Frequently asked questions
Recommended eye exam frequency for children
Soon after the baby is born, pedriatrician will examine their eyes to rule out signs of congenital cataracts, malformed eyelids, glaucoma or other serious neonatal eye problems and abnormalities. All children who are found to have an ocular abnormality or who fail vision assessment should be referred to a pediatric ophthalmologist.
Premature babies should be checked by a pediatric ophthalmologist 6-7 weeks after birth as they are at risk of being born with an eye disorder called retinopathy of prematurity that can lead to vision loss.
In addition, professional eye exam is required for babies who receive incubator care after birth or if parents have spotted a tiny white glow in the baby's eye.
Children should have their first comprehensive eye examination performed by pediatric/ophthalmologist at 6 to 12 months of age. This is an important time to ensure the eyes are healthy, eye and muscle movements and alignment are developing properly, and the eyes are focusing together. The doctor will look for anything that may interfere with normal and continuing vision development.
This exam becomes much more important for children with family history of amblyopia, strabismus or serious metabolic or genetic diseases and if parents wear high prescription glasses or contacts.
Eye exam should be repeated at age 3 in children without any evident eye problems. The eye doctor will reassess a child's visual system to confirm the absence of any eye disease or refractive error (the need for glasses), as well as monitor the continued growth and efficiency of visual skill development. This is also the examination where eye muscle problems such as crossed-eyes (strabismus) and lazy eye (amblyopia) are carefully assessed. If detected and treated at an early age, these conditions will often resolve completely.
The doctor will do visual acuity screening using eye chart tests, pictures, letters, or the Tumbling E test. This test measures how well children see the form and detail of objects.
A child’s third visit to the pediatric ophthalmologist should take place just before they enter the first grade at about age 6 or 7. This is an important opportunity for the ophthalmologist to assess if vision is continuing to develop well and ensure that child’s eyes are ready to support learning as they begin school.
For school-age children, a comprehensive eye exam is recommended every two years if no vision correction is required. Children who need eyeglasses or contact lenses should be examined annually or as recommended by their ophthalmologist.
A children's eye exam is an expert assessment of child's eye health and vision performed by an ophthalmologist. A brief examination of child’s eyes by a pediatrician is not a substitute for a comprehensive exam. Early eye examinations are crucial to make sure children have normal, healthy vision so they can perform better at schoolwork or play.
What you should know about contact lenses
Contact lens wear is not a matter of age. Even infants can wear contact lenses. Young children wear contacts if both eyes require a different prescription or they just don't like their glasses.
Assessing child’s maturity, personal hygiene habits, motivation and ability to handle contact lenses responsibly can help to determine if they are ready for contact lenses. Contact lenses often provide a more convenient mode of correction for young, active children who participate in a variety of sporting activities. Daily disposable contact lenses are the most frequently prescribed lenses for children 12 years old and under because the chances of developing contact lens related eye infections are almost a non-issue.
At your first contact lens exam, you will be provided with personalized instruction concerning safe use and care of contact lenses.
Eye and contact lens exam will determine if your eyes are healthy and if you are suitable for lens wear. You will not be able to wear lenses if your eyes are uncomfortable/unusually red, your vision is blurred or if you have an eye infection.
It's important to follow the rules for using contact lenses according to their type. You should not wear contact lenses past the expiration date or beyond their recommended wearing time. Once opened, monthly lenses are only safe for 30 continuous days. You must replace them with fresh new lenses after the recommended wear period is over.
Misuse of contact lenses can cause visual conditions such as allergy or infections with serious consequences for our vision.
Before handling your lenses, always wash and rinse your hands thoroughly. Dry your hands with a lint-free towel.
Remove the right lens from the storage container, place it on your forefinger and inspect it to make sure the lens is not inside out.If the lens is in the correct position it will have the shape of a cup and the edges will curve upright. When inverted, the lens will have the shape of a rimmed bowl and the edges will flare out. If you place an inside-out lens on your eye it will feel uncomfortable and will move too much when you blink.
There are two techniques for inserting contact lenses:
Technique 1: Placed the lens on the tip of your pointer finger of the hand, which will be used to insert the lens. Hold the upper lashes/lid with the hand not holding the lens. Secure the lower lid with the middle finger of the hand holding the lens. Slowly bring the lens toward your eye while looking “through” the lens and finger. Gently place the lens squarely on the cornea.
Technique 2: Hold the upper lashes/lid with the hand not holding the lens. Hold the lower lid with the middle finger of the preferred hand and look up. Place the lens on the lower white part of your eye. Look down to center the lens on the eye and slowly release the lower lid. Blink a few times to ensure that the lens is centered, free of trapped air, and comfortable.
After removing your lenses from the case, rinse your case well with contact lens solution or saline and allow the case to air dry. The storage case should be cleaned every week with liquid detergent and warm water. Replace your case every 3 months. A dirty contact lens case can contaminate your contact lenses with bacteria/ germs, which can be transferred to your eye.
If there is a feeling of stinging, itching or discomfort after contact lens insertion, remove your lense and check if it is inverted or damaged. If the lens appears undamaged, you should thoroughly clean, rinse, and disinfect the lens and then reinsert it. After reinsertion, if the problem continues, you should immediately remove the lenses and consult your eye care professional.
Wash your hands with a mild soap and dry them using a lint-free towel.
Pull down the lower lid with the middle finger of your preferred hand. With the tip of your index finger of the preferred hand, lightly touch the bottom edge of the lens. While looking up, slide the lens down onto the white part of your eye. Then gently pinch the lens off the white part of your eye using your thumb and index finger.
A single solution is used for disinfecting, cleaning, and storing soft contact lenses. Contact lens case (storage box) is provided with the solution.
Three steps to proper contact lens care must be followed every time the lenses are removed from your eye. They include cleaning, rinsing, soaking and disinfection.
After removing the lens, place a few drops of cleaner in the palm of your hand and in the bowl of the lens. Gentle but firmly rub the lens for 20-30 seconds between your palm and the index finger of the opposite hand. Rub in a plus-sign or straight line motion.
Place the lens in the opposite palm. Cup your hand and fill the palm with a pool of rinsing solution until the lens is immersed. Rub the lens using the same motion in the cleaning step. Turn the lens over and repeat until all cleaner is removed.
After cleaning and rinsing your lenses, place them in the storage case. Make sure the lens is completely covered with storage solution. Change solution daily. The lenses must be stored a minimum of 4 hours before being worn.
After each use, you should remove, clean and rinse your contact lenses. Place the lens in your clean lens case and fill with fresh solution. Always discard all of the leftover contact lens solution after each use.
If you wear contact lenses full-time, you should also have an up-to-date prescription pair of glasses in case you need to stop wearing contacts due to an eye infection or irritation, or you simply want to give your eyes a break.
Adaptation period depends on the type of contact lenses. Most people find soft contact lenses comfortable and assimilate to them almost right away. On the other hand, GP and hard lenses will always require an adaptation period, sometimes up to a couple of weeks, before they feel as comfortable as soft contact lenses.
Wearing schedule for GP and hard contact lenses: patients should wear their contact lenses 1 h a day and increase lens wearing time for 1 h for each following day until they reach up to 10 h of continuous wearing when they are required to visit their eye care professional for contact lens check-up.
Contact lens prescriptions and eyeglass prescriptions are not the same. Therefore, if you want to wear both contact lenses and eyeglasses, you will need two separate prescriptions.
There's no need to take a break from wearing soft contact lenses prior to your scheduled visit to retest your vision in order to get an up-to-gate prescription for your eyeglasses. You can remove your lenses at the ophthalmologist's office, wait a couple of minutes and your eyeglass prescription can be determined.
However, you should take a break from wearing GP lenses prior to your vision retesting for accurate eyeglass prescription.
What are progressive lenses?
Although progressive lenses were first introduced at the beginning of 20th century they didn’t enjoy commercial success until the early 1970s. Since then progressive lens materials and design have been constantly developing. Advanced technology provides higher accuracy compared to standard progressive lenses as well as easier and faster adaptation to progressive eyeglasses.
Progressive lenses are multifocal lenses that have three prescriptions in one pair of glasses. They are used to correct distance, intermediate (computer usage), and near (reading usage) at the same time. They look exactly the same as single vision lenses (monofocals). The distance prescription is at the top and gradually increases in power to your full reading prescription as you move down the lens. By having all vision correction needs met in one set of lenses, user day to day life will become easier, as they are not constantly having to carry around two or three different pairs of glasses.
Adaptation to progressive lenses usually takes some time because the gradient power of the lens can cause aberrations in your peripheral vision. The left and right extremes of the lens are not as strongly progressive as the central, vertical corridor, which means your vision could seem blurry when looking to the sides. However, every new generation of progressive lenses brings significant improvements, and many people never experience any problems at all.
Progressive lenses have gained widespread acceptance and the quality is reflected in progressive lens design that the transitional zone for distance, intermediate and near vision is as wide and comfortable as possible with minimal distortion of peripheral regions of the lens. This is also basic requirement for fast adaptation and user satisfaction.
There are many different progressive lenses available today and selection of the lens type is dependent on the visual needs of the presbyopic patient. Modern progressive lenses can even be designed and mounted into almost any shape or size frame, including being adapted into sunglasses. The main difference between lenses is the width of the central corridor. Different areas are expanded, depending on the function the lens is designed to be used for.
Progressive lenses are the best option for maintaining perfect vision at all distances- near, far, and everything in between. Progressives significantly improve the aesthetic appearance by eliminate visible line between viewing areas in bifocals. Thus they make the transition between prescriptions much smoother and users quickly adapt to progressive lenses.
Many adults over 40 may start to have problems seeing clearly at close distances, especially when reading and working on the computer. They may need to hold reading materials farther away to see them clearly, remove your glasses to see better up close or they need more light to see as well as they used to. If people have never needed eyeglasses or contact lenses to correct distance vision, then experiencing near vision problems after age 40 can be concerning and frustrating. Now their eyes don't have enough focusing power to see clearly for reading and other close vision tasks.Losing this focusing ability for near vision, called presbyopia, occurs because the lens inside the eye becomes less flexible. This flexibility allows the eye to change focus from objects that are far away to objects that are close.
Single pair of glasses or contact lenses you previously wore generally will no longer give you clear vision at all distances. Many people deal with presbyopia by purchasing two or more pairs of eyeglasses with single vision lenses. Due to presbyopia nearsighted patients will have higher prescription for distance vision and lower prescription for near vision. Farsighted patients will have lower prescription for distance vision and higher prescription for near vision. Patients with astigmatism will have the same prescription for near and distance vision. People with emmetropia (normal refractive condition of the eye) aged 40 and beyond experiencing presbyopia will need only the prescription for near vision. The power of lenses for presbyopia will depend on the person's age.
If you have multiple prescriptions for different distances and need to carry along two or three pairs of glasses, or are beginning to find that no single prescription is correcting your vision to a high enough standard for all daily activities, progressive lenses could be the answer.
Multifocal design of progressive lenses provides:
Clean and sharp vision at all distances (you won’t need to have more than one pair of glasses)
Vision with progressives can seem natural. If you switch from viewing something up close to something far away, you won't get a "jump" like you would with bifocals.
No telltale lines in the lenses as with bifocals. Progressive lenses appear more youthful are more cosmetically attractive.
A professional optician can help you select the best progressive lens brand and design for your prescription and unique visual needs.
For the best clarity, comfort and protection in all lighting, anti-reflective coating, tinting, polarization and photochromic lens treatment can be added to your new progressive lenses.
The most important goal of progressive lens producers is to make progressive corridor or the transitional zone as wide as possible and minimize peripheral regions of the lens, as a basic requirement for optimal vision.
The benefits of progressive lenses can only be experienced when the lenses are properly adjusted to best fit the frame and the way the frame fits user's face. This makes progressive eyeglasses almost instantly comfortable though you will still need some time to get used to them completely.
Fast and easy adaptation to progressive lenses will be possible if:
Detailed medical history of the patient is provided
Accurately determined prescription, monocular PH
Lens type is selected according to patient's specific and visual needs
Properly selected frame with all technical and aesthetic properties
Accurately taken measures for fitting (fitting height, pantoscopic angle, frame curvature, back vertex distance)
Measures should be accurately centered in the lens
If all these requirements are fulfilled everyone can quickly get used to progressive lenses and adaptation period will last up to 7-10 days. People who never adjust to progressive lenses are rare.
Eye exam for adults
First you'll be asked about your general health, any vision problems you might be experiencing and your personal and family medical history to check if you are at special risk for eye problems.
Then your eye doctor will use visual acuity tests that measure the sharpness of your vision to see if you need glasses or contact lenses to improve you vision. You should expect a projected eye chart to analyze distance visual acuity and a handheld acuity chart for near vision measurement. The doctor asks you to identify different letters of the alphabet called optotypes printed on the chart. The lines of type get smaller as you move down the chart. Each eye is tested separately (right eye is tested while left is covered and vice versa). Inability to read the smallest row of letters indicates that your vision acuity is reduced due to a refractive error. Having a refractive error means you need some form of correction, such as glasses or contact lenses to see as clearly as possible. Your doctor will also check the position of your eyes and the eyeball mobility in all directions.
Refraction assessment is the test ophthalmologist uses to determine your exact eyeglass or contact lens prescription. Your eye doctor usually fine-tunes this refraction assessment by having you look through a masklike device that contains wheels of different lenses (phoropter). Doctor shows you a series of lens choices and then asks you to judge which combination of two lenses in each choice looks clearer. Based on your answers, your eye doctor will continue to fine-tune the lens power until reaching a final eyeglass/contact lens prescription.
The doctor may also use a computerized refractor (autorefractor) to automatically estimate your prescription for glasses or contact lenses. In this procedure, the doctor shines a light into your eye and measures the refractive error by evaluating the movement of the light reflected by your retina back through your pupil. If light rays don't focus perfectly on the back of your eye, you have a refractive error. Autorefractor, like manual refraction, determines the lens power required to accurately focus light on your retina that will give you the sharpest, most comfortable vision.
After determining your exact eyeglass/contact lens prescription, the doctor will use biomicroscope to examine the structures of the front of your eyes including your eyelids, cornea, conjunctiva, iris and lens under high magnification. Your eye doctor will use ophthalmoscope to shine a beam of light through your pupil to evaluate the back of your eye, including the retina, the optic disk, the underlying layer of blood vessels that nourish the retina and optic nerve. Before your doctor can see these structures, your pupils must be dilated with eyedrops that keep the pupil from getting smaller when your doctor shines light into the eye. This type of examination is especially important for nearsighted patients with high prescriptions.
You'll be also given a numbing drop in your eyes. Then your eye pressure is measured.
Eye exam is painless and many patients find it interesting due to various devices that use advanced technology to detect even obscure eye changes that can affect vision.If you have had your pupils dilated, it's a good idea to have someone with you to look after you or escort you home as your vision will be blurred for several hours after the examination.
Regular eye check-ups can help to identify vision problems at an early stage and you can start treatment to reduce the risk of any permanent damage to your eyes. Eye exams can also detect other serious health problems such as diabetes, hypertension, high blood pressure, high cholesterol.
In general if you’re 40 or older, healthy and have no symptoms of vision problems, you should get your eyes checked every 1 to 2 years. If you’ve had eye trouble in the past, or if you’re at risk for developing it, you should see an eye doctor every year.
It's recommended that you occasionally test your vision at home. Cover the left eye with your hand while your right eye is open and vice versa to check whether your both eyes have the same level of visual acuity. You might be unaware of having unequal vision because the stronger eye and the brain compensate for the shortfall and the weaker eye gets progressing worse. If you notice any changes in your visit while doing the test you should schedule an eye exam as soon as possible.
Eye exams for children
Regular children's eye exams are important to ensure normal vision development. A child is never too young for a complete vision examination. Infants should have their first comprehensive eye exam at 12 months of age. If there are no concerns regarding possible vision problems children should have additional eye exams at age 3. At that time they are old enough to cooperate with an eye exam using an eye chart and visual acuity can be tested.
Unfortunately most children have their first eye exam before they start schooling and when their vision has been fully developed. Eye problems recognized that late such as hyperopia, astigmatism, myopia, strabismus or anisometropia will be much more difficult or even impossible to treat and the child's vision may be permanently impaired.
Specifics of how eye exams are conducted depend on your child's age, but generally the exams will include a case history, vision testing, determination of whether eyeglasses/contact lenses are needed (existence of a refractive error), testing of eye alignment, an eye health evaluation and, if needed, prescription of eyewear.
Refractive errors include myopia (nearsightedness) - a child should wear glasses or contacts with minius prescription, hyperopia (farsightedness) - a child should wear glasses or contacts with plus prescription and astigmatism (irregularly shaped cornea) that can be correct with both plus and minus prescriptions. The doctor will also look for the most common eye problems in children such as strabismus (crossed eyes) - visual problem in which the eyes are not aligned properly and point in different directions.
Depending on your child’s age the eye exam will include:
"Fixate and follow" testing (determines whether your baby's eyes are able to fixate on and follow an object such as a light as it moves)
Tests of pupil responses
Inspection of the eyelids
Tests to diagnose a blocked tear duct
Binocular vision testing
Diplopia (double vision) testing
Stereoscopic vision testing
Ocular mobility tests (testing eye movements)
Tests to find a squint (strabismus) can involve covering and uncovering each eye in turn. This shows which eye has the squint and how it moves.
Visual acuity testing (objectively and subjectively)
Eye examination using biomicroscope and ophthalmoscope
A routine eye exam will include:
Visual acuity testing (objectively and subjectively)
Visual acuity check with already worn eyeglasses
Cover test- procedure to determine binocular vision
Checking general eye muscles
Examining the front of the eye using biomicroscope
Examining the back of the eye using ophthalmoscope
Tell your child what to expect - the doctor will look into their eyes and ask them to identify shapes or pictures. You can make the exam preparation fun by practicing naming shapes or preparing for the Tumbling E test.
The Tumbling E test assesses how well your child sees details and forms by mimicking the letter E with his or her fingers to indicate which direction the letter is facing. Use your homemade cardboard E letter and describe the E prongs as horns or legs to make it fun. Ask your child to say the animal or object it looks like while pointing their fingers – if the legs are pointing up, it might look like a rabbit with three ears and if it’s pointing down it could be a table with three legs.
Some of the first signs that children may have a vision problem and need a comprehensive eye exam before their third birthday include:
- Appearance of a white pupil (in babies)
- Baby's eyes don't follow mother's face and a toy moved from side to side in front of her
- Red, itchy or watering eyes
- Eyes that flutter or shake
- Turning of an eye in or out
- Sitting close to the TV or holding a book too close
- Squinting, rubbing the eyes, or excessive blinking
- Eyes look crossed or don’t move in unison
- Sensitivity to light
- Tilting the head when looking at things
- Child becomes nervous, irritable, or quickly fatigued while looking at colorbooks, or doing close work
While playing with your child do a cover-uncover test to check if their eyes function well. If child protests and tries to remove your hand from one of their eyes this means that the other, uncovered eye is weaker and child should have an eye exam peformed by pediatric ophthalmologist/strabologist as soon as possible.
Children younger than 3 should have additional comprehensive eye examination if their parents wear glasses or if they notice something unusual in their child's eyes or visual functioning. A preventive eye exam is the only way to detect refractive errors in their early stages and successfully correct them.
Children may not realise they have a vision problem and without regular eye exams there is a risk they could go undiagnosed for months or years. Therefore, it's important for eye problems such as refractive errors or anisotropia to be identified when the child's vision is still developing as early detected eye problems are often much easier to treat.
Though strabismus may occur in some children with serious health and development problems in most cases it is related to refractive errors - farsightedness, nearsightedness and astigmatism. If detected and treated early, strabismus can often be corrected with excellent results.
Children with strabismus usually have reduced visual acuity.