What is an optometrist?
An optometrist is an independent primary care doctor who specializes in examination, diagnosis, treatment, management and prevention of diseases and disorders of the eye and associated ocular conditions. Treatments may include prescription eye glasses, contact lenses, low vision aids and drug therapies. Optometrists are also involved in the prescription, supervision and management of therapy for the improvement & monitoring of ocular health. Optometrists are the primary eye care providers in Ontario and work directly in cooperation with other physicians and health care practitioners when required.
Like physicians and dentists, optometrists are regulated health professionals who have completed a specialized 4-year University post graduate degree program, which includes extensive lectures and clinical training experience in human health and disease, anatomy, vision systems, optics, and patient care.
What are the differences between optometrists, ophthalmologists and opticians?
Optometrists are primary care eye doctors that are trained to provide the best standards of comprehensive eye care, ranging from an assessment and review of overall eye health and visual function, to informing a prescription for vision correction, to referring for secondary treatment by an ophthalmologist.
Ophthalmologists are medical doctors who have completed specialized residency training in the study, diagnosis, and treatment of eye disease. They are secondary-level health care providers and they usually use drugs and/or surgery for treatment. A person that requires ophthalmological care (to obtain cataract surgery, for example) usually require a referral from the optometrist or family doctor.
Opticians are technicians trained through a college program to fabricate and fit vision aids based on prescriptions from optometrists, ophthalmologists and physicians. Opticians are licensed to provide spectacles, and they may also dispense contact lenses and other optical aids. They do not assess, diagnose, or treat eye conditions, nor do they write out prescriptions for eyeglasses or contact lenses.
When should I have an eye exam?
Regular eye exams are recommended for people starting at age 3. We recommend annual eye exams for children up to age 19. Adults aged 20 to 64 are recommended to come every 2 years, unless advised otherwise by their optometrist or doctor. Seniors 65 and over should visit their optometrist once every year. If you have any concerns about your eyes and vision, you may make an appointment to see your optometrist at any time between your regular visits.
I don't wear glasses. Why should I have regular eye exams?
Many conditions and disorders have no symptoms and can develop without the patient being aware. Glaucoma, cataracts, retinal detachment and macular degeneration are only a few of things that your doctor will be checking for. Your optometrist is trained to check the health of your eyes and can detect and monitor your eyes for any problems. Many general health conditions, such as diabetes and high blood pressure can be detected through regular, preventative eye exams.
What is an eye exam?
An eye exam is more than just an eye chart - it is a complete, comprehensive exam and detailed examination of your visual ability, vision and eye health. This examination is defined in regulation under Ontario's Health Insurance Act as:
Relevant History (ocular medical history, past medical history, family history)
In this step, your optometrist will assess your past and current medical history, and the medical history within your family, in order to determine your risk factors for certain eye health conditions and overall health conditions that may affect your eyes. Your ocular history - incidences of eye conditions, prescriptions, eyewear, work with any other eye doctors, etc - will also be assessed.
Visual Acuity Examination
As a baseline, your optometrist will examine your visual acuity by means of an eye chart. The placement, sizing and gradations on a standardized eye chart will help your optometrist gauge your current visual acuity (the clearness of your vision) for far near and distances.
Ocular Motility Examination
In order to determine how well your eyes and visual system function in terms of movement, reflexes and tracking, your optometrist will conduct a number of tests to determine if there are any underlying problems. Any problems found in your eye movement or binocular vision may require treatment, or could be symptomatic of other physiological or neurological disorders.
As part of this step, a phoropter can be used to determine amount of refractive error which is needed to create a prescription for eyeglasses if one is needed. A series of lenses and settings are used to assess the refractive error of your vision and define any corrective prescription.
Slit Lamp Examination of the Anterior Segment (Biomicroscopy)
A slit lamp is used to shine a light into the eye to facilitate an examination of the anterior segment of the human eye - including the conjunctiva, iris, natural crystalline lens and the cornea. The binocular slit-lamp examination provides a stereoscopic magnified view of the eye structures in detail, enabling anatomical diagnoses to be made for a variety of eye conditions.
Ophthalmoscopy (Direct, Binocular Indirect, or Monocular Indirect Ophthalmoscope or Non Contact Fundus
Ophthalmoscopy is a test that allows your optometrist to see inside the fundus of the eye and other structures (including the retina, optic disc, macula and fovea). This is conducted to help detect eye conditions such as retinal detachment, diabetes, macula degeneration or glaucoma.
Advice & Instruction for the Patient
Pending your individual needs for care and follow-up, your optometrist will provide advice and/or referrals on a case by case basis. At this time, your optometrist will also advise you on how often to return for an eye exam.
Additional Testing that Maybe Recommended/Needed
And if required in accordance with generally accepted professional standards, any or all of the following elements may be included in the eye exam:
- Tonometry is conducted by your optometrist in order to determine the intraocular pressure, the fluid pressure inside the eye. It is an important test in the evaluation of patients with glaucoma and to assess risk factors for glaucoma.
- Digital Retinal Photography is done with a specialized instrument that takes a high resolution, digital image of the retina, the light sensing tissue at the back of the eye. This new technology is an important tool for helping the optometrist screen for and monitor, many different eye diseases such as glaucoma, macular degeneration, and diabetes.
- Dilated Fundus Examination is similar to the fundus examination mentioned above, but with the pupils dilated with drops to enhance what your optometrist can see during the examination.
- Visual Field examination by Confrontation Field is a visual field examination is used to detect and measure visual field loss. Visual field loss is the condition of having lost degrees of peripheral vision as a result of one or more eye health conditions. Such conditions may be of the eye alone, of the optic nerve or of the brain. Your optometrist can help determine causal factors in any visual field loss and implement a referral if needed.
- Visual Field Examination by Automated Visual Field Analyzer is a specialized piece of equipment designed for the early detection and monitoring of many different neurological disorders of the eye including glaucoma, multiple sclerosis and even tumours. A Humphrey Field Analyzer has a concave dome with a central fixation target. Generally, only one eye is tested at a time. The patient rests their chin in front of the dome and asked to focus on the center fixation light. The computer will shine lights inside the dome and the patient clicks the button whenever a light is seen. The computer then automatically maps and calculates the patient's full visual field to help the optometrist interpret the results.
- Corneal Topography is a specialized instrument used to give a detailed 3D map of the outer surface of the eye and is important in the diagnosis and monitoring of many different corneal diseases such as keratoconus, pellucid marginal degeneration and keratoglobus. Topography is used for complex astigmatic, keratoconic and orthokeratology contact lens fits. It is also very important in the pre- and post-operative care for laser eye surgery patients.
- Corneal Pachymetry is the measurement of the thickness of the cornea with a specialized ultrasound. It has many applications such as screening LASIK patients and detecting patients at risk of glaucoma.
- Relevant History (ocular medical history, past medical history, family history)
How does diabetes affect my eyes?
The most damaging eye condition caused by diabetes is diabetic retinopathy. The incidence of retinopathy increases the longer someone has diabetes. Diabetic retinopathy causes the blood vessels of the retina (inner layer of the back of the eye) to leak, swell or develop abnormally which causes damage to the retina. This can result in vision loss that can range from mild to severe.
Very often people with diabetes don't even know they have diabetic retinopathy until significant damage to the retina has already happened. Prevention of diabetic retinopathy is best accomplished by maintaining normal blood glucose levels, blood pressure and blood lipid levels. A regular eye exam (minimum once a year) by an optometrist or ophthalmologist is essential to catch retinal changes as early as possible.
What are cataracts?
A cataract is a clouding of the internal crystalline lens of the eye. When a cataract is first developing, there is often a shift in a person's vision and refraction. Other symptoms may include glare and troubles with night vision. Usually, cataracts will cause a reduction in vision over many years but can be potentially blinding if left untreated. Cataracts usually affect both the eyes, but often one eye is affected earlier than the other. The risk of cataract development increases with age, however cataracts can be found in infants and children as well. Other risks include UV light, diabetes and many medications such as steroids. In the early stages, the symptoms of cataracts are simply treated with glasses or contact lenses. Once the cataracts are more significantly impairing vision, cataract surgery is a good option. Modern cataract surgery techniques are safe and effective. In fact, it is the most commonly performed surgery in North America.
What is glaucoma?
Glaucoma is a group of eye disease that causes vision loss without warning. In the early stages of the disease, most patients have no symptoms. Vision loss is caused by damage to the optic nerve tissue at the back of the eye. It was once believed that intraocular pressures (IOP) where the sole cause for glaucoma. However, today we better understand that IOP is simply a risk factor for glaucoma, but not the only cause. Other risk factors may include a family history, migraine headaches and sleep apnea. We also have much more advance diagnostic equipment to help with earlier detection. There is no cure for glaucoma, only treatment. Medication and surgery options will vary greatly depending upon the type of glaucoma a patient has. Early detection is key in preventing the progression of this silent disease.
What is macular degeneration?
Macular degeneration or AMD is the leading cause of blindness in the developed world. It is a disease that causes a progressive breakdown of the macula region of the retina, the light receiving layer of the eye. This leads to a slow loss in a patient's central vision, however most patients will still maintain good peripheral vision. There are many risk factors for the condition including family history, smoking, UV light and age. There are two main categories of AMD, dry and wet. Symptoms for patients with dry AMD can vary significantly and many may still have excellent vision in the early stages. Wet AMD is less common, affecting only about 15-20% of patients with AMD, but has a much greater impact on vision. It accounts for about 2/3 of all vision loss from macular degeneration. While there are no cures for either dry or wet AMD, there are many good treatment options available today to help slow the progression of the disease. Therefore it is important for anyone at risk for macular degeneration to have routine eye examination to help with early detection so treatments can be started to help slow the condition if detected.
What is presbyopia?
Presbyopia is a condition common after age 40 in which a gradual lessening of the eye's power of accommodation causes difficulty in seeing near objects. At middle age, we typically require glasses for reading. People who are nearsighted do not require reading glasses because they can simply take off their glasses to read. People who have a prescription for distance often where bifocal lenses with added power in the lower part of the lens to aid with reading.
Does pregnancy affect my eyes?
Pregnancy causes changes to women on many levels, physically and emotionally. With an increase in hormone levels, some women may experience difficulty in focusing on objects. Women may also suffer from pregnancy-induced dry eye, which can be worsened for contact lens wearers. Pregnant women with diabetes are of particular concern. Properly maintaining control of blood glucose levels is crucial to the mother and baby. Your optometrist is watching for diabetic retinopathy that occurs in diabetic patients. Gestational diabetes typically does not cause diabetic retinopathy. Not all women experience the conditions mentioned above and in most cases the changes are temporary. Pregnant women should consult their optometrist with any eye concerns.
What should I eat?
Here are six important nutrients for vision health:
- Vitamin C because it helps the body absorb iron, which ocular blood vessels and other eye cells need. Citrus fruits, bananas, apples, kiwis, peaches, tomatoes, broccoli and spinach are good sources.
- Vitamin D to help maintain calcium and phosphorus levels (milk, fish, eggs).
- Vitamin E is good for cell membranes and DNA repair (salads, wheat germ, nuts, peanuts, sunflower seeds, sweetpotatoes).
- Omega-3, DHA and EPA essential fatty acids are good for overall health (fish).
- Lutein and zeaxanthin are antioxidants that help the eyes absorb UV and blue light (leafy green vegetables,corn, green peas, eggs).
- Zinc helps move Vitamin A to the retina to help protect eye pigment. Low zinc levels are associated with cataracts and poor night vision (red meat, seafood, poultry and eggs, wheat germ, tofu).
How can the optometrist test my child's eyes if they can't read yet?
The doctor will use symbols and pictures instead of letters. Most of the testing that is done by the doctor requires little input from the child. The child's eye exam is focused on objective measurement of visual acuity and refraction, binocular vision and ocular motility, and eye health to ensure proper vision development. Critical information can be obtained about your child's eyes without them needing to say a word!
How do I know if my child is having a vision problem?
Some symptoms that indicate your child may be having a problem include rubbing eyes, squinting, blinking, turning or tilting head, headaches, wandering eyes, red eyes, complaints of blurry vision.
How does ortho-k work?
Orthokeratology is a non-surgical process which softly reshapes the central cornea by wearing specially designed gas permeable contact lenses overnight. Lenses are removed when awake and must be worn every night to be effective. The effect of ortho-k is temporary and completely reversible.
Are ortho-k lenses uncomfortable to wear overnight?
Overnight wearing of the lenses should not be uncomfortable. Most patients are unaware of their presence within a few minutes of insertion. And because the lenses are worn during sleep, the normal adaptation process is very short.
What are the risks of wearing the lenses overnight?
The risks associated with wearing contact lenses overnight are probably higher than wearing contact lenses only while awake and probably less than when wearing contact lenses continuously (day and night). The complications of wearing contact lenses include corneal in-growth of vessels, ulcers and abrasions. Contact lenses cannot become "lost" behind the eye (this is anatomically impossible) and it is rare for ortho-k lenses to become decentered.
Is everyone a candidate for ortho-k?
No! The procedure is often most effective for those prescriptions falling within a specific range. It is generally not recommended for people with prescriptions above 4.00 diopters of myopia or above 1.50 diopters of astigmatism. Also, people with pupils that are larger than normal and those having irregular corneal astigmatism or any corneal disorder such as keratoconus, are generally not candidates. Additional factors include corneal rigidity and shape factors as well as an ability to wear contact lenses. A thorough consultation and examination can determine if orthokeratology is right for an individual.
How old do you have to be for ortho-k?
While ortho-k can be performed on practically anyone of any age who can insert a contact lens and follow lens care directions, we find that children aged 10 and up are usually able to comply with the treatment.
How long does it take to be able to see well without glasses?
Rapid visual improvement normally occurs in the first few days and weeks. Stabilization then follows over the next few months. Most people will need to wear the lenses six to seven consecutive nights in order to enjoy good, unaided vision for all their waking hours. We recommend a minimum of 6 hours to a maximum of 12 hours each of wear each night.
Is ortho-k permanent?
Once the patient stops wearing the lenses, their eyes will return to their pre-existing prescription after about 2 weeks. The patient may need to be fitted with disposable soft lenses or spectacles to provide good vision during the transitional period.
What is the ortho-k treatment schedule?
After the completion of the initial consultation appointment, a typical treatment schedule involves a series of visits as follows:
- Lens pick-up (1 – 1½ hours)
- Next day (30 – 45 minutes) early morning
- 1 week (30 – 45 minutes)
- 2 weeks (30 – 45 minutes)
- 6 weeks (30 – 45 minutes)
- 6 months (30 – 45 minutes)
- 1 year (30 – 45 minutes)
At the first visit we will instruct you on insertion and removal of lenses, as well as proper lens care. At all of the visits the doctor will assess lens fit, as well as visual acuity and ocular health. Topographies are also done at each follow-up visit to assess the changes to the cornea. More frequent visits may be required in more complex cases. Please bring your carrying case containing all contact lenses and solution(s) to every appointment.
What is Vision Therapy?
Vision therapy is an individualized treatment program that is designed to improve, enhance, and develop visual performance. It is a subspecialty of optometry that helps treat eye problems that cannot be fixed with glasses or surgery alone. The objective of vision therapy is to "rewire" the neural connections between the eyes and the brain, which can help school performance and overall quality of life.
Who can benefit from Vision Therapy?
The visual system accounts for over 70% of sensory information that is absorbed; thus, it is not surprising that vision plays a critical role in learning and a child's performance at school. Even though children do account for the majority of vision therapy participants, vision therapy can be beneficial for individuals of any age. Vision therapy has been used to help computer users reduce eyestrain, professional athletes improve hand-eye coordination, and head trauma/stroke patients whose vision is affected.
There is a common myth that having "20/20" eyesight constitutes perfect vision; however, an individual can have good vision but have deficits in their eye-teaming, eye-focusing, and eye-movement abilities.
Vision therapy works to improve conditions such as:
- Oculomotor disorders (inability to quickly and accurately move eyes)
- Non-strabismic binocular disorders (inefficient eye teaming)
- Strabismus (misalignment of the eyes)
- Amblyopia (poorly developed vision)
- Accommodative disorders (inability for the eyes to sustain focus for long periods of time when doing near work, and change focus from distant to near objects)
- Visual information processing disorders
What is involved in Vision Therapy?
The optometrist guides the patient through a series of procedures that are tailored to each individual. In order to promote the use of these abilities in everyday life, gross and fine motor training are often incorporated. The various vision exercises are completed by using lenses, prisms, filters, patches, and other materials and equipment.
Vision therapy involves weekly in-office sessions along with home activities which usually take between 15 – 30 minutes and should be done 4 – 5 times a week. Vision therapy can take anywhere from 6 weeks to a year or more before treatment is complete. Most problems can be significantly improved over 10 – 15 weeks, but certain dysfunctions, such as strabismus, usually take the longest. An average vision therapy length at most clinics is 4 – 6 months. Once vision therapy has been completed, the skills that are learned usually remain throughout life!
What is the success rate?
Vision therapy results vary from person to person, and they can depend on many factors including the severity of the binocular vision disorder, the age and motivation of the patient, and the level of improvement desired. Even though a vision therapy program can entail a significant time commitment, the potential benefits can be life changing. Please ask your optometrist for more information about scientific evidence and success rates of each binocular vision disorder.
What are common symptoms of a binocular vision disorder?
A binocular vision disorder can cause a number of symptoms including (but not limited to):
- Double vision
- Frequent headaches or eye strain
- Avoidance of reading or close work
- Blurred distance or near vision, particularly after reading
- Difficulty following a moving target
- An eye turning in, out, up, or down
- Tendency to close one eye
- Loss of place when reading
How much does it cost?
Unfortunately, OHIP does not cover the cost of vision therapy. Before starting vision therapy, a binocular vision assessment must be performed to determine a patient's current binocular vision status and it allows a more accurate estimate of the therapy duration. Vision therapy programs are typically 30 minutes – 1 hour in length and sessions are offered in packages. Please ask your optometrist for a more detailed explanation of the cost.
Where can I get more information?
Still have questions? Feel free to contact us or schedule an appointment. We will be happy to help.