Vision For a Lifetime – Eye exam with a refractive focus

Many of us distinctly remember the first time we were prescribed glasses. For some, it was noticing that the board at school was blurry or that street signs were hard to see while driving. For others, it was realizing that the phone, computer, or the newspaper became difficult to read. For parents, it may have been during your child’s visual screening or when they noticed their child squinting to see.

The thought of losing vision can be frightening. Fortunately, in most cases vision can be restored by correcting your refractive error with glasses, contact lenses, orthokeratology, or permanently with refractive surgery such as LASIK, EVO ICLTM, PRK, or Refractive Lens Exchange. At the Cornea and Laser Eye Institute, we perform a comprehensive eye exam focused on your refractive needs. From our highly specialized refractive diagnostic equipment to our team of expert doctors, your exam will be focused on finding the right solution for your specific refractive needs.

What is Refractive error?

Refractive error is the misalignment of the focus of the eye on the retina, it results in blurry vision. Your glasses prescription is a measurement of your refractive error, and the use of refractive lenses moves the focus to the retina to improve your vision. There are three types of refractive error: 

Myopia, also known as “nearsightedness,” is when an image is focused in front of the retina instead of on it. In myopia, your near vision remains clear, but distance vision is blurry. 

Hyperopia, or “farsightedness,” is when the eye focuses an image behind the retina. In patients under 40 years old with mild hyperopia, the natural lens inside your eye can adjust its focus, allowing an image from behind the retina to focus on the retina to see a clear image. As hyperopes reach their early 40s, near vision becomes blurry first and then over time distance vision becomes blurry as well. 

Regular astigmatism occurs when the shape of the cornea (the clear dome at the front of the eye) or the natural lens inside the eye is more oval shaped than round. This oval shape creates 2 focal points which can focus in different positions and cause generally blurry vision. For patients with astigmatism both near and distance vision may seem blurry. 

Finally, presbyopia occurs when the natural lens inside the eye loses its ability to actively focus. In this case, while distance vision remains unaffected, focusing on and reading small print up close can become challenging.

Why is it important to undergo an exam focused on refractive care?

All comprehensive eye exams, first and foremost, evaluate the general health of your eyes which includes whether or not you need glasses. You should have an exam yearly. For those with refractive error, going to the eye doctor for an exam and a glasses prescription update is routine. However, many patients don’t realize that they have more options to correct their vision than glasses alone. This is where a comprehensive eye exam with a refractive expert makes all the difference. Eye doctors with refractive expertise will focus on more than just updating your glasses prescription, it will focus on completely reviewing all of your surgical and non-surgical options to manage, and in many cases treat, your refractive condition. 

What options exist for improving my vision without using glasses?

There are many surgical and non-surgical options to correct your vision and many eye doctors will not discuss all of the vision correction options with their patients. Many times patients assume that because their eye doctor did not discuss other options with them that they are not candidates for glasses free options like contact lenses, orthokeratology, or refractive surgery. As a tip, ask your doctor what are all the options you have for correcting your vision. Here at the Cornea and Laser Eye Institute, our specialty is in correcting vision in a way that best suits your life and at the different milestones in life. 

What options exist to improve vision in kids and teens?

During early childhood, evaluations for refractive error are vital as this is the period when the eye is growing and the visual cortex is forming its connection with the brain. In cases of extreme anisometropia (a large difference in prescription between the two eyes), astigmatism, and significant refractive error, an early diagnosis can prevent a permanent loss of vision, known as amblyopia. Depending on the case, this could be treated with eyeglasses, or additional interventions such as eye patching might be required.

Detecting astigmatism early is critical to determine if a child’s astigmatism is regular or irregular. Regular astigmatism can be addressed with glasses, contact lenses, and in low astigmatism orthokeratology but irregular astigmatism, such as in keratoconus, intervention with corneal crosslinking must be performed to stabilize the cornea before vision permanently worsens. 

The most common refractive error diagnosed during childhood is myopia (nearsightedness). Early intervention with myopia management may slow down and in some cases halt the progression of nearsightedness over time. It is critical to be evaluated for myopia management at a young age, and to start myopia control treatments between 8 and 12, to offer the best opportunity to slow down progression over time. For active children and teenagers, myopia management and visual correction with orthokeratology could be an ideal solution. Orthokeratology involves wearing a customized contact lens at night, which allows for an active lifestyle free from glasses and contacts during the day.

What options are there to improve vision in young adults, between the age 20 to 40?

Generally the early twenties mark the point of “ocular maturity” where glasses and contact lens prescriptions stop changing and become more stable. This is an optimal time to consider surgical vision correction, such as LASIK, EVO ICLTM, and PRK. These options greatly improve quality of life by eliminating the hassles of glasses and contact lenses. 

How can I get rid of my reading glasses?

In your early forties, you will begin to notice that reading small print is more difficult, this is the being of presbyopia. Some patients will begin to wear reading glasses and others will begin to need bifocals to correct both distance and near vision with one pair of glasses. A comprehensive eye exam with a refractive focus is essential to determine both non surgical and surgical options to correct your distance and near vision. Specifically for reading vision, there are a bunch of options to improve your near vision, prescription eye drops, multifocal contact lenses, LASIK, and RLE are all options to manage presbyopia and minimize your need for glasses.

Can I get rid of glasses and contact lenses at the same time cataract surgery? 

Eventually, as time progresses, we will all begin to experience changes in vision secondary to cataracts. Cataracts are a “cloudiness” that develops in the natural lens of the eye which causes vision to become more blurry. When cataracts develop vision correction with glasses or contact lenses is more difficult, and cataract surgery is required to improve vision. Cataract surgery improves vision by removing the cloudy cataract to give you a clear line of sight but it is also an opportunity to permanently improve your vision without glasses. There are many intraocular lens options to improve vision without glasses, and it is important to have a surgical evaluation with a refractive surgery specialist, not just a regular cataract surgeon, to determine which intraocular lens will work best to restore your vision. In some cases LASIK enhancements may further improve your vision after cataract surgery, and in these cases having cataract surgery performed by a refractive surgeon who specializes in both cataract and refractive surgery is key to achieving the best visual result.

In summary, everyone will experience different visual milestones. Some will experience their first need for glasses before starting school, others will experience it in school, and others will experience it in adulthood. Certain visual milestones, such as presbyopia and cataracts are a certainty. No matter when you experience your first visual milestone, an evaluation with a refractive specialist is essential to review all of your options for your specific refractive condition and achieve clear vision for a lifetime.

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