Don't be one of the thousands of parents every year who wish, "I wish I had realized sooner that my child coudn't see properly!"

Did you know that early intervention in children's vision is the key to success?

• 80% of learning comes through vision.
• In the first year of life, then again by age 3 or 4, each child needs a comprehensive eye exam.
• 6 months old is not too early.

Even though a school vision screening, nurse evaluation, or pediatrician screening is important, it doesn't take the place of a comprehensive eye exam by an eyecare professional. Some symptoms of an undetected vision problem include: decreased performance in school, aversion to reading, excessive blinking, eye rubbing, headache, or inability to see 3-D movies properly.

This could indicate conditions such as amblyopia (lazy eye), nearsightedness (myopia), astigmatism, or farsightedness (hyperopia) that can be corrected with glasses.

More serious conditions may need surgery such as esotropia, where the eye turns in, or exotropia where the eye turns out.

Although school screenings, nurses, and pediatricians are extremely valuable, they don't take the place of a comprehensive eye exam by an Optometrist or Ophthalmologist.

In fact, school screenings can give a false sense of security. There are visual skills necessary for reading that aren't diagnosed easily just by reading an eye chart. If a child frequently lose his or her place while reading, he or she may benefit from glasses, vision exercises, or therapy.

Vision Therapy is training of the eyes that help alleviate issues that glasses alone can not.

A comprehensive exam can also reveal more serous threats to vision and health in children. A more rare, but life threatening condition is a fast growing eye tumor called retinoblastoma. The proximity of the eye to the brain makes fast intervention critical. This is a condition that parents might notice by looking at pictures and noticing a "white pupil."

Resources to find out more information on children's vision can be found through your local eye care provider or websites such as American Optometric Association.

Also look for the InfantSEE program. It is a no cost public health program for early detection in the first year of life.

Don't Shake is the National center on Shaken Baby Syndrome

And American Academy of Pediatrics

The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ.

Cataracts are part of the natural aging process. Everyone gets them to one degree or another if they live long enough. Cataracts, as they progress, create increasing difficulty with the normal activities of living. The symptoms vary from one person to another. Some people have more difficulty with their distance vision, some with reading. People may report difficulty with glare, or foggy, blurry, or hazy vision.

Doctors have noticed an increase in requests for second opinions because patients are sometimes told they have cataracts and they HAVE to have surgery--even though the patient has no visual complaints. Just having a cataract is not a reason to have cataract surgery.

According to the American Academy of Ophthalmology, "The decision to recommend cataract surgery should be based on consideration of the following factors: visual acuity, visual impairment, and potential for functional benefits." Therefore, the presence of a cataract is not enough to recommend surgery. There needs to be some degree of visual impairment that is altering the ability to perform your normal activities of daily living. There also needs to be some reasonable expectation that removing the cataract is going to improve vision.

A patient with advanced macular degeneration has significant visual impairment. If she has just a mild cataract, then removing that cataract is unlikely to alleviate the visual impairment. You therefore need to have both things - a visual impairment that interferes with your normal daily activities AND a reasonable expectation that removing a cataract is going to help improve vision to a significant degree.

There are some instances where a dense cataract might need to be removed even though the above criteria are not being met. One example is when a cataract gets so bad that it starts causing glaucoma. Another instance would be if the cataract interferes with treating a retinal problem because the retina cannot be well visualized if the cataract is severely hampering the view of the retina. Those conditions are VERY rare in the U.S.

Most people who need cataract surgery are aware they have a visual impairment and that impairment is altering their normal daily activities. There are times, however, when we recommend cataract surgery because there is a visual impairment but the patient is not aware of just how bad their vision is. For example, the legal driving requirement in New Jersey is 20/50 or better in at least one eye. So we do occasionally see a patient who think he sees fine but when tested his vision is worse than 20/50 and he is still driving. In that case we would recommend cataract surgery (assuming the cataract is the problem) even though the patient does not think he has an impairment.

If you have been told you need cataract surgery but feel you are not having any significant visual problem, you should consider getting a second opinion.

Article contributed by Dr. Brian Wnorowski, M.D.

The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ

Is making an appointment for a comprehensive eye exam for your children on your back-to-school checklist? It needs to be.

No amount of new clothes, backpacks or supplies will help your child succeed in school if they have an undetected vision problem. 

The difference between eye exams and vision screenings

An annual exam done by an eye doctor is more focused than a visual screening done at school. School screenings are simply "pass-fail tests" that are often limited to measuring a child’s sight clarity and visual acuity up to a distance of 20 feet. But this can provide a false sense of security.

There are important differences between a screening and a comprehensive eye exam.

Where a screening tests only for visual acuity, comprehensive exams will test for acuity, chronic diseases, color vision and eye tracking. This means a child may pass a vision screening at school because they are able to see the board, but they may not be able to see the words in the textbook in front of them.

Why back-to-school eye exams matter

Did you know that 1 out of 4 children has an undiagnosed vision problem because changes in their eyesight go unrecognized? 

Myopia, or nearsightedness, is a common condition in children and often develops around the ages of 6 or 7. And nearsightedness can change very quickly, especially between the ages of 11 and 13, which means that an eye prescription can change rapidly over a short period of time. That’s why annual checkups are important.

Comprehensive eye exams can detect other eye conditions. Some children may have good distance vision but may struggle when reading up close. This is known as hyperopia or farsightedness. Other eye issues such as strabismus (misaligned eyes), astigmatism or amblyopia (lazy eye) are also detectable. 

Kids may not tell you they're having visions issues because they might not even realize it. They may simply think everyone sees the same way they do. Kids often give indirect clues, such as holding books or device screens close to their face, having problems recalling what they've read, or avoiding reading altogether. Other signs could include a short attention span, frequent headaches, seeing double, rubbing their eyes or tilting their head to the side.

What to expect at your child's eye exam

Before the exam, explain that eye exams aren’t scary, and can be fun. A kid-friendly eye exam is quick for your child. After the doctor tests how she sees colors and letters using charts with pictures, shapes, and patterns, we will give you our assessment of your child’s eyes. 

If your child needs to wear glasses, we can even recommend frames and lenses best for their needs.

Set your child up for success

Staying consistent with eye exams is important because it can help your kids see their best in the classroom and when playing sports. Better vision can also mean better confidence because they are able to see well. 

Because learning is so visual, making an eye examination a priority every year is an important investment you can make in your child's education. You should also be aware that your health insurance might cover pediatric eye exams.

Set your child up for success and schedule an exam today!

The 2017 National Coffee Drinking Trends report showed that 62 percent of more than 3,000 people who participated in the online survey said they had drunk coffee the previous day, which is interpreted as daily consumption. This was up from 57 percent in 2016, said the report, which was released at the coffee association's conference in Austin, Texas.

Even though the U.S. population is drinking more coffee than ever, the nation still only ranks 22nd overall in per capita consumption. The people of Finland average 3 times as much coffee consumption as people in the U.S.

So what does all this caffeine intake do to our eyes?

The research is rather sparse and the results are mixed.

Here are some major eye topics that have been investigated:

Glaucoma

One study, published in the journal Investigative Ophthalmology and Visual Science, showed that coffee consumption of more than 3 cups per day compared to abstinence from coffee drinking led to an increased risk for a specific type of Glaucoma called Pseudoexfoliation Glaucoma.

Another analysis of several existing studies by Li,M et al demonstrated a tendency to have an increase in eye pressure with caffeine ingestion only for people who were already diagnosed with Glaucoma or Ocular Hypertension, but no effect on people without the disease. A separate study, published by Dove Press, done with the administration of eye drops containing caffeine to 5 volunteers with either Glaucoma or Ocular Hypertension showed that there was no change in the eye pressure with the drops administered 3 times a day over the course of a week.

Summing up the available studies in terms of Glaucoma, the evidence points to maybe a slight increase in Glaucoma risk for people who consume 3 or more cups of coffee a day.

Retinal Disease

A study done at Cornell University showed that an ingredient in coffee called chlorogenic acid (CLA), which is 8 times more concentrated in coffee than caffeine, is a strong antioxidant that may be helpful in warding off degenerative retinal disease like Age Related Macular Degeneration.

The study was done in mice and showed that their retinas did not show oxidative damage when treated with nitric oxide, which creates oxidative stress and free radicals, if they were pretreated with CLA.

Dry Eyes

A study published in the journal Ophthalmology looked at the effect caffeine intake had on the volume of tears on the surface of the eye. In the study, subjects were given capsules with either placebo or caffeine and then had their tear meniscus height measured. The results showed that there was increased tear meniscus height in the participants who were given the caffeine capsules compared to placebo. Increased tear production, which occurred with caffeine, may indicate that coffee consumption might have a beneficial effect on Dry Eye symptoms.

Eyelid Twitching

For years eye doctors have been taught that one of the primary triggers for a feeling of twitching in your eyelid has been too much caffeine ingestion (along with stress, lack of sleep and dry eyes). I have been unable to find anything substantial in the literature to support this teaching. Therefore, I’m going to have to leave this one as maybe, maybe not.

The End Result

Overall, the evidence for the pros and cons of coffee consumption and its effects on your eyes appear to be rather neutral. There are one or two issues that may increase your risk for glaucoma but it also may decrease your risk of macular degeneration or dry eyes.

Since there is no overwhelming positive or negative data, our recommendation is--and this holds for most things--enjoy your coffee in moderation.

Related links

• Study: Coffee is good for your eyes
• Study links caffeinated coffee to vision loss
• Effect of caffeine on intraocular pressure
• Effect of caffeine in patients with primary open angle glaucoma
• Drinking coffee prevents eye damage
• Caffeine increases tear volume

Article contributed by Dr. Brian Wnorowski, M.D.

This blog provides general information and discussion about eye health and related subjects. The words and other content provided on this blog, and in any linked materials, are not intended and should not be construed as medical advice. If the reader or any other person has a medical concern, he or she should consult with an appropriately licensed physician. The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ.

It's the summer and one of the most common questions eye doctors are asked is, “Is it safe to swim in my contact lenses?”

The answer we give is “NO!"

Do millions of people swim with their contact lenses in? The answer is “Yes, they do, but it is NOT a recommended activity.’’ There are several reasons why, ranging from comfort issues to others that are far more sinister and potentially blinding.

The first reason not to swim with contacts in is that the pH and buffering of your tears is not the same as plain water, and certainly not that of ocean or pool water.

Contact lenses, especially soft ones, are designed to do best in pH and buffers of solutions that mimic your natural tear film. This pH difference is often why after you swim in a chlorinated pool your eyes tend to become red, burn or blur.

When pool water or another water source mixes with your tears, the pH rapidly changes and there is a mini-chemical reaction occurring on the surface of your eye. Now if you add a contact lens to this mix it prolongs the chemical mixing that occurs. The actual contact lens will often swell due to the pH and buffer changes that are occurring and this swelling results in blurred vision.

When a contact lens swells it often tightens its fit onto your eye, causing discomfort or even pain. This is usually temporary until the volume of tears surpasses the volume of foreign water and the tears take over and the contact lens returns to its normal thickness, but the discomfort and blurring can last several minutes.

The second reason for not wearing your contacts swimming is that you can lose your lenses under water.

Contact lenses adhere to your eyes via a principle called capillary attraction, which happens when two surfaces are held together by a thin layer of liquid.

When a contact lens is placed on your eye it is the tears that hold it there more than anything else. Now if you go into a large body of water - like a pool, ocean, etc. -there is more water outside of your eye than the little layer between the contact and your eye and your contact lens floats out.

This can result in either a dislocated contact lens under an eyelid or a lost contact lens. Since most people wear disposable lenses it may not be a big deal, but if they were the only pair of lenses you wore to the beach and your sunglasses are not prescription, you could have a difficult ride back home.

The final and most important reason not to wear contacts while swimming is infection.

There are many different types of waterborne bacteria, viruses, fungi, and microorganisms. Some may result in the typical types of conjunctivitis that is easily treated with antibiotics. But as with any infection, you will have to stop wearing your contact lenses while you are being treated.

The two most difficult types of infections to treat are fungal infections and microorganisms/protozoans, and treatment options are limited.

Fungal infections are notoriously difficult to treat and tend to require very long treatment times; these infections can lead to corneal scarring and sometimes permanently decreased vision.

The most dangerous type of infection is called Acanthamoeba. This is a protozoa commonly found in soil and fresh water. If you happen to contract Acanthamoeba the infection commonly results in a painful eye, can ultimately cause blindness, and the only course of treatment if that happens is to consider a corneal transplant.

The incidents of this infection are quite low – but you don’t want to be the person who contracts it because you swam in your contacts.

To avoid infection risks, organizations like the American Optometric Association (AOA), American Academy of Ophthalmology (AAO), and even the US Food and Drug Administration (FDA) recommend against swimming in any type of pool, lake, ocean or other body of water while wearing contacts.

So with all those authorities advising against swimming with contact lenses, what are you options?

First, if your vision is not too bad, you should swim without your contact lenses and wear prescription sunglasses while on the beach. Second, if your prescription is significant, they do make prescription swim goggles that can be worn while swimming. Then once you have stopped swimming, switch over to prescription sunglasses for relaxing afterwards or consider putting your contact lenses in after you have done your laps.

One bright spot on the horizon for those who absolutely MUST swim in their contact lenses is that with the ever-growing use of daily disposable contact lenses, swimming in contacts is safer than for those who wear extended wear 2-week or monthly lenses.

While there is still risk for a potentially sight-threatening infection, those who dispose of their contacts after swimming see this risk decrease dramatically.

Please use extreme caution if you need to swim in contact lenses. For avid swimmers who have high prescriptions and cannot use prescription goggles, daily disposables are a must. However, most people do just fine with not wearing contacts at all while in the water.

Article contributed by Dr. Jonathan Gerard

This blog provides general information and discussion about eye health and related subjects. The words and other content provided in this blog, and in any linked materials, are not intended and should not be construed as medical advice. If the reader or any other person has a medical concern, he or she should consult with an appropriately licensed physician. The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ.

There is an old adage in the eye care industry: Glasses are a necessity, contact lenses are a luxury. Ninety-nine percent of the time this is absolutely true. In the absence of unusual eye disorders or very high prescriptions that don’t allow a person to wear glasses comfortably, contact lenses should only ever be worn if there is a good, sturdy, updated set of prescription glasses available, too. This is due to the fact that there are often emergencies where people can not wear their contact lenses.

In the 21st century, contact lens technology has gotten to the point where we have drastically cut down on the number of adverse events related to contact lens wear. However, human beings were not meant to wear little pieces of plastic in their eyes. Contact lenses are still considered a foreign body in the eye, and sometimes with foreign bodies, our eyes might feel the need to fight back against the “invader.” As such, issues like red eyes, corneal ulcers, eyelid inflammation, dry eyes, and abnormal blood vessel growth can result from wearing contact lenses.

More often than I would like, I have patients who are longtime contact lens wearers come in, and when I inquire as to the condition of their glasses, they say they don’t own any. My next question is inevitably: “What happens if you get an eye infection and you can’t wear your contacts?” I then see the proverbial light bulb go off in their heads followed by a blank stare. Why? “Because I’ve never had a problem before.” Well, just because you maybe have never been in a car accident before, that doesn’t mean you shouldn’t wear your seat belt!

I will therefore repeat the most important takeaway here: Glasses are a necessity, contacts are a luxury. Even if you don’t want to go “all out” and get the most expensive frames or lenses in your glasses, having a reliable pair of glasses is an absolute must for any contact lens wearer.

Article contributed by Dr. Jonathan Gerard

Philadelphia Phillies prospect Matt Imhof lost his right eye in 2016 after suffering a freak injury during a normal training session.

He was the 47th overall pick in the 2014 draft.

Even though his injury did not occur on the playing field, the incident has brought significant attention to sports-related eye injuries.

Here are some facts about sports-related eye injuries:

1. Eye injuries are the leading cause of blindness in children in the United States and most injuries occurring in school-aged children are sports-related.
2. One-third of the victims of sports-related eye injuries are children.
3. Every 13 minutes, an emergency room in the United States treats a sports-related eye injury.
4. These injuries account for an estimated 100,000 physician visits per year at a cost of more than $175 million.
5. Ninety percent of sports-related eye injuries can be avoided with the use of protective eyewear.

Protective eyewear includes safety glasses and goggles, safety shields, and eye guards designed for a particular sport.

Protective eyewear lenses are made of Polycarbonate or Trivex.

Ordinary prescription glasses, contact lenses, and sunglasses do not protect against eye injuries. Safety goggles should be worn over them.

The highest risk sports are:

• Paintball
• Baseball
• Basketball
• Racquet Sports
• Boxing and Martial Arts

The most common injuries associated with sports are:

1. Abrasions and contusions
2. Detached retinas
3. Corneal lacerations and abrasions
4. Cataracts
5. Hemorrhages
6. Eye loss

Protect your vision--or that of your young sports star. Make an appointment with your eye doctor today!

Article contributed by Dr. Brian Wnorowski, M.D.

The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ

It can be common that eye doctors get patients who come in asking if the white part of their eye, the sclera, has a growth or is turning a gray color.

This is called a senile scleral plaque, which is commonly seen in people over the age of 70. It is a benign condition and more commonly seen in women.  This condition is symmetrically found on both sides of eyes and is due to age-related degeneration and calcification of the eye muscle insertion into the eye.  In one study, the size of the senile scleral plaque increased as the person ages and was not associated with any medical conditions.  People are asymptomatic, as the plaques do not affect vision and no treatment is needed.

Another commonly asked question is: Why is the colored part of my eye turning white?  

The colored part of the eye is the iris, which is covered by a clear layer called the cornea.  It is actually the edge of the cornea that attaches to the white part of the eye that becomes grey or whitish colored.

This condition is called arcus senilis, which is seen in over 60% of people over the age of 60 and approximately 100% over the age of 80.  There is no visual impairment and no treatment is needed. Sometimes when this condition is seen in younger patients, it may be related to high cholesterol so a visit to the primary care doctor may be needed.  

These are two very commonly encountered conditions that may cause distress for patients because it seems like their eyes are changing colors.

Thankfully, no treatment is needed for these two conditions, as they do not affect vision.

Article contributed by Dr. Jane Pan

Fireworks Eye Injuries Have More Than Doubled in Recent Years

Fireworks sales will be blazing across the country from now through the Fourth of July. As retailers begin their promotions, the American Academy of Ophthalmology is shining a light on this explosive fact: The number of eye injuries caused by fireworks has more than doubled in recent years.

Fireworks injuries cause approximately 10,000 emergency room visits each year, according to data from the U.S. Consumer Product Safety Commission. The injuries largely occurred in the weeks before and after the Fourth of July. The CPSC’s most recent fireworks report showed that about 1,300 eye injuries related to fireworks were treated in U.S. emergency rooms in 2014, up from 600 reported in 2011.

To help prevent these injuries, the Academy is addressing four important things about consumer fireworks risks:

1. Small doesn’t equal safe. A common culprit of injuries are the fireworks often handed to small children – the classic sparkler. Many people mistakenly believe sparklers are harmless due to their size and the fact they don’t explode. However, they can reach temperatures of up to 2,000 degrees – hot enough to melt certain metals. 
2. Even though it looks like a dud, it may not act like one. At age 16, Jameson Lamb was hit square in the eye with a Roman candle that he thought had been extinguished. Now 20, Lamb has gone through multiple surgeries, including a corneal transplant and a stem cell transplant. 
3. Just because you’re not lighting or throwing it doesn’t mean you’re out of the firing line. An international study of fireworks-related eye injuries showed that half of those hurt were bystanders. The researchers also found that one in six of these injuries caused severe vision loss. 
4. The Fourth can be complete without using consumer fireworks. The Academy advises that the safest way to view fireworks is to watch a professional show where experts are controlling the displays.

If you experience a fireworks eye injury:

• Seek medical attention immediately.
• Avoid rubbing or rinsing the eyes or applying pressure.
• Do not remove any object from the eye, apply ointments, or take any pain medications before seeking medical help.

Watch the AAO’s animated public service announcement titled “Fireworks: The Blinding Truth.”

Article contributed by Dr. Brian Wnorowski, M.D.

The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ

Ocular allergies are among the most common eye conditions to hit people of all ages.

Though typically worse in the high allergy seasons of spring and summer, some people suffer with these problems all year. This is especially true for people who have allergies to pet dander, mold, dust mites, and other common allergens that tend to linger throughout the year.

The hallmark sign of ocular allergies is itching.

While itching can be a symptom of other eye conditions, the likelihood that there is at least some allergy component to the condition is quite high.

One component of this itching that I've found particularly true is when the itching occurs mainly in the inner corner of the eyes. This signals that the condition is allergy-related, whereas itching along the eyelid margin suggests other conditions.

Allergy itching is usually accompanied by redness, tearing, and string-like mucus discharge from the eye. When accompanied by rhinitis, sinusitis, and sneezing, people can truly suffer from their allergies - especially as it relates to the eye.

The good news is there are numerous avenues for relief from this annoying condition.

There are many over-the-counter antihistamine drops. Alaway and Zaditor are the ones I prescribe most often.

In particularly severe cases, prescription antihistamine/mast cell stabilizer combination drops, or even topical steroids, can be used. In addition, cold compresses can be a great therapy in combination with the drops.

Article contributed by Dr. Jonathan Gerard

This blog provides general information and discussion about eye health and related subjects. The words and other content provided in this blog, and in any linked materials, are not intended and should not be construed as medical advice. If the reader or any other person has a medical concern, he or she should consult with an appropriately licensed physician. The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ.

Do you have floaters in your vision?

Floaters are caused by thick areas in the gel-like fluid that fills the back cavity of your eye, called the vitreous.

Many people, especially highly near-sighted people, often see some degree of floaters for a good portion of their lives. Often, these floaters are in the periphery of your vision and may only be visible in certain lighting conditions. The most frequent conditions are when you are in bright sunlight and are looking toward the clear blue sky. This I know from personal experience as I have a floater in my left eye that I most often see when swimming outdoors. Every time I turn my head to the left to breathe I see this floater moving in my peripheral vision.

This is totally harmless other than when I’m swimming in the ocean and swear that sudden object in my peripheral vision is a shark bearing down on me. Some people who have floaters are not as lucky and the floater can be very central and almost constantly annoying, especially when trying to read.

The second scenario in which floaters occur is during the normal aging process.  The vitreous gel in the back of the eye starts to shrink as we age and at some point it collapses in on itself and pulls away from the retina. This sometimes results in a sudden set of new floaters.

When that happens you need to be checked for signs of a retinal tear or detachment.  As long as your retina survives that episode without any problems, the floaters themselves may stick around for a while and can be rather annoying.  

Most people eventually adapt to the floaters; the brain learns to filter them out so you are no longer aware of them. The vitreous can also collapse more as time goes on and the dense floater you are seeing initially may move further forward and drop lower in the eye so the shadow it is casting is less intense and more in the periphery of your vision where it is much easier to ignore.

The first line of treatment for floaters has been, and still is, to live with them. Once you have your retina checked and there is nothing wrong there, the floaters themselves are harmless and will not lead to any further deterioration of your vision, which is why, if at all possible, you should just live with them. This is especially true if the floaters are new because the overwhelming majority of people with new floaters will eventually get to the point where they are no longer seeing them or at least where they are not interfering with normal daily activities.

If you have tried to wait them out and live with them but they are still interfering with your normal daily activities, you may want to consider having them treated with a laser.

This treatment relatively new and involves using a special laser to try to break down large floaters into much smaller pieces that may no longer be visible. In a recent study of the laser treatment involving 52 patients, 36 were treated with the laser (a single laser treatment session) and 16 people had a sham treatment (meaning they went through everything the treated group did but did not actually have the real treatment done).  In the people who were actually treated, 54% reported a significant improvement in the floater symptoms while 0% in the sham group reported any improvement (no placebo effect). There were no significant side effects in either group.

Some points to note in the above study:

Fifty-four percent of people treated noted a significant improvement in their floater symptoms with a single treatment. That’s clearly not anywhere near a guaranteed improvement.
Other people have noted an improvement after more than one session, bringing the total expected improvement into the 70% range, with one or more treatments.
Another point to note is that there were no significant side effects to the treatment.
Although true in this small study, it does not mean that there are no risks to the laser treatment. Although rare, there have been reports of damage to the retina, optic nerve or the lens of the eye.  

Another treatment that can be used to treat floaters is a surgical procedure called a vitrectomy. This involves surgically going inside the back of the eye and removing the vitreous. This surgical procedure carries a higher risk than the laser treatment and is not 100% effective.

In summary, this new laser treatment is a good addition to the tools to deal with significant floater problems. If you have floaters for at least six months and they are central and interfering with your normal daily activities such as reading or driving and you want to see if this laser treatment could be right for you, check with your eye doctor.

Article contributed by Dr. Brian Wnorowski, M.D.

One of the most commonly asked questions in an eye exam comes right after the refraction, or glasses prescription check: “What is my vision?”

Almost invariably, people know the term “20/20”. In fact, it’s a measure of pride for many people. “My doctor says I have 20/20 vision.” Or, on the other side of that same coin, having vision that is less than 20/20, say 20/400, can be a cause of great concern and anxiety. In this discussion I will describe what these terms actually mean.

To lay the foundation, let’s discuss some common terms. Visual acuity (VA) is clarity or sharpness of vision. Vision can be measured both corrected (with glasses or contact lenses) and uncorrected (without glasses or contact lenses) during the course of an eye exam. The result of an eye exam boils down to two different but related sets of numbers: your VA and your actual glasses prescription.

The notation that doctors use to measure VA is based off of a 20-foot distance. This is where the first 20 in 20/20 comes from. In Europe, since they use the metric system, it is based on meters. The 20/20 equivalent is 6/6 because they use a 6-meter test distance. The second number is the smallest line of letters that a patient can read. In other words, 20/20 vision means that at a 20-foot test distance, the person can read the 20/20 line of letters.

The technical definition of 20/20 is full of scientific jargon - concepts such as minutes of Arc, subtended angles, and optotype size. If you’d like to read more of the technical details there is a well-written article with illustrations by Dr. John Ellman, you can find here.  For the purposes of our discussion here I’ll try to explain it in less technical terms.

“Normal” vision is somewhat arbitrarily set as 20/20 (some people can see better than that). Let’s say you have two people: Person A with 20/20 vision and Person B with 20/40 vision. The smallest line of letters that person B can see at 20 feet is the 20/40 line.  Person A, with “normal” 20/20 vision, could stand 40 feet away from that same line and see it. There is somewhat of a linear relationship in that the 20/40 letters are twice the size of the 20/20 letters and someone with normal vision could see a 20/40 letter at twice the distance as the person with 20/40 vision.

So how does this translate to a glasses prescription?

Eye doctors can often estimate what your uncorrected VA will be based on your glasses prescription. This works mainly for near-sightedness. Essentially, every quarter step of increasing glasses prescription (i.e. -1.25 as compared to -1.50) means a person can see one less line on a VA chart.

A prescription of - 1.25 works out to roughly 20/50 vision, -1.50 to 20/60 and so on. Anybody with an anatomically sound eyeball, meaning the absence of any kind of disease process, should generally be correctable to 20/20 with glasses or contact lenses. It is important to note, however, that rarely a person’s best corrected VA may be less than 20/20 with no noticeable signs of disease.

Far-sightedness is more difficult to estimate because it is affected by a number of other factors, including one’s age and focusing ability. But that’s a topic for another article.

So there you have it! Hopefully this has shed some light on what these measurements that we take actually mean, and it has allowed you to understand your eye health a little bit better.

Article contributed by Dr. Jonathan Gerard

If you are seeing the 3 F’s, you might have a retinal tear or detachment and you should have an eye exam quickly.

The 3 F’s are:

• Flashes - flashing lights.
• Floaters - dozens of dark spots that persist in the center of your vision.
• Field cut - a curtain or shadow that usually starts in peripheral vision that may move to involve the center of vision.

The retina is the nerve tissue that lines the inside back wall of the eye and if there is a break in the retina, fluid can track underneath the retina and separate it from the eye wall. Depending on the location and degree of retinal detachment, there can be very serious vision loss.

If you have a new onset of any of the three symptoms above, you need to get in for an appointment fairly quickly (very quickly if there are two or more symptoms).

If you have just new flashes or new floaters you should be seen in the next few days. If you have both new flashes and new floaters or any field cut, you should be seen in the next 24 hours.

When you go to the office for an exam, your eyes will be dilated. A dilated eye exam is needed to examine the retina and the periphery. This may entail a scleral depression exam where gentle pressure is applied to the outside of the eye to examine the peripheral retina. Some people have a hard time driving after dilation.   since the dilating drops may last up to 6 hours, so you may want to have someone drive you to and from your appointment.

If the exam shows a retina tear, treatment would be a laser procedure to encircle the tear.

If a retinal tear is not treated in a timely manner, then it will progress into a retinal detachment. There are four treatment options for retinal detachment:

• Laser - A small retinal detachment can be walled off with a barrier laser to prevent further spread of the fluid and the retinal detachment.
• Pneumatic retinopexy - This is an office-based procedure that requires injecting a gas bubble inside the eye.  The patient then needs to position his or her head for the gas bubble to reposition the retina back along the inside wall of the eye. A freezing or laser procedure is then performed around the retinal break. This procedure has about 70% to 80% success rate, but not everyone is a good candidate for a pneumatic retinopexy.
• Scleral buckle - This is a surgery that needs to be performed in the operating room. This procedure involves placing a silicone band around the outside of the eye to bring the eye wall closer to the retina. The retinal tear is then treated with a freezing procedure.
• Vitrectomy - In this surgery, the gel - the vitreous inside the eye - is removed and the fluid underneath the retina is drained. The retinal tear is then treated with either a laser or freezing procedure. At the completion of the surgery, a gas bubble fills the eye to hold the retina in place.  The gas bubble will slowly dissipate over several weeks.  Sometimes a scleral buckle is combined with a vitrectomy surgery.

Prognosis

The final vision after retinal detachment repair is usually dependent on whether the center of the retina - called the macula - is involved. If the macula is detached, then there is usually some decrease in final vision after reattachment. Therefore, a good predictor is initial presenting vision. We recommend that anyone with symptoms of retinal detachments (flashes, floaters, or field cuts) have a dilated eye exam. The sooner the diagnosis is made, the better the treatment outcome.

Article contributed by Dr. Jane Pan

Do you have floaters in your vision?

Floaters are caused by thick areas in the gel-like fluid that fills the back cavity of your eye, called the vitreous.

Many people, especially highly near-sighted people, often see some degree of floaters for a good portion of their lives. Often, these floaters are in the periphery of your vision and may only be visible in certain lighting conditions. The most frequent conditions are when you are in bright sunlight and are looking toward the clear blue sky. This I know from personal experience as I have a floater in my left eye that I most often see when swimming outdoors. Every time I turn my head to the left to breathe I see this floater moving in my peripheral vision.

This is totally harmless other than when I’m swimming in the ocean and swear that sudden object in my peripheral vision is a shark bearing down on me. Some people who have floaters are not as lucky and the floater can be very central and almost constantly annoying, especially when trying to read.

The second scenario in which floaters occur is during the normal aging process.  The vitreous gel in the back of the eye starts to shrink as we age and at some point it collapses in on itself and pulls away from the retina. This sometimes results in a sudden set of new floaters.

When that happens you need to be checked for signs of a retinal tear or detachment.  As long as your retina survives that episode without any problems, the floaters themselves may stick around for a while and can be rather annoying.  

Most people eventually adapt to the floaters; the brain learns to filter them out so you are no longer aware of them. The vitreous can also collapse more as time goes on and the dense floater you are seeing initially may move further forward and drop lower in the eye so the shadow it is casting is less intense and more in the periphery of your vision where it is much easier to ignore.

The first line of treatment for floaters has been, and still is, to live with them. Once you have your retina checked and there is nothing wrong there, the floaters themselves are harmless and will not lead to any further deterioration of your vision, which is why, if at all possible, you should just live with them. This is especially true if the floaters are new because the overwhelming majority of people with new floaters will eventually get to the point where they are no longer seeing them or at least where they are not interfering with normal daily activities.

If you have tried to wait them out and live with them but they are still interfering with your normal daily activities, you may want to consider having them treated with a laser.

This treatment relatively new and involves using a special laser to try to break down large floaters into much smaller pieces that may no longer be visible. In a recent study of the laser treatment involving 52 patients, 36 were treated with the laser (a single laser treatment session) and 16 people had a sham treatment (meaning they went through everything the treated group did but did not actually have the real treatment done).  In the people who were actually treated, 54% reported a significant improvement in the floater symptoms while 0% in the sham group reported any improvement (no placebo effect). There were no significant side effects in either group.

Some points to note in the above study:

Fifty-four percent of people treated noted a significant improvement in their floater symptoms with a single treatment. That’s clearly not anywhere near a guaranteed improvement. Other people have noted an improvement after more than one session, bringing the total expected improvement into the 70% range, with one or more treatments. Another point to note is that there were no significant side effects to the treatment. Although true in this small study, it does not mean that there are no risks to the laser treatment. Although rare, there have been reports of damage to the retina, optic nerve or the lens of the eye.  

Another treatment that can be used to treat floaters is a surgical procedure called a vitrectomy. This involves surgically going inside the back of the eye and removing the vitreous. This surgical procedure carries a higher risk than the laser treatment and is not 100% effective.

In summary, this new laser treatment is a good addition to the tools to deal with significant floater problems. If you have floaters for at least six months and they are central and interfering with your normal daily activities such as reading or driving and you want to see if this laser treatment could be right for you, check with your eye doctor.

Article contributed by Dr. Brian Wnorowski, M.D.

Just like adults, children need to have their eyes examined. This begins at birth and continues into adulthood.

Following are my recommendations for when a child needs to be screened, and what is looked for at each stage.

A child’s first eye exam should be done either right at or shortly after birth. This is especially true for children who were born premature and a have very low birth weight and may need to be given oxygen. This is mainly done to screen for a disease of the retina called retinopathy of prematurity (ROP), in which the retina does not develop properly as a result of the child receiving high levels of oxygen. Although rarer today due to the levels being monitored more closely, it is still a concern for premature babies.

The next level of an eye exam that I would recommend would be at 6 months. At this stage, your pediatric eye doctor will check your child’s basic visual abilities by making them look at lights, respond to colors, and be able to follow a moving object.

Your child’s ocular alignment will also be measured to ensure that he or she does not have strabismus, a constant inward or outward turning of one or both eyes. Parents are encouraged to look for these symptoms at home because swift intervention with surgery to align the eyes at this stage is crucial for their ocular and visual development.

It is also imperative for parents and medical professionals to be on the lookout for retinoblastoma, a rare cancer of the eye that more commonly affects young children than adults. At home, this might show up in a photo taken with a flash, where the reflection in the pupil is white rather than red. Other symptoms can include eye pain, eyes not moving in the same direction, pupils always being wide open, and irises of different colors. While these symptoms can be caused by other things, having a doctor check them immediately is important because early treatment can save your child’s sight, but advanced cases can lead to vision loss and possibly death if the cancer spreads.

After the 6-month exam, I usually recommend another exam around age 5, then yearly afterward. There are several reasons for this gap. First, any parent with a 2- to 4-year-old knows that it’s difficult for them to sit still for anything, let alone an eye exam. Trying to examine this young of a patient can be frustrating for the doctor, the parent, and the child. Nobody wins. By age 5, children are typically able to respond to questions and can (usually) concentrate on the task at hand. If necessary at this stage, their eyes will be measured for a prescription for glasses and checked for amblyopia, commonly known as a “lazy eye”. Detected early enough, amblyopia can be treated properly under close observation by the eye doctor.

The recommendations listed above are solely one doctor’s opinion of when children should have eye exams. The various medical bodies in pediatrics, ophthalmology, and optometry have different guidelines regarding exam frequency, but agree that while it is not essential that a healthy child’s eyes be examined every year, those with a personal or family history of inheritable eye disease be followed more closely.

1. Vision is so important to humans that almost half of your brain’s capacity is dedicated to visual perception.

2. The most active muscles in your body are the muscles that move your eyes.

3. The surface tissue of your cornea (the epithelium) is one of the quickest-healing tissues in your body. The entire corneal surface can turn over every 7 days.

4. Your eyes can get sunburned. It is called photokeratitis and it can make the corneal epithelium slough off just like your skin peels after a sunburn.

5. Ommatophobia is the fear of eyes.

6. You blink on average about 15 to 20 times per minute. That blink rate may decrease by 50% when you are doing a visually demanding task like reading or working on a computer – and that’s one reason those tasks can lead to more dry-eye symptoms.

7. Your retinas see the world upside down, but your brain flips the image around for you.

8. If you are farsighted (hyperopia) your eye is short, and if you are shortsighted (myopia) your eye is long.

9. An eyelash has a lifespan of about 5 months. If an eyelash falls out it takes about 6 weeks to fully grow back.

10. All blue-eyed people are related. The first person with blue eyes was thought to have lived 6,000 to 10,000 years ago. All people before that had brown eyes.

11. One in every 12 males has some degree of “color blindness.”

Alzheimer's Disease International estimates that the number of people living with dementia worldwide - nearly 44 million in 2014 - will almost double by 2030 and more than triple by 2050.

There is no single test that can show if a person has Alzheimer's, but doctors can almost always determine if a person has dementia, although it may be difficult to determine the exact cause. Diagnosing Alzheimer's requires careful medical evaluation, neurological testing and sometimes brain imaging and blood tests to rule out other causes of dementia.

Most of the testing for early disease - MRI scans of the brain, brain PET scans looking for amyloid, and spinal taps looking for certain proteins in the spinal fluid - are not very accurate, they are invasive and they can be expensive.

Researchers have now turned to findings in the eye to help with early detection and are hoping to find ways to make the diagnosis earlier when potential treatments may have a better outcome. There is also hope that these tests will be less expensive and invasive then the other options.

One of the tests that shows promise is an OCT of the retina. Almost every eye doctor’s office already has an OCT so if this research proves fruitful, the test could be done relatively cheaply because there is not a need to buy more expensive equipment. Right now, the average OCT exam is reimbursed at about the $50 per exam level, much less than the cost of an MRI or PET Scan.

Neuroscientists at the Gladstone Institutes in San Francisco showed a proof of concept in frontotemporal dementia, which is like Alzheimer’s but attacks much earlier and accounts for just 10% to 15% of dementia cases. They found that patients with frontotemporal dementia had thinning of the neuron layer of the retina on OCT.

In a study at Moorfields Eye Hospital they also found that people who had a thinner layer of neurons in the macula on an OCT exam were more likely to perform poorly on the cognitive tests - a clear warning sign they may be undergoing the early stages of dementia.

Study leader Dr. Fang Ko, said: “Our findings show a clear association between thinner macular retinal nerve fiber layer and poor cognition in the study population. This provides a possible new biomarker for studies of neurodegeneration.”

A second marker that is getting a careful look is identifying the presence of amyloid in the eye. Amyloid, thought to be one of the key causes of Alzheimer’s, which makes up most dementia cases, is often found to have formed into clumps and plaques in the brain. Scientists at Waterloo University in Canada found people with severe Alzheimer’s disease had deposits of a protein amyloid on their retinas.

Research being conducted at Lifespan-Rhode Island Hospital in Providence co-led by Peter Snyder, a professor of neurology at Brown University, and Cláudia Santos, a graduate student at the University of Rhode Island, is attempting to detect amyloid in the retina by OCT and follows people over time to see if the amyloid increases and if it correlates with cognitive impairment.

Another angle being pursued by a company called Cognoptix is looking for amyloid in the lens of the eye. Using Cognoptix's SAPPHIRE II system, which detects amyloid in the lens, a 40-person Phase 2 clinical trial was conducted at four sites. The study recruited patients who were clinically diagnosed with probable Alzheimer’s disease (AD) via a rigorous neuropsychological and imaging workup. The study, using age-matched healthy controls, showed outstanding results of 85% sensitivity, and 95% specificity in predicting which people had probable AD.

The company is now planning a Phase 3 study that must show a strong correlation in a bigger study group to obtain ultimate FDA approval.

One of the other items I was going to include in this post was information on what visual symptoms occur in dementia patients and how family and friends can support them but I found an outstanding review already available online by the Alzheimer’s society that covers all those points. If you have a loved one with dementia this is an excellent read and I highly recommend you take the time to review it.

Article contributed by Dr. Brian Wnorowski, M.D.

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