Online Eye Exams?

Do you save time and money getting an online eye exam?   What is the cost of a “do-it-yourself” eye exam?  Wouldn’t it be nice to just check your vision and get your prescription on your computer at home?   It sure beats the commute, waiting in a doctor’s office, and taking time off from work.  Yet so much can be missed with an online eye exam.   Did you know that vision and life threatening conditions can first be found on a physical eye examination?   Did you know that you can have 20/20 vision, but have a serious eye disease?   Early intervention and treatment can save you time and money later, as well as preserve your eyesight.   And what could be more precious than your eyesight?

Indeed, technology is a powerful tool in medicine and telemedicine certainly has the potential to greatly improve our quality of life and access to health care.   However, the risk with all telemedicine is “cut-rate,” substandard professional services.  All physicians are required to put  the welfare and health of patients first   An online eye exam is only a part of a comprehensive eye examination and is certainly not an eye health exam.  Many eye diseases have no symptoms, but early intervention can prevent permanent eye damage and blindness.

Here are some of my cases over the years, with contributions from others!   Many times, despite 20/20-20/25 vision, a serious eye and/or medical condition is found during the comprehensive eye examination.  It would have been missed during an online eye exam!   A comprehensive eye exam includes an evaluation of the back of your eye, which includes your retina and optic nerve.  Any damage to these structures of your eye may cause permanent vision loss.   The back of your eye can be examined in 2 ways:  1:  dilation of your eye.    2.  A retinal imaging device, such as the Optos.   However, if anything suspicious is observed on the Optos, a dilation is still recommended.



“Can Glasses Help Me?”

CNVMUnfortunately, my answer to this patient was “no.”   This is wet macular degeneration that I had to send for Avastin treatment by a retinal specialist.

There are two basic types of macular degeneration: “wet” and “dry.” Approximately 10-15% of the cases of macular degeneration are the “wet” (exudative) type.

In the “wet” type of macular degeneration, abnormal blood vessels (known as choroidal neovascularization or CNV) grow under the retina and macula. These new blood vessels may then bleed and leak fluid, causing the macula to bulge or lift up from its normally flat position, thus distorting or destroying central vision. Under these circumstances, vision loss may be rapid and severe.

A Freckle in Your Eye

You know about freckles on your skin, but did you know you can have a freckle in your eye?   It can only be found on a dilated eye exam.  And it must be carefully monitored for any changes.


What Shiny Yellow Spots Can Mean

By Dr. Yvonne Alomia

liverfailureRecently, I saw a 16 year old girl for a routine eye examination.  Last exam had been 2-3 years ago.   Her medical history was negative for everything.  Picture of her right eye’s retina is above.   Blood work by primary care physician shows she has HIGH LIVER ENZYMES but they don’t know why.    The shiny, yellow spots in the retina are called hard exudates. They are the lipid residues of serous leakage from damaged capillaries.   Causes are diabetes, retinal vein occlusion, angiomas (Von Hippel-Lindau Disease), other vascular dysplasias, and radiation-induced retinal vasculopathy.

More common causes of elevated liver enzymes include:

  1. Certain prescription medications, including statin drugs used to control cholesterol
  2. Drinking alcohol
  3. Heart failure
  4. Hepatitis A
  5. Hepatitis B
  6. Hepatitis C
  7. Nonalcoholic fatty liver disease
  8. Obesity
  9. Over-the-counter pain medications, including acetaminophen (Tylenol, others)

When Glaucoma Causes Devastating Vision Loss

by Dr. Luu


Glaucoma Research Foundation

I had a new 30 year old patient come in for an eye exam.   There were no complaints reported and vision was 20/20 in both eyes.   The patient reported that vision had always been clear.   Intraocular pressures were measured 30mm Hg in both eyes, which is higher than normal.  Dilated eye exam revealed damaged optic nerves in both eyes.   Peripheral vision testing showed significant vision loss due to end stage glaucoma.


Mr. Gareth T Higgins, Consultant Ophthalmic Surgeon

Visual loss from glaucoma results from characteristic deterioration of the optic nerve leading to progressive loss of the field of vision. At least 3 million Americans suffer from glaucoma. Glaucoma is one of the leading causes of adult blindness, and it is also the leading cause of preventable blindness. Most people who go blind from glaucoma are blind in at least one eye at the time of original detection, which points to the need for better early diagnosis. Because glaucoma usually does not manifest any symptoms until extensive peripheral visual loss becomes apparent in the final stages of the disease, it is often likened to the “sneak thief of sight.” Unlike most eye diseases, most varieties of glaucoma are chronic, virtually lifelong disorders than can be controlled but not cured. Like diabetes, high blood pressure, asthma, or arthritis, glaucoma requires some modification in lifestyle, such as compliance with medical regimens, regular physician visits, and acknowledgment of the disease to achieve successful treatment.  READ MORE

When Contact Lenses Cause Inflammation

infiltrateSometimes contact lenses can cause inflammation of the cornea, with an accompanying bacterial infection.  The white dot shown on the cornea above is an infiltrate, caused by bacterial inflammation.  Symptoms can range from mild discomfort, feeling like there’s something in your eye, tearing, and redness, to severe pain, light sensitivity, and decreased vision.  Corneal infiltrates must be treated right away to prevent corneal ulceration, which results in permanent scarring and vision loss.   Proper care of contact lenses is very important for the health of your eyes.

When the Retina Detaches

by Dr. Lisa Shin

I recently saw a 39 year old lady for an eye examination.  She had no medical or eye conditions, but reported a “black spot” on her right eye, that had started 6 months prior to the exam.   She also described a “floater” in her left eye, which had been persistent for about 1 year.    Uncorrected vision was 20/30 in her right eye and 20/25 in her left eye.   Corrected vision was 20/20 in both eyes.   Dilated eye examination revealed a retinal detachment with retinal holes in her right eye and retinal holes in her left eye.    Prompt referral to the retinal surgeon for laser treatment in both eyes, prevented further damage and vision loss.

A retinal detachment is considered an emergency where your retina pulls away from the layer of the eye that nourishes it.    The longer a retinal detachment goes untreated, the greater the risk of permanent vision loss.

Note the whitish sheen over the left half of the retinal photo.  This is the part of the retina that has detached.

Note the whitish sheen over the left half of the retinal photo. This is the part of the retina that has detached.

When You are at Risk for Glaucoma

by Dr. James Sanderson

I saw a healthy, white, 36 year old female in my office for a routine eye examination.   Her vision was 20/20 in both eyes, with no need for glasses.   Her intraocular pressures measured 32 mm Hg OD and 28 mm Hg OS.   With elevated pressures inside her eye, she needed additional testing and more frequent examination since she is at higher risk for glaucoma.

Glaucoma is the second most common cause of blindness in the United States.   Glaucoma has few symptoms until there’s permanent damage.   Regular eye health exams are the key to detecting glaucoma early enough to successfully diagnose, treat your condition, and prevent further progression of your condition.

A small bleed on the optic nerve pictured here is a sign of trouble.   Damage due to glaucoma is likely.  Treatment and intervention is necessary to prevent this damage.

A small bleed on the optic nerve pictured here is a sign of trouble. Damage due to glaucoma is likely. Treatment and intervention is necessary to prevent this damage.


When Contact Lenses Harm Your Eyes

Q:   How can contact lens wear be a risk?

A:  Contact lenses are considered a medical device, which can put you at risk for serious eye infections 

Q:  Why does a contact lens prescription have a specified expiration date?

A:  Because the doctor must evaluate the health of your eye, to make sure that contact lens wear is safe for you.  If your eye health is being compromised by contact lens wear, then the doctor can’t give you the prescription or must set the expiration date accordingly.

Q:  How would the health of my eyes be compromised?

A:  If your eye doesn’t breathe properly due to the contact lens, blood vessels can grow onto the cornea.  Other complications are alternations in your corneal cells, inflammation of the cornea, thinning of the cornea, and reduced corneal sensitivity.  With any of these problems, you must discontinue or decrease contact lens wear.   The doctor may find another contact lens that will minimize these complications.   Eventually, these problems can lead to contact lens intolerance, where you will not be able to wear your contact lenses any longer.

Q:   How can I know if my eyes are being compromised by contact lens wear?

A:  By a physical examination of your eyes.   Just because you are an established contact lens wearer or do not have symptoms does not mean contact lenses are safe to wear!   And a “selfie” of your eye is not enough to determine whether your eye health is being compromised by contact lens wear.

when your eye has an allergic reaction to the contact lenses

when your eye has an allergic reaction to the contact lenses

Bausch & Lomb:   inflammation of the cornea

Bausch & Lomb: inflammation of the cornea

complications due to contact lens wear

blood vessels growing onto the cornea

A Diagnosis of Anemia

by Dr. Karl Stoler

26 year old woman came in for an eye exam.   She reported blurry vision for the past few weeks, but her best corrected visual acuities were 20/25 in both eyes.   Dilation of the eyes revealed hemorrhages in both eyes, with exudates (which occur with leakage from damaged blood vessels).    She was referred to the retinal specialist, who then sent her to the primary care physician.   She was diagnosed with severe anemia. 

Anemia is a condition in which your blood lacks enough healthy red blood cells.   Cells in your body don’t get enough oxygen and your organs won’t get what they need to function properly.   Severe or long-lasting anemia can damage your heart, brain, and other organs in your body.  Symptoms include shortness of breath, dizziness, or headaches.     Treatment for anemia depends on the underlying cause.   Anemia caused by iron deficiency is treated with iron supplements.

American Academy of Ophthalmology: retinal hemorrhages due to anemia

A Softball Size Frontal Lobe Meningioma

by Dr. Karl Stoler

A 18 year old man came to my office because he needed new glasses for night driving.   His visual acuities were 20/20 in both eyes.   Peripheral vision test showed problems, and his optic nerves appeared slightly swollen.    He was referred to a ophthalmologist.    MRI of his head showed a frontal lobe meningioma, the size of a softball.

Meningiomas are the most common benign brain tumor and treatment is usually surgical removal.   Early detection and treatment offers the highest chance of recovery.

Frontal Lobe of Brain

Eye Cancer by Dr. Douglas Haigh


I saw a 32 year old female for her first eye exam.  She had no complaints and her vision was 20/20 in both eyes.  She was seen on the mobile clinic because she “never had time for an eye exam.”  She presented with a chief complaint of “nothing, I can see fine, I just wanted to do it today because I have insurance and it’s convenient.”   A closer look at her retina revealed a freckle, which turned out to be an early choroidal melanoma (eye cancer).  I asked the patient if she happened to have a family history of skin cancer. She replied, “Yes, and breast cancer.”

Most choroidal melanoma patients have no symptoms and the melanoma is found on a routine eye examination.   Choroidal melanoma can be seen by ophthalmoscopy (when your eye doctor looks through a lens into your dilated pupil).  Similar to like-sized melanoma of the skin, patients are much more likely to survive a choroidal melanoma. This is because it is much more difficult for a choroidal melanoma to spread from the eye to other parts of the body. However, large tumor size increases the risk of permanent vision loss.  In general, the larger the choroidal melanoma the worse the prognosis for both vision and metastasis (spreading to other areas).

A Blood Clot

by Dr. Lisa Shin

A 20 year old man in good health, taking no medications, came in for an eye exam, with a complaint of “a spot of light.”    Vision without correction was 20/20, in both eyes.   Dilated exam revealed a bleed on his optic nerve, pictured below.    He was referred to his primary care physician for further examination and blood work.  He was diagnosed with hypercoagulation, which is excessive blood clotting.  This can be very dangerous as blood clots can travel to the arteries or veins in the brain, heart, kidneys, lungs and limbs, which in turn can cause heart attack, stroke, damage to the body’s organs or even death.   Patient was educated on risks and benefits of taking Plavix, a blood thinning medication.  2014-07-07_22-33-30

When You’re 18 Years Old, with a Whole Life Ahead…

by Dr. Lisa Shin

Early in my career, I saw a 18 year old man who came in for an eye exam because he needed more contact lenses.  His vision was 20/20 in both eyes, with no change in contact lens prescription.   I dilated his eyes, which means the pupils are enlarged to look at the retina.   Thebitemporalhemianopia appearance of his optic nerve prompted me to recommend a peripheral vision test.    This test showed peripheral vision loss indicating a much more serious condition.    An MRI was ordered and a pituitary tumor was diagnosed.   Pituitary tumors press on the optic nerve in your brain.  The next day, the neurosurgeon performed surgery to remove the tumor, which was so large that it was a complicated, risky surgery.   Thankfully, Petty survived the surgery and his peripheral vision slowly came back.   Pituitary tumors can not only impact your vision, they can cause permanent hormone deficiency and diabetes mellitus.    A rare complication of a pituitary tumor is sudden bleeding into the tumor, which can cause serious neurological impairments.


What his peripheral vision test revealed


University of Florida Health:  Surgical removal of pituitary tumor

University of Florida Health: Surgical removal of pituitary tumor

A Retinal Hole

Recently, a 32 year old patient came in for an eye examination with no vision complaints or systemic conditions.  She was interested in being evaluated for Lasik.   Best corrected visual acuities were 20/20 in both eyes.   I dilated the eyes for a full view of the retina and found retinal holes with underlying fluid.  I referred her to the retinal specialist. Prompt treatment, with laser prevented severe vision loss.   The retinal specialist is monitoring her other eye, which also has retinal holes but do not require immediate treatment.    He also recommended waiting on Lasik and reviewed precautions for retinal detachment after Lasik.

This patient suffered from a severe retinal detachment and macular hole, and has permanent vision loss.