Michael J. Schermer, MD - Improving Sacramento's Vision Since 1976
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Eye Health

Being proactive in maintaining your eye health is important. Advances in medicine and new technology give us many tools in which to screen, monitor, diagnose, and manage conditions of the eye. Our doctors recommend a thorough, dilated eye exam every year for most patients.

 

Why do we dilate your eyes?

Dilation of your pupils will allow the doctor to observe the back of your eye (the retina). The doctor can check for signs of glaucoma, macular degeneration, diabetic retinopathy, and many other conditions. The retina provides a unique view of your blood vessels, which means the doctor can also check for signs of uncontrolled hypertension. A certain area of your retina (called the optic nerve head) opens to an optical pathway that leads to your brain; swelling of this area can indicate a tumor, or past history of a stroke.

 

Even if you do not wear glasses, you should still have dilated examinations as indicated by your doctor. An eye exam is one of the best ways to protect your vision because it can detect eye problems at their earliest stage — when they're most treatable.

 

What to expect when your eyes are dilated

The dilating drops work by relaxing a muscle in the eye that controls your pupil reaction. When this muscle is relaxed, your pupil dilates. Think of your pupil like a window – the bigger it is, the better view the doctor has.

 

In children, dilation of the pupil can lead to a more accurate vision exam, because a young eye has a natural tendency to over-accommodate during a vision test: when that muscle is relaxed, it eliminates that possibility.

 

Dilation can last 2-3 hours for the average person. Because your pupil is bigger, it allows more light in, causing you to be sensitive. You should wear sunglasses in bright light after dilation, until you are no longer sensitive. Most people can still drive after dilation. Some patients may find near vision difficult.

Special Screening

For certain patients, your doctor may recommend you return for further screening. These are tests that are not part of the routine eye examination. Most medical insurance will cover your tests. Every year, new advances are made in the screening process of certain conditions. New technology is available to screen, document, monitor, and treat the health of your eye. We start with a baseline examination. Follow up examinations can be compared to your baseline, and if there are any changes, it can be detected sooner rather than later. Even if you have had a particular condition for years, new special testing can now make it easier to monitor.

HRT II

This scanning laser is comfortable, fast, and extremely helpful in screening or monitoring glaucoma conditions. This laser will take an image of a particular area of the eye. In many cases, you may not need to be dilated for this test.

 

What is glaucoma?

Images from the HRT II scanning laser help monitor glaucoma.
Images from the HRT II scanning laser help monitor glaucoma.

Glaucoma is the build up of fluid inside the eye. The build up of this fluid can cause pressure and can permanently destroy tissue around the optic nerve head. The optic nerve head opens to an optical pathway (optic nerve) that sends images to your brain. The brain and your eyes are a team; you actually see with your brain. If the tissue of the optic nerve head has been damaged, it will affect how your brain interprets what the eyes are sending. Often, if this tissue has been damaged, it can make the optic nerve head appear enlarged. Now, an optic nerve head is like a thumbprint: no two are exactly alike. Some people have a naturally occurring large optic nerve head: your doctor may want a baseline image just to document and ensure there are no changes over time.

 

Once you have lost vision to glaucoma, it cannot be restored. The good news is that regular exams can detect glaucoma early before there is any loss of vision.

 

Glaucoma Diagnosis

If you have been diagnosed with glaucoma, you may be taking eye drops to help relieve the build up of pressure. The goal in your case is to arrest any worsening of the glaucoma condition.

 

Glaucoma Suspect

Even though you have not been diagnosed with glaucoma, your doctor may feel you are more at risk than an average person is. Your doctor will want to perform a baseline examination, and compare it to your follow up images. Even if you have been told you are at risk, it does not mean you will have glaucoma. With today’s technology and advances, even a minor risk warrants the best care we can provide.

 

Patients who are at higher risk of glaucoma

  •  Over the age of 40
  •  Abnormally high eye pressure
  •  African-American heritage
  •  Family history of glaucoma
  •  Diabetes
  •  Long-term steroid treatment
  •  Prior injury or trauma to the eye
  •  High blood pressure

 

Visual Field

Glaucoma is the build up of fluid inside the eye. If the condition advances, you could suffer permanent peripheral vision loss. Peripheral loss can be so gradual, that a person may not notice until it has become severe. Because of this, it can seem to just ‘happen overnight’. Routine exams are designed to check the pressure of your eye, check the retina, and screen your peripheral vision. Your doctor may determine that you need a specialized, automated screening of your peripheral vision and will ask that you return to do a visual field test. The visual field will map out your peripheral vision, so that the doctor can determine if there has been any loss.


A visual field test may also be requested for a reason other than glaucoma screening. Certain medications or drooping of the eyelids can warrant a reason for checking your peripheral vision.

 

Fundus Photography

Fundus photography is used to document all manner of eye conditions. This is a digital camera designed to take images of the retina. Not only can your doctor have a sharp color image in your records, but also follow up images can be compared to the baseline and studied for changes. Your retina is what the doctor can see when your eyes are dilated. Having a photo also means the doctor can examine your retina as much as needed, without patient discomfort from bright lights and magnifiers.


Fundus photography does not replace dilation. Dilation still provides a fuller view and a real image that photography can’t replace.

 

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