How often should an adult or senior get an eye exam?
Adults should get their eyes checked at least once per year. This recommendation is based mainly on the eye health portion of the exam. Your vision and prescription for eyeglasses and contacts may not change, but you still want to have that annual checkup with an optometrist or ophthalmologist. Our eye doctor will determine your risk for developing blinding eye conditions in the future. Many of these conditions like glaucoma, cataracts, macular degeneration, and dry eye are detected by change over time. When our eye doctor is able to collect data from your eye exam on an annual basis, they can establish a trend analysis to detect eye conditions before they ever affect your vision. Often times, treatments for conditions like glaucoma, macular degeneration, cataracts, and dry eye are relatively straight forward and non-invasive, when caught early. The later stages of these conditions can be more difficult to treat, may require surgery, and damage can be irreversible. Let your eye doctor know if you have any family history of eye disease, have any history of trauma to the eyes, face, or head, and all of the medications and supplements you take. All of these can help your eye doctor diagnose and treat conditions before they cause irreversible damage.
What does an adult or senior eye exam test for?
Visual Acuity - The first part of the exam determines how well you can read the eye chart without glasses. This value is often recorded as 20/XX. The first value is usually "20" which is the testing distance in feet. Eye exam rooms are either 20 feet long or have a mirror that you view the eye chart through to make it appear 20 feet away. The second value is essentially the smallest font size that you can read at that testing distance. Usually a line on the eye chart will have 5 letters and if you are able to read at least 3 of the letters correctly, then you get credit for that line. The smaller the font size you can see at 20 feet, the better your visual acuity is. For example, if you can only read 80 point font at 20 feet, your vision would be considered 20/80. Someone that is able to read 30 point font at 20 feet would be considered to have better distance vision and have a visual acuity of 20/30. Typically, the bottom of the eye chart will have the 20/20 line and is the standard for having good vision. Every state has different regulations on driving, but as a general reference if you are able to read the 20/40 line with both eyes together that is often adequate enough to be able to drive without correction. Please check with your local state's driving regulations and visit your eye doctor to determine if you need glasses or contacts to drive.
Refraction - Next, our eye doctor will determine your best corrected visual acuity. This is the "what's better: one or two?" test and will determine the glasses prescription that provides your best distance vision. All adults over the age of 40 begin developing a condition called presbyopia. Presbyopia is when our eyes lose the ability to focus at near. The main sign that you are developing presbyopia is when you have your optimal distance correction on, glasses or contacts, and you experience blurred vision when an object or text is brought closer to your eyes. Our eye doctor will determine both your optimal prescription for both distance and near. The eye doctor will work with you to determine what solution will be most advantageous for both your vision and lifestyle. Some adults opt for separate pairs of glasses for each distance: one for far, one for computer, and one for near. The alternative is progressive lenses, that provide simultaneous vision at all distances in one lens. Traditional bifocal lenses offer two separate prescriptions in one lens, separated by a physical line, enabling you to see at distance or near, but lacks clarity in the intermediate distances.
Eye Health Examination - This part of the exam may be even more important that the vision check and why annual exams with our eye doctor are recommended. In general, the most common eye conditions like: cataracts, glaucoma, and macular degeneration may be silently developing over decades before they would ever affect your vision. When they do start to affect your vision, often times they are already in an advanced, irreversible state. Luckily, these conditions are relatively easy to diagnose with monitor technology including: retinal imaging and ocular coherence tomography (OCT) along with routine dilated eye exams. The key is allowing an eye doctor to make an early diagnosis and initiating treatment. The only way to do so is with routine checks with an eye doctor to see trends over time and pick up signs decades before it ever affects the vision. Other conditions like: dry eye, allergic conjunctivitis, meibomian gland dysfunction (MGD), rosacea, auto-immune disease, migraine, and many more can cause unnecessary discomfort, eye strain, and aggravation. There are so many treatment options available for each specific symptom so you no longer have to "just deal with" this everyday irritation.
Refraction - Next, our eye doctor will determine your best corrected visual acuity. This is the "what's better: one or two?" test and will determine the glasses prescription that provides your best distance vision. All adults over the age of 40 begin developing a condition called presbyopia. Presbyopia is when our eyes lose the ability to focus at near. The main sign that you are developing presbyopia is when you have your optimal distance correction on, glasses or contacts, and you experience blurred vision when an object or text is brought closer to your eyes. Our eye doctor will determine both your optimal prescription for both distance and near. The eye doctor will work with you to determine what solution will be most advantageous for both your vision and lifestyle. Some adults opt for separate pairs of glasses for each distance: one for far, one for computer, and one for near. The alternative is progressive lenses, that provide simultaneous vision at all distances in one lens. Traditional bifocal lenses offer two separate prescriptions in one lens, separated by a physical line, enabling you to see at distance or near, but lacks clarity in the intermediate distances.
Eye Health Examination - This part of the exam may be even more important that the vision check and why annual exams with our eye doctor are recommended. In general, the most common eye conditions like: cataracts, glaucoma, and macular degeneration may be silently developing over decades before they would ever affect your vision. When they do start to affect your vision, often times they are already in an advanced, irreversible state. Luckily, these conditions are relatively easy to diagnose with monitor technology including: retinal imaging and ocular coherence tomography (OCT) along with routine dilated eye exams. The key is allowing an eye doctor to make an early diagnosis and initiating treatment. The only way to do so is with routine checks with an eye doctor to see trends over time and pick up signs decades before it ever affects the vision. Other conditions like: dry eye, allergic conjunctivitis, meibomian gland dysfunction (MGD), rosacea, auto-immune disease, migraine, and many more can cause unnecessary discomfort, eye strain, and aggravation. There are so many treatment options available for each specific symptom so you no longer have to "just deal with" this everyday irritation.
If I don't wear glasses or contacts, do I still need an annual eye exam?
Yes. Annual eye exams are broken up into 2 components: the comprehensive eye exam and the refraction. The refraction checks for any glasses prescription that may optimize your vision and determines your best corrected visual acuity. The comprehensive eye exam is when the optometrist or ophthalmologist examines all structures related to the eye including: the eyelids, eyelashes, eyebrows, tear glands, conjunctiva, sclera, vasculature, cornea, iris, anterior chamber, posterior chamber, intraocular lens, vitreous, retina, choroid, retinal vasculature, and optic nerve. Obviously, the eye doctor is determining if there are any eye conditions that need treatment or closer monitoring like: glaucoma, macular degeneration, dry eye, allergic conjunctivitis, red eyes, inflammation, skin or eye cancer, corneal dystrophies, and many more. The eye doctor is also checking for any underlying conditions of your general health like: autoimmune conditions, hypertension (high blood pressure), hypercholesterolemia (high cholesterol), diabetes, cancers, infectious diseases, inflammatory conditions, brain tumors, aneurysms, neurological conditions, and many more. Some of these conditions are first detected at routine eye exams. Other patients will already know of these conditions and their primary care physician will recommended regular eye exams to determine how these conditions are affecting their body.
What are the options to help improve my vision while reading or on the computer?
Presbyopia is an age-related eye condition in which everyone over the age of 40 begins to experience. There is a lens inside the eye, similar to a camera lens, that allows your eye to focus on objects as they come closer. As we age and lose the ability to focus, we require more help from the eyeglasses or contact lenses. The rate in which our eyes lose the ability to focus is independent of what type of correction or how often you wear it. In other words, wearing reading glasses, bifocals, progressives, monovision contacts, or multifocal contacts will not make your near vision better or worse in the long run. Oftentimes, patients will associate their near vision worsening with the use of reading glasses because they require more and more power every few years, but that progression would have happened at the same rate whether they used a correction or not.
- Reading Glasses: Whether they are over-the-counter reading glasses or prescription reading glasses, they will provide clear vision at near that is optimized at one specific distance. This means you may require different powers depending on what distance you are looking at: one for a desktop computer, one for a laptop, one for a phone, and one for fine detail up close. Prescription reading glasses provide improved quality, eye alignment, and clarity compared to over-the-counter reading glasses that essentially provide magnification. Also, over-the-counter reading glasses have the same prescription for each eye, while most patients require different powers for the right and left eyes. Not having your eyes balanced while reading will lead to eye fatigue and the perception that words are moving along the page while reading.
- Bifocal Glasses: The traditional bifocal lens are exactly what is sounds like: two (bi) focal points. Typically your optician will set the top portion of the lens with your distance prescription and the bottom portion of the lens, the reading segment, as your near vision. What this means is that your TV and street signs will be clear when viewing above the line and your phone and books will be clear when viewing below the line. Bifocals are all-or-nothing, meaning there is an abrupt change in focus from distance to near and it does not provide clarity at intermediate distances like a computer screen, reading at arm's length, or viewing things in that 3-15 foot range.
- Trifocal Glasses: This takes the bifocal lens described above and adds one more additional segment for the intermediate range. There will now be multiple physical lines within the lenses and still provides an abrupt change in focus from distance to arm's length, to near. This can be a solution for some patients that like having the lines in their vision as reference points, but these lenses are not as popular because the lines can interfere with vision and the segments for viewing have narrow fields of view.
- Progressive Glasses: Sometimes referred to as the "no-line bifocal" or "invisible bifocal" provide simultaneous vision at all distances without any visible lines or segments. Naturally, when looking far we tend to be viewing through the top of the lens, then as we look at something closer and closer our eyes drift down through the lens. There are over 2,000 types of progressive lenses, which can be customized depending on your visual needs. The modern progressive technology that our optician utilizes ensures that you no longer have to compromise your vision at distance, intermediate, or near. They are custom fit to your eyes based on how you are viewing from the particular frame that you choose. This means that our complete pair of progressive lenses and frame will be much easier to adapt to than previous offerings. Once you adapt to your new progressives it should feel similar to the vision you had in your 30s, where you simply look at something and can see it.
- Monovision Contact Lenses: This is an old technique that has been brought into the modern world. Our eye doctor will help determine which is your dominant eye and then fit it with your optimal distance prescription. Then, our eye doctor will fit your non-dominant eye with a lens that provides adequate near vision. When both eyes are open together, the brain seamlessly transitions between the eyes depending on if you are looking at distance or near. Vision with monovision contacts is often very clear at the particular object you are viewing. Technically, there is a reduction in depth perception, since both eyes are required to be in focus at the same time to see in 3D. Monovision may not be the best option for pilots, golfers, tennis players, or viewing 3D screens. One option that these patients take advantage of is wearing both contact lenses for distance when doing activities that require ideal depth perception, but then switch to a monovision prescription for functional use like: shopping, going out to dinner, driving, or going to an event when there is a need for both distance and near vision without wanting to fumble around with reading glasses over your contact lenses.
- Multifocal Contact Lenses: Some would call these progressive contact lenses, but the technology of the optics differs from that in glasses. Instead of providing distance vision through the top of the lens and near vision through the bottom of the lens like with bifocal or progressive glasses, multifocal lens offer distance vision through the center of the lens, which blends to near vision towards the edge of the lens. Think of a bulls-eye pattern where the center has your normal distance prescription and then each ring that gets further from the center provides more and more reading power. The amazing thing about these lenses is that you do not have to look up or down or any which way. You put these lenses in and it provides simultaneous clear vision and depth perception through both eyes at the same time. These lenses are very customizable and may require a couple of follow-up visits for your eye doctor to refine the vision. For patient that require a much higher reading prescription, there may sometimes be some give and take between distance and near vision. Occasionally, our eye doctor will fit patients with a "modified monovision" approach. This is where both eyes are fit with multifocal contact lenses so that depth perception is achieved, but the dominant eye is slightly geared more towards distance and the non-dominant eye more for intermediate and near. This method can help reduce the compromise between clear distance vision and excellent near vision without losing 3D vision.
- Vuity Eye Drop: An eye drop was introduced in early 2022 that can increase your depth of focus, which may help some patients see near objects more easily without eyeglasses or contact lenses. The drug, pilocarpine, has been used for decades in the treatment for glaucoma and is generally well established and safe. The concentration of pilocarpine used in Vuity is even less than was was previously used for glaucoma, which generally means less risk and side effects that may be listed on the label for the medication. The way Vuity works is utilizing the "pinhole effect". When viewing through a smaller aperture, or opening, it allows objects at a wider range of distances to be in focus at the same time. It is the opposite of "portrait mode" on our camera phones, which uses a larger aperture to allow the subject to be in focus, but anything else at a different distance to be out of focus. The pupil is the eye's aperture and the size is controlled by the iris muscle. In dark conditions our pupils will dilated, get bigger, to allow for more light to enter, but also results in less clarity in the vision. In light conditions or when we are focused on a near object, our pupils will constrict, get smaller, to reduce the amount of light entering the eye and sharpen the vision. Vuity is able to help constrict the pupil, resulting in sharper vision at near that can last around 6 hours. The side effects of Vuity make sense based on what it is doing: dimmer vision especially at night and a headache along the eyebrows similar to what it feels like when you walk outside on a bright sunny day. These side effects tend to decrease after a few days of using the eye drop as your body adapts to the new condition. An optometrist or ophthalmologist will need to determine if you are a candidate for Vuity based on your age, eyeglass prescription, and will perform a dilated eye exam to see if there are any risk factors within the eye's retina that could be exacerbated by the use of Vuity.
What can I be doing to preserve my vision as I get older?
The primary focus should be scheduling an annual eye exam. An optometrist or ophthalmologist can then determine if you are at a higher risk of specific eye conditions based on your current eye anatomy and health, your age, any systemic conditions, family history, what medications you are taking, and your lifestyle. Our eye doctor will be sure to review all results from the eye exam and go over preventative measures based on your specific findings. In general there are things that everyone should be doing to prevent eye disease:
- UV protection: Protecting our eyes from the sun is important all year and sometimes forgotten in the winter months. Eyeglass lenses, especially those with no-glare treatments often provide a good base UV protection. Many of the newer generations of contact lenses come with UV filters, which can protect light going into the eye, but not the sclera, white of the eye, or eyelids. Ask your eye doctor if your contact lenses provide UV protection. Sunglasses should always be worn over your contact lenses to protect the rest of the eye and eyelid skin. Always make sure that all of your sunglasses provide 100% UV protection for both UV A and UV B rays. Interestingly, since sunglasses make your environment appear dimmer, it can result in slight pupil dilation allowing for more light to enter the eye. If your sunglasses do not have a proper UV filter, then wearing non-protective tinted lenses could potentially cause more harm to the inside of the eye. Polarized sunglass lenses are extremely efficient and reducing glare that bounces off of surfaces. Our optician recommends polarization for everyone, but especially if you do a lot of driving or spend time on the water. The glare that comes from the surface of the road, oncoming cars, and the reflections on water can be debilitating and result in light sensitivity even when wearing tinted lenses. Therefore, polarized lenses provide optimal vision when outdoors, but not necessarily more UV protection. That is why it is important to make sure your polarized lenses are also 100% UV protecting, because that it not necessarily always the case.
- Blue Light Protection: We often get the question, "Is the whole blue light thing real?" The answer is, "Yes blue light is real!" What the question is referring to is about if we really need to protect our eyes from blue light. The real term for what this subject is referring to is High Energy Visible (HEV) light. The colors we can see fall on a very small portion of the electromagnetic spectrum. Energy is being emitted all around us at various wavelengths and frequencies, and only a small portion of it is visible: the rainbow. Examples of things with short wavelengths and high energy are gamma rays, x-rays, and UV light. None of these we can see, but we do know that too much UV exposure or too many x-rays can result in damage at the cellular level. Ultraviolet light becomes visible at around 380-400 nanometers, in which hours eyes start to perceive the color violet. HEV light is essentially that violet-blue light that our eyes can perceive, which is the highest energy of any colors, but not in the UV range. Our eye doctor encourages people to protect their eyes from HEV light that's emitted from the sun by wearing tinted or Transitions lenses anytime they are outdoors. HEV light being emitted from screens is significantly less intense than what comes from the sun, so although you may not be worried about eye disease from staring at screens all day, the high energy light can be very stimulating. This constant stimulation from HEV, blue light, leads to "digital eye strain", which is why it may be more uncomfortable to read on a screen rather than on paper. HEV blue light is absorbed by the retina by special receptors known as "Intrinsically Photoreceptive Retinal Ganglion Cells" (ipRGCs). Aside from the rods and cones that provide vision, the ipRGCs absorb HEV light and send a signal to the sleep center of our brains to suppress melatonin secretion, which helps us fall asleep. Therefore, our eye doctor recommends reducing blue light exposure once the sun goes down so that your body can prepare for a good nights sleep until the sun rises. There are 3 main ways to block blue light:
- Tinted lenses. Yellow-Orange tinted lenses absorb Violet-Blue light and let Yellow-Orange light through. These are extremely effective at blocking HEV light, but with the side effect that it alters color perception. This means that if you are a graphic designer or something that requires true perception of color, this may not be the best option for you. Transitions has recently come out with the XtrActive lenses, which have a subtle tint indoors that provides excellent blue light protection and then activate to very dark sunglasses when outdoors for enhanced HEV and UV protection from the sun.
- Specialty No-Glare Treatments. These lenses have either a treatment within it or a coating on the surface that reflect HEV blue light. So instead of HEV blue light passing through the lens it is reflected back out. When held or worn at certain angles, someone looking at you will see a violet-blue reflection coming back at them. Our optician can show you samples of these lenses which are called Crizal Prevencia so that you can decide if you want that aesthetic of the violet-blue reflection on your lenses.
- Clear HEV Blue Filters. These lenses are known as EyeZen and are able to filter out HEV blue light without a visible tint or violet-blue reflection. This is a good option that everyone can take advantage of now that most of our day is spent looking at screens and our phones, while not messing with your color perception and allowing your lenses to appear transparent to others looking at you.
- Diet: Eat vegetables. The more color in the vegetables the better. You hear about carrots being good for your eyes, but it also includes all vegetables with a lot of pigment such as: kale, spinach, leafy greens, bell peppers, etc. The plant pigments known as lutein and zeaxanthin can act as 'sunscreen' for the inside of your eyes. They contribute to the pigment found in the macula, the center of the retina, which provides anti-oxidant properties to protect from a lifetime of UV and HEV light exposure. An early treatment for Dry Macular Degeneration are the AREDS2 vitamins, which contain high concentrations of these plant pigments. Although that vitamin is only indicated when you already have macular degeneration, by eating plenty of colorful vegetables you can potentially reduce your risk of developing macular degeneration.
At what age should I start worrying about developing eye diseases like cataracts, glaucoma, and macular degeneration?
With the modern diagnostic technology that is available through your annual comprehensive eye exams, our eye doctor at SeeSharp is able to detect risk factors for common eye diseases years before they start to affect your vision. Although glaucoma, macular degeneration, and cataracts may be associated with the population in their 60s and older, they may start developing decades prior. Being able to diagnose something like glaucoma when you are in your 30s can mean easier management with less invasive treatments and better outcomes long term.
