The Snellen chart is a simple way to measure visual acuity, or how clearly you see, and is often used in vision screening to help identify people who may have vision problems and need corrective lenses. A vision screening can provide critical information, but it is not the same as an eye exam and is not intended to take the place of one.

A vision screening is not the same as an eye exam.

School nurses and DMV employees can conduct a vision screening. There are even smartphone apps available so you can do one at home. A comprehensive eye exam, on the other hand, is performed by a doctor and includes thorough testing and evaluation of all aspects of your vision and eye health. Such an exam involves much more than just determining your prescription for eyeglasses or contact lenses. I check for eye disease (which is why people with “perfect vision” should still get eye exams) and evaluate your eyes as an indicator of overall health. In fact, I am often the first healthcare professional to detect chronic systemic diseases such as high blood pressure and diabetes.

It is generally recommended that people schedule an eye exam every one to three years, depending on age, health, family history and other factors as determined by their doctor. Patients with diabetes should schedule an exam once at least once a year to monitor any changes. (Learn more.)

What to expect in a comprehensive eye exam

Generally, patients can expect the following in a complete exam:

• Visual acuity testing (how well you see at various distances)
• Visual field test to measure peripheral vision (loss of side vision is a sign of glaucoma)
• Prescription evaluation
• Thorough evaluation of the visual system (anatomy and function)
• Medical evaluation (disease detection and diagnosis)
• Measurement of intraocular pressure

Your exam may involve pupil dilation and the use of imaging equipment and/or other diagnostic technology.

Also as part of the exam, I go over family and personal medical history and lifestyle factors that may put you at greater risk for eye disease and other health problems, with the goal of minimizing risk and preserving your vision for lifelong satisfaction at work and at play.

Crizal is the brand name of an anti-reflective coating applied to optical lenses. The coating provides a smoother finish to lenses, which reduces glare and makes it more difficult for dust and water to adhere to the surface. A coating of varnish is also applied to resist scratching. In its simplest form, Crizal performs comparably to any other popular brand of anti-reflective (AR) coating.

With that said, Crizal offers advanced lens coatings that cost a bit more, and there’s one in particular that is worth the money. Crizal Avancé with Scotchgard Protector is a newer upgrade offering top-tier performance including the clearest lenses and an added protective coating for scratch-resistance and durability. From what I’ve seen, it is superior to Crizal Alizé, which also improves upon the basic anti-reflective coating but has been known to scratch and peel. It is also superior to Crizal Sapphire, which has a slightly bluish tint although it is advertised as “the clearest no-glare lenses.”

Because every patient has different needs there will always be exceptions, but generally speaking, Crizal Avancé with Scotchgard Protector outperforms and offers a better value than Crizal’s other advanced coatings.

At Insight Eyecare of Kilgore and White Oak, we offer a range of other AR coatings and technologies in addition to Crizal. For a fuller description of the benefits of AR coatings in general, click here.

Dr. Jeff Pinkerton
iCare for you.

Who gets cataracts?

Cataracts are an equal-opportunity affliction. Everyone who lives long enough gets them eventually, with most people requiring surgical removal between the ages of 65 and 85. But I’ve also seen cataracts in babies, teens and young adults due to genetics, medication side effects, certain diseases, or eye trauma.

I can detect the initial stages of cataract formation around age 50, before the patient notices changes. I monitor changes from then on, and when the patient’s eyesight cannot be corrected anymore with glasses to allow him or her to see better, I likely will recommend surgery. The procedure is performed by an eye surgeon by breaking up the lens with ultrasound or via a small incision. A plastic lens is inserted, and this new lens becomes a permanent part of the eye.

Does cataract surgery hurt?

Cataract surgery is usually an efficient and painless procedure. Patients can expect to be put in a “twilight state,” rather than given general anesthesia, so they won’t feel or remember the procedure.
Patients react differently to surgery, but most adapt to their new lenses after a few days. It is not unusual for tissue to grow around the new lens. This “after-cataract” will need to be corrected with a laser.

Can I live with cataracts?

Until surgery becomes necessary, patients can live more comfortably with cataracts by adjusting their indoor lighting. Look for lightbulbs that are closest to 6,500 Kelvin; the nearest I’ve seen at Lowe’s and Home Depot are LED 5000 bulbs. The whiter light produced by these bulbs passes more readily through cataracts.

We sell products at Insight Eyecare to help patients magnify their reading material and tasks, and make the space around them brighter. Daylight Company offers a range of products, including a portable magnifier with an LED light and flexible arm.

Many people push off how cataracts are affecting their vision because they don’t want to acknowledge signs of aging. But comfort, safety, and quality of life depend on restoring sharp vision through surgery.

Dr. Jeff Pinkerton
iCare for you.

Floaters form when the gel that fills the eye (called the vitreous) loses firmness and begins to separate from the back wall of the eye. You may know that a substance in your skin called collagen breaks down as you age. Floaters are caused by the same process in your eye — and in fact, the jelly-like substance swishing around your eye also contains collagen. Sometimes, the gel tugging on the retina as it separates can cause flashes.

Floaters are more common if you are:

• Nearsighted
• Have had cataract or other eye surgery
• Have had eye inflammation or an injury

Most of the time, floaters are just a nuisance, not a medical emergency. Surgery is rarely necessary, although if a patient experiences bleeding or hemorrhaging, or if floaters are numerous enough to affect vision, a vitrectomy, or removal of the vitreous, may be required. Another complication from the development of floaters could be a retinal detachment, which severely affects vision and requires immediate surgery. Watch out for sudden vision loss, like a curtain or veil coming down into your field of vision, or for floaters that dramatically increase, resembling a swarm of gnats.

If you start seeing floaters or flashers that persist over 30 minutes, call for an appointment right away.

Dr. Jeff Pinkerton
iCare for you.

Many videogames can help with hand-eye coordination, but there are so many downsides to excessive screen time that none are included on the list.

If you’re buying your child’s first bike for Christmas, consider one of the newer “balance bikes” instead of a tricycle or a two-wheeler with training wheels. These bikes have no pedals or chain, and are designed to teach children to balance and steer first. To function properly, a balance bicycle must allow the rider to sit comfortably on the seat, feet flat on the ground. The rider first “walks” the bike and eventually learns to cruise with both feet up while balancing on the two wheels.

Building toys like Lego sets, wooden blocks, and model cars and airplanes help with fine motor skills and hand-eye coordination.

Crafts like sand art and beading, and art and school supplies like coloring books, finger paints, a chalkboard or easel, modeling clay, and Spirograph (spiral art) also help develop motor skills and hand-eye coordination. Diggin’ Rigs by Play-Doh lets kids make a construction zone and construction materials (bricks, etc.) so they can build things.

Kids can sharpen their space perception with classic games like Operation and Jenga, and with sports and recreation equipment (balls, Nerf toys, Velcro darts, ping pong).

Old-school games and activities like Battleship, Perfection, Memory, checkers, card games and jigsaw puzzles help with visual memory and pattern recognition.

Jump ropes, Twister, Slip’N Slide, trampolines, inline skates, skateboards and all sorts of other things that kids like to play and ride on help them gain confidence and develop balance and coordination. And as I’ve said before, it’s important to get kids moving.

A healthy start in life is a gift that keeps on giving.

Dr. Jeff Pinkerton
iCare for you.

It’s appropriate, then, that November is American Diabetes Month. This month, the American Diabetes Association has sought to raise awareness of the disease. One of the risks of diabetes is retinal damage caused by excessive pressure in the blood vessels of the eye, a disease called diabetic retinopathy. It is the leading cause of blindness in adults in the United States.

At its onset, diabetic retinopathy often is asymptomatic, and it’s not until the blood vessels in the retina actually begin to leak that patients notice vision problems. Therefore, it is crucial to see your optometrist each year for a comprehensive eye exam if you have diabetes.

Patients with diabetes can also develop other eye diseases, such as cataracts, glaucoma, retinal detachment, and blurred vision. Early detection of diabetes-related eye problems, via a dilated eye exam, could be the key to preventing vision loss or even blindness. While your eyes are dilated, I can examine and create a detailed, photographic record of the blood vessels in your eye, checking for swelling or signs of damage over time.

In addition to getting a comprehensive dilated eye examination at least once a year, it is recommended that people with diabetes make the following New Year’s resolutions:

• Control your blood sugar, as high blood sugar affects the shape of the eye’s lens resulting in temporarily blurred vision. High blood sugar can also damage the blood vessels in the eye.
• Maintain healthy blood pressure and cholesterol levels. Keeping both under control helps your eyes and overall health.

• Quit smoking. Smoking increases the risk for a whole host of eye problems.

• Start exercising. Generally, what’s good for the heart is good for the eyes. And regular exercise helps control diabetes.

For more information on the relation between diabetes and your vision and eye health, visit the American Diabetes Association’s Living With Diabetes page.

Dr. Jeff Pinkerton
iCare for you.

Following a fifteen-year study exploring the effects of lifestyle on vision, researchers concluded in 2006 that adults with an active lifestyle were 70 percent less likely to develop age-related macular degeneration (AMD), a degenerative eye disease, than those who were more sedentary.

More recently, in 2010, the online edition of the Archives of Ophthalmology reported that women with healthy diets who regularly exercise and do not smoke are two-thirds less likely to develop AMD.

AMD is the leading cause of severe vision loss in people over 60 and results when the light-sensitive cells in the back of the eye, an area called the macula, stop working.

Exercise, along with nutritious foods and adequate sleep, keeps our physical machine — eyes included — in top shape.

No matter your preferred exercise, make sure you consider eye safety and comfort. Certain youth and competitive sports may require special safety gear, but for the average adult, the sun is perhaps the biggest concern. Any time you are outdoors for a period of time (golfing, biking, hiking, etc.), wear sunglasses to protect your eyes from harmful UV rays. Brands like Oakley and Maui Jim — available at Insight Eyecare’s Kilgore and White Oak locations, with no sales tax —offer snug-fit, lightweight sunglasses to meet the needs of hardcore athletes and occasional exercisers alike.

Dr. Jeff Pinkerton
iCare for you.

Stories like Amanda’s show how critical it is that we teach children how to prevent and respond to bullying. A great place to start is www.stopbullying.gov.

People of a certain age tend to think of bullying as physical abuse and taunting. But technology has given rise to “cyber bullying,” or using cell phones and social media to spread pictures, rumors and hurtful comments about others.

Educators also recognize social or relational bullying, including spreading rumors and purposely excluding someone from a group or event.

How to Recognize Bullying

Bullying is easy to recognize when you catch the aggressor in the act, but most of the time you won’t witness the actual abuse. It is important to watch for changes in a child’s behavior that may indicate he or she is being bullied. Look for changes in mood such as depression or rage. Sometimes, the emotional distress can cause physical symptoms such as headaches. As was the case with Amanda Todd, victims of bullying may intentionally cut or otherwise harm themselves. Loss of friends or change of social crowd might also be signs of bullying.

What to Do if You Witness or Suspect Bullying

Stop bullying on the spot if you witness it. The Respond to Bullying section on www.stopbullying.gov tells you how to safely and decisively intervene, get to the bottom of what’s happening, and support the kids involved.

If a child is being bullied at school, enlist the help of teachers, the school counselor and the principal.

Above all, always set a positive example. Treat people with dignity and respect, and make it clear to kids you expect them to do the same.

The following web pages provide additional information on preventing and responding to bullying:

http://www.stompoutbullying.org/

http://www.nctsn.org/resources/public-awareness/bullying-prevention-awareness-month

http://www.pacer.org/bullying/nbpm/

Dr. Jeff Pinkerton
iCare for you.

When blood pushes against artery walls in the eye, the very small and delicate blood vessels can be damaged. HBP can cause bleeding in the eye, fluid buildup under the retina or a blood flow blockage to the optic nerve. These conditions may lead to blurred or distorted vision, or even a complete loss of vision. If you have both diabetes and high blood pressure, you’re at an even greater risk.

If you needed one more reason to remember to schedule a thorough exam with your optometrist, this is it: Many people have HBP but don’t know it. Our equipment at Insight Eyecare enables me to look at the network of tiny capillaries on the retina to evaluate the condition of the blood vessels in the eyes. My examination might lead to your first diagnosis of hypertension.

The effects of HBP are cumulative, so the longer it goes untreated, the higher the likelihood of permanent damage.

But you don’t have to wait for your next appointment to get a handle on your blood pressure. Most pharmacies have machines that will give you an idea of your blood pressure numbers. The systolic, or top, number measures the pressure in the arteries when the heart beats. The diastolic, or bottom, number measures the pressure in the arteries between heartbeats (when the heart is resting and refilling with blood).

• Normal: top number under 120, bottom under 80
• Prehypertension: top 120-139, bottom 80-90
• Stage 1 hypertension: top 140-159, bottom 90-99
• Stage 2 hypertension: top 160+, bottom 100+
• Hypertensive crisis (emergency care needed!): top 180+, bottom 110+

If your blood pressure climbs above normal, talk to your physician. HBP can be managed with prescription medication and lifestyle changes.

Dr. Jeff Pinkerton
iCare for you.

According to the National Sleep Foundation, newborns, infants, toddlers, preschoolers, and school-aged children all need different amounts of sleep as they grow. But these are guidelines – each child’s sleep needs and napping patterns can vary considerably.

What is the same for every child is the need for healthy sleep, defined as:

• A sufficient amount of sleep
• Quality uninterrupted sleep that allows your child to move through necessary stages of sleep (REM sleep solidifies the previous day’s events into memories, and sequences of learned skills, like playing sports or an instrument, become muscle memories)
• The proper number of age-appropriate naps
• A sleep schedule that is in sync with the child’s natural biological rhythms

To help ensure your child gets healthy sleep:

• She shouldn’t eat, drink or exercise close to bedtime.
• Turn off the TV, computer, and smartphone an hour before bedtime.
• He should get in the habit of doing the same things every night before bedtime to signal his body that it’s time for bed. A shower or bath works for some (and leaves extra time in the morning), while reading or journaling works for others.
• Advise older kids to keep a to-do list on the nightstand. Jotting down notes helps put the mind at ease so your busy scholar will be less likely to stay awake worrying or stressing.

As with adults, children and teens sleep best in a cool, dark, quiet room. Recent research has even shown that using a night light or television close to bedtime can disrupt circadian rhythms and trigger mood disorders.

Encouraging healthy sleep not only positively affects neurological development but can also help prevent many problems later in life. Poor or inadequate sleep can lead to mood swings, behavioral issues such as hyperactivity, and cognitive difficulties that affect a child’s ability to learn in school.

Don’t give in to your child’s insistence that she isn’t tired. Try an earlier bedtime – just 15 to 20 minutes may do the trick. After a few nights, your well-rested child will likely be easier to put to bed.

Dr. Jeff Pinkerton
iCare for you.