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Also called a “vision test,” a refraction is given as part of a routine eye examination in our Princeton-area ophthalmology practice. This test allows your eye doctor to determine the best prescription lens for your eyeglasses and contact lenses. A value of 20/20 is considered optimum, or “perfect” vision.

When performing a refraction, your eye care professional uses an instrument called a phoropter, which resembles an oversized pair of glasses. As an individual gazes through the phoropter, the doctor flips different lenses in front of their eyes until the patient chooses the correct combination of lenses. The refraction is best known to the patient as the test during which the doctor asks, “Which is better: 1 or 2?”

The results of a refraction can determine the following visual conditions:

  • Myopia, also known as nearsightedness
  • Hyperopia, also known as farsightedness
  • Astigmatism, a condition that causes blurry vision due to the shape of the cornea
  • Presbyopia, a condition that causes blurred vision at near distances. This is due to a decrease in the ability of the natural lens to focus, and it’s often related to age.

The following conditions can frequently interfere with the refraction test’s ability to correct the patient to 20/20:

  • Macular degeneration
  • Diabetic retinopathy
  • Retinal vessel occlusion
  • Retinal detachment
  • Retinitis pigmentosa

Because Medicare and many private insurance companies consider a refraction to be a non-medical test, it is not a covered benefit. Therefore, the refraction cost or fee is charged separately and payment is typically the responsibility of the patient.



Age-related macular degeneration is one of the most common causes of blindness in older adults — but that doesn’t mean it’s inevitable. Early detection can be the key to saving your sight, and it’s easier than you think. In fact, your best line of defense against macular degeneration may be something you’re already doing: getting regular exams with your eye doctor here in Hamilton, NJ.

If you’re over 65, the American Academy of Ophthalmology recommends getting a regular eye exam at least once every 2 years, even if you don’t have any symptoms. In fact, this is a good schedule for anyone to maintain, because it helps your provider identify any changes in your eyes quite early on. Eye exams check for much more than macular degeneration, too. During a routine eye exam, your provider also checks for evidence of other eye disease, such as glaucoma, cataracts, and other retinal conditions.

You can easily screen yourself at home for macular degeneration with this easy test.

Take a look at the grid pictured here. Sitting about 18 inches away from your screen, focus on the dot in the middle of the grid. Cover your left eye and look at the dot, then cover your right. If at any time the boxes in the grid appear distorted, misshapen, or blurry, contact us so we can perform a more in-depth eye exam.

Left untreated, age-related macular degeneration can cause rapid and irreversible sight loss. But by simply seeing your eye care provider, you’re doing your part to make sure you retain excellent vision well into old age!


Cataracts develop gradually, and it can be difficult to know when cataract surgery is needed. Our eye doctors in Hamilton, Princeton, and other central New Jersey communities see men and women daily who wonder if it’s time to undergo surgery to improve their blurred vision.

Cataracts are the most common cause of vision loss in people over age 40, and the condition currently affects more than 22 million Americans. And as our population grows older, more than 30 million Americans are expected to have cataracts by the year 2020. So, how do you know if you’re at risk? What are cataracts actually like? And how do you decide that it’s time for surgery?

Risk Factors

Anyone can develop cataracts, but there are certain risk factors that make it more likely for someone to develop a cataract:

  • Family history of cataracts
  • Diabetes
  • Smoking
  • Extensive exposure to sunlight
  • Suffering a serious eye injury
  • Prolonged use of steroids, especially combined use of oral and inhaled steroids

Wearing sunglasses that block the sun’s UVA and UVB rays can reduce your risk of developing cataracts, as can avoiding smoking (or quitting if you are a smoker). In an earlier blog post, we wrote about recent studies showing that women who undergo hormone replacement therapy have increased chances of needing cataract surgery in the future, as well. As we noted, the research suggests a cautious approach to hormone replacement therapy.

Cataract Symptoms

In its initial stages, a cataract is very small, and you may not even notice any change to your vision. As it develops over time, though, vision begins to blur. As the cataract grows, it becomes increasingly difficult to see. Someone with a cataract may notice light from a lamp or the sun seems glaring, or that oncoming headlights at night cause more glare than before the cataract developed. Different types of cataracts also have slightly different symptoms that may become noticeable at different times.

Timing of Cataract Surgery

Deciding whether to get cataract surgery is a conversation you’ll need to have while consulting with an ophthalmologist. It often depends on your lifestyle and daily activities. Getting annual vision tests after age 65 will help ensure the surgery is performed at the appropriate time, as well, because regular check-ups will tell you if cataracts are developing. The American Academy of Ophthalmology™ has an online consumer guide to cataract surgery with helpful information for men and women considering the procedure.

At Outlook Eyecare, we recommend a baseline eye exam for anyone older than 40, even people who aren’t considered at risk for developing cataracts. You can [cert] request a consultation [/cert] to meet with one of our eye doctors or call us at (609) 409-2777 in Monroe Township, (609) 419-1920 in Princeton, or (609) 587-4700 in Mercerville.


Steroids are a broad, versatile group of drugs that effectively reduce inflammation anywhere from the lungs to the skin. If you have asthma, COPD, or even seasonal allergies, you may rely on inhaled or oral steroids to keep you feeling your best. But a recent study links steroids to the development of cataracts, and it’s something that we want our cataract surgery patients here in New Jersey to be aware of.

What the Study Found

The study followed more than 3,600 adults over the course of a decade. The study found that the risk of cataract development was significantly elevated in people who met all of the following criteria at the beginning of the study:

  • Had ever used inhaled steroids
  • Had used oral steroids for at least 1 month
  • Had no pre-existing cataracts

Why You Shouldn’t Be (Too) Worried

Only 10 people involved in the study fit these criteria, but 7 of them had developed cataracts by the end of the study. That’s more than a chance relationship, and you would be right to conclude that using both inhaled and oral steroids has a significant.

Steroid use is more closely associated with a specific type of cataract called a subcapsular cataract. This type of cataract occurs farther toward the rear of the eye, as opposed to nuclear cataracts (the most common variety) that develop around the nucleus of the lens. Subcapsular cataracts do cause the same symptoms, including cloudy visual disturbances, increased nighttime glare, and less vibrant colors.

While these results are concerning, it’s also not yet safe to say that anyone who uses a combination of oral and inhaled steroids will eventually develop cataracts. That said, if you regularly use both oral and inhaled steroids, we recommend seeing your ophthalmologist to further evaluate your risk.

At that point, you’ll need to weigh the benefits of continuing to take the steroids against your chances of developing cataracts. This is not meant as a recommendation to stop taking them — we simply wanted to bring it to our patients’ attention. Do not stop taking any medications unless you’ve spoken with your doctor.


During our years providing the Hamilton and Princeton areas with ophthalmology services, we have heard from many patients who have simply felt overwhelmed by the amount of information available on the Internet about their eye needs. That’s why we’ve added a blog to our site. We hope this platform will serve as a trustworthy, easy-to-use resource for both our patients and other people researching eye care topics.

We’ll be sure to keep the blog regularly updated with the topics that matter most to you, including:

  • News from the field of ophthalmology, including FDA approvals and emerging science
  • Announcements related to our practice, such as new treatments or staff members
  • Answers to common questions and concerns regarding eye conditions and procedures
  • General tips to keep your eyes at their best

We also want this forum to be a way to connect directly with you, our valued patient. You can expect candid advice from our experienced team, and we invite you to ask us questions and leave comments about what’s on your mind.

Do you have a topic about which you’d like to learn more? Leave us a comment, and we’ll do our best to address it in an upcoming post. Be sure to check back regularly to keep yourself in the know about what’s going on at Outlook Eyecare!

Contact us

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Monroe Township
Outlook Eyecare
5 Centre Drive #1B
Monroe Township, NJ 08831
Phone: (609) 409-2777

Visit us anytime

Outlook Eyecare
100 Canal Pointe Boulevard #100
Princeton, NJ 08540
Phone: (609) 419-1920

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