The Cornea is the transparent outer covering on the front surface of the eye. The cornea is responsible for bending or refracting the rays of light that reflect off an object.
The Pupil is the round hole that connects the front chamber of the eye to the interior chamber of the eye.
The Iris, or colored portion of the eye, surrounds the pupil and opens and closes to regulate the amount of light that enters the interior chamber of your eye (making the pupil bigger or smaller).
The Lens inside your eye is the focusing mechanism of your visual system. It changes shape to bend light rays, allowing the light to focus on the retina.
The Vitreous Humor is the jelly-like substance inside your eye and helps to maintain the shape and pressure of your eye.
The Retina is a thin layer of tissue at the back of the eye that contains the millions of rods and cones. These rods and cones convert the light into electrical impulses for the brain to interpret.
Cones are concentrated in the center of the retina, in an area called the macula. Cones, in bright light conditions, provide clear, sharp central vision and detect colors and fine details
Rods are located outside the macula and extend all the way to the outer edge of the retina. They provide peripheral or side vision allowing the eyes to detect motion and help us see in dim light and at night.
The Optic Nerve sends the converted electrical impulses to the brain.
1. Light reflects off an object and enters the visual system through the front of your eye called the cornea.
2. After the light passes through the cornea, it passes through the front chamber of the eye.
3. After the light passes through the front chamber, it passes through the pupil.
4. The iris, the colored part of your eye, regulates the amount of light that passes through your pupil.
5. The light then passes through the lens into the interior chamber of the eye.
6. There, the image passes through the jelly-like fluid called the Vitreous Humor.
7. After passing through the Vitreous Humor, the image reaches the Retina, home of the rods and cones that process the image into a format the brain can interpret. This is where the image flips upside down.
8. The retina sends the image to your Optic Nerve and the Optic Nerve finally sends the information to your brain
9. Your brain converts the information from your Optic Nerve into the picture of the object you see.
A comprehensive eye examination is necessary to ensure optimal vision and eye health. When visiting your Optometrist, please bring the information about your personal and family eye and health history, including allergies and medications you are taking. Discuss the problems you are experiencing with your vision and your occupational and recreational visual needs. This allows your Optometrist to provide you with the best possible care for your eye health and vision.
During your comprehensive eye examination, your Optometrist will:
· Review your family and personal health history.
· Conduct an examination of your visual system for:
· Signs of eye diseases and disorders.
· General health problems.
· Eye pressures.
· Field of vision.
· Visual acuity at distance and near.
· Myopia, hyperopia, astigmatism, presbyopia, depth perception, and color deficiency.
· Eye muscle balance and coordination.
· Effectiveness of Current treatment (if applicable).
After your examination, your Optometrist will discuss his/her findings with you and if necessary, offer you treatment options.
Infants
Your baby's eyes should be examined for signs of congenital eye conditions or diseases at birth. Early diagnosis and treatment of eye conditions are important to your child's development and future vision.
You should take your infant to your Optometrist for his or her first comprehensive eye examination at six months. Your Optometrist will test your child for myopia (nearsightedness), hyperopia (farsightedness), or astigmatism, eye movement ability and muscle balance, and overall eye health. It is critical for your child's future vision to identify potential visual problems as early as possible. Eye disorders and conditions, such as strabismus (eye turn) or amblyopia (lazy eye), can be dealt with more effectively if diagnosis and treatment begins at a very early age.
Preschoolers
Unless you notice a problem, or your doctor advises you differently, your child's next comprehensive eye examination should be done by the age of three. In the meantime, watch for signs of vision development problems. These may include, but are not limited to, a short attention span, difficulty with eye-hand-body coordination, or avoidance of detailed near work.
Children
Your child's next comprehensive eye examination should be done when they reach five years old or before they enter kindergarten. In order for your child to have a good start in school, they need good vision. Unfortunately, this is when most parents discover their child's visual disorders and most children begin developing progressive myopia and astigmatism. Observe your child and answer the following questions in between their eye exams.
· Does your child have difficulty seeing the board at school?
· Does your child hold their reading materials closer than normal?
· Does your child use their finger to maintain their place while reading?
· Does your child avoid close work or have difficulty reading?
· Does your child turns or tilt their head to use one eye?
· Does your child have frequent headaches or nausea after reading?
· Do your child's eyes turn in, out, up, or down?
· Does your child have difficulty distinguishing colors or shades?
· Does your child complain of eye pain?
Since vision changes occur without warning, take your child to visit your Optometrist every two years or more frequently if recommended by your Optometrist. If a problem exists, your doctor will prescribe the appropriate treatment including eyeglasses, contact lenses, or vision therapy. A school vision screening does not substitute for a thorough eye examination.
Teenagers
It is critical that teenagers have their eyes examined before they start their freshman year in high school. This ensures that their vision is performing at optimal levels before they start their new school. This will also help them excel in the sports they may try out for or other activities they may embark on. It is also a good idea to have their eyes checked before they enroll into driver's education. This will ensure that they meet the minimum vision requirement for driving and have time to get correction if needed (before they get their permit). Good vision is critical to safe driving.
Adults
Adults, age 21-40, should have their eyes examined every two years. Your Optometrist can monitor any potential eye health problems that may occur and make sure that you are seeing the world the best that you can. As you reach the "magical" age of 40, you will notice that you hold your reading materials farther and farther away. Eventually, your arms become too short or you have to remove your distance glasses to read fine print. This development is a natural part of the aging process and is called Presbyopia. At this point you will probably need reading glasses or bifocal or multi-focal contact lenses or glasses. Today's contact lenses and lenses (glasses) are significantly better than the ones of yesteryear. Most lenses (for glasses) are no-line or progressive power lenses, which gradually get stronger in reading power as you look down in them. These lenses are ideal for computer users since they also provide good vision for midrange. Today, contact lenses also come in bifocal and multifocal designs. Your Optometrist will help you choose the best option to fit your specific needs. Multifocal contacts may also give you intermediate range vision if you need it.
After forty years old, one should have an annual eye check up. During your comprehensive examination, your optometrist will monitor you for sight threatening diseases such as glaucoma, macular degeneration, and diabetes. In addition, other diseases, such as hypertension, can be detected.
Seniors
As you age, you are more likely to develop complex eye problems. Fortunately, today's technological breakthroughs allow doctors to diagnose and treat eye diseases and disorders better than before. Cataracts, which begin when you reach your 60's, used to be one of the leading causes of blindness. With current surgical techniques it has become a quick outpatient surgery, with excellent visual recovery.
Other eye problems that may show in this age category are glaucoma and macular degeneration. Glaucoma is managed usually by drops, but surgical intervention may be necessary if the drops do not correctly manage the disease. Age related macular degeneration, another sight threatening disease, is currently the leading cause of blindness in America. Your doctor will inform you if you show any signs of changes and may recommend vitamins or other treatments that are being developed to help fight this devastating problem
Optometrist
Optometrists are licensed eye doctors who specialize in the examination, diagnosis, treatment, and management of eye diseases and disorders of the visual system. Optometrists complete four years of Optometry school and their curriculum includes ocular and human anatomy, human and ocular physiology, optics, embryology, pharmacology, histology, neuroanatomy, neurophysiology, biochemistry, binocular vision, ocular motility, visual perception, pathophysiology, color vision and development, neurobiology, immunology, ocular disease, contact lenses, clinical medicine, stabisumus, amblyopia, general and ocular emergencies, geriatric care, public health, patient care, low vision, neuro-eye disease, vision and learning, clinical rounds, externships, and internships.
Ophthalmologists
An ophthalmologist is a physician who specializes in the diagnosis, treatment, and management of eye diseases and disorders of the visual system, performing surgery when needed. Physicians complete four years of medical school and an internship before beginning their residency in ophthalmology. After completing their residency, Ophthalmologists may spend an additional one to two years training in a subspecialty such as retina, cornea, etc.
Opticians
Opticians are professionals in the field of finishing, fitting, and dispensing of eyeglasses and contact lenses, based on an eye doctor's prescription.
Paraoptometric
Paraoptometric individuals work under the direct supervision of a licensed doctor of optometry. They collect patient data, administer routine technical tests, and assists in office management. State laws may limit, restrict or otherwise affect the duties that may be performed by the paraoptometric. There are two types of Paraoptometric staff, Assistants and Technicians.
Optometric Assistant
Optometric assistants are primarily involved in front office procedures, optical dispensing, and contact lens patient education. The optometric assistant may be trained on the job or may have completed a formal education program and successfully completed the National Optometric Assistant Registry Examination. A registered optometric assistant will have the Opt.A.R. designation.
Optometric Technician
Optometric Technicians work directly with Optometrists in the areas of patient examination and treatment, including contact lenses, low vision, vision therapy, optical dispensing, and office management. The optometric technician may have completed a college program in optometric technology or successfully completed the Optometric Technician Registry Examination. A registered optometric technician will have the Opt.T.R. designation.
What is Myopia?
Myopia is a progressive disorder of the visual system that blurs objects at distance and distorts the physical structure of the eye. The human eye, when affected by myopia, exhibits a steepening of the front surface of the eye, called the cornea, and an elongation in the fundamental structure of the eye, called axial elongation. Myopia has a genetic predisposition, but is driven more by environmental stresses that are found with intense close work such as reading or computer use. Myopia and its associations with retinal detachments and glaucoma, is one of the leading causes of blindness in the United States, United Kingdom, and Canada.
The Development of Myopia
Myopia develops as a result of adaptation. Our visual system copes with increased nearpoint demands by adjusting the way we focus and see. A myopic eye can see better up close than at distance. Being nearsighted reduces the fatigue and stress that can occur due to extended near point viewing. Humans before the Industrial Revolution used their eyes for activities that were predominantly distance viewing. The incidence of myopia in these cultures was frequently less then five percent. Today, in our technological society, myopia affects more then a quarter of the population and in near point occupations, like computer programmers and college students, it can be well over sixty percent.
The Dangers of Myopia
Myopia and its progressive disorders can cause abnormal or adverse ocular changes. Elongation of the axial length of the eye can cause posterior detachments of the Vitreous (Gel like substance at the posterior pole of the eye) which may pull at the Retina ( a Thin membrane at the posterior of the eye containing the rods, cones and axons that become the Optic Nerve) leading to its detachment. Excessive myopia may cause thinning of the retinal pigment epithelium resulting in atrophic changes to the supporting layers of the retina. Lattice degeneration of the peripheral retina, common among high Myopes, can result in detachment of the retina and is often listed as predisposing sign for retinal detachment. This distortion of the Retina can lead to sight threatening detachments and degenerative changes to our more acute central vision through its effect on the Macula( The area of the eye containing the majority of the cone receptors which give 20/20 vision). These changes can lead to " lacquer cracks" (Breaks in membranes right underneath the Macula) or spots in the Macular area (Fuchs’ spot) leading to loss of vision. Patients with myopia are more likely to have most forms of glaucoma, another leading cause of blindness.
Preventative techniques for Myopia containment and prevention are based on the fact that are large percentage of Myopia is acquired rather then being of a hereditary nature.. A core program in Myopia prevention would emphasize early diagnosis of the symptoms of stress in the visual system before their disruptive results are apparent.
Patients should seek Optometrists who perform early preventive eye examinations, which evaluate the patient with the goal of reducing or eliminating stresses that may lead to myopic changes. Preventative treatment may include vision training to improve eye coordination and focusing. Bifocal or multifocal glasses to correct for distance and reduce stress at nearpoint, orthokeratology, and gas permeable contact lenses which reshape the cornea (allowing the visual system to deal with closework demands while reducing potential myopic changes).
Patients should be seen at two years of age and then periodically until treatment is begun. Myopia containment would involve in addition rigid contact lenses to stop axial elongation of the eye combined with a flattening of the corneal curvature non invasively. These measures create a proactive prevention and therapy system that treat the core problems of Myopia and not its resultant symptoms.
What is Orthokeratology?
Orthokeratology is a therapeutic procedure using specialized rigid gas permeable contact lenses to gently reshape the cornea. An analogy for Orthokeratology is "braces for your eyes". Just as the orthodontist put braces on teeth to straighten them, the Orthokeratologist designs custom contact lenses to change the curvature of the cornea. There is no pain and no surgical risk! Once the maximum results are achieved, a retainer lens is used to maintain your vision. Some people use their retainers while they are sleeping, while others use their retainers during the day.
Orthokeratology is used to treat myopia (nearsightedness), astigmatism and, in some cases, hyperopia (farsightedness). A comprehensive examination, corneal topography and a diagnostic lens fitting are usually needed to determine if you are a good candidate for this procedure.
Benefits of Orthokeratology
Improved vision without glasses or contact lenses. Many people, who undergo Orthokeratology, enjoy good functional vision throughout most, if not all, of their waking hours.
No surgical risks. Orthokeratology is a non-surgical procedure and therefore does not have the risks associated with surgery.
Retards the progression of myopia. Clinical and scientific studies have shown that rigid gas permeable contact lenses retard the progression of myopia.
No age restrictions. As long as the patient can properly handle their lenses, there are no age restrictions. This is important for the young progressive Myope. Orthokeratology offers the benefit of improved functional vision without glasses or contact lenses, and the retardation of progressive myopia.
Orthokeratology is reversible. If Orthokeratology therapy is discontinued, for any reason, the cornea and the vision returns to the pretreatment state, without loss of vision.
Risks Associated with Orthokeratology
The risks associated with Orthokeratology are the same as those associated with traditional rigid gas permeable lens wear. Because the patient is monitored very closely during the program, these risks are minimized.
Some Orthokeratology patients may experience transient ghosts, halos or starbursts during the reshaping phase of Orthokeratology. By the time, you enter the retainer phase of Orthokeratology, these side effects should be minimized or eliminated.
While careful monitoring decreases potential risks, the patient plays a major role. Good hygiene while handling the lenses and carefully following your doctor’s instructions will allow for early detection and appropriate treatment of any potential problems.
Frequently Asked Questions
How long will it be before I begin to see improvement in my vision? Many people will see improvement after their first wearing session. Results vary, but most patients will see significant improvement in the first week.
How long will it take to reach maximum results? The rate of change will vary from individual to individual. Typically, maximum results are achieved in the first few weeks to the first few months.
Will I need to wear glasses or contact lenses after Orthokeratology? Most people find that they do not require glasses or contact lenses beyond retainer wear. Retainer lenses must be worn to maintain the changes made to your corneas.
Will I be able to see clearly at near or will I need reading glasses? If you are over 40 and find it more comfortable to read without your glasses or you wear bifocals, you should expect to wear reading glasses after you have entered the retainer phase.
Will I be able to see clearly while wearing my Orthokeratology lenses and/or retainer lenses? Yes, all lenses used in the process are designed to allow you to see clearly in the distance.
Can Orthokeratology be done with soft lenses? No, soft lenses are much too flexible to produce the necessary changes for Orthokeratology.
What can I expect during the reshaping phase of Orthokeratology? Your doctor will prescribe a specific schedule of office visits to allow your progress to be monitored. At these visits, your doctor will evaluate the health of your corneas, assess your vision and corneal shapes and contours. As necessary, changes will be made to your lenses, your wearing schedules, and/or your follow up schedule.
What happens during the retainer phase of Orthokeratology? As long as you are wearing your retainer lenses, it will be necessary for your doctor to evaluate the health of your corneas and the condition of your Orthokeratology lenses at regular intervals. Of course, an Annual Eye Health Examination is a necessary part of your overall care.
Is Orthokeratology covered by insurance? You must consult with your insurance carrier or your benefits office to answer this question.
What qualifications should I look for in an Orthokeratologist? Doctors who have achieved Fellowship in the International Orthokeratology Section (FIOS) of the National Eye Research Foundation have demonstrated, through written and oral evaluation, that they have the necessary skills to perform Orthokeratology.
Will having Orthokeratology disqualify me from any careers? You should be aware that some agencies and organizations have physical or vision requirements for participation. The government, the military, the FAA, airlines, fire departments, police departments, and possibly others, may have or decide to have restrictions on those who have undergone refractive procedures including Orthokeratology. You should investigate and verify the restrictions and requirements prior to beginning Orthokeratology.
Questions you should ask your Doctor.
1. Are you a Fellow of the International Orthokeratology Section of NERF?
2. How many cases have you successfully completed?
3. How long have you been practicing Orthokeratology?
4. What is the fee for Orthokeratology and what is included in this fee?
5. How much does it cost to replace a lost or damaged lens?
6. What is your refund policy?
What are Gas Permeable Contact Lenses?
Gas permeable contact lenses are made of a durable polymerized plastic that "breathes (allows oxygen and carbon dioxide to pass through the molecules)." They are used to treat myopia (nearsightedness), astigmatism, and hyperopia (farsightedness) and provide better vision and corneal health, are easier to clean and handle, last longer than soft lenses, and are custom made for each individual.
The fitting of gas permeable contact lenses requires accurate technical skills to ensure success. In addition, new materials and fabrication processes have made gas permeable lenses more comfortable than ever before. A comprehensive examination, corneal topography, and a diagnostic fitting are usually needed to provide the best possible vision.
Benefits of Gas Permeable Contact Lenses
Gas permeable contact lenses retard the progression of Myopia. Clinical and scientific studies have shown that rigid gas permeable contact lenses retard the axial elongation and corneal steepening associated with progressive myopia.
Gas permeable contact lenses are healthier for your eyes. Gas permeable materials resist deposits and are less likely to harbor bacteria because the material does not contain water. In addition, because of the way they are designed and fit, they flush out trapped particles and bacteria from underneath the lens.
Gas permeable contact lenses correct for corneal astigmatism. The rigid nature of gas permeable materials can correct astigmatism by "smoothing out" the irregularity in the cornea either by reshaping or masking.
Gas permeable contact lenses provide superior optics for sharper, clearer vision. The rigid nature of gas permeable materials provides less flexure and aberration allowing the light rays to pass through the eye without distortion.
Gas permeable contact lenses are easier to handle. Because the material is rigid, the lens does not flip inside out, fold, dehydrate, or tear.
Gas permeable contact lenses are more economical. Because the gas permeable material does not tear, dehydrate, or spoil due to improper care and treatment, weekly or monthly replacement is unnecessary.
There are no age restrictions. As long as the patient can follow the doctor’s instructions, there are no age restrictions.
Risks Associated with Gas Permeable lenses
The risks associated with gas permeable contact lenses are minimal. If you are a first time wearer of gas permeable lenses, you should feel the lens on your eye. This sensation usually lasts anywhere from two weeks to one month. During this adaptation period, you may experience some redness and a general feeling of tired lids. After your initial adaptation period, the lenses will feel more comfortable and the feeling of wearing lenses will disappear.
Proper care and handling of the lenses are critical to reducing the potential risk of infection and/or abrasions. Fortunately, gas permeable materials resist deposits and are less likely to harbor bacteria because the material is not made of water.
Frequently Asked Questions
Can gas permeable contact lenses cause damage to the cornea? Gas permeable contact lenses have a proven track record of providing healthy, clear vision to millions of people. Visiting your Optometrist regularly, following their instructions, and properly caring for your lenses are critical to achieving this goal.
Can wearing gas permeable contact lenses control Myopia? Clinical studies have proven that gas permeable contact lenses retard the corneal steepening and axial elongation associated with progressive myopia.
Can I wear gas permeable contact lenses if I have astigmatism? The distortion of images caused by Astigmatism can be corrected or masked by gas permeable contact lenses.
Can I wear my gas permeable contact lenses while playing sports? Gas permeable contact lenses are the best vision correction option for athletes. They can enhance visual skills like depth perception, peripheral awareness, and eye-hand/eye-foot coordination.· Are gas permeable contact lenses hard to take care of? Gas permeable contact lenses are durable and can last for years. They require daily cleaning and disinfecting.
Are gas permeable lenses covered by insurance? You must consult with your insurance carrier or your benefits office to answer this question.