Behind The Scenes


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Presentation done by Park Family Eye Care, Dr. Quentin Park

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  • Behind The Scenes

    1. 1. Behind the Scenes Presented by : Dr. Quentin Park Doctor of Optometry
    2. 2. Goals or Purpose <ul><li>Understanding the field of optometry in terms of its historical origin and what the scope of optometry is today </li></ul><ul><li>Knowledge base of what entails a routine eye exam instead of being the patient who is “just going through the motions” </li></ul><ul><li>Standard routine exams/equipment are the basis of optometry and ophthamology, but lets take a look at how some doctors are going high tech </li></ul><ul><li>Diabetes </li></ul>
    3. 3. The History of Optometry Although optometry is relatively a new health care profession, its roots can be traced back through many centuries.
    4. 4. Note: The dates in this very abbreviated history are very approximate <ul><li>3000 B.C. The discovery of glass </li></ul><ul><li>1000 B.C. First lenses were used for starting fires </li></ul><ul><li>500 B.C. Early theories of vision were developed </li></ul><ul><li>100 A.D. Discovery of vision problems </li></ul><ul><li>300-1000 A.D. The Dark Ages cause scientific discovery to halt </li></ul><ul><li>1000 A.D. The first book on physiological optics </li></ul><ul><li>1300 A.D. The invention of spectacles </li></ul><ul><li>1400 Increasing need for vision care due to increased reading, </li></ul><ul><li>education and industrialization </li></ul>
    5. 5. Cont’d <ul><li>1600 The first book on practical optometry </li></ul><ul><li>1800 The first instrument design </li></ul><ul><li>1850-1900 The first schools of optometry </li></ul><ul><li>1901-1924 The passage of laws in all states to regulate optometry </li></ul><ul><li>1926 The first accreditation of optometry schools </li></ul><ul><li>1940 Contact lenses begin to be used </li></ul><ul><li>1970 Soft contact lenses become available </li></ul><ul><li>1970-present Diagnostic and therapeutic drug laws are passed </li></ul><ul><li>1970-present Refractive surgery techniques improve and become widely available </li></ul>
    6. 6. History highlights <ul><li>Legal cases in the first half of the </li></ul><ul><li>20 th century ruled that optometry was separate from medicine. </li></ul><ul><li>Their origins differ both in the sciences from which they developed and in the shift of tradesmen into the professions. </li></ul>
    7. 7. So Quentin, what’s your point? <ul><li>The field of Optometry has changed greatly since its early beginnings </li></ul><ul><li>Scope of practice and training for optometrists has leaned more towards ocular or eye disease management vs. refractive diagnosis and treatment. </li></ul>
    8. 8. Food for thought: The roles of optometrists, opticians, and ophthalmologists are sometimes confused. Opticians are unlicensed craftspeople who fabricate and dispense lenses and frames; they do not examine eyes or prescribe treatment. Ophthalmologists are licensed physicians who provide medical and surgical care of the eyes.
    9. 9. Thus, optometrists can be defined as….. <ul><li>??????????????????????????????????? </li></ul><ul><li>??????????????????????????????????? </li></ul><ul><li>The definition will be revealed at the end of the presentation. </li></ul>
    10. 10. Part Two: The Comprehensive eye exam
    11. 11. The goals of the comprehensive eye examination are to: <ul><li>Evaluate the functional status of the eyes and vision system, taking into account special vision demands and needs </li></ul><ul><li>Assess ocular health and related systemic health conditions </li></ul><ul><li>Establish a diagnosis and formulate a treatment plan </li></ul><ul><li>Counsel and educate the patient regarding his or her visual, ocular, and related systemic health care status, including recommendations for treatment, management, and future care. </li></ul>
    12. 12. Clinical note: <ul><li>Determine whether a patient’s visual condition is a result of a: </li></ul><ul><li> - refractive problem (near sighted or far sighted) </li></ul><ul><li>- eye teaming problem or focusing problem </li></ul><ul><li>- disease problem either systemic or eye (ocular) related only. </li></ul>
    13. 13. The primary care exam sequence can be grouped into four general areas: <ul><li>CASE HISTORY (chief complaint, medical hx, family hx…, medications, surgeries, etc.) </li></ul><ul><li>REFRACTIVE STATUS (near-sighted, far-sighted, etc.) </li></ul><ul><li>BINOCULAR & ACCOMODATIVE STATUS (eye-teaming and focusing ability) </li></ul><ul><li>OCULAR HEALTH  </li></ul>
    14. 14. CASE HISTORY <ul><li>The exam sequence begins with a case history. This is an important part of the examination as it can indicate what the problem may be even before any testing is completed. History is obtained in the following areas: </li></ul><ul><li> - chief complaint -visual and ocular history -general health history -medication usage -allergies to medications -family eye and medical histories -occupational visual requirements -recreational visual requirements </li></ul>
    15. 15. REFRACTIVE STATUS <ul><li>Depending on responses during the case history, the standardized examination can be customized to fit the needs of the patient. Following the case history, the exam continues by assessing the visual acuity of the patient. </li></ul>
    16. 16. Visual Acuity <ul><li>Visual Acuity is taken at the beginning of each office visit and is used as one of the techniques to monitor the patient's current visual status. Acuities are tested by having the patient report what can be seen in the distance and at near with and without their current correction. In most cases, a standard Snellen Acuity Chart is used as the target. </li></ul>
    17. 17. Entrance Tests <ul><li>Entrance Tests are used to initially define the patient's visual abilities, ocular health and related systemic health status. The following areas are assessed:   </li></ul>- patient appearance -a head tilt or turn can be a clue to an eye problem such as a compromised extraocular (eye) muscle. - external ocular and facial areas -signs such as excessive forehead wrinkling, lid droop or squinting give clues to ocular problems. - pupillary responses -changes or alterations in pupil size, shape or reaction to light serve as important diagnostic clues when assessing a patient's visual and neurological functioning. - ocular motility tests -eye movements are tested at near using a fixation bead to assess extraocular muscle function.
    18. 18. Cont’d <ul><li>cover tests -provide information about eye alignment. </li></ul><ul><li>near point of convergence -the closest point at which both eyes together are able to see a single image. </li></ul><ul><li>near point of accommodation -the closest point at which the image is seen clearly. </li></ul><ul><li>Stereopsis -provides information about the ability to see three dimentionally. </li></ul><ul><li>color vision -can provide clues to some retinal diseases or inherited color vision abnormalities. </li></ul><ul><li>confrontation fields -screening test for peripheral vision. </li></ul>
    19. 19. Keratometry <ul><li>The keratometer is an instrument used to measure the curvature of the front surface of the cornea. Findings are used when fitting contact lenses and are an initial indicator of astigmatism. </li></ul>
    20. 20. Refraction <ul><li>When evaluating the refractive status (near sightedness, farsightedness, etc.) of the patient, doctors go thru a extensive battery of tests. Depending on a patient's ocular complaints, a customized examination is given drawing on this battery of tests. When analyzing the refractive error, both subjective and objective sources of information are combined to determine the patient's ideal eye prescription. </li></ul>
    21. 21. “ phoropter” <ul><li>Several of the tests used during a vision exam are done using the phoropter , an instrument equipped with numerous lenses that can be used to find a specific lens combination that will provide clear and comfortable vision for the patient. </li></ul>                                                     
    22. 22. Retinoscopy <ul><li>Retinoscopy is an objective method used to measure refractive error. It is useful in establishing a baseline or reference point from which to begin the refraction portion of the examination. It is especially useful with infants, nonverbal patients, and difficult refractive cases. </li></ul>
    23. 23. Retinoscopy: Shine retinoscope (bottom left image) on the eye to see a reflex movement. Neutralize this movement (bottom right image)using the phoropter lenses.
    24. 24. The neutralized movement (seen bottom left) will result in a estimated prescription of that eye
    25. 25. Retinoscopy cont’d <ul><li>After retinoscopy has been completed, the patient is given a series of lens choices. This process helps fine tune the lenses that the patient likes best for both distance and near viewing. When the end point of this portion of the refraction has been reached, the patient's visual acuity is re-tested. Once the lens combination providing the best visual acuity is in place, the exam continues with an assessment of the patient's binocular and accomodative status. </li></ul>
    26. 26. BINOCULAR AND ACCOMMODATIVE STATUS <ul><li>AKA Eye-Teaming and Eye-Focusing </li></ul><ul><li>Additional tests for binocular function and accommodation (focusing ability) are incorporated into the examination depending on a patient's chief complaint, work and recreation requirements, age, and results of entrance testing. </li></ul>
    27. 27. Binocular/Acc. Status cont’d <ul><li>With the lens combination providing the best visual acuity and most comfort in place, tests are conducted to evaluate the eye-teaming and focusing ability of the eyes. Results from these tests can uncover functional vision problems. For example, if a patient has an eye-teaming or binocular problem, he/she may experience difficulty seeing an object as single. What can result is double vision or fatigue when reading. An example of an eye focusing problem occurs when a patient sees blur in the distance after reading for a while. </li></ul>
    28. 28. These specific tests can be performed with or without the use of a phoropter: Vs.
    29. 29. OCULAR HEALTH EVALUATION <ul><li>What the heck is that? </li></ul><ul><li>Find out in these next few slides………. </li></ul>
    30. 35. Ocular Anatomy 101 <ul><li>Cornea The cornea is the most anterior structure on the eye.   Since it has to be transparent to allow light to enter the eye, there are no blood vessels in the cornea .  The cornea also has the highest concentration of nerve endings in the entire body, thus making it extremely sensitive to any kind of trauma.  Approximately 3/4 of the focusing power of the eye is provided by the cornea , with the other 1/4 provided by the crystalline lens. </li></ul><ul><li>Iris The iris is more recognizable as the coloured part of the eye.  It is mostly comprised of muscles that serve to increase and decrease the size of the pupil (see the write-up on the pupil below).  </li></ul><ul><li>Pupil </li></ul><ul><li>The pupil is the small black dot in the centre of the iris .   This dot is actually a hole which allows light to enter the eye.  Muscles in the iris control the size of the pupil which is how the eye regulates the amount of light that enters it.   </li></ul>
    31. 36. <ul><li>Lens </li></ul><ul><li>The crystalline lens is located immediately behind the iris .  This structure provides approximately 1/4 of the focussing power of the eye while the other 3/4 is provided by the cornea .  The crystalline lens is transparent and flexible.  outwards. vitreous </li></ul><ul><li>Retina </li></ul><ul><li>A common analogy that is often used by eye care practitioners is that the eye can be thought of as being a camera and the retina is the film.  The retina is in fact a thin layer of tissue that is spread out across the inside back of the eye.  It is actually composed of 10 main layers, the most important of which is a layer of light-recepting cells commonly known as rods and cones.  These specialized cells basically capture light that has entered the eye and converts it into nerve impulses which are processed by the brain and are perceived as light.  Any images that are focussed on the retina by the eye are actually inverted and everted (ie- they are upside down and flipped horizontally).  The brain then inverts and everts this image again so that we perceive the world </li></ul>
    32. 37. <ul><li>Optic Nerve </li></ul><ul><li>The optic nerve can be thought of as a cable that carries the visual information that is detected by the retina directly to the brain where it is processed.  The optic nerve itself is composed of millions of nerve fibres, each one of which is connected to either a rod cell or a cone cell in the retina .  These individual nerve fibres then converge at the back of the eye to form the optic nerve .  </li></ul>
    33. 38. Direct Ophthalmoscopy <ul><li>This technique provides a view of the retina, optic nerve and ocular media (cornea, lens, vitreous, etc). It can be used with a non-dilated pupil , however the field of view is smaller as compared to other fundus viewing techniques </li></ul>
    34. 39. Biomicroscopy &quot;Slit Lamp&quot; <ul><li>The slit lamp provides a </li></ul><ul><li>magnified, three dimensional </li></ul><ul><li>view of the ocular structures </li></ul><ul><li>and the surrounding tissues. It </li></ul><ul><li>is used to perform ocular health </li></ul><ul><li>assessments which include </li></ul><ul><li>evaluation of: </li></ul><ul><li>trauma </li></ul><ul><li>irritation </li></ul><ul><li>infection </li></ul><ul><li>inflammation </li></ul><ul><li>fit and management of contact lenses </li></ul>
    35. 40. Applanation Tonometry (Goldman) Using the tonometry attachment, the slit lamp can be used to measure the intraocular pressure (IOP) of the eye. This is one of the tests used to evaluate the presence or absence of glaucoma.                                                                                                             
    36. 41. <ul><li>High Plus Lens Examination </li></ul><ul><li>When using a high magnification </li></ul><ul><li>Lens (see image below) with the </li></ul><ul><li>slit lamp, a highly detailed </li></ul><ul><li>stereoscopic view of the </li></ul><ul><li>retina and vitreous is possible. </li></ul><ul><li>This type of view is crucial when </li></ul><ul><li>examining these structures for </li></ul><ul><li>evidence of disease . </li></ul>
    37. 42. Binocular Indirect Ophthalmoscopy (BIO) <ul><li>BIO is a technique used to evaluate the entire retina and vitreous. Since both eyes are used, it provides a three dimensional view as opposed to the direct ophthalmoscope which provides a two dimensional view. BIO typically requires the pupils to be dilated. </li></ul>
    38. 43. Part III: Modernizing the Standard
    39. 44. <ul><li>Now that you’ve seen the oh so boring (ZZZZZZZZZZZZ) basics of a routine optometric exam………… </li></ul><ul><li>Let us take a look at how some optometrists have stepped up a notch to improve the level of eye care. </li></ul><ul><li>Welcome to a quick tour of Dr. Bill Park office. </li></ul>
    40. 45. CEO-Dr. Bill Park
    41. 46. THE ROTA TABLE
    42. 47. Rota Table allow the following tests to be performed: <ul><li>FDT (side vision screening test) </li></ul><ul><li>Auto-tonometer </li></ul><ul><li>Entrance Tests (Pupils, Cover Test, NPC, Stereopsis, Blood Pressure) </li></ul><ul><li>Auto-refraction/Auto-keratometry </li></ul><ul><li>Fundus Photography </li></ul><ul><li>Advantages: </li></ul><ul><li>-faster exams </li></ul><ul><li>-efficient test taking </li></ul><ul><li>-patient convenience </li></ul><ul><li>-high end technology </li></ul><ul><li>-space </li></ul>
    43. 48. Frequency Doubling Technology(FDT)
    44. 49. <ul><li>Innovative Technology </li></ul><ul><li>The Humphrey FDT is a screener test that isolates a subset of retinal ganglion cell (M-cell). The damage of these cells in the disease process makes FDT efficient and effective for the detection of visual field loss. </li></ul><ul><li>With supra-threshold screening tests in only 40 seconds, the FDT enables efficient screening for all patients. Full threshold testing in under 4 minutes. </li></ul>FDT vs. Visual Field Fig 1. (lower left) Image of target pt. must click on during test
    45. 50. Canon Fundus Camera
    46. 51. <ul><li>Retinal photography assists in the detection and management of problems such as diabetic changes, hypertensive retinopathy, macular degeneration, optic nerve disease, and retinal holes or thinning.  </li></ul><ul><li>We recommend that all our patients receive this test. It is especially important for people with a history of high blood pressure, diabetes, retinal diseases, flashing lights, floaters, headaches, or a strong glasses prescription. </li></ul><ul><li>Provides a excellent reference point for future comparisons </li></ul>
    47. 52. Autorefractor/Keratometer
    48. 53. Can you say air puff test? <ul><li>Old School </li></ul>
    49. 54. Canon Auto-tonometer (glaucoma test) Not nearly as harsh as the old “air-puff” machines
    50. 55. Lensographer,Lensometer, Radiuscope
    51. 56. Corneal Topography
    52. 57. <ul><li>Of all the technology currently available, corneal topography provides the most detailed information about the curvature of the cornea.  The computer generates a color map from the data.  This information is useful to evaluate and correct astigmatism, monitor corneal disease, and detect irregularities in the corneal shape.  </li></ul><ul><li>The cool shades of blue and green represent flatter areas of the cornea, while the warmer shades of orange and red and represent steeper areas. This corneal map allows the physician to formulate a “3-D” perspective of the cornea’s shape. Measuring astigmatism is important for planning refractive surgery, fitting contact lenses, and calculating intraocular lens power. </li></ul>
    53. 58. <ul><li>One of uses many uses of topography is in diagnosing a corneal disease called Keratokonus where the cornea &quot;cones&quot; and becomes weak. </li></ul>
    54. 59. Slit Lamp Digital Photography
    55. 60. <ul><li>Anterior segment photography is the imaging of the anterior chamber and it's contents, tear film and outer surface of the eye </li></ul>
    56. 61. Diabetes 101
    57. 62. EPIDEMIOLOGY (USA) <ul><li>16 million Americans have diabetes with as many as half undiagnosed </li></ul><ul><li>>60% have some degree of diabetic retinopathy </li></ul><ul><li>Leading cause of new blindness (20 to 74 yrs) </li></ul><ul><li>Leading cause of vision loss under age 60 </li></ul><ul><li>Prevalence increases with duration of DM </li></ul><ul><li>Klein R Diab Am 1985 </li></ul><ul><li>Klein R Diabetes Care 1987 </li></ul><ul><li>Olk RJ Ophthalmology 1986 </li></ul>
    58. 63. <ul><li>Diabetes is a disease that occurs when the pancreas does not secrete enough insulin or the body is unable to process it properly. Insulin is the hormone that regulates the level of sugar (glucose) in the blood. Diabetes can affect children and adults. </li></ul>
    59. 64. How does diabetes affect the retina? <ul><li>Patients with diabetes are more likely to develop eye problems such as cataracts and glaucoma , but the disease’s affect on the retina is the main threat to vision. Most patients develop diabetic changes in the retina after approximately 20 years. The effect of diabetes on the eye is called diabetic retinopathy . </li></ul>
    60. 65. ETDRS Severity Scale <ul><li>Mild NPDR </li></ul><ul><li>Moderate NPDR </li></ul><ul><li>Severe NPDR </li></ul><ul><li>Very Severe NPDR </li></ul><ul><li>Mild PDR </li></ul><ul><li>Moderate PDR </li></ul><ul><li>High-risk PDR </li></ul><ul><li>Advanced PDR </li></ul>“ BACKGROUND DIABETIC RETINOPATHY” “ Proliferative Diabetic Retinopathy”
    61. 66. <ul><li>Over time, diabetes affects the circulatory system of the retina. The earliest phase of the disease is known as background diabetic retinopathy . In this phase, the arteries in the retina become weakened and leak, forming small, dot-like hemorrhages. These leaking vessels often lead to swelling or edema in the retina and decreased vision. </li></ul>Dot & Blot Hemorrhages
    62. 67. “ waxy” hard exudates
    63. 68. <ul><li>The next stage is known as proliferative diabetic retinopathy. In this stage, circulation problems cause areas of the retina to become oxygen-deprived or ischemic. New, fragile, vessels develop as the circulatory system attempts to maintain adequate oxygen levels within the retina. This is called neovascularization. Unfortunately, these delicate vessels hemorrhage easily. Blood may leak into the retina and vitreous , causing spots or floaters , along with decreased vision. </li></ul>
    64. 69. Neovascularization of the Disc
    66. 71. <ul><li>In the later phases of the disease, continued abnormal vessel growth and scar tissue may cause serious problems such as retinal detachment and glaucoma </li></ul>
    67. 72. Detection and Diagnosis <ul><li>Diabetic patients require routine eye examinations so related eye problems can be detected and treated as early as possible. Most diabetic patients are frequently examined by an internist or endocrinologist who in turn work closely with the opthamologist or optometrist. </li></ul><ul><li>The diagnosis of diabetic retinopathy is made following a detailed examination of the retina with an ophthalmoscope . Most patients with diabetic retinopathy are referred to vitreo-retinal surgeons who specialize in treating this disease </li></ul>
    68. 73. Treatment <ul><li>Depends on the stage/severity of diabetes </li></ul><ul><li>PRP (Laser Treatment) </li></ul><ul><li>Vitrectomy </li></ul>
    69. 74. Thus, optometrists can be defined as….. <ul><li>     … . a health care professional trained and state licensed to provide primary eye care services. These services include comprehensive eye health and vision examination; diagnosis and treatment of eye diseases and vision disorders; the detection of general health problems; the prescribing of glasses, contact lenses, low vision rehabilitation, vision therapy, and medications; the counseling and care of patients regarding their surgical alternatives and vision needs as related to their occupation, avocation an lifestyle. The optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the Doctor of Optometry (O.D.) degree. Some optometrists complete a residency. </li></ul>
    70. 75. Most Frequently Asked Questions
    71. 76. <ul><li>Careers in Optometry </li></ul><ul><li>Q: What educational requirements are needed to become an optometrist? A: Most Optometrists complete a four-year bachelor's degree before beginning the four-year program leading to the doctor of optometry (O.D.) degree. About 10% complete an additional resident or post-graduate program in a particular area of interest. </li></ul><ul><li>Q: Who are paraoptometrics? A: Paraoptometrics are allied health personnel who extend the optometrist's capabilities by assuming routine and technical aspects of vision care services. Paraoptometrics are to optometrists what paralegals are to lawyers. </li></ul>
    72. 77. <ul><li>Contact Lenses </li></ul><ul><li>Q: What are the advantages/disadvantages of contact lenses? A: </li></ul><ul><ul><li>Advantages of contact lenses: </li></ul></ul><ul><li>Offer good peripheral (side) vision </li></ul><ul><li>Reduce visual distortion that may occur with some eyeglasses </li></ul><ul><li>Fit an active lifestyle </li></ul><ul><li>Improve one's appearance </li></ul><ul><li>     </li></ul><ul><ul><li>Disadvantages of contact lenses: </li></ul></ul><ul><li>They require more daily care than eyeglasses </li></ul><ul><li>Some types require a short adaptation period </li></ul><ul><li>You need to return to your optometrist more often for follow-up to maintain eye health </li></ul><ul><li>Q: Do contact lenses work for everyone? A: There are many different types and styles of contact lenses that are an option for correcting most types of refractive error. But contact lenses are not for everyone. Ask your optometrist which contact lenses could be right for you. </li></ul>
    73. 78. <ul><li>Examinations/Procedures </li></ul><ul><li>Q: What is the purpose of dilation? A: When the pupil is functioning normally, shining a bright light into a person's eyes causes the pupil to constrict. Using dilating drops allows the optometrist to use the instruments necessary to evaluate the posterior portion of the eye, including the retina and optic nerve, without the pupil becoming smaller. In fact, the large, dilated pupil allows a much better view all the way to the &quot;far corners&quot; of the retina. </li></ul><ul><li>Q: What are the long-term effects of Laser Correction? A: Though laser refractive correction has only been available for about 10 years, it is strongly believed that there are no long-term consequences of PRK or LASIK. Long-term effects of such procedures are within the purview of the Food and Drug Administration. The FDA has approved both procedures. </li></ul><ul><li>Q: How soon should I take my child for his/her first eye examination? A: An infant should have his/her first eye exam at six months of age. Another exam should be scheduled at age three, and then again prior to your child entering first grade. </li></ul>
    74. 79. <ul><li>Eye Conditions </li></ul><ul><li>Q: What causes spots and &quot;fireworks&quot; in an eye? A: The spots and floaters, as we generally refer to them, may be associated with migraines. But they are usually caused by a shrinkage of the jelly that fills the back two-thirds of the eye. As this jelly (vitreous) shrinks two things occur. As light goes through the shrunken jelly, a shadow is formed on the back of the eye. This is what is commonly perceived as a floater. Secondly, as the jelly shrinks, it can pull or tug on the retina causing flashing lights. A thorough evaluation by your family optometrist including a dilated examination is suggested. This examination rules out any serious conditions that also can cause spots and floaters. </li></ul><ul><li>Q: When someone says that you have 20/200 vision, is that very bad or very good? In other words, is it what you see at 20 feet, they see at 200 ft or vice versa? A: This is a common question. 20/200 vision although significantly less than the standard 20/20, is not real bad. It is moderate. 20/200 vision is certainly reduced enough that it should be corrected with glasses or contacts. This may also depend on the patient's visual needs, but most people would feel that this is blurry (poor) vision if uncorrected. The 20/200 visual measurement means that at 20 feet away you see a size 200 letter. The first number is the distance away that the vision is checked and the second number is the size of the letter that you can read. The larger the number the larger the letter size. If you are 20/200, it means that what you see at 20 ft. is what a person 20/20 can see at 200 ft. </li></ul>
    75. 80. <ul><li>Q: What is farsightedness? A: Farsightedness (hyperopia) is a vision condition in which distant objects are usually seen clearly, but close ones appear blurred. </li></ul><ul><li>Q: What is presbyopia? A: Presbyopia is an aging vision condition in which the crystalline lens of your eye loses its flexibility. This results in progressive difficulty in focusing on close objects. Your eye stops growing in your early teens. The lens, however, continues to grow and produce more and more cells. This continued growth eventually causes the lens to harden and lose some of its elasticity and therefore some focusing ability. </li></ul><ul><li>Q: Up to what age can Strabismus be treated? A: Generally, the earlier that strabismus is treated, the better the outcome. Strabismus is treatable at any age. You should speak with your eye care doctor to determine which treatments—glasses, vision therapy and/or surgery--if surgery would be most effective in your case. </li></ul>
    76. 81. <ul><li>What, if any, treatment is available for lazy eye? A: Corrective lenses, prisms and/or contact lenses are often used to treat lazy eye, or amblyopia. Covering or occluding the better eye, for periods during the day, may be used to stimulate vision in the amblyopic eye. In addition, a program of vision therapy may be prescribed to help improve vision function. </li></ul><ul><li>Q: What is an astigmatism? A: Astigmatism is a vision condition in which light entering the eye is unable to be brought to a single focus, resulting in vision being blurred at all distances. Astigmatism is not a disease, but rather, a vision condition that is quite common. It often occurs in conjunction with other refractive errors like nearsightedness and farsightedness. </li></ul><ul><li>Q: What causes crossed-eyes? A: Coordination of your eyes and their ability to work together as a team develops in early childhood. Failure of your eyes (or more precisely, your eye muscles) to coordinate together properly can lead to crossed-eyes. Excessive eye focusing effort in children who are farsighted can also result in crossed-eyes. Crossed-eyes also have a tendency to be hereditary. </li></ul><ul><li>Q: What is nearsightedness? A: Nearsightedness (myopia) is a vision condition in which you can usually see close or near objects clearly, but cannot see distant ones as clearly. </li></ul>
    77. 82. <ul><li>Eye Diseases </li></ul><ul><li>Q: My husband is diabetic. How could this affect his vision? A: Diabetes and its complications can affect many parts of the eye. Visual symptoms of diabetes include fluctuating or blurring of vision, occasional double vision, night vision problems and flashes and floaters within the eyes. Sometimes early signs of diabetes are detected in a thorough optometric examination. The most serious eye problem associated with diabetes is diabetic retinopathy. Diabetic retinopathy occurs when there is a weakening or swelling of the tiny blood vessels in the retina of your eye, resulting in blood leakage, the growth of new blood vessels and other changes. If diabetic retinopathy is left untreated, blindness can result. </li></ul><ul><li>Q: What is Glaucoma? A: Glaucoma is an eye disease in which the internal fluid pressure of your eye rises to a point that the optic nerve is damaged. The pressure that builds up is usually due to inadequate drainage of fluid normally produced in your eyes. Glaucoma is one of the leading causes of blindness in the U.S. </li></ul>
    78. 83. <ul><li>Q: What are the symptoms of a cataract? A: Cataracts usually develop slowly and without pain. Some indications that a cataract may be forming include blurred or hazy vision, decreased color perception, or the feeling of having a film over the eyes. A temporary improvement in near vision may occur, and increased sensitivity to glare, especially at night, may be experienced. Cataracts usually develop in both eyes, but often at different rates. </li></ul><ul><li>Q: What is Conjunctivitis? A: Conjunctivitis is an inflammation of the conjunctiva, a thin, transparent layer covering the surface of the inner eyelid and a portion of the front of the eye. This condition appears in many forms, including an infection, and affects people of all ages. </li></ul><ul><li>Q: How can glaucoma be treated? A: Glaucoma is usually effectively treated with prescription eye drops and medicines that must be taken regularly. In some cases, laser therapy or surgery may be required. The goal of treatment is to prevent loss of vision by lowering the fluid pressure in the eye. Anyone with this condition should be under the regular care of his or her optometrist </li></ul>
    79. 84. <ul><li>Q: What causes dry eye? A: Dry eye occurs when your eyes do not produce enough tears or produce tears which do not have the proper chemical composition. Dry eye symptoms can result from the normal aging process, exposure to environmental conditions, problems with normal blinking or from medications such as antihistamines, oral contraceptives or antidepressants. Dry eye can also be symptomatic of general health problems or can result from chemical or thermal burns to the eye. Always schedule regular appointments with your optometrist, but if you are experiencing any unusual symptoms, call your optometrist immediately. </li></ul><ul><li>Q: What is the seriousness of vitreous detachment? A: A vitreous detachment, often noticed by the appearance of &quot;floaters&quot; in one's vision is usually a benign (non-serious) condition. However, it is important to note that floaters often precede a retinal detachment, a more serious sight-threatening problem. You should check with your optometrist if or when you notice an increase in the number of spots or floaters present, or you experience the sensation of flashing lights. You should also schedule regular examinations with your optometrist so that your pupils may be dilated to allow better diagnosis of retinal conditions. </li></ul><ul><li>Q: Is &quot;pink eye&quot; contagious? A: True &quot;pink eye&quot; is caused by infectious organisms, such as virus, bacteria or fungus that is contagious. However, &quot;pink eye&quot; is just one of many types of conjunctivitis that are similar. In any case, if you have any type of conjunctivitis, it is best to use good hygiene by washing hands regularly, not sharing towels, and trying not to touch or rub the eyes </li></ul>
    80. 85. <ul><li>Learning </li></ul><ul><li>Q: How does vision affect learning? A: Vision problems can and often do interfere with learning. People at risk for learning-related vision problems should be evaluated by an optometrist who provides diagnostic and management services in this area. The goal of optometric intervention is to improve visual function and alleviate associated signs and symptoms. Prompt remediation of learning- related vision problems enhances the ability of children and adults to perform to their full potential. People with learning problems require help from many disciplines to meet the learning challenges they face. Optometric involvement constitutes one aspect of the multidisciplinary management approach required to prepare the individual for lifelong learning. </li></ul><ul><li>Q: How soon should I take my child for his/her first eye examination? A: An infant should have his/her first eye exam at six months of age. Another exam should be scheduled at age three, and then again prior to your child entering first grade. </li></ul>