Last time I wrote about the value of having a baby’s eyes examined. Now I will address the question of how do you check a baby’s eyes?
Obviously an infant is not able to read the letters on the eye chart or perform subjective tests such as selecting the clearest image. An example would be when I ask “which is better 1 or 2” question. Fortunately, there are other ways to determine visual acuity. Measurements of visual acuity and refraction are intended to identify nearsightedness, farsightedness and astigmatism. All are risk factors for amblyopia. Amblyopia is caused from non-use or deprivation that negatively impacts the development of the visual system. Instead of an eye chart with letters that I use on school age children or a chart with shapes that I would use on a preschooler, I use a preferential-looking technique. Humans prefer to look at interesting objects instead of plain ones. I have several paddles with different size gratings and one paddle that is only gray. I flash the paddles in front of the infant and watch his/her response. This tells me how small the baby can see at a given distance. The smaller the gratings, the better the acuity. If the baby doesn’t prefer the gratings to the solid gray, I know we have passed the acuity threshold.
Retinoscopy is the other technique I use to measure the refraction, how much correction is needed for the baby to see clearly. Retinoscopy is the same technique my staff uses to get a starting prescription on most of my patients. They use a computerized system that measures the light as it comes off the retina (back of the eye). I do the same thing for the babies, but with a hand-held scope and some lenses.
Other assessments for eye alignment, motility and binocularity are done with various penlights, small toys and puppets. These tests measure eye coordination, which is the ability of both eyes to work together as a team to create one three-dimensional image in the brain. Good eye coordination, a skill that is not innate and must be developed, keeps the eyes in alignment. Later in life, poor eye coordination can make reading for extended periods of time difficult and may result in avoidance of detail work, such as writing or artwork, poor reading comprehension and clumsiness.
To evaluate the overall health of the baby’s eyes I dilate the pupils. The dilation causes little to no discomfort for the infant and allows a much more thorough examination. With light and magnifiers I can see the anterior eye structures like the cornea, lens, lids and lashes and the posterior structures such as the retina, optic nerve and blood vessels.
As an InfantSee provider, I provide a complimentary comprehensive eye assessment to all baby’s less than a year. (Nine months old is perfect for the exam).
When I bring up the discussion about examining an infant’s eyes, I am asked 2 questions:
Why should I have my baby’s eyes examined and how do you check a baby’s eyes?
I am going to answer the first question today, why should I have my baby’s eyes examined?
The first year of a baby’s life is one of the most critical stages of visual development. 1 out of 10 children is at risk from undiagnosed vision problems. Early detection and treatment can prevent many of the complications vision and eye health problems cause. Some of the problems detected during infant eye exams include lazy eye (amblyopia), muscle imbalance and ocular disease.
Pediatric well baby checks include many tests, but they do not include refractive measurements for unusual or unequal amounts of astigmatism, nearsightedness or farsightedness. These conditions are risks for amblyopia that develops in an otherwise healthy eye. The effected eye is not used properly because the vision is too blurry. Uncorrected blur in an infant’s developing eye can cause the brain to favor the better seeing eye, suppressing vision in the other eye which prevents the vision from developing and causes impairment. This visual impairment can be prevented if detected early enough.
A routine well baby check does not include a dilated pupil examination either. By viewing more of the retina, a better ocular health exam can be performed.
And the best reason to have your baby’s eyes examined is that it is free. Many optometrists, including myself think that infant eye examinations are so important we have signed on to the American Optometric Association’s InfantSEE program. We offer a one-time comprehensive eye assessment to infants in their first year of life. If you have a grandchild, niece, nephew or friend that lives in another area, you can find an InfantSEE provider on the website infantSEE.org.
I saw a few statistics about protective eyewear and sports this week. The most important fact about wearing safety eyewear for sports is that it prevents you and your children from becoming one of the following statistics. This information is from the US Department of Health and Human Services:
Nearly 2.5 million eye injuries occur each year.
More than a quarter of these injuries occur during sporting and recreational activities.
Children under 15 years of age account for nearly one-third of all eye trauma hospital admissions and 43 % of sports and recreational eye injuries overall
It is important to remember that even if an eye injury seems to be minor it may be serious. Loss of vision, severe pain or tenderness and cuts around the eye require immediate medical attention. Secondly, if you do go to the emergency room, are discharged, but your vision and/or eye still do not seem right, give me a call. I have seen patients after ER visits with foreign bodies still in the eye and undiagnosed broken orbit bones (the bones around the eye).
More than 90 % of all eye injuries can be prevented with the use of appropriate protective eyewear. Sports participants using corrective eyewear or sunglasses that do not conform to safety standards are at greater risk of eye injury than participants using no eye protection at all. Safety frames must pass two rigorous impact tests, which dress frames do not undergo. Basically, a steel ball and a pointed projectile are dropped on the lenses of the glasses. No parts or fragments of the frame or goggle can fly off which might contact the eye.
The lenses in regular eyeglasses could easily pop out and puncture or cut the eye. A frame mangled from impact could also injure the eye and face.
Most contact lens wearers use their lenses for an average of 13 hours a day. To stay comfortable all day it is important that the lenses maintain hydration (stay wet). There are many factors that can make the lenses dry out quickly, dry environment, medications and poor tear quality. Sometimes the type of lens is to blame. The newer silicone materials allow more oxygen to the eye, but silicone is hydrophobic which means it does not absorb moisture. Contact lens manufacturers use special surface treatments on the silicone lenses to improve wettability and comfort. Not all contact lens solutions and lens materials are compatible with each other. Some disinfecting solutions work better on the silicone lenses than others, both in maintaining comfort and safety. If your lenses feel dry and or filmy, it could be the contact lens solution that you are using. If the lenses are older than recommended, the effect of the special surface treatment may be gone too. Use recommended solutions and replace your lenses as prescribed for optimal wearing comfort.
I think the safest and most comfortable lens choice are the dailies. The lenses are used one time and thrown away. There is no confusion or complications with solutions and the user has a new clean lens each day.
The most important thing you can do if you have diabetes, is educate yourself about the disease. There are some excellent resources available. Start with the National Diabetes Education Program (NDEP) sponsored by the National Institute of Health. http://ndep.nih.gov/ . In addition to information about diabetes and other resources, you can order free pamphlets about controlling your diabetes and preventing type 2 diabetes. Information is available in English and Spanish.
Another resource is the American Diabetes Association, http://www.diabetes.org/. There is information about food, fitness and medications.
Most American are aware that being overweight and physically inactive increases the risk for type 2 diabetes. Unfortunately, that awareness does not translate into action. The NDEP was created to provide tools and resources to help people be proactive in preventing and controlling diabetes. If you have a family history of diabetes, had gestational diabetes and/or are overweight, you are at risk. Take action. Check out the NDEP website and educate yourself.
As November is diabetic retinopathy month, I want to continue sharing information about the condition. Let me repeat that diabetic retinopathy is the number 1 cause of new cases of blindness for adults 20-70 years old. The increasing number of people with diabetes means the number of people who will develop diabetic retinopathy will also increase. This is significant because severe vision loss can be prevented 90% of the time.
It is my job as an optometrist to identify and detect diabetic retinopathy. When I see diabetic retinopathy in a patient I have to decide when to refer for further evaluation and/or treatment
PREVENTING VISION LOSS
Have a dilated eye examination every year if you are diabetic.
If you notice changes in your vision or it seems blurry, call your eye doctor immediately.
TREATMENT
If I think treatment is indicated, I will refer you to a retinologist. A retinologist is an ophthalmologist, who treats conditions of the vitreous and retina, both effected by diabetic retinopathy. He or she will chose the best treatment option.
A laser may be used to stop blood vessels from leaking. It may also be used over a larger part of the retina to reduce the growth of abnormal blood vessels. Laser maintains sight, but the side effects can include, blind spots in the vision and reduced vision.
Corticosteroid injections into the eye provide a temporary treatment. To maintain control of the retinopathy, repeated injections are necessary every 6-8 weeks. The continued use of corticosteroids increases the risk of developing cataracts and glaucoma.
Another treatment is the injection of anti-vascular endothelial growth factor (anti-VEGF) to prevent the blood vessels from leaking. This treatment also needs to be repeated every 6-8 weeks.
The retinologist will often use a combination of the above treatments.
Researchers are looking for therapies with long-term results and minimal side effects.
1. True or False? People who have good control of their diabetes are not at risk for diabetic eye disease. 2. True or False? Diabetic eye disease usually has early warning signs. 3. True or False? Cataracts are common among people with diabetes.
Complications from diabetes can affect many systems in the body, such as the heart and kidneys. Diabetes-related eye diseases can also affect vision. Diabetic retinopathy accounts for 12 % of all new cases of blindness each year for people between 20 and 74 years of age. While there are other eye complications associated with diabetes, I am discussing diabetic retinopathy here because patients are often not aware of it until quite late in its progression. By then vision can be lost permanently.
In diabetic retinopathy the blood vessels in the back of the eye leak fluid or blood, which seeps into the retina and causes it to swell. Retinal blood vessels may also close, preventing blood and nutrients from reaching areas of the retina. This causes those areas to die. New blood vessels may grow to compensate for the closed blood vessels, but they always bleed and create scarring. The scarring may even cause the retina to detach or wrinkle.
Early detection and appropriate treatment significantly reduces the risk of vision loss from diabetic retinopathy. Diabetic patients should perform an easy vision test every day to detect subtle changes in their vision. However this is not a complete guarantee that the eyes are healthy. Symptoms of diabetic retinopathy are usually not obvious until the advanced stages. Pain, blurred or shadowy vision, and redness may only occur when treatment is more difficult and less successful. A variety of laser treatments and injections may be used in order to prevent further vision loss. Treatment is more successful if started early at the first signs of retinopathy. These signs are detected with a dilated eye examination.
Not everyone with diabetes develops diabetic retinopathy, but the chances increase after being diabetic for several years. In fact, sometimes the diagnosis of diabetic retinopathy leads to the diagnosis of diabetes. Evidence also suggests that such factors as pregnancy, high blood pressure and smoking may cause diabetic eye disease to develop or worsen.
To help prevent the development of diabetic retinopathy and minimize vision complications:
Take prescribed medications as instructed.
Follow a proper diet
Exercise regularly
Perform a simple visual test daily
Have your eyes examined annually
Answers to quiz:
1. False; good control of blood glucose is very important in over-all management of diabetes, but may not prevent diabetic eye disease. All people with diabetes should have an eye examination through a dilated pupil. 2. False; often there are no early warning signs of diabetic eye disease. Vision may not change until the disease becomes severe. 3. True; people with diabetes are twice as likely to develop cataracts and to develop them at an earlier age than those without diabetes.
November is Diabetes Eye Disease Month. Before discussing how diabetes effects the eyes, I want to begin with the disease itself. Approximately 16 million Americans have diabetes. Classified as a “chronic disease epidemic” by the Centers for Disease Control and Prevention, the prevalence of diabetes has increased dramatically over the past forty years.
The term “diabetes mellitus” refers to a group of diseases that affect how your body uses blood glucose, commonly called blood sugar. Glucose is vital to your health because it is the main source of energy for the cells that make up your muscles and tissue. Glucose comes from two major sources: the food you eat and your liver. During digestion, sugar is absorbed into the bloodstream. Normally, sugar then enters cells with the help of insulin. If you have diabetes, no matter what type, it means you have too much glucose in your blood, although the reasons may differ. Too much glucose can lead to serious health problems.
There are different classifications of diabetes. 2 types are potentially reversible. Prediabetes is defined by having blood sugar levels that are higher than normal, but not high enough to be classified as diabetes and gestational diabetes, which occurs during pregnancy. Chronic diabetes conditions include type 1 diabetes which is caused when your immune system attacks and destroys the insulin-producing cells in the pancreas and type 2 diabetes which is caused when your cells become resistant to the action of insulin and sugar builds up in your bloodstream.
Diabetes is a chronic, complex and destructive disease that can cause a wide range of problems including heart disease, kidney failure, amputations and blindness. Both types of chronic diabetes, Type 1 and Type 2 are serious diseases, and can lead to the same kind of complications. But people with diabetes can take several steps to stay well. Most important are eating a healthy diet, exercising regularly, maintaining close control of blood sugar levels, and learning as much as possible about living with diabetes. By taking care of yourself through diet, exercise and special medications, diabetes can be controlled.
Impress your friends with these amazing eye facts.
An owl can see a mouse moving more than 150 feet away, with light no brighter than candlelight.
Mosquitoes can see into the infrared range, so humans appear to light up to them, even in the dark. To a mosquito at night, you look like a neon diner sign!
An ant has two eyes, each of which is made up of many smaller eyes. This type of eye is called a compound eye.
A worm has no eyes at all.
A chameleon’s eyes can look in different directions – at the same time!
An owl can see a mouse moving more than 150 feet away, with light no brighter than candlelight.
An ostrich eye is only two inches across, but it weighs more than its brain.
The giant squid has the largest eyeball on the face of the earth. At 18 inches across, it’s about the size of a beach ball.
Do you think a change of eye color or a pair of WildEyes will help you create the perfect Halloween costume? Use caution with these lenses. In 2005, the United States Food and Drug Administration (FDA) classified all contact lenses, whether they correct vision or are used simply for cosmetics as medical devices. In the US, contact lenses cannot be obtained legally without a prescription. Not only do the lenses have to be FDA approved, but so do the dyes. Any product in your eyes or touching your eyes should always be dispensed with a current prescription from your eye doctor. Without proper fitting and care there is a risk of bacterial infection, corneal abrasion and corneal ulcers. Don’t risk your eyesight, if you are interested in colored contacts give the office a call.
