Children need many skills for effective learning. Being able to see clearly and comfortably is one of the most important abilities for success at school, as it is estimated that 80% of the learning that a child does happens through his or her eyes. As children graduate to different levels of learning, the visual demands expected of them increase – font size becomes smaller, the amount of time reading and studying increases, and more school work/homework increases the strain on the child’s eyes. If the visual skills and abilities are not functioning properly, education can suffer because learning turns into a difficult and stressful task.

Children may not have the experience to know that they are having trouble with their vision, and may not specifically complain about their eyes or their ability to see. However, children might:

  • Avoid reading and other close work
  • Attempt to do the work, but struggle with comprehension and efficiency
  • Experience discomfort, tiredness, and short attention spans

These undetected vision problems can sometimes be confused with symptoms of other learning disorders/disabilities, such as ADHD or dyslexia.

Other signs that might indicate your child has a vision problem include:

  • Squinting, or moving close to objects to see them clearly
  • Excessive eye rubbing or blinking
  • Frequent headaches
  • Covering one eye, or tilting the head to one side
  • Holding reading materials very close to the face
  • An eye turning in or out (“crossed eyes”), or double vision
  • Losing place when reading, difficulty remembering what was read

Because children have many visual demands in the classroom – and because their bodies are growing rapidly – it is important to have a comprehensive eye exam performed yearly (or sooner if any vision changes are noticed). In my experience, it is not uncommon that a child may be seeing 20/20 in both eyes one year, and the following year, vision can become worse than 20/100 – all while the child is reporting they “see just fine”. I have also seen many instances where a child might have 20/20 vision in one eye – but extremely poor vision in the other eye – leading to problems with depth perception, and if not corrected, the development of a “lazy eye”.

There is much more to vision than the ability to see clearly, or “20/20″ vision. Children also need to be able to focus their eyes, and use their eyes together as a team. Every child needs the following visual abilities in order to learn and be able to comprehend what they read and observe:

  • Visual Acuity – the ability to see clearly at all distances (far: whiteboard/overhead screens, intermediate: computer, near: reading/homework)
  • Eye Focusing – the ability to quickly and accurately maintain clear vision when looking from near to far or vice versa (like changing focus from the distance whiteboard to books/reading material on the desk)
  • Eye Tracking – the ability to keep the eyes on target while moving (like reading words across a page)
  • Eye Teaming – the ability to coordinate and use both eyes together (judge distances, depth perception)
  • Visual perception – the ability to organize images seen (such as letters on a paper) into words and ideas to understand and remember what was read
  • Hand-Eye Coordination – the ability to use visual information to direct the hands what to do (like when writing or playing sports)

The summer months are the best time to bring your children to your eye doctor for a comprehensive vision exam. If vision problems are detected, or their prescription changes, we are able to get the necessary glasses for your child before school begins. Also, a dilation can be performed to check the health inside the eye (which causes temporary blurry vision of 4-6 hours) – without interfering with any school work your child may need to complete (as during the school year).

In my office, we offer the latest in technology for your child’s visual needs – UV protecting and impact resistant lenses, high quality frames with 1 year warranty, and superior anti-glare coatings to reduce eyestrain and glare. We are currently accepting new patients, and would be happy to address the vision needs of your entire family. Ask me about the latest in research on controlling myopia (near-sighted) progression in children with contact lenses – please stop by or call for an appointment!

-Dr. Mika Fu


Dry eye is a very common problem where the eye lacks enough tears for lubrication and nourishment. Because tears are essential in keeping the front surface of the eye healthy, vision quality and comfort can suffer when the eye surface is not maintained by healthy tears. Usually, people with dry eye either do not have enough tears or the tears that they do produce are of poor quality. Symptoms can vary depending on time of year, and are often chronic – meaning, the condition never fully goes away.

Common symptoms of “Dry Eye” include:

  • Watery eyes (the eye tries to compensate for the dryness by watering)
  • Stinging/burning sensation
  • Foreign body sensation (feels like something is in the eye)
  • Blurred vision that clears slightly when blinking, or worsens depending on time of day
  • Difficulty wearing contact lenses
  • Mild itchiness
  • Redness
  • Pain/irritation
  • Light sensitivity

In dry climates, like we have here in San Diego, many people also experience environmental dry eye. The dry air causes the tears to evaporate at a faster rate from the surface of the eye, producing bothersome symptoms. Computer use and extended periods of reading can also contribute to symptoms – when focusing, our blink rate tends to decrease, reducing the amount of times the eyelids spread tears over the surface of the eye. When the Santa Ana winds kick up in the fall, the dry hot air from the Mojave Desert and Great Basin blow down towards coastal areas, exacerbating dry eye – or even causing dry eye in normally healthy individuals.

Risk factors for dry eye:

  • Age (tear production decreases as we get older)
  • Hormonal changes (pregnancy, menstruation, menopause)
  • Contact Lens (contacts act like sponges and absorb your tears)
  • LASIK/Refractive surgery (reduced corneal nerve sensitivity which normally triggers tear production)
  • Medications (antihistamines, nasal decongestants, birth control pills, antidepressants, Accutane, and many others)
  • Autoimmune conditions (Lupus, Rheumatoid Arthritis, Sjogren’s syndrome, etc.)
  • Blepharitis or other eyelid problems
  • Environmental Factors:
    • Wind/Dry Climate
    • Computer Use/Prolonged periods of reading or TV
    • Air conditioning/fans/hair dryers
    • Cigarette smoke/Dust

One of the best (but least expensive) methods to treat dry eye is to add Omega-3 fatty acid (fish oil) nutritional supplements to your everyday diet. The typical starting dosage for the Omega-3 fish oils is 1200 mg/day (typically one large sized gel capsule), and these supplements can be found as an odorless version that do not cause a fishy aftertaste or smell. It may take several weeks for the effects to show – and use of artificial tears is recommended concurrently. Other benefits of the Omega-3 fatty acids include a lower risk of heart disease and reduction of chronic inflammation that can lead to conditions such as stroke or cancer. There is also evidence that the DHA/EPA in omega-3 fish oils can reduce the risk of Macular Degeneration and Cataracts.

Ask your eye doctor for more information on the treatment of dry eye, including prescription strength artificial tears and medications that can increase tear production.

-Dr. Mika Fu

The Retina & Retinal Eye Exams

The light-sensitive tissue that lines the back of the inner eye is called the “retina”. Images that you look at are projected through the pupil and focused onto the retina. The rod and cone cells in the retina then convert that image into electric signals, which are then sent to the brain through the optic nerve. Understandably, the retina is vital to your visual system, and if damaged or diseased, can cause blindness or loss of vision.

There are 3 important structures in the retina:

  • Optic Nerve: The ‘wire’ that connects the eye to the brain. This nerve carries visual signals to the brain, much like the cables that connect a DVD player to your TV.
  • Macula: This is the area of the eye with the highest density of rods and cone cells. Much like more pixels in a digital photo give you a clearer higher resolution image… the higher density of rods and cone cells in the macula give you more detailed and higher resolution central vision.
  • Retinal Blood Vessels: These are the arteries and veins that feed the eye nutrients and oxygen and are responsible for removing waste materials. The retina needs a constant blood supply to function properly and provide good vision.

There are many diseases and disorders that can affect the retina. Systemic disorders such as high blood pressure, high cholesterol, diabetes, atherosclerosis, blood disorders, and many more can negatively affect retinal health. External factors such as accidents/injuries, UV light, lasers, smoking, occupational hazards, and medications can also cause damage to the retina and affect your vision. Some conditions like glaucoma, macular degeneration, retinal detachments/holes, can have some genetic inheritance ? but can also occur spontaneously in individuals with no family history of these issues.

Because there are so many known (and unknown) conditions that can cause problems for the retina, it is important to have the health of your retina assessed yearly at your comprehensive eye exam – even if you do not wear glasses or have perfect vision.

The latest technology that we have to screen central retinal health is the retinal camera. This camera uses a special set of focusing lenses to take a quick and painless digital image of your retina. Most of the time, good images can be taken without dilation eye drops, and there are no side effects (other than the temporary brightness from the camera flash). In addition, these photos can be used as a baseline to look for changes that can occur to your retina through the years. Although this instrument is not yet considered the standard of care, it is quickly becoming so. In our office, we offer digital retinal photography to all patients for a nominal fee, and are happy to email these photos to our patients at no charge.

A more comprehensive way to assess eye health is with the dilated eye exam. Without dilating the pupils, peripheral portions of the retina are not viewable. It is important to view these parts of the retina in order to properly assess eye health and screen for potentially vision threatening conditions. The dilation also allows for a much more thorough assessment of the central retina, as it increases the field of view for the doctor to see inside the eye – much like viewing the inside of a room is easier through a big open doorway vs. an old fashioned keyhole in the door. In order to dilate the eyes, the technician or doctor will put eye drops into the eyes, and when the pupil widens, the doctor will exam the retina using a special head-mounted scope. In my office, we offer the dilated eye exam free of charge within 30 days of your comprehensive eye exam. The main side effects of dilation include blurry vision, light sensitivity, and inability to focus for a few hours ? because of this; it is usually a good idea to have a driver take you home.

Ask your eye doctor for more information on how you can keep your retina healthy, and what tools they use to check your retinal health.

-Dr. Mika Fu

Yearly Comprehensive Eye and Vision Exams

Regular eye and vision exams play an important role in preventative health care, even for people with “perfect” vision. There are many serious eye problems and diseases with no obvious signs or symptoms, and people may not aware that these problems exist until the damage is already done. Early diagnosis and treatment of eye and vision issues is essential in keeping the eyes healthy and preventing vision loss.

What goes on during an eye exam? A proper comprehensive eye exam is more than just checking for a prescription. During a comprehensive eye exam, the doctor will conduct a number of tests to determine status of vision and eye heath:

  • Patient History: symptoms, health problems, medications taken, occupational/environmental concerns.
  • Visual Acuity: how clearly each eye is seeing.
  • Eye Pressure: to check for glaucoma and other eye diseases.
  • Visual Field: assess your side vision to check for any problems with the nerve or visual pathway.
  • Refraction : to check for your glasses prescription if you are nearsighted, far-sighted, have astigmatism, or have focusing problems.
  • Eye focusing, Teaming, & Depth Perception: to assess how the eyes work together.
  • Color Vision: to check for reduced color perception or blindness.
  • Microscope evaluation of the eye: to check the health of the eye surface (cornea, conjunctiva), and the interior of the eye (iris, pupil, intraocular lens, optic nerve, and a portion of the retina.
  • Dilation & Retinal Photography: to assess the health of the retina.
  • Additional testing as needed: contact lens services, red eye evaluation, dry eye, etc..

Many people are under the misconception that if they can “see fine”, they do not need an eye exam. This could not be further from the truth. Several years ago, a young mom with “perfect vision” brought her daughter in for her first exam because she couldn’t see the board in class. Her daughter was apprehensive, so the mother decided to have an eye exam first and let her daughter watch (to calm her fears and show her nothing ‘scary’ would happen). During that exam, we found a suspicious looking spot in the mother’s eye and referred her to a specialist. It turned out, the mother had never had an eye exam before (since she always had “perfect vision”), and the “suspicious looking spot” was actually a slow-growing malignant tumor – which thankfully, the surgeon was able to remove since it was detected early! Although this scenario does not happen every day in my office, it happens often enough that I worry about those individuals who never have their eyes checked.

Comprehensive eye examinations are recommended once a year for individuals who wear glasses/contacts or have risk factors (e.g. diabetes, high blood pressure, use of certain medications, eye disease, family history of eye disease, crossed eyes, or other health conditions/concerns). For asymptomatic individuals (people with “perfect vision”), eye exams are recommended at the following intervals:

  • Birth to 24 months: At 6 months of age
  • 2 to 5 years: At 3 years of age
  • 6 to 18 years (school-aged children): Annually
  • 18 to 59 years: Every two years
  • 60 and older: Annually

It is especially important that school-aged children are seen for comprehensive eye exams on an annual basis (1st grade through 12th grade). During these years, children’s bodies are growing and changing, and large changes in vision can occur rapidly. Although some schools perform quick “vision screenings” to help identify children who have undetected vision problems – many children still fall through the cracks and may “pass” the screening, delaying further examination and treatment.

If you can’t remember the last time you had your eyes checked, it’s time to call your doctor and schedule an appointment!

-Dr. Mika Fu

Advances in Contact Lenses Technology

As the New Year begins, many of us have made the resolution to exercise and live healthier lives. However, it can be difficult to exercise when glasses are bouncing up and down on your face, falling down, or fogging up as you run, bend, and stretch! For many people – even those who rely on progressive or bifocal glasses – contact lenses may be the solution to provide clear vision while enabling a healthy lifestyle. Contact lenses can also help people feel more confident in their appearance, and offer a respite for those that would otherwise have to wear thick and heavy glasses.

Many people have been told in the past that their eyes or their prescriptions were not suitable for contact lens wear. However, times have changed, and contact lens technology has significantly improved over the last few years. While before, choices were limited, these days there are numerous brands, materials, lens designs, and wear schedules that can fit almost everyone’s individual needs. For example:

  • Daily disposables: for the occasional wearer, children, or people with dry eye or allergies.
  • Monthly/Bi-weekly disposables: for the average contact lens wearer – someone who wears their contacts 5-6 days per week.
  • Toric or Astigmatic contact lenses: for people with moderate to high amounts of astigmatism.
  • Multifocal contact lenses: for people who need to wear reading glasses, bifocals, or progressives.
  • Custom made soft lenses: for people with extremely high or unusual prescriptions.
  • Rigid Gas Permeable “hard” contacts: for people with high or unusual prescriptions, corneal problems such as keratoconus, or for those that require very sharp crisp vision.

Contact lens materials have also changed significantly over the past few years. The last generation of soft contact lenses were made of plastic polymers which provided good comfort, but poor oxygen breathability. (Oxygen breathability is an important factor in safe and comfortable contact lens wear, as the cornea gets oxygen from the environment directly through diffusion – a contact lens sitting on the cornea can block that process.) The newest generation of contact lens materials offer superior oxygen breathability – silicone is incorporated into the polymer which allows more oxygen to pass through the contact lens directly to the cornea. These new materials can afford up to ten times more oxygen to the cornea than the previous generation of contact lenses, providing superior comfort and wearability.

For those who have been unable to wear contacts in the past due to dryness or dry eye – new research has shown that Omega-3 fish oil supplements (1200mg/day taken orally) can significantly improve the tear film. Many patients who were previously unable to tolerate contact lenses are actually now able to wear contact lenses comfortably for 8-10 hours with the introduction of fish oil into their daily vitamin routine. In addition, advances in re-wetting eye drop technology have improved the wearability of contacts while performing visually demanding tasks like computer use, reading, and long-distance driving.

Better contact lens care products have also enhanced the comfort and wearability of contact lenses. One-step hydrogen peroxide based cleaning systems such as Clear Care and OcuSoft offer a high level of preservative-free disinfection for those with sensitive eyes, or those who are allergic to various contact lens solution preservatives. The newest multi-purpose solutions (such as Opti-free Pure Moist, RevitaLens OcuTec, and BioTrue) offer increased comfort and moisture for everyday contact lens wear.

Ask your eye doctor if you are a candidate for contact lens wear, or if there have been any advances in contact lens technology that could be beneficial for your visual needs!

-Dr. Mika Fu