Wednesday, August 19, 2015

I Got a "Bad Batch" of Contacts

You probably didn't. You probably have an eye problem. Here's how this often goes: a patient comes in saying that suddenly BOTH eyes are very uncomfortable with contact lenses in, and they "move around". Patient thinks "bad batch", I think GPC. I just had a patient who bought their contact lenses from WalMart...the ones she got from us were always fine. The ones from WalMart were uncomfortable and were very easily ripped. Patient thought "bad batch". I figured out that although her written Rx from us said "Acuvue Oasys", WalMart had sold her (inadvertently?) Acuvue 2, which is totally different. Getting a "bad batch" is rare. Possible, but not the 1st thing I think of. I am usually thinking "eye problem" way before I consider "bad batch".

Friday, August 14, 2015

Automated Refraction

TOPCON CV-5000 We just spent big bucks on 2 of these, along with the corresponding topographer, lensometer, new EMR software (that's a topic for a different post...), new chairs, stands, the works. It's pretty cool. It has taken some time to get used to...still getting used to it a week later, in fact. There is a split-prism portion for measuring astigmatism that is unlike anything I have ever used or any patient has works pretty well. The whole thing has a pretty good "wow factor". PLUSSES: wow factor, intigrates with paperless EMR, very versatile. MINUSUS so far: LOUD. Haha those manual phoropters are almost soothing with their soft "clicks". This one has servos going ZZZZZHHHHHT! ZZZZHHHHHHHHHHHHHHT! ZHT! ZZZZHHHHHHHT like a bad printer cleaning itself. It relies on a bluetooth signal and a network and when those don't work it can get ugly pretty quick. Anyone else use these or have a doc who uses them? Thoughts?

Monday, August 10, 2015

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!