Archive for the ‘Eye Problems’ Category

Correcting for an astigmatism puts it all in fine focus!

Most people understand that nearsightedness means things near to you are clear, things far away from you are  blurry. And on the flip side, farsightedness means that things far away from you are clear while things closest to you are blurry. Got that? If not, let’s simplify it.

Nearsight= near objects clearest, far away ones are blurry

Farsight= far away objects clearest, near objects blurry

Now if I really want to confuse you, I’ll talk about Presbyopia which is what happens to all of us around age 40. That is when our eyes lose their ability to “auto-focus” things near to us to make them clear. You see, there is a crystalline lens behind your iris that changes its shape to autofocus things for near or far, much like the autofocus lens of a camera. As we get older, the lens can’t as easily change its shape anymore and things up close start to feel fuzzy, we can’t get them into focus (like the newspaper, small print on a pill bottle, a menu in a dimly lit restaurant.) It is then that we require a reading prescription to be able to get those objects close to us clear once again.

Presbyopia= the need for a reading prescription after age 40 due to the crystalline lens inside the eye losing its ability to autofocus.

Sometimes people who are nearsighted don’t feel the burden of presbyopia so much at first because they see ‘near objects clearest’ naturally. All they have to do is take off their glasses or peek beneath the frame and the natural focal point of their eyes happens to be at the perfect distance for reading. They can see clear and read very comfortably like this for long periods of time without glasses. It’s ok to use your natural nearsight to read, it won’t harm your eyes, but it may become cumbersome to put the glasses on and off all day long and there may come a point where doing this just doesn’t work for you as well as it did in the beginning. But maybe we can get into that in another article.

What I really wanted to talk to you about today is astigmatisms. An astigmatism has to do with the curvature of the front of the eye, the cornea. If the cornea is not shaped like a perfect sphere, if it is, let’s say, a little more pointed than it is round like the tip of a football, then your view through that imperfectly shaped cornea is distorted and vision will be blurry at ALL distances, (near, far, intermediate and everything in between). The cornea is a clear tissue, you can think of it as the ‘windshield of the eye.’ Notice how your windshield has a certain even curve to it? Now imagine the windshield was distorted, maybe even coming to a point in the middle, it would distort your view through it and everything you saw through it would appear a bit warped and a little blurry. That is what an astigmatism is!

Having an astigmatism is sort of like having a warped windshield, your view through it is distorted at all distances.

Astigmatism= blur at all distances due to imperfectly shaped cornea

You can have an astigmatism by itself in your prescription or it can be accompanied by nearsight or farsight and/or presbyopia. Your eye doctor can tell you precisely which type/types of these ‘refractive errors’ you have during your eye exam. Some people don’t have any refractive error, their eyes see perfect 20/20 vision naturally, we call them ’emmetropes.’

Emmetrope= no refractive error (no astigmatism, nearsight, farsight present), no glasses needed

But back to astigmatisms and our example of the car windshield. This type of visual distortion causes blur. We correct for this distortion or blur in your new glasses and that requires us putting a corrective lens in your glasses that counterbalances the distortion caused by your own cornea. This can sometimes take some getting used to because essentially what the new glasses are doing is taking the picture of the world that you usually see and stretching it in a different way. Glasses that correct for an astigmatism can sometimes feel a little strange when you first try them on, the floor may look curved, the walls may look bowed, you may feel like you are walking around in a fish bowl for the first few days until your eyes and your brain get used to the new way the world is being stretched. Most people adapt to most changes in astigmatism in their glasses within about a week and then they benefit from the extra clarity without experiencing that funny feeling anymore.

It is also possible to correct for an astigmatism with contact lenses, these special contact lenses are often referred to as toric contact lenses. They are a little more complicated to fit than regular spherical contact lenses (the kind that correct for nearsight or farsight) because they have to be lined up at a precise angle and maintain that precise alignment even when you blink or move your eyes a lot in order for you to see clear at all times. It’s common for them to move a little, or come out of a focus maybe a couple of times throughout the day but the majority of the time we want the lenses stable with no rotation and that will ensure the best clarity.

So, see? There is no stigma involved with having an astigmatism (sorry, I had to). Many people have an astigmatism, it is very common for the front of the eye not to be shaped like a mathematically perfect circle. See your eye doctor for an eye exam and get an up-to-date prescription. If you are prescribed glasses that correct for an astigmatism or if you have a change in your astigmatism prescription, the new glasses may take a little getting used to but once you do, you just might be amazed to see what you have been missing!


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My Studies in Visual Development

My passion for Vision began with research.


When I was an undergraduate at SUNY Albany, I remember late nights and early mornings spent happily peering into a microscope. I was fortunate enough to work in the incredible laboratory of Dr. Suzannah Bliss Tieman, who studied neural visual development. Her enthusiasm for her work was infectious and it ignited my then small curiosity in vision into a lifelong passion for learning all I could on the subject.

Under her direction, I examined cross sections of the brain and measured angiogenesis, or blood vessel growth. Using a special computer aided drawing program that was superimposed with the image I was seeing in the oculars of my microscope, I could trace the length of the blood vessels in that slice of brain tissue and calculate their length. I was measuring blood vessels in the specific area of the brain that interprets vision. We were proving that when an eye was deprived of all visual information during its critical period of development, the neural connections in that ‘vision center’ of the brain would also be decreased and underdeveloped. If this part of the brain is underdeveloped, then you may not see as clearly or at as high a resolution as the average person can. You can think of it as the brain not enabling your eyes to see the world with the proper number of “pixels.”

Definition of Amblyopia




A decrease in the best corrected vision, usually in one eye, due to a “disturbance in retinal image formation” (source 1) during the critical period or during the “first ten years of human life.”

The formation of Amblyopia

When your brain and your eyes are first developing, neural connections are formed. These connections will help our brain to interpret what our eyes are seeing as well as the level of detail that they can see. If something reduces the amount of information that the eyes can take in (for example if the eye is aimed off center from where it should be looking), it lessens how much the brain can interpret and decreases the overall number of neural connections in the brain. When the visual areas of the brain are not utilized to their potential, the overall output of the brain is diminished. In other words, if something stops you from seeing great detail when your brain and your eyes are going through their critical period of development, the neural connections that you need in order to achieve good, clear vision may be reduced permanently.* You may not end up seeing 20/20 vision. The good news is, there are, of course, exceptions.

The brain has high plasticity, its “wiring” can be changed, particularly when you are young.*If you ‘exercise’ the eye as directed by your eye doctor, you can strengthen these connections and improve the resolution of your vision. Most doctors say these connections have the best opportunity to be strengthened before about eight years of age. However, there is a chance to improve your best potential vision and re-wire the brain even into your adult years but it would require more time and more intensive therapies.


Causes and Treatments

There are different causes for amblyopia, some examples are listed below:

  • strabismus (an eye turn)
  • when one eye has a large amount of uncorrected refractive error (nearsight, farsight or astigmatism) compared to the other eye (blurred input from one eye).
  • a medical condition such as a cataract (blocked/blurred input from one eye)

Treatments for amblyopia include eliminating the cause of the amblyopia and also, strengthening the weaker of the two eyes. Strenghtening the amblyopic eye can be achieved by blocking the sight in the good eye through patching the good eye for a period of time each day or by giving eyedrops such as atropine that temporarily blur only the good eye. This essentially forces the amblyopic eye to seek more visual information, to really pay attention to what it is looking at so it can re-wire and add some new neural connections to the visual area of the brain, making your best potential vision better!

Concluding Thoughts

The brain is an amazing structure. The way it directs and choreographs our body and its development, is even more amazing. To learn more about amblyopia you can click here, and don’t forget to visit your eye doctor. They are happy to answer all of your questions.

Epicanthal folds of an infant or a turned eye, let your eye doctor make the call!


If you are a parent, consider bringing your baby into a participating INFANT SEE doctor and receive a eye exam within their first year of life at no charge. Also, any time you are suspicious of problem with your child’s vision or eyes including a possible eye turn or if one or both eyes are not seeing as well as you think they should, bring your child to the eye doctor immediately. As a mother and a doctor I would advise you to, it is always a good thing to have your suspicions checked out. Keep in mind that the younger a patient is when diagnosed with amblyopia, the faster treatment can start and the better their vision will be for life! When in doubt, get it checked out!

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headacheI started off wanting to write a simple article on headaches, and now I have one, a headache that is. All joking aside, the topic of headaches is very complex because there are so many different types, causes and treatments for headaches. There are many different reasons you may be experiencing aches and pains in the head or even in and around the eyes. If you are experiencing frequent headaches, a complete eye examination in addition to a full and thorough evaluation with your family doctor is helpful in accurately diagnosing the problem. Once you know the cause, you are that much closer to relief. Even if the problem turns out to be unrelated to your eyes or vision, you have one more thing that you can check off your list of possible reasons for your headaches and that “rule-out” can prove to be very valuable.

“An eye examination is an important part of the headache evaluation.” (Source 1) Patients often come to me complaining of headaches, in or around the eyes. They, along with their family doctor, are trying to determine the source of their headache pain in order to properly diagnose any medical conditions that may be causing the problem. Sometimes headaches can be caused by “eye strain.” Eye strain is sort of a catch-all phrase which can mean there are problems with the eyes’ ability to focus when reading (accomodation), to accurately aim at the object of regard (alignment), to work together as a team giving depth perception/3-D vision (binocularity) or to see things clearly (refractive error, corrected for by prescription glasses). These are some of the things that your eye doctor will check for and help you correct. 

However, there are other more health-threatening factors that can induce eye pain and aches in or around the eyes therefore it is crucial to have extensive tests done in order to promptly determine the true source of the pain. There are things that can be going wrong with the health of the eyes or other parts of the body.  Your eye doctor will check your vision, as well as the health of the eyes usually through a dilated eye exam and may also suggest a peripheral vision or visual field test. Make sure they proactively communicate their results with your general physician and also suggest additional tests if indicated in order to contribute to your complete and thorough quality of care.

One of the most common topics under the category of headaches that I find myself explaining to patients is the mechanism of an ocular migraine. An ocular migraine (ophthalmic migraine) is an episode of “temporary vision loss or distortion in one eye, usually accompanied or followed by a headache.” (source 2) It is due to a tightening of the blood vessels in the head causing a restriction of blood (and oxygen) to areas of the brain. When the occipital lobe (part of the brain which processes vision) does not get enough oxygen it can cause visual symptoms and side effects, some of which are listed below. The re-dilation of these blood vessels about 20 minutes later is thought to be the cause of the actual pain involved with a person’s migraine.

Some of the visual symptoms you may experience during an ocular migraine are:

  • flashing lights/sparks in your vision which may radiate outwards over time
  • shimmering zebra stripes/zig zags of light 
  • temporary blurring of vision or “missing pieces”, black spots in your vision

(source 3)

These symptoms can last anywhere from about 5 to 20 minutes and may or may not be followed by an intensely painful migraine headache. Vision should return back to normal shortly after, it it does not, seek medical help immediately. Sometimes your doctor will have you keep a simple journal which will chronicle details about the headaches when they happen as well as the activities you did that day and food you consumed.  Migraines usually begin in the morning or some time during the day (it is interesting to note that many eye strain issues occur towards the end of the day or after long periods of reading, computer use, etc). If it is determined by your doctor that you are experiencing migraines it is good to know the triggers of  migraines so that you will be able to avoid them whenever possible.

Some triggers for migraines are:wine

  • stress
  • hormonal changes (as well as use of oral contraceptives)
  • alcohol consumption (red wine being a common trigger)
  • cheese
  • chocolate
  • meats preserved in nitrates
  • monosodium glutamate (MSG)
  • light (intense sunlight)
  • smoking

(source 3)

Talk to your doctors, they will work with you to find the source of your pain and to make sure it is not a serious and urgent health problem. Relief will be its way, so don’t delay. Get it checked out today!

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Photo by C. Murphy

Photo by C. Murphy

Although it’s cold outside, spring is hiding right around the corner and will be here before you know it! With that warm weather comes flowers, robins and itchy, watery, red eyes, well at least for some of us. Those who suffer from Seasonal Allergic Conjunctivitis (SAC) know exactly what I am talking about. Seasonal Allergic Conjunctivitis (SAC) is triggered by an outdoor environmental allergen such as grass, pollen and/or weeds.

Your body mounts an immune response against this irritant, the side effects of this mounted attack are manifested in those bothersome symptoms of:

  • itching
  • redness
  • tearing
  • blurred vision
  • excess mucous production

If you suffer from these symptoms, your eye doctor will be able to provide relief! Once the allergen causing your discomfort is identified the best possible thing to do is to avoid coming into contact with that irritant. Since Seasonal Allergic Conjunctivitis is produced by the changing of the seasons (spring causing tree pollen, summer causing grass pollen and fall causing weed pollen), it is near impossible to avoid SAC. Who could stay indoors until winter and miss out on all the fun that warmer weather can bring?! To cope, a prescription medication for allergies may be given by your general doctor if you have problems with your sinuses and nose as well as your eyes. For the people who only experience the eye symptoms or for those who take the prescription oral medications and need a little something extra for the eyes, there are plenty of eye drop medications that are available. Some eye allergy drops require a prescription while others are available over-the-counter. Your doctor will pick one specific to your individual needs!

Talk to your eye doctor about the symptoms you are experiencing. They will examine the inner lining of your eyelids, your tear film layer (the layer of tears that coat our eyes to keep them moist at all times) and conjunctiva or sclera (the white part of the eye) to determine the severity of your eye allergies. That exam paired with a thorough investigative medical history will allow them to choose the specific method of treatment which will yield maximum relief.

Besides SAC, there is another type of allergic conjunctivitis called Perennial Allergic Conjunctivitis. With PAC, you are allergic to indoor irritants instead of outdoor irritants which is the reason for the classification of PAC lasting all year long and not just one season. Dust, insects and pet dander are examples of indoor environmental allergens.

Here are some Ways you can try to Reduce your exposure to Allergens:

  • Reduce the allergen load by minimizing places where allergens collect (keep knickknacks, unneccessary pillows, draperies and linens to a minimum).
  • Minimize carpeting; dust mites collect there.
  • Clean surfaces frequently and thoroughly including the regular washing of linens to remove dust and mold.
  • Eliminate water leaks and standing water where mold tends to grow.
  • Use mattress and pillow allergen covers.
  • Use allergen filters in your air conditioners and furnaces and clean them regularly.
  • Keep outdoor allergens outdoors by keeping windows and doors shut.
  • Avoid pet dander and clean up pet hair and areas regularly.

In addition to medication and avoiding the triggers of allergies, some patients also find comfort in placing cool compresses on their closed eyes, using artificial tears which can help flush stagnant allergens out of the eyes, and drinking more water.

Photo by C. Murphy; Old Westbury Gardens

Photo by C. Murphy; Old Westbury Gardens

See your eye doctor today so that when “Spring has Sprung” you will be ready to take a deep breath and enjoy the fresh air.


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I have so many patients eager to tell me how their eyes feel tired, dry, and sometimes water so much that tears form and fall down their cheek. Sound familiar? Dry Eye Syndrome is a real problem for many people across the board. It affects each person differently. Some people feel burning and dryness almost every waking minute of the day, while others’ eyes only feel dry when they use a computer, watch tv, drive or wear their contacts. Since there are many forms of dry eye, there are many causes and with that, different treatment options that need to be ‘tailor-made’ to complement the specific needs of each individual.

Here are some Symptoms of Dryness:

  • dry, stinging or burning feeling (can be exacerbated by certain activities such as computer use, driving, reading, dry forced air in the enviroment, etc.)
  • watery eyes (this may seem counter-intuitive but, making your eyes water is actual a biofeedback response to your eyes being dry, the only trouble is your lacrimal (or tear) gland is like a faucet and once it turns on it is not great at knowing when to stop the flow of those ‘extra’ tears).
  • temporarily blurred vision (which may improve upon blinking)
  • redness

Treatment options for Dry Eyes can vary anywhere from the use of artifical tears, gels and ointments, to nutrional supplements, punctal plugs, even prescription eye drops. There are also different behavioral modification treatments such as avoiding the triggers or irritants that cause dryness, drinking more water and eating a diet rich in omega 3 fatty acids, fish oil, flaxseed oil and vitamin E, taking frequent breaks from the computer, reading and tv watching, and even practicing better blinking patterns to ensure that your upper and lower eye lids are completely closing when you blink.

Seem complicated? It can be! That is why it is necessary to have an optometrist perform various testing on your eyes to measure the quantity and quality of your tears. Through specific diagnostic testing used to pinpoint the cause of your specific form of dry eye, they can then recommend a treatment technique tailored to meet your needs. The doctor will measure your tear production, evaporation and quality. They will ask you a detailed medical history.  Certain medications that you are taking and systemic conditions that you may have (or not realize you have) can exacerbate dryness of the eyes. If you wear contact lenses, it may be as simple as being fit with another brand of lenses made of a different lens material to bring your comfort level back up to par.

Noone should have to suffer from Dry Eyes. It affects your quality of life. See your eye care professional today and take back the comfort your eyes deserve!

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Many people tell me that their eyes feel tired at the end of the day and they feel fatigued when they use a computer for a prolonged period of time. They often state their computer “hurts their eyes” but there is nothing they can do about it because they have to use a computer while at work. Not true!

There is such a condition called Computer Vision Syndrome which basically is an umbrella diagnosis that covers many eye and vision-related problems associated with using a computer for many hours a day, many days a week. But there is something you can do about it! Let’s talk a little about what causes computer-related eye strain and visual discomfort first, then we will go over some simple tricks you can use every day (coupled with yearly eye exams) to help prevent that “eye strain and pain caused by a computer.”

Some symptoms of computer-related vision problems can be:

  • headaches
  • dry eyes
  • blurred vision
  • watery eyes
  • eyes burning or stinging
  • problems focusing

When viewing a computer screen, our eyes do “work harder.” Here’s why:

 Looking at a computer is different than looking at a book or words printed on paper. The contrast of the letters to the background can be reduced on a computer screen due to a certain program or webpage’s design for example, and there can also be reflections and glare present on the screen which do not exist on paper. Also, viewing distances and angles can be different when comparing reading documents on paper to that on a computer screen. As a result, your eye focusing and eye movement requirements may take on more than they usually have to.  Also, eyeglasses or contacts designed for general use may not be suitable for computer use. Lenses designed for intermediate viewing distances (which means the distance from your eyes to your computer screen) can be tailored to fit your computer viewing needs.

One can get overwhelmed at all of the ways your computer can contribute to that tired, eye-strain feeling. But don’t fret. There are simple ways to help!

Let’s start with Ergonomics and see what the proper distances and viewing angles of your computer should be set up at in order to help your body and eyes feel relaxed.


“Be Kind to Your Eyes” Computer Set-Up:

  1. Location and Angle of Computer Screen– Most people feel it most comfortable when their screen is 20- 28 inches from their eyes and when they are looking slightly downward at the screen so position your screen so that the center of the screen is about 4 inches below your eye level and the screen is tilted slightly upward by about 10-15 degrees.
  2. Reference Materials– if you are continually referring to a book or document while typing on the computer screen the best thing to do is to have this document held above the keyboard but below the monitor by a document holder that can sometimes attach right to the side of your computer screen. This will help your posture because you will not have to continually move your head or twist your body to look from the document to the screen and back.
  3. Lighthing– Windows and overhead lights can cause glare, try to position your computer screen at a place in your office to minimize this reflection if possible. Use blinds or drapes on windows and use lower watt bulbs on desk lamps that may be reflecting on the screen. If there is no way to avoid certain sources of glare, a glare filter may be available for your screen to help filter out the unwanted reflections. An anti-glare or anti-reflective coating on your eyeglass lenses can also reduce these troublesome reflections. Also, don’t forget to clean your screen so that it is free of fingerprints, dust and debri.
  4. Take Breaks! It is essential when using a computer for prolonged periods of time to take breaks. We have a rule that we nicknamed the “20/20” rule and it is as follows: “Every 20 minutes, take 20 seconds to look at something 20 feet away from you.” This gives your eyes a chance to relax their focusing efforts from looking at something up close for so long and it also gives your eyes a chance to blink. Blinking rates when using a computer are dramatically reduced, I guess you could say we sort of stare at the screen. When you don’t blink, the tears that naturally coat the surface of your eyes at all times have a chance to evaporate away and your eyes in turn, get dry which can lead to that tired feeling as well as redness, burning and tearing. So, take a half a minute, three times an hour to stretch, look out of the window or down the hallway and daydream. You will come back to your work refreshed and relaxed and so will your eyes!

Technology is grand and so is free software! There is actually a free simple-to-use program for your computer out there called “Eyes Relax 0.74” that you can put on your toolbar and it pleasantly reminds you that it is time for a break. You can customize it to your preferences to schedule your breaks and reminders. Did I mention it’s free and is tested by cnet to be spyware free? Download it here.


By incorporating these simple tricks into your work station, you can do your eyes a world of good. And remember, get yearly eye exams to test your eyes to make sure you have the most accurate prescription possible and that your prescription is tailored to all of your visual needs.

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