When should my child have their vision checked?

Following the guidelines of the American Optometric Association (AOA), children should have their first eye exam at 6 months of age. This exam can be conducted at no cost through the InfantSEE program. ( www.infantsee.org ) As long as no problems are detected for the first exam, then the child should be checked again at age 3 and again at age 5, or before they start kindergarten. Once the child is school age, exams are recommended every year.

It is important to catch any problems at a young age, so that they can be fixed early. Vision has a “critical window” of development that ranges approximately from ages 3 to 6. If the brain does not receive a perfect clear image from both eyes, then 20/20 vision will not develop in one or both eyes. This is how someone gets a “lazy eye”, or an eye that does not see well even with glasses or contacts. It is important to know that most vision problems (such as “lazy eye”) are preventable with early intervention!

Find out what it means to be nearsighted.​​​​​​​

Nearsightedness, or myopia in medical terms, is a refractive error where near objects are seen clearly but distant objects are blurry. This is due to the eye being too long in anatomy and having too much focusing power, which places the image in front of the retina, but not on it. This is why a person with myopia will receive a minus prescription, such as -2.00 diopters.

While you might think farsightedness is the opposite of nearsightedness, that is not always the case.​​​​​​​

Farsightedness, or known as hyperopia medically, is a refractive condition where distance objects are seen clearly but near objects can be seen as blurry. This is because the eyeball is too short and does not have enough focusing power, which forms the image behind the retina instead. This is why a person with hyperopia will receive a plus prescription, such as +2.00 diopters. It is possible for a young person to “mask” or overcome their hyperopia by increasing the focusing system of the eye, called accommodation. But this can lead to headaches and eyestrain if the effort is extensive to compensate for the farsightedness.

A strange word that causes strange effects to your vision.

Astigmatism is also a refractive error, just like hyperopia and myopia, but it has to do with the curvature of the cornea (the clear part on the front of your eye) and the crystalline lens (inside your eye, behind the iris). There are two different curvatures that focus the image in two different places. This makes vision blurry at all distances. A good example is your facial reflection on the backside of a spoon. The flatter longer curve on the spoon (flatter means less focusing power) will stretch your face reflection. While the steeper shorter curve on the spoon (steeper means more focusing power) will squish your face image. This is why a person with astigmatism needs a multiple-numbered prescription such as -2.00 -1.00 x 180 to see clearly.

If you need reading glasses to read this, you know what we are talking about.

Presybopia is a natural aging process of the crystalline lens (inside your eye, behind the iris) that controls your focusing system, called accommodation. The lens becomes less flexible around the age of 43 and continues to worsen until about age 55, when the changing levels off. There is no way to prevent presybopia. Bifocals or reading glasses will be necessary to see clearly for near tasks.

A “lazy eye” is more than just a poor work ethic.

Amblyopia, or “lazy eye”, is a lack of central vision development in one or both eyes that cannot be corrected with eyeglasses or contact lenses. It usually develops before the age of 6 during visual brain development. There are three types: Refractive, strabismic, and occlusive. Refractive amblyopia occurs when one or both eyes has a high prescription that is uncorrected. The child will be unable to see 20/20 because the brain never was able to see clearly during visual development and never learned how to see 20/20. In strabismic amblyopia, one eye turned inward or outward and caused the brain to have double vision. Since this is not pleasant, the brain will just “turn off” the deviating eye. That eye will never learn to see 20/20 if it is not being used. Occlusive amblyopia occurs when something physically blocks the eye such as a congenital cataract or a droopy eyelid. The eye cannot learn to see clearly if it cannot see at all.

Treatment for lazy eye may include a combination of prescription lenses, prisms, vision therapy and eye patching. While results are better if treatment is initiated before age 6 before visual development is complete, it is possible to have improved vision from treatment at any age.

When your eyes do not look at the same thing.

Strabismus occurs when both eyes do not point at the same object at the same time. One eye may turn inward or outward, or it may alternate between the two eyes. Strabismus is usually something you are born with but it can be acquired due to trauma. In cases where strabismus has been present before the age of six, stereopsis or “3D vision” is usually absent because the brain did not learn how to look at an object with both eyes at the same time. Surgery is sometimes indicated to help re-align the deviating eye, as well as vision therapy to encourage both eyes to work together.

Why are my eyes so uncomfortable?

Dry Eye Syndrome refers to the breakdown in the quantity or quality of tears that moisten, cleanse and protect the eyes. Your tear film is very important because each blink helps to wash away dust and microorganisms as well as nourish and moisturize the cornea. Proper care of the tear film is important to maintain a lifetime of healthy vision!

Many patients do not realize that keratoconjunctivitis sicca (dry eyes!) is actually a medical condition that requires medical treatment. Whether it’s burning, itching, sandy feeling, gritty sensation, tired eyes, blurry vision, or any number of symptoms that patients will experience, you do not need to “settle” with life-long chronic uncomfortable eyes. Some patients will even stop wearing their contact lenses because they are uncomfortable due to dry eyes, which does not have to be the case. There are many different causes of dry eye and determining your specific cause will help your optometrist determine what is the best management program for your individual eyes. Most of the time, dry eyes cannot be “cured”. Instead, the focus is getting your eyes to a comfortable state and then maintaining that level over time.

If you are having trouble with dry eye symptoms, the doctors at Vision Source Mandan can help!

Published in the Bismarck Tribune once a month on the last Thursday

What to do if you get something in your eye.

While the most common foreign body injury is metal, it is possible to get other things into your eye that you just cannot remove without the aid of a microscope and steady, educated hands. If it is indeed metal, it must be removed or else it will continue to rust in your eyes and cause inflammation. If you feel you have gotten something in your eye, please do not hesitate to call us. If it is after business hours, our answering service will direct you to one of our doctors.

And remember: Most injuries to the eye can be prevented by wearing proper safety eyewear.

This common eye infection can be treated at Vision Source Mandan!

“Pink Eye” is often a catch-all term for an eye infection but there can be different types of eye infections depending on the cause (virus, bacteria, fungus, parasite, etc). The most common eye infection that we see are usually viral in nature and are usually associated with being sick with the cold or flu. It is very important that the correct medication is used to treat the eye infection. For example, if the infection is not bacterial, then you do not want to treat with an antibiotic. (Antibiotics should always be used with care due to increasing concerns with antibiotic resistance.) Proper diagnosis of eye infections can be made under the view of a microscope and with a trained eye from your optometrist.

If you feel you may be having an eye infection, call our office immediately and we will get you in for a same-day urgent eye visit. Please note that these types of visits are billed to medical insurance and not to vision insurance. If it is after-hours, call our office anyway. Our automated system can direct you to one of our eye doctors.

The retina is one of the most important structures in the eye.

Contusions or a “black eye” on the outside can cause damage on the inside of the eye too. If you have experienced ocular trauma, it is best to have a dilated eye examination to check for any retinal tears or hemorrhages that may have formed inside the eye from the force. The retina is the “seeing” part that lines the inside of your eye and it is very delicate and sensitive. Without proper treatment, the damage done can be permanent.

Find out why it is so important to keep your body (and your eyes) healthy.

Diabetic retinopathy is a complication of diabetes and the leading cause of blindness in adults aged 20 to 64 in the United States. Diabetes damages the tiny blood vessels inside your body, including the retina inside your eye, usually related to poor control or to the length of time you have had diabetes. The blood vessels become “leaky” and leak blood and proteins into the retina. These fluids are toxic to the retina. If not controlled, diabetic retinopathy can lead to blindness. Yearly dilated eye examinations can help detect the onset of diabetic retinopathy as well as maintaining proper control with your diabetic doctor.

Did you know that high blood pressure can affect the inside of your eye?

The majority of patients with vascular problems in the retina will also have systemic problems such as hypertension (high blood pressure), chronic open-angle glaucoma, diabetes, atherosclerosis (hardening of the arteries), and high cholesterol. An artery occlusion usually occurs due to an embolus (clot) in the blood stream while a vein occlusion usually occurs due to a thrombus (non-moving clot) that has formed in the vein due to blood turbulance. The retina is very sensitive to the oxygen supply it receives from the bloodstream, and can be permanently damaged quickly. Most artery or vein occlusions do not have any pain associated with them but are characterized by sudden and severe vision loss. If you ever experience a loss in your vision, even for brief seconds, you should always see your eye doctor.

Learn more about this very common vision problem.

Macular degeneration is caused by the deterioration of the central portion of the retina, called the macula. It is responsible for your central clear vision. AMD is the leading cause of blindness in people over 65 years of age. There is a dry form (most common) and a wet form. The dry form involves the destruction of the retinal tissue. This may convert to the wet form if bleeding or fluid becomes involved. While there are treatments to manage the wet form, there is no definitive treatment for the dry form. No treatment can reverse the damage but treatment may be able to slow or prolong it.

It is often called the “slow silent killer” of vision that leads to blindness.

Glaucoma is a group of eye diseases that gradually steal sight without any warning. Glaucoma does not have any symptoms until serious damage has already been done. The optic nerve is the nerve that connects your eyes to your brain so that you can process what your eyes see. When glaucoma damages the nerve, you lose peripheral vision. While there is no cure for glaucoma, medication, laser treatment, or surgery can slow the vision loss. The earlier we start treatment, the better we can manage the disease. While having a high intraocular pressure is a risk factor for glaucoma, there are other things that can cause it including previous trauma or systemic diseases. And there is even a type of glaucoma where the intraocular pressure is normal. The only way to monitor yourself for glaucoma is to see your eye doctor for regular comprehensive eye examinations.

As you age, the world will become less colorful and less sharp because of these.

A cataract is a clouding of the eye’s natural crystalline lens, which lies behind the iris (the colored part of your eye) and the pupil. The lens works much like a camera lens, focusing light onto the retina at the back of the eye. Cataracts are a normal aging process but they can also form due to trauma, systemic disease, or even be present at birth. With a normal aging cataract, the most common kind, you will notice your vision becomes dimmer, colors are less bright, and have issues with glare. Today, cataract surgery is a relatively simple outpatient procedure and usually has great results.

A scary masquerade full of floaters that can sometimes lead to bigger issues.

While a vitreous detachment is a normal aging process, it can mimic a retinal emergency. As part of the natural aging process, the vitreous shrinks with time. The vitreous is a jelly-like substance that fills the inside of your eyeball. Eventually, the vitreous will pull away from the retina as it shrinks. This may be accompanied by a flash of light and leave floaters in your vision, with one of them most likely being in a large ring shape. In about 10% to 15% of cases, the vitreous can also pull off or tear your retina, which is an ocular emergency. Whenever you experience flashes of light or floaters, we always recommend coming in immediately for a dilated eye examination so we can be sure a retinal detachment has not occurred, and it is simply a vitreous detachment.

Educate yourself on this serious ocular emergency that can be vision-threatening.

A retinal detachment is an ocular emergency and needs treatment as soon as possible. The retina is the sensitive seeing layer that lines the inside of your eye. It usually occurs in the middle-aged to elderly, can be associated with high nearsightedness, and can occur after a forceful trauma. If not treated, you can permanently damage or lose vision. The three most common warning signs include: Sudden new floaters that were not there before, flashes of light that persist, or a curtain or veil that blocks a portion of your vision. We always prefer to have a “false alarm” retinal detachment, than the real thing, so please do not hesitate to call our office.

A potentially fatal condition that every parent should know about.

Retinoblastoma is a relatively uncommon tumor of childhood that accounts for about 3% of the cancers in children under the age of 15. However, death can occur in 10 to 15% of cases, so it is worth raising the alarm. The tumors originate in the retina, which is the inside lining of the eye. They usually occur in one eye, but can occur in both eyes. There is some connection to family history, but the majority of cases have no family history. In 50% of cases, leukocoria (a white reflex in the eye, instead of a normal red reflex) can be seen and is what usually prompts parents to bring in their children. The best way to check for retinoblastoma is to have your child get a comprehensive eye exam with your eye doctor.

One form of cancer that can occur inside the eye.

While there are many lumps and bumps that can occur on, around, or inside your eye, choroidal melanoma is one that deserves concern. It is a primary cancer of the eye, which means it started in the eye and did not migrate from any other part of the body. Since it is malignant, the cancer could metastasize (spread) to other parts of the body. Although some choroidal melanomas are more life-threatening than others, almost all should be treated as if they were malignant. A dilated eye examination with your eye doctor can look for any tumors or irregularities on the inside of your eye.