Topic: Eye Treatments & Examinations

Civil Aviation Safety Authority (CASA) credentialed optometrists

The Australian Civil Aviation Safety Authority (CASA) regulations require that all pilots with a Class 1 commercial licence and all air traffic controllers with a Class 3 licence must have an aviation eye exam performed by a designated aviation ophthalmologist (DAOs) or a credentialed optometrist (CO).

As anyone in the field of aviation knows, good visual function is necessary for the safe performance of aviation activities: pre-flight checks, take-offs, navigation, landings and the proper use of displays, dials, gauges, and maps in modern cockpits.

The eye exam is a required part of the medical certificate for a Class 1 or Class 3 licence and exams must be performed by a designated aviation ophthalmologist (DAO) or credentialed optometrist (CO), listed below.

Main criteria for Class 1 and Class 3 licence

In accordance with the Civil Aviation Act, the vision criteria for commercial pilots includes:

• Distance visual acuity of 6/9 or better in each eye separately and 6/6 or better binocular (with or without correcting lenses
• The ability to read (with or without correcting lenses) an N5 chart binocularly in the range of 30 to 50cm
• The ability to read an N14 chart binocularly (with or without correcting lenses) at 1m
• Contact-lens-wearing pilots need to be able to use their lenses for twice the projected flight or duty time without deterioration in visual acuity or discomfort. They must also have backup spectacles available and pass the appropriate standards with them immediately after removing their contact lenses
• The ability to readily distinguish the colours that need to be distinguished for the safe exercise of privileges, or performance of duties. Candidates with colour deficiencies will undertake a ‘operational colour vision assessment’ or OCVA.

Renewals and further assessments

After the age of 60, eye exams are performed every two years. During the intervening years, designated aviation medical examiners (DAME) perform frequent overarching aviation medical exams which involves a rudimentary eye test – if issues are spotted, pilots are referred to a DAO or CO for further assessment.

• A Class 1 medical certificate is valid for one year and is required for…
• Air Transport Pilot Licence
• Commercial Pilot Licence (other than balloons)
• Multi-crew Pilot (aeroplane) Licence
• Flight Engineer Licence
• Student Flight Engineer Licence.

A Class 3 medical certificate is valid for two years and is required for:

• Air Traffic Control Licence
• Flight Service Officers

Please note: Medicare does not cover vision screening services and an examination and reporting fee will be applied. Visit the Civil Aviation Safety Authority’s website for details on their medical certification process.

Eyecare Plus CASA-credentialed optometrists

Eyecare Plus’s Credentialed Optometrists (COs) are trained to perform vision and eye exams for Class 1 and 3 medical certificates. They are formally recognised as trained occupational vision experts. All applicants for Class 1 and Class 3 licence can be assured that the Eyecare Plus COs have the essential skills to provide the proper vision assessment, exam and vision care to critical staff in the aviation industry.

Eyecare Plus’s COs are required by CASA to maintain certain clinical competencies, including familiarity with the aviation standards and CASA’s medical record system and statutory declarations.

The aviation eye examination

An eye exam for a Class 1 or Class 3 licence typically takes approximately one hour. It involves a full assessment of vision, including binocular vision, peripheral vision and an ocular health assessment.

Remember to bring your glasses or contact lenses to the exam. CASA requires that your vision is tested with your spare lenses, so bring them to the exam as well.

To book an exam appointment contact one of the Eyecare Plus practitioners below. They are CASA-certified as credentialed optometrists (COs), and trained to conduct vision and eye examinations for pilot licensing.

Eyecare Plus practitioners who are credentialed optometrists are located in…

NSW

Eyecare Plus Orange – Jacob Hansen

Eyecare Plus Parkes – Jacob Hansen

Eyecare Plus Raymond Terrace – Peter Scher

NT

Eyecare Plus Alice Springs – Bill Robertson

QLD

Eyecare Plus Benowa – Jonathan McCorriston

Eyecare Plus Burleigh – Jonathan McCorriston 

Eyecare Plus Clifton Beach  – Shane Mortier

Eyecare Plus Southport – Jonathan McCorriston

VIC

Eyecare Plus Cheltenham  – Randal Lamont

Eyecare Plus Clifton Hill – Murray Smith

Eyecare Plus Cranbourne – David West

Eyecare Plus Mitcham – Riki Gibson, Tony Gibson, Hayden Merrett and Catherine Tay

WA

Eyecare Plus Glen forrest – Dr Kristin Larson

Dry eye is one of the most common reasons people visit an optometrist. Millions of people throughout the world suffer symptoms of dry eyes every day. Dry eye disease is much more complicated than you might think. It isn’t simply a matter of getting a bottle of eye drops and applying them to your eyes when they feel dry. 

 

In the last decade, new research and technology  have led eye care professionals to a much more advanced understanding of dry eye. Dry eye symptoms include itchiness, stinging or burning, occasional blurred vision, redness and tired eyes.

 

Dry eyes can be a common problem for people who wear contact lenses. If you are wearing contact lenses incorrectly they can aggravate the eye surface and cause dry eye problems.

Diagnosing dry eye

Dry eye disease is classified as a ‘multifactorial disease,’ which means that it is caused by a variety of reasons, so the first step to the treatment of dry eye disease is determining the real  reasons behind a person’s eye irritation.

 

Basically, dry eye disease stems from the quality or quantity of either water or oil in the tears.

 

Every time we blink, the little lacrimal glands in the upper eyelids secrete a dose of salty water that the eyelid spreads across the eye. At the same time, meibomian glands (also in the eyelids) secrete a dose of oil over the watery tear fluid to keep it from evaporating too quickly.

Not enough water 

‘Aqueous-deficient’ dry eye means that the lacrimal glands which produce the water in tears aren’t functioning properly.

Not enough oil 

‘Evaporative dry eye’ is a lack of oils in the tears and is usually traced to meibomian gland dysfunction, the most common type of dry eye (affecting approximately 85% of people with dry eye symptoms). 

 

A person may have aqueous deficient dry eye or evaporative dry eye, or both at the same time. To find out, your optometrist will perform a comprehensive eye exam, including an evaluation of the quality and quantity of the tears produced by the eye. 

 

Once the optometrist determines what kind of dry eye you have, and how severe it is, they will tailor a treatment plan to fix it. 

Treating dry eye

There is no single approach to dry eye treatment that will suit all patients.

For many people with mild or occasional dry eye symptoms, dry eye treatment can be as simple as the frequent use of over-the-counter artificial tears or lubricating eye drops. 

Artificial tears

The goal of dry eye treatment is to reduce symptoms of dry eyes and improve function. Dry eye treatment is something of an art, requiring a tailored approach for each individual patient.

Warm compress

If your optometrist suspects that you have evaporative dry eye due to meibomian gland dysfunction, they may apply warm compresses to the patient’s closed eyes to help reduce eyelid inflammation. 

 

Warm compresses rest on the eyelids for approximately 15 minutes, will open the clogged meibomian glands by softening the hardened oils trapped in them. 

Blephasteam

Your optometrist may provide an in-chair procedure involving a pair of heated goggles, similar in appearance to swimming goggles, that provide a warm, humid environment around the closed eyes, effectively melting the clogged oils in the meibomian glands.

 

Following use of the goggles, the optometrist may apply pressure to the eyelids to express the meibomian glands and press out the blocked oil glands. 

Intense Pulse Light (IPL) treatment

To treat severe meibomian gland dysfunction, your optometrist may suggest IPL treatment, where a series of painless pulses of light are applied to the lower eyelid to stimulate the meibomian glands. 

 

The positive effects of IPL are cumulative. Sessions usually take approximately 10 minutes each and are performed over a series of four visits. 

Discuss dry eye with your Eyecare Plus optometrist

While some people experience mild dry eye symptoms that can be treated with over-the-counter eye drops, other people may have more severe symptoms that require an eye care professional to treat dry eyes.

 

If you are experiencing eye infections, increased tear evaporation, decreased tear production or moderate symptoms of dry eyes, you need to speak with an eye care professional about your eye health. An eye care professional will determine your risk factors and treat dry eye symptoms to help relieve symptoms. 

 

Only an eye care professional can treat dry eye symptoms effectively, whether you have mild dry eye symptoms or you need prescription eye drops.

 

It is important to speak with your Eyecare Plus optometrist about your symptoms. They can determine the reasons behind them and discuss with you the best way to restore the health of your eyes. For an eye check near you, book an appointment today.

Vision therapy is like ‘physiotherapy for the visual system.’ 

Vision therapy refers to the course of exercises designed and prescribed by a Behavioural Optometrist. 

Visual therapy can enhance the performance of the visual system and improve its speed, flexibility and accuracy.

Vision therapy exercises, as part of a vision therapy program, are designed to train the brain to use vision more effectively. 

Patients will receive a unique course of eye exercises specially designed for them to enhance visual skills such as focusing, visual processing speed, eye tracking and hand-eye coordination.

Vision therapy eye exercises commonly address issues that are prevalent during the development stage of childhood, so they are typically prescribed for paediatric patients. 

That said, they can also be used to treat some vision disorders in adults as well.

 

What is Vision Therapy used for?

Behavioural Optometrists suggest that ‘20/20 vision does not mean perfect vision.’ In other words, vision problems can exist even if you have healthy eyes and can see clearly.  Although ’20-20 vision’ indicates how clearly you can see, it does not explain how you see. 

Even with 20-20 vision, vision problems can still occur with the system that processes and coordinates visual information. These vision problems – often undiagnosed – can lead to issues with reading, coordination and learning.

 

Who is Vision Therapy for?

Throughout our lifetime, our eyes grow and change – especially during the first two years of our life and during puberty when we are teenagers. With so many things in motion, vision problems can occur when there are delays in development that can affect learning, comprehension or coordination.

Vision therapy aims to relieve vision problem symptoms and improve conditions such as:

Lazy eye (amblyopia)

Lazy eye is a vision-development problem that starts with a miscommunication between the eyes and the brain, this can lead to one eye getting stronger than the other.

Crossed eyes (‘strabismus’)

A condition of misaligned eyes.

Eye tracking (‘oculomotor dysfunction’)

When both eyes are unable to work together efficiently while following a moving object, or while moving the eyes between two objects, the person has an oculomotor dysfunction. Often, it affects children with normal or above-average intelligence who still struggle with reading.

Eye teaming (‘convergence insufficiency’)

Eye teaming is when you have trouble keeping both eyes turned in to point in the same position. This condition makes it hard for a struggling reader to see the words clearly on a page.

Hand-eye coordination (‘visual-motor integration dysfunction’)

Visual motor integration is the ability to take visual information that we perceive and correctly execute movement of our arms, legs and hands. Symptoms of visual motor integration difficulties include: poor handwriting, difficulty catching a ball or the inability to colour within the lines on a colouring book.

Visual memory problems (visual perception dysfunctions)

These are issues with the way the brain processes visual information. A child may have trouble seeing the difference between similar letters, shapes, or objects or they may struggle to remember shapes, symbols, or objects they have seen once they have seen them.

What is done in vision therapy?

Behavioural Optometrists design each vision therapy program to suit the needs of each individual to help improve a person’s unique visual problems. It is not unusual for patients at the same eye doctor to have different programs. Nevertheless, the goal of vision therapy is the same: to improve the coordination and control of eye movements and enhance comprehension.

Although programs differ, vision therapy consists of three main elements….

• diagnostic tests
• training procedures
• exercises

The frequency of optometrist visits, amount of visual training and duration of the therapy will depend on the nature and severity of your eye problem. Over time, the more one trains their brain, the easier and more automated the exercises will become. Ultimately, results depend on the patient’s active participation and compliance with the program.

Eyecare Plus Behavioural Optometrists

If you or your child has issues with learning or struggles with reading or has trouble comprehending their reading material, discuss these issues with an Eyecare Plus Behavioural Optometrist. They will be able to perform a full assessment of functional vision as well as an evaluation of the visual system. They may be able to suggest a program of vision therapy exercises that can address the problems.

Eyecare Plus Behavioural Optometrists can help their patients achieve more effective vision performance in the classroom, in sports and in the workplace. They can develop strategies to and vision skills to ensure the performance of your child’s vision system gets back on track.

Behavioral Optometrists are optometrists who have medical expertise in ‘vision development.’ They check the health of their patients’ eyes to ensure they have clear vision. As part of a patient consultation, they also investigate problems that occur between the information the eyes take in and how the brain makes sense of it.

In clinical practice, a Behavioural Optometrist makes the distinction between ‘eyesight’ and ‘vision.’ 

‘Eyesight’ is only one of a number of visual skills needed for an efficient and accurate visual system.

Most people develop their visual skills in infancy, however, there are a number of children who don’t develop them  adequately. They need vision therapy. Vision problems can lead to difficulties in learning, reading, writing or participation in sports activities.

Vision problems are totally unrelated to intelligence and physical ability.

The goal of Behavioural Optometry is to determine if a patient has a problem with their visual system and to develop vision therapies that will ensure that their vision develops to its full potential.

The problem behind the problems

Our visual system represents 70% of the information coming into our brains. It is central to maintaining balance, reading and learning. Even so, if a child has a visual system that is deficient, it is often difficult for parents to understand or discover why.

Often, children who are affected by vision problems don’t understand why they are struggling. They see the words on the printed page ‘moving,’ or fail to track a football across a field, but they don’t understand that their vision problems are out of the ordinary.

If a child has a problem with their legs, for example, it will be obvious why they have trouble running in the playground. But children with vision problems may have trouble reading or learning and, because the cause is not immediately apparent, it can go undetected into adulthood.

Learning problems

Problems with visual processing development do not ‘cause’ learning disabilities, but they can interfere with learning and often thwart attempts to address them.

When you consider the fine ocular motor skills and abilities that are needed on a day-to-day basis, it is easier to understand how some learning difficulties can arise.

For example: if a child has a maladaptive strategy for reading, their eyes may move through text in such a way that they read words backwards, not because they ‘see words backwards,’ but because their eyes go to the end of the word first, and then come back to the beginning of the word.

Signs and symptoms of issues

If your child has developmental delays or struggles to read and write; if they struggle with everyday tasks or with visual demands and routinely exhibit visual development problems, you may want to arrange a behavioural vision evaluation with an Eyecare Plus Behavioural Optometrist. They will be able to provide diagnostic and management services.

Signs include…

• Slow reading with poor reading comprehension
• Avoidance of near visual work
• Fatigue
• Short attention span
• Double Vision
• Declining academic performance
• Avoidance of sports (or games with balls or small flying objects)

Behavioural Vision Assessments

If your child has learning related vision problems, book an appointment with your local Behavioural Optometrist.

A visit to a Behavioural Optometrist will begin with a comprehensive assessment to determine functional vision ability and their ocular health. Like a traditional optometrist, eyesight and eye health will be assessed and a determination will be made if corrective prescription lenses are needed.

From there, the Behavioural Optometrist will investigate how efficiently the patient’s eyes are receiving information. This may involve vision therapy, tests of eye coordination, flexibility of focus, sustainability of focus and tracking.

A visual cognitive assessment may be undertaken, using a standardized written test that determines where the child’s skills lie compared to other children of the same age.

Beery Visual Motor Integration Test

A ‘Beery Visual Motor Integration Test’ is another written test that might be performed. It helps Behavioral Optometrists to develop a better understanding of a child’s visual motor deficits that can lead to learning and behavioural issues.

Readalyser

A ‘Readalyser’ may be used to obtain a clinically-measurable assessment of a child’s ability to track and keep their place on a page while reading. During this test, the patient wears goggles that have infra-red sensors to monitor how their eyes track as they read a passage of text.

Eyecare Plus Behavioural Optometrists

Eyecare Plus Behavioural Optometrists can help their patients achieve more effective visual performance in the classroom, in sports and in the workplace. They can develop strategies and visual skills to ensure the performance of your child’s visual system gets back on track.