Color Deficiency, Radio Interview, Medicine, Night & Day, Oasys Bifocal

Cool "Color Blindness" Simulator
i found this site today and its pretty cool. we have a color deficient son (eye docs dont say "colorblind"... i did in the title of this post b/c a lot of people refer to it like that, but its in quotes b/c i dont say it that way) and i've always kind of wondered what his world looked like! its very revealing. i found out by using this simulator that our own practice website is not really seen very well at all by color deficient people! i may have to remedy that.

anyway here's the link:
Tags: colorblind, colordeficiency, colorvision | Edit Tags
Monday March 30, 2009 - 11:00am (CDT) Edit | Delete | Permanent Link | 0 Comments
Radio Interview Aired Today
my radio interview:

...that was scheduled to air Sun morning April 5th at 7am local time...aired THIS morning at 7am. i'm a little upset about it. i missed it, my family missed it, everyone i told about it missed it. no explanation from the station, just moved me up a week unannounced.

i'm going to see if my buddy can host it on his website and i'll put a link up as soon as i get the cd from the radio station. wish they had'nt done that.
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Sunday March 29, 2009 - 01:29pm (CDT) Edit | Delete | Permanent Link | 1 Comment
Medicine = Estimated Guessing

when my wife met me i think she was shocked at how often my patient diagnoses were guesses. other docs will attest: rarely do the signs/symptoms cleanly & exactly match the diagnosis/treatment.

the patient i just saw is an excellent example of this. young, healthy 20 year-old college student who gets frequent headaches and has occasional blurred vision. the exam showed there was no ocular or systemic disease, but she does have some prescription and eye "teaming" problems that could be contributing to her symptoms. the conundrum with her is that the 2 minor vision problems she has are opposites of each other. let me explain:

1) she's a little nearsighted: a known headache-causer


2) she's a little convergence excess (over-crosses her eyes when she reads up close): also a known & common cause of headaches

so. what to do? its a problem b/c...

1) if i rx low minus nearsighted-power for her mild myopia, she'll see better far away. and if her headaches are caused from eyestrain trying to see far away, it should help. BUT! minus lenses cause slight convergence. so if her headaches are from the convergence excess, those glasses could actually make her headaches WORSE.


2) if i rx low plus power to more accurately align her eyes (diverge a little) for aiming at a near reading'll help her if her headaches are caused by the convergence excess. BUT! if her headaches are from distance-vision eyestrain it'll make her headaches WORSE.

or how about

3) BIFOCALS! low minus at the top for her distance vision myopia problem, low plus at the bottom for her near vision convergence excess. in theory a great idea except for a few major problems:

a) you think i'm going to talk a 20 year old into bifocals? how about her parents when they call me and ask why their daughter is the only person under 45 they've ever heard of getting bifocals? yeah this is a tough sell. perception is reality


b) the lowest "add" power of most brands of bifocal lenses comes in a minimum add power of +1.00. her add power really needs to be +0.50...half of the lowest i could get. this is probably unmake-able, and if i could find some optical lab to custom make it for me it'd likely be excessively expensive.

so what to do? i have to make a judgment call based on her kind of vague complaints, her conflicting exam testing info, the associated treatment options, and my past experience. it aint easy, i'm telling you. luckily in this case its just a glasses rx and the worst thing that happens is i "choose wrong" and make her headaches worse. not like some of my eye disease cases where i could blind or even kill someone if i write them the incorrect prescription for medication. like my mom always says, "this is why they call it 'practicing' medicine". this is also why in difficult cases a second opinion is always a good idea. another doc has different experience, different ways of testing, different treatment options, etc.

i wont leave the cliffhanger unresolved: i ended up Rx'ing low minus for nearsightedness. i did this b/c since she's so young & healthy IMO its a little more likely for that to be causing her headaches. but i could be wrong and i told her that. if she wears the new glasses and her headaches are worse, she's going to come back and we'll try the OTHER option (low plus for convergence excess). and of course we'll remake the 2nd pair at no charge. cuz we're nice like that.
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Thursday March 26, 2009 - 11:20am (CDT) Edit | Delete | Permanent Link | 1 Comment
Air Optix Night & Day Aqua
Air Optix Night & Day Aqua magnify
bad name, pretty good lens/idea. the big knock on extended-wear (i.e. sleeping in) contacts like Night & Day as far as patient complaints are concerned is usually DRYNESS. they sleep in the contacts and the next a.m. they're "stuck" and "peeling them off" and all the other probably slightly exaggerated statements patients make about dryness....but the complaint is still valid: they ain't comfortable in the a.m.

so CIBA adds their moisturizing agent. this isn't a novel idea, Vistakon has been doing this with their "hydraclear" lens line for years. the difference, of course, is that none of Vistakon's materials/products are designed for/FDA approved for 30-day extended wear. "ah-HA!", says the Ciba rep.

with this re-design Ciba also addressed some of the other complaints about Night & Day:

1) "its hard to find when i drop it in the sink": CIBA added a visitint (previously N&D didn't have one)


2) "i cant tell if its inside-out or not": Ciba added an inversion marker. i'm a BIG FAN of inversion markers and wish every lens had one.

i have to admit i'm probably not going to call it "Air Optix Night & Day Aqua", and i'm sure-as-heck not going to write "Air Optix Night & Day Aqua" on the chart. thats just ridiculous. i'm probably going to call it "Night & Day" and continue to write "N&D" on the file. i'm the doc and i can do what i want

but...i am probably going to use it more than i used the "old" N&D. actually, i know i will.

Tags: optixnight&dayaqua | Edit Tags
Monday March 23, 2009 - 03:22pm (CDT) Edit | Delete | Permanent Link | 0 Comments
Acuvue Oasys for Presbyopia
so our kit got here today and the rep talked to me as well. its not a center-near aspheric like i thought it would probably be (and like soflens multifocal is), but rather a front surface aspheric zonal design. i call this type of lens an "annular" design, but that may be a misnomer.

a little disappointed that its really only designed for "emerging" presbyopes, read: "under 50". but he says they'll have a "high" add power later so that'll help.

at least we have another multifocal option, especially in silicone.


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