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Vision loss
What is vision loss?
Vision loss means that a person’s eyesight is not corrected to a “normal” level.
Vision loss can vary greatly among children and can be caused by many things.
What causes loss of vision?
Vision loss can be caused by damage to the eye itself, by the eye being shaped incorrectly, or even by a problem in the brain. Babies can be born unable to see, and vision loss can occur anytime during a person’s life.
When should my child be checked?
Your child should be checked for vision problems by an ophthalmologist, optometrist, paediatrician, or other trained specialist at
  • newborn to 3 months.
  • 6 months to 1 year .
  • About 3 years .
  • About 5 years .
Having your child’s vision checked is especially important if someone in your family has had vision problems.

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What are some of the signs of vision loss?
A child with vision loss might
  • Close or cover one eye.
  • Squint the eyes or frown .
  • Complain that things are blurry or hard to see n.
  • Have trouble reading or doing other close-up work, or hold objects close to eyes in order to see n.
  • Blink more than usual or seem cranky when doing close-up work (such as looking at books).
One eye of a child with vision loss could look out or cross. One or both eyes could be watery, and one or both of the child’s eyelids could also look red-rimmed, crusted, or swollen.
What can I do if I think my child may have vision loss?
Talk with your child’s doctor. If you or your doctor thinks there could be a problem, you can take your child to see an ophthalmologist.

What are Refractive Errors?
The cornea and lens bend or refract light rays so they can be focused on the retina, the nerve layer that lines the back of the eye. The retina receives the picture formed by these light rays and sends the image to the brain through the optic nerve. A refractive error means that the shape of the eye does not allow the light to be properly refracted making images blurry.

Refractive errors include
  • Myopia (nearsightedness).
  • Hyperopia (farsightedness).
  • Astigmatism.
  • Presbyopia.
  • Monovision.

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What is myopia (nearsightedness)?
Myopia (nearsightedness) occurs when light rays are focused in front of the retina instead of directly on the retina. Myopia is a vision problem experienced by approximately one-third of the population. When the eyeball is too long from front to back, the image of a distant object focuses in front of the retina, instead of directly on it. As a result, the distant object appears blurred. The more myopic the eye, the closer an object must be before it is in sharp focus. Nearsighted people have difficulty seeing objects at a distance, such as highway signs, but usually can see up-close for tasks such as reading or sewing.

Some people with myopia can use their natural nearsightedness to read without glasses at an age when other people must wear reading glasses. However, if they have refractive surgery to correct myopia, they may be able to see distant objects without glasses, but will probably need to wear glasses to read sometime after age 40, due to presbyopia.
What is hyperopia (farsightedness)?
Hyperopia or farsightedness occurs when light rays are not bent enough to focus on the retina. Hyperopia is a common vision problem, affecting about one-fourth of the population. If the eye is too short from front to back, light rays reach the retina before they converge (focus). People with hyperopia can sometimes see distant objects very well, but may have difficulty seeing objects that are close.

Young eyes can sometimes compensate for this refractive error —- depending on age and the degree of hyperopia present. But with aging, the human lens loses this ability and a hyperopic person eventually may have difficulty seeing objects at a distance, as well as those that are nearby. In fact by age 40, even those with little or no refractive error will begin to experience difficulty focusing on close objects.
What is astigmatism?
Regular astigmatism occurs when light rays are focused at more than one point on the retina. Astigmatism is the most common vision problem. It occurs when the cornea surface is not ideally rounded, but is curved more along one axis than the other —- that is, when the eye is shaped more like the side of a football than a basketball. Light entering the eye does not focus symmetrically on the retina. The result is astigmatism, which blurs both near and distance vision. This refractive error may occur in patients who are either myopic (nearsighted) or hyperopic (farsighted). There are various types of astigmatism included regular, mixed and irregular astigmatism.
What are the signs of astigmatism?
Patients with only a small amount of astigmatism may not notice it or may have slightly blurred vision. Sometimes uncorrected astigmatism can cause headaches or eyestrain and distort or blur vision.
What is presbyopia (age-related difficulty with near vision)?
With increasing age, the lens inside of the eyes loses the ability to focus on nearby objects. The problem usually manifests itself around age 40 and can be corrected with bifocals or reading glasses. This is a normal aging process, called presbyopia and all people develop.

Some people with myopia can use their natural nearsightedness to read without glasses at an age when other people must wear reading glasses. However, if they have refractive surgery to correct myopia, they will be able to see distant objects without glasses, but probably will need to wear glasses to read sometime after age 40 due to presbyopia.
What is monovision?
Monovision is a method of distance vision correction to account for presbyopia. In monovision, refractive surgery is used to adjust one eye for “near” vision and the other eye for “distance” vision. Contact lenses or glasses may be required for best distance or night vision activities, including driving. This option is not suitable for everyone and a trial period of monovision using contact lenses may help decide if it is right for the patient.

What are Cataracts?
A cataract occurs when the lens in the eye can become cloudy and hard. Cataracts can develop from normal aging, from an eye injury, from previous eye surgery or if you have taken certain medications. Cataracts may cause blurred vision, dulled vision, sensitivity to light and glare, and/or ghost images. If the cataract changes vision so much that it interferes with your daily life, the cataract may need to be removed. Surgery is the only way to remove a cataract. The alternative to surgery is to not have the cataract removed. If you do not have the surgery, your vision probably will not improve and may continue to get worse.

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What are the different types of cataracts?
  • Age-related cataractMost cataracts are related to aging.
  • Congenital cataractSome babies are born with cataracts or develop them in childhood, often in both eyes. These cataracts may not affect vision. If they do, they may need to be removed.
  • Secondary cataractCataracts are more likely to develop in people who have certain other health problems, such as diabetes. Also, cataracts are sometimes linked to steroid use.
  • Traumatic cataractCataracts can develop soon after an eye injury, or years later.
What are the treatment options for cataract?
Your ophthalmologist will help you decide on the type of IOL that will replace your cloudy lens. There are different types of IOLs available: standard single vision, accommodating, multifocal, and “toric” IOLs that reduce your astigmatism.
Single Vision fixed focus IOLs
These usually provide either sharp vision at distance or sharp near vision. If the lens is focused for distance, then near vision will be blurred. Reading glasses would be necessary to read. Conversely, a single vision lens which focuses the eye for near and reading will give blurred vision in that eye for distance. If the eye is focused for reading/near then glasses would be necessary to see at distance, such as for driving. Standard single vision lenses do not correct astigmatism, and any remaining astigmatism may produce blurring at all distances without glasses.
Toric single vision fixed focus IOLs
These are fixed focus single vision IOLs that help persons with astigmatism see better for distance OR near than they otherwise would if they had a non-toric single vision IOL. (Although Toric lenses improve the sharpness of your vision at distance OR near without glasses, they do not provide BOTH near and distance vision simultaneously.)
Accommodating IOLs
These are designed to give good distance vision as well as usable intermediate distance vision such as for the computer screen. Most patients are also able to read large type without glasses but some patients will need reading glasses to read small type. Correction of astigmatism, if necessary, is accomplished through limbal relaxing incisions (LRI).
Multifocal IOLs
These are designed to simultaneously give you distance and intermediate and/or reading vision with each eye. The optical results are sometimes not perfect and some patients are bothered by subnormal distance and/or reading vision. Other common optical side effects include halos around lights at night and reduced vision either in bright or dim light.

What is Diabetic Retinopathy?

Anyone with diabetes is at risk for developing diabetic retinopathy. The longer a person has diabetes, the greater their chance of developing diabetic retinopathy. It is the leading cause of blindness in working-aged adults in the United States. Diabetes damages the retina in two ways. The first, known as non-proliferative diabetic retinopathy, occurs when the blood vessels of the retina begin to bleed or leak fluid. This results in retinal swelling (macular edema), small hemorrhages, and the formation of deposits known as exudates.

The second way that diabetes damages the retina is known as proliferative diabetic retinopathy. This is a more severe type of retinal damage. It occurs when blood vessels in the retina or optic nerve become blocked, consequently starving the retina of necessary nutrients. In response, the retina grows new blood vessels (neovascularization). Unfortunately these new vessels are abnormal, causing bleeding or formation of scar tissue.

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Proliferative diabetic retinopathy may lead to any one of the following

  • Vitreous hemorrhage – the new vessels bleed profusely into the eye, blocking vision.
  • Retinal detachment – scar tissue pulls on the retina, causing it to tear or detach.
  • Neovascular glaucoma – abnormal blood vessels block drainage of fluid out of the eye, causing high eye pressure.
Symptoms

Early diabetic retinopathy is asymptomatic. A dilated eye exam is the only way to detect changes inside the eye before loss of vision begins. People with diabetes should have an eye examination at least once a year. More frequent exams may be necessary after diabetic retinopathy is diagnosed.

Later stages of diabetic retinopathy may cause the following symptoms

  • Blurry or distorted vision.
  • Floaters.
  • Loss of peripheral vision.
  • Sudden visual loss.
Prevention
The best way to prevent diabetic retinopathy is through strict control of blood sugar and blood pressure. These measures significantly reduce the risk of long-term vision loss. With annual eye exams and prompt treatment of diabetic retinopathy, few people progress to serious vision loss.

What is Conjunctivitis (pink eye)?
This term describes a group of diseases that cause swelling, itching, burning, and redness of the conjunctiva, the protective membrane that lines the eyelids and covers exposed areas of the sclera, or white of the eye. It is caused by a virus which is very contagious and spreads easily. The virus may affect one or both eyes. At its onset, conjunctivitis is usually painless and does not adversely affect vision but can be uncomfortable. The body’s defenses will clear viral conjunctivitis in one to three weeks, and medication is not always necessary. Cold compresses several times a day on the eyes may offer relief as may artificial tears and dark sunglasses.

But for some forms of conjunctivitis, treatment will be needed. If treatment is delayed, the infection may worsen and cause corneal inflammation and a loss of vision.

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