Frequently Asked Questions
General Examination Questions
What is the difference between an ophthalmologist, an optometrist and an optician?
An ophthalmologist (MD ) is a licensed physician, with 12 years of post-high school training, having completed 4 years of medical school, at least 1 year of post-graduate internship in general medicine or surgery, and 3 years additional residency training in medicine and surgery of the eye. He/she is licensed to practice medicine, diagnose and treat all eye disease, prescribe and fit contact lenses and glasses and perform traditional and laser ocular surgery. Some ophthalmologists have spent an additional 1-2 years sub-specializing in a particular area such as retinal disease, corneal disease, glaucoma, muscle problems, neural disorders, tumors, inflammation, pathology or plastic surgery.
An optometrist (OD) is a licensed professional with 8 years of post-high school training. The four year doctorate degree concentrates on the visual system, diagnosing and treating eye disease and disorders. Optometrists are independent, primary care providers who examine, diagnose, treat and manage diseases and disorders of the visual system, the eye and associated structures as well as diagnose related systemic conditions. Optometrists can prescribe medications, however they do not perform surgery.
An optician is a technician trained either in a 2 year opticianry school or receive on-the-job training in the fitting of frames and dispensing of lenses prescribed by a licensed ophthalmologist or optometrist.
What does a comprehensive ophthalmologist do?
Comprehensive ophthalmologists are trained in all aspects of medicine and surgery of the eye, and perform many of the examinations and procedures that the sub-specialists do. In addition, the comprehensive ophthalmologists can coordinate specialized care, when necessary in complex cases, with multiple consultants, both ophthalmic and general medical, while keeping the overall condition of the patient in mind.
How often should an adult’s eye’s be examined?
In the absence of symptoms, the American Academy of Ophthalmology (AAO) recommends that children under 18 should be seen every 1-2 years; healthy adults ages 19-64 with no risk factors should be seen every 2-3 years, ands those 65 or older every 1 year.
Hereditary risks for ocular disease require more frequent checkups. There are a number of diseases, such as diabetes, high blood pressure, thyroid disease, rheumatoid arthritis, colitis, AIDS/ HIV, to name a few, and taking certain oral medications that carry a heightened risk for eye complications. African Americans, or any patient with a family history of glaucoma should be screened yearly. You should ask your ophthalmologist or primary care doctor when and how often you need to be checked.
At what age should a child’s eyes be examined?
Children can be examined by an eye care physician at any age, from birth onwards, as necessary . Although games can be taught to very young children to help assess their vision more accurately, this is not necessary to diagnose a problem in an eye. The official AAO recommendation is that screening be performed by the child pediatrician or family doctor in the first 3 months of life, at 6 months to 1 year, at approximately 3 years, and again at approximately 5 years, with referral immediately if any pathology is suspected. We recommend that normal children be seen by an ophthalmologist/optometrist by age three to five, before starting kindergarten.
Any child under the age of 7 who is seen by the parent to favor one eye should be examined by an ophthalmologist/optometrist as soon as possible in order to rule our disease which could result in permanent loss of sight in an eye.
What are symptoms for which I need to see the ophthalmologist/optometrist?
Regular examinations are critical in detecting eye disease such as glaucoma that can silently threaten your sight. However, signs and symptoms can arise suddenly in between regular visits that may warrant immediate attention. You should contact your eye physician as soon as possible if you or any family member experiences:
- Sudden blurring or loss of vision, regardless of duration
- Temporary or permanent loss of central or peripheral vision
- Flashing lights (lightning bolts, streaks)
- A sudden increase in number or pattern of floaters (strings, dots, cobwebs or shadows)
- Pain in or around the eye
- Onset of extreme sensitivity to light
- Red eye
- Watering or pus, lids sticking together
- Brow or headache with rainbow haloes around lights, nausea
- Double vision
- Sudden crossing or wandering eye
- Trauma
- Unequal pupils
Additionally especially in children/infants:
*one eye turning inward or outward
- White pupil(s)
- Jerking of eyes
- Tilting of head to see
- Squinting or covering one eye
- Frequent eye rubbing
- Swelling or lump near the eye
- Wet-appearance of eyes when not crying
Where do I seek emergency eye care?
During office hours, our PES physicians have emergency timeslots to accommodate emergency appointments. After hours, and on weekends, Hilton Head Regional Medical Center should be called to contact our on-call doctor. The Medical Center can be reached at 681-6122.
Vision Questions
How does the eye work?
The eye is like a camera, with a series of lenses (the tear film, the cornea, and the crystalline lens) which focus images on film (the retina).
What does 20/20 mean? 20/200?
When a patient can see at 20 feet what a normal eye can see at twenty feet, that is recorded as 20/20. If a patient needs to get 20 feet away to see an object that a normal eye can see at 200 feet, that is recorded as 20/200. This number is referred to as visual acuity.
What is legal blindness?
The technical definition of legal blindness relies on two factors: visual acuity and peripheral vision ( visual field). By federal regulation, anyone with best-corrected vision of 20/200 or less or peripheral vision limited to a central 20 degree circle is considered legally blind, and are entitled to certain tax benefits. Some states modify these criteria for aid.
What is near-sightedness?
When the crystalline lens is too strong, or the eye longer than average, the image is focused in front of the retina, the eye is near-sighted. The more near-sighted the eye, the closer objects must be to remain in focus.
What is far-sightedness?
An eye in which the crystalline lens is too weak, or the eye is relatively short, images are focused behind the retina. Objects far away are clearer than images close by.
What is astigmatism?
Astigmatism exists when the cornea or lens is oval-shaped (more like a football), rather than spherical (like a basketball)—with one aspect more curved than another. The glasses need to correct both curves separately. In order to be able to successfully wear such glasses, however, a person must get used to them early in life to avoid headaches, nausea and distortion. Often compromises must be made in the glasses prescribed for reasons of comfort. Therefore it is really important to bring old glasses with which you are comfortable—even if they are bent or broken—to your eye appointment, so that any new glasses prescribed take into account any compromises previously made with your old prescription.
Why do I need bifocals?
Independent of near sightedness or far-sightedness, the eye possesses “zoom power” to focus objects as they get closer to the eye. As we age, the crystalline lens and muscles in the eye stiffen, with a loss of “zoom capacity” up close.
Are drugstore magnifying glasses safe to use?
Over-the-counter magnifiers do work well for many people, especially if they do not have astigmatism and have fairly equal need for correction in each eye.
What kind of sunglasses should I buy?
Look for sunglasses that carry and ANSI rating of 100% blockage of UVA and UVB. Dark glasses without such protection may actually expose the eye to more harmful rays as the pupil dilates behind the darker lens. Some clear lenses, such as polycarbonate naturally block UV light. Additional UV lens coating is commercially available.
In addition, the orange-brownish tint that blocks blue light may also protect against cataracts and macular degeneration. The color distortion that results is not acceptable to everyone, however. People with sun-damaged eyes should also look for wraparound style sunglasses that protect from side exposure to UV rays.
Is reading in dim light harmful?
Though the eye has to work harder with less contrast in dimmer light, there is no damage caused by reading or writing in dim light. In very dark rooms, the high resolution area of the retina called the macula is not active, and vision is naturally less crisp.
Will reading a lot or watching television hurt my eyes?
No. Eyes are meant to see. If you use them a lot, they will tire, just like any other part of the body. They need to rest every so often.
Can eyes be transplanted?
No. Currently there is no way to transplant a whole eye. Corneas have been successfully transplanted for over 50 years, and a new stem cell transplants procedure for surface disease are done by our sub-specialists at UCI. Exciting new research with stem cells may allow for other transplants in the future, but are still in the experimental stage.
How do vision problems factor in learning disabilities?
There have been studies suggesting a linkage in some patients with ADHD and reduced ability for the eyes to converge (come together). No hard evidence has been found to connect visual function with learning disabilities such as dyslexia. Your comprehensive ophthalmologist can check for any problems that co-exist, however.
What is vision therapy and does it work?
Vision therapy is a controversial, long-term series of exercises designed to improve “tracking” of the eye. There is no evidence to support that this treatment works, however many patients do benefit from vision therapy.
Contact lens questions
At what age can a child be fitted with contact lenses?
This is highly individualized, depending on medical necessity, the motivation of the child and how responsible the child is.
Depending on the medical condition, lenses can even be fitted on infants. However, cosmetic contact lenses are usually not recommended for those under 15.
Can contact lenses permanently correct near-sightedness or prevent it from getting worse?
Hard contact lenses, by molding the corneal surface can temporarily reduce or retard steepening of the cornea (while the lenses are being worn) and are in fact used in certain corneal thinning diseases for that purpose. However, there is no permanent effect. Using progressively flatter contact lenses-orthokeratology— can be harmful to the cornea.
Can I use my eyeglasses prescription to buy over-the-counter contact lenses by mail or at a discount warehouse?
No. The prescription for glasses only takes into account the strength of the lenses, but not the curve of the cornea on which a contact lens must rest. A complete evaluation is necessary to fit contact lenses, including assessment of the tear film and a special set of surface curve measurements to assure a safe fit. Even once lenses are fitted, repeated checkups are necessary to assure the lenses do not tighten as the eye eventually gets used to the lens and reduces its efforts to wash the lens out by tearing.
Is it safe to use home-made solutions to clean contact lenses?
No. Never use a home-made solution. Even boiling salt water will not rid a solution of contaminants that can infect the cornea. Use only fresh commercially available solutions, following strict hand-washing procedures and all instructions on the box.
My contact lenses are extended wear. Can I sleep with them in?
Although such lenses are approved for extended wear, we do not recommend sleeping with them in. If you are interested in contact lenses approved to sleep in , discuss this with your doctor. You must NEVER sleep in contact lenses after swimming in a pool/lake/ocean even if they are extended wear!! The risk for infection is multiplied greatly by sleeping with them, and since one can dream in 20/20 Technicolor without them, the moment of seeing the alarm clock upon awakening is not worth the risk of a sight-threatening infection.
Computer-related Questions
My eyes feel strained using the computer. What should I do?
Glare is the biggest problem from computer screens, and special anti-glare/radiation filters are commercially available. The position of your light source relative to the screen may need to be adjusted. If you need reading glasses, you may need to be evaluated by your doctor to see if the distance from your eye to the computer monitor is within range of your glasses correction.
What are floaters?
You can occasionally see small specks or cobwebs moving in your field of vision. These are known as floaters. They are most easily seen against a plain background such as the sky or a blank wall. Floaters are actually tiny clumps of cells or gel within the eye that cast shadows on the retina. While they may appear to be an object floating in front of your eye, they are actually floating inside your eye. The central part of your eye is filled with a gel known as vitreous. Commonly, in middle age, this vitreous gel begins to thin and shrink, and can form lumps, clumps, and strands inside the eye.
Are floaters ever serious?
As the vitreous gel shrinks and pulls away from the back of the eye, the retina can sometimes be torn. This can result in a small amount of bleeding, which appears as innumerable fine specks of floaters in your vision. A torn retina is always a serious problem as it can lead to retinal detachment and serious visual damage. You should see an ophthalmologist as soon as practical for a sudden onset of new floaters or floaters associated with flashes of light. If you have symptoms of lost vision or loss of peripheral vision, this is an emergency and you should immediately seek an ophthalmologist’s care.
What causes flashing lights?
Any injury to the retina results in flashing lights since the retina is not capable of any sensation of pain. Usually flashes represent some tugging of the vitreous on the retina, creating the sensation of light. For any new sudden onset of flashes, you need a complete ophthalmologist’s examination to rule out the possibility of a torn or detached retina.
Can migraines cause flashing lights?
Some people experience flashing lights that appear as zigzag or jagged lines of “heat wave” appearance in both eyes preceding the onset of a migraine headache. Typically, this visual symptom lasts 10 to 20 minutes, and then gradually fades away on its own. Commonly, a migraine headache, nausea, weakness, or dizziness can follow this. On some occasions, no other symptom of headache or other migraine symptom follows the eye symptom. If this is a new occurrence for you, a complete eye exam is indicated; however, if you have had these before with your migraines you need to watch to be sure the symptoms clear over a normal time frame.
Why Does My Eye Twitch?
Mild twitching of the eyelid is a common phenomenon. Although these involuntary contractions of muscles are annoying, they are almost always temporary and completely harmless. The medical name for this kind of twitching is ocular myokymia. It is quite common and most often associated with fatigue. When your eye is twitching, it is not visible to anyone else. Ophthalmologists often are asked what causes the twitching and what can be done to stop it. Lack of sleep, too much caffeine or increased stress seem to be root causes. Often, gently massaging your eye will relieve the symptoms. Usually, the twitch will disappear after catching up on your sleep.