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

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

Common myths about eyeglasses debunked!

Photo courtesy of Ben Andreas Harding on Flickr.

Photo courtesy of Ben Andreas Harding on Flickr.

As an optometrist, I often hear a variety of misconceptions about eyeglasses from my patients. Most concerns fall into a few broad categories with a few bizarre ones sprinkled in. I would like to take a brief moment to address some of the most common ones I hear:

  1. “Wearing glasses will make your eyes weaker.” This is probably the one myth I hear the most often and it is absolutely false. The biggest thing people forget to account for when they notice they are more reliant on their prescription glasses is that they are a bit older. As a person gets older, their ability to continue to see clearly without prescription glasses deteriorates. While this applies to everyone, it is most pronounced in my far-sighted patients in particular.
  2. “Not wearing your prescription glasses will make your eyes get worse.” This also is not true. Not wearing your glasses will not damage your eyes, but it can cause a significant amount of eyestrain. Extended viewing of computer monitors, smart phones, tablets or televisions without a proper prescription can lead to significant eyestrain and may cause you to discontinue viewing sooner than you planned.

    Photo Courtesy of TempusVolat on Flickr

    Photo Courtesy of TempusVolat on Flickr

  3. You can’t play sports with glasses on.” Not true! Glasses for sports can be made to protect your eyes and clear your vision at the same time. Protective lenses such as polycarbonate plastic can be put into sports goggles to allow a person to wear glasses when participating in sporting activities. Many patients prefer to wear contacts when they play sports, but it is a personal preference. Be sure to talk to your optometrist if you need specialty lenses for any of the activities you participate in.
  4. “Over the counter readers are just as good as prescription glasses.” This myth is not necessarily untrue. For a small group of patients, over the counter readers do work just as well as prescription reading glasses. The bad news is it’s an extremely small group of patients and those glasses work only when they are reading. Proper prescription glasses can correct each eye individually for the distance so both eyes are in focus and balanced. Once the eyes are balanced and working together, your optometrist can determine the proper power you need for your computer monitor or for reading materials. For the overwhelming majority of patients, there is a difference between the prescriptions between their eyes or some astigmatism in their correction that you cannot find in over the counter glasses.

I hope these answers help open your eyes to how prescription glasses can help you see clearly.

~Ranjeet S. Bajwa, OD, FAAO
California Optometric Association
http://www.coavision.org

“What if 1 and 2 look the same?!”

Courtesy of riekhavoc (caughtup?) on Flickr

Courtesy of riekhavoc (caughtup?) on Flickr

A common concern for some of my patients is if they don’t tell me the correct choice of lens, then their prescription for that year will be off and not work properly. This is not true. When an optometrist is switching between lenses (which we in “the business” call a refraction), we are fine-tuning a prescription using the patient’s input to find the lenses that are the most clear and comfortable.

Optometrists are trained to filter out incorrect answers from our patients as we double and sometimes triple check on your responses to make sure we have the right powers. Many optometrists do this by bracketing the lens choices presented to patients. Bracketing means we pick two lenses with a noticeable difference in powers and move towards the most clear of the two. By doing so, the lenses in 1 and 2 may end up being the same lens or lenses in choices 7 and 8, etc.

Additionally, when we bracket the lens choices our goal (or “end point”) is when the two choices look just about the same. So if your optometrist is checking your eyes and the two choices look about the same, tell them- that’s what we want to know.

Another thing that we as optometrists don’t want is to give you a glasses prescription that are too strong for you. That is why it is important for you to relax and try not to squint when your optometrist is checking your prescription. If you are constantly squinting when we try to refract you, then you are more likely to end up with glasses that only work well when you squint, but are too strong for you when you don’t.

Courtesy of Lyn Kelley Author on Flickr

Courtesy of Lyn Kelley Author on Flickr

Something I have found to help patients give better responses is remembering to blink often. Occasionally, a patient will get so fixated on telling me which lens looks better that they don’t blink as often as they normally would. This can cause your tear film on the surface of your eyes to start to break up and affect your ability to tell which lens looks better. Blinking often lets your eyelids put a smooth layer of tears over the front of your eyes. It is similar to polishing a lens, and a polished lens is always easier to see out of than a scratched lens.

Your optometrist can check on the health and structures of your eyes as well as check the function of your two eyes working together when you go in for your annual eye exam. The art of determining a person’s prescription is not easy, but an optometrist is trained to work with the responses of their patients. Don’t worry about getting it wrong! If you just remember some of the tips mentioned above, you can be sure your optometrist find your proper prescription.

~Ranjeet S. Bajwa OD
California Optometric Association
http://www.coavision.org

Night blindness 101

The term night blindness sounds alarming, as though some people are actually blind at night.  There is a small percentage of the population that does in fact experience true night blindness, but it is rare and often the result of late stage eye disease.  In optometry, it is not common to use the term night blindness although we do encounter a significant number of patients who complain of poor night vision.  The symptoms are usually blur and dimming of vision at night, glare and haloes around lights and poor adaptation from light to dark environments.  How do you know if what you are experiencing is normal or a result of something more serious?

There are a handful of eye conditions that can create symptoms of poor night vision.

Photo Courtesy of kenleewrites on Flickr

Photo Courtesy of kenleewrites on Flickr

  1.  Patients who have had surgery to the corneas such as LASIK or corneal transplants may notice glare and haloes around light.  They may also experience diminished contrast sensitivity which can cause images in the evening to appear more dim.  Unfortunately, surgical results usually cannot be reversed.
  2. Cataracts are the number one cause of decreased night vision.  Patients over the age of 40 will begin developing mild cataracts.  This is when the natural lens inside the eye becomes more yellow and opaque as a result of age and ultraviolet exposure.  Cataracts can cause haloes and dimming of vision in the dark and decreased contrast sensitivity.  Fortunately, cataracts are easily removed thereby restoring problems with night vision.
  3. Corneal diseases such as keratoconus and severe dry eyes may also affect one’s vision in the evenings causing double vision or haloes.  For some of these patients, specialty contact lenses or eyedrops will alleviate these symptoms.
  4. Newer technology has also allowed optometrists to detect higher order aberrations in some patients.  For these patients, standard spectacle lenses may not improve night vision problems.  An instrument to detect higher order aberrations will determine whether a patient requires a specialty custom-made spectacle lens to improve night vision.

Some patients do in fact have true night blindness caused by an eye disease in its late stage.  Usually, symptoms begin slowly over time and progress to an inability to see in the dark.  These patients usually suffer from one of two eye conditions.

  1.  Retinitis pigmentosa is an inherited eye disease of the retina, the tissue that lines the back wall of the eye and captures visual images.  Retinitis pigmentosa affects the rods of the retina and causes slow deterioration of these structures.  The rods (unlike the cones) are responsible for night vision and for peripheral vision.  As the disease progresses, patients will notice a decrease in their ability to see in the dark and in the periphery.  Unfortunately, there is no current cure for retinitis pigmentosa.
  2. Glaucoma is an eye disease where the optic nerve slowly degenerates.  Patients with glaucoma usually have no symptoms in the early stages of the disease.  As the disease progresses, nerve fibers in the retina begin to deteriorate resulting in a decrease in peripheral vision as well as night vision.  Usually, patients do not experience symptoms of poor night vision and poor peripheral vision until the late stages of the disease.

Now that you know the causes, what are some ways to alleviate or improve poor night vision?  The simplest solution is to wear an updated pair of prescription glasses (if you have a prescription) with higher index lenses and an anti-glare coat.  Your optometrist can also inform you if you require customized lenses to correct for higher-order aberrations.  If your night vision problems are not a result of surgery or any eye diseases that you are aware of, then it is important that you visit your optometrist for a comprehensive eye examination.

– Cindy P. Wang, O.D., F.A.A.O.
California Optometric Association
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

Should I get contact lenses? Quick guide to help you decide!

Prescription contact lenses can provide the freedom and comfort to perform a number of activities that cannot be achieved in glasses.

  • The most common example is sports. For those instances where you know you will be running or jumping for extended amount of time and hopefully breaking a sweat at the same time, contact lenses are an ideal choice for vision correction. No need to worry about your frames slipping off your nose or blocking your peripheral vision. Contacts can provide you with crisp and clear vision throughout your entire visual field so you can focus on being your best.
Courtesy of nikozz on Flickr

Courtesy of nikozz on Flickr

  • Another great example is for social events or gatherings where you know there will be cameras everywhere. This can range from brides-to-be prepping for their big day to just spending a night out with friends. When you know you want to look your best in the photos commemorating important times in the lives of your family and friends, contact lenses are the best accessory you could ask for!
  • Similarly, prescription color contact lenses can give you that extra pizzazz when you want to be a little different. Whether you are just adding a little blue or green to match your outfit or a purple or gray tint to draw some extra attention to your face, prescription color contacts can be a great choice to help you stand out in a crowd.
  • I personally choose to wear my prescription contact lenses on days when it is raining or cold. That way I can avoid having rain drops on my glasses or having my lenses fog up for 30 seconds or more when I go indoors in the winter time.
Courtesy of maikel_nai on Flickr

Courtesy of maikel_nai on Flickr

  • The best thing about contact lenses is the new technology used in the current manufacturing processes of prescription contact lenses. This allows your optometrist the ability to fit nearly any prescription you can imagine in materials that are approximately 10 times better than what we used only a few years ago! Today’s prescription contact lenses are available in aspheric designs to help you see more clearly and with UV blocking filters to help protect your eyes throughout the day.

If you think contact lenses may work for you, call your optometrist today to schedule a contact lenses fitting.

~Ranjeet S. Bajwa, OD