The Emotional Toll of Keratoconus

The stories that people share about their vision loss help remind everyone not to take your vision for granted. The following article is from the Keratoconus Group Blog, and is used with their permission. It reveals the emotional toll of keratoconus, while trying to find the most comfortable treatment option that will allow you to see.

A New Lease on Life

My keratoconus story begins just as one major life event ended and another was just starting.

Rene and family -  emotional toll of keratoconus,
Rene Vasquez with his son Ernie and Wife Jennifer

I finished my dissertation and successfully defended it in June of 2007 then set off across the country with my then girlfriend (now wife) to start new jobs. Everything was on the upswing and all appeared normal. However, it had been about a year since my last visit to the optometrist and being in a new place, I had to go through the dubious task of finding one.

I ended up getting an appointment with the optometrist at our local Walmart as I had broken my only pair of glasses and needed a quick replacement. The visit was going normal (or so I thought) until he came back into the exam room after checking on something. It was with a grave expression that he told me that he noted some concerning findings and I should probably speak with someone who had more experience with keratoconus.

For the next hour or so, I was in a panic that I was going blind. That is until I got online to get more details on what this was all about. After reading into the late evening, a great many eye-related issues over the past several years suddenly made sense. I immediately recalled my many complaints about my night time driving becoming more bothersome because oncoming headlights were blinding. It was on the many forums where I first learned of the terms halos and ghosting, which I would become all too familiar with in subsequent years. Lastly, I had tried to switch from glasses to soft contact lenses roughly a year before my move and was not able to do it. I didn’t know it then but my left contact kept sliding off because of my enlarged cone. In retrospect, I still cannot fathom how my optometrist did not recognize the symptoms.

After a little research, I found a local optometrist who had experience with KC. He basically wanted to put me in RGP lenses and call it a day. This was a horrible experience and I will save everyone the gory details. Suffice it to say, I would stay in glasses until February of this year–nearly 7.5 years since my initial diagnosis.

Little by little I was becoming aware that my vision was getting worse. Night time driving was becoming near impossible, reading on the computer (which is a huge bulk of my job) was increasingly difficult and the photophobia was simply impossible to ignore–especially at stores and restaurants that used brutal florescent lighting. I did have tomography scans done yearly and thankfully the progression was slow, but it was still progression. Something had to change.

Vasquez family - emotional toll of keratoconus
Vasquez family at the beach

After leaving my optometrist for several philosophical reasons, I was able to find a group outside of my area, but still within driving distance, who were expert with patients with KC. It was there that I learned about scleral lenses and how they could be of benefit. My ophthalmologist and I also discussed cross-linking, but decided that since FDA approval is around the corner, we have the luxury of time to wait. However, he strongly encouraged me to switch to the scleral lenses.

I am ever thankful that he did. My life, in just a few short weeks, has been irrevocably changed. We are still working out the fine tuning, but the vision restored is unbelievable. I never thought I would see this well again. Overall, vision is 20/25 and I’ve also noted that my peripheral vision is back to normal. Also, and most thankfully, my night time vision and ability to drive safely have been restored. It is still unbelievable what these lenses have done for me and my overall quality of life.

There is the old cliché that you don’t know what you have until it is lost. I am still amazed how I didn’t truly realize how bad my vision had gotten until I got the sclerals. For those with KC and are on the fence as to how best to deal with it, please don’t hesitate to talk with your doctor to find the best solution for you.


Rene Vasquez - emotional toll of keratoconusRene Vasquez
Keratoconus Advocate

All Eyes Are Not Created Equal

Animals With Unique Eyes

Vision, while it is important to humans to carry out daily tasks, is a matter of life and death to animals in the wild. Predators need powerful, accurate vision to stalk their targets, while prey animals have developed a wide field of vision that is sensitive to movement, alerting them of danger. For each animal, their vision is a product of their environment and may have evolved over time. Here are some animals with unique eyes.
tasier - animals with unique eyes
The tarsier is a small mammal about the size of a squirrel with eyes that are the largest of any mammal relative to body size, and weighing more than its brain. For a human to have eyes in the same proportion to body size, our eyes would be the size of grapefruits! The other unusual thing about a tarsier’s eyes is that they do NOT rotate in the eye socket. The tarsier must use his very flexible neck to rotate his head 180 degrees to see around him. He has great night vision, but very poor color vision, which is common with most nocturnal animals.
owl - animals with unique eyes
Another animal with relatively large fixed eyes is the owl. He also has a layer of tissue in the eye called the tapetum lucidum. This tissue is commonly found in nocturnal animals and deep sea animals in the back of the eye immediately behind the retina. It reflects visible light back through the retina, increasing the light available to see. Also because the eyes are fixed, owls can rotate their heads up to 270 degrees in both directions and 90 degrees vertically to look around.
chameleon - animals with unique eyes
A chameleon’s eyelids are fused, covering almost the entire eyeball except for the pupil. What is more unique is that the eyes work independently of each other and the chameleon can process the completely different images at the same time. However, when the chameleon spots potential prey, it focuses both eyes in the same direction, using stereoscopic vision for precise distance and depth perception. They have a full 360 degree field of vision and can see ultraviolet light.
goat - animals with unique eyes
Goats, along with most other hooved animals, have horizontal rectangular pupils. These pupils give them a field of vision of 320-340 degrees. Because of the special shape and large size of these pupils, the goat is able to have more control on how much light enters the eye, so they can see more easily at night.
dragonfly - animals with unique eyes
Dragonflies have compound eyes that almost cover their heads and give them a full 360 degree filed of vision. The large part of their eyes is made up of 30,000 visual units called ommatidia (a cluster of light-sensing photoreceptor cells with a lens). dragonfly eyes - animals with unique eyesThis gives them very acute vision, even in low light. What makes their vision even more remarkable is that they also have three smaller eyes call ocelli which can detect movement faster than the larger eyes, sending the information to the dragonfly’s motor center allowing for spilt second reaction times.
leaf-tailed gecko - animals with unique eyes
One of the most unusual eyes is that of the leaf-tailed gecko. The pupils are vertical with a series of “pinholes” that widen at night, allowing as much light as possible into the eye. Since they also have a more photoreceptor cells than most animals, they have incredible night vision. The eyes also have a series of intricate eye patterns to help with camouflage since there is no eyelid. Their eyes are protected by a transparent membrane, which they clean with their tongues.
jaguar - animals with unique eyes
Cats such as lions, tigers jaguars and leopards have extremely sharp night vision due to the fact they have the tapetum lucidum reflective tissue and far more rods (the light sensors of the eye) than cones (the color sensors of the eye) in their eyes compared to humans. However, because of the reduced number of cones, they can only distinguish a very limited range of colors.
manits shrimp - animals with unique eyes
The mantis shrimp has compound eyes like the dragonfly but with only 10,000 ommatidia per eye. However, each row of ommatidia has a particular function – some are for detecting light, others for detecting colors, etc. Mantis shrimp (who are not actually shrimp) have remarkable color vision with 12 types of color receptors (humans have three) as well as ultraviolet, infrared and polarized light vision. This means they have the most complex eyesight of any animal. Each of the manits shrimp’s eyes sit at the end of stalks allowing them to move independently from each other and the ability to rotate up to 70 degrees. Finally, unlike humans, the visual information is processed by the eyes themselves instead of the brain.
colossal squid - animals with unique eyes
While the tarsier has the largest eyes relative to its size, the colossal squid has the largest eyes in the animal kingdom. Each of the colossal squid’s eyes can be as large as a foot in diameter. These exceptionally large eyes allow them to see well in dim light conditions, 2000 meters below the ocean surface. Also each eye has a built-in “flashlight” which can produce light so that whenever the squid focuses it eyes to the front, there is enough light for it to see its prey in the dark.

These are just a few of the animals with varied and unique vision. If you know of any others, please share them in the comments section below.


Susan DeRemerSusan DeRemer, CFRE
Vice President of Development
Discovery Eye Foundation

May Is Healthy Vision Month

May Is Healthy Vision Month

It’s Healthy Vision Month! Make Your Vision Last a Lifetime.

When it comes to our health, we often visit our doctor or nurse regularly to make sure our bodies are healthy. But what about our eyes? They’re not always top of mind, but they’re just as important.

During Healthy Vision Month, held each May, the National Eye Institute (NEI) reminds you to make your eye health a priority and encourages you to take important steps to protect your sight.
healthy vision month
Get a dilated eye exam. Getting a dilated eye exam is the only way to detect eye diseases early, because with many, there are no warning signs. Talk to your eye care professional about how often you should have one. If you want to see what your eye care professional sees during a dilated eye exam, check out NEI’s new eye exam animation!
Live a healthy lifestyle. Eating healthy foods, maintaining a healthy weight, managing chronic conditions, and not smoking can lower your risk of eye disease.
healthy vision month
Know your family history. Talk to your family members about their eye health history. It’s important to know if anyone has been diagnosed with an eye disease, since many are hereditary. This will help to determine if you are at higher risk for developing an eye disease yourself.
Use protective eyewear. Protect your eyes when doing chores around the house, playing sports, or on the job to prevent eye injuries from happening. This includes wearing safety glasses, goggles, safety shields, and eye guards that are made of polycarbonate.
Wear sunglasses. When purchasing sunglasses, look for ones that block out 99 to 100% of both UVA and UVB radiation, so you can keep your eyes healthy. Prolonged exposure to sunlight can increase your risk for getting an eye disease. A wide-brimmed hat offers great protection, too!

These steps can help you keep your eyes healthy and prevent vision loss and blindness from eye disease.

To learn more about Healthy Vision Month and find additional eye health information, visit


NEI LogoNational Eye Institute
National Institute of Health

The Future of Keratoconus

The National Keratoconus Foundation, a program of the Discovery Eye Foundation, has been serving the keratoconus (KC) community for over 27 years. They have been a leading source of information on KC, while also providing support and educational programs, such as the OC Keratoconus Seminar this Saturday, March 14th. One of the reasons for the timely, quality information they are able to share, are their relationships with leading eye care professionals around the world.
future of keratoconus
We are happy to report that a new professional organization for eye care professionals treating KC and other forms of corneal ectasia has been formed, the International Keratoconus Academy of Eye Care Professionals. It is our hope that we can join together in in providing accurate information on KC as well as find future treatments and cures, defining the future of keratoconus. Here is more information about the new organization.

Establishment of the International Keratoconus Academy of Eye Care Professionals

The International Keratoconus Academy of Eye Care Professionals (IKA) was recently established to promote ongoing professional education and scientific development in the area of keratoconus and other forms of corneal ectasia. Its mission is to promote and develop the knowledge base and awareness of the state of the art pertaining to the diagnosis and management of keratoconus and other forms of corneal ectasia. And further to promote the awareness and understanding of the most appropriate and effective treatment strategies for the management of these diseases. According to S. Barry Eiden, OD, FAAO, co-founder and president,” I.K.A. is dedicated to providing comprehensive education to the eye care professions and to foster ongoing clinical research in order to improve the lives of patients suffering from these diseases. “

I.K.A. will accomplish its mission by providing an array of educational initiatives which will include live events, web-based education, social media activities and publications in the professional literature. It will also be dedicated to supporting ongoing clinical research. I.K.A. will function as a complementary entity to other organizations that support patients with these diseases such as the National Keratoconus Foundation (NKCF). These organizations will work cooperatively to establish a comprehensive effort to advance knowledge, awareness and quality of care.

The founding executive board of the International Keratoconus Academy of Eye Care Professionals is comprised of a group of highly regarded experts in the field including:

  • S. Barry Eiden, OD, FAAO
  • Andrew Morgenstern, OD, FAAO
  • Timothy McMahon, OD, FAAO
  • Joseph Barr, OD, FAAO
  • William Tullo, OD, FAAO
  • Clark Chang, OD, FAAO
  • Eric Donnenfeld, MD
  • Yaron Rabinowitz, MD

An international physician’s advisory board comprised of expert optometrists and ophthalmologists is being formed. For more information or questions about IKA, please contact them at


Susan DeRemerSusan DeRemer
Vice President of Development
Discovery Eye Foundation

Happy Holidays!


On behalf of Discovery Eye Foundation, we would like to wish you the best this holiday season!
New Years 201
Because this is such a busy time of the year, we will not be posting to the blog, giving you more time to enjoy your family and friends.

We will resume posting on Tuesday, January 6th.

Susan DeRemerSusan DeRemer, CFRE
Vice President of Development
Discovery Eye Foundation

Charles Bonnet Syndrome – Fast Facts


“The theater of the mind could be generated by the machinery of the brain.”Older woman - Charles Bonnet Syndrome

What is Charles Bonnet Syndrome (CBS)?

  1. It was discovered in 1790 by Charles Bonnet.
  2. 10-40% of low vision individuals experience hallucinations.
  3. Only 1% of them acknowledge it!
  4. Images usually appear suddenly and stop as suddenly. They don’t fade in and out.
  5. Most of the time, the images are not people or things familiar to you.
  6. They may be startling, but they are not frightening or sinister.
  7. It is like watching a movie as the images don’t interact with you, unlike psychological images that interact with you and you with them.
  8. CBS usually stops within 12-18 months.

Why does it happen?

  1. Vision takes place in the brain.
  2. Different parts of the visual brain are triggered by different information. Faces fire up one part of the brain; buildings another and the scientists can see what activity is happening where.
  3. As you lose vision and the visual parts of the brain are not getting any input, they become hyperactive and excitable. This causes them to start to “fire” spontaneously.
  4. Example – If you damage (or lose vision) in a particular area, such as the one for faces, you lose the ability to recognize faces.  That will create abnormal activity in that area and you will hallucinate faces (*see more detailed explanation below).

What Can You Do?

  1. There is no cure or truly effective treatment.
  2. Acknowledge that you are having the visions and talk about them.
  3. Look on them as an experience rather than a problem. It’s fascinating how the brain works, isn’t it?
  4. Having a good sense of humor can help in adjusting well to CBS.
  5. Sometimes, eye exercises — such as looking from left to right without moving one’s head for 15 to 30 seconds — can help stop a hallucination.
  6. Increased room lighting can sometimes prevent an episode of CBS visions if they commonly take place in low light. Changing the lighting in the middle of an episode may stop them.
  7. Stress and fatigue could be contributing factors, so try to get enough rest and reduce stress.
  8. Identify and engage in activities you enjoy; keep up your social life. Reduced social isolation, boredom, lack of stimulation, and low activity seem to increase CBS.

For more information on Charles Bonnet Syndrome, please go to the Macular Degeneration Partnership website.

*Testing for functional brain imagery as individuals hallucinate can find different parts of the brain are activated.

Your brain has a particular area or lobe where vision is interpreted. The light energy that bounces off objects enters the eye and is converted to chemical energy by the retinal cells. That energy is sent through the optic nerve where processing of the vision starts to occur. When it reaches the visual cortex, it is sent to very specific areas of the brain and specific areas of the brain see specific things.

The fusiform gyrus processes faces, but different areas process the parts of faces. While damage in the fusiform gyrus causes you to lose the ability to recognize faces, abnormal activity in that area will  cause you to hallucinate faces. An area in the anterior part of this gyrus is where teeth and eyes are recognized. There are other areas that specifically sees cartoons and another part for buildings and landscapes.

Judi Delgado - age-related macular degenerationJudith Delgado
Executive Director
Macular Degeneration Partnership
A Program of Discovery Eye Foundation

Common Pediatric Eye Diseases


In the third of this series, Buddy Russell, from the Emory University Eye Center, provides a great overview of common pediatric eye diseases.

Some Conditions Frequently Seen in Pediatrics

A basic understanding of some of the conditions that may be present in pediatric patients is important to not only know what they are but also understand well enough to explain to the parent or caregiver. The following is intended to be an overview of some of those conditions and not a complete explanation.Girl with eye chart-common pediatric eye diseases

  1. Nystagmus – Nystagmus is a vision condition in which the eyes make repetitive, uncontrolled movements, often resulting in reduced vision. These involuntary eye movements can occur from side to side, up and down, or in a circular pattern. As a result, both eyes are unable to hold steady on objects being viewed. Unusual head positions and head nodding in an attempt to compensate for the condition may accompany nystagmus. Most individuals with nystagmus can reduce the severity of their uncontrolled eye movements and improve vision by positioning their eyes to look to one side. This is called the “null point” where the least amount of nystagmus is evident. To accomplish this they may need to adopt a specific head posture to make the best use of their vision. The direction of nystagmus is defined by the direction of its quick phase (e.g. a right-beating nystagmus is characterized by a rightward-moving quick phase, and a left-beating nystagmus by a leftward-moving quick phase). The oscillations may occur in the vertical, horizontal or torsional planes, or in any combination. The resulting nystagmus is often named as a gross description of the movement, e.g. downbeat nystagmus, upbeat nystagmus, seesaw nystagmus, periodic alternating nystagmus. Having nystagmus affects both vision and self-concept. Most people with nystagmus have some sort of vision limitations because the eyes continually sweep over what they are viewing, making it impossible to obtain a clear image. If a refractive error is found, contact lenses may be the most effective way of obtaining best-corrected vision.
  2. Strabismus – Strabismus is any misalignment of the eyes. It is estimated that 4% of the U.S. population has strabismus. Strabismus is most commonly described by the direction of the eye misalignment. Common types of strabismus are esotropia (turn in), exotropia (turn out), hypotropia (turn down), and hypertropia (turn up). Eye misalignment can cause amblyopia in children. When the eyes are oriented in different directions, the brain receives two different visual images. The brain will ignore the image from the misaligned eye to avoid double vision, resulting in poor vision development of that eye. Also, an eye that sees poorly tends to be misaligned. The goal of strabismus treatment is to improve eye alignment, which allows for better work together (binocular vision). Treatment may involve eyeglasses, contact lenses, eye exercises, prism, and / or eye muscle surgery.
  3. Amblyopia – Amblyopia, sometimes called a “lazy eye,” occurs when one or both eyes do not develop normal vision during early childhood. Babies are not born with 20/20 vision in each eye but must develop it between birth and 6-9 years of age by using each eye regularly with an identical focused image falling on the retina of each eye. If this does not occur in one or both eyes, vision will not develop properly. Instead, vision will be reduced and the affected eye(s) are said to be amblyopic. This common condition, affecting up to 4% of all children, should be diagnosed and treated during infancy or early childhood to obtain optimum three-dimensional vision and to prevent permanent vision loss. What causes amblyopia?
      • Misaligned eyes (strabismus)
        Misaligned eyes are the most common cause of amblyopia. When both eyes are not aimed in exactly the same direction, the developing brain “turns off” the image from the misaligned eye to avoid double vision and the child uses only the better eye — the dominant eye. If this persists for a period even as short as a few weeks, the eye will not connect properly to the visual cortex of the brain and amblyopia will result.
      • Unequal refractive error (anisometropia)
        Unequal refractive error is an eye condition in which each eye has a different refractive error and therefore both eyes cannot be in focus at the same time. Amblyopia occurs when one eye (usually the eye with the greater refractive error) is out of focus because it is more nearsighted, farsighted or astigmatic than the other. Again, the brain “turns off” the image from the less focused eye and this eye will not develop normal vision. Because the eyes often look normal, this can be the most difficult type of amblyopia to detect and requires careful vision screening of acuity measurements at an early age. Treatment with glasses or contact lenses to correct the refractive error of both eyes, sometimes with part-time patching of the better seeing eye, is necessary in early childhood to correct the problem.
      • Obstruction of or cloudiness (deprivation)
        Obstruction of or cloudiness in the normally clear eye tissues may also lead to amblyopia. Any disorder that prevents a clear image from being focused can block the formation of a clear image on the retina and lead to the development of amblyopia in a child. This often results in the most severe form of amblyopia. Examples of disorders that can interfere with getting a clear image on the retina are a cataract or cloudy lens inside the eye, a cloudy and or irregular shaped cornea, or a droopy upper eyelid (ptosis) or eyelid tumor.It is not easy to recognize amblyopia. A child may not be aware of having one normal eye and one with reduced vision. Unless the child has a misaligned eye or other obvious external abnormality, there is often no way for parents to tell that something is wrong. In addition, it is difficult to measure vision in very young children at an age in which treatment is most effective.To treat amblyopia, a child and their caregiver must be encouraged to use the weaker eye. This is usually accomplished by patching the stronger eye. This covering of the stronger eye with an adhesive patch, an cclude contact lens or temporary surgery often proves to be a frustrating and difficult therapy. Patching will often continue for weeks, months, or even years in order to restore normal or near normal vision and maintain the improvement in the amblyopic eye. Occasionally, blurring the vision in the good eye with eye drops or lenses to force the child to use the amblyopic eye treats amblyopia. In some cases, cataract surgery or glaucoma surgery might be necessary to treat form deprivation amblyopia. Patching may be required after surgery to improve vision, and glasses or contact lenses may be required to restore appropriate focusing.Surprising results from a nationwide clinical trial in 2005 show that many children age seven through 17 with amblyopia may benefit from treatments that are more commonly used on younger children.
        Treatment improved the vision of many of the 507 older children with amblyopia studied at 49 eye centers. Previously, eye care professionals often thought that treating amblyopia in older children would be of little benefit. The study results, funded by the National Eye Institute (NEI), appear in the April issue of Archives of Ophthalmology.
  4. Congenital Cataract – A congenital cataract, or clouding of the crystalline lens is present in 2-3 per 10,000 live births of children. The presence of a visually significant cataract in a child is considered an urgent disorder. The resultant form deprivation of vision requires immediate surgery to remove the obstruction, prompt optical correction and amblyopia therapy in unilateral cases. Until the 1970s, it was generally believed that there was no means of restoring the vision in an eye with a unilateral congenital cataract. However, subsequent studies demonstrated that excellent visual results could be obtained with early surgical treatment coupled with optical correction with a contact lens and patching therapy of the fellow eye. However, treatment results continue to be poor in some infants with unilateral congenital cataracts due to a delay in treatment or poor compliance with contact lens wear or patching therapy of the fellow eye. The Infant Aphakia Treatment Study (IATS) was designed to compare the visual outcomes in children 1 to 6 months of age with a unilateral congenital cataract randomized to optical aphakic correction with contact lenses or an intraocular lens (IOL). Children randomized to IOL treatment had their residual refractive error corrected with spectacles. Children randomized to no IOL had their aphakia treated with a contact lens. In previous publications we have shown that the visual results are comparable for these two treatments at 1 year of age, but significantly more of the infants randomized to IOL implantation required additional intraocular surgeries.
  5. Accommodative Esotropia – Accommodative esotropia refers to a crossing of the eyes caused by farsightedness. Accommodative esotropia is a type of strabismus. Children who are farsighted easily and automatically focus on objects at distance and near through accommodation. As a result, a child who is farsighted usually does not have blurred vision. However, in some children who are farsighted, this accommodative effort is associated with a reflex crossing of the eyes. Accommodative esotropia can begin anywhere from 4 months to 6 years of age. The usual age of onset is between 2 and 3 years of age.Full-time use of the appropriate hyperopic glasses prescription or contact lenses will often control the esotropia. When wearing the correction, the child will not need to accommodate and hence the associated eye-crossing reflex will disappear. However, after removing the prescribed correction, the crossing will reappear, perhaps even more than before the child began wearing the correction. Sometimes the correction will only cause the crossing to disappear when the child views a distant object. However, when gazing at near objects, crossing may persist despite the use of the correction. In these circumstances, a bifocal lens is often prescribed to permit the child to have straight eyes at all viewing distances. One potential advantage of contact lenses compared to spectacles when correcting hyperopic powers is the decrease in accommodative demand. The increased effort to converge the eyes with spectacles requires one to over come the resultant base out prism when viewing a near object.


Buddy Russell - pediatric contact lensesBuddy Russell, FCLSA, COMT
Associate, Specialty Contact Lens Service
Emory University Eye Center

Treatment Options For Children


Here is part two in Buddy Russell’s series; this one focusing on contact lenses as a treatment option for children.

We Are Not Born With Good Vision

The human visual system at birth is poorly developed, but rapidly becomes the remarkable combination of nerve tissue, muscles and optics that provide us with the sense of vision. Those babies born with “perfect” eyes have only the opportunity to develop normal vision. The information processed by the eyes is sent directly to the brain and is interpreted as vision.Toddler looking through glasses - treatment options for children During the first few weeks, the child sees shapes, lines and space between objects. The child’s visible world is most usable within 8-14 inches of his/her eyes. During this time, the eyes may appear to wander. After about a month or so, the normal child’s eyes will appear more coordinated and they start to show more interest in looking at objects. It is usually in the third month that a child who has normal eyes can fix and follow on a near object. The growth of the eye is a dynamic process, influenced by genetics and the environment.
Early detection of any eye problem is key to treating the disorder. The prevalence of vision problems in children is higher than you might think. For example:

  • 1 in 10 children are at risk from undiagnosed vision problems
  • 1 in 25 will develop strabismus
  • 1 in 30 will be affected by amblyopia
  • 1 in 33 will show significant refractive error
  • 1 in 100 will exhibit evidence of eye disease
  • 1 in 20,000 children have retinoblastoma

As a result of his granddaughter and her eye problem, former President Jimmy Carter initiated a program in 2002 called InfantSEE. This program allows children to have an eye exam at a very young age at no charge to the family. Participating eye doctors provide a more thorough exam than the busy pediatrician. As a result, there is a greater opportunity to detect and treat eye disorders that may otherwise go undetected.

“Have to” Contact Lenses

Fitting pediatric patients is not usually about routine visits and patients who want to wear contact lenses. It is about critical and often urgent situations and patients who have to wear contact lenses. The more common medical indications for contact lenses can be categorized into three groups; anisometropia, irregular corneal astigmatism and “large” refractive errors.


One of the more common conditions potentially leading to a permanent loss of vision in a young patient is anisometropia. This difference in the refractive errors of the two eyes can lead to suppression of the less clear image. As a result of the non-focused eye, the brain of a young patient simply turns off the blurred eye. Early detection is key to successful treatment. Following the diagnosis of this problem being present, simply correcting the refractive error may be enough. However, it has been reported that as little as one diopter difference between the two eyes corrected with spectacles and the resultant anisokonia, can lead to foveal suppression impacting stereopsis and depth perception. The use of a contact lens or contact lenses alters the effective image size due to the vertex distance being zero compared to either the magnification or minification of the image size due to the vertex distance with spectacles. One of the most severe examples of this condition would be a child with a unilateral congenital cataract and managed with spectacles postoperatively.

Irregular Corneal Astigmatism

Whether acquired or congenital, the presence of irregular corneal astigmatism of the anterior curve of the cornea is best managed with a contact lens. This condition is to be considered urgent if the patient is of a young age. The eye may forever loose the opportunity to be corrected as the resultant amblyopia develops over a short period of time. By neutralizing the corneal irregularities with a contact lens, the eye of a young child will hopefully gain enough vision improvement to avoid the potential permanent loss.
Obviously, patching the better eye may also be necessary if the treated eye’s vision is not as correctable as the unaffected eye. The length of time the child is to be patched is to be determined by the pediatric ophthalmologist or optometrist, as this area of treatment is sometimes controversial. The factors that are considered include the level of vision obtained, age of the child and the condition of the other eye.

Large Refractive Errors

The optics of spectacle correction in high powers have inherent properties that include distortion, prismatic effect and minification / magnification. For instance, the decrease in image size when one views an object through high minus spectacles may result in less vision. This decrease in image size may impact the opportunity to fully develop normal vision in a young child. The smaller image size that is due to the vertex distance of spectacles may be better managed with a contact lens that has a vertex distance of zero thus providing a larger image. This larger image size often increases best-corrected vision.

“Fitting” the Caregiver

Arguably, the most important factor with young children having a good outcome is the parents / caregivers. The technical challenges that exist in these cases are secondary to the ability the fitter must possess to effectively explain and train the person or persons that will take care of the child outside of the office. They must be your partner in the child’s treatment. They must understand the urgency of the situation, they must understand the seriousness of the problem, they must be trained to properly apply, remove and care for the lens / lenses, they must also follow any and all instructions concerning the child. Many of these parents struggle with feelings of nervousness, guilt and sadness. My strategy is to be sensitive to their feelings but not let them feel sorry for themselves too long as the clock is ticking. I provide verbal instructions, written instructions, videos, my email address and a 24-hour phone number. I welcome the caregiver to ask any question at any time. I do my best to let them know that I do care and that I want them and their child to be successful. I am tough on them. There is no good excuse not to do as I have instructed them to do.

When the child and the parent / caregiver are convinced that I am confident in my ability and they know that I do care, the partnership develops as we walk the path together. I want the child to know that they are coming to see me. I want them to know I will reward their cooperation with all phases of the visit. This positive reinforcement may be in the form of a piece of candy, a small toy or just a sticker when the child allows me to see their eye, measure their cornea or intraocular pressure or they just tell me what they can see. Kids love to please us just like they love to please their parents. Reward them for it. Whether you consider this approach bribery or positive reinforcement, it works.

Buddy Russell - pediatric contact lensesBuddy Russell, FCLSA, COMT
Associate, Specialty Contact Lens Service
Emory University Eye Center

Ways to Reduce the Harmful Effects of Sun Glare

During the height of summer sunshine (and heat!), it’s helpful to discuss the importance of eye protection, including ways to reduce the harmful effects of sun glare.

Fundamentally, we need light to see. Approximately 80% of all information we take in is received through the sense of sight. However, too much light – and the wrong kind of light – can create glare, which can affect our ability to take in information, analyze it, and make sense of our surroundings.

Facts about Sunlight

Every type of light has advantages and disadvantages, and sunlight is no exception:


• Sunlight is the best, most natural light for most daily living needs.
• Sunlight is continuous and full-spectrum: the sun’s energy at all wavelengths is equal and it contains all wavelengths of light (explained below).


• It is difficult to control the brightness and intensity of sunlight.
• Sunlight can create glare, which can be problematic for many people who have low vision.
• Sunlight is not always consistent or reliable, such as on cloudy or overcast days.

Visible Light and Light Rays

An important factor to consider is the measurement of visible light and light rays, beginning with the definition of a nanometer:

• A nanometer (nm) is the measurement of a wavelength of light.
• A wavelength is the distance between two successive wave crests or troughs:

Wavelength - glare

• A nanometer = 1/1,000,000,000 of a meter, or one-billionth of a meter. It’s very small!

The human visual system is not uniformly sensitive to all light rays. Visible light rays range from 400 nm (shorter, higher-energy wavelengths) ? 700 nm (longer, lower-energy wavelengths).
Visible Light Spectrum - glare
The visible light spectrum occupies just one portion of the electromagnetic spectrum, however:

• Below blue-violet (400 nm and below), is ultraviolet (UV) light.
• Above red (700 nm and above), is infrared (IR) light.
• Neither UV nor IR light is visible to the human eye.

Ultraviolet Light and Blue Light

Ultraviolet (UV) light has several components:

• Ultraviolet A, or UVA (320 nm to 400 nm): UVA rays age us.
• Ultraviolet B, or UVB (290 nm to 320 nm): UVB rays burn us.
• Ultraviolet C, or UVC (100 nm to 290 nm): UVC rays are filtered by the atmosphere before they reach us.

Blue light rays (400 nm to 470 nm) are adjacent to the invisible band of UV light rays:

• There is increasing evidence that blue light is harmful to the eye and can amplify damage to retinal cells.
• You can read more about the effects of blue light at Artificial Lighting and the Blue Light Hazard at Prevent Blindness.

A new study from the National Eye Institute confirms that sunlight can increase the risk of cataracts and establishes a link between ultraviolet (UV) rays and oxidative stress, the harmful chemical reactions that occur when cells consume oxygen and other fuels to produce energy.

Sunlight and Glare

Glare is light that does not help to create a clear image on the retina; instead, it has an adverse effect on visual comfort and clarity. Glare is sunlight that hinders instead of helps. There are two primary types of glare.

Disability glare

• Disability (or veiling) glare is sunlight that interferes with the clarity of a visual image and reduces contrast.
• Sources of disability glare include reflective surfaces (chrome fixtures, computer monitors, highly polished floors) and windows that are not covered with curtains or shades.

Discomfort glare

• Discomfort glare is sunlight that causes headaches and eye pain. It does not interfere with the clarity of a visual image.
• Sources of disability glare include the morning and evening positions of the sun; snow and ice; and large bodies of water, (including swimming pools).

Controlling Glare

You can protect your eyes from harmful sunlight and minimize the effects of glare by using a brimmed hat or visor in combination with absorptive lenses.

• Absorptive lenses are sunglasses that filter out ultraviolet and infrared light, reduce glare, and increase contrast. They are recommended for people who have low vision and are also helpful for people with regular vision.
• Lens colors include yellow, pink, plum, amber, green, gray, and brown. Ultra-dark lenses are not the only choice for sun protection.
• Lens tints in yellow or amber are recommended for controlling blue light.
NoIR Medical Technologies: NoIR (No Infra-Red) filters absorb UVA/UVB radiation and also offer IR light protection.
Solar Shields: Solar Shields absorb UVA/UVB radiation and are available in prescription lenses.
• You can find absorptive lenses at a specialty products store, an “aids and appliances store” at an agency for the visually impaired, or a low vision practice in your area. Before you purchase, it’s always best to try on several different tints and styles to determine what works best for you.

More Recommendations

• Always wear sunglasses outside, and make sure they conform to current UVA/UVB standards.
• Be aware that UV and blue light are still present even when it is cloudy or overcast.
• Make sure that children and older family members are always protected with UVA/UVB-blocking sunglasses and brimmed hats or visors.

Maureen Duffy-editedMaureen A. Duffy, CVRT
Social Media Specialist,
Associate Editor, Journal of Visual Impairment & Blindness
Adjunct Faculty, Salus University/College of Education and Rehabilitation