Specialist Exams

L'OCT (from the Anglo-Saxon acronym of Optical Coherence Tomography or optical coherence tomography) is a recent non-invasive diagnostic technique that allows, without coming into contact with the eye, to obtain through a series of photographs taken using the reflection of the laser and infrared rays sent on the anterior segment of the eye to obtain high-resolution images of the cornea, of the anterior chamber, of the iris, of the iridocorneal angle, of the pupil and lens. It is of fundamental importance in the prediction and post-operative course of some types of refractive surgery and in the diagnosis and therapy of some diseases of this eye region. As mentioned, it is a non-invasive examination, lasting a few minutes that does not require pupil dilation and the patient at the end of the evaluation can resume their activities without particular precautions or warnings.

Pachymetry is a diagnostic test by which accurate measurement of the thickness of the cornea is obtained, i.e. the transparent dome in front of the iris (the colored part of the eye). The cornea in normal conditions in the center is about thick 540 micron, that is, thousandths of a millimeter (0,54 mm) and the thickness increases in the area near the center (about 550 micron) and in the peripheral (650 micron). In the presence of some diseases, the cornea may be thicker or thinner. The measurement of the thickness of the cornea can be performed with an ultrasound probe (ultrasonic pachymetry), by infrared radiation (optical pachymetry) or through OCT (of the anterior segment). All three methods can be performed in our office. The pachymetry represents the exam fundamental in refractive surgery procedures affecting the cornea, often conditioning (together with pupillometry and refractive defect) the choice of the type of intervention. Finally, it is indispensable as a corrective factor in the evaluation of ocular pressure measurement in ocular hypertension and glaucoma. It is a non-invasive examination, lasting a few minutes that does not require pupil dilation (only in ultrasonic pachymetry a few drops of local anesthetic are needed) and the patient at the end of the evaluation can resume their activities without particular precautions or warnings

It is an exam through which pupil diameter is measured both in strong light conditions (fotopica) than low lighting (scotopica). The information collected through this examination is used by the ophthalmologist both for the study of refractive surgery and in modern cataract surgery, because the pupillary kinetics significantly affects the quality of the image produced on the retina. It is a non-invasive examination, lasting a few minutes that does not require pupil dilation and the patient at the end of the evaluation can resume their activities without particular precautions or warnings

The synoptophore is an ophthalmological instrument considered the "gold standard" for the diagnosis and corrective therapy of the various dysfunctions of ocular motility, like squint, Amblyopia, diplopia, etherophoria, ecc. Used by the orthoptist, it can be used to measure the angle of strabismus, the heterophorias, the degree of stereopsis, of fusion and convergence and is indispensable for performing ocular motility rehabilitation exercises. The instrument is also able to measure latent strabismus allowing to act promptly in order to correct it before it becomes manifest. It is a device equipped with two eyepieces through which the patient sees two plates with figurines and knobs by means of which the images seen can be moved by making them move away or closer, thus exercising the eye muscles.. It is a non-invasive examination, lasting a few minutes that does not require the instillation of drops and the patient at the end of the evaluation can resume their activities without particular precautions or warnings.

The screen of Hess-Lancaster o test di Hess-Lancaster is an ophthalmological diagnostic test that allows you to diagnose and document any defects in ocular motility, responsible for diplopia, strabismus or paralysis of the eye muscles. The test consists in evaluating the motor coordination of the two eyes and their possible deviation in the various gaze positions, managing to define which ocular muscle is responsible for the deviation. During the exam, the patient is asked to sit in front of a squared screen and wear a pair of glasses with one red and one green lens. Finally, he is given a green torch with which he will illuminate the aim projected by the orthoptist. During the exam, the orthoptist reports the points illuminated by the patient on the test, from which a graph is obtained that allows you to diagnose the possible presence of defects in ocular motility. It is a non-invasive examination that can be performed on patients of all ages, lasting a few minutes that does not require the instillation of drops and the patient at the end of the evaluation can resume their activities without particular precautions or warnings.

Using Topcon's Myah tool. (Link https://topconmyah.com/), our studio is equipped with, it is possible to carry out this test and computerized and non-invasive tests for the complete study of the tear film, such as imaging of the meibomian glands, the analytical study of the lacrimal meniscus, the study of the blink frequency and the evaluation of aberrations between blinks. They are non-invasive tests, drops are not instilled and lasts a few minutes and the patient at the end of the evaluation can resume their activities without particular precautions or warnings.

Using Topcon's Myah tool. (Link https://topconmyah.com/), our studio is equipped with, it is possible to carry out this test and computerized and non-invasive tests for the complete study of the tear film, such as imaging of the meibomian glands, the analytical study of the lacrimal meniscus, the study of the blink frequency and the evaluation of aberrations between blinks. They are non-invasive tests, drops are not instilled and lasts a few minutes and the patient at the end of the evaluation can resume their activities without particular precautions or warnings.

Using Topcon's Myah tool. (Link https://topconmyah.com/), our studio is equipped with, it is possible to carry out this test and computerized and non-invasive tests for the complete study of the tear film, such as imaging of the meibomian glands, the analytical study of the lacrimal meniscus, the study of the blink frequency and the evaluation of aberrations between blinks. They are non-invasive tests, drops are not instilled and lasts a few minutes and the patient at the end of the evaluation can resume their activities without particular precautions or warnings.

Using Topcon's Myah tool. (Link https://topconmyah.com/), our studio is equipped with, it is possible to carry out in addition to computerized and non-invasive tests for the complete study of the tear film, such as imaging of the meibomian glands, the analytical study of the lacrimal meniscus, the study of the blink frequency and the evaluation of aberrations between blinks, also biometry using low coherence optical interferometry (ie the anteroposterior measurement of the eyeball). Myopia occurs due to excessive anteroposterior elongation of the eyeball (axial myopia). It is estimated that the 50% of the world population, including European regions, become nearsighted by 2050¹. The MYAH tool in children allows you to monitor the progression of myopia and compare the measurements obtained with the growth curves for axial length using the large data set collected by the Erasmus University (Rotterdam, NL)³. Today integrating this data with the use of a new generation of lenses, both in contact and for glasses, in addition to correcting the myopic refractive defect, a "treatment" can be carried out that can slow down the progression of myopia in the age group from 4 to 16 age. The Rx and Axial Length charts allow you to monitor the progression and monitor the effectiveness of the treatment. MYAH provides this data so you can compare changes over time. It is an exam, non-invasive, drops are not instilled and lasts a few minutes and the patient at the end of the evaluation can resume their activities without particular precautions or warnings.

¹Holden, BA, Fricke, TR, Wilson, DA et al. Global prevalence of myopia and high myopia and temporal trends from 2000 through 2050. Ophthalmology. 2016; 123:1036–42.

²Mandal, P, Berrow, EJ, Naroo SA, et al. Validity and repeatability of the Aladdin ocular biometer. BJO. December 01, 2015. Available from

³Coordinates incorporated in this Myopia device are the most recent available data and originate from the Myopia Research Group of Erasmus MC, Rotterdam

http://dx.doi.org/10.1136/bjophthalmol-2013-304002

Auto-refractometry is a computerized diagnostic test capable of determining the objective evaluation sight defects, like myopia, hyperopia and astigmatism. The test performed by the auto refractometer, he is able, in a few seconds and in a non-invasive way, to identify the refractive defect of the eye subjected to the examination with absolute precision. The easy-to-perform exam, non-invasive, for both adults and children, it is carried out with high precision computerized tools. To auto-refractometry at our office, it is associated with the measurement of the axial length using the Myah tool from Topcon (Link https://topconmyah.com/). For children from 0 a 6 age, instead, a computerized self-refractometer is used which allows the acquisition of any visual defects at a distance of over 1 metro, instrument specially designed and built for these little patients. It is a non-invasive examination, drops are instilled for pupillary dilation and lasts for a few seconds. At the end of the evaluation, the little patient can resume his activities without particular precautions or warnings.

The perception of colors is a complex phenomenon, still not fully clarified, which is achieved thanks to the cortical processing of information transmitted by particular cells of the retina (cones) which are sensitive to the perception of red, of green and blue. A genetic defect involving the lack of one or more of these specialized cells results in a lack of perception of all colors, condition said achromatospia or only of particular colors said dyschromatopsia (including the color blindness). Furthermore, there may be individuals who are sensitive to all three basic colors (trichromatism), but they are deficient, to varying degrees, of the receptors of one of the three basic colors (dyschromatoanomalies). The tests that study such color alterations are mainly the Ishihara test and the test of Fansworth-Munsell. The first is the evaluation in a series of 38 boards (this “Ishihara tablets”) each of which has many circles of different sizes and colors willing to define a "number" or a "path" that is impossible for people with dyschromatopsia to perceive. The "Tablets of Ishihara" is a quick examination, a few minutes, aimed above all at identifying patients suffering from dyschromatopsia of the red-green axis even if they are able to define the extent of the defects in chromatic sensitivity.

The perception of colors is a complex phenomenon, still not fully clarified, which is achieved thanks to the cortical processing of information transmitted by particular cells of the retina (cones) which are sensitive to the perception of red, of green and blue. A genetic defect involving the lack of one or more of these specialized cells results in a lack of perception of all colors, condition said achromatospia or only of particular colors said dyschromatopsia (including the color blindness). Furthermore, there may be individuals who are sensitive to all three basic colors (trichromatism), but they are deficient, to varying degrees, of the receptors of one of the three basic colors (dyschromatoanomalies). The tests that study such color alterations are mainly the Ishihara test and the test of Fansworth-Munsell. For the first read COLOR SENSITIVITY TEST (Ishihara tablets). Il test Farnsworth-Munsell 100 Hue Color Vision, o Munsell Vision Test, is a test that evaluates with greater precision and specificity the presence of an anomaly in the perception of colors. Indeed the patient must order, according to his perception of colors, 100 colored tokens that have miniscule differences between them and that cover all the visual shades described by the Munsell color system. The arrangement of the colored pieces is then processed by a computer which identifies with extreme precision any anomalies in the perception of colors (including color blindness). This examination is particularly important for designers, photographers and colorists, as well as in particular sports that require an accurate chromatic vision. The exam lasts approximately 20 minutes and the diagnosis is reported immediately. Both tests can be performed in our office and afterwards the patient can resume their activities without particular precautions or warnings.

The binocular vision, also called stereoscopic vision the stereopsi, it is the ability of the visual system to add up a small part of the visual field that is seen simultaneously by the two eyes and to form a single image. The shape, the breadth and visual acuity, of binocular vision are subjective characteristics influenced by genetics and biology of the eyes, from the morphology of the face (nose, eye position and distance, cheeks, eyebrows, ecc), as well as culture, to the experience and knowledge of the objects observed. The binocular vision depends on the merger which involves the activity of the ocular extrinsic muscles, for the positioning of the visual axes on the object concerned and the psychic ability to train, from two similar retinal images, a single visual representation. The stereo it is the perceptive capacity that allows you to combine the images coming from the two eyes, that due to their different anatomical positioning, have a disparity of vision that is exploited by the brain to obtain information on the depth and spatial position of the targeted object and therefore stereopsis allows the generation of three-dimensional vision. The study through fusion and stereopsis test (Stereo Test Lang I e II) are of paramount importance in the development of vision in children from 2 to 5 years as they give us direct information on the state of collaboration of the two eyes and the cortical processing of the images and to highlight a squint.

Although it is a subjective test (just lose the setting for invalidating the test) and is unable to highlight scotomas (alterations in the visual field) below the 6 ° which is the majority represents an extremely easy exam to use, repeatable at home and sensitive enough if done carefully to determine even small and incipient retinal, as well as to monitor evolution of scotomas preexisting. In carrying out the test AMSLER, the patient has to position the grid at about 30 cm, with correction for near-sighted and if you examine each eye. The test grid is able to evaluate the entire macula. Staring at the black dot in center with a focus (absolutely without moving your eyes from this target reference) with good lighting, You can highlight distortions, irregularities and deformations (metamorfospie) the grid in correspondence with possible alterations retinal macular foveali. For this simple test and a subjective, done with care, can be extremely significant for a pathology of the macular and foveal, ie that area of ​​the retina dedicated to vision sharp. Taking care not to move the eye from the black dot, the squares must be observed, which should always be straight and have no interruptions, areas of confusion or distortion. If these were present, it is advisable to contact your ophthalmologist to deepen the study of the macular area with a visit to the fundus and OCT.

The test of 4 Worth's lights is a clinical test that evaluates how captured images are transmitted to the brain. The binocular vision, also called stereoscopic vision the stereopsi, it is the ability of the visual system to add up a small part of the visual field that is seen simultaneously by the two eyes and to form a single image. The shape, the breadth and visual acuity, of binocular vision are subjective characteristics influenced by genetics and biology of the eyes, from the morphology of the face (nose, eye position and distance, cheeks, eyebrows, ecc), as well as culture, to the experience and knowledge of the objects observed. The binocular vision depends on the merger which involves the activity of the ocular extrinsic muscles, for the positioning of the visual axes on the object concerned and the psychic ability to train, from two similar retinal images, a single visual representation. Under normal conditions the visual axes, the imaginary lines that join the object with the fovee, converge on a single point. The brain thus receives the image of an object, from each eye, and unites them in a single image. This ability is called Merger. In the merger we distinguish two aspects: a motor one (indicates the ability to align the eyes in order to maintain sensory fusion) and one sensory, aspects that occur simultaneously. Fusion occurs only if the images sent to the brain come from corresponding points and if they are the same in size and sharpness. The WORTH test is used for the study of fusion. The patient is made to wear a pair of glasses with different colored lenses: one red and one green and made to observe 4 lights of different shape and color. He tests, which can be performed both far and near, allows you to assess the degree of cortical fusion of the patient in the presence of diplopia or suppression of one eye and to evaluate the dominant eye.

The Schirmer test proposed in 1903 and now surpassed by computerized tools for the study of the tear film such as the Myah from Topcon (Link https://topconmyah.com/), used in our studio, serves to determine if the eye produces enough tears to keep it moist. It is performed with the application of a small strip of graph paper placed between the eye and the eyelid. The test is negative (normal) if the tears absorbed by the paper exceed i 10 mm in 5 minutes or positive (severe hypolacrimia if less than 10 mm, severe hypolacrimia less than i 5 mm). The use of anesthetic eye drops ensures that only the basal tear secretion is measured (Jones test). Secretion varies according to age and other factors (hormonal, width of the eyelid rim, etc..) can affect the sensitivity of the test.

By tonometry we mean the measurement of eye pressure (tension present inside the eye also called IOP from the Anglo-Saxon acronym Intra Ocular Pressure). This measurement can be performed with the so-called applanation tonometer (Goldmann tonometer considered the "gold standard"), instrument that through contact with the cornea is able to carry out the measurement and in this case a few drops of an anesthetic eye drops and a dye are instilled (fluoresceina) from and alternative, at our studio, the breath tonometer can be used (pneumotonometria) which does not require contact of an instrument with the cornea, therefore the instillation of anesthetic or dye is not necessary and the intraocular pressure measurement is obtained by means of a light puff of air directed towards the patient's eye. Furthermore, this instrument is able to detect the thickness of the cornea (see pachymetry), correcting the measured value with the one actually present inside the eye using an algorithm. Measurement of eye pressure is an indispensable test in the prevention and monitoring of glaucoma, subtle and underestimated disease that can cause irreparable damage to the visual field and sight.

The corneal topography, also called corneal map, is a test that studies the curvature of the anterior surface of the cornea, in each of its points. The points that have the same curvature are then indicated on the exam printout with the same color, and this print ends up resembling a geographical map with its colored contour lines, that identify, with blue color, for example the sea and its depths, while with the red color the top of a volcano. Corneal topography is of great use, in particular in anticipation of a refractive intervention; it allows the surgeon to know if the cornea has a normal shape, but also to identify irregular astigmatism caused by the imprint on the cornea of ​​excessive use of contact lenses (phenomenon called warpage), keratoconus and other thickness abnormalities. It also allows us to understand if the cornea, for example, has undergone surgery and to highlight any previous trauma or even to study the result of refractive surgery.

The orthoptist (or assistant in ophthalmology) is the professional figure who supports the ophthalmologist, in prevention, in the assessment and visual rehabilitation of motor and sensory disturbances of vision. So with the visit orthoptic, the orthoptist is not only able to assess the possible presence of an alteration in the neuromuscular system of the eyes (strabismus, abolition, diplopia, exophoria, esoforia, convergence deficit, etc..), but also to treat these diseases in synergy with the ophthalmologist and often, in small patients, with parents, in order to recover the correct neuro-functional balance of ocular motility and visual function. The orthoptist in fact, in synergy with the ophthalmologist, takes care of the treatment amblyopia or lazy eye, or that condition in which a reduction in visual acuity occurs in one eye (or more rarely of both) determined by a different visual defect between the two eyes, a squint or other alterations of the visual apparatus. It is also useful in the study of patients who are candidates for refractive surgery and those with a high refractive defect in cataract surgery. The orthoptic examination is an examination, non-invasive, drops are not instilled is lasting 20-30 minutes and the patient at the end of the evaluation can resume their activities without particular precautions or warnings.

The development of vision at birth has only just begun and only during the following ones 6 years will be finished. It is therefore essential, respect a calendar of eye and orthoptic checks that they might highlight a visual problem that the child is unable to perceive or manifest.

So here are the recommended appointments for our children:

1° control. It is carried out in the days following the birth, usually by the pediatrician, with a screening exam (red reflex test) which serves to reveal serious diseases such as retinoblastoma, congenital cataract, congenital glaucoma or other congenital anomalies. Fundus evaluation, carried out by the ophthalmologist, it is also “mandatory” for preterm babies as they could develop retinopathy of the premature baby (ROP).

2° control. Within the first year of life in preterm births, whether or not they develop retinopathy of the premature baby, as the risk of developing visual defects and strabismus in these subjects is greater than in term births. Children of mothers who have contracted must also be checked within the first year of life diseases during pregnancy, such as toxoplasmosis or rubella, children with family members with retinal diseases hereditary and children to whom the pediatrician finds (after 6 months) and'abnormal eye movements or squinting deviations which may or may not be associated with refractive defects.

3° control. Ai 3 years of age, even if the child does not complain of any complaints, a complete eye examination should be performed, essential for identifying refractive and ocular motility abnormalities, diagnose any Amblyopia, (the so-called lazy eye) and undertake the necessary treatment as soon as possible.

4° control. A 5/6 age in conjunction with the start of elementary school. At this age i visual defects they must be corrected promptly to ensure the best possible visual acuity and to better manage their evolution.

5° control. A 8 age because the onset of myopia often occurs at this age, especially if there is a familiarity with this refractive defect.

Subsequently continue with periodic eye exams depending on the information provided by the ophthalmologist.

A few months or years after the cataract operation between the 20 and the 30% Of the eyes, the capsule (the outer layer a “bag” of the lens) where the artificial lens is placed, it can become opaque in its posterior part causing a reduction of vision (secondary cataract). This opacity can be permanently removed by laser treatment (capsulotomia YAG laser). Completely painless non-invasive treatment lasting a few minutes that requires only the instillation of eye drops for pupil dilation and possibly anesthetics for the application of a contact lens. At the end of the session, the patient can resume his activities without particular precautions or warnings.