One of the most commonly asked questions in an eye exam comes right after the refraction, or glasses prescription check: “What is my vision?”

Almost invariably, people know the term “20/20”. In fact, it’s a measure of pride for many people. “My doctor says I have 20/20 vision.” Or, on the other side of that same coin, having vision that is less than 20/20, say 20/400, can be a cause of great concern and anxiety. In this discussion I will describe what these terms actually mean.

To lay the foundation, let’s discuss some common terms. Visual acuity (VA) is clarity or sharpness of vision. Vision can be measured both corrected (with glasses or contact lenses) and uncorrected (without glasses or contact lenses) during the course of an eye exam. The result of an eye exam boils down to two different but related sets of numbers: your VA and your actual glasses prescription.

The notation that doctors use to measure VA is based off of a 20-foot distance. This is where the first 20 in 20/20 comes from. In Europe, since they use the metric system, it is based on meters. The 20/20 equivalent is 6/6 because they use a 6-meter test distance. The second number is the smallest line of letters that a patient can read. In other words, 20/20 vision means that at a 20-foot test distance, the person can read the 20/20 line of letters.

The technical definition of 20/20 is full of scientific jargon - concepts such as minutes of arc, subtended angles, and optotype size. If you’d like to read more of the technical details there is a well-written article with illustrations by Dr. John Ellman, you can find here.  For the purposes of our discussion here I’ll try to explain it in less technical terms.

“Normal” vision is somewhat arbitrarily set as 20/20 (some people can see better than that). Let’s say you have two people: Person A with 20/20 vision and Person B with 20/40 vision. The smallest line of letters that person B can see at 20 feet is the 20/40 line.  Person A, with “normal” 20/20 vision, could stand 40 feet away from that same line and see it. There is somewhat of a linear relationship in that the 20/40 letters are twice the size of the 20/20 letters and someone with normal vision could see a 20/40 letter at twice the distance as the person with 20/40 vision.

So how does this translate to a glasses prescription?

Eye doctors can often estimate what your uncorrected VA will be based on your glasses prescription. This works mainly for near-sightedness. Essentially, every quarter step of increasing glasses prescription (i.e. -1.25 as compared to -1.50) means a person can see one less line on a VA chart.

A prescription of - 1.25 works out to roughly 20/50 vision, -1.50 to 20/60 and so on. Anybody with an anatomically sound eyeball, meaning the absence of any kind of disease process, should generally be correctable to 20/20 with glasses or contact lenses. It is important to note, however, that rarely a person’s best corrected VA may be less than 20/20 with no noticeable signs of disease.

Far-sightedness is more difficult to estimate because it is affected by a number of other factors, including one’s age and focusing ability. But that’s a topic for another article.

So there you have it! Hopefully this has shed some light on what these measurements that we take actually mean, and it has allowed you to understand your eye health a little bit better.

Article contributed by Dr. Jonathan Gerard

There are certain eye conditions where an injection into your eye might be recommended.

Injections into the eye, specifically into the vitreous or gel-filled cavity of the eye, are called intravitreal injections.

In Part 1 of this series, we talked mostly about anti-vascular endothelial growth factor (anti-VEGF) injections. Anti-VEGF injections are probably the most commonly injected agents and they are used to treat wet age-related macular degeneration (ARMD), diabetic retinopathy, and retinal vein occlusion.  

But there are other injections that may be used as treatment.

Another injected medication used in combination with Anti-VEGF agents to treat wet macular degeneration, diabetic retinopathy and retinal vein occlusion are steroids. Additionally, steroids can be used to treat inflammation, or uveitis, in the eye. There is a steroid implant called Ozurdex, that looks like a white pellet and can last up to 3 months in the eye. The downside of steroids is that they can increase eye pressure and cause progression of cataracts.  

Antibiotics are another type of medication that can be injected into the eye. Sometimes an infection called endophthalmitis can develop inside the eye. This can occur after eye surgery or a penetrating injury to the eye. The presenting signs and symptoms of endophthalmitis are loss of vision, eye pain and redness of the eye. Bacteria is usually the cause of the infection, and antibiotics are the treatment. The best way to deliver the antibiotics is to inject them directly into the eye.  

Another relatively new injection is Jetrea, an enzyme that breaks down the vitreous adhesions that may develop on the surface of the retina. As we age, the vitreous contracts away from the retinal surface.  When this occurs over the macula, the region responsible for fine vision, the result is visual distortion. Jetrea is an injection that will dissolve the vitreous adhesions and relieve the traction on the retina.  Prior to the advent of Jetrea, the only treatment would have been surgery to physically remove the vitreous jelly and traction on the retina. 

The next time you visit your eye doctor and are told you need an injection of medication, it will likely be one of the agents, or something very similar, that we've discussed in this series.

Article contributed by Dr. Jane Pan

There are some eye conditions where your doctor might recommend an eye injection as a treatment option.

Injections into the eye, specifically into the vitreous or gel-filled cavity of the eye, are called intravitreal injections.

Anti-vascular endothelial growth factors (anti-VEGF) are probably the most commonly injected agents. They are used to treat wet age-related macular degeneration (ARMD), diabetic retinopathy, and retinal vein occlusion.

In these conditions, there are abnormal leaky blood vessels that cause fluid and blood to accumulate in and under the retina. This accumulation of fluid results in loss of central vision. The role of anti-VEGF agents is to shrink these abnormal vessels and restore the normal architecture of the retina.

Three anti-VEGF agents that are widely administered are Lucentis, Avastin, and Eylea.

Lucentis (Ranibizumab) is FDA approved for treatment of wet ARMD, diabetic retinopathy, and vein occlusion. It is specially designed for injection into the eye and is a smaller molecule than Avastin so it may have better penetration into the retina.

Avastin (Bevacizumab) was originally approved by FDA for treating colorectal cancer. It is used “off-label” for the same treatment indications as Lucentis. Off-label usage of medication is legal, but pharmaceutical companies can't promote a medication for off-label use. The amount of Avastin needed for eye injections is a fraction of the amount used to treat colorectal cancer, therefore, the cost of ophthalmic Avastin is only a fraction of the cost of Lucentis. This means that Avastin needs to be prepared sterilely into smaller doses by an outside pharmacy prior to injection into the eye.  

Eylea (Aflibercept) is the third anti-VEGF agent. It was designed to have more binding sites than Avastin and Lucentis so it may last longer in the eye than the former two.  Eylea is FDA approved for treatment of wet ARMD, diabetic disease, and vein occlusion, and therefore, the cost of Eylea is similar to the cost of Lucentis.

There are also newer agents on the market.  Your doctor will determine which might work best for you.

There is a thought that after prolonged injections, some patients may develop resistance to one particular agent but still respond to the a different agent. Therefore, your ophthalmologist will individualize your treatment.

Article contributed by Dr. Jane Pan

There have been studies undertaken over the past several years to try and understand if there are any of our day-to-day activities that either help or hurt the management of glaucoma.

Most of the studies demonstrated very little impact on the course of glaucoma. Here are some of the things researches have looked at.

Aerobic exercise: This means doing something at least four times per week for more than 20 minutes at a time that raises your pulse rate to a level that makes your heart work harder. Going from a sedentary lifestyle to active one with aerobic exercise resulted in a very slight decrease in baseline eye pressure.

Yoga: A study conducted at the Mount Sinai Health System (http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0144505) showed a significant increase in eye pressure with any head-down positioning. People with glaucoma would be wise to avoid any exercise that involves a position where your head is lower than your heart.

Weight lifting: Holding your breath while exerting yourself (called the Valsalva maneuver), is also a time when your eye pressure can go sky high. So if you lift weights for exercise, which is generally a good idea to maintain bone density, make it low weights with more repetitions of lifting, rather than heavy weights that make you grunt.

Wind instruments: A similar breath-holding problem applies to those playing the larger wind musical instruments like the French horn. One study suggested that there was a greater chance of glaucoma in symphonic wind players. If you play a brass instrument, it makes sense to have frequent checks of pressure, optic nerve head, and visual field.

Marijuana: Smoking marijuana can lower eye pressure. However, due to its short duration of action (3-4 hours), side effects, and lack of evidence that it alters the course of glaucoma, it is not recommended for glaucoma treatment.

Wearing tight neckties: This creates a very short-duration increase in eye pressure but doesn’t seem to have any long-term effects.

If it's been a while since your last eye exam--or if you've never had one done--it's always nice to know what testing you might have done and what issues the eye doctor looks for.  Here's the scoop on some common testing...

Visual Field

The visual field test is designed to check your peripheral vision, which is your ability to see things where you are not directly looking.

When we test your vision on the basic eye chart, we are testing how well you see right in the center and it gives us no idea if you can see out away from the center. Your peripheral vision is very important because it gives you the ability to move around your environment without running into things.

There are several diseases that can severely impact your peripheral vision while leaving central vision unaffected. Some people can have perfectly normal 20/20 central visual acuity and have almost complete loss of their peripheral vision.

The main culprits that can greatly affect your peripheral vision are glaucoma, some retinal diseases such as retinal detachments or retinitis pigmentosa, and some neurological problems like brain tumors, strokes, pseudotumor cerebri, and multiple sclerosis.  

Most visual field tests are now done on an automated machine that flashes lights in your peripheral vision while you stare straight ahead. The lights continue to get dimmer until you can no longer detect that they are there. The machine is trying to find the dimmest light you can see at each point in your peripheral vision that it is testing for.

Many patients get anxious when they take this test because everyone wants to do well on it. That can result in people not staring straight ahead but trying to look around to find the lights in an effort to do better.

That just makes the test come out worse. The machine also makes some noise as it changes location of the test light. Some people start pressing the buzzer whenever they hear a noise. They think there must be a light they missed but the machine, several times during the test, makes noise and then doesn’t put a light on to specifically see if you are trying to cheat by hitting the buzzer on the noise rather that seeing the light. Please don’t do those things - you are only cheating yourself and making it more difficult to figure out your problem.

Ocular Coherence Tomography (OCT)

The OCT really took hold in eye doctors' offices at the beginning of this century. It was the first time we were able to see anatomy and pathology inside the eye on a microscopic level without the use of any radiation.

It has been a great addition to our examination techniques and allowed us to see many causes of vision loss at a level of detail we never had before.

The two biggest uses for OCT in optical health are diagnosing diseases of the retina, particularly the area of central vision called the macula, and for diseases of the optic nerve, the most common of which is glaucoma.

For retinal disease it has been extremely helpful for macular problems such as macular degeneration (the leading cause of blindness in the U.S.), diabetic retinopathy, retinal vascular occlusions, and retinal swelling from inflammation.

The OCT allows us to see the individual cellular levels of the retina and helps in diagnosing the exact level where the pathology is occurring. If you look into the eye at the retina and see some bleeding in the macula it is difficult to judge where that blood exists without this machine. Is it superficial in the retina and coming from the retinal circulation or is it deep in and coming from the choroidal circulation under the retina?

The difference between those two locations can have a significant impact on what disease is causing the problem and what the proper treatment is. The OCT is also helpful in following the effect of treatment. If you are treating a bleeding or swelling problem in the retina, the OCT can track the degree of improvement with a level of detail that could never be matched by the human eye.

For glaucoma and other problems with the optic nerve, the OCT can precisely measure the thickness of the nerve tissue as it passes through the optic nerve. The hallmark of glaucoma is progressive loss of nerve fibers in the optic nerve.  Being able to measure the nerve thickness down to the micron level assists in both diagnosing and watching for progression of any optic nerve disease.

Fundus Photography

A picture is worth 1,000 words...

Fundus photography is just that, a regular picture of the inside of your eye. The pictures highlight the appearance of the macula and the optic nerve and record it for prosperity.

As eye doctors we make notes in the medical record of what we see when we look in the eye. The wording of anything that looks abnormal with the retina or optic nerve does vary somewhat from doctor to doctor. One of things we record is something called the cup to disk ratio (C:D) of the optic nerve. We express that ratio as a percentage. Normal is about 30% or .3. The range of normal is very wide and some “normal” eyes have a .1 cup and others can have a .7.

In glaucoma those percentages get larger over time as the person loses nerve tissue. So, if you were born with a .3 cup but in your 60’s you were found to have a .5 cup that would be a strong indicator that you might have glaucoma.  However, if you were born with a .5 cup and at 60 you still have a .5 cup then you don’t have glaucoma.  When you look at someone at 60 with a .5 cup it’s hard to be sure if this is normal for that person or did they progress from a .3 cup to a .5 cup.  If only I had a picture …  

Pictures of the back of the eye really do tell the story better than words. I can describe what the C:D looks like to me but a different doctor may describe it differently. Doctors are usually fairly consistent in their estimate of the C:D when it is the same doctor watching that C:D over time. When a different doctor estimates the C:D that consistency is just not there. My .4 C:D may be my partner’s .5. But you can’t argue with the picture.  

The same thing occurs with retinal bleeding. Rating the amount of bleeding as mild, moderate, or severe is somewhat helpful but there is a broad range of “mild” or “moderate”. When comparing two pictures taken at two different points of time it is much easier to decide if something is really getting better or worse.

We also use fundus photography to keep an eye on small tumors, called choroidal nevi, that can develop in the eye. These are increased areas of pigmentation under the retina in an area called the choroid. Most eye doctors explain these pigmented spots as “freckles in the eye.”  Most choroidal nevi are small and fairly flat. They can, however, sometimes grow larger and rarely turn into a melanoma in the eye. Serial photographs are very helpful in watching the lesions for growth.

These three tests - visual field, OCT, and fundus photography - make up the core of our testing. There are many other tests that can be performed along with your eye exam but these three we described here probably make up about 80% of the tests you may encounter, depending on your eyes.

Article contributed by Dr. Brian Wnorowski, M.D.

This blog provides general information and discussion about eye health and related subjects. The words and other content provided in this blog, and in any linked materials, are not intended and should not be construed as medical advice. If the reader or any other person has a medical concern, he or she should consult with an appropriately licensed physician. The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ.

If it's been a while since your last eye exam--or if you've never had one done--it's always nice to know what testing you might have done and what issues the eye doctor looks for.  Here's the scoop on some common testing...

Visual Field

The visual field test is designed to check your peripheral vision, which is your ability to see things where you are not directly looking.

When we test your vision on the basic eye chart, we are testing how well you see right in the center and it gives us no idea if you can see out away from the center. Your peripheral vision is very important because it gives you the ability to move around your environment without running into things.

There are several diseases that can severely impact your peripheral vision while leaving central vision unaffected. Some people can have perfectly normal 20/20 central visual acuity and have almost complete loss of their peripheral vision.

The main culprits that can greatly affect your peripheral vision are glaucoma, some retinal diseases such as retinal detachments or retinitis pigmentosa, and some neurological problems like brain tumors, strokes, pseudotumor cerebri, and multiple sclerosis.  

Most visual field tests are now done on an automated machine that flashes lights in your peripheral vision while you stare straight ahead. The lights continue to get dimmer until you can no longer detect that they are there. The machine is trying to find the dimmest light you can see at each point in your peripheral vision that it is testing for.

Many patients get anxious when they take this test because everyone wants to do well on it. That can result in people not staring straight ahead but trying to look around to find the lights in an effort to do better.

That just makes the test come out worse. The machine also makes some noise as it changes location of the test light. Some people start pressing the buzzer whenever they hear a noise. They think there must be a light they missed but the machine, several times during the test, makes noise and then doesn’t put a light on to specifically see if you are trying to cheat by hitting the buzzer on the noise rather that seeing the light. Please don’t do those things - you are only cheating yourself and making it more difficult to figure out your problem.

Ocular Coherence Tomography (OCT)

The OCT really took hold in eye doctors' offices at the beginning of this century. It was the first time we were able to see anatomy and pathology inside the eye on a microscopic level without the use of any radiation.

It has been a great addition to our examination techniques and allowed us to see many causes of vision loss at a level of detail we never had before.

The two biggest uses for OCT in optical health are diagnosing diseases of the retina, particularly the area of central vision called the macula, and for diseases of the optic nerve, the most common of which is glaucoma.

For retinal disease it has been extremely helpful for macular problems such as macular degeneration (the leading cause of blindness in the U.S.), diabetic retinopathy, retinal vascular occlusions, and retinal swelling from inflammation.

The OCT allows us to see the individual cellular levels of the retina and helps in diagnosing the exact level where the pathology is occurring. If you look into the eye at the retina and see some bleeding in the macula it is difficult to judge where that blood exists without this machine. Is it superficial in the retina and coming from the retinal circulation or is it deep in and coming from the choroidal circulation under the retina?

The difference between those two locations can have a significant impact on what disease is causing the problem and what the proper treatment is. The OCT is also helpful in following the effect of treatment. If you are treating a bleeding or swelling problem in the retina, the OCT can track the degree of improvement with a level of detail that could never be matched by the human eye.

For glaucoma and other problems with the optic nerve, the OCT can precisely measure the thickness of the nerve tissue as it passes through the optic nerve. The hallmark of glaucoma is progressive loss of nerve fibers in the optic nerve.  Being able to measure the nerve thickness down to the micron level assists in both diagnosing and watching for progression of any optic nerve disease.

Fundus Photography

A picture is worth 1,000 words...

Fundus photography is just that, a regular picture of the inside of your eye. The pictures highlight the appearance of the macula and the optic nerve and record it for prosperity.

As eye doctors we make notes in the medical record of what we see when we look in the eye. The wording of anything that looks abnormal with the retina or optic nerve does vary somewhat from doctor to doctor. One of things we record is something called the cup to disk ratio (C:D) of the optic nerve. We express that ratio as a percentage. Normal is about 30% or .3. The range of normal is very wide and some “normal” eyes have a .1 cup and others can have a .7.

In glaucoma those percentages get larger over time as the person loses nerve tissue. So, if you were born with a .3 cup but in your 60’s you were found to have a .5 cup that would be a strong indicator that you might have glaucoma.  However, if you were born with a .5 cup and at 60 you still have a .5 cup then you don’t have glaucoma.  When you look at someone at 60 with a .5 cup it’s hard to be sure if this is normal for that person or did they progress from a .3 cup to a .5 cup.  If only I had a picture …  

Pictures of the back of the eye really do tell the story better than words. I can describe what the C:D looks like to me but a different doctor may describe it differently. Doctors are usually fairly consistent in their estimate of the C:D when it is the same doctor watching that C:D over time. When a different doctor estimates the C:D that consistency is just not there. My .4 C:D may be my partner’s .5. But you can’t argue with the picture.  

The same thing occurs with retinal bleeding. Rating the amount of bleeding as mild, moderate, or severe is somewhat helpful but there is a broad range of “mild” or “moderate”. When comparing two pictures taken at two different points of time it is much easier to decide if something is really getting better or worse.

We also use fundus photography to keep an eye on small tumors, called choroidal nevi, that can develop in the eye. These are increased areas of pigmentation under the retina in an area called the choroid. Most eye doctors explain these pigmented spots as “freckles in the eye.”  Most choroidal nevi are small and fairly flat. They can, however, sometimes grow larger and rarely turn into a melanoma in the eye. Serial photographs are very helpful in watching the lesions for growth.

These three tests - visual field, OCT, and fundus photography - make up the core of our testing. There are many other tests that can be performed along with your eye exam but these three we described here probably make up about 80% of the tests you may encounter, depending on your eyes.

Article contributed by Dr. Brian Wnorowski, M.D.

This blog provides general information and discussion about eye health and related subjects. The words and other content provided in this blog, and in any linked materials, are not intended and should not be construed as medical advice. If the reader or any other person has a medical concern, he or she should consult with an appropriately licensed physician. The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ.

In light of the holiday season, here are our top 10 eye care jokes.

1) What do you call a blind deer?No Eye Deer!

2) What do you call a blind deer with no legs?Still No Eye Deer!

3) Why do eye doctors live long lives?Because they dilate!

4) Why did the blind man fall into the well?He couldn’t see that well.

5) Why shouldn’t you put avocados on your eyes?Because you might get guac-coma!

6) What did the right eye say to the left eye?"Between you and me, something smells."

7) A man goes to his eye doctor and tells the receptionist he’s seeing spots. The receptionist asks if he’s ever seen a doctor.The man replies, “No, just spots.”

8) How many eye doctors does it take to screw in a light bulb?One … or two

9) Unbeknownst to her, a woman was kicked out of peripheral vision club.She didn’t see that one coming!

10) What do you call a blind dinosaur?A do-you-think-he-saurus

Bonus: What do you call a blind dinosaur’s dog?A do-you-think-he-saurus rex!

Article contributed by Dr. Jonathan Gerard

We commonly see patients who come in saying that their eyes are bleeding.

The patient is usually referring to the white part of their eye, which has turned bright red. The conjunctiva is the outermost layer of the eye and contains very fine blood vessels.  If one of these blood vessels breaks, then the blood spreads out underneath the conjunctiva. This is called a subconjunctival hemorrhage.

A subconjunctival hemorrhage doesn't cause any eye pain or affect your vision in any way. Most of the time, a subconjunctival hemorrhage is asymptomatic.  It is only noticed when looking at the mirror or when someone else notices the redness of the eye.  There should not be any discharge or crusting of your lashes.  If any of these symptoms are present, then you might have another eye condition that may need treatment.  

What causes a subconjunctival hemorrhage?  The most common cause is a spontaneous rupture of a blood vessel.  Sometimes vigorous coughing, sneezing, or bearing down can break a blood vessel.  Eye trauma and eye surgery are other causes of subconjunctival hemorrhage.  Aspirin and anticoagulant medication can make patients more susceptible to a subconjunctival hemorrhage but there is usually no need to stop these medications.  

There is no treatment needed for subconjunctival hemorrhage.  Sometimes there may be mild irritation and artificial tears can be used.  The redness usually increases in size in the first 24 hours and then will slowly get smaller and fade in color.  It often takes one to two weeks for the subconjunctival hemorrhage to be absorbed.  The larger the size of the hemorrhage, the longer it takes for it to fade.

Having a subconjunctival hemorrhage may be scary initially but it will get better in a couple of weeks without any treatment. However, redness in the eye can have other causes, and you should call your eye doctor, especially if you have discharge from the eye.

Article contributed by Dr. Jane Pan

This blog provides general information and discussion about eye health and related subjects. The words and other content provided in this blog, and in any linked materials, are not intended and should not be construed as medical advice. If the reader or any other person has a medical concern, he or she should consult with an appropriately licensed physician. The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ.

You’ve been diagnosed with a cataract and you’ve been told you should have cataract surgery. The surgeon is also telling you that you should consider paying out-of-pocket for certain features.

Where did this come from? Why should you have to pay out-of-pocket for cataract surgery? Shouldn’t your health insurance just cover it?

In trying to answer these questions, you will first need a little history of both cataract and refractive surgery, which corrects errors of refraction such as nearsightedness, farsightedness, and astigmatism.

Radial keratotomy (RK) was the first widely used refractive surgery for nearsightedness. It was invented in 1974 by Russian ophthalmologist Svyatoslav Fyodorov, and it was the primary refractive procedure done until the mid-1990s. Then it was surpassed by the laser procedure called PRK and then, eventually, LASIK; they are still the predominately pure refractive surgeries done today.

Cataract surgery has its origins all the way back to at least 800 BC in a procedure called couching. In this procedure, the cataract was pushed into the back of the eye with a sharp instrument so the person could look around the cataract. Medically that is all that was done with cataracts until around 1784 when a cataract was actually removed from the eye.

The next big advance was implants to replace the removed cataract. The invention of implants was spurred by Harold Ridley, who recognized that injured Royal Air Force pilots could retain shards of their canopy made out of a substance called PMMA in their eye without the body rejecting it. Implants became commonplace after the FDA approved them in 1981. The implants have improved over the years and most implants today are foldable, enabling them to fit through tiny incisions of around 3 millimeters.

Medicare and most other insurances cover the cost of MEDICALLY NECESSARY cataract surgery. This means they will cover the surgery when someone has symptoms of visual trouble that is interfering with their normal daily activities AND the cataract is the cause of those visual disturbances. There is no reason to remove a cataract just because it is there. It needs to be causing a problem to make it medically necessary to remove it.

Medicare and most other insurances do not cover refractive surgery (LASIK, PRK, etc.). The general perception of refractive surgery by the insurance industry is that it is not MEDICALLY NECESSARY. You can correct the refractive errors in almost all cases by non-surgical means, such as glasses and/or contact lenses.

Today there are methods of doing additional procedures, or using special implants, at the time of cataract surgery to correct more than just the cataract alone. This is where the two types of surgeries, refractive and cataract, have merged into a single operation that tries to take care of both problems.

The merging of cataract and refractive surgeries is why there are now options to not only get your cataract removed, but also to correct your astigmatism (irregular shape to cornea) and/or presbyopia (the inability to see well up close that hits nearly everyone in their 40’s).

This is where the "paying for cataract surgery" comes in. Surgery to correct astigmatism and presbyopia are not considered MEDICALLY NECESSARY because they can be corrected with eyeglasses or contacts.

Your cataract, once it hits a certain point, cannot be corrected with glasses or contacts and therefore it is MEDICALLY NECESSARY and your insurance will pay for that component of your surgery. What it won’t pay for is any additional amount that is charged to correct your astigmatism or presbyopia.

If you want to address your astigmatism and/or presbyopia at the time of cataract surgery in order to be less dependent on wearing glasses after surgery, then paying for those components is going to be an out-of-pocket payment for you.

Article contributed by Dr. Brian Wnorowski, M.D.

This blog provides general information and discussion about eye health and related subjects. The words and other content provided in this blog, and in any linked materials, are not intended and should not be construed as medical advice. If the reader or any other person has a medical concern, he or she should consult with an appropriately licensed physician. The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ.

Your Eyes Are A Precious Gift--Protect Them During The Holidays

“I want an official Red Ryder, carbine action, two-hundred shot range model air rifle!”

“No, you'll shoot your eye out.”

These lines from “A Christmas Story” form one of the most memorable Christmas movie quotes ever. Funny in the movie, but the holiday season does present a real eye injury threat.

For those who celebrate Christmas, that risk begins even before the actual day.

Some of the most frequent holiday-related eye injuries come from the Christmas tree itself.

Holiday eye safety begins with the acquisition of the tree. If you are cutting down your own tree, please wear eye protection when doing the cutting--especially if you are going to be using a mechanical saw, such as a chain saw or sawzall. You need to also be careful of your eyes when loading a tree on top of the car. It is easy to get poked in the eye when heaving the tree up over your head.

Once back at home, take care to make sure no one else is standing close to the tree if you had it wrapped and now need to cut the netting off. The tree branches often spring out suddenly once the netting is released.

Other injuries occur in the mounting and decorating phase. Sharp needles, pointy lights, and glass ornaments all pose significant eye injury risk. If you are spraying anything like artificial tree snow on the branches, be sure to keep those chemicals out of your eyes.

Having now successfully trimmed the tree without injury, let’s move our holiday eye safety talk to the toys.

We want to spend the holiday happily exchanging gifts in front of a warm fire, drinking some eggnog, and snacking on cookies--not going to the emergency room with an injury.

The Consumer Product Safety Commission reported there were 254,200 toy-related emergency room visits in 2015, with 45% of those being injuries to the head and face--including the eyes.

In general, here are the recommendations from the American Academy of Ophthalmology in choosing eye-safe toys for gifts:

• “Avoid purchasing toys with sharp, protruding or projectile parts."
• “Make sure children have appropriate supervision when playing with potentially hazardous toys or games that could cause an eye injury."
• “Ensure that laser product labels include a statement that the device complies with 21 CFR (the Code of Federal Regulations) Subchapter J."
• “Along with sports equipment, give children the appropriate protective eyewear with polycarbonate lenses. Check with your eye doctor to learn about protective gear recommended for your child's sport."
• “Check labels for age recommendations and be sure to select gifts that are appropriate for a child's age and maturity."
• “Keep toys that are made for older children away from younger children."
• “If your child experiences an eye injury from a toy, seek immediate medical attention.”

More specifically, there is a yearly list of the most dangerous toys of the season put out by the people at W.A.T.C.H. (world against toys causing harm).

Here are types of toys to avoid:

• Guns that shoot ANY type of projectile. This includes toy guns that shoot lightweight, cushy darts.
• Water balloon launchers and water guns. Water balloons fired from a launcher can easily hit the eye with enough force to cause a serious eye injury. Water guns that generate a forceful stream of water can also cause significant injury, especially when shot from close range.
• Aerosol string. If it hits the eye it can cause chemical conjunctivitis, a painful irritation of the eye.
• Toy fishing poles. It is easy to poke the eyes of nearby children.
• Laser pointers and bright flashlights. The laser or other bright lights, if shined in the eyes for a long enough time, can cause permanent retinal damage.

There are plenty of great toys and games out there that pose much lower risk of injury so choose wisely, practice good Christmas eye safety, and have a great holiday season!

Article contributed by Dr. Brian Wnorowski, M.D.

This blog provides general information and discussion about eye health and related subjects. The words and other content provided in this blog, and in any linked materials, are not intended and should not be construed as medical advice. If the reader or any other person has a medical concern, he or she should consult with an appropriately licensed physician. The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ.

A quick explanation and background of a progressive addition lens (or PAL) is necessary in order to understand the importance of choosing the proper lens for your needs.

A progressive lens gives people an array of prescriptions - placed in the proper positions throughout the lens - to best imitate normal vision. Imagine having the precise correction needed to see a television screen more than 15 feet from you, while reading this article on your desktop computer, and then looking down at your keyboard in order to start entering the address to your favorite website. This, in a nutshell, is exactly what the progressive lens is ideally capable of accomplishing with one pair of glasses.

Having the least amount of peripheral distortion, and one of the wider ranges in both distance power, astigmatism, prism, and add power availability, we find this lens to be very versatile. The most important thing to you is that this product feels very natural in front of your eye. For first-time progressive lens wearers, there is a stigma that it takes a bit of time to adjust to a lens that holds multiple prescriptions. This is often still an issue if places use old technology lenses or don’t take careful measurements to assure the proper placement on the lens in the frame. However, with modern technology, the use of computers to fine tune this amazing product, and careful measurements and lens positioning by your optician, this lens does the best job we have seen in mimicking perfect 20/20 vision at all focal lengths.

Along with the progressive lens itself, there are other additional treatments, or “add-ons” that can immensely improve one’s experience with their glasses. These options include photochromic lenses, anti-reflective coatings, and polycarbonate scratch-resistant lenses.  Talk with your eyecare team about what options might work best for you!

Article contributed by Richard Striffolino Jr.

This blog provides general information and discussion about eye health and related subjects. The words and other content provided in this blog, and in any linked materials, are not intended and should not be construed as medical advice. If the reader or any other person has a medical concern, he or she should consult with an appropriately licensed physician. The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ.

What's one of the most common questions people ask when a baby is born? "WHAT COLOR ARE HIS EYES?” is usually right up there.

What makes the color of our eyes appear as they do? What role do genetics play? What if you don’t like your eye color--can you change it? Are there any medications that can change eye color? Get ready to explore the science behind eye color by starting at the beginning.......

Baby’s eye color can change. A baby can start out with blue eyes, for example, that change to brown as she ages. It’s all dependent on a brown pigment called melanin which develops as a child grows. The more melanin present, the darker the eye color. Brown eyes have the most pigment saturation, green/hazel eyes have less melanin, and blue eyes have the least pigment. The color of eyes is dependent upon genetics. Genetics are complicated, but generally speaking brown trumps blue if there is a brown-eyed parent. This is because darker pigment is the dominant trait in genetics. This isn’t to say that two brown-eyed parents could not have a blue-eyed child......it's just not very common.  In recent years, scientists have found many genes that play a role in determining eye color.  For example, in March 2021, researchers announced that they had discovered 50 new genes that play a role.  So yeah...it's more complicated than was thought.

So what if you don’t like your eye color? Can you change it? Yes, you can. The most common way is through cosmetic colored contact lenses. It’s possible to change almost any eye color, even changing brown to blue. A special colored dye is injected into the contact lens material, creating magnificent colors. There are also surgical methods for changing iris color but the risks far outweigh the benefits, so it is not recommended. Furthermore, contact lenses are medical devices that alter cellular tissue, which makes it really important to get your color contacts by obtaining a prescription for a legitimate brand from an eyecare practitioner.

Some medications can change eye color. A class of medication called prostaglandins, used to treat glaucoma, has a side effect of darkening the iris color. This same class, in a weaker strength, is used to lengthen eyelashes. Studies have shown that in a certain percentage of patients, light blue and green eyes have turned brown.

So maybe Crystal Gayle was looking into a crystal ball when she sang "Don’t It Make My Brown Eyes Blue," predicting eye color changing medications to come.

Only future science holds the key to permanent eye color change. But in the meantime, genetics, medication, and cosmetic colored contact lenses can enhance and change the color of your eyes. 

This blog provides general information and discussion about eye health and related subjects. The words and other content provided in this blog, and in any linked materials, are not intended and should not be construed as medical advice. If the reader or any other person has a medical concern, he or she should consult with an appropriately licensed physician. The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ.

Now that you have picked up your new pair of prescription eyeglasses, your focus becomes taking care of them. This is a task many disregard, but it is absolutely imperative that you make sure you are following a couple simple steps to keep the quality of your vision with your new spectacles.

We are all guilty of using a garment when in a rush to wipe away a pesky smudge on our glasses. This act is unfortunately about the worst thing you can do for your lenses.

No matter how clean your clothes are, dust particles and even small bits of sand and debris cling to them. Since eyeglass lenses are not made of diamonds, these tiny little particles can do tremendous amounts of damage to your new lenses. The smallest little crumb can grind a scratch directly in your line of vision, which in turn can render your glasses almost useless.

Most of us know what it feels like trying to concentrate on the world in front of you when there is a little scratch distorting and distracting your vision. A majority of the time, these little scratches can be avoided by following a few simple steps.

You may have noticed while shopping in your favorite store that they sell a variety of eyeglass cleaners. You need to be careful because the sprays and wipes which you can purchase in retail stores are not necessarily approved for all types of eyeglass lens materials.

This factor makes them fall under that category of products that many eye care professions cannot recommend. Most of these liquids contain a form of acetone or other cleaning agent that is too harsh for plastic lenses. Many years ago, when all eyeglasses were actually made out of crown glass, these products would have worked just fine. Now, during a time with thinner, lighter materials like cr-39 plastic and polycarbonate, these products have proven to be too hard on the lenses.

Over time, the lenses will start to break down if exposed to the chemicals used in these sprays, causing a fogging effect. Once again, you are left with a pair of glasses that are now unable to be used.

Now that we have gone over the two main culprits in the destruction of eyeglass lenses, other than accidents, let’s focus on some tips to extend the life of your glasses.

Most importantly, you should use an eyeglass case. For the large portion of patients who wear their glasses all day, it’s understandable how awkward it can be to carry a case around. But it’s nowhere near as frustrating as realizing the new pair of eyeglasses you just purchased is becoming scratched and ruined.

Also, you do not need to carry the case with you everywhere you go. Strategically leaving a case on a bedside table, in your car, or in a purse is the difference between “life or death” for your glasses.

There is also a simple way to clean your glasses that does not require you to purchase anything you probably don’t already have at home. Using lukewarm water at the sink, place a small, pea-sized dab of dish soap on your fingers. Gently rub the soap on both lenses from side to side, and then rinse with warm water. A soft, lint-free microfiber cloth is recommended to dry the glasses.

Taking care of your glasses today means you have them for clear vision tomorrow and into the future.

Article contributed by Richard Striffolino Jr.

This blog provides general information and discussion about eye health and related subjects. The words and other content provided in this blog, and in any linked materials, are not intended and should not be construed as medical advice. If the reader or any other person has a medical concern, he or she should consult with an appropriately licensed physician. The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ.

Diabetic retinopathy is an eye condition that can affect the retina of people who have diabetes.

The retina is the light-sensitive tissue that lines the back of the eye, and it detects light that is then processed as an image by the brain. Chronically high blood sugar or large fluctuations in blood sugar can damage the blood vessels in the retina. This can result in bleeding in the retina or leakage of fluid.

Diabetic retinopathy can be divided into non-proliferative or proliferative diabetic retinopathy.

Non-proliferative diabetic retinopathy:  In the early stage of the disease, there is weakening of the blood vessels in the retina that causes out-pouching called microaneurysms. These microaneurysms can leak fluid into the retina. There can also be yellow deposits called hard exudates present in the retina from leaky vessels.

Diabetic macula edema is when the fluid leaks into the region of the retina called the macula. The macula is important for the sharp central vision needed for reading and driving. The accumulation of fluid in the macula causes blurry vision.

Proliferative diabetic retinopathy: As diabetic retinopathy progresses, new blood vessels grow on the surface of the retina. These blood vessels are fragile, which makes them likely to bleed into the vitreous, which is the clear gel that fills the middle of the eye. Bleeding inside the eye is seen as floaters or spots. Over time, scar tissue can then form on the surface of the retina and contract, leading to a retinal detachment. This is similar to wallpaper contracting and peeling away from the wall. If left untreated, retinal detachment can lead to loss of vision.

Symptoms of diabetic retinopathy:

• Asymptomatic: In the early stages of mild non-proliferative diabetic retinopathy, the person will usually have no visual complaints. Therefore, it is important for people with diabetes to have a comprehensive dilated exam by their eye doctor once a year.
• Floaters: This is usually from bleeding into the vitreous cavity from proliferative diabetic retinopathy.
• Blurred vision: This can be the result of fluid leaking into the retina, causing diabetic macular edema.

Risk factors for diabetic retinopathy:

• Blood sugar. Lower blood sugar will delay the onset and slow the progression of diabetic retinopathy. Chronically high blood sugar and the longer the duration of diabetes, the more likely chance of that person having diabetic retinopathy.
• Medical conditions. People with high blood pressure and high cholesterol are at greater risk for developing diabetic retinopathy.
• Ethnicity. Hispanics, African Americans, and Native Americans are at greater risk for developing diabetic retinopathy.
• Pregnancy. Women with diabetes could have an increased risk of developing diabetic retinopathy during pregnancy. If they already have diabetic retinopathy, it might worsen during pregnancy.

Article contributed by Jane Pan M.D.

This blog provides general information and discussion about eye health and related subjects. The words and other content provided in this blog, and in any linked materials, are not intended and should not be construed as medical advice. If the reader or any other person has a medical concern, he or she should consult with an appropriately licensed physician. The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ.

Have you ever felt a twitching sensation in your eye? Did it feel like everyone was looking at you because of it? Were you worried that it was the beginning of a big problem?

Relax--it’s not likely to be a big deal. Most of the time it is not even visible to other people.

It's reassuring to know it’s almost never your actual eyeball that is twitching; it’s your eyelid muscle. Actual eye twitching is fairly rare and your vision would be pretty blurry if that's what were really happening.

The eyelid has a muscle in it that closes the eyelid and that muscle has a very high concentration of innervation. Because of that dense nerve tissue in the eyelid, anything that makes your nervous system a little hyped up or off kilter can result in the eyelid twitching.

What are some of the risk factors for eyelid twitching?

Fatigue

Not getting enough sleep can result in your nervous system not performing at its best and one of the results may include eyelid twitching. If you are getting frequent eyelid twitching, try to make sure you are getting the proper amount of sleep.

Caffeine

Too much caffeine can certainly overexcite your nervous system and result in frequent eyelid twitching. If twitching is becoming something you experience frequently, it might be time to cut down your caffeine intake. While coffee tends to be the biggest offender, caffeine does come in other flavors. Tea, colas, and chocolate are other common ones. Other items that you don’t think of as much: ice cream (especially chocolate or coffee flavors), de-caffeinated coffee (still has some caffeine), power or energy bars, non-cola soft drinks (Mountain Dew, Dr. Pepper, some root beers) and some OTC pain relievers (Excedrin Migraine, Midol Complete, and Anacin).

Stress

This is a hard one to quantify but if I ask most people who come to me with eyelid twitching if they are under more stress than usual the answer is almost always, "YES!" This is not an easy thing to mitigate. You may need to seek some help from your internist or psychiatrist or you could try some home remedies like long baths or whatever helps you relax.

Dry Eyes

One of the first things I tell people suffering from eyelid twitching is to use a lubrication drop in their eye. Anything that irritates your eye may result in eyelid twitching and an OTC lubricating drop in the eye might decrease the eyelid twitching. It is certainly worth a try.

What if the twitching won’t go away? Could it be anything more serious?

There is a condition called essential blepharospasm that could cause frequent twitching of the eyelid. In this condition you don’t just feel the lid twitching, but the entire eye starts closing involuntarily like you are trying to wink at someone. This can start to interfere with your normal daily life and can make things like driving and reading difficult to do. If the lid closing gets that significant, the main treatment for it is Botox injection to weaken the muscle that closes the eyelids. This stops the lid twitching very effectively, but it often needs to be repeated every 3 or 4 months.

Most of the time, eyelid twitching just goes away on its own as mysteriously as it came. If you experience twitching that doesn’t go away, try making some of the modifications I mention above and if that doesn’t work you should schedule an exam.

Article contributed by Dr. Brian Wnorowski, M.D.

There are certain eye conditions where an injection into your eye might be recommended.

Injections into the eye, specifically into the vitreous or gel-filled cavity of the eye, are called intravitreal injections.

In Part 1 of this series, we talked mostly about anti-vascular endothelial growth factor (anti-VEGF) injections. Anti-VEGF injections are probably the most commonly injected agents and they are used to treat wet age-related macular degeneration (ARMD), diabetic retinopathy, and retinal vein occlusion.  

But there are other injections that may be used as treatment.

Another injected medication used in combination with Anti-VEGF agents to treat wet macular degeneration, diabetic retinopathy and retinal vein occlusion are steroids. Additionally, steroids can be used to treat inflammation, or uveitis, in the eye. There is a steroid implant called Ozurdex, that looks like a white pellet and can last up to 3 months in the eye. The downside of steroids is that they can increase eye pressure and cause progression of cataracts.  

Antibiotics are another type of medication that can be injected into the eye. Sometimes an infection called endophthalmitis can develop inside the eye. This can occur after eye surgery or a penetrating injury to the eye. The presenting signs and symptoms of endophthalmitis are loss of vision, eye pain and redness of the eye. Bacteria is usually the cause of the infection, and antibiotics are the treatment. The best way to deliver the antibiotics is to inject them directly into the eye.  

Another relatively new injection is Jetrea, an enzyme that breaks down the vitreous adhesions that may develop on the surface of the retina. As we age, the vitreous contracts away from the retinal surface.  When this occurs over the macula, the region responsible for fine vision, the result is visual distortion. Jetrea is an injection that will dissolve the vitreous adhesions and relieve the traction on the retina.  Prior to the advent of Jetrea, the only treatment would have been surgery to physically remove the vitreous jelly and traction on the retina. 

The next time you visit your eye doctor and are told you need an injection of medication, it will likely be one of the agents, or something very similar, that we've discussed in this series.

Article contributed by Dr. Jane Pan

Shingles is the term we use to describe a condition that is caused by a re-activation of the Herpes Varicella-Zoster virus. The origin of this infection usually goes way back to childhood with a disease we know as chickenpox.

When you have a chickenpox infection, your immune system manages to eventually suppress that virus from causing an active infection, but the virus does not get completely eliminated from your body--it is able to go and hide in your nerve roots.

Your immune system manages to keep the virus in check for most of your life but there may come a time in adulthood when your immune system is not working as well as it used to, and the virus can reappear. It usually does this along the distribution of a single sensory nerve called a dermatome.

The most common area for this to occur is along your trunk (chest, abdomen, or back) but it is also commonly found on the face.

There are three branches of nerves that supply sensation to your face. They are all branches of the fifth cranial nerve. Those three branches supply the upper face (V1), the mid face (V2), and the lower face (V3).  Most of the time, shingles breaks out along only one of the branches at a time. The one that most frequently involves the eye is a rash breakout in the V1 distribution. This can involve the forehead and both the upper and lower eyelid.  It is also much more likely that the inside of the eye will be involved if the tip of the nose has a lesion on it.  The reason for that is that there is a specific subbranch of the V1 nerve called the nasocilliary nerve. This nerve is responsible for sensation on the tip of the nose and the inside of the eye.

The hallmark of shingles is that once the rash erupts it stays on one side of the body, including when it happens on the face. The rash will go up to the centerline of your face but will not go to the other side. You may get lesions on your scalp, but they will not show up on the back of your head. That is because the V1 does not go past half way back on your scalp. The back of your head has its sensation handled by nerves that come out of your spinal cord not cranial nerves that come out of the front of your skull.

Many people have a hard-to-describe sensation of pain, irritation, or itching along the distribution of the nerve for a day or two before the rash shows up. It is important to recognize the rash as quickly as possible because the drugs that treat shingles--usually Acyclovir, Famvir (famciclovir), or Valtrex (valacyclovir)--are much more effective if they are started within three days of the beginning of the rash.

Eye problems may occur along with the rash, especially if there is a lesion on the tip of the nose.

The two biggest problems are swelling or inflammation of the cornea and inflammation inside the eye, which we call iritis or uveitis.  

The inflammation in the eye can cause pain and it can also increase eye pressure and cause glaucoma. Most often the treatment for the eye problem is to use the same oral medication mentioned above and sometimes it also can require eye drops to decrease the inflammation the virus is causing (steroid drops) or drops to try and lower the elevated pressure (glaucoma drops).

The eye inflammation can cause blurred vision, pain, and significant light sensitivity. It can be hard to treat and control and can continue to be a problem long after the skin lesions are gone. In fact, many times problems don’t even start until the skin lesions are starting to go away.

It is recommended that if you have shingles affecting the distribution of V1, you should have an eye exam within a few days of the diagnosis being made and then another exam again a week later because, as mentioned above, the eye problems can present a week later than the skin eruptions.

There can be some serious long-term effects of shingles on your eye, including glaucoma and corneal scarring that can be bad enough to require a corneal transplant. The symptoms are often obvious with the vision being blurry and the eye being very red and painful, but sometimes the symptoms may be much more mild even when significant trouble is brewing inside the eye. So even if you think the eye feels fine, you need an exam to ensure there is not subtle inflammation or significant elevation of the pressure in the eye.

The other long-term problem with shingles around the eye is the possibility of there being ongoing pain in the area that can last for many years. This is called Post Herpetic Neuralgia (PHN). This pain can occur all along the dermatome where shingles had occurred. The eye itself may look perfectly normal but the pain persists. This is often treated with drugs that were originally developed as seizure medication but have since been shown to help alleviate neurological pain. The two most commonly used drugs for this are Neurontin (Gabapentin) and Lyrica (Pregabalin).

The most important thing you can do to try and make sure this doesn’t happen to you is to be vaccinated for shingles. The original vaccination called Zostavax has been available since 2006 in the U.S.  It is a single-injection vaccine and was recommend for everyone over 60.  The main issue with this vaccine is that it only reduced the risk of getting shingles by 51% and PHN by 67%.  In 2017 a new vaccine was approved in the U.S. called Shingrix. This vaccine is a two-injection vaccine with the second shot given 2 to 6 months after the first. This vaccine is recommended for everyone 50 years or older.  The big advantage of this vaccine is that is 85-97% effective in preventing both shingles and PHN in people with normal immune systems.  For more information about this vaccine you can go to the CDC website by clicking here.

Article contributed by Dr. Brian Wnorowski, M.D.

This blog provides general information and discussion about eye health and related subjects. The words and other content provided in this blog, and in any linked materials, are not intended and should not be construed as medical advice. If the reader or any other person has a medical concern, he or she should consult with an appropriately licensed physician. The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ.

Will reading glasses make your eyes worse? The short answer is "No."

Although we don’t know the exact mechanism by which humans lose the ability to focus up close as we age (a process called presbyopia), the fact remains that it happens to almost all of us.

The leading theory of how this occurs is that the lenses in our eyes get stiffer and thicker as we age--one of the muscles in the eye that contracts to change the shape of the lens does so less and less effectively because the lens itself gets less pliable.

The process of changing the focus of the lens from far away objects to up-close objects is called accommodation. If you have normal distance vision without glasses, then your eye's natural focus spot is far off in the distance. In order to focus on an object close to you, the lens in your eye has to alter its shape. The ability of your lens to do that is at its best when you are born and it slowly gets less and less pliable as the years go on. You have such a tremendous ability to accommodate when you are young that the slow loss of this ability is not perceptible, until you reach about the age of 45.

At around 45 the lens has lost so much accommodative ability that you start to have difficulty focusing on near objects. The impact usually starts when you notice that in order to look at anything small up close, you start holding it further away. Even though this decreasing ability to focus up close has been slowly getting worse since the day you were born, many people feel like the problem has occurred very suddenly. We have many people who come into the office around age 45 telling us “all of a sudden” they can’t read. What has probably been happening is they have just very slowly been adapting by holding things farther away until one day “their arms are too short” and then they can’t read easily.

That is where reading glasses come in. Some people just buy over-the-counter readers, which can work fine for them, but if you haven’t had an exam in some time it is much wiser to get your eyes checked first to make sure the normal aging process is the only problem. Once it is confirmed through a medical eye exam that there are no other issues, reading glasses are usually prescribed. Contact lenses are also an option at this point.

At the beginning,  low-powered reading glasses are used. As time goes on, the lens in your eye continues to stiffen and your ability to focus up close continues to worsen. The result of that is that your reading glass prescription gets stronger, usually at a clip of about one step every 2 to 3 years.

IT IS NOT USING THE READING GLASSES THAT ARE MAKING YOU WORSE. TIME IS THE CULPRIT.

The decrease in reading ability is going to continue to get worse as you get older whether you wear the reading glasses or not. Trying to avoid wearing glasses and struggling along without them is not going to stop the march of time. You really can’t preserve your reading ability by not wearing them--you are just needlessly making things harder on yourself.

Article contributed by Dr. Brian Wnorowski, M.D.

This blog provides general information and discussion about eye health and related subjects. The words and other content provided in this blog, and in any linked materials, are not intended and should not be construed as medical advice. If the reader or any other person has a medical concern, he or she should consult with an appropriately licensed physician. The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ.

Fall brings a lot of fun, with Halloween playing a big part in that.

But did you know that some Halloween practices could harm your vision? Take Halloween contacts, for instance. Costume contacts vary widely, with everything from monster eyes to goblin eyes to cat eyes to sci-fi or glamour looks. They can be just the added touch you need for that perfect costume. However, some people do not realize that the FDA classifies contact lenses as medical devices that can alter cells of the eye and that can damage the eye if they are not fit properly.

Infection, redness, corneal ulcers, hypoxia (lack of oxygen to the eye) and permanent blindness can occur if the proper fit is not ensured. The ICE, FTC, and FDA are concerned about costume contacts from the illegal black market because they are often unsafe and unsanitary. Proper safety regulations are strictly adhered to by conventional contact lens companies to ensure that the contact lenses are sterile and packaged properly and accurately.

Health concerns arise whenever unregulated black-market contacts come into the US market and are sold at flea markets, thrift shops, beauty shops, malls, and convenience stores. These contacts are sold without a prescriber's prescription, and they are illegal in the US. There have also been reports of damage to eyes because Halloween spook houses sometimes ask employees to share the same pair of Halloween contact lenses as they dress up for their roles.

So the take home message is, have a great time at Halloween, and enjoy the flare that decorative contacts can bring to your costume, but get them from a reputable venue using a proper legal prescription. Don't gamble with your eyes for a night of Halloween fun!

This blog provides general information and discussion about eye health and related subjects. The words and other content provided in this blog, and in any linked materials, are not intended and should not be construed as medical advice. If the reader or any other person has a medical concern, he or she should consult with an appropriately licensed physician. The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ.

A refraction is a test done by your eye doctor to determine if glasses will make you see better and what your prescription is.

The charges for a refraction are covered by some insurances but not by all.

For example, Medicare does not cover refractions because they consider it part of a “routine” exam and Medicare doesn’t cover most “routine” procedures--only health-related procedures.

So if you have a medical eye problem like cataracts, dry eyes, or glaucoma then Medicare and most other health insurances will cover the medical portion of the eye exam but not the refraction.

Some people have both health insurance--which covers medical eye problems--and vision insurance--which covers “routine” eye care (no medical problems) such as refractions and eyeglasses.

If you come in for a routine exam with no medical eye problems or complaints and you have a vision plan, then the refraction is usually covered by your vision insurance.  Give us a call..we'll be happy to try to answer your questions!

Article contributed by Dr. Brian Wnorowski, M.D.

This blog provides general information and discussion about eye health and related subjects. The words and other content provided in this blog, and in any linked materials, are not intended and should not be construed as medical advice. If the reader or any other person has a medical concern, he or she should consult with an appropriately licensed physician. The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ.