Sunday, March 18, 2012
Just a Little Stronger, Doc
One of the funnier things about this profession is how simple a lot of people (patients & primary care doctors alike) think it is. I'm sure a lot of professions are like this...harder/more complicated than you'd think.
Just about every patient who thinks they have blurry vision assumes they need "stronger". You have to admit that's kind of comical: that a profession that needs a doctorate to perform could be boiled down to the absolute simplest of solutions..."stronger!"
So many things to talk about here. Firstly, "stronger" only works when your refractive error has increased. Sometimes "weaker" is the answer. Sometimes a change in astigmatism orientation is it. Sometimes it's corneal edema, or retinopathy, or excess mucous production, or cataracts, or dry eye, or literally dozens (hundreds?) of other things.
One of the things I talk about with patients is expectation. A spherical (no astigmatism) myope sees *awesome* up close, and many of them judge their vision at all other distances by that standard, expecting to see exactly that well at all other distances & through every material in glasses, contacts, etc, which is unrealistic.
Another thing I frequently discuss is perception. Patients get hung up on acuity...20/20 being their standard, when really vision is very subjective. What is "blurry" and what is "clear" is a lot like asking patients what is painful and what is not. On a scale of 1-10 how much does a fire ant bite hurt? Well it depends on who you ask. My daughter would say at least a "7". Vision is a lot like that. PLENTY of people who see normally, have 20/20 acuity & don't even need glasses tell us that their vision is "so blurry". Ok what do we do with that? Usually nothing. I certainly don't prescribe them "stronger". This is kind of a 'how blue is the sky' kind of issue. I've blogged about this before:
VISION IS SUBJECTIVE
In the end, medicine is somewhat limited in what we can do for people who see blurry. If it's refractive error, we account for it. If it's eye disease, we treat it the best we can. But if it's perception/expectation, there's not a lot we can do. I spend a lot of my day explaining why 'stronger glasses' won't help a person with cataracts or macular degeneration see better, and why 'stronger contacts' won't stop a young myope from having headaches when they read. It just doesn't work that way...some of these vision issues are more complicated than a lot of patients assume. Which is fine...that's why they're at the optometrist's office!
Saturday, February 25, 2012
“Use of Optical Scan Machines” H.B. 408 Utah State Legislature 2012
THIS BLOG POST from David Langford, O.D. on optoblog.com was so well written that I am going to let you go there to read it:
“Use of Optical Scan Machines” H.B. 408 Utah State Legislature 2012
It has to do with the scummy practices of 1-800-CONTACTS & Wal-Mart, and their attempts to circumvent the need for an eye exam to be able to buy glasses & contacts.
Saturday, February 18, 2012
Debbie's Theme
Debbie's Theme
The embedded song you're hearing on autoplay is an instrumental I wrote for my wife last night. I have a band (TACKAPBAND, which I will blog about soon, as we're currently in the studio) but this is just a home demo recording of an instrumental I wrote for my wife. She liked it! It's very "sweet", I think.
If you want it to stop, scroll to the bottom of the page & click the pause button on the soundcloud widget next to my picture.
Monday, February 13, 2012
Some Confusion About Lid Scrubs
I often have patients tell me that they've been told (by their last eye doctor or a nurse, etc) to "wash" their eyes with baby shampoo.
There is no scenario I can think of where the surface of your eye should be "washed" with any soap. They're confused about a common treatment for blepharitis called "lid scrubs". I usually recommend OCuSOFT Lid Scrub PLUS Extra Strength Pre-Moistened Pads
There is a video from Ocusoft which details how to perform lid scrubs at the BOTTOM OF THIS PAGE. Notice they are not "washing their eyes" with the formula. An older method of this is to use baby soap on a warm washcloth instead of a premoistened towelette. This is where the confusion comes from, I believe: patients made the natural assumption that since baby soap is intended for "washing" babies, that if their practitioner told them to use it on their eyes, it must be to "wash" the eyes. Please do not do this. No soap is intended for use on the surface of your eyes - that does not exist in medicine. You should not be "washing" or rinsing anything purposely into your eyes, unless you're rinsing out your eyes immediately after chemical exposure or something.
There is no scenario I can think of where the surface of your eye should be "washed" with any soap. They're confused about a common treatment for blepharitis called "lid scrubs". I usually recommend OCuSOFT Lid Scrub PLUS Extra Strength Pre-Moistened Pads
There is a video from Ocusoft which details how to perform lid scrubs at the BOTTOM OF THIS PAGE. Notice they are not "washing their eyes" with the formula. An older method of this is to use baby soap on a warm washcloth instead of a premoistened towelette. This is where the confusion comes from, I believe: patients made the natural assumption that since baby soap is intended for "washing" babies, that if their practitioner told them to use it on their eyes, it must be to "wash" the eyes. Please do not do this. No soap is intended for use on the surface of your eyes - that does not exist in medicine. You should not be "washing" or rinsing anything purposely into your eyes, unless you're rinsing out your eyes immediately after chemical exposure or something.
Friday, February 3, 2012
New Acuvue 1-Day Moist for Astigmatism
I am not "breaking" this story. The news is out there on the net already. Apparently some of the trial offices are "advertising". Due to be officially unveiled in 3 weeks at SECO on Mar 1. I first heard of it & blogged about it on Jan 5:
http://myeyepod.blogspot.com/2012/01/new-acuvue-lens-coming.html
http://www.prweb.com/releases/eye-doctor/bay-area/prweb9139954.htm
Bay Area Eye Care Office, 20/20 Optometry of Silicon Valley Announces Pre-Ordering and Fittings for 1-Day Acuvue Moist for Astigmatism
Bay Area's 20/20 Optometry of Silicon Valley announces the availability of the 1-day Acuvue Moist for astigmatism for pre-order and fitting prior to its national release during the second quarter of this year.
Pre-ordering and fittings for 1-day Acuvue Moist for Astigmatism available at 20/20 Optometry
The fitting set just arrived the third week of January, and we can begin fitting the lenses now
San Jose, CA (PRWEB) January 26, 2012
For more than ten years, 20/20 Optometry of Silicon Valley has successfully served the Bay Area, providing exceptional eye care to its diverse San Jose-based clientele. And now, 20/20 Optometry of Silicon Valley is one of the few select offices in San Jose that can fit and order the 1-day Acuvue Moist for Astigmatism prior to its national release in the second quarter of this year.
"The fitting set just arrived the third week of January, and we can begin fitting the lenses now," said Dr. Jeanette Lee of 20/20 Optometry of Silicon Valley. "Patients can try the new lenses if they receive a contact lens evaluation and fitting performed at our office."
The 1-day Acuvue Moist for astigmatism has been available internationally but has only just passed the FDA, allowing it to now be available for fittings and purchase in the U.S.
As one of the leading brands of contact lenses sold worldwide, Acuvue brand contact lenses are the first and only daily disposable lenses that feature a unique "blink-stabilized design" that allows a wearer to maintain consistently clear vision throughout the day. Daily disposable lenses are the healthiest option for contact lens wearers since the patient begins each day with a fresh pair of lenses versus re-cleaning existing lenses for 2 weeks or 1 month. The contact lenses offer high UV protection and dramatically reduce the chance of an eye infection. The daily disposables are convenient for travelers, swimmers or sports enthusiast.
http://myeyepod.blogspot.com/2012/01/new-acuvue-lens-coming.html
http://www.prweb.com/releases/eye-doctor/bay-area/prweb9139954.htm
Bay Area Eye Care Office, 20/20 Optometry of Silicon Valley Announces Pre-Ordering and Fittings for 1-Day Acuvue Moist for Astigmatism
Bay Area's 20/20 Optometry of Silicon Valley announces the availability of the 1-day Acuvue Moist for astigmatism for pre-order and fitting prior to its national release during the second quarter of this year.
Pre-ordering and fittings for 1-day Acuvue Moist for Astigmatism available at 20/20 Optometry
The fitting set just arrived the third week of January, and we can begin fitting the lenses now
San Jose, CA (PRWEB) January 26, 2012
For more than ten years, 20/20 Optometry of Silicon Valley has successfully served the Bay Area, providing exceptional eye care to its diverse San Jose-based clientele. And now, 20/20 Optometry of Silicon Valley is one of the few select offices in San Jose that can fit and order the 1-day Acuvue Moist for Astigmatism prior to its national release in the second quarter of this year.
"The fitting set just arrived the third week of January, and we can begin fitting the lenses now," said Dr. Jeanette Lee of 20/20 Optometry of Silicon Valley. "Patients can try the new lenses if they receive a contact lens evaluation and fitting performed at our office."
The 1-day Acuvue Moist for astigmatism has been available internationally but has only just passed the FDA, allowing it to now be available for fittings and purchase in the U.S.
As one of the leading brands of contact lenses sold worldwide, Acuvue brand contact lenses are the first and only daily disposable lenses that feature a unique "blink-stabilized design" that allows a wearer to maintain consistently clear vision throughout the day. Daily disposable lenses are the healthiest option for contact lens wearers since the patient begins each day with a fresh pair of lenses versus re-cleaning existing lenses for 2 weeks or 1 month. The contact lenses offer high UV protection and dramatically reduce the chance of an eye infection. The daily disposables are convenient for travelers, swimmers or sports enthusiast.
Thursday, January 19, 2012
Vision is Subjective
A few things that I frequently talk to my own patients about that might be of some use to you out there is internetland:
1) Vision is subjective. What do I mean by that? Mostly what I am referring to is that the perception & description of "blur" varies greatly between patients. It is anything but standard. We're talking about "how blue is the sky" and "on a scale of 1-10 how much does it hurt to have your foot smashed when someone steps on it" kind of thing. What is & is not "blurry" and how to describe to another person exactly what you see is virtually impossible to ACCURATELY PINPOINT. And even if we could exactly pinpoint to the Nth degree how blurry your vision is...as eye doctors we really can only do TWO things: a) eliminate refractive error and b) treat existing eye disease. If you have no eye disease and you're wearing the correct Rx...that's all we can do. Most people are happy with that, but some 20/20 patients will still tell us "it's so blurry". Ok, we believe you! But...we're limited by what we can do about it. There are other things besides disease & refractive error that cause blur, mostly optical aberrations: spherical aberration, coma, pincushion/barrel distortion, chromatic aberration, field curvature, etc, also macular cone spacing...but we can't really DO anything about any of those here in the real world. Just measuring them in a human eye takes special expensive lab equipment, and we cannot (yet) make a pair of glasses that would eliminate any of those other optical aberrations. Sometimes we have to tell healthy patients with good Rx's that we're at the limit of how "clear" we can make their vision.
2) Subjective testing is what it is: subjective. Ok so we just got finished reading a diatribe on how vision is subjective...but don't we optometrists base our glasses Rx's off of "subjective refraction"? Well yes & no. By the time we have you in the chair & behind the phoropter we've already taken multiple OBJECTIVE measurements on your eyes & refractive status. So we know basically what we're going to Rx you...possibly exactly what it's going to be. So we let you "fine tune" your Rx by offering you a little more or a little less, a little to the left & a little to the right, etc. But there are no "wrong" answers here. If you "choose" something way off, we're not giving it to you. Plus a lot of the time we're "bracketing" anyway...showing you just to the left & just to the right of your Rx but NOT RIGHT ON. So there REALLY isn't a wrong answer there...they're BOTH BLURRY choices. This is one reason why so many people get frustrated by the process of subjective refraction: they assume (incorrectly) that the lenses are "supposed" to be getting subjectively clearer with each successive choice. But they're not. That's not how it works. You're really relying a lot more on the skill & experience of the doctor than you are on your own choices behind the phoropter. That's why it's important to find an optometrist that you connect well & communicate well with.
3) If you hear hoofbeats, think "horses", not "zebras". This is a derivation of Occam's Razor: the simplest solution is probably the correct one. If you're a contact lens wearer & your eye is red, it's probably from contact lens wear. It is probably not "pink eye", etc. It *could be* contagious viral or bacterial conjuntivitis, but that's not the MOST LIKELY cause. If your head hurts it's probably a tension headache, not a tumor. Ok it *could* be a tumor...but statistically it's probably not. Especially in the age of the internet, often patients Google their own eye symptoms/conditions & come up with some very IMPROBABLE scenarios ("zebras"). Even some docs do this. I had a patient with known, longstanding neurological deficits and known, longstanding ataxia (can't walk w/o falling down), and his neurologist referred him for another eye exam saying it "could be" his glasses. Well ok yes it "could be"...but the patient had been here annually for eye exams and his refractive status was virtually unchanged in 20 years. His ataxia is PROBABLY NOT the result of an incorrect glasses Rx. That's a "zebra" for sure.
4) A lot of eye conditions have the same symptoms: The human eye can only respond in a limited number of ways - pain, redness, foreign-body sensation, vision loss, light sensitivity. That's pretty much it. Consequently many patients will call me asking me to please refill their eye drop Rx from 2.5 years ago b/c "it's the same thing again." Well, how do you know it's the same thing? You don't. There's no way for you to know it's the same, or even for ME to know it's the same unless I *LOOK* at your eye. Listing the symptoms again (foreign body sensation, redness, blur, etc) over the phone does not help much, b/c most symptoms are the SAME for most eye conditions. Someone has to LOOK at your eye anyway.
1) Vision is subjective. What do I mean by that? Mostly what I am referring to is that the perception & description of "blur" varies greatly between patients. It is anything but standard. We're talking about "how blue is the sky" and "on a scale of 1-10 how much does it hurt to have your foot smashed when someone steps on it" kind of thing. What is & is not "blurry" and how to describe to another person exactly what you see is virtually impossible to ACCURATELY PINPOINT. And even if we could exactly pinpoint to the Nth degree how blurry your vision is...as eye doctors we really can only do TWO things: a) eliminate refractive error and b) treat existing eye disease. If you have no eye disease and you're wearing the correct Rx...that's all we can do. Most people are happy with that, but some 20/20 patients will still tell us "it's so blurry". Ok, we believe you! But...we're limited by what we can do about it. There are other things besides disease & refractive error that cause blur, mostly optical aberrations: spherical aberration, coma, pincushion/barrel distortion, chromatic aberration, field curvature, etc, also macular cone spacing...but we can't really DO anything about any of those here in the real world. Just measuring them in a human eye takes special expensive lab equipment, and we cannot (yet) make a pair of glasses that would eliminate any of those other optical aberrations. Sometimes we have to tell healthy patients with good Rx's that we're at the limit of how "clear" we can make their vision.
2) Subjective testing is what it is: subjective. Ok so we just got finished reading a diatribe on how vision is subjective...but don't we optometrists base our glasses Rx's off of "subjective refraction"? Well yes & no. By the time we have you in the chair & behind the phoropter we've already taken multiple OBJECTIVE measurements on your eyes & refractive status. So we know basically what we're going to Rx you...possibly exactly what it's going to be. So we let you "fine tune" your Rx by offering you a little more or a little less, a little to the left & a little to the right, etc. But there are no "wrong" answers here. If you "choose" something way off, we're not giving it to you. Plus a lot of the time we're "bracketing" anyway...showing you just to the left & just to the right of your Rx but NOT RIGHT ON. So there REALLY isn't a wrong answer there...they're BOTH BLURRY choices. This is one reason why so many people get frustrated by the process of subjective refraction: they assume (incorrectly) that the lenses are "supposed" to be getting subjectively clearer with each successive choice. But they're not. That's not how it works. You're really relying a lot more on the skill & experience of the doctor than you are on your own choices behind the phoropter. That's why it's important to find an optometrist that you connect well & communicate well with.
3) If you hear hoofbeats, think "horses", not "zebras". This is a derivation of Occam's Razor: the simplest solution is probably the correct one. If you're a contact lens wearer & your eye is red, it's probably from contact lens wear. It is probably not "pink eye", etc. It *could be* contagious viral or bacterial conjuntivitis, but that's not the MOST LIKELY cause. If your head hurts it's probably a tension headache, not a tumor. Ok it *could* be a tumor...but statistically it's probably not. Especially in the age of the internet, often patients Google their own eye symptoms/conditions & come up with some very IMPROBABLE scenarios ("zebras"). Even some docs do this. I had a patient with known, longstanding neurological deficits and known, longstanding ataxia (can't walk w/o falling down), and his neurologist referred him for another eye exam saying it "could be" his glasses. Well ok yes it "could be"...but the patient had been here annually for eye exams and his refractive status was virtually unchanged in 20 years. His ataxia is PROBABLY NOT the result of an incorrect glasses Rx. That's a "zebra" for sure.
4) A lot of eye conditions have the same symptoms: The human eye can only respond in a limited number of ways - pain, redness, foreign-body sensation, vision loss, light sensitivity. That's pretty much it. Consequently many patients will call me asking me to please refill their eye drop Rx from 2.5 years ago b/c "it's the same thing again." Well, how do you know it's the same thing? You don't. There's no way for you to know it's the same, or even for ME to know it's the same unless I *LOOK* at your eye. Listing the symptoms again (foreign body sensation, redness, blur, etc) over the phone does not help much, b/c most symptoms are the SAME for most eye conditions. Someone has to LOOK at your eye anyway.
Wednesday, January 11, 2012
2-day Underwear
The staff & I have heard so many statements/excuses on how patients justify overwearing their contacts that we recently decided it would be funny (to us anyway) if we used those same arguments to justify overwearing our underwear.
I just keep wearing them until they're uncomfortable.
I have "2-day" underwear.
I wear my brother's underwear. We share. Especially colored underwear.
I hardly ever change my underwear unless they start bothering me. I know when it's time.
Do I really have to wash my underwear? Can't I just soak them in water?
I can't afford to be buying underwear all the time...what's *THE CHEAPEST* underwear I could POSSIBLY have?
If my underwear feels like something is in there, can I put it in my mouth to clean it?
There are different SIZES & kinds of UNDERWEAR!!?? I thought they were all the same.
I buy my colored underwear at the flea market.
I want the underwear that you never have to change.
Sometimes my underwear gives me a rash, when that happens I can still wear it, right? I don't have to change it, do I?
I ran out of new/clean underwear a few months ago, so I just made this final pair last.
My old doctor told me I can wear my underwear twice as long as they're supposed to be worn. That's ok, right?
What size & material of underwear do I have on, you ask? Uh, I don't know...Hanes.
I got a rash from never changing my underwear & so I started changing them faithfully every day. But as soon as the rash is gone I can go back to wearing them all the time & never changing them again, right?
I just keep wearing them until they're uncomfortable.
I have "2-day" underwear.
I wear my brother's underwear. We share. Especially colored underwear.
I hardly ever change my underwear unless they start bothering me. I know when it's time.
Do I really have to wash my underwear? Can't I just soak them in water?
I can't afford to be buying underwear all the time...what's *THE CHEAPEST* underwear I could POSSIBLY have?
If my underwear feels like something is in there, can I put it in my mouth to clean it?
There are different SIZES & kinds of UNDERWEAR!!?? I thought they were all the same.
I buy my colored underwear at the flea market.
I want the underwear that you never have to change.
Sometimes my underwear gives me a rash, when that happens I can still wear it, right? I don't have to change it, do I?
I ran out of new/clean underwear a few months ago, so I just made this final pair last.
My old doctor told me I can wear my underwear twice as long as they're supposed to be worn. That's ok, right?
What size & material of underwear do I have on, you ask? Uh, I don't know...Hanes.
I got a rash from never changing my underwear & so I started changing them faithfully every day. But as soon as the rash is gone I can go back to wearing them all the time & never changing them again, right?
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