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These three health care providers differ in their training and what services they are permitted to provide. An ophthalmologist is a medical doctor that specializes in vision and eye health. They are permitted to do eye examinations, write glass or drug prescriptions, and perform eye surgeries. Many ophthalmologists specialize in a particular eye disease or eye tissue, such as the cornea or retina. An optometrist is considered a primary eye care provider. During a routine eye examination, he/she examines vision, eye alignment, and eye health. Specifically, they are trained to measure and provide glass prescriptions, as well as dispense glasses and contact lenses. They also assess how well the eyes work together, looking for strabismus (“turned eye”) and other eye coordination problems that may cause symptoms such as eye strain, headaches, double-vision, or blurred vision. Optometrists also check the health of the eyes, screening for such things as glaucoma and retinal problems. They are able to write drug prescriptions for certain eye conditions, but may need to refer to an ophthalmologist for further treatment or surgery. An optician designs, fits, and dispenses glasses and contact lenses, using a prescription provided by an ophthalmologist or optometrist. They are not permitted to perform eye examinations or provide prescriptions for glasses or contact lenses. However, they are able to provide advice on lens and frame selection. Some specialize in specific devices, such as prosthetic eyes.
According to the college of optometrists, children should have their first eye exam at 6 months of age. They should have an additional eye exam at 3 years of age and then yearly thereafter. Children should be seen earlier than this if a vision problem is suspected (for example, there is a family history of vision or health problems; the child has a medical condition that may affect the eye health; or the child has a white pupil).
Clues that your child may have a vision problem include: he/she is bumping into objects, squinting, rubbing the eyes a lot, tilting his/her head to see better, complaining of blurred vision or headaches, or if the parent observes an eye turn or unusual redness/discharge.
It is important that children have an eye examination early in life to avoid permanent vision loss.
Some children have very poor vision in one eye only, and so with both eyes open they appear to see very well. If treatment is begun at an early age, such as wearing glasses and/or patching of an eye, it is possible to reverse some or all of the vision loss in the poorer eye. If treatment is begun later in life, it may not be possible to recover lost vision.
A child does not need to be able to read or recognize letters to undergo an eye examination, as the optometrist can use easily recognizable pictures. Children can even undergo an eye examination if they are not yet speaking, as the optometrist is still able to assess eye health, eye coordination, and glass prescription without verbal responses from the child.
Eye examinations are covered by OHIP if:
- The person is 0-19 years old or 65+ years old, or
- The person has one or more of the medical conditions deemed covered by OHIP (for example diabetes, glaucoma, macular degeneration, keratitis, strabismus)
OHIP allows one complete eye examination per year, for those that qualify. They may be covered for additional visits if they have an eye condition requiring more frequent assessment, or if they have an eye injury or infection.
Definitely! Permanent vision loss can be avoided or slowed significantly by undergoing routine eye and vision examinations. The optometrist is trained to detect and identify early signs of eye or systemic disease which may be evident even before a person has symptoms.
The optometrist will begin the examination with several questions about your vision and eye health, general health, and family history. Then a series of tests will be performed, which assess:
- Visual acuity
- Eye alignment (testing for strabismus ie “turned eye”)
- Eye motility and coordination
- Peripheral vision
- Pupil responses
- Refraction (measuring glass/contact lens prescription)
- Eye health (including examination of the external and internal structures of the eye)
- Eye pressure (when indicated)
- Colour vision (when indicated)
The results of these tests may prompt the optometrist to do additional tests, such as digital retinal photography, visual field testing, or stereoacuity (depth perception testing).
The examination will conclude with a discussion of the optometrist’s findings and recommendations. As well, you will be given an opportunity to ask questions.
Diabetes can affect your vision and eye health. Your blood sugar level will influence the strength of your glasses. Therefore, if your blood sugar level changes/fluctuates, your glass prescription may change/fluctuate, resulting in blurred vision, eye strain, or headaches. The more consistent you keep your blood sugar levels, the more consistent your vision should be. Diabetes can also affect the blood vessels of the eye. Specifically, a person can have “leaky” blood vessels, causing hemorrhages or swelling inside the eye, or they may have poor blood supply to structures of the eye. Since diabetes can lead to retinal problems, cataracts, and glaucoma, it is recommended that a person with diabetes have a thorough eye exam every year (minimum). Early detection and intervention, when needed, can significantly improve the prognosis for preserving vision.
There is a lens located just behind the iris (the coloured part of your eye). When you are born, this lens is clear/transparent, allowing light to pass through unobstructed. As we age, the lens can become cloudy. This is a cataract – a cloudy or opacified lens. Just like looking through a foggy windshield, a cataract will blur your vision. As a cataract matures, there is a slow, painless decline in vision. Other symptoms may include glare, haloes around lights, loss of contrast, and change in colour perception. When there is a significant decline in vision, the cataract can be removed during surgery and replaced with an intraocular implant. Risk factors for cataracts include age, smoking, UV exposure, and certain medications.
Glaucoma is a medical condition in which there is a progressive loss of optic nerve tissue, which results in a slow, progressive loss of vision. Since the peripheral vision is affected first, most people do not have any visual complaints when diagnosed. As well, most people with glaucoma do not have any symptoms of eye pain. An abnormally high eye pressure is a risk factor for glaucoma, but does not necessarily mean that a person has glaucoma. In fact, some people diagnosed with glaucoma have normal eye pressure. Therefore, it is important to assess the optic nerve, the nerve fiber layer, and the visual fields when screening for glaucoma. Risk factors for glaucoma include a family history of glaucoma, certain medications, certain medical conditions, history of eye trauma or vascular incident in the eye. Unfortunately, there is no cure for glaucoma, however, treatment can prevent or slow further vision loss. Therefore, is it important to diagnose glaucoma as early as possible. This is achieved by having routine eye examinations.
Macular degeneration is a medical condition in which there damage to a part of the retina called the macula. The macula is responsible for the center of your vision. When you are looking directly at an object, it’s image falls directly on your macula. It is therefore responsible for your ability to read and see fine details. Symptoms of macular degeneration include blurred vision, distorted vision (straight lines might look crooked or bowed), blacked-out spots in the vision, and abnormal colour vision. Macular degeneration does not affect peripheral vision. Macular degeneration is predominantly in people over the age of 50, as it is an age-related disease. The greatest risk for macular degeneration is a family history. Other risk factors include UV exposure, smoking, obesity, and poor diet. There are 2 types of macular degeneration – dry and wet. As with glaucoma, there is no cure for macular degeneration, however early detection and treatment can slow the progression of the disease and help preserve vision.
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