What happens during a routine eye exam?
When you come in for your eye exam at one of our offices, our eyecare provider or optometrists always ask about your general health history and any specific eye concerns that you have. Following that, our specialists will perform a thorough eye exam, which is painless and swift. They check your vision through a visual acuity test in the exam room, where you will have to read letters out loud from the visual chart at a distance. You will also have your vision tested for near vision through a series of printed cards.

After that, you will receive eye drops from the doctor to numb your eyes. By doing so, the doctors will be able to test your eye pressure without discomfort. Other eye drops will dilate your pupils, allowing the doctors to see the inner portion of your eye. Depending on the information obtained about the condition of your eyes during the exam, you may receive additional testing or care recommendations to pursue.

What happens during a comprehensive eye exam?
In addition to the visual acuity test, additional tests like the evaluations of side vision, movement of the eyes, and the ability to track a moving object will be performed in a comprehensive eye exam. A device known as the Phoropter helps determine the proper prescription if you need glasses or contact lenses. Another common eye test known as Tonometry, is used to measure the pressure in your eyes. Eye drops will be administered to numb your eyes, which will make this part of the exam more comfortable.

The magnification and illumination provided by the slit lamp will allow your doctor to see the front portion of your eyes and check for irregularities in your cornea, lens, iris or the eyelid. Your doctor will use dilating drops to widen your pupil and enabling access to see your retina and the nerve You might be sensitive to light right after this portion of the exam, but after a a few hours, your eyes will adjust and are no longer sensitive to light.


What is refraction assessment and why is it important?
Refraction assessment is a test performed to measure the strength of your eyeglass lens prescription and it is performed using a device called a Phoropter. The phoropter is a large device that looks like a mask and is positioned in front of your face. The doctor will adjust the device to sit at your eye level during the testing process. During this procedure, our eyecare providers and optometrists typically use the phoropter to check the refraction in your vision by testing under several different lens. You respond to each option to pick the best lens that gives you the sharpest and the most precise visuals.

How is retinal examination accomplished?
A retinal examination is an extremely powerful diagnostic tool that can help with early intervention and treatment of several severe eye disorders and detect abnormalities in blood vessels and the optic disk. Our eyecare providers at Johnson Eyecare can examine the rear portion of your eye by administering special eye drops to dilate your pupils a bit wider, allowing more light to enter your eyes. Other devices like the ophthalmoscope may be used to direct a light beam into your eye to illuminate the rear portion. Another option is to combine a condensing lens and bright light to examine the inner structures of your eyes, like the retina and the optic nerve. This process can be completed in both the sitting up or reclining position.

What are common eye diseases or conditions?
If your eye doctor at Johnson Eyecare observes any signs of degenerative conditions or eye disease, additional testing may be required to investigate further. The doctor also charts the results of your exam, which allows them to easily track any changes over time.
Common eye problems and diseases include the following:

• Cataracts
• Refractive errors
• Retinal disorders
• Optic nerve disorders
• Macular degeneration
• Conjunctivitis
• Diabetic eye conditions

How often should I get a routine eye exam?
A variety of factors can contribute to eye health and need to be considered and monitored by your doctors during exams. These factors include but are not limited to age, pre-existing health conditions, genetics, and the use of certain medications. Depending on which factors you are or are not facing as a patient, you may need to visit an eyecare provider more often than another patient would. This chart covers a basic recommended eye care and exam schedule for the average patient, based on patient age. We advise that you use this as a general guideline for making appointments, but that you always follow your doctor’s advice first when determining when to schedule your next regular exam.

What is the definition of an “At-Risk” Patient?
There are a number of reasons your doctor may classify you as an “at-risk patient” who requires more frequent eye testing and evaluations than the average patient.

Infants, toddlers and young children are often considered at risk of developing a visual impairment if they:

• Are born prematurely or suffer from other premature birth-related symptoms, such as a low birth weight or low oxygen levels
• Have a family history of certain eye conditions or genetic diseases
• Could have been exposed to certain infections or diseases while in-womb
• Were delivered through a difficult or assisted labor
• Have or had crossed or turned eyes at or since their birth
• Are suffering from a central nervous system issue
• Have already been diagnosed with an oddly shaped eye, retinal damage, or other problems within the eye or with properly seeing objects.

Adults, on the other hand, are more often considered to be at risk if they:

• Suffer from diabetes or hypertension
• Have a history of eye diseases
• Work in visually demanding workplaces, as well as in workplaces that are potentially hazardous to our eyes
• Take certain medications with side effects that affect the eye
• Wear contact lenses or undergo eye surgery

Ultimately, you as a patient are likely to have personalized eye health needs that need attending to; if this is the case, these basic eye care guidelines may not be the right fit for you. If you are at all unsure about how often you should be seeing your eyecare provider, we recommend scheduling an appointment to determine how frequently your eyes should be examined based on your family and medical history, as well as your individual needs as a patient.

How do I prepare for my routine eye exam?
You’ve made your appointment for your annual eye exam - now what? After you’ve saved the date in your phone or planner, we advise that all of our patients make a secondary note about preparing for their visit. We do this because we know from experience that patients who prepare for their eye exam are more likely to have a simple, straightforward visit, and a better experience at their eyecare providers or optometrist office overall.

Preparing for an eye exam is a fairly easy process. Patients just need to remember to bring several key items and pieces of information for their - and their doctor’s - benefit:

Your vision and health insurance information: Insurance information is a must at any doctor’s appointment. It’s particularly important, however, to remember to bring your vision insurance information in addition to your health insurance information - depending on the type of exam you’re undergoing and the reason for your visit, your regular health insurance may not cover your visit.

Your current glasses or contacts (if applicable): Whether you wear these items full-time or only during certain activities, it’s important to bring any vision aids you wear to your appointment. Doing so will help eye doctors confirm whether or not the prescription in these aids is giving you the best vision possible. Your doctor may also want to confirm that your contacts, if you wear them, still properly fit. If they don’t, your doctor will want to carry out a new fitting to make sure your contacts are less likely to irritate or injure your eyes.

New information about your eyes and eyesight: If you’ve experienced any changes in your vision since your last appointment, you’ll need to bring these changes up to your doctor so they can look into the matter. While some changes may indicate an ordinary change in vision, others may be symptoms of more serious developing eye problems.
New information about your health: Think that your eyecare provider / optometrist only wants to hear about your eyes? Think again. In addition to examining your eye, your eye doctor is responsible for making sure your overall health isn’t affecting your vision. To help them do this, patients are encouraged to bring:
list of any medications you’re taking (not just prescription), as certain medications can affect our vision and eyes
Updates on any new health issues that have developed, as well as any recent injuries, operations, or illnesses you’ve experienced lately
Any new information you may have about your family’s history of eye problems, such as cases of glaucoma or cataracts in close relatives
Sunglasses and maybe a driving buddy: Eye dilation is a basic component of most eye exams. However, the eye dilation process makes our eyes much more sensitive to light, and often makes it much harder to see clearly. Because of this, it’s important that patients bring sunglasses to ensure they’ll be able to protect their eyes after an appointment. Patients who know they have particularly strong reactions to eye dilation are also advised to bring a friend or family who can drive them home after the procedure to their appointment.

There are several things all patients should bring with them to an eye exam. Up-to-date vision and medical insurance information, a method of payment, and proper identification are all must-have items.
You should also remember to bring as much background information as possible to your exam, including:

• A description of any symptoms or problems you may be experiencing with your vision.
• Information about your family’s history of eye problems, if there is any information to report.
• Notes about non-vision related health problems in the family, particularly concerning cases of heart disease or diabetes.
• A list of medications you take or allergies you suffer from; this information is critical in giving your eye doctor an idea of what sorts of problems they need to look for or address during your exam.
  
• ​ Tinted glasses, which will protect your light-sensitive eyes after they’re dilated and will help you drive home safely after your eye exam.

What should I expect during an appointment?
If you’re visiting your eye doctor for an eye exam, you should be prepared to sit through several basic tests. The following are some examples of tests we perform during a routine eye exam:

We take basic vital signs, such as your blood pressure, to check for underlying health issues that could affect your vision.
You’ll be asked to read a line of letters from a Snellen eye chart (i.e. the chart of differently sized lines of letters or numbers you often see at vision centers).
You’ll likely be asked to do simple visual acuity tests that track your ability to focus on certain objects or look in specific directions.
Your pupil will be dilated, or widened, using special drops so that our team can carry out a more thorough examination of your eye.
All of these tests are designed to reveal signs of potential vision problems or diseases within your eyes. Some additional testing may be needed if our team sees something that needs to be examined further during a routine exam. In addition to these tests, you should also be prepared to talk about any changes in your medical history that have occurred since the last time you saw your eye doctor.

What is a Cataract?
A cataract is the clouding of the internal lens in the eyes, which interferes with the ability to see clearly. In a healthy eye, this lens would be clear, allowing light to enter seamlessly, and that enables you to see clearly. When you have a cataract, the clouding of the lens makes it like seeing through a foggy window. Some common symptoms of cataracts are:

• Blurry vision
• Problems seeing at night
• Seeing halos around lights
• Double vision in one eye
• Fading colors

What are the Surgical Treatments for Cataracts?
At present, there is no way to eliminate a cataract other than surgically removing it. Cataract surgery is the most common treatment for this medical condition. Here at Johnson Eyecare, our eyecare providers specializing in cataract surgery can help you in providing personalized care on two of the most common surgical treatments for cataracts. They are:

• Phacoemulsification or Phaco: This is the most common line of treatment for cataracts, which utilizes ultrasound waves to break the cataract which is subsequently removed through a process called Aspiration.
• Extracapsular cataract extraction: This method is used to treat more advanced cataracts and it involves the removal of the cataract and the lens, and replaced by an artificial lens implant. While it takes about a month to heal completely after the procedure, these eye surgeries provide vision improvement rapidly in the first day or two after surgery.

Who is a candidate for cataract surgery?
Many people with cataracts can see quite well, and are not in need of cataract surgery. It is only when the cataract impairs vision to the extent that activities like reading or driving or if the vision is not correctable with prescription glasses, a cataract surgery may be necessary. Our team of expert eyecare professionals at Johnson Eyecare can help you determine if surgery is the right step for you.

What does traditional cataract surgery entail?
Cataract surgery is almost always an outpatient procedure performed under local anesthesia, so you are awake for the entire procedure. Techniques vary widely, but the eye is always numbed completely with an anesthetic, and you are often given a mild sedative to help you relax. The surgery is performed under a microscope to provide a magnified view of the eye. The doctor makes a small incision with a diamond blade in the eye to open up the front surface of the cataract and this allows access to the clouded tissue. The cloudy portion is then removed, leaving the thin clear back surface of the capsule in place. This can be done either with a phacoemulsifier or manually with extracapsular instruments. The clear artificial lens implant is then placed in the capsule of the natural lens, and the incision is closed.

Patients return home the day of the surgery, and are examined the next day. To accelerate the healing process and prevent infections, eye drops will be prescribed to you. You will also be given some recommendations on keeping your eyes from straining, as it affects the healing process.

What are the benefits of Cataract Surgery?
Vision almost always improves greatly within 4-6 weeks, although many patients may see better within 1-2 weeks or less. Almost everyone will need a new glasses prescription after surgery, although they may be needed only for distance or for reading depending on the power of the lens implant.

Is Premium Lens Cataract Surgery better for me?
Premium lens surgery may be considered when cataracts develop in one or both eyes, the same as normal cataract surgery. But the premium lens cataract surgery goes a step beyond "normal" cataract replacement surgery, in that it uses intraocular lenses (IOLs) that address patients' vision needs, specifically near and far vision (Multifocal Lens) and astigmatism (Toric Lens). Patients who opt for premium surgeries, however, will need to consider the cost of the procedure, as insurance companies and Medicare typically only cover standard cataract surgeries (Read More).

What are Multifocal / Toric lens implants?
There have been many advances in cataract surgery that have made the process easier and more successful. The intraocular lens or IOL technology is one such advance. Lens implants, also known as intraocular lenses (IOLs) are the lenses that replace your natural lens after cataract surgery. IOLs are now even able to correct astigmatism and give people a range of vision. That means you no longer have to choose either distance or near vision when having surgery.

There are two types of IOLs:
- Monofocal lenses: They provide clear vision at one distance only. This means that the patient has to wear glasses to supplement their vision and achieve the full range of sight.
- Multifocal premium lenses: They are FDA-approved and can be chosen specifically for patients electing to correct near, intermediate, and distance vision after cataract surgery. This gives you an increased independence from glasses as it can be personalized to your lifestyle. These premium lenses require a comprehensive ophthalmic examination to check for conditions like Astigmatism and the overall health of the retina. During your visit, our eyecare providers will discuss these lenses in detail and go over all the available options and alternatives.

How can Multifocal / Toric lenses help me with Cataract?
Most people who need cataract surgery wear glasses full time and/or the glasses do not improve their vision. Once cataract surgery is completed, many people expect to not wear glasses at all. With a traditional monofocal lens, that is not possible. Most people will still need a reading glasses, and some will need to wear glasses full time. At the time of surgery, you can chose to be more independent from glasses by correcting astigmatism, and implanting a multifocal lens. This allows you to see at a distance and up close under most lighting conditions. There will still be times when glasses would be helpful though. Not all patients are good candidates though for a multifocal lens. Please talk to us if you have interest in this type of lens. It is important to have a thorough exam to see if if this lens is right for you.

Astigmatism can also be corrected with the special toric lens. This lens counteracts the irregular shape of a cornea and brings images into focus. For example, astigmatism makes a circle look like an oval by elongating the image in one direction. In practical terms, it makes it hard to distinguish an 8 from a 6. A toric lens will correct this issue and give you the best possible vision uncorrected (without glasses). You may still need a prescription to read and sometimes to see at a distance, but in general, a toric lens is a great investment.

One important thing to consider here: Specialty lenses are not covered by any insurance plan. Insurance companies regard them as cosmetic meaning that all associated expenses are considered out of pocket. If you would like more information, call and make an appointment with one of our doctors and we would be happy to help you.

What if I have cataracts in both eyes?
Each eye will have to be evaluated separately and together for cataracts to ensure the lenses you choose fit your needs in the best possible way. Typically, surgery is performed in one eye at a time. After a few weeks of healing and evaluation, the surgery on the next eye will be performed.

There are effective treatment options for cataracts. If you have any of the symptoms or are experiencing vision loss due to cataracts, it is time that you discuss treatment options with our ophthalmologists. You can call our office to request an appointment.

What is a Glaucoma?
Glaucoma can be described as a group of diseases that affect the eyes. It is characterized by the damage of the optic nerve and loss of visual fields. Unfortunately, any damage to the optic nerve can lead to progressive and even irreversible vision loss, which is what makes this disease so serious. Glaucoma is most likely to be caused by a failure within the eye to properly maintain a healthy intraocular pressure or IOP, resulting in an elevated pressure within your eyes. while elevated eye pressure is a common contributor to glaucoma cases, even people with a normal IOP can develop glaucoma.

Experts currently believe that patients with glaucoma who do not have elevated eye pressure levels may suffer from poor blood flow to the optic nerve. A viscous fluid within the eye called the aqueous humor circulates through your eyes and it brings nourishment and lubrication before draining through a tiny mesh-like tissue. When that drain gets clogged, the fluid gets backed up and creates a greater-that-normal pressure on your eyes, leading to severe damage to your optic nerve. The optic nerve is responsible for transmitting data from your eyes to your brain, and over time, the damage caused by the increase in pressure can lead to permanent blindness.

What are some common symptoms of Glaucoma?
It is important to note that while the damage from glaucoma can cause vision distortions or even blindness, some people have very few to no symptoms initially. This is why it is absolutely critical to get your eyes checked through routine eye exams to proactively identify subtle signs of glaucoma.
Some common symptoms of Glaucoma include:

• Problems with peripheral vision
• Blurred vision or halo effects
• Tunnel vision
• Hazy vision
• Severe pain in your eye or forehead
• Nausea and vomiting
• Blind spots in your field of vision
• Redness
• Complete vision loss

How is Glaucoma treated?
Damages to your eyes due to glaucoma is irreversible, and all treatment efforts from your doctors will focus on preventing further damage. Prior to any treatment, the first step that your ophthalmologist does is to complete a thorough eye examination and health history check. They use the information from your exam to devise a customized treatment plan. A more conservative approach would be to use special eye drops and medications to reduce pressure within your eyes, which applies for early stage glaucoma. Another approach is to use targeted beams of light through laser surgery to clear the blockage of your aqueous fluid. This can improve the angle at which the aqueous fluid drains from your eyes, as well as create a tiny hole to allow more fluid to drain, if need be.

In special cases, our eye surgeons can perform procedures to adjust the physiology of your eyes to decrease the pressure being applied or a glaucoma drainage device can be implanted to assist with drainage. Laser surgery is a popular glaucoma treatment option as it is effective, non-invasive and painless. Depending on the cause of glaucoma, laser surgeries will target different cells in the eye to help relieve the building pressure on the optic nerve. Patients should always review the pros and cons of this surgery versus other treatment options before undergoing the procedure.


How to prevent Glaucoma?
While there is currently no surefire way to prevent glaucoma, regular eye exams will allow your doctors to find and treat the problem sooner rather than later, which will protect your eyes from the worst of its effects. Glaucoma tests during an eye exam are painless and very quick.

Certain people are more at risk of developing glaucoma than others, and should take care to schedule annual eye exams to ensure they are screened regularly for glaucoma. People at risk include patients who:

• Are over the age of 40
• Have a family history of glaucoma
• Suffer from poor vision in general
• Have diabetes
• Experienced a traumatic event or accident that affected their eyes
• Are of African, African-Caribbean, Hispanic or Asian descent

Patients should also bring a list of any medications they are on to their eye doctor during their annual eye exam, as some medications can increase your risk of developing conditions such as glaucoma.

Early detection is the best way to prevent vision loss from glaucoma. Our eyecare providers at Johnson Eyecare are equipped with the training and expertise required to perform a wide range of services, from basic diagnostics to highly advanced surgeries to treat Glaucoma. Schedule an appointment today using our online booking tool for a comprehensive eye exam with Johnson Eyecare or call our office for an appointment.

What is Macular Degeneration?
The macula is the portion of your eye that collects images and sends them to your brain to be interpreted as sight. As AMD develops, the condition begins damaging the macula - a term used to refer to a small spot that sits near the center of the retina. It is the part of your eyes that collects light and sends to your brain to be transformed into sight. The macula is the most sensitive part of the retina and it is responsible for creating a sharp, clear central field of vision.

When the macula is damaged, it affects your ability to receive sensory data perfectly, so the center of your field of view may appear blurry, distorted, or dark - resulting in progressive vision loss. Macular degeneration can be of two types; Wet and dry.

In wet macular degeneration, aberrant blood vessels is the major cause of the problem as they leak blood and fluid. With dry macular degeneration, the macula becomes thin and brittle resulting in the development of tiny clumps of protein. This type of macular degeneration constitutes of about 70 - 80% of cases.

What causes macular degeneration?
The actual causes of macular degeneration are unknown but for many people, this condition occurs as they near seniority, and scientists and medical researchers believe that this could happen in tandem with a combination of environmental factors. This age-related macular degeneration (AMD) occurs in three stages: Early, Intermediate and Late.

In the early stage, macular degeneration is very manageable. It can usually be detected during regular eye exams and most people don’t experience vision loss. In the intermediate stage, there might be some some degree of vision loss, and it usually exhibits some noticeable symptoms. In the late stage, vision loss is pronounced and getting treatment at this stage could potentially reduce the progression of the condition, but the chances of completely restoring vision are low. Patients suffering from AMD typically report developing distorted or blurry vision, particularly in the line of sight that sits straight ahead of them. As the disease progresses, the blurry or distorted area may grow in size, and patients are even likely to develop blank spots in their field of vision. Many patients also report that objects in their line of sight appear darker and lose their brightness as the disease progresses.

AMD by itself does not lead to complete blindness. However, it can definitely prevent patients from being able to carry out simple everyday activities safely and/or efficiently. As AMD progresses patients are likely to lose the ability to see faces, drive, read, write, cook or fix things around the house - just to name a few tasks AMD can interfere with.

Besides age, some other common risk factors of macular degeneration include:

• Smoking - Smoking doubles the risk of AMD.
• Race - AMD is more common among Caucasians than among African-Americans or Hispanics/Latinos.
• Family History - People with a family history of AMD are at higher risk.
• Genetics - As many as 20 genes may affect one’s risk of developing AMD; more may be discovered as researchers continue to investigate this condition.

What are the treatment options for macular degeneration?
As of now, AMD is considered incurable once it begins to develop. There is no set action plan can fully prevent AMD either. Treatment focuses on decelerating the condition’s progression and making lifestyle changes to bolster health of the eyes and support healthy vision.

Our expert eyecare providers would work with you to lead a healthy lifestyle and prevent further vision loss. Some of those efforts include:

• Smoking cessation
• Balanced nutrition (i.e. filled with fruits, leafy green vegetables, fish, and other healthy foods)
• Staying active and regular exercise
• Protecting eyes from ultraviolet light
• In addition to that, patients with the condition can be treated with injections of anti-VEGF medications. Along with that, patients can take certain vitamins, or can use vision aids to help treat its symptoms and slow the progression of the disease. Some patients do respond well to laser therapy, which is used to destroy the abnormal blood vessels using laser.

In any case, early detection is key to treating macular degeneration. In many cases patients do not experience symptoms until any damage related to AMD is quite severe. Annual complete eye exams are the best way for patients to ensure their vision is not being damaged without their knowledge. Schedule your comprehensive eye exam with our ophthalmologists today.

How does diabetic retinopathy cause vision loss?
The retina is the innermost part of your eyes that is made up of a light-sensitive layer, or coat of shell tissue. It detects light and transmits that signal to the brain to facilitate sight. Diabetes affects the body’s ability to use and store sugar, and without proper management, sugar levels in the bloodstream elevate. These higher sugar levels can ultimately cause damage to our blood vessels, as they can weaken the walls of the blood vessels.

Since our eyes and retina rely on a healthy blood supply to function, any damage to the blood vessels within them can affect our vision. Weakened blood vessels often leak blood or a fatty fluid into the retina area, resulting in swelling or vision problems within the eye. Since the retina detects light and converts it into signals that are sent through the optic nerve to the brain - where said light is translated by the brain into an image for us to process - any damage or interference with it is likely to at least result in some distortion of vision, if not full-on blindness.

What are the effects of diabetic retinopathy on my eyes?
If you are dealing with diabetic retinopathy, you are likely to suffer a range of complications.
Some examples of the effects on vision include:

• Swelling of the macula: The macula is a specific spot within the retina that helps our eyes create sharp images in our central field of vision; any damage to the macula is likely to create vision problems. In diabetics, as the blood vessels leak fluid, the macula begins to swell. This swelling effect has its own name: Diabetic macular edema (DME).
• Vitreous Hemorrhage: Sometimes diabetics grow extra blood vessels which are particularly weak. In many cases, these weakened vessels leak. If the leaks and fluid build-up grows severe enough, this will cause a sudden loss of vision or create lots of new floaters.
• Loss of vision: Complete loss of vision is a possible side effect from advanced diabetic retinopathy, as by this stage scar tissue and long-term weakening of the blood vessels may result in a full retinal detachment.

What are the stages of diabetic retinopathy?
Diabetic retinopathy has four progressive stages. In the mild stage, microaneurysms (small areas of swelling) can leak fluid to your retina. As diabetic retinopathy progresses during the moderate stage, blood vessels swell and change its shape, which prevents them to carry blood efficiently. In the severe stage, there the blood vessels get blocked within the eye, leading to the blockage of growth factor secretion that initiates new blood vessel development. When diabetic retinopathy reaches the proliferative stage, your body compensates and grows new blood vessels inside the retina and the vitreous gel. These new blood vessels fills the retina and can leak and bleed, and scar tissue may also aggregate, which could lead to retinal detachment.

Am I at risk of developing diabetic retinopathy?
You have an elevated risk of diabetic retinopathy development if you have type 1, type 2 or gestational diabetes. About 45% of people with diabetes are in some stage of the diabetic retinopathy, even if they show no symptoms. As the early stages of diabetic retinopathy are often asymptomatic, it is critical that people with diabetes go through routine eye exams and focus on improving their overall healthcare approach. Even when you don’t have diabetic retinopathy, the fluctuating blood sugar levels can affect your vision. It can impact the shape of your eye’s lens and cause blurry vision. This blurred vision might return back to normal, after the sugar levels in your blood stabilizes, so having a good control of your blood sugar could help reduce intermittent episodes of blurred vision.

What are the treatment options for diabetic retinopathy?
Our eyecare providers at Johnson Eyecare can help you determine the best course of treatment and design customized care plans to maintain a healthy vision. Depending on your unique physiology and the severity of the condition, our eye care professionals can offer you with a wide array of treatment options.

They may involve the injection of anti-VEGF drugs, to block the vascular endothelial growth factor, and reduce the volume of fluid in your retina. This is done to reverse the aberrant growth of blood vessels within the retina. They may also recommend the focal/grid macular laser surgery, which entails the use of targeted beams of light to destroy portions of your blood vessels. This laser surgery is often coupled with anti-VEGF drug therapy to achieve optimal results.

In some critical cases, corticosteroid injections can help suppress diabetic retinopathy. However, this approach can increase your risk of developing cataracts and glaucoma, so it might not a good fit for everyone. In cases with sustained and severe bleeding into the vitreous gel, our doctors may also recommend the surgical removal of your vitreous gel through a process called the vitrectomy.

How can I prevent diabetic retinopathy?
The good news is that with proper detection and treatment, patients are unlikely to suffer from permanent effects of diabetic retinopathy. There are several things that can be done to prevent and address diabetic retinopathy:

If possible, a patient should take steps to minimize their risk of developing diabetes.
If you are already living with the condition, you should report this to your eye doctor immediately, and should also make sure you never miss an annual eye exam. Comprehensive eye exams are the only way you can be sure that any early signs of diabetic retinopathy will be caught and treated. Remember, the condition does not always present with initial symptoms. Only by scheduling an eye exam will you ensure that your doctor diagnoses the problem before irreversible damage sets in.
Properly working with your primary care doctor to manage your diabetes and glucose levels through exercise, proper diet, and medications (if necessary) will also help in minimizing the effects or development of diabetic retinopathy. The tighter the control of your blood sugar, the lower your risk of severe complications and blindness will be.
To schedule a comprehensive eye exam and protect your eyes from vision loss due to diabetic retinopathy, call or schedule an appointment online today with one of our ophthalmologists.

Myopia  - Near Sightedness
Blurry or strained distant vision tasks
Corrected with:
glasses
contact lenses
refractive surgery
orthokeratology 

Hyperopia - Far Sightedness
More blur and significant strain near vision tasks
Corrected with:
glasses
contact lenses

Presbyopia - Eyes of the Aging
Increasing difficulty with near tasks due to aging after 40 years of age (sometimes earlier)
Corrected by:
progressive addition lenses (PAL)
lined bifocal / trifocal systems
multifocal contact lenses
monovision contact lenses

Astigmatism
Visual irregularity in the way the eye focuses light due to irregular shape changes within the optical structures of the eye such as the cornea and lens.
Corrected by:
glasses
contact lens (Toric)
some refractive surgeries (determined by thorough exam)

Myopia - (near sightedness) Control
In today's near-point-dominated environment with computer screens, tablets and excessive cell phone use, children, as a population, will continue to become more myopic. This excessive near usage will create visual strain and progressive changes. Specific treatments will reduce near-point stress and therefore reduce strain / stress and near sightedness progression. 

What are dry eyes?
The name implies the eye is actually dry yet many people who have the problem complain of tearing. In 1995, the National Eye Institute defined it as a disorder of the tear film due to tear deficiency or excessive tear evaporation which causes damage to the eye surface and is associated with symptoms of ocular discomfort. Since then, there has been much interest at improving and treating the root causes of dry eyes.

What are the symptoms of dry eyes?
Your eyes produce adequate tear to function correctly and keep it lubricated, so the surface of your eyes are clear and smooth.
Tears in and of itself, is made up of three layers:

• An oily outer layer - to prevents evaporation
• A watery middle layer - to wash away tiny debris and clean the surface of the eye
• An mucus inner layer - to retain moisture and allows your tears to cling to your eyes
• When your eyes doesn’t produce adequate volume of tears, you may notice the following symptoms:
• Redness of the eye
• Pain while putting on contacts
• Scratchy or stinging eyes
• Strings of mucus in or near the eyes

There are many risk factors for dry eyes. Medications, age, sex, occupation, systemic diseases, contact lens use, and post Lasik or refractive surgery are frequent causes. Even more common is poor blinking. All day long we stare at our phones or tablets or computer screens and we blink less frequently. This clearly affects a lot of us and is another risk factor for developing dry eyes. Even the secretion of excess tears can be because of dry eyes, as your body created a compensatory response for insufficient tear production.

What causes dry eyes?
Various factors cause dry eyes like:

• Wearing contact lenses for a lengthy period
• Certain medications
• Exposure to environmental irritants
• Eye strain from computer or phone use
• Certain diseases, including rheumatoid arthritis and thyroid disease

What are some treatment options for dry eyes?
Diagnosing and treating dry eyes is important because the condition affects our daily lives. If not properly tended to, dry eyes can cause blurred vision and tearing. This can affect your ability to do your work, to read your medication bottles, or can even be embarrassing because you have to wipe your eyes all the time. Now, we have the ability to precisely diagnose the condition using new and old technology.

Treatment options for dry eyes depend on the cause of your condition, as well as the overall health of the patient. In any case, our expert eyecare providers at Johnson Eyecare have a deep understanding of various risk factors of dry eyes and they would perform a thorough eye exam on all patients before beginning the treatment. Depending on your symptoms, you may also benefit from evaluation with the TearLab Osmolarity System. In addition, the LipiView allows the doctor to view your actual oil producing glands, to observe your blink rate, and to quantify your tear film’s oil content. Once they have a good understanding of your condition, they can then focus on the treatment.

Our doctors may suggest lubricating your eyes with artificial tears. If that doesn’t give positive results, then our doctors may consider you for implanting punctal plugs. These plugs are tiny in nature and they are made up of silicone or a special type of gel. They would be inserted into your tear ducts to prevent the draining of your natural tears from the eyes; the goal being to prevent moisture from escaping.

Another viable approach would be boost your body’s natural production of tears, aided by special eye drops. To achieve optimal results, our doctors might pair this method with additional efforts to reduce environmental irritants. If all those efforts have not addressed the problem adequately, surgical closure of your tear ducts would be the best way to treat dry eyes.

To relieve yourself from persistent dry eyes, call or schedule an appointment online with one of our dry eyes specialists for a comprehensive eye exam.

What is Ptosis?
Ptosis is characterized by the drooping of one or both eyelids. In some cases, it might be barely noticeable, but usually it is very pronounced and it interferes with your ability to see clearly.

What Causes Ptosis?
Ptosis could occur for various reasons, but aging is the most common one. Some babies are born with ptosis, while others develop ptosis suddenly after injury. disorders like Myasthenia gravis and Horner syndrome, also feature ptosis as part of their disease symptoms.

Your eyelids are drooping because the muscle is weak or has loosened from its attachment. The drooping eyelids block peripheral vision making driving more difficult. It also affects reading, and walking especially down the stairs or stepping off the curb. Sometimes people bump their heads on objects above them because they cannot see it. For children, it threatens normal visual development. The ptosis would need to be corrected in a timely fashion to restore vision.

How Is Ptosis Treated?
Before proceeding with the treatment, our doctor would first have to evaluate on why the patient is seeking the treatment. Your doctor will review the surgical plan to correct the drooping eyelids and make it look proportional. For patients dealing with vision-related problems due to ptosis, eyelid surgery would be done in the first place to correct the drooping eyelids, followed up by addressing the remaining vision problems through other treatment methods or even a corrective surgery. In most cases, the eyelid surgery will sufficiently remove the vision problem, and further treatment may not be necessary.

What is Dermatochalasis?
Dermatochalasis is characterized by loose, excessive skin around the eyelids. It causes a tired, aged look around your eye because the skin adjacent to your eyes does not have adequate elastin or collagen to hold it in place. The amount of collagen in the skin decreases with age leading to the breakdown of its fibers. As it loses its elasticity, the bulky portion of the eyelid droops over the eyelashes. This would perpetually block the field of vision of the patient and could cause irritation in the eyelid as well as the eye itself.

What is a Blepharoplasty?
A blepharoplasty is a surgical procedure to correct the drooping and sagging of the patient’s eyelids. During a blepharoplasty, our doctor would remove or redrape the excess skin, muscle and the fatty tissues over and around the eyes, to create a more natural and youthful looking eyelid. This procedure to fix the upper eyelid is relatively straightforward and it affects only the surface layers of your skin and the soft tissues around the eye.

On the other hand, Blepharoplasty for the lower lids is complicated and requires more precision. The fat surrounding the eyes can protrude forward, right above the orbital bone, creating bags underneath the eyes. Regular exposure to light usually casts shadows underneath these bags, which creates dark circles under the eye and this makes people look aged and tired. Many surgeons would aggressively remove fat underneath the lower eyelid to eliminate these bags causing a complication. the lower eyelid becomes pulled down causing the eye to be too exposed and dry.

Our doctor has years of experience on various techniques to remove and redrape tissues into the depression between the upper cheek and the lower eyelids. This natural way of filling creates a smooth transition from the lower eyelid to the cheek, which will give you a healthier and more youthful appearance. In addition to that, the skin and muscle tissues are elevated and tightened to reduce the skin wrinkles. Your insurance may cover the cost of surgery depending on the amount and severity of obstruction of vision fields by the drooping eyelids. However, lower eyelid blepharoplasty is very rarely considered a covered benefit.

What are eye floaters?
Eye floaters are spots or tiny shadows or specks in your vision that appears to be floating or moving across your eyes. It would appear to be shifting or darting away if you virtually try to focus on them directly. In the vast majority of cases, eye floaters in all of their forms are benign, and are simply the result of a natural aging process in which flecks of protein and gel shrink and break away from the retina of the eye.

This process creates tiny shapes or flecks that can begin floating within the gel that fills in the back of the human eye, creating shadows on the retina, which leads to the image of floaters in our field in vision. If you suddenly experience an increase in floaters or if you see flashes of light, it is a good idea to schedule an eye exam immediately.

What is causing flashes of light in my vision?
Patients often describe the flashes as sudden instances of bright light on their eyes and it could have a pricking effect. Some patients also describe this condition as swift streaks of light or wavy lines of brightness. When experiencing flashes of light and floaters across the field of vision, most people misinterpret this to be originating from sources outside their body. But in reality, these spots could be originating from either your brain or your eye.

Changes in your vision caused by dark floaters accompanied by sudden flashes of light can be the outcome of retinal detachment, which is a serious emergency medical condition and without immediate medical intervention, a detached retina can lead to permanent blindness. Occasional floating dark spots and bright light flashes on your eyes are normal and they could occur more frequently as you age. However, both the floating dark spots and bright light flashes are also critical symptoms of other pertinent eye conditions, like:

• Bleeding in the vitreous gel
• Damage to blood vessels
• Inflammation
• Retinal tears or detachment

Often, cases of eye floaters that present with flashing lights or halos of light are suffering from one of these more serious causes of eye floaters. But this is not a guaranteed sign of trouble, as some benign cases of eye floaters also present with flashing lights - and some severe cases of them do not. In any case, patients are advised to schedule an appointment for an eye exam, if you experience a sudden change in your vision any time and every time. Early detection of an eye condition can make a world of difference for you and help you prevent vision loss.

How can I prevent eye floaters?
While regular eye visits and good eye care may help to prevent the emergency causes of floaters, age-related floaters cannot be prevented. Similarly, treatment options for eye floaters varies depending on the cause. If a serious vision health issue is the underlying cause, treatment of that vision issue will be an essential part of taking care of one’s eye floaters. In the majority cases, however, floaters that are related to natural aging will become less bothersome with time.

Large, aggravating floaters that interfere with a patient’s inability to function, or which fail to improve, may require a consult with a retina specialist. Treatments such as laser or surgery or medication can be used to address the issue, but carry significant risk. Talk with one of our retina specialists before considering such a treatment.

Because the causes and options for treating eye floaters is so heavily dependent on their cause and severity, scheduling an eye appointment immediately after developing an eye floater or multiple new eye floaters in a short time span is a critical part of ensuring your eyes are not being subjected to a serious health problem. Additionally, annual complete eye exams can ensure that patients dealing with serious vision issues can obtain treatment for them, perhaps long before eye floaters begin to develop.

If you notice a floating dark spots or or a sudden increase in the number and intensity of light flashes, it is time to reach out to our eyecare providers at Johnson Eyecare for an eye exam. Click or call to book your first appointment today.

Pink eye (conjunctivitis) is an inflammation or infection of the transparent membrane (conjunctiva) that lines your eyelid and part of your eyeball. Inflammation causes small blood vessels in the conjunctiva to become more prominent, which is what causes the pink or red cast to the whites of your eyes.
The cause of pink eye is commonly a bacterial or viral infection, an allergic reaction or, in newborns, an incompletely opened
tear duct. Though the inflammation of pink eye makes it an irritating condition, it rarely affects your sight. If you suspect pink eye, you can take
steps to ease your discomfort. But because pink eye can be contagious, early diagnosis and treatment is best to help limit its spread.
The most common pink eye symptoms include:

• Redness in one or both eyes
• Itchiness in one or both eyes
• A gritty feeling in one or both eyes
• A discharge in one or both eyes that forms a crust during the night
• Tearing

Pink eye may make you feel as if you've got something in one or both of your eyes that you just can't remove. When you wake up in the morning, your eyes may seem to be pasted shut from the discharge coming from your eyes.
Causes of pink eye include:

• Viruses
• Bacteria
• Allergies
• A chemical splash in the eye
• A foreign object in the eye

Viral and bacterial conjunctivitis
Viral conjunctivitis and bacterial conjunctivitis may affect one or both eyes. Viral conjunctivitis usually produces a watery or mucous discharge. Bacterial conjunctivitis often produces a thicker, yellow-green discharge and may be associated with a respiratory infection or with a sore throat. Both viral and bacterial conjunctivitis can be associated with colds. Both viral and bacterial types are very contagious. Adults and children alike can develop both of these types of pink eye. However, bacterial conjunctivitis is more common in children than it is in adults.

Allergic conjunctivitis
Allergic conjunctivitis affects both eyes and is a response to an allergy-causing substance such as pollen. In response to allergens, your body produces an antibody called immunoglobulin E (IgE). This antibody triggers special cells called mast cells in the mucous lining of your eyes and airways to release inflammatory substances, including histamines. Your body's release of histamine can produce a number of allergy signs and symptoms, including red or pink eyes. If you have allergic conjunctivitis, you may experience intense itching, tearing and inflammation of the eyes — as well as itching, sneezing and watery nasal discharge. You may also experience swelling of the membrane (conjunctiva) that lines your eyelids and part of your eyeballs, resulting in what may look like clear blisters on the whites of your eyes.

Conjunctivitis resulting from irritation
Irritation from a chemical splash or foreign object in your eye is also associated with conjunctivitis. Sometimes, flushing and cleaning the eye to rid it of the chemical or object causes redness and irritation. Signs and symptoms, which may include a mucous discharge instead of pus, usually clear up on their own within about a day.

Risk factors for pink eye include:
- Exposure to an allergen for allergic conjunctivitis
- Exposure to someone infected with the viral or bacterial form of conjunctivitis

Both viral and bacterial conjunctivitis are common among children and are very contagious. Someone with conjunctivitis may be contagious for seven to 14 days after signs and symptoms first appear. People who wear contact lenses, especially extended-wear lenses, may be more prone to conjunctivitis. Pink eye can be an irritating condition, but it's usually harmless to your sight and typically doesn't require extensive or emergency treatment. Yet because pink eye can be highly contagious for as long as two weeks after signs and symptoms begin, it's important to seek diagnosis and treatment early. Keep children with bacterial conjunctivitis away from child care facilities or school until after they start treatment. Children with viral conjunctivitis may be contagious for several days to as long as a week or more. Check with your doctor if you have any questions about when your child can return to school or child care. Most schools and child care facilities require that your child wait at least 24 hours after starting treatment before returning to school or child care. Your doctor may take a sample of eye secretions from the conjunctiva for laboratory analysis to determine which form of infection you have and how best to treat it.

Bacterial conjunctivitis
If your infection is bacterial, your doctor may prescribe antibiotic eye drops as pink eye treatment, and the infection should clear within several days. Antibiotic eye ointment, in place of eye drops, is sometimes prescribed for treating bacterial pink eye in children. An ointment is often easier to administer to an infant or young child than are eye drops, though they may blur vision for up to 20 minutes after application. With either form of medication, you should notice a marked improvement in signs and symptoms
within one to two days. Be sure to use the medication for the entire time your doctor prescribes it, to prevent recurrence of the infection.

Viral conjunctivitis
Viral conjunctivitis doesn't respond to treatment with antibiotic eye drops or ointment. Like with a common cold, you can use an over-the-counter remedy to relieve some symptoms, but the virus just has to run its course. You may notice a worsening of symptoms in the first three to five days. After that, your signs and symptoms should gradually clear on their own. It may take up to two to three weeks from the time you were infected for the virus to go away.

Allergic conjunctivitis
If the irritation is allergic conjunctivitis, your doctor may prescribe one of many different types of eye drops. These may include antihistamines, decongestants, mast cell stabilizers, steroids and anti-inflammatory drops. Practicing good hygiene is the best way to control the spread of pink eye. Once the 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.
• Change your pillowcase often.
• 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.

If your child is infected, avoid close contact with other children. Many schools send children with conjunctivitis home, and will likely ask that your child receive at least one full day of treatment before returning. You can soothe the discomfort of pink eye by applying warm compresses to your affected eye or eyes. To make a compress, soak a
clean, lint-free cloth in warm water and wring it out before applying it gently to your closed eyelids. For allergic conjunctivitis, avoid rubbing your eyes so that you don't release more histamines. Instead, use cool compresses to soothe your eyes. You might also try specially formulated over-the--counter eye drops such as Naphcon-A or Opcon-A, which contain an antihistamine and an agent that constricts blood vessels.