Vision Problems

Eye health information on common vision problems, syptoms and treatments
Myopia | Nearsightedness 
Nearsightedness (myopia) is a common vision condition in which you can see objects near to you clearly, but objects farther away are blurry. 

Nearsightedness may develop gradually or rapidly, often worsening during childhood and adolescence. Nearsightedness tends to run in families.

A basic eye exam can confirm nearsightedness. You can easily correct the condition with eyeglasses or contact lenses. Another treatment option for nearsightedness is surgery.

  • Nearsightedness symptoms may include:

    • Blurry vision when looking at distant objects

    • The need to squint or partially close the eyelids to see clearly

    • Headaches caused by eyestrain

    • Difficulty seeing while driving a vehicle, especially at night (night myopia)

    Nearsightedness is often first detected during childhood and is commonly diagnosed between the early school years through the teens. A child with nearsightedness may:

    • Persistently squint

    • Need to sit closer to the television, movie screen or the front of the classroom

    • Seem to be unaware of distant objects

    • Blink excessively

    • Rub his or her eyes frequently

  • Nearsightedness is diagnosed by an eye exam. A complete eye exam involves a series of tests. Your eye doctor may use various instruments, aim bright lights directly at your eyes and ask you to look through several lenses. Your doctor uses these tests to examine different aspects of your eyes and vision and to determine the prescription needed to provide clear vision with eyeglasses or contact lenses.

    The goal of treating nearsightedness is to improve vision by helping focus light on your retina through the use of corrective lenses or refractive surgery.

  • Corrective lenses
    Wearing corrective lenses treats nearsightedness by counteracting the increased curvature of your cornea or the increased length of your eye. Types of corrective lenses include:

    1. • Eyeglasses. This is a simple, safe way to correct vision problems caused by myopia. The variety of eyeglasses is wide and includes bifocals, trifocals and reading lenses.
    2. • Contact lenses. These lenses are worn right on your eyes. They are available in a variety of types and styles, including hard, soft, extended wear, disposable, rigid gas permeable and bifocal. Ask your eye doctor about the pros and cons of contact lenses and what might be best for you.

    Refractive surgery
    Refractive surgery improves vision and reduces the need for eyeglasses or contact lenses. Your eye surgeon uses a laser beam to reshape the cornea. This type of surgery has become routine, but it's usually not recommended until the eyes have fully developed, in the 20s.

    Your doctor can discuss these options in more detail with you at your comprehensive eye exam.

Hyperopia | Farsightedness 
Farsightedness (hyperopia) is a common vision condition in which you can see distant objects clearly, but objects nearby may be blurry. 

The degree of your farsightedness influences your focusing ability. People with severe farsightedness may see clearly only objects a great distance away, while those with mild farsightedness may be able to clearly see objects that are closer.

Farsightedness usually is present at birth and tends to run in families. You can easily correct this condition with eyeglasses or contact lenses. Another treatment option is surgery.

  • Farsightedness may mean:

    1. • Nearby objects may appear blurry
    2. • You need to squint to see clearly
    3. • You have eyestrain, including burning eyes, and aching in or around the eyes
    4. • You experience general eye discomfort or a headache after a prolonged interval of conducting close tasks, such as reading, writing, computer work or drawing)

  • Farsightedness is diagnosed by a basic eye exam. A complete eye examination involves a series of tests. Your eye doctor may use odd­looking instruments, aim bright lights directly at your eyes and request that you look through an array of lenses. Each test allows your doctor to examine a different aspect of your eyes, including your vision. 

  • The goal of treating farsightedness is to help focus light on the retina through the use of corrective lenses or refractive surgery. 

     

    Corrective lenses
    In young people, treatment isn't always necessary because the crystalline lenses inside the eyes are flexible enough to compensate for the condition. But as you age, the lenses become less flexible and eventually you'll probably need corrective lenses to improve your near vision.

    Wearing corrective lenses treats farsightedness by counteracting the decreased curvature of your cornea or the smaller size (length) of your eye. Types of corrective lenses include:

    1. • Eyeglasses.The variety of eyeglasses is wide and includes bifocals, trifocals, progressive lenses and reading lenses.
    2. • Contact lenses. A wide variety of contact lenses are available — hard, soft, extended wear, disposable, rigid gas permeable and bifocal. Ask your eye doctor about the pros and cons of contact lenses and what might be best for you.

    If you're also having age­related trouble with close vision (presbyopia), monovision contact lenses may be an option for you. With monovision contacts, you may not need correction for the eye you use for distance vision (usually the dominant eye). But a contact lens can be used for close­up vision in your other eye. Some people have trouble adapting to this kind of vision because 3­D vision is sacrificed in order to be able to see both nearby and in the distance clearly. Monovision contacts can be worn intermittently as desired.

    Modified monovision contact lenses are another option. With this type of contact lens, you can wear a bifocal contact lens in your nondominant eye and a contact lens prescribed for distance in your dominant eye. You can then use both eyes for distance and one eye for seeing objects nearby.

    Refractive surgery
    Although most refractive surgical procedures are used to treat nearsightedness, they can also be used for farsightedness. These surgical treatments correct farsightedness by reshaping the curvature of your cornea.

    Your doctor can discuss these options in more detail with you at your comprehensive eye exam.

Astigmatism 
Astigmatism (uh­STIG­muh­tiz­um) is a common, mild and generally easily treatable imperfection in the curvature of your eye. The condition can cause blurred vision. 

Astigmatism occurs when the front surface of your eye (cornea) or the lens, inside your eye, has a slightly different surface curvature in one direction from the other. Instead of being even and smooth in all directions, the surface may have some areas that are flatter or steeper.

Astigmatism blurs your vision at all distances. Astigmatism is often present at birth and may occur in combination with nearsightedness or farsightedness. Often it's not pronounced enough to require corrective action. When it is, your treatment options include corrective lenses and surgery.

  • Signs and symptoms of astigmatism may include:

    1. • Blurred or distorted vision
    2. • Eyestrain
    3. • Headaches

  •  

    To diagnose your condition, your eye doctor (ophthalmologist) may review your symptoms and conduct a comprehensive eye examinatiYour eye examination may include several tests, such as:

    1. • Vision tests. Your doctor may ask you to read letters on a chart to test your vision in a visual acuity test.
    2. • Test to measure the curvature of your cornea. By measuring light reflected from the surface of your cornea, a device called a keratometer measures the amount of curvature to your cornea's surface and can confirm the presence of astigmatism. This test is called keratometry.
      The curvature of your cornea is an important piece of information for contact lens fitting. The curvature tends to be irregular in astigmatism.
      To measure variations in corneal surface curvature, doctors may use a process called computerized corneal mapping. It will create a map of your cornea's surface.
    3. • Test to measure light focus.To measure how your eyes focus light, your eye doctor may place different lenses in front of your eyes using a device called a phoropter. Your doctor may also use a device called a retinoscope, which directs a beam of light into your eye, to determine how your eye focuses light. These procedures can assess the degree of your refractive error and help calculate prescriptions for contact lenses and glasses.

  • The goal of treating astigmatism is to address the uneven curvature that's causing your blurred vision and improve your vision.

    Treatments include corrective lenses and refractive surgery.

    Corrective lenses
    Wearing corrective lenses treats astigmatism by counteracting the uneven curvature of your cornea.

    Types of corrective lenses include:

    1. • Eyeglasses. Eyeglasses can be made with special lenses that help compensate for the uneven shape of your eye. In addition to correcting astigmatism, eyeglasses can also correct for other refractive errors, such as nearsightedness or farsightedness.
    2. • Contact lenses. Like eyeglasses, contact lenses can correct astigmatism. A wide variety of contact lenses are available, including hard, soft, extended wear, disposable, rigid, gas permeable and bifocal contact lenses. Ask your eye doctor about the pros and cons of each and which contact lenses might be best for you.
      Contact lenses are also used in a procedure called orthokeratology. In orthokeratology, you wear rigid contact lenses for several hours a day until the curvature of your eye improves. Then, you wear the lenses less frequently to maintain the new shape. If you discontinue this treatment, your eyes return to their former shape.
      Wearing contact lenses for extended periods of time increases the risk of infection in the eye.

    Refractive surgery
    This astigmatism­treatment method corrects the problem by reshaping the surface of your eye. Before surgery, doctors will evaluate you and determine if you're a candidate for refractive surgery.

    Your doctor can discuss these options in more detail with you at your comprehensive eye exam.

Presbyopia 
Presbyopia is the gradual loss of your eyes' ability to focus on nearby objects. It's a natural, often annoying part of aging. Presbyopia usually becomes noticeable in your early to mid­40s and continues to worsen until around age 65. 

You may become aware of presbyopia when you start holding books and newspapers at arm's length to be able to read them. A basic eye exam can confirm presbyopia. You can correct the condition with eyeglasses or contact lenses. You might also consider surgery. 

  • Presbyopia develops gradually. You may first notice these signs and symptoms after age 40:

    1. • A tendency to hold reading material farther away to make the letters clearer
    2. • Blurred vision at normal reading distance
    3. • Eyestrain or headaches after reading or doing close work

    You may notice these symptoms are worse if you are tired, drank alcohol or are in an area with dim lighting.

  • Presbyopia is diagnosed by a basic eye exam. A complete eye exam involves a series of tests. Your eye doctor likely will put drops in your eyes to dilate your pupils. This may make your eyes more light sensitive for a few hours after the exam. Dilation enables your doctor to more easily evaluate the inside of your eyes.

    Your doctor may use various instruments, aim bright lights at your eyes and ask you to look through several lenses to test your distance and close­up vision. Each test allows your doctor to evaluate a different aspect of your vision.

  • The goal of treatment is to compensate for the inability of your eyes to focus on nearby objects. Treatment options include wearing corrective lenses, undergoing refractive surgery or getting lens implants.

    Eyeglasses
    Eyeglasses are a simple, safe way to correct vision problems caused by presbyopia. You may be able to use over­the­counter (nonprescription) reading glasses if you had good, uncorrected vision before developing presbyopia. Ask your eye doctor if nonprescription glasses are OK for you.

    You'll need prescription lenses for presbyopia if over-­the-­counter glasses are inadequate or if you already require prescription corrective lenses for nearsightedness, farsightedness or astigmatism. Your choices include:

    1. • Prescription reading glasses. If you have no other vision problems, you can have prescription lenses for reading only.
    2. • Bifocals. These glasses come in two styles — those with a visible horizontal line and those without a line (progressive lenses). When you look through progressive bifocals at eye level, the lenses correct your distance vision. This correction gradually changes to reading correction at the bottom. Many people with presbyopia find progressive lenses to be a good solution.
    3. • Trifocals. These glasses have corrections for close work, middle­distance vision — such as for computer screens — and distance vision. Trifocals come with visible lines or progressive lenses.

    Contact lenses
    People who don't want to wear eyeglasses often try contact lenses to improve their vision problems caused by presbyopia. This option may not work for you if you have certain conditions related to your eyelids, tear ducts or the surfaces of your eyes. Several lens types are available:

    1. • Bifocal contact lenses. Bifocal contact lenses provide distance and close­up correction on each contact. In one type of bifocal lens, the bottom, reading portion of the lens is weighted to keep the lens correctly positioned on your eye. These are frequently difficult to fit and often don't provide satisfactory results.
      Newer types of bifocal contact lenses offer distance correction through the edges (periphery) of each lens and near correction through the center. Or distance correction may be offered through the center of each lens and near correction in the periphery.
      You might want to try these for a trial period to see if either of these lens styles work for you.
    2. • Monovision contact lenses. With monovision contacts, you wear a contact lens for distance vision in one eye (usually your dominant eye) and a contact lens for close­up vision in the other eye. Your dominant eye is generally the one you use when you're aiming a camera to take a picture.
    3. • Modified monovision. With this option, you wear a bifocal or multifocal contact lens in one eye and a contact lens set for distance in the other (usually your dominant eye). You use both eyes for distance and one eye for reading.

    Refractive surgery
    Refractive surgery changes the shape of your cornea. For presbyopia, this treatment is used to improve close­up vision in your nondominant eye. It's like wearing monovision contact lenses. Even after surgery, you may need to use eyeglasses for close­up work.
    Talk with your doctor about the possible side effects, as this procedure is not reversible. You might want to try monovision contact lenses for a while before you commit to surgery.

Amblyopia
Lazy eye (amblyopia) is reduced vision in one eye caused by abnormal visual development early in life. The weaker — or lazy — eye often wanders inward or outward. 

Amblyopia generally develops from birth up to age 7 years. It is the leading cause of decreased vision in one eye among children. Rarely, lazy eye affects both eyes.

Early diagnosis and treatment can help prevent long­term problems with your child's vision. Lazy eye can usually be corrected with glasses or contact lenses, or eye patches. Sometimes surgery is required.

  • Signs and symptoms of lazy eye include:

    1. • An eye that wanders inward or outward
    2. • Eyes that appear to not work together
    3. • Poor depth perception
    4. • Squinting or shutting an eye
    5. • Head tilting
    6. • Abnormal results of vision screening tests

    Sometimes lazy eye is not evident without an eye exam.

  • See your child's doctor if you notice his or her eye wandering at any time after the first few weeks of life. A vision check is especially important if there's a family history of crossed eyes, childhood cataracts or other eye conditions.

    For all children, a complete eye exam is recommended between ages 3 and 5.

  • Your doctor will conduct a thorough eye exam, checking for eye health, a wandering eye, a difference in vision between the eyes or poor vision in both eyes. Eyedrops are generally used to dilate the eyes. The eyedrops cause blurred vision that lasts for several hours or a day.

    1. • Preverbal children. A lighted magnifying device can be used to detect cataracts. Other tests can assess an infant or toddler's ability to fixate his or her gaze and to follow a moving object.
    2. • Children ages 3 and older.Tests using pictures or letters can assess the child's vision. Each eye is patched in turn to test the other.

  • It's important to start treatment for lazy eye as soon as possible in childhood, when the complicated connections between the eye and the brain are forming. The best results occur when treatment starts before age 7, although half of children between the ages of 7 and 17 respond to treatment.

    Treatment options depend on the cause of lazy eye and on how much the condition is affecting your child's vision. Your doctor might recommend:

    1. • Corrective eye wear
    2. • Eye patches.To stimulate the weaker eye, your child may wear an eye patch over the stronger eye
    3. • Eyedrops
    4. • Surgery. If your child's eyes cross or wander apart, your doctor may recommend surgical repair for the eye muscles. Your child may also need surgery if he or she has droopy eyelids or cataracts
    5. • Vision Therapy

Strabismus 
Strabismus is a disorder in which both eyes do not line up in the same direction, so they do not look at the same object at the same time. The condition is more commonly known as "crossed eyes." 

  • Symptoms of strabismus may be present all the time, or may come and go. Symptoms can include:

    1. • Crossed eyes
    2. • Double vision
    3. • Eyes that do not align in the same direction
    4. • Uncoordinated eye movements (eyes do not move together)
    5. • Loss of vision or depth perception

    It is important to note that children may never have double vision because amblyopia can develop quickly.

  • The health care provider will do a physical exam that includes a detailed examination of the eyes.

    Tests will be done to determine how much the eyes are out of alignment.

    1. • Corneal light reflex
    2. • Cover/uncover test
    3. • Retinal exam
    4. • Standard ophthalmic examination
    5. • Visual Acuity

  • The first step in treating strabismus in children is to prescribe glasses, if needed.

    Next, amblyopia or lazy eye must be treated. A patch is placed over the better eye. This forces the weaker eye to work harder and get better vision.

    Your child may not like wearing a patch or eyeglasses. A patch forces the child to see through the weaker eye at first. However, it is very important to use the patch or eyeglasses as directed.

    Eye muscle surgery may be needed if the eyes still do not move correctly. Different muscles in the eye will be made stronger or weaker.

    Eye muscle repair surgery does not fix the poor vision of a lazy eye. Muscle surgery will fail if amblyopia has not been treated. A child may still have to wear glasses after surgery. Surgery is more often successful if done when the child is younger.

    Adults with mild strabismus that comes and goes may do well with glasses and eye muscle exercises to help keep the eyes straight. More severe forms will require surgery to straighten the eyes. If strabismus has occurred because of vision loss, the vision loss will need to be corrected before strabismus surgery can be successful.

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