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Services

Patient Services

Virginia Pediatric Eye Center provides a range of services including eye exams, specialized imaging and testing, and surgical interventions.  Below is an overview of the services we offer.  Please feel free to ask our team for more information about any of these.

Exams

Virginia Pediatric Eye Center provides thorough eye exams for all our patients. Routine eye exams are offered to our healthy patients with no medical conditions or symptoms except for visual changes that can be corrected by eyeglasses or contact lenses. Glasses and contact lens prescriptions may be updated during this type of visit. Myopia (nearsightedness), hyperopia (farsightedness), and astigmatism are all diagnoses associated with routine eye exams. If your exam only involves obtaining or updating glasses then it is likely billed to the vision insurance plan. If you are complaining of itchy eyes or eye pain it is not a routine exam.

Refraction is the process of determining the proper prescription for glasses or contact lenses. A refraction determines the amount of myopia (near-sightedness), hyperopia (far-sightedness), and astigmatism that need to be corrected to allow a patient to see clearly. Refractions are performed during routine vision exams, on your first visit with us, at your annual visit, and anytime your vision changes significantly. The refraction is a vital test for the care of your eyes because it allows for assessment of your current eye health and the detection of eye diseases. We use the refraction process to determine if a patient needs a glasses prescription, or it may be required by insurance plans to determine if you qualify for particular eye procedures such as cataract or other eye surgeries. The refraction can be obtained by VPEC doctors in several different ways:

  • Cycloplegic refractions are refractions performed by the doctor by first dilating the patient to relax the muscles related to accomodation. Then a refractive instrument called a retinoscope is used to look into the eye along with special lenses to determine the power of the eye and refractive error of the patient. This is accomplished without the need for feedback from the patient and is typically done on children.
  • A specialized instrument called an autorefractor is often used initially to determine a starting point for the refraction. For this procedure the patient looks into the autorefractor which automatically scans the eyes to determine how farsighted or nearsighted the patient is and how much astigmatism is present.
  • Ultimately the refraction can be further refined with a specialized instrument called a phoropter or trial lenses are used to determine the refractive error of the patient. This technique is accomplished by presenting different powered lenses in front of the patient’s eyes while determining which combination of lenses will make their vision clearer.  This can also be done with input from the patient, though this is not necessary in younger children.  While you look at the eye chart through the phoropter, the lenses are adjusted until the clearest vision is achieved. You may hear the doctor say something like, “which is better, lens one or lens two,” for example. This process can take place with or without dilation or after a cycloplegic refraction depending on the condition being treated and assessed.

We provide vision testing and refractions for patients of all ages. If needed, our office can even provide a refraction for a newborn infant.

Virginia Pediatric Eye Center is a specialist practice and as such we see many patients with both minor and complex medical eye conditions. Medical eye exams are provided to patients with an eye problem or disease. Our team is able to evaluate children’s vision from birth and are particularly skilled in issues related to visual development and eye alignment. We help our patients manage a wide spectrum of medical conditions that affect the eyes, including strabismus, amblyopia, cataracts, genetic conditions, glaucoma, retinal diseases, lid drooping, nasolacrimal duct obstructions, and ocular trauma.  Your visit will be coded as a medical eye exam whenever you are being evaluated or treated for any medical condition or symptom or a condition that the doctor finds during the examination. Examples that will necessitate your visit being submitted to your medical insurance instead of your vision insurance include headache, diabetes mellitus, eye irritation, pink eye, dry eyes, allergies, floaters, contact lens intolerance, glaucoma, cataract, eye muscle imbalance, strabismus (eye turn), amblyopia (lazy eye), macular degeneration, overactive/underactive thyroid, and others. Please note that if you have diabetes mellitus, and would like us to send a letter to your primary care physician regarding your eye exam, the visit will be coded as a medical eye exam. Refractions are also performed during medical eye exams.  There are many medical conditions with ophthalmologic associated conditions which also require evaluation and will be billed under the associated medical condition, such as juvenile rheumatoid arthritis.  Essentially, any examination pertaining to a medical condition, injury, eye complaint, or follow-up to a previously diagnosed condition are considered  medical eye exams.

Whenever possible, we recommend you obtain a referral from your medical health plan prior to your eye exam. Even if you are scheduling a routine eye exam, a referral will simplify billing your insurance if a medical condition is found during the examination.

Our staff are highly trained in routine and difficult contact lens fitting, particularly pediatric contacts, aphakic contacts, and toric contacts. Contact lenses may be prescribed if it is determined that your child is ready for an alternative to glasses. If you decide to opt for contact lens wear, it is very important that the lenses fit properly and comfortably and that you understand contact lens safety and hygiene. A contact lens exam will include both a comprehensive eye exam to check your overall eye health, your general vision prescription and then a contact lens fitting and measurement to determine the proper lens fit.


Following a comprehensive eye exam, we offer a private fitting session for first time contact lens wearers. The patient will learn how to put contacts in, take them out, and be taught the proper care of using contact lenses. A trial pair of lenses, contact solution, and a case are given to the patient for the fitting session.


The patient returns in 2 weeks after his or her initial fitting for another visit with the doctor just to make sure that the contacts are fitting properly and that the patient can see well. This service is particularly useful for children, teens, or other first time contact lens wearers who may be a little nervous at the thought of trying contacts. Proper lens fit, type, manufacturer, technique, hygiene and care are essential for new contact lens wearers. Our professional ophthalmic team has the experience, patience and variety of training methods suitable for your child. We will take the time necessary for your child to perfect their technique and offer dedicated follow-up care to ensure your child is comfortable inserting, removing, and cleaning their lenses on their own.

Please ask for Gaylord when scheduling your contact lens fitting.

This exam is done by Virginia Pediatric Eye Center (VPEC) ophthalmologists to look for retinopathy of prematurity (ROP). ROP is an abnormal growth of blood vessels in the retina. It is a condition that can occur in premature infants born prior to 32 weeks or those that have a low birth weight under 3.3 pounds (1500 grams).  It is critical that these infants be closely monitored because ROP can cause vision loss or blindness. This exam will help determine if ROP is present and if treatment is needed. If your infant is at risk for ROP, this eye exam will be scheduled with us by the hospital and then by VPEC at regular intervals as indicated by the current state of the disease. After the ROP critical period, we periodically monitor former ROP patients in order to rule out eye misalignment, nystagmus, and refractive errors as the child continues to develop.

What to Expect During An ROP Visit

  • The ophthalmic tech will put eye drops in your infant’s eyes. These will make the pupils open wide. The drops will take about 30-45 minutes to work. In some cases, your doctor may offer for you to start the drops at home prior to arriving at your appointment. The eye exam does not hurt, but many infants prefer to avoid bright lights.  Numbing drops are placed in the eyes to numb them and keep your child as comfortable as possible.  
  • The VPEC doctor will insert an eyelid speculum, which holds the infant’s eyelids open; and will use a scleral depressor, which helps move the eye into different positions so the retina can be assessed for the current state of the disease.
  • The doctor will also shine an indirect ophthalmoscope and a special condensing lens to view the retina.

Testing

Our team of ophthalmic technicians and doctors can diagnose eye movement disorders and assess the binocular visual status through a variety of testing procedures. The results of this testing provide a basis for determining the most appropriate treatment plan for eye misalignment or double vision.

Visual field testing is used to determine how large a patient’s field of view is and whether there are any defects in their vision. An initial visual field test provides baseline information for a patient, and successive tests over time allow visual field changes to be monitored. Regular visual field testing is important for patients who have a disease such as glaucoma that can adversely affect their vision. These tests are also used to detect signs of damage to central or peripheral retinal diseases of the retina, eyelid conditions such as drooping (ptosis), optic nerve damage and disease, conditions affecting the visual pathways from the optic nerve to the area of the brain (occipital cortex) where this information is processed into vision, and patients on certain medications such as Plaquenil. The visual field test typically takes 5-15 minutes each eye and is done with an instrument that examines how each eye can see, looking at one eye at a time. We cover the eye not being tested with a patch, and we must put an exact lens correction in front of the tested eye to get the best results. The patient looks into a dimly lit bowl-shaped area and small oval lights appear briefly in different places in the field of view. The hardest part for patients is to keep looking in the center of the bowl while responding when lights appear in the side vision. The patient presses a button to indicate when lights are seen and the instrument records which were not seen. For example, during a visual field test for glaucoma, our natural instinct is to look where the target light appears. But, that would show what you see directly in front. Since glaucoma affects the mid-peripheral vision early on, we need patients to look at the center target during the test, so that we learn what damage may have happened in the area away from the center. As the disease progresses, more and more of the peripheral vision is lost until eventually, in very late and advanced disease, the central vision is also affected. Sometimes there are patients with glaucoma who have their central vision affected early in the course of the disease, which is another reason that formal visual field testing is so important. Over time, visual field testing is performed many times because recurrent visual field tests are a critical part of establishing a baseline for monitoring glaucoma over time. Visual field testing is one of your doctor’s most useful measures of how well you are seeing now and how well you are likely to see in the future. It also helps determine whether your current treatment is sufficient.
We can provide color vision testing for patients interested in having their color vision assessed. Color vision testing is also performed in patients who may have certain retinal or neurologic diseases. Color vision problems can have a genetic basis, so family members of a person with color vision problems may also wish to be examined. Color vision problems can cause difficulties seeing in school and in meetings, particularly when viewing a projected presentation.
Clinical photography is available in our new digital photography suite. Photography can document anterior segment and posterior segment pathology, and it provides an important reference point for comparison in future exams.

Visual Evoked Response (VER or VEP) testing measures the rate at which visual information travels down the optic nerve i.e. how well the eye communicates with the brain.  VER is useful in diagnosing a variety of symptoms and conditions and is utilized when patients are suspected of having damage to the visual pathways.  Some of these symptoms and conditions may include:

  • Sudden loss of vision (this can be painful or non-painful);
  • Double vision;
  • Blurred vision;
  • Flashing lights;
  • Alterations in colour vision;
  • Optic nerve atrophy
  • Retinal disease
  • Retinitis pigmentosa
  • Multiple sclerosis 
  • Other genetic or demyelinating conditions

The test is also useful because it can be used to check vision in children and adults who are unable to read eye charts or accurately articulate vision issues.

During the VER test, a few electrodes are placed on the scalp and face and the patient is asked to watch black and white moving squares on a monitor or flashing red light.  The electrodes are held in place by a conductive paste, and not an adhesive, for the greatest comfort.  This testing does not require dilation drops and there is no pain or discomfort.  The test is done on one eye at a time.  While one eye is covered with a patch, the patient looks at the screen or the flashing light and this is repeated for the other eye.

Electro-retinography (ERG) is a specialized test used in evaluating various retinal disorders and is useful in differentiating retinal pathophysiology for optic nerve pathology.  The test is also recommended in monitoring drug interactions with the retinal physiology for certain medications.

ERG testing is useful in diagnosing a variety of symptoms and conditions.  Some of these symptoms may include:

  • Sudden loss of vision (this can be painful or non-painful);
  • Double vision;
  • Blurred vision;
  • Flashing lights;
  • Alterations in colour vision;
  • Optic nerve damage
  • Retinal disease 

During the ERG test, electrodes are placed on the scalp and on the lower eyelid. The patient is then asked to watch a flashing strobe light. The electrodes are held in place by combination of conductive paste and medical tape for the greatest comfort. The test may be done with both eyes open or on one eye at a time.  Patients will be dilated for this test.

The Optical Coherence Tomography (OCT) is a safe, non-invasive test that takes cross-sectional images or 3-dimensional images of the back of your eye.  It is used to visualize layers of the retina and optic nerve and has the ability to detect problems in the eye prior to any symptoms being present in the patient. With an OCT, VPEC doctors are able to see a cross section or 3D image of the retina and detect the early onset of a variety of eye conditions and eye diseases such as glaucoma and various other retinal and macular conditions.  OCT can also aid in diagnosis and management of diseases.

The OCT is similar to an ultrasound which is used to image internal organs inside the body.  The OCT uses an array of light to rapidly scan the eye.  These scans are interpreted and the OCT then presents an image of the tissue layers within the retina.  These layers can be differentiated and their thickness measured.  By comparing the thickness of the layers measured by the OCT scan against the normal thickness of healthy retinal layers, VPEC doctors can determine which retinal disease or eye condition exists in the eye.

For this procedure, we will first apply dilating eye drops for better results. Then, a camera-like device directs waves of light, which bounce back with an accurate 3-D picture of your eye structure. You sit at the machine and place your head as directed, and within minutes, the VPEC ophthalmic technician will tell you they have the images they need and you go on to the next portion of your eye exam. The OCT device never makes any contact with your eyes.

Ultrasound examination allows an ophthalmologist to see parts of the eye that are not externally visible.  This is useful for detecting certain types of injuries or for measuring anatomic structures.

Genetic testing for genetically-linked eye conditions is available.  Specimens can be ordered and sent to a laboratory that specializes in genetic testing.  We also can provide information on testing that is available through the eyeGene project sponsored by the National Institute of Health.

Therapies and Treatments

Many eye conditions can be treated with glasses or contact lenses.  Most people know that a refractive error (near sightedness, far sightedness, and astigmatism) can be corrected with glasses or can have their double vision eliminated with glasses.  However, glasses can also be a treatment for medical conditions in certain conditions.  We have experience and resources available to prescribe and dispense glasses and contact lenses.  For more information about glasses dispensing, check out The Optical Shop for Kids.

We can instruct patients with amblyopia, strabismus, or other visual deficits on techniques and orthoptic exercises they can use to try to improve vision, both for reading and depth perception.  Prism adaptation and occlusion modalities are also employed when indicated.  

In addition to the non-surgical treatments for ocular disorders and visual rehabilitation, we also provide surgical treatment for various ocular conditions.  All surgeries that we perform are supported by evidence-based medicine and scientific study.  You may review our extensive research page for more information.  We perform surgery for certain eye misalignment problems, eyelid abnormalities and lesions, eyelid hemangiomas, pediatric cataracts, ocular trauma, orbital tumors, intraocular diseases, glaucoma, retinopathy of prematurity treatments, eyelid drooping, eyelid tumors, external ocular surface disease, chronic tearing problems (including nasolacrimal duct probings, balloon dilations, canalicular stents, and endoscopic dacryocystorhinostomy procedures), intraocular injections, strabismus surgeries including adjustable suture strabismus surgery, surgical management of craniofacial disorders with strabismus, complex strabismus surgeries, amniotic membrane transplants, and other ocular abnormalities.  Each surgical treatment is tailored to the severity and disease process of a particular patient.

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