Information Page

Educational Features

     When to see your eye doctor. Eye doctors generally recommend children have their first eye exam at about age 5 years old. Up until this point, the child's pediatrician checks the overall health of the eyes in the course of the routine physical exam. If there are any abnormalities, the child's pediatrician will refer the child to the proper eye care professional. After age 5, the child needs to be examined before entrance into the school system.
     Adults should have a routine eye health check every two years. Even though the prescription may not change over time, this allows the doctor to check for sight-stealing diseases such as Glaucoma. More frequent exams may be recommended if the patient is under 18 years of age, has diabetes or any existing diseases such as glaucoma or macular degeneration.
     Sometimes it may be advisable to see a doctor sooner than the two year period. If you notice any changes in vision or any eye discomfort, contact your eye doctor. Also, if you experience any eye trauma, get checked. The rule of thumb is: better safe than sorry. Your eyesight is too important!

What you need to tell your eye doctor. Your doctor needs to know certain information to best serve your vision needs.

	Any medications you are taking. Medications can have side-effects that may affect your vision. Your doctor will know which of the medications (or combinations of medications) will interfere with the exam results.
	Distance at which you like to read. The normal distance at which a doctor adjusts the bifocal is approximately 16 inches. If you normally place your reading material on a table and stand up to read, that distance is closer to 28 inches. Traditional bifocal power will not allow for that. The doctor can adjust the bifocal power to accommodate your lifestyle needs. However, the doctor can only do that if you communicate your special needs to him.
	Special vision tasks. Certain professions or hobbies may require specialty lenses or frames. Some people require a bifocal at the top of their glasses to see detail over-head. These "occupational bifocals" can make a job much easier on both the eyes and the neck. Likewise, if a person spends many hours in front of a computer, special computer glasses might make life easier. Any special vision tasks you have, tell your eye doctor!
	Your medical history. Your eye doctor needs to know of any physical problems such as diabetes, epilepsy, eye or cranial trauma, and family history of glaucoma or other eye diseases.

Anatomy of the eye -

The eye consists of three basic layers. The outermost protective layer consists of the sclera and the cornea. The middle layer is the vascular layer that nourishes the eye, and the innermost light-sensitive layer is called the retina.

The sclera (the white of the eye) is a fibrous membrane that maintains the shape of the eye and protects the interior of the eye.

The cornea is a transparent membrane that allows light to pass through to the interior chamber of the eye. It consists of five layers. The outermost layer is called the epithelium and is the only layer in which the cells are constantly renewed. The interior layers are called Bowman's membrane, the stroma and Decemet's membrane. The stroma makes up about 90% of the cornea and is sandwiched between the Bowman's and Decemet's membranes. The innermost layer is called the endothelium and consists of a single layer of cells which prevents the cornea from absorbing the liquid aqueous.

The iris is the "colored" portion of the eye that we often describe as being brown, blue, hazel or green. The iris is actually two sheets of muscle that expands and contracts to regulate the amount of light that enters the eye. A layer of pigment cells give the iris its color and assist in darkening the interior of the eye.

Located behind the iris, is the crystalline lens. This structure is a biconvex, transparent capsule containing substances known as cortex and nucleus. When the eye is young, the lens is pliable and changes shape to provide a variety of focusing powers (accommodation). As the eye ages, the lens hardens and looses its flexibility. The result is presbyopia.

The retina is the innermost layer of the eye. It is actually an extension of the brain. The retina is held in place by a jelly-like substance that fills the eye, called the vitreous. The retina is made up of photoreceptor cells called the rods and the cones. The rods provide vision in dim light and the detection of movement. The cones provide sharper images in brighter light conditions and color recognition. The macula is the area that contains the most cones, and the central concentration of these cones is called the fovea. The place where the optic nerve enters the eye is called the optic disc. It is located nasally from the fovea and since there are no rods and cones present, it is a true blind spot.

The eyelids (palpebra) serve to protect the eye as well as to distribute the tear film which lubricates and oxygenates the cornea.

The mucous membrane that lines the inside of the eyelids and the exposed part of the eye up to the limbus (the joining point of the sclera and the cornea), is called the conjunctiva. This is the area that often times becomes inflamed (pink eye).

    Macular Degeneration is a condition of the eye that is often related to aging. It is commonly referred to as Age-related Macular Degeneration, and is abbreviated as AMD. While its cause is unknown, the early or late stage of AMD affects about 8.5 million Americans over the age of 40. The late stage, associated with vision loss, is the most common cause of legal blindness in people over the age of 50 in the western world. In AMD, the macula of the eye is affected. The macula, is located at the center of the retina, a light-sensitive tissue which lines the back of the eye. The retina receives images of external objects, then sends them as impulses to the brain. The macula provides us with central vision and allows us to see fine detail, such as recognizing a face, reading, or watching television. When the macula becomes damaged, extreme and dramatic vision loss can occur.
    The early stages of AMD typically start with the appearance of spots beneath the retina. These spots, called drusen, are small round lesions which usually do not change vision very in and of themselves. Most people with drusen will never have a serious loss of vision. However, certain changes may occur that lead to the late stage of AMD which is usually accompanied by vision loss. Most often, vision loss begins in one eye. Because the healthy eye compensates for the loss of vision in the damaged eye, AMD may initially go unnoticed.
    There are two forms of AMD. Dry AMD and wet AMD. When the early stage of drusen are present for a long time, they probably cause the macula to become thinner (atrophic) and stop functioning. This is referred to as the Dry form of AMD. This may cause some people to detect "blank" areas in their central vision. While there no treatments and no preventive measures currently available for people with dry AMD, various vision aids including magnifiers, are available to help these people continue to live their lives as normally as possible.
    The Wet form of AMD is responsible for up to 90% of the severe vision loss associated with this condition. Wet AMD is caused by the growth of abnormal blood vessels across the macula and beneath the retinal pigment epithelium layer of the retina. As these abnormal vessels leak fluid and blood into the tissue at the back of the eye, scar tissue typically forms and loss of vision may occur.
    In the early stages of wet AMD, a person's vision may become blurred or distorted. Therefore, an easy and effective way to test and possibly detect the smallest vision changes caused by wet AMD when they first appear is by using the Amsler Grid. Many doctors give their patients this simple visual test to take home with them. The patients can test themselves on a regular basis and alert their doctor if there are any changes between regular medical eye exams.

Follow the directions below to test yourself using the Amsler Grid.

If you use reading glasses, be sure you are wearing them.
Cover one eye and look at the center dot.
Keep your eyes focused at all times.
Look directly at the center dot and only at the center dot.
All of the lines should appear straight. All of the squares should be the same size.
Do this test for each eye separately.

If any area on the grid suddenly appears blurred, distorted, discolored, or in any way appears abnormal to a person taking this test, they are urged to contact their eye care professional immediately. Below, is what a person might see with Wet AMD.

This is an example of the distortion a person may experience due to the recent onset of macular degeneration, where the grid may have appeared normal one month before.

Since many patients with drusen, or the early stages of macular degeneration have no symptoms that would be detected by using the Amsler Grid, regular medical eye checks by an eye care professional are strongly recommended for everyone after age 40.

Cataracts are a discoloration of the crystalline lens inside the eye. The clouding of the lens prohibits light from passing through to the retina, thus rendering the persons vision cloudy or dim. Many people feel as though there is a film on their eye or as if they are looking through a cloud. Even though cataracts can become severe enough to render a person blind, the cataracts do no actual damage to the eye. Once the cataracts are removed, vision can be restored to an acceptable level and in some cases, glasses may no longer be necessary. The surgery to remove the cataracts is relatively painless and uncomplicated. The recovery time is now just hours instead of days. Most insurance companies will cover the surgery at least in part.

   Over-wearing of contact lenses can be a dangerous practice. Many people leave their contacts in too long and fail to clean them properly. This can lead to eye infections and corneal ulcers.
    The eye needs oxygen to remain healthy. The tear layer on the eye provides the means of transmitting the oxygen across the eye. When the eye is closed, (as in sleep) the oxygen level is decreased. This causes corneal edema (swelling). When a contact lens is placed on the eye, the level of oxygen transmitted to the eye is also reduced. This means if a person sleeps in the contacts, the level of oxygen transmitted to the cornea is reduced to a level that can become problematic over time. The oxygenated tear layer also acts as a barrier against bacteria and eye irritants. If this tear layer isn't working properly, bacteria can infect the cornea and produce corneal ulcers. These ulcers can be painful and dangerous. If the ulcers are not treated properly, they can break down the corneal layers and cause permanent blindness.
    Proper care of contact lenses is essential to eye health. Eyesight is too precious a gift to waste on vanity. Don't over-wear contacts. The dangers are too great.

Epidemic Conjunctivitis or Pink-eye is an inflammation of the conjunctiva (the thin, transparent membrane which derives its name from the fact that it attaches the eyeball to the eye lids). The symptoms are:

discomfort and in rare cases, pain. The discomfort is usually experienced as a feeling of heat in the eye, accompanied by an irritation similar to that produced by a foreign body in the eye.
The lids may also feel heavy and the patient is very conscious of the effort required to open them.
There may be an increase in the mucous collecting on the cornea that could blur vision at times.
Photophobia (light sensitivity) is present and causes the patient to squint in an effort to control the amount of light entering the eye.

These symptoms may develop rapidly and simultaneously. This form of conjunctivitis is highly contagious and can be spread from one eye to another by indirect contact (such as touching the infected eye or contaminated surface and then touching the non-infected eye) or be infected contact lenses. If you have pink-eye, do not wear your contacts. The bacteria can live on the lens and re-infect you every time you re-insert the lens. In case of disposable lenses, discard the infected lens and do not insert a new lens until the doctor certifies that the eye is free of infection. For hard, gas permeable and soft contact lens, ask your doctor about recommendations on replacing the lenses.

   Seasonal allergies can cause problems with vision. Watery eyes can blur vision and cause excess buildup on contact lenses. Never use the over-the-counter allergy eye drops with contacts. They contain chemicals that can discolor and damage contact lenses. If eye drops are required, your eye doctor can recommend the appropriate type.
     Certain antihistamines can cause fluctuations in vision, especially near vision. People often experience an inability to focus on text or fine details. The patients eyes may feel dry and scratchy or there may be a slight burning sensation.
     If you are taking any allergy medications, please tell your doctor. Certain medications can have an affect on an eye exam. The more information your eye doctor has, the better he can serve you.

Diabetes is a disease that stems from the body's inability to produce insulin and regulate the level of insulin needed to maintain the bodily functions. If diabetes is not controlled, it can cause many problems that can lead to blindness. In fact, diabetic ocular changes are responsible for approximately 12% of the blind population of the United States. Fluctuations in blood sugar levels can also cause tremendous changes in vision. If you are a diabetic, proper management of the disease is imperative. Your eyesight and your life depend on it. If you have not been diagnosed with diabetes, your eye doctor may see the symptoms which are hemorrhages in the back of the eye. When these hemorrhages are present, the eye has already been subjected to some degree of damage. Immediate control and maintenance of the blood sugar levels is imperative.

Glaucoma is a disease often called the "Sneak Thief of Sight". This disease causes an increase in the pressure inside the eye. If left untreated, the patient will ultimately suffer a permanent loss of vision. Glaucoma can occur even in someone with "perfect eyesight". This is why it is so very important to have regular eye health exams. Just because you can read the road signs, doesn't mean you can see the signs of eye disease!

Care of your eyeglasses. Never use window cleaner on eyeglasses. The harsh chemicals strip tints, scratch coatings, anti-reflective coatings and also damage frame finishes. Use a cleaner