Children’s Eye Exam: When Should My Child Have an Eye Exam?

Eye examinations begin in the hospital nursery when a baby’s eyes are examined for a clear strong red reflex indicating a clear pathway for light to enter the eye. Though uncommon, blockage of the visual axis in infancy, such as with a cataract, must be addressed in the first weeks of life to avoid permanent loss of vision.

This type of assessment is repeated on follow up visits to the pediatrician for well baby care at which times testing for strabismus or eye alignment is also performed. More formal vision testing with an eye chart of picture symbols or letters is typically attempted in the three to four year old range. The recommendation is for this to occur as well in the pediatrician’s office during well child appointments. Each eye is tested individually, as poor vision in one eye may not be evident in the normal course of the child’s lifestyle. Some newer photoscreening devices can provide objective measurements of vision in preverbal children. If results are normal during this testing, examination by an eye doctor is not necessary. If any testing is abnormal or inconclusive or parents notice any vision or eye abnormalities, a referral to a Pediatric Ophthalmologist may be indicated.


Louis Furlan, M.D.
Thank you to our guest blogger: Louis Furlan, M.D., Pediatric Ophthalmologist at The Eye Care & Surgery Center

LOW VISION AIDS: Using Technology to Help You Read

Many of our patients suffer with Macular Degeneration or other diseases of the eye that restrict their ability to read comfortably. With the advancements in technology, there are now options for patients with low vision that may make daily activities, such as reading the newspaper or their favorite book, possible.

Ivan Jacobs, M.D., often recommends his patients begin using a tablet computer for reading. The images are brighter, bigger and sharper. The size of the font and graphics is at the control of the user by simply dragging their fingers across the screen.

Dr. Jacobs has seen patients who had given up trying to read as a result of degeneration of their vision, now reading and researching with ease and clarity with the help of technology based instruments. As always, speak with your own ophthalmologist regarding your specific limitations and expectations.

Types of Contact Lenses: Which One is Right for Me?

Contact lenses have advanced tremendously in the last decade. As a result, there are several options available to consumers. When choosing an appropriate contact lens, several factors are taken into consideration. These factors include lifestyle, expense and the type of vision correction needed. Contact lenses can be worn by people of varying ages.

There are two main types of contact lenses; rigid gas permeable contact lenses and soft contact lenses. There are subsets of each type of lens to correct refractive errors such as Toric contact lenses for the correction of Astigmatism, Bifocal lenses, and Multifocal contact lenses.

Rigid gas permeable contact lenses are made of a more rigid material and are subsequently more durable than soft contact lenses. Rigid gas permeable contact lenses are often used for people with corneal irregularities.

Soft contact lenses are the most popular type of contact lens. The majority of soft contact lenses are disposable meaning they can be thrown away after a short period time. Disposable contact lenses can be replaced daily, bi-weekly, monthly or every three months. The main advantage of disposable contact lenses is that they decrease the risk of infection because there is less likelihood of protein build up.

Toric (Astigmatic) contact lenses are designed to correct astigmatism. Astigmatism occurs when the cornea has a curvature that resembles a football rather than a basketball. Toric contact lenses are available in soft and rigid gas permeable materials.

Bifocal contact lenses are designed to correct presbyopia. Presbyopia is the change in the natural lens of the eye that generally affects people in their early 40s. Bifocal contact lenses correct distance and near prescriptions simultaneously.

Multifocal contact lenses have multiple focal points that may assist in enlarging the range of vision to include some mid-range vision as well.

In conclusion, regardless of the type of contact lenses a patient wears, proper hygiene is essential in the maintenance of contact lenses to prevent infections and to obtain optimal vision. Individuals interested in contact lenses should consult an eye care professional.

Thank you to our Guest Blogger Hanifah Haamid, lead contact lens technician and A-Scan Specialist. Hanifah also has a YouTube Video on the Top 5 Contact Lens Questions.

Your LASIK Evaluation-What to Expect?

The only way to confidently know whether LASIK or any type of Laser Eye Surgery for vision correction is going to safely, effectively and predictably help you achieve your personal vision correction goals is to have a thorough evaluation and consultation. The LASIK evaluation should be thorough enough to gather sufficient clinical and personal information so as to enable your LASIK Surgeon to make proper recommendations about to proceed. Your LASIK consultation should consist of a number of clinical tests including:

• Measurement of your uncorrected visual acuity


• Measurement of your visual acuity with your current eyeglasses or contact lenses


• Optical measurement of the current prescription that you are wearing in your eyeglasses and/or a review of your current contact lens prescription


• A thorough review of your medical and eye history including all prescription and non-prescription medication that you have been or are currently taking


• A refraction-automated or manual-to determine your current prescription


• A topography measurement to digitally map the shape of your cornea


• A pachymetry measurement of the thickness of your cornea


• A measurement of pupil size


• A microscopic evaluation of the health of your cornea and tear film including testing for dry eyes
  

From this testing it can be determined whether you should proceed to the final level of testing whereby the actual preoperative measurements are taken for your treatment and a thorough examination of the Retina and Optic Nerve can be performed.

In addition to the actual clinical testing your LASIK evaluation will include a full discussion of LASIK risks, benefits and complications and a thorough analysis of the personal goals and objectives that you feel are important to your success. The best way for you or someone you know to find out if they are a good candidate for LASIK is to have an evaluation, examination, and consultation with Dr. Confino who is a Corneal Surgeon and LASIK specialist. Please feel free to contact us schedule an appointment by calling The Eye Care & Surgery Center Toll Free at 800-504-1083.

A New Solution for Presbyopia

Vision Correction Surgery, both in the form of corneal laser surgery and refractive lens implant surgery, has made great advances in the treatment of near-sightedness (myopia), far-sightedness (hyperopia) and astigmatism. The “Holy Grail” of vision correction continues to be the search for a safe and effective correction of Presbyopia, or the age-related loss of reading ability. An ideal treatment would allow for enhanced reading ability without detracting from distance visual acuity, as current strategies, such as monovision, do.

A new and promising approach is the Kamra inlay. It is a synthetic disc, 3.8mm in diameter with a central 1.6mm aperture, composed of a bio-compatible material that can be safely and permanently implanted into the cornea of the “non-dominant” eye. This can be done under a corneal flap previously created during a LASIK procedure or under a newly-created laser flap. It works on the principle of “Small Aperture Optics”, or “the pinhole effect”, essentially what cameras use to get depth of focus. The central opening allows for light to be focused at near without detracting from distance visual acuity. If desired, the implant is reversible and potentially removable at any time.

Although currently classified as an “investigational device” enrolled in studies in the USA, it is approved and freely used in Europe and Asia, where it has been shown to deliver high-quality visual results. We are looking forward to it receiving official approval for use in the USA and bringing it into our office laser refractive suite to offer to our many interested patients. Our Ziemer femtosecond laser has been specially equipped with the ability to create the corneal flap for the Kamra inlay, and can be used in conjunction with LASIK procedures or as a stand-alone treatment for presbyopia.

Thank you Dr. Joel Confino, today’s guest blogger.

Cataract Risk and Celiac Disease

Celiac disease is a condition that damages the lining of the small intestine and prevents it from absorbing parts of food that are important for staying healthy. The damage is due to a reaction to eating gluten, which is found in wheat, barley, rye, and possibly oats. The exact cause of celiac disease is unknown. The lining of the intestines contains areas called villi, which help absorb nutrients. When people with celiac disease eat foods or use products that contain gluten, their immune system reacts by damaging these villi. This damage affects the ability to absorb nutrients properly. A person becomes malnourished, no matter how much food he or she eats.

As a result of being malnourished, Vitamin deficiencies are common in celiac disease (CD). Vitamin deficiencies are also associated with cataract formation, and a recent study confirmed that persons with Celiac disease are at increased risk of cataract. Reporting in the American Journal of Epidemiology researchers found an excess and increased risk of cataract formation in Celiac disease sufferers.

LASIK or PRK-Which One for Me?

Some patients may be given the option of having either Bladeless LASIK or PRK and could have a difficult time deciding which one might be the best choice. Here is some information that may be helpful as patients go through the decision making process.

In terms of the actual vision correction outcomes, both PRK and LASIK produce almost identical visual results. However, there are some slight and other not so slight differences between LASIK and PRK.

Long Term
There are some studies that show that patients who have LASIK may have very slightly reduced contrast sensitivity in dim illumination. If one uses extremely sensitive clinical measuring methods they can sometimes find a slight reduction in “low contrast” vision such as driving at dusk or in rainy conditions. Often it is so slight that the patient doesn’t even notice it as they navigate their daily routine. This really is a limited problem for most patients.

The real differences between PRK and LASIK are based on the fact that PRK is a “surface treatment” and LASIK is a “lamellar treatment”. That is, PRK is performed on the surface of the cornea whereas LASIK is performed between the layers of the cornea. To perform Bladeless LASIK Dr. Confino first creates a “layer” or a “flap” using the femtosecond laser for greatest precision and accuracy. He then carefully folds back the “flap” and applies the excimer laser to reshape the cornea to give the right prescription for your vision correction. Then he replaces the “flap” into its original position where it “sticks” without the need for stitches or sutures. So it is really a 3-step procedure. To perform a PRK is a single step procedure, just applying the laser. Whenever you have a multi step eye surgery procedure this is always a greater risk of complications and side effects. However the risks, side effects and complications of LASIK are relatively few and minor if you are selected as a good candidate and under the care of Dr. Confino. So, PRK does offer a safer risk profile because it is a single step procedure.

One of the not so subtle differences is that because LASIK is a lamellar procedure, LASIK Surgery does not disturb the surface of the cornea during treatment. This provides patients with a much faster visual recovery and significantly less discomfort than PRK. This is why from a consumer perspective patients prefer LASIK over PRK. They can get back to pretty much normal activities within a couple of days without any real pain-just some mild discomfort-and with good vision. Most LASIK patients are able to pass a drivers test with 24-48 hours of their laser treatment. PRK patients often experience moderate discomfort that can last a few days and depending on the degree of their prescription can take a week or so to achieve good functional comfortable vision.

The best way for you or someone you know to find out if they are a good candidate for LASIK is to have an evaluation, examination, and consultation with Dr. Confino who is a Corneal Surgeon and LASIK specialist. Please feel free to contact us schedule an appointment by calling The Eye Care & Surgery Center Toll Free at 800-504-1083.