My eye doctor prescribed spending time outside

We have all heard about how much time kids spend inside watching TV, studying, and playing video games. My seven-year-old son is addicted to rainbow looms, and could loom all day if I let him. New studies have indicated that the amount of time children spend outside may decrease the risk of developing myopia.

What is myopia?

Myopia, or nearsightedness, is a vision condition in which close objects are seen clearly but far objects appear blurred. Nearsightedness is a very common vision condition, affecting nearly 30 percent of the US population, and up to 90 percent of developed East and Southeast Asian countries such as Singapore, Taiwan, China, Japan and Korea. Myopia typically presents in school age children. Because the eye continues to grow as children grow, myopia may progress until approximately age 21.

Photo Courtesy of Shirley Binn

Photo Courtesy of Shirley Binn

Recent studies have indicated that more time spent on near work, less time spent outdoors, higher educational level and parental history of nearsightedness are risk factors for developing nearsightedness. Spending time outdoors plays a crucial role in myopia development and can slow its progression.

A recent study presented at the Association for Research in Vision and Ophthalmology (ARVO) 2014 Annual Meeting demonstrated the importance of time spent outdoors in order to control nearsightedness. The study evaluated visual acuity (vision) and axial length (length of the eye) of 6690 multiethnic children at 6 years of age. Axial length was significantly longer in children who spent less than one hour per day outdoors than in those who spent more than 2 hours outdoors.
Jan Roelof Polling, at the University of Applied Sciences Utrecht, lead investigator of the study recommended “Children with an increased risk of near-sightedness, such as those from a near-sighted family, should be prompted to spend at least 15 hours a week outside and should avoid spending long hours doing near work, even when they are very young.”

Photo Courtesy of RavEytan

Photo Courtesy of RavEytan

How does spending time outdoors help with myopia progression?

The protective effect of being outdoors is not well understood. Researchers suspect that bright outdoor light helps children’s developing eyes maintain the correct distance between the lens and the retina, keeping vision in focus. The intensity and / or specific spectral distribution of outdoor lighting may be beneficial. Indoor lighting that is dim does not provide the same kind of feedback. Therefore, when children spend too many hours inside, their eyes fail to grow correctly and the distance between the lens and retina becomes too long, causing far-away objects to look blurry. Hormonal changes associated with outdoor activities may also be beneficial.

Encouraging children to spend more time outdoors can be a simple and cost-effective way to improve their vision and general health. Head outside and enjoy the summer! Just remember to keep spending time outside when school resumes.

Melissa Barnett, OD, FAAO

California Optometric Association

Eye Injury- It’s more common than you think

Courtesy of Geoffrey Fairchild on Flickr

Courtesy of Geoffrey Fairchild on Flickr

Injuries can happen to anyone at any time. You can scratch your cornea with your fingernail or have a fractured eye socket from being hit by a baseball. Some are more drastic, but they are all more common than you think.

The most common eye injuries include:

1.  Scratches to the cornea (Corneal Abrasion). This can result from something like a fingernail in the eye or even from a foreign object such as dirt or sand.  Abrasions can also happen if something falls into the eye during home improvement projects or working out in the garage. Symptoms of a corneal abrasion include tearing, pain, the sensation that something is in the eye and often extreme light sensitivity. If you suspect you have scratched your cornea, call your optometrist immediately.  Scratched corneas are more prone to infection and depending on where the scratch is located, can cause scarring and loss of vision if not treated urgently.

2. Chemical Burns from household items. Many household cleaners can burn the eyes if the product splashes in the eye. These burns can range from mild to severe depending on the product used. Alkali burns from cleaners can be less painful but more damaging than acid burns. Symptoms  of both burns include redness, pain and swelling. If something splashes in your eye, rinse it under copious amounts of water for 15 minutes and call your eye doctor or visit urgent care. You will want to let the doctor know what the substance was that got in the eye. This will help your eye doctor with the appropriate treatment.

3.  Penetrating eye injury. Metallic objects and things such as fishhooks can certainly cause severe damage to the eye structures.  This is a potentially very dangerous situation. A metallic object can lodge itself in the cornea and cause a great amount of scarring if not removed.  Do not attempt to remove the item yourself. Call your eye doctor and go to urgent care.

4.  Orbital Fractures. This can happen if a moving object hits the eye at a high speed. For example, a baseball, a bat, a fist, or similar trauma.  This type of injury can be very serious and involve the eye as well as the surrounding bones and tissues.  This is an emergency and should be treated urgently.

Eye injuries can happen anytime and anywhere.  We can use some common sense precautions to help limit damage to the eye and surrounding structures.  As much as possible, use safety glasses or goggles when working with chemicals or any items that may cause a scratch or penetration to the eye. Sports safety goggles are a good choice for both children and adults to help prevent injuries while participating in sports.

A little protection will go along way in preventing eye injuries.

Stay safe!

~Lisa Weiss, OD, MEd, FCOVD
California Optometric Association
http://eyehelp.org
http://www.coavision.org

What if my child’s eyes are crossed? Strabismus 411.

HELP! It looks like my child’s eye is turning in, or out or I’m not sure. What do I do? What is strabismus anyway?

Photo courtesy of mjtmail (tiggy) on Flickr

Photo courtesy of mjtmail (tiggy) on Flickr

Strabismus, or crossed eyes, is a condition in which both eyes do not look at the same place at the same time. It occurs when an eye turns in, out, up or down. Strabismus is classified by the direction the eye turns:
• Esotropia = Inward turn
• Exotropia = Outward turn
• Hypertropia = Upward turn
• Hypotropia = Downward turn

There are six muscles attached to each eye that control eye movement. Normally, the eyes work together so both eyes look at the same place at the same time. An eye turn may be visible when there are problems with eye movement control.
The eye turn may be present constantly or only at certain times such as when the person is tired, ill, or has done a lot of reading or close work. One eye or both eyes may alternate turning.

Proper eye alignment is important to avoid seeing double, for good depth perception, and to prevent the development of poor vision in the turned eye.

What causes strabismus?

There are many causes, including:

  • Eye muscle problems.
  • Problems with the nerves that transmit information to the muscles.
  • Trouble with the control center in the brain that directs eye movements.
  • General health conditions or eye injuries.

What are risk factors for developing strabismus?

  • Family history – Those with parents or siblings who have strabismus are more likely to develop it.
  • Refractive error – Especially a large amount of uncorrected farsightedness (hyperopia).
  • Medical conditions – Including Down syndrome, cerebral palsy, stroke or head injury.

How is strabismus diagnosed?
Strabismus is diagnosed through a comprehensive eye exam. Testing may include:

  • Visual acuity, or vision – “Normal” distance visual acuity is 20/20.
  • Refraction – Determine the appropriate lens power needed to compensate for any refractive error (nearsightedness, farsightedness, or astigmatism).
  • Alignment and focusing testing – How well the eyes focus, track, move and work together.
  • Examination of eye health – This includes the front and back of the eyes. Eye pressure is also evaluated.

Because vision may change frequently during the school years, regular eye and vision care is important.

How is strabismus treated?
There are several treatment options to treat strabismus, including:

  • Eyeglasses or contact lenses – For some conditions, glasses alone will align the eyes.
  • Prism lenses – Prisms align the images seen by both eyes, so the eyes can fuse or see the same image, restoring visual clarity and depth perception.
  • Vision therapy – Vision therapy trains the eyes and brain to work together more effectively.
  • Eye muscle surgery – Surgery may be able to physically align the eyes so they appear straight. A vision therapy program may also be needed after surgery.

What can happen if the eye turn is not treated?

Photo courtesy of jmoneyyyyyyy on Flickr

Photo courtesy of jmoneyyyyyyy on Flickr

Potentially an untreated eye turn can lead to amblyopia, otherwise known as lazy eye. Amblyopia is permanently reduced vision in one eye.

When does a child develop strabismus?
Typically strabismus develops in infants and young children by age 3. It may be present in older children and adults. Children do not “outgrow” strabismus.

Most importantly…
If detected and treated early, strabismus can often be corrected with excellent results. Eye examinations are important for all children and adults, starting at 6 months of age. If any eye turn is in question, schedule a comprehensive eye examination immediately.

~Melissa Barnett, OD, FAAO
California Optometric Association
http://www.eyehelp.org
http://www.coavision.org

Bob Costas’ eyes – An eye doc’s perspective

Screen shot of Bob Costas on air

Screen shot of Bob Costas on air

I’ve been seeing quite a bit of pink eyes these last couple of days. The first one started with Bob Costas’ left eye on TV Friday night while watching the Olympics coverage. The next day, I received two calls on my on-call line from patients worried that they might have a contagious pink eye. I returned to work Monday and have seen more pink eyes in three days than I can remember.

I believe I have Bob Costas to thank for that. Sure, Sage Kotsenburg scored the first gold medal in snowboarding slopestyle, but that wasn’t what my Facebook friends were talking about these last two days. They wanted to know what’s going on with Bob Costas’ eye.

Sadly, I noticed that his infection has spread to the other eye, although the Twitter account @BobCostasEyes probably let slip the 4-1-1 first.

I wish I could definitively diagnose his eye condition. But being that all I have to go on are pixelated images of Bob Costas frozen in mid-speech without the use of microscopes and surface dyes to judge for irregularities, I can only surmise.

If it was a bacterial infection from a contact lens, antibiotics should have cleared it up by now, and it wouldn’t have spread to the other eye.  Now that it’s spread to the right eye, it’s most likely a viral infection.  It looks much worse than it feels. The eyes are usually watery, glassy and bright red. A microscope would show bumps on the inner eyelids as well as any cloudy areas on the surface. This can be treated with medications to limit the length of the infection, although it can last up to three weeks. Cool compresses and artificial tears can provide some relief of symptoms also.

But if you look at Costas’ outer eyelids, they’re also very red and irritated. It’s quite possible that he was given medications that he discovered he was allergic too. In either case, it was smart to finally take a sick day and go off the air to give him time to recuperate. Let’s hope for a speedy recovery before Matt Lauer’s beard has its own Twitter account.

So, to all of you with healthy, white and clear eyes, keep your hands clean and away from your face, don’t shake hands with someone with a pink eye, and see your optometrist if you think you have an irritated pink eye. To read more about pink eye, see our previous blog article on this topic.

~Cindy P. Wang, OD, FAAO

California Optometric Association
http://www.coavision.org

What did my doctor just say? Common terms your eye doctor will use and what they mean

Courtesy of riekhavoc (caughtup?) on Flickr

Courtesy of riekhavoc (caughtup?) on Flickr

Have you ever felt like you were not quite sure what just happened at your optometrist’s office? It is difficult enough to answer the “which is better, one or two?” questions and then at the end of the exam to try and understand the doctor’s explanations with difficult optometry terms without secretly worrying that you might have said something wrong!

Hopefully this blog will help you better understand some of the more common terms we use in our examinations.

1) First of all, most comprehensive exams will include a detailed case history. The doctor will want to know your family medical and ocular (eye) history. Some terms you may hear include the most common eye diseases – cataracts, glaucoma and macular degeneration.

  • Cataract is the term used when the natural lens of your eye becomes cloudy, causing blurred and distorted vision.
  • Glaucoma is the eye disease that causes your eye to have excessively high pressure, which can lead to long-term damage of the nerve in the eye.
  • Macular degeneration is a disease that affects your central or straight ahead vision.

Not only will the optometrist ask you about a family history of any of these conditions, they will also assess your eye health and your possible risk for developing any of them.

2) Next, the optometrist will perform a refraction to get you the best possible glasses or contacts that will correct your vision.

  • A refraction is just the process of determining for each individual what are the best lenses to give you maximum visual clarity and comfort at both distance and near.
  • Myopia – nearsightedness or the ability to see better at near than at far.
  • Hyperopia or farsightedness, really means that it is more difficult to focus at near and at far distances.
  • Astigmatism: this refers to the shape of the front surface of the eye being more football shaped rather than basketball shaped.

3) There are a few terms you might hear specifically in an child’s exam.

  • Pursuits: slow, smooth eye tracking.
  • Saccades: fast reading eye tracking.
  • Accommodation: focusing.
  • Binocularity: the ability of the eyes to work together as a team.

4) Finally, there are some terms regarding glasses that it might help to define.

  • Progressive lenses are the kind of “no line bifocal” that you might hear about on TV. But, unlike a bifocal, where there are two areas of vision, near and far, progressives have an unlimited amount of areas as you look from distance to near in the lens.
  • Transition lenses are the kind that change to dark outside. They undergo an anti-reflective treatment, which eliminates all glare and allows for crisper vision, especially at night.

Hopefully, this quick explanation helps with some of the confusing terms in an eye exam. As for any others, always ask your optometrist to explain something that does not make sense.

~Lisa Weiss, OD, MEd, FCOVD
California Optometric Association
http://www.coavision.org

Are contact lenses dangerous?

Courtesy of wader on Flickr

Courtesy of wader on Flickr

The Benefits

Contact lenses are medical devices that millions of people wear safely every single day. Many people enjoy the freedom from glasses that contact lenses allow.

Contact lenses are also great options for:

  • Sports
  • Changing eye color
  • People who have irregularities to the front of the eye, cornea, or are not able to see with glasses.

Contact lenses make it possible to see and function in everyday life.

The Dangers

Contact lenses can be dangerous if they are abused.

Contact lenses are medical devices and can only be prescribed and dispensed by a licensed eye doctor. If they are sold without being evaluated on the eye by a doctor it can lead to:

  • Eye infections
  • Eye inflammation
  • Eye injuries

Proper care is key

Proper contact lens care and handling are important components of the contact lens fitting process. Contact lens solution used incorrectly or “topping off contact lens solution” (adding more without disposing of the current solution) can lead to multiple complications. It is important to use sterile contact lens solution and not tap water due to bacteria in water. Never, ever put contact lenses in your mouth or spit on them to try to clean them.

Courtesy of listentothemountains on Flickr

Courtesy of listentothemountains on Flickr

It is also important to replace contact lenses at the recommended frequency. For example, daily disposable contact lenses should be replaced each day. Contact lenses that are overused and abused can lead to serious problems.

Certain contact lenses are approved for sleeping or extended wear. However, if your contact lenses are not approved for extended wear, this can lead to complications on the cornea, or front of the eye.

If you are interested in contact lenses, schedule an appointment with a doctor of optometry today.

~Melissa Barnett, OD, FAAO

It’s just the FACTS: Vision & Learning Go Hand in Hand

August has been recognized as the Vision & Learning month.  It would seem appropriate since many children return to school in August or shortly thereafter.  In addition to getting new clothes and supplies for our kids, this yearly routine should spur us to take our children in for a comprehensive eye and vision examination.

Vision is a highly complex and intricate process.  So, it is not surprising that reading and learning is dependent on not only having excellent 20/20 vision, but also accurate eye movement, eye focusing, eye teaming, and visual motor skills.

It’s just the plain ole fact that there is a direct correlation between vision and learning.

Courtesy of woodleywonderworks on Flickr

Courtesy of woodleywonderworks on Flickr

Did you know that…

  • “25% of students in grades K-6 have visual problems that are serious enough to impede learning.” – American Public Health Association
  • Approximately “80% of children with a learning disability have an  undiagnosed vision problem.”– Vision Council of America
  • “1 in 4 children has an undiagnosed vision problem which can interfere with learning and lead to academic and/or behavioral problems.”  – College of Optometrists in Vision Development
  • Studies show that “children who had visual perceptual and eye movement difficulties did poorly on standardized tests.” – Dr. Lynn Hellerstein, FAAO, FCOVD, Past President of COVD
  • “When vision problems go undetected, children almost invariably have  trouble reading and doing their schoolwork.  They often a display fatigue, fidgeting and frustrations in the classroom – traits that can lead to a misdiagnosis of dyslexia or other learning disabilities.” – American Optometric Association
  • A “child with a vision based learning problem has excellent verbal skills, causing parent and educators to think the child must be lazy, have ADD/ADHD, or is learning disabled.”
    – College of Optometrists in Vision Development

A cursory vision screening is just not enough to detect vision-related learning difficulties.  Early prevention of a child’s vision problem is so important for school readiness, learning and academic success.  So make it an integral part of your child’s back-to-school preparations.  Buy school supplies, outfit your child with new clothes, and most important, take your child to see a doctor of optometry for a thorough eye and vision examination.

~Judy Tong, OD, FAAO

(Special thanks to my colleagues Drs. Carmen Barnhardt, Eric Borsting, Ray Chu, and Rebekah Louie.)