An eye exam consists of more than just checking to see if you need glasses.  During a comprehensive eye exam, we not only determine your prescription for glasses or contact lenses, we also assess your eyes’ ability to work together as a team (binocular vision). The dilated portion of the comprehensive eye exam helps us check for eye diseases such as glaucoma, cataract, and macular degeneration; and helps us evaluate your eyes for signs of systemic disease such as diabetes, high blood pressure, even brain tumors.  Adults and children should have routine eye exams to keep prescriptions current and to check for early signs of eye diseases. Early detection can prevent vision loss.
Below is a list of a few eye conditions and eye diseases that we look for during a comprehensive eye exam:

• Refractive error: This is your eyes’ “optical” prescription. There are 3 types of refractive error, myopia (nearsightedness), hyperopia (farsightedness), and astigmatism (irregular shape to the eye which results in two separate focal points). These conditions can be corrected with glasses, contact lenses, and refractive surgery.
• Presbyopia: This is the eyes inability to focus up close. This happens as a result of the aging process. This condition can be corrected with glasses, contact lenses, and refractive surgery.
• Amblyopia: Amblyopia is poor development of central vision as a result of a turned eye or a large asymmetry (difference) in refractive error between the two eyes. If untreated, amblyopia can slow visual development of the affected eye, which can lead to permanent vision loss.
• Strabismus: Strabismus is an eye that turns inwards or outwards relative to the other eye. If left untreated, a strabismus can lead to amblyopia, and decrease depth perception.
• Glaucoma: Glaucoma is the degeneration of the optic nerve (a nerve tract that connects and transmits information from the eye to the brain) often associated with high eye pressures. During a comprehensive eye exam, we perform numerous tests that tell us whether or not you have glaucoma. Because there are virtually no symptoms, it is important to have regular eye exams to prevent permanent vision loss.
• Macular degeneration: Macular Degeneration is a disease that affects the small “sweet spot” (macula) of the retina critical for acute central vision tasks such as reading, driving, and watching television. A comprehensive examination can detect the condition in its early stages.
• Cataracts: A cataract is a clouding of the crystalline lens which rests just behind the colored part of the eye. Once cataracts develop patients often feel as if they are looking through a dirty window pane, which can cause symptoms of glare at night.
• Systemic diseases: A comprehensive eye exam can detect early signs of many systemic diseases including diabetes and high blood pressure.

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Contact Lens Exam

A contact lens exam consists of a comprehensive eye exam and requires additional testing to determine the power and fit of your contact lenses. Whether you are just interested in being fit with contacts or an experienced contact lens wearer, please make sure to mention this when booking your eye exam.
 
We first determine your lifestyle needs which may include work environment, sports, special social and recreational needs. We then determine your prescription power for glasses and contact lenses, assess your eyes ability to work together as a team (binocular vision), and check for eye diseases. Measurements of corneal curvature, evaluation of your tear film, and measurement of pupil size will be taken to ensure an optimum fit.
 
After finding a contact lens that is comfortable for you, fits properly, and provides good vision, we will write a contact lens prescription which contains the parameters of your new contact lenses. Annual eye exams are recommended so we can monitor the health of your eyes and check on the progress with the contact lenses.
 
Please read our Contact Lens Information page for more details on contact lenses.

Fitting for Eyeglasses

We offer a wide range of designer eyeglass and sunglass frames. After a comprehensive exam to determine your prescription needs we’ll ensure you leave with the right fit. You can learn more about the brands we offer by visiting our brands page.
 

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Refractive Surgery (LASIK/PRK) Co-management

A comprehensive eye exam can be the precursor to the pre-operative measurements necessary for refractive surgery (LASIK, PRK, and ICL) if desired. We collaborate with Thomas Tooma, MD, medical director for NVision Laser Eye Centers and Dan Tran, MD medical director for Coastal Vision to provide refractive surgery pre/post operative care.
 
We also provide routine yearly comprehensive eye exams following refractive surgery to monitor visual outcomes and the health of the eye. Please mention if you are interested in refractive surgery. We will fill out the necessary paperwork for a complimentary consultation with NVision Laser Eye Centers or Coastal Vision to determine your candidacy.

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Computer Vision Syndrome Evaluation

Modern society has changed the way we use our visual system. Our frequent use of desk top computers, lab tops, tablets, and mobile devices all requiring viewing at near, which puts tremendous strain on our visual system, often leading to painful symptoms. Many of experience digital device OVERLOAD on a daily basis.
 
A breakthrough discovery in the field of neurology revealed that people experiencing symptoms like headaches, neck pain and eyestrain when using digital devices all shared a common trait: a misalignment in their vision.
 
Computer Vision Syndrome describes the eyes and brain reacting differently to the characters on the screen than they do to printed characters. Our eyes naturally focus on objects that have clearly defined edges. Characters on a computer screen, however, lack these sharp edges, making it difficult for the eyes to maintain focus. Specialized reading/computer glasses may help in reducing eye strain associated with computer use. In addition, if the eyes are not in alignment, the brain must do the work to compensate for the misalignment. The additional work puts stress on the trigeminal nerve (largest nerve in the brain) and is the nerve responsible for the majority of head, eye, and shoulder sensations. The over stimulation of the trigeminal nerve can lead to visually induced headaches, stiffness in neck/shoulders, discomfort with computer use, tired eyes, dry eye sensation, light sensitivity,and dizziness.
 
We have state-of-the-art instruments to properly and accurately measure the right prescription and to check for eye misalignment to create the correct prescription for your glasses to address your visual needs.
 
Do you suffer from headaches, neck pain, and eye strain? Take our online survey to see if a neurolens screening and prescription could help relieve your symptoms!

LifeStyle Index SURVEY
 

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Dry Eye Evaluation

22 million American suffer from Dry Eye Syndrome. It is one of the most common eye disease we diagnosis and treat. Tears are composed of three layers. The mucin layer coats the cornea (the clear outer structure in front of the colored part of the eye), allowing tears to stick to the front surface of the eye. The middle layer is the aqueous layer. It is the watery layer of the tear film that provides moisture and supplies oxygen and nutrients to the eye. The outer lipid layer is the oily layer of the tear film which sits on top of the aqueous layer and prevents the tears from evaporating from the eye.
 
There are two main types of dry eye: aqueous deficiency dry eye from reduced watery layer production and evaporative dry eye from deficient or poor quality oils. Many suffer a mix of the two. During a dry eye evaluation, we will determine which tear layer is the problem. Treatment of dry eyes depends exclusively on the underlying cause. Artificial tears, prescription eye drops, nutritional support, eyelid hygiene, and lifestyle changes are included in the various treatment options. Other advances in dry eye treatment include procedures such as: IPL (intense pulsed light), heat therapies, eye lid margin debridement, and meibomian gland expression. Depending on the severity of the dry eye condition we will determine the best treatment option for you.
 
In your dry eye evaluation the different options for dry eye treatment will be presented to you once the appropriate diagnosis has been made. Based upon on the severity of your signs/symptoms we will recommend over the counter options, prescription eye drop options, oral therapies, and in office procedures. These options will be designed to either increase tear production or restore meibomian gland function depending on your diagnosis.
 

Dry Eye Treatments

 
1. Heat therapy with ThermaMedex EverTears eye pads, eyelid debridement, and manual meibomian gland expression. This treatment will heat the meibum to the correct temperature for expression. The debridement removes skin that my be growing over the gland orifices to allow of optimum oil flow. The manual expression is done with a mastroda paddle to allow for a thorough expression.
 
2. Blepharitis treatment with ZEST, heat therapy with ThermaMedex EverTears eye pads, eyelid debridement, and manual meibomian gland expression.This treatment will involve a thorough cleaning of the eyelid margin with Zocular’s okra gel and it will heat the meibum to the correct temperature for expression. The debridement removes skin that my be growing over the gland orifices to allow of optimum oil flow. The manual expression is done with a mastroda paddle to allow for a thorough expression.
 
3. Intense Pulse Light Therapy (IPL) This treatment is designed to apply light therapy to the cascade of blood vessels (located along your cheeks/flanks of your nose) feeding inflammatory mediators to the meibomian glands along the eye lid margin. This treatment photo-disinfects bacteria and demodex, desaturates meibum for expression, decreases inflammation to the treated areas, and increases mitochondrial activity to the glands for remaining meibomian gland preservation.It also stimulates collagen deposition to the periorbital skin.Four sessions are needed for four consecutive months to effectively restore the meibomian gland function.Maintenance after the four consecutive sessions usually occurs every 6 months to a year. If there is severe blepharitis a ZEST eye lid treatment may be recommended prior to the first IPL session.
 
4. Punctal occlusion This treatment can bring great relief to patients with advanced aqueous deficient dry eye. The puncta are four tiny openings found in the inside corner of the eyelids toward the nose (one in each lid). These openings lead to unseen ducts responsible for draining tears in to our nose and throat. Those suffering from severe aqueous deficiency often benefit by having their punctal openings painlessly occluded (blocked) to improve tear retention. Punctual occlusion options include: a temporary “plug” (1 week up to 3 months) made of dissolvable collagen or synthetic materials, or semi-permanent “plugs” made of silicone or hydrogel. These semi-permanent plugs are explantable if the need arises to remove them.

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Pediatric Eye Exams (ages 3–5)

Pediatric Eye exams (ages 3-5) are extremely important for children in the detection of focusing difficulties, eye muscle teaming and coordination problems, visual perception abnormalities, and eye disease.
Vision Screenings from school nurses and pediatrician offices are helpful in detecting a potential eye condition but a comprehensive eye exam is recommended for a more conclusive diagnosis and treatment plan. Even with a serious eye or visual condition, many children may have no apparent signs or symptoms present. By identifying your child’s visual problems early, greater success can be achieved with treatment.  If left untreated, some eye conditions and diseases may prevent normal visual development leaving permanent impairment. Annual routine exams should begin at age three to monitor for changes.
 
When scheduling an eye exam for your child, choose a time when he or she is usually alert and in a good mood.  Be sure to tell us if your child has a history of delayed motor development, frequent eye rubbing, squinting, or head tipping or turning, fails to maintain eye contact, cannot keep visual fixation on an object, or has poor eye tracking.  We will also want to know about previous ocular diagnoses. Make sure to inform us of any family history of eye problems, such as nearsightedness, farsightedness, strabismus, amblyopia, or eye diseases.

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Cataract Co-management

A comprehensive eye exam can detect cataracts. In the event a cataract is diagnosed, we collaborate with Thomas Tooma, MD, medical director at NVision Eye Institute and  Dan Tran, MD, medical director at Coastal Vision to remove the cataract and address your visual needs.
In conjunction with NVision Eye Institute and Coastal Vision we provide you with the latest advances in cataract surgery. In addition to the option of monofocal intraocular lenses (IOLs), there are premium intraocular lens implants for presbyopia (the condition which requires the use of reading glasses) which include Restor, Crystalens, and Technis multifocal IOL. These multifocal IOLs have revolutionized the option to correct both far and near vision, often eliminating the need for prescription eyeglasses.
 
Additionally, very recent new technology utilizing Alcon’s LenSx image-guided femtosecond laser make completely bladeless micro-incisions and crystalline lens emulsification possible. For the first time ever, cataract surgery can be accomplished almost completely with a laser improving both safety and the visual outcome. Cataract surgery is a relatively pain-free outpatient experience which allows for a quick return to daily functions with extraordinary vision the very next day.

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Ocular Disease Diagnosis and Management

We are licensed to diagnose and manage virtually all eye diseases discovered in a comprehensive eye exam. In the event we feel additional management of the eye disease is required, we will make the appropriate referral to the specialist. Eye diseases may include the following:

• Glaucoma is an eye disease, in most cases painless, which causes progressive damage to the optic nerve (a complex nerve bundle which transmits visual impulses to the brain). It is often associated with elevated intraocular pressure. Left untreated, glaucoma can lead to permanent loss of sight including total blindness. Because visual field loss usually begins in mid-periphery, the condition often goes undetected by patients until advanced damage has occurred. The treatment of glaucoma is typically managed with pressure-lowering eye drops. In more advanced or resistant cases, surgery is sometimes necessary. During your comprehensive annual exam, we will perform various tests to detect glaucoma. Once diagnosed, we will determine the best treatment plan for you to ensure you maintain your precious sight for life.
• Macular Degeneration is a disease which affects central vision, that is needed for reading and driving. In advanced cases, it can lead to serious vision loss. Early detection of this sight-threatening disease can lead to the preservation of your vision.
• A cataract is a clouding of the eye’s crystalline lens. The lens is composed mostly of water with protein cell layers specially arranged to maintain clarity and transparency. A healthy lens guarantees maximum transmission of light to the retina. As we age, protein in the lens tends to become denatured leading to opacification. This clouding of the lens is called a cataract. Over time cataracts typically progress to point where surgery must be considered to restore vision. Cataracts are diagnosed during annual comprehensive eye examinations. Modern cataract surgery offers many hi-tech options for treatment. By evaluating your visual needs and the density of the cataract, we will determine your need for cataract surgery and what technology should be considered.
• Eye infections can be caused by bacteria, viruses and fungi. We are able to differentiate the type of infection you may be suffering so we can treat with appropriate medications.
• Ocular allergies range from the acute to the chronic. We have many therapeutic options to effectively manage this condition.

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Urgent Eye Care Needs

We provide care for emergency patients with red or painful eyes, sudden changes in vision or vision loss, flashes of light, or foreign bodies. It is important to schedule an urgent care exam with us as soon as you notice any of these symptoms. Early treatment may prevent permanent vision loss. For after hours emergencies, please call 949-545-8431. In the event you cannot reach someone promptly, please call 911.

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