Eye Condition Information
Our office provides a full range of optometric services including comprehensive eye exams, emergency eye care, eyeglasses and contact lens fitting, laser surgery consultations and visual training.
Our office has state-of-the-art equipment for early diagnosis of cataract, glaucoma and other eye diseases. Our eye doctor, Dr. Mila Kisilevsky, has an extensive clinical experience in the management of pediatric vision problems, low vision, cataract, glaucoma and retinal diseases.
Dr. Kisilevsky received her MD degree from Leningrad Pediatric Institute. Dr. Kisilevsky worked as a pediatric ophthalmologist in Leningrad, Russia and has completed her ophthalmology residency in Israel. In 2002 Dr. Kisilevsky has joined Toronto Western Vision Research Institute. The focus of her research has been diabetic retinal disease and blood flow in the eye. In 2008 Dr. Kisilevsky has received Master of Science (Medical Sciences) degree from the University of Toronto. Dr. Kisilevsky is licensed by the College of Optometrists of Ontario and is a member of Ontario Association of Optometrists, the Association for Research in Vision and Ophthalmology, the International Society of Eye Research.
Please schedule your appointment by phone 416-987-1325.
New patients including kids as young as 6 months of age are welcome. We accept walk-in patients depending on the availability and we make sure all emergent cases like red, painful eyes or sudden loss of vision are seen on the same day and as soon as possible.
When you visit our office it is recommended to bring your sunglasses and not to drive after your appointment, since pupil dilation drops could be used to improve the accuracy of the examination. If you are a new patient, please bring your old glasses/contact lenses and/or your old prescriptions, and any eye drops you are currently using.
Dr. Kisilevsky and staff speak English, Russian and Hebrew.
Patients 19 or younger and adults 65 years and older are eligible for a comprehensive eye exam once a year and for additional medical eye exams as prescribed by a doctor.
Adults between 20 and 64 years of age
- Who are recipients of Ontario Works (OW) or (Ontario Disability Support Program ) ODSP financial assistance are eligible for an eye exam once in 2 years (proof of social assistance is required at each visit).
- Who are treated for diabetes are eligible for an eye exam once a year as part of their diabetes care (referral note from a family doctor is required for new patients only).
- If diagnosed with corneal abrasion, retinal tear, sudden loss of vision or other medical conditions could be eligible for OHIP covered medical eye exam. The eligibility for OHIP coverage in such cases could be determined only after completion of an eye exam.
Regular eye exams are very important for prevention of eye diseases and loss of vision.
The recommended frequency of comprehensive eye exam in a low-risk patient is as follows:
kids – at the age of 6-8 months, 3 years, 5 years and every year thereafter; adults – age 20–40 years: every3 years, age 41–65 years: every 2 years, age > 65 years: every year.
Comprehensive eye exam comprises many components that are performed by the doctor and her assistants. The order and the amount of components are modified depending on patient’s age and eye conditions. These components are automatic pre-tests of the refractive power and pressure of the eye, visual acuity measurement, determination of prescription for the best possible vision, assessment of eye movements and the health of the external and internal structures of the eye. Depending on the results the
Contact lenses are prescribed for a variety of eye conditions including nearsightedness, farsightedness, and astigmatism. Fitting of the contact lenses by an eye doctor is essential for prevention of red eyes or some other adverse effects. Contact lenses are fitted according to the curvature of the front surface of the eye, which is unique for every patient.
There are many different types of contact lenses:
- Gas permeable or hard contacts give crisp vision and transmit more oxygen to the eye. The downside of hard contacts is that, unlike soft lenses, to achieve maximum comfort they must be worn regularly (although not necessarily every day).
- Traditional soft contacts are made from soft, water-containing plastics. The plastic itself is not oxygen permeable, so the water carries oxygen through the lens to the eye. But the more water a lens contains, the greater its tendency to dehydrate after long periods of wear. That is why people wearing traditional soft contacts for long hours might experience end-of-day discomfort. Traditional soft contacts such as Frequency 55, Proclear, Hydrosoft, Biomedics, Acuvue offer top of quality and value.
- Daily disposable contacts enable a healthier wearing experience. The more frequently contacts are replaced, the healthier and more comfortable eyes can be. Protein, calcium, lipids and other substances found naturally in tears can build up on contacts. These deposits make contacts less comfortable and can also make eyes more prone to infection. Cleaning is not 100 percent effective and some deposits remain and increase over time. Daily disposable contacts 1Day Acuvue Moist, Acuvue TruEye, Dailies Total, Proclear 1 day, Biomedic 1 day, Focus Dailies, SofLens Daily Disposable, are more expensive, however the incremental cost of choosing disposables over traditional lenses is slight, and is offset by the reduced need for cleaning products.
- Silicone hydrogel contacts transmit unprecedented amounts of oxygen to cornea comparable to hard contacts and provide better end-of-day comfort. Silicone hydrogel contacts include Night & Day, O2Optix and AirOptix by CIBA Vision, PureVision from Bausch & Lomb, Acuvue Oasys and Acuvue Advance from Johnson and Johnson, and CooperVision’s Biofinity. Silicone hydrogel lenses generally have a replacement schedule of two to four weeks.
- Toric contacts provide good vision for astigmatism through a wide choice of lenses: Acuvue Toric, Acuvue Advance for Astigmatism, Proclear Toric, Frequency55Toric, Hydrosoft Toric, Biomedics Toric, Focus Toric, AirOptixforAstigmatism, PureVision Toric, Soflens Toric.
- Bifocal contacts or monovision contacts provide both near and distance vision. Traditional or silicone hydrogel contacts AirOptix Multifocal, Acuvue Bifocal, Proclear Multifocal, Focus Progressives, PureVision Multifocal have bifocal prescriptions.
- Colored contacts give eyes a subtle or dramatic change. Colored contacts should be fitted as all other types of contacts. The FDA issued a consumer alert regarding such lenses, saying that they “present significant risks of blindness and other eye injury if they are distributed without a prescription or without proper fitting by a qualified eye care professional.” FreshLook, Acuvue2 Colors color contact lenses are available for people who don’t need vision correction as well as for those who need prescription.
Laser eye surgery can eliminate the need for glasses or contact lenses in many patients. LASIK, PRK, corneal rings or lens exchange are different kinds of surgery that are performed to improve vision without glasses. The appropriate type of surgery is recommended in each individual case depending on the results of the eye exam.
During LASIK surgery the cornea (front surface of the eye) is cut and reshaped. Cutting of the cornea is performed with a blade or with laser (all laser LASIK). Many patients choose custom LASIK over regular LASIK. Custom LASIK surgery, also known as wavefront LASIK uses 3-dimensional measurements of how your eye processes images to guide the laser in re-shaping the front part of the eye. Wavefront technology is groundbreaking because it has the potential to improve not only how much you can see, visual acuity measured by the standard 20/20 eye chart, but also how well you can see, in terms of contrast sensitivity and fine detail. This translates into a reduced risk of post-LASIK complications, such as glare, halos, and difficulty with night vision.
During pre-operative consultation Dr. Kisilevsky determines the amount of nearsightedness, farsightedness or astigmatism to be corrected by the surgery, corneal thickness, and any eye diseases. After the surgery Dr. Kisilevsky monitors proper healing that is essential for the achievement of the best visual outcome.
Vision training is prescribed for a variety of conditions including improper alignment of eyes, weakness or over reactivity of eye muscles, decreased vision and lazy eye. Vision training program consists of exercises with various pieces of equipment, red / green filters, and various optical devices and is designed individually for each patient after extensive testing. Visual training improves visual acuity, three-dimension vision, eye movements, eyes and eye-hand coordination. Types of problems benefiting from vision training:
- Learning problem (dyslexia, handwriting, reading, math and comprehension problems)
- Eye strain in the office including computer eye strain
- Suboptimal sports performance, especially ball games and team games
- Traumatic brain injuries
- Eye turns and lazy eyes
- Headaches, double vision, fatigue
- ADD and ADHD (Attention Deficit Disorder and Attention Deficit Hyperactivity Disorder)
- Children with behavioral problems.
Floaters appear as tiny, dark spots, circles, lines, cobwebs or other shapes in front of the eye. There may be lots of floaters or just one or two, and they may appear to move when the eyes move. They are usually grey and semi-transparent. Floaters aren’t noticeable all the time. Floaters tend to be most noticeable when while looking at a clear-colored background, such as a white wall or clear sky.
What are floaters?
The back of the eye is filled with a jelly like transparent substance called the vitreous. Floaters are the opacities within the vitreous.
Floaters can be of different kinds:
- As the vitreous gets older, strands of a protein start to become visible within it. This can happen as early as during teenage years.
- In people in their 60s and 70s the vitreous starts to shrink away from the retina. This is called posterior vitreous detachment. The floaters appear at the site where the vitreous separates from the retina.
- Sometimes, as the vitreous shrinks and pulls on the retina, it ruptures tiny blood vessels causing a ‘shower’ of lots of floaters at once. It also can cause flashes of bright, white light.
- In rare cases posterior vitreous detachment can cause a retinal tear. Tears in the retina need to be treated straightaway, because sometimes they can lead to retinal detachment. Retinal detachment is dangerous because it can cause sight loss.
You can’t prevent floaters. Floaters are usually harmless and do not affect sight. However, it’s important to go for regular eye exams to check for floaters and it’s important to see your optometrist immediately if:
- you suddenly start seeing floaters and white flashes
- you notice a sudden increase in the number of floaters or flashes you have,
- a grey area (like a curtain) appears in your outer vision,
- you’ve had floaters or flashes for a while but they’re now starting to look different,
- you’ve had floaters or flashes in one eye for some time, and now they are also affecting the other eye.
There is no specific treatment for floaters. Sometimes floaters get smaller or disappear. In most of the cases the brain learns to ignore floaters. However, if the retinal tear is diagnosed it is treated with laser to prevent retinal detachment.
Cataract or opaque eye lens.
The natural lens of the eye is transparent and is situated right behind the pupil. Eye lens focuses light into the eye. The transparency of the lens is sustained through unique metabolism and balance of nutrients, even though the lens is devoid of blood vessels. Due to different diseases and with normal aging this unique balance is easily disturbed and the lens becomes opaque. This opacity is called a cataract.
How many types of cataract do exist?
A cataract can be characterized by the causative factor and by its location in the lens. Location of the cataract can be in the lens nucleus, lens cortex and under the lens capsule. A Nuclear cataract develops very slowly over the years and usually decreases far vision. A Subcapsular cataract may progress quickly over the course of few months and decreases near vision. There is also a secondary cataract, which can develop after cataract surgery. In this case the opacification develops in the lens capsule, inside which the artificial lens is implanted.
What are the risk factors for the development of a cataract?
Age is the most common risk factor. A cataract can start to develop after the age of 50. After the age of 65-70 the risk is much higher. Smoking, UV radiation, X-rays, diabetes, steroid medications, eye injuries and eye infections, all can cause cataract development.
What are the signs and symptoms of a cataract?
The major sign of a cataract is the decrease in visual acuity. However, sometimes the improved vision for near and the ability to read without reading glasses are the early signs of cataract. As the cataract progress, the vision becomes foggy; glare and poor night vision worsen. In very late stages cataract may cause blindness and sometimes urgent surgery is indicated due to the secondary increase in the intraocular pressure.
What is the treatment of a cataract?
The treatment of a cataract is a very common and generally safe surgical procedure. The opaque lens is removed and artificial lens is implanted in its place. In the majority of cases the surgery is done under local anesthesia with the help of ultrasound knife and with no sutures. The kind of artificial lens to be implanted is specifically chosen depending on the exact parameters of each individual patients eye as well as the stage of their cataract.
What could be done to prevent a cataract?
- Eye protection from different kinds of radiation, especially UV radiation, is very important. Sunglasses should be worn starting in early childhood.
- Helmets and protective glasses can prevent traumatic cataract.
- Smoke cessation or never starting to smoke keeps the eye lens healthy.
- Healthy diet is important for the eye and the eye lens health.
- Cataract surgery is very successful in the majority of cases. However to prevent vision loss it is important not to wait till the very late stage of the disease. Regular eye exams help to determine the best time for surgery.
Glaucoma or increased intraocular pressure – it is increased pressure of the eye fluid. Increased pressure is caused by disturbed balance of inflow and outflow of the fluids.
Which part of the eye is affected by glaucoma?
The normal intraocular pressure is between 10 and 21 mm Hg. Higher pressure damages the optic nerve. This in turn disturbs the transfer of visual signals into the brain. First, the peripheral vision suffers. Later on the visual acuity decreases and late stages of the disease can cause blindness.
Are there different kinds of glaucoma?
There are about 10 different kinds of glaucoma. 95 % of the patients have open angle glaucoma. The second most common kind is the closed angle glaucoma. Another kind of glaucoma is the normal pressure glaucoma. Sometimes glaucoma is caused by intraocular or other diseases.
What are the risk factors for glaucoma development?
- Age. Glaucoma can start at any age, however it usually develops after age of 40. The risk is even greater after the age of 60.
- Family history of glaucoma.
- Nearsightedness or farsightedness.
- Treatment with steroids.
- Eye injuries or surgery.
- Cardio-vascular diseases.
What are the signs of glaucoma?
Open angle glaucoma is the most common type and develops slowly and subtly”. Regular testing is extremely important as there are often no signs until irreversible optic nerve damage has occurred. Sometimes the following signs might be present:
- blurriness of vision
- poor vision in dim light
- defects in the peripheral vision (usually several years after first signs)
- without treatment glaucoma can cause blindness
Closed angle glaucoma causes:
- pain in and around the eye, headache,
- periods of blurry vision,
- nausea and sickness caused by acute attack with very high eye pressure.
Acute attack of closed angle glaucoma is often confused with other diseases. Acute attack of very high pressure if not treated can cause blindness.
What are the tests for glaucoma?
Glaucoma screening includes test of visual acuity, eye pressure check, and examining of the back of the eye after pupil dilation. Your eye doctor can detect changes in the optic nerve even before the early subjective symptoms of glaucoma develop. Often additional tests of visual fields and eye photography are needed.
How glaucoma is treated?
The damage of optic nerve is irreversible and there is currently no treatment available that can restore lost vision. However, treatment of glaucoma suspends its progression. There are medications, laser and surgical treatments of glaucoma. Every patient gets an individual combination of treatments and it stops disease progression in many cases.
How glaucoma can be prevented?
Vision loss due to glaucoma can be prevented by early detection of the disease. Therefore, yearly eye exam is very important, especially for people with risk factors for glaucoma.
In certain cases prophylactic laser treatment is performed for closed angle glaucoma.
Protective glasses can prevent eye injury and traumatic glaucoma.
Every patient treated with steroid medication for prolonged periods of time should be examined by eye doctor to exclude high eye pressure