Wednesday, February 25, 2015
When should your child have their first eye exam?
Your child needs to have their first eye exam by age four or five. There are two especially important problems we look for at this age. Amblyopia (“lazy eye”) must be detected at a very young age so it can be treated. Children with amblyopia rarely complain about their vision (because one eye still works well) and they usually show no signs of problems to their parents. We can treat amblyopia with eye patching therapy and/or eyeglasses at a young age, but treatment is generally ineffective in children eight years or older. Amblyopia is often caused by a large imbalance in prescription between the eyes, normally from hyperopia (farsightedness). It can also be caused by a slight misalignment between the eyes. If there is a slight inward crossing of the eyes, one of the eyes will become amblyopia and will never see well unless we treat it at an early age.
The other problem we frequently see in young children is moderate or large amounts of farsightedness (hyperopia). These children will often see 20/20 on a standard eye chart but they will suffer from problems with reading and sometimes headaches. This problem frequently gets overlooked for many years because children often get screened with distance eye charts. These children will pass a standard distance visual acuity screening but they will not perform at their best in school or with reading.
I have seen many children suffer for years with hyperopia and their parents thought they had no problems because they had seen well on a distance visual acuity chart. I have also had very upset parents when I tell them their 12 year child will never see well out of one eye because of amblyopia, but that we could have treated this problem had the child been much younger.
We are certainly willing to see children younger than four if the parents are concerned about their eyes. One important condition I want to stress is it VERY important that we see a child if their eyes cross inward, even if it only happens occasionally. We have see children as young as one or two with one inward crossing eye. This is called esotropia or strabismus. This is often caused by a large amount of farsightedness and often leads to permanent vision impairment in one eye and permanent eye crossing unless treated early. It is important to treat this as soon as possible, with excellent results in two -four year old children.
Some parents ask how can we measure the prescription in a young child. We have invested in sophisticated equipment for this purpose. We have two autorefractors, including a hand-held version that works very well with children to measure their prescriptions with good accuracy. We also use retinoscopes to further evaluate their vision. We have a computerized visual acuity chart called Acuity Pro, that uses randomized pictures that works well to determine the visual acuity in young children. We also sometimes use potent eye drops called cycloplegic agents that in conjunction with retinoscopy or autorefractors can give us a very accurate determination of prescriptions even in a two or three year old.
Sunday, March 4, 2012
What eye problems require immediate attention?
When to Seek Medical Care
You should call us if you have continuing symptoms of pain, visual disturbance,or light sensitivity. These symptoms could mean you have serious problems that require prompt treatment. A person can permanently lose vision within a day or two from some of these conditions without treatment.
The following are some symptoms that would warrant prompt medical attention:
Increased light sensitivity:
1. Corneal abrasions cause pain, and sometimes blur, and increased light sensitivity. This diagnosis is usually obvious to the patient because there was an injury to the eye that caused this problem.
2. Uveitis is another common cause of light sensitivity. This is an internal inflammation of the eye that can cause very serious complications if not treated early. Uveitis also becomes very painful as it worsens. we can easily treat it with potent steroids and cyclopleging eye drops. It is much easier to treat in the early stages.
3. Corneal ulcers cause pain and light sensitivity. These are serious and most commonly occur in people who sleep in their contact lenses. If the ulcer is caused by Pseudomonas bacteria, the eye can be lost within 48 hours. Fortunately most ulcers can not caused by Pseudomonas. We treat ulcers with antibiotics and daily monitoring of the ulcer until it is cured.
Loss of vision or distorted vision:
Retinal problems can cause a rapid blurring or loss of vision in one or both eyes. The retina is the tissue in the back of the eye where the visual image is formed. Common problems include retinal hemorrhages, tears or detachment, macular bleeding, retinal vascular occlusion or optic nerve problems. These are all serious conditions that require us to see you immediately. Retinal detachments are especially important to treat diagnosis and treat rapidly. The retina is the tissue in the back of the eye where visual images are created. Warning signs of retinal detachments may include flashes of light, new or increased numbers of floaters, and/or a painless loss of peripheral vision. We had one patient who noticed a dark area in the periphery of one eye. She waited days to see if it would improve. Each day the non-seeing area increased in size. After about one week she came to see us but by then it was too late. The retinal detachment was treated but she had permanent vision loss.
Pain
This could be from abrasions, corneal ulcers, uveitis, angle-closure glaucoma or corneal foreign bodies. Foreign bodies of all types can become lodged in the cornea. It is especially important to see you promptly if the foreign body is metal. Iron fragments will rust rapidly and this complicates the treatment. We have to remove the foreign body and the rust. The longer it is in the cornea, the more difficult it is to remove all the rust. Sometimes the foreign bodies get stuck under the eyelids and cause pain or a scratchy sensation with each blink. Pain is also present in angle-closure glaucoma. This is were the internal eye pressure because very high and can cause blindness within a short time period.
When to call us
It is often hard for patients to know if their condition is serious. When in doubt, CALL US. Our staff will listen to your symptoms and get you in immediately if the symptoms indicate that it may be serious. Many of these eye problems can rapidly get worse and may cause permanent loss of vision if not treated in time. We have not listed all the potential problems and symptoms in this short discussion - give us a call if you have any unusual symptoms.
We also have an emergency after hours telephone number. When in doubt, call us anytime. We would much rather see you as soon as possible for emergency problems. This includes weekends or evenings. Please note that the after-hours emergency service is limited to current patients and their families. If you or a member of your family are a patient of ours, we can be reached at 910.583.5953 or 910.797.4909. We are happy to talk with you after hours to determine if your problem may be serious. If for some reason you can not reach us, then visit your hospital emergency room.
You should call us if you have continuing symptoms of pain, visual disturbance,or light sensitivity. These symptoms could mean you have serious problems that require prompt treatment. A person can permanently lose vision within a day or two from some of these conditions without treatment.
The following are some symptoms that would warrant prompt medical attention:
Increased light sensitivity:
1. Corneal abrasions cause pain, and sometimes blur, and increased light sensitivity. This diagnosis is usually obvious to the patient because there was an injury to the eye that caused this problem.
2. Uveitis is another common cause of light sensitivity. This is an internal inflammation of the eye that can cause very serious complications if not treated early. Uveitis also becomes very painful as it worsens. we can easily treat it with potent steroids and cyclopleging eye drops. It is much easier to treat in the early stages.
3. Corneal ulcers cause pain and light sensitivity. These are serious and most commonly occur in people who sleep in their contact lenses. If the ulcer is caused by Pseudomonas bacteria, the eye can be lost within 48 hours. Fortunately most ulcers can not caused by Pseudomonas. We treat ulcers with antibiotics and daily monitoring of the ulcer until it is cured.
Loss of vision or distorted vision:
Retinal problems can cause a rapid blurring or loss of vision in one or both eyes. The retina is the tissue in the back of the eye where the visual image is formed. Common problems include retinal hemorrhages, tears or detachment, macular bleeding, retinal vascular occlusion or optic nerve problems. These are all serious conditions that require us to see you immediately. Retinal detachments are especially important to treat diagnosis and treat rapidly. The retina is the tissue in the back of the eye where visual images are created. Warning signs of retinal detachments may include flashes of light, new or increased numbers of floaters, and/or a painless loss of peripheral vision. We had one patient who noticed a dark area in the periphery of one eye. She waited days to see if it would improve. Each day the non-seeing area increased in size. After about one week she came to see us but by then it was too late. The retinal detachment was treated but she had permanent vision loss.
Pain
This could be from abrasions, corneal ulcers, uveitis, angle-closure glaucoma or corneal foreign bodies. Foreign bodies of all types can become lodged in the cornea. It is especially important to see you promptly if the foreign body is metal. Iron fragments will rust rapidly and this complicates the treatment. We have to remove the foreign body and the rust. The longer it is in the cornea, the more difficult it is to remove all the rust. Sometimes the foreign bodies get stuck under the eyelids and cause pain or a scratchy sensation with each blink. Pain is also present in angle-closure glaucoma. This is were the internal eye pressure because very high and can cause blindness within a short time period.
When to call us
It is often hard for patients to know if their condition is serious. When in doubt, CALL US. Our staff will listen to your symptoms and get you in immediately if the symptoms indicate that it may be serious. Many of these eye problems can rapidly get worse and may cause permanent loss of vision if not treated in time. We have not listed all the potential problems and symptoms in this short discussion - give us a call if you have any unusual symptoms.
We also have an emergency after hours telephone number. When in doubt, call us anytime. We would much rather see you as soon as possible for emergency problems. This includes weekends or evenings. Please note that the after-hours emergency service is limited to current patients and their families. If you or a member of your family are a patient of ours, we can be reached at 910.583.5953 or 910.797.4909. We are happy to talk with you after hours to determine if your problem may be serious. If for some reason you can not reach us, then visit your hospital emergency room.
Thursday, December 8, 2011
Metal lodged in the cornea
We frequently see patients with small pieces of metal lodged in their cornea. Very often these are people who work as machinists, welders, or mechanics. The epithelium, or outer layer of the cornea, is soft and metal fragments easily become stuck within the cornea. There is usually immediate pain when the foreign body gets into the cornea. Then they start to rust and the pain slightly decreases because the outer surface of the metal fragment becomes less jagged and sharp. Then the pain worsens the next day as the entire eye becomes red and inflamed. Eventually a severe inflammation called uveitis may develop and this complicates the treatment.
We anesthetize the cornea with eye drops and then can remove the foreign body using a small tool and a high-powered biomicroscope to allow for easy visualization. But if the metal fragment has been in the cornea for much more than one day, the rusting increases and permeates deeper into the cornea. We must remove this rust or the eye will not heal properly. We use a low intensity spinning burr to remove this rust, but this necessarily leaves a corneal scar and lengthens the healing time.
The important point I am trying to make is that the sooner we get to remove the metal, the less chance there is of complications and the quicker the healing process. It is much better when we see these patients the same day they get the foreign body into their eye. We have an emergency phone number listed on our answering machine. We will see established patients in the evening or on the weekends who have these types of problems. We would much prefer to fix this problem on a Saturday then deal with a more complicated problem on Monday morning!
We anesthetize the cornea with eye drops and then can remove the foreign body using a small tool and a high-powered biomicroscope to allow for easy visualization. But if the metal fragment has been in the cornea for much more than one day, the rusting increases and permeates deeper into the cornea. We must remove this rust or the eye will not heal properly. We use a low intensity spinning burr to remove this rust, but this necessarily leaves a corneal scar and lengthens the healing time.
The important point I am trying to make is that the sooner we get to remove the metal, the less chance there is of complications and the quicker the healing process. It is much better when we see these patients the same day they get the foreign body into their eye. We have an emergency phone number listed on our answering machine. We will see established patients in the evening or on the weekends who have these types of problems. We would much prefer to fix this problem on a Saturday then deal with a more complicated problem on Monday morning!
Saturday, October 22, 2011
Why eye exams are so important at age four or five
Why you need to get your child’s eyes examined before kindergarten
Four or five years of age is an important age for a first eye examination. There are two especially important problems we look for at this age. Amblyopia (“lazy eye”) must be detected at a very young age so it can be treated. Children with amblyopia rarely complain about their vision (because one eye still works well) and they usually show no signs of problems to their parents. We can treat amblyopia with eye patching therapy and/or eyeglasses at a young age, but treatment is generally ineffective in children eight years or older. Amblyopia is often caused by a large imbalance in prescription between the eyes, normally from hyperopia (farsightedness). It can also be caused by a slight misalignment between the eyes. If there is a slight inward crossing of the eyes, one of the eyes will become amblyopia and will never see well unless we treat it at an early age.
The other problem we frequently see in young children is moderate or large amounts of farsightedness (hyperopia). These children will often see 20/20 on a standard eye chart but they will suffer from problems with reading and sometimes headaches. This problem frequently gets overlooked for many years because children often get screened with distance eye charts. These children will pass a standard distance visual acuity screening but they will not perform at their best in school or with reading.
I have seen many children suffer for years with hyperopia and their parents thought they had no problems because they had seen well on a distance visual acuity chart. I have also had very upset parents when I tell them their 12 year child will never see well out of one eye because of amblyopia, but that we could have treated this problem had the child been much younger.
We are certainly willing to see children younger than four if the parents are concerned about their eyes. One important condition I want to stress is it VERY important that we see a child if their eyes cross inward, even if it only happens occasionally. We have see children as young as one or two with one inward crossing eye. This is called esotropia or strabismus. This is often caused by a large amount of farsightedness and often leads to permanent vision impairment in one eye and permanent eye crossing unless treated early. It is important to treat this as soon as possible, with excellent results in two -four year old children.
Some parents ask how can we measure the prescription in a young child. We have invested in sophisticated equipment for this purpose. We have two autorefractors, including a hand-held version that works very well with children to measure their prescriptions wit h good accuracy. We also use retinoscopes to further evaluate their vision. We have a computerized visual acuity chart called Acuity Pro, that uses randomized pictures that works well to determine the visual acuity in young children. We also sometimes use potent eye drops called cycloplegic agents that in conjunction with retinoscopy or autorefractors can give us a very accurate determination of prescriptions even in a two or three year old.
Four or five years of age is an important age for a first eye examination. There are two especially important problems we look for at this age. Amblyopia (“lazy eye”) must be detected at a very young age so it can be treated. Children with amblyopia rarely complain about their vision (because one eye still works well) and they usually show no signs of problems to their parents. We can treat amblyopia with eye patching therapy and/or eyeglasses at a young age, but treatment is generally ineffective in children eight years or older. Amblyopia is often caused by a large imbalance in prescription between the eyes, normally from hyperopia (farsightedness). It can also be caused by a slight misalignment between the eyes. If there is a slight inward crossing of the eyes, one of the eyes will become amblyopia and will never see well unless we treat it at an early age.
The other problem we frequently see in young children is moderate or large amounts of farsightedness (hyperopia). These children will often see 20/20 on a standard eye chart but they will suffer from problems with reading and sometimes headaches. This problem frequently gets overlooked for many years because children often get screened with distance eye charts. These children will pass a standard distance visual acuity screening but they will not perform at their best in school or with reading.
I have seen many children suffer for years with hyperopia and their parents thought they had no problems because they had seen well on a distance visual acuity chart. I have also had very upset parents when I tell them their 12 year child will never see well out of one eye because of amblyopia, but that we could have treated this problem had the child been much younger.
We are certainly willing to see children younger than four if the parents are concerned about their eyes. One important condition I want to stress is it VERY important that we see a child if their eyes cross inward, even if it only happens occasionally. We have see children as young as one or two with one inward crossing eye. This is called esotropia or strabismus. This is often caused by a large amount of farsightedness and often leads to permanent vision impairment in one eye and permanent eye crossing unless treated early. It is important to treat this as soon as possible, with excellent results in two -four year old children.
Some parents ask how can we measure the prescription in a young child. We have invested in sophisticated equipment for this purpose. We have two autorefractors, including a hand-held version that works very well with children to measure their prescriptions wit h good accuracy. We also use retinoscopes to further evaluate their vision. We have a computerized visual acuity chart called Acuity Pro, that uses randomized pictures that works well to determine the visual acuity in young children. We also sometimes use potent eye drops called cycloplegic agents that in conjunction with retinoscopy or autorefractors can give us a very accurate determination of prescriptions even in a two or three year old.
Wednesday, June 1, 2011
frame allergies - why your eyeglasses temples turn green
Some people have allergies to the metal used in eyeglass frames. These are usually frames containing nickel. The temples become pitted, rough and green and the skin touching the frame can become quite irritated. You can prevent this problem by getting frames made of pure titanium. Titanium will never react with your skin or cause any allergies. It is also a very strong and light metal. Stainless steel frames are also available, and they rarely cause allergies. And of course, plastic frames preclude this problem.
Sunday, May 15, 2011
What are eye vitamins for macular degeneration?
Macular degeneration is a serious disease of the macular area of the retina. The macula is where your eye focusses your central vision. The macular tissue sometimes deteriorates as we get older and we gradually lose the ability to drive, read, and function normally.
There is some evidence that certain vitamins and dietary nutrients can reduce the chance of macular degeneration. A large scientific study called the AREDS study identified a number of nutrients that might reduce the risk of macular degeneration. These formulations are available over-the-counter in most drug stores. Typical brands include Ocuvite, ICaps, and PreserVision. There are not many difference between these formulations, as they all use the AREDS recommendations.
There is also some evidence that omega-3 fatty acids help reduce the risk of this disease. Good sources of Omega-3 fatty acids include fish like salmon, flax seed, and fish oil capsules. Another helpful nutrient is lutein. There is a lot of lutein in dark, green, leafy vegetables like spinach, collards, turnip greens, and kale. Cooking these vegetables does not hurt lutein.
Studies show Vitamin D seems to lower the risk of getting this disease, but does not help much once the disease has begun. Smoking makes macular degeneration about 2-3 times more likely.
We always look at your macula during your yearly eye exam. We also take digital retinal photographs to help look for macular degeneration. This also lets us evaluate any changes that occur from year to year. The first sign of macular degeneration is a color change in the macula. We usually see that before you see any problems with your vision.
A good source of information about macular degeneration is http://www.amd.org
There is some evidence that certain vitamins and dietary nutrients can reduce the chance of macular degeneration. A large scientific study called the AREDS study identified a number of nutrients that might reduce the risk of macular degeneration. These formulations are available over-the-counter in most drug stores. Typical brands include Ocuvite, ICaps, and PreserVision. There are not many difference between these formulations, as they all use the AREDS recommendations.
There is also some evidence that omega-3 fatty acids help reduce the risk of this disease. Good sources of Omega-3 fatty acids include fish like salmon, flax seed, and fish oil capsules. Another helpful nutrient is lutein. There is a lot of lutein in dark, green, leafy vegetables like spinach, collards, turnip greens, and kale. Cooking these vegetables does not hurt lutein.
Studies show Vitamin D seems to lower the risk of getting this disease, but does not help much once the disease has begun. Smoking makes macular degeneration about 2-3 times more likely.
We always look at your macula during your yearly eye exam. We also take digital retinal photographs to help look for macular degeneration. This also lets us evaluate any changes that occur from year to year. The first sign of macular degeneration is a color change in the macula. We usually see that before you see any problems with your vision.
A good source of information about macular degeneration is http://www.amd.org
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