Vision Library


Vision Library

Dry Eyes

The increasing number of older individuals in the population is bringing about a higher prevalence of symptomatic, age-related eye problems, including ocular surface disease. Its most common presentation is tear-deficient dry eye. The normal secretion and distribution of tears is essential for clear and comfortable vision. The tear film forms a smooth surface over the optically uneven corneal surface, provides lubrication for eyelid movement, acts as nutrient vehicle for ocular surface metabolites, dilutes irritants, flushes away debris, provides antibacterial activity and transports white blood cells to help heal corneal injuries. These complex and interrelated functions are dependent upon the continuous production of tear components, their segregation into a multi-layered film over ocular surface and frequent blinking to remove and resurface that tear film.

Dry eyes, or a disruption in the tear film, can be caused by a number of factors such as autoimmune conditions, connective tissue disease like rheumatoid arthritis, medications, inflammation, chemical burns, and scarring after eyelid injury to name a few. The most common type of dry eyes will occur in both eyes during the fifth decade of life, particularly in women.

The most common symptoms of dry eye include burning, itching, and a feeling of some foreign substance in the eye like a grain of sand. Severe dry eye can also be accompanied by light sensitivity, redness, and uncontrollable tearing. These symptoms can be both irritating and sometimes debilitating.

Dry eye symptoms can also mimic a myriad of other eye conditions and determining the underlying cause of any symptoms is critical to an effective treatment. Once the diagnosis of the specific type of dry eye has been made, many treatment plans are available.

Think of our eyes as a faucet and drainage unit. Dry eyes can be treated by using artificial tears to augment natural tears and by using good lid hygiene. You can use a warm compress to keep tear glands open and clean, thereby opening the faucet. In addition, the drainage unit of the eye can be plugged utilizing a piece of collagen or plastic carefully placed in the drainage canal of the eye, called the puncta, to impede the eye’s outflow of tears.

Punctal plugs is a viable treatment option when lid hygiene and artificial tears do not relieve symptoms. The procedure involves a topical anesthetic to the eye similar to that used prior to measuring for eye pressure in the glaucoma test. After the eye is numb the small plug in inserted with great care into the tiny puncta. The entire procedure usually takes about 15 minutes. Different types of punctal plugs are available. Some dissolve in the eye after 3 to 5 days while others can be more permanent yet still reversible.

Dry eyes is a condition that probably has affected all of us at one time. As we age it can become chronic and in severe cases sight-threatening. Thankfully there are treatment options available to help manage the symptoms and effects of dry eyes.

Diabetic Eye Disease


King County, WA–People who have had diabetes for several years are at risk of developing a potentially blinding condition called diabetic retinopathy and need to take steps to protect their vision.

In Washington state alone, over 350,000 people have diabetes, according to the American Diabetes Association of Eastern Washington. The Association also says that diabetes is the leading cause of blindness in adults between 20 and 74 years old.

Over time, diabetes can weaken and cause changes in the small blood vessels that nourish the retina. The retina is the delicate lining at the back of the eye containing the light-sensitive nerve cells needed for seeing. When these blood vessels begin to leak, develop brush-like branches or become enlarged, the condition is called diabetic retinopathy. While vision can be affected in many different ways, changes include blurred central or side vision, a blind spot in the center of vision, cloudy or hazy vision, or seeing floaters.

“Unfortunately, a patient can develop the most severe eye complications from diabetes and have no symptoms,” says Paul Chous, O.D., of the King County Society of Optometric Physicians. This is why the King County Society recommends a thorough, yearly eye health and vision examination for people with diabetes. Your family eye doctor can diagnose diabetic retinopathy in its earliest stages, when treatment is most effective, by looking inside the eye with an instrument that allows direct viewing of the blood vessels that nourish the retina.

Those who have recently been diagnosed with diabetes may also have an increased risk for diabetic retinopathy if they: have fluctuating blood sugar levels;

  • are pregnant
  • have high blood pressure;
  • or smoke.

The good news is that early diagnosis of the disease combined with a proper diet, exercise, yearly dilated eye exams, and careful blood sugar control, will allow your eye doctor to minimize the risk of severe loss of vision,” says Dr. Chous. “The formula for disaster is just the opposite.”


Spots (often called floaters) are small, semi-transparent or cloudy specks or particles within the vitreous, the clear, jelly-like fluid that fills the inside of your eyes. They appear as specks of various shapes and sizes, threadlike strands or cobwebs. Since they are within your eyes, they move as your eyes move and seem to dart away when you try to look at them directly.

Spots are often caused by small flecks of protein or other matter trapped during the formation of your eyes before birth. They can also result from deterioration of the vitreous fluid, due to aging, or from certain eye diseases or injuries.

Most spots are not harmful and rarely limit vision. By looking in your eyes with special instruments, it can be determined if what you are seeing is harmless or the symptoms of a more serious problem that requires treatment.

Most people may notice spots at one time or another. They usually pose an annoyance but should not be ignored if you notice a sudden change or increase in your spots. Because these changes can be indications of more serious problems, you should be seen for a comprehensive eye examination. This examination often includes a dilated fundus (back of the eye) exam in which drops are instilled into the eyes to temporarily enlarge the pupil size.

Infant’s Vision: Learning To See

Your baby has a whole lifetime to see and learn. But, did you know your baby also has to learn to see? As a parent, there are many things you can do to help your baby’s vision develop. First, proper prenatal care and nutrition can help your baby’s eyes develop even before birth. At birth, you baby’s eyes should be examined for signs of congenital eye problems. These are rare, but early diagnosis and treatment are important to your child’s development.

Certain tests can be performed, even in infancy, to determine if your baby has excessive or unequal amounts of near-sightedness, farsightedness, or astigmatism. Other tests would be performed to look at eye movement ability and eye health problems. These problems are not common, but it is important to identify children who have them at this stage. Vision development and eye health problems can be more easily corrected if treatment is begun early.

Between birth and age three, when many of your baby’s vision skills will develop, there are ways that you can help.

During the first four months of life, your baby should begin to follow moving objects with the eyes and reach for things, first by chance and later more accurately, as hand-eye coordination and depth perception begin to develop.

To help, use a nightlight or other dim lamps in your baby’s room; change the crib’s position frequently and your child’s position in it; keep reach-and-touch toys within your baby’s focus, about eight to twelve inches; talk to your baby as you walk around the room; alternate right and let sides with each feeding; and hang a mobile above the crib.

Between four and eight months, your baby should begin to turn from side to side and use his or her arms and legs. Eye movement and eye/body coordination skills should develop further and both eyes should focus equally.

You should enable your baby to explore different shapes and textures with his or her fingers; give your baby the freedom to crawl and explore; hang objects across the crib; and play “patty cake” and “peek-a-boo” with your baby.

From eight to twelve months, your baby should be mobile now, crawling and pulling himself or herself up. He or she will begin to use both eyes together and judge distances and grasp and throw objects with greater precision. Crawling is important in developing eye-hand-foot-body coordination; give your baby stacking and take-apart toys; and provide objects your baby can touch, hold and see at the same time.

From one to two years, your child’s eye-hand coordination and depth perception will continue to develop and he or she will begin to understand abstract terms. Things you can do are encourage walking; provide building blocks, simple puzzles and balls, and provide opportunities to climb and explore indoors and out.

There are many other affectionate and loving ways in which you can aid your baby’s vision development. Use your creativity and imagination and remember, enjoy this precious time, it will go fast.

Laser Vision Correction

What is Laser Vision Correction?

Laser vision correction treats vision problems like myopia and astigmatism using a state-of-the-art, computer-controlled excimer laser. This gentle beam of cool laser light carefully reshapes a thin layer of the cornea, flattening the curvature and improving the focusing problem. The laser pulses remove less tissue from the cornea than the width of a human hair. These pulses “dissolve” the molecular bonds of the corneal tissue without generating any heat – ensuring that thermal damage to adjacent tissue does not occur, and that the structural integrity of the cornea is maintained. Since 1988, more that 1,300,000 excimer procedures have been performed worldwide.

There are currently two procedures available in the U.S. utilizing the excimer laser: Photorefractive Keratectomy (PRK) and Laser Assisted Intrastromal Keratomileusis (LASIK). Both LASIK and PRK use the laser to sculpt the cornea with microscopic accuracy, differing primarily in the treatment of the outermost layer of the cornea (epithelium). In PRK, the surgeon gently removes the epithelium with a sponge, alcohol, and/or laser pulses, and then sculpts the cornea underneath. With LASIK, a small mechanical device called a microkeratome creates a thin cap of tissue from the cornea. The cap is folded back from the surface and the laser then sculpts the inner layer of the cornea, altering the shape to correct the curvature. The corneal cap is then returned to its original position, adhering back to the cornea within minutes, without stitches.

Is Laser Vision Correction right for me?

Laser vision correction is well-suited for active people who find glasses and contacts to be a nuisance and those who simply don’t want to so dependent on them. If you wear glasses or contacts and are over 18 years old, you may be a good candidate. Your lens prescription should be relatively stable for at least one year and you should be free of medical problems related to your eyes.

You should also make sure you have realistic expectations about laser vision correction. Though laser vision correction has the potential to greatly reduce or eliminate dependency on corrective lenses, there can be no assurances that you will obtain perfectly corrected vision. If necessary, visual sharpness after laser vision correction can be enhanced with lenses, however, for most people, the use of glasses should be merely occasional.

People who are most satisfied with the results of laser vision correction clearly understand the potential risks and side effects and have realistic expectations of what their vision will be like after surgery.

Is Laser Vision Correction painful?

There is virtually no discomfort during the procedure. No needles or general anesthetics are used. The eyes are anesthetized with eye drops that are instilled prior to the procedure.

Some PRK patients experience mild discomfort during the initial healing period after the procedure is performed. This level of discomfort, rarely experienced by LASIK patients, is often compared to having sand or an eyelash under a contact lens.

Are there any risks involved?

The excimer laser procedure, like all medical procedures, has limitations and risks, although the risk of having a serious vision-threatening complication is less than 1%. We all fear losing our vision. NO cases of blindness have been reported as a result of either the PRK or LASIK procedures.

While rare, some side effects that may be encountered after laser vision correction include infection, delayed healing of epithelium resulting in haze, corneal flap problems, corneal surface irregularities, under/over-correction, contact lens intolerance, or regression. We will review the potential risks with you in detail during your consultation.

How soon can I return to my daily activities?

For the first 12 hours immediately following your procedure, we strongly encourage you to rest and keep your eyes closed as much as possible. Typically, PRK patients will wear a clear bandage contact lens for 3 to 5 days. With LASIK, patients wear a protective eye shield until the next morning. Most PRK patients can work and drive 2 or 3 days after the procedure, while the wait time for LASIK patients is typically 1 or 2 days. You should avoid rubbing or touching your eye for 24 hours and then only so with caution for 1 week. Avoid getting soap, shampoo, hair spray, etc. in your eyes for 1 week. Avoid sunlight exposure, scuba diving, swimming, saunas, hot tubs, and water sports for a minimum of 1 week. Wear proper eye protection when participating in active sports and working with machinery, tools, or hazardous materials. These are only guidelines and the healing response varies from person to person.