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Eye Doctor Exams

After years of pre-professional undergraduate education and four or more years at a college of optometry, an eye doctor earns a doctorate in optometry. Some also complete a medical residency.

Eye care professionals often spot problems that may not appear on a blood or urine test, such as diabetes-related damage to the retina and blood vessels in the back of the eye. Early treatment of these conditions can prevent vision loss. Contact Dry Eye Center of Maryland now!

Refraction is the part of an eye exam determining your prescription for glasses or contacts. It involves the doctor shining a light into your eyes and looking at how it bounces off the retina (the light-sensitive tissue at the back of your eye). This gives the doctor a clue as to what kind of refractive error you might have. They can then use a machine called a phoropter or a handheld device to narrow down your vision problems, such as nearsightedness, farsightedness, and astigmatism.

Refractive errors occur because the cornea and lens of your eye can’t create a real image on the light-sensing retina in a way that is correct for all distances. Instead, the lens and cornea curve differently in different meridians of your eye, causing blurry up-close and distant vision. The refraction test tells the doctor what kind of lenses will help you see clearly at all distances, so the doctor can give you a complete prescription for your contact or glasses.

During the refraction portion of an eye exam, you’ll be seated in front of a piece of equipment called a phoropter or a hand-held device that looks like a large mask with holes for your eyes. On a wall about 20 feet away, you’ll see a row of letters that get smaller and smaller until you can no longer read them. The last row that you can no longer read is your visual acuity or 20/20 vision value.

The doctor uses the phoropter or handheld device to change the lenses to find the pair that will give you clearest vision at all distances. They can also adjust the lens for any astigmatism you have, which is caused by the irregular curvature of your cornea or the shape of your lens.

The final prescription is written on a slip of paper that you’ll take home with you. You can then go to a pharmacy or optometrist for your new lenses. Some vision insurance plans cover refraction tests, and Medicare Part C may also include some of the cost of your exam.

Visual Acuity Test

Most people have had a visual acuity test at some point without even knowing it. A wall chart with rows of letters that get smaller and smaller is a common sight in eye care specialist offices or vision screenings.

A visual acuity test measures how well you see things at a distance. Your eye care specialist will ask you to stand about 20 feet away from a chart with rows of capital letters that get smaller and smaller until you can no longer read them clearly. The eye doctor will then move to the next row, and you’ll repeat the process. The eye doctor may also ask you to do the test with just one eye and then with both eyes.

The results of the visual acuity test will be given as a fraction, such as 20/20. Having 20/20 vision means that you can see as well as the average person can from about 20 feet away. The higher your visual acuity score, the better your vision is.

To measure visual acuity, the eye doctor will use an eye chart that has 11 rows of letters that get progressively smaller. Each row has a number at the top that indicates how large the letter is. The eye doctor will then ask the patient to read each row, starting with the largest letter and moving down the chart until he or she can no longer see the letters clearly.

Some doctors use a less complicated chart that has just 10 rows of letters, all in lowercase. This type of chart is easier to read for children. Some doctors also test a patient’s visual acuity using a random E test, in which they project images of the capital letter E facing different directions and ask the patient to identify which direction each letter is facing. This test is often used in vision screenings in schools or other public places. The random E test is not used as often as the Snellen chart, but it can help diagnose certain vision problems. Patients who can see at least 6/6 on the Snellen chart typically do not need further evaluation.

Slit Lamp Examination

Slit lamp examination is a powerful tool that gives your eye care professional a look at the different structures in your eye, both inside and out. It is a mainstay of any comprehensive eye exam and can detect many diseases that cannot be seen with the naked eye. It can also help determine whether you need a prescription or not.

The slit lamp is a microscope with a bright light, allowing your eye doctor to see a variety of details about the front of your eyes. This test can diagnose many conditions, including glaucoma, macular degeneration, corneal ulcers, and other infections. The slit lamp can also identify other problems that might not be apparent to the naked eye, such as iris heterochromia and periorbital neoplasms.

Before the slit lamp exam, your eye doctor will place drops in your eyes to enlarge your pupils. He will then sit you down in a chair and ask you to rest your chin and forehead on supports that keep your head steady. The slit lamp will be placed in front of your eyes, and the doctor will then use various lenses to examine the different parts of your eye.

During the exam, your eye doctor will use the slit lamp to look at the surface of your cornea and the conjunctiva. He will then look for signs of inflammation, such as flares and cells, and he will evaluate the structure of your lens and the anterior chamber. He may also conduct a Seidel’s test to assess the integrity of your cornea.

If you are having a slit lamp exam done, be sure to wear your glasses. Your vision will be blurry, and your eyes will be very sensitive to light after the test is over. It is important to bring sunglasses with you to your appointment and plan on having someone drive you home afterward. Also, if you have any symptoms of nausea, vomiting, or eye pain while your eyes are dilated, please make an appointment to see your eye care provider right away, as these might be signs of increased fluid pressure in your eyes, which is an emergency.

Tonometry

Tonometry measures the pressure inside your eye, which is called intraocular pressure (IOP). It’s important to have this test performed because elevated IOP is a risk factor for glaucoma. Glaucoma is a disease that can cause blindness if left untreated. Your eye doctor can determine whether your IOP is within the normal range during a complete exam.

To perform the tonometry test, your doctor will use eyedrops to numb your eyes. You will then rest your chin on a padded surface and look directly into the machine’s light. A puff of air will be blown at your cornea, and the tonometer will measure the resistance to the indentation. Then it will provide a reading of your IOP, which is written in millimeters of mercury.

Your eye doctor will likely use a Goldmann applanation tonometer, which is the industry standard. It is a small instrument that attaches to the slit lamp biomicroscope used in all eye doctors’ offices. You may also see a tonometer shaped like a pen or the handheld Icare rebound tonometer, which can be used at home to monitor daily eye pressure. The PASCAL dynamic contour tonometer is a more advanced device that uses a technique similar to pachymetry, instead of applanation. It is especially useful when the patient can’t place his chin at the slit lamp instrument, as in children and elderly patients in wheelchairs.

The Goldmann tonometer requires a small amount of anesthesia, usually proparicaine or tetracaine. It is important to follow your doctor’s instructions for this test, as it can be dangerous if not performed properly.

Another way of measuring IOP is the Schiotz tonometer, which involves a curved footplate that touches the supine subject’s eye. A weighted plunger attached to the footplate sinks into the cornea, and a scale at the top of the plunger registers the kickback from the corneal surface that corresponds to a specific eye pressure measurement. The tonometer has several safety features that prevent complications such as corneal abrasion, corneal ulcer, ocular inflammation, and glaucoma aggravation. It is important that the IOP measured with an alternative tonometer be confirmed by GAT, because of the potential for elevated IOP to be due to factors other than ocular hypertension.

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Improving Cardiometabolic Risk Factors and Function

Sustained weight loss results in improvements in cardiometabolic risk factors and function. This is especially important for people with obesity-related chronic conditions.

During run-in, participants received once-weekly injections of semaglutide (2.4 mg) and followed an individualized diet and lifestyle regimen. They were then randomized to continue receiving semaglutide or placebo for 68 weeks. Contact Semaglutide San Diego now!

In clinical trials, semaglutide has proven effective in helping individuals lose weight. In a 2021 phase 3 trial, 2.4 milligram weekly injections of semaglutide produced a mean weight loss of 14.9% after 68 weeks when compared to a placebo in individuals with type 2 diabetes and an elevated body mass index (BMI) of 27 or more. This led to FDA approval in June of 2021 of injectable semaglutide under the brand name Wegovy for chronic weight management in people with or without diabetes.

Like other medications that help individuals lose weight, semaglutide works by reducing appetite and lowering caloric intake. It also slows stomach emptying, leading to prolonged feelings of fullness after eating and reducing the inclination to overeat.

Semaglutide may interact with a number of medications, including blood thinners and other anti-diuretics; it is important to inform your doctor of all current medications you are taking. The medication can also cause side effects such as nausea, vomiting, diarrhea and constipation. It can also increase your blood sugar levels and you should tell your care team if you develop hypoglycemia, a dangerous low glucose level.

Individuals with serious liver or kidney problems, a history of pancreatitis, or a condition such as medullary thyroid cancer or multiple endocrine neoplasia type 2 should not take semaglutide. It is also not safe for pregnant women, and it is not recommended to use this medication if you have certain types of depression or suicidal thoughts.

Considering its efficacy for treating obesity, semaglutide is typically prescribed as part of a comprehensive treatment plan that includes dietary and exercise changes. It’s important to discuss your goals with your doctor and work together to develop a plan that will help you reach your target weight.

Semaglutide is an expensive medication and you will need to discuss insurance coverage with your provider before starting it, says Dr. Saunders. Additionally, you should be comfortable with the idea of being on the medication long-term, since obesity is a chronic disease. Patients who are unable to obtain coverage for the medication can sometimes find it by asking their local pharmacist to compound the drug, which is the process of combining, mixing or altering ingredients to create a tailored medication.

Cholesterol Lowering

The GLP-1 agonist drugs in the injectable class, including semaglutide, have been shown to significantly reduce levels of cholesterol and triglycerides in patients with type 2 diabetes. These effects are due to the binding of GLP-1 to the GPR40 receptor on the gut, reducing gastrointestinal secretions and increasing satiety and calorie burn. Semaglutide has also been shown to improve insulin sensitivity and reduce overall inflammation in the body.

In the STEP 5 trials, semaglutide 2.4 mg significantly improved multiple cardiometabolic parameters compared to placebo (eg, waist circumference, systolic blood pressure, total and low-density lipoprotein cholesterol, very-low-density lipoprotein cholesterol). This was observed regardless of background OAD treatment. The rate of hypoglycaemic events was lower with semaglutide compared to the comparator groups. In general, the safety profile of semaglutide was consistent with the other trials in the STEP program6,7,9,16 and with other GLP-1 agonists in general.

Serious adverse events leading to discontinuation of the trial drug were less common with semaglutide compared to the comparators, but occurred in more than two percent of all subjects treated. Gastrointestinal disorders were most commonly reported with the semaglutide group and were typically transient, mild to moderate in severity, and did not lead to treatment discontinuation. Malignant neoplasms were reported in four subjects with semaglutide and in two subjects with dulaglutide, but none of these were considered to be related to the trial product by an independent external event adjudication committee.

TRICARE covers anti-obesity medications, including semaglutide (Ozempic), if they meet the prior authorization criteria. Service Members should discuss any operational, training, or deployment implications with their military medical provider and ensure that all of their medications are recorded in the electronic health record.

The FDA approved the Novo Nordisk’s product, semaglutide injection (Ozempic), in 2017. It is available by prescription only. It is given by injection under the skin in the upper leg (thigh) or stomach area, usually once per week. Be sure to use only the prescribed dosage and change (rotate) injection sites each time. Check the RxList Drug Interaction Checker for more information on avoiding interactions. The Food and Drug Administration (FDA) is responsible for ensuring the safety, efficacy, and security of medical devices, foods, vaccines, medicines, and cosmetics. The FDA’s website includes information about reporting problems and finding help.

Blood Sugar Lowering

Semaglutide is a type 2 diabetes medication that can be taken orally (Rybelsus) or by a once-per-week prefilled injection pen that is self-administered subcutaneously (under the skin) (Ozempic). It mimics the effect of GLP-1, a naturally occurring hormone released by your gut when you eat. GLP-1 stimulates insulin release to drive blood sugar into cells where it can be used for energy. In addition, GLP-1 slows the stomach’s emptying to promote a feeling of fullness. This prevents overeating and can contribute to weight loss.

Semaglutide also lowers blood sugar levels by preventing the release of glucagon, another hormone that elevates blood sugar. It inhibits the liver’s production of glucagon, which reduces blood sugar by forcing your body to use its stored glucose for energy. Combined, this helps maintain stable blood sugar levels and reduces the hunger pangs that often occur when blood sugar drops too low.

In a study of diabetic patients, semaglutide reduced A1C by 7.6 points on average. It also lowered weight, waist circumference, and systolic blood pressure. Researchers noted that a combination of semaglutide and a healthy diet and exercise routine was more effective than other diabetes medications at reducing these risk factors.

Unlike many other diabetes medications, semaglutide does not cause hypoglycemia (low blood sugar). It is considered safe for pregnant women. However, it has not been adequately studied in pregnant women and should be used only when the potential benefits outweigh the risks of uncontrolled diabetes, which include preeclampsia, spontaneous abortion, or preterm delivery.

A recent study sponsored by the drug’s manufacturer found that semaglutide significantly lowered cardiovascular disease risk in people with obesity and heart failure. It decreased symptoms like fatigue and shortness of breath and improved overall physical function. Semaglutide can be prescribed “off-label” to treat other conditions, if the doctor feels it will benefit the patient.

Taking semaglutide may interact with several medicines including ACE inhibitors, diuretics, and some anti-seizure medications. It is not recommended for pregnant women, breastfeeding mothers, or anyone who has a serious kidney or liver problem. It has also been reported to be habit forming.

Cardiovascular Health

In addition to helping people lose weight, semaglutide appears to reduce heart disease risk factors. In the SELECT trial, which was sponsored by Novo Nordisk, which makes semaglutide, researchers found that people who took it had lower cholesterol levels and less systolic blood pressure (the top number of your heart rate) than those who did not take the medication. Semaglutide also significantly reduced blood sugar and blood fats.

A similar study found that the drug lowers blood pressure and helps prevent heart attack, stroke, and other cardiovascular events in people with type 2 diabetes who have coronary artery disease or other risk factors for those problems. The newest findings suggest that the same benefits may apply to people who are overweight and do not have diabetes, but who have a higher-than-average risk for heart disease.

The SELECT researchers analyzed results from the first two double-blind, placebo-controlled trials (STEP 1 and STEP 4), which involved participants with obesity without diabetes who were at high risk for cardiovascular disease. They compared the effects of once-weekly subcutaneous injections of semaglutide versus placebo for 68 weeks. The primary endpoint was the composite of death from cardiovascular causes, nonfatal myocardial infarction, and nonfatal stroke. Other secondary endpoints included changes in waist circumference, systolic and diastolic blood pressure, fasting serum insulin, and HOMA-IR.

In the randomized studies, the researchers observed that at week 68, semaglutide significantly reduced systolic and diastolic BP, as well as fasting glycemia and total lipids (see Table S3). In addition, a greater proportion of the participants taking semaglutide achieved their ACC/AHA BP target than did those on placebo (i.e., 130/80 mmHg).

The researchers conclude that the SELECT data provide “evidence of substantial secondary cardiovascular benefit with long-term treatment of patients with obesity and no history of diabetes with semaglutide.” But they note that more research is needed to understand how the drug achieves these benefits in people without diabetes, and whether the reductions in heart disease risk factors are just a side effect of the weight loss associated with semaglutide. As many as 6.6 million Americans fit that criteria, and it is important to know how the drug could help them avoid heart disease.