Types of Eye Emergencies

TYPES OF EYE EMERGENCIES

Your eyes are extremely delicate and complex too. They tend to get injured easily and they are irreplaceable. They are easy targets for infections and other forms of sickness. Have you ever thought about the reason for an eye emergency or when you should start going for one? Then this information is meant just for you.

WHAT AN EYE EMERGENCY IS AND WHAT IT’S NOT

Eye emergencies arise as a result of a sudden accident. It might be a foreign object in the eye, exposure to injury or harmful chemicals. Although, most eye infections can be very painful, makes you feel uncomfortable and unpleasant, some eye infections cannot be categorized as such that needs an eye emergency.

SYMPTOMS OF AN EYE EMERGENCY

types of eye emergenciesThere are several symptoms when it comes to eye infections and diseases. And a lot of them could be a warning that you should go for an eye emergency. They include:
• A sudden loss of vision or blurring of objects.
• A stinging, burning or painful sensation in the eyes.
• When one of the eyes fail to move in accordance with the other one as a result of paralysis or bulging of the eye.
• When one of the pupils of the eyes is different from the other.
• Severe sensitivity to light or double vision.
• Bleeding around the eyes.
• A severe headache that can not be explained.
Some of these symptoms occur suddenly in a severe state. When such happens, then you should know that you are experiencing an eye emergency, you should seek medical attention immediately.

WHAT YOU SHOULD DO AND NOT DO WITH EYE INJURIES

If a foreign body enters your eye, you should seek medical help immediately. Your eyes will be checked thoroughly by a trained professional who will use the right tools to examine your eyes and remove any foreign body without causing any damage to the eyes.
Avoid attempting to remove the foreign body on your own to avoid damaging your eyes. It’s important to cover your eyes when a foreign body enters the eye mistakenly. So that your eyes can stop tracking movement and light to avoid further injury.

If a chemical substance mistakenly splashes into your eye, bend your head towards the affected eye, so it will face downwards. Then pour cool and clean water into the eyes for about 15mins to flush out the substance from the eyes.
In some cases, a small object that enters the eye can be flushed with clean water or by blinking the eye. This will enable the object to move to the corner of the eye where it can easily fall off. Avoid rubbing the eye if it itches you, instead; seek medical help.

OTHER EYE INJURIES

There are other types of eye-related diseases that need urgent attention such as:
• A cut or a scratch on the surface of the eye.
• A black eye as a result of injury or a severe medical condition.

Sudden swelling in the eyes may be as a result of an allergy, disease or symptom of another illness.
Time is crucial for any eye related problem. So, it’s good to seek help even if you are unsure whether it’s an emergency or not. Rather than wasting time and the condition will only get worse.

Pediatric Eye Care

The National Health Interview Survey, in the United States, recently conducted a research and discovered that about 3% of children who are 18 years and below suffer from various forms of visual impairment, blindness or could not see even with the aid of glasses.
Some of the commonest visual impairments that where identified include:

Pediatric Eye Care - AMBLYOPIA

Some children between the ages of 6 months to 5 years were discovered to have cases of Amblyopia. It primarily causes vision loss in children. It is generated as a result of abnormal development of the neural connectivity between the eye and the brain during the child’s early life. Amblyopia is also referred to as “lazy eye.”
A typical case of a loss in vision can only affect one of the eyes, but children who suffer from Amblyopia are more likely to suffer from vision impairment in their later life than those who do not have it. With this, it’s therefore vital to detect amblyopia at its early stage so it could be treated and curbed in time before the child gets to the age of seven. If it’s neglected or not treated on time, it could lead to loss of vision permanently in one or both eyes.

Pediatric Eye Care - STRABISMUS

Strabismus is best described as the non-arrangement of the eyes, and it has affected 2% to 4% of children under the age of 6. Strabismus causes the brain to receive complex visual inputs because the eyes are oriented in different directions. This impairs the perception process and binocular vision development.

Pediatric Eye Care - REFRACTIVE ERRORS

This represents the most common causes of visual disorder in children. It can consist of hyperopia, astigmatism, and myopia. It results in blurred vision because the lights are not focused on the retina. When such refractive errors are not corrected in infants, and children in pre-school age, due to parental concerns regarding the developmental delay. Also, the clinically based deficiency in visual-motor and cognitive functions that might later affects the child’s readiness for school. But its prevalence varies among different studies due to different examination techniques and diagnostic criteria.

Pediatric Eye Care - MYOPIA

Myopia refers to any condition whereby the visual images focuses on the front of the retina and causes a defective vision of distant objects. According to reports, about 4 percent of children between 6 months to 72 months old and 9 percent of older children between 5-17 years are suffering from myopia. Its prevalence varies by ethnicity, race, and age.

Pediatric Eye Care - HYPEROPIA

Hyperopia occurs when the visual images focus at a point beyond the retina resulting in a defective vision of near objects. It’s also known as farsightedness because it makes nearby objects to appear blurry. Its occurrence is about 21 percent among children (6 months to 5 years of age) and 13 percent among children (5 to 17 years of age). Its appearance varies among race, age, and ethnicity.

Pediatric Eye Care - ASTIGMATISM

This is an irregularity in the shape of the lens or cornea which leads to a blurred vision of distant objects. About 15 and 28 percent of children under the age of 17 years old have astigmatism. Most children who suffer from myopia and hyperopia tend to have astigmatism too.

To book your Pediatric Eye Exam and consult with one of our optometrists call our downtown Toronto today. 

What is Orthokeratology?

What if you could temporarily correct your vision while you sleep? Orthokeratology (ortho-k) is a specially designed contact lens system that corrects myopia (shortsightedness) overnight. The effects last for up to two days, and the lenses can be worn again.

Ortho-k lenses are gas permeable contacts you wear overnight. Gas permeable, or rigid lenses are made of durable plastic that allows for more oxygen to reach the cornea than most soft contact lenses—making them “breathable” lenses. Ortho-k lenses work by gently reshaping the cornea, or front surface of the eye. In the morning, when the contacts are removed, the wearer can see clearly for up to 48 hours.

orthokeratologyThe lenses are prescribed for patients with mild to moderate myopia who are not eligible or don’t want LASIK surgery. They also assist in temporary correction of astigmatism, where the eye has difficulty focusing light for clear vision, and some cases of hyperopia (farsightedness). Ortho-k lenses have been proscribed to slow the progression of myopia in children, as well.

These overnight corneal reshaping contact lenses are prescribed and fitted by optometrists who measure the curvatures of a patient’s cornea to create a topographical map of the eye’s surface. Custom lenses are then ordered, or the optometrist can fit lenses that are in stock.

Patients report that the Ortho-k lenses are easy to adapt to, and comfortable for sleeping. Most have clear distance vision after only a day or two of overnight use. The effects of Ortho-k are cumulative, but also reversible, meaning people can stop using them and their eyes will gradually return to the previous corneal shape.

Ortho-k lenses are more expensive than regular contact lens systems, but about half the price of laser vision correction. There is no harm with long-term use and wearers can some using them and opt for laser correction (if deemed appropriate) within weeks or months of stopping Ortho-k.

Children’s Eye Exam – Wearing glasses

Glasses can help correct many types of vision problems.

  • If a child is very farsighted, nearsighted, or has astigmatism, the brain only receives blurry images. Glasses help the child see clearly, which helps vision develop normally.
  • If a child has crossed eyes, glasses can correct the problem and help vision develop normally. Glasses may be used to correct crossed eyes, even when vision is clear.
  • If a child has good vision in just one eye, glasses will protect the eye from injury. These glasses must be made of shatterproof material such as polycarbonate or trivex.

The doctor will:

  • Discuss your child’s vision and how glasses will help.
  • Give you a prescription for your child’s glasses

The optometrist’s prescription is used to make the lenses for your child’s glasses. The choice of frames is up to you. Here are some suggestions for choosing frames:

  • Let your child pick out the frames. If your child likes them, he or she will be more interested in wearing them.
  • Choose frames that are not too small or your child will look over them.
  • Make sure the glasses fit well, don’t slip or feel too tight or heavy.
  • Regular glasses won’t protect your child’s eyes from injury. Your child may also need safety glasses for sports.

For any tips on eye care for your children, selecting the right frames and ways of encouragement, give us a call today. Metro Eye Care is an optometrist office located in downtown Toronto and accepting new patients!

What you need to know about aqueous tear deficient dry eye disease

 

What is aqueous tear deficient dry eye disease?

Your tears do much more than indicate that you are crying. They have other functions. The tear glands supply your eyes with the tears required to keep them moist. Each time you blink, they supply the tears needed. Those tears keep your eyes moist, clean, and healthy. If your tear glands stop this supply for any reason, it can lead to the condition called aqueous tear deficient dry eye disease. This condition usually comes with vision problems, redness of the eyes, and eye discomfort or pain.

Causes of aqueous tear deficient dry eye disease

Many factors can cause or contribute to aqueous deficient dry eye disease but the two most common ones include Sjogren’s syndrome and advanced age. 

Sjogren’s syndrome

Sjogren's syndrome is a disease that attacks both tear glands and saliva glands. Tear glands will no longer be able to produce tears and the glands that secrete your spit will also stop functioning. So, those who have the disease will usually have both aqueous tear deficient dry eye disease and dry mouth disease.

It has also been observed that women are more prone to Sjogren’s syndrome than men. The fact that about 10 percent of people with dry eye disease also have Sjogren’s syndrome underscores the strong link between both conditions.

Age

Just like most body parts, the tear glands function less as you grow older. Besides, since your immune system will also naturally get weaker with age, your chances of getting Sjogren’s syndrome, aqueous tear deficient dry eye disease, or any other disease, will become higher as you grow older.

 Other conditions causing aqueous tear deficient dry eye disease include:

• Damaged tear glands or tear ducts

• Virus infection

• Any of the following diseases can also lead to dry eye disease; Amyloidosis, Hemochromatosis, Sarcoidosis, Lymphoma, and Hepatitis C.

Symptoms include feeling dry and itchy.  You may also find it very uncomfortable to wear contact lenses. In addition, you may have blurred or fluctuating vision. There may be a burning sensation in your eyes. Eye pain and redness of the eyes have also been observed to be common symptoms of the disease. Sometimes, you may feel like there is dirt or sand in your eyes.  A dry eye exam can uncover the underlying cause of such symptoms. 

How to diagnose aqueous tear deficiency? 

The most effective way to diagnose aqueous tear deficient dry eye disease is through a reliable dry eye exam. While there are numerous dry eye tests, the best approach is through a comprehensive assessment using multiple tests including the Oculus Keratograph 5M Meibography and osmolarity.   The Oculus Keratograph 5M is an advanced test that involves the use of both color camera and keratometer for optimized external imaging of the eye. It also includes Meibography which is an imaging study of the morphology of meibomian glands in vivo.

Depending on the findings of your dry eye assessment you optometrist might recommend further testing for  Sjogren's syndrome.  Depending on the severity of your dry eye disease and the cause, your doctor will determine the best treatment for you.

The standard of care is usually to treating the underlying etiology that's causing the dry eye condition. Your doctor may also recommend the use of certain lubricating eye drops or supplements. You may also need to use plugs to prevent your tears from draining off. On rare cases, your doctor may suggest a surgery.  It's best to start with a comprehensive dry eye exam which will first determine the form of the dry eye disease involved.  To book your comprehensive dry eye assessment at our sister clinic please visit their Dry eye clinic page. 

 

 

Top Methods Used To Test Your Eye Pressure And Why It Is Important

Testing your eye pressure, also known as intraocular pressure or IOP, is an integral part of a comprehensive eye exam and a primary reason to see your optometrist regularly. Frequency of eye examinations can vary depending on each patients. Patients diagnosed with Glaucoma for example will require a closer monitor and more frequent visits than patients who are being monitored due to family history.

Commonly used methods to test eye pressure:

• Goldmann applanation tonometry

testing_eye_pressure

Goldmann applanation tonometry is one of the most accurate techniques used to check the eye pressure. It is still the gold standard for measureing intraocular pressure (IOP) in glaucoma patients. This technique examines your eye pressure by determining the amount of force required to flatten a corneal surface area. Optometrists using this method to test eye pressure use a tonometer that consists of a tonometer arm, contact prism, contact probe, and measuring drum.

Before an optometrist starts checking your pressure, some detailed instructions highlighting the process are offered to the patient. Below is a complete procedure on how to go about this method. The procedure starts by instilling anesthetic drops and small amounts of fluorescein into the eye. Once the patient is ready and situated in the slit lamp the probe is gently moved towards the corneal centre. One the tip touchs the cornea the knob is adjusted until the edges of the two mires are just touching. Once this is achieved the reading obtained is recorded.  This represents the amount of pressure taken to flatten the surface. 

• Tono-Pen tonometry

Tono-Pen tonometry is a method of testing the eye pressure where an optometrist touches the cornea with a pen tip until a reading is displayed. This method is not only accurate but also reliable and it's used in many clinical settings.  One advantage of this instrument is it's mobility and portability.  It's great for patients who are wheelchair ridden and have limited mobility.  An optometrist can repeat the procedure several times if the final measurements differ by more than two mmHg to ensure an accurate measurement is obtained. 

• Non-contact tonometry (NCT)

Non-contact tonometry (NCT) is a method of testing the eye pressure that works on a time-interval principle. Optometrists’ uses the tonometer to measure the total time it takes from the first generation of the puff of air to where your cornea flattens. Note that it takes milliseconds for a puff of air to obtain the reading. This method is commonly used in screenings and as a part of a pretest in routine examinations. 

Why is it essential to test for eye pressure?

Testing for eye pressure helps in determining the risk for glaucoma. Undetected elevated pressure in the eye can lead to glaucoma, an eye condition that's characterized by a damage to the optic nerve. It’s never too late, book an appointment with your optometrist to have your eyes checked. Make it a routine to stay safe and healthy.

To book your eye exam with one of our optometrists in the downtown Toronto area call our office today at 416-782-7301 or email us at eyedocs@x8t.d92.myftpupload.com. 

Keratoconus treatment with scleral lenses

What is Keratoconus and how it can be corrected with scleral lenses?

Keratoconus is a corneal disorder that is mainly characterized by the thinning of the irregular cornea. It is believed to be caused by a combination of factors such as genetics, hormonal and environmental factors. Keratoconus may result in blurry vision, nearsightedness, double vision, light sensitivity as well as severe astigmatism.

While the condition can be corrected during its initial stages, the damage may become permanent if the cornea degradation continues. As a result, patients with who might experience early symptoms are advised to see an optometrist for a full ocular health assessment. In many cases, the condition can be corrected with scleral gas permeable (GP) lenses.

What are gas permeable scleral lenses?

They are large diameter lenses that rest over the sclera and vault the cornea entirely. Unlike conventional contact lenses which rest on the cornea. As a result, there is a space between the lens and the cornea. Usually, the lenses are inserted after filling with sterile isotonic fluid.

As a result, these lenses can be used to correct corneal ectatic diseases which result in high irregular astigmatism. These include keratoconus as well as pellucid marginal degeneration.

How can the lenses correct Keratoconus?

The field of Scleral contact lenses (ScCLs) has seen much advancement in terms of both design and lens materials. As a result, GP scleral lenses are now replacing the older corneal rigid gas permeable (RGP) lenses which are less useful in cases where the conicity of the cornea increases dramatically (a major characteristic of keratoconus),

ScCLs contains three parts:

•the Scleral portion (Haptic) which rests on the sclera

•the vault, this section is responsible for corneal as well as limbal clearance of the lens

•the optical part of the lens, this is usually 0.2mm more extensive than the horizontal iris diameter.

This design ensures that the lens does not move too much on the eye after fitting

A few other design features may also be included to enhance ScCLs.  Those include:

•Front surface eccentricity (FSE), these act as wavefront aberrations correction to the spherical scleral lens.

•Air-ventilation or fluid ventilation, this will help in providing oxygen to the ocular surface.

It’s important to note that the fluid reservoir found on the scleral lenses is able to mask irregular astigmatism. Therefore, the lenses have to align the haptic to the sclera perfectly. This is made possible through the application of submicron lathe machines as well as computerized lathe machines to produce custom lenses for each patient. This also allows the adding of toricity to match the edge lifts for each individual patient.

Advantages of using gas permeable scleral lenses to correct keratoconus:

1.Improved oxygen transmissibility due to their thin nature that allows oxygen to permeate through them freely.

2.Reduced amount of debris collection between the lens and cornea

3.The lenses are much more comfortable to wear compared to others

4.The minimal movement ensures that the lens stays in position and therefore allows for better, more stable vision.

5.Fenestrations that help in oxygen delivery as well as tear exchange.

If you are interested in scleral lenses contact our downtown office today at eyedocs@x8t.d92.myftpupload.com for further information or to book your eye exam and consultation with one of our optometrists.

What is astigmatism and how to correct it?

What is astigmatism? 

 Astigmatism is a refractive error that is quite common for both children and adults. It is a condition in which the eye fails to focus light onto the retina evenly. Astigmatism arises when the light that strikes the cornea is bent differently. It is because the shape of the cornea or crystalline lens is irregular as opposed to the typical spherical shape.  Simply, the eye is not perfectly spherical. Astigmatism correction is done using special spectacle lenses or contact lenses.

A comprehensive eye exam by an optometrist is undertaken by patients who might suspect astigmatism.  The optometrist will provide glasses or contact lenses prescription if necessary at the conclusion of the eye exam. 

Astigmatism results in a blurred or distorted vision to some degree. Common symptoms associated with astigmatism include headaches, eyestrains, and squinting. Some patients having slight astigmatism will fail to notice the change in their vision. It is therefore essential to have regular eye examinations to determine astigmatism.

Astigmatism

How to correct astigmatism? 

Spectacle lenses (Glasses)

The use of glasses is the most common method used to correct vision. Eyeglasses having cylindrical lenses are the most popular way of correcting astigmatism.  Studies have shown that most patients with high astigmatism prefer glasses. Glasses are either positive or negative depending on the type of prescription. These glasses have special cylindrical lenses, which compensate for astigmatism by providing additional powers in certain areas of the lens. In most cases, a single-vision lens is provided which serves to provide clear vision. Nonetheless, patients who are over 40 years and have presbyopia may be prescribed an additional progressive or bifocal lens.

Contact lenses

Contact lenses are also another way of correcting astigmatism. Some years back, astigmatic patients could not use soft contact lenses; instead, the correction was only possible by the use of hard contact lenses, an example being the gas permeable contact lenses. Today, astigmatism correction is carried out using unique toric soft contact lenses. These contact lenses can have toric on either the back or the front surface. The contact lenses having toric on the front surface will correct both lenticular and corneal astigmatism of up to 4.5 D. Corneal astigmatisms is corrected by contact lenses having a toric back surface. Usually correction is up to 60. D with the custom designs. 

The use of custom contact lenses is known to remedy high astigmatism as well as allowing favorable conditions for binocular vision. Many patients also prefer contact lenses over glasses for cosmetic reasons. 

Since these contact lenses are worn directly to a patient’s eye, they should ensure that they are regularly cleaned and cared for to protect their eye health.

Laser vision correction 

For the right candidates, procedures such as LASIK, LASEK, or PRK can also correct astigmatism. 

Patients with astigmatism have a broad range of options to correct their vision condition. Upon consultations with the optometrist, patients can select the treatment that best fits their visual needs and life style. To book your eye exam and consultation with one of our optometrists call our downtown Toronto today. 

Optometrist: Primary Eye Car provider

Optometrist: Primary Eye Car provider

 

The roles of optometrists in primary eye care goes beyond the testing of vision and prescribing spectacles and contact lenses. In this blog, we'll highlight some of the work optometrists are involved in.

Optometrists are often the first point of contact for patients with vision problems. They also receive referrals from the patient’s family doctor. A patient who has a condition that affects sight will be referred by the primary doctor to the optometrist for further tests and treatment.

eye exam, optometrist

Medical ocular diagnosis and treatment:

 

Optometrist are primary eyecare doctors. Monitoring the retina for diabetic complications, treating and managing dry eye disease and other chronic conditions, and removing foreign bodies from the eye are some of the many conditions patients see optometrist for.

What is the role of the optometrists in management of diabetes?

 

Diseases like glaucoma and diabetes usually have no obvious early symptoms. Optometrists will conduct a dilated fundus exam to detect eye diseases such as glaucoma and diabetes.  Early detection and treatment of such diseases will help minimize the risk of developing permanent vision loss. The importance of regular eye exams cannot be stressed enough.  Your optometrist plays a vital role in management of your diabetes.  Most ocular complications due to diabetes are usually asymptomatic in the early stages.  When detected early, the progression of further complications is minimized and usually treatment is most successful. Your optometrist will communicate with your family doctor or endocrinologist with the test results. 

Comprehensive eye examinations involve numerous tests starting with preliminary external tests following by refraction and dilated retinal assessment.

External ocular examination and refraction:

 

The eye doctor performs examinations to measure the depth perception, ocular motility, color perception and eye coordination. They also determine the deviation of the eyes and provide a leading role in vision therapy when needed as a rehab treatment. Vision therapy includes orthoptic exercises, prismatic correction, and occlusion therapy.

The optometrists conduct other preliminary eye tests such as automated refractory, streak radioscopy and vision assessment. Optometrists play a significant role in the treatment of refractive errors. Once refraction is completed, the optometrist will provide a prescription for glasses. Contact lenses including soft and gas permeable lenses are also fitted and prescribed by your optometrist. Optometrists who are trained in low vision are also able to provide low vision aids to correct and amplify vision for people with subnormal vision.  Patients with enucleated eyes can be fitted with prosthetic shells or lenses cosmetically. 

The importance of regular Eye Examinations:

 

Optometrists are often the first point of contact for patients with vision problems. They also receive referrals from the patient’s family doctor and other health care practitioners. Usually a patient who has a condition that affects sight will be referred by the general practitioner to the optometrist for further assessment and management.  Individuals are advised to take regular eye exams even if they are otherwise healthy or experience no visual symptoms. Eye exams can help detect eye conditions early enough when it is more likely to be successfully treated.  The exam will allow the optometrist to evaluate the patient's eye health as an indicator of the overall body health and communicate with the patients family doctor as needed. If you are looking to book an eye exam in downtown Toronto contact our office at eyedocs@x8t.d92.myftpupload.com to book your appointment with one of our optometrists today. 

 

Anti-reflective coatings and other lens treatment options

what are lens treatment options?

More often than not, the final step in the creation of a pair of glasses is applying lens treatment. This step can sometimes be opted out of, usually due to cost. When purchasing lenses for your eyeglasses prescription, you should be educated on the available coating options and which ones might be best suited for your prescription. 

There is a multitude of treatments available for prescription lenses; all applied during the manufacturing process. The most common one is the Anti-Reflection Treatment (or AR), which cuts glare from highlights – a feature which is very useful in some instances, especially when driving. This treatment also improves clarity and comfort. Other common lens coatings are photochromic (changing tint with protection against UV rays), polarized (enhances contrast and visual clarity, also reduces glare), scratch-resistance, or mirroring. Also, a patient can also opt for having their lenses permanently tinted with various colors. 

By far, the most common lens treatment is the Anti-Reflection coating. However, not all AR treatments are created equally. There are several levels of AR treatments, from basic to more elaborate. Let’s see the differences:

- Basic. The most standard AR lens treatment comes with a basic scratch-resistant coating, along with the standard anti-reflective coating. This treatment does get the job done under most conditions, but without additional coatings many suffer from issues like dust collection, scratches and usually difficulty cleaning them.

- Intermediate: The next level of AR lens treatment includes an oil-resistant hydropholic coating which also with the added layers improves scratch resistance and helps keep your glasses cleaner for longer periods. The hydrophobic coating will help if you get caught in the rain – the droplets will simply slide of your lens.

- Top: The next additions are UV protection and static resistance, along with optimum scratch-resistance strength.  These coatings will help minimize dust buildup and are much easier to clean .

In recent year, the top-level AR treatments can benefit from one more type of coating: a blue filter which is great for filtering light produced by electronic devices, such as computer and phone screens. That’s about all the technology that can fit into your lens at this moment in time.

If you’re in the market for lenses and want some of the best coatings available at this moment, there are a couple of manufacturers whose quality is undoubted. Nikon is one of them, with their SeeCoat series (SeeCoat Premium and SeeCoat Blue are the highlights of that particular line), and another one is Hoya, with their EX-3 series. Both these producers have many years of experience in manufacturing high quality lenses, which can also be seen in their photographic work – Nikon produces excellent cameras and sensors, while Hoya manufactures some of the greatest filters on the market.

All in all, it’s essential to know what your budget is when choosing the coatings for your lenses and what you need them to do. Some people dislike dust on their glasses most, while others despise smudges and constantly having to clean them. Blue light protection is always useful given how much time we spend in front of screens, but at the end of the day, the decision is yours.

For further information, before purchasing your next pair of glasses visit our Metro Eye Care clinic on 40 University in the Toronto downtown core and ask to speak to one of our opticians or book an appointment with one of our optometrists.  We will gladly walk you through all the options for your prescription.