Alamo Optometry Blog

LASIK

2010-03-06T15:35:00.000-08:00

LASIK
(As appeared in Alamo Today, March 2010, page 24)

During the past few months, I have had more patients inquire about and proceed with LASIK. Most people at this point are pretty well-informed about the subject and have either gone through the procedure themselves or know someone who has. Since there have been more questions about it recently, I will cover some of the frequently asked questions without going into the technical aspects of the procedure itself.

What is LASIK? LASIK is an acronym and stands for Laser ASsisted In-Situ Keratomelusis. A thin flap is made in the shape of a horseshoe within the cornea and then peeled back to expose the inner structures of the cornea. The excimer laser is then applied to the tissue to remove and reshape the cornea depending on your correction. The flap is then put back in place and heals on its own.
What is the difference between LASIK and PRK? PRK or photorefractive keratectomy, was the precursor to LASIK. The main difference between the two procedures is that in PRK a corneal flap is not made. Patients usually decide to do PRK instead if they are not an optimal candidate for LASIK due to thin corneas and/or large pupils. Even though the end results are the same, the healing time with PRK is longer and only one eye is done at a time.
What is wavefront technology? This is an optimized or "personalized" version of LASIK. The procedure is the same except for the program the computer uses to apply the laser treatment. Everyone has corneas that are just a little irregular and has hills and valleys in addition to being near-sighted or far-sighted. This procedure seeks to eliminate all of the known impediments to vision, so the only limit is what your brain can process for you. This leads to crisper and improved vision especially at night.
Am I a candidate for LASIK? There is a wide-range of prescriptions that can be corrected by LASIK. Large amounts of far-sightedness, near-sightedness, and astigmatism can be eliminated with the procedure. Keep in mind that there are FDA limitations on the amount of correction that can be done by LASIK and that some prescriptions might not be optimal for full LASIK correction, but can be done nonetheless. A comprehensive eye examination is required to fully assess your prescription and eye health and must be done within 6 months of the surgery.
How long is the recovery? Assuming the procedure goes well, you can be back to work within a few days. Most people schedule the surgery at the end of the week so they have the weekend to rest and are ready to go on Monday morning.
What are the side effects? The main side effect from the procedure is dry eyes. Most people will experience some dryness/stinging/burning after the surgery. For some people it could last for a few months. For most, it is mild and resolves within a few weeks. There is always risk for infection, but that is minimal as you will use an antibiotic drop the day before the surgery and for a few days after. If you have large pupils, there will be a chance of glare and haloes in dim lighting, especially night driving.
Are there any age limitations? Most surgeons will wait until you are 21 to do the procedure. There is no maximum age for the procedure; however, it is not recommended into your 60's because of cataract formation which will blur your vision. Keep in mind that your prescription needs to be stable to do the procedure. So regardless of age, if your prescription is always changing, LASIK will not halt the progression. When you are older and need reading help, monovision is a viable option for most patients, but it must be trialed with contacts first to ensure adaptation and good vision before proceeding with the surgery.
Obviously this is meant as some general information regarding the procedure. There are many other things that need to be discussed, along with other refractive surgery or contact lens options. We are more than happy to do your exam here in the office and give you an opinion on your visual and refractive surgery needs.

Dr. K. at Alamo Optometry is your hometown eye doctor for outstanding service, vision care, and designer eyewear. He can be reached at 925-820-6622 or visit his office at 3201 Danville Blvd., Suite 165 in Alamo. Visit our website at: ww.alamooptometry.com.

Eye Terms

2010-02-03T19:51:00.000-08:00

Eye Terms
(As appeared in Alamo Today, February 2010, pg. 29)

When I have patients in my office and I am explaining to them the results of my examination, I try to explain terms and conditions in a manner that is easy to understand. At times that is difficult, but I believe my patients need to leave the exam understanding what went on and why my recommendations were given. To help assist, I will give some straight-forward definitions of everyday conditions I see in the office.

Myopia: "near-sighted", this means that without any type of correction on, it is easier to see close than far. Depending on how high the prescription, it might even be very difficult to read since you will have to hold reading material extremely close to have it in focus.
Hyperopia: "far-sighted", it is easier to see farther away than up close. Far-sighted people are always working to keep objects in focus and the closer the point of focus, the more power and work needed. Patients with a high prescription generally will have sustained near-point issues like fatigue, headaches, avoidance, etc. Keep in mind this only refers to your distance vision, not up close difficulty (see next).
Presbyopia: "short-arm syndrome". This diagnosis is given when your ability to focus up close starts to decline. Keep in mind this is a completely normal process that starts in your 40's and stops somewhere in your mid 50's. Remember this does not mean you are far-sighted, that defines your distance vision only.
Astigmatism: This occurs when your cornea is not completely round. A simple analogy is that it is shaped more like a football or egg. It is not a disease; it is just how your eye was formed and developed. This can be corrected with glasses, most contact lenses, and LASIK (also depending on other factors.)
Cornea: This is the clear front portion of the eye that is in front of the iris (colored part of the eye). This structure is where contact lenses are placed and what is operated on in LASIK. The cornea has no blood vessels so it only receives oxygen from the air and your tears.
Cataracts: This is another age-related finding in which the lens, which is inside your eye, becomes harder and denser. This eye structure continues to grow throughout life, so as you mature, if becomes a barrier to clear vision and needs to be removed. The three main contributors besides age are UV exposure, diabetes, and therapeutic steroid use. Surgery to do this is simple with a relatively quick recovery.
Macular Degeneration: Everyone seems to be concerned about this condition, including myself. This is a disease that degrades your sharp, central vision along with color vision. The macula is the very small area in your central retina that gives you 20/20-corrected vision and color vision. Once this vision is lost, you do not get it back. As of now, there is no cure. There are many treatments, but they are aimed at treating the bleeding blood vessels in the retina, which hopefully halt or slow down the progression. There is a genetic link to this disease, but currently the best thing you can do to improve your chances besides annual exams is to not smoke. Everything else equal, there is a 4-6 fold increase risk for any person who currently smokes or smoked a considerable amount in the past, but has since quit.
Retina: This structure has 10 layers and of all the organs in the body, it uses the third most amount of oxygen (behind the heart and brain). The retina interprets the light images it receives and changes it into an electrical signal that is sent to your brain to process via the optic nerve.
Optic Nerve: The optic nerve is the wiring connection between the eye and the brain. The optic nerve does not contain photoreceptors, so it does not interpret any images you see; hence this is your blind spot when you look out into the world. Glaucoma is a disease that slowly kills the optic nerve, so end-stage of the disease is blindness since no signal is sent to your brain from the affected eye(s).

Dr. K. at Alamo Optometry is your hometown eye doctor for outstanding service, vision care, and designer eyewear. He can be reached at 925-820-6622 or visit his office at 3201 Danville Blvd., Suite 165 in Alamo. Visit our website at: ww.alamooptometry.com.

Glaucoma

2010-01-06T20:23:00.000-08:00

Glaucoma
(As appeared in Alamo Today, January 2010, pg. 27)

Since I have had a few cases recently of glaucoma, I believe a discussion on the disease itself and its treatment is needed. There seems to be a lot of confusion and misinformation regarding this sight-threatening disease.
First of all, let’s talk about the definition of glaucoma. Glaucoma is a group of diseases that slowly kills your optic nerve and is a leading cause of blindness in the world. The typical age of onset is late 60’s and later, and affects about 4% of the population. The exact cause of glaucoma is not known at this time. However, the end-stage result of glaucoma is blindness, since the optic nerve is the wiring connection between your retina and brain. Glaucoma usually develops when the pressure in the eye becomes elevated. This can usually happen when too much fluid is produced, or the drainage channels in the eye do not drain the fluid properly. However, a patient does not have to have high pressures to have glaucoma. Up until recently, glaucoma used to be a completely pressure-dependent disease. Studies have now shown that not to be the case. Unfortunately, the exact etiology still eludes us.
One of the big problems with glaucoma is that it is a “silent” killer; it does not bring you into the office. It does not give you a headache, blur your vision, make your eye red, etc., like the normal conditions that bring you in for an eye exam. I tell my patients that when you can start to appreciate some peripheral vision loss, you are already about 75% of the way to full progression of the disease. Therefore, annual exams are extremely important for early detection because we can only stretch out the course of the disease, not cure it.
The difficulty with glaucoma is that the diagnosis is usually not definitive. Most patients I see are initially labeled as “glaucoma suspects”, pending further tests. When the diagnosis is not evident, we try to elicit some personal and family history that can help sway the verdict one way or the other. Information such as age, ethnicity, family history of glaucoma, personal history of diabetes, hypertension, or heart disease can be instrumental in assessing a patient. Glaucoma is more common as we age and has a strong genetic component. African-Americans have a higher incidence of glaucoma; however, the exact reason is unknown. In addition, if a patient has any condition that is vascular (related to blood vessels) in origin such as diabetes and hypertension, they would need to be followed more closely if they are suspected of having glaucoma.
If you are sent to the glaucoma specialist for an evaluation, he or she will run specific tests on your optic nerve, retina, visual field, and they will also measure the thickness of your cornea, which has been shown to be a contributing factor in glaucoma. If a diagnosis of glaucoma is determined, drops to lower and control your pressures are usually prescribed. Since glaucoma is a chronic disease, it is imperative to know for sure if you have glaucoma, because you will be treated and monitored for the rest of your life. Frequent visits to help monitor the progression will occur several times a year. It is also paramount for patients to continue to take their drops. Since patients initially do not experience any visual symptoms, non-compliance with treatment is high because the patient otherwise feels and sees fine.
As described above, glaucoma is a disease that is difficult to diagnose and continue to treat because of the long-term care needed for the patient. At your annual exams, we will measure your pressures and assess eye health including the optic nerves to determine the likelihood of glaucoma. I always recommend to my patients that if some uncertainty exists regarding glaucoma, to get a consult at the specialist. I definitely prefer a conservative approach and have a full evaluation and determine that there is no disease versus waiting several years to have a consult and you have progressed in that time frame without any treatment.

Dr. K. at Alamo Optometry is your hometown eye doctor for outstanding service, vision care, and designer eyewear. He can be reached at 925-820-6622 or visit his office at 3201 Danville Blvd., Suite 165 in Alamo. Visit our website at: ww.alamooptometry.com.

Flexible Spending Accounts (FSA) vs. Health Savings Accounts (HSA)

2009-12-03T09:19:00.000-08:00

Flexible Spending Accounts (FSA) vs. Health Savings Accounts (HSA)

(As appeared in Alamo Today, December 2009, pg. 27)

The holiday season has arrived and on top of all the hustle and bustle that brings, insurance decisions for a lot of people need to be made for this year and next year. Many companies have their open enrollment during this period, so cafeteria, vision, and medical plans can be in effect as of January 1. In addition, many of our patients want to (and often need to) fully utilize their benefits for this year or they will be forfeited. To help clarify, here is a brief introduction to the common types of benefits that can be used at our office.
A Flexible Spending Account (FSA) is one of a number of tax-advantaged financial accounts that can be set up through a cafeteria plan of your employer. An FSA allows an employee to set aside a portion of his or her earnings to pay for qualified expenses as established in the cafeteria plan; most commonly for medical expenses but also often for dependent care or other expenses including eye care, dental, and orthodontics. Money deducted from an employee's pay into an FSA is not subject to payroll taxes, resulting in a substantial payroll tax savings. Depending on the employer, an FSA may be utilized by paper claims or an FSA debit card, also known as a Flexcard. The important thing to remember is that any unused money not spent by December 31 will be forfeited by the employee. As the end of the year approaches, it is paramount that you know how much is left in your account to ensure full utilization.
By comparison, a Health Savings Account (HSA), is a tax-advantaged medical savings account available to employees who are enrolled in a High Deductible Health Plan (HDHP) for your medical insurance. The funds contributed to the account can be made by both the employer and employee and are not subject to federal income tax at the time of deposit. Unlike a flexible spending account, funds roll over and accumulate year over year if not spent. Funds may be used to pay for qualified medical expenses at any time without federal tax liability. Like an FSA, most HSA patients have a debit card that can be used to cover any out-of-pocket expenses.
The government has a wide range of specified expenses that qualify as a medical expense. These include any office co-pays, pharmacy bills, any necessary or elective surgical procedures (including LASIK), dental bills, orthodontics, and laboratory bills. Included in that list is any vision correction device (glasses, computer glasses, contact lenses, sports goggles, etc.) and sunglasses (prescription and non-prescription). As long as your purchase is made by the end of the year, it will count on your 2009 account balance.
In addition to these tax-friendly accounts, do not forget to utilize your vision insurance. At our office, we are providers for Vision Service Plan (VSP), Eyemed (which can include vision coverage for Anthem Blue Cross and Aetna if the plan has a eye care provision), and Medicare. All plans have an exam benefit and have variable material allowances towards glasses or contact lenses. Some plans recycle on the change of the new year, so this is an optimal time to use your benefits. Between your vision coverage and your FSA or HSA, most if not all of your charges will be covered.
Since this can be confusing for some people, we are available to answer any of your questions regarding insurance and FSA/HSA utilization. We are able to verify any insurance coverage on-line within a matter of minutes as long as we have all of the necessary information. You will always receive a detailed receipt showing your purchase if any proof is needed by your employer. We look forward to seeing you this holiday season and in the years to come.

Dr. K. at Alamo Optometry is your hometown eye doctor for outstanding service, vision care, and designer eyewear. He can be reached at 925-820-6622 or visit his office at 3201 Danville Blvd., Suite 165 in Alamo. Visit our website at: ww.alamooptometry.com.

Adult Vision Over 60 Years of Age

2009-11-04T19:36:00.000-08:00

Adult Vision Over 60 Years of Age

(As appeared in Alamo Today, November 2009, pg. 34)

At last we reach the final article in our series. Here we tackle the vision and eye health issues over age 60. As your body and eyes age, vision changes do occur; some are natural and some are not. Conditions such as presbyopia (decreased ability to read) and cataracts are a normal part of the aging process. Other issues such as glaucoma and macular degeneration are more likely as you age, but are not a normal age-related finding.
Even though cataracts are considered an age-related finding, they are so common that it is almost considered normal. According to some studies, half of all people over 65 have some degree of cataract formation, and that increases with age. A cataract is a clouding of the lens inside your eye. Cataracts cause a slow decrease in vision, a dulling of colors, and increased glare. The procedure to remove cataracts is extremely simple and is the most widely performed procedure in the United States.
Age-related macular degeneration (AMD) is the leading cause of decreased vision among our seniors. The macula is in the center part of your retina, where light comes to a focus. Your macula is responsible for giving you good acuity and color vision. All detail work whether it is driving, reading, or recognizing faces is controlled by the macula. It is important to keep it mind that from macular degeneration alone one will never go “blind.” You will always have your peripheral or side vision intact; however, the periphery of your retina does not allow sharp vision. Your likelihood for AMD increases as you age; generally 1 in 5 over 70 and 1 in 3 over the age of 85 are affected. There are many new treatments available that we did not have even a few years ago. However, these are targeted to halt the progression, not to regain what has been lost.
Glaucoma is a disease that causes irreversible damage to the optic nerve. The optic nerve carries the visual information it receives from the retina to your brain. Unfortunately, at this time, there is no cure for glaucoma; we are only able to slow the process down. Glaucoma is also a problem because it does not bring you into the office, i.e. it does not blur your vision, make your eyes red, give you a headache, etc. I tell my patients that by the time they can functionally see a decrease in their vision and peripheral vision, the disease has progressed about 75%. Early detection and treatment is paramount for this condition.
The above-mentioned eye conditions generally take a long time to progress. These following conditions result in rapid progression and should be addressed as soon as possible:
- You experience a sudden increase in floaters and/or flashes of light, or a dark curtain comes across your field of view. This can be a sign of a retinal detachment and requires a dilated examination as soon as possible.
- Sudden eye pain, redness, headache with nausea. This is likely an acute attack of glaucoma caused by rapid increase in the pressure within the eye.
- Sudden double vision. There can be many causes for this including a binocular vision disorder (eye-teaming) or diabetes. However, it could also indicate an underlying health condition such as a stroke.

Even though I have only touched the surface of potential vision issues that affect humans as they age, it is important to understand that early diagnosis and treatment is key. Generally speaking, the earlier the diagnosis, the better the prognosis. Annual dilated examinations for these patients should be mandatory. As stated above, some issues can begin to affect your eyes without any tangible signs for you to notice. We have a great network of retina, glaucoma, and cataract surgeons at our disposal that we can refer to if needed.

Dr. K. at Alamo Optometry is your hometown eye doctor for outstanding service, vision care, and designer eyewear. He can be reached at 925-820-6622 or visit his office at 3201 Danville Blvd., Suite 165 in Alamo. Visit our website at: ww.alamooptometry.com.

Adult Vision Ages 41-60

2009-09-30T18:54:00.000-07:00

Adult Vision: Ages 41-60

(As appeared in Alamo Today, October 2009, pg. 27)

In our next-to-last installment in our series, we will address vision and eye health issues after ago 40. The most noticeable condition at this point is presbyopia. As those of you in this age range can attest, it is the need for reading and up-close help. In addition, systemic issues like diabetes and hypertension, medications including anti-depressants and antihistamines, and a family history of eye diseases such as glaucoma and macular degeneration come into play.
Presbyopia or the “short-arm syndrome”, affects everyone at this time. It may affect some sooner than others, but there will be a point in time when through your distance correction (or no correction if your distance vision is fine), where you will need to address your up-close vision. The key thing to remember is this a completely normal part of the aging process. The decrease in focusing ability is the result of your lens in the middle part of your eye becoming less flexible. This flexibility allows the eye to change focus from near to far objects. For those of you that have never had to wear glasses, it tends to be a little more of a shock, because for the first time in over 40 years, you are having difficulty with vision. For the rest, it is simply a necessary change to your current vision correction. Keep in mind that there are many options for correction including progressive lenses, bifocals, and near-vision only glasses. In contact lens wearers, depending on your correction, bifocal contacts and monovision are always viable possibilities.
Many systemic ailments including diabetes, hypertension, auto-immune diseases, and high cholesterol affect the eyes. A dilated evaluation of the retina allows the only view of the blood vessels without an invasive procedure. Being able to observe the size and appearance of the blood vessels can go a long way in telling whether you might have the disease in question. If you do have a condition, it is a good way to determine how well it is being controlled. The best thing you can do is follow-up with your treating doctor to ensure your treatment plan is successful and to have your eyes checked annually.
Patients do not realize that certain conditions and medications can have a large impact on the eyes. Medications such as antihistamines, any hormone therapy including birth control, and diuretics for high blood pressure can have a drying effect, which can cause blurred and fluctuating vision, and decrease contact lens comfort and wearing time. Some antidepressants can affect focusing ability, and these patients might notice a difficult time reading. Steroids like prednisone, when taken for long periods of time can increase the pressure in the eyes (a possible sign of glaucoma) and lead to premature cataracts. It is paramount that your eye doctor knows all of your medical history including all prescribed and over-the-counter medications. Even though you might not think it is relevant to your eyes, it is very likely that it does.
Lastly, it is around this age that patients’ parents are developing eye issues like glaucoma and macular degeneration. Our patients are obviously concerned for their loved ones, but are also concerned for themselves. These diseases do have a genetic component; however, it is not absolute. It does not mean that you will also be afflicted, but it does mean that you need to be more vigilant in your overall health and eye care to help ensure if something does develop, it will be caught early and treated aggressively.
Patients in this age group have both visual and health issues to be addressed. Whether it is presbyopia, dry eyes, or diabetes management and detection, your eye doctor should be a major part of your overall care. Our office is well-equipped to assess and recommend options for all of your vision and medical needs; and when a referral to a specialist is required, we have a local network of qualified doctors to help.

Dr. K. at Alamo Optometry is your hometown eye doctor for outstanding service, vision care, and designer eyewear. He can be reached at 925-820-6622 or visit his office at 3201 Danville Blvd., Suite 165 in Alamo. Visit our website at: ww.alamooptometry.com.

Adult Vision Ages 19-40

2009-09-04T07:15:00.000-07:00

Adult Vision Ages 19-40

(As appeared in Alamo Today, September 2009, pg. 29)

In this installment of our series, we will tackle what to expect from your eyes and how to take care of them from after high school until age 40. For most adults, this is the time of healthy eyes and good correctable vision. The two main issues for this age group are visual stress from heavy computer use, fatigue, poor lighting, etc., and injuries from sports and work. For a majority of patients, simple vision issues like near-sightedness, far-sightedness, and astigmatism can be well-corrected with glasses and contact lenses without having to deal with presbyopia or other eye diseases which will be discussed in later articles.
As you start out in the world after school, your eyes and vision are integral to your success. Whether you need them for long hours studying pursuing a college or post-graduate degree, beginning your career in your chosen field, or enjoy sports, your vision will be paramount in your endeavors.
The first thing to remember is that healthy eyes and good vision go together; if you don't take good care of your eyes, they will not help you in your daily life. A healthy diet consisting of fruits and vegetables will only help your overall health, including the eyes. Supplemental vitamins are also recommended if your diet is lacking in some of these areas. In addition, hydration is very important. Dryness is a big problem with heavy computer use, and staying hydrated can help alleviate some end-of-day redness and discomfort. Exercise helps improve blood circulation throughout the body and helps remove toxins in the bloodstream away from the eyes. Smoking cessation can be extremely beneficial to your overall health. Besides the heart, lung, and other systemic diseases that smoking can lead to, the risk for macular degeneration later in life in increased about 4-6 fold. As always, routine eye care in conjunction with the above suggestions will help maintain your overall vision and ocular health.
Now that we have addressed the health issues with the eye, we need to discuss how to deal with the visual stress that is present in our daily world. The most common causes are computer use and long hours reading documents and contracts. Even though computer use has become a major part of society, most people compound the problem by not having the correct eyeglass prescription, having improper lighting and incorrect viewing angles and working distances. As the day progresses, eyestrain and visual fatigue manifest themselves as tired eyes, red eyes, dry, stinging, burning, and focusing difficulties. Making some adjustments like keeping your eyes above the level of the computer monitor, taking a break from the monitor every 30 minutes and let your eyes rest, blinking, staying properly hydrated, and reducing a lot of artificial light and glare can go a long way in relieving visual fatigue and stress.
In addition to taking care of your eyes at work and college, the eyes need the proper care for sports and at-home activities. Sports such as basketball, football, baseball, and racquetball require the safety from protective eyewear or goggles that regular eyeglasses and contact lenses do not provide. Frames and goggles for adults and kids at our office made by Liberty provide both a fashionable and functional option for vision and eye protection. The lenses can be made in most prescriptions and made out of polycarbonate, which offers both UV protection and shatter-resistance.
At home, some of the everyday activities that we do can pose a danger to the eyes. Things such as mowing the lawn, woodworking, and using strong household chemicals require safety goggles. Non-prescription safety goggles can be found in some hardware stores and depending on the type of glasses, prescription lenses can be put into them.
Even though a majority of patients in this age range are healthy and have good correctable vision, there are always issues and pitfalls are present at work and home that can lead to vision loss. Staying healthy with routine medical care in conjunction with coordinated eye care will help you optimize your vision and eye health.

Dr. K. at Alamo Optometry is your hometown eye doctor for outstanding service, vision care, and designer eyewear. He can be reached at 925-820-6622 or visit his office at 3201 Danville Blvd., Suite 165 in Alamo. Visit our website at: ww.alamooptometry.com.

School-Aged Vision

2009-08-11T07:22:00.000-07:00

School-Aged Vision

(As appeared in Alamo Today, August 2009, pg. 30)

In our second installment of vision and eye health throughout our lifetime, this month we will discuss the needs of a school-aged child. In contrast to preschool kids, school-age children are required to use their eyes and vision not only learning, but for comprehension, extended times of visual attention, and sports. From learning to read in the early years to taking notes and transitioning quickly between the board to your paperwork in junior high and high school the visual demands placed on a student are many and varied.
To be able to succeed in school, good vision is paramount. According to the American Optometric Association, it has been estimated that nearly 80% of learning occurs through the eyes. However, about 20% of school-aged children struggle to read. Some of these children suffer from learning disabilities that inhibit their ability to read. And some children are labeled as having Attention Deficit Hyperactivity Disorder (ADHD), because an undetected vision problem can have the same signs and symptoms as ADHD. Obviously these children will have problems with learning, but sadly a large portion of children have vision difficulties that are interfering with reading.
The major thing to know as parents is that vision is more than just seeing 20/20. Obviously that is important, but you also need the ability to understand and respond to what is seen. Every child needs to have the following skills to effective read and learn: visual acuity, eye focusing, eye tracking, eye teaming, eye-hand coordination, and visual perception. If any or all of these necessary skills are lacking, your child will have to work harder to compensate. This can lead to headaches, fatigue, and inattention to detail.
As children progress in school, they face increasing demands on their visual abilities. The size of print in schoolbooks becomes smaller and the amount of time spent reading and studying increases significantly. When the visual abilities of the child are unable to keep up, learning becomes difficult and frustrating. When this occurs, children will start to avoid reading and other near work or attempt to do the work with lower efficiency, and experience discomfort, fatigue, and a short attention span.
Keep in mind that a child might not always tell their parents that they have a vision problem because they assume that is the way everyone sees or struggles to see. Some signs to look for that your child might have a vision problem include: frequent eye rubbing or blinking, avoiding reading, headaches, covering or favoring one eye, tilting the head to read, seeing double, consistently losing place when reading, and lower reading comprehension.
In addition to the vision requirements for school and learning, sports and recreation activities also come with their own vision issues. Besides good vision, depth perception, wide peripheral vision, and effective eye-hand coordination are essential for success in any sport. If appropriate, contact lenses offer an effective means of correcting any vision issues while allowing for the freedom of running and exercising without the hassle of glasses. For those who are not interested in contacts, sports goggles are also a great option. These are becoming more fashion-forward and are impact resistant. The lenses should be made in polycarbonate, which are shatter-proof. In addition, they can be tinted for day games, or have transitions lenses (which turn from clear to dark) for more versatility. Regardless of the type of glasses or sunglasses, your child should have UV protection. Children receive about 75% of their entire UV exposure for their lifetime by the time they are 18. More children should be wearing UV-blocking sunglasses and have UV protection in their everyday glasses.
Vision changes can occur without your child or you noticing them. We recommend a comprehensive eye exam at the latest before entering Kindergarten, and then every 1-2 years thereafter, unless otherwise directed. Keep in mind, the earlier a problem is found and treated, the higher the success rate and improvement in your child’s education and well-being.

Dr. K. at Alamo Optometry is your hometown eye doctor for outstanding service, vision care, and designer eyewear. He can be reached at 925-820-6622 or visit his office at 3201 Danville Blvd., Suite 165 in Alamo. Visit our website at: ww.alamooptometry.com.

Preschool Vision

2009-06-29T20:30:00.000-07:00

Preschool Vision

(As appeared in Alamo Today, July 2009, pg. 30)

Over the next few months, I will be addressing vision and eye health needs by age group. Each age group has its own needs and challenges. Whether it is dealing with crossed eyes as a youngster, presbyopia (needing reading help) in your 40’s, or macular degeneration in your later years, everyone needs to maximize and preserve their vision and eye health. This month we will start young and discuss preschoolers between 2 to 5 years of age.
During the preschool years, your child will be fine-tuning the vision they have already developed during the infant and toddler years. Young preschoolers pedal, steer and watch where they're going at the same time. Older preschoolers are learning how to use more sophisticated sports equipment such as baseball bats and baseballs and working on the fine motor skills needed to write their names. Preschoolers depend on their vision to learn tasks that will prepare them for school. They are developing eye-hand coordination, fine motor skills, and visual perceptual abilities necessary to learn to read and write.
Approximately 10% of preschoolers have eye or vision problems, but rarely complain because they assume that the world is blurry or distorted because they have nothing else to compare it to. This is generally the time when parents need to be on the look out for vision problems like crossed eyes (strabismus) or lazy eye. Strabismus involves one or both eyes turning inward or outward. Amblyopia, or lazy eye, is a lack of clear vision in one eye, which cannot be fully corrected with glasses. Amblyopia can be caused by many things including strabismus, a very high prescription, having a large difference in prescription between the eyes, disease, and trauma. If not treated early enough, the amblyopic eye does not develop normally and good vision may be permanently lost.
Parents also need to look for refractive errors like farsightedness, nearsightedness, and astigmatism in their preschoolers by watching for any of these warning signs: consistently sitting too close to the TV or holding a book too close, squinting, tilting the head to see better, frequent eye rubbing when your child is not sleepy, sensitivity to light, excessive tearing, closing one eye to read, and avoiding activities which require near vision, such as coloring or reading, or distance vision, such as playing ball or tag.
Make sure your child receives a comprehensive eye exam from an eye care practitioner, not just screenings from school nurses or pediatricians. Screenings may help spot problems, but they can easily miss them, too, because they are not complete tests. Passing a vision screening can give parents a false sense of security. Many screenings only assess one or two areas of vision. Generally they do not evaluate color vision, eye health, and how well the eyes work and focus together. In addition, screenings are typically administered by people who don't have enough eye-specific training in order to catch all vision and eye health problems.
If your child exhibits no symptoms of a refractive error or other visual problems, he or she should have an eye exam by the age of 6 months, then again at age 3, according to the American Optometric Association (AOA). Having a complete eye exam before the child enters school allows enough time to catch and correct any problems while the visual system retains its flexibility.
We believe an eye exam in necessary for the social and academic growth of your child. An exam should definitely be done in their preschool years, but absolutely before entering Kindergarten. We recommend scheduling the eye exam at a time that's good for your child. Some kids are more focused early in the day, while others come to life after lunch or an afternoon nap. Our office and staff are very child and family-centered. We have a toy box, books, and coloring books to help occupy your child and other siblings during the examination.

Dr. K. at Alamo Optometry is your hometown eye doctor for outstanding service, vision care, and designer eyewear. He can be reached at 925-820-6622 or visit his office at 3201 Danville Blvd., #165 in Alamo. Visit our website at: www.alamooptometry.com.

How Does The Eye Work?

2009-06-01T19:32:00.000-07:00

How Does the Eye Work?

(As appeared in Alamo Today, June 2009, pg. 29)

Last month I gave you an overview of our office. This month I thought I would give you an overview of the eye itself. It is an amazing organ that works in unison with our brains to allow us to visually interpret the world around us. They eye works similar to a camera. If any part of your camera is not working well, your photos will not turn out; similarly, if any of the structures or pathways of the eye are damaged, vision will be compromised.
The white part of the eye is called the sclera. The sclera is made of collagen and covers most of the eye. The clear front part of the eye is called the cornea. The cornea is where contact lenses are placed and is the first structure that light comes in contact with on its way to being focused on the retina.
Your pupil is the round black circle in your eye that gets bigger and smaller depending on the amount of light. The iris is the colored muscle fibers surrounding the pupil and controls the size of the pupil. The pupil and iris are like a camera's aperture which is an open space that allows the light to pass through farther into the eye. Between the iris and cornea is the anterior chamber. This chamber is filled with a special fluid that gives the front part of the eye oxygen, protein, and glucose to keep it healthy. The light then travels to the lens of your eye.
The lens is similar to the lens of a camera; they help to bring the light into focus. The lens bends light further and sends it to the back of the eye. The lens is suspended in the eye by a bunch of fibers. These fibers are attached to a muscle called the ciliary muscle. The ciliary muscle changes the shape of the lens. When you look at things up close, the lens becomes thicker to focus the correct image onto the retina. When you look at things far away, the lens becomes thinner.
The biggest part of the eye sits behind the lens and is called the vitreous body. The vitreous body forms two thirds of the eye's volume and gives the eye its shape. It's filled with a clear, jelly-like material called the vitreous humor. After light passes through the lens, it shines straight through the vitreous humor to the back of the eye.
In the back of the eye is the retina. The retina contains photoreceptor nerve cells called rods and cones. Each eye has about 120 million rods and 7 million cones. The cones are mainly in the macula, the center of the retina. The cones are responsible for sharp vision and color vision. The rods are situated in the periphery of the retina and allow us to see at night. These cells take the light and transform them in to electrical impulses. These electrical impulses are then sent to the optic nerve. The optic nerve then transmits the information to the brain. Using a camera demonstration, you can call the retina the film of the camera. If your film goes bad you will not be able to view any pictures no matter what you do. The same goes with the retina. If the retina is damaged by macular degeneration or diabetes, you are not going to be able to fully process any pictures or images.
How the eye processes light is only part of the process. When you do not see well, the problem might be simple in that you are near-sighted or far-sighted and just need glasses or contacts. Also, any disease or trauma to any of the above-mentioned structures can be a cause of decreased vision. Anything from cataracts (clouding of the lens), diabetes, glaucoma (optic nerve deterioration), to almost any systemic disease can cause vision and ocular health concerns. That it why comprehensive exams with dilation that test more than vision alone can help ensure that the entire eye system is working as well as possible.

Dr. K. at Alamo Optometry is your hometown eye doctor for outstanding service, vision care, and designer eyewear. He can be reached at 925-820-6622 or visit his office at 3201 Danville Blvd., Suite 165 in Alamo.

Alamo Optometry

2009-05-11T07:15:00.000-07:00

Alamo Optometry

(As appeared in Alamo Today, May 2009, pg. 25)

We have had such a great response to our monthly columns so I thought it would be nice to give the residents of Alamo an idea of who we are and what we do. My articles to date have focused on conditions and issues that I see daily in my practice, but what I am finding is that our patients are interested in forming long-lasting relationships in addition to receiving quality eye care and products.
Alamo Optometry is in the Alamo Commons building (next to the old Yardbirds), and has been here since 1992. It was formerly known as Diablo Optometry when Dr. Kirschbaum started the practice. Our office is and always has been a small and professional practice that values patient care and service over commercialism. We do comprehensive eye exams, LASIK pre- and post-exams, all types of contact lens fittings, including daily disposables and multifocal lenses, and medical eye care which include diagnosing and treating eye infections, allergies, and dry eyes. Patients of all ages are welcome to our office. All of our staff, including myself, has children; so we are comfortable with even our youngest patients. We are committed to serving the community and making sure everyone has an enjoyable experience. To that extent, we follow-up with our patients after they receive their glasses to see how they are doing, and remind them that free lifetime adjustments and on-site repairs are welcome on any of their glasses.
I have now owned the practice for almost 2 years. I truly enjoy the office, my staff, and the residents of Alamo. Since I graduated 9 years ago, I have gained a lot of clinical knowledge to apply to my school work to offer a well-rounded doctor-patient relationship. I believe patients should be in control of their care in conjunction with their doctor. I offer solutions and recommendation to your vision problems; your vision and ocular health are my main concerns.
Our optician Robert has years of clinical experience in frame and lens selection, along with frame adjustments and repairs. He can adjust and repair most frames in the office. Robert and I work together to make sure you have a frame that is both fashionable and functional in that it will accommodate your prescription and type of lens that you need. I am fortunate to be able to work with an optician that is very knowledgeable and skilled like Robert.
Debbie is our front-desk receptionist and optometric assistant. She is very personable and eager to help anyone who needs an appointment, frame adjustment and selection, and ordering and dispensing glasses and contacts. Debbie has been with the office for over 1 year and patients appreciate her demeanor in assisting patients in the office or on the phone. Her goal is to make sure every patient has a good experience and their vision needs are successfully fulfilled.
Our new website www.alamooptometry.com, has information about the staff and office. We have a blog that is updated monthly with all of our articles in Alamo Today. There is information about the services we provide and some of the frames brands we carry in the office. In addition, we recently added a link on the website to enable our patients with a valid prescription to order contacts at your convenience instead of having to call the office. We have late office hours on Thursdays and are available on select Saturdays by appointment to accommodate our patients’ busy schedules. We all look forward to continuing to serve the vision and eye care needs of the local community by upholding our reputation of outstanding service and vision care.

Dr. K. at Alamo Optometry is your hometown eye doctor for outstanding service, vision care, and designer eyewear. He can be reached at 925-820-6622 or visit his office at 3201 Danville Blvd., Suite 165 in Alamo.

Allergies

2009-04-05T16:02:00.000-07:00

(As appeared in Alamo Today, April 2009, pg. 23)

Allergies

Since the rainy season is mostly behind us, we can now all look forward to allergy season. From about mid-March until early summer, I hear several times a day of how patients suffer from systemic allergy symptoms as well as ocular ones. As a fellow allergy sufferer, I can attest that allergies can affect your daily life in many different ways. From sneezing to sinus congestion to coughing, these limit our ability to function during the day, and limit our ability to sleep at night. As for the eyes, they get very red, itchy, and teary to the point where vision and visual comfort is compromised. This leads to decreased production at school and work due to the inability to visually attend to the task at hand. Here I will mainly discuss the ocular effects of allergies, but they are related in how they are treated and managed.
In the United States, allergies affect about 20% of the population, and over half of those have ocular symptoms. Eye allergies mainly involve the conjunctiva, which is the tissue that covers the white surface of the eye and the inner folds of the eyelids. The conjunctiva is a barrier structure that is exposed to the environment and the many different allergens. It is rich in blood vessels and contains more mast cells (histamine-releasing cells) than the lungs. Histamine is the chemical that dilates blood vessels and makes them more permeable; this allows other chemicals in the blood stream to leak out which intensifies itching, redness, and swelling.
For contact lens wearers, the effect of allergies can cause blurry vision, decreased wearing time, and an increase in build-up on the lenses. Therefore, it is important to be mindful of the "surface environment" that contact lenses create. Extended wearing times, infrequent replacement of lenses, and use of potentially irritating contact lens care products can significantly exacerbate symptoms. Proper lens care is an important part of keeping contact lens wearers safe and comfortable.
When allergy symptoms kick in, patients usually visit the local drugstore to pick up a systemic antihistamine for relief. These medications can clear up systemic symptoms like runny noses, sneezing and coughing, but can make the eye condition worse. A major side-effect of antihistamines is that they have a drying effect on the eyes, thereby decreasing tear quality and quantity. Since tears are a major combatant of allergies, this can have a detrimental effect on the eyes. If your tears can’t adequately protect against and flush out the allergens on the eyes, they remain on the eye longer and make matters worse. Also, a dry eye condition can develop which will add burning and stinging to your already itchy eyes.
Firstly, allergy sufferers can help themselves by controlling their ocular environment. Limiting exposure to environmental allergies (keeping the windows closed during the worst seasons, washing your eyes after being outside) can limit the severity of symptoms. In addition, there are many prescription drops that help ease the effects of allergies. Depending on the symptoms and ocular presentation, there are different classes of medications that can help, including lubricating drops. Our ability to visualize the structures of the eye enables us to diagnose allergies and to initiate appropriate therapy. Since there are some other conditions that can mimic the symptoms of allergies, an office visit can help sort out the diagnosis instead of self-prescribing. Keep in mind it is much easier to treat allergies early on before the symptoms become unbearable.

Dr. K. at Alamo Optometry is your hometown eye doctor for outstanding service, vision care, and designer eyewear. He can be reached at 925-820-6622 or visit his office at 3201 Danville Blvd., Suite 165 in Alamo.

Conjunctivitis

2009-03-02T20:59:00.000-08:00

Conjunctivitis (Pink Eye)
Tuesday, February 24, 2009

(As appeared in Alamo Today, March 2009, pg. 35)

This is the time of the year when we are all fighting the winter colds and flus. The same bacteria and viruses that cause these illnesses also cause conjunctivitis. It is very common for different family members or co-workers to either have the upper respiratory infection or the conjunctivitis, or both.
Conjunctivitis is an inflammation or infection of the conjunctiva, the thin transparent layer of tissue that lines the inner surface of the eyelid and covers the white part of the eye. Conjunctivitis, often called "pink eye," is a common eye disease, especially in children. It may affect one or both eyes. Some forms of conjunctivitis can be highly contagious and easily spread in schools and at home. While conjunctivitis is usually a minor eye infection, sometimes it can develop into a more serious problem.
Conjunctivitis may be caused by a viral or bacterial infection. It can also occur due to an allergic reaction to irritants in the air like pollen and smoke, chlorine in swimming pools, and ingredients in cosmetics or other products that come in contact with the eyes. Bacterial conjunctivitis is an infection most often caused by staph. or strep. bacteria from your own skin or respiratory system. Infection can also occur by transmittal from insects, physical contact with other people, poor hygiene (touching the eye with unclean hands), or by use of contaminated eye makeup and facial lotions.
Viral conjunctivitis is most commonly caused by contagious viruses associated with the common cold. The primary means of contracting this is through exposure to coughing or sneezing by persons with upper respiratory tract infections. It can also occur as the virus spreads along the body’s own mucous membranes.
Practicing good hygiene is the best way to control the spread of conjunctivitis. Once an infection has been diagnosed, follow these steps:
Don't touch your eyes with your hands.
Wash your hands thoroughly and frequently.
Change your towel and washcloth daily, and don't share them with others.
Discard eye cosmetics, particularly mascara.
Don't use anyone else's eye cosmetics or personal eye-care items.
Follow your eye doctor's instructions on proper contact lens care.
For allergic conjunctivitis, avoid rubbing your eyes. Instead of warm compresses, use cool compresses to soothe your eyes. Over the counter eye drops are available. Antihistamine eye drops should help to alleviate the symptoms, and lubricating eye drops help to rinse the allergen off of the surface of the eye.
At our office, conjunctivitis can be diagnosed through a focused office visit. Testing, with special emphasis on evaluation of the conjunctiva and surrounding tissues, will include:
Patient history to determine the symptoms the patient is experiencing, when the symptoms began, and the presence of any general health or environmental conditions that may be contributing to the problem.
Visual acuity measurements to determine the extent to which vision may be affected.
Evaluation of the conjunctiva and external eye tissue using an optometric microscope.
Evaluation of the inner structures of the eye to ensure that no other tissues are affected by the condition.

Even though the diagnosis of conjunctivitis is relatively straightforward, the cause of the condition is often more difficult. Depending on the exact signs and symptoms, several different kinds of causes can overlap. In addition, other more serious issues such as a foreign body in the eye or a corneal infection can initially cause some of the symptoms of conjunctivitis, but needs to be treated in a different manner. We are able to diagnose, treat, and manage all forms of conjunctivitis due to our extensive training and equipment that allows us to see very clearly the structures of the eye. We have same-day appointments for any type of emergency visit.

Dr. K. at Alamo Optometry is your hometown eye doctor for outstanding service, vision care, and designer eyewear. He can be reached at 925-820-6622 or visit his office at 3201 Danville Blvd., Suite 165 in Alamo.

Systemic Diseases and the Eye

2009-02-09T20:36:00.000-08:00

Systemic Diseases and the Eye
Monday, February 2, 2009

(As appeared in Alamo Today February 2009, pg.33)

As many of you may or may not be aware, almost every systemic disease can have ocular effects. Any disease, including cardio-vascular, auto-immune, intestinal, and cancer can and do affect the eye. The eye is no different from any other organ in the body; it receives and needs blood and oxygen to survive. If this is affected or reduced, vision and/or ocular health will definitely be affected. These can vary from a prescription change, cataract formation, or retinal disease, to name a few. That is why it is very important to let us know of any systemic ailments and medications, as these can have a profound effect on the eyes. For the purposes of this article, I will just cover the two most prevalent diseases, diabetes and high blood pressure.
Diabetes affects about 8 percent of the population in the United States and is characterized by either a deficiency in insulin production (type 1) or insulin resistance (type 2). The main ocular effect of diabetes is retinopathy, which is a disease of the retina. Diabetic retinopathy can lead to poor vision and even blindness. Most of the time, it gets worse over many years. At first, the blood vessels in the eye get weak. This can lead to blood and other liquid leaking into the retina from the blood vessels. This is the most common kind of retinopathy. If blood sugar levels stay high, diabetic retinopathy will keep getting worse. Due to the poor retinal blood flow through the damaged blood vessles, new blood vessels grow on the retina. This may sound good, but these new blood vessels are weak. They can break open very easily, even while you are sleeping. If they break open, blood can leak into the middle part of your eye in front of the retina and change your vision. This bleeding can also cause scar tissue to form, which can pull on the retina and cause the retina to move away from the wall of the eye (retinal hole or detachment). Retinopathy can also cause swelling of the macula of the eye. This is called macular edema. The macula is the middle of the retina, which gives you your sharp 20/20 vision and color vision. When it swells, it can make your vision much worse. The only way to diagnose this is a comprehensive dilated optometric examination. Annual exams can help detect retinopathy and monitor retinopathy before it affects your vision.
High blood pressure, or hypertension, is another vascular disorder that forces your heart to work harder to pump blood through your arteries. This can lead to hardening of the arteries and subsequent heart failure. In addition to all of the other body organs it can affect, the eye can also be compromised. The blood vessels of the retina over time can narrow and cause a decrease in blood to the retina. Compromised blood flow can cause swelling of the optic nerve and macula, which over time can lead to decreased vision and possible stroke in the eye. Since this is something that can not be self-monitored, an annual dilated examination can help in the detection and monitoring of this potentially blinding disease.
To help combat these diseases, the absolute best thing you can do is to keep the disease under control. The more your blood sugar and blood pressure are under control, the less likely eye consquences will be an issue. That means visits to your doctor and taking your medications, life-style changes, etc. as prescribed. Keep in mind that just because you “feel” fine and have your diseases under control, the fact is you still have the disease. Besides the ocular consequences, you also have heart, liver, kidneys, brain, and other organs that need to be monitored to help avoid any long-term or life-threatening issues. Along with your regular doctor visits, annual eye exams should be on your list to keep these devastating diseases monitored and under control.

Dr. K. at Alamo Optometry is your hometown eye doctor for outstanding service, vision care, and designer eyewear. He can be reached at 925-820-6622 or visit his office at 3201 Danville Blvd., Suite 165 in Alamo.

Computer Vision Syndrome (CVS)

2009-01-14T11:27:00.000-08:00

(As appeared in Alamo Today January 2008 edition, pg.34)

Computer eyestrain affects more than 70 percent of the approximately 143 million Americans who work on a computer on a daily basis, according to the American Optometric Association (AOA). Eyestrain and other symptoms of computer vision syndrome don't occur only in adults. Millions of children work at a computer and/or play video games every day, either at home or in school. Prolonged computer and gaming device viewing can stress a child's eyes and may affect normal vision.

Computer eyestrain and computer vision syndrome are caused by our eyes and brain reacting differently to characters on a computer screen than they do to printed characters. Our eyes have little problem focusing on printed material that has dense black characters with well-defined edges. But characters on a computer screen don't have the same degree of contrast and definition. CVS is caused by our eyes and brain reacting differently to characters on a computer screen than they do to printed characters. Words on a computer screen are created by combinations of tiny points of light (pixels), which are brightest at the center and diminish in intensity toward their edges. This makes it more difficult for our eyes to maintain focus on these images. If you or your child spend more than two hours per day in front of a computer screen, it's likely you will experience some degree of computer vision syndrome. Symptoms of CVS include: headaches, burning and tired eyes, blurred vision, double vision, and neck and shoulder pain.

There are several things you can do to help with the symptoms of CVS. First, attempt to cut down on the glare at your screen by altering the lighting near your desk. Next, keep your head above the level of your monitor. This will allow you to be more ergonomically situated and reduce neck and shoulder strain. Permit yourself to take breaks from the monitor. Allow for a short 1-minute period of rest about every 30 minutes; look out a window, down the hall, get a drink of water, or just close your eyes to allow you to defocus from the monitor. Lastly, stay hydrated. We recommend drinking plenty of water, and using lubricating drops as needed. It is also recommended to reduce your caffeine intake, as it is a diuretic and dries your eyes out further.

However, the most important thing is to make sure you have computer prescription glasses, either single vision or progressives. Having an up-to-date prescription can definitely reduce the amount of strain and focusing necessary for continued monitor work. In addition, lenses with a good antiglare coating will not only make your lenses cosmetically look better, but will reduce about 95% of the glare from your monitor. Finally, studies are showing that low tints on the lenses will filter out some of the unnecessary light entering the eye, therefore making vision a little bit easier.

Since computer vision syndrome and playing video games is a mainstay in today's society, we are introducing Gunnar Optiks glasses to the office. These specialized glasses are made with computer-specific tints and coatings to help reduce much of the symptoms of CVS. They can have no prescription (if you currently wear contact lenses), or can be made with your specific prescription in either single vision lenses or progressives. In addition to the prescription, coatings, and yellow tint, the frames have a high wrap, which helps control against airflow near the eyes, and allows the eyes to remain moist. Our display has most of the frames to try on with a computer screen so you can see the results for yourself.

We are finding more and more that CVS is not a condition for adults only. Children, with an increased amount of computer and video game use, are just as likely to have symptoms as adults. CVS requires a multi-factorial approach; ergonomics, current eyewear with coatings, staying hydrated, and taking breaks will all help to alleviate these problems. We are more than happy to discuss your optical and ocular health options and what would work best for you at your exam.

Dr. K. at Alamo Optometry is your hometown eye doctor for outstanding service, vision care, and designer eyewear. He can be reached at 925-820-6622 or visit his office at 3201 Danville Blvd., Suite 165 in Alamo.

Insurance and Flexible Spending Accounts

2008-12-01T11:07:00.000-08:00

(As appeared in Alamo Today Dec 2008 edition, pg.28)

People are often confused when it comes to insurance. Sometimes with your medical insurance comes a vision reimbursement plan; you are allowed a certain amount every year and you get reimbursed from your insurance company. However, most patients have separate medical and vision coverage. There are many companies offering vision insurance, the most common is Vision Service Plan (VSP). In addition, if you have Kaiser for your medical coverage, you might have VSP for vision coverage, so you can go to any private office for your eye care. The nice thing about vision insurance is that it tends to be simpler than medical insurance. No referrals are needed; regardless of what type of insurance you have from VSP to Medicare, you can visit the doctor of your choice with no prior authorization required.

Our office only directly bills VSP and Medicare; however, if you have another insurance, we are happy to have you as a patient. At the end of your visit, we will give you an itemized receipt to submit for possible reimbursement. As for VSP, annual exams are covered with a small office co-pay. In addition, an allowance and discounts for glasses or contact lenses are usually permitted annually, depending on the individual plan. With VSP, you use your benefits or you lose it, you can't go back and utilize unused benefits from the past. Also, full VSP benefits can only be used at private offices, not at commercial stores like Costco and Lenscrafters, or online for contacts. If we are unable to help you find the glasses for you, we recommend at least you find an office where your benefits can be fully utilized.

As for Medicare, it will cover the medical portion of the exam, not the refraction (the determination of your eyeglass prescription). Medicare only has benefits for glasses after cataract surgery. If you have already met your annual deductible, Medicare will cover a good portion of the exam.

There are many instances where a medical eye problem would bring you to the office. When the visit involves a medical condition (red eye, infection, foreign body, allergies), a majority of the time the bill can be submitted to the medical plan for reimbursement. Since optometrists can treat most ocular medical conditions, patients can be seen at our office instead of going to their primary care doctor or emergency room. In addition, some VSP plans also contain a provision called Primary Eye Care, which covers medical visits for only a $5 co-pay. Since we have the necessary equipment and training to handle most eye conditions, you can feel comfortable using our office for your medical visits as well as for your annual exams.

Finally, it is that time of year where Flexible Spending Accounts (FSA) need to be used before the end of the calendar year, or the benefits will be lost. A FSA plan allows employees to take out money pre-tax to help pay for qualifying medical bills. These include doctor visits, office co-pays, prescription drugs, surgery, and dental bills. In addition, all glasses, sunglasses, and contact lenses are controlled by federal regulations and are considered medical devices. Any purchase of these materials can be used using your FSA. We will give you a detailed receipt for you to submit to your Human Resources Department for reimbursement.

It is our job to help explain your benefits to you and how to best utilize your coverage. If you have any questions regarding your insurance or FSA reimbursement, we would be more than happy to assist you.

Dr. K. at Alamo Optometry is your hometown eye doctor for outstanding service, vision care, and designer eyewear. He can be reached at 925-820-6622 or visit his office at 3201 Danville Blvd., Suite 165 in Alamo.

Presbyopia

2008-11-01T11:03:00.000-07:00

(As appeared in Alamo Today Nov 2008 edition, pg.28)

Presbyopia, or the "short-arm syndrome", eventually affects everyone. Your lens, which is in the inside of the eye, continues to grow throughout life. As it becomes thicker and denser, it becomes less flexible, and this is what causes a decrease in your near focusing ability. Overall, your focusing ability is best when you are born, and decreases from that point on. Usually the symptoms of presbyopia include pushing reading material farther away, the need for good lighting, eyestrain, and fatigue, begins in your low-to-mid 40's. As you age, your ability to focus decreases. As your accommodation decreases, which will happen regardless if you wear glasses full-time, part-time, or never, you will need more power to make up the difference. This process will cease in your upper 50's to around 60 years of age. After that point, you might need some fine-tuning in your glasses or contacts, but the constant change will stop. Even though this is a completely normal process, there are several methods to help.

Progressive Lenses: These lenses have the advantage of 1 pair of glasses giving you clear vision at distance, intermediate, and close. Another advantage is that they have no lines; cosmetically they look like single-vision lenses. There will be adaptation necessary for this type of lens because you have a smaller area to use for near compared to a single vision lens. In addition, for heavy computer users, computer progressives are available. These lenses do not correct for distance vision, but allows a wider field of view compared to regular progressive out to about 7 feet. With the proper frame size and motivation, well over 90% of patients do very well with all types of progressives.

Bifocal Lenses: This lens will allow you to see well at distance and near. However, intermediate vision eventually will become compromised. These lenses don't require the adaptation that progressives do, but the "line" will be evident.

Single Vision Glasses for Near Work: Some people choose to have separate glasses for distance (if needed) and near. The nice thing is that there is no adaptation required; you can use any part of the lenses to see. However, the compromise is that you will need to remove or slide them down your nose to see clearly outside of a few feet.

Contacts: Some people are still under the impression that once presbyopia hits, you can no longer wear contacts. These days, that could not be farther from the truth. Assuming you can comfortably wear contacts, there are basically 3 options:

Multifocal contacts allow you to see distance and near with each eye. All of the power is centered in the middle of the lens, and you just pay attention to the object in focus. These require very little adaptation and care of the lenses is no different than any other type.

Monovision allows you to see distance out of one eye and reading out of the other. Your need for reading glasses is minimal; they usually are only required for small print like reading medicine bottles. This modality does require some getting used to, since you are artificially changing the power of one eye to read. Greater than 75% of patients get comfortable with monovision after the initial week or so. If you are happy with the comfort of your current contacts, this allows you to remain in them and just change the power in one eye.

Distance contact with reading glasses is also the choice for many people. This allows clear distance vision out of both eyes, and clear reading through the glasses. Even though you still need glasses for near work, the contacts still give you the flexibility for sports, recreation, and other activities where detail near work is not needed.

As you can see, all is not lost when your accommodation (focusing ability) decreases. It is a completely normal process; but the advantage we have now is that we have several tools to help solve the problem. Depending on your personality, activities, and prescription, we will determine what will work best for you and help guide and assist you in the process.

Dr. K. at Alamo Optometry is your hometown eye doctor for outstanding service, vision care, and designer eyewear. He can be reached at 925-820-6622 or visit his office at 3201 Danville Blvd., Suite 165 in Alamo.

Myth Busters

2008-10-01T11:01:00.000-07:00

(As appeared in Alamo Today October 2008 edition, pg.27)

I thought for this month's article I would tackle some everyday questions and myths regarding the eyes and eye care and help set the record straight. Let's see how many you can get right.

TRUE/FALSE: The eye, and retina in particular, can reveal many effects of both prescription drugs and systemic diseases.

Answer: True. The retina is the only place in the body where blood vessels can be directly observed without an invasive procedure. It can give a very good indicator of the status and medical control of systemic diseases such as diabetes, high blood pressure, and high cholesterol. In addition, some medications can also cause some harmful consequences in the eye, which need to me monitored. Some of these include tamoxifen (for breast cancer), some heart medications, and prednisone. That's why it is very important to let your eye doctor know what medications you are taking to make sure they are not affecting your eyes.

TRUE/FALSE: I don't want to start wearing my glasses because they will only make my eyes worse.

Answer: False. Before you have any type of vision correction, your brain is used to seeing blurry because it has nothing else to compare it to. When you do get glasses, your brain is then presented with a clear image. If you then remove your glasses, it appears that your vision is worse. Now that your brain knows what it should be seeing, your vision prior now appears much worse, even though your prescription has not changed. Keep in mind, everything else being equal, if your prescription is going to change, it will change regardless of how much you wear your glasses.

TRUE/FALSE: Contact lenses are labeled as medical devices.

Answer: True. Federal law requires an annual examination to renew your contact lens prescription. Regardless of how your vision or comfort is with your contacts, after 12 months the prescription expires. This has caused some frustration with patients, as they don't understand why they can't just order more contacts. For eye and corneal health and to ensure the contacts are not causing any detriment to the eye, it was federally mandated a few years ago that annual exams would be necessary.

TRUE/FALSE: Reading in the dark will hurt the eyes.

Answer: False. Although reading in the dark will add some strain and possibly be uncomfortable, it does not cause any damage to the eyes. Having good light enables you to see easier and generally causes less fatigue while reading.

TRUE/FALSE: You get cataracts and glaucoma when you are elderly.

Answer: True and False. Cataracts are a completely normal part of the aging process. As you age, cataracts begin to develop and gradually decrease vision and increase glare. In comparison, glaucoma is more likely as you age, but you do not get glaucoma just because you are older. It thankfully only affects about 4-5% of the population, and your likelihood increases as you age. Cataracts are a normal process; glaucoma is a disease and is not.

TRUE/FALSE: Gray tinted lenses are better for sun protection than any other color.

Answer: False. The color of the lens makes no difference. It is the UV filter in the lenses that blocks the harmful rays from the sun. A tinted lens lets just as much UV light through to your eyes than a clear lens. All lenses should either be made of a UV-blocking material (polycarbonate), be polarized, or have a UV coating applied to the lenses.

TRUE/FALSE: Eating carrots can improve eye health.

Answer: True. Carrots will help maintain eye health, not improve vision. Carrots are rich in vitamin A, which is very important in the health and functioning of the retina. Vitamin A deficiency is a leading cause of blindness in under-developed countries. So eating carrots will not help you see better, but maintain overall eye health.

TRUE/FALSE: Only males can be colorblind.

Answer: False. It is much more likely for a male to be color blind than a female, but it is not impossible for a female. Since this condition is X-linked, both X chromosomes need to carry the gene for a woman to be colorblind. Since males only have 1 X chromosome, if it is on that chromosome, that male will be colorblind.

Dr. K. at Alamo Optometry is your hometown eye doctor for outstanding service, vision care, and designer eyewear. He can be reached at 925-820-6622 or visit his office at 3201 Danville Blvd., Suite 165 in Alamo.

Vision Screenings vs. Vision Examinations…What is the Difference?

2008-09-01T10:58:00.000-07:00

(As appeared in Alamo Today Sept 2008 edition, pg.27)

This question comes up often in practice as parents are questioning whether or not a screening at school or their child's pediatrician is sufficient to ensure good vision and eye health. Obviously, each parent must make their own decision; however, here are some of the glaring differences between a screening and a comprehensive examination.

Vision screenings conducted at school or in a doctor's office test for distance vision only. Since distance vision is defined at 20 feet, a child might pass this without any difficulty, but gives no information whether a child can read a book and use the eyes well as a team up close. If the screening is done at school, a rough determination of prescription and eye alignment is attempted without the use of any machines. This information is then used to either pass or fail the child. However, the standards for pass/fail are arbitrary and can differ from clinic to clinic and child to child. The last thing to consider about a screening is who is conducting the test. Most of the time it is a doctor's assistant or nurse at the pediatrician's office, and at schools, an optometrist or school nurse conducts the screening. However, in both circumstances, the ability for the child to focus on the tasks at hand and for the tester to get accurate results are often compromised due to the noise and distractions of other children and students waiting to be tested.

Comprehensive eye examinations should be conducted by an eye care professional. Optometrists have the necessary training and experience to make a diagnosis of vision, binocular vision, and health status and to recommend treatment if needed. Often, the necessary equipment and tests to fully evaluate the status of the eyes are not available at a vision screening. Here are just some of the highlights of a pediatric exam at our office.

Visual acuity at distance and near is determined. Since a child needs to be able to see and function at many distances, simply testing distance only is not sufficient. In addition, the focusing ability is also assessed. Your child needs to focus on the board or overhead and then to their notes or book and back all day long. The ability for sustained focusing also allows your child to attend to reading and writing for a period of time.

The exact prescription for good comfortable vision is determined. Amblyopia, or "lazy eye", occurs in about 8% of the pediatric population, and is when one or both eyes cannot be corrected to 20/20 vision. The need to correct this is important early in life to help both eyes develop and see well. Sometimes glasses or contact lenses are needed and sometimes they are not; however, knowing the exact status of the eyes is paramount.

Binocular vision, color vision, eye movements, and depth perception are all tested. If your child cannot move his/her eyes well to track objects, or to differentiate colors well, activities such as reading, sports, and copying information from the white board will be affected. Good eye alignment allows the muscles in the eye to converge (come together) and diverge (move apart) depending on the task. This allows for good depth perception and a precise eye alignment so the brain can fuse what it sees from each eye into a single, clear image.

Finally, the health of both the front and back (retina) part of the eyes is determined by examining all structures through the use of a microscope and lenses. We will also measure of the pressure in the eyes, and use drops if needed to make the health assessment process easier.
Even though most screenings figure out which children need to be evaluated further, it is based on decreased distance visual acuity alone. As stated above, many things aid or are a detriment to good and comfortable vision, and are usually not evaluated at a screening. My recommendation is to have your child's eyes examination early (preschool age or by kindergarten), and if a recommendation for a vision evaluation is given, we would be more than happy to examine your child and give you an honest recommendation based on the findings of the exam.

Dr. K. at Alamo Optometry is your hometown eye doctor for outstanding service, vision care, and designer eyewear. He can be reached at 925-820-6622 or visit his office at 3201 Danville Blvd., Suite 165 in Alamo.

Back to School

2008-08-01T10:56:00.000-07:00

(As appeared in Alamo Today August 2008 edition, pg.24)

It seems like yesterday that our kids got out of school. Now as we turn the calendar to August, it is time to start thinking about back to school and going off to college. For most parents, including myself, that usually means stocking up on clothes and school supplies. In addition to these necessities to start school off on the right foot, it is important to have an eye exam on your list.

Good and comfortable vision gives your child the first tool in learning and doing well in school. Since a large amount of learning is done through the eyes, if your child has difficulty seeing the board or their up-close work, they will not start off the year right. In a pediatric exam, I determine the child's prescription, eye health, peripheral vision, and eye teaming and movement skills; at a first visit, I also test depth perception and color vision. Here are some common refractive and binocular vision disorders that can hinder vision, and therefore the ability to learn.

Myopia is commonly referred to as near-sightedness. That means that without any correction, a person has difficulty seeing in the distance. This is very common among students, and tends to progress as the child gets older. Blurry distance vision will hinder things such as taking notes in class, sports, and driving. This can easily be addressed with contacts or glasses.

Hyperopia, or far-sightedness, is the opposite of myopia. If you are far-sighted, it is easier for you to see distance than up close. Since you need to focus more up close than you do far away, a hyperope usually has near vision problems. Being in a constant state of “focusing” can lead to headaches, eyestrain, and early fatigue. Sometimes the problem is more complicated, but most of the time reading glasses for homework can make a huge improvement.

Astigmatism, unlike the prior conditions, typically affects distance and near vision equally. Astigmatism means that the cornea, the clear front part of your eye, is shaped more oblong than spherical. Because it is steeper in one direction, when light comes into the eye, it doesn't come to one single point of focus. It can cause distorted and uncomfortable vision; however, astigmatism can typically be corrected with glasses or contact lenses.

Binocular vision disorders are those that involve the muscles and movements of the eyes, and how well they work together. If the eyes are turned or have the tendency to do so, or don't "team" well, sustained focusing can cause objects to appear blurry, distorted, and possibly double. These conditions can be very difficult for the parents to identify, because in some cases, the child may see 20/20 and not have any noticeable vision problems. However, it can be very frustrating because the student or adult for that matter, will have difficulty with sustained near-task work, which can lead to early fatigue, headaches, and avoidance of the task altogether.

As a whole, most screenings at your child's pediatrician office or school will reveal if your child needs an eye exam. However, they generally do not have the knowledge or expertise to ascertain some of the above-mentioned conditions. Parents always ask when they should have their kids' eyes checked. Sometimes an exam is needed as early as 6 months of age, however, that is rare. Preschool age is generally a good time to have your child checked. Your child does not need to know his/her letters to do the exam; the prescription can be arrived at without the active participation of the patient. I do recommend a first exam before kindergarten at the latest. Kids accept the world that is presented to them because they have nothing else to compare it against. If objects are blurry, they assume that is how it is until it is proven in the exam room that they should be seeing much better. Our office and staff are very kid-friendly; we all have children of our own and there are toys and books to make the children more comfortable.

Dr. K. at Alamo Optometry is your hometown eye doctor for outstanding service, vision care, and designer eyewear. He can be reached at 925-820-6622 or visit his office at 3201 Danville Blvd., Suite 165 in Alamo.

Contact Lenses

2008-07-01T10:52:00.000-07:00

(As appeared in Alamo Today July 2008 edition, pg.24)

Recent advancements in contact lens technology and manufacturing have made contact lens comfort and vision easier than ever. Depending on your prescription, eye health, and how often you want to wear contacts, there is likely a contact lens for you. Soft daily disposable contacts are gaining popularity because they are convenient and healthy for your eyes. These lenses are very thin, and therefore easy to adapt to. From an eye health perspective, these are the best lenses for you because there is no build-up on the lenses, which can lead to decreased wearing time and possible infections. In addition, these are very convenient because you don't have to worry about cleaning and storing your lenses, or having to buy solution. The other advantage is you can wear these lenses as much or as little as you like. If you want to wear them just for sports, recreation, vacation, or just going out to dinner, these lenses are the choice for you. However, even if you want to wear them every day, dailies are still the most convenient and healthy lenses on the market.

If you need heavy contact lens wear including extended wear (sleeping in your lenses), you might want to try silicone hydrogel lenses. Some of these lenses are now FDA approved for up to 30 days of continuous wear. This new material makes the lenses firmer, and allows for an average of a 4 to 6 fold increase in oxygen flow to the eye. Obviously, there are some potential health issues with the eyes that come along with sleeping in your lenses, so it is not for everybody; that can be determined at your exam and at follow-up visits. Most people enjoy the freedom these lenses give you and the increased end of day comfort. If your eye receives more oxygen, it will be less fatigued and red at the end of the day.

Toric contact lenses are now better than ever. If you have astigmatism, that means the front part of your eye (the cornea) is more oblong-shaped, similar to an egg. Because the eye is not equally curved, a toric lens is needed to help you see well. These lenses are still soft and you care for them the same as any other lens. Toric contacts are now available in daily disposable and in the silicone hydrogel material.

For those of you who love your contacts but need some reading help, multi-focal contacts and monovision are your options. Multifocal lenses allow you to see both distance and near out of each eye, while maintaining binocular vision. Being able to see the same out of each eye enables the brain to use your eyes as a team, as compared to monovision, which corrects one eye for distance and the other for near. With monovision, you wear a single vision distance contact on one eye and a near lens on the other eye. Both modes of correction are popular and both have their attributes and drawbacks. Whether multi-focals or monovision would work best for you would depend on prescription and what your visual demands are at work and for leisure.

Lastly, color contacts are available in daily disposable, toric, and regular 2 or 4-week disposable lenses. The colors vary across the spectrum and will give you either a subtle change in color or a profound one. Some patients use these lenses full-time, and some wear clear contacts, but have a small supply of color lenses for special occasions. The nice thing is you can try on some of the colors in the office to see if they are a good fit for the change you are looking for.
Finally, it is important to remember that contact lenses are medical devices, and can cause eye health consequences if not worn and cared for properly. That is why annual exams are mandatory to ensure good vision and eye health. We will patiently work with you to determine which prescription and type of lenses would be best for you. Our goal is that your vision and comfort with your lenses is the best that it can be.

Dr. K. at Alamo Optometry is your hometown eye doctor for outstanding service, vision care, and designer eyewear. He can be reached at 925-820-6622 or visit his office at 3201 Danville Blvd., Suite 165 in Alamo.

U.V. Light

2008-06-01T10:44:00.000-07:00

(As appeared in Alamo Today June 2008 edition, pg.26)

Now that we are entering the summer months, I often get asked about UV (ultraviolet) protection in glasses. There seems to be some confusion about what UV light is and how we can protect ourselves.

First of all, ultraviolet light is invisible and is divided into the categories of UV-A, UV-B, and UV-C. Generally speaking, UV-A and UV-B are most harmful to the eyes. Repeated and prolonged exposure to UV light can cause many eye conditions. The important thing to remember is that exposure to ultraviolet light is cumulative; meaning a person starts absorbing UV as a child and each day we live we add more. A person will receive about two-thirds of their entire lifetime UV radiation by the time they are 18 years old.

Depending on the duration of UV exposure, different eye conditions can occur. The most common result of a sudden amount of UV-B radiation is photokeratitis, or "sunburn on the eyes". The most common cause is excessive glare off the snow during skiing or the water during water sports. These can be very painful, but after treatment, usually resolve within a few days.
Long-term exposure has been linked with an early onset of cataracts, pinguecula formation, and ocular melanomas. As we age, we will all develop cataracts; however, continued exposure to sunlight can speed up the process. It has been shown that people that live close to or on the equator get cataracts about 10 years sooner than people who live closer to the poles. This is due to the fact that on the equator, one receives the same amount of UV light each day. We here in California still receive UV everyday, but we receive much more in the summer months and less in the wintertime. A pinguecula is the yellowish-looking bump on the "white part" of the eye, and is a direct result of long-term UV light exposure. Most people, including myself, have them and they are completely benign. However, over time they can become red and irritated, which just makes them grow faster.

Now that we know what ultraviolet light is and what harm it can do to the eyes, what kind of defense is there? The easy one is to never leave your house, but that is not very practical. Our next best choice is UV-blocking lenses in our glasses or sunglasses. The UV coating on your lenses is a clear coating and it does not change the appearance, color, or thickness of the lenses. It is important to understand that just having your standard plastic lenses tinted dark does absolutely nothing for UV protection. All that will do is block some visible light from getting to your eyes, but will not block any more UV than clear plastic lenses. Some options include using polycarbonate, transitions, or polarized lenses in your glasses. Polycarbonate lenses have several advantages: in addition to blocking UV light, they make your lenses thinner, impact-resistant, and come inherent with a scratch-resistant coating. Transition lenses are also an option; these lenses become darker outside and clear indoors, and come with UV protection in the lenses. Polarized lenses for your sunglasses, with an inherent UV block, eliminate glare, can be tinted gray or brown, and are great for overall outdoor comfort, especially if you participate in snow or water sports.

Most, if not all, non-prescription over-the-counter sunglasses have UV protection in them. Even the inexpensive child and adult sunglasses found at local discount stores will still have this protection. The primary difference between the high quality sunglasses and the lower quality is in the craftsmanship and optics of the lenses. For example, some of the brands in our office like Maui Jim and Oakley have polarized lenses and an anti-glare coating that provides clear and sharp vision while outdoors. In addition, we can make them in prescription and adjust them to fit you specifically, just like your regular glasses.

I believe it is a good idea for all kids and adults to have some sun protection for their eyes. I like to call UV protection "suntan lotion for the eyes". We are trained to put on suntan lotion when outdoors for a period of time, and we need to start doing it more for our eyes.

Dr. K. at Alamo Optometry is your hometown eye doctor for outstanding service, vision care, and designer eyewear. He can be reached at 820-6622.