Eye Dork - Eye Have the Answer

Nearsighted is another term for myopia. Myopia is when your eyes are focused at a distance closer than 20 feet. For mild amounts of myopia it is more difficult to identify distant images, such as road signs. For moderate amounts of myopia reading a book or focusing on the computer is easy, but images past that distance are blurry. For high amounts of myopia, images must be very close to the eye to be focused. Myopia can develop at any age. It is most common for myopia to develop between the ages of 8 to 12. Increased near work (reading and computer) is the leading cause for this trend. There has been a great deal of research put into finding ways to slow down or avoid myopia development. At this time, the only treatment proven to help is time outdoors. A good goal is one hour per day outdoors and trying to limit time spent on hand held devices. Time outdoors myopia study. With myopia, images are focused in front of the retina. To focus images on the retina a concave lens is neede...

Farsighted is another term for hyperopia. This means that the uncorrected eye is focused at a distance beyond 20 feet. For small amounts of hyperopia this results in great distance vision.  As the amount of hyperopia increases, near work (computer and reading) becomes more difficult. For larger amounts of hyperopia, images have to be too far away to focus. For larger amounts of hyperopia there is no useful distance images focus at. Younger patients are able to use the ciliary muscle to focus through hyperopia to see. As the ciliary muscle flexes, it changes the shape of the lens. The change in shape allows images to be focused at closer distances. If an eye is naturally focused at 30 feet, flexing of the ciliary muscle can change the focused distance to 20 feet. If the muscle flexes harder, it can focus images at 16 inches or closer depending on the patients' age and focusing ability. For every year of life, the lens in our eye becomes larger. When the lens is larger, the cilia...

Neovascularization of the iris (NVI) is a true eye emergency. If this condition is left untreated, a patient can quickly lose all vision in the affected eye. Anytime vision is lost in one or both eyes, seek treatment as soon as possible. It is very unlikely for vision to return to normal without treatment and the sooner treatment is initiated the greater the chance of recovering some vision.  The most common causes of NVI are proliferative diabetic retinopathy and ischemic central retinal vein occlusion. NVI can result from any condition that results in severe damage to the retina and its vascular system without completely killing the retinal tissue. The severely damaged retinal tissue desires fresh nutrients and metabolites from the vascular system to allow the tissue to repair itself and continue functioning. However, the damage to the vascular system of the retina prevents sufficient blood flow to these damaged areas of the retina.  In desperation, the damaged retinal tissue relea...

HIPAA or the Health Insurance Portability and Accountability Act was created to protect Americans through two parts. The first part was to protect workers insurance coverage during the lose of a job or transition between jobs. The second part works to standardize electronic medical records (EMRs). The goal was to standardize how health information is exchanged between Doctors. The second portion also established national identifiers for providers, health insurance companies and employers. The second portion of HIPAA relates most to Patients and Eye Doctors, since it covers security and privacy of patient records. Thanks to this provision, Doctors cannot release a patients health information unless the patient signs a form of concent to do so. A minor violation consists of negligence of failing to protect the privacy of a patients medical record. A major violation consists of knowingly compromising the privacy of a patients medical record for personal gain. The main concern was that a...

Contact information includes phone number, address and email address. This information is used to remind patients about appointments or to let patients know glasses or contacts are ready to be picked up. In certain circumstances, this information is used to set up an appointment with a specialist. Some Eye Doctors use this information to send out a newsletter or to inform patients about sales or upcoming events. Thanks to HIPPA, a patients personal and contact information must be kept private. This information cannot be sold to advertisers or companies wanting to sell products to the patient.

For this entry, personal information refers to birth date, social security number, insurance information, ocular history, medical history, hobbies, work, alcohol or drug use. To file an insurance claim we need birth date, social security number and insurance information to prove the patient we saw for an exam is the same person who was on the insurance plan. Eye and medical history is required for insurance and helps the Eye Doctor anticipate any potential eye or vision problems. Medications, alcohol or drug use can also affect vision and the structure of the eye. Questions about hobbies and work help the Eye Doctor understand the distances a patient needs to focus at and any environmental factors that can strain or threaten a patients vision. Also, this information helps the Eye Doctor identify solutions to these environmental factors. Anti-relective coatings can diminish eye strain from computer use. Polarized sunglasses can ease strain from sun exposure.

Exam fees vary from office to office. Eye Doctors often have trouble establishing a set price for exams, tests and procedures. A smart way to establish fees in based on the patients in the area. Do patients in the area have insurance? What is the most common type of insurance in the area? The price of an exam is legally supposed to be the same whether or not insurance is used. Depending on patients in the area the Eye Doctor might establish exam fees to appeal more to out of pocket (non-insurance) patients or may set exam fees based on the most common type(s) of insurance in the area. Insurance based fees could relect a single company or the average of multiple plans in the area. Different types of exams or procedures can vary in price. For contact lens fitting a simple nearsighted prescription can vary in price when compared to a patient with astigmatism and/or near focusing problems. For medical problems the severity of the problem often affects pricing. A benign finding is differe...

The main difference between eye and health insurance is in the findings during the eye examination. For most patients during the eye examination we find a new glasses or contact lens prescription to correct their vision problems. With these general exams, eye insurance covers most of the cost of the exam and part of the cost for the glasses or contacts. All vision or eye insurance coverages vary. Depending on the plan, the amount of the co-pay and materials coverage can be different. The co-pay is the amount the patient has to pay for the visit. Certain plans will cover the fee for fitting contact lenses, but most don't. Materials coverage or the amount insurance will pay for glasses or contacts varies also. Most vision plans offer around $100 towards glasses or contacts. There can be additional rebates with glasses, since most plans offer lower rates on glasses add-ons such as no-line bifocals, transitions, anti-reflective coatings, etc. Eye insurance can help pay for a general ...

The tests and procedures performed during an eye exam depend upon the patient and the situation. For a regular eyeglasses eye exam the following tests are done: chief complaint, ocular history, medical history, visual acuity, intraocular pressure measurement, extraocular muscle evaluation, visual field evaluation, pupil testing, eye alignment testing, refraction, slit lamp examination of the front surface of the eye and its internal structures. Certain complaints or findings on the general examination can show a need for additional testing. Patients with Diabetes or those who notice flashes of light or a shadow over their visual field often need to have their eyes dilated to completely evaluate the retina. If the optic nerve doesn't appear to be healthy, then a glaucoma evaluation may be necessary. Patients with double vision often require more extensive eye alignment testing. Those with unexplained vision loss or headaches which don't seem to involve the eyes or vision corr...

The tests and procedures performed during an eye exam depend upon the patient and the situation. For a regular eyeglasses eye exam the following tests are done: chief complaint, ocular history, medical history, visual acuity, intraocular pressure measurement, extraocular muscle evaluation, visual field evaluation, pupil testing, eye alignment testing, refraction, slit lamp examination of the front surface of the eye and its internal structures. Certain complaints or findings on the general examination can show a need for additional testing. Patients with Diabetes or those who notice flashes of light or a shadow over their visual field often need to have their eyes dilated to completely evaluate the retina. If the optic nerve doesn't appear to be healthy, then a glaucoma evaluation may be necessary. Patients with double vision often require more extensive eye alignment testing. Those with unexplained vision loss or headaches which don't seem to involve the eyes or vision corr...

The terms Optometrist and Ophthalmologist sound so similar. For those who don't speak our dorky eye language it can be difficult to differentiate between the two. This article will attempt to describe the differences and similarities between these professions. Let me start by saying this post intends to only highlight the educational background of these two professions. I do not intend take anything away from either profession. Every individual practitioner Optometrist or Ophthalmologist has their own unique skill set and billing schedule. For this blog, I will only discuss general trends of each profession. Optometrists are similar to a primary care physician for the eyes, or the Doctor you see on a yearly basis for your physical. Most Ophthalmologists are surgeons, who specialize in different surgeries for the eye. The greatest skill Optometrists possess is in the art of refraction (the 1 or 2 test) and concepts for prescribing glasses and contacts. In their education, Optome...

A copy of the medical history form for our office can be downloaded and printed here. A lot of information is required for this form. It is a bit annoying to fill out, but all of the information does serve a purpose. Your name, address, phone number and identification numbers are required for your insurance company to pay for the eye exam. Also, this information is used to communicate with your primary care Doctor or other specialist (such as a retinal specialist) in the event of an emergency. Medical History is a comprehensive listing of any medical conditions a patient or their family may have. Proper function of the eye is significantly affected by the health of the rest of the body. Also, certain signs identified in a patient's eye can indicate various systemic conditions. Many health conditions can be linked to genetics. For genetic conditions, when one family member has a condition, this represents increased risk of this condition for other family members. Symptoms are ...

The retina is an incredibly complex structure.  This entry will be about the larger structures involved in processing an image. To learn how an image is focused on the retina, check out anterior eye anatomy. If you want to learn about the individual cells of the retina, check out phototransduction (conversion of a light ray into a chemical message for the brain). For information on the utilization and regeneration of vitamin A in the retina, check out the biochemistry of the visual process. The goal of glasses, contact lenses or refractive surgery is to get images focused on the fovea of the macula. The macula is the general pigmented area surrounding and supporting the fovea. The fovea is the specific structure that processes all of the detailed (letters, print) visual information we see. The fovea is a small structure, seen on examination only as a small pinpoint of light. In this small space, the fovea packs in over 10...

For vision to be a continuous process the photoreceptors (rods and cones) must continually regenerate 11-cis retinal. Rods and cones have slightly different ways of doing this. WARNING: this is only for the extremely nerdy. If you aren't very interested in the biochemical processing of vitamin A in the retina, this entry probably isn't for you. For rods: A photon (light ray) is absorbed by pigment within the opsin in the outer segment of the photoreceptor cell. Inside the activated opsin, 11-cis retinal is converted to all-trans retinal and released to the disc of the inner segment of the photoreceptor. Within the disc, all-trans retinal binds phosphatidylethanolamine. This produces N-retinylidine-phosphatidyl-ethanolamine (NRPE). ATP binding cassette transporter carries the NRPE complex to the cell membrane of the disc. At the cell membrane the all-trans retinal portion of the NRPE complex is transported to the cytoplasm within the cell body of the photoreceptor. Insi...

Light rays from an image are focused onto the retina by glasses or contacts and the anterior structures of the eye. Light rays are converted from a physical wave into a chemical and electrical message to be interpreted by the brain. This process is called phototransduction. In the sensory retina, there five main cell types and nine layers involved in this process. The sensory retina is an optically clear structure. For phototransduction to begin, an image must pass through the anterior blood supply and every layer of the sensory retina until the image finally reaches the photoreceptor layer. The photoreceptor layer is composed of rods and cones. There are roughly 120 million rods in the adult retina. These cells allow us to see the difference between light and dark. Rods are utilized for night vision and low lighting conditions. There are 6 to 7 million cones in the adult eye. Cones are only utilized for day or brighter conditions. These cells are specialize for color detection. ...

The main purpose of the front half of the eye is to focus a clear image on the retina. The next step in the process of vision is to convert that visual information (light rays) into a chemical message for the brain to process. However, before the image reaches the retina, it must first pass through a jelly-like substance called the vitreous. The vitreous fills most of the volume of the eye. It is mostly composed of water, but can also contain salt, sugar, a collagen called vitrosin, hyaluronic acid and other various proteins. When all these components are spaced out uniformly the vitreous remains clear and images pass on through to the retina undisturbed. With time more water concentrates in the lower portion of the eye. This leaves more proteins in contact with one another in the superior portion of the eye. The positive and negative charges of the molecular components of these proteins attract one another and result in the various proteins clustering together. This clustering cre...

My favorite part of each eye exam is getting the slit lamp (microscope) out and studying the various structures of a patient's eyes. The eye is a structure with many beautiful features. Each component of the eye plays a role in capturing images from the external environment and preparing that visual information for its journey through the brain. The first structures examined are the eyelids and eyelashes. These structures work to protect the eye from debris in the air and reset the tear film with each blink. A major contributor to our natural tears, the meibomian glands, are located just behind the eyelashes. Our major concern when looking at the eyelid are various skin cancers (basal cell carcinoma, squamous cell carcinoma, sebaceous gland carcinoma). Past the eyelids the tear film is observed. The tear film lubricates and protects the front surface of the eye, the cornea, and plays a vital role in keeping images clear on the way to the retina. The tear film is composed of thr...

Vision is a very complex task that begins in the eye and ends in visual cortex located in the back end of the brain. For visual information to get to the back of the head it must take a long and complex course. If there is an obstruction along the way, a scotoma results. A scotoma is a missing piece of the visual puzzle. Based on the size, shape and location of the missing vision we can predict the location of abnormal brain function. Normal peripheral vision consists of a 150 degree view for an individual eye and 180 degrees for both eyes working together. Peripheral vision can be roughly estimated by counting fingers at the edge of the visual field (confrontations) or more precisely with a small beam of light at random spots in the visual field (automated visual field testing. Different structures in the eye can influence peripheral vision testing. Cataracts or a corneal condition can dim vision and only allow patients to see brighter test points. Retinal defects produce a scotom...

The pupil is the hole that allows images to enter the eye and determines the level of brightness inside the eye. The pupil can sharpen vision by constricting and blocking out peripheral image rays that cause a larger blur circle. This can be demonstrated by looking through a pinhole (1 to 1.5mm hole). During the day or in a bright environment the pupil constricts (miosis). At night, the pupil dilates to let more light into the eye. A larger pupil is the cause for most patients night driving problems. A larger pupil allows more peripheral image rays into the eye. A larger surface area of the cornea is required to focus images which exaggerates nearsightedness or astigmatism present. If cataracts are present, a larger pupil leads to more image ray scattering and bluriness. Pupil size can be affected by factors other than light. When reading up close the pupil constricts. The pupil is closely tied to the focusing system. This link is located anatomically at the ciliary ganglion. The c...

Headaches are a common problem patients encounter. Sometimes a new glasses prescription can fix the problem; other times the problem can be more severe or complex. When headaches are located in the forehead, temples and/or around the eyes the headaches are likely due to changes in prescription. Focusing issues from excess computer use and/or reading can also cause headaches in this area. Anti-reflective coating and polarized sunglasses can prevent headaches caused by glare. Eye alignment should also be evaluated. Cluster headaches are felt in or behind the eye. These headaches can be caused by caffeine, stress, nitroglycerin and/or tobacco use. For some patients the headaches are caused by narrow drainage strucures within the eye which require laser treatment to open the drainage structures. For those with normal drainage, the source of pain can be ovetaction of the trigeminal nerve or hypothalamus. Prescription headache medications are often required for patients with normal drain...