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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.



Here at our Princeton ophthalmology group, we’re pleased to offer a better way to treat a common visual condition. Orthokeratology, or Ortho-K, corrects an individual’s vision with the use of custom contact lenses while the patient sleeps. The contact lenses are made of a rigid, gas-permeable (hard) material. Due to their unique curvature, they can reshape the corneas overnight.

Optimum vision is usually achieved after 1 to 2 weeks of wearing the contact lenses each night. Continued wear maintains excellent vision throughout the day without the need for glasses or soft contact lenses. Studies have proven that this is a safe, nonsurgical alternative for nearsighted patients. Both children and adults can benefit from the freedom that Ortho-K offers.

The most successful Orthokeratology patients include people who:

  • Consistently get 6 to 8 hours of sleep per night
  • Have less than -5.00 sphere and less than -1.00 astigmatism power in their eyeglass prescription
  • Can commit to the prescribed schedule for wearing the lens, as well as keep checkup and maintenance appointments

Because of the specialized fitting procedure, our office uses only FDA approved Orthokeratology custom contact lenses. Our contact lens professional has undergone extensive training and experience to ensure positive results.



Excess tearing can be a perpetual nuisance. The condition occurs when the amount of tears produced by the eye overwhelms the tear drainage mechanism. Even though tearing by itself never harms the eye, it can blur vision and produce discomfort in social situations. Our eye doctors in Hamilton, N.J. understand the problems caused by excessive tearing and can treat its causes.

The tear film — a complex solution made up of mucous, salt water and oil — is essential for the health of the eye. There must be a balance between the tears produced and the tears drained. That balance is achieved when tears leave the eye. This occurs in 1 of 3 ways:

  • Evaporation
  • Down the tear ducts
  • Flowing out onto the cheek

Does dry eye cause tearing?

In most cases, no. A better definition of tearing is needed to answer this question. When tears leave the confines of the eyelids and run down the cheek, that’s called tearing.  This is almost never caused by dry eyes. Dry eye patients feel their eyes are wet and may call it tearing but the tears do not run down the cheek. Instead, patients with dry eye have excess mucous and oil in the tear film and this causes a slime that makes the eyes feel wet. Incorrectly treating the condition can make tearing worse.

Nearly all excessive tearing patients have a structural abnormality of the tear drainage system. This illustration shows the tear drainage system’s anatomy. There is a small tear duct in both the upper and lower eyelids called the canaliculus. These come together and drain to the lacrimal sac. The lacrimal sac joins with the nasolacrimal duct that travels through a bony canal to exit in the nose. 

Incorrectly positioned eyelids block the small tear ducts from contacting the tear lake, preventing tears from draining. Excess conjunctiva (the clear film that covers the white of the eye) may cover the opening to the tear duct. The nasolacrimal duct may be narrow or blocked as it travels down the bony canal into the nose. Blockage of the nasolacrimal duct not only causes tearing but also an accumulation of discharge in the eye and puts one at risk for a serious infection known as dacryocystitis.

These structural abnormalities often require surgery to alleviate the blockage and restore normal tear outflow.  Fortunately, many of these procedures are relatively minor and can be performed in the office.  Some do require outpatient surgery.

Tearing can be extremely bothersome and interfere with clarity of vision and your ability to perform at your best. Fortunately, our ophthalmology practice serving Princeton, Hamilton Township, and Monroe Township have the tools and the expertise to diagnose and treat all causes of tearing. We recommend coming in for a consultation if you’re bothered by excessive tearing.

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Over 25 million Americans suffer from dry, irritated eyes, making it the number-one complaint seen by eye doctors. Our Hamilton, New Jersey practice is no different. Symptom severity can vary from a mild intermittent nuisance to severe pain and loss of vision. Although the condition cannot be cured, advances in treatment options allow most symptoms to be brought under control, restoring comfort and preserving vision. If left untreated, dry eye progresses over time.

How Dry Eye Happens

The tear film is a complex solution made up of mucous, salt water and oil. It functions to protect the surface of the eye, keeping it moist and lubricated. This complex fluid washes away allergens, infectious bacteria, and viruses. This plays into the inner workings of the eye.

Much like a recipe, poor quality ingredients (mucous, salt water, and oil) together with improper proportions produces a poor tear film incapable of protecting the eye. The corneal surface begins to break down, causing eye redness and irritation. Environmental stressors such as heat, low humidity, wind, and allergens exacerbate the symptoms of dry eye.

Dry eye is a low-grade inflammation of the surface of the eye. A treatment plan must be tailored to the individual based on the intensity of the symptoms and findings of the eye exam.

The Prevailing Treatment Methods

At our Princeton-area ophthalmology practice, we have several approaches for treating dry eye. In each case, the goal of treatment is to increase the volume and quality of the tears.

  • Artificial tears and ointments: These provide the first line of defense. They do not alter the course of the dry eye itself, but they do provide temporary relief by coating the corneal surface.
  • Eyelid hygiene: Keeping the eyelids clean decreases the bacteria that normally inhabit the eyelids. These bacteria release toxins that irritate the eye. Baby shampoo, antiseptic wipes, or solutions will decrease the bacterial load on the eyelid and improve symptoms. Antibiotic drops may sometimes be added to decrease the number of bacteria on the eyelid skin.
  • Blocking the tear ducts: The tear ducts (one for each eyelid) drain away the tears. Blocking them keeps the tears in contact with the eye longer and slows the egress of tears, keeping the eye more moist.
  • Anti-inflammatory medications: Because the underlying cause of dry eye is inflammation, medications for inflammation can improve signs and symptoms of dry eye. Steroid drops provide rapid relief of symptoms, but they can only be used for short periods due to a possibility of causing glaucoma or cataracts. For long-term treatment, anti-inflammatory drops RESTASIS® and Xiidra® are now available.

Dry eye is an exceedingly common condition that can manifest as only a minor nuisance — but in the most serious cases, it may lead to severe visual loss. That’s why we recommend coming in for a consultation if you are experiencing symptoms. There is currently no cure for dry eyes, but treatments can improve comfort and prevent visual loss.


Learn about the most common things that affect your eyes and your vision as you gracefully navigate through your senior years. Dr. Colleen Coleman, a board certified Ophthalmologist and Glaucoma specialist at Outlook Eyecare will touch on dry eye, refractive cataract surgery, macular degeneration prevention, and glaucoma prevention.

The Aging Eye Talk
Presented by Dr. Colleen Coleman

Two Opportunities:

When: Wednesday, October 19, 2016 at 3 to 4 p.m.
Where: Lawrenceville Library, 2751 Brunswick Pike, Lawrenceville, NJ

When: Wednesday, November 2, 2016 at 2 to 3 p.m.
Where: Hopewell Branch Library, 245 Pennington-Titusville Road, Pennington NJ

Registration suggested. To register, visit the library online or call 609.989.6920.





In this day and age, it seems we are surrounded by digital screens that vie for our attention constantly. And for most of us, they are hard to resist because they have become affordable, accessible, and portable. Think TVs, laptops, tablets, and smartphones. Together, they’re a major factor in ocular health for the Princeton patients who visit our optometrists and eye care professionals.

As a society, we have become hungry for information — be it useful or mostly irrelevant. Other than reading e-books, this also means extended viewing of our emails, the latest YouTube videos, or our friends’ posts on Facebook and Instagram. We are so attached to our smartphones that a mere few hours apart from it can give us anxiety.

What Causes Digital Eyestrain?

Prolonged Exposure

Every eye doctor in Princeton, New Jersey and throughout the country will tell you that digital eye strain is a serious issue. A new study by the Vision Service Plan (VSP) shows that by the time an American teenager turns 17, that teenager has spent a third of his or her life staring a digital device. That’s almost 6 years — or about 50,000 hours. And because of this amount, eye care specialists are witnessing a growing number of patients suffering from digital eye strain.

So please, encourage your kids to lead an active lifestyle, teach them to enjoy the outdoors and maybe even read a book or 2 during the summer (the old-fashioned way, that is).

Reading Too Close

According to another report published in 2011, we have a tendency to stay closer to digital screens when reading than we do when reading something in print. About 20% closer, to be exact. Reading from devices up close places heavy demands on the eyes, since you are forced to focus harder and your eyes actually angle inward towards each other.

The next time you are staring at a digital screen, try reading from farther away — and if that’s not possible, there’s nothing wrong with increasing the font size.

Reduced Blinking

We also blink less when staring at a digital screen than we do when reading a printed page, which in turn results in our eyes becoming dry and sore.

On a personal note, I think my nephew forgot how to blink entirely when he got his new racing game and started playing it on the big screen TV. So remember to take breaks — and please don’t forget to blink.

Artificial Blue Light

Artificial blue light also plays an important part in contributing to digital eye strain. All the LCD and LED screens that surround us emit it. Due to its short wavelength, our eyes are not very good at blocking blue light. Therefore, it penetrates all the way to the retina. Prolonged exposure to these digital screens will adversely affect the health of the retina, and it can possibly lead to macular degeneration. I will talk in more detail about blue light and its adverse short-and-long-term effects in my next blog post.

How to Protect Your Eyes

Remember, the easiest way to minimize digital eye strain is to reduce overall exposure to digital displays and to take breaks in between. When that’s unavoidable, here are a couple rules of thumb to live by:

1) Follow the 20-20-20 break plan: Take a 20-second break every 20 minutes and look at something 20 feet away.

2) For every inch of screen size you should be 2 ½ times as far away from it. So you should be about 10 feet (i.e., 120 inches) away from a 50-inch HD screen.

Have more questions about how best to take care of your eyes? Leave us a question in the comments below!


Children waving sparklers on the 4th of July is as American as apple pie and baseball. Few of us know, however, that those small wands shooting out sparks sizzle at temperatures of up to 2,000 degrees and, along with other fireworks, cause thousands of eye injuries each year.

Watching fireworks with family and friends on Independence Day is a time-honored tradition, but the reality is that eye injuries caused by fireworks have doubled in recent years, resulting in about 1,200 visits to emergency rooms across the nation in 2014. Outlook Eyecare, with eye doctors in Hamilton Township, Princeton, and Mercerville, NJ is highlighting this fact to help prevent fireworks-related eye injuries this year.

Video Courtesy of the American Academy of Ophthalmology

To help New Jersey residents stay safe this Independence Day, we’ve compiled some tips that will help keep your celebrations free of eye injuries:

  • Never allow children to ignite fireworks. Yes, that includes sparklers and other small, seemingly harmless products. Small doesn’t equal safe. They can even pose more danger because people are less vigilant in supervising kids lighting these fireworks. Even tiny poppers or snappers can ricochet and burn the eyes of toddlers or small children.
  • Be extra cautious handling “duds.” That’s because fireworks that appear defective and are thought to be extinguished are unpredictable. Anyone igniting fireworks or handling them after they’ve been lit should wear protective eyewear to avoid accidents.
  • Even spectators need to be cautious. Just because you’re not the one lighting the firework doesn’t mean you are out of the firing line. Half of those suffering eye injuries caused by fireworks were bystanders, according to an international study. Of those, 1 out of 6 victims sustained severe vision loss.
  • Explosive fireworks that shoot projectiles into the air are illegal for a reason. Bottle rockets and other explosive fireworks are extremely dangerous and should not be used.
  • Attend a community-sponsored fireworks show. These family-friendly events can become a new 4th of July tradition. Go just for the show, or make it a daylong outing with family and friends. Leaving the fireworks to the professionals is the safest way to enjoy the Fourth.

Remember, you should get immediate medical attention if you do suffer an eye injury and avoid rubbing or applying pressure to the eye. If you know or suspect there’s an object in your eye, don’t remove it, apply ointments, or take pain medication before getting medical help.



Dry eye syndrome is one of the most common conditions eye doctors treat on a daily basis, both here in the Hamilton and Princeton, NJ area and nationwide. It is a very common disorder, affecting approximately 30% of the population. Tears adhere to the surface of our eyes in order to protect and keep them moist. Dry eye is the result of either decreased tear production or increased tear evaporation.

There are multiple risk factors for dry eye. I find that environment plays one of the largest roles. Cold, dry winters, heaters and air conditioners, smoke, and dust are some of the factors that can aggravate dry eye. Certain medications such as antihistamines, beta blockers, and antidepressants can cause a decrease in tear production. Additionally, diseases such as rheumatoid arthritis, Sjogren’s syndrome, and lupus can have a severe impact on dry eye.

Patients with dry eye will experience symptoms such as a gritty or sandy feeling in their eyes, redness, blurry, fluctuating vision, and light sensitivity. Interestingly, patients may also experience tearing, which is a reflex secretion due to dryness.

In mild cases of dry eye where a patient has minimal symptoms, artificial tears used as needed provide relief. In more moderate to severe cases, patients will require regular use of artificial tears along with anti-inflammatory drops. RESTASIS® is a wonderful medicine for patients with moderate symptoms who need long-term treatment.

Dry eye is caused by inflammation of the glands that make tears, resulting in less production and a poor quality. RESTASIS helps to prevent this inflammatory process and improves the amount and quality of tears. Omega-3 supplements have also been shown to have an anti-inflammatory effect on the eyes, allowing for better tear production. There is even a simple and easy procedure that can be performed in the office to block the tear ducts, which prevents tears from draining out of the eyes, keeping them moister.

Although a very common disease, dry eye can be very debilitating if left untreated. Fortunately, over the years, wonderful new medicines and therapies have arisen for treating dry eye. Patients who have dry eyes should feel reassured that with the appropriate treatment, their symptoms can be dramatically improved and even completely resolved.

Do you think you may have dry eye syndrome? I urge you to contact us to find out some strategies for improving your vision, your comfort, and your quality of life.

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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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