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Patient Education
Eye Exams and Sight Tests: Understandning THe DIfference
Make no mistake – a sight test is not a proper eye exam, which only optometrists and ophthalmologists are trained and licensed to perform.
What is an eye exam?
A comprehensive eye exam performed by an optometrist looks at the entire eye and vision system and is an important part of preventative health care. Eye exams assess vision – how well you see – and the health of the eyes inside and out. Think of it as a physical for your eyes.
A thorough eye exam from an optometrist includes:
- assessment of eye health to diagnose a range of diseases
- analysis of how well eyes focus at all distances
- measuring of muscle alignment of the two eyes working as a team – called binocular vision
- consideration of the patient’s visual needs, at work and at play, to determine the ideal prescriptions for eyeglasses and/or contact lenses.
An eye exam could uncover anything from a minor deficiency of the tears to major eye diseases or disorders like glaucoma or retinal detachments. Eye exams can even detect signs of problems elsewhere in the body – serious conditions such as diabetes, high blood pressure and brain tumors.
What is a sight test?
A sight test is a limited test of vision performed by a non-doctor using automated equipment. The accuracy and effectiveness of the eyeglass prescription generated is limited – the operator is not trained or licensed to test the eyes or to diagnose, and the computer program cannot consider all the factors that an optometrist does when prescribing lenses.
Why does knowing the difference matter?
A comprehensive exam is essential in arriving at an accurate prescription that is customized to your visual needs. A sight test falls short of that. Most important, a sight test completely ignores your eye health, which could end up causing permanent vision loss.
Having a sight test without an eye health examination poses a serious risk. Don’t settle for anything less than the highest quality eye care you and your family deserve.
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Everybody, Especially Diabetics Should Eat This Way
As your eye doctor, it my job to educate you, so that you know what it is that you need to do to keep your eyes healthy. It is important that you understand that diabetes affects every organ in the body and the eyes are no exception.
As a diabetic, it is imperative that you moderate your blood sugar. If you are successful in doing this, you will have no damage to the eyes and suffer no loss of vision. If you eat in a manner that keeps your blood sugars level, you will keep your vision and not lose it to diabetic retinopathy. (If you don’t have diabetes, and you eat this way, you will never get diabetes and your blood pressure and cholesterol will stay good. You’ll stay at your ideal weight and feel energetic. Everybody should eat this way.)
How should you eat in order to keep your blood sugars fairly level? You should always eat foods with a low glycemic index. That means foods that convert to sugar gradually after eaten, instead of giving a quick burst of sugar into the bloodstream.
The foods that are OK are:
- Most veggies (except for the high starch ones such as carrots, potatoes, turnip, squash)
- Proteins like fish, chicken, beef, pork, eggs, cottage cheese.
- Healthy fats like olive oil, nuts, avocado, some butter, cheese.
- Fruit, in small to moderate quantities (example: half an apple eaten at a time), eaten whole. No fruit juice. No dried fruit.
- Dairy products: all dairy including milk, cottage cheese, plain unsweetened yogurt (Liberty Organic is yummy)
- These are generally fresh, perishable foods. These are foods that were available three thousand years ago.
The foods that are NOT OK are:
- All foods with sugar, which are, not only the desserts, but also boxed cereals, sweetened yogurts, granola bars, sweet drinks, the list goes on and on, etc. Look for the hidden sugars in food. Check the ingredients for sugar. You’ll find it’s hidden in most processed food. No fruit juice. No peanut butter. No boxed breakfast cereal.
- Starches. These convert to sugar so quickly that they are just as bad. Potatoes, bread, pasta, rice, any food made with flour.
- Don’t eat foods that your ancient ancestors did not have access to. Example: non perishable processed foods in your pantry. Eating healthy means that your fridge should be full and your pantry should be bare.
- Don’t even buy the foods you shouldn’t eat. Don’t bring them into your house.
“But what about carbohydrates?” you say. “Shouldn’t I have some carbohydrates?” The answer is this:
Vegetables are carbohydrates. Fruits are carbohydrates. Veggies (lots) and fruits (a bit) are the carbohydrates that our bodies are designed to eat. Our bodies are not designed to eat highly processed foods like sugars and starches.
If you must have bread, have sprouted 100% whole grain bread, but only one per day.
So what does a great meal plan look like? Here are some examples:
Breakfast:
- one egg, sliced tomato, cottage cheese and fruit
- just cottage cheese and fruit
- an omelette (with or without veggies and/or cheese) with or without a slice of sprouted 100% whole grain bread with butter
- plain large flake oatmeal with a heaping Tblsp of cottage cheese, a Tsp of olive oil and a Tsp of cinnamon or nutmeg
Lunch and Dinner:
- 2/3 to 3/4 of your plate is covered in veggies and the rest is protein (meat, seafood, poultry, tofu)
Snacks:
- Nuts, veggies, half a piece of fruit with cottage cheese, plain yogurt, slice of meat, cheese
Beverages:
- Milk, water, tomato juice, V8 Juice, green tea, up to one coffee per day, up to one glass of wine per day
Sweetener:
When you follow this plan, your eyes, and your whole body, will benefit from improved health!
Vision and Aging
What could be more important?
Eyes, like many other organs in your body, are very important to help you lead an active and productive life as you age. As you get older, you are at higher risk of developing many serious eye conditions that could be avoided, treated or corrected with regular eye exams.
Common Vision Conditions After 40
Several again conditions, such as high blood pressure, diabetes, arthritis or medications, can contribute to eye health conditions. There are other eye-related complications that can occur over time as well.
- Presbyopia is the loss of ability to change focus from far to near.
- Glaucoma is an eye disease (in which the internal pressure of the eye rises to point) that causes damage to the optic nerve. It is sometimes related to eye pressure and can lead to blindness if not diagnosed and treated in time.
- Cataracts occur as the lens inside the eye becomes cloudy, distorting vision. Cataracts often require corrective lens changes or surgical removal.
- Macular Degeneration is a disease that obscures a person’s central vision. It is the leading cause of blindness, with the risk of the disease increasing directly with age.
Health complications such as arthritis and diabetes often require medications – some of which affect the eyes and vision. In their early stages, many conditions associated with aging may not cause symptoms or create problems that are readily apparent, but can be detected through routine examination by your Optometrist. As the senior years approach, it is especially important that regular eye examinations be part of your plan for maintaining good health and vision. Your Optometrist can help you identify and understand your individual needs, making specific recommendations for you.
The Value of Prevention
As with health and nutrition, prevention is the key to quality of life as well as age. Maintaining excellent general health can often delay and reduce the effects of aging on your eyes.
But even with the best preventative efforts, it is likely that eventually some loss of vision will occur. There is often a greater need to rely on glasses for a specific task such as reading. Special filters and sunglasses can help with age-related problems associated with glare, light sensitivity or reduced contrast. Extra lighting or special magnification can also be helpful, especially for people with reduced or low vision.
Your Optometrist understands the effects of aging, eye disease and the medications you may be taking. Your Optometrist can help improve your quality of life, even if your vision becomes limited. Routine optometric examinations are important to identify your individual needs assist you in understanding your conditions and allow and allow your eye doctor to make specific recommendations for you.
As you age, be sure to see your Optometrist regularly.
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Age Related Macular Degeneration
AMD tends to be a progressive condition. If you do the following things, you will reduce the risk of progression.
Lifestyle Modifications:
* Quit smoking
* Improve dietary intake. Eat lots of vegatables twice a day. (Lettus and starches don’t count.) At lunch and dinner, half your plate should be vegetables. Especially good are green leafy ones, like spinich and broccoli, plus all other coloured veggies.
* Lose excess abdominal weight. Keep waist circumference down (as measured at the navel) below 31.5” for women and below 36” for men. The best way to do this is to eliminate, or, at least, reduce, foods with sugar and starch. Check the label to find the hidden sugars in food. Starches include potatoes, rice, pasta, bread, crackers and anything made with flour.
* Wear UV protected sunglasses outside.
* Put a UV filter in all your eyewear.
* Wearing a hat outside is helpful.
* Regular walking is beneficial.
* If you have hypertension, manage it well (stress reduction, walking, medications).
* Unless contraindicated, take low dose aspirin.
Vitamin Therapy (two per day) slows the progression of AMD.
Macular Protect T2, the best quality product, is also the least expensive. For now, only available through eye doctors’ offices, you can get it at the front desk.
Weekly at home monitoring with Amsler Grid:
Check the vision of each eye alone with the Amsler Grid weekly to see if the lines are distorted and make an appointment to see me if there is any deterioration.
See me, your eye doctor, at least yearly.
For more information visit www.amdalliance.org
P.S. Your family members, who are at risk for developing macular degeneration, may take one Macular Protect T2 per day.
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Cataracts
What are cataracts?
The crystalline lens of the eye is normally clear so light readily passes through it, producing a sharp image on the back of the eye. When the lens becomes cloudy, it is known as a cataract. This loss in transparency is what causes the vision to appear hazy and gradually decreased.
 
In the normal eye, the lens is clear, allowing light to pass through and produce a sharp image on the retina. A cataract is a clouding of the lens which disrupts the transmission of the light to the retina.
What causes Cataracts?
Chemical changes within the protein material of the lens are responsible for the clouding and discoloration see in cataracts. These changes are a part of the natural aging process, but may also be caused by injury, certain diseases, birth defects or inherited tendencies. Other contributing factors include exposure to ultraviolet light, certain drugs and poor nutrition.
Who is affected?
Cataracts are the number one cause of poor vision among adults. Over 2/3 of the population have a vision problem from cataracts.
How are cataracts diagnosed?
A comprehensive eye health exam by an Optometrist or Ophthalmologist is needed to detect a cataract. Once diagnosed regular follow-up care is important to determine the best treatment option.
What are the different types of cataracts?
There are several different types of cataracts, but some of the more common ones are as follows:
- Nuclear Sclerotic Cataract – This occurs when there is a hardening of the protein in the lens. The colour of the lens turns from clear to light yellow to brown. As this occurs, the rear vision seems to improve even without glasses – this is referred to as “second sight”
- Posterior Subcapsular Cataract – This cataract usually begins in the central portion of vision and is located in the back half of the lens. This type of cataract usually develops faster and is generally the most bothersome. Patients are quite affected by bright lights and reading is more difficult.
- Cortical Cataract - They occur in the periphery of the lens as water builds up and the swelling forms cloudy streaks.
Can cataracts be prevented?
There is not any known cure for cataracts that occur as a part of the normal aging process. However, there is evidence that exposure to ultraviolet radiation (sunlight) speeds up their progression, so it is advisable to take preventative measures when outdoors (e.g. wearing sunglasses with 100% UV protection) or have your eyeglasses treated with an ultraviolet filter.
What is the treatment for cataracts?
At first, our office can prescribe eyeglasses that can help treat the loss in vision that occurs with cataracts. As the lens in the eye becomes more opaque, however, glasses alone will not work. When that occurs, surgery may be the best option to restore vision. The decision to have a cataract surgically removed depends on a number of factors, such as how dense the cataract is, where it is located and most important, the degree to which it impairs normal daily activities.
What about surgery?
Cataract surgery has improved dramatically in the last decade, with a success rate of 95% or better. Only one eye is operated on at a time, usually the eye with poorer vision. Surgery involves the removal of the clouded lens, followed by an implant with an artificial lens. (Known as an intraocular lens, or IOL)
Modern advances in cataract surgery
With traditional cataract surgery, the hardened lens would be “popped out” of the eye like a pea from the pod. This required a large incision, and many stitches to seal the wound and several weeks for the eye to fully heal. Today’s surgical procedures have fewer complications and faster recovery times than those in the past. Some advances in the field are described below:
- No-stitch breakthrough – with no-stitch surgery, the incision into the eye is made on an angle which allows the eye to heal itself. This is less traumatic to the eye, the vision improves sooner and the patient returns to normal activities sooner.
- Phacoemulsification – the lens is ground into small fragments with ultrasonic vibrations, and then removed by suction. The thin shell of the lens is left in place and the IOL is inserted. With this procedure, the cataract is removed through an incision as small as ¼ of an inch. There is a smaller wound site, and therefore, less trauma and a faster recovery time.
- Foldable Implants – Patients may opt for “foldable” implants, which are made from softer materials than the standard plastic implants. Some advantages of theses are slightly faster healing, small wound size and less distortion of the cornea (clear covering of the front of the eye). At present, there is an additional fee for this type of implant, over and above the basic medical coverage.
What complications may occur?
While the possibility exists, serious complications are relatively rare. Bleeding on or in the eye can occur, but this usually absorbs in the first few days. Eye infections are rare because of the use of antibiotics. Retinal detachments occur in <1% of patients. The most common complication is 3-24 months after surgery – clouding of the transplant capsule (the thin shell). A laser painlessly opens the hazy capsule to restore clear vision.
After cataract surgery
Eye drops are given after the surgery. The eye will take 6-8 weeks to heal completely, but normal activities can be resumed almost immediately. Vision should begin to improve shortly after the operation but sometimes, cataract removal does not result in complete improvement in vision. In such cases, a proper eyeglass prescription may bring it to an acceptable level.
Cataracts can be treated successfully
Post-operative care is often shared between practitioners for the mutual benefit of the patient. Three to six weeks after the surgery (or sooner if required), am evaluation of your prescription should be done by your optometrist. Proper co-management provides convenient access for the patient to allow for best in health and vision care.
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