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Myopia: Should We Treat It Like a Disease?

The research is mounting, but whether the projections hold true in clinical practice is still up for debate. By Julie Poteet, OD

The rising rates of myopia worldwide leave little up for debate—the condition is already considered a public health concern by the World Health Organization (WHO). But what to do about it is less clear. Most agree mitigating the spread of high myopia is a must, but what about low myopes? Will a lifetime correction of just -2.00D or -3.00D really make a difference in the long run for the patient’s ocular health and quality of life? A close look at the numbers and the host of possible long-term effects suggests the answer is yes.

By the Numbers

In 2015, the World Health Organization (WHO), along with the Brien Holden Vision Institute, gathered top myopia researchers from around the world for a global scientific summit on myopia. The researchers noted that in 2010, myopia and high myopia were estimated to affect 27% and 2.8% of the world’s population, respectively. Current models project that by 2050 myopia and high myopia will reach epidemic proportions affecting 53% and 10% of the world’s population, respectively. Based on these projections, the WHO identified the increase in myopia as the number one health threat facing vision worldwide, in part because of its association with myopic macular degeneration and other conditions such as cataracts and glaucoma.

Rates of high myopia are on the rise as well. Although the definition of high myopia varies in the literature from -5.00D to a threshold as high as -8.00D—making analysis challenging—the WHO consensus recommends clinicians and researchers define it as -5.00D of myopia or worse.1 Children are being diagnosed at a much younger age now than in the past, and younger age at onset has been linked to faster progression and increased myopic severity.

A study published in September 2020 also found that the age of onset significantly impacts the risk of high myopia in adulthood.6 Onset at age seven or eight led to a more than 50% risk of high myopia, and the risk drops with each year free of myopia. Patients with myopia onset at nine had a 30% risk, onset at age 10 had a 20% risk and onset at the age of 12 or older only had a 5% risk for progression to high myopia.

Current research suggests myopia rates vary by population as well. Among late teenagers and young adults in Korea, Taiwan and China, for example, the prevalence in now between 84% and 97%.

In the United States, one study found that the prevalence of myopia between -2.00D and -7.90D nearly doubled from 11.4% in 1971-1972 to 22.4% between 1999 and 2004. The prevalence of high myopia in the same study, defined as more than -8.00D, increased eightfold, 0.2% to 1.6%, during the same period.

An Environmental Issue

Although myopia develops as a complex interaction between environmental and genetic factors, environmental changes are believed to be the primary drivers behind the current myopia epidemic. Emmetropization, a visually guided process, depends on environmental exposures as a child. Myopia progression is due to elongation of the axial length, which is primarily due to the elongation of the vitreous chamber of the eye. Optical blur produced by a lag of accommodation or the eye’s response to accommodation may be what drives excessive growth.

However, the visual processes at play with myopia development remain unclear, and research has yet to solidify a strong correlation with near work and the onset or progression of myopia. In fact, a recent study suggests the lag of accommodation develops concomitantly with, not prior to, myopia. The same researchers propose the involvement of the ON and OFF pathways in reading and myopia. While the natural environment is largely balanced between ON and OFF signaling, the team found reading dark text on a light background overstimulates the OFF channels and leads to reduced choroidal thickness within an hour. The opposite is true with light text on a dark background, which overstimulates the ON channels and increases choroidal thickness in one hour.

Risk factors for myopia development include age, family history, race (Asian>Caucasian>Black), cycloplegic refraction at six years of age (<+0.75D increases risk of myopia later in life), near work and less time outdoors. A new study now suggests other environmental factors may increase the risk of myopia, such as the use of LED lighting when doing homework, dim light while performing near tasks, fewer sleeping hours, a consistent reading distance less than 25cm and living in an urban setting.

Smartphone use was recently implicated as a possible risk factor, as school-aged children with myopia appear to use about twice as much data as their normal vision counterparts. Another study suggests less than three hours a week of physical activity and more than six hours a day of screen time can approximately double the risk of a teen developing or worsening myopia.

Still, a literature review and meta-analysis published January 2020 found no significant association between screen time and myopia. The researchers speculate that reduced time outdoors, not increased screen time, might be more to blame for the myopia risk. The authors noted that myopia prevalence increased primarily with increasing education in urban Asia a few decades ago, not recently alongside increasing screen time. Yet another team found viewing electronic displays didn’t cause study subjects any more hyperopic defocus than the defocus caused by other stimuli.

Visual Impact

Worsening myopia comes with a number of drawbacks, all of which are proportional to the degree of myopia present, highlighting the importance of myopia control, even for low myopes.

Cost. The disease is associated with high financial costs to an individual, with one study finding a lifetime cost of as much as $17,020 for those who have myopia for 80 years.19 The mean cost per individual was approximately $709 per person per year and, not surprisingly, costs increased the earlier patients began wearing glasses. The Singaporean study noted the costs were driven by spectacles, contact lenses and optometry services, culminating in a total cost of approximately $755 million per year in Singapore.

Impaired vision. Even if myopic patients are correctable to 20/20, their vision impairment can restrict their vocational options and provide them with poorer quality of life.
One study found patient with pathologic myopia experienced reduced quality of life and functional status in daily living compared with controls as a result of handicap, disability and lack of support. Even patients using vision correction experienced lower quality of life than their emmetropic counterparts, the study found, and the average decrease in quality of life was -7.1% for LASIK patients, -13.0% for those using orthokeratology, -15.8% for spectacle wearers and -17.3% for soft contact lens wearers.

Vision-threatening conditions

These are typically the result of excessive elongation of the eye, which leads to degenerative retinal and choroidal changes. Globally, high myopia is ranked second behind cataracts as the leading cause of correctable visual impairment, with 10% of all myopes having 6.00D of refractive error or worse, according to a review. Myopic degeneration is the leading cause of blindness in Japan and the second leading cause of vision impairment in China and Denmark.

Myopic maculopathy is the most significant myopia-related cause of irreversible vision loss. Research suggests as many as 10% of pathologic myopia patients will develop this complication, of whom 30% will have a bilateral presentation. It is characterized by stretched blood vessels, peripapillary atrophy, posterior staphyloma, lacquer cracks in Bruch’s membrane, geographic atrophy of the retinal pigment epithelium and choroid, subretinal hemorrhages and choroidal neovascularization.

One meta-analysis estimates that 10 million people globally had myopic maculopathy in 2015, of whom 3.3 million were blind. The researchers estimate that by 2050 visual impairment will grow to 55.7 million (one in 175), 18.5 million of whom will be blind. The risk of myopic maculopathy and its impact on public health are not limited to high myopes. Significant disease associations exist even at low levels of myopia. For example, patients with less than -5.00D of myopia contributed to 43% of the cases of myopic maculopathy in the Australian Blue Mountains Eye Study. There is no evidence of a safe threshold level of myopia for any of the known ocular diseases linked to myopia, including myopic maculopathy.

A recent meta-analysis evaluated all observational studies performed between 1988 and 2019 related to myopia and found the condition is a risk factor for retinal detachments, primary open-angle glaucoma (POAG) and early and posterior subcapsular cataracts. The team found a prevalence of myopic macular degeneration of only 0.1% to 7% in patients with low myopia, but in as many as 65% of high myopes. While only a handful of studies investigate retinal detachment based on refractive error, the pooled analysis suggests in increased odds ratio of 3.45 for patients with any level of myopia, but as high as 12.62 for high myopes. The risk of cataract and POAG increased for all patients with myopia as well, and for high myopes in particular. Overall, the researchers found myopic patients had:

  • 100-fold higher risk of myopic macular degeneration
  • Three-fold higher risk of retinal detachment
  • Three-fold higher risk of posterior subcapsular cataract
  • 1.59-times the risk of POAG Based on this analysis, one in three high myopes is at risk of bilateral low vision with age.

Why Control Matters

In a recent review, researchers used data from five population-based studies of the prevalence of myopic maculopathy to show that a 1.00D myopic increase was associated with a 67% increased prevalence of myopic maculopathy. The researchers further suggest that slowing myopia by 1.00D—regardless of baseline myopia—should reduce the risk of myopic maculopathy by 40%.

According to myopia experts at the WHO Myopia World Summit, reducing the rate of myopia progression by 50% could reduce the prevalence of high myopia by up to 90%.1 And with a projected global prevalence rate of high myopia of 9.7% (924 million people) by 2050, the potential benefits are significant.

Another study suggests that if a child could be kept from progressing from -1.00D to -3.00D, the risk of myopic maculopathy would decrease four- to five-fold, retinal detachment by three-fold and posterior subcapsular cataract by 1.5-fold.

In another study published in April 2020, researchers analyzed 4,257 patients with retinal detachments and 39,181 controls from the UK Biobank cohort. They found that for each 6.00D increase in myopia, retinal detachment increased 7.2-fold. The study authors concluded that their results add weight to existing evidence suggesting that myopia control efforts may help prevent retinal detachments.

Maintaining a patient at -1.50D instead of progressing to -5.00D or -6.00D is not only a matter of reducing the risk of axial elongation; it also significantly affects quality of life. Consider the patient who never progresses beyond -1.50D of myopia and can still drive without glasses or contacts. Keeping a patient functional without glasses is important, and a -1.50D myope is typically better able to navigate their surroundings than a -5.00D or -6.00D myope. Consider the following scenarios: a patient loses their glasses during a car accident, or a hiker loses their glasses and has to navigate without them. Every diopter matters not only in visual acuity but also in their ability to function at different levels of lighting.

Researchers recently looked at the relationship between myopia severity and macular retinal thickness as it pertains to visual performance and found that visual acuity worsened progressively with dimmer lighting and higher myopia. The authors concluded that visual performance under photopic, mesopic and simulated night vision (with goggles) lighting conditions are influenced by both refractive error and retinal thickness. Thus, because visual acuity worsens progressively with dimmer lighting, going from -8.00D to -9.00D may not seem like a large jump as far as visual acuity, but the quality of vision will differ significantly based on lighting.

Research on myopia is growing quickly, now showing that if Caucasian children diagnosed with myopia progress, on average, at a rate of -0.50D per year, then a six-year-old with -1.00D of myopia will be a -6.00D to -7.00D myope by the time they graduate from high school. Asian children progress even more rapidly on an average of -0.87D per year. Of note: estimated progression rates are dependent on baseline age with decreasing progression rates as age increases. Intervening at age six could mean the difference between a final prescription of -2.00D to -3.00D compared with -6.00D or -7.00D, or even more depending on the child. One study shows reducing progression by 33% will keep 73% of myopic children below -5.00D—a threshold linked with an increased risk of choroidal neovascularization, retinal detachment, glaucoma and cataract.

Available options to control the rate of myopia progression include low-dose atropine therapy, multifocal soft contact lenses, orthokeratology and, in some countries, bifocal or multifocal eyeglasses. The Brien Holden Vision Institute provides a free myopia calculator that can help clinicians estimate the annual progression of myopia, showing the approximate refractive error that will result with and without myopia management. Clinicians can choose the management method, and based on probability and predicted efficacy of treatment, the calculator provides the predicted amount of myopia with and without treatment. This is calculated using the patient’s age, refractive error at presentation and ethnicity.

A Group Effort

Convincing a patient and their parents of the need to intervene now to prevent a future risk takes strong conviction on the practitioner’s part. If clinicians do not advocate for the prevention of myopic progression, it will be almost impossible to prevent future vision loss from the increasing rates of myopia. Optometrists must take an interest, or patients will not.

Key points for patient education:

  • Myopia rates are increasing at epidemic proportions, which is environmentally related
  • Every incremental increase in myopia is associated with a greater risk of permanent vision loss.
  • By being proactive, rather than reactive we have the opportunity to reduce myopia progression, which can improve quality of life and protect against disease risks.
  • Slowing myopia by 1.00D should reduce the risk of myopic maculopathy by 40%.

With more than half of the world’s population projected to be myopic by 2050, it is imperative that we heed the warning by the WHO and other proponents of myopia control—and treat myopia as a disease. This could make a significant difference in the lives of those with myopia, particularly those at higher risk of progression, including those of Asian descent, those with a higher refractive error at a young age and those who have myopic parents.

Dr. Poteet practices at TrueVision EyeCare in Acworth, GA, where she specializes in pediatric vision care. She currently serves as the president of the Ocular Wellness and Nutrition Society. She has a Master of Science in Human Nutrition and is a certified nutrition specialist.

Attribution: ‘Originally published in Review of Optometry, October 2020.’

Please contact TrueVision Eyecare in Acworth at 770-529-7789 with any further questions, or to schedule an eye doctor’s appointment.

12 Tips for Optimal Eye Health

Expert Eye Care| Optometrist in Acworth | TrueVision Eyecare

Good Eye Care Habits & Hygiene

By practicing good eye care habits and hygiene, you can prevent many vision problems from occurring. Eye problems and the risks associated with vision loss only grow as you age. By neglecting eye care, you place yourself at a higher risk of suffering from cataracts, macular degeneration, glaucoma, diabetic retinopathy, and low vision.

So make sure you maintain great eye health by following these 12 tips for optimal eye health.

1. Avoid rubbing your eyes

Itchy eyes can be a hallmark symptom of allergies, and though rubbing may bring temporary relief, it ultimately increases swelling and worsens the itch. If you wear contact lenses, rubbing your eyes can also dislodge or even break a lens, causing the lens to get lost or scratch the cornea. Plus, eye rubbing can lead to eye infections, since our hands are typically covered with a host of germs.

2. Regularly wash your hands

Conjunctivitis (pink eye) is often caused by germs and bacteria carried to your eyes by unclean hands. Frequently washing your hands with soap and warm water helps keep bacteria away and prevents eye contamination. Prior to inserting or removing contact lenses, make sure to wash your hands with mild soap and dry them using a lint-free towel.

3. Beware of UV rays

By exposing yourself to sunlight and UV rays, you increase the risk of developing macular degeneration and corneal sunburn. Beyond just adding some style and zest to your look, sunglasses should protect your eyes from dangerous UV rays. Speak to your optometrist about the different options available for people who wear prescription eyeglasses or contact lenses too, to keep your eyes safe in the sun.

4. Stay hydrated

Staying hydrated is crucial for your body’s overall health and wellbeing — and that includes your eyes. Among other complications, if you don’t have enough fluid in your body, it impacts tear production and can cause dry eyes and irritation. Drink up!

5. Don’t smoke cigarettes

Need some extra motivation to quit smoking?

Smokers are more prone to developing age-related macular degeneration, cataracts, and other eye conditions. Cigarette smoking can also destroy optic nerves, which can adversely affect your vision over time. So think twice before you light up, and speak to your doctor about getting help to quit.

6. Eat a healthy diet

Eat plenty of fruits and vegetables to ensure that your diet is rich in antioxidants, such as Vitamins A and C. These can be found in leafy greens (your mom was right about spinach!), orange vegetables (think, carrots and sweet potato) and citrus fruit. Furthermore, fatty fish like salmon contain essential omega-3 fatty acids which also promote excellent eye health.

7. Keep a healthy distance from screens

Nip digital eye strain in the bud by positioning your computer monitor about an arm’s length away from the eyes and 20 degrees below eye level. Ideally, work in a room with enough diffused lighting to reduce stress on your eyes from the computer light.

8. Remember the 20-20-20 rule

Speaking of computers, have you heard of the 20-20-20 rule? When using digital devices, rest your eyes every 20 minutes by looking 20 feet away for 20 continuous seconds.

Once you’re at it, blink 20 times in succession to prevent dry eyes, and make it a habit to rise from your seat and take 20 steps to promote good posture and blood circulation, which helps your vision too.

9. Be careful with eye make-up

Make sure that your eye shadow, mascara, and eyeliner don’t cause your eyes an allergic reaction. Get in the habit of removing your make-up before going to sleep in order to avoid bacterial build-up from residual make-up left in the eye area. And, from time to time, clean your make-up brushes, especially those used to apply cosmetics around the eye area.

10. Sleep is golden

Just as with the rest of your body, your eyes need a break. So make sure that you get sufficient shut-eye (8 hours) each night to keep your eyes revitalized and healthy.

11. Wear protective eyewear

Whatever you do, make sure your eyes are well-protected. If you’re swimming, wear goggles to prevent chlorine from entering your eyes. If you’re gardening or engaged in a DIY project at home, wear safety glasses to keep dust particles and bacteria at bay and prevent eye injuries. Ask your local eye doctor about protective eyewear for sports and other activities.

12. Regularly visit your eye doctor

Don’t underestimate the importance of getting a routine eye exam, whether you need an updated prescription or not. Even if you can see well today, a comprehensive eye exam can pick up early signs of eye diseases and conditions before symptoms become noticeable, such as glaucoma, diabetes, retinal holes which could lead to retinal detachment, and cancers like melanoma. Early detection and management can prevent further complications and serious vision loss down the line.

Only an eye doctor has the required knowledge, experience, tools and techniques to determine whether you have these or other eye conditions.

It is recommended that everyone gets a comprehensive eye exam once a year (or at least every two years). Children, whose eyes are rapidly developing, and people at higher risk for developing eye problems such as diabetics and older people, need to undergo eye exams even more frequently: at the minimum, yearly.

During the evaluation, the eye doctor will check for things like:

  • Farsightedness, nearsightedness, astigmatism and/or presbyopia
  • Eye coordination
  • Optic nerve and eye pressure tests to spot glaucoma

It’s also important to be on the look-out for any changes in your vision. If you experience hazy or double vision, worsening eyesight, red eyes, eye pain, swelling or floaters, contact Dr. Mays.

Incorporate these tips and habits into your lifestyle to maintain healthy eyes and a high quality of life. TrueVision Eyecare offers comprehensive eye exams in Acworth, Georgia, and will be happy to answer any questions you may have about ways to maintain healthy vision.

Exercise and Your Eye Health

TrueVision Eyecare - Local Sunglasses Shop and Sports Safety glasses center in Acworth, Georgia

Regular exercise is an essential component of overall health and wellness. It is proven that exercise reduces sickness and disease; it increases strength, immunity, and mental health; and it also helps regulate bodily functions and maintain a healthy weight. Research shows that exercise can lower our risk of chronic conditions such as high blood pressure, heart disease, diabetes, diabetic retinopathy and diabetic macular edema, as well as other eye diseases such as glaucoma, cataracts and wet age-related macular degeneration (AMD).

Whereas, a sedentary lifestyle increases the risk of these diseases and of vision loss, studies show that even moderate exercise at least three times a week can improve the prognosis of the above-mentioned chronic illnesses and reduce the risks of developing vision threatening eye diseases.

Inactivity is an even higher risk factor if you have other co-factors for developing eye diseases, including: a family history, previous eye injury or surgery, diabetes, high blood pressure or very high myopia. A combination of healthy lifestyle habits which include regular exercise and a nutritious diet and tending to your mental and emotional well-being can reduce these risks significantly.

Tips for Incorporating Physical Activity Into Your Day

  • Make it a priority. Schedule your exercise time into your day as if it is a non-negotiable appointment. Find the time of day that works best – for some that is early morning and for others late at night. Work your way up to a half hour at least three times a week.
  • Be realistic. You don’t need to become a fitness expert to experience the benefits of exercise. Walking, yoga, swimming, even dancing around the house are all options for staying fit. Find a type of exercise that you love so you will enjoy working this habit into your life.
  • Just move. Find ways to move your body throughout your day. Park your car a little further away from the mall entrance, take the stairs instead of the elevator or walk or bike to work. Remember, every little bit of movement helps.
  • Find something you enjoy. Often finding the right exercise is a good stress reliever, and reducing stress will also reduce risk of many chronic diseases.
  • It’s never too late. Exercise for the elderly can be a challenge especially during the cold winter months, when many seniors can’t get out of the house due to the weather. Even walking up and down the stairs in the house or following an exercise video can be helpful to keep from being sedentary.

Where can you find Eye Saftey Protection & Prevention services in Acworth, Georgia?
Call TrueVision Eyecare on 770-282-8487 in Acworth, GA to schedule an eye exam with our optometrist.

If you are exercising outdoors or playing contact sports, make sure to protect your eyes with sunglasses or sports safety glasses to ensure your eye health and safety.

Regular exercise can significantly decrease your risks of certain eye conditions but you still have to ensure that you visit your eye doctor for regular exams. Schedule a comprehensive eye exam every year to ensure your vision and your eyes are healthy and to catch any possible problems as early as possible.

Eye health and disease prevention are just two of the many health and wellness benefits you gift yourself when you make exercise a regular part of your lifestyle. Speak to your doctor if you have any health issues that need to be considered. At any age or level of physical fitness, you can find some form of exercise that works for you.

Call TrueVision Eyecare on 770-282-8487 in Acworth, GA to schedule an eye exam with our optometrist.


Alternatively book an appointment online here CLICK FOR AN APPOINTMENT

Is Too Much Screen Time Dangerous For Your Kids?

Keeping your children safe from damaging their eyes

TrueVision Eyecare - Local Eye Care Clinic and Blue light specialist in Acworth, Georgia

Whether it is homework, email, gaming, chatting with friends, searching the web or watching Youtube, kids these days seem to have an endless number of reasons to be glued to a screen. Many parents out there are wondering how bad this can be for their kids and whether they should be limiting screen time.

There are certainly benefits to allowing your kids to use digital devices, whether it is educational, social or providing a needed break. However, studies show that excessive screen time can have behavioral consequences such as irritability, moodiness, inability to concentrate, poor behavior, and other issues as well. Too much screen time is also linked to dry eyes and meibomian gland disorders (likely due to a decreased blink rate when using devices), as well as eye strain and irritation, headaches, back or neck and shoulder pain, and sleep disturbances. Some of these computer vision syndrome symptoms are attributed to blue light that is emitted from the screens of digital devices.

What Is Blue light?

Blue light is a short wavelength, high-energy visible light that is emitted by digital screens, LED lights and the sun. Studies suggest that exposure to some waves of blue light over extended periods of time may be harmful to the light-sensitive cells of the retina at the back of the eye. When these cells are damaged, vision loss can occur. Research indicates that extreme blue light exposure could lead to macular degeneration or other serious eye diseases that can cause vision loss and blindness. Studies show that blue light also interferes with the regulation of the the body’s circadian rhythm which can have a disruptive impact on the body’s sleep cycle. Lack of quality sleep can lead to serious health consequences as well.

All this is leading to an increase in the amount of eye strain eye care professionals are reporting. For instance, VSP Global’s survey of the group’s providers found that 82 percent reported an increase in patients experiencing eye strain and other effects of blue light exposure. American Optometric Association

Beyond these studies, the long term effects of blue light exposure from digital devices are not yet known since this is really the first generation in which people are using digital devices to such an extent. While it may take years to fully understand the impact of excessive screen time on our eyes and overall health, it is probably worth limiting it due to these preliminary findings and the risks it may pose. This is especially true for young children and the elderly, who are particularly susceptible to blue light exposure.

What Can Be Done To Prevent or Treat Myopia in Acworth, Georgia

How can I protect my kids Eyes From Blue Light

  • The first step in proper eye protection is abstaining from excessive exposure by limiting the amount of time spent using a computer, smart phone or tablet – especially at night, to avoid interfering with sleep. Many pediatricians even recommend zero screen time for children under two.
  • The next step would be to reduce the amount of blue light entering the eyes by using blue light blocking glasses or coatings that deflect the light away from the eyes. There are also apps and screen filters that you can add to your devices to reduce the amount of blue light being projected from the screen. Speak to your eye doctor about steps you can take to reduce blue light exposure from digital devices.
  • As a side note, the sun is an even greater source of blue light so it is essential to protect your child’s eyes with UV and blue light blocking sunglasses any time your child goes outside – even on overcast days.
  • The eyes of children under 18 are particularly susceptible to damage from environmental exposure as they have transparent crystalline lenses that are more susceptible to both UV and blue light rays. While the effects (such as increased risk of age-related macular degeneration) may not be seen for decades later, it’s worth it to do what you can now to prevent future damage and risk for vision loss.

Call TrueVision Eyecare on 770-282-8487 in Acworth, GA to schedule an eye exam with our optometrist.


Alternatively book an appointment online here CLICK FOR AN APPOINTMENT

The Dangers of An Online Eye Test

laptop with eye

An online eye test may seem like a convenient way to check your vision or get an eyeglass prescription but beware, these tests aren’t all they are chocked up to be. In fact, they may even be dangerous.

What is an online eye test really testing?

An online eye test is actually not an eye test at all but just a vision or sight test – and a partial test at that. It is designed to measure your visual acuity and refractive error (nearsightedness, farsightedness or astigmatism) and to determine an eyeglass prescription – which is the lens power needed to correct the refractive error in your vision.

Given that there is no one with medical training actually performing or checking the accuracy of the test, it is questionable how well the exam does even this. In fact, when an eye doctor does a refraction for glasses or contact lenses it also involves some judgement on the doctor’s part. The eye doctor will often adjust the prescription slightly based on the patient’s age, occupation or hobbies. The doctor may prescribe a prism in the lenses to help with binocularity and to prevent double vision in those who have deviations of the eye. There is no way an online exam can do any of this.

Further, a refraction is only one very small part of an eye exam and if it takes the place of a regular comprehensive eye exam by an eye doctor, you put your eyes and vision at serious risk.

A Comprehensive Eye Exam – Where Online Tests Fail

Even if the eyes see clearly and you have 20/20 vision, there may still be vision problems or eye disease present even without pain, blurred vision or other symptoms. What the online eye test fails to measure is your complete visual health and capacity (beyond just visual acuity), the curvature of the eye (which is needed for accurate lens prescriptions- especially for contact lenses) and an assessment of the health of the eye itself.

Just as we need regular medical and dental checkups as a part of preventative health care to prevent disease and maintain our health, we also need regular eye exams. A vision test does not suffice. A comprehensive eye exam will examine much more than just how well you see. It will also check for visual processing, color vision, depth perception and proper eye movement. It will measure your eye pressure, examine the back of your eye and look for early signs of eye disease or conditions such as glaucoma, macular degeneration, diabetes, tumors and high blood pressure – many of which threaten your eyes and vision if not caught early.

If you do have some vision loss, the doctor will be able to determine if there is any serious underlying problem that is causing the disturbance in your vision. If you don’t have symptoms that doesn’t mean there isn’t a problem. Many serious eye conditions develop gradually without any symptoms. Some eye diseases do not affect the macula, and therefore you may still have good vision even though there is a problem (such as glaucoma, early dry macular degeneration, early cataract, diabetes, blood pressure and even tumors). Many of these conditions threaten the eyes and even general health if not caught early and when undetected they can cause permanent and irreversible damage to your vision

Eye exams are the best way to detect these early and treat them before they develop into serious eye problems.

Whether online vision tests are inaccurate, misleading or simply insufficient, they can fail to provide essential information and can delay or prevent vision saving treatments. Additionally, you could be walking around with the wrong vision prescription which can cause unnecessary eye strain, headaches and difficulty.

Will an Online Eye Test Really Save you Money?

No. Besides the fact that most eye exams are covered by insurance, the eye exam you are getting from an eye doctor is much more thorough and comprehensive than an online eye test, so you are not comparing apples to apples. The eye doctor’s exam uses real equipment and performs a complete and professional evaluation of your vision and eye health. There is simply no comparing this to a self administered test on a computer screen.

An online eye test may be touted as a time and money saving convenience however, that is hardly the case. An eye exam is a medical procedure that requires training, precision, and proper equipment. Anything less can put your eyes and vision at serious risk.


Eye Dangers in the Dorm – Eye Health for College Students

university guy slide

It’s almost back to school time for college students and whether this is your first time away from home or you are already a pro, you want to be prepared with as much knowledge as possible to live safely on your own. This knowledge includes eye and vision safety, as failing to take care of your eyes today could cause damage to your eyes and vision now and in the future.

So put down your text books for a second and learn these four simple lessons about protecting your precious eyes:

Blue Light Protection

College students spend a LOT of time in front of screens. From each class, homework assignment, and research project, to texting, tinder, netflix and gaming – life is largely digital. This comes with a slew of potential side effects known as computer vision syndrome, including sore and tired eyes, headaches, neck, shoulder and back pain, dry eyes and blurred vision, largely due to the effect of the blue light emitted from the screens. Research shows that blue light can also impact your sleep quality and may possibly be connected to the development of retinal damage and macular degeneration later in life.

There are a few ways to protect your eyes and vision from blue light and computer vision syndrome:

  1. Use computer glasses or blue-light blocking coated lenses or contact lenses when working on a screen for long periods of time. These lenses are made to allow optimal visual comfort for the distance and unique pixelation of working on a computer or mobile screen, by reducing glare and eye strain. They also block potentially harmful blue-light radiation from entering your eyes.
  2. Prescription glasses may be considered as well. Many students who never needed glasses previously experience eyestrain with extensive hours studying in university. A minor prescription can make a big difference in reducing eye fatigue and helping to improve concentration.
  3. Implement the 20-20-20 rule by taking a break every 20 minutes to look at something 20 feet away for 20 seconds. This allows your eyes to pause from the intensity of the computer screen.
  4. Depending on your environment, eye drops prescribed from the eye doctor may be helpful. Your blink rate often goes down substantially when you are concentrating on reading or computer work, which can cause dry eyes. Using eye drops and remembering to blink frequently can help reduce these uncomfortable symptoms.
  5. Install bluelight filters on your digital devices to reduce the amount of blue light exposure. There are a number of free apps available to download on your phone or computer.

Proper Contact Lens Use

Many college students opt for contact lenses as they are convenient and great for the appearance, but they come along with responsibility. The busy days and late nights can sometimes make contact lens care difficult so make sure to plan ahead. If you wear contact lenses you need to make sure that you always get them from an authorized lens distributor and that you follow your eye doctor’s instructions for proper care.

Always follow the wearing schedule and never sleep in lenses that are not designed for extended wear. Clean and disinfect as needed, and don’t rinse them with anything other than contact lens solution. Failing to follow the proper use and hygiene for contact lenses can result in irritation, infections and even corneal scarring which can result in vision loss.

One-day disposable lenses can be a great option especially for college students as they offer ultimate convenience (no cleaning and storing) and optimal eye health.

Further, if you enjoy wearing contact lenses, then remember to get a proper fit from your eye doctor. Many “exclusive” contact lenses available online may actually be poorly fit and made from inferior materials. One size does not fit all.

UV Protection

Ultraviolet rays from the sun are known to cause long term eye damage and lead to vision threatening eye conditions such as macular degeneration and cataracts. Additionally in extreme cases of unprotected UV exposure you can get sunburned eyes, known as photokeratitis, which can cause a gritty, dry feeling, burning, swelling, light sensitivity, vision changes and sometimes serious pain. These symptoms typically go away within a day or two. Wearing 100% UV reflective sunglasses whenever you are outside – rain or shine – is a first step to eye protection. A large brimmed hat to protect the eyes from exposure from the top and sides is also a recommended addition for sunny days.

Get a regular eye exam

To start off college with the right foot forward, it’s recommended to get a comprehensive eye exam prior to the start of the the school year, especially if you haven’t had one recently. This way you can ensure that your eyes and vision are in top shape and, if you wear glasses, that your prescription is still accurate. The last thing you want to worry about when getting adjusted to college is problems with your eyes and vision.

It’s also recommended for students that are going away to another city to get a recommendation for a local eye doctor in case of an emergency. Most eye doctors know of colleagues located in other cities who they could recommend.

Just remember to think about your eyes because the better you take care of them now, the healthier eyes and vision you will have down the line.

How-to Guide for Buying Sunglasses

Male Sunglasses and Tie

Sure, sunglasses might add the final touches to your chic ensemble, but the real reason to purchase your shades is to protect your eyes from the sun. Not only does glare from the sun make it difficult to see, but the UV rays it reflects can cause permanent damage to your eyes and vision. You want to make sure your sunglasses offer optimal protection, fit, comfort and of course, the best possible vision. Here are some things to consider when purchasing your next pair.

UV Protection

There are two types of UV radiation, UVA and UVB. UVA rays are less intense yet more prevalent than UVB rays, making up 95% of the UV radiation that reaches the surface of the Earth. They have been linked to skin cancer, aging and the development of cataracts. UVB rays are very dangerous to the eyes and are the primary cause of sunburns and cancer. While they are dangerous year round, these rays are more intense during the summer months, especially mid-day between around ten in the morning and four in the afternoon. UVB rays also reflect off of snow, water, sand and concrete.

The damage caused by UV rays is irreversible and cumulative, building up over a long period of time. This is why it is important to start wearing sunglasses when you are young (also because your eyes are more sensitive at a younger age). You want to make sure your sunglasses block out 100% of UV rays. This is the most important factor to consider when purchasing your sunglasses.

Additionally, in certain circumstances of intense UV exposure, a condition called keratitis can occur, which is essentially a sunburn on the eye. Symptoms often occur hours after sun exposure and can include temporary vision loss and severe pain.

Sunglass Lens Options

Once you are certain your sunglass lenses have the requisite UV protection, you can begin to consider other lens possibilities. Here are some other lens options to consider:

Polarized Lenses:

Reduce glare from light reflecting off glass, water, snow, sand or pavement. You should consider polarized lenses if you participate in water or snow sports such as fishing, boating or skiing as the water and snow can create a strong glare. They are also great for comfort while driving by reducing glare and to enhance vision when on the road.

Tinted Lenses:

Certain lens tints enable you to see better or more comfortably under certain circumstances but you have to be careful. Lens tints can distort or reduce vision and some can even harm your vision by increasing your pupil size which leads to an increase of UV radiation penetrating the eye. Look for lenses with a medium tint that keep your eyes comfortable and do not have a negative impact on your vision. Your optometrists’ office can often make specific tint recommendations depending on your lifestyle or particularly activities (ex. golfing vs fishing) and the health of your eyes (for example, cataracts tend to cause more glare).

Photochromic Lenses:

Automatically darken when exposed to UV light. Photochromic lenses are a great option for individuals that wear prescription eyeglasses: one pair can serve you both indoors and outdoors. As soon as you step outside, the lenses will darken, and they’ll reverse when you go back indoors.

Lens Materials

There are also a few options when it comes to lens materials, such as plastics – including polycarbonate or acetate; trivex – which is a polymer material; or glass. The type of lens will determine the durability, clarity of vision and price of your lenses, so you should consider the factors that are most important for you and try out a few options to see how they feel.

Sunwear Frames

Frame Size

The size of your sunglass frame is important for both comfort and protection. Your frames should fit according to your face size and provide ample coverage for your eyes. When you try on your frames, make sure they cover your eyes and feel comfortable around the bridge and temples. Also check that they don’t slip off when you move your head down toward the floor.

Frame Materials

Frames can be manufactured from a number of materials and, these days, frame companies are constantly innovating to come up with new and improved options. These materials vary in strength, flexibility, weight, comfort and price. You need to choose a frame material that is comfortable, safe, and functional and that suits your lifestyle and your fashion style.

Making the Purchase

When purchasing sunglasses, keep in mind that your vision insurance may help to cover the costs when purchased at an optometry office rather than at a sports or recreation store. Check with your insurance and your local optical to find out about any discounts or coverage. Another advantage of purchasing from an optometrist’s optical is that the optician can help you to find the perfect pair to suit your eye and vision needs, as well as your lifestyle and fashion preferences.

The good news about choosing the right pair of sunglasses is that there are ample brands, colors, styles and materials to choose from. So when it comes to your shades, don’t settle for less than optimal protection, fit and comfort for your eyes.

Signs of Eye and Vision Problems in Infants

Dad Hugging Baby Girl

Infant Eyesight

Despite nine months of growth in utero, babies are not born with fully developed eyes and vision – just like they can’t walk or talk yet. Over the first few months of life, their visual systems continue to progress, stimulated by their surroundings.

Babies will develop the ability to track objects, focus their eyes, and move them like a team. Their visual acuity will improve and they will gradually be able to see more colors. They will also form the neural connections that will allow them to process what they see, to understand and interact with the world around them.

Healthy eyes and good vision are necessary for proper and timely progress; ocular or visual problems can lead to developmental delays.

So how do you know if your infant is developing normally? What can you do to ensure your baby’s eye health and vision are on track? While infant eye problems are not common here are some steps you can take to ensure your child’s eyes are healthy.

#1 Schedule a six month check-up.

It is recommended to get the first professional comprehensive eye and vision exam for your child between six and 12 months of age.

Your optometrist should check for the following skills at the 6-month checkup:

  • Visual acuity (nearsightedness, farsightedness or astigmatism)
  • Eye muscle and movement capabilities
  • Eye health

If you have any concerns prior to six months, don’t hesitate to take your baby for an exam earlier.

#2 Engage in visually stimulating play.

Incorporating visually stimulating play for your child will help develop visual processes like eye tracking and eye teaming.

A baby’s initial focusing distance is 20-30 cm, so to nurture healthy vision skills, keep high contrast “reach and touch” toys within this distance. Alternate right and left sides with each feeding, and provide toys that encourage tracking of moving objects to foster eye-hand coordination and depth perception.

Pediatricians in North America recommend that NO screen time be allowed under the age of 2, as many forms of development may be delayed from premature use of digital devices.

#3 Be alert to eye and vision problems.

Keep an eye out for indications of an eye health problem, and contact an eye doctor to discuss any concerns you may have. Some symptoms to pay attention to include:

  • Red eyes or eyelids, which may or may not be accompanied by discharge and crusty lids. This may indicate an eye infection that can be very contagious and may require medication.
  • Excessive eye watering or tearing. This may be caused by a problem with the tear ducts, such as a blockage.
  • Extreme light sensitivity. While some light sensitivity is normal, significant sensitivity to light can be a sign of disease or elevated eye pressure.
  • Eye “jiggling” or bouncing. This suggests a problem with the muscle control of the eyes.
  • Eye turn. Whether it is an eye that seems to cross in or a “lazy eye” that turns out, this is often associated with a refractive error or eye muscle issues that could require treatment such as eyeglasses, vision therapy, patching or surgery.
  • White pupil. This can be a sign of a number of diseases, including cancer. If you see this have it checked out immediately.

Since your infant’s eyes are still maturing, any issues that are found can likely be corrected with proper care and treatment. The important thing is to find a pediatric eye care provider that you trust because you will want to regularly check the health of your child’s eyes to ensure proper learning and development throughout infancy and beyond.

Trouble Seeing at Night? All About Night Blindness

night driving blues and reds

At this time of year when the sun sets early, many people are affected by night blindness. Night blindness or nyctalopia refers to difficulty seeing at night or in poor or dim lighting situations. It can be caused by a number of underlying conditions, sometimes completely benign and sometimes as a symptom of a more serious eye disease. So, if you are experiencing trouble seeing in low light, especially if it is a sudden onset of the condition, it is worth having it checked out by your eye doctor.

Signs of Night Blindness

The main indication of night blindness is difficulty seeing well in dark or dim lighting, especially when transitioning from a brighter to a lower light environment, like walking from outside into a dimly lit room. Many experience difficulty driving at night, particularly with the glare of the streetlights or the headlights from oncoming traffic.

Causes of Night Blindness

Night blindness is a condition that can be present from birth, or caused by a disease, injury or even a vitamin deficiency. In order to treat the condition, your eye doctor will need to determine the cause. Here are some of the common causes:

  • Nearsightedness (myopia) – many people with nearsightedness (or difficulty seeing objects in the distance) experience some degree of night blindness, especially when driving.
  • Retinitis Pigmentosa – a genetic condition in which the pigmented cells in the retina break down causing a loss of peripheral vision and night blindness.
  • Cataracts – a clouding of the natural lens of the eye causing vision loss.
  • Glaucoma – a group of diseases that involve damage to the optic nerve and subsequent vision loss.
  • Vitamin A Deficiency – vitamin A or retinol is found in greens (kale, spinach, collards, broccoli etc.), eggs, liver, orange vegetables (carrots, sweet potatoes, mango etc.), eggs and butter. Your doctor may also prescribe Vitamin A supplements if you have a serious deficiency.
  • Eye Surgery – refractive surgery such as LASIK sometimes results in reduced night vision as either a temporary or sometimes a permanent side effect.
  • Injury – an injury to the eye or the part of the brain that processes vision can result in reduced night vision.
  • Uncorrected Visual Error – many people experience better daytime vision as the pupils are smaller and provide greater depth of field to compensate for any vision problems. At night, the pupils dilate, so blur is increased from uncorrected nearsightedness, farsightedness, astigmatism or distortions/aberrations on the cornea from refractive surgery. Even a slight prescription for someone who may not need glasses during the day can make a significant improvement in night vision.
  • Eyewear Problems – even if your vision correction is accurate, badly scratched glasses or poor/defective lens coatings can also cause trouble seeing at night. Special lens coatings are now available on glasses for night time and foggy conditions.

Treatment for Night Blindness

Some causes for night blindness are treatable, while others are not, so the first step is a comprehensive eye exam to determine what the root of the problem is. Treatments range from simply purchasing a special pair of glasses, lens coatings or contact lenses to wear at night (for optical issues such as myopia) to surgery (to correct the underlying problem such as cataracts), to medication (for diseases like glaucoma). In some cases, your doctor may recommend that you avoid driving at night. During the day, it may help to wear sunglasses or a brimmed hat to ease the transition indoors.

As with any change in vision, it is critical to get your eyes checked as soon as you begin to experience symptoms, and on a routine basis even if you’re symptom-free. Not only will this improve your chances of detecting and treating a vision-threatening disease if you have one brewing, but treatment will also keep you more comfortable seeing in low-light, and keep you and your loved ones safe at night or in poor light conditions.

The Sneak Thief of Sight

Dark Hair Man Purple Shirt Sunglasses

It’s that time of year again. January is National Glaucoma Awareness Month, a time set aside each year to create awareness about this potentially devastating disease. The reason awareness about glaucoma is so important is because as its nickname, The Sneak Thief of Sight, describes, the disease often causes permanent damage to your eyes and vision without any noticeable symptoms, until it’s too late. In fact, up to 40% of your vision could be lost without any noticeable symptoms! This is why awareness and early detection are essential for effective treatment.

What is Glaucoma?

Glaucoma is the leading cause of permanent blindness worldwide. It is a group of eye diseases that results in damage to the optic nerve, which can lead to vision loss and eventual blindness.

Most cases of glaucoma occur without obvious symptoms. Often people think they will experience headache or eye pain, however this is largely a misconception. There are several types of glaucoma and only one, angle closure glaucoma, typically presents with pain.

Treatment for Glaucoma

While there is still no cure for glaucoma, there are medications and surgical procedures that are able to prevent and slow any further vision loss. However, any vision that is lost is irreversible, usually. Again, this is why early detection is key to stopping and preventing vision loss and blindness. Glaucoma screening includes a number of tests. Many people believe the “air-puff” test used to measure eye pressure is what detects glaucoma, but this is not the whole picture. In fact, many people can develop glaucoma with normal eye pressure. Today newer technologies are available, such as OCT (like an ultrasound), which allow eye doctors to look directly at the optic nerve to assess glaucoma progression. The treatment plan depends on a number of factors including the type of glaucoma and severity of the eye damage.

While anyone can be affected by glaucoma, there are certain risk factors that are known to increase the likelihood of getting the disease. Being aware of the risk factors and knowing whether you are at higher risk puts you in a better position to take steps toward prevention, including regular screenings by an eye doctor. Here are some of the major risk factors:

Glaucoma Risk Factors

  • Over 60 years old (over 40 for African Americans)
  • Family history of glaucoma
  • African or Hispanic descent
  • Previous eye injury or surgery – even a childhood eye injury can lead to glaucoma decades later
  • Diabetes
  • High nearsightedness or farsightedness
  • Cortisone steroid use (in the form of eye drops, pills, creams etc.)

Glaucoma Prevention

Now that you know the risk factors, what can you do to prevent glaucoma? Here are some guidelines for an eye healthy lifestyle that can prevent glaucoma, as well as many other eye and not-eye related diseases:

  • Don’t smoke
  • Exercise daily
  • Maintain a healthy weight
  • Prevent UV exposure (by wearing sunglasses, protective clothing and sunscreen when outdoors)
  • Get regular comprehensive eye exams – and make sure to tell your eye doctor if you have risk factors for glaucoma
  • Eat a healthy diet rich in a large variety of colorful fruits and vegetables, vitamins A, C, E and D, zinc and omega 3 fatty acids

Even if you have 20/20 vision, you may still have an asymptomatic eye disease such as glaucoma. Glaucoma Awareness is step one in prevention but there is a lot more to do to keep your eyes and vision safe. During January, make a commitment to take the following additional steps toward glaucoma prevention:

  1. Assess your risk factors
  2. Schedule a comprehensive eye exam and discuss glaucoma with your eye doctor. Even if you feel you have clear vision, it is worthwhile to book an eye exam in order to detect eye diseases such as this “Sneak Thief”.
  3. Adopt the healthy, preventative lifestyle guidelines outlined above
  4. Spread the word. Talk about glaucoma to friends and family to ensure that they too can become aware and take steps to prevent glaucoma from stealing their sight.