COMMON EYECARE TERMINOLOGY

COMMONLY ASKED QUESTIONS
What role does the optometrist play in your health care?
How often should you have your eyes examined?
What causes blindness -- and how can you prevent it?
Does everyone need to wear bifocals at a certain age?
Which sunglasses offer the best protection for your eyes?
How do parents know if their child's reading problems are caused by vision problems?
Do computers hurt your eyes?
What are the DMV vision requirements and how should motorists prepare their eyes for safe driving?
What are floaters and who gets them?
When is cataract surgery necessary?

COMMON EYECARE TERMINOLOGY

Optometrists are eye doctors who have earned the Doctor of Optometry (O.D.) degree. Optometrists are primary eyecare providers and examine eyes for both vision and health problems. They diagnose and treat eye disease and prescribe eyeglasses, contact lenses and many eye medications. Optometrists also may participate in your pre- and postoperative care if you have eye surgery. Optometrists complete a four-year college degree program in the sciences, four years of post-graduate training in optometry school and sometimes a one-year optometric residency program.

Ophthalmologists are eye doctors with an M.D. or D.O. degree who diagnose and treat eye disease and perform eye surgery. Ophthalmologists generally complete four years of college, four years of medical school, one year of internship, and a minimum of three years of hospital-based residency in ophthalmology.

Opticians are not eye doctors, but opticians are an important part of your eye care team. Opticians use prescriptions written by the optometrist to fit eyeglasses or other eyewear.

Farsightedness, or hyperopia, is a vision condition in which distant objects are usually seen clearly, but close ones do not come into proper focus. Farsightedness occurs if your eyeball is too short or the cornea has too little curvature so light entering your eye is not focused correctly. Farsighted eyes have to do extra work to bring images into focus. Common signs of farsightedness include difficulty in concentrating and maintaining a clear focus on near objects, eye strain, fatigue and/or headaches after close work, aching or burning eyes, irritability or nervousness after sustained concentration.

Nearsightedness, or myopia, is a vision condition in which near objects are seen clearly, but distant objects do not come into proper focus. This occurs if your eyeball is too long or the cornea has too much curvature, so the light entering the eye is not focused correctly. Some evidence supports the theory that nearsightedness is hereditary, although there is also growing evidence that nearsightedness may be caused by the stress of too much close vision work. It normally first occurs in school age children and, since the eye continues to grow during childhood, it generally develops before age 20. A sign of nearsightedness is difficulty seeing distant objects like the television or chalkboard.

Astigmatism is a vision condition that occurs when the front surface of your eye — the cornea — is slightly irregular in shape and not perfectly curved the same in all directions. This irregular shape prevents light from focusing properly on the back of your eye. People with severe astigmatism will usually have blurred or distorted vision at all distances, while those with mild astigmatism may experience headaches, eye strain, fatigue or blurred vision.

Presbyopia is a vision condition in which the crystalline lens of the eye loses its flexibility making it difficult to focus on close objects. Presbyopia may seem to occur suddenly, but the actual loss of flexibility takes place over a number of years. A natural part of the aging process of the eye, it usually becomes noticeable in the mid- to late-forties. It is not a disease and it cannot be prevented. Some signs of presbyopia include the tendency to have to hold reading material at arm's length, blurred vision at normal reading distance and eye fatigue or headaches when doing close work. To help compensate for presbyopia optometrists can prescribe reading glasses, bifocals, trifocals or contact lenses

Lazy eye, or amblyopia, is the loss or lack of development of central vision in one eye - it is often associated with crossed-eyes or a large difference in the degree of nearsightedness or farsightedness between the two eyes. Lazy eye usually develops before age six, and the good news is that early diagnosis increases the chance for complete recovery. Treatment may include a combination of prescription lenses, prisms, vision therapy and eye patching. Lazy eye will not go away on its own. If not diagnosed until the pre-teen years or later, treatment takes longer and is often less effective. To increase the opportunity for early diagnosis and treatment, the American Optometric Association recommends an initial infant eye exam at six months of age and comprehensive eye exams at age three and five.

Crossed-eyes (strabismus) occurs when one or both of your eyes turns in, out, up or down, usually caused by eye muscle control. This misalignment often first appears before age two but may develop as late as age six. There is a common misconception that a child will outgrow crossed-eyes. This is not true. In fact, the condition may get worse without treatment. Treatment for crossed-eyes may include single vision or bifocal eyeglasses, prisms, vision therapy, and in some cases, surgery. Vision therapy helps align your eyes and solves the underlying cause of crossed-eyes by teaching your two eyes to work together. Surgery alone may straighten your eyes, but unless your eye muscle control is improved, your eyes may not remain straight. If detected and treated early, crossed-eyes can often be corrected with excellent results, which is why infant and toddler eye exams are so important.

Cataract is a clouding of the normally clear lens within your eye that can cause blurred or distorted vision. This is often due to advancing age (cataracts most often appear in people 55 plus, but are occasionally found in younger people) or an injury or disease. Excessive exposure to UV radiation in sunlight, diabetes, cigarette smoking or the use of certain medications are risk factors for the development of cataracts. Although cataracts develop without pain or discomfort, there are some indications that a cataract may be forming including blurred or hazy vision, increased sensitivity to glare or the feeling of having a film over the eyes. Currently, there is no proven method to prevent cataracts from forming. If your cataract develops to the point that it affects your daily activities, your optometrist can refer you to an eye surgeon who may recommend surgery. During the surgery, the eye's natural lens is removed and usually replaced with a plastic artificial lens.

Diabetic Retinopathy is an eye disease caused by poor control of systemic diabetes. People who have diabetes, a disease that interferes with the body's ability to use and store sugar, can have many other health problems associated with the disease, and one of these is diabetic retinopathy. Diabetic eye disease is the leading cause of new cases of blindness in those of working age (20-74 years old). Diabetes can weaken the small blood vessels that nourish the eye's retina. These small blood vessels may begin to leak fluid into the retina causing vision loss and scarring. Blurred central or side vision or a blind spot in central vision may indicate diabetic eye disease however there may be no visual symptoms at all. As the disease progresses, you may notice a cloudiness of vision, blind spots or floaters. If left untreated, diabetic retinopathy can cause blindness. Diabetics should have a dilated eye exam at least every year, even if they have no symptoms. To detect diabetic retinopathy, your optometrist can look inside your eyes with special equipment to examine the retina and blood vessels. If you have diabetic retinopathy, laser and other surgical treatments can be used to reduce its progression and decrease the risk of vision loss. If you are a diabetic, you can help prevent diabetic retinopathy by taking your prescribed medication as instructed, sticking to your diet, exercising regularly, controlling high blood pressure and avoiding alcohol and smoking.

Glaucoma is an eye disease in which the internal pressure in the eyes increases enough to damage the nerve fibers in the optic nerve and cause vision loss. Noticeable symptoms of glaucoma may be loss of side vision or blurred vision; however, there are often no symptoms until the advanced stages of the disease. Glaucoma is one of the leading causes of blindness in the U.S. It most often occurs in people over age 40, people with a family history of glaucoma, African Americans or Hispanics, and those who are very nearsighted. The most common type of glaucoma develops gradually and painlessly, without symptoms. A rarer type occurs rapidly and its symptoms may include blurred vision, loss of side vision, seeing colored rings around lights and pain or redness in the eyes. Glaucoma cannot be prevented, but if diagnosed and treated early, it can be controlled. Vision loss from glaucoma cannot be restored, which is why annual eye examinations are so important to detect the disease early. Treatment includes prescription eye drops to lower the pressure in your eyes. In some cases, laser treatment or surgery may be necessary.

Macular degeneration results from changes to the macula, a portion of the retina that is responsible for sharp, detailed vision located at the back of the eye. It is the leading cause of severe vision loss in those over age 50 in the US. Some common symptoms are a gradual loss of ability to see objects clearly, distorted vision, a gradual loss of color vision or a missing area in the center of vision. Side vision is not affected, however central vision is reduced making it difficult to read or see detail. Most people with macular degeneration have the “dry” form, for which there is no treatment. The less common “wet” form may respond to special medications injected into the eye and/or laser procedures, if diagnosed and treated early. Recent research indicates certain vitamins and minerals may help prevent or slow the progression of macular degeneration; your optometrist can give you more information about this. A low vision examination can be performed for those with vision loss from macular degeneration to prescribe special devices, such as lenses and magnifiers to maximize and enhance vision.

Keratoconus is a condition where the clear and normally round structure at that front of the eye (cornea) becomes thin and irregularly shaped or cone-shaped. This abnormal shape prevents light entering the eye from being focused correctly and causes distortion of vision. In its earliest stages, usually in a person’s late teens or twenties, keratoconus causes slight blurring of vision. It may progress for 10-20 years, with each eye affected differently, and then slow in its progression. Although there are no medicines that can prevent the disorder from progressing, there are several things that an optometrist can do. In the early stages of Keratoconus, vision usually can be corrected with eyeglasses or soft contact lenses. As the disorder progresses and the cornea continues to change shape, carefully fitted, rigid gas permeable contact lenses can be prescribed to correct vision. In most cases, this is adequate and all that is needed are frequent checkups and lens changes to achieve and maintain good vision. Surgical options, such as corneal transplants are usually only considered in severe cases, where contact lenses can no longer adequately correct vision.

COMMONLY ASKED QUESTIONS

1. What role does the optometrist play in your health care?

Patients are provided healthcare these days by a multi-disciplinary team of healthcare providers. Your primary care physician often relies on other providers to assist in your care, and optometrists, as primary eyecare doctors, are vital members of your healthcare team.

Optometrists are able to diagnose and treat most eye and vision problems. The Doctor of Optometry has received extensive education in pharmacology, neurology, and pathology. Some of the eye conditions California optometrists diagnose and manage or co-manage include: ocular complications from diabetes and hypertension, glaucoma, macular degeneration, cataracts, strokes, various eye infections ("pink eye"), herpes, dry eye, allergies, corneal disease/abrasion, removal of foreign bodies and eyelid problems (such as styes).

2. How often should you have your eyes examined?

Nearly everyone should be checked annually by his or her eye doctor. School age children and people over 65, in particular, need annual exams because these are the times in life when the eyes change most significantly. Others needing at least yearly exams include contact lens wearers; diabetics; those with high blood pressure; and others whose medical conditions could impact their eyes. For children, the American Optometric Association recommends an initial infant eye exam within the first year of life (we find this exam is easiest to perform at 8-10 months of age) and comprehensive eye exams at age three and five, and every 1-2 years thereafter.

3. What causes blindness -- and how can you prevent it?

It is important to understand that there is a spectrum of vision loss that exists – from mildly decreased vision to complete loss of vision or blindness. The term "legally blind" means that a person has central visual acuity of 20/200 or less in their better eye (with corrective lenses) OR a person has a limitation in their peripheral vision such that the visual field is no greater than 20 degrees in their better eye.

The primary causes of visual impairment are diseases such as macular degeneration, glaucoma, diabetes and cataracts. Less commonly, genetic conditions, such as inherited retinal diseases can cause vision loss, but these disorders generally are diagnosed in adolescence or early adulthood. The most common eye diseases leading to vision loss are age-related and occur later in life. In many cases, blindness can be prevented and vision loss can be stabilized with treatment. The best preventive actions include healthy lifestyle with proper diet (lots of fruits and vegetables), exercise, avoidance of cigarette smoking, and regular eye examinations to detect eye diseases early.

4. Does everyone need to wear bifocals at a certain age?

You really have no choice but to accept some kind of visual aid when you reach the bifocal age (usually in the 40's) if you want to continue to see comfortably at near distances. As the condition of "presbyopia" (decreased ability to focus up close) progresses, correction with glasses or contact lenses can provide continuous, comfortable vision. Wearing (or not wearing) reading glasses does not speed up or slow down the natural loss of focusing ability that occurs over time.

5. Which sunglasses offer the best protection for your eyes?

To provide protection for your eyes, your sunglasses should:
• Block 100 percent of both UV-A and UV-B radiation
• Screen out 75 to 90 percent of visible light
• Be perfectly matched in color and free of distortion and imperfection

"Transitions" (photochromic) lenses provide 100% UV protection, darken in response to UV light, and are available in both plastic and glass materials. Polycarbonate lenses are a must for your sunglasses if you participate in potentially eye hazardous work or sports. These lenses provide the most impact resistance. If you spend a lot of time outdoors in bright sunlight, wrap-around frames can provide additional protection from harmful UV radiation. Polarized lenses significantly improve the sharpness of vision by reducing sun glare bouncing off smooth surfaces, such as pavement and water. Don't forget protection for children and teenagers. They typically spend more time in the sun than adults do.

6. How do parents know if their child's reading problems are caused by vision problems?

About 16 percent of children 5 to 12 years old have vision problems that can lead to reading disabilities. Some signs that your child may have a vision problem include: dislike and avoidance of close work, short attention span, tilting the head to one side, holding books close, excessive rubbing of eyes, losing place while reading, and blurred vision. Early detection through a complete eye exam is the best way to correct any visual deficiency and prevent a vision-related learning problem.

7. Do computers hurt your eyes?

Eye irritation, eyestrain and fatigue are common symptoms among people who work with VDTs (Video Display Terminals). Symptoms can be related to the ergonomics of your workstation or they can be the result of a vision or eye problem. Anytime you experience symptoms like headaches, eyestrain, blurred vision, eye irritation, double vision, excessive tears or burning eyes, pain in the eyes or excessive blinking or squinting, you should visit your optometrist for a comprehensive eye examination. There are many optical solutions available for computer-users as well as treatments for dry eye related to computer use.

8. What are the DMV vision requirements and how should motorists prepare their eyes
for safe driving?

Most states require drivers to take a vision screening test for licensing. DMV of California currently requires that vision measure 20/40 with both eyes tested together, 20/40 in one eye and 20/70, at least in the other eye. Corrective lenses may be worn for testing. When vision does not meet these requirements, the DMV requires that your eye doctor fill out a special form with recent eye exam findings. If you cannot meet the vision requirements due to an eye condition, you may need to take a special DMV driving test and you may have certain restrictions on your license. If vision is 20/200 or worse (with corrective lenses), you are not eligible for a driver’s license.

Safe driving depends on optimal vision, and regular eye examinations will ensure that drivers are wearing their best correction. Vision can be adversely affected by glare and nighttime difficulties. Polarized or anti-reflective lenses can alleviate these impairments. Don't forget to keep your headlights clean and well-aligned, and your mirrors well-adjusted.

9. What are floaters and who gets them?

Floaters look like moving dark specks or threads in your vision. Most people see them occasionally. Normal floaters are made up of collagen fibers that float in the vitreous gel inside your eye, and are usually harmless. You will probably notice floaters more as you get older. However, if you have floaters that appear suddenly or greatly increase in number, especially if accompanied by flashes of light in your vision, you should be seen immediately by your eye doctor to rule out a retinal tear or detachment.

10. When is cataract surgery necessary?

Cataracts tend to develop slowly, and usually do not need to be surgically removed in the early stages. You may need to have your eyeglass prescription changed, and you may need to use more light for reading. When cataracts affect your abilities to drive, read, or participate in your normal activities, it may be time to consider surgery.