The facts on buying glasses online

Photo courtesy of

Photo courtesy of

By now, many of you have heard that glasses can be purchased online, and at a significant discount compared to your local eye care provider. As a consumer, I would probably jump at the opportunity to save some money and try them out. However, as an optometrist who has had to “redo” glasses for these patients, I’m going to tell you to save your time and money and get them at your eye care provider.

What a shocker – of course an optometrist would urge you to purchase from the local eye care practice. But not for the obvious reason you might think. It’s for you, the patient’s own benefit. You visit your optometrist expecting an updated prescription to see your best. Your optometrist places you behind the phoropter (think Justin Timberlake’s 20/20 album cover), adjusts the instrument for measurements specific to your eyes such as vertex distance, pantoscopic tilt and pupillary distance. Then, you painstakingly choose between lens ‘1’ and ‘2’, sweating for fear of choosing incorrectly. And after many tests for binocularity, focusing skills and eye alignment, you are given a prescription that is highly specific and customized.

Once the rest of the eye health exam is completed, I will then instruct my optician to help choose the correct style of frame. A patient needing a progressive lens may need a larger frame, extending about an inch below his eyelid, for enough reading power. The patient with high amounts of astigmatism cannot be placed into a frame that wraps the face too much. A patient who is highly farsighted may not do well in a half-rim frame. A child needs an impact-resistant lens material. The specific requirements go on and on.

Many online retailers simply ask for your prescription and a measurement called pupillary distance. That is simply the distance between your pupils. But that is not the only measurement required in making a good pair of glasses. Tilt of the frame, how close the glasses sit to the eyes and optical center are equally important and contribute to clarity and comfort of vision.

After multiple visits and purchasing new glasses (in addition to the online pair that doesn’t work), many of my patients have learned to not skimp on eye wear. I do not fault those for purchasing less expensive glasses. I understand that some just can’t afford a good quality pair. Speak to your optometrist about that. We may have more affordable frames to choose from or can discuss specific items needed in your glasses.

The bottom line is that we want you to see and look your best. Understandably, that may come at a higher price, but why hold back on something that sits in the middle of your face?

~ Cindy P. Wang, OD, FAAO
California Optometric Association

Decorative contact lenses & Halloween – fun or danger?

Photo courtesy of College of Medicine at Chicago

Photo courtesy of College of Medicine at Chicago

November 1 2012, a 19-year-old woman from the local college came into my office complaining of scratchy, painful, swollen eyes. As the story goes, she had purchased decorative contact lenses online to complement her Halloween costume. Although I’m sure she looked amazing, after a few hours of wearing the contact lenses, her eyes started hurting which progressed throughout the evening. By the next morning she was in my exam chair being treated for Iridocyclitis, a deep swelling of the eye tissues. Luckily, with treatment, she recovered without permanent damage.

Cases like this led the US government to establish regulation that define contact lenses, whether prescription or cosmetic, as medical devices with protections in place to safeguard the public. According to the FDA, “On November 9, 2005, section 520(n) was added to the Federal Food, Drug, and Cosmetic Act (the Act) by Public Law 109-96 to establish that all contact lenses are devices under section 201(h) of the Act.”  Click here for more info >>

“Without a valid prescription, fitting, supervision, or regular check-ups by a qualified eye care professional, decorative contact lenses, like all contact lenses, can cause a variety of serious injuries or conditions. For example, lens wear has been associated with corneal ulcer, which can lead rapidly to internal ocular infection if left untreated. Uncontrolled infection can cause corneal scarring, which can lead to vision impairment, and in extreme cases, blindness or the loss of an eye. Other risks include conjunctivitis; corneal edema (swelling); allergic reaction; abrasion from poor lens fit; reduction in visual acuity, contrast sensitivity, and other visual complications that can interfere with driving and other activities.

Because of these risks, contact lenses, including decorative contact lenses that are non-corrective, are not safe for use except under the supervision of a practitioner licensed by law to direct the use of such devices. The Agency believes that these risks cannot be sufficiently controlled unless the wearer does the following under professional supervision:

  • Obtains advice about using contact lenses;
  • Has a valid prescription;
  • Has the lenses fitted properly; and
  • Remains under appropriate professional care for contact lens use.”

Unfortunately, even though the United States government has set in place regulations to control the illegal sale of contact lenses, overseas companies are still selling contact lenses that are being shipped into the country.

~ Dr. Steven Sage Hider, OD
California Optometric Association

A contact lens exam, what’s different?

Photo courtesy of Valley Eyecare Center

Photo courtesy of Valley Eyecare Center

I often get this question from patients: “I can see fine. My contacts are fine. Why do I have to have a contact lens exam?” This is not an unusual conversation in my office. Now is a great opportunity to explain the different tests done in a Contact lens exam.

One important thing we need to understand is that contact lenses are FDA approved medical devices.  They are actually small, very thin, pieces of plastic that sit directly on the cornea. The cornea of the eye is a very small, yet complicated structure that needs to be examined regularly when a patient wears contacts. Misuse of contacts and/or poor fitting contacts can cause serious harm to the health of the cornea and ultimately your vision.

My vision is fine. Why do I need another exam?

There are several tests your optometrist will do to determine that contacts are safe, healthy on your eyes and that the prescription is correct. We measure the curvature of the surface of the cornea – using a Keratometer or a Topographer – to determine the right size of contact to put on. Taking this measurement every year will help ensure that the contacts are not causing any subtle damage to the surface of the cornea. There is also a highly specialized microscope that some doctors are beginning to use that is able to count the number of corneal cells to make sure that they are staying stable while using contact lenses. These tests are early detectors of corneal changes due to the use of contacts that may not initially affect the vision or comfort of your lenses.

The contact lens exam also includes a detailed tear analysis to determine if you have dry eyes or allergy eyes. These common conditions can affect the comfort of your lenses and your vision. There are many different types of materials that contacts are made of and some are not compatible with certain eye surface conditions. For example, someone might need a contact with more water in it, others might need one that transmits more oxygen to the cornea. All of these factor are determined in the contact lens exam.

Next, the contact lens prescription needs to be determined. Due to the fact that that contact lens sits on the eye, not in front of the eye like glasses do, there is actually a different determination of the contact lens prescription that needs to be done in some cases. So, no … the contact lens prescription is not the same as the glasses prescription.

Once all of the parameters of the contact lens is chosen – size, material and optical prescription – the lens needs to be evaluated on the eye. We look at how the lens moves on the eye and how it sits to determine if it is going to be a healthy lens for you. Sometimes, differences in eyelids, blinking and tears can affect how a lens sits on the eye and adjustments might need to be made.

Finally, when your optometrist is happy with the fit and the vision through the contacts, then your contact lens examination is complete. Depending on the difficulty of your prescription, any eye surface disease, such as dry eyes or allergies, and if you are an experienced wearer or not, this process can take from one visit to several. Work with your optometrist during the process so that your can safely wear contact lenses for many years to come.

~ Lisa M. Weiss, O.D.
California Optometric Association


Lighting in the home: a way to improve daily vision

How does poor lighting ‘hurt’ your eyes?

Photo Courtesy of BBC (Copyright: Thinkstock)

Photo Courtesy of BBC (Copyright: Thinkstock)

I often get asked by parents of my pediatric patients if it is “okay” for their child to read in dim lighting and will it harm their eyes? Well, let me try to answer this two part question with a real life situation that happened recently to me, and coincidentally to two of my patients.

I was reading the latest news on my new smart phone in the dark.  After ten minutes of reading, I noticed that I had, what appeared to be a black, circular spot directly in front of my vision. Of course I panicked.  I ran to the bathroom to inspect my eyes in the mirror. I couldn’t see anything unusual, though I still had that “blind spot” in front of my vision. I soon realized that I must have harmed my eyes by reading in the dark. You see, whenever we are in a dark environment our pupils open up to allow more light into the eye so we can see better. But a big pupil in the presence of a bright light source can put the eyes in a more vulnerable state of damage. With my widely dilated pupils, I was so focused on reading off of the bright screen of my smart phone that I literally burned or photostressed my eye. It took quite some time for my vision to return back to normal. As for my two patients, they were watching movies on their tablet while in the dark which caused a similar situation to occur.

No … it’s not “okay” to read in the dark. And yes … poor light settings can damage your eyes!

Lighting to consider

Having good lighting in the home is very important to seeing clearly, safely, and comfortably. The best suggested type of lighting is natural light or incandescent light. It provides just the right amount of illumination to view one’s surroundings. On the other hand, it’s best to avoid cool white or blue white fluorescent lights as they tend to provoke light sensitivity, glare and headaches. The best wall colors to have are pink, peach and warm beige. These colors tend to be easier on the eye and elicit less visual symptoms. Those that work on their computers for extended periods of time may find an ultraviolet or tinted overlay to the screen be helpful as well. For our senior folks, bright incandescent lighting is a must since many of them have some level of media opacities in the form of cataracts. As we know, cataracts limit the amount of light getting into the eye so the visual world appear dimmer to those harboring cataracts.

Remember, a way to improve your daily vision and for better visual health … draw back the window shades to let natural sunlight penetrate through, and turn on and up the incandescent lights in your home.

And P.S. avoid reading in the dark!

~ Judy Tong, O.D., F.A.A.O.
California Optometric Association