Saturday, January 21, 2017

Dragonfleye 44 - My Book has Been Published!

My book is available exclusively on Amazon Kindle readers and the Amazon Kindle app! You can buy it for $0.99, or read it for free if you have Amazon Unlimited. It's science fiction, here's the description: "Optometrist Peter Jeffries is behind schedule trying to finish up the day when a patient walks in without an appointment complaining of a painful, red eye. He soon finds himself unwittingly helping a dying Russian scientist rescue his marooned comrades from a decades-old Soviet space station 300 million light years from Earth."

Friday, January 13, 2017

Why the "Contact Lens Fitting Fee" Exists

You can basically thank 1-800-CONTACTS. As I've blogged before, in the 90's 1-800-CONTACTS made it unprofitable for OD's to sell contacts. We still do it, mostly as a courtesy. Everyone knows we make most of our money on glasses sales. We don't even try to hide it. We make no money on CL sales. Ok so how, then, can we afford to fit contacts? After all we're taking on the liability for your eyes/vision and our liability goes WAY UP when you're wearing contacts. In fact we have to purchase malpractice insurance just for this purpose. Enter the fitting fee. We basically charge you to write you a CL Rx. Of course we don't change our exam a whole lot, so this confuses the heck out of patients. They don't understand why we charge more to hand you a CL Rx if we didn't do anything different. The answer, of course, is that we *ARE* doing something different: we're taking on the responsibility and liability of you wearing contacts. I got in a discussion (argument? a polite one, maybe) in the comments section of a Washington Post article this week over this. The author, obviously a spurned CL wearer who was opposed to the fitting fee among other things, basically considered it his right to buy cheap contacts whenever he wanted wherever he wanted with just a regular "eye exam". One of his arguments was that people in Japan & Europe don't have this problem - there are no "fitting fees" in a lot of those countries. And to that I replied basically that unfortunately the US is a litigious society/culture. The malpractice insurance is driven up by all the lawsuits and settlements, a problem that really doesn't exist too many other places. So in my opinion you can blame 1-800-CONTACTS for making optometrist contact lens sales unprofitable, and the 205 or so US law schools and 1.22 MILLION US attorneys for making expensive malpractice insurance necessary.

Friday, January 6, 2017

I Wrote a Book!

Technically it's a "novella" because it clocks in at around 25,000 words and a true novel is usually considered to be 40,000+. No, it's not an optometry book but it IS about an optometrist! An optometrist who teams up (sorta) with a drug dealer (sorta!) to rescue a group of Russian scientists marooned on...well I'll let you read it! It's #scifi and in the final editing before I self-publish on Amazon on #kindle. Obviously when it's done I'll post a link!

Thursday, December 22, 2016

Myopia: It's Not the Tablet

Last week I had a young Asian family come in with their 10 year old daughter. This was the daughter's very first eye exam. Both parents were high myopes, I later learned: father -10.00 mother -8.00. The exam revealed that the child needed vision correction and was myopic. When I broke the news, the parents were distraught. The father especially couldn't believe it. "We never even let her use the tablet!", he exclaimed. I had to explain to them about axial myopia and genetics. Listen people, I know it's all over the internet that blue light is evil and near point stress causes refractive error, but it really doesn't. It is almost all genetics. When both parents are high myopes, the children are likely to be myopic. No amount of restricting access to the iPad is going to stop it. Axial myopia is from having an eye that is too large. Well if both parents have large eyes...guess what? Their children are more likely to have large eyes. If both parents had large ears, would you be surprised if the child had large ears? Apparently some parents are. They shouldn't be. Restricting use of headphones will not lessen the likelihood of the child's ears being big. They're just gonna be big because...genetics. Yesterday I saw a young mother who brought me her 3rd child...both older siblings had high astigmatism. Guess what? Younger brother also had high astigmatism. She asked me "why"? It's genetics. It's inherited. It's not from reading too much or reading in low light or too much gaming or rubbing their eyes or using the tablet too much or standing too close to the TV or not eating enough carrots or playing the Nintendo 3DS too much...literally NONE OF THAT. Refractive error is almost all genetic. I will admit that environmental factors (time spent outside, near point stress, etc) *can sometimes* play a *slight* role in myopia progression, but in my professional opinion it is not the root cause. The root cause is genetics. I feel like all patients and even some medical professionals GREATLY OVERSTATE the role of environmental factors in the development and progression of refractive error. So while it's not good parenting to hand your child a tablet and just let them spend all day on it, it's not going to "ruin their eyes". If they're going to be myopic (or astigmatic, or hyperopic, or strabismic, etc etc), they're probably just destined to be that way no matter how much you restrict their access to the iPad. Some of these eye myths (like carrots being good for your eyes, crossing your eyes makes them stick that way, standing too close to the tv ruins your eyes, looking at a tablet too much or too close causes nearsightedness, etc etc ) are so ingrained in popular culture that people FIRMLY BELIEVE them, so much so that even when a medical professional explains them away, they're still skeptical.

Thursday, December 15, 2016

Teachers: Don't Keep Your Student's Glasses at School

OK prepare for rant. I've been meaning to blog about this for some time now but haven't got around to it. But I just had another two of these cases this week and I'm a little riled up so now is the time. Apparently some teachers are very annoyed by students who lose their glasses and leave them at home, obviously making school work a problem. So annoyed, in fact, they have the brilliant idea that in order to make their lives more convenient and presumably help the student with their school time performance they decide it's best if the teacher keeps the glasses at school! That way when the student shows up, the teacher has kept the glasses safe overnight or over the weekend (or over the SUMMER EVEN) and the student can perform in the classroom! What a nice idea. This obviously occurs almost exclusively in low in come areas with low income schools and students. Let me tell you what I think of this idea: it's absolutely terrible, and even selfish. These teachers may think they're helping the student but they are not. YES I UNDERSTAND the reasoning: the patient has one pair a year paid for by Medicaid or whatever insurance plan, and without them they can't see in the classroom, and the parents are unable to spring for another pair if/when they're lost/broken. I get it. But some of these kids literally can't see w/o their glasses. Earlier this week I saw a kid with 5 diopters of astigmatism, teacher has his glasses at school. In fact she took them up from him to "keep them safe" before he left school early for his EYE EXAM APPOINTMENT. Just now I saw a 10 year old with -8.00 glasses. Teach: this kid can't see anything past about 4 inches and you kept her glasses at school. Why? So she can pass the TAKS test or whatever next week? How do you expect her to walk to school? Watch TV? Heck make it from her bedroom to the bathroom? It occurs to me that you might not understand just how poor this patient's vision is...? Please stop keeping the glasses at school, no matter what your reasoning is. If you see a kid with glasses on, assume they need them all the time, not just from 8am to 3:30pm weekdays.

Tuesday, November 15, 2016

Coke Bottle Glasses

People are obsessed with this! I get 2 questions a day about them. "THESE GLASSES WON'T BE COKE BOTTLE WILL THEY?" No, they won't. Let's talk about coke bottle glasses: They pretty much don't exist in 2016. Yes, I'm serious. Everyone knows that the "worse" your prescription is, the "thicker" the lenses are. That's true, but it was a much bigger problem in prior generations when lens materials were limited to crown glass and CR-39. More recent materials, the use of flatter base curves and better frame fitting and lens edging equipment have made this much less of a problem. There are other factors as well: most high myopes are in contact lenses now, when they weren't prior to about the late 80's, so a bunch of the people who were wearing "coke bottles" before...aren't now. They're in contacts instead. Also, only high prescriptions were ever thick. I get people with literally a -2.00 Rx asking me if their glasses will be "thick". No! You'll never, ever be thick. The people with coke bottle glasses (the ones with high Rx's) started out very early. You can't get there from the lighter -2.00 Rx's. Going from -2.00 to -2.25 (or -2.50 or -2.75 or -3.00 etc etc etc) will never be "coke bottles". You need to get into the -8.00 range before we're talking notable lens thickness, and again most of those are wearing contacts anyway. Plus with the frame styles that are popular right now, any lens thickness not taken care of by high index lens material is usually hidden by the plastic frame. Basically you all are worrying about nothing! Almost nobody leaves our office with "coke bottle glasses" haha so you can rest easy!

Tuesday, November 1, 2016

The Case of the New Diabetic

Here's something I get every few months, and I got one yesterday. A newly-diagnosed diabetic gets put on medication and their vision vastly changes. This patient yesterday went from basically plano (prescriptionless) to +4.50 4 days after he starts taking blood sugar medication. Well that's a problem. So Rx him some glasses! Easy, right? To quote sports celeb Lee Corso: "not so fast my friend." He just got put on his 1st medication. There will be adjustments made to his medications in the 1st few weeks/months. Maybe some different medications and maybe some different dosages of the same medications. He flat out told me he was prescribed two medications but one of them "made him feel funny" so he stopped taking it and is going to tell his doc that he is only taking one medication at their visit next week. So what do we do? His Rx is VERY LIKELY to change again, probably as soon as next week when the doc either puts him back on the medication that made him feel funny or changes meds/dosages. Plus his insurance plan makes us use their outside lab - we won't be making his glasses, they'll be made in Maryland or wherever, and they take 2-3 weeks to come in. So if we made him glasses we run the risk of his vision literally changing before the 1st (of many?) glasses order even comes back from the lab. And do you think the insurance company is going to pay for us to change his Rx 1, 2, maybe 3 or more times? NO WAY. Ok so here's how I usually deal with this: I put them in contacts. I measure today's Rx, teach him how to insert/remove and take care of contacts, then load him up on trials. Then I tell him to come back if/when his vision changes after his meds have been changed. I re-take the measurements and change the contact lens Rx and give him more trials. Easy, cheap, fast and quickly adjustable. Then after his Rx and blood sugar has leveled out in a few weeks/months we can remeasure and Rx some glasses that we won't have to remake 5 times. Heck this guy was so impressed with the contacts he may just be a convert anyway.