Dr. Sylvia Hargrave Hargrave Eye Center | Vision

Ocular Photography

Opthamologists are constantly using technology to gain a better understanding of what diseases are plaguing the eye. If you have ever been to the eye doctors before for a procedure then you have probably had pictures taken of your eyes. Ocular photography or external ocular photography serves a crucial purpose in diagnosing and identifying eye diseases and problems. This article will give an overview of how external ocular works and the capabilities it has to help patients and medical professionals.


There is a variety of equipment that can be used during eye exams to diagnose a wide range of problems within the eye. Some basic and common pieces of equipment that you may have seen or heard of before include a Phoropter, Retinal Camera, and Slit Lamp.

Phoropter – also spelled Phoroptor is one of the most common pieces of equipment people think about when they imagine an eye doctor’s office. A Phoropter is used to test an individual’s vision and identify if they may suffer from something like nearsightedness, farsightedness, or astigmatism. The Phoropter gives the doctor the ability to adjust the intensity of a lens on the fly allowing them to analyze how your vision is corrected through the different intensities. The patient plays a integral part in this because they ultimately decide what lens they think works best for their vision by answering questions from the eye doctor as they change the lens intensity.

Retinal Camera – A Retinal Camera is used to view the back of your eyes including the retina and optic disk. The optic disk holds the optic nerve which is responsible for sending information from your eye to your brain. A Retinal Camera can help your opthamologist identify eye disease such as macular degeneration.

Slit Lamp – A Slit Lamp is another more common piece of equipment that people may be familiar with. A Slit Lamp is used to look at multiple parts of your eye at once. The Slit Lamp is used to view the sclera, the cornea, and the lens of your eye. The Slit Lamp aims a high-powered, bright beam at your eye that scans the previously listed areas of your eye. Preparation for using a Slit Lamp can include dilating your pupils and inserting yellow colored eye drops into your eye to see potential problems in the front of your eye.

Macular Holes

Macular Holes have the potential to cause vision loss in some serious cases. The Macula is in the center of the retina and is arguably the most important part of the eye. Macular Holes can form in a variety of different ways and can have several symptoms before they create significant vision loss. This article will briefly talk about what Macular Holes are and how they are caused.


Macular Holes is formed by a break in the Macula. The Macula is in the retina of the eye and is used to help us see and interpret small details. The Macula is used for driving, reading and helping us achieve 20/20 vision. Macular Holes can be caused by several different factors. Aging is the leading cause of Macular Holes. As we age the gel-like substance called vitreous can shrink. This substance makes up about eighty percent of our eye and lines the walls of the retina. When the vitreous shrinks it can pull away from the retina and create a hole. The pulling away from the retina can cause natural fluids to take its place. That hole can then be filled with the natural fluid and cause vision impairment. A few other causes of Macular Holes not related to aging include diabetic eye diseases, myopia or nearsightedness, and eye injury.


In some cases a Macular Hole does not need to be treated and can sometimes heal itself in time. In a situation where a Macular Hole does require treatment, a surgery can be performed to help heal Macular Holes. A Vitrectomy can be performed to heal the Macular Hole over time. A Vitrectomy is an extremely accurate procedure that requires patients to be under local anesthesia. A Vitrectomy is performed by removing the vitreous from the eye and replacing it with a bubble that stops the vitreous from pulling on the retina. Over time the bubble while dissolve and be replaced with natural fluids by the eye. Patients are asked to remain in a face-down position throughout the recovery period of a Vitrectomy so that the hole heals correctly. Recovery from a Vitrectomy could take as long as three months.

Talk to your doctor to learn what would be the best way to treat your Macular Hole!

Why You Shouldn’t Sleep In Your Contacts

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If you wear contact lenses, then you may know the problems that arise from having them in too long or overnight. To most people, it is common knowledge that they should not wear their contacts overnight. Sleeping in your contacts can cause a wide array of problems starting with small, almost unnoticeable irritations to severe permanent damage. In this article, we will discuss a few issues that can arise from consistently sleeping in your contacts.


Your cornea is the outermost layer of your eye and is the portion of your eye that is most in contact with your contact lenses. Consistently sleeping in your contacts can lead to severe problems for your corneal health and overall sight. The cornea requires constant oxygen and the occasional flow of liquids from your glands to clean out debris and bacteria. Leaving contacts in overnight cuts off some oxygen flow to your corneas as well as tears created by your glands to filter out bacteria. Even within a short period, someone can experience dryness, irritation, or pain from dry and dirty contacts.


Prolonged use of contact lenses can lead to a variety of infections in the cornea. In severe cases, things like a corneal ulcer can form. The corneal ulcer forms from accumulated bacteria on the eye and can cause irritation, vision impairment, blindness, and strange sensations in the eye. Conjunctivitis or pink eye is a common infection that can be caused by dirty contact lenses. In rare cases, a person can experience Acanthamoeba keratitis which is an infection of the cornea from a single-celled organism, or ameba that invades the cornea. The Acanthamoeba can be found in water or soil and is most commonly transferred by improper care of contact lenses.


The best way to prevent eye injury and infection from contacts is to follow the instructed care of your lenses from a professional. Wash your hands before dealing with your contacts and remove your contacts before participating in an activity that involves being in the water. Schedule frequent checkups with your optometrist to evaluate your contact routine and receive examinations. Follow the instructions of your optometrist or contact lens packaging to ensure fresh and clean contacts throughout.

While you may not be intentionally sleeping in your contacts, always try to be aware when you have them in and to take them out at the necessary times to avoid any kind of impairment to your vision. Take care of your eyes!

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5 Things You Should Do For Your Eyes in Your 20s

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You know the old adage, “Youth is wasted on the young”?

Well, I’ve never quite liked that saying. I’ve always wanted to reword it somehow.

It’s not that we waste our individual youthfulness when we’re young; it’s that most of us aren’t aware of all the ways that getting older affects the many health privileges that youth affords. Yes, we sometimes take our good health for granted when we’re young. But that’s not a waste. It’s just…well, it’s just that being healthy is something that’s easy to casually overlook.

If you’re a 23-year-old with relatively good eyesight (with or without a boost from contacts or glasses), and you’re not looking at the screen and struggling to make out the letters, then you might be enjoying a perk of youth without even knowing it.

And that’s okay. To an extent. Just keep in mind that the eyesight you have today may not be the eyesight you have tomorrow.

See, the risk of vision loss increases with age. A disease known as Age-related Macular Degeneration (AMD) is one of the most common cause of blindness in people older than 60 years. In AMD, there’s a deterioration of the macula, a small area of the retina that is responsible for your central vision. When the macula is compromised you’re less able to see fine details clearly. For many older people, AMD is part of the body’s natural aging process. That doesn’t mean you should walk into your golden years, shrugging your shoulders with a sense of inevitability that you’ll eventually be blind.

Here are 5 things that you can do now to prevent AMD:

1. Don’t Smoke (Quit Now or Don’t Start in the First Place) According to numerous studies, smoking is a huge risk factor for macular degeneration. The Bright Focus Foundation, a nonprofit that supports research into the treatment and prevention of macular degeneration, even says that smoking is “the largest modifiable risk factor for age-related macular degeneration.” That’s right: Smoking is the largest risk factor, not just a leading one. Plus: It’s modifiable. Cigarette smoke contains chemicals that, when absorbed by the lungs, can damage the retina as they travel through the bloodstream. The damage can be quite severe, so much so that some research suggests that risk for getting AMD is even double for smokers than for nonsmokers. If you’re a smoker, consider reading one of the many articles online with advice about quitting.

2. Maintain a Healthy Weight Obesity is another major risk factor for macular degeneration. The June 2003 issue of Archives of Ophthalmology reported that people, who performed a vigorous activity (at least) three times per week, reduced their risk of developing advanced AMD, compared with inactive patients.

3. Know Your Family History Some experts suggest a genetic component to AMD. Although there’s not a specific pattern of inheritance, the condition appears to run in families in some cases. The National Institutes of Health says, “An estimated 15 to 20 percent of people with age-related macular degeneration have at least one first-degree relative (such as a sibling) with the condition.” Now, I’m not suggesting that you run out and order genetic testing. I do hope, however, you keep an even closer eye on your eye health if you have a close relative with AMD. Remember the advice I’ve shared here and also check out this more extensive list of AMD prevention suggestions at AllAboutVision.com.

4. Schedule Annual Eye Exams If not every year, then every two years. Regular eye exams can mean an early diagnosis when something’s wrong. The earlier you find out about a problem, then you can limit any vision loss and help preserve your eyesight. Furthermore, don’t hesitate to see your eye doctor if you notice any changes in your vision, like double or hazy vision. Your eyesight is a precious resource, and I recommend being just as vigilant about your vision as you are about other elements of your health and wellbeing.

5. Get Checked Regularly for Diabetes and High Blood Pressure If left untreated, these are two diseases that can cause severe macular degeneration leading to vision loss. Sufferers of these conditions might also experience vision loss from eye strokes, which are blockages in the veins of the retina, or diabetic retinopathy, which is a complication of diabetes that is caused by damage to the eye’s blood vessels.

Now, having shared those five points with you, I wish you many yeas of good health and great eyesight. Here’s to doing those things now that will help you maintain optimal sight well into the future.


Smoking and Age-Related Macular Degeneration Age-Related Macular Degeneration – A Complete Guide

Understanding Age-Related Macular Degeneration (AMD)

What Is Age-Related Macular Degeneration?

Age-Related Macular Degeneration PPP – Updated 2015

Eight Ways to Protect Your Eyesight

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5 Tips To Help Reduce Your Digital Eye Strain

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Many of us sit in front of a computer for long hours without breaks as part of our jobs. But, sitting all day can lead to dangerous health conditions.  Similarly, starring at a computer screen all day can also lead to dangerous health conditions. This is known as digital eye strain and its becoming more and more popular among people working in this digital age.  According to new research by The Vision Council, 65% of Americans suffer from too much time spent in front of screens.

WebMD adds, research shows that people hold digital devices closer to their eyes than they hold books and newspapers. This forces your eyes to work harder than usual as they strain to focus on tiny font sizes. Digital devices may also be linked to eye fatigue because of a tendency to blink less often when staring at a computer screen. People usually blink about 18 times a minute. This naturally refreshes the eyes. But studies suggest that people only blink about half as often while using a computer or other digital device. This can result in dry, tired, itching, and burning eyes. 

In The Vision Council’s new research report called, Eyes Overexposed: The Digital Device Dilemma, 10,000 Americans were surveyed to learn more about the symptoms, conditions and treatments of digital eye strain. Surprisingly, 80 percent of surveyed Americans also use two or more devices simultaneously. Think of this as working on your computer, then checking an email or text on your phone. The report also found one out of every ten Americans is spending three-fourths of their time awake using a device — that’s nearly 18 hours a day!

Although digital device use is a family affair, every generation has their own unique habits. Here are some of the generational habits stats included in the most recent report:

  • Grandparents: More than 30% of adults 60 and older have had prolonged use of digital devices (two or more hours per day) for more than 15 years.
  • Young Adults: Nearly nine of 10 use two or more devices at a time and are more likely to use their smartphones for activities such as getting news updates.
  • Children and Teens: 65% spend two or more hours per day on a digital device, yet 77% of parents report being somewhat or very concerned about the impact of devices on children’s eyes.
  • Parents and Caregivers: 64% spend more than five hours a day looking at digital screens. 55%  use computers to shop online.

So, what can you do to prevent digital eye strain?  The Medical Daily website shares these five tips laid out by The Vision Council:

  1. Wear computer eyewear and glasses with lens options that can help reduce symptoms of digital eye strain, block harmful blue light, and improve vision.
  2. Follow the 20-20-20 rule: Take a 20-second break from the screen every 20 minutes and look at something 20 feet away.
  3. Build an optically optimal workspace to mitigate outside irritants. For example, reduce overhead lighting to eliminate glare.
  4. ‘High-five’ the screen for the right viewing distance when sitting at a computer.
  5. Increase text size on devices to better define content on the screen.

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Everything You Need To Know About Vision

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This highly complex system of vision is designed to detect light energy and transduce it into electrical information that is sent to the visual cortex of the brain for perception. Interestingly, light input in the right eye is perceived in the left part of the bran and vice versa. This crossing of the information and the slightly offset position of the eyes allow the brain to perceive different dimensions, including depth perception.

Anatomy of the eye Hargrave Eye Center BlogThe eyes are organs that capture and focus light energy on the back portion of the eyeball where the retina is.  The retina contains the photoreceptor cells. The sclera forms the outer covering of the eye and can be found in the front as the cornea (clear portion of the eye), which allows photons of light to pass into the eye. Under the cornea is a spherical diaphragm that can open or close to regulate the amount of light that will pass into the next compartment. This colored portion of the eye is called the iris, and its opening, which is black because it is dark in the back of the eye, is the pupil.

Suspended behind the irish and positioned immediately behind the pupil, the lens is kept in place by the ciliary muscle, which can apply tension to the lens to stretch it or allow it to contract in order to change the focal length of the light entering the eye (i.e., permit focal accommodation to see objects up close and then far away as the focus of the eye automatically adjusts). After light enters the eye and is focused by the lens, it passes through the large chamber of the eyeball that is filled with a gelatinous material called vitreous humor before passing into the photoreceptor layer: the retina.

retina Anatomy of the eye Hargrave Eye Center BlogThe back of the eyeball has a layer of photoreceptor cells called the retina. This layer is actually designed upside down from what one may imagine. Light first must pass through several layers of neurons and interconnecting cells before the photon will impact and excite a photoreceptor cell buried in the deeper parts of the retina. The only part of the retina deeper than the photoreceptors is a layer of pigmented epithelial cells that will absorb light and prevent its reflection to reduce extraneous light and improve fine detail.


Anatomy of the Eye Hargarve Eye Center BlogThese cells can be found in the deep retina and contain a photo pigment that, when activated by a photon of light, will change shape and lead to a signal transduction cascade, ultimately generating an electrical signal in a neuron that will signal the visual cortexof the brain.

One type of photoreceptor is the rod cells.  Shaped much like a comb for your hair, these rows of folded membranes that resemble the teeth of a comb contain the photo pigment rhodopsin, which, when activated, will lead to change in the shape of the larger molecule where it is attached (opsin). An essential component of this photo pigment complex is a molecule called retinol, which is related to vitamin A. Rods are the more sensitive of the 2 types of photoreceptors and are responsible for vision in low light, which many have referred to as black and white vision. Also concentrated at the edge of the retina you will find the cones. Cones are essential for peripheral vision.

Cone cells are the second type of photoreceptor and are responsible for color vision in the retina. These cells also have folds of photo pigment, but are shorter than the rods and have a tapering or “cone” shape, hence the name. Three different cones are based on the photopsin (pigment) and the wavelength of light they detect. They are the red, green, and blue cones. Which cones are simulated and to what degree determines the color of light that is signaled and perceived. This is not unlike your television screen or computer monitor where the same 3 colors are used to blend into any visual color in the spectrum. While cones are much less abundant than rods in the retina in general, in the fovea of the retina (the central part of the retina responsible for sharp central vision), cones greatly outnumber rods.

Source: Langford, K. (2015). Sensory System. In The everything guide to anatomy and physiology: All you need to know about how the human body works. F W Media.

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Crossed Eyes, Wall Eye, and Lazy Eye

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ocular healthThe medical term for misaligned eyes is strabismus. There are six different muscles that are attached to each eye to help it turn and rotate. The eyes may not appear straight because one or more muscles are pulling too hard or other muscles are too weak. If the eyes turn inward leading to “crossed eyes” we call it esotropia. If they turn outward, called “wall eyes,” then the condition is labeled exotropia. There are different treatments for strabismus depending on the specific cause. Some cases are managed with eye muscle surgery, some simply need glasses.  

Crossed eyes (esotropia) needs to be treated early to prevent vision impairment later in life. As a baby grows and develops, so do his or her eyes. During the first few months of life, an infant does not have crisp, clear vision. Thereafter, the eye’s focusing mechanisms and eye movements rapidly develop as the eye and brain develop the visual apparatus. By about the age of 6 months, both eyes should consistently work together, allowing a baby to see both near and far away targets. The infant’s eyes should be aligned, both looking at the same object.

ocular healthHowever, in some situations the eyes do not appear to work together. One eye may tend to drift inward or outward some or all of the time. Prompt evaluation by an eye specialist is essential to determine whether any suspected drifting is due to a muscle imbalance or an internal eye problem that interferes with good eyesight.  Simply stated, the eye doctor needs to determine how well each eye sees and why the eyes do not appear straight. Parents will be relieved to know that the eye doctor’s exam can find the answers without any help from the baby. Any problems that are identified need to be addressed in order to preserve good eyesight in both eyes.

Maintaining proper eye alignment is important to avoid seeing double, for good depth perception, and to prevent the development of poor vision in the turned eye. When the eyes are misaligned, the brain receives two different images. At first, this may create double vision and confusion, but over time the brain will learn to ignore the image from the turned eye. If the eye turning becomes constant and is not treated, it can lead to permanent reduction of vision in one eye, a condition called amblyopia or lazy eye. Put simply, amblyopia is a healthy eye that does not see. Only infants and children develop amblyopia; and the vision loss can be reversed with therapy if the contributing eye problem is corrected early enough during childhood — typically before the age of 7.

According to the American Optometric Association, people with strabismus have several treatment options available to improve eye alignment and coordination. They include:

  • Eyeglasses or Contact Lenses: may be prescribed for patients with uncorrected farsightedness. This may be the only treatment needed for some patients with accommodative esotropia. Once the farsightedness is corrected, the eyes require less focusing effort and may remain straight.
  • Prism Lenses: special lenses that have a prescription for prism power in them. The prisms alter the light entering the eye and assist in reducing the amount of turning the eye has to do to look at objects. Sometimes the prisms are able to fully compensate for and eliminate the eye turning.
  • Vision Therapy: a structured program of visual activities prescribed to improve eye coordination and eye focusing abilities. Vision therapy trains the eyes and brain to work together more effectively. These eye exercises help remediate deficiencies in eye movement, eye focusing and eye teaming and reinforce the eye-brain connection. Treatment may include office-based as well as home training procedures.
  • Eye Muscle Surgery: can change the length or position of the muscles around the eye in an attempt to better align the eyes. Eye muscle surgery may be able to physically align the eyes so they appear straight. Often a program of vision therapy may also be needed to develop a functional improvement in eye coordination and to keep the eyes from reverting back to their previous condition of misalignment.



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