MY EYE POD

Vision is Subjective

2012-01-19T12:00:00.003-06:00

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.

2-day Underwear

2012-01-11T14:19:00.003-06:00

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?

New Acuvue Lens Coming

2012-01-05T10:07:00.002-06:00

Just got this sent to me:

Latest & Greatest Acuvue Lens

Its going to be unveiled at SECO on March 1, 2012 apparently. We'll see what it is! If I get info before then I'll post it!

Ortho-k + Corneal Cross-Linking

2011-12-08T12:32:00.006-06:00

Ortho-k is a non-surgical way of going glasses-free during the day. Wear "retaining" lenses at night, wake up 20/20. I've blogged about it repeatedly (just search this site with the box in the upper left for "ortho-k") and we perform this procedure in our office with a high success rate.

Corneal cross linking is a procedure that uses riboflavin eye drops and UV light exposure to stiffen corneal stromal fibers. Its currently a treatment for arresting keratoconus progression.

Well Dr. Sami El-Hage (a pioneer in ortho-k and one of the most interesting people I have ever met) has proposed combining the two; the idea being to initially get the patient seeing well with ortho-k, then perform the cross-linking procedure to make it permanent or semi-permanent. This article is kind of technical, but SUPER INTERESTING (to me, anyway b/c I'm nerdy & into this stuff!):

ortho-k + corneal cross linking

Pawn Shop Rescue Bass

2011-12-02T12:55:00.008-06:00

A few months ago now I saw a used bass guitar in a pawn shop for under $50. It was a kind of "vintage" mid-1970's "Memphis" brand knock-off copy of a Fender Precision Bass. Natural finish with a weathered "yellow-y" look, maple neck, white pickguard. I loved the way it looked & felt, but nothing worked. No sound from the pickups and the neck was cracked. I got the guy to sell it to me for even less than the $50 asking price and took it home. Took it all apart, cleaned it all up, made the pickups work (loose connection) & made it playable. Still had the cracked neck & it turns out the truss rod didn't work so it was shot. Couldn't adjust the "relief" or "action" (height of strings from neck).

So a few weeks later I ordered a replacement neck for it (and new tuners and a new pickguard and new knobs...and flatwound strings! gotta have "flats"). It all came in & I spent a night assembling it all (great fun) and now this "pawn shop rescue" bass is my main bass. It just "feels" right and I love the playability & sound. I REALLY love the vintage look. Here's a picture of the finished product...I'm pretty proud of it:

My other bass and former "main player" is a 5-string Squier Jazz. I still like that bass and I'm not getting rid of it. There are plenty of times when a 5-string is needed, especially with the recent "low tuning" & "alt tuning" craze in music (Eb tuning, "drop-D", etc). But I think I'm figuring out that given the choice, I'm a "4-string guy". I like the extra hand positions of the 5 string, but there's something cool about a simple 4-string precision bass.

Allergic Conjunctivitis

2011-11-27T09:57:00.012-06:00

This is my bad time of the year for ocular allergy. For most people its spring, but for me its Sept-Oct-Nov-Dec. I don't know what I'm allergic to but whatever it is, its out in those fall months. I get the nasal congestion, etc but worst of all is the ITCHY THROAT (palate) and itchy/watery eyes. My eyes are also very gooey/sticky in the mornings (mucous). I know, TMI right?

I just wanted to discuss what personally works for me b/c I'm using Rx antihistamines daily right now. Here's what I use myself and what I Rx for patients and why:

1) Bepreve: I really like this drug and its recently been one of my "go-to" Rx antihistamines. It clears the "goo" quickly, stops the itch & even helps with the itchy throat (palate), no kidding. This stuff really works. It has a pretty bad aftertaste, tho...which I personally do not mind at all, but patients (and my wife) absolutely detest. So that's a downer. To be used twice a day.

2) Lastacaft: This stuff works really well too and has zero aftertaste. This is what my wife uses (a GPC sufferer, since I blog about GPC a lot). I don't think it helps with the itchy palate, so for that reason I still like Bepreve a little better for my own use. But for the actual ocular symptoms that most of you are asking the O.D. about, this one is as good as you can get. Plus my wife & daughter both greatly prefer this one b/c it has no sting & no aftertaste. 12/14/2011 edit: I just found out this is ONCE a day (QD) not twice a day (BID!) I can't believe I didn't know that! I mistakenly thought it was BID. Oops. Hey I can admit when I am wrong! My excellent Allergan rep corrected me.

3) Pataday (olopatadine 0.2%): Also a great drug. Designed for once-a-day dosing, this is the successor of the wildly successful "Patanol" (which was twice-a-day). I'm not sure I ever bought the idea that simply doubling the concentration of Patanol (olopatadine 0.1%) lengthened the effectiveness of the drug another 8 hrs, but I guess it's possible. This is probably the most-Rx'd eye drop right now (edit: Allergan rep says the most Rx'd drops are XALATAN & RESTASIS). Very popular.

4) There's one OTC antihistamine that I think works pretty well, and it's not Visine-A, Opcon-A nor Clear Eyes-ACR, as all of those are mainly vasoconstrictors with old, not very effective antihistamines. Over the counter I like ketoifen fumarate, which is sold under at least 4 (and probably more) brand names: Alaway, Zaditor, Wal-Zyr (Walgreens brand Eye Itch Relief), and Zyrtec Itchy Eye Drops. This drug works better (IMO) than any other OTC anti-allergy eye drop, and almost as well as the Rx ones above, at a fraction of the cost.

5) When the patient has significant redness, swelling or inflammatory signs beyond just the symptoms of itch & mucous production, I typically get more aggressive & Rx steroids. My steroid of choice for this is Bausch & Lomb's Alrex. This stuff is very safe, even for long term usage, and eliminates itch as well as swelling, redness & inflammation. The only downsides are the sometimes-overhyped stigma of steroid usage (glaucoma, cataracts, etc), and the fact that usually steroids don't INSTANTLY eliminate the itch, like the antihistamines above do.

Lotemax Ophthalmic Ointment

2011-11-03T10:55:00.002-05:00

ALL RIGHT! I guarantee I'll be Rx'ing this. Finally a new ocular steroid ointment on the market, so I can stop using dexamathasone & hydrocortisone, both of which can & do raise intraocular pressure. It's funny the little things I get excited over, but this will change the way I practice, I promise:

LOTEMAX OPHTHALMIC OINTMENT

Now if B+L would just please, please, pretty please combine a fluoroquinolone with Lotemax so I can have a decent combo drug that doesn't contain 40-year old tobramycin! Is anyone at B+L listening? Please?

Corneal Onlays in the News Again

2011-11-02T12:09:00.003-05:00

I originally blogged about this in October of 2007, but that blog post was lost in June of 2009 when the "Yahoo360" blog host folded. I re-posted it here in 2009:

Oct 2007 Corneal Onlay Blog post

Anyway today they're back in the news, as the Flexvue Microlens has received "medical device registration approval" in both Israel and Brazil. I really think this is the future of eye care, even moreso than LASIK. Maybe I'm wrong but we'll see. IMO this has a lot of potential to change eye care:

Presbia Flexivue Microlens

The basics of onlays are...it would be a truly "implantable" contact lens. If you google "implantable contact lens" you get a result for something that is nothing like a corneal onlay. The device named "implantable contact lens" is an anterior chamber implant designed for high myopes, and its insertion & removal are fairly invasive procedures.

Conversely a corneal onlay is a MINIMALLY invasive & reversible procedure. Currently a laser "flap" is made just like in LASIK, but instead of using another laser to then permanently DESTROY corneal tissue, a super-thin "contact lens-like" implant is instead inserted into the corneal stroma. The result is...pretty much an implanted contact lens. Still only available as a monovision presbyopia correction, in the future it would be conceivably relatively easy to do just about any Rx like this.

Maybe I'm not well-enough educated on the subject, but I don't even see why one would REALLY need a laser flap (possibly b/c its easy & clean). In my mind corneal epithelium could be removed any number of ways (alcohol?), place the onlay, then bandage it with a traditional extended-wear soft contact & voila! Same result (?) That would make it a fairly affordable in-office procedure that a non-surgeon could feasibly perform. Maybe I'm dreaming here.

Regardless, this is a cool deal IMO.

Common LASIK Misconceptions

2011-10-25T10:52:00.004-05:00

I spend a lot of my time answering questions about LASIK. That's fine...I'm the guy to ask! I'm not a surgeon, but we comanage LASIK and I actually had LASIK in March of 2007.

I've blogged about this before, but occasionally its okay to re-blog, right?

The big misconception that I most often hear from patients about LASIK is...for whatever reason they're unhappy with their CORRECTED vision and they think that LASIK will make them see *BETTER* than they've ever seen before. This is just simply not true. Most people see about the same after LASIK as they did through their best glasses Rx. LASIK just removes refractive error. That's it. If your retinal receptor spacing is such that you've "never" had clear vision (or vision that you're satisfied with), even with brand new glasses & contacts on...you will also not have clear vision after LASIK. It will likely be the SAME vision, and it could be WORSE. My vision is actually *very slightly* worse after LASIK than it was before (through my best set of glasses). It is most certainly not better. I'm okay with that because I knew that was a possibility, and the convenience of not having glasses or uncomfortable contacts was worth it to me. But for people whose MAIN GOAL & desire is to SEE BETTER than they've ever seen through glasses...LASIK is not the answer. There probably isn't an answer.

The other big LASIK misconception is that LASIK permanently makes you glasses-free. This is not true because eventually (after 40) everyone needs some form of reading correction because of presbyopia.

And lastly, LASIK does not fix anything other than refractive error. If you see blurry because of amblyopia, cataracts, macular degeneration, etc etc etc...LASIK will not help you.

Why We Cry

2011-09-28T11:53:00.003-05:00

Actually today's post is about "epiphora" or excessive tearing. It's one of the most common complaints we get, and unfortunately one of the most UNSOLVABLE ones.

It makes me laugh when you look up "epiphora" on the internet. There are literally dozens of causes, ranging from allergies to dry eye to contact lenses to conjunctivitis...even GLAUCOMA is listed as a possible (but highly improbable) cause of excessive tearing. So let me break it down into a little real world medicine here:

The vast majority of patients complaining of CHRONIC excessive tearing are over about 50 years of age. Sure when a 12 year old complains of ACUTE tearing I'm thinking possible allergies, but when an 85 year old is mentioning that they deal with it all day every day, it's probably something else.

In said patients over 50, frequently the cause of the tearing is a problem with the punctum or tear-drainage-hole on the lower eyelid near the inner corner. The punctum can become "stenosed" or clenched shut from aging. It can be re-opened with an in-office procedure (punctal dilation), but the procedure can be somewhat uncomfortable, and it frequently re-closes.

Another common cause of excessive tearing in patients over 50 is that the punctum doesn't face "up" anymore; the eyelid margin has turned in (entropion) or is lax & turns out (ectropion). Again this is not easy to fix. A reconstructive eyelid surgery can sometimes help, but it's expensive, its real/bonafide surgery, and sometimes it doesn't work. No guarantees.

So what is to be done? Well there's no easy fix. There are a lot of palliative treatments with varying degrees of success: antihistamine eyedrops to try & eliminate an allergic component, artificial tears to try & alleviate a dryness or tear film evaporative problem (that leads to "reflex" tearing), etc. But there is no one "fix all" treatment for epiphora, unfortunately. You end up having to weigh the inconvenience of your tearing vs the risk & potential (but not guaranteed) reward of surgical procedures. Hey, that's the 2nd blog post in a row that mentions risk/reward. It's a common theme in medicine.

Newsflash: Professionals Disagree

2011-09-08T09:04:00.006-05:00

Sometimes I think I'm becoming a rogue when it comes to contact lens safety. Ok yes "don't share contacts", that's an obvious one. But how about "don't sleep in your contacts" or "NEVER wear your contacts swimming"? Really? NEVER? Come on.

Take, for example, this recent blog post from Women's Day:

Swimming Solutions for Contact Lens Wearers

The following statement appears prominently in the post:

"Always remove contacts before swimming. The chlorine in the pool is alkaline, which can strip away moisture from contact lenses and irritate your eyes"

Really? "ALWAYS" remove your contacts before swimming? I disagree with this. It's a calculated risk. "The chlorine could irritate your eyes", the author states. Yeah? So what? Newsflash: chlorine irritates everyone's eyes, even non-contact lens wearers. Sometimes you have to weigh the risk vs the reward. Would you rather SEE while you swim (and risk IRRITATION!!??) ...or wear your glasses? Because glasses in the pool are oh-so-awesome, right? OH NO YOU COULD POSSIBLY LOSE OR SCRATCH YOUR GLASSES! WHAT THEN!!?? Ok so instead just don't wear any vision correction at all while you swim. How about that? You don't really need to see if your child is drowning or not, right?

I mean I'm obviously being facetious here. Use your best judgement is all I'm saying. YOU have to weigh your potential risk with your potential reward. It's up to you if you want to "risk" possibly having irritated eyes vs seeing what you need to see in the pool with your contacts on. Let's be clear: I am not advocating that everyone "always" wear their contacts while they swim. I'm just saying that IMO...making a blanket statement like everyone should "ALWAYS" remove their contacts before they swim is a little overboard. Use some common sense, is all.

How about "NEVER consume alcohol, it's bad for you". Uh, ok. I'll consider that one tonight over a glass of scotch.

My wife & my son both wear their contacts lenses while they swim...with my blessing.

Contact Lens Fitting: Sometimes 2+2=5

2011-08-18T15:22:00.004-05:00

People kind of think that contact lenses are "1 size fits all" or standard for everyone. I could go into all the reasons why that's not true, but trust me: its not. Gas perms are custom-fit. I always joke that fitting soft contacts is usually like fitting tee-shirts: small, medium, large, X-large, XX large, etc. That's really not true, either, because of base curvature & material, but its a decent analogy that's understood by most of the population. Most adults can't wear small tee-shirts...but SOME can. Most children do not need XX large, but SOME do, etc.

Usually we take auto keratometry readings of a patient's corneal curvature, measure the Rx with refraction, look at the overall diameter of the cornea with a biomicroscope, and pick a contact lens that has an appropriate size & shape, accounting for the patient's preferred modality (if they want to sleep in them or if they've had GPC, etc). This method works well over 95% of the time. Probably more like 99%.

Well I just had a statistical outlier. He was a young patient with a normal-sized cornea, average keratometry readings and a low spherical Rx (no astigmatism). Usually these are slam-dunk cases: put on almost any "median" base curve, average diameter soft lens & he's good to go. Not with this kid, tho. The 1st 4 pairs of lenses we tried on him fit horribly. Excessive movement, displacement, great discomfort, etc. All of those "should" have fit based on his normal corneal measurements, but they very much did not fit. In the end we ended up going with a lens that in theory should have been way too steep for his cornea, but it fit well & was comfortable. Sometimes you can't "play by the rules".

Diplopia aka "Double Vision"

2011-07-31T13:27:00.004-05:00

We get a few patients/referrals a month complaining of "double vision". Things that cause double vision and their solutions are not easily understood by even medical professionals.

Far and away the most common cause of "double vision" is ASTIGMATISM. Uncorrected astigmatism (or any corneal distortion) causes what I call "ghosting', which is 2 images nearly superimposed, but slightly displaced. I consider it a form of blur, not TRUE "double vision" or diplopia". This is an easy fix - glasses/contacts/lasik. If the corneal distortion is from keratoconus or trauma, obviously a special contact lens or possibly even a surgical procedure may be indicated. But *most* people who complain about seeing "two of everything"...they're not talking about true diplopia. They're talking about ghosting. They just don't know what to call it.

True diplopia is: one eye sees one image, the other eye sees a totally different image at a different point in space. You must have 2 working/non-suppressed eyes to experience true diplopia, that's why when anyone asks me about double vision or tells me they think they might have double vision, I ask them "one eye or both eyes?" If you shut one eye and the double vision is still present, that's not diplopia. That's "monocular diplopia", or GHOSTING from astigmatism or corneal distortion (or rarely retinal distortion or "metamorphopsia" like in macular degeneration).

I had a patient tell me they only "see double" when they look closely in a mirror. That's not diplopia...that's not any eye problem at all. That patient just noted (correctly) that there are 2 reflected images from a mirror- one from the mirrored back side of the glass, and another, fainter reflection from the ANTERIOR surface.

I also have parents of strabismus children worried about their children seeing double. That almost never happens. The brain greatly dislikes diplopia (because its fairly disconcerting) and children with "crossed" eyes instead experience SUPPRESSION, not double vision. Suppression is when the brain "ignores" one of the images in order to avoid diplopia. Suppression is a big problem because it usually leads to permanent vision loss in children (amblyopia).

True diplopia usually occurs in adults with a new-onset eye or brain condition. That's why its so interesting in medicine. True double vision implies a new problem that needs to be investigated. Cranial nerve palsies & trauma are the most common causes of true diplopia, and both require a neurological work-up. It's not really usually from any "eye" problem - the eyes themselves are usually fine. Its the muscles/nerves that control them (or not) that are the problem.

The treatment for true diplopia is treatment of the underlying cause of the diplopia - many nerve palsies are self-resolving, but obviously must be monitored by a neurologist or neuro-ophthalmologist. If there is trauma and muscle-entrapment, surgery is indicated to correct that. Some patients can end up with permanent diplopia because their traumatic condition or nerve palsy never really resolves. For those patients we can usually prescribe glasses with PRISM in them to account for the eye/eyes that don't track/move/aim properly. The prism doesn't treat the diplopia, it just accounts for it by bending light to "aim" it in a way where the patient doesn't see double.

A quick note about prism: I could blog all day about it because there are so many misconceptions, but prisms do not "move" your EYE. A prism moves the IMAGE. Even some eye care professionals are confused on this point. I've heard eye care professionals tell patients that the prism glasses "move the eyes so they're aligned" - no, that's absolutely incorrect. Prism glasses move the IMAGE to account for an eye pointing the wrong way. Prism doesn't "treat" diplopia, it just accounts for it.

In short & the main message of this blog post is: MOST people who think they have "double vision", don't. They have ghosting from a corneal problem. Maybe if someone is Googling "double vision" they'll find this post and be a little less anxious about it! It still warrants a visit to an eye doc, tho ;)

Edit: a fellow O.D. emailed me and brought up the topic of binocular vision & vision therapy. While I do not discount the existence of convergence insufficiency (my wife is CI) nor the validity of vision therapy, I do not consider it a "common" cause of diplopia. A "common" cause of headaches, eyestrain, asthenopia - YES. But not diplopia...IMO, anyway. Maybe I'm wrong. But he's right in one aspect - it does deserve a mention in this post.

I'm admittedly a little biased against VT and binocular vision disorders. Here goes my feather-ruffling, but hey! It's my blog! :D I attended SUNY College of Optometry where I received an excellent education. Top notch ocular disease & contact lens training especially. However IMO we spent way, way too much time diagnosing and treating vision therapy problems. My "pediatrics" internship was quite literally all VT. I was...uh...not happy. This was after I had already completed a separate entire VT internship that was all VT. Then I went & did an externship at a VA hospital where I saw a lot of eye disease and learned a lot...but also did a lot of VT. No joke. SUNY was a little bit VT-overboard IMO. Maybe its changed now, I don't know. I haven't been back in 10 years. But they burned me out on VT. I don't practice VT, and I don't diagnose a lot of binocular vision disorders like CI. I do *some*, but its a minute part of our practice. Maybe if I was more interested in it...?

But again, IMO binocular vision problems are probably not a major cause of diplopia.

Ibanez Artwood

2011-07-16T14:25:00.006-05:00

I purchased an Ibanez Artwood series acoustic-electric guitar last Summer in Dallas when I helped my son move from his freshman dorm into an apartment for his sophomore year. After owning it for a year, I'm ready to report on it. Here's basically what happened last Summer:

I had been looking for an affordable (read: under $500) acoustic-electric guitar for gigging & home recording. I sold my vintage Alvarez that I didn't like very much ("vintage" guitars can be seriously overrated IMO but that's a post for another time) a few years ago on Ebay and got good money for it. Then I bought a super cheap Ibanez acoustic-electric for bumming around with. Well I used that guitar way more than I ever thought I would. Multiple recording projects, multiple gigs, leading worship at church, etc etc. It was a good guitar, especially for the money. I was impressed. But one of the things my oldest son was going to do in the Fall of his Sophomore year was take an acoustic guitar class, so I had already given him that Ibanez and was on the hunt for a "better" one for myself.

So I walked into Guitar Center in Dallas just kid of looking. I had not planned on purchasing a guitar that day, I but I had seen the new (at the time) Dean Exotica line of acoustic-electrics on the internet and thought they really looked stylish, so I was at GC to pick one up and try it out. I had already confirmed via phone that GC had a few in stock.

I went in, found the Deans and picked them all up. I didn't just love any of them. I wanted to like them b/c the look was awesome. But none of them had very good sustain, none of them played particularly well, none of them sounded very deep, and all of them had the same horrible on-board tuner. That was the back-breaker for sure...the tuner just sucked. There's no other word for it. It would flash & announce the string was in tune when it wasn't even close. I was very disappointed. Ah well so much for the Dean line (I still think they're absolutely beautiful guitars...maybe with a string change & a new tuner...)

So I went about playing some other acoustic-electrics. Picked up a $2000 Martin...man I just do not see what everyone loves about Martin. I have played literally dozens of them and I have yet to find one I like. I picked up some Taylors...I *do* see what everyone loves about those guitars. They all sound great & feel great to me. But I was not dropping $2500 on a guitar that day.

I picked up my "dream" guitar (for looks, anyway): a Gibson Hummingbird. I hated it. That was a sad realization. Plus that's another $2500 axe. No thanks.

I did like a few Breedloves & Seagulls. Both really good feel & sounds. They were still too pricey, tho. I really didn't want to spend over $500.

Then I picked up an Ibanez Artwood. It didn't have a price tag on it. It was the Ibanez AW30ECE in the Dark Violin Sunburst, and I liked the look okay. The 1st thing I did was play with the on-board tuner. I really wanted my next acoustic guitar to have an on-board tuner. The tuner was fine. It wasn't awe-inspiring exactly right, but it was a heck of a lot closer than some of the other ones I tried. I have a Korg pedal tuner at home that is absolutely dead-on exactly right every time...I love that thing. This tuner on the Ibanez Artwood was not *that* good, but it was a good one. So I got it tuned up. For some reason that day I tuned to drop-D...which at the time I was just starting to get into a little bit (now I'm tuning mostly Eb but again, that's another blog post).

I started playing, and I literally had an "OMG" moment. The sound. Wow. This thing sounded MAGICAL. It really was nice. It whipped every guitar I played that day except for say 3 Taylors and a Breedlove. I played for roughly 10min and loved it. Another great feature is the sanded/smooth neck. I've always preferred those to lacquered necks, but *most* acoustics have lacquered necks, so I figured I might have to settle for another one. But no...this one was sanded & it felt nice.

So I drag a GC kid over there to ask him the price. I had not been shopping Ibanez online like I had the Deans...I had no idea what it cost. I figured it wasn't going to be a Taylor-esque $2500 or anything, but I thought it'd be $700-ish like the Breedloves & Seagulls.

The GC kid comes back with a price: "on sale for $349", he says.

"What?" Did I hear that kid correctly? Uh, I'm going to need a box b/c I'm buying this right now.

I've had it a year now. I play Elixer strings on it. Everywhere I play it people tell me how great it sounds, and it has a unique look with the Dark Sunburst that I have grown to like a lot. I never did like the traditional "natural" color of most acoustics. I love the feel of the smooth non-lacquered neck, and I use the heck out of the on-board tuner. There are other features that I love and have used, that I didn't even know the guitar had when I bought it! The tuner & pre-amp uses AA batteries instead of 9-volt! That's really handy b/c you can get AA's *everywhere* for CHEAP. We always have AA's at our house for all the LCD/DVD/Wii remotes. Who usually has a 9V laying around? I mean *guitarists* do, but nobody else does. Also the guitar sports a 1/4" line out...AND AN XLR OUT! Wow! I've already used the XLR at 2 venues with older sound systems, and it kept me from having to use a direct box. One more thing...the preamp also has a "phase shift" button, that I figured I'd never use. But if I'm lying I'm dying...the very 1st time I ever tried to plug my brand new Ibanez Artwood acoustic-electric into my solid state Vox guitar amp...it sounded TERRIBLE. Beyond terrible. There was some horrible feedback. I nearly panicked. Until, of course, I pressed the phase button and it all instantly went away. Wow, that's cool.

There's one drawback I've found: it doesn't do well with tube electric guitar amps. It sounds funny & feeds back, and the phase shift doesn't help. Tube amps are getting rarer these days, and are almost exclusively for electric guitar anyway, but I thought that was interesting.

But the sound. The thing sounds AMAZING. Really, really good. a whale of a lot better than my old "vintage" Alvarez ever did, and better that most guitars, I'm not joking. I won't name names here, but I have a friend with a vintage Martin worth $5000+ and this thing kills it in sound. I also have another friend with a new Martin and mine sounds better (and has a lot more features). It really is a great guitar. I can't believe it retails for $400 (and I got mine on sale for $350!). I've been playing guitar for 25 years and this is the best acoustic guitar I've ever owned, and *one* of the top 5 guitars I've ever *played*...and its $2100 cheaper than the other 4 in my top 5.

It's a great guitar. I can't say enough about Ibanez & the Artwood series.

Top 5 Most Common Eye Conditions You've Never Heard Of

2011-06-23T12:27:00.003-05:00

All the time I am faced with diagnosing and managing very common ocular & refractive conditions that patients just haven't heard of. They often reply "I have WHAT??". But just b/c you haven't heard the correct name for it doesn't mean it's not common. The following eye conditions are my top 5 most common eye conditions you've never heard of:

1) pinguecula/pingueculitis: a pinguecula is a raised/lumpy degeneration on the surface of the white part of your eye caused by long term heat, wind & UV exposure. They are usually yellow or off-white, prompting many patients to think they have jaundice. "Pingueculitis" is when a pre-existing pinguecula becomes inflamed, usually from ACUTE heat, wind or UV exposure. Although the word "pingueculitis" may sound like I'm saying "pink eye", pingueculitis is not a form of pink eye.

2) Giant Papillary Conjunctivitis: I've repeatedly blogged about this here. Many, many people have it and IMO this condition is underdiagnosed. GPC is when inflammatory bumps or "papules" form on the backside of your eyelids, usually in people with ocular allergy who wear silicone soft contact lenses. My fix is...DAILIES AND STEROIDS.

3) Presbyopia: you'd think everyone would know what this is, but they don't. All that most people know is "when you get older, your vision goes bad". Well that's not entirely true...more like when you get 40+ you start needing reading glasses and bifocals. Everyone will have this problem eventually. LASIK does not fix this problem. It always surprises me how many 42 year olds come in telling me they're "going blind" and when I tell them they need reading glasses/bifocals they're shocked. They've never heard of this problem.

4) Latent hyperopia: poorly understood by the general populus (because its not an easy concept), latency is the very 1st thing I blogged about in 2006. Latent hyperopia is "hidden farsightedness". I tell patients that their "real" Rx is more than they will accept. It sounds contradictory...in a simple world we'd just Rx what we measure, but in reality it usually takes some skill & experience in order to write a good Rx for any farsighted person, especially a latent one. Most lifelong farsighted people will eventually end up with a glasses Rx that they think is "wrong" & they assume the doc was a moron & "didn't take his time" or whatever. Well It ain't all that easy, which is why I usually give the "last eye doctor" a pass on their "horrible" Rx haha! I've certainly been the "moron last eye doctor" to some farsighted patients myself. We all have.

5) Accommodative esotropia: a "crossed" eye in a young person who is moderately or severely farsighted & is not wearing glasses. This understandably freaks parents out when their child has one eye pointing towards their nose. Everyone thinks that a crossed eye is strabismus & surgery is indicated, but MOST "cross-eyed" children just need glasses. "Strabismus", "lazy eye" and "amblyopia" are all generally confused & intermingled among laypeople, and adding in "accommodative esotropia" and a patching regimen doesn't help at all. Its not all that easy to understand.

My "FAVORITE" Contact Lens

2011-05-27T14:44:00.005-05:00

Many patients & every contact lens rep asks me about my "favorite" lenses or "the best" mulitfocal, etc. I usually answer that "the best" contact lens for any given patient is THE ONE THAT FITS THEIR EYE. Have to take into account corneal curvature and diameter (HVID) as well as Rx, lens parameters etc. It can be quite complicated and it is generally much more complicated than the average patient thinks that it is. "The best" lens for a patient varies from patient to patient.

Ok but still...for a given Rx with an average cornea & median HVID & curvatures etc, here are a few of my current "favorites":

SPHERE:
1a) Ciba Air Optix Aqua: like the monthly modality, like the cushioning component, good optics
1b) B&L Purevision 2 HD: again, i like the fact that its a monthly, its a great design with great optics
3) J&J Acuvue Oasys: dislike the 2 week modality but this is a comfortable & safe lens with a HUGE market presence so we have to fit it. Its our #2 bestseller but this blog entry is not about what sells the best...

ASTIGMATISM:
1) Ciba Air Optix for Astigmatism: far and away the best toric I have ever used. I am not "endorsing" Ciba or anything, but this design really is easy to fit & works really well & is comfortable.
2) (intentionally blank)
3) everything else: Acuvue Oasys for Asigmatism, Biofinity Toric, etc etc nothing much new to see here. Some decent designs but nothing special

MULTIFOCAL:
1) Ciba Air Optix Multifocal: pretty good lens. Not too much success with any multifocal but way more success with this one than its competitors
2) Acuvue Oasys for Prebyopia: decent lens

Ok so looking at that list you'd think I'm partial to Ciba & Ciba products, but I'm not. I don't care which manufacturer makes which product. I don't get paid endorsements or "kickbacks" or any of that. Ciba just has better products out there right now in the multifocal & toric arenas, especially the toric. As far as spheres, I do like Purevision 2 HD as good as I've liked any lens. Its equal to Air Optix Aqua in my mind.

So there you have them! My "fav's".

Alcon releases Moxeza

2011-05-17T10:40:00.002-05:00

MOXEZA from Alcon

Billed as "A NEW ophthalmic solution for the treatment of bacterial conjunctivitis". Well, okay. Moxeza is 0.5% moxifloxacin, which is the exact same drug in the exact same concentration as Alcon's older drug Vigamox, which has been available for quite some time. This link says the two are "formulated differently", but does not specify how they are different:

They're different?

Moxeza is to be used twice a day for bacterial conjunctivitis, whereas Vigamox was to be used 3x/day. I'm sure there is some difference in the "formulation", but I'd like to know what it is. I personally doubt they are very "different". I'm pretty cynical, right? :P

the P.A.L.M.P.I. Technique

2011-05-04T15:07:00.003-05:00

I think I may have developed my own technique for identifying the laser mark positioning of toric contact lenses. I have come up with a quick acronym for it:

the
Prince
Astigmatism
Laser
Mark
Position
Identifier
Technique

or "PALMPI" Technique (pronounced "PALM-pie") for short.

Here's how it came about: I have multiple toric contact lens wearing patients who for whatever reason cannot put their head easily into a slit lamp biomicroscope. Either they're too obese or wheelchair-bound or have a head tilt or whatever. So how does one assess the position of the laser marks on the toric lens? Well if they see well out of the torics its easy...its probably close to being positioned correctly. But if they don't see well, then what? Is the lens twisted 10 degrees left? Or 10 degrees right? Or TWENTY degrees?

The ambitious OD would say "do a spherocylindrical over-refraction". Yes, that works. Its also a monumental pain in the rear hahah. the PALMPI Technique is more fast & dirty than that.

Here's now it works. Its easy:

1) with the lenses on, dim the lights & have the patient looking in primary gaze (straight ahead)
2) shine a light (transilluminator, direct ophthalmoscope, MIO, etc) at the pupil as if you were performing pupillary testing
3) look carefully for the shadow of the laser mark projected onto the iris
4) estimate rotation (LARS rule, etc) accordingly

Well it may not be all that big of a revelation to some people, and maybe some OD's already use this previously-unnamed technique. But now it HAS a name! :D Since figuring this out a few weeks ago I've already used it 3-4 times in clinic and it has worked well! Its not as accurate as using a slit lamp, but its not as annoying as a spherocylindrical over-refraction & associated calculations, either.

Dry Eye Zone

2011-04-20T11:55:00.002-05:00

I found this link today & it's very informative! All about the currently-available OTC artificial tears, what their "active ingredient" is, and the preservative used. Very useful information!

http://www.dryeyezone.com/encyclopedia/lubricants.html

Pingueculitis a.k.a. "Inflamed Pinguecula"

2011-04-12T10:18:00.011-05:00

practicing in Texas (and the associated heat, dust, etc) we get a lot of these. I always joke that its one of the most common things no one has ever heard of. Every time I say the word "pingueculitis" the patient inevitably replies "PINK EYE!!??" No, not pink eye. :D

a pinguecula is an inflammatory degeneration or degradation of the bulbar conjunctiva & sclera on the surface of the eye. brought on by "exposure" to high heat, wind, & UV rays, the collagen fibers of the sclera & conjunctiva degrade and deformed elastin fibers are produced. the result is a yellow or off-white bubbly-appearing "bump" or raised lesion on the surface of the eye, usually nasally & temporally only (b/c the superior & inferior conjunctiva is generally protected by the eyelids).

Many, many patients see a pingucula on the surface of their eye, Google "yellow eyes" and come up with "jaundice". I first blogged about this in 2007 (reposted in 2009):

http://myeyepod.blogspot.com/2009/06/visine-pingueculajaundice-dailies.html

jaundiced eyes are EXCEEDINGLY rare. pinguecula is not.

But today we're discussing "pingueculitis" or inflamed pinguecula. the pinguecula is the bump. when the bump becomes irritated, red, painful & bothersome, we call it "pingueculitis". here's how it usually presents:

the patient has a red, painful eye. they go to their PCP and are occasionally prescribed antibiotic eye drops (or maybe they use some eye drops they already had in their medicine cabinet). after 3-4 days of the "pink eye not going away", they present to our office with "pink eye that won't go away". that's of course because antibiotics kill bacteria, but will not solve an inflammatory problem.

the treatment of the acute pain & redness of pingueculitis is steroid eye drops. I usually Rx Lotemax when its mild and Pred Forte when its more severe. steroids do not make the pinguecula any smaller or make it go away, they only make it not inflamed and remove the pain, redness & swelling. the only way to get rid of a pinguecula is to have it surgically excised.

pinguecula formation is usually a response to UV rays & exposure that you got a long time ago. "a lifetime of sunshine" I always say. in other words, you won't develop a pinguecula from a weekend at the beach w/o sunglasses. more like LIVING on the beach w/o sunglasses. a lay term for pinguecula is "farmer's eye" b/c many farmers who don't wear sunglasses or hats or adequate sun protection develop these.

you CAN, however, get pingueculitis from a weekend at the beach w/o sunglasses. in other words, if you have a pre-existing pinguecula it can become inflamed (red, painful) after a particularly high dose of UV (or wind, or heat, etc). even though its called "farmer's eye", BIKERS are at high risk of both pinguecula & pingueculitis because frequently they're out on their motorcycle in the high heat, wind & UV.

active pingueculitis (red, painful - this is a mild case):

other various presentations of non-inflamed pingueculae:

more on EKC (viral keratitis)

2011-03-18T10:18:00.003-05:00

in June of '09 I blogged about using betadine to treat viral keratitis:

Treat EKC with Betadine

I've had good success with this therapy. It works. However, patients generally hate it. Betadine burns. It doesn't just burn when you put it in, it burns for the rest of the day. Plus a lot of patients opt out: when I tell them "this is going to burn", they tell me they don't want to do it.

I just read an article in the Feb 2011 Edition of Refractive Eyecare Magazine about new EKC treatment options:

New Directions in the Diagnosis and Treatment of Viral Conjunctivitis

At the end of the article the author recommends ganciclovir gel (brand name Zirgan) for the topical treatment of viral keratitis. Zirgan is intended for the treatment of herpes simplex keratitis (a different virus) but the author claims efficacy against adenovirus as well. I'm definitely doing to give this a try.

2 Quick Things About Childrens Vision

2011-03-17T10:43:00.004-05:00

I see a lot of pediatrics & I get both of these next 2 topics occurring with my patients more than I'd like to. I'd like to comment on them as politely as I can:

1) LEAVING THE GLASSES AT SCHOOL: children who need glasses need to be able to wear them all the time. I get some teachers/school nurses/counselors/parents who get fed up with a child who forgets to wear their glasses, breaks the glasses, loses the glasses...and the teacher or whomever decides that its a good idea to "leave the glasses at school" so the child can wear them during school hours & not lose them. So they tell a -4.00 myope basically "you can only see during school hours". I think this is a terrible idea. If the child sees poorly w/o glasses, then the child needs to be able to wear them at home, even if its inconvenient for the school. Children lose/break/forget their glasses. Its a fact of life. But don't saddle the kid with poor vision all weekend & 6 hrs a day during the week by leaving the glasses at school.

2) FITTING A CHILD IN CONTACTS BECAUSE THEY LOSE/BREAK THEIR GLASSES: occasionally a parent gets fed up with a child who is irresponsible with their glasses (loses them, breaks them, etc) and their idea is to "just put them in contacts". Their logic is that contacts (if lost) are cheaper to replace and that if the contacts are extended wear, the child is less likely to lose them, break them, forget them vs glasses b/c they can just wear the contacts 24/7. However contacts require MORE responsibility on the patient's part vs glasses...not less. There is more risk when the child does not comply with the regime & wearing schedule of the contacts than there is when they forget/lose/break their glasses. "Just put them in contacts" is not the "answer" for a child who continually breaks/loses/forgets their glasses.

Lastacaft

2011-03-14T13:11:00.003-05:00

got our samples of Lastacaft, Allergan's newest entry into the topical antihistamine market (ant-allergy eye drops).

Designed for once or twice a day to relieve ocular itching, redness, tearing, etc associated with seasonal allergies. This is not a new market, just a new entry. I'll try it & maybe post again, especially if its significantly different (better or worse) than any of the other ones already out there (Patanol/Pataday, Bepreve, Optivar, etc etc etc)

its GPC again, Margaret

2011-02-17T14:15:00.003-06:00

sorry, old Ray Stevens reference :)

the most commented-on blog post ever on this site is from June of '09 about GPC:

http://myeyepod.blogspot.com/2009/06/gpc.html

there is a lot of bad info about GPC on the net. I am not claiming the be a GPC expert or anything, but I guess I think I know more about it than most. I treat it *all the time*. every week here in East Texas where the pollen count is sky high and the college students are wearing contacts way, way more than glasses.

some thoughts on GPC to add for 2011:

1) GPC is vastly under-diagnosed IMO. a whole lot of people who think they're "getting pink eye repeatedly" and whose doctors are even telling them this and Rx'ing antibiotics...a bunch of those are probably really GPC

2) GPC is poorly managed by under-aggressive docs. even when they get the diagnosis correct, which is IMO rare, putting some heavy contact lens wearing college student on Crolom & telling them "don't wear your contacts for a few days" is just not going to work IMO for so many reasons

3) docs are generally scared of prescribing steroids. well that makes treating GPC really difficult (impossible in some cases). pred forte causes cataracts (I've seen it do this). dexamethasone can cause glaucoma (I have also personally witnessed this). so docs are scared of it. understandable. its for those reasons that I don't use pred or dex for treating GPC. Lotemax is very safe. Lotemax is not the same as pred or dex (despite pharmacists telling patients otherwise occasionally).

4) treating GPC is expensive. there is no generic for Lotemax, its too new. dailies are the most expensive modality, and a BUNCH of Rx's are not available in dailies.

5) treating GPC takes patience. some docs & some patients just can't stick with it long eough to solve it

6) GPC can be permanent. some people never get over it. I have at least 2-3 patients off the top of my head that despite my best/most aggressive efforts we never made a dent in their GPC. they just have a hearty immune response. so for them...LASIK or glasses.

for all you who have GPC: good luck. hopefully you found a doc who will Rx you some Lotemax & put you in dailies. if you're getting a Rx for Crolom Patanol, you might need a second opinion.

Myokymia

2011-01-18T09:50:00.007-06:00

myokymia or orbicularis oculi myokymia is benign eyelid twitching. it is most frequently caused by high stress, lack of sleep or too much caffeine. the recommended treatments are: more sleep, less stress, less caffeine. warm compresses usually stop it temporarily as well. it has also been noted anecdotally that topical (eyedrop) antihistamines may help (off label usage). some good ones to try 1st are inexpensive OTC eye drops like Bausch & Lomb "Alaway" or Novartis "Zaditor", which are both ketoifen fumarate. there are multiple generic versions with the same active ingredient.

sometimes some vitamin deficiencies can play a role, so a multivitamin can help.

myokymia is really common. people ask about it on yahoo answers nearly daily. there is some really bad info out there on this subject and i have to "thumbs-down" bad answers on it all the time.

myokymia is not the same as "blepharospam". blepharospasm is facial cranial nerve damage & needs a neurological workup. blepharospasm is CONSTANT. so the easiest way to tell if you have totally benign myokymia vs more serious blepharospasm is:

if it is constant, 24/7, never ever stops...could be blepharospasm
if it comes & goes, its myokymia

also, myokymia only involves the upper or lower eyelids. if its your EYELID thats twitching, its myokymia. blepharospasm almost always involves multiple facial muscles like the muscles that help you "squinch" your eyes together tightly or wink. if its ONLY your eyelid, its myokymia not blepharospasm.

and finally, blepharospasm can be seen by others when they look at you, myokymia almost can never be seen by others. so if you feel it but no one else can see it twitch, then its myokymia.

Wile E. Coyote experiences myokmia. have you seen this on the old Roadrunner cartoons? the roadrunner does something that irritates the coyote & Wile E. Coyote looks at the camera & his facial muscles twitch. this is confusion on the part of the animators...as myokymia is not seen from the outside. I guess thats the only way they can portray that stress, tho.

i am currently sufferring from myokymia myself. i know what my cause is: lack of sleep. i wake up in the morning and i dont twitch...but later in the day it starts. i know i need more sleep & less caffeine but its difficult with work & family. this happens to me a few weeks a year so i'm used to it. no biggie: i usually use topical Bepreve (Rx antihistamine eye drop) b/c we have in-office samples. a warm compress is not really feasible at work.

Kindle, Ipad, Nook May Change Our Profession Some

2010-12-31T09:50:00.003-06:00

more and more of my patients are using e-readers & tablets these days. handheld devices like that (and even Itouch/Iphone/Droid, etc) are quite a bit different for your eyes/vision than doing all of your work/reading on a desktop or laptop computer.

for years us OD's have had a large chunk of our patients spending 8+ hours on their computer at work, then coming home and doing another 1-2 hours on the computer at home. for presbyopes (i.e. patients who need bifocals or reading glasses) this is a nightmare. desktop computers are:

- high in your vision
- at an intermediate distance

so traditional "lined" flat-top bifocals will not work. the bifocal portion of a flat top is LOW in your vision and prescribed for CLOSE. so what do you do for presbyopes who *need* to see great at 20-22 inches and eye level? its not easy. a trifocal has a 7mm tall intermediate portion. 7mm is not very much space vertically. patients have to hold their head very still and aim their face just right in order to use that narrow slit. a progressive or lineless bifocal is what we usually recommend, but the "channel" devoted to intermediate vision in a progressive is very narrow HORIZONTALLY, i.e. back to holding your head just right. so between lined trifocals & progressives for a computer user its usually "pick your poison": have a vertically-narrow 7mm tall slit of intermediate prescription in a lined trifocal, or choose a horizontally-narrow "channel" in a progressive. what a choice.

now back to the e-readers & Ipads: you hold them in your hands...low in your vision and close, like 16" or so. PERFECT for either a bifocal or the bottom portion of a progressive, which is a WIDE "channel". wow, thats a lot easier for us eye-docs to Rx for.

Myopic correction with an orthokeratology lens design creates a myopic defocus in the periphery, which may slow myopic progression

2010-12-07T17:06:00.003-06:00

a new article from Contact Lens Spectrum:

Ortho-k to reduce myopia

BioTrue

2010-12-07T13:17:00.003-06:00

finally got some BioTrue samples today. B+L Purevision 2 to be released in Jan. will post some reaction on BioTrue in a few weeks after some feedback.

i have to admit after kind of dogging Acuvue Advance Plus a few weeks ago, I am liking the "24-pack" idea (thats a year supply for one eye). and the lipid deposit problem with Acuvue Advance does seem to be solved by all initial accounts.

Aggies can PLAY!

2010-11-22T12:28:00.002-06:00

big Texas A&M Aggie football fan here. my Ags are good this year & I'm very happy about it. we're on a 5 game streak including wins over 2 top 10 teams (OU & Nebraska) and a top-25 road win (Baylor).

fun, fun times! tu up next

2 "NEW" Contact Lenses (but not really)

2010-10-10T17:01:00.007-05:00

redesigns, really.

the 1st is "Acuvue Advance Plus". boy, this is gonna confuse patients. i'll give you an abbreviated history of the Acuvue Advance line of products from my point of view:

around 1999/2000 Acuvue Advance (made of galyfilcon) was released. quickly I started seeing something I had never seen before in patients wearing soft contacts: LIPID DEPOSITS. we had all seen protein deposits before but lipid deposits were new, to me anyway. something like 1/5 of all patients I put in that lens came back in 3 days with uncomfortable, blurry lenses with white deposits all over them. Vistakon's official response was: "rub more". uhhh, ok. then RIGHT AFTER THAT (2003?) suddenly Acuvue Oasys (made of senofilcon) comes out. normally its like 10 years between MAJOR spherical lens releases from a manufacturer. this time it was like 2.5. hmmmm. guess they knew they had a dog.

now today I learn about "Acuvue Advance Plus" being released. guess they finally figured out the lipid problem & solved it in the galyfilcon. course they're not telling us exactly WHAT is different, but assumedly its some sort of coating, since I remember them touting that Advance "didn't have any coatings"...but later Oasys did. they just say that the new "Plus" version has "improved cleanliness"...assumedly they imply better lipid deposit resistance...AKA COATING. Acuvue Advanced will no longer be available starting in Nov. patients are gonna be confused. they're gonna think its a "new" lens & they're gonna start asking for it. then the patients who are happy with the OLD Advance lens will probably be UN-happy with the redesign. I'd have just dropped the thing since Oasys is the worldwide bestselling contact lens...but what do I know? why re-brand/re-design & re-release your biggest failure lens? I don't get it. Guess they don't wanna "waste" all the R&D. is Acuvue Advance "Plus" gonna be better than Oasys? a better lens OR a better seller? doubt it. I don't see the point in this move.

ACUVUE ADVANCE PLUS (with "Hydroclear Plus"...thats not redundant at all)

Here's a blurry (how appropriate? haha) photo of the new box from an online retailer who doesn't have it yet to sell:

Then there's also the Purevision 2 lens. Oh, excuse me...Purevision 2 HD, since every lens manufacturer is naming lenses to direct-market to patients nowadays, and "HD" implies "looks cool", so gotta have that in there. patients love technology, and who wouldn't want to see in "HD" !!?? who, indeed.

as far as I can discern from the purposely-vague information B+L (and Vistakon, too for that matter) puts out about the lens, its their same old Purevision material (balafilcon) from what? 1995? but with a thinner profile, smoother edges & "reduced halos & glare", which to me implies increased optic zone size. I guess those are all good qualities to have. I'd have just liked it better if they'd have just called it "PV2" and left off the "HD" moniker.

PUREVISION 2 "HIGH DEFINITION"

so...look for these "new" products to be advertised soon. I'll probably give PV2 a shot at our office. don't know about Acuvue Advance "Plus", tho. Can't get real excited over that one.

Costume Contacts? NOW IS THE TIME

2010-09-22T11:34:00.003-05:00

if you want your Halloween costume to include cosmetic costume contacts...NOW IS THE TIME TO ORDER THEM. they usually run about $50 each (thats $100...not a cheap costume).

every year we get a bunch of people on Friday Oct 29th deciding they want freaky eyes & costume contacts. No, sorry. need to plan better. takes a few weeks.

More Eye "Myths" & a Little Soapboxing

2010-08-25T12:38:00.004-05:00

Ok all over the net you'll read "eye myths" like:

sitting close to the tv makes your vision bad
and
carrots reduce the need for glasses
and
marijuana cures glaucoma

etc etc etc. Those myths are debunked on everyone's page/blog, mine included. But here are some eye myths you may not have read before:

1) "patching" DOES NOT "strengthen eye muscles" or un-cross a crossed eye. I don't know how many times I've read this answer given by people on Yahoo Answers & elsewhere on the net. IT IS NOT TRUE. Not one time in the history of mankind has wearing a patch "strengthened an eye muscle" or helped a crossed (esotropic) eye be straight. That's impossible. Patching does ONE THING & ONE THING ONLY: it can increase the acuity of an amblyopic eye by patching the GOOD eye and forcing the patient to "use" (stop suppressing) the amblyopic eye. THAT'S IT. Patching doesn't "strengthen" anything.

2) not every pink eye is "pink eye". Ok here's my pink eye soapbox:

- sleeping in your contacts & waking up with a red eye is not "pink eye"
- viral keratitis is not treated with antibiotics (AHEM, primary care providers & pediatricians)
- NO ONE can diagnose "pink eye" based on the symptoms. Its impossible. Someone has to look. You can tell me bacterial pink eye is "goopier" or viral pink eye is "watery" or allergic pink eye is yellow discharge vs the green discharge of bacterial pink eye etc etc etc yadda yadda yadda til you're blue in the face. I am telling you that the symptoms don't usually match up "perfectly" with any one diagnosis. All "pink eyes" LOOK the same & feel similar until I examine your cornea with a slit lamp. It makes me laugh when someone says "I know this is not pink eye b/c I had pink eye before & it was blurrier than this", etc. No. Sorry. You don't know if it is or is not pink eye unless some qualified person (i.e. optometrist) looks. School nurse, pediatrician, etc does not count.
- viral "pink eye" (epidemic keratoconjunctivitis) has a latent period of about a week (8 days is what the studies show). So you "have" it way before you show symptoms, and you are exposing your friends coworkers to it a full week before you show symptoms. SO: sending kids home from school & adults home from work for having pink eye is totally worthless. By the time you send someone home they've already exposed everyone they're going to expose. Pointless to send these people home IMO
- do not pressure patch an eye with any form of "pink eye". pressure patching is an old school treatment for a CORNEAL ABRASION.
- throwing away ALL of your makeup when you get diagnosed with pink eye is total overkill. The only people who suggest doing this are primary care providers, and as I suggest above, they probably don't know what you have anyway
- "pink eye" is listed as one of the top reasons people see a doctor. Well that's not surprising b/c if you go to your PCP or the ER with a red eye, you're going to get diagnosed with either "pink eye" or "a scratch" b/c that's the only 2 red eye diagnoses those people know. A *WHOLE BUNCH* of people diagnosed with "pink eye" by their PCP or the ER *do not* have "pink eye". If your eye is red, go to your optometrist or ophthalmologist. The ER doesn't know what you have.
- a cold does not "settle" in your eye & cause pink eye
- no form of "pink eye" is emergent. In fact, viral & bacterial pink eye are both self resolving! The problem, of course, is that some eye conditions which mimic the symptoms of "pink eye" ARE emergent. Actual "pink eye" is NO BIG DEAL. People act like its the plague & uber contagious. Not one time in 11 years have I contracted any form of pink eye from a patient (or anyone else for that matter)

3) NOTHING reduces myopia. NOTHING. Not carrots, eye exercises, supplements, herbs, spices, foods, leafy green vegetables, ginko biloba, St John's wort, bilberry, palming, patching, eye drops, "weak" glasses, wearing glasses, not wearing glasses, plus lenses, bifocals, fish oil, Bates Method, See Clearly Method, "resting" your eyes, "concentrating on black", pinholes, vitamins, lutein, vitamin A, N-O-T-H-I-N-G. Glasses, contacts, LASIK, ortho-k. That's it. No "natural" way to reduce myopia. If this existed in medicine I think we'd be on board by now, and the World Health organization wouldn't have "myopia" listed at the top of their concerns

4) there is a prominent website which I will not name that flat out directly states that ALL OPTOMETRISTS WORLDWIDE are *ALL* secretly involved in a VAST conspiracy to over-prescribe myopes in order to PURPOSELY make them more myopic so that we can sell them more & stronger glasses & get rich. I'm not kidding you this statement exists out there on the net, & it won't even take you very long to find it. That is the most ridiculous statement I have ever heard of. What a bunch of quacks.

5) blue filters & overlays are totally worthless & Scotopic Sensitivity is a bunch of bunk ("IMO", btw so I can't get in too much trouble heheh)

6) I read everywhere that infants are "born with" adult-sized eyes. What? No. Ok I'll admit they're born with eyes that are larger proportionately AND that they're eyes are "ALMOST" adult sized, but factually corneas increase in diameter over time and myopes eyes get longer axially if they're going through juvenile myopia progression. Making a blanket statement like "all infants are born with adult sized eyes" is a gross oversimplification.

7) I also read everywhere that "all infants are born with blue eyes". What? No. Plenty are born with all kinds of colors. Ok all infants have blue eyes at some point in their development in the womb: YES. But "all are born with blue eyes": NO. False.

So there! Bet you haven't read those "eye myths" before, have ya?

Soft Ortho-k? (aka "Softo-k")

2010-08-17T12:45:00.007-05:00

this is cool:

LESSONS IN SOFT ORTHOKERATOLOGY

Basically they are experimentally using inverted high-minus high-modulus (stiff silicone) soft contact lenses for an orth-k effect! Brilliant. I may try this soon in my own office.

Benefits that I can immediately see:

1) COST: those lenses are not expensive
2) COMFORT: an inverted lens is not awesomely comfortable, but could be more so than a custom gas permeable ortho-k lens
3) NOT CUSTOM: could use lenses that we have in-office for immediate dispense

Problems:

1) the big one is that in that article the most they've ever done is -1.75 diopters of myopia. I routinely do -5.00, so that's kind of limiting right there

2) limited number of fitting options. since they're not custom, it'd have to be an average cornea, which is again limiting

3) vision though the lens. one of the "perks" of accelerated ortho-k is that at no time in the day do you see poorly. you see well with the lenses off during the day aftr your cornea has been reshaped, and you ALSO see well through the custom-made gas permeable orth-k lenses while they're on. with soft ortho-k (can I coin the term "softo-k? haha!) they're using a -9.50 soft silicone lens on a maximum amount of myopia of -1.75 diopters. that's nearly an EIGHT DIOPTER difference. so yeah...you won't see well with the lenses on.

I'm still likely going to try it soon, tho!

Some Theories of Mine

2010-08-10T16:49:00.004-05:00

ok so I've been an OD for 10 years. not a long time in the scheme of things. but still...I have a few theories on eyes that I don't think have much information out there on the net & I'd like to share. These theories may be INCORRECT for all I know. I just came up with them based on 10 years of experience, which is admittedly not a lot. Here's what I think:

Theory #1: most spherically nearsighted people are accommodative insufficient. that means as long as you don't have a lot of astigmatism, then I think most nearsighted people don't "focus" their eyes very well. Tonic accommodation & myopia progression are probably factors, as those are accounting for some of their myopia as well as taking away some accomodative amplitude. spherical myopes see awesome up close uncorrected with zero accommodation, and i think sometimes (often?) this affects their accommodative amplitude. some of this is helped with a base-in prismatic effect in glasses, but when spherical myopes wear contact lenses to do heavy near work (computer, etc) they're the ones with all of the "computer vision syndrome" symptoms of headaches, eyestrain, blur, etc. Should we be fitting more of these patients in multifocals? Probably, IMO.

Theory #2: lenticular astigmatism most commonly manifests secondary to constant accommodation. I think that patients with normal corneas who are progressing in their amount of astigmatism in the absence of a change in corneal toricity are probably doing so b/c of constant tonic accommodation.

If there is info out there on these topics, I haven't seen it. If you find some info, please comment below. I'm sure I have other theories I haven't remembered to post here...if/when I do remember them I'll add them later

This'll be a LONG Week

2010-08-02T11:31:00.002-05:00

besides kids & family, I have 2 hobbies:

1) music - guitar, bass guitar, home recording, etc

and

2) TEXAS A&M FOOTBALL. I am a true "fanatic" as I can list all of the players on the 2-deep and much of the entire roster from memory, live & die with every recruit to commits to the Aggies or ditches us for an enemy, watch every win on tivo in excess of 10 times, analyzing every play & re-living the glory, but instantly delete every loss never to be tortured again by it, etc. seriously I have a "problem" :D

anyway Sunday Aug 8 starts fall drills for the Aggie football team. I have been in Aggie sports limbo since the baseball team lost in the playoffs to Miami in May, and football is so close I can smell it.

so yeah. Long week. can't wait.

Corneal Onlays are Here!

2010-07-24T19:52:00.002-05:00

well, in Bogota, at least:

http://www.presbia.com/

I initially blogged about this in Oct of 2007! what a forward-thinker I am! :D

My Old Corneal Onlay Post

so far they're only inserting the lens into one eye for monovision...but myopic Rx's (which is what most of you want) are coming soon, I'm sure.

Glaucoma is Better with Elevated Nocturnal Head Position

2010-07-20T11:08:00.003-05:00

Head-Up Sleeping Position May Keep Intraocular Pressure From Spiking at Night

TORONTO, July 2010 — If you have high eye pressure (IOP), you may want to consider sleeping with an extra pillow under your head.

In a small study of 17 glaucoma patients with controlled IOP and new disc hemorrhage, University of Toronto researchers compared their IOP at regular intervals while asleep and lying flat and while asleep and lying in a 30-degree head-up position.

The researchers measured an IOP reduction in the 30-degree head-up position of 20 percent or more in 35 percent of the subjects, with 16 of the 17 patients having lower IOP in this position than in the lying-flat position.

The study results appeared in Ophthalmology in July.

Now my thoughts on this: a 20 percent decrease in IOP is a very big deal. Most glaucoma patients who initiate topical therapy for their glaucoma have an initial target pressure reduction of 20%! Very interesting, indeed.

Myopia Control: Ortho-k vs Gas Perms

2010-07-18T13:20:00.006-05:00

here's a new journal article discussing "Peripheral Refraction With and Without Contact Lens Correction". it basically compares peripheral refractive error in soft & GP ("hard" or gas permeable lenses). its a bit technical even tho this is just the abstract, but its very interesting. what it says is that gas perms correct peripheral hyperopic refractive error better than soft lenses do. but the super interesting statement is at the end:

"The tradeoff between field curvature and off-axis astigmatism with GP lenses may limit their effectiveness for control of myopia progression."

and what THAT means in English is: while both ortho-k & GP's correct peripheral hyperopic refractive error, GP's likely don't have the same "myopia control" effect as ortho-k lenses do b/c of the GP's tendency to induce oblique, off-axis astigmatism. an interesting finding, for sure:

-----------------------------------------------

Peripheral refractive error degrades the quality of retinal images and has been hypothesized to be a stimulus for the development of refractive error. The purpose of this study was to investigate the changes in refractive error across the horizontal visual field produced by contact lenses (CLs) and to quantify the effect of CLs on peripheral image blur.
A commercial Shack-Hartmann aberrometer measured ocular wavefront aberrations in 5 degrees steps across the central 60 degrees of visual field along the horizontal meridian before and after CLs correction. Wavefront refractions for peripheral lines-of-sight were based on the full elliptical pupil encountered in peripheral measurements. Curvature of field is the change in peripheral spherical equivalent relative to the eye's optical axis.
Hyperopic curvature of field in the naked eye increases with increasing amounts central myopic refractive error as predicted by Atchison (2006). For an eccentricity of E degrees, field curvature is approximately E percent of foveal refractive error. Rigid gas permeable (GP) lenses changed field curvature in the myopic direction twice as much as soft CLs (SCLs). Both of these effects varied with CLs power. For all lens powers, SCL cut the degree of hyperopic field curvature in half whereas GP lenses nearly eliminated field curvature. The benefit of reduced field curvature was partly offset by increased oblique astigmatism. The net reduction of retinal blur because of CLs is approximately constant across the visual field.
The researchers concluded that both SCL and GP lenses reduced the degree of hyperopic field curvature present in myopic eyes, with GP lenses having greater effect. The tradeoff between field curvature and off-axis astigmatism with GP lenses may limit their effectiveness for control of myopia progression. These results suggest that axial growth mechanisms that depend on retinal image quality will be affected more by GP than by SCL lenses.
Shen J, Clark CA, Soni PS, Thibos LN. Peripheral Refraction With and Without Contact Lens Correction. Optom Vis Sci. 2010 Jul 1.

FYI here's the explanation of how ortho-k lenses slow myopia progression:

Negative Image Shell

Study Confirms What Optometrists Have Known Forever

2010-07-13T08:57:00.010-05:00

.
.
Eye Chart "Exams" May Miss Vision Problems

"The tests detect nearsightedness accurately but not farsightedness or astigmatism, study shows"

Yes. I have been screaming this from the mountaintops for 10+ years now. A "school screening" (or DMV "eye test", etc) is not an "eye exam". Those distance-vision acuity tests pretty much only pick up nearsightedness. Children with *significant* visual deficits who are literally at risk for blindness from refractive amblyopia routinely "pass" a visual acuity school screen with flying colors. I don't know how many times I've told a parent their child needed immediate intervention with glasses & patching to treat amblyopia, only to have the parent reply "but she never failed the school eye exam!"

I had a child one time who "passed" the school screening despite a +7.00 refractive error and 15 prism diopter esotropia. The school nurse called me a week later asking "WHY DID YOU PRESCRIBE GLASSES THAT HE DOESN'T NEED!!?? HE READ 20/40!!!!" I replied with an explanation of accommodative esotropia, suppression & 100% chance of amblyopia if not corrected.

A school screen is not an eye exam, and "passing" a school screen unfortunately doesn't mean much.

"Two or More" by TACKAP

2010-07-07T13:27:00.001-05:00

Last nite Dave came over & we finished off our 2nd song, "Two or More"! It's now available for streaming (grey triangle) or download (white triangle):

http://music.kxoj.com/members/191/music.php

The recording process is so funny. Its amazingly different from playing live. I don't want to tell you how many takes it took Dave & I to lay down the 2 electric guitar parts, but it was a lot. Not b/c we couldn't play them, but b/c when you know its going down kind of "permanently", you want to make sure you hit every single note exactly right, bend the solo exactly in tune, get the "pinch" harmonics just right & every note on the beat, etc etc. Its hard & it takes a lot of work.

By contrast, Dave laid down the vocals in only 3 takes, and 1 of those was fine but there was a "clicking" in the background that we couldn't get rid of so we had to change the setting & re-record. So *really* he did it in *2* takes, which is amazing b/c its a wordy song & fairly demanding vocally (not too many spots to breathe). Also the song is so wordy that there are few places to "punch in" if one only wanted to record say the 2nd chorus by itself, for example. On all 3 takes Dave sang the entire song all the way through. That just goes to show where Dave & I's strength is - singing. Most bands have the *most* trouble laying down the vocals/lyrics...we know b/c we've been in the studio with them. But Dave & I are both singers turned instrumentalists, not the other way around. It was the same with "Fly Away"...we got both the vocal tracks down in 5 takes total.

As soon as "Fly Away" went up, all of our friends & family were contacting us asking when the next song would be available. Flattering! I laughed & thought to myself "I don't think these people realize how much time & effort goes into this" haha! But the 2nd song is finally up so go listen to it!

Anyway, just a little insight to what goes on when we're recording. This home-studio thing is really fun! Enjoy the songs, stream them repeatedly & share with your friends!

Matthew 18:20 "For where two or three come together in my name, there am I with them."

2 Samuel 16:12 "It may be that the LORD will see my distress and repay me with good for the cursing I am receiving today."

Circle Lenses

2010-07-06T11:35:00.002-05:00

one of the many questions that comes up daily on Yahoo Answers is about "Circle" lenses...cosmetic "semi-scleral" soft contacts. They're popular right now b/c Lady Gaga wears them in some of her videos.

Here's a New York Times article about the danger of these lenses when used improperly and/or w/o a prescription:

LINK TO A LIBERAL RAG NEWSPAPER THAT'S GOING BANKRUPT, BUT THIS STORY SUITS MY PURPOSES

Did you see what I did there? :D

MIT Android Optometry App

2010-07-05T13:55:00.005-05:00

an Android phone & a camera-like aperture create a refraction device:

ANDROID REFRACTION DEVICE

It is pretty cool. Thanks to my friend "MS" for bringing this to my attention.

I'd use it, especially on mission trips, etc.

There are problems with it, however. We have an aberrometer at our office. You'd think it provides *incredibly* accurate information, right? Well...yes & no. One problem with all objective measurements of refraction is that what you "like" to look through is hardly ever exactly the same as what your eye refractive state actually exists as. Why do you think in the age of computers & software we still painstakingly "ask" you what you "like"? Its not b/c we enjoy doing it or even that we O.D.'s think thats more "accurate". Its not. But still. For example almost *NO* farsighted person can tolerate their actual refractive state. They *all* want "less" power than the amount of farsightedness that their eye actually exists as. I could get into why, but the short version is that its fact.

Another problem is that young nearsighted people will *always* "choose" way more nearsighted power then they actually need. This is the main reason why nearsighted power lenses are not available OTC in the US. What's the harm in wearing "too much?"

1) headaches, eyestrain
2) progressive myopia...wearing too much could "make you worse" over time
3) near vision blur

So when you're looking at this Android device, will nearsighted patients still "over focus" and "choose" way more than they need? Probably. If you watch the video, this is still a "subjective" process. Will farsighted people ever find an Rx they can use? Doubtful IMO, especially for youngsters.

Refraction is easy. A computer can do an objective refraction NO PROBLEM. But "prescribing" is not the same as refraction. In the end, no device will ever "replace" the experience needed to be a good glasses-prescriber.

Another problem with any device but especially "hand held" devices to help determine a refractive state is "proximal accommodation". In short, your eye isn't fooled into thinking its looking far away & it focuses accordingly. So is the result affected by this? Almost assuredly so.

If this type of thing makes it to the US market, I'll buy one. It really could come in handy at screenings or mission trips to remote areas. BUT...implying that it could be used to skip an eye exam or "save a trip to the doctor's office" is pretty ludicrous IMO.

What about eye disease? Peripheral vision loss as in glaucoma? What about media opacities like cataracts or corneal dystrophies? How about fitting contact lenses, or irregular corneal topographies? No device will ever be a substitute for an eye exam.

The video makes it sound like anyone could use it & get a great Rx out of it...which I personally kind of doubt. Docs Rx straight from autorefractors & aberrometers all the time...the bad ones do. Those are the ones that get ridiculed on the net & have a bad reputation for writing "bad" Rx's. This ain't as easy as people presume it to be, even MIT types. If it were, why would you need a doctorate to do it?

Predictability of Color Deficiency

2010-07-03T17:00:00.006-05:00

color deficient males cannot have color deficient children (unless their spouse is a carrier...). BUT: exactly 1/2 of the male GRANDCHILDREN born to the DAUGHTERS of a color deficient person will be color deficient. so *this* really *is* one of those things that "skips a generation", unlike having twins. twins "skipping a generation" is a myth.

color deficiency is carried on the X chromosome. males are XY & females are XX. when a color-deficient male has a son, those males got their normal (not color-deficient) X from their mother and their Y from the color-deficient father, but the Y doesn't carry the color-deficient gene. Almost ALL males born to a color-deficient male will be normal-color-vision (the rare exception would be if the mother was also a carrier from a color-deficient father from another, different bloodline/genepool).

when a color-deficient male has a daughter, the daughter gets one X from their mother & the "defective" color-deficient X from their color-deficient father. these females will be "carriers" for color-deficiency but will not be color-deficient (b/c they have a "normal" X from their mother).

so none of the children of a color-deficient male will be color-deficient, unless the mother was a carrier.

however its when the daughters of color-deficient males have male children...thats when it gets interesting. if the daughters of a color-deficient male have SONS...there is a 50/50 chance those males will be color-deficient, b/c there's a 50/50 chance that the X they get from their mother will be the color-deficient X.

also, 50% of female offspring of color-deficiency carriers will also be carriers (but won't be color-deficient themselves), so 50% of THEIR sons will be color deficient as well.

got your brain wrapped around THAT yet? :D

now lets talk about eye color & "incomplete dominance"...no just kidding. the short version is: no one can predict eye color based on the eye color of the parents b/c of an uber-complicated genetic pattern called "incomplete dominance" that eye color genes exhibit. patients want me to "predict" the color of their baby's eyes...but b/c of incomplete dominance its impossible to do so. no one can.

a post from "T.O.B" (The Other Blog)

2010-07-03T12:06:00.002-05:00

a plug for my other blog, our Contemporary Christian band TACKAP:

http://music.kxoj.com/members/191/

"Two or More" is almost ready. We started over & re-recorded the drums, acoustic, electric & bass. The 1st version had too many little mistakes in it, plus I decided I just couldn't fix the bass line; I ended up playing it straight. Bassists have to admit that sometimes simple is better. I also changed all the sounds: dirtied up the acoustic with just a little crunch, changed the drum beat a little & wrote an overlaying clean, delayed electric guitar sound. Its a lot better.

The lead guitar has to be redone. Dave has to do it - he's good at that stuff. Plus all the vocals have to be laid down so there's work left. But the song is 70% done.

I'm going to have to consider upgrading my Ableton Live. I just have the "Lite" version with 8 tracks, and I've been up against the track number every time. It's only going to get worse. My son Matt tried to convince me to switch to his favorite software but I feel like I *just* got decent at Live so for now I'm resisting.

Anyway its still "coming soon".

In the meantime, click here to listen to our 1st song "Fly Away":

http://music.kxoj.com/members/191/music.php

Click on the grey triangle to stream the song for free! As of right now we're still #1 on that website's "charts"!

Thanks!

Patching Confusion

2010-06-30T12:44:00.005-05:00

there is *a lot* of confusion about this, especially on the internet. when to "patch" & when not to, what patching is for & what its not for and how it works (and how it DOESN'T work).

1st of all NO ONE should patch any eye on their own. you really need an optometrist to prescribe a patching regimen. you can't just patch an eye randomly & hope for improvement..you might even cause damage!

let's talk about what patching is: whenever an eye is poorly developing, usually in children under 8, patching is sometimes used to help that eye "catch up" in visual development/acuity. the patch is placed over the GOOD eye (or "better" eye) in order to FORCE the brain to "pay attention" to the "bad" or worse eye.

here's what patching CAN do:

- increase the acuity of an amblyopic eye, especially if instituted before age 8.

here's what patching DOES NOT do:

- "straighten" an eye thats turned (strabismus)
- "strengthen" a muscle thats "weak"
- reduce refractive error
- "lift" an eyelid thats droopy (thats not "lazy eye", thats "ptosis")
- make your vision "perfect" in the bad eye
- replace glasses or contact lenses as a form of vision correction...in fact patching ONLY works when the "bad" eye is wearing the BEST POSSIBLE PRESCRIPTION WHILE THE "GOOD" EYE IS PATCHED.
- fix "blindness"...amblyopia is not "blindness". a "blind" eye will not benefit from a patching regimen. FREQUENTLY patients with retinopathy or corneal conditions or macular degeneration will try to improve the vision of their "bad" eye by patching the good eye...NO. stop.

ONLY patch under DIRECT supervision of an optometrist, and ONLY while you are wearing the best possible glasses/contacts Rx. do not patch on your own, and patching does not "replace" vision correction

My Other Blog

2010-06-29T09:52:00.002-05:00

I was going to entitle this entry "The Other Me", but that would imply I'm multiple personality...or maybe since I have an identical twin brother it might be making some twin joke, so I refrained.

I have another blog. its HERE

That's the website of a Christian radio station in Oklahoma that allows artists to upload a limited number of their original Christian music for free, and makes them available for streaming and download, also for free. Its pretty cool. They even have a "chart" where the most streamed/downloaded songs are at the top:

KXOJ CHART

My twin borther & I have an entry this week, the song is called "Fly Away". We call ourselves "TACKAP" (its an acronym). Here is our BIO page:

TACKAP BIO

and here is the link to our song page (currently only 1 song available for stream/download...its "Fly Away". But coming soon are more):

SONG PAGE - click to stream/download for free

so, anyway read up if you desire & click to listen to our music free!

Travatan Discontinued

2010-06-28T11:17:00.002-05:00

Alcon is no longer going to make/distribute/sell the prostaglandin-analog glaucoma medication Travatan. They are instead going to promote their newer, less irritating Travatan-Z version, which does not contain benzalkonium chloride (BAK), a preservative that a large portion of the population has sensitivity reactions to.

TRAVATAN DISCONTINUED

This is more of a nuisance than a problem, as most eye care practitioners agree that Travatan-Z is the better formula. They have the same exact drug in the same concentration, its just that the Travatan-Z version has a less-irritating preservative.

Axial Length, Accommodation & Myopia Progression

2010-06-26T10:16:00.006-05:00

Here's a new study that I find very interesting. It possibly links myopia progression with reading. We have long suspected that heavy near-work could & probably does increase nearsightedness over time, but now here's a postulated theory on the exact mechanism of that myopia progression. It doesn't immediately change how we're going to go about treating myopia progression: I still don't believe "eye exercises" will reverse myopia, as is claimed by many (especially those selling books on the subject). I am still going to treat/prevent myopia progression in children by recommending ortho-k for its "negative image shell" mechanism of action that has been proven to work. After all, can I realistically tell a parent & child "sorry, your child's myopia progression is caused by too much reading, so stop"? That's not feasible. Plus, how much reading is "too much"? Just like everything, its probably different for every child, and children who are already myopic are probably more likely to get more nearsighted with less reading vs non-myopic children. Atropine can & does stop accommodation...maybe now we know how that method of treatment could prevent associated axial lengthening? All very interesting, however I don't foresee me recommending a lot of atropine for children: too many side effects & not enough evidence that it works. Plus the compliance is really low. A drop that burns like fire AND ALSO makes your vision terrible...hmmmm...yeah kids don't like that a lot.

So basically I doubt I'll be doing anything too differently, but I still think this is a fascinating finding.

Axial Length Changes During Accommodation in Myopes and Emmetropes

A total of 40 young adult subjects had ocular biometry measured using a noncontact optical biometer (Lenstar LS 900) based on the principle of optical low coherence reflectometry under three different accommodation demands (0 D, 3 D, and 6 D) to investigate the influence of accommodation on axial length (AXL) and a comprehensive range of ocular biometric parameters in populations of young adult myopic and emmetropic subjects. Subjects were classified as emmetropes (n = 19) or myopes (n = 21) based on their spherical equivalent refraction (mean emmetropic refraction –0.05 ± 0.27 D sphere and mean myopic refraction –1.82 ± 0.84 D sphere).

AXL changed significantly with accommodation, with a mean increase of 11.9 ± 12.3 µm and 24.1 ± 22.7 µm for the 3 D and 6 D accommodation stimuli, respectively. A significant axial elongation associated with accommodation was still evident even after correction of the AXL data for potential error because of lens thickness change. The mean “corrected” increase in AXL was 5.2 ± 11.2 µm and 7.4 ± 18.9 µm for the 3 D and 6 D stimuli, respectively.

There was no significant difference between the myopic and emmetropic populations in terms of the magnitude of change in AXL with accommodation, regardless of whether the data were corrected or not. A number of other ocular biometric parameters, such as anterior chamber depth, lens thickness, and vitreous chamber depth also exhibited significant change with accommodation. The myopic and emmetropic populations also exhibited no significant difference in the magnitude of change in these parameters with accommodation.

The eye undergoes a significant axial elongation associated with a brief period of accommodation, and the magnitude of this change in eye length increases for larger accommodation demands, however, there is no significant difference in the magnitude of eye elongation in myopic and emmetropic subjects.

SOURCE: Read SA, Collins MJ, Woodman EC, Cheong SH. Axial Length Changes During Accommodation in Myopes and Emmetropes. Optom Vis Sci. 2010 Jun 17

Sorry, there's no link

Azasite for MGD

2010-06-24T13:37:00.010-05:00

meibomian gland dysfunction is a super common form of blepharitis or eyelid margin inflammation. i see at least a few cases a week, some of them I classify as "raging". blepharitis & MGD can be responsible for all of the following symptoms & more:

BURNING...probably the #2 cause of burning behind dry eye
blur
dryness
red/irritated eyelids
frequent stye formation
loss of eyelashes

traditionally the treatment for both MGD & other forms of blepharitis have been warm compresses & "lid scrubs" like you see up top (Ocusoft brand...thats my favorite).

I still think lid scrubs is the best way to treat MGD. however for some patients lid scrubs aren't enough, and some patients aren't coordinated enough or compliant enough to reliably do eyelid cleansing.

well now studies show that a macrolide antibiotic eyedrop called Azasite works well to treat MGD. antibiotic eyedrops in general usually don't work well against MGD & bleph, but Azasite does b/c of its inherent anti-inflammatory properties as well as its ability to modify eyelid metabolism & oil-secretion function.

I have yet to Rx Azasite for MGD, but after reading about it more today, I'm going to try it for my next "raging" case of meibomian gland dysfunction.

Its Finally Here! 1-Day Acuvue TruEye

2010-06-21T16:05:00.005-05:00

Well, its *almost* here. The FDA signed off on it and now we're just waiting on J+J to "release" it in the US & send us samples, etc.

1-Day TruEye is not really all that new. Its been available in Europe for some time...I remember someone asking me on a contact lens message board about it in *2006*. but it is new to the US market.

what makes it new & different? its the very 1st silicone hydrogel daily disposable. thats super interesting, as is kind of "solves" multiple problems: you get the hygiene, theoretical compliance & no-solution-allergy of a daily disposable combined with the oxygen permeability & all day comfort of a silicone lens. all in theory of course.

i have 2 concerns with this product, and i havent seen it yet:

1) cost. the 1-day acuvue moist is the most expensive daily disposable on the market. many patients are turned off by it for that reason. the TruEye has to be even more, wouldn't you think?

2) abuse. silicone lenses tend to be durable lenses with generally low water contents & high moduli. a silicone lens like O2 Optix will "last" and stand up to quite a bit of abuse, whereas a floppy/fragile lens like Biomedics XC will fall apart. most dailies fall apart rather quickly b/c of their high water content, plastic material & low modulus. but a SILICONE daily seems to me to be an "abuse-able" lens. seems like if it held up to more than 1 wear...patients would just wear it repeatedly, which negates the "1-Day" compliance. maybe J+J has made some adjustment accounting for this that I don't know about (but I doubt it). We'll see!

1-Day Acuvue TrueEye

The BigHorn Conference

2010-06-18T15:48:00.003-05:00

To say that I'm not a "fan" of the renegotiated Big12-2 Conference is a severe understatement. The President & Admin of my beloved Texas A&M University threw the fans, alum & donors under the bus by taking our 90+% majority preference to go to the SEC and telling us to "shut up, we know what's best for you. You'll stay in the Little BigHorn Conference & you'll like it".

All for the promise of "magic bean" Fox tv money and a pathetic attempt at making UT look like the hero for God knows what reason. Nevermind the fact that donor $$ & ticket sales will plummet when they could have soared.

The whole thing makes me sick. It is very apparent that Texas A&M has one of the greatest fan bases in college sports, only to be usurped by Dr. Bowen Loftin, et al who are very obviously puppets for their "masters", the University of Texas & their AD.

Puke. Sad days to be an Aggie.

BioTrue Contact Lens Soluion from B+L

2010-06-03T13:20:00.005-05:00

Bausch + Lomb finally has a new entry into the soft contact lens care & solutions market: BioTrue. This is their first *new* entry into this market since the Renu Moistureloc debacle/recall in 2005

Interesting as I haven't heard anything about this until today. The website is not super informative. it just states that BioTrue "matches the pH of healthy tears, utilizes a lubricant found naturally in the eyes, & keeps certain beneficial tear proteins active". All great claims, but what we really really want to know is whether its compatible with silicone hydrogel contact lenses or not, as no B+L product right now is compatible. The BioTrue website doesn't say either way. Moistureloc was compatible with silicone, but of course it had a fungus problem. I bet BioTrue is compatible. I'd be surprised if they did all that R+D only to release another lens solution that wasn't compatible with half of the contacts currently available, including their own biggest line of products: Purevision.

I'm pretty excited for a number of reasons: new products are always good, as is competition in the marketplace. Can't wait to get some samples!

edit: here's more info on BioTrue from Contact Lens Spectrum:

http://www.cltoday.com/issues/CLToday_060610.htm

"Bausch + Lomb (B+L) announced the launch of Biotrue multi-purpose solution across the U.S. Biotrue multi-purpose solution is bio-inspired to work like the eyes to help lenses stay clean and moist throughout the day, according to the company.
B+L reports that Biotrue was developed following intensive study on how the eye naturally works to clean, hydrate and keep itself healthy. It has exceptional disinfection properties, and is formulated to work like the eyes with three bio-inspired innovations. Firstly, it is pH-balanced to match healthy tears, helping to maintain the eye's natural condition and enabling optimal activation of Biotrue's dual disinfectants. In clinical trials 81% of patients who tried the solution said it felt like their natural tears.
The second innovation noted by the company is the use of hyaluronan, a natural lubricant found in the body and in the eye. This helps attract water to envelop lenses in a moisture-rich cushion and to stabilize the tear film and reduce friction. Even after 20 hours, a high level of hyaluronan has been shown to remain on both hydrogel and silicone-hydrogel lenses, helping to provide all day comfort. The third innovation is how Biotrue keeps certain beneficial tear proteins active longer. It surrounds and protects lysozyme, a protein found in tears, helping to maintain its natural antimicrobial activity and prevent denaturization. Additionally, Biotrue lifts and dissolves denatured proteins.
"By studying the eye, we're able not only to observe natural processes that have been proven evolutionarily, but we're also able to develop health care solutions that work with the body, rather than interfering with it," said Mo Merchea, Medical Affairs Manager, North America, Vision Care at Bausch + Lomb. "Biotrue uses the science of the eye itself, and therefore the lens care solution is optimally designed to work within the eye."
Biotrue exceeds FDA/ISO stand-alone procedure for disinfecting products and, according to information supplied by the company, it also has been tested against a broad range of bacteria and fungi, collected from clinically worn lenses, lens cases and infected eyes. It achieves consistently high log reductions against staphylococcus aureus, MRSA and fusarium solani and is also effective against acanthamoeba cysts and tryphozoites.
Beginning in this month, Biotrue multi-purpose solution will be available at retailers across the U.S. Biotrue features a clear bottle that allows the patient to track how much solution remains and comes in a range of sizes."

That article does specifically mention silicone hydrogel lenses, so thats promising!

Lacrisert

2010-05-18T10:13:00.008-05:00

we just received professional samples of Lacrisert. its not super new, but I have to admit that I've never Rx'd it.

Lacrisert is conjunctival insert for treatment & relief of Dry Eye Syndrome. most dry eye sufferers start with artificial tears & do okay. but for some of them the artificial tears aren't enough...they're still dry & they have to administer artificial tears every hour, which is inconvenient.

for others they become sensitive to the preservatives in some artificial tear products & have a red-eye reaction, which defeats the purpose of a soothing, lubricating eye drop.

other treatments for dry eye include punctal plugs, which I never have been a huge fan of, and prescription Restasis eyedrops, which sting & don't always provide relief. both of those treatments really only work in "aqueous deficient" dry eye cases where tear production is low, but neither of them works well in "evaporative" dry eye where the tear film evaporates quickly.

Lacrisert is basically a slow-release artifical tear insert. you put the tiny insert into your lower conjunctival sac & it slowly dissolves over the course of a day, eliminating the need for any eyedrop insertion, prescription or otherwise. it also works for both aqueous deficient & evaporative dry eye. its preservative-free which prevents secondary reactions of redness & discomfort.

we got our samples yesterday & I plan on trying it out soon! I'll let you know how it goes!

http://www.lacrisert.com/

Adjustable Glasses!!??

2010-05-04T20:34:00.002-05:00

awesome!

http://www.geek.com/articles/gadgets/joshua-silvers-silicon-injected-eyeglasses-for-the-poor-20090326/

some problems:

1) ugly
2) only spheres (no cylinder)
3) limited parameters (although admittedly +6.00 to -6.00 is pretty impressive)

interesting nonetheless!

"Vision Declines with Age"

2010-04-27T09:49:00.005-05:00

ok true or false on the following statement?

vision "declines" with age.

what do you think?

I'll tell you what *I* think:

false. that statement groups all refractive errors together. *some* refractive errors GET BETTER with aging! here's a rough refractive error scale to look at:

(farsighted)
+4
+3
+2
+1
0 ---- prescriptionless or "plano"
-1
-2
-3
-4
(nearsighted)

most people move DOWN that scale in their teens. so...farsighted patients get LESS farsighted (closer to zero) or "better" as they "age". nearsighted people are generally getting more nearsighted or "worse" in their teens.

also though...

most people move UP that scale in their late 30's/early 40's. for nearsighted people...they're getting "BETTER" during this time! not worse. they're moving up the scale, closer to zero, less nearsighted. is that "declining with age?" no...its not. farsighted people tho...they are most certainly "getting worse" (farther away from zero, more farsighted) in their late 30's/early 40's. they're not happy during this time.

so you see...you cannot accurately use blanket statements like "vision declines with age" or "vision only gets worse with time". those statements just aren't true. its not even true for "most" people. its not like "most" people "decline" but there are a few exceptions....literally at any given point there are probably as many farsighted & nearsighted people "getting better" or closer to zero than there are patients "getting worse" or farther from zero.

there is one glaring exception & that is presbyopia or the need for reading glasses/bifocals. that starts in the early 40's and generally "gets worse" for everyone (every mammal, actually). maybe thats what people are talking about when they say "vision declines with age"...except that that's not how that statement is generally used: its often used to imply ALL refractive errors worsen over time, which....is false.

"I keep getting pink eye"

2010-04-07T12:20:00.003-05:00

if you are a contact lens wearer and your eyes get red/irritated/itchy/watery/goopy/blurry...and the symptoms lighten up or go away when you stop wearing contacts, and the symptoms progressively worsen with contacts on...

thats not "pink eye".

many, many people come in telling us they "caught pink eye again" or they "get pink eye all the time". they're not catching contagious viral or bacterial "pink eye" repeatedly. rather, those patients almost always have some type of contact lens related inflammatory problem, the most common of which IMO is "GPC" or giant papillary conjunctivitis which i have blogged about repeatedly:

http://myeyepod.blogspot.com/2009/06/gpc.html

treatment from our office (highly successful treatment, might add) usually involves a short course of anti-inflammatory (steroid) eye drops and a switch to a different type of contact lens, usually dailies b/c they're thin & low modulus (stiffness).

any red eye warrants a visit. but frequently these patients tell these symptoms to their primary care provider (not their optometrist) and invariably the PCP Rx's antibiotics for "pink eye".

3-D blockbusters can cause headaches/eyestrain

2010-04-05T09:13:00.004-05:00

something us O.D.'s have known for quite some time but some of the general public is just now figuring out: 3D can hurt your head. it doesn't "damage" your eyes or vision or anything, but for some people it can be an unpleasant experience:

ARTICLE ABOUT 3D MOVIE EYESTRAIN

all 3D movies work in basically the same way: the right eye sees a different image than the left eye. well that only works if:

a) the right & left images are both clear
b) the right & left images are the same size as each other (ballpark same Rx)
c) your brain is "paying attention" to both images (no "suppression")
d) your brain can "fuse" the separate images into one
e) both eyes are able to accurately point the correct direction (converge/diverge)

a lot of assumptions there. i guesstimate that conservatively 10-15% of the general populous can't get the effect at all or it gives them a monster headache to do it. heck 5+% of the population has refractive amblyopia and absolutely cannot do it at all, so the number of people who have an unpleasant experience with 3D movies could be much higher than 10-15%.

good thing you can usually see the films in 2D. cheaper that way, anyway.

current blockbuster 3D films:

AVATAR
HOW TO TRAIN YOUR DRAGON
CLASH OF THE TITANS

Laser for Cataract?

2010-03-24T11:31:00.003-05:00

every week someone asks me if they can have "laser eye surgery" for their cataracts, or tells me that they know someone who HAD laser for cataracts.

no, they didnt. they're just confused/misinformed. currently THE ONLY treatment for cataracts is cataract extraction surgery: complete removal of the cataract & replacement with an acrylic or silicone implant. no one has had their cataracts removed with a laser. that doesn't exist.

the confusion likely arises from the formation of posterior capsular opacification: some patients bodies put "debris" (cells, fibers, etc) on the backside of their NEW IMPLANT after cataract surgery. the debris can be removed with a laser procedure (not LASIK but rather "yag capsulotomy"). posterior capsular opacification is often called "after-cataract"...so the lay term "after-cataract" often gets confused with an actual diagnosis of cataract. they are not the same.

ok now:

A NEW article in the NYT suggests that research is being done to possibly treat cataracts with a laser:

Laser Treatment May Work for Cataracts

I personally kind of doubt this line of thinking will work for treating cataracts, but I'm just reporting the news. Plus i need an explanation (this blog post) to point to when patients ask me about "laser for cataracts", which if this news article is very widely read I figure the questions about "laser for cataracts" are about to increase exponentially.

Negative Image Shell

2010-03-19T12:37:00.003-05:00

an explanation from Cary M. Herzberg, OD on the mechanism of ortho-k myopia control:

Image Shells and Ortho-k: Preventive Care With the discovery of the phenomenon of form deprivation myopia, research has demonstrated that ocular growth and refractive development are regulated by visual feedback associated with the eye's refractive status. The conclusions of Dr. Earl Smith and colleagues (2009) point to the peripheral retina in primates as being more influential for controlling eye growth than previously thought possible. When susceptible visual systems are corrected with myopic lenses, it creates an image shell described as a positive curvature of field. These visual systems, while being corrected centrally, suffer from a relative hyperopia peripherally that causes conflicting visual stimulus. The result is elongation of the eye to correct the peripheral hyperopia. If, however, the peripheral retina is experiencing a relative myopia effect (negative curvature of field), then elongation may slow. The measurement of this discrepancy between peripheral and central retina is performed via peripheral refraction (Mutti, 2007).

Unlike conventional methods of correcting myopia such as glasses or regular contact lenses, myopia-correcting corneal reshaping lenses create a negative image shell on the retina of a treated patient (Figure 1). It is not yet apparent what ortho-k design is optimal to accomplish the best image shell. It may also be possible to track changes in peripheral refraction through corneal topography. Future research will include the optimization of orthokeratology to correct peripheral refractive error and the development of testing equipment that can measure a patient's susceptibility to develop myopia based on peripheral refraction (Mutti, 2007). This could lead to early treatment with corneal reshaping of those patients most susceptible to axial elongation of the eye (Cross, 2008). It is with great optimism that I look forward to a future of improved, efficient, and efficacious delivery of corneal reshaping products to solve our patients' corneal and refractive conditions.

excerpt from THIS ARTICLE

Hormone Replacement Therapy May Cause Cataracts

2010-03-04T13:23:00.002-06:00

a new study from Sweeden says

Interesting. It also links alcohol consumption as a possible factor, and goes on to say that naturally-occurring estrogen probably protects the eye from cataracts, while exogenous hormone supplements do not.

Drug companies, marketing & the patient

2010-02-16T15:53:00.005-06:00

so here's what just happened: my staff hands me a chart & tells me the patient has been using "Zyrtec eyedrops".

"that can't be", I say, "because Zyrtec is a PILL. You must mean some other eye drop."

"No, the bottle said 'Zyrtec'", my assistant says.

"No, it didn't.", I laughingly replied. After all there are lots of eye drops that start with a "Z": Zylet, Zaditor, Zymar, etc.

Sure enough I go in the exam room & the patient is holding a bottle of eye drops that clearly says "Zyrtec".

I keep up with this stuff. I know what "new" eye drops are coming on the market months, sometimes even years before they're available. There is not a "new" anti-allergy eye drop formula in the works by any manufacturer. I know there isn't b/c I routinely research this stuff. "Zyrtec" (the pill) is cetirizone hydrochloride, of which there is not currently, nor is there going to be, an ophthalmic formulation any time soon.

Sure enough I read the label: "Zyrtec" eye drops are ketoifen fumarate...a drug thats been around in eye drop form since at least 1999, and available OTC since around Jan of 2007. Marketed by Bausch & Lomb as "Alaway" & by Novartis as "Zaditor".

Look I have no problem admitting when I am "wrong", but I'm not wrong. My assistant wasn't "wrong" either. But I contend that there is STILL not a true "Zyrtec Eye Drop".

Look at this chart:

ZYRTEC PRODUCT COMPARISON

of the EIGHT "Zyrtec" products, SEVEN of them are cetirizone hydrochloride. ONE of them (guess which one) is not. The "Zyrtec" eye drop drug is ketoifen fumarate.

Its not the same. That's at best misleading marketing. I don't see how one can justify using a TOTALLY DIFFERENT DRUG and calling it the same "brand name" as another drug.

So, while I did tell my assistant that she was right, the bottle did say "Zyrtec", I contend that I am also not wrong: there is no "Zyrtec" eye drops (i.e. no cetirizone hydrochloride eye drops, as "Zyrtec" is the brand name of the drug cetirizone hydrochloride). There are only ketoifen fumarate eye drops (misleadingly?) labeled with the same "brand name" as cetirizone hydrochloride pills. They are most certainly & unmistakably NOT the same drug...but yet they are somehow allowed to have the same "brand name". Seems..errrrrr... fishy to me to say the least.

Save your vision in a "Curry" ?

2010-02-08T12:49:00.003-06:00

I could have also said "Curry up & save your vision!"

oh, the cheesy puns. apologies.

Aussie study says saffron (an ingredient in most curry recipes) improves vision & may help with macular degeneration. I'm skeptical, but just reporting the news!

THE NEXT MIRACLE SPICE

all the time some researcher announces that some herb/spice/vitamin/mineral/etc is the next big thing to save us all from blindness. the "flavor of the week" so to speak haha! i mean maybe this has some merit...we'll see! further studies are needed before we all go start eating Indian food at every meal.

College Basketball

2010-01-27T10:56:00.003-06:00

I love college basketball. specifically Texas A&M & Big 12 basketball. much to the chagrin of my wife i watch 3-4 games a week starting in Jan (conference play).

teams I love: Texas A&M

teams I loathe: Baylor, tu

Last nite I got to watch Baylor lose at home (Waco). That was fun...almost as fun as getting to watch my Aggies win!

Tonight: A&M at Oklahoma State. I don't think we pull off a win. Road games in the Big12 (or any big basketball conference) are really difficult. But were we to win it'd be great!

Axis Intolerant

2010-01-25T09:30:00.003-06:00

another new term I think I just made up. Its like "lactose intolerant" but for people who have problems with the orientation of their astigmatism.

as a person who has formerly had significant astigmatism (see here) I know from personal experience that sometimes for some people a TINY change in amount or orientation of astigmatism can really make a difference in their vision. sometimes even if its "within tolerance" (i.e. close enough by government standards) a difference can still cause a problem.

its ok. I always say: "you have the right to see as clearly as I can make you see". We have no problem rechecking your Rx or remaking it if there's a difference in what you're wearing vs what was Rx'd.

Bifocals & Myopia Progression

2010-01-12T15:19:00.004-06:00

as you may know from reading my blog, i'm a big fan of ortho-k & myopia control. there is new data, however that says that PRISMATIC BIFOCAL GLASSES may also help.

Link to LA Times story

I am just reporting the news. However...the last big study I remember from China about myopia control said (falsely) that ortho-k lenses cause acanthamoeba infection (they do not...it was repeatedly debunked by multiple subsequent studies in the U.S., U.K. & Australia). The culprit in that study was thought to be untreated Chinese tap water.

Furthermore MANY American O.D.'s have Rx'd bifocals for children in the last 60 years in an attempt to slow myopia progression, and in my opinion its never worked. In theory adding prism is a little different, b/c there's not such a disconnect between accommodative (focusing) stimulus & stimulus to convergence ("crossing" your eyes to read)...but is it really all that different than traditional bifocals? In bifocal glasses you still have the problem of PERIPHERAL ASPHERIC BLUR, which is thought to be a major contributor in myopia progression. Plus good luck getting the average kid to wear "bifocals". Boy you think we have enough problems with compliance with glasses...just add in bifocals to that equation.

The good news, I guess, is that Medicaid & some insurance providers will probably pay for a child to have bifocals if Rx'd, whereas ortho-k is still totally un-insured. So now parents may have a myopia control option that they could afford on their plan.

I doubt I'll be Rx-ing many pediatric bifocals for myopia control, especially until/unless I read some non-Chinese study confirming the results. Who knows, tho?

Bowl Games

2009-12-26T18:43:00.002-06:00

my Texas A&M Aggies play Georgia in the Independence Bowl in a few days. unfortunately i'm pretty jazzed about it. i say "unfortunately" because it seems like every Aggie game that i think could be a turn-the-corner/gain momentum type game...we get not only beat but blown out/totally embarrassed on tv.

please, please, please prove me wrong, Ags. i'm beggin' ya.

to add insult to injury, the t-sips (t.u., texas wronghorns) lucked into the national championship game with Bama by hitting a 49 yd FG in the Big 12 Championship game vs Nebraska after time had expired... buuuuut the refs put time back on the clock after reviewing film...which of course was illegal b/c that is not a reviewable play. if you read the rules, its not like basketball where you can look at the clock to see how much time is left. there is a very unique & specific set of instances in which a play can be reviewed, and "checking to see if there is time left on the clock" is not one of them.

so yeah. ROLL TIDE!!!!!!!!!!!!

More Ortho-k

2009-12-25T10:02:00.005-06:00

I am not obsessed with ortho-k, i promise. But there is so little info on the web about it, and some of the info out there is just flat out old & wrong & needs to be corrected, so i keep blogging about it.

I am also not anti-lasik. i had lasik in March of 2008 & i'm very happy with it. i had a prescription (high astigmatism) that does not fall into the parameters of ortho-k.

Today (Christmas Day 2009 by the way...Merry Christmas!) i found this blog entry about ortho-k on an ophthalmologist's blog:

LASIKBLOG

the poster briefly describes the procedure, states that he "doesn't believe" in myopia control, cites an old/debunked journal article that states ortho-k causes acanthamoeba infection, then exclaims that he "doesn't get it", meaning he doesn't understand why anyone would ever undergo ortho-k instead of lasik.

well i feel the need to comment, and i have my own blog with which to do so...so here i go:

1) myopia control may or may not work, but there are multiple, multiple studies indicating that it probably or at the very least possibly does. one can certainly choose what to believe, but just b/c he chooses not to does not make him the definitive answer on the subject. i *do* believe that it works based on my own anecdotal experience with the procedure... and multiple studies agree with me.

2) another citing of the Chinese study that said 100+ children had acanthamoeba corneal infections. sigh. this again? that study has been repeatedly debunked by Western reviews & further studies. it was found that in that particular Chinese study, *tap water* (untreated Chinese tap water, mind you) was used for cleaning & storage of the lenses. well guess where the acanthamoeba came from? anyone who stores any lens in untreated Chinese tap water is at VERY HIGH RISK of acanthamoeba infection. this had exactly zero to do with ortho-k. i can definitively say that ortho-k most certainly does not in & of itself cause acanthamoeba corneal infection. NOT ONE American, Australian, or British ortho-k study has ever reported a single acanthamoeba case. Z-E-R-O.

3) he correctly points out that ortho-k is reversible. if you stop wearing the lenses at night, you go back to how you were (but not as myopic as you would have progressed to if you believe in myopia control!). so if it doesn't "last", why would anyone ever do it? well guess what? lasik sometimes "doesn't last" itself. its called "regression" & its actually quite common:

FDA STATEMENT ON LASIK REGRESSION

4) he "doesn't get it". why would anyone in their right mind choose ortho-k over lasik!!?? as if this is the most absurd thought anyone could ever have. i am not saying ortho-k is "better" than lasik, nor is ortho-k the be-all-&-end-all of vision correction. but i most certainly can give many compelling reasons why someone would be SO ABSURD as to choose ortho-k:

a) children can have ortho-k: if your child wants the benefits of not wearing glasses/contacts, this is their only option if they want to see. interesting that he implies that lasik is safer & ortho-k could be potentially dangerous...except the FDA has cleared ortho-k as being safe & approved for use in children and they have not done so for lasik, nor will they. so according to the FDA, ortho-k is safer.

b) cost: ortho-k runs about half the cost of lasik

c) reversibility: ortho-k is reversible. if something goes wrong you can always go back to how you were. not true in lasik

d) myopia control: if one was to believe the studies saying ortho-k can curb myopia progression (i do, he does not) then one might be compelled to have ortho-k

so the surgeon recommends surgery & kind of implies that anything else is inferior & dangerous. not surprising. well here's the opposing view from the non-surgeon: ortho-k is neither inferior to lasik nor is it dangerous. its just different. another vision correction option.

Jazz G.A.S. & Seller's Remorse

2009-12-20T10:55:00.012-06:00

"G.A.S." is "Guitar Acquisition Syndrome", and i pretty much always have a mild case of it. right now, however, its acute.

so a week ago i traded both my 25-year-old Peavey Patriot bass & my relatively-new Squier Vintage Modified Jazz bass towards a new 5-string bass:

PEAVEY PATRIOT

VINTAGE MODIFIED JAZZ

now i think i'm having a little seller's remorse.

i never played the Peavey. i had it a long time and there are a few memories associated with it, but i generally didnt like it. i didnt like the way it played, i didnt like the single soapbar pickup, i didnt like the way it looked... i only kept it b/c it was my 1st bass. i did some research on it & its not a collector's item. its worth basically nothing except some sentimental value. its heavy & it takes up space. i'm not too broken up about this one.

the Vintage Modified Jazz was the bass i have played exclusively for the last year or so. i loved it. i got a very good price for it, so i dont feel too badly, but since i dont have ANYTHING to play right now, i'm really missing it. it was solid maple, however, and reealllllly heavy.

i guess the kicker is i wish the new bass would get here. maybe that'd solve my G.A.S. problem. i wanted to move "up" to a 5-string bass, as our church's praise team plays a LOT of songs in G, C & D, and i'd like to have the option of playing those notes below the low-E of a 4-string.

here's the bass i ordered...its regrettably not here yet, sigh:

its a SQUIER DELUXE ACTIVE V 5-string Jazz bass. most notably it has 5 strings (the 5th is a low-B), but it also sports a wider & flatter neck which is very easy to play. it also has a unique "ebonol" fingerboard which is a form of synthetic phenolic composite (kind of like fancy rubber) instead of wood. its really smooth, durable, and is advertised to hold up to humidity, which we in East Texas definitely have a problem with. i love the all-black look, as it has the black body, black ebonol fingerboard & matching black headstock. it also has battery-powered "active" electronics, which i hope will make amplification through the church's sound system easier & better, as the sound guys seem to always have a problem putting enough bass into the mix.

as you can probably tell i'm pretty excited about it. i just wish it'd GET HERE! i ordered it from a local shop (lippman music) instead of an internet dealer, so i feel better about that. i keep telling myself i've done the right thing buying locally.

BAH! tomorrow it will have been 10 days since i placed the order and paid in full...my G.A.S. is building up!

1 day early!

2009-12-16T12:00:00.002-06:00

boy yesterday i blog about the "myopia epidemic"...and today its ALL OVER the news. its the top story on yahoo, there's an ABC video about it, and a reuters story on it:

ABC Video

Reuters Story

Myopia Epidemic!

2009-12-15T10:41:00.002-06:00

according to this video:

http://okglobal.org/videos/index.htm

"by the year 2020 we're going to see HALF OF THE PEOPLE IN THE WORLD WILL BE NEARSIGHTED. And this is an amazing trend that has taken place over the last 100 years or so. For instance, in the United States 100 years ago 5% of us were nearsighted. Today over 30% of us are nearsighted."

"This procedure (accelerated orthokeratology) also is the ONLY PROCEDURE THAT CAN CONTROL MYOPIA IN CHILDREN."

Super interesting!

Perception is Reality

2009-12-02T13:48:00.005-06:00

I think I have determined that some long-time myopes (most?) just assume that their Rx is "worse" every single year. I think they also assume that they can always see a *little* better (smidge, hair, scosh, etc) with just a *little* more Rx. FREQUENTLY myopes will come in complaining that their vision is just not as clear as it used to be...and once we examine them we come up with the EXACT same Rx. So why are they perceiving themselves to be blurry if they're already wearing the correct Rx? I have a few ideas:

1) conditioning: they're just SO used to the O.D. telling them their vision has declined EVERY single year, that they expect it to decline, and if they ever see anything not-as-clearly as they think they should, they attribute that sensation to declining vision

2) retinal anatomy: some people are nearsighted b/c of "axial" myopia, or an enlarged eye. This frequently leads to a stretched retina and subsequent spacing of retinal receptors. If retinal receptors (cones, rods, etc) are not densely packed, the "resolution" goes down. Even in the exact correct Rx, these people don't have the potential to see as well as people with normally-spaced retinal receptors

3) corneal anatomy: some myopes are nearsighted b/c of "refractive" myopia, or a cornea that is to "steep" or pointy. such a cornea can induce distortion that is not conducive to having excellent acuity

4) chronic contact lens wear: heavy contact lens wear frequently causes corneal distortion and morphological changes. These are usually not too dangerous, but again are sometimes not conducive to achieving awesome vision

The Commute

2009-10-21T12:29:00.005-05:00

Here's a pic i took with my cameraphone on the way home from work last nite! Came out pretty good given that it was through a cracked windshield!

Myopia Control & SMART Study Make the News Again

2009-10-21T12:13:00.006-05:00

In the news yesterday from a U.K. paper:

New U.K. article about myopia control & the S.M.A.R.T. trial

I've blogged about this before:

HERE

and

HERE

If you read the U.K. article, YES I'm one of the "comments".

We just had another new ortho-k fit yesterday. I guess we have about 1 new fit a week. I'm a big fan

Air Optix Aqua Multifocal

2009-10-19T11:56:00.005-05:00

Air Optix Aqua Multifocal: we got our kit last week, one of the 1st Houston-area practices to receive the kit. As is my usual with the 2000's-era Ciba products, I'm not fond of the name. I mean I understand the marketing of "branding" & creating a unique name, but "Air Optix Aqua Multifocal" is too long. That being said, this is a good product (as were the sphere & toric versions before it). Excellent material for comfort & extended-wear safety, and Ciba really hit a home run with the initial parameter release & kit availability. It gets tedious for us docs when new products are only initially available in limited near-sighted Rx's (no farsighted, and no "high minus"), but Ciba gave us all 3 add powers as well as plus powers & high minus all at one time. BRAVO, CIBA! This marketing strategy is MUCH APPRECIATED!

Now a little about the lens: Air Optix Aqua Multifocal is a silicone hydrogel center-near annular design with 3 add powers (low, med, high) intended for daily wear monthly disposable or up to 6 nights of extended wear (sleeping in your lenses). Its got the same moisturizing component as the Air Optix Aqua spherical lens, and it really works well for maximizing comfort. How it compares to other multifocals on the market as far as vision is concerned is still up for debate. In theory it should be as good or better than other similar annular designs (Acuvue Oasys for Presbyopia, Proclear Multifocal, etc). We'll see!

Phone Medicine

2009-10-05T14:11:00.002-05:00

people ask me all the time to help them figure out whats wrong with their eye over the phone and just "call in" a Rx for it.

the problem with that is that its really difficult. diagnosing eye problems is hard enough when your eye is in front of me, its nigh impossible when i cant see it.

the problem is that most things that turn your eye "red" have all the same symptoms:

blur, redness, foreign-body sensation, watery, goopy, "matted", light sensitive...unfortunately that group of symptoms describes literally dozens of totally different diagnoses with completely different management strategies. pretty much impossible from those symptoms to diagnose allergies vs virus vs angle-closure glaucoma. all of those have totally different clinical presentations, but pretty much identical symptomology.

so yeah...sorry but if your eye is bothering you, come in. we'll work you in to see a doctor. cant do this accurately over the phone.

Conjunctivitis

2009-09-02T10:22:00.003-05:00

i read the other day that "conjunctivitis" is one of the most common diagnoses given out by primary care providers/GP's. i found that very interesting for multiple reasons:

1) any time any GP/nurse practitioner sees an eye that is red, they diagnose "conjunctivitis". technically they're kind of right: conjunctivitis is inflammation of the conjunctiva, or surface layer of the eye. a red eye *is* "itis" of the conjunctiva. the problem with this diagnosis is that its not nearly specific enough. diagnosing a red-eyed patient with "conjunctivitis" is like saying a person who feels malaise is ill. no kidding. but the specific cause of the inflammation absolutely has to be determined before a treatment plan is initiated. "conjunctivitis" aint specific enough: you gotta tell me WHAT KIND of "conjunctivitis" it is. viral, bacterial, inflammatory, allergic. most GP's dont go that far tho. they assume bacterial conjunctivitis & look in their trusty Palm device for the cheapest Rx antibiotics they could write, which is frequently incorrect (I know b/c I see them all later).

2) a lot of the time the patient has SECONDARY "conjunctivitis". in other words, the conjunctiva is inflamed, true, but thats not the primary problem. the conjunctivitis is present b/c of the primary problem. I'll give you a few REALLY common ones. these are non-conjunctivitis eye problems that *FREQUENTLY* get mis-diagnosed & consequently mis-treated by non-eye docs:

iritis: internal inflammation
keratitis: corneal inflammation (also can be viral, bacterial, inflammatory)

if you have a red eye, go to an eye doc. if you are a contact lens wearer & have a red eye, do not go to any non-eye doc practitioner unless its just an emergency.

Motivations for LASIK

2009-09-02T08:50:00.004-05:00

the LASIK radio & internet ads (not so much tv...) are kind of driving me crazy of late.way too many people think LASIK is the answer to all of their vision problems. I am not "anti-LASIK". I *had* LASIK in March of '07, and frequently refer patients for it. But lets get into some misconceptions many people have about the procedure:

1) LASIK is not "better" than glasses & contacts. I mean it is more convenient...if your motivation for LASIK is that you're tired of putting on glasses and/or contacts, or your contacts are uncomfortable, etc, then GREAT! LASIK will simplify your life. but you most likely *WILL NOT* see "better" after LASIK than you do with your current glasses/contacts. I don't wear glasses anymore (which is cool!), but I can tell you that my acuity was better in glasses than it is now after LASIK. if you get LASIK, you should expect your vision to be about the same as it is in glasses & contacts. *NOT* "better".

2) LASIK does not fix presbyopia or the need for reading glasses/bifocals. If you are wearing reading glasses, bifocals, bifocal contacts or monovision contacts and you "just want to be done with it & get LASIK", LASIK is not the answer. You could have monovision LASIK...but if you don't like monovision or reading glasses, you wont like LASIK. if you are over 45 or plan on becoming that way at some point in your life, you *WILL* need reading correction of some kind. LASIK does not remove the need for reading correction of some kind.

3) LASIK works well if you're nearsighted. if you're anything else (farsighted, highly astigmatic, presbyopic) LASIK either doesn't work at all or doesn't work well. sure farsighted LASIK exists, but its not too awesome.

4) LASIK does not fix non-refractive errors. if your vision is blurry from retinal problems, cataracts, macular degeneration, corneal dystrophy, etc etc...LASIK is not the answer.

because of all the above, I tell considerably more people "no" they can't have LASIK than I actually refer for the procedure. if you want to know about LASIK...great! ask! but just ask with the knowledge that a *LOT* of people think LASIK is a "cure-all" and it is not. LASIK makes nearsighted people not nearsighted anymore. THATS IT.

Aggie Football

2009-08-17T14:48:00.001-05:00

I just renewed my Aggie Football season tickets. I'm officially bat-crazy

Took a Week Off...now Back to School!

2009-08-05T14:28:00.002-05:00

this is the busiest time of year for optometrists. we have "back to school" specials on glasses & contacts, and we're booked weeks out. its good b/c we are rolling & making money right now, but it makes for long days with not much lunch break.

ah well. better'n being slow!

Video Games Good for Your Vision?

2009-07-22T15:11:00.001-05:00

a recent study says so:

Action video games heighten contrast sensitivity — indicating a possible method to improve eyesight in pilots or those with impaired vision.

Contrast sensitivity (CS), the ability to detect subtle differences in shading, is a core component of vision that declines with age or with illness but is necessary for object recognition, attention, and driving at night. These researchers examined whether changes in neural processing of visual information could enhance CS in young adults with normal sight.

CS was measured by how accurately subjects could recognize a low-contrast gray-scale area on a computer screen. First, 10 expert action video game players were found to have significantly greater CS at various spatial frequencies than sex- and age-matched nonaction gamers. Then, in a "training" study, 13 nongamers played 50 hours of two action video games or an equally complex and engaging but slower-paced video game (as a control). After training, the action-trained group, but not the control-trained group, had significant improvement of CS (by 43%–58%). In separate studies, detection speed was faster in the groups of expert action game players and action-trained nongamers than in their comparator groups.

Comment: This study suggests that neuroplasticity enhanced by game playing can improve CS in people with normal vision. An editorialist notes that if this is so, game playing might improve vision in individuals with impaired sight and in those whose vision should be enhanced (e.g., pilots). People with ADHD or with attentional disorders associated with neurological insults might benefit from training the brain to process rapidly shifting visual sets. Action video games appear to address many dimensions of information processing, and their benefit generalizes to different situations, not just playing other video games.
— Steven Dubovsky, MD
Published in Journal Watch Psychiatry June 8, 2009

Le Tour

2009-07-19T09:45:00.004-05:00

I'm a big Texas A&M college football fan, college basketball fan & college baseball fan. I don't really follow any pro sports.

Except one: The Tour de France

I did some cycling in high school & college, & competed in a few races, so I know a little more than the average person about the sport, and it keeps me from being so bored in the Summer doldrums when there's no Aggie football, basketball & baseball.

Today is the 1st day of the Alps stages...things will shake up today for sure. GO LANCE!!!

ReNu Rebranding

2009-07-14T09:09:00.002-05:00

a few weeks ago we got a new B+L product...a "Sensitive Eyes" formula of contact lens chemical MPS or multipurpose solution:

blog entry re: Sensitive Eyes

there was not much explanation on how "Sensitive Eyes" was different than the traditional ReNu Multiplus...only that Sensitive Eyes was the 1st new B+L MPS since the failed/recalled "Moistureloc" formula in 2005.

now today i stumbled across this article:

Bausch & Lomb Vision Care Strengthens Its Commitment to ReNu® Brand and the Eye Care Community

it talks about a kind of "Re-branding" of the Renu trademark name. apparently the older/traditional Renu Multiplus will change names and now be called "ReNu Multiplus Fresh Lens Comfort". Same formula, different name.

so how is the "Sensitive Eyes" formula different? well the article implies its the same formula as the Renu Multiplus Fresh lens Comfort, except diluted, and its not a "no rub" formula...a rubbing regimen is recommended:

"Proven to help provide gentle lens care for soft contact lenses, ReNu® Sensitive Eyes® features fewer ingredients and is intended to provide gentle cleaning without sacrificing performance and a high level of disinfection for healthy lens wear. It is specifically formulated to gently draw teardrops to the lenses and create a moisturizing comfort that results in less burning, stinging and irritation for the wearer. The suggested rub regimen also helps to remove potentially irritating particles"

not a bad move, seeing as how IMO Renu Multiplus is GREAT at killing bugs, but sometimes not-so-gentile for some folks.

still- i wish B+L had come up with a totally new formula specifically designed for use with silicone hydrogels (a la their old recalled "Moistureloc" formula and their competitor's and market-leading "Opti-Free Replenish". i guess they're still feeling burned by their 2005 attempt at entry into this market.

the B+L rep is buying our office lunch on Thurs a.m....too bad i wont be there to ask her these questions & talk more about it. but alas i'll be in Dallas taking my oldest son to college orientation & registering him for classes. he's an incoming freshman at University of Texas at Dallas.

the new Renu Multiplus Fresh Lens Comfort website:

http://www.renufresh.com/

Test

2009-07-10T13:14:00.000-05:00

Test to see if posting from my palm smartphone works!

S.M.A.R.T. STUDY YEAR 1 RESULTS

2009-07-09T12:30:00.000-05:00

the "S.M.A.R.T." study is an ongoing myopia control study done by a group of Optometrists using accelerated orthokeratology (the Euclid Systems "Emerald" orthokeratology lens, which is the lens we use in our office). S.M.A.R.T. stands for "Stabilization of Myopia by Accelerated Reshaping Technique" & is a 5-year longitudinal study with the stated purpose of "To determine if the wearing of overnight corneal reshaping lenses influences the progression of myopia in children".

(info taken from their website: http://www.facebook.com/pages/Deerfield-IL/SMART-Clinical-Trial/72558518387#/pages/Deerfield-IL/SMART-Clinical-Trial/72558518387?v=app_2347471856&viewas=725575092):

SMART One Year Results
Refractive Outcomes
Summary:
At 1-Year the change in “best sphere” (= sph. eqv.) for the control group was significantly more myopic than for the test group (p <0.0001) (Test OD +0.02D, OS +0.03D vs. Control OD -0.37D, OS -0.35D)

here's what that means in English: the kids wearing the Emerald ortho-k retainers at night did not get more nearsighted at all. the "control" group who are wearing glasses GOT MORE NEARSIGHTED by an average of -0.4 diopters. so if we catch a kid who is -1.00 diopters at age 10 and put him in ortho-k...

age 11: -1.00, uncorrected vision 20/40 (approx)
age 12: -1.00, uncorrected vision 20/40
age 13: -1.00, uncorrected vision 20/40
age 14: -1.00, uncorrected vision 20/40
age 15: -1.00, uncorrected vision 20/40
age 16: -1.00, uncorrected vision 20/40
age 17: -1.00, uncorrected vision 20/40
age 18: -1.00, uncorrected vision 20/40

if we choose to just go with regular glasses or soft contacts, and we use the data from the year-1 SMART study to extrapolate:

age 11: -1.40, uncorrected vision 20/70 (approx)
age 12: -1.80, uncorrected vision 20/100
age 13: -2.20, uncorrected vision 20/150
age 14: -2.60, uncorrected vision 20/200
age 15: -3.00, uncorrected vision 20/250
age 16: -3.40, uncorrected vision 20/300
age 17: -3.80, uncorrected vision 20/350
age 18: -4.20, uncorrected vision 20/400 ("the big E")

this is why i'm such a big fan of ortho-k in children. yes, its expensive (about $1000-$1500 for both eyes, $500-$750 per eye). but most people will agree that there is a SIGNIFICANT difference in vision between being 20/40 vs 20/400, as well a SIGNIFICANTLY higher dependence on vision correction between being -1.00 and -4.25. if a 20/40 person loses their glasses they can still function. they can still legally drive. a 20/400 person absolutely cannot function in daily life w/o vision correction.

Bausch & Lomb Orthokeratology Promotional Ad

2009-07-04T10:32:00.000-05:00

B&L calls their version of accelerated orthokeratology "VST", short for "Vision Shaping Treatment". This is the system I currently use:

Bausch & Lomb VST Promotional Ad

the video isnt awesomely informative, and they lost my wife when the voice-over said "your corneas will revert back...". thats one of her bad-grammar pet-peeves.

Bausch & Lomb VST website

a good interview with an orthokeratologist

another good video on ortho-k

here's what I always say: "the MOST convenient time to wear contacts is while you're sleeping". of course these are not really "contacts", but rather shaping/retaining lenses...

Just Try it! You'll Like it!

2009-06-24T22:21:00.000-05:00

like "Mikee" in the old LIFE cereal commercials.

if you go to the optometrist and get an exam, and they tell you that they are changing your Rx...when you get the new glasses you are obligated to try it. I never buy the "oh no this won't work!" complaint if you've only had the new glasses on literally less than 1 min, yet people try this seemingly all the time (couple of times a month).

just give it a shot. the doc knows what he's doing and this is the Rx YOU CHOSE during refraction...so we already know you like it. once we've quality-controlled the Rx to make sure its correct, just give it a shot b/c we're not going to "re-make" it until you've tried it a few days 1st.

you'll like it! trust us. we do this for a living. have some faith!

Ortho-k for Astigmats! Dual Axis CRT

2009-06-17T20:29:00.001-05:00

Paragon makes orthokeratology available to a significantly larger patient base with the advent of a "Dual Axis" Corneal Refractive Therapy (CRT) design. the new design makes it possible to treat more amount of astigmatism (up to approx 3.5 diopters of astigmatism according to this recent article) as well as astigmatism that involves a larger area of the cornea ("limbal-to-limbal" astigmatism).

ORTHO-K FOR ASTIGMATS

New Discussion Forum Now Works!

2009-06-17T16:22:00.000-05:00

www.myeyepod.info

ask questions & discuss eye-related topics!

Sensitive Eyes Renu

2009-06-17T14:48:00.000-05:00

2005 was the year Baush & Lomb had a recall with their "Renu with Moistureloc" brand of soft contact lens solution. since that recall B+L was forced to go back to marketing their older "Renu Multiplus" formula, which is a great formula but is not for everyone. some silicone lens wearers and some patients with sensitive eyes have problems using the Multiplus formula.

today we got our 1st samples of B+L's NEW contact lens solution, "Renu for Sensitive eyes", or "Sensitive Eyes Renu". Its so new i couldnt find a picture of it on the web, so i'm uploading a blurry photo i hastily took in the file room with my cell phone so you can see it. assumedly and knowing B+L's distributing practices this stuff will soon be widely available. apologies for the blurry pic, maybe i'll try taking another better one later & uploading it.

anyway i STILL get the occasional misinformed patient who tells me: "Renu is bad, right?". NO Renu is not bad. its perfectly safe and a very good line of products. the "Renu with Moistureloc" that got recalled is in no way related to either Renu Multiplus or this new Sensitive Eyes formula. different formulas made in different facilities. hopefully this one will be a good product! it sounds good!

Aggies National Champs!

2009-06-13T14:27:00.000-05:00

last week the Texas A&M Men's Golf won the national championship in dramatic fashion. today BOTH the Aggie Men's AND the Aggie Women's track & field teams won national championships.

i'm pretty thrilled since i know a track team member (occasionally babysits for us)!

i wish we could just compete in football (last in big 12 south), baseball (6th in big 12), or men's basketball (8th in big 12)...but maybe this is the start of something.

GENESIS: DUKE

2009-06-10T20:37:00.000-05:00

yes! brilliant. being a longtime fan of prog rock, how have i not discovered this album to date?

lovin' it.

genesis = band
duke = 1980 album

No Home Internet

2009-06-08T09:54:00.001-05:00

spent all weekend with my wireless internet down. its still down, i'm blogging from work. wife & kids still at home with no internet.

i had previously emailed them (from dialup!) to report the problem: no response. so this morning i call them from work. w/o going into too much detail, imagine possibly one of the most infuriating tech support calls you've ever had (even tho i was super overly nice):

1st he "cant find me" in the system. argues with me over what phone number is "on the account".

then he tells me matter-of-factly that the problem is "on your end" b/c his tower works fine. no, its not "on my end"...my router broadcasts perfectly fine. my modem is not receving signal.

after that he tells me to reboot my computer, unplug the router, unplug the modem, right-click and choose "repair connection", yadda yadda yadda...stuff i've already done literally 10x in 3 days trying to get it to work. same old standard stuff that only works when the problem is on my end, which it is not.

so after i inform him that i've already tried all that stuff he SIGHS loudly right into my ear and says "we'll take care of it".

"what does that mean?", i ask. "will you call me? are you sending a service guy?"

BIG SIGH again.

no, he says. they're going to go look at he tower, but it looks fine from his station. "the problem is on your end", he ends the conversation with, about the 3rd time he's told me that.

wow. keep in mind this is the very 1st time i've ever called them. its not like i pester them all the time and they're tired of me. heck they didnt even know who i was since he "couldnt find me in the system".

but they sure dont mind auto-drafting my account every month. pretty darned infuriating.

Optometry Exam Problem

2009-06-03T14:40:00.000-05:00

i just realized something today. actually i've known this for some time but i was REMINDED of it again today and decided to mention it here.

you know how the dentist & dental hygienist pry your mouth open, then proceed to ask you questions"

Dental Hygienist: "so, how's your week?"
patient: " aye yi yo yo ya yer yak"

well we optometrists do pretty much the same thing! (no, not prying your eye open, although we do sometimes do that as well).

Optometric Assistant: "please remove your contacts, walk this way, sit here, read this, the doctor will be here in a few minutes to see you"

patient: "but *I* won't see HIM! and I CAN'T walk this way w/o my contacts! I can't SEE!"

many times when i come into the exam room the patient doesn't know what i look like. if they're a new patient this has got to be incredibly weird.

but...not really fixable. as annoying as that scenario is/sounds...its still probably the most efficient way to pretest a patient prior to an exam. ah well. just know that your O.D. knows you can't see him, till the end of the exam, anyway ;)

Biomedics EP is changing names to Proclear EP

2009-06-03T12:39:00.000-05:00

Rec'd in an email from Coopervision:

Same lens. New brand name.

We're making this change so that it will be easier for you to transition your patients into Proclear Multifocal as their condition progresses by keeping them in the same brand.

Rest assured that on July 1, only the name on the box will change. Everything else will remain the same:

Same price (list, bank, and bulk)
Same material, design, and manufacturing
Same parameters
Same rebate value

The name Proclear is synonymous with lens comfort. And its PC Hydrogel^TM material has many unique advantages for the presbyopic patient. With the name change to Proclear EP, you will be better positioned to discuss PC Hydrogel's unique material benefits with your patients.

IMPORTANT DATES TO REMEMBER

TUESDAY, JUNE 30, 2009: Last day CooperVision will accept orders for Biomedics EP.

WEDNESDAY, JULY 1, 2009: All orders will be for Proclear EP. Biomedics EP will no longer be available as of July 1, 2009.

PDF FAQ about the transition

New Discussion Forum! www.myeyepod.info

2009-06-03T11:52:00.000-05:00

ask me questions or discuss eye care and new products!

www.myeyepod.info

i just registered the domain name today and it usually takes nearly 24 hrs for the forwarding to be handled by the host, so give it a day or 2.

Sorry for the SPAM

2009-06-02T20:29:00.002-05:00

i just went through my old yahoo360 blog and copied/pasted the most interesting/pertinent blog entries...the ones about eye care that i reference the most to patients and yahoo answers, etc.

i tried to "upload" the entire thing, but yahoo360 downloads it into some unusable text file, while blogspot asks for it in an ".xml" file. irritating.

anyway point is...i just posted like 35 entries for TODAY, tues june 2, 2009. a bunch of those posts are years old.

so...sorry for the spam. but now i can concentrate on THIS blog and forget the yahoo360 one. whew

Ciba Dailies Aqua Comfort Plus

2009-06-02T20:29:00.001-05:00

Ciba Dailies Aqua Comfort Plus: we've really had a lot of success with this product lately! very thin, very "wet", very comfortable, good visual quality, high compliance rate, super easy to take care of (there IS NO "care"), and not expensive.

http://www.dailies.com/

we're moving more and more patients into this modality because its safe for us to Rx (low incidence of infectious & inflammatory problems), easy for the patient to use, and very comfortable b/c of the low profile (thin & flexible).

we see a lot of GPC because we're in a college town SHSU that just happens to be located in East Texas, one of the worst places in the world to live if you have seasonal allergies because of our large pine forest, high humidity (mold) and heat. a lot of the time dailies are the only modality that an allergy-sufferer can wear.

Gas Permeable Photochromic Lens

2009-06-02T20:28:00.003-05:00

Gas Permeable Photochromic Lens: people as me all the time: "wouldnt it be cool if there were transitions CONTACTS!!??

well i think i just found them on the internet:

http://www.gasperm.com/index.php?function=viewcategory&categoryid=5

they're gas permeables ("hard" contacts) which will turn some people off, but still intriguing. they're also true photochromics, meaning they're dark when they're exposed to UV and light when they're not, so like transitions glasses they're un-usable as a driving option (b/c your UV is blocked by your windsheild). if you read the description it looks like they're light green normally, then turn dark blue when exposed to UV.

i emailed them to see if they still offer this product. i'll post their reply if they give one