Dr. Shalu Pal

  • "If you want quality and wonderful service, please go to Dr. Shalu Pal! The patience, care, and true concern that Dr. Pal has for her clients is wonderful. "

    --Seleena J
  • " I was pleasantly surprised by finding a hidden gem within Dr. Pal's office"

    --Naveed
  • "Finally a doctor who is extremely knowledgeable, patient and explains things clearly. She is a wonderful human being who really takes the time to care for your needs. The office has a wonderful atmosphere and the staff are just as helpful as Dr. Pal. "

    --Mikail
  • "I couldn't ask for a better Optometrist. She is a delight to deal with, very patient, helpful and extremely knowledgeable. She was very good with my kids who can be very fussy at times.. And who could ask for a more beautiful location. Highly Recommend! "

    --Natalie M.
  • "My wife and I, highly recommend Dr. Pal. The staff, the service, the merchandise, are all top notch. They really make you feel welcomed. It has been several years since I have been able to see this well !!! You and your staff are the best !!!! "

    --Steve and Maria L.
  • "We barely go to optometrists so when we do, we should look for the best! I am super pleased I chose Dr. Pal\'s office. They were helpful from beginning to end, from booking on the phone to my actual visit. Dr. Pal was very detailed and went in-depth about my eye health. She is very patient and made me feel calm. The optician helped me pick a great pair of glasses, they were genuinely friendly which is a huge bonus."

    --Ahmad S
  • "I have been going to Dr. Pal for several years now. My most recent visit on June 6, 2016 was the best experience there that I have ever had. Firstly, the women on the desk were friendly and efficient - a very good prelude to my examination. Dr. Pal, herself, was, as usual, very thorough and encouraging in her examination. And she puts you at ease before we get into the eyes examination by discussing other things in life. That helps to ease any stress I may have. And they now have a man in the office who does that difficult examination (name of which I do not know!). He is so patient and encouraging and made the exam not so difficult for me this time. After all that, I saw Dr. Pal again before I left and she told me my eyes were good! Even had the news been not so good, I believe that I would be able to handle it because I truly believe that Dr. Pal and her staff would have taken good care of me. I will always go back to Dr. Pal and members of her team because I truly believe"

    --A. Howlett
  • " I have been to a few appointments at Dr. Pal\'s office over the last year for dry eye issues and every time it has been a very positive experience. The 3 receptionists at the front desk are warm and friendly. They are attentive and provide a very high level of customer service. I appreciate that they call me by name and remembered conversations we had at previous visits. I find Dr. Pal to be an excellent practitioner who is very thorough with her exams, has a lovely personality and takes the time to answer any and all questions that may arise. I am happy with the computer glasses I purchased and value the honest opinions I received from the staff when selecting frames. It was refreshing to have multiple opinions on styles and I felt they truly wanted me to walk out with a frame that was best suited to me. I highly recommend Dr. Pal \'s office! As a health care practitioner myself, I think all health care experiences should be this personilzed and friendly!"

    --A. Mclean
Your Child Needs a Eye Examination!


Contents

Your Child Needs a Eye Examination!

Above: Here's someone willing and able to learn and explore his world.

When?

Children should have a comprehensive vision examination before the age of three, and another exam before the child begins school. Because children grow fast, their eyes also change quickly, so it is appropriate that they be examined each year after that

If vision problems go undetected, there can be a profound effect on the process of learning and the child's success in school. Unfortunately, many vision problems aren't detected early because children think everyone else sees the same way they do, and they don't usually complain.

Do not rely on school vision screenings to detect vision problems.

What to Expect

While a vision exam can vary widely based on the age of the child, most of the key points are the same.

(Note: for the purposes of this article, we will use the pronoun "he" to refer to the child being tested, but that is only for convenience, not because the testing will be different for girls than for boys.)

You may help your child by reassuring him that getting his eyes tested is mostly fun, and doesn't hurt at all. In fact, most children find getting a vision exam really is fun and interesting.

First, the eyecare practitioner will need to ask for some information regarding the child's personal health and the family history, both for general health and for ocular disease. This is because many eye conditions do run in families.

If the child has had a previous examination or a vision screening, please bring that information with you for the eyecare practitioner to review. Changes in the eyes and with a child's vision happen relatively quickly, but the more information that is available, the better the practitioner will be able to review his or her findings and point out any differences.

Many times, children don't complain or ask questions about their vision because they think everyone else sees the same way they do, but if your child has had difficulties in pres-school, kindergarten or elementary school, please share that with the eyecare practitioner, too.


The Vision Examination

An example of a child's eye chart

After reviewing the family history, the first test will be to establish how well he sees by testing his visual acuity. For preschool-age children, the doctor may use pictures instead of letters, but these are standardized to represent the same sizes of the letters that would be used for older patients. Each eye will be tested separately, at 20 feet and at reading distance.

Parents may wonder how it is possible to determine whether a child needs vision correction when he is too young to be able to answer questions about it, but in fact it is relatively easy, using an instrument called a retinoscope. The retinoscope is mounted on a handle and is made in such a way that the EP can look through it while shining its light across the pupil of the eye. The light is reflected back from the retina, in much the same way as an animal's eyes reflect the light from an automobile headlight; by evaluating how much and how fast the reflected light moves, it is possible to determine whether there is a refractive error and what lenses will correct it. The person being tested doesn't need to say anything at all.

Stereoscopic vision and the ability to appreciate 3-dimensions are tested by using a set of 3-D glasses. The child is asked to choose the 3-D image from among a series of pictures. Very young children may be asked to "touch" the tips of the wings of a fly which is presented in three dimensions; the wings will usually appear to be floating above the image presented. Different versions of these tests are available, so the child may be asked to touch the tips of the antlers of a large deer, for example.

A type of stereoscopic viewer may be used in conjunction with special cards to test whether the child is using both eyes at the same time, and roughly how they line up together.

Eye muscle coordination is tested by asking the child to follow a moving light in a set pattern to make sure the ocular muscles are working correctly, in each eye separately and then together. The ability to track a moving target accurately is important in reading.

Peripheral vision, or vision off to the sides, can be tested by asking the child to pay attention to a small toy or light, then bringing in another object and taking note of how far off to the side the child notices it. This is a test done on each eye separately.

Alignment and aiming of the eyes is tested by having the child look at a small object, then covering one eye and removing the cover a few times to see if the other eye moves when the first is occluded. Then, the paddle is moved from one eye to the other several times while the child is still looking at the toy, to test whether there is a tendency for the eyes to cross too much or diverge too much.

Colour vision testing is done using a set of Ishihara plates in a booklet. Each plate in the booklet is covered with coloured dots, and will contain a number made of dots of a slightly different colour hidden within it. Each eye is tested separately here, too. Small children may be asked to use a soft, dry paintbrush or similar tool to trace the figures hidden within the plates if the child doesn't yet know his numbers.

To check for a normal response of the pupils to light is checked by dimming the lights in the room and watching carefully to see if each pupil contracts in response to a light shining in it, and opens up (dilates) when the bright light is removed.

To evaluate the health of the anterior segment, or the front of the eye, the doctor will use an instrument called a biomicroscope, or slit lamp. He or she will check for anything unusual in the front part of the child's eyes, including the eyelids, lashes, tears, conjunctiva, cornea and iris, and the crystalline lens behind the iris. By using a hand-held lens in conjunction with the slit lamp, it is also possible to view parts of the retina and optic nerve.

The health of the structures located in the interior of each eye will be checked using another instrument called an ophthalmoscope to see the retina and the head of the optic nerve.

Usually, the eyecare practitioner will use drops in the eyes to dilate the pupils for a better look, but this isn't necessary for all young patients. One effect of dilating the pupils is that the drops used may temporarily remove the ability to focus the eyes, which is useful for the doctor to re-check for refractive errors with the retinascope.


A Word About School Vision Screenings

Sometimes, a school vision screening catches a child with a vision problem; more often, however, their value is questionable at best.

When the screening is done by eyecare practitioners or ophthalmic technicians, it can be of value, but when performed by teachers or parent volunteers, screenings will usually catch only one or two types of vision problems: myopia (nearsightedness) and high astigmatism. The reason for this is that the vision is checked by having each child read from an eye chart across the room. Children who are farsighted or have lower amounts of astigmatism can usually do that easily.

Having good vision across the room is necessary, but many school screenings don't test for how well the eyes work as a team, or how they track a moving object, both of which are skills needed to be a good reader. Some screening protocols don't test the vision up close, where the child holds reading material or his computer monitor.

The risk of screening by non-professionals is that if the child doesn't fail the screening, his parents may feel there is no need for a comprehensive vision exam. Relatively simple problems like uncorrected hyperopia (farsightedness) can cause the child to lag behind his peers and have serious long-term consequences.

We applaud the efforts of parents, teachers and other school officials to do what they can, but vision problems can easily hide behind a school screening that doesn't find anything wrong.

Unless your own eyecare professional has done the screening, please don't take the results seriously.

Results

By all these methods and tests, a complete picture of the health of the eyes, their ability to see clearly, how they align and work together, how they move, how well they track, colour vision and neurological health has been constructed. Even without the child answering any questions, there is a lot of information that can be gathered.

If there is a need for corrective lenses or any other treatment, it is better to know earlier rather than later, because problems in any of these areas can interfere with learning and development.

Parents wouldn't think of sending their children to school without the proper supplies, clothing and other equipment needed to participate in the learning experience, and they would make sure he eats a good breakfast after getting enough sleep the night before. Having his eyes and vision examined, too, is just good, common sense.

 
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