Many of us will experience a “foreign body sensation” in our eye. That usually happens if the wind blows dust, an allergen or a foreign body into our eye or under an eyelid. This should not be dismissed as just an uncomfortable feeling.

For many, the feeling of grittiness, dryness, burning or stinging or even excessive tearing cannot be relieved simply, or with over the counter methods. It may be the sign of a chronic condition known as dry eye syndrome. Dry eye is a condition in which there are insufficient tears to lubricate and nourish the eye. Tears are necessary for maintaining the health of the front surface of the eye and for providing clear vision. People with dry eyes either do not produce enough tears or have a poor quality of tears. Dry eye is a common and often chronic problem, particularly in older adults.

With each blink of the eyelids, tears are spread across the front surface of the eye, known as the cornea. Tears provide lubrication, reduce the risk of eye infection, wash away foreign matter in the eye, and keep the surface of the eyes smooth and clear. Excess tears in the eyes flow into small drainage ducts, in the inner corners of the eyelids, which drain in the back of the nose.

Dry eyes can result from an improper balance of tear production and drainage.

•    Inadequate amount of tears – Tears are produced by several glands in and around the eyelids. Tear production tends to diminish with age, with various medical conditions, or as a side effect of certain medicines. Environmental conditions such as wind and dry climates can also affect tear volume by increasing tear evaporation. When the normal amount of tear production decreases or tears evaporate too quickly from the eyes, symptoms of dry eye can develop.
•    Poor quality of tears – Tears are made up of three layers: oil, water, and mucus. Each component serves a function in protecting and nourishing the front surface of the eye. A smooth oil layer helps to prevent evaporation of the water layer, while the mucin layer functions in spreading the tears evenly over the surface of the eye. If the tears evaporate too quickly or do not spread evenly over the cornea due to deficiencies with any of the three tear layers, dry eye symptoms can develop.

The most common form of dry eyes is due to an inadequate amount of the water layer of tears. This condition, called keratoconjunctivitis sicca (KCS), is also referred to as dry eye syndrome.

People with dry eyes may experience symptoms of irritated, gritty, scratchy, or burning eyes, a feeling of something in their eyes, excess watering, and blurred vision. Advanced dry eyes may damage the front surface of the eye and impair vision.

Treatments for dry eyes aim to restore or maintain the normal amount of tears in the eye to minimize dryness and related discomfort and to maintain eye health.

What causes dry eyes?

The majority of people over the age of 65 experience some symptoms of dry eyes.

The development of dry eyes can have many causes. They include:

•    Age – dry eye is a part of the natural aging process. The majority of people over age 65 experience some symptoms of dry eyes.
•    Gender – women are more likely to develop dry eyes due to hormonal changes caused by pregnancy, the use of oral contraceptives, and menopause.
•    Medications – certain medicines, including antihistamines, decongestants, blood pressure medications and antidepressants, can reduce the amount of tears produced in the eyes.
•    Medical conditions – persons with rheumatoid arthritis, diabetes and thyroid problems are more likely to have symptoms of dry eyes. Also, problems with inflammation of the eyelids (blepharitis), inflammation of the surfaces of the eye, or the inward or outward turning of eyelids can cause dry eyes to develop.
•    Environmental conditions – exposure to smoke, wind and dry climates can increase tear evaporation resulting in dry eye symptoms. Failure to blink regularly, such as when staring at a computer screen for long periods of time, can also contribute to drying of the eyes.
•    Other factors – long term use of contact lenses can be a factor in the development of dry eyes. Refractive eye surgeries, such as LASIK, can cause decreased tear production and dry eyes.

How are dry eyes diagnosed?

Dry eyes can be diagnosed through a comprehensive eye examination. Testing, with special emphasis on the evaluation of the quantity and quality of tears produced by the eyes, may include:

•    Patient history to determine any symptoms the patient is experiencing and the presence of any general health problems, medications taken, or environmental factors that may be contributing to the dry eye problem.
•    External examination of the eye, including lid structure and blink dynamics.
•    Evaluation of the eyelids and cornea using bright light and magnification.
•    Measurement of the quantity and quality of tears for any abnormalities. Special dyes may be instilled in the eyes to better observe tear flow and to highlight any changes to the outer surface of the eye caused by insufficient tears.

Using the information obtained from testing, Rose Optical optometrists can determine if you have dry eyes and advise you on treatment options.

Rose Optical can diagnose a ‘cataract’ condition with a comprehensive eye examination. The examination may include

•    Patient history to determine vision difficulties experienced by the patient that may limit their daily activities and other general health concerns affecting vision.
•    Visual acuity measurement to determine to what extent a cataract may be limiting clear vision at distance and near.
•    Refraction to determine the need for changes in an eyeglass or contact lens prescription.
•    Evaluation of the lens under high magnification and illumination to determine the extent and location of any cataracts.
•    Evaluation of the retina of the eye through a dilated pupil.
•    Measurement of pressure within the eye.
•    Supplemental testing for color vision and glare sensitivity.

Additional testing may be needed to determine the extent of impairment and evaluate whether other eye disease exists.

Your Rose Optical Optometrist can determine if you have cataracts and will recommend treatment options.

What is a cataract?

A cataract is a clouding of the eye’s natural lens, which lies behind the iris and the pupil.

Cataracts are the most common cause of vision loss in people over age 40. Cataracts are the principal cause of blindness in the world. In fact, there are more cases of cataracts worldwide than there are of glaucoma, macular degeneration and diabetic retinopathy combined, according to Prevent Blindness America (PBA).

Today, cataracts affect more than 22 million Americans age 40 and older. And as the U.S. population ages, more than 30 million Americans are expected to have cataracts by the year 2020, PBA says.

Types of cataracts include:

•    A subcapsular cataract occurs at the back of the lens. People with diabetes or those taking high doses of steroid medications have a greater risk of developing a subcapsular cataract.
•    A nuclear cataract forms deep in the central zone (nucleus) of the lens. Nuclear cataracts usually are associated with aging.
•    A cortical cataract is characterized by white, wedge-like opacities that start in the periphery of the lens and work their way to the center in a spoke-like fashion. This type of cataract occurs in the lens cortex, which is the part of the lens that surrounds the central nucleus.

Cataract Symptoms and Signs

A cataract starts out small and at first has little effect on your vision. You may notice that your vision is blurred a little, like looking through a cloudy piece of glass or viewing an impressionist painting.

Hazy or blurred vision may mean you have a cataract.

A cataract may make light from the sun or a lamp appear too bright or glaring. Or you may notice when you drive at night that the oncoming headlights cause more glare than before. Colors may not appear as bright as they once did.

The type of cataract you have will affect exactly which symptoms you experience and how soon they will occur. When a nuclear cataract first develops, it can bring about a temporary improvement in your near vision, called “second sight.”

Unfortunately, the improved vision is short-lived and will disappear as the cataract worsens. On the other hand, a subcapsular cataract may not produce any symptoms until it’s well-developed.

If you think you have a cataract, contact Rose Optical for an exam to find out for sure. The sooner you have the condition diagnosed and treated the better the outcome will be.

More Info

What Causes Cataracts?

The lens inside the eye works much like a camera lens, focusing light onto the retina for clear vision. It also adjusts the eye’s focus, letting us see things clearly both up close and far away.

The lens is mostly made of water and protein. The protein is arranged in a precise way that keeps the lens clear and lets light pass through it.

But as we age, some of the protein may clump together and start to cloud a small area of the lens. This is a cataract, and over time, it may grow larger and cloud more of the lens, making it harder to see.

No one knows for sure why the eye’s lens changes as we age, forming cataracts. But researchers worldwide have identified factors that may cause cataracts or are associated with cataract development. Besides advancing age, cataract risk factors include:

•    Ultraviolet radiation from sunlight and other sources
•    Diabetes
•    Hypertension
•    Obesity
•    Smoking
•    Prolonged use of corticosteroid medications
•    Statin medicines used to reduce cholesterol
•    Previous eye injury or inflammation
•    Previous eye surgery
•    Hormone replacement therapy
•    Significant alcohol consumption
•    High myopia
•    Family history

One theory of cataract formation that’s gaining favor is that many cataracts are caused by oxidative changes in the human lens. This is supported by nutrition studies that show fruits and vegetables high in antioxidants may help prevent certain types of cataracts (see below).

Cataract Prevention

Though there is significant controversy about whether cataracts can be prevented, a number of studies suggest certain nutrients and nutritional supplements may reduce your risk of cataracts.

One large, 10-year study of female health professionals found that higher dietary intakes of vitamin E and the carotenoids lutein and zeaxanthin from food and supplements were associated with significantly decreased risks of cataract.

Good food sources of vitamin E include sunflower seeds, almonds and spinach. Good sources of lutein and zeaxanthin include spinach, kale and other green, leafy vegetables.

Other studies have shown antioxidant vitamins such as vitamin C and foods containing omega-3 fatty acids may reduce cataract risk.

Visit our Nutrition & Eyes section to read more about eye vitamins and how a healthful diet and good nutrition may help prevent cataracts.

Another step you can take to reduce your risk of cataracts is to wear protective sunglasses that block 100 percent of the sun’s UV rays when you are outdoors.

Cataracts and Your Diet

Does Eating Less Meat Reduce Your Risk for Cataracts?

This interesting question has received a lot of public comment since researchers at the University of Oxford published a study in March 2011 that compared cataract incidence with dietary intake.

Could eating more greens and less meat help you delay the onset of cataracts?

The study, as reported in The American Journal of Clinical Nutrition, examined the dietary surveys filled out by 27,670 self-reported non-diabetic people aged 40 or over and monitored their medical records to see if and when cataracts developed. Strong correlations showed up between cataract risk and diet type.

The risk was greatest for high meat eaters (who ate more than 3.5 ounces of meat each day), and it decreased from one group to the next, in this order: moderate meat eaters, low meat eaters, fish eaters (people who eat fish but no other meat), vegetarians and vegans. In fact, the risk for vegans was roughly 40 percent lower than for the high meat eaters.

Does this mean you should stop eating meat? Maybe, but not necessarily. The study doesn’t answer every question. Perhaps the reason for the lower risk is that if you eat less meat, you probably eat more vegetables. And perhaps those veggies are providing nutrients that reduce cataract risk.

Also, vegetarians and vegans may tend to lead healthy lifestyles, avoiding cataract risk boosters such as smoking, excess sun exposure and diabetes. It may be true that cataracts are inevitable if you live long enough, but living healthy just might delay them for a good long time. — L.S.

Cataract Treatment

When symptoms begin to appear, you may be able to improve your vision for a while using new glasses, strong bifocals, magnification, appropriate lighting or other visual aids.

Think about surgery when your cataracts have progressed enough to seriously impair your vision and affect your daily life. Many people consider poor vision an inevitable fact of aging, but cataract surgery is a simple, relatively painless procedure to regain vision.

Cataract surgery is very successful in restoring vision. In fact, it is the most frequently performed surgery in the United States, with more than 3 million Americans undergoing cataract surgery each year, according to PBA. Nine out of 10 people who have cataract surgery regain very good vision, somewhere between 20/20 and 20/40.

During surgery, the surgeon will remove your clouded lens and in most cases replace it with a clear, plastic intraocular lens (IOL).

New IOLs are being developed all the time to make the surgery less complicated for surgeons and the lenses more helpful to patients. Presbyopia-correcting IOLs potentially help you see at all distances, not just one. Another new type of IOL blocks both ultraviolet and blue light rays, which research indicates may damage the retina (see illustration).

Diabetic Retinopathy
(REH-tih-NOP-uh-thee)

Diabetic Retinopathy is the medical term for the most common diabetic eye problem. Diabetic retinopathy is the leading cause of blindness in American adults which when untreated causes progressive damage to the retina, the light sensitive lining at the back of the eye. It is a serious sight-threatening complication of diabetes.

Blurred vision or temporary blindness can occur when blood vessels weaken, bulge and leak fluid into surrounding tissue, causing swelling – a condition called macular edema. Abnormal new blood vessels may often, grow on the retina, where they can bleed into the eye and block vision.

As the disease progresses, the retina can detach from the eye, resulting in permanent blindness. Irreversible vision loss can be prevented with early detection and treatment. This is just one of the reasons it is so important to have your eyes checked on a regular basis. In addition to testing your vision, we will look for any signs of eye disease.

Retinal damage happens slowly. Your retinas have tiny blood vessels that are easy to damage. Having high blood glucose and high blood pressure for a long time can damage these tiny blood vessels.

First, these tiny blood vessels swell and weaken. Some blood vessels then become clogged and do not let enough blood through. At first, you might not have any loss of sight from these changes. This is why you need to have a comprehensive eye exam once a year even if your sight seems fine.

Symptoms of diabetic retinopathy include:

•    Seeing spots or floaters in your field of vision
•    Blurred vision
•    Having a dark or empty spot in the center of your vision
•    Difficulty seeing well at night

Often there are no visual symptoms in the early stages of diabetic retinopathy. That is why the American Optometric Association and Rose Optical recommend that everyone with diabetes have a comprehensive dilated eye examination once a year. Early detection and treatment can limit the potential for significant vision loss from diabetic retinopathy.

Treatment of diabetic retinopathy varies depending on the extent of the disease. It may require laser surgery to seal leaking blood vessels or to discourage new leaky blood vessels from forming. Injections of medications into the eye may be needed to decrease inflammation or stop the formation of new blood vessels. In more advanced cases, a surgical procedure to remove and replace the gel-like fluid in the back of the eye, called the vitreous, may be needed. A retinal detachment, defined as a separation of the light-receiving lining in the back of the eye, resulting from diabetic retinopathy, may also require surgical repair.

If you are a diabetic, you can help prevent or slow the development of diabetic retinopathy by taking your prescribed medication, sticking to your diet, exercising regularly, controlling high blood pressure and avoiding alcohol and smoking.

Call us right away if you are having any vision problems or if you have had a sudden change in your vision.

Retinal Detachment 

What is retinal detachment?

The retina is the light-sensitive layer of tissue that lines the inside of the eye and sends visual messages through the optic nerve to the brain. When the retina detaches, it is lifted or pulled from its normal position. If not promptly treated, retinal detachment can cause permanent vision loss.

In some cases there may be small areas of the retina that are torn. These areas, called retinal tears or retinal breaks, can lead to retinal detachment.

Frequently Asked Questions about Retinal Detachment

What are the different types of retinal detachment?

There are three different types of retinal detachment:

Rhegmatogenous [reg-ma-TAH-jenous]—A tear or break in the retina allows fluid to get under the retina and separate it from the retinal pigment epithelium (RPE), the pigmented cell layer that nourishes the retina. These types of retinal detachments are the most common.

Tractional—In this type of detachment, scar tissue on the retina’s surface contracts and causes the retina to separate from the RPE. This type of detachment is less common.

Exudative—Frequently caused by retinal diseases, including inflammatory disorders and injury/trauma to the eye. In this type, fluid leaks into the area underneath the retina, but there are no tears or breaks in the retina.

Causes and Risk Factors

Who is at risk for retinal detachment?

A retinal detachment can occur at any age, but it is more common in people over age 40. It affects men more than women, and Whites more than African Americans.

A retinal detachment is also more likely to occur in people who:

•    Are extremely nearsighted
•    Have had a retinal detachment in the other eye
•    Have a family history of retinal detachment
•    Have had cataract surgery
•    Have other eye diseases or disorders, such as retinoschisis, uveitis, degenerative myopia, or lattice degeneration<
•    Have had an eye injury

Symptoms and Detection

What are the symptoms of retinal detachment?

Symptoms include a sudden or gradual increase in either the number of floaters, which are little “cobwebs” or specks that float about in your field of vision, and/or light flashes in the eye. Other symptoms are the appearance of a curtain over the field of vision, blurred vision, blind spots or water vision. A retinal detachment is a medical emergency. These symptoms do not always indicate retinal detachment, but if you’re experiencing them, you should go to an emergency room, call us or see one of our doctors as soon as possible.

As we get older we expect to have problems with our eyes, so we tend to ignore them.

One minor symptom that can cause a bigger problem, if not treated, is the occurrence of floaters and flashes. These are those tiny lights that seem to blink through your vision and that you can never catch when you direct your focus toward them.

•    Floaters

Floaters are small specks or clouds moving in your field of vision. You may see them more clearly when looking at a plain background, such as a blank wall. Floaters are actually tiny clumps of gel or cells inside the vitreous, the clear jelly-like fluid that fills the inside of your eye. Floaters can have different shapes, such as little dots, circles, lines, clouds, or cobwebs.

Though these objects look like they are in front of your eye, they are actually floating inside of it. What you see are the shadows they cast on the retina, the nerve layer at the back of the eye that senses light and allows you to see.

When people reach middle age, the vitreous gel may start to thicken or shrink, forming clumps or strands inside the eye. Floaters often occur when the vitreous gel pulls away from the back wall of the eye, causing a posterior vitreous detachment. In some cases, the retina can tear as the shrinking vitreous gel pulls away from the wall of the eye. A torn retina is always a serious problem, since it can lead to a retinal detachment.

The appearance of floaters may be alarming, especially if they develop suddenly. You should see a Rose Optical ophthalmologist right away if you suddenly develop new floaters.

•    Flashes

When the vitreous gel inside your eye rubs or pulls on the retina, you may see what looks like flashing lights or lightening streaks. You may have experienced this sensation if you have ever been hit in the eye and see “stars.”

These flashes of light can appear off and on for several weeks or months. As we grow older, it is more common to experience flashes. If you notice the sudden appearance of flashes, you should visit your ophthalmologist immediately because it could mean that the retina has been torn.

Causes

Floaters can be caused by normal aging of the eye when the vitreous jelly begins to shrink. Other causes of floaters include the sudden release of blood cells from the retinal blood vessels or pigmented cells from underneath the retina into the vitreous jelly. This can occur with the tearing of the retina. It is not always possible to distinguish between the causes of new floaters in the eye, which is why it is essential to have an immediate ophthalmologic examination to look for retinal holes or tears.

Risk Factors

Aging is a large risk factor for new floaters. People who are very nearsighted (high myopes) are at greater risk of developing floaters earlier in life and are also at a greater risk of a retinal tear or detachment.  Inflammation inside the eye (uveitis) and recent intraocular surgery are also risk factors for developing floaters in the eye. 

Tests and Diagnosis

Most causes of new floaters and flashes can be determined through a clinical exam by an ophthalmologist. If the cause of the symptoms is not seen during a clinical exam, your Rose Optical ophthalmologist may order additional testing, such as an ultrasound of the eye.

Treatment and Drugs

The treatment for floaters and flashes depends on the underlying condition. While not all floaters and flashes are serious, you should always have a medical eye examination by a Rose Optical ophthalmologist to make sure there has been no damage to your retina.

While some floaters may remain in your vision, many of them will fade over time and become less bothersome. Even if you have had some floaters for years, you should have an eye examination immediately if you notice new ones.

There is no specific treatment for separation of the vitreous gel from the retina although laser or freezing therapy or surgery may be required for retinal tears.

Amblyopia is the medical term used when the vision in one of the eyes is reduced because the eye and the brain are not working together properly. The eye itself looks normal, but it is not being used normally because the brain is favoring the other eye. This condition is also sometimes called lazy eye.

Amblyopia Defined

What is Amblyopia?

The brain and the eyes work together to produce vision. The eye focuses light on the back part of the eye known as the retina. Cells of the retina then trigger nerve signals that travel along the optic nerves to the brain. Amblyopia is the medical term used when the vision of one eye is reduced because it fails to work properly with the brain. The eye itself looks normal, but for various reasons the brain favors the other eye. This condition is also sometimes called lazy eye.

How common is Amblyopia?

Amblyopia is the most common cause of visual impairment among children, affecting approximately 2 to 3 out of every 100 children. Unless it is successfully treated in early childhood, amblyopia usually persists into adulthood. It is also the most common cause of monocular (one eye) visual impairment among young and middle-aged adults.

What causes Amblyopia?

Amblyopia, which usually begins in infancy or childhood, is a condition of poor vision in an otherwise healthy eye because the brain has learned to favor the other eye. Although the eye with amblyopia often looks normal, there is interference with normal visual processing that limits the development of a portion of the brain responsible for vision. The most common causes of Amblyopia are crossed or wandering eyes or significant differences in refractive error, such as farsightedness or nearsightedness, between the two eyes.

Amblyopia can result from any condition that prevents the eye from focusing clearly. Amblyopia can be caused by the misalignment of the two eyes—a condition called strabismus. With strabismus, the eyes can cross in (esotropia) or turn out (exotropia). Occasionally, Amblyopia is caused by a clouding of the front part of the eye, a condition called cataract.

A common cause of Amblyopia is the inability of one eye to focus as well as the other one. Amblyopia can occur when one eye is more nearsighted, more farsighted, or has more astigmatism. These terms refer to the ability of the eye to focus light on the retina. Farsightedness, or hyperopia, occurs when the distance from the front to the back of the eye is too short. Eyes that are farsighted tend to focus better at a distance but have more difficulty focusing on near objects. Nearsightedness, or myopia, occurs when the eye is too long from front to back. Eyes with nearsightedness tend to focus better on near objects. Eyes with astigmatism have difficulty focusing on far and near objects because of their irregular shape.

How is Amblyopia treated in children?

Treating Amblyopia involves forcing the child to use the eye with weaker vision. There are two common ways to treat Amblyopia:

Patching

An adhesive patch is worn over the stronger eye for weeks to months. This therapy forces the child to use the eye with Amblyopia. Patching stimulates vision in the weaker eye and helps parts of the brain involved in vision develop more completely.

A National Eye Institute study showed that patching the unaffected eye of children with moderate Amblyopia for two hours daily works as well as patching for six hours daily. Shorter patching time can lead to better compliance with treatment and improved quality of life for children with Amblyopia. However, a recent study showed that children whose Amblyopia persists despite two hours of daily patching may improve if daily patching is extended to 6 hours.

Previously, eye care professionals thought that treating Amblyopia would be of little benefit to older children. However, results from a nationwide clinical trial showed that many children from ages seven to 17 years old benefited from treatment for Amblyopia. This study shows that age alone should not be used as a factor to decide whether or not to treat a child for Amblyopia.

Atropine

Another treatment option for Amblyopia is a drug called Atropine.  A drop of Atropine is placed in the stronger eye to temporarily blur vision so that the child will use the eye with Amblyopia, especially when focusing on near objects. National Eye Institute supported research has shown that Atropine eye drops, when placed in the unaffected eye once a day, work as well as eye patching. Atropine eye drops are sometimes easier for parents and children to use.

Rose Optical doctors will discuss all treatment options and recommend the best treatment for your child!

Can Amblyopia be treated in adults?

Studies are very limited at this time, and scientists don’t know the success rate for treating Amblyopia in adults. During the first seven to ten years of life, the visual system develops rapidly. Important connections between the eye and the brain are created during this period of growth and development. Scientists are exploring whether treatment for Amblyopia in adults can improve vision.

This information was developed by the National Eye Institute to help patients and their families search for general information about Amblyopia. Contact Rose Optical to answer specific questions.

Strabismus is a visual problem in which the eyes are not aligned properly and point in different directions. One eye may look straight ahead, while the other eye turns inward, outward, upward or downward. The eye turn may be constant, or it may come and go. Which eye is straight (and which is misaligned) may switch or alternate.

Strabismus is a common condition among children. About 4 percent of all children in the United States have Strabismus. It can also occur later in life. Strabismus occurs equally in males and females. It may run in families; however, many people with Strabismus have no relatives with the problem. The exact cause of Strabismus is not fully understood. In some cases, Strabismus may be due to problems with the muscles controlling eye movement.

There are six muscles attached to each eye that control how it moves. The muscles receive signals from the brain that direct their movements. Normally, the eyes work together so they both point at the same place. When problems develop with eye movement control, an eye may turn in, out, up or down. The eye turning may be evident all the time or may appear only at certain times such as when the person is tired, ill, or has done a lot of reading or close work.

In some cases, the same eye may turn each time, while in other cases, the eyes may alternate turning.

Maintaining proper eye alignment is important to avoid seeing double, for good depth perception, and to prevent the development of poor vision in the turned eye. When the eyes are misaligned, the brain receives two different images. At first, this may create double vision and confusion, but over time the brain will learn to ignore the image from the turned eye. If the eye turning becomes constant and is not treated, it can lead to permanent reduction of vision in one eye, a condition called amblyopia or lazy eye.

Some babies’ eyes may appear to be misaligned, but are actually both aiming at the same object. This is a condition called pseudoStrabismus or false Strabismus. The appearance of crossed eyes may be due to extra skin that covers the inner corner of the eyes, or a wide bridge of the nose. Usually, this will change as the child’s face begins to grow.

Strabismus usually develops in infants and young children, most often by age 3, but older children and adults can also develop the condition. There is a common misconception that a child with Strabismus will outgrow the condition. However, this is not true. In fact, Strabismus may get worse without treatment. Any child older than four months whose eyes do not appear to be straight all the time should be examined.

Strabismus is classified by the direction the eye turns:

•    Inward turning is called esotropia
•    Outward turning is called exotropia
•    Upward turning is called hypertropia
•    Downward turning is called hypotropia.

Other classifications of Strabismus include:

•    The frequency with which it occurs – either constant or intermittent
•    Whether it always involves the same eye – unilateral
•    If the turning eye is sometimes the right eye and other times the left eye – alternating.

Treatment for Strabismus may include eyeglasses, prisms, vision therapy, or eye muscle surgery. If detected and treated early, Strabismus can often be corrected with excellent results.

Schedule an appointment today with Rose Optical for an eye exam!

What causes Strabismus?

Strabismus can be caused by problems with the eye muscles, the nerves that transmit information to the muscles, or the control center in the brain that directs eye movements. It can also develop due to other general health conditions or eye injuries.

Risk factors for developing Strabismus include:

•    Family history – individuals with parents or siblings who have Strabismus are more likely to develop it.
•    Refractive error – people who have a significant amount of uncorrected farsightedness (hyperopia) may develop Strabismus because of the additional amount of eye focusing required to keep objects clear.
•    Medical conditions – people with conditions such as Down syndrome and cerebral palsy or who have suffered a stroke or head injury are at a higher risk for developing Strabismus.

Although there are many types of Strabismus that can develop in children or adults, the two most common forms are accommodative esotropia and intermittent exotropia.

Accommodative esotropia often occurs because of uncorrected farsightedness (hyperopia). Because the eye’s focusing system is linked to the system that controls where the eyes point, the extra focusing effort needed to keep images clear in farsightedness may cause the eyes to turn inward. Signs and symptoms of accommodative esotropia may include seeing double, closing or covering one eye when doing close work, and tilting or turning of the head.

Intermittent exotropia may develop due to an inability to coordinate both eyes together. The eyes may have a tendency to point beyond the object being viewed. People with intermittent exotropia may experience headaches, difficulty reading, and eye strain. They also may have a tendency to close one eye when viewing at distance or in bright sunlight.

How is Strabismus diagnosed?

Strabismus is diagnosed through a comprehensive eye exam. Testing for Strabismus, with special emphasis on how the eyes focus and move, may include:

•    Patient History – A patient history is obtained to determine any symptoms the patient is experiencing or the parent is observing, and to note the presence of any general health problems, medications taken, or environmental factors that may be contributing to the symptoms.
•    Visual Acuity – Visual acuity measurements are taken to assess the extent to which vision may be affected. As part of the testing, you will be asked to read letters on distance and near reading charts. This test measures visual acuity, which is written as a fraction such as 20/40. When testing distance vision, the top number is the standard distance at which testing is done, twenty feet. The bottom number is the smallest letter size you were able to read at the twenty foot distance. A person with 20/40 visual acuity would have to get within 20 feet of a letter that should be seen at forty feet in order to see it clearly. “Normal” distance visual acuity is 20/20.
•    Refraction – A refraction is conducted to determine the appropriate lens power needed to compensate for any refractive error (nearsightedness, farsightedness, or astigmatism). Using an instrument called a phoropter, your optometrist places a series of lenses in front of your eyes and measures how they focus light using a hand held lighted instrument called a retinoscope. Or the doctor may choose to use an automated instrument that automatically evaluates the refractive power of the eye. The power is then refined by the patient’s responses to determine the lenses that allow the clearest vision.
•    Alignment and Focusing Testing – How well your eyes focus, move and work together needs to be assessed. In order to obtain a clear, single image of what is being viewed, the eyes must effectively change focus, move and work in unison. This testing will look for problems that keep your eyes from focusing effectively or make it difficult to use both eyes together.
•    Examination of eye health – The structures of the eye are observed to rule out any eye disease that may be contributing to Strabismus. The health of the external and internal parts of the eye will be assessed using various testing procedures. This testing may be done without the use of eye drops to determine how the eyes respond under normal seeing conditions. In some cases, such as for patients who can’t respond verbally or when some of the eyes focusing power may be hidden, eye drops may be used. They temporarily keep the eyes from changing focus while testing is done. Using the information obtained from these tests, along with results of other tests, your Rose Optical optometrist can determine if you have Strabismus. Once testing is complete, your optometrist can discuss options for treatment.

How is Strabismus treated?

People with Strabismus have several treatment options available to improve eye alignment and coordination. They include:

•    eyeglasses or contact lenses
•    prism lenses
•    vision therapy
•    eye muscle surgery

Eyeglasses or contact lenses may be prescribed for patients with uncorrected farsightedness. This may be the only treatment needed for some patients with accommodative esotropia. Once the farsightedness is corrected, the eyes require less focusing effort and may remain straight.

Prism lenses are special lenses that have a prescription for prism power in them. The prisms alter the light entering the eye and assist in reducing the amount of turning the eye has to do to look at objects. Sometimes the prisms are able to fully compensate for and eliminate the eye turning.

Vision therapy is a structured program of visual activities prescribed to improve eye coordination and eye focusing abilities. Vision therapy trains the eyes and brain to work together more effectively. These eye exercises help remediate deficiencies in eye movement, eye focusing and eye teaming and reinforce the eye-brain connection. Treatment may include office-based as well as home training procedures.

Eye muscle surgery can change the length or position of the muscles around the eye in an attempt to better align the eyes. Eye muscle surgery may be able to physically align the eyes so they appear straight. Often a program of vision therapy may also be needed to develop a functional improvement in eye coordination and to keep the eyes from reverting back to their previous condition of misalignment.

Call 618-466-8787 to schedule an eye exam at Rose Optical today!

Conjunctivitis, sometimes referred to as pink eye, is an infection or inflammation of the conjunctiva. The conjunctiva is a thin, protective membrane that covers the surface of the eyeball and inner surface of the eyelids. Inflammation can be caused by bacteria, viruses and other germs that are transmitted to the eye through contaminated hands, towels, and eye makeup or extended wear contacts. It can also result from exposure to irritants such as chemicals, smoke or dust; or by pollen and other allergens. It is not uncommon for conjunctivitis to accompany a cold or flu.

Bacterial or viral conjunctivitis is contagious and tends to be prevalent in daycare centers and schools. It can spread by direct person-to-person contact, in airborne droplets that are coughed or sneezed, or from sharing makeup, towels and washcloths. Its hallmark sign is redness in the white of the eye that may be accompanied by increased tearing and/or a discharge that is watery or thick with mucus and pus and causes the eyelids to stick together.

Although usually a minor problem that improves within two weeks, some types can develop into serious corneal inflammation and vision loss if not treated. If you wear contact lenses and suspect you have conjunctivitis, discontinue wearing your contacts until the condition clears; you may also need to replace your contact lenses to prevent recurrence.

There are four primary types of conjunctivitis:

Bacterial conjunctivitis can affect one or both eyes and is usually accompanied by a heavy, yellow discharge that may cause the eyelids to stick together in the morning. Caused by a variety of bacteria, bacterial conjunctivitis is treated with antibiotic eye drops and typically resolves within 5 days. If there is concurrent inflammation of the eyelids, your eye care provider may also recommend an eyelid scrub to remove bacteria and dried mucous from the lid margin.

Viral conjunctivitis is often caused by adenoviruses, the family responsible for upper-respiratory illnesses such as colds, but can also result from herpes simplex and other viruses. This type can also affect either one or both eyes, and usually causes a lighter discharge. Although viral conjunctivitis usually produces a superficial case that clears on its own within two weeks, you should still see your eye care provider to ensure it doesn’t lead to a more serious infection that can involve the cornea.

Antibiotics are ineffective for viral conjunctivitis. Artificial tears may be used, or your doctor may recommend a topical anti-inflammatory drop to relieve discomfort. Topical or oral anti-herpetic medications can help suppress herpes viral infections.

Allergic conjunctivitis results from a response to airborne pollen, dust, smoke, or environmental agents. Both eyes are usually affected and may itch, tear excessively and discharge a stringy mucous. You may also have other allergic reactions, such as a runny or itchy nose. Depending on the severity, your eye doctor may prescribe topical drops that are effective in relieving the itching and discomfort. A very specific kind of allergic conjunctivitis may occur in contact lens wearers, especially if they do not clean the lenses well or if the lenses are not replaced often enough. Several treatments are available for this condition, including prescription allergy drops, changing contact lens solutions to keep the lenses cleaner, and changing to lenses that are replaced more frequently such as daily disposable contacts.

Chemical conjunctivitis is caused by exposure to irritating liquids, powders, or fumes and requires immediate action. Common irritants in include chlorine, detergents, fuels, ammonia, smoke and pesticides. First, flush the eye with cold water continuously for 15 minutes, then have the eyes evaluated by your eye doctor. For minor irritants such as chlorine, often artificial tears will effectively resolve the irritation. For chemicals burns from a strong acid or base, emergency medical treatment is needed.

Conjunctivitis Symptoms

Viral conjunctivitis
Watery Discharge
Irritation
Red Eye
Usually begins with one eye but may spread easily to the fellow eye

Allergic conjunctivitis
Usually affects both eyes
Itching
Tearing
Swollen eyelids

Bacterial conjunctivitis
Stringy discharge that may cause the lids to stick together, especially after sleeping
Swelling of the conjunctiva
Redness
Usually affects only one eye but may spread to the fellow eye

To prevent the spread of conjunctivitis you should:
•    Wash your hands after touching or wiping your eyes.
•    Avoid touching other people unless hands are freshly washed.
•    Throw away or carefully wash items that touch your eyes.
•    Not share eye makeup or other items used on your eyes (for example, towels, or tissues).
•    Cover mouth and nose when coughing or sneezing.
•    Consult your doctor in case treatment or medication is needed.
•    See a doctor if the eye discharge is yellow, if the eye or eyelid is red, or if the symptoms do not start improving after 2-3 days. See a doctor immediately if the symptoms suggest a more severe infection.

• Be excluded from school and child care settings until cleared by a health care provider confirming that you are not contagious, after taking antibiotics for 24 hours, or until symptoms have resolved.

If you exhibit the symptoms listed above or think you may have conjunctivitis contact Rose Optical as soon as possible. The doctors at Rose Optical will provide a comprehensive eye exam to determine the cause of inflammation and prescribe the treatment to best resolve the condition.

Computer Vision Syndrome, also referred to as Digital Eye Strain, describes a group of eye and vision-related problems that result from prolonged computer, tablet, e-reader and cell phone use. Many individuals experience eye discomfort and vision problems when viewing digital screens for extended periods. The level of discomfort appears to increase with the amount of digital screen use.

Computer Vision Syndrome (CVS) affects three out of four computer users. It is a series of symptoms related to extended periods of computer usage. Although it is no cause for panic, measures can be taken to relieve symptoms of CVS.

The most common symptoms associated with Computer Vision Syndrome (CVS) or Digital Eye Strain:

•    eyestrain
•    headaches
•    blurred vision
•    dry eyes
•    neck and shoulder pain

These symptoms may be caused by:

•    poor lighting
•    glare on a digital screen
•    improper viewing distances
•    poor seating posture
•    uncorrected vision problems
•    a combination of these factors

The extent to which individuals experience visual symptoms often depends on the level of their visual abilities and the amount of time spent looking at a digital screen. Uncorrected vision problems like farsightedness and astigmatism, inadequate eye focusing or eye coordination abilities, and aging changes of the eyes, such as presbyopia, can all contribute to the development of visual symptoms when using a computer or digital screen device.

Many of the visual symptoms experienced by users are only temporary and will decline after stopping computer work or use of the digital device. However, some individuals may experience continued reduced visual abilities, such as blurred distance vision, even after stopping work at a computer. If nothing is done to address the cause of the problem, the symptoms will continue to recur and perhaps worsen with future digital screen use.

Prevention or reduction of the vision problems associated with Computer Vision Syndrome or Digital Eye Strain involves taking steps to control lighting and glare on the device screen, establishing proper working distances and posture for screen viewing, and assuring that even minor vision problems are properly corrected.

What causes Computer Vision Syndrome or Digital Eye Strain?

Viewing a computer or digital screen often makes the eyes work harder. As a result, the unique characteristics and high visual demands of computer and digital screen device viewing make many individuals susceptible to the development of vision-related symptoms.

Uncorrected vision problems can increase the severity of Computer Vision Syndrome or Digital Eye Strain symptoms.

Viewing a computer or digital screen is different than reading a printed page. Often the letters on the computer or handheld device are not as precise or sharply defined, the level of contrast of the letters to the background is reduced, and the presence of glare and reflections on the screen may make viewing difficult.

Viewing distances and angles used for this type of work are also often different from those commonly used for other reading or writing tasks. As a result, the eye focusing and eye movement requirements for digital screen viewing can place additional demands on the visual system.

In addition, the presence of even minor vision problems can often significantly affect comfort and performance at a computer or while using other digital screen devices. Uncorrected or under corrected vision problems can be major contributing factors to computer-related eyestrain.

Even people who have an eyeglass or contact lens prescription may find it’s not suitable for the specific viewing distances of their computer screen. Some people tilt their heads at odd angles because their glasses aren’t designed for looking at a computer. Or they bend toward the screen in order to see it clearly. Their postures can result in muscle spasms or pain in the neck, shoulder or back.

In most cases, symptoms of CVS or Digital Eye Strain occur because the visual demands of the task exceed the visual abilities of the individual to comfortably perform them. At greatest risk for developing CVS or Digital Eye Strain are those persons who spend two or more continuous hours at a computer or using a digital screen device every day.

How is Computer Vision Syndrome or Digital Eye Strain diagnosed?

Computer Vision Syndrome, or Digital Eye Strain, can be diagnosed through a comprehensive eye examination. Testing, with special emphasis on visual requirements at the computer or digital device working distance, may include:

•    Patient history to determine any symptoms the patient is experiencing and the presence of any general health problems, medications taken, or environmental factors that may be contributing to the symptoms related to computer use.
•    Visual acuity measurements to assess the extent to which vision may be affected.
•    A refraction to determine the appropriate lens power needed to compensate for any refractive errors (nearsightedness, farsightedness or astigmatism).
•    Testing how the eyes focus, move and work together. In order to obtain a clear, single image of what is being viewed, the eyes must effectively change focus, move and work in unison. This testing will look for problems that keep your eyes from focusing effectively or make it difficult to use both eyes together.

This testing may be done without the use of eye drops to determine how the eyes respond under normal seeing conditions. In some cases, such as when some of the eyes’ focusing power may be hidden, eye drops may be used. They temporarily keep the eyes from changing focus while testing is done.

Using the information obtained from these tests, along with results of other tests, your optometrist can determine if you have Computer Vision Syndrome or Digital Eye Strain and advise you on treatment options.

How is Computer Vision Syndrome or Digital Eye Strain treated?

Solutions to digital screen-related vision problems are varied. However, they can usually be alleviated by obtaining regular eye care and making changes in how you view the screen.

Eye Care

In some cases, individuals who do not require the use of eyeglasses for other daily activities may benefit from glasses prescribed specifically for computer use. In addition, persons already wearing glasses may find their current prescription does not provide optimal vision for viewing a computer.

•    Eyeglasses or contact lenses prescribed for general use may not be adequate for computer work. Lenses prescribed to meet the unique visual demands of computer viewing may be needed. Special lens designs, lens powers or lens tints or coatings may help to maximize visual abilities and comfort.
•    Some computer users experience problems with eye focusing or eye coordination that can’t be adequately corrected with eyeglasses or contact lenses. A program of vision therapy may be needed to treat these specific problems. Vision therapy, also called visual training, is a structured program of visual activities prescribed to improve visual abilities. It trains the eyes and brain to work together more effectively. These eye exercises help remediate deficiencies in eye movement, eye focusing and eye teaming and reinforce the eye-brain connection. Treatment may include office-based as well as home training procedures.

Viewing the Computer

Some important factors in preventing or reducing the symptoms of CVS have to do with the computer and how it is used. This includes lighting conditions, chair comfort, location of reference materials, position of the monitor, and the use of rest breaks.

•    Location of computer screen – Most people find it more comfortable to view a computer when the eyes are looking downward. Optimally, the computer screen should be 15 to 20 degrees below eye level (about 4 or 5 inches) as measured from the center of the screen and 20 to 28 inches from the eyes.
•    Reference materials – These materials should be located above the keyboard and below the monitor. If this is not possible, a document holder can be used beside the monitor. The goal is to position the documents so you do not need to move your head to look from the document to the screen.
•    Lighting – Position the computer screen to avoid glare, particularly from overhead lighting or windows. Use blinds or drapes on windows and replace the light bulbs in desk lamps with bulbs of lower wattage.
•    Anti-glare screens – If there is no way to minimize glare from light sources, consider using a screen glare filter. These filters decrease the amount of light reflected from the screen.
•    Seating position – Chairs should be comfortably padded and conform to the body. Chair height should be adjusted so your feet rest flat on the floor. If your chair has arms, they should be adjusted to provide arm support while you are typing. Your wrists shouldn’t rest on the keyboard when typing.
•    Rest breaks – To prevent eyestrain, try to rest your eyes when using the computer for long periods. Rest your eyes for 15 minutes after two hours of continuous computer use. Also, for every 20 minutes of computer viewing, look into the distance for 20 seconds to allow your eyes a chance to refocus.
•    Blinking – To minimize your chances of developing dry eye when using a computer, make an effort to blink frequently. Blinking keeps the front surface of your eye moist.

Regular eye examinations and proper viewing habits can help to prevent or reduce the development of the symptoms associated with Computer Vision Syndrome.

Low vision is a reduced level of vision that cannot be fully corrected with conventional glasses. It is not the same as blindness. Unlike a person who is blind, a person with low vision has some useful sight. However, low vision usually interferes with the performance of daily activities, such as reading or driving. A person with low vision may not recognize images at a distance or be able to differentiate colors of similar tones.

You are legally blind when your best corrected central acuity is less than 20/200 (perfect visual acuity is 20/20) in your better eye, or your side vision is narrowed to 20 degrees or less in your better eye. People who are legally blind may still have some useful vision. If you are legally blind, you may qualify for certain government benefits. It is estimated that approximately 17 percent of people over the age of 65 are either blind or have low vision. 

At Rose Optical, we see the challenges of low vision every day. Whether it is driving, viewing a computer screen or reading a book, our goal is to identify low visions solutions based on your individual needs.

Symptoms

•    Difficulty recognizing objects at a distance (street signs or bus signs)
•    Difficulty differentiating colors (particularly in the green-blue-violet range)
•    Difficulty seeing well up close (reading or cooking)

The symptoms described above may not necessarily mean that you have low vision. However, if you experience one or more of these symptoms, contact your Rose Optical eye care team for a complete eye exam. Rose Optical will identify the differences between normal changes which are common with age and changes caused by eye disease.

Causes

Although low vision can occur at any stage in life, it primarily affects the elderly, but is not a natural part of aging. Although most people experience some physiological changes with age (presbyopia), these changes usually do not lead to low vision. Most people develop low vision because of eye diseases. Common causes of low vision, particularly with older adults, include macular degeneration, glaucoma, and diabetic retinopathy. When vision impairment is recognized early, treatment can be more effective, enabling people to maintain as much independence as possible.

Tests and Diagnosis

To determine the extent of your useful vision, you will need to have your eyes examined. The examination for low vision differs from a typical eye examination. During a low vision examination, your Rose Optical professional may administer the following tests:

•    Refraction (to assess your vision and determine the prescription for your glasses, if glasses may be of any use)
•    Visual field (to assess your peripheral vision)

Because low vision examinations may involve a variety of tests, they are often more time consuming than standard examinations. For instance, refraction may be done through a telescope or trial lens frame so you can judge which lens is best.

Treatment and Drugs

The Rose Optical eye care team embraces a multi-disciplinary approach to the treatment of low vision. Starting with your vision examination and continuing work with you to recommend treatment options, which may include:

•    Optical devices to help you adapt, such as magnifiers, telephones, or closed-circuit televisions
•    Techniques to help you utilize your remaining vision
•    Environmental modifications to maximize your remaining vision
•    Adaptive non-optical devices, such as large-print cookbooks and talking watches.
•    Suggestions for modifying your home to enable you to become more independent and to improve safety.

Low Vision Aids

Many types of assistive devices are available to help people with low vision. These items include special glasses and other magnification devices and large print reading materials. Other communication aids include computer software and various other technological devices.