on the brand of lenses that works best for all of your needs along with the proper fitting and prescription.

I have astigmatism. Can I wear contact lenses?

Many options exist today for astigmatism correction. In the past few years, many soft contact lenses have come out on the market that are more comfortable and have a wider range of parameters to fit more prescriptions than before. They also come in the newer lens materials that allow more oxygen to the eyes and therefore, the lenses stay hydrated longer.

A gas permeable lens is another option for astigmatism. Gas permeable lenses allow clearer and more stable vision due to the design of the lenses. They work well for higher prescriptions and for those that have fluctuating vision with soft contact lenses.

With the many advances in contact lenses in the past few years, there are very few prescriptions that are unable to be fit with contact lenses.

Can I change my eye color?

Yes!

There are many contact lenses available to change eye color. Some of the contacts enhance the natural color of your eyes, while others cause a more definite change. There are many different shades of blue, green and brown available, along with purple and gray.

Most of the colored contact lenses are two week disposable lenses, but there are some colors that are available in a one day disposable lens. These are great to slip in for an evening out!

There are even colored contacts available to correct for astigmatism. Since they are a medical device, just as any other contact lens, they need to be fitted to ensure optimal vision and healthy eyes.

My contact lenses bother during allergy season. Do I just have to wear my glasses?

In most cases, contact lenses can be worn comfortably during allergy season with just a few simple changes.

Allergens can cause itching and a white, ropy discharge that can adhere to the lenses, causing blurred vision and discomfort. It is important to keep the contact lenses as clean as possible.

One way is to use a hydrogen peroxide solution instead of a multipurpose solution. Another way is to replace the lenses more frequently. Many people find that daily disposable lenses work best during allergy season as they get a fresh lens every day.

Even though oral medication may help the sneezing, it may not always take care of the itching eyes. Prescription allergy eye drops are available to take care of the eye symptoms of allergies. They work better than over the counter allergy eye drops and can be used in conjunction with contact lenses.

As you can see, minor changes during allergy season can greatly enhance the comfort of contact lenses.

Are there differences between contact lens solutions?

There is a difference in contact lens solutions and most people can tell in how the contact lenses feel with different solutions used.

All multi-purpose (no rub) solutions contain preservatives and each brand has a different one. These preservatives can soak up into the lenses as they sit each night to disinfect.

If you notice that your lenses feel much better right out of the packages rather than after a few days of wearing and soaking in solution, you may have a solution sensitivity. All generic products are bought from whichever company has the best deal at the time, so one bottle could contain something different than the next bottle purchased.

To disinfect without preservatives, a hydrogen peroxide solution is used. This eliminates any solution sensitivity issues so the lenses usually feel much better for a longer period of time.

Some contact lenses are more compatible with certain solutions so using what your doctor recommends is always the best option.

Are there differences between contact lens solutions?

There is a difference in contact lens solutions and most people can tell in how the contact lenses feel with different solutions used.

All multi-purpose (no rub) solutions contain preservatives and each brand has a different one. These preservatives can soak up into the lenses as they sit each night to disinfect.

If you notice that your lenses feel much better right out of the packages rather than after a few days of wearing and soaking in solution, you may have a solution sensitivity. All generic products are bought from whichever company has the best deal at the time, so one bottle could contain something different than the next bottle purchased.

To disinfect without preservatives, a hydrogen peroxide solution is used. This eliminates any solution sensitivity issues so the lenses usually feel much better for a longer period of time.

Some contact lenses are more compatible with certain solutions so using what your doctor recommends is always the best option.

Can I still wear contact lenses if I need reading glasses?

Yes! Many options exist with improvements made yearly for multifocal contact lenses. These lenses are available in both gas permeable and soft materials. The best vision will come from a distance-only pair of contact lenses used along with prescription reading glasses. However, this alternative is not as convenient as some people would like.

The next best option is a multifocal contact lens. With this option, however, nighttime driving is not quite as sharp as with glasses, or tiny print in a dimly lit area may not be as clear. Since the majority of the day is spent reading, driving and using the computer, the inconvenience is minimal.

The last option is monovision, which prescribes one eye for distance viewing and one eye for near viewing. This method works better when only a small amount of reading power is necessary. With the many options available today, there is a contact lens that will work for you!




Eye Health

I have astigmatism. Can I wear contact lenses?

Many options exist today for astigmatism correction. In the past few years, many soft contact lenses have come out on the market that are more comfortable and have a wider range of parameters to fit more prescriptions than before. They also come in the newer lens materials that allow more oxygen to the eyes and therefore, the lenses stay hydrated longer.

A gas permeable lens is another option for astigmatism. Gas permeable lenses allow clearer and more stable vision due to the design of the lenses. They work well for higher prescriptions and for those that have fluctuating vision with soft contact lenses.

With the many advances in contact lenses in the past few years, there are very few prescriptions that are unable to be fit with contact lenses.

My eye is red and itchy. Does that mean I have pink eye?

Pink eye is a general term for conjunctivitis, an inflammation of the conjunctiva, the clear membrane that covers the white part (sclera) of the eye. There are many forms of conjunctivitis--bacterial, viral and allergic. All can appear very similar from a general observation.

Other red eyes can occur from excessive dryness, contact lens induced irritations, foreign matter in the eye or more seriously, a problem deeper into the eye. Many red eyes are mistakenly diagnosed with "pink eye" when they are actually due to another cause. This can increase the time it takes to get over the redness.
An optometrist has the proper instrumentation and knowledge to diagnose and treat these conditions. It is always best to get a "pink eye" checked out as it could mean a more serious problem starting and may not go away on its own.

What is a lazy eye?

Amblyopia, commonly known as “lazy eye”, is a decrease in vision to 20/30 or less in one eye with no presence of any disease process. It occurs due to a number of different reasons.

One of the most common is a difference in prescription between the two eyes. If there is a considerable difference, the eye that has the higher prescription will not be used and therefore, not get the same visual connections as the eye with the more minor prescription. The brain will prefer the eye that takes the least amount of work to use.

Depth perception will be affected as you need equal vision in both eyes to use them at the same time. Fortunately, this is relatively easy to diagnose and manage, especially if caught at an early age.

Many times, amblyopia will not occur if proper management is done. Other reasons why amblyopia may occur are due to an eye turn (strabismus), cataract or other disease process making it difficult or nearly impossible for the light to travel through to the retina.

Unfortunately, there are no reliable signs to make a parent suspect the presence of amblyopia. Only a thorough eye examination can diagnose this issue and start on the proper management to decrease the effects of amblyopia.

How does diabetes affect the eye and what can I do to prevent it?

Diabetes can cause changes in vision and may even cause blindness if left untreated.

The eye is the only place that blood vessels can be seen directly without cutting the body open. These blood vessels can show changes that are happening in other areas of the body, such as diabetes and high blood pressure.

Over 17 million people have diabetes and one-third do not know they have it. Type 2 diabetes accounts for 90-95 percent of all cases of diabetes. Commonly known risk factors for diabetes are older age, obesity, physical inactivity, family history of diabetes, history of gestational diabetes and race/ethnicity.

There are some ways to reduce the risk of diabetes developing: maintain a healthy diet and exercise regularly, get high blood pressure under control, keep blood sugar levels under tight control and quit smoking. November is National Diabetes Month so make appointments to have your physical health and your eye health examinations.

What is low vision?

Low vision is a visual impairment, which cannot be corrected by glasses, contact lenses, medicine or surgery. This visual impairment interferes with daily activities.

Approximately 14 million Americans have low vision. Most people develop low vision because of eye diseases such as cataracts, glaucoma, diabetic retinopathy or age related macular degeneration. People can also develop low vision at a young age due to inherited diseases.

Lost vision does not have to mean loss of quality of life. Preventative eye care can be done to begin treatment early. If the disease progresses, vision aids and resources are available for those at all stages of low vision. Vision aids such as magnifiers, telescopes and video magnifiers can help with certain tasks.

Also, resources such as large print books, audio books and special lighting can help with other situations. Many devices can help with everyday living situations so those with low vision maintain their independence.

What is refractive surgery?

Refractive surgery is a procedure that changes the shape of the eye to decrease or even eliminate the need for glasses or contact lenses. Prescriptions with nearsightedness, farsightedness and astigmatism can be corrected.

Since the cornea, the very front surface of the eye, is changed, the amount of prescription that can be eliminated is dependent on the corneal thickness.

The procedure is very short, about 10-15 minutes in length and both eyes are usually done the same day. Depending on the procedure used, improved vision can be noticed immediately and will get better within the first few months.

Custom procedures are beneficial as they take into account the curvature of the eye and maximize the surgeon’s ability for a good result. The two most common procedures done today are LASIK and PRK.

The correct procedure can be determined by a consult with your optometrist or a surgery center.

What are cataracts?

Cataracts are a cloudiness in the lens of the eye.

The lens sits directly behind the iris (colored part of the eye) and refracts the light to cause an image on the retina. Normally, the lens starts out crystal clear. As we age, the lens becomes less transparent and does not allow as much light back to the retina. When the lens is too cloudy to allow good vision, it is considered a cataract.

Some risk factors that cause cataracts to form sooner in life are diabetes, certain medications, especially prednisone, and smoking. UV damage also is a large factor in cataract formation.

To correct the cataract, a simple procedure is done to take out the cloudy lens and implant a clear lens in its place. If you live long enough, most people will develop cataracts, but it may not hinder every day life so it would not have to be removed.

To prevent cataracts from developing early, wear sun protection and refrain from smoking.

Am I a candidate for refractive surgery?

Many different tests are done to identify if a person is a candidate for refractive surgery. Many of these tests can be done with your optometrist in a comprehensive eye exam. Other tests that are incorporated with the surgical instruments that will be used during the procedure will be done at a refractive surgery center. Most of these centers give a free consultation so you can find out for sure if you would be a candidate.

Just a few of the many things that are looked at are the prescription, thickness of cornea, mapping of cornea and overall health of the eye and body. If any of these parameters are outside the range for what is done with refractive surgery today, the likelihood of a good and stable result decreases.

A good candidate would have a moderate nearsighted prescription with thick corneas and overall good eye and body health. It is recommended to wait until the prescription has been stable at least three years so that no enhancements would be needed. This often puts the earliest age to have refractive surgery done in the early 20’s.

Many different procedures are available so even though you may not fit the above criteria, a procedure may be available to enhance your vision. Talk with your optometrist on your next visit if you are considering refractive surgery.

What can I do when I’m younger to keep my eyes healthy longer?

Be proactive about your eye health and get annual eye examinations even if you feel you are seeing well. Early detection is the key to preventing vision loss.

Protect your eyes from UV rays year round with sunglasses. Clear prescription lenses and contact lenses should also have UV protection.

Eat foods with antioxidants -- spinach, broccoli, corn, peas and tangerines.

Quit smoking. Smoking contributes to the onset of cataracts, macular degeneration and dry eyes.

What should I do if I get something in my eye?

If something goes into your eye, start with these procedures and contact your eye doctor or hospital emergency room immediately.

For chemical splashes, flood the eye non-stop with low pressure water for 15 minutes. Continue to flush until the chemical is neutralized and then see your eye doctor.

For blows to the eye, apply cold compresses for 15 minutes and see your eye doctor immediately.

Never wash an eye that is cut or punctured. Bandage it lightly and go to the hospital.

If an object is stuck into the eye, leave it there and seek treatment at the nearest hospital.

For any piece of metal or wood in the eye, see your eye doctor for removal.

Optometrists and ophthalmologists have the proper equipment and training to take care of any harmful objects that get into the eyes. The best way to avoid these situations is to wear proper safety glasses while doing activities that may have flying objects.

What are the symptoms of a retinal detachment?

A retinal detachment is one of the few eye emergencies, so it is important to recognize the symptoms that it could be happening, even though it is not common.

Symptoms of a retinal detachment are flashes of light that occur over a period of time, not just once. The flashes may occur when looking in one certain direction. Another symptom is a lot of new floaters, sometimes with a reddish brown tint. It would be different than the normal floaters that you may be accustomed to. Last, a black or gray curtain that comes from any direction in your field of vision is also a symptom.

These symptoms should be checked out immediately by an eye care professional.

What is a stye?

A stye, also known as a hordeolum, is a blocked oil gland that produces the oily layer of the tears. It is similar to a blocked pore, such as a pimple. The gland becomes red and inflamed and can be tender to the touch.

It is located along the upper or lower lid edge. Usually, it will go away on its own or with warm washcloths.

If there is swelling of the whole lid, pain even when not touching it or any change in vision, it should be looked at by an eye care professional.

Are your eyes tired while using a computer?

Many people experience eye strain, headaches, blurred vision, dry or irritated eyes and neck or backaches while using a computer.

This combination of symptoms associated with using the computer is called “computer vision syndrome”. Often neck and backaches are associated with improperly fitted glasses for the type of work being done. This causes one to assume a position that is not correct for the alignment of the body and therefore causes strain to the neck and back.

Many different lenses are available for computer use, depending on each individual’s needs. A good rule of thumb to help prevent eye strain is the 20/20/20 rule. Every 20 minutes, look 20 feet away for 20 seconds. This gives the eyes a chance to relax.




Eye Exams

At what age should you get your first eye examination?

The American Optometric Association recommends the first eye assessment be performed between 6 months and 1 year of age.

At this time, the optometrist can look to make sure the eyes are developing normally. The optometrist will test for visual acuity, excessive or unequal amounts of nearsightedness, farsightedness, or astigmatism, evaluate eye alignment, and examine eye teaming ability.

The health of your baby’s eyes will be assessed as well. Although problems are not common, it is important to identify children who have specific risk factors at this stage. Vision development and eye health problems can be more easily corrected if treatment is begun early.

InfantSEE is a public health program that offers a free comprehensive eye examination for infants 6 months to 1 year of age. For more information, go to www.infantsee.org.

I feel I see fine. Is an eye exam really necessary?

Yes! An eye examination looks at more than just the prescription. A comprehensive exam looks at the way each eye is seeing and also how they work together. It shows the nerves and muscles that work the eye and how they are functioning.

Also, the complete eye health evaluation can show even systemic problems such as diabetes, high blood pressure and cancer. Many eye diseases like glaucoma are “silent” in the fact that there are rarely any symptoms a person has even while damage is being done.

A comprehensive examination should be looked at in the same way as a medical or dental check up—done every year for preventative health care.

Why does a contact lens exam cost more than one for glasses?

A comprehensive eye examination includes a full health evaluation and a refraction, which determines the prescription for glasses. Contact lenses have a fitting and evaluation process.

We start out by finding out the needs and wants of the contact lens wearer. For example, are the contact lenses comfortable for as long as you would like to be able to wear them each day? Does vision stay clear throughout the day and for the life of the lens? After finding out information on how the lenses are working currently and also checking for a new prescription, we can find a contact lens that would be the best for your situation and lifestyle.

There are hundreds of different brands to choose from and each has their own unique qualities and benefits. We need to do extra measurements, such as looking at the curvature of the front surface where the contact lens will be sitting and also looking at the fitting of the contact on your eye. It needs to move enough to allow oxygen exchange, but not too much that it will cause discomfort.

Most fittings include follow up appointments to ensure that the lenses are comfortable and the fit is still adequate after wearing the lenses for an extended period of time. A contact lens prescription is found based on the brand of lenses that works best for all of your needs along with the proper fitting and prescription.

Why is it important to have your eyes dilated?

Dilation is important as it allows a complete health check of the back of the eye called the retina. It also makes it easier to see any signs of cataracts. Dilation opens up the pupil and widens the area that can be seen. Without dilation, only the very central part of the retina can be viewed and often times that can be more difficult with small pupils.

Problems that can occur in the retina that can be seen with dilation are holes or tears that can cause a retinal detachment, glaucoma and macular degeneration. Early detection of these diseases is key to a better long term outcome.