PATIENTS & PUBLIC

A patient’s history helps to determine any symptoms the individual is experiencing, when they began, the presence of any general health problems, medications taken and occupational or environmental conditions that may be affecting vision. The Optometrist will ask about any eye or vision problems you may be having and about your overall health. The eye care practitioner will also ask about any previous eye or health conditions that you and your family members may have had.

Reading charts are often used to measure visual acuity. Visual acuity measurements evaluate how clearly each eye is seeing. As part of the testing, you are asked to read letters on distance and near reading charts. The results of visual acuity testing are written as a fraction such as 6/12

When testing distance vision, the top number in the fraction is the standard distance at which testing is done, The bottom number is the smallest letter size you were able to read. A person with 6/12 visual acuity would have to get within 6m of a letter that should be seen at 12m in order to see it clearly. Normal distance visual acuity is 6/6

Preliminary testing may include evaluation of specific aspects of visual function and eye health such as depth perception, colour vision, eye muscle movements, peripheral or side vision, and the way your pupils respond to light.

This test measures the curvature of the cornea, the clear outer surface of the eye, by focusing a circle of light on the cornea and measuring its reflection. This measurement is particularly critical in determining the proper fit for contact lenses.

Determining refractive error with a phoropter and retinoscope

Refraction is conducted to determine the appropriate lens power needed to compensate for any refractive error (nearsightedness, farsightedness, or astigmatism). Using an instrument called a phoropter, your optometrist places a series of lenses in front of your eyes and measures how they focus light using a hand- held lighted instrument called a retinoscope. The optometrist may choose to use an automated instrument that automatically evaluates the focusing power of the eye. The power is then refined by patient's responses to determine the lenses that allow the clearest vision.

This testing may be done without the use of eye drops to determine how the eyes respond under normal seeing conditions. In some cases, such as for patients who can't respond verbally or when some of the eyes focusing power may be hidden, eye drops are used. The drops temporarily keep the eyes from changing focus while testing is done.

Assessment of accommodation, ocular motility and binocular vision determines how well the eyes focus, move and work together. In order to obtain a clear, single image of what is being viewed, the eyes must effectively change focus, move and work in unison. This testing will look for problems that keep your eyes from focusing effectively or make using both eyes together difficult.

Tonometry measures eye pressure. Elevated pressure in the eye signals an increased risk for glaucoma.

External examination of the eye includes evaluation of the cornea, eyelids, conjunctiva and surrounding eye tissue using bright light and magnification. Evaluation of the lens, retina and posterior section of the eye may be done through a dilated pupil to provide a better view of the internal structures of the eye. Measurement of pressure within the eye (tonometry) is performed. Normal eye pressures range from 10 to 21 millimetres of mercury (mm Hg), averaging about 14 to 16 mm Hg. Anyone with eye pressure greater than 22 mm Hg is at an increased risk of developing glaucoma, although many people with normal pressure also develop glaucoma.

Additional testing may be needed based on the results of the previous tests to confirm or rule out possible problems, to clarify uncertain findings, or to provide a more in-depth assessment.

At the completion of the examination, your optometrist will assess and evaluate the results of the testing to determine a diagnosis and develop a treatment plan. He or she will discuss with you the nature of any visual or eye health problems found and explain available treatment options. In some cases, referral for consultation with, or treatment by, another optometrist or other health care provider may be indicated.

If you have questions regarding any eye or vision conditions diagnosed, or treatment recommended, don't hesitate to ask for additional information or explanation from your SAOA optometrist.

If you’re wondering what the difference is between a vision screening test (the kind you received in school) and a comprehensive eye exam, a vision screening only indicates a potential need for further evaluation. Even the most sophisticated vision screening tools, administered by the most highly trained screeners, can miss children with eye or vision disorders.

Screening will only tell you if you would benefit from spectacles and will not tell if your eyes are healthy. Not being able to see well, is the most common sign of eye problems including eye disease, that can cause blindness. Therefore, it is always necessary for an optometrist to examine your eyes thoroughly to make a diagnosis before prescribing a treatment.

Periodic eye and vision examinations are an important part of preventive health care. Many eye and vision problems have no obvious signs or symptoms. As a result, individuals are often unaware that problems exist. Early diagnosis and treatment of eye and vision problems are important for maintaining good vision and eye health, and when possible, preventing vision loss.

An eye examination takes a while so you should expect to be in the chair for at least 30 minutes and maybe more. For many people the news will be that they have great eye health. Approximately 75 percent of people examined need to be prescribed spectacles or contact lenses for refractive error.

A comprehensive adult eye and vision examination may include but is not limited to the tests mentioned under ’what to expect from an eye exam?’ Individual patient signs and symptoms, along with the professional judgment of the optometrist, may significantly influence the testing done.

You may have seen apps advertised that can ‘replace going to the eye care professional’ However, online vision tests attempt to replace one element of an eye examination, the refraction, to yield a prescription for spectacles or contact lenses. It is not unlike taking a blood pressure reading at a kiosk and expecting a prescription – the reading does not provide sufficient information to determine a patient's needed course of therapy. The refraction performed by online vision tests is only one of many tests performed during an eye examination, and taken by itself, does not provide sufficient information regarding the treatment of a patient, including the prescription of glasses or contact lenses.

Online vision tests may give inaccurate or misleading information, and can give patients a false sense of security. In fact, patients may delay essential, sight-saving treatment. Comprehensive eye exams with your optometrist are one of the most important, preventive ways to preserve vision, and the only way to accurately assess eye health, diagnose an eye disorder or disease, and determine the need for corrective lenses.

SAOA Optometrists, through their clinical education, training and experience have the means to provide effective primary eye and vision services to children. Vision care and regular eye examinations are essential for children, the earlier the better. According to the South African Optometric Association (SAOA) early detection of visual problems followed by early intervention in vision care is crucial to achieve normal vision in infants and young children with visual anomalies.

• Holds a book very close when he/she reads.
• Tilts his/her head at an extreme angle to the book when reading.
• Covers one eye when reading.
• Constantly maintains a poor posture when working close.
• Moves his or her head back and forth while reading instead of moving only the eyes.
• Has a poor attention span.
• Feels drowsy after prolonged near work.
• Takes longer than it should to do his/her homework.
• Occasionally or persistently reports seeing blurred or double while reading or writing.

• Vision problems in school-age children very frequently lead to learning problems.
• 80% of what a child learns in the classroom depends on the efficiency of the visual system. Reading, spelling, writing, chalkboard work and computers are among some of the visual tasks learners tackle all day long at school.
• Clear vision or eyesight is not the only requirement for successful performance of visual tasks. Scanning, focusing, binocular vision and visual coordination are some of the essential requirements for successful performance of visual tasks.
• Most of the school screenings programmes focus only on the clarity of the vision and not so much on the other visual requirements, thereby leaving so many vision problems in learners, undetected. Research has indicated that over 10 million children suffer from undetected vision problems due to the lack of appropriate evaluation.
• Take your child to your nearest SAOA Optometrist for a thorough visual examination.

Contact lens care systems are highly important to the success of wearing contact lenses and also the reduction of risk for infections. A contact lens care system has been carefully selected by your optometrist in order to be compatible with the lens materials as well as the way you wear your lenses eg daily disposable, monthly disposable, extended wear or specialized lenses.

There are many different types of contact lens care systems, but the basic two types are multipurpose care solutions and hydrogen peroxide care solutions. For gas permeable (GP) lenses, your solutions may contain either a one-step (multipurpose) solution or a two-step (cleaning and soaking) solution or you may also use a hydrogen peroxide solution. These types of solutions all have different recommendations for use depending on the manufacturer. Consult the package insert or your optometrist for the best practices regarding the use of your lens care system.

Lens materials and contact lens solutions can interact, which can also affect the disinfection process. Generic (or store brand) contact lens solutions may have been formulated for older lens materials; new lens materials have different chemical compositions and may not be compatible with generic solutions. If you wish to change your contact lens care system, contact your optometrist first to make sure it is safe for the particular type of contact lenses that you wear.

Yes, if you are using a multipurpose solution with soft contact lenses (there are currently no recommended “no-rub” multipurpose contact lens solution regimens). Rubbing the contact lens for between two and 20 seconds, depending on your contact lens care solution, removes deposits and micro-organisms and reduces complications. You follow the rubbing step with a thorough rinse with solution for the time specified by the manufacturer (usually between five and 10 seconds). Recent evidence conclusively demonstrated that rubbing and rinsing the lens after wear provides the safest lens wear for all contact lenses and care systems currently on the market. Some hydrogen peroxide systems contain a rinse step prior to soaking the lenses overnight. Gas permeable (GP) lenses also contain a rub step with hydrogen peroxide systems prior to this rinse step. If you are unsure how to care for your lenses, please refer to the manufacturer’s instructions provided with your care system or contact your optometrist.

Contact lens solutions should never be used after the expiration date listed on the packaging. The United States Food and Drug Administration (US FDA) has also recommended that solution manufacturers begin labelling solution bottles with a discard date, in addition to the usual expiration date. The discard date is the date the solution should be thrown out after opening (typically within 90 days but varies depending on the manufacturer and solution type). Refer to the solution’s package insert for directions and the discard dates and be sure to ask your optometrist if you are unsure of how to use your prescribed care solutions. It should be noted that preservative-free contact lens solutions (such as unit-dose single vial saline) should be discarded within 24 hours after opening. Saline that is packaged in aerosol containers typically has a longer discard date. Refer to the solution’s package insert for more information or contact your optometrist.

Any eye drops not approved for contact lens wear can cause damage to both the contact lens and the eye. Stay away from drops that claim to “get the red out,” as they typically contain chemicals that may be detrimental to your long-term eye health. Preservative-free eye drops, in general, are very safe to use with contact lenses. Eye drops that contain preservatives can have a toxic effect on the eye and should be avoided. Consult an optometrist about which drops are best for your eyes and contact lens materials.

Care systems for contact lenses are all very different, and it is important to note how long contact lenses can be safely stored in solution long term before the solution needs to be replaced. Some solutions are only good for 24 hours of storage while others can store lenses for up to one month.

Some soft contact lens multipurpose solutions allow for long-term storage of up to one month in a tightly closed contact lens case. For GP lenses, some GP lens solutions also allow for one month of long-term storage. Some hydrogen peroxide-based systems allow for seven days of long-term storage before the lenses need to be re-disinfected but others are as short as 24 hours of storage time. The night before you are ready to wear your lenses again, it is a good idea to inspect the lens and then re-clean and disinfect it according to the solution manufacturer’s instructions. Check the manufacturer’s recommended storage times on the package insert or contact your optometrist for further guidance if needed.

If you only wear lenses on occasion, a daily disposable contact lens may be an option for you. Daily disposable lenses are great for part-time wearers to keep costs down and ensure a safe contact lens wear experience. You don’t need to worry about how long your lenses have been sitting in solution or whether your solution is past its discard date. Daily disposable lenses are also highly portable and convenient. In addition, daily disposable lens wearers experience fewer contact lens complications like infections when compared to other lens replacement schedules.

Contact lenses are all taken care of differently; this is an example of how most soft contact lenses are cared for after removal in conjunction with a multipurpose solution (rub and rinse times may vary depending on solution manufacturer). Hydrogen peroxide care systems are different from below. Keep in mind that daily disposable contact lenses are removed each night and thrown away, so no cleaning is required.

• Always wash and dry your hands thoroughly before handling your contact lenses.
• Always work with the same lens first (example: always remove your right lens first or your left lens first).
• Remove one lens and place it in the palm of your hand.
• Apply multipurpose contact lens solution and rub the lens for about 20 seconds on each side (actual rub time depends on the solution manufacturer’s instructions).
• Rinse the contact lens with the multipurpose solution for about 10 seconds on each side (actual rinse time depends on the solution manufacturer’s instructions). Never use tap water to rinse your lenses as it has been shown to significantly increase the risk of severe ocular infections.
• Place the contact lens into a clean, dry lens case and then completely fill the well of the case with a multipurpose solution.
• Repeat steps three through six with the other eye’s lens.
• Soak the lenses according to the manufacturer’s recommended soaking time. This time will vary depending on the brand of solution but is usually between four and eight hours.
• Read the solution packaging thoroughly for instructions about lens cleaning and always follow the manufacturer-recommended procedure.
• Dispose of your contact lens case every one to three months. Overuse of a case can result in significant eye infections due to bacterial contamination. A new case is typically provided with each new bottle of solution purchased.
• Always rinse your case with fresh solution and allow it to air dry in the morning before reusing it. Never “top off” your solution—doing so increases your chances of a contact lens-related complication.

It is not enough simply to rinse off the contaminants and dust particles from the floor. Bathroom floors and other such surfaces may harbour significantly high numbers of microorganisms. While the tear film and corneal surface provide a remarkable barrier to infection, one never knows when the barrier may break down.

The only sure way to guarantee safety is to apply a new contact lens. This can be easily accomplished if you are wearing disposable soft contact lenses. The next best thing is to wear your back-up glasses while you clean the lens through the entire disinfection cycle as recommended by your care system's manufacturer. Every contact lens wearer should have a pair of glasses to wear as needed in cases like these when their lenses cannot be worn.

No. Tap water contains micro-organisms which can lead to serious eye infections and loss of vision. One of the more well-known water-borne infections is caused by Acanthamoeba, a microscopic, free-living amoeba (single-celled organism). Acanthamoeba can cause an infection of the cornea, the transparent outer covering of the eye where a contact lens sits. These organisms are very common in nature and can be found in bodies of water (for example, lakes and oceans), hence the recommendation to avoid the use of water with lenses.

You should never use tap water in any area of your lens care, including rinsing the lenses and the lens case. Do not attempt to make your own homemade saline or contact lens solutions. Also, make sure your hands are completely dry before handling your lenses.

Commercial airline cabins expose passengers to reduced atmospheric pressure, reduced oxygen availability, reduced humidity, and dry air. These conditions can lead to discomfort with contact lens wear, especially on flights lasting longer than three hours. Instillation of lubricating eye drops approved for use with contact lenses may help relieve some eye dryness during your flight. Keep in mind that the South African Civil Aviation Authority limits the size of any liquid container carried onboard an airplane to a 100 ml bottle or less unless the liquids are medically necessary. Contact lens solution is considered a medically necessary liquid, so full-size bottles must be declared separately at the entry to the security checkpoint. The solution is then subject to further screening. Solution manufacturers do tend to sell 60ml travel size containers of solution for those still wary of restrictions. In the absence of a smaller manufacturer-supplied container of solution, do not attempt to transfer contact lens solution to a smaller container. This allows for contamination of the solution during transfer, which can lead to a serious eye infection.

It is recommended not to wear contact lenses while in a bathtub or hot tub. The South African Optometric Association has recommended that contact lenses not be exposed to any form of water. Although rare, a sight-threatening eye complication known as Acanthamoeba keratitis is caused by an organism present in all forms of impure water (e.g. swimming pools, tap water, saunas, wells, and showers). Acanthamoeba and certain forms of bacteria present in water can become attached to contact lenses, resulting in potential infection.

If lenses are worn while in the bathtub or hot tub, care should be taken to avoid water being splashed into the eyes. Recent studies have recommended the use of tight-fitting swim goggles to limit eye exposure to water while swimming. If lenses are accidentally exposed to water, instil a lubricating drop to help loosen the lens on the eye then remove the lens with clean, dry hands. Next, clean and disinfect the lens before re-inserting, or discard the lens. Never sleep in a lens that has been exposed to water without first cleaning and disinfecting it. If lenses were removed prior to getting in a bathtub or hot tub, they must be properly cleaned and disinfected before being re-inserted.

• Always wash and thoroughly dry your hands before handling contact lenses.
• Carefully and regularly clean contact lenses as directed by your optometrist. If recommended, rub the contact lenses with your fingers and rinse them thoroughly before soaking the lenses overnight in a multipurpose solution that completely covers each lens.
• Store lenses in the proper lens storage case and replace the case at least every three months. Clean the case after each use, and keep it open and dry between cleanings.
• Use only fresh solution to clean and store contact lenses. Never reuse old solution. Change your contact lens solution according to the manufacturer's recommendations, even if you don't use your lenses daily.
• Always follow the recommended contact lens replacement schedule prescribed by your optometrist.
• Remove contact lenses before swimming or entering a hot tub.
• Avoid tap water to wash or store contact lenses or lens cases.
• See your optometrist for your regularly scheduled contact lens and eye examination.

• Use cream soaps. They can leave a film on your hands that can transfer to the lenses.
• Use homemade saline solutions. Improper use of homemade saline solutions has been linked with a potentially blinding condition among soft lens wearers.
• Put contact lenses in your mouth or moisten them with saliva, which is full of bacteria and a potential source of infection.
• Use tap water to wash or store contact lenses or lens cases.
• Share lenses with others.
• Use products not recommended by your optometrist to clean and disinfect your lenses. Saline solution and rewetting drops are not designed to disinfect lenses.
• Sleep in contact lenses after being exposed to pools, lakes, oceans, hot tubs or other sources of water that can contain bacteria.

It is generally not difficult to wear contact lenses. Following your optometrist’s advice and regular follow-up care will prevent most problems.

However, here is a list of some signs that things may not be going well. If you experience any of these, contact your optometrist as soon as possible.

• Blurred or fuzzy vision, especially of sudden onset.
• Red, irritated eyes.
• Uncomfortable lenses.
• Pain in and around the eyes.

You can wear contacts and cosmetics safely and comfortably together by following these helpful tips:

• Put on soft contact lenses before applying makeup.
• Put on rigid gas-permeable (RGP) lenses after applying makeup.
• Avoid lash-extending mascara, which has fibres that can irritate the eyes. Also avoid waterproof mascara, which cannot be easily removed with water and may stain soft contact lenses. Replace mascara at least every three months.
• Avoid applying eyeliner along the watermark of the eyelid.
• Remove lenses before removing makeup.
• Choose an oil-free moisturizer.
• Don't use hand creams or lotions before handling contacts. They can leave a film on your lenses.
• Use hairspray before putting on your contacts. If you use hairspray while you are wearing your contacts, close your eyes during spraying and for a few seconds after.
• Blink your eyes frequently while using a hair drier to keep your eyes from getting too dry.
• Keep false eyelash cement, nail polish and remover, perfume and cologne away from lenses. They can damage the plastic.
• Choose water-based, hypoallergenic liquid foundations. Cream makeup may leave a film on your lenses.

In the last 20 years, eye health research has linked diet and nutrition with a decreased risk of age-related macular degeneration (AMD). A major clinical study of older adults concluded that taking an antioxidant vitamin or mineral supplement significantly reduced the risk of advanced AMD progression in some people. Additionally, today there is significant evidence that vitamin D plays a role in preventing AMD.

The Age-Related Eye Disease Study (AREDS) was a major clinical trial sponsored by the National Eye Institute. It enrolled 3640 subjects, age 55 to 80, and was released in October 2001. This landmark study provided evidence that nutritional intervention in the form of supplements could delay the progression of AMD. The study concluded that taking an antioxidant vitamin or mineral supplement reduced the risk of advanced AMD progression by about 25 percent and showed a 19 percent reduction in visual acuity loss in some of the subjects.

Many optometrists are expanding their traditional roles to include other areas that affect eye health, such as nutritional education. Research has shown that certain nutrients can delay the development and progression of cataracts and AMD. These are two of the leading causes of blindness and visual impairment for millions of aging South Africans. Nutrition may be particularly important in treating AMD. Currently, treatment options after diagnosis of this condition are limited. Also, people who suffer from dry eye, an increasing problem due to the visual demands of digital devices, can often benefit from nutritional supplements.