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A comprehensive eye examination comprises of 4 major test components:

1.Medical history taking and complaints

• To understand why a patient is seeking an eye examination and what are the major complaints. Individual and family medical and ocular histories are explored for any possible link to the complaints.

2.Visual functions tests

• Vision / visual acuity
• Contrast sensitivity
• Refraction (sight test) for short-sightedness, long-sightedness, astigmatism or presbyopia (aging sight)
• Binocular vision: muscle motility, focusing ability, squint, amblyopia (lazy eye) and stereopsis (depth perception)
• Pupil reflex
• Visual field
• Colour blindness

3.Ocular health tests

• Intraocular pressure
• Anterior and posterior segments: eyelid and annex, tears, conjunctiva, cornea, iris, crystalline lens, vitreous, retina and macula
• Dry eye
• Contact lens related complications

4.Case Analysis and management

• Analysis and explanation of clinical test findings
• Suggestion of appropriate actions or management plans
• Abnormal conditions, when suspected, will be referred to appropriate medical specialties
• Common referrals include:
  • Glaucoma
  • Cataract
  • Floaters
  • Macular degeneration
  • Retinal holes, tears or detachments
  • Diabetic retinopathy
  • Retinal blood vessel occlusion
  • Brain tumour
  • Hypertensive retinopathy

Primary eye care examination not only ensures that you have clear and comfortable vision but also maintains that your visual system stays healthy and functional: a key to preventive eye care.

Dry Eye Assessment

Dry Eye Disease is one the most common eye diseases worldwide.

Dry Eye Symptoms include:

• Dryness
• Grittiness
• Foreign body sensation
• Red eyes
• Sore eyes
• Photophobic
• Tearing
• Discharge
• Swelling and heavy eyelids
• Transient blurred vision

Dry Eye Examination includes assessments of:

• Ocular Surface Disease Index (OSDI) Questionnaire
• Tears meniscus height
• Tears volume
• Tears break up time
• Fluorescein / Lissamine Green staining of cornea and conjunctiva
• Meibomian gland function / dysfunction
• Ocular surface cell damage
• Tears lipid quality
• Tears pH-values

According to studies from the School of Optometry at the Hong Kong Polytechnic University, the prevalence of myopia (short-sightedness) for different age groups is shown below:

• Age 6 – 7 ： 30%
• Age 10-11： 60%
• Age 16-17： 74%
• Age 19-39： 71%

It can easily be seen that the problem of myopia is very serious in Hong Kong.

According to other studies, currently one third of the world population is myopic and by Year 2050, half of the population will be myopic, equivalent to 5 billion people worldwide. Of these people, 1 billion of them will be of high myopia.

Myopia will become the most common cause of blindness.

More and more evidence has shown that myopia, high or low, will increase the risk of visual impairments and is higher for higher myopia. Myopia results in an elongation of the eye which causes the retinal and choroidal tissues to become thinner leading to a higher chance of retinal detachment and myopic maculopathy (disease of the macula). High myopia may also increase the incidence of cataract and glaucoma.

Researchers from a sample of 21,000 patients were able to demonstrate that for every increase of 1.00 dioptre in myopia, the prevalence of myopic maculopathy would increase by 67%.

Myopia management aims to control or slow down the progression of myopia by means of different methods or procedures in order to prevent future visual loss or blindness.

Therefore, myopia prevention and control are much more important than just correcting for it. In other words, when a child starts to develop and/or progress fast in myopia, myopia management strategy should be considered, in addition to a proper eye examination.

One or more of the following means can be considered for myopia control:

• D.I.M.S. optical defocus spectacle lenses (MyoSmart)
• Other optical defocus spectacle lenses (MyoVision)
• Progressive spectacle lenses (Myopilux)
• DISC-1 Day daily disposable soft contact lenses
• Other optical defocus daily disposable soft contact lenses (MiSight)
• Orthokeratology
• Atropine eye drops

(NB：This centre does not provide atropine eyedrops)

Orthokeratology (Ortho-K)

Orthokeratology is the application of specially designed gas permeable contact lenses to gradually reshape the central and peripheral cornea for the correction of short-sightedness and control of myopia progression.

Orthokeratology lens is designed based on a combination of advanced ophthalmic instrumentation and precision computer technology together with the professional knowledge and experience of the Ortho-K practitioner.

According to studies from the Hong Kong Polytechnic University and others, Orthokeratology slows down myopia progression by about 50% on average.

Safe Ortho-K requires:

1. A comprehensive eye exam with special attention to the health of the cornea, conjunctiva and tears.
2. Strict compliance with hygiene and lens care regimen by parents and children
3. A thorough understanding of the relationship between hygiene and contact lens complications.
4. Regular follow up exams

In addition to regular contact lens instruments, special equipment such as a corneal topographer and an axial length scan are essential in monitoring changes and results.

Depending on the individual, Ortho-K may show its optical effect from a few hours to a few days or weeks and optimal reshaping effects can usually be achieved with one to three pairs of lenses. The wearer will then continue with the final retainer lenses during sleep for clear vision the following day.
Orthokeratology is suitable for people of all ages, especially young children during their growth stages, as long as they meet the refractive and health requirements. The safety of Ortho-K lenses is no different from any other contact lenses provided proper fitting, hygiene, lens care and follow up are closely observed.

DISC-1 Day Myopia Control Soft Contact Lens

Myopia or shortsightedness occurs when the eyeball is too long relative to the focusing power of the eye. Light focuses in front of the retina rather than on it, making distant objects blurry.

The DISC lens, developed by the PolyU, is a multi-zone soft contact lens that provides clear vision and at the same time projects blurred, defocused peripheral images onto the retina to slow down the increase in the axial length of the myopic eye.

The clinical trial conducted by PolyU showed that DISC lens can effectively retard the progression of myopia by approximately 60% amongst Hong Kong children aged 8 to 13, thus providing another effective choice in myopia control for children aged 6 or above during a period of high progression rate.

DISC – 1 Day is a daily disposable lens without the need for cleaning and disinfecting which minimizes the risk of complications arising from hygienic issues and it corrects myopia up to -10.00 diopters.

Stringent assessments of ocular health, refractive errors, lens fitting and regular follow up care are warranted to ensure safety for our wearers.

(Source: Daylite Vision Care and Hong Kong Polytechnic University)

Corneal Topography

Corneal topography is a non-invasive imaging procedure for mapping the curvatures of the cornea in both cross-sections and three-dimensions. It is an important tool for assessing the fitting of contact lenses, particularly orthokeratology lenses as it compares corneal surface changes before and after treatment.

Clinically, it can be used for monitoring the effect of orthokeratology, assessing tears quality or assisting in the diagnosis and treatment of some corneal conditions such as keratoconus.

Glaucoma Examination

Glaucoma has become the world’s second leading cause of blindness, after cataract.

Although it is common, most patients are not aware of having it until vision has become bad and visual field defective. Because of this lack of symptoms in the early stages, glaucoma is sometimes called ‘the silent thief of vision’. It has been estimated that there is about 50% of undiagnosed glaucoma. Routine eye examination is surely most important in the detection and prevention of the disease from progressing to a point of irreversible vision loss.

Glaucoma is a multifactorial condition with characteristic optic nerve damage and visual field defects.

Risk factors:

• Age
• Family history/genetics
• Race
• Intraocular pressure (IOP)
• Myopia
• Diabetes

Glaucoma examination includes the following:

• Complaints and history taking
• Visual function tests
• IOP measurement
• Corneal thickness measurement
• Assessment of the anterior segment, anterior chamber and angle
• Visual field test
• Evaluation of the Optic Nerve
• Fundus photography
• Optical Coherence Tomography (OCT)
• Analysis of findings and recommendation

Intraocular Pressure Measurement

Measurement of the intra-ocular pressure (IOP) of the eye is termed Tonometry.

As Intra-ocular pressure is one of the risk factors for glaucoma, it is measured as a routine procedure in a primary eye care examination as a screening and diagnostic tool for the assessment of glaucoma. The IOP values can also be used a measurement of efficacy of glaucoma treatment.

Normal IOP values range from 10 – 21 mmHg. It should be noted that normal IOP values do not necessarily exclude the possible presence of glaucoma.

Clinically, there are two ways IOP can be measured:

1. Contact Tonometry
   • The cornea is first anaesthetised before the contact tonometer is touching the cornea for a pressure reading in mmHg. (Photo 1)

2. Non-Contact Tonometry
   • No anaesthesia is required. A small puff of air is sent to the surface of the cornea and a digital device receives and interprets the deflected air for an IOP reading in mmHg. (Photo 2)

(Photo 1)

(Photo 2)