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All About Vision

Surgery for Presbyopia

Presbyopia is a common age-related condition in which near vision worsens due to the hardening of the lens of our eye. It causes people to have difficulty reading and performing other tasks that require sharp and focused close vision.

Symptoms begin around the age of 40 when you begin to see people with untreated presbyopia holding books, magazines, newspapers, and menus at arm’s length in order to focus properly and avoid eye strain. Other symptoms include headaches or fatigue when trying to focus on something at close range.

Causes of Presbyopia

During our youth, the lens of our eye and the muscles that control it are flexible and soft, allowing us to focus on close objects and shift focus from close to distant objects without difficulty. As the eye ages however, both the lens and the muscle fibers begin to harden, making near vision a greater challenge.

Surgical Treatment for Presbyopia

The most common form of treatment for presbyopia is wearing reading glasses, bifocals or progressive lenses. Bifocal and multifocals are also available in contact lenses for those who prefer to be glasses-free. A third option, however, is a number of surgical procedures that allow you the freedom of correcting your near vision without the use of glasses or contact lenses.

LASIK

Monovision LASIK

Monovision is a technique that began with presbyopia-correcting contact lenses designed for individuals with presbyopia and nearsightedness or astigmatism. Each eye gets a different lens power – one lens is used in the dominant eye to correct for distance vision and the other for near vision. The eyes adapt to the two lens powers by learning to use the appropriate eye for the necessary distance power. Monovision LASIK surgery is based on the same principle of correcting each eye for a different refractive power and has shown just as high if not higher success rates than the contact lens technique. Usually, patients will try out monovision with contacts first to ensure that it works and that the eyes adapt properly.

PresbyLASIK

PresbyLASIK is a procedure that is currently available in Canada and Europe and undergoing clinical trials in the United States. As opposed to monovision LASIK, this procedure is a multifocal alternative in which different rings of refractive power are created on the cornea, similar to multifocal lenses. This provides vision correction at all distances simultaneously.

Conductive Keratoplasty (CK)

Conductive Keratoplasty uses radio waves via a hand-held instrument to mold the corneal surface to improve near vision. The procedure can be done on one eye using the monovision principle and is a good solution for those that do not need vision correction for nearsightedness or astigmatism. The effects of CK, however are not permanent and the improvement in near vision will diminish over time.

Corneal Inlays or Onlays

Corneal inlays and onlays involve surgically implanting a small lens into the eye to increase focus and near vision. The distinction between inlays and onlays is in where the lens is placed on the eye.

Refractive Lens Exchange

In refractive lens exchange the eye’s hardened lens is replaced with an artificial lens called an intraocular lens (IOL) to provide multifocal vision. This surgery is similar to and often done in conjunction with cataract surgery.

Treatment of Macular Degeneration

While there is no cure for macular degeneration, treatments do exist that can delay the progression of the disease, preserve existing vision and sometimes even improve vision loss.

Currently, there are no approved treatments to prevent or cure dry AMD, although there is evidence that indicates that certain nutritional supplements, including omega 3 fatty acids, lutein and zeaxanthin, can prevent the progression of the disease to the more advanced wet form, which can cause more severe vision loss.

There are a couple of options for treating wet AMD to slow the progression of vision loss which include medicated injections and laser therapy. These therapies are designed to stop the development of new blood vessels, to destroy existing ones and to prevent leakage into the macula – the main dangers with wet AMD.

Unfortunately, while much research continues to be conducted, currently there is no treatment and no way to fully regain vision lost by AMD. Those who have suffered significant vision loss can benefit from the many low vision devices on the market which utilize your existing vision to assist in maintaining your independence. Such devices include standing and hand-held magnifiers and telescopes and other aides that can help to improve your vision.

If you have been diagnosed with AMD, regular vision tests are essential. Close monitoring and adherence to treatment can not only prevent further vision deterioration but can sometimes even improve vision.

Why are Eye Exams Important?

For both adults and children alike, eye exams are an important part of one’s general health maintenance and assessment. Your eyes should be checked regularly to ensure that you are able to see as best as possible. Regular eye health exams will also check for signs of eye disease or conditions that can affect not only your vision but your overall health. Vision and eye health is such a critical part in learning and development, therefore, we highly recommend eye exams for infants and children.

Vision Screening vs. an Eye Exam

When we recommend regular eye exams, this should not be confused with a vision screening. A vision screening is a basic test that indicates if you have difficulty seeing and require further assessment and corrective measures. It can be performed by anyone, whether it is a school nurse, a pediatrician or even a volunteer at a vision clinic. A vision screening usually only checks vision, it does not check eye health. Also, most vision screenings for kids only check for nearsightedness (when you can not see far), but what happens when the majority of children are farsighted? Most of the time many of these kids get overlooked.

A comprehensive eye exam on the other hand, can only be performed by an eye doctor as it requires special knowledge and equipment to look around and into your eye to check your eye and vision health. Such an exam can assess whether there are underlying causes for vision problems and whether there are any signs of disease which can threaten your site and the health of your eye. A comprehensive eye examination can also diagnose symptoms of diabetes, high blood pressure, high cholesterol, tumors, cancer, autoimmune disorders, and thyroid disorders. A comprehensive eye examination will also provide an accurate prescription for eyeglasses or contact lenses.

Eye Exams for Eye Health

Eye exams are critical because many vision threatening eye diseases such as glaucoma, macular degeneration, cataracts, or diabetic retinopathy have no or minimal symptoms until the disease has progressed. In these cases, early detection and treatment is essential to halting or slowing down the progression of the disease and saving eyesight. During a comprehensive eye examination, your eye doctor will be looking for initial signs of these diseases. If a problem with your eyes arises such as red eyes, eye allergies, dry eyes, eye swelling,eye pain, always seek an eye doctor as your first doctor to call since they are specifically trained to treat eye diseases.

Eye Exams and Children

If your child is having developmental delays or trouble in school there could be an underlying vision problem. Proper learning, motor development, reading, and many other skills are dependent upon not only good vision, but your eyes functioning together. Children that have problems with focusing or hand-eye coordination will often experience frustration and may exhibit behavioral problems as well. Often they don’t know that the vision they are experiencing is abnormal so they aren’t able to express that they need help. Many conditions are much easier to treat when they are caught early while the eyes are still developing, so it is important to diagnose any eye health and vision issues as early as possible.

Eye Exams Over 40

Just like the rest of our bodies, our eyes begin to weaken as we age. There are a number of common age-related eye conditions such as presbyopia, cataracts, and age-related macular degeneration that can begin to affect your vision and your daily life. While some of these conditions are more of an inconvenience, others could lead to vision loss and dependency.

In addition to regular yearly eye exams, it is important to be aware of any changes in your eye health and vision. Also know your potential risk factors as well as your family ocular and medical history. Over half of the vision loss worldwide is preventable with proper treatment and care.

Preparing for an Eye Exam

For both adults and children, an eye exam is a critical part in maintaining your overall health and well-being, and therefore, regular eye exams should be incorporated into your health routine. Comprehensive eye exams assess your vision and the health of your eye, looking for early signs of disease that may not have obvious symptoms. You should not wait until you experience a vision problem or symptoms of an eye condition to schedule a routine exam.

Depending on your age, family history, general health and eye health, it is recommended to have an eye exam every one to two years. Of course if you experience any serious symptoms that affect your eyes or your vision, you should contact your eye doctor immediately.

The Difference Between an Optometrist (OD) and an Ophthalmologist (MD or DO)

Confusion about the difference between optometrists and ophthalmologists is common, and many people are not aware of how the two eye care professionals differ.

Optometrists

Optometrists or Doctors of Optometry attend optometry school which is usually at least four years of graduate level training. They are able to perform eye exams, provide prescriptions for eyeglasses and contact lenses, and diagnose and treat eye diseases as as glaucoma, dry eyes, or eye infections that may require medication or drops. They can consult with and co-manage patients in pre- or post-op surgical care, however they do not perform surgery.

Ophthalmologists

Ophthalmologists are medical doctors that attend medical school and later specialize in ophthalmology. They are able to do all of the services mentioned above but also perform eye surgeries such as cataract surgery, refractive surgery such as LASIK and deal with more urgent eye conditions such as retinal detachment.

Infant and Child Eye Exams

According to the American Optometric Association (AOA) children should have their eyes examined by an eye doctor at 6 months, 3 years, at the start of school and then at least every 2 years following. If there are any signs that there may be a vision problem or if the child has certain risk factors (such as developmental delays, premature birth, crossed eyes, family history or previous injuries) more frequent exams are recommended. A child that wears eyeglasses or contact lenses should have his or her eyes examined yearly.

Adult Eye Exams

Healthy adults under 40 with good vision and who do not wear eyeglasses or contact lenses are recommended to have an eye exam at least every two years. Those that do use vision correction or have a health issue such as diabetes, high blood pressure or another health condition that can have an impact on your eye health should schedule a yearly exam, unless the eye doctor recommends more frequent visits.

Once you reach 40, you become susceptible to a number of age-related eye conditions such as presbyopia, cataracts or macular degeneration, therefore annual or bi-annual exams are strongly recommended.

As you continue to age, particularly after age 55, the risks of eye disease increase, and early detection can be critical to preventing significant vision loss or blindness. Scheduling a yearly eye exam can make all the difference in maintaining your independence and quality of life.

How to Prepare for Your Exam

Prior to your exam you should decide whether you will be seeking special services such as a contact lens exam or LASIK consultation. These services may cost extra. Check with the doctor’s office or your insurance provider to see if they cover any of the exam expenses.

You need to know if you have medical insurance, vision plan coverage or both. Medical insurance usually does not cover “wellness/refractive” exams for glasses or contact lenses. Vision plans will cover exams for glasses or contacts, but usually cannot be used for red eyes, floaters, or other medical eye health problems. Please bring your insurance cards with you.

In addition to bringing your current pair of glasses or contacts if applicable, it is important to be aware of your personal and family history and to have a list of medications or supplements you are currently taking. Your pupils will probably be dilated as apart of your exam, so plan accordingly.

Your Comprehensive Eye Exam

Your eyes are one of the most complex organs in your body. A comprehensive eye exam to assess your visual system and eye health involves a number of different of tests. Unlike a simple vision screening, which only assesses your vision, a comprehensive eye exam includes a battery of tests in order to do a complete evaluation of the health of your eyes and your vision.

The tests that you will undergo in a comprehensive eye examination may vary from eye doctor to eye doctor but here are are some common exams that you may encounter:

Patient Background and History

One of the most important parts in a comprehensive eye exam is your patient health history. This information will alert your doctor to any conditions that should be monitored closely, such as an allergy to any medications, current or family history of systemic or eye pathology or environmental conditions that could be affecting your vision or eye health. This will also help your doctor to determine any preventative eye care measures that are relevant to keep your eyes healthy for years to come.

Visual Acuity

Visual acuity is a measurement of your vision using an eye chart, the Snellen Eye Chart. In this test the patient is seated at a standard distance and is asked to read letters or symbols of various sizes, which get smaller as you move down the chart. The results are the familiar ratio of 20/20, 20/40 etc. which is a comparison of your vision compared to the average person with good vision, which is typically 20/20. For example, a patient that has 20/40 vision, can only see at 20 feet what the normal person can see from a distance of 40 feet. This test is a preliminary test of how clearly you are seeing in each eye but it does not give you a prescription for corrective lenses.

Refraction

Those who don’t have 20/20 vision have what is referred to in most cases as a “Refractive Error.” The patient may have nearsightedness, farsightedness, astigmatism or other eye conditions that prevent the patient from seeing 20/20. A refraction will tell the doctor which prescription lenses will correct your eyesight to achieve 20/20 vision or whichever amount your vision is correctable to.

A refraction may include a couple of steps.

Retinoscopy

Retinoscopy is a test that allows the doctor to obtain an approximate prescription for eyeglasses. In this test the doctor uses a hand-held instrument called a retinoscope that shines a light into the patient’s eye. The doctor then analyzes the reflex of the light from the patient’s eye to determine the patient’s prescription for glasses.

An instrument called a phoropter is something most patients associate with an eye exam. This space age appearing instrument, positioned in front of the patient’s face during the eye exam, gives the doctor the ability to determine the patient’s focusing ability as well as their eye alignment. The phoropter also determines which, out of the hundreds and hundreds of potential eyeglass prescriptions, will help the patient see as clear as possible. Using the phoropter, the doctor will ask the patient which series of lenses makes their vision the clearest.

While retinoscopy is quite effective for children and nonverbal patients, there are now a number of computerized or automated instruments available today to help doctors accurately determine a patient’s eyeglass prescription.

Autorefractors and Aberrometers

Autorefractors and aberrometers are computerized machines that are able to measure your refractive error to determine your prescription for glasses or contact lenses. These instruments are usually used in addition to testing described earlier:

– An autorefractor is similar to retinoscopy, which electronically analyses the light reflex from the patient’s eye.

– An aberrometer measures distortions or aberrations in the cornea and lens of the eye that disrupt proper focus of light on the retina. Using wavefront technology, the instrument measures the rays of light as they pass through your eye to look for imperfections which may indicate a refractive error.

Eye Focusing and Eye Teaming Tests

During the comprehensive eye exam, your eye doctor will also want to test how your eyes function individually and together from a mechanical perspective. In order to see clearly and comfortably, your eyes need to work together as a team.

Eye Health

The final and most important aspect of a comprehensive eye exam is a check of your overall eye health. These tests (below) are done to identify any eye conditions or diseases, both inside the eye as well as the external parts of the eye, that could affect your vision and general health.

Slit Lamp Test

The slit lamp or biomicroscope is an instrument that allows the doctor to examine the internal and external parts of the eye in detail, such as the conjunctiva, iris, lens, cornea, retina and the optic nerve. The patient rests their forehead and chin on a headrest to stabilize the head, while the doctor looks into the eye with the slit lamp microscope, which is magnified with a high-intensity light. A slit lamp test enables the doctor to evaluate the eyes for signs of normal aging and eye pathology, such as conjunctivitis, cataracts, macular degeneration or retinal detachment. Early diagnosis and treatment of eye diseases are essential for preventing vision loss.

Tonometry

Tonometry is a test to detect glaucoma by measuring the pressure inside your eye or IOP (intraocular pressure). Glaucoma can cause vision loss and even blindness if the IOP in the eye is too high and damages the optic nerve.

The applanation tonometer, typically attached to a slit lamp, is one of the most common instruments used to measure the pressure in the eye. Prior to doing this test the doctor will numb the patient’s eyes using an anesthetic, before gently applanating (putting pressure on) the patient’s cornea to measure the pressure in the eye.

Pupil Dilation

During your comprehensive eye exam, your doctor may decide to do a dilated eye exam. In this test, your doctor will instill dilating drops in each eye, which would enlarge your pupils to give the doctor a better view of certain parts of the back of the eye. Dilation is done at the discretion of the doctor, with some patients dilated every year and others at specified intervals; the frequency of dilation will vary for each patient.

Typically the drops take around 20 to 30 minutes to take effect and may last up to several hours following the exam; each patient is different. Since more light enters your eyes when your pupils are dilated, you will be more sensitive to bright light, especially sunlight. Although your doctor may provide disposable sunglasses, you may want to bring a pair of sunglasses to wear after the exam to make it more comfortable until the drops wear off.

A comprehensive eye exam is an important part of your overall general health maintenance and should be scheduled on a regular basis. The findings from your comprehensive eye exam can give your doctor important information about your overall health, particularly diabetes and high blood pressure.

Eye Exams for Contact Lenses

Contact lenses are a great alternative to wearing eyeglasses. An often unknown fact is that not all patients wear contact lenses as their primary source of vision correction. Each patient is different, with some patients wearing contact lenses only on weekends, special occasions or just for sports. That is the beauty of contact lens wear, the flexibility it gives each individual patient and their lifestyle.

If you decide to opt for contact lens wear, it is very important that the lenses fit properly and comfortably and that you understand contact lens safety and hygiene. A contact lens exam will include both a comprehensive eye exam to check your overall eye health, your general vision prescription and then a contact lens consultation and measurement to determine the proper lens fit.

The Importance of a Comprehensive Eye Exam

Whether or not you have vision problems, it is important to have your eyes checked regularly to ensure they are healthy and that there are no signs of a developing eye condition. A comprehensive eye exam will check the general health of your eyes as well as the quality of your vision. During this exam the eye doctor will determine your prescription for eyeglasses, however this prescription alone is not sufficient for contact lenses. The doctor may also check for any eye health issues that could interfere with the comfort and success of contact lens wear.

The Contact Lens Consultation

The contact lens industry is always developing new innovations to make contacts more comfortable, convenient and accessible. Therefore, one of the initial steps in a contact lens consultation is to discuss with your eye doctor some lifestyle and health considerations that could impact the type of contacts that suit you best.

Some of the options to consider are whether you would prefer daily disposables or monthly disposable lenses, as well as soft versus rigid gas permeable (GP) lenses. If you have any particular eye conditions, such as astigmatism or dry eye syndrome, your eye doctor might have specific recommendations for the right type or brand for your optimal comfort and vision needs.

Now is the time to tell your eye doctor if you would like to consider colored contact lenses as well. If you are over 40 and experience problems seeing small print, for which you need bifocals to see close objects, your eye doctor may recommend multifocal lenses or a combination of multifocal and monovision lenses to correct your unique vision needs.

Contact Lens Fitting

One size does not fit all when it comes to contact lenses. Your eye doctor will need to take some measurements to properly fit your contact lenses. Contact lenses that do not fit properly could cause discomfort, blurry vision or even damage the eye. Here are some of the measurements your eye doctor will take for a contact lens fitting:

Corneal Curvature

In order to assure that the fitting curve of the lens properly fits the curve of your eye, your doctor will measure the curvature of the cornea or front surface of the eye. The curvature is measured with an instrument called a keratometer to determine the appropriate curve for your contact lenses. If you have astigmatism, the curvature of your cornea is not perfectly round and therefore a “toric” lens, which is designed specifically for an eye with astigmatism, would be fit to provide the best vision and lens fit. In certain cases your eye doctor may decide to measure your cornea in greater detail with a mapping of the corneal surface called corneal topography.

Pupil or Iris Size

Your eye doctor may measure the size of your pupil or your iris (the colored area of your eye) with an instrument called a biomicroscope or slit lamp or manually with a ruler or card. This measurement is especially important if you are considering specialized lenses such as Gas Permeable (GP) contacts.

Tear Film Evaluation

One of the most common problems affecting contact lens wear is dry eyes. If the lenses are not kept adequately hydrated and moist, they will become uncomfortable and your eyes will feel dry, irritated and itchy. Particularly if you have dry eye syndrome, your doctor will want to make sure that you have a sufficient tear film to keep the lenses moist and comfortable, otherwise, contact lenses may not be a suitable vision option.

A tear film evaluation is performed by the doctor by putting a drop of liquid dye on your eye and then viewing your tears with a slit lamp or by placing a special strip of paper under the lid to absorb the tears to see how much moisture is produced. If your tear film is weak, your eye doctor may recommend certain types of contact lenses that are more successful in maintaining moisture.

Contact Lens Trial and Prescription

After deciding which pair of lenses could work best with your eyes, the eye doctor may have you try on a pair of lenses to confirm the fit and comfort before finalizing and ordering your lenses. The doctor or assistant would insert the lenses and keep them in for 15-20 minutes before the doctor exams the fit, movement and tearing in your eye. If after the fitting, the lenses appear to be a good fit, your eye doctor will order the lenses for you. Your eye doctor will also provide care and hygiene instructions including how to insert and remove your lenses, how long to wear them and how to store them if relevant.

Follow-up

Your eye doctor may request that you schedule a follow-up appointment to check that your contact lenses are fitting properly and that your eyes are adjusting properly. If you are experiencing discomfort or dryness in your eyes you should visit your eye doctor as soon as possible. Your eye doctor may decide to try a different lens, a different contact lens disinfecting solution or to try an adjustment in your wearing schedule.

Eye Exams for Children

According to experts, 80% of learning is visual, which means that if your child is having difficulty seeing clearly, his or her learning can be affected. This also goes for infants who develop and learn about the world around them through their sense of sight. To ensure that your children have the visual resources they need to grow and develop normally, their eyes and vision should be checked by an eye doctor at certain stages of their development.

According to the American Optometric Association (AOA) children should have their eyes examined by an eye doctor at 6 months, 3 years, at the start of school, and then at least every 2 years following. If there are any signs that there may be a vision problem or if the child has certain risk factors (such as developmental delays, premature birth, crossed or lazy eyes, family history or previous injuries) more frequent exams are recommended. A child that wears eyeglasses or contact lenses should have his or her eyes examined yearly. Children’s eyes can change rapidly as they grow.

Eye Exams in Infants: Birth – 24 Months

A baby’s visual system develops gradually over the first few months of life. They have to learn to focus and move their eyes, and use them together as a team. The brain also needs to learn how to process the visual information from the eyes to understand and interact with the world. With the development of eyesight, comes also the foundation for motor development such as crawling, walking and hand-eye coordination.

You can ensure that your baby is reaching milestones by keeping an eye on what is happening with your infant’s development and by ensuring that you schedule a comprehensive infant eye exam at 6 months. At this exam, the eye doctor will check that the child is seeing properly and developing on track and look for conditions that could impair eye health or vision (such as strabismus(misalignment or crossing of the eyes), farsightedness, nearsightedness, or astigmatism).

Since there is a higher risk of eye and vision problems if your infant was born premature or is showing signs of developmental delay, your eye doctor may require more frequent visits to keep watch on his or her progress.

Eye Exams in Preschool Children: 2-5

The toddler and preschool age is a period where children experience drastic growth in intellectual and motor skills. During this time they will develop the fine motor skills, hand-eye coordination and perceptual abilities that will prepare them to read and write, play sports and participate in creative activities such as drawing, sculpting or building. This is all dependent upon good vision and visual processes.

This is the age when parents should be on the lookout for signs of lazy eye (amblyopia) – when one eye doesn’t see clearly, or crossed eyes (strabismus) – when one or both eyes turns inward or outward. The earlier these conditions are treated, the higher the success rate.

Parents should also be aware of any developmental delays having to do with object, number or letter recognition, color recognition or coordination, as the root of such problems can often be visual. If you notice your child squinting, rubbing his eyes frequently, sitting very close to the tv or reading material, or generally avoiding activities such as puzzles or coloring, it is worth a trip to the eye doctor.

Eye Exams in School-Aged Children: Ages 6-18

Undetected or uncorrected vision problems can cause children and teens to suffer academically, socially, athletically and personally. If your child is having trouble in school or afterschool activities there could be an underlying vision problem. Proper learning, motor development, reading, and many other skills are dependent upon not only good vision, but also the ability of your eyes to work together. Children that have problems with focusing, reading, teaming their eyes or hand-eye coordination will often experience frustration, and may exhibit behavioral problems as well. Often they don’t know that the vision they are experiencing is abnormal, so they aren’t able to express that they need help.

In addition to the symptoms written above, signs of vision problems in older children include:

  • Short attention span
  • Headaches
  • Frequent blinking
  • Avoiding reading
  • Tilting the head to one side
  • Losing their place often while reading
  • Double vision
  • Poor reading comprehension

The Eye Exam

In addition to basic visual acuity (distance and near vision) an eye exam may assess the following visual skills that are required for learning and mobility:

  • Binocular vision: how the eyes work together as a team
  • Focusing
  • Peripheral Vision
  • Color Vision
  • Hand-eye Coordination
  • Tracking

The doctor will also examine the area around the eye and inside the eye to check for any eye diseases or health conditions. You should tell the doctor any relevant personal history of your child such as a premature birth, developmental delays, family history of eye problems, eye injuries or medications the child is taking. This would also be the time to address any concerns or issues your child has that might indicate a vision problem.

If the eye doctor does determine that your child has a vision problem, they may discuss a number of therapeutic options such as eyeglasses or contact lenses, an eye patch, vision therapy or Ortho-k, depending on the condition and the doctor’s specialty. Since some conditions are much easier to treat when they are caught early while the eyes are still developing, it is important to diagnose any eye and vision issues as early as possible.

Following the guidelines for children’s eye exams and staying alert to any signs of vision problems can help your child to reach his or her potential.

Corrective Eye Surgery Basics

In recent years there have been tremendous advances in the field of vision correcting eye surgery which is also known as refractive or laser surgery. Corrective eye surgery offers patients clear vision without the use of glasses and contact lenses. There are a number of types of refractive surgeries that are able to correct different vision problems, so if you are considering surgery here are some of the options you should know about.

LASIK

LASIK (laser-assisted in situ keratomileusis) surgery is perhaps the most well-known refractive surgery today. LASIK can help patients with myopia (nearsightedness), hyperopia (farsightedness) and astigmatism. During the procedure, the doctor makes a flap in the outer layer of the corner to reach the underlying tissue and then uses a laser to reshape the tissue which allows the cornea to then focus light properly. The procedure is usually painless and vision is usually clear within a few hours.

Recent advances in the field have developed subcategories of LASIK surgery such as Bladeless LASIK, which uses a laser rather than a mechanical tool to make the initial flap or Wavefront (custom) LASIK which uses computer mapping to guide the reshaping of the cornea and is able to create a much more precise visual correction for very subtle optical imperfections. There is also a procedure called Epi-LASIK in which following the procedure, the doctor applies a soft contact lens to protect the surgical area, holding the flap in place while it heals.

PRK

PRK (photorefractive keratectomy) also uses a laser to correct mild to moderate myopia, hyperopia and astigmatism. PRK was a precursor to LASIK which eliminated many of the complications of prior surgeries such as glare, seeing halos around lights, blurred vision and regression of vision. Unlike LASIK, the procedure only reshapes the surface of the cornea and not the underlying tissue. Consequently, there is often some discomfort for a couple of weeks until the outer layer of the cornea heals. Additionally, the patient may experience blurred vision during this period of healing. PRK does offer an advantage over LASIK in that there is less risk of certain complications. Wavefront technology is also available for PRK surgeries.

Due to the increased comfort of LASIK there was a period that PRK saw a decline. Recent studies show however that LASIK and PRK have similar long-term success for improved visual acuity and with the assistance of newly developed effective pain medications, PRK has become more popular again as an option.

LASEK

In LASEK or laser-assisted sub-epithelial keratomileusis, the doctor creates a flap smaller but similar but to LASIK, and then uses an alcohol solution to loosen the tissue around the cornea which is pushed aside, and then a laser is used to reshape the cornea itself. In an Epi-LASEK procedure, the doctor may apply a soft contact lens to hold the flap in place to assist in reattaching to the cornea as the eye heals. Patients that undergo LASEK generally experience less discomfort and quicker vision recovery than PRK patients. LASEK may be preferred over LASIK as a safer option for patients with a thin cornea.

Cataract Surgery

Cataract Surgery is a very common refractive surgery that removes the clouded natural lens of the eye and replaces it with an artificial lens called an IOL (intraocular lens). Many patients these days will receive a lens that also corrects any refractive error they have such as nearsightedness, farsightedness or presbyopia.

RLE

RLE or refractive lens exchange is a non-laser procedure the replaces the natural lens of the eye. This is the same as the surgery that is used to treat cataracts, ,yet for non-cataract patients, RLE is used to correct severe nearsightedness or farsightedness. The procedure involves the doctor making a small cut in the cornea, removing the natural lens and replacing it with usually a silicon or plastic lens. It is particularly useful for patients with minor corneal problems such as thin corneas or dry eyes.

RLE is more risky than the other procedures mentioned and can affect the patient’s ability to focus on close objects, possibly requiring reading glasses following the procedure. However, in cases of severe vision correction it is often the preferred method.

PRELEX

PRELEX or presbyopic lens exchange is for patients with presbyopia, the age-related condition in which you lose the flexibility of your lens and can no longer focus on close objects. Patients that prefer not to wear reading glasses or multifocals, can opt for a procedure in which the doctor removes the natural lens of your eye and replaces it with a multifocal artificial lens. This procedure is often done in conjunction with cataract surgery.

Phakic Intraocular Lens Implants

Phakic IOLs are implants that are used for individuals with very high nearsightedness who do not qualify for LASIK or PRK. The implant is attached to your iris or inserted behind your pupil, while the natural lens remains intact. Because this is a procedure that involves the inner eye, it is more risky than LASIK or PRK and is therefore also typically more expensive.

Conductive Keratoplasty (CK)

CK uses a hand-held radio wave device to shrink tissue on the cornea to reshape it. The procedure is typically used to treat mild farsightedness and presbyopia, particularly for patients who have already undergone LASIK.

Any surgical procedure has risks and may have some side effects or complications that you should research before you decide to go ahead with the surgery. Nevertheless, as technology advances these complications are being significantly reduced making refractive surgery a great option for vision correction in many patients.

LASIK

LASIK or laser-assisted in situ keratomileusis is a refractive surgery that is used to correct myopia (nearsightedness), hyperopia (farsightedness) and astigmatism as an alternative to eyeglasses or contact lenses. LASIK is currently the most common of the refractive eye surgeries, largely because of the relatively low risk and the quick recovery and improvement in eyesight.

Also known as laser eye surgery or laser vision correction, LASIK uses a laser to reshape the cornea which is responsible for clear vision. The procedure is quick and relatively painless and eyesight is usually improved to 20/20 vision within one day of the surgery.

How Does LASIK Work?

LASIK is an outpatient procedure, which takes about 15 minutes for the actual surgery on both eyes and an hour total with recovery. A topical anesthetic drop is used and there is no need for bandaging or stitches following the procedure. The doctor will start by stabilizing the eye and then making a small flap in the outer layer of the cornea. Then with access to the underlying tissue, he uses a laser to reshape the corneal tissue and re-closes the flap, which will heal on its own. The nature of the corneal reshaping depends on the type of refractive error.

Wavefront LASIK

Wavefront LASIK uses computer mapping technology to guide the laser treatment based on the precise shape of the cornea. This can correct very precise issues, provide much sharper vision than non-wavefront LASIK and can reduce complications such as halos, glare and problems seeing at night.

What to Expect During and After LASIK?

During the procedure you may feel some pressure on your eye while the laser is working. Immediately following you will likely experience some blurriness and may feel burning or itching (be sure not to rub your eyes!). For your journey home you will be given protective shields to guard your eyes and will need someone to drive you. You will also be prescribed medicated eye drops for a week or so to aid in healing and prevent infection. Your doctor may also recommend artificial tears to moisten the eyes and keep them comfortable in the days following the procedure.

The day after the surgery you will be asked to visit your eye doctor (or the surgeon) for a checkup and to evaluate whether you are able to drive. Most people experience an improvement in vision by then, although for some it can take a few days or even a week. Your eyes may be sensitive to light for a day or two as well. You will likely be advised to rest for a day or two and to refrain from strenuous physical activity for about a week until further healing has taken place.

Most people achieve at least 20/20 vision following the surgery, although this can vary and there are cases where 20/40 vision is obtained or where people continue to wear glasses or contacts with a much lesser prescription. Some patients have light sensitivity, particularly when driving at night, also suffering from seeing halos around lights or glare. There are glasses and lenses available to reduce this glare and assist with night driving.

For some, it can take weeks or even months until the vision completely stabilizes. Occasionally, after a few months, patients who do not experience perfect results will schedule an enhancement or touch up surgery to correct the vision even further.

Am I a Candidate for LASIK?

The ideal LASIK candidate is a patient over 18 with generally healthy eyes. Since the procedure involves shaping the cornea by removing some of the tissue, it is not ideal for individuals with a thin cornea or any sort of corneal condition or disease. Patients with chronic dry eyes might also be disqualified as LASIK can often exacerbate these symptoms.

During a comprehensive eye exam your eye doctor will assess your eligibility by looking at the general health of your eye including your cornea, your pupil, the moisture in your eye, the type of refractive error you have and whether you have any other eye conditions of concern.

For the right candidate, LASIK can offer a lifestyle improvement in giving clear vision without the need for glasses or contact lenses, however, the results are not guaranteed. You and your eye doctor need to weigh the benefits and the potential risks based on your personal needs.

Symptoms & Risk Factors of Macular Degeneration

Macular Degeneration can cause low vision and debilitating vision loss, even blindness if not diagnosed and treated in the early stages. Because the disease often has no obvious symptoms early on, it is critical to have regular comprehensive eye exams, particularly if you are at risk.

Symptoms of AMD

Macular degeneration is a disease in which the macula slowly breaks down, resulting in a gradual progressive vision loss, at least in its’ early stages. Frequently there are no symptoms and the disease is only diagnosed when a doctor detects signs such as a thinning macula or the presence of drusen in a comprehensive eye examination. Early vision loss can include blurry, cloudy or distorted central vision or dark spots in your central field of view. With advanced stages, vision loss can be severe and sudden with larger blind spots and total loss of central vision.

Risk Factors for Macular Degeneration

Age is the most prominent risk factor for AMD, as the disease is most common in individuals over the age of 60 (although it can happen in younger individuals as well). Other risk factors can increase your chances of developing the disease such as:

  • Genetics and Family History: Research shows that there are actually almost 20 genes that have been linked to AMD, and they suspect that there are many more genetic factors to be discovered. Family history greatly increases your chances of developing AMD.
  • Race: Caucasians are more likely to get AMD than Hispanics or African-Americans.
  • Smoking: Cigarette smoking can double your likelihood of developing AMD.
  • Lifestyle: Research shows that UV exposure, poor nutrition, high blood pressure, obesity and a sedentary lifestyle can also be contributing factors.
  • Gender: Females have a higher incidence of AMD than males.
  • Medications: Certain medications may increase the chances of developing AMD.

To reduce your risks of developing AMD it is recommended to make healthy choices such as:

    • Regular eye exams; once a year especially if you are 50 or over.
    • Stop smoking.
    • Know your family history and inform your eye doctor.

 

  • Proper nutrition and regular exercise: Research indicates that a healthy diet rich in “Eyefoods” with key nutrients for the eyes such as orange peppers, kale and spinach as well as regular exercise may reduce your risks or slow the progression of AMD.
  • Maintain healthy cholesterol levels and blood pressure.
  • Dietary supplements: Studies by the National Eye Institute called AREDs and ARED2 indicated that a high dosage of supplements of zinc, vitamin C, vitamin E and lutein may slow the progression of advanced dry AMD (it is not recommended for those without AMD or early AMD). Speak to a doctor before taking these supplements because there may be associated risks involved.
  • Wear 99% -100% UV-blocking sunglasses.

 

The first step to eye health is awareness. By knowing your risk, taking preventative measures and visiting your eye doctor on a regular basis, you can greatly reduce your chances of facing this debilitating disease.