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Home » Pediatric Eye Exams Draft

Pediatric Eye Exams Draft

Although children receive vision screenings with the pediatrician or the school nurse, a thorough eye exam with an eye doctor is necessary to ensure that the child’s vision and eyes are developing properly.  A child is not able to articulate problems with vision, so the only way to ensure that the eyes are undergoing normal development is with a comprehensive exam with an eye care professional. It is important to diagnose any abnormalities in children as soon as possible to enable early and more effective treatment.

Normal ocular and visual development is particularly important for learning.  According to experts, 80% of learning is visual, which means that if your child is having difficulty seeing clearly, his or her learning will likely be affected.  This also goes for infants who develop and learn about the world around them through their sense of sight.

According to recommendations from the American Optometric Association, a child’s first eye exam should be between 6-12 months old.  If there are no risk factors found during the first exam, the next exams should be at age 3, and then again before starting 1st grade.

Dr. Patricia Samuel, our pediatric specialist, is a provider for InfantSee an organization designed to ensure that eye and vision care becomes an essential part of infant wellness care by providing comprehensive eye exams to infants from 6-12 months.  Dr. Samuel sees children of all ages and is able to diagnose and treat nearsightedness, farsightedness, astigmatism, amblyopia (lazy eye), strabismus (eye turn), eye infections and ocular trauma.

Eye Exams in Infants: Birth - 24 Months

A baby’s visual system develops gradually over the first few months of life. They have to learn to focus and move their eyes, and use them together as a team.  The brain also needs to learn how to process the visual information from the eyes to understand and interact with the world. With the development of eyesight, comes also the foundation for motor development such as crawling, walking and hand-eye coordination.

You can ensure that your baby is reaching milestones by keeping an eye on what is happening with your infant’s development and by ensuring that you schedule a comprehensive infant eye exam at 6 months.  At this exam, the eye doctor will check that the child is seeing properly and developing on track and look for conditions that could impair eye health or vision (such as strabismus(misalignment or crossing of the eyes), farsightedness, nearsightedness, or astigmatism).

Since there is a higher risk of eye and vision problems if your infant was born premature or is showing signs of developmental delay, your eye doctor may require more frequent visits to keep watch on his or her progress.

Eye Exams in Preschool Children: 2-5

The toddler and preschool age is a period where children experience drastic growth in intellectual and motor skills.  During this time they will develop the fine motor skills, hand-eye coordination and perceptual abilities that will prepare them to read and write, play sports and participate in creative activities such as drawing, sculpting or building.  This is all dependent upon good vision and visual processes.

This is the age when parents should be on the lookout for signs of lazy eye (amblyopia) - when one eye doesn’t see clearly, or crossed eyes (strabismus) - when one or both eyes turns inward or outward. The earlier these conditions are treated, the higher the success rate.

Parents should also be aware of any developmental delays having to do with object, number or letter recognition, color recognition or coordination, as the root of such problems can often be visual.  If you notice your child squinting, rubbing his eyes frequently, sitting very close to the tv or reading material, or generally avoiding activities such as puzzles or coloring, it is worth a trip to the eye doctor.

Eye Exams in School-Aged Children: Ages 6-18

Undetected or uncorrected vision problems can cause children and teens to suffer academically, socially, athletically and personally.  If your child is having trouble in school or afterschool activities there could be an underlying vision problem. Proper learning, motor development, reading, and many other skills are dependent upon not only good vision, but also the ability of your eyes to work together. Children that have problems with focusing, reading, teaming their eyes or hand-eye coordination will often experience frustration, and may exhibit behavioral problems as well. Often they don’t know that the vision they are experiencing is abnormal, so they aren’t able to express that they need help.

In addition to the symptoms written above, signs of vision problems in older children include:

  • Short attention span
  • Headaches
  • Frequent blinking
  • Avoiding reading
  • Tilting the head to one side
  • Losing their place often while reading
  • Double vision
  • Poor reading comprehension

The Eye Exam

In addition to basic visual acuity (distance and near vision) an eye exam may assess the following visual skills that are required for learning and mobility:

  • Binocular vision: how the eyes work together as a team
  • Focusing
  • Peripheral Vision
  • Color Vision
  • Hand-eye Coordination
  • Tracking

The doctor will also examine the area around the eye and inside the eye to check for any eye diseases or health conditions. You should tell the doctor any relevant personal history of your child such as a premature birth, developmental delays, family history of eye problems, eye injuries or medications the child is taking. This would also be the time to address any concerns or issues your child has that might indicate a vision problem.

If the eye doctor does determine that your child has a vision problem, they may discuss a number of therapeutic options such as eyeglasses or contact lenses, an eye patch, vision therapy or Ortho-k, depending on the condition and the doctor’s specialty.   Since some conditions are much easier to treat when they are caught early while the eyes are still developing, it is important to diagnose any eye and vision issues as early as possible.

Following the guidelines for children’s eye exams and staying alert to any signs of vision problems can help your child to reach his or her potential.

Contact Lens Exam

At Illuimeyes Vision Care in Nashua, NH, Drs. Samuel, Daldine and Steadman offer a wide choice of contact lenses such as disposable soft contact, bifocal/multifocal, toric, gas permeable, and colored lenses. Whether you wear every day, week by week or month to month disposables, or traditional (vial) lenses, look at our variety of lenses suitable for your specific needs.

A decent contact lens fit begins with an exhaustive eye exam to guarantee the most accurate prescription and preclude any  previous conditions that could disturb contact lens wear.

contact-lense-nashua-nhWe will decide the best fitting contact lens after understanding your way of life, as well as the shape and well being of your eye. Often, you'll have the chance to try on lenses just after your eye exam. You can even leave the exam with a few samples before settling on your choice.
We follow up the first fitting and after that make any improvements in fit or materials to get you the most ideal fit. We show every one of our patients appropriate lenses as well as conceivable possible outcomes if proper care is not used. At that point we proceed with long-term follow-up to monitor the state of the lenses and to guarantee that appropriate cleanliness is being kept up.

Scleral Contact Lenses


Scleral lenses are a specialized contact lenses that make contact lens use possible for many people for the first time - and they have advantages for normal contact lens wearers as well.

A scleral lens is a larger lens that rests on the sclera or white of the eye, rather than the colored portion (or iris). The lens has many advantages which can make contact lens wear an option for those who have previously been told otherwise.

The lens, which covers a larger area than a normal contact lens, creates a pocket filled with artificial tears, fitting securely around the eye. Due to their size, scleral lenses provide sharper vision, greater durability, easier handling and a lower risk for complications.

We have a unique library of scleral contact lens solutions for you.


Schedule a free scleral lens screening

Are you one of the 5 patient types that would likely benefit from a scleral lens?

Candidates Include Patients with:

  1. Allergies
  2. High or complicated prescriptions that have been told they can't wear contact lenses.
  3. Unsuccessful history with other lenses either due to poor comfort or poor vision.
  4. Keratoconus or any type of corneal degeneration or dystrophy, transplants, scarring or trauma or post-LASIK complications.
  5. Dry eyes or high sensitivity to light or Steve Johnson Syndrome.

What are the 5 main benefits of a scleral lens vs. a regular lens?

  1. Easier to insert and remove.
  2. Improved, consistent quality of vision all day long.
  3. Better comfort. Other lenses may dry out and get uncomfortable.
  4. Longer lasting. With proper maintenance, they can last over a year.

What are three key differences in the scleral lens technology?

  1. The lens doesn't touch the cornea but rests on the sclera or the white part of the eye to increase comfort.
  2. Microscopic adjustments to the lenses can be made with new advanced manufacturing technology to customize the fit of each lens to each patient's unique needs.
  3. Can add highly customized, unique prescriptions onto each lens to provide even better vision.
Schedule a free scleral lens screening

Special Instances That Can Benefit from Scleral Lenses


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Legal Blindness:
It is not uncommon for someone who is legally blind from a corneal irregularity to regain great vision. This lens design provides a protective cushion of saline that can reduce pain and photosensitivity caused by other lens designs.
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Sports:
Scleral lenses are great for athletes who require excellent acuity and a stable lens fit while they are physically active.

They are also useful in situations where other contact lens types are not effective or appropriate, including dusty environments and contact sports.

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Protective & Therapeutic:
Scleral lenses can provide hydration to the cornea in severe cases of dry eye and ocular pemphigoid.
They can also help in keeping the eye hydrated in conditions where the eyelids do not close properly such as facial nerve palsy, trauma, or ptosis.

Schedule a free scleral lens screening

Custom Fit
We customize the lenses to the exact specifications of each individual wearer.

The entire process may take several visits in order to optimize the design and ensure the process of application and removal is comfortable and efficient. For these reasons professional fees associated with fitting sclera lenses and lens replacement costs are higher than other contact lenses. We are happy to discuss your specific costs based on your individual needs.

Diabetic Eye Exams

Diabetes is a disease that can affect the entire body, including the eyes.  Early diagnosis and prompt treatment of any ocular complications is necessary to preserve vision in patients with diabetes.  It is essential for patients who have been diagnosed with diabetes to have a comprehensive eye exam at least annually, or more frequently if recommended by your eye doctor.  At Illumineyes Vision Care, our office coordinates with your primary care doctor and endocrinologist to ensure that all your medical needs are met. This continuity of care allows all your doctors to be aware of how diabetes is affecting your entire body.  Ocular complications from diabetes include diabetic retinopathy, cataract, glaucoma, double vision, dry eye syndrome, and changes in glasses prescription.

Diabetic retinopathy is the leading cause of blindness in American adults.  It is caused by changes in the blood vessels in the retina.  In the early stages of diabetic retinopathy there are often no symptoms; vision may not change until the disease becomes severe and more difficult to treat.  As the disease progresses, blurred vision may occur when the macula (the part of the retina that provides sharp, central vision) swells from leaking fluid. This condition is called macular edema.  If new vessels grow on the retina, they can bleed into the eye, blocking vision. But even in advanced cases, the disease may progress without symptoms. That’s why regular eye exams for patients with diabetes is so important.

Diabetic retinopathy can only be detected with a thorough evaluation of the eye, including retinal photos and/or dilation.  An evaluation of visual acuity, dilated eye exam (viewing the inside of the eye with lights and special magnifying lenses), retinal photos (to view the blood vessels in the retina and check for bleeding), along with assessment of pertinent health history are all necessary to properly diagnose the existence and severity of diabetic retinopathy.  If diabetic retinopathy is diagnosed, laser procedures or injections may be necessary to slow the damage of the tissues of the eye and preserve vision.

Cataract, a clouding of the eye’s lens, is commonly diagnosed at an earlier age and tends to progress more quickly in patients who have diabetes.  With a cloudy lens, light cannot pass to the retina properly and vision becomes blurred. Very often, the first signs of cataract are difficulties with night vision that progresses gradually over the years.  As cataracts worsen, there is a subtle loss of contrast so that more light is required for reading and colors may not seem as vibrant. Other symptoms such as halos around lights, starburst effects, double vision, or ghost-like shadows can also be indicators of cataracts.  Once cataracts start to affect your vision significantly, your optometrist may recommend cataract surgery to improve your vision.

In addition to maintaining good blood sugar control, the best way to prevent the development and progression of cataracts is by minimizing sun damage to the eye’s lens with sunglasses.  Patients with diabetes should look for sunglasses with UVA and UVB protection and make sure to wear them whenever outdoors.

Glaucoma is an eye disease in which the internal eye pressure rises to a point that can cause damage to the optic nerve.  As the optic nerve becomes damaged it causes a permanent irreversible loss of peripheral vision that may lead to blindness.  Patients with diabetes are at a higher risk for developing glaucoma than the average population. The process in which glaucoma develops is generally very gradual occurring over years to decades and usually has no significant symptoms until the disease has become severe.  In the early stages, glaucoma will not cause a noticeable change in vision. As the disease progresses, the patient’s side vision will become gradually less sensitive. Left unchecked, the side vision will continue to deteriorate and a “tunneling” effect will occur with vision appearing as if looking through binoculars.  Ultimately, the central vision can become involved and blindness is possible.

The diagnosis of glaucoma can only be made after a comprehensive eye exam and patients with diabetes are carefully screened for any changes related to glaucoma during their annual diabetic eye exams.  If diagnosed with glaucoma, prompt treatment (generally with prescription eye drops) is initiated to preserve good vision.

Double vision is a rare but serious symptom that can occur in patient with diabetes.  Double vision in patients with diabetes is often caused by damage to one of the nerves responsible for eye movement.  Out of the 12 cranial nerves, 3 of them are dedicated solely to eye movement. When one of these nerves is damaged, it results in the inability of one eye to move in one or more directions.  This leads to one eye viewing one image while the other eye is viewing another image which causes double vision. If a patient notices a sudden onset of double vision, it is important to call our office immediately.  Your optometrist will need to determine the cause of your symptoms and rule out other possible causes, including a stroke.

Dry eye syndrome is the number one ocular complication in patients with diabetes.  In fact, over 50% of patients with diabetes experience symptoms of dry eye disease.  Diabetes causes insulin insufficiency, triggers inflammation, and damages nerves all over the body including the eye.  The combination of these factors leads to decreased tear production and a dry ocular surface. Patients with dry eye syndrome may experience the following symptoms:  dryness, burning, redness, tearing, grittiness/sandiness,

Changes in glasses prescription is a common finding in patient with diabetes, especially in patients with poorly controlled glucose levels.  As blood sugar fluctuates, is causes changes to the shape of the lens in the eye, leading a shift in prescription.  These fluctuations may happen within days or weeks, so if your blood sugar is too high, your optometrist may not be able to get an accurate reading of your prescription for glasses or contact lenses until blood sugar levels improve.  The best way to avoid frequent changes in your prescription is to make sure your blood sugar levels are well controlled with diet, exercise, and medications as prescribed.

The best thing you can do to prevent ocular complications from diabetes is maintain good control of your blood sugar.  Good control of your diabetes can lower your risk of developing diabetic retinopathy by as much as 76%. See your physician regularly and follow instructions about diet, exercise, and medication.  See your optometrist as recommended for your comprehensive eye exam when you are first diagnosed with diabetes. Continue to have a thorough eye exam at least annually thereafter or more often as recommended by your eye doctor.

Emergency Eye Care

Our goal at Illumineyes Vision Care is to provide overall eye health care in addition to vision correction.  When an eye emergency arises (including trauma, pink eye, double vision, etc.) you should always seek care with an eye care professional; avoid going to an emergency room, urgent care clinic, and primary care doctor as they often do not have the right equipment to correctly diagnose and properly treat eye conditions.  Call our office should any problems arise with your eyes. During office hours, our staff has been well trained to triage eye health problems, and one of our doctors is always on call to handle emergencies when the office is closed.

At Illumineyes Vision Care we are able to diagnose and treat all “red eyes” including conjunctivitis/pink eye, contact lens related problems, chemical burns, corneal abrasion, and foreign bodies. Additionally, we can also treat any eyelid problems including styes, insect bites, contact dermatitis, and shingles/cold sores.  Finally, any sudden changes in vision including sudden loss in vision, double vision, or flashes and floaters in vision should warrant a prompt call to our office.

Cataracts

What is a Cataract

A cataract is a clouding of the crystalline lens inside the eye.  With a cloudy lens, light cannot pass to the retina properly and vision becomes blurred.  An analogy easily visualized would be looking through a dirty windshield while driving. Although cataracts result from may conditions, the most frequent cause is the natural aging process.  Eye injury, certain eye diseases, some systemic medications, and health problems such as diabetes increase the risk for cataract development. Exposure to sun and smoking also promote cataract development.

What are the Symptoms

In the early stages of development, there may no symptoms associated with cataracts.  As the clear protein of the crystalline lens matures, some of the clarity is lost and cloudy areas form inside the lens.  Depending on the amount of clouding and the location, the patient may not be aware of any loss in vision. Very often, the first signs of cataract are difficulties with night vision that progresses gradually over the years.  As cataracts worsen, there is a subtle loss of contrast so that more light is required for reading and colors mya not seem as vibrant. Frequent changes in glasses prescriptions often occur as the cataract progresses. Occasionally, other symptoms such as halos around lights, starburst effects, double vision, or ghost-like shadows are indicators of cataracts.  Cataracts usually continue to progress but do not have to be remove unless the patient is visually compromised. Eye doctors used to say that the cataract had to be “ripe” before it could be removed, but today the accepted time is when the patient cannot see well enough to the things that they enjoy and an eyeglass prescription change will not help.

How are they Detected?

Cataracts can best be detected through a thorough dilated eye examination.  An evaluation of the visual acuity, intraocular pressure (for risk of glaucoma), and dilated fundus exam (viewing the inside of the eye with lights and special magnifying lenses), along with assessment of pertinent health history are all necessary to properly diagnose vision problems arising from cataracts.  Once the diagnosis is made, one of our optometrists will discuss the effects that cataracts are having on your vision. Other conditions such as macular degeneration, glaucoma, and retinal disease must be ruled out to determine if cataracts are the cause of vision loss.

How Are Cataracts Treated?

Once cataracts have been diagnosed by one of our optometrists as the cause of vision loss, options will be discussed with the patient.  In early cases, simply changing the glasses prescription may improve vision enough to allow the patient to function well. Once it becomes advanced, cataract surgery is the only treatment and is necessary to remove the cataracts and improve vision.  No medications, eye drops, or exercises have been scientifically proven to reverse the effects of cataracts on vision.

You can help slow the progression of cataract formation by not smoking, eating a well-balanced healthy diet diet, controlling your blood sugar, blood pressure, cholesterol, and most importantly, by wearing sunglasses.

Glaucoma

What is Glaucoma?

Glaucoma is an eye disease in which the internal eye pressure rises to a point that can cause damage to the tissue of the optic nerve.  As the optic nerve becomes damaged it causes a permanent loss in peripheral vision that may lead to blindness. The process is generally very gradual, occurring over years to decades and usually has no significant symptoms until the disease has become severe.

What Causes Glaucoma?

The exact cause of glaucoma is still unknown.  In certain patients, the individual fibers of the optic nerve begin to die when the pressure of the fluids in the eye are too high for that specific individual.  Other factors may be involved in nerve loss, but high eye pressure is the biggest controllable risk factor. The precise pressure at which optic nerve tissue begins to die varies from patient to patient; however, the higher the pressure the more likely optic nerve damage will occur.

How Does Glaucoma Affect Vision?

In the early stages, glaucoma will not cause a noticeable change in vision.  The patient’s side vision will become gradually less sensitive. Central vision is almost never affected until very late in the disease.  Left unchecked, the side vision will continue to deteriorate and a “tunneling” effect will occur with vision appearing as if looking through binoculars.  Ultimately, the central vision can become involved and blindness is possible.

What are the Symptoms?

In the vast majority of glaucoma cases, there are no early warning signs of symptoms.  Since glaucoma is usually a very slow (years to decades), progressive process, it is virtually impossible for a patient to detect a problem; it is almost always diagnosed by an eye doctor.  On the other hand, a very small percentage of glaucoma cases (less than 5%) are associated with symptoms including halos, pain, redness, and blurred vision.

How is Glaucoma Diagnosed?

The diagnosis of glaucoma can only be made after a comprehensive eye exam including assessment of the patient’s medical and family history, measurement of the pressure of the fluid inside the eye, examination of the optic nerve through a dilated pupil, evaluation of the fluid drainage network using a gonioscope, and an interpretation of a visual field test.  The visual field is performed using a sophisticated computer analysis of the patient’s peripheral vision. Additionally, a laser optic nerve analysis and retinal photography aid in diagnosis and managing glaucoma patients.

Who is Affected by Glaucoma?

Over 3 million people in the United States have been diagnosed with glaucoma; however, the actual number is probably much higher because it is estimated that 50% of the people with this disease are unaware and go undiagnosed.  Every year in the US, more than 120,000 lose vision due to glaucoma. Glaucoma can occur in anyone, but the following are the most important risk factors: age, race, diabetes, family history of glaucoma, history of reduced blood flow, and farsightedness.

How is Glaucoma Treated?

Fortunately, with early detection and prompt intervention, glaucoma can be successfully managed and the long-term outlook is good.  Most patients are treated with prescription eye drops specifically designed to lower the pressure in the eyes or enhance ocular blood flow, and thereby reduce the risk of progressive damage to the optic nerve and preventing loss in vision.  Sometimes, laser treatment or eye surgery is necessary when the eye drops are not sufficient in controlling the eye pressure or if for any reason the patient is not able to maintain the necessary prescription eye drop regimen. It is very important that we monitor the condition regularly (usually 3-4 times per year) to assess how well our prescribed treatment plan is working and make adjustments as soon as progression is noted.  It is equally important that the patient uses any medications exactly as directed and reports ay side effects to us immediately. With early diagnosis along with good care and management most patient can keep their sight and live a very normal and productive live.

Macular Degeneration

What is Macular Degeneration

Macular degeneration is an accumulation of deposits in the retina that causes loss of function of the specific portion of the retina used for central vision (the macula).  This causes difficulty with activities such as reading, driving, and recognizing faces. The macula is a highly specialized area of the retina which is 100 times more sensitive to detail that the rest of the retina and is responsible for color discrimination.  Even in its most severe form, macular degeneration will not cause total blindness as it does affect peripheral (side) vision, so people can lead independent lives in familiar environments.

Macular degeneration has two basic forms:  wet and dry. The dry form is much more common, encompassing about 90% of people with macular degeneration, and typically causes a gradual decrease in vision most noticeable when reading.  It almost always occurs in both eyes, but may be worse in one eye. Once a patient has been diagnosed with dry macular degeneration, it may remain dry or can undergo a sudden change to the wet form.  Wet macular degeneration occurs when blood (or fluid from blood vessels) enters the macula and damages the sensitive retinal tissue. The blood comes through a barrier layer behind the retina that breaks down as a result of the process of macular degeneration.  Exactly why some eyes convert to wet macular degeneration is not know; however, there is often a subtle change in the vision that may serve as a warning sign. It is important to diagnose and treat wet macular degeneration as soon as possible in hopes of preserving the best vision possible.

What are the Risk Factors?

Age is the biggest risk factor for macular degeneration.  It is very unlikely in people under the age of 50, while it is the leading cause of blindness in Americans over the age of 55.  Racial differences also play a large role in the likelihood of macular degeneration. The condition is far more likely to occur in Caucasians and rare in African-American, Asians, and Hispanics.  The two main risks factors that you can control are smoking and sun exposure. Long-term exposure to UV light from the sun’s rays increases the risk of developing macular degeneration. The effects of UV exposure seem to be cumulative over the years, so high quality sunglasses with UVA and UVB protection is recommended.  Cigarette smoking also increases the risk of developing macular degeneration. Like sun exposure, the effects of smoking are cumulative and even being a former smoker can put you at a higher risk.

How is it Diagnosed?

Most patients will notice a gradual loss of focusing ability, but many have no symptoms in the early stages of the disease.  Occasionally, visual changes such as distortion of straight lines, missing areas of central vision or fuzzy areas may be seen.  Since these symptoms also occur in conditions such as cataracts or retinal disease, a comprehensive examination of your eyes is necessary.  In the wet form of the condition, a dramatic change in the vision occurs very rapidly in the affected eye.

The diagnosis is made by one of our optometrists after examining your eyes following dilation of the pupils.  The macula undergoes characteristic changes in appearance that lead to the diagnosis of macular degeneration. The examination will also allow us to determine whether you have the dry or wet type.  Photographs and/or retinal scans are often used to monitor progression through time.

How is it Prevented?

A diet rich in dark leafy green vegetables (spinach, kale, collard greens, etc)and bright colored vegetables (bell peppers, tomatoes, carrots) is important in protecting the sensitive macula.  Sun protection with UVA and UVB sunglasses is imperative to prevent sun damage that can lead to macular degeneration.

How is it Treated?

The treatment for macular degeneration depends on whether the condition is wet or dry.  For the dry type of macular degeneration, vitamins containing antioxidants and/or carotenoids are beneficial in slowing the progression of dry macular degeneration.  Depending on the degree of macular damage, your doctor may recommend AREDS 2 (containing lutein and zeaxanthin) and/or omega 3 supplements with can help reduce progression.  In wet macular degeneration, intraocular injections and/or laser surgery may be necessary to help partially restore lost vision and prevent further progression.

 

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