back-to-school eye exams

For many parents, the next few weeks will be filled with orientations, school supply lists, sports physicals, and immunizations.  If you are in that boat, be sure to include a visit to your eye doctor to have your child's eyes examined before starting the school year.  Experts estimate that as much as 80% of learning occurs through the visual system (1), so give your child every possible opportunity to succeed in school.  Learning, particularly in the form of reading, requires a combination of many visual skills.  There is far more to vision than just seeing 20/20.  

Vision screenings at the pediatrician's office and at school, though helpful in flagging some potential problems, usually only assess one or two aspects of vision.  Screenings are limited and non-diagnostic, so they are not a substitute for a comprehensive eye exam.  I regularly see kids who pass school screenings but have vision problems that need to be addressed.  Some states actually require a comprehensive eye exam before entering kindergarten, which is a fantastic idea.  The visual system is not fully developed in young children, and equal input from both eyes is necessary for proper development.  The earlier problems are detected, the better the chance of treatment being successful.  The American Optometric Association (AOA) recommends an eye exam at 6 months old, 3 years old, and again before entering first grade.  While in school, a child/teen should have an eye exam at least every 2 years if no issues exist, or yearly if he/she wears glasses or contact lenses.  Depending on the child and the condition, your eye doctor may recommend more frequent examinations.  

Some common signs and symptoms for parents and teachers to keep an eye out for:

• squinting
• eye(s) turning in or out
• sitting close to the TV 
• holding books close to the face
• complaining of seeing double
• complaining of headaches
• tilting head 
• avoiding reading and/or reading slowly
• losing place when reading and/or skipping words

While some children will have symptoms and signs that parents and/or teachers can pick up on, it is not uncommon to find children with issues that do not report any symptoms at all.  That is why the objective tests done during a comprehensive eye exam are so important for young children.    

According to the American Public Health Association, about one in four school-aged children has a vision problem that interferes with learning.  Here is a brief overview of some eye conditions that are relevant to this age group:

• Hyperopia, myopia, and astigmatism:  These are all types of refractive error.  A refractive error exists when the eye doesn't focus light exactly on the back of the eye (the retina).  An eye doctor measures the refractive error of the eyes and prescribes glasses/contact lenses if needed.  Correcting a child's refractive error when appropriate is the first step in addressing problems with the visual system because it may be the root cause of other vision problems, like those described later in this post.  
• Hyperopia, or farsightedness, is when the eye focuses light behind the retina.  Small amounts of hyperopia are normal in young children.  Kids can often compensate for this by using their eye muscles to bring images into focus.  But when the amount of hyperopia is substantial, it creates an unnecessary burden on the system and can result in blur, fatigue, eye strain, and headaches, especially when reading.  High amounts of uncorrected hyperopia can cause an inward eye turn to develop as well (accomodative esotropia).  
• Myopia, or nearsightedness, is when the eye focuses light in front of the retina.  Those with myopia have difficulty seeing far away.  Myopia is often first detected in school-aged children, and typically progresses through the adolescent years.
• Astigmatism is when the curvature of the cornea and/or the lens of the eye is different in one direction than it is in another, and light gets focused at two different points.  This can cause blur and distortion up close and far away.    
• Strabismus:  Commonly called crossed eyes, strabismus is a misalignment of one or both eyes, present in 2-5% of the general population.  The eye may turn in (esotropia), out (exotropia), up (hypertropia), or down (hypotropia).  It may happen all the time, or it may happen only some of the time (constant vs. intermittent).  The turned eye may be the same eye all the time, or it may alternate between the two (unilateral vs. alternating).  When the eyes are pointing in two different directions, they are sending the brain two different images.  Depending on the frequency and severity of the eye turn, it may cause double vision.  Alternatively, the brain may learn to ignore the image from the turned eye in an attempt to relieve the confusion.  This adaptation is called suppression.  If left uncorrected, strabismus can result in decreased vision in the turned eye (ambylopia) and loss of depth perception.     
• Amblyopia:  Sometimes referred to as lazy eye, amblyopia affects 2-3% of the general population.  Amblyopia is defined as reduced vision in one eye, or less commonly both eyes, in the absence of disease or structural abnormalities.  It can be caused by an eye turn (strabismic amblyopia), or a high prescription in one or both eyes that hasn't been corrected (refractive amblyopia), or something physically obstructing the line of sight (deprivation amblyopia).  Amblyopia occurs in the brain during the developmental stage, and it is often a preventable and treatable cause of vision loss.  The sooner it is diagnosed and treated, the better the chance of achieving normal visual function.  This is a big reason why eye exams are recommended early in life. 
• Ocular motor dysfunction (OMD):  Patients with OMD have problems keeping their eyes on a target (fixation), moving their eyes quickly and accurately from one target to another (saccades), and following a moving target with their eyes (pursuits).  These eye movements play an important role in reading and sports.  OMD usually does not present by itself; a child with OMD may also have issues with focusing and/or eye teaming.  The primary treatment here (assuming the appropriate glasses prescription has been given) is vision therapy.    

Vision therapy is a program of activities designed to help correct deficiencies and improve efficiency of the visual system.  Vision is a developed skill, and thus can be enhanced with guided training.  Vision therapy can be prescribed to help treat some conditions I mentioned above, as well as others relating to focusing and/or eye coordination.  Not all optometrists offer vision therapy, but all optometrists can direct you to one in your area that does provide such services.

CliffsNotes: Be sure to add a comprehensive eye exam to your child's yearly back-to-school checklist.  Clear, comfortable, single vision is important to a child's academic success!

     Additional recommended resources:

• Vision and Learning
• College of Optometrists in Vision Development

(1) Gazzaniga MS, Ivry RB, Jangun CR. Cognitive Neuroscience, the Biology of the Mind. New York, NY; WW Norton & Co, 1998.  

summer sun safety

Inspired by the book What's New, Cupcake?

The season that we were all dreaming of during Snowpocalypse has finally arrived!  But with the sweet summer sunshine comes dangerous UV radiation, and it is important to protect yourself from its harmful effects.  

The majority of the sun's energy can be classified as either visible light (that we see), infared radiation (that we feel as heat), and ultraviolet radiation.  Ultraviolet radiation has a shorter wavelength and more energy than visible light.  There are 3 categories of UV rays: UV A, UV B, and UV C.  

• UV C rays have the shortest wavelength (100-279 nanometers) and the most energy of the three.  We don't hear much about UV C rays because they are, for the most part, blocked by the ozone layer.  
• UV B rays have a slightly longer wavelength (280-314 nm) and are partially filtered by the ozone layer.  This is the category of UV radiation that is linked to sun burns and skin cancer.  In terms of the eye, most UV B rays are absorbed by the cornea (the clear part of the front of the eye).  
• UV A rays have the longest wavelength (315-380 nm) of the three.  Though they are lower in energy, UV A rays penetrate the skin more deeply than UV B rays and are thought to contribute to premature skin aging and wrinkling, as well as skin cancer.  Most of the UV radiation that we are exposed to is UV A.  Unlike UV B, UV A rays can pass through the cornea of the eye, potentially causing damage to the lens and retina.    
• Beyond UV, research is being done on the effects of the sun's high energy visible (HEV) radiation, or blue light.  Some studies suggest there is a possible association between exposure to large amounts of blue light and the development of macular degeneration, a disease in which the tissue of the back of the eye that is responsible for your central vision (the macula) is damaged, thus leading to vision loss.  

How is UV radiation dangerous to your eye health?

• In the short term, intense exposure to UV radiation while unprotected can cause a condition called photokeratitis.  Also known as snow blindness or UV keratitis, photokeratitis is essentially a sunburn of the eye.  The symptoms usually begin a few hours after exposure, and they include pain, redness, tearing, and light sensitivity.  It is a temporary, but very unpleasant, condition.  
• The most dangerous effects of UV radiation occur over time.  Because damage from UV radiation is cumulative, it is important to develop good sun safety habits early on in life.  Here are some examples of conditions that are thought to be linked to long-term UV exposure:    
• A pterygium is a benign growth of the conjunctiva (the tissue covering the white part of the eye) that extends onto the cornea (the clear part).  Surgical removal may be advised if the pterygium interferes with vision.  A pinguecula is a similar finding, but it is confined to the conjunctiva and does not extend onto the cornea.  It appears as a yellow-ish raised nodule on the white of the eye. 

Pterygium

• Exposure to UV radiation is thought to play a role in accelerated cataract formation (clouding of the lens) and retinal damage.
• Beyond that, skin cancer can also develop on the eyelids or on the skin around the eyes.  The Skin Cancer Foundation reports that eyelid skin cancer accounts for 5-10% of all cases of skin cancer, with basal cell carcinoma being by far the most common.

Basal cell carcinoma

Here are my top 5 sun safety tips:

1. Protect the little ones!  Kids spend a lot of time outdoors, and the lenses of their eyes allow more UV radiation through to the back of the eye when compared to adults.  As mentioned before, UV damage is cumulative, so be sure to start protecting the eyes early!  The Vision Council reports that 25% or more of an individual’s lifetime exposure to UV radiation occurs before age 18.  
2. Check the labels.  Whether you are looking for sunglasses for yourself or your kids, be sure to purchase sunglasses that block 99-100% of UV A and UV B rays.  The darkness of the lens is not an indication of how much UV-blocking action you have, so be sure to check the labels.  The label may read 100% UV protection or UV 400 (meaning it blocks rays shorter than 400nm).  
3. Talk to your optometrist and optician about your outdoor activities.  There are several options available in terms of prescription sunglasses, so your best bet is to speak with your eye care professional and determine which is best for your lifestyle.  Polarized lenses are designed to reduce glare and reflections off of surfaces like water, snow, or pavement, so they are an especially good choice for boaters, fishers, and skiers.  If you wear prescription glasses, there are coatings that can be placed on the front and back of lenses to block UV radiation and reflections.  Additionally, you can opt for photochromic lenses (Transitions is a well-known brand) that darken on exposure to UV.  There are clip-on/magnetic sunglasses that can attach to your glasses as well.  So many options!
4. Contact lenses that block UV radiation are available.  The Food and Drug Administration (FDA) puts UV blocking contact lenses into two classes: Class 1 UV blockers absorb over 90% UV A and over 99% UV B radiation, and Class 2 UV blockers absorb more than 70% of UV A and more than 95% of UV B radiation.  Ask your optometrist about what options are available for you.  Wearing contact lenses that help block UV radiation does not replace the need to wear sunglasses, as contact lenses do not cover the whole eye and do not protect the eyelids.  
5. Last but not least, wear a wide brim hat to minimize the amount of exposure your eyelids and eyes have to harmful UV radiation.  Wrap-around sunglasses help in this regard too, as they are more fitted to the face and prevent peripheral rays from reaching the eye.  Be sure to take precautions even if it is not particularly sunny outside.  While peak sun hours are between 10am and 2pm, it is believed that the eyes receive the most UV exposure in the hours directly preceding and following this time period, due to the angle of the sun in relation to the eyes.      

CliffsNotes: UV radiation is bad.  Wear sunglasses, a hat, and sunscreen.  

Enjoy the summer season safely!

Additional recommended resources:

• The Vision Council UV Report 2014
• Skin Cancer Foundation: Sun protection for your eyes
• Animals wearing sunglasses

healthy vision month

May is Healthy Vision Month (nei.nih.gov/hvm)!  Yes, I realize May is almost over.  In my defense, I wrote most of this article a couple of weeks ago.  It just took so long to post because I couldn't decide on fonts for the blog...

Even though I was visiting the eye doctor fairly regularly as a child and a teenager, I didn't really have a clue what was being done during the exam or why it was being done until I began looking into optometry as a career.  I think it's important to know at least a little about what your eyes do, how they work, and why it's important to get them checked regularly.  I will try not to bore you too much and just hit the high points!

• On the most obvious level, your eyes allow you to see the world around you.  The goal is to have clear, comfortable, and single vision.  Eye doctors have multiple tools they can utilize to achieve this goal, such as glasses, contact lenses, vision therapy, and surgery.  But "seeing well" is only a piece of the puzzle and is not an indication of your eye health.

• Aside from revealing signs of eye infections, glaucoma, cataracts, and macular degeneration, your eye exam can also reveal general health problems.  Your eyes are connected to the rest of your body, so conditions that affect your body can manifest in the eyes.  The eyes are the only place in the body where your blood vessels can be viewed directly and non-invasively.  Through a dilated eye exam, your eye doctor can examine the blood vessels and tissue of the back of the eye (the retina), which can reveal signs of systemic conditions such as diabetes, hypertension, anemia, cardiovascular disease, and more.  Some of these conditions can present with no symptoms early on, so it is important to see your eye doctor regularly.

photo of the back of the eye

• Your eyes are an extension of your brain.  Visual processing begins at the retina of the eye and ends at the visual cortex of the brain.  Many aspects of an eye exam evaluate the state of the visual pathway, including pupil testing, visual fields, extra-ocular motility testing, and fundus examination.  These tests can uncover central nervous system issues such as multiple sclerosis, brain tumors, increased intracranial pressure, brain aneurysms and more.  

So now that we've covered why you need an eye exam, let's discuss how often you should have an eye exam.  

• ADULTS:  The American Optometric Association (AOA) recommends that asymptomatic/risk-free adults have an eye exam at least every 2 years until age 60, and every year thereafter.  Adults “at risk” are recommended to have eye exams every 1-2 years, or as deemed appropriate by their eye care professional.  Many of us fit into the “at risk” category, as that includes people who wear contact lenses, people with a family history of eye diseases like glaucoma or macular degeneration, people working in occupations with high visual demands or eye hazards, and people with diabetes, high blood pressure, or other vascular abnormalities.  I personally recommend a comprehensive eye exam at least every year for most patients, but it's particularly advised if you fall into this group.  
• CHILDREN:  The AOA recommends an eye exam at 6 months old, 3 years old, before first grade, and every two years after that for asymptomatic/risk-free children.  As with adults, the recommended frequency of examination increases if the child is “at risk,” which can include those children born premature, those with developmental delays, those with eye turns, and those with a high prescription in one or both eyes.  While vision screenings at school and at the pediatrician's office are incredibly valuable tools, they do not replace comprehensive eye exams.  I cannot stress enough the importance of getting children to the eye doctor early.  The sooner things like eye turns and high prescriptions can be detected, the better the visual prognosis for the child.  I will dedicate a separate post to children's eye health in the future.

I hope this post gave you some insight into eye examinations and why they are an important part of your health care.  As always, feel free to email me with any questions, comments, or concerns.  Thanks for visiting, and I hope you continue to follow the blog!

welcome!

Hello and welcome to Eyecing on the Cake!  This is simply a fun and educational blog about vision and eye health, with some adventures in cupcake baking sprinkled in as well.  For more background information about this blog, check out the Introduction page.  If you are interested, please consider signing up to receive email notifications when the blog is updated (see the "Follow by Email" area on the right side of this page).  Or "Like" our Facebook page (the icon on the right will direct you to our Facebook page).

Thanks for visiting!