Good Vision Throughout Life

1.
Infant Vision:
Birth to 24 Months of Age

2.
Preschool Vision:
2 to 5 Years of Age

3.
School-aged Vision:
6 to 18 Years of Age

4.
Adult Vision:
19 to 40 Years of Age

5.
Adult Vision:
41 to 60 Years of Age

6.
Adult Vision:
Over 60 Years of Age
7.---------------------------
Infant Vision: Birth to 24 Months of Age
Steps in Infant Vision Development

Signs of Eye and Vision Problems

What Parents Can do to Help With Visual Development

Baby's First Eye Exam

Babies learn to see over a period of time, much like they learn to walk and talk. They are not born
with all the visual abilities they need in life. The ability to focus their eyes, move them accurately,
and use them together as a team must be learned. Also, they need to learn how to use the visual
information the eyes send to their brain in order to understand the world around them and interact
with it appropriately.

From birth, babies begin exploring the wonders in the world with their eyes. Even before they learn
to reach and grab with their hands or crawl and sit-up, their eyes are providing information and
stimulation important for their development.Healthy eyes and good vision play a critical role in how
infants and children learn to see. Eye and vision problems in infants can cause developmental delays.
It is important to detect any problems early to ensure babies have the opportunity to develop the
visual abilities they need to grow and learn. Parents play an important role in helping to assure their
child's eyes and vision can develop properly. Steps that any parent should take include:
Watching for signs of eye and vision problems.
Seeking professional eye care starting with the first comprehensive vision assessment at about 6
months of age.
Helping their child develop his or her vision by engaging in age-appropriate activities.
Steps in Infant Vision Development
At birth, babies can't see as well as older children or adults. Their eyes and visual system aren't fully
developed. But significant improvement occurs during the first few months of life.The following are
some milestones to watch for in vision and child development. It is important to remember that not
every child is the same and some may reach certain milestones at different ages.
Birth to four months
Up to about 3 months of age, babies' eyes do not focus on objects more than 8 to 10 inches from
their faces.
At birth, babies can't see the biggest letter on the eye chart (approximately 20/200 visual acuity). An
older child or adult with normal vision can see this letter as far away as 200 feet.

Up to about 3 months of age, babies' eyes do not focus on objects more than 8 to 10 inches from
their faces.
During the first months of life, the eyes start working together and vision rapidly improves. Eye-hand
coordination begins to develop as the infant starts tracking moving objects with his or her eyes and
reaching for them. By eight weeks, babies begin to focus their eyes on the faces of a parent or other
person near them.
For the first two months of life, an infant's eyes are not well coordinated and may appear to wander
or to be crossed. This is usually normal. However, if an eye appears to turn in or out constantly, an
evaluation is warranted.
Babies should begin to follow moving objects with their eyes and reach for things at around four
months of age.
Five to eight months
During these months, control of eye movements and eye-body coordination skills continue to
improve.
Depth perception, which is the ability to judge if objects are nearer or farther away than other
objects, is not present at birth. It is not until around the fifth month that the eyes are capable of
working together to form a three-dimensional view of the world and begin to see in depth.
Although an infant's color vision is not as sensitive as an adult's, it is generally believed that babies
have good color vision by five months of age.
Most babies start crawling at about 8 months old, which helps further develop eye-hand-foot-body
coordination. Early walkers who did minimal crawling may not learn to use their eyes together as
well as babies who crawl a lot.
Nine to twelve months
By the age of nine to twelve months, babies should be using their eyes and hands together.
At around 9 months of age, babies begin to pull themselves up to a standing position. By 10 months
of age, a baby should be able to grasp objects with thumb and forefinger.
By twelve months of age, most babies will be crawling and trying to walk. Parents should encourage
crawling rather than early walking to help the child develop better eye-hand coordination.
Babies can now judge distances fairly well and throw things with precision.
One to two years old
By two years of age, a child's eye-hand coordination and depth perception should be well developed.

Children this age are highly interested in exploring their environment and in looking and listening.
They recognize familiar objects and pictures in books and can scribble with crayon or pencil.
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Signs of Eye and Vision Problems
The presence of eye and vision problems in infants is rare. Most babies begin life with healthy eyes
and start to develop the visual abilities they will need throughout life without difficulty. But
occasionally, eye health and vision problems can develop. Parents need to look for the following
signs that may be indications of eye and vision problems:
Excessive tearing
 - this may indicate blocked tear ducts
Red or encrusted eye lids
- this could be a sign of an eye infection
Constant eye turning
- this may signal a problem with eye muscle control
Extreme sensitivity to light
- this may indicate an elevated pressure in the eye
Appearance of a white pupil
- this may indicate the presence of an eye cancerThe appearance of any of these signs should
require immediate attention by your pediatrician or optometrist.
What Parents Can do to Help With Visual Development
There are many things parents can do to help their baby's vision develop properly. The following are
some examples of age-appropriate activities that can assist an infant's visual development.
Birth to four months
Use a nightlight or other dim lamp in your baby's room.
Change the crib's position frequently and change 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 left sides with each feeding.

Five to eight months

Hang a mobile, crib gym or various objects across the crib for the baby to grab, pull and kick.
Give the baby plenty of time to play and explore on the floor.
Provide plastic or wooden blocks that can be held in the hands.
Play patty cake and other games, moving the baby's hands through the motions while saying the
words aloud.
Nine to twelve months
Play hide and seek games with toys or your face to help the baby develop visual memory.
Name objects when talking to encourage the baby's word association and vocabulary development
skills.
Encourage crawling and creeping.
One to two years
Roll a ball back and forth to help the child track objects with the eyes visually.
Give the child building blocks and balls of all shapes and sizes to play with to boost fine motor skills
and small muscle development.
Read or tell stories to stimulate the child's ability to visualize and pave the way for learning and
reading skills.
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Baby's First Eye Exam

Even if no eye or vision problems are apparent, at about age 6 months

, you should take your baby to your doctor of optometry for his or her first thorough eye
examination. Things that the optometrist will test for include: 1.excessive or unequal amounts of
nearsightedness, farsightedness, or astigmatism 2.eye movement ability 3.eye health problems.
These problems are not common, but it is important to identify children who have them at this
young age. Vision development and eye health problems are easier to correct if treatment begins
early.InfantSEE® is the American Optometric Association's public health program designed to ensure
that eye and vision care becomes an integral part of infant wellness care to improve a child's quality
of life. Under this program, participating optometrists provide a comprehensive infant eye
assessment between 6 and 12 months of age as a no-cost public service. Click here
to learn more and locate a doctor in your area who can provide the free infant assessment.
Preschool Vision: 2 to 5 Years of Age
Signs of Eye and Vision Problems

Understanding the Difference Between a Vision Screening and a Vision Examination

What Parents Can Do to Help with Preschool Vision Development

Every experience a preschooler has is an opportunity for growth and development. They use their
vision to guide other learning experiences. From ages 2 to 5, a child will be fine-tuning the visual
abilities gained during infancy and developing new ones. Stacking building blocks, rolling a ball back
and forth, coloring, drawing, cutting, or assembling lock-together toys all help improve important
visual skills. Preschoolers depend on their vision to learn tasks that will prepare them for school.
They are developing the visually-guided eye-hand-body coordination, fine motor skills and visual
perceptual abilities necessary to learn to read and write.

Steps taken at this age to help ensure vision is developing normally can provide a child with a good
"head start" for school.
Preschoolers are eager to draw and look at pictures. Also, reading to young children is important to
help them develop strong visualization skills as they "picture" the story in their minds.This is also the
time when parents need to be alert for the presence of vision problems like
crossed

eyes
or
lazy eye
. These conditions often develop at this age. Crossed eyes or strabismus involves one or both eyes
turning inward or outward. Amblyopia, commonly known as lazy eye, is a lack of clear vision in one
eye, which can't be fully corrected with eyeglasses. Lazy eye often develops as a result of crossed
eyes, but may occur without noticeable signs. In addition, parents should watch their child for
indication of any delays in development, which may signal the presence of a vision problem.
Difficulty with recognition of colors, shapes, letters and numbers can occur if there is a vision
problem.The preschool years are a time for developing the visual abilities that a child will need in
school and throughout his or her life. Steps taken during these years to help ensure vision is
developing normally can provide a child with a good "head start" for school.
Signs of Eye and Vision Problems
According to the American Public Health Association, about 10% of preschoolers have eye or vision
problems. However, children this age generally will not voice complaints about their eyes. Parents
should watch for signs that may indicate a vision problem, including:
Sitting close to the TV or holding a book too close
Squinting
Tilting their head
Frequently rubbing their eyes
Short attention span for the child's age
Turning of an eye in or out
Sensitivity to light
Difficulty with eye-hand-body coordination when playing ball or bike riding
Avoiding coloring activities, puzzles and other detailed activitiesIf you notice any of these signs in
your preschooler, arrange for a visit to your doctor of optometry.

Understanding the Difference Between a Vision Screening and a Vision Examination

It is important to know that a vision screening by a child's pediatrician or at his or her preschool is
not the same as a comprehensive eye and vision examination by an optometrist. Vision screenings
are a limited process and can't be used to diagnose an eye or vision problem, but rather may
indicate a potential need for further evaluation. They may miss as many as 60% of children with
vision problems. Even if a vision screening does not identify a possible vision problem, a child may
still have one.Passing a vision screening can give parents a false sense of security. Many preschool
vision screenings only assess one or two areas of vision. They may not evaluate how well the child
can focus his or her eyes or how well the eyes work together. Generally color vision, which is
important to the use of color coded learning materials, is not tested. By age 3, your child should
have a thorough optometric eye examination to make sure his or her vision is developing properly
and there is no evidence of eye disease. If needed, your doctor of optometry can prescribe
treatment, including eyeglasses and/or vision therapy, to correct a vision development
problem.With today's diagnostic equipment and tests, a child does not have to know the alphabet or
how to read to have his or her eyes examined. Here are several tips to make your child's optometric
examination a positive experience:1.Make an appointment early in the day. Allow about one hour.
2.Talk about the examination in advance and encourage your child's questions. 3.Explain the
examination in terms your child can understand, comparing the E chart to a puzzle and the
instruments to tiny flashlights and a kaleidoscope.Unless your doctor of optometry advises
otherwise, your child's next eye examination should be at age 5. By comparing test results of the two
examinations, your optometrist can tell how well your child's vision is developing for the next major
step into the school years.
What Parents Can Do to Help with Preschool Vision Development
Playing with other children can help developing visual skills.
There are everyday things that parents can do at home to help their preschooler's vision develop as
it should. There are a lot of ways to use playtime activities to help improve different visual
skills.Toys, games and playtime activities help by stimulating the process of vision development.
Sometimes, despite all your efforts, your child may still miss a step in vision development. This is
why vision examinations at ages 3 and 5 are important to detect and treat these problems before a
child begins school.Here are several things that can be done at home to help your preschooler
continue to successfully develop his or her visual skills:1.Practice throwing and catching a ball or
bean bag 2.Read aloud to your child and let him or her see what is being read

3.Provide a chalkboard or finger paints 4.Encourage play activities requiring hand-eye coordination
such as block building and assembling puzzles 5.Play simple memory games 6.Provide opportunities
to color, cut and paste 7.Make time for outdoor play including ball games, bike/tricycle riding,
swinging and rolling activities 8.Encourage interaction with other children.
School-aged Vision: 6 to 18 Years of Age
Vision Skills Needed for School Success

Signs of Eye and Vision Problems

When is a Vision Exam Needed?

Sports Vision and Eye Protection

A child needs many abilities to succeed in school. Good vision is a key. It has been estimated that as
much as 80% of the learning a child does occurs through his or her eyes. Reading, writing,
chalkboard work, and using computers are among the visual tasks students perform daily. A child's
eyes are constantly in use in the classroom and at play. When his or her vision is not functioning
properly, education and participation in sports can suffer.
As children progress in school, they face increasing demands on their visual abilities.
The school years are a very important time in every child's life. All parents want to see their children
do well in school and most parents do all they can to provide them with the best educational
opportunities. But too often one important learning tool may be overlooked - a child's vision.As
children progress in school, they face increasing demands on their visual abilities. The size of print in
schoolbooks becomes smaller and the amount of time spent reading and studying increases
significantly. Increased class work and homework place significant demands on the child's eyes.
Unfortunately, the visual abilities of some students aren't performing up to the task.When certain
visual skills have not developed, or are poorly developed, learning is difficult and stressful, and
children will typically:
Avoid reading and other near visual work as much as possible.
Attempt to do the work anyway, but with a lowered level of comprehension or efficiency.
Experience discomfort, fatigue and a short attention span.

Some children with learning difficulties exhibit specific behaviors of hyperactivity and distractibility.
These children are often labeled as having "Attention Deficit Hyperactivity Disorder" (ADHD).
However, undetected and untreated vision problems can elicit some of the very same signs and
symptoms commonly attributed to ADHD. Due to these similarities, some children may be
mislabeled as having ADHD when, in fact, they have an undetected vision problem.Because vision
may change frequently during the school years, regular eye and vision care is important. The most
common vision problem is nearsightedness or myopia. However, some children have other forms of
refractive error like farsightedness and astigmatism. In addition, the existence of eye focusing, eye
tracking and eye coordination problems may affect school and sports performance.Eyeglasses or
contact lenses may provide the needed correction for many vision problems. However, a program of
vision therapy may also be needed to help develop or enhance vision skills.
Vision Skills Needed For School Success
There are many visual skills beyond seeing clearly that team together to support academic success.
Vision is more than just the ability to see clearly, or having 20/20 eyesight. It is also the ability to
understand and respond to what is seen. Basic visual skills include the ability to focus the eyes, use
both eyes together as a team, and move them effectively. Other visual perceptual skills include:
recognition
(the ability to tell the difference between letters like "b" and "d"),
comprehension
(to "picture" in our mind what is happening in a story we are reading), and
retention
(to be able to remember and recall details of what we read).Every child needs to have the following
vision skills for effective reading and learning:
Visual acuity
— the ability to see clearly in the distance for viewing the chalkboard, at an intermediate distance
for the computer, and up close for reading a book.
Eye Focusing
— the ability to quickly and accurately maintain clear vision as the distance from objects change,
such as when looking from the chalkboard to a paper on the desk and back. Eye focusing allows the
child to easily maintain clear vision over time like when reading a book or writing a report.
Eye tracking
— the ability to keep the eyes on target when looking from one object to another, moving the eyes
along a printed page, or following a moving object like a thrown ball.

Eye teaming
— the ability to coordinate and use both eyes together when moving the eyes along a printed page,
and to be able to judge distances and see depth for class work and sports.
Eye-hand coordination
— the ability to use visual information to monitor and direct the hands when drawing a picture or
trying to hit a ball.
Visual perception
 — the ability to organize images on a printed page into letters, words and ideas and to understand
and remember what is read.If any of these visual skills are lacking or not functioning properly, a child
will have to work harder. This can lead to headaches, fatigue and other eyestrain problems. Parents
and teachers need to be alert for symptoms that may indicate a child has a vision problem.
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Signs of Eye and Vision Problems
A child may not tell you that he or she has a vision problem because they may think the way they see
is the way everyone sees.Signs that may indicate a child has vision problem include:
Frequent eye rubbing or blinking
Short attention span
Avoiding reading and other close activities
Frequent headaches
Covering one eye
Tilting the head to one side
Holding reading materials close to the face
An eye turning in or out
Seeing double
Losing place when reading
Difficulty remembering what he or she read
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When is a Vision Exam Needed?
Your child should receive an eye examination at least once every two years-more frequently if
specific problems or risk factors exist, or if recommended by your eye doctor.

Unfortunately, parents and educators often incorrectly assume that if a child passes a school
screening, then there is no vision problem. However, many school vision screenings only test for
distance visual acuity. A child who can see 20/20 can still have a vision problem. In reality, the vision
skills needed for successful reading and learning are much more complex.Even if a child passes a
vision screening, they should receive a comprehensive optometric examination if:1.They show any of
the signs or symptoms of a vision problem listed above. 2.They are not achieving up to their
potential. 3.They are minimally able to achieve, but have to use excessive time and effort to do
so.Vision changes can occur without your child or you noticing them. Therefore, your child should
receive an eye examination at least once every two years-more frequently if specific problems or risk
factors exist, or if recommended by your eye doctor. The earlier a vision problem is detected and
treated, the more likely treatment will be successful. When needed, the doctor can prescribe
treatment including eyeglasses, contact lenses or vision therapy to correct any vision problems.
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Sports Vision and Eye Protection
Outdoor games and sports are an enjoyable and important part of most children's lives. Whether
playing catch in the back yard or participating in team sports at school, vision plays an important role
in how well a child performs.Specific visual skills needed for sports include:1.Clear distance vision
2.Good depth perception 3.Wide field of vision 4.Effective eye-hand coordinationA child who
consistently underperforms a certain skill in a sport, such as always hitting the front of the rim in
basketball or swinging late at a pitched ball in baseball, may have a vision problem. If visual skills are
not adequate, the child may continue to perform poorly. Correction of vision problems with
eyeglasses or contact lenses, or a program of eye exercises called vision therapy can correct many
vision problems, enhance vision skills, and improve sports vision performance. (Link to Sports
Vision)Eye protection should also be a major concern to all student athletes, especially in certain
high-risk sports. Thousands of children suffer sports-related eye injuries each year and nearly all can
be prevented by using the proper protective eyewear. That is why it is essential that all children
wear appropriate, protective eyewear whenever playing sports. Eye protection should also be worn
for other risky activities such as lawn mowing and trimming.Regular prescription eyeglasses or
contact lenses are not a substitute for appropriate, well-fitted protective eyewear. Athletes need to
use sports eyewear that is tailored to protect the eyes while playing the specific sport. Your doctor
of optometry can recommend specific sports eyewear to provide the level of protection needed. It is
also important for all children to protect their eyes from damage caused by ultraviolet radiation in

sunlight
. Sunglasses are needed to protect the eyes outdoors and some sport-specific designs may even help
improve sports performance.
Adult Vision: 19 to 40 Years of Age
Dealing With Visual Stress at School or on the Job

Ensuring Eye Safety at Work, Home or Play

Protecting Your Eyes From the Sun

Most adults, aged 19 to 40, enjoy healthy eyes and good vision. The most common eye and vision
problems experienced by people in this age group are due to visual stress and eye injuries. By taking
proper steps to maintain a healthy lifestyle and protect your eyes from stress and injury, you can
avoid many eye and vision problems.Good vision is important as you pursue a college degree, begin
your career, or perhaps start and raise a family. Here are some things you can do to help maintain
healthy eyes and good vision:
Eat Healthy
— As part of a healthful diet, eat five servings of fruits and vegetables each day. Choose foods rich
in
antioxidants
like leafy, green vegetables and fish.
Don't Smoke
— Smoking exposes your eyes to high levels of noxious chemicals and increases the risk for
developing
age-related macular degeneration
(AMD) and
cataracts
.
Get Regular Exercise
— Exercise improves blood circulation, increases oxygen levels to the eyes and aids in the removal
of toxins.
Wear Sunglasses
— Protect your eyes from harmful ultraviolet (UV) rays when outdoors.
Choose sunglasses
with UVA and UVB protection, to block both forms of ultraviolet rays.
Get Periodic Eye Examinations
— Although vision generally remains stable during these years, some problems may develop
without any obvious signs or symptoms. The best way to protect your vision is through regularly
scheduled professional
eye examinations
.The American Optometric Association recommends that adults aged 19 to 40 receive an eye exam
at least every two years. If you are at risk for eye problems due to a family history of eye disease,
diabetes, high blood pressure or past vision problems, your doctor of optometry may recommend
more frequent exams. In between examinations, if you notice a change in your vision, contact your
doctor. Detecting and treating problems early can help maintain good vision for the rest of your life.
Dealing with Visual Stress at School or on the Job
Eyestrain is a common occurrence in today's visually demanding world. A typical college schedule or
office workday involves spending long hours reading, working at a desk, or staring at a computer. A
poorly designed study or work environment, with elements such as improper lighting,
uncomfortable seating, incorrect viewing angles and improper reading or working distances can add
to the visual stress. As the day progresses, the eyes begin to fatigue and eyestrain and discomfort
can develop.
A poorly designed study or work environment, with elements such as improper lighting,
uncomfortable seating, incorrect viewing angles and improper reading or working distances can add
to the visual stress.
The following are several key signs and symptoms of eyestrain:
Sore or tired eyes
Itching or burning sensations in the eyes
Sensitivity to light

Dry or watery eyes

Headaches
Difficulty focusingHere are some simple steps you can take to minimize eyestrain, particularly during
computer work:
Workplace Adjustments
Position the top of your computer monitor below eye level so you look slightly downward when
viewing the screen. This will help minimize strain on the eyes and the neck. If you are typing from
copy, position the text at the same level as the screen. Adjust the screen brightness so it is most
comfortable for you. Avoid glare on the computer screen by adjusting window curtains or blinds,
repositioning the monitor, or using a glare reduction filter.
Proper Lighting
Examine the lighting in your work area. Overhead lights can be harsh and often are brighter than
necessary. Consider turning some of the lights off for a more comfortable lighting situation. Use an
adjustable shaded lamp to provide specific task lighting as needed.
Rest Breaks
Throughout the day, give your eyes a chance to rest. Take several minutes every hour to look away
from the computer and allow your eyes to re-adjust. Consider standing up and walking around or
doing alternate tasks that do not require extensive near focusing. Blink often to refresh the eyes and
use artificial tear solutions, if necessary.
Posture
When seated at a desk, make sure your feet are flat on the floor. Use a chair that is adjustable and
provides adequate support for your back. When working at a computer, your arms should form a 90
degree angle at the elbows and your hands should be tilted up slightly to allow your fingers to travel
freely over the keyboard.Making these simple adjustments to your study or work area can pay big
dividends in terms of preventing or reducing eyestrain. If you continue to experience eye-related
symptoms, you may have a vision problem requiring treatment. Ask your optometrist.
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Ensuring Eye Safety at Work, Home or Play
The National Institute for Occupational Safety and Health reports about 2,000 U.S. workers sustain
job-related eye injuries that require medical treatment each day. But more injuries to the eye
actually result from use or misuse of products at home rather than on the job. Nearly 60 percent of
all product-related eye injuries occur in and around the home, according to Prevent Blindness
America.Any injury to the eye has the potential for causing some vision loss or even blindness.
Fortunately,
most eye injuries can be prevented
with the use of proper eye protection. Prevention involves being aware of the common causes of
injury and knowing how to protect your eyes-
at home, at work and at play.
At Work

Eye injuries occurring at work, whether in a factory, on a construction site, on a farm, or in a

laboratory, can result from chemical burns, foreign objects in the eye and cuts and scrapes of the
cornea. Common causes of injuries include
splashes with chemicals, grease and oil
burns from steam
ultraviolet or infrared radiation exposure; and flying wood or metal chipsNot all forms of safety
eyewear provide the same level of protection from flying objects, chemical splashes or radiation
exposure. Be sure to wear the appropriate protection for the type of eye hazards in your workplace.
At Home
Using common sense can help protect the eyes at home. Following manufacturer's instructions and
safety warnings will help prevent many household product-related eye injuries.Wearing eye
protection while performing certain household activities can prevent eye injuries. Some activities
include:1.Cleaning the oven or using other strong household chemicals 2.Chopping wood or doing
woodworking 3.Using motorized equipment or power tools like lawn trimmers and electric drills
4.Jump-starting a car batteryNon-prescription safety goggles are sold at many home building stores
and hardware stores. If you wear prescription glasses, ask your optometrist to make a
recommendation on appropriate safety eyewear for household tasks.
At Play
Sprained ankles, skinned knees, and bruises are common occurrences when participating in sports.
Unfortunately, so are injuries to the eye.Regular eyeglasses and contact lenses do not offer
adequate protection from sports-related eye injuries. Special eye protection is needed for
basketball, football, hockey, baseball and racket sports.

Eye injuries occurring at work, whether in a factory, on a construction site, on a farm, or in a

laboratory, can result from chemical burns, foreign objects in the eye and cuts and scrapes of the
cornea. Common causes of injuries include
splashes with chemicals, grease and oil
burns from steam
ultraviolet or infrared radiation exposure; and flying wood or metal chipsNot all forms of safety
eyewear provide the same level of protection from flying objects, chemical splashes or radiation
exposure. Be sure to wear the appropriate protection for the type of eye hazards in your workplace.
At Home
Using common sense can help protect the eyes at home. Following manufacturer's instructions and
safety warnings will help prevent many household product-related eye injuries.Wearing eye
protection while performing certain household activities can prevent eye injuries. Some activities
include:1.Cleaning the oven or using other strong household chemicals 2.Chopping wood or doing
woodworking 3.Using motorized equipment or power tools like lawn trimmers and electric drills
4.Jump-starting a car batteryNon-prescription safety goggles are sold at many home building stores
and hardware stores. If you wear prescription glasses, ask your optometrist to make a
recommendation on appropriate safety eyewear for household tasks.
At Play
Sprained ankles, skinned knees, and bruises are common occurrences when participating in sports.
Unfortunately, so are injuries to the eye.Regular eyeglasses and contact lenses do not offer
adequate protection from sports-related eye injuries. Special eye protection is needed for
basketball, football, hockey, baseball and racket sports.

Initially, you may find you need to hold reading materials farther away to see them clearly. Print in
the newspaper or on a restaurant menu may appear blurred, especially under dim lighting. If you
already wear prescription glasses or contact lenses to see clearly in the distance, the near vision
changes caused by presbyopia can bring about the need to use bifocal or multifocal lenses. If you are
nearsighted, you may have discovered that you now need to remove you glasses to see better up
close. Fortunately, people with presbyopia now have many options to improve their ability to see
well. Along with the onset of presbyopia, an increase in the incidence of eye health problems occurs
during these years. Whether or not there is a need for eyeglasses, adults should be examined for
signs of developing eye and vision problems. A comprehensive eye examination is recommended at
least every two years. Don't rely on an insufficient substitute like the limited driver's license vision
test or other vision screenings to determine if you have an eye or vision problem.Adults over 40 may
be particularly at risk for the development of eye and vision problems if any of the following exist:
Chronic, systemic conditions such as diabetes or high blood pressure.
A family history of glaucoma or macular degeneration.
A highly visually demanding job or work in an eye-hazardous occupation.
Health conditions like high cholesterol, thyroid conditions, anxiety or depression, and arthritis for
which you take medications. Many medications, even antihistamines, have ocular side-effects.
Understanding Age-related Vision Changes
Just like your body, your eyes and vision change over time. Aging changes in various parts of the eye
can result in a number of noticeable differences in how well you see. While not everyone will
experience the same level of symptoms, the following are common age-related vision changes:
Need for More Light
As you age, you need more light to see as well as you did in years past. Brighter lights in your work
area or next to your reading chair will help make reading and other near tasks easier.
Difficulty Reading and Doing Close Work
Printed materials are not as clear as before, in part because the lens in your eye becomes less

flexible with time. This makes it harder for your eyes to focus near objects with the same ability you
had when you were younger.
Problems with Glare
You may notice additional glare from headlights at night or sun reflecting off of windshields or
pavement during the day, making it more difficult to drive. Changes within the lens in your eye cause
light entering the eye to be scattered rather than focused precisely on the retina, thus creating more
glare.
Changes in Color Perception
The normally clear lens located inside your eye may start to discolor making it harder to see and
distinguish between certain shades of colors.
Reduced Tear Production
With age, the tear glands in your eyes will produce fewer tears. This is particularly true for
women after menopause
. As a result, your eyes may feel dry and irritated. Having an adequate amount of tears is an essential
element in keeping your eyes healthy and maintaining clear sight.
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Encountering Problems with Near Vision after 40
If you have enjoyed relatively good vision throughout your life and haven't needed eyeglasses or
contact lenses to correct distance vision, then the development of near vision problems after age 40
can be somewhat of a concern and a frustration. Losing the ability to read the newspaper or see the
cell phone numbers may seem to have occurred abruptly. Actually, these changes have been
occurring gradually since childhood. But up until now, your eyes have had adequate focusing power
to allow you to see clearly for reading and close work. Now your eyes no longer have enough
focusing power for clear and comfortable near vision tasks.
Persons with presbyopia have several options available to regain clear near vision.
This loss of focusing ability for near vision, called presbyopia
, is simply the result of the lens inside the eye becoming less flexible. This flexibility allows the eye to
change focus from objects are far to objects that are close. Persons with presbyopia have several
options available to regain clear near vision. They include:1.Eyeglasses, including single vision
reading glasses and multifocal lenses
2.
Contact lenses, including monovision and bifocal lenses 3.Laser surgery and other refractive surgery
procedures

As you continue to age through your 50s and beyond, presbyopia becomes more advanced. You may
notice the need for more frequent changes in eyeglass or contact lens prescriptions. Around age 60,
these changes in near vision should stop and prescription changes should occur less
frequently.Presbyopia can't be prevented or cured, but many options are available to help
compensate for the loss of near focusing ability. Most individuals should be able to obtain clear,
comfortable near vision for all of their lifestyle needs.
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Warning Signs of Eye Health Problems
This is also the time in life when your risk for developing a number of eye and vision problems
increases. If you experience any of the following symptoms, you may have the early warning signs of
a serious eye health problem:
1.
Fluctuating Vision
If you experience frequent changes in how clearly you can see, it may be a sign of diabetes or
hypertension (high blood pressure). These chronic conditions can damage the tiny blood vessels in
the retina, the light sensitive layer at the back of the eye, causing vision loss that can sometimes be
permanent.
2.
Seeing Floaters and Flashes
Occasionally, you may see spots or floaters in your eyes. In most cases, these are actually shadowy
images of particles floating in the fluid that fills the inside of the eye. Although they can be
bothersome, spots and floaters are usually harmless and typically do not risk vision. They are a
natural part of the eye's aging process. But if you suddenly see more floaters than normal, and they
are accompanied by bright, flashing lights, they may be a warning sign of impending
retinal detachment
—a tear of the retina. This should be treated immediately to prevent serious loss of vision. (Link to
Spots and Floaters)
3.
Loss of Side Vision
If it seems that you are losing peripheral or side vision, this may be a sign of
glaucoma
. Glaucoma occurs when the optic nerve is damaged and no longer transmits all visual images to the
brain. It often has no symptoms until damage to sections of your vision has begun. (Link to
glaucoma)
4.
Seeing distorted images
If straight lines appear distorted or wavy or there appears to be a blind spot or empty area in the
center of your vision, you may have the signs of
age-related macular degeneration

(AMD). The disease affects the macula, the part of your retina that is responsible for central vision
where the eye's acuity is sharpest. The disease causes a blind spot that's right in the middle of your
field of vision. (Link to age-related macular degeneration) Regular eye examinations and early
diagnosis and treatment of eye diseases can help you continue to preserve good vision throughout
life.
Adult Vision: Over 60 Years of Age
Age-related Eye and Vision Problems

Driving Safely After 60

Dealing with Vision Loss

It's a fact of life that vision changes occur as you get older. But these changes don't have to
compromise your lifestyle. Knowing what to expect and when to seek professional care are
important steps to safeguarding your vision. As you reach your 60s and beyond, you need to be
attentive to warning signs of age-related eye health problems that could cause vision loss. Many eye
diseases have no early symptoms. They may develop painlessly and you may not be aware of
changes to your vision until the condition is quite advanced. But wise lifestyle choices and regular
eye exams can significantly improve your chances of maintaining good eye health even as you age.
Safeguarding your vision as you age can have a tremendous impact on your quality of life.
You may not realize that health problems affecting other parts of your body can affect your vision as
well. Individuals with diabetes or hypertension (high blood pressure), or taking medications that
have eye-related side effects, are at greatest risk for developing vision problems.Therefore, regular
eye exams
are even more important as you reach your senior years. The American Optometric Association
recommends annual eye examinations for everyone over age 60. See your doctor of optometry
immediately if you notice any changes in your vision.
Age-related Eye and Vision Problems
In the years after you turn 60, a number of eye diseases may develop that can change your vision
permanently. The earlier these problems are detected and treated, the more likely you can retain
good vision.The following are some vision disorders of which you should be aware:
Age-related macular degeneration (AMD)
is an eye disease affecting the macula, the center of the light sensitive retina at the back of the eye,
causing loss of central vision. Although small, the macula is the part of the retina that allows us to
see fine detail and colors. Activities like reading, driving, watching TV and recognizing faces all
require good central vision provided by the macula. While macular degeneration causes changes in
central vision, peripheral or side vision remains unaffected.

An anuual eye exam can help catch evastating eye diseases, like glaucoma and macular
degeneration, early. Early detection increases the chances of maintaining healthy vision in senior
years.
Diabetic retinopathy
is a condition occurring in people with diabetes. It is the result of progressive damage to the tiny
blood vessels that nourish the retina. They leak blood and other fluids that cause swelling of retinal
tissue and clouding of vision. The condition usually affects both eyes. The longer a person has
diabetes, the more likely they will develop diabetic retinopathy, which can cause blindness.
Retinal detachment
is a tearing or separation of the retina from the underlying tissue. It can be caused by trauma to the
eye or head, health problems like advanced diabetes, and inflammatory disorders of the eye. But it
most often occurs spontaneously as a result of changes to the gel-like vitreous fluid that fills the
back of the eye. If not treated promptly, it can cause permanent vision loss.
Cataracts
are cloudy or opaque areas in the normally clear lens of the eye. Depending upon their size and
location, they can interfere with normal vision. Usually cataracts develop in both eyes, but one may
be worse than the other. Cataracts can cause a decrease in contrast sensitivity, a dulling of colors
and increased sensitivity to glare.
Glaucoma
is a group of eye diseases characterized by damage to the optic nerve resulting in vision loss. People
with a family history of glaucoma, African Americans and older adults are at higher risk for
developing the disease.
Dry eye
is a condition in which there is an insufficient amount of tears or a poor quality of tears to lubricate
and nourish the eye. Tears are necessary for maintaining the health of the front surface of the eye
and for providing clear vision. Dry eyes are a common and often chronic problem, particularly in
older adults.
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Driving Safely After 60

If you are 60 or older, driving a car may be increasingly difficult. Age-related vision changes and eye
diseases can compromise driving ability, even before you are aware of symptoms. You may be
noticing difficulty judging distances and speed. Bright sunglight or the headlights of oncoming traffic
at night may impair your vision.
Night driving with cortical cataract.Image courtesy of Eyemaginations®
Some age-related vision changes that commonly affect seniors' driving are:
Not being able to see road signs as clearly
Having difficulty seeing objects up close like the car instrument panel or road maps
Changes in color perception
Problems seeing in low light or nighttime conditions
Difficulty adapting to glare from headlights
Experiencing a loss of side vision These tips can help you stay safe when driving, especially at night:
Use extra caution at intersections.
Many collisions involving older drivers occur at intersections due to a failure to yield, especially
when taking a left turn. Look carefully in both directions before proceeding into an intersection and
turn your head frequently when driving to compensate for any decreased peripheral vision.
Reduce your speed and limit yourself to daytime driving.
If you are having trouble seeing at night or your eyes have difficulty recovering from the glare of
oncoming headlights, slow down and avoid driving at night or on unfamilair roads, whenever
possible.
Avoid wearing eyeglasses and sunglasses with wide frames or temples.
Glasses with wide temples (side arms) may restrict your side vision.
Take a driving course for seniors.
Participate in a program for older drivers in your community, such as those offered by the American
Association of Retired Persons (AARP). This can help you learn more about physical changes that
may affect your driving ability and how to compensate for them.
Have an annual vision examination.
Yearly eye exams can ensure your eyeglass or contact lenses prescription is up to date and provide
for early detection of any developing eye health problem.
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Dealing with Vision Loss

Unfortunately, some people over 60 experience loss of sight beyond the normal, age-related vision
changes. Macular degeneration, glaucoma, and diabetic retinopathy are among the eye health
conditions that can lead to permanent vision loss. This loss of vision can take many forms and it may
exist in varying degrees.It is important to understand that visual acuity alone is not a good predictor
of the degree of visual difficulty that a person may have. Someone with relatively good acuity (e.g.,
20/40) can have difficulty functioning, while someone with worse acuity (e.g., 20/100) might not be
experiencing any significant functional problems. Other visual factors such as poor depth perception,
limited side vision, extreme sensitivity to lights and glare, and reduced color perception can also
limit a person's ability to do everyday tasks.However, low vision rehabilitative services can provide
people with the help and resources needed to regain their independence. Individuals with low vision
can be taught a variety of techniques to allow performance of daily activities with the remaining
vision. Your doctor of optometry can help plan a rehabilitation program so that you may resume an
independent life within your condition's limitations. A wide variety of rehabilitation options are
available to help people with low vision live and work more effectively, efficiently, and safely. Most
people can be helped with one or more low vision treatment options
. The more commonly prescribed devices are:
1.
Spectacle-mounted magnifiers
— A magnifying lens is mounted in spectacles (this type of system is called a microscope) or on a
special headband. This allows use of both hands to complete a close-up task, such as writing a letter.
2.
Hand-held or spectacle-mounted telescopes
— These miniature telescopes are useful for seeing longer distances, such as across the room to
watch television, and can also be modified for near (reading) tasks.
3.
Hand-held and stand magnifiers
— These are convenient for short-term reading of things such as price tags, labels, and instrument
dials. Both types can be equipped with lights.
4.
Video magnification
— Table-top (closed-circuit television) or head-mounted systems enlarge reading material on a
video display. Some systems can be used for distance views tasks. These are portable systems, and
those that can be used with a computer or monitor

Image brightness, image size, contrast, and foreground/background color and illumination can be
customized. In addition, there are numerous other products to assist those with a vision impairment,
such as large-type books, magazines, and newspapers, books-on-tape, talking wristwatches, self-
threading needles, and more. Talk with your optometrist to learn more about the options available
to you.
Comprehensive Eye and Vision Examination
1.
Recommended Eye Examination Frequency for Pediatric Patients and Adults

2.
Limitations of Vision Screening Programs
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. A comprehensive
adult eye and vision examination may include, but is not limited to, the following tests. Individual
patient signs and symptoms, along with the professional judgment of the doctor, may significantly
influence the testing done.
Patient History
A patient history helps to determine any symptoms the individual is experiencing, when they began,
the presence of any general heath problems, medications taken and occupational or environmental
conditions that may be affecting vision. The doctor will ask about any eye or vision problems you
may be having and about your overall health. The doctor will also ask about any previous eye or
health conditions of you and your family members.
Visual Acuity
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 20/40. When testing distance vision, the top number in the fraction is
the standard distance at which testing is done, twenty feet. The bottom number is the smallest
letter size you were able to read. A person with 20/40 visual acuity would have to get within 20 feet
of a letter that should be seen at 40 feet in order to see it clearly. Normal distance visual acuity is
20/20.

Preliminary Tests
Preliminary testing may include evaluation of specific aspects of visual function and eye health such
as depth perception, color vision, eye muscle movements, peripheral or side vision, and the way
your pupils respond to light.
Keratometry
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.
Refraction
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 doctor 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.
Eye Focusing, Eye Teaming, and Eye Movement Testing
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.
Eye Health Evaluation

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 millimeters 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
.
Supplemental testing
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
doctor.
http://www.aoa.org/eye-exams.xml