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All About Vision

Eyeglass Basics

Modern eyewear serves a dual purpose. In addition to being a vision-correcting medical device used to enhance your safety and quality of life, eyeglasses have become a major fashion accessory. Therefore, when it comes to selecting eyeglasses there are many important factors to consider.

The Frame

Frames are made from a large variety of materials ranging from acetates and hard plastics to metals and metal alloys. The quality of frame materials is very high nowadays with many cutting-edge manufacturers investing heavily in developing new innovations and materials to make stronger, more flexible, lighter and more beautiful frames.

In considering the optimal material for your eyeglass frame, your lifestyle plays a big role. Children and those with active lifestyles require durable and flexible frames that are resistant to breaks from hits and falls. Those who have skin allergies need to seek out frames made from hypoallergenic materials such as acetate, titanium or stainless steel. Other characteristics of frame materials to consider are the weight or flexibility of the material as well as the price. Many designers also use wood, bone or precious metals to adorn frames and add an extra .

Hinges and nosepads also play an important role in durability and comfort of your frames. Children in particular can benefit from spring hinges and nosepads which can keep the frames from slipping off. Rimless or semi-rimless glasses are also an option for those that durability is not a primary concern.

Frame size is a very important factor in frame selection. Frames should fit well and not slip off the nose or be too tight and press against the temples or the sides of the nose.

More and more top fashion design brands are coming out with designer eyewear collections to suit every taste and style. Frames come in all colors, sizes and shapes so the choices are endless in finding a frame that suits your personal style and looks good with your face shape and coloring.

Lenses

Even though people spend much more time focusing on frame selection, as a medical device, the lenses of your eyeglasses are the most important part. It is therefore very important that you obtain your lenses (and therefore your glasses) from a reputable source. It is always best to buy eyeglasses through an eye doctor who is able to check that the lenses are made and fitted properly to ensure your best possible vision.

There are a number of variables to consider in selecting lenses.

If you have a high prescription which may require thicker lenses, you may want to ask for aspheric lenses which are thinner than normal lenses.

There are lenses that are made from materials that are more durable and shatter-resistant such as polycarbonate or trivex, which can be useful for children or sports eyewear.

Photochromic lenses can serve as eyeglasses and sunglasses as the lenses darken when exposed to the sunlight to block out the sunlight and UV rays.

Polarized lenses create greater eye comfort by reducing glare specifically from the water or snow and are great for sunglasses for those that spend time outdoors.

There are also a number of coating options that you can add onto lenses to enhance certain characteristics such as anti-reflective coatings, anti-scratch coatings or UV coatings to reduce exposure from the sun. Adding a coating may require special cleaning or treatment so ask your eye doctor or optician about special instructions.

Eyeglasses Over 40

Once you approach age 40 you are likely to begin to experience presbyopia which is the loss of the ability to focus on close objects. This happens as the eye begins to age and can easily be corrected with reading glasses. However, if you already have an eyeglass prescription for distance vision, you will need a solution that enables you to see your best both near and far.

There are a number of options available for presbyopes including bifocals, multifocals and progressive lenses with new technology improving the options all the time. You should speak to your eye doctor about the best solution for your individual needs.

Whether they are for a child’s first pair, a second pair of designer frames or a senior with a complicated prescription, you should always consult with your eye doctor for a new pair of glasses. Ultimately, your eyeglasses have a job and that it to help you to see your best to get the most out of every day.

Styes

A stye (known by eye doctors as a hordeolum) is an infection of an oil gland which forms a pimple-like bump on the base of the eyelid or within the eyelid itself. Sytes can be uncomfortable, causing swelling, pain, redness, discomfort, and sometimes excessive tearing. If the stye is large and it distorts the front surface of the eyes, it can cause blurred vision.

What causes a stye?

The oil glands on the eyelid sometimes become blocked with dirt, dead skin, or a buildup of oil. When this occurs, bacteria can grow inside. Blockage is also commonly from eye cosmetics that block the orifices within the lid. This blockage causes the gland to become infected and inflamed, resulting in a stye. A stye can form on the inside or the outside of the eyelid and can cause swelling around the eye, sometimes affecting the entire eyelid.

Treating a stye

Styes are treated with antibiotics, often in moderate and severe cases with a prescription for oral antibiotics to reduce the bacteria responsible for the infection. Treatment for a stye is recommended otherwise there is a likelihood of recurrence. Applying a hot compress to the eye for 10-15 minutes a few times throughout the day will bring some relief and speed up the healing process.

Similar to a pimple, the stye will likely rupture, drain and heal on its own. Occasionally a stye, especially one on the inside of the eyelid will not resolve itself and may require the assistance of an eye doctor for additional treatment. In such a case the stye is surgically opened and drained to reduce the swelling and cosmetic issues associated with the style.

You should never pop a stye! This can cause the bacteria to spread and worsen the infection. The infection can then spread around the top and bottom eyelids and even reach the brain. If a stye is getting worse, painful, or irritated, contact your eye doctor for treatment.

In cases where styes occur frequently, your eye doctor may decide to prescribe topical antibiotic ointment or a cleansing regimen to prevent recurrence.

Chalazia: Another type of bump on the eyelid

Similar to a stye, a chalazion is a blocked oil gland on the eyelid that becomes enlarged. The main difference between a chalazion and stye is that the chalazion is usually non-infectious. A chalazion in most occasions is an old hordeolum that did not resolve. Treatment involves lid hygiene, warm compresses, and lid massage. In most cases, a chalazion requires surgical removal.

CMV Retinitis

CMV or cytomegalovirus retinitis is a vision threatening virus that causes inflammation of the retina, primarily in individuals with a compromised immune system, such as those with AIDS (Acquired Immunodeficiency Syndrome).

Symptoms of CMV Retinitis

Symptoms of CMV retinitis often appear relatively suddenly. They include general blurriness, seeing flashes or floaters, sudden loss of peripheral (side) vision, or blind spots in central vision. These symptoms all appear as the virus attacks the retina, the light-sensitive layer of nerves at the back of the eye. If left untreated, the virus can cause retinal detachment and will eventually destroy the retina and damage the optic nerve, causing permanent vision loss. Usually there is no pain felt as the retinal damage is taking place. Symptoms usually start in one eye and but can spread to the other eye as well.

Causes of CMV Retinitis

Cytomegalovirus is a herpes type virus that is actually present in most adults. However, most healthy adults never experience any symptoms or problems from the virus. Individuals with a weakened immune system however, such as those with AIDS, chemotherapy or leukemia patients, newborns or the elderly are at greater risk of the virus being activated and spreading throughout the body, including the retina.

Treatment for CMV Retinitis

Treatment includes antiviral medications such as ganciclovir, foscarnet or cidofovir, which can be administered orally, via injection through a vein or directly into the eye or through a time-release implant the releases the medication at intervals. Laser surgery to improve the damaged area of the retina, such as in a retinal detachment, may also be prescribed.

Immune strengthening is also a critical part of preventing and treating CMV retinitis. Individuals with HIV or AIDS may be put on a regimen of highly active antiretroviral therapy (HAART) to boost the immune system and fight the virus. This has been shown to be highly effective in reducing the incidence of CMV retinitis in AIDS patients and reducing the damage for those that are affected.

While these treatments can stop further damage to the retina, any vision that is lost cannot be restored. Further, even if the virus is temporarily stopped, further progression may occur in the future. This is why it is critical to see a retinal specialist on a regular basis if you have had the condition or you are at risk.

Children’s Vision – FAQ’s

Most parents believe that if their child had an eye or vision problem they would know. However, this is far from the truth for a number of reasons. First of all, children often can’t express or don’t realize the difficulty they are having, and often vision problems will be overlooked by the associated behavioral issues that come as a result of frustration. Further, many eye or vision problems don’t show symptoms until they have progressed significantly which often makes the condition harder to treat.

Conditions such as amblyopia (lazy eye) or strabismus (crossed-eyes) can be corrected more effectively when they are diagnosed and treated early at a young age. Further, the sooner you diagnose and correct a vision problem, the sooner your child will be able to achieve his or her potential without struggling with these difficulties. This is why it is critical to have your child’s eyes examined by an eye doctor at regular intervals. Here are some FAQ’s and answers about Children’s Vision that every parent should know:

Q: At what ages should children have their eyes examined?

A: The official recommendations for the American and Canadian Optometric Associations are that infants should have their first eye exams at 6 months. Following that, children with no known vision issues should have another exam at 3 years and then prior to entering kindergarten. Children who do not require vision correction or therapy should have a vision checkup every year or two years and those who use vision correction should have an annual eye exam. Of course if your child is experiencing difficulty in school or after school activities that may be due to a vision problem schedule an eye exam immediately.

Q: My child passed a vision screening by the nurse at school. Does he still need an eye exam?

A: Yes. Many schools implement a basic vision screening test to assess whether the child sees clearly at a distance, however these tests are limited in scope. They do not assess functional vision such as the child’s ability to focus, track words on a page or the eyes’ ability to work in tandem. They also do not look at the health of the eye itself. These tests are essential to know the comprehensive picture of how healthy the eyes are and how well they are doing their job. In fact, studies shown that up to 43% of children with vision problems can pass a vision screening test! A comprehensive eye exam will assess all of these functions as well as color vision, depth perception, and eye coordination.

Q: My child was diagnosed with strabismus and amblyopia. Can this be treated and if so, what are the options?

A: Especially when diagnosed early, chances of a complete correction for strabismus and amblyopia are good when treated properly. The optimal age for this to occur is before 8-10 years old. Depending on the severity of the strabismus (crossed-eye), surgery may be required to straighten and properly align the crossed eyes. Amblyopia (lazy eye) can then be treated using eyeglasses, eye patching, or vision therapy to strengthen the weak eye and train the eyes to work together. A doctor that specializes in pediatric optometry can assess the condition and discuss treatment options on an individual basis.

Q: What is vision therapy?

A: Vision therapy is a doctor-supervised, individualized program of exercises to strengthen the functions of the eye. It is used to correct issues with eye alignment, focusing, coordination, tracking and more. Vision therapy often utilizes tools such as specialized lenses or prisms and involves exercises both during office visits and at home to reinforce the changes. The process usually takes about 6 months to see lasting improvement.

Q: My son’s nearsightedness keeps getting worse – he needs a new prescription every year. Is there a way to stop this?

A: There is research that shows that progressive myopia can be stopped or slowed during the childhood years. There are a number of therapies that are used for what is called “myopia control” including multifocal eyeglasses or contact lenses, orthokeratology (ortho-k) or atropine eye drops. Speak to a pediatric optometry specialist to learn more about the options and what might work best for your child.

Q: Every morning it is a fight to get my child to wear her glasses. What can I do?

A: It may take time for your child to adapt to the feel of the glasses and to be comfortable seeing with them. For little children, you can find glasses that come with integrated headbands that can help to hold the glasses in place. It helps to be consistent in putting them on to allow the child to adapt to the feel of the glasses.

Very often, especially for small children that can’t tell you what is bothering them, the reason for a child’s refusal to wear glasses is that something is not comfortable. It could be that the prescription is not right, that the glasses pinch or that are feeling heavy. It could be worthwhile to take the glasses back to the eye doctor to ensure that they are in fact a proper fit.

Q: At what age is it acceptable for a child to wear contact lenses?

A: Contact lenses can be a great convenience, especially for kids that are active or tend to break or lose their glasses. However, they are a medical device that must be treated with proper care and hygiene. If a child is not responsible enough to take care of them properly he could end up with a serious eye infection, a scratched cornea or worse. Most experts agree that the youngest age that contact lenses should be considered would be between 10-12 depending on the child’s maturity and cleanliness. Consult with your eye doctor about what would be best for your child.

Causes of Cataracts

Cataracts are part of the natural aging process of the eye and therefore, if you live to an old age, you will likely eventually develop one. While most cases of cataracts develop as part of this process, there are instances of congenital cataracts which are present at birth. Further, secondary or traumatic cataracts can occur at any age as a result of an eye injury, surgery or disease.While the risk of developing a cataract does increase as you age, it is not the only risk factor. Research shows that there are environmental, health and behavioral risk factors that can also play a role in cataract development. Many of these risk factors are avoidable and preventable. These risk factors include:

  • Smoking and excessive alcohol consumption
  • Prolonged exposure to ultraviolet (UV) radiation from the sun or other sources
  • Obesity
  • Diabetes
  • Hypertension
  • Certain medications such as steroids or statin medications
  • History of eye injury or eye surgery
  • Family history

Since they are largely a part of the the natural aging process of the eye, cataracts can’t necessarily be avoided, however knowing if you have additional risk factors can help you to take preventative steps to delay the onset of the condition.

Eyeglass Frame Materials

It’s time to choose a new pair of eyeglasses, and the current selection of frames is overwhelming. Armed with only your vision prescription, you now need to navigate between different materials, colors, prices and unique features of all the eyeglass frames. Here is a basic guide that explains about the most common types of frames and what they have to offer.

Metal Frames
The most popular material for eyeglass frames, there is a whole array of metals to consider. Each metal comes with a distinctive set of properties and characteristics.

Titanium: Extremely resilient and corrosion-resistant, titanium is also hypoallergenic and weighs in at 40% lighter than other metals. Available in a variety of color tones, titanium is an ideal material for eyeglasses.

Beta titanium: Titanium mixed with small quantities of aluminum and vanadium, this alloy is more flexible than pure titanium. Adjustments to your eyeglass fit are therefore done easily.

Memory metal: Frames made of memory metal are composed of a titanium alloy that has approximately 50% nickel and 50% titanium. These eyeglasses are very bendable and will return to their original shape even after they are twisted and turned. Memory metal frames are superb for kids or anyone who is rough on their eyeglasses.

Beryllium: The primary advantage of beryllium is its corrosion-resistance. A less costly metal than titanium, beryllium doesn’t tarnish. It is an ideal option for anyone who spends a lot of time around salt water, or who possesses high skin acidity. Flexible, durable and lightweight, beryllium comes in a range of colors.

Stainless steel: Manufactured in both matte and polished, glossy finishes, stainless steel is strong, flexible, corrosion-resistant and lightweight. An iron-carbon alloy, it also contains chromium.

Monel: This popular alloy of copper and nickel is less expensive than other metals, yet depending upon the quality of plating used – it sometimes discolors or causes skin reactions after long use.

Aluminum: Lightweight and very resistant to corrosion, aluminum boasts a unique look and is frequently used in high-end, exclusive eyewear.

Plastic Frames
Zyl: Abbreviated from “zylonate” (cellulose acetate), zyl is relatively inexpensive and very popular in plastic eyeglass frames. Lightweight, it is available in a rainbow of colors, including multi-colored versions and layers of different colors within one frame.

Propionate: Often used in sports frames, propionate is extremely durable and flexible. This nylon-based plastic is also lightweight and hypoallergenic.

Nylon: Over recent years, nylon has been replaced largely by more resilient nylon blends, such as polyamides, gliamides and copolyamides. While 100% nylon is lightweight and strong, it tends to weaken with age and become brittle.

Cellulose acetate: A plant-based plastic that is hypoallergenic. This material was first used for eyewear in the late 1940’s because of brittleness and other problems with previously used plastics. Today’s acetates are known for being strong, lightweight, and flexible. Cellulose acetate also has the widest range for transparency, rich colors, and finishes. More complex colorations are able to be produced by layering several colors or transparencies in layers and sandwiching them together.

Combination Frames
The best of both worlds, combination frames offer metal and plastic components in one frame. These styles were trendy in the 1950s and 1960s and have recently been revitalized for a fun comeback in many more colors and tones than the classic versions.

Mix It Up!
Each respective frame material brings unique features and advantages to your eyeglasses. One pair of glasses may not fit every part of your daily routine, in addition to social outings and special occasions. Perhaps a pair of titanium frames is best for your sophisticated, conservative work environment, but on the weekends you’d prefer to show off style with a retro zyl frame in laminated colors? Consider purchasing more than one pair of eyeglasses, and match your frames to your personality and lifestyle.

Retinitis Pigmentosa

Retinitis pigmentosa (RP) is an eye disease that is inherited, and very rare. About one in four thousand Americans are affected by this disease. The retina, which is the light-sensitive portion of the eye, degenerates progressively over time. The result of this degeneration is the loss of peripheral vision, loss of central vision, night blindness, and sometimes blindness.

Retinitis Pigmentosa Symptoms

Childhood is when the first symptoms of retinitis pigmentosa generally appear. Usually both eyes are implicated in the disease. Sometimes RP doesn’t appear until older age, at age 30 or even older.

The main symptom of RP in the beginning stages is night blindness. Tunnel vision may develop in the later stages of the disease, where central vision is affected, and only a small portion of sight is available.

One study of patients suffering from RP revealed that, in patients 45 years and older, 52% had at least 20/40 central vision in one eye, 25% had 20/200 vision or below, and 0.5% were completely blind.

Causes of Retinitis Pigmentosa

Very little is known about the causes behind RP, beyond that it is an inherited disease. Scientists believe that defective molecules in our genes cause RP. This explains why the disease affects patients so differently.

If one parent carries the defective gene, it’s possible to get RP, even if your parents do not have the disease. Approximately one percent of the population are carriers of the RP recessive gene. Sometimes this recessive gene is passed on to the child, who will then develop retinitis pigmentosa.

RP affects the retina in the eye. The disease causes the light-sensitive cells that are located in the retina to die gradually. Most often, the cells that are used for night and peripheral vision, called rod cells, are affected. Sometimes the cells that are used to see color and for central vision, called cones, are also affected.

Diagnosis and Treatment

The main diagnostic tool employed is visual field testing. This test determines how much peripheral vision loss has occurred. Other diagnostic tools may be used to test night vision and color vision.

Few treatments exist for RP. What is available helps conditions associated with RP, not the disease itself. For patients older than 25, there is a prosthesis system that was recently approved. This system captures images via glasses, and transmits the signal captures to an implanted device located on the retina.

Most treatments center around helping the patient learn to deal with their vision loss. Psychological counseling, and occupational therapy, may be recommended. Technological instruments that help with low vision, such as illuminated magnifiers, can help patients with RP see as well as possible with their limited vision. Some doctors recommend vitamin A supplements as there is some evidence that vitamin A might help delay the progression of the disease.

For the future, scientists are hopeful that there will be additional treatments for RP, including new drug treatments and retinal implants.

Blepharitis

Blepharitis is an eye condition characterized by an inflammation of the eyelids which causes redness, itching and irritation. The common eye condition is caused by either a skin disorder or a bacterial infection. Blepharitis is generally not contagious and can affect patients of any age. While it can be very uncomfortable, it usually does not pose any danger to your vision.

There are two types of blepharitis: anterior and posterior.

Anterior blepharitis occurs on the front of your eyelids in the area where the eyelashes attach to the lid. This form is less common and is usually caused by a bacterial infection or seborrheic dermatitis, which is a skin disorder (dandruff) that causes flaking and itching of the skin on the scalp and eyebrows. While it is more rare, allergies or mites on the eyelashes can also lead to this condition.

Posterior blepharitis occurs on the inner eyelid that is closer to the actual eyeball. This more common form is often caused by rosacea, dandruff or meibomian gland problems which affect the production of oil in your eyelids.

Symptoms of Blepharitis

Blepharitis can vary greatly in severity and cause a variety of symptoms which include:

  • Red, swollen eyelids
  • Itching
  • Burning or gritty sensation
  • Excessive tearing
  • Dry eyes
  • Crusting on eyelids

If left untreated, symptoms can become more severe such as:

  • Blurred vision
  • Infections and styes
  • Loss of eyelashes or crooked eyelashes
  • Eye inflammation or erosion, particularly the cornea
  • Dilated capillaries
  • Irregular eyelid margin

Treatment for Blepharitis

Treatment for blepharitis depends on the cause of the condition but a very important aspect is keeping the eyelids clean. Warm compresses are usually recommended to soak the lids and loosen any crust to be washed away. It is recommended to use a gentle cleaner (baby soap or an over the counter lid-cleansing agent) to clean the area.

For bacterial infections, antibiotic drops or ointments may be prescribed, and in serious cases steroidal treatment (usually drops) may be used.

Blepharitis is typically a recurring condition so here are some tips for dealing with flare-ups:

  • Use an anti-dandruff shampoo when washing your hair
  • Massage the eyelids to release the oil from the meibomian glands
  • Use artificial tears to moisten eyes when they feel dry
  • Consider breaking from use of contact lenses during the time of the flare-up and or switching to daily disposable lenses.

The most important way to increase your comfort with blepharitis is by keeping good eyelid hygiene. Speak to your doctor about products that he or she recommends.

Vision Therapy for Children

As a child’s eyes develop, it is not uncommon for a number of problems to occur. Beyond blurred vision due to refractive error including nearsightedness (myopia) and farsightedness (hyperopia), children can develop a number of other visual and perceptual problems that are often not detected by a simple vision exam. Even a child with 20/20 vision, can have underlying vision problems!

Some of these issues are functional vision problems having to do with the actual eyes, how they move individually and as a pair, as well as their ability to focus. Functions such as eye teaming, tracking, focusing, and hand eye coordination, all affect a child’s success in school, sports or general functioning. Often children that have difficulty with these functions will suffer physical symptoms as well such as headaches, eye fatigue or short attention spans. With these critical visual skills lacking, tasks such as reading and writing can be extremely difficult and exhausting which can lead to frustration and behavioral problems.

Just like we are able to train our bodies to build strength, speed and agility, our vision skills can be strengthened. Vision therapy offers a doctor-supervised program to guide children to develop these skills.

What is Vision Therapy?

Vision Therapy is a program of progressive eye exercises individualized for each patient designed to retrain or help the patient develop or improve upon particular visual skills or to improve processing and interpretation of visual information. It is used to treat conditions like strabismus (crossed eyes) and amblyopia (lazy eye) as well as eye movement, focus and coordination problems.

Typically, the sessions take place in the optometrist’s office weekly or bi-weekly and utilize a variety of tools such as therapeutic lenses or prisms. Often the patient will be asked to practice certain exercises or activities at home as well in order to reinforce the skills that are being developed. Through repetition of these tasks, the ultimate goal is to strengthen the skills such as focusing, and improving eye movement and alignment, to the point where the eyes and vision are working efficiently and comfortably. The duration of the therapeutic program usually lasts about 6-9 months.

Vision therapy has been scientifically proven to improve functional vision skills and is approved by the major optometric bodies such as the American Optometric Association and the Canadian Association of Optometrists. It does not improve refractive error and should not be mistaken for some of the alternative self-conducted eye exercises out there that claim to improve your vision.

Vision therapy has also been shown to be effective in adults. If you think that vision therapy could be right for your child or yourself, it is worthwhile to have an assessment by a trained vision therapist to determine whether it could help resolve the vision problems that are present.

Signs & Symptoms

Cataracts don’t suddenly develop overnight. They generally start off small and only begin to noticeably affect your vision as they grow. The first symptom is usually that your vision becomes blurred, hazy or cloudy. Additionally, you may become sensitive to light, making sunlight, oncoming headlights or indoor lighting appear exceptionally glaring or bright. Colors may seem dim and you may notice halos around lights or double vision.

The symptoms people experience from cataracts may vary. Some individuals even report a temporary improvement in near vision when a cataract first develops, a phenomenon known as “second sight”.

Here is a list of possible signs and symptoms of developing cataracts:

  • Blurry or cloudy vision (that can’t be corrected with a change in eyeglass prescription)
  • Glare from lamps, sunlight, oncoming traffic when driving at night or indoor lighting
  • Colors appear dim and less vibrant
  • Halos around lights
  • Double vision
  • Poor night vision
  • Sudden improvement in near vision

If you experience any change in your vision, visit your eye doctor immediately.