Children’s Eye Exam and Why Your Child Needs One?

We are constantly hearing about the importance of children’s back to school eye exams.  Why are these exams so important?  What are we as eye doctors looking for?  What are we trying to prevent?

The reason that an eye exam is so important is that 80% of a child’s learning in school  is done through his or her eyes.  This means that if there is any kind of problem with your child’s eyes, your child’s learning in school may be impaired.

What are some of the eye problems or concerns eye doctors look for during a child’s eye exam? 

The first thing we will check is visual acuity to ensure the child has good vision in each eye.  If vision is good in each eye, then we have ruled out amblyopia or lazy eye, which is our number one enemy.  Amblyopia is a condition in which visual acuity is reduced in an eye and not completely correctable by glasses or contact lenses.  If vision is 20/30 or less in an eye, it is diagnosed as amblyopia or lazy eye.

Another concern is strabismus where the two eyes are not aligned in the same direction at the same time.  Strabismus is commonly known as an eye-turn or squint.

A further concern is anisometropia which is a significant difference in vision or refractive error between the two eyes.  What this means is that one eye is significantly more nearsighted, far sighted or has more astigmatism than the other eye.

Amblyopia is caused by anisometropia, strabismus or high refractive error in one or both eyes.  Therefore, during a child’s eye eyam, we are not only looking for vision problems that are correctable with glasses or contact lenses, but we are also looking for amblyopia and its causes.

There is a 6.7% prevalence of amblyopia and strabismus and they are the most common visual abnormalities in children.  Approximately 50% of childhood strabismus starts within the first year of life, with the rest starting before the age of 5 or 6.  The earlier amblyopia is detected, the easier it can be treated.  This is because there is a critical period up to the age of about 6 or 7 during which visual development occurs where it is much easier to reverse the effects of amblyopia.  After this visual development period, it becomes more difficult to treat amblyopia although it is still possible.  That is why we hear of adults with a lazy eye whose vision in one eye cannot be fully corrected, even with their glasses or contact lenses.  The brain favors the retinal image of the good eye and starts to suppress the image of the bad eye.  When this happens, the visual cells in the bad eye do not fully develop during this critical visual development period.  The eye becomes lazy and amblyopia forms.  New research, however, has shown that adults have been able to correct their amblyopia with vision therapy.

Another eye disorder in children is retinoblastoma.  Retinoblastoma is an eye tumor that is screened for during an eye exam.  Children can also have congenital cataracts and other disorders.

The American Optometric Association recommends that a child’s eyes should first be examined at 6 months of age.  It is highly recommended that you have your child’s eyes examined at least before the age of 3 and again before the age of 5, and then every year thereafter.  Your eye doctor will use completely different methods and techniques during your child’s eye examination compared to the eye examination of an adult.

I hope this article helps illucidate the importance of the back to school eye exams that we hear so much about at this time of year and why it is so important to have your child’s eyes examined by an optometrist or ophthalmologist.

Meyer Izaac, O.D.



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Red, Itchy and Watery Eyes?

  Do you suffer from red, intensely itchy and watery eyes?  If you do, then you probably have eye allergies.  Your symptoms may run concurrently with a runny nose and you may blame it on a “cold” you keep getting when in fact you have allergies and don’t know it.

How do you know it is not pink eye or dry eyes?  Patients with pink eye report some itching.  Those with eye allergies describe intense itching.  Pink eye, which is usually caused by a bacteria or virus, typically starts in one eye and affects the other eye (although not as badly) after a few days.  By contrast, eye allergies involve both eyes from the beginning.

Bacterial pink eye causes a yellowish discharge and your eyelids may be stuck together in the morning.  Bacterial pink eye is most common in infants and toddlers whose immune systems are not yet fully developed, and in those with compromised immune systems, such as seniors.  Viral pink eye is generally accompanied by a watery discharge and other signs on the eye surface, such as follicles (or dendrites in the case of herpes viral infections that affect the eyes), that can be used by an optometrist or ophthalmologist to differentiate it from the bacterial form. Viral pink eye is the most common conjunctivitis seen in school-aged children.  Viral pink eye may also affect the lymph nodes.  More often than not, those with viral pink eye have been recently ill with an upper respiratory infection.

Both bacterial and viral pink eye are highly contagious and can be transmitted by contact with family or friends with recent pink eye.

The hallmark of eye allergies, on the other hand, is profound or intense itching causing the patient to rub his or her eyes very frequently and occasionally even with the knuckles.  This is not to be confused with dry eyes, where the patient may experience some minor itching,  but dry eyes typically present as a foreign body sensation, burning, grittiness and tearing and the eyes are not as red as they are with eye allergies or pink eye.  Dry eyes and eye allergies may go hand in hand — if you have dry eyes, then you don’t produce enough tears to flush out the allergens in your eyes, which may lead to eye allergies.  In such cases, your eye doctor may need to treat your dry eyes in order to treat your eye allergies.  If you have allergies or dry eyes, and you wear contact lenses, your best option is 1-day disposables.

Contact lens related red eyes are usually caused by poor contact lens hygiene and compliance, overuse of contact lenses, sleeping with contact lenses and allergic reactions to contact lens solutions.

Inflammatory conditions such as iritis or an auto-immune disorder such as rhuematoid arthritis etc. can also cause red eyes.

Often, patients see an optometrist or ophthalmologist for red or intensely itchy and watery eyes only after trying (unsuccessfully) over-the-counter eye drops.  However, over-the-counter eye drops will not treat bacterial or viral infections of the eyes, including herpes viral eye infections and chlamydia bacterial eye infections.  It is also important to be aware that some over-the-counter eye drops have vaso-constrictors in them: vaso-constrictors reduce redness by constricting the blood vessels in the eyes.   Although eyes may appear to be less red, the eye drops may not be treating the cause of the redness.  Further, sustained use of vaso-constrictors can actually cause rebound hyperemia — chronic red eyes.

Anti-histamines, such as Claritin and Allegra, may help with eye allergies but they also dry up eye tissue, causing dry eyes.

Eye allergies that lead to vigorous eye rubbing is not a good thing because there is an association between vigorous eye rubbing and a condition called keratoconus, a degenerative disorder of the eye in which structural changes within the cornea cause it to thin and become more conical in shape.

In conclusion, red eyes can be caused by:

  • Infection – bacteria and viruses.
  • Non infection – allergies and dry eyes
  • Improper use of contact lenses and contact lens solutions
  • Inflammation

The importance of seeing an optometrist or ophthalmologist for professional diagnosis and treatment cannot be over-emphasized.  An optometrist or ophthalmologist can prescribe drops that can provide relief from the symptoms of eye allergies within 3 minutes! OR, prescribe drops for bacterial ,  some viral infections of the eye, dry eyes or eye inflammations should that be the case.

So if you have red, intensely itchy and watery eyes, you now know that it may be allergies and not that same cold you keep getting.

Meyer Izaac, O.D.

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Keratoconus causes a bulging of the cornea from its normal shape to a cone shape causing the person to see blurry and distorted. Keratoconus usually starts during adolescence and slowly progresses, causing the cornea to continually bulge forward, making the cornea thin and causing scar tissue and thereby making vision progressively worse.

What causes keratoconus?  The exact cause is unknown. There are many theories based on research, but no one theory can explain it all. It is believed that genetics, the environment and the endocrine system all play a role in keratoconus. It is estimated that 1 in every 2000 people have it.

  • Eye Rubbing: It has been suggested that keratoconus corneas are more easily damaged by minor trauma such as eye rubbing as well as poorly fitted contact lenses that continually rub on the cone.
  • Allergies: Many who have keratoconus report vigorous eye rubbing and also have allergies. Their allergies cause eye itching and irritation, leading to eye rubbing. However, the link to allergic disease also remains unclear. A higher percent of keratoconic patients have atopic disease such as hay fever, eczema, asthma, and food allergies. Those with keratoconus are advised to avoid eye rubbing as much as possible because there seems to be an association with eye-rubbing and keratoconus.

What are the Symptoms? The first symptoms are blurring or distortion of vision and frequent changes in the spectacle prescription especially the astigmatism correction. In the early stages, glasses can be used to correct the vision. As the vision gets progressively worse, rigid gas permeable contact lenses, hybrid contact lenses or scleral contact lenses are the only way to provide adequate vision correction. Fortunately, in most cases, this is a permanent remedy. Surgical implants is another method that can be used to help.  In about 10% of cases, a corneal transplant becomes necessary.

Scleral Contact Lenses for Keratoconus:  Scleral contact lenses provide a good option in most advanced cases of keratoconus.  It is fitted so that it does not touch the cornea.  There is therefore no contact on the bulging cone making this a comfortable option for the patient.  The patient usually reports not feeling the lenses.  The lenses  come in a large diameter so that they rest on the peripheral white part of the eye avoiding contact with the cone and cornea completely.  The area between the lens and the cornea is filled with the patient’s tears and this in effect becomes a moisture chamber that does not evaporate easily into the air making it a great option for those that have severe dry eyes as well.   Scleral lenses provide good vision results too.  The initial fitting process may take several follow-up visits and close monitoring for the best outcomes.  Check out this youtube video on more about scleral lenses.

Rigid gas permeable contact lenses using the Wave Contact Lens design system has provided excellent lens designs for keratoconus with amazing results as well.

The latest in Hybrid contact lens designs called the Synergeyes UltraHealth contact lenses have also produced excellent and very comfortable results.   Here is a link for more on this:

Since keratoconus seems to be associated with eye rubbing and allergies, the best advise you can provide to your friends and family is to share this article with them and to caution them against eye rubbing especially those in their young teenage years.

Meyer Izaac, O.D.

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When should we have an eye exam?

When should we have an eye exam?  Should we have an eye exam only if we have a vision problem?  Should we see the optometrist or ophthalmologist only when we need to update our glasses or contact lenses?  Ask your friends or colleagues at work who don’t wear glasses or contact lenses when they last had an eye exam and you will learn that most of them have not had an eye exam for many years.  Some of them have not had one at all. There seems to be a notion that if you can see well enough, and you don’t have a vision problem, then why have an eye exam?

We see our dentist every 6 months and our primary care physician every year.  What about our eyes?  Our eyes are our most precious gift.  It is our most precious of all our senses.  It is the window to our world.  Whatever we learn and perceive is through our eyes.  Children at school learn over 80% through their eyes.  Yet, most of us only show up at our eye doctor’s office if we have a vision problem.  Sadly enough, we will learn that there are some blinding disorders such as glaucoma that do not affect vision or have any symptoms in its early stages, and they are usually detected at an eye exam.  In most cases, the patient comes in to update his or her glasses or contact lenses and the doctor discovers this potentially blinding disease during the eye exam.  I have seen this very scenario many times at my practice.

So, back to my question.  When should we have an eye exam?  If you have a vision problem and you wear glasses or contact lenses, you should have an eye exam once a year. If you don’t have a vision problem, you should also have an eye exam once a year because an eye exam consists of 2 components:

2 components of an eye exam:

  • A Vision Exam to verify good vision and to ensure the 2 eyes are working and tracking equally well together.  Any vision errors such as nearsightedness, farsightedness, astigmatism and close-up reading difficulties can be corrected with glasses, contact lenses or refractive surgery.
  • An Eye health Exam to ensure the eyes are healthy and free from any eye diseases such as dry-eyes, glaucoma, keratoconus, cataracts, tumors, retinal tears or retinal detachments, blood vessel diseases such as uncontrolled diabetes or hypertension etc., eye turns or squints, lazy-eye (amblyopia) etc.

Please check out this video:

It is important to realize that some of these disorders do not affect vision and may not have any symptoms and they are usually detected at an eye-exam.  If detected, early treatment can have the best outcomes.  It is also vital that children at age 3 and 5 have eye exams before going to school to detect eye-turns, lazy-eye and significant vision errors in one or both eyes.  These disorders can significantly affect their learning in school and early treatment provide the best outcomes.  Children are usually not aware they have a vision problem.  If they don’t see well, they believe that is how everyone else sees.

So now that you have asked your friends and colleagues when they last had their eye exam, you know what to advise them.  Please share this important information that can possibly save their eyes.

Meyer Izaac, O.D.

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Eyeglasses in Encino, Ca.

The Basics of Eyeglasses

Eyeglasses are even more popular today than they ever used to be,  despite the large availability and use of contact lenses and vision correction surgery.

Frame styles branded with high-profile designer brands are always in demand because eyeglasses have become a fashion accessory. The average person now has several pairs with different styles and colors matching their wardrobe and outfit for the day.  Eyeglass frame materials have evolved with the advent of new plastics and various types of metals.

For safety glasses, you may want an extra tough plastic, such as polycarbonate. If you suffer from skin allergies, hypoallergenic metals such as titanium or stainless steel are good choices.

Certain frames are made with highly flexible metal alloys, which reduce the possibility of breakage. Spring hinges also add durability, and are a great option for children’s eyewear.

Eyeglass frames styles

Multi-colored inlays, composite materials, designer emblems, and enhancements such as insets of precious stones may also be found in popular frame styles.

Rimless styles have become more popular in recent years as another way to wear eyeglasses without obvious frames. Some of them are made of titanium making them so light and comfortable, it almost feels like not wearing anything at all. Rimless styles mainly involve attaching plastic or metal temples directly onto the lenses rather than onto a frame.

Advances in eyeglass lenses

You also have many options when choosing the lenses for your eyeglasses.  My biggest recommendation is to get your lenses coated with the anti-reflective coating. It provides the best vision and makes your eyeglasses look its best. Among the most popular types of lenses and lens options prescribed today are:

  • Aspheric lenses, which have a slimmer, more attractive profile than other lenses. They also eliminate that magnified, “bug-eye” look caused by some prescriptions.
  • High index lenses, which are made of new materials that enable the lenses to be noticeably thinner and lighter than regular plastic lenses.
  • Polycarbonate lenses are thinner, lighter and up to 10 times more impact-resistant than regular plastic lenses. These lenses are great for safety glasses, children’s eyewear, and for anyone who wants lightweight, durable lenses. They also have an in-built UV protection.
  • Photochromic lenses are sun-sensitive lenses that quickly darken in bright conditions, and quickly return to a clear state in ordinary indoor lighting. It is also known as Transition lenses. A nice convenient add-on to have if you are indoors and outdoors frequently.
  • Polarized lenses diminish glare from flat, reflective surfaces (like water) and also reduce eye fatigue. A must add-on for your prescription sunglasses.
  • Anti-reflective coatings are among the most popular add-ons for lenses. They can dramatically improve the look and comfort of your glasses by minimizing the amount of light that reflects off the surface of your lenses, which also has the added benefit of reducing glare and thus easing eye fatigue. A must add-on if you want the best and clearest vision.
  • Other lens coatings include scratch-resistant, ultraviolet treatment, and mirror coatings.

Eyeglass lenses for presbyopia

Presbyopia is the normal, age-related loss of near focusing ability that makes reading and other close-up tasks more difficult after age 40.

This means that the usual type of eyeglass lenses you’ve likely been accustomed to wearing, known as single vision lenses, no longer will work well for you.

Multifocal eyeglass lenses available for presbyopia correction include:

  • Bifocals: Lenses with two powers – one for distance and one for near – separated by a visible line.
  • Trifocals: Lenses with three powers for seeing at varying distances – near, intermediate and far – separated by two visible lines.
  • Progressive lenses: These lenses have advanced over time and today we have varying designs and qualities with some designs offering wider zones with less distortion than others allowing more comfortable viewing.  I recommend paying more for the best lens design as it really makes a difference.  These lenses have many advantages over bifocals and trifocals because they allow the wearer to focus at many different distances, not just two or three. Because they have no lines, progressive lenses allow a smooth, comfortable transition from one distance to another. This is my best recommendation especially if you also work on the computer as part of your daily routine. Always get the the anti-reflective coating on your lenses as it reduces reflections and eye fatigue.

 If you see well in the distance without the need for eyeglasses, simple reading glasses with single vision lenses may be all you need to deal with near vision problems caused by presbyopia. 


We should all be aware of the importance of protecting our eyes from the harmful UV rays when we are outdoors. It is especially important for children to have sunglasses on when outdoors. Most of our UV exposure in our life occurs when we are less than 18 years of age as that is when we spend our most time outdoors. UV rays are known to accelerate cataracts and macular degeneration so sunglass protection can slow down its development. Sunglasses come in varying styles and colors and it can be made in your prescription. I recommend getting it polarized with an anti-reflecting coating to cut down glare. If you wear prescription glasses, you should definitely have a pair of prescription sunglasses in your car when you drive.

Advice for Buying Eyeglasses

Your appearance, personal taste and lifestyle should all be considered when choosing eyeglasses. We can help you choose frames and lenses that both complement your appearance and meet your lifestyle needs.

For more information on prescription eyeglasses, visit All About Vision®.

Meyer Izaac, O.D.

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Contact Lens Care

So you started wearing contact lenses!  Congratulations!   Now What?   Now you have to clean them and disinfect them and wear them according to your doctor’s recomended wear schedule or else you run the risk of getting an eye infection.  Compliance with wear and care of contact lenses remains one of the most challenging aspects of caring for our patients who wear contact lenses particularly with lens disinfecting regimens.

So what are we to do?  Daily disposables are probably the best mode of contact lens wear from a health perspective.  With this mode, not only does the contact lens solution become a non-issue, there is also no contact lens case that needs to be cleaned or that can become contaminated.  If we are not using daily disposable contact lenses, then multipurpose disinfecting solutions are used to clean, rinse and disinfect contact lenses. 

Are we actually rubbing and cleaning and rinsing our lenses before we store them in the disinfecting solution?  Are our lens cases clean?  How often are we replacing our lens cases? Are we using the right contact lens solution that is compatible with the type of contact lenses that we have been prescribed?  Are we using fresh and new disinfecting solution every night?  Are we disposing our lenses at the recommended interval?  Are we washing our hands with soap and water before handling our contact lenses?  These are the type of compliance issues both doctors and patients have to deal with.

Research has shown that adding a rub step removes 90% of the debris thereby reducing or eliminating deposit buildup on lenses.  What is more crucial is that the rubbing step removes lots of bacteria from the contact lenses.  This reduced bacterial load makes it easier for the disinfecting solution to take care of the rest.  Yet, some lens wearers have reported never rubbing and rinsing their lenses after removal before storing their lenses in the disinfecting solution.  What about the disinfection soak time?  Some solutions require that the lenses be soaked a minimum of 4 to 6 hours for complete disinfection.  Yet some lens wearers have not been soaking their lenses for the minimum indicated disinfection time.

Bacterial and microbial contamination of lens cases have been found to be as high as 40%. Of all the contact lens care proceedures, compliance with the care of the lens case has been reported to be the poorest.  It is recommended that the case be mechanically scrubbed both the inside and outside with contact lens disinfecting solution, avoiding the use of tap water to wash or store lens cases, and to air dry the lens case when not in use.  It is highly recommended that patients replace their lens cases every one to three months.

Most contact lens eye infections is caused by patients either sleeping with their lenses or  overwearing them past the recommended disposable interval.  For 2-week disposable lenses, a helpful reminder is to replace them on the first or fifteenth of the month.  If you get paid every two weeks, use that as a reminder.  For lenses replaced every month, replace them on the first of the month or link it with a monthly activity such as paying your mortgage.

There has been a higher rate of lens complications in patients who use private label or generic contact lens solutions.   Generic brands are often older formulations of the name brands and they can change in composition every quarter.  In fact, many of the generic lens care solutions predate the new silicone hydrogel contact lens materials that are widely used today.  More importantly, few of the current generic lens care products contain formulations indicated by the FDA for use with silicone hydrogel contact lenses.  I can’t stress enough how many contact lens patients with red, irritable eyes I have solved simply by switching contact lens solutions.  If the hypersensitivity to the solution is a delayed type response, it can take months of exposure to the solution before the patient starts to show symptoms.  Therefore, only use the contact lens solutions that have been prescribed by your eye doctor and follow-up with your eye doctor if your eyes start to get red or irritated or if you find you can no longer wear your lenses comfortably all day like you used to be able to do.

Discard all used contact lens solutions and always use fresh solutions every day.  Contact lens wearers should not swim, shower or use a hot tub while wearing contact lenses.  Always remove your lenses and report to your doctor immediately if you experience symptoms of redness, pain, tearing, increased light sensitivity, blurry vision, discharge or swelling.

So now that you have started wearing contact lenses, you can clearly see that all these issues concerning the proper care of your lenses will contribute to your successful lens wear.  Hygienic practices and proper compliance with prescribed wearing regimens is crucial, as is the use of appropriate lens care solutions.

Meyer Izaac, O.D.

Optometrist in Encino, Ca.!/Izaaceyes

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Scleral Contact Lenses –

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