Tuesday, July 14, 2015

I Found a New Eye Blog and It's Great! "Eyedolatry"

EYEDOLATRY BLOG I don't know this person, but I really like their blog...I just found it today! So I'm spreading the word. Here's some samples taken from an April post on myopia control: "The most successful method to date of slowing down myopia progression has been orthokeratology; specialized corneal molds that are worn at night and reshape the eye while you sleep. The CRAYON study and the SMART study demonstrated effective reduction of myopia prescription rate of change, as well as reduced lengthening of the eye (called axial length) with nightly orthoK lens wear. Studies suggest that wearing orthoK lenses reduces the rate of myopia progression between 50-90% and the axial length elongation between 40-80% compared to single vision glasses wear. Wearing these molds will not reverse myopia that has already developed, but they can greatly minimize the speed with which a child's prescription increases if worn nightly during the years of typical myopic growth (usually through the early 20s). Orthokeratology is FDA approved for treatment of myopia up to -6.00D of prescription in the United States." And this is a great statement on "what doesn't work" to control myopia: "What Doesn't Work Through the course of research scientists have also found that many methods don't help reduce myopia progression, and can even make it increase faster! Two popular concepts that have now been proven ineffective were the use of bifocal glasses or undercorrecting the myopic prescription. The COMET Study showed no statistically significant benefit in the use of bifocal or progressive lenses in slowing myopia rates compared to wearing single vision glasses. Sometimes I am asked by parents to reduce a prescription for their child in the hopes to keep their Rx lower, but undercorrecting prescription can actually increase the worsening of near sightedness and should be avoided!" Great job, ladies!

Monday, July 13, 2015

Acuity is Hard

It's back to school! The busiest time of the year for optometrists. Everyone needs new glasses and contacts, preferably before school starts! It's also the time of year most kids are getting their sports physicals to participate in football, volleyball, tennis, track, etc etc etc. That brings us to today's topic: acuity. It's simple, right? Cover one eye, read letters, write down the numbers. Easy! SO EASY, in fact, that almost anyone can do it! School, DMV, pediatrician's office... so why am I even bringing this up? Well obviously because too often those people are coming up with crazy/wrong vision measurements. We get them all the time. The pediatrician's office told the mother of a recent patient of mine that her daughter had "terrible" 20/50 acuity in both eyes with her NEW contacts on...the ones I prescribed two months ago. This mother was naturally distraught! I mean they JUST PURCHASED A WHOLE BUNCH OF BOXES OF CONTACTS! Are all of those contacts now RUINED!? Naturally when we retested her vision she was 20/20 with those same contacts on. Actually she was 20/15! I had another patient just this morning who was tested at their sports physical and was told his left eye was "20/100". When we re-tested he was 20/20. Almost every day I get someone who "fails" the DMV acuity test who is easily 20/20. And of course we get the opposite as well: the school nurse "passes" a child on their vision screening...we test them and they're 20/200 and moderately nearsighted. So how does this happen? Here are some the factors in play for incorrectly measuring subjective visual acuity: wrong test distance/calibration, allowing the patient to press their hand/occluder into one eye VERY HARD while testing the other eye, not pushing the patient to guess at all, allowing the patient to look around the occulder, allowing the patient to squint, and falling for an obvious faker. In the case of the DMV the culprit is often the device they use which often has opposing polarized lenses. Basically nobody but the eye doctor's office really knows what they're doing. It's bad. When someone tells me they've been told they're 20/xx it literally means nothing to me. Could be bad acuity, could be fine...not enough information. So if the sports physicals people "fail" your son or daughter for vision and you have to come to the optometrist...don't fret! Often they're fine.

Thursday, July 2, 2015

Foreign Body in Eye: What to Do (FLUSH!) and What Not To Do (Everything Else)

If you get something in your eye, flush it with saline (if you have it) or tepid water (if you don't have saline). That's it! Simple! If that doesn't work...STOP! Everything else you could try will probably make it worse. Here is a short list of things people often tell me they have tried to remove foreign material from their eye, along with the result I see when they finally get here: credit card (makes a HUGE mess of your corneal epithelium, almost always fails) Q-tip (makes a mess) magnet (this never, ever works. NEVER. can't be good for your eye) heavy eye rubbing (just swells your lids up) someone else's tongue (I can't believe I have to type this, but obviously I do. doesn't work AND promotes bacterial infection) If you cannot see something in your eye, STOP TRYING TO REMOVE IT. We get a few of these every week, usually contact lens wearers who swear there is a "piece of contact lens" stuck in their eye. They try and try and try and dig and dig and dig trying to remove it, even tho they can't see it. IT IS USUALLY NOT THERE. That's why they are unable to remove it. No kidding 9 times out of 10 when a patient thinks there is a contact lens or a piece of one "stuck" in there, it's not there. They're just feeling what we call "foreign body sensation", which means their eye is swollen or inflamed or irritated and it's sending a signal that there's something in there. When they dig and dig and dig, they just compound all of their problems. If you flush and you can't remove the foreign body that you see, or you can't get rid of the foreign body sensation of something you CAN'T see...JUST. STOP. Come in to the eye doc. We can get it out quickly and painlessly and we won't make a big mess of your cornea, or we can confirm that there's nothing in there so you can stop digging and causing more damage! To summarize: FLUSH! That's it! Don't do anything else! Reserve everything else for the optometrist!

Tuesday, June 30, 2015

Contact Lens Abuse and How to Handle It

We all have them: the 15-35 year old patient who literally wears the same pair of disposable contacts w/o removing them for months at a time. Some of them even BRAG about it! "Yeah I've had THIS pair in for 6 months! Hahaha!!!!", like it's cool and funny. Or they announce that they "know when" to change contacts because they "start hurting" and all that. Obviously they're putting their health at risk. Some of them have symptoms: red eyes, dryness, etc, but a lot of them are totally fine. No redness. No pain. Corneas are clear. It's all fine! So what's the problem? An optometrist really has to be careful here. People do not like to be reprimanded, even when they know they're wrong. If you "cut them off", not allowing them to have any trials or buy any boxes, they're just going elsewhere, and probably give you a negative review on Angie's List/Google to boot. Then you've both lost their business and sent your problem patient to some other unsuspecting eye doc. And those patients are much more likely to lie to the next doc because telling the truth about their contact lens habits got them cut off from buying them, so now their vision is even more at risk! No, we must tread lightly. I find that people generally despise being scolded or having scare tactics used on them. It's a turn off. I really believe the best way to handle it is to NICELY and maybe even laughingly say something like "well you know we recommend that for your safety and long term vision you need to be taking the contacts out nightly and changing them regularly...the brand you're wearing is designed for two weeks of daily wear". We're just kind of politely reminding them to do the right thing. I usually jokingly throw in something like "you know - people who smoke 2 packs of cigarettes a day usually feel great! They don't think it's a problem at all until one day someone diagnoses them with lung cancer!" Have any of you patients experienced some optometrist "yelling" at you about the way you wore your contacts? Any of you docs have a method of patient education that you wish to share? Chime in below in the comments section!

Friday, June 26, 2015

Coopervision "MyDay" Silicone Daily Disposables

Coopervision has its answer to Alcon's Dailies Total One and J+J's Acuvue TruEye: http://coopervision.com/our-company/news-center/press-release/coopervision-introduces-myday%E2%84%A2-daily-disposable-lenses CooperVision introduces MyDay™ daily disposable lenses June 06, 2013 MANCHESTER, ENGLAND, 6 June 2013 — Combining its deep understanding of daily disposable wearing habits, practitioner demands and advances in materials science, CooperVision Inc. (NYSE: COO) today unveiled MyDay™ daily disposable lenses at the British Contact Lens Association (BCLA) Clinical Conference & Exhibition. Featuring a unique chemical structure called Smart Silicone™ chemistry, MyDay™ lenses (stenfilcon A) create efficient channels for oxygen delivery to the cornea. With less silicon needed to achieve the desired oxygen permeability levels, the efficient silicone network allows for increased hydrophilic materials. This results in improved lens surface wettability, higher water content and lower hydrogel-like modulus for a softer, more comfortable wearing experience. Consequently, MyDay™ lenses offer practitioners and patients the optimal balance of comfort, handling and breathability for a healthy lens-wearing experience. The lenses are expected to be available in Europe by September 2013, with rollouts in other global markets beginning in 2014. “As the silicone hydrogel daily disposable category has evolved, we’ve been patient in our approach, spending time to develop a lens platform that addresses all critical requirements from the industry and wearers,” said Dennis Murphy, executive vice president, Global Sales and Marketing, CooperVision. He added: “MyDay™ is silicone hydrogel taken to the next level. It’s designed for today’s generation that’s approaching life faster, smarter and more efficiently – people who want to experience all the world has to offer, yet do so effortlessly. MyDay™ promises healthier wear while minimising patient interaction with, and awareness of, the lens.” Clinical research indicates that nine of every 10 patients are satisfied with the comfort of MyDay™ lenses. In a bilateral, randomised, investigator-masked wearer comparison with the current leading daily disposable lens, MyDay™ lenses enjoyed superior performance across all measures: comfort, dryness, handling (by a staggering five-to-one ratio) and overall satisfaction. In addition, after two weeks of daily disposable lens wear, the high oxygen permeability of MyDay™ daily disposables contributed to less eye redness, resulting in whiter looking eyes.” Keith Tempany, practitioner and owner of renowned boutique opticians and contact specialists, ‘Tempany’s’, based in Broadstone, United Kingdom, trialled the lens. He said: “I’ve found MyDay™ to be one-of-a-kind: a daily disposable lens without compromise. MyDay™ lenses with Smart Silicone™ bring oxygen transmission at a greater level than needed for daily wear. The high water content enhances lens movement and contributes to wearer comfort. And the hydrogel-like modulus has superb handling and is gentle against the ocular tissue, allowing effortless transition of existing hydrogel daily disposable wearers. I expect high demand among practices who understand what daily wearers need in an optimised lens.” Mark Harty, European president of CooperVision, said: “We are delighted to be bringing to market a completely new product that forever changes the face of the daily disposable contact lens market. We know that silicone hydrogel is currently the preferred material for daily wearers, yet the lenses available today continue to be perceived by some practitioners and patients as difficult to fit, not easy to handle and uncomfortable at the end of the day. We aim to advance the entire industry with the launch of MyDay™, helping eye care practitioners offer the benefits of silicone hydrogel lenses to even more patients by providing a product with an optimal balance of comfort, handling and breathability for a healthy lens-wearing experience. We’re confident that once patients try MyDay™, they won’t look back.” MyDay™ lenses will be available in sphere powers of -10.00D to +6.00D (in 0.25D steps to -6.00D and 0.50D steps to -10.00D; and in 0.25D steps to +5.00D and 0.50D steps to +6.00D). All lenses have an 8.4mm base curve and 14.2mm diameter, with a 0.08mm centre and 0.07mm edge thickness. An ultraviolet radiation blocker helps protect wearers’ eyes, limiting 75 percent of UVA and 99 percent of UVB rays. About CooperVision CooperVision, a unit of The Cooper Companies, Inc. [NYSE: COO], is one of the world’s leading manufacturers of soft contact lenses. Dedicated to continually bringing a fresh perspective to the contact lens experience for practitioners and patients, CooperVision specialises in lenses for astigmatism, presbyopia, and ocular dryness. The company routinely collaborates with eye-care professionals in the research and development of relevant products. CooperVision manufactures a full array of monthly and daily disposable contact lenses featuring advanced materials and optics. For more information, visit www.coopervision.com. Contact lenses are medical devices and can only be prescribed and dispensed by a licensed eye care professional.

Wednesday, June 17, 2015

Online Glasses and More 1-800-CONTACTS Talk

So last night I got a few replies to some of my blog posts about contact lens sales and 1-800-CONTACTS: "Um no. You shysters got slammed by the FTC for your anti-competitive practices and withholding your "patient's" contact lens prescriptions - which you already got busted for in the 70's with eyeglass prescriptions. Can't blame 1-800-contacts for that now can you?" and "Yet another OD in support of anti-competitveness and price fixing." So let's address some of this. Yes, OD's got in trouble in the 70's and 80's for withholding glasses and contact Rx's, and rightfully so. How does that make it ok for 1-800-CONTACTS to fill box orders with passive verification in 2015? Or battle the contact lens manufacturers in state court over unilateral pricing? Come on. I already said we don't even try to make money on the box sales anymore. Did you miss that? I'll tell you something else we have never done here: withhold an Rx for anything. I am not disputing that some OD's have done this, but we never have. Let me tell you about online glasses: they suck. I'm serious. I mean it's probably fair for you young, low-prescription single-vision wearers out there who happen to fit in an average sized frame, and many of my patients have done this. I willingly and freely offer those patients the written Rx *WITH* the PD so they can do just that. But a bunch of them (even the easy Rx's!) come back complaining, and when we take measurements on the glasses they turn out to be some seriously shoddy work. Some of them are really bad. The worst are the progressives. Virtually none of them are right. Some of them are *close*, but MOST of them have been pretty darned terrible. That's because you can't "ballpark" an optical center/seg height measurement on a progressive. The only way it works is when the patient is sitting in front of a real person who knows what they're doing and has the right instrumentation and experience to choose the right brand/design for the precise vision needs of that individual person. And when it's not exactly right the patient has major problems. Not to mention the lenses are almost always cut way, WAY too big for the frame (a common newbie mistake). A too-large lens will never pop out, which is one reason why they do this. It's also the fastest way to make a pair of glasses, and should we be surprised that the online guys are in a big hurry? Or are that they are probably newbies? But a too-large lens will break a metal frame way before it's time, and seriously distort a plastic frame in a way that eventually makes the edge show and look *terrible*. How long is the warranty for? Better check up on it. I am not "in support of anti-competitveness (sic)". I just see through 1-800-CONTACTS obvious struggles and resultant state legislative lobbying. The single thing that makes their model work is going away, and I predicted it. I have already said that I don't care where patients get their contacts because we literally do not even try to make a profit on them anymore.

Monday, June 15, 2015

Are We "Spoiling" Patients?

We read all the time that myopia is a worldwide "epidemic", and I'm not disputing this. Something like 80% of Asians are myopic. But some of this IMO is that people are getting spoiled. We eye docs can and do make people see *awesome*. Literally better than 20/20. So much so that most glasses wearers EXPECT 20/20. Some of them are not even happy with 20/20. I'm serious. They wanted better than that. They complain about having normal acuity. They have seen superhuman 20/10 acuity and now that's what they want all the time, at all distances. I mean we OD's kind of brought this on ourselves to some degree. Gone are the days of only the severely vision impaired wearing glasses. Before about the 1920's we couldn't even make astigmatism glasses! So a whole bunch of people out there were walking around with 20/30 acuity and -1.50 uncorrected cylinder. Let me tell you that almost no one with -1.50 astigmatism goes uncorrected nowadays in the US. Almost all of them are wearing glasses or contacts or getting lasik. So what changed? Are we as a culture really having our eyes deteriorate THAT much more than in years past? Studies say we are, but I bet some of it is that people just won't deal with/accept 20/40 vision anymore. People want better, ESPECIALLY if they have experienced better in glasses. Once they've seen 20/15 they will not go back to 20/40. They DEMAND 20/15. And we sell it to them! That's all fine and good... Good for our pocketbooks, I guess. But there are some problems, like: 1) when elderly people who have seen 20/15 for many, many years start having cataracts, dry macular degeneration and other problems that affect their acuity. I have so many 65+ patients who see ok... 20/25 even... But are very, very upset. They want "sharper" than that. 2) parents who demand their children wear glasses when their acuity is really pretty good and their Rx is low. The parents see 20/15 and when someone tells them the child is "only 20/30" they are very, very upset. But do children need to see 20/15 all the time? I mean I don't know. I'm not saying they don't, but I am saying a case could be made that they don't. 100 years ago a 20/30 child was considered totally fine. 3) presbyopes who have seen 20/15 at all distances for their entire life refuse to accept that having "clear, sharp" vision at all distances SIMULTANEOUSLY is absolute fantasy. It's not possible, and a lot of them are in absolute denial. If you're over 45 you will have to give up clarity at some distance for some visual task, no matter how much money you are willing to spend. It's inevitable and it's a compromise and there is no way around it. You will have to tolerate some blur. I'm rambling here but the point is this: I think it's possible that routinely making patients see INCREDIBLE may be creating a culture that absolutely DEMANDS that. So much so that we have a lot of people who are upset with normal 20/20 vision. It's potentially a problem.