January 28, 2011

10 ways to tell you are overdue for an eye exam

I find it interesting to see how long some people go between eye exams.  Reasons range from busy schedules to financial considerations but this post covers some of them.  So to borrow from Jeff Foxworthy, “It might be time for an eye exam if…”

1.  Your glasses are held together with a combination of tape, paper clips and super glue.

2.  You avoid driving when the sun is not in the sky.  I bet we can help.

3.  You hated that 3D movie and were the only person in the theater watching it without the glasses on.  This has become such a common occurrence that we’ve added a question about 3D movies to our patient symptom questionnaire.

4.  You’ve bought the strongest drug store reading glasses and you still can’t see the buttons on your cell phone.

5.  You were told at your last eye exam that you couldn’t wear contact lenses because you have astigmatism.

6.  You no longer enjoy that fine-detailed hobby because the detail is too fine.

7.  You’ve forgotten that you should actually rub or rinse those contact lenses every night AND put fresh solution in that case.  Could that be why the eyes are a little red every day?

8.  You thank the heavens for the invention of Visine so that you’re not drug-tested at work or school.  Continuous eye redness means your eyes are trying to tell you something.  Let us help you figure it out.

9.  You thank the heavens for the ability to enlarge your computer font so that only 12 words at a time are visible on your screen.  I wonder if that cuts in to your efficiency at work?

10.  You think those frontal headaches must be sinus-related and couldn’t have anything to do with those 6 eye muscles that work non-stop every day.  Many eye muscles, including my own sometimes get very tired of pointing my eyes toward the computer screen.  My glasses virtually eliminate any discomfort.

So if any of these struck a chord with you or makes you think of someone you know, then I would suggest it’s time to check the peepers.  Vision is so much more than seeing a small black letter on a chart that’s 20 feet away.  How often do you really use your eyes for that task on a daily basis?

Have a great weekend!

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December 3, 2010

8 Breakthroughs in Eye Care That You Can Take Advantage of Today

Most days I do not have enough time to tell my patients about all the exciting breakthroughs that are at my disposal to help them or their family members enjoy better vision.  So I thought of eight items that I feel most patients don’t know about.  And I bet most of my readers could potentially take advantage of at least one of these.  I have listed them in no particular order.

Anti-Fatigue Lenses: This is a relatively new discovery for me and has been perfect for those young-ish patients under 43 who have to read a lot and/or look at a computer screen all day.  These tasks can result in complaints of headaches around the eyes and late-in-the-day blurry vision.  The lens has a different prescribed power in the top vs. the bottom and the feedback I’ve received has far exceeded my expectations.

Restasis for dry eyes: The most successful prescription eye drop for dry eyes (at this point anyway).  It can take up to 3 months to see results, but used faithfully twice a day every day, 9 out of 10 of my patients have seen improved tear production resulting in better vision and more comfortable eye balls.  Allergan, the makers of Restasis, gives you your first two months free and lots of money saving coupons if you enroll in their dry eye program.

Corneal Remolding Therapy lenses: This is something I’ve taken a renewed interest in after successfully using this modality about 6 years ago.  Ideal for low to moderate myopic (near-sighted) patients, you put the lenses in when you go to bed and when you remove them in the morning, you’ve gently reduced/eliminated your myopia for up to 48 hours.  It’s about 20% of the price of LASIK surgery and is very good for teens AND pre-teens.  Plus it’s completely reversible.  FDA approved since 2002.

Multifocal Intraocular Lenses (IOLs): These are prescription lenses that are implanted behind the colored part of the eye (iris).  Many patients have chosen this option as an elective procedure to reduce or eliminate the need for bifocals or progressive lenses.  Of course if you have significant cataract formation, your health insurance will help you with the cost of this procedure.  As an elective procedure, it can cost over $4,000 per eye.  Very good visual outcomes however with this option.

Extendend Wear (overnight) Contact Lenses for Astigmatism: Not such a secret anymore, but I’m surprised how many patients are kept in the dark about contact lenses for astigmatism.  Although these lenses should be worn with reasonable caution, they have proven to be very safe and reliable.  At least 4 good brands that I can think of available for most prescriptions.

Sports Vision Training: Oh yeah, we do that too!  Most people haven’t heard of this because this service is offered in very few places.  But the basic premise is simple:  each and every decision an athlete makes on the playing field is because of the information that they gather through their eyes.  Sitting in the exam chair and reading stationary letters doesn’t come close to simulating the vision needed on the field/court/ice.  We test athletes by putting targets in motion, among other things.  The goal is to see the field better, in every way imaginable.

TheraTears products: Based in Woburn, MA, (up here it’s pronounced “Woo-burn”) this company was started by an ophthalmologist with a passion for dry eye treatment.  Readily available over the counter from coast to coast, their products include artificial tears, eyelid cleansers, omega-3 supplements, and a macular health supplement.  I hand out samples left and right and I’ve received great feedback from patients.

Daily Disposable Torics: Historically, people with astigmatism kinda get the shaft when it comes to contact lens options.  But CibaVision has a nice set of parameters for their daily disposable contacts which are ideal for allergy season and dry eyes.  No hassle with daily cleaning, just make sure you hit the trash can when you flick it off your finger.

Feel free to send me any follow up if you have questions.  Hopefully some of these breakthroughs can help you or someone you know see better.

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Filed under binocular vision, Dry Eye, Sports Vision, Vision Therapy

November 11, 2010

Are you part of this club?

The No Rub Club…I just made that up but if you’re like the majority of contact lens wearers today, you use disposable lenses and some brand (or non-brand) of “no rub” multi-purpose disinfecting solution.

But I’ve found that too many patients don’t know how to use this product properly because of the misleading phrase of No Rub (which by the way is being printed smaller and smaller on bottles).

I make it a point to always ask my contact lens patients if they ever rub or rinse their lenses before placing them in their container.  Many do not, and many don’t even put fresh solution in their containers every night!

The directions on the back of the bottle reads like this:  ”Thoroughly rinse each side of the lens (5 seconds) with solution.  Fill your case with fresh solution and store overnight or at least 6 hours.”  So technically that’s no rub, but you do have to rinse.  But don’t worry…if you do this, you’re part of a very large club and you can very easily change your ways.

It’s the collective fault of we, the eye care professionals, who haven’t done an adequate job of stressing the proper way to clean your lenses with No Rub solution.  So please accept my apology.  You are now free to rub and/or rinse away!

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October 25, 2010

The Brief History of Eye Glasses

It’s difficult to fathom how far spectacle lenses have come from the earliest days 1,000 years ago to the modern day.   Here is an interesting post describing how spectacle lenses evolved.  Thanks to Dr. Facchiano’s website!   The Brief History of Eye Glasses.

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October 20, 2010

Is this why I love it here?

 

Ashuelot River off of Highway 12A

 

Fall is here in the Monadnock region and the colors of the leaves seem to be much more impressive than what I recall from last year.

I was on my to Alstead on Monday when I saw two perfect places to pull over and snap some pictures.  Most of them got uploaded to my Facebook page, but the one above is the one I like the best.

It helped me remember back to when I was a sophomore in high school, and my family took a two week driving vacation through Colorado, Wyoming,  and Washington and drove back down the northern coast of California on the way back to Texas.

At one of our stops around Yellowstone Park, I got out our video camera and took what seemed to be hours of video of the rushing flow of a river (it was actually about 10 minutes but to everyone who watched, it seemed like an hour).  To me, there was just something mesmerizing about it.  I didn’t fish in it, canoe in it, or swim in it…I just watched and listened to the sound of it.

I thought back to that never ending video as I was snapping a few pictures and standing all alone by the Ashuelot River.  All the while hoping that a moose or bear might wander in to the view of my lens.  They never did.

It got me to thinking…Is this why I love it here?

Did I always want to live in a place surrounded by mountains and flowing rivers?  Well, apparently so.  Since moving here over a year ago, I’ve climbed one mountain for the first time in my life and fly fished in the Contoocook River, not caring that I didn’t really catch anything…just enjoying listening to the water and looking in to the trees.  I can’t wait to do it again and I don’t really care if I catch much the next time either.

Before this time next year, I hope to get a kayak or canoe, maybe some cross country skis, and break out the snow shoes that my parents bought for me last winter.  I don’t really know how to take advantage of all these new opportunities yet, but I’m working on it…

Soon enough, the beautiful foliage will just be a whole lot of leaves that need to be raked or mowed.  The sun will go down earlier, it will be pitch dark at 5:15 pm and nothing but cold, cold, cold.  At that point, I may ask myself why I ever moved up here.  And then I’ll bundle up, put on some good boots and gloves and go try something new.  Because doing the same thing over and over again just isn’t for me.

Happy Hump Day!

 

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September 8, 2010

7 Common Eye & Vision Myths

I like to think that I know a lot about the eyes.  And I like to think that I know a lot about vision, as they are not one in the same.

But I always find it interesting what my patients think they know or have heard about somewhere along the way.

So with this post, I’ll address some common (mis)beliefs about vision and the eyes.

1.  If I start wearing glasses, my eyes will get weaker and become dependent on them. This is the most common misconception that I hear.  It’s kind of like saying “if I start taking my car everywhere, my legs will get weaker.”  Okay, maybe not the greatest analogy.   But the point is once you realize how much better you can see with the proper prescription, the more likely it is you will notice how much more difficult the alternative can be.

2.  If I lose a contact lens in my eye, can it roll back in to my head behind my eye? Anatomically impossible.  No worries on this one.

3.  My vision is good because I’ve been eating a lot of carrots. Thanks to DiscoveryHealth.com for the following:  Carrots became associated with vision, particularly night vision, during World War II. The British Royal Air Force published a story that said skilled fighter pilot John “Cats’ Eyes” Cunningham could thank a steady diet of carrots for his night vision flying prowess. In response to the story, many British people began to grow and eat more carrots. They wanted to improve their vision so that they could see better during the compulsory blackouts that were common during World War II. Although Cats’ Eyes’ carrot eating made for a great story, it was, in fact, propaganda put out to conceal the fact that the Royal Air Force’s was actually using radar to locate Luftwaffe bombers during the night.  Although British propaganda may have lent carrots a bit more vision-related cachet than they deserve, there’s still no doubt that the vitamins found in carrots can promote overall eye health.

4.  I can read 20/20 letters, so my eyes must be healthy. It would be nice for all of us if this one was true.  Reading an eye chart can be quick and easy and tell an eye doctor a lot about the eyes, but it doesn’t tell us much about the overall health of the eyes.

The eye chart doesn’t tell us how high the pressure is in your eyes.  It doesn’t tell us if you have the early signs of dry eyes, diabetes, high blood pressure or a tumor growing in the back of the eye.  All of these may be found during a thorough eye exam.  And it doesn’t matter if you’re 8 or 88 years old.

5. Vision automatically gets worse with age. Not necessarily.  I’ve seen plenty of patients whose vision has improved as they got older.  It’s not always easy to point to the reason why it happens, but it does.

6.  There is no difference between generic and brand name contact lens solutions. Well, actually there really is.  Generic solutions use a preservative called polyaminopropyl biguanide and according to the study on www.staininggrid.com, has a 10 times greater likelihood of causing ocular surface irritation versus our top recommended solution:  Optifree Replenish.

7.  If mom and dad have good vision, then it seems natural that all their offspring will have good vision too. This ought to be the case, but it’s not.  On more than one occasion I’ve seen a mom brought to tears because she couldn’t understand where her son’s poor vision came from.  If the child’s eyes are healthy, then poor vision results from imperfect anatomy of the eye such as it being too long or too short.  Also keep in mind that the vision demands on the kids today are not the same as they once were.

If I think of more I will add them or if you want more information on something you’ve heard, please add to the comment section below!

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August 25, 2010

Hey doc, why can’t I see those letters any clearer?

(Part 2 of my last post.  Make sure you read it before reading this one.)  So I have a patient in my chair with healthy eyes, but he/she still can’t see the letters as sharply as they’d like.  Making the lenses stronger doesn’t help and backing off on the prescription doesn’t help.  By now, I would have already referred to the Z-View printout and looked at the categories listed above that 18-wheeler barreling down the highway at me.

The beauty of the Z-View aberrometer is that it measures three additional imperfections in our vision beyond near-sighted/far-sighted and astigmatism.  They are known as higher order aberrations (trefoil, coma, and spherical aberration) and the amount found in the eye is color coded as a Low, Moderate, or High level.  These imperfections are responsible for halos, tails and star bursts around lights.  If I see red in those lower boxes, it’s a pretty good bet that the traditional lens is not correcting every imperfection in my patient’s vision.

Thankfully, we can use this Z-View printout to develop a lens that can incorporate these imperfections and give what some have described as high-definition vision.  Unlike the typical lens prescription that would be pulled out of a drawer, these lenses are designed specifically for each eye’s unique imperfections and they often take 3 to 4 weeks before completion.

If you go to the company’s website at www.izonlens.com, we are one of only two practices in the state that own the aberrometer and we’ve had patients drive from the other practice telling us that “the folks in Nashua don’t use it”, so they made the drive to Keene.  We’ve had some patients drive from 150 miles away to get this scan.

So every now and then I get a patient who has never found a satisfactory answer for a long-standing vision problem.  But because we do the scan on every patient, we can point out virtually every reason why the 20/20 line may not be crystal clear.  More times than not, the Z-View has provided that answer.  It’s a luxury I haven’t always had, but it really helps to complete the puzzle when evaluating one’s vision.

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August 23, 2010

Some insight in to our technology…the Z-View shows me how you see at night!

As I’m thinking about how to begin this post, I think back to optometry school and the availability of the diagnostic equipment that was there for us along with the wealth of knowledge of the different doctors and professors there.  We pretty much had it all at the University of Houston.

When I started practicing at Vision Source in Kingwood, Texas, we had the opportunity to try virtually any new diagnostic equipment because I worked for the CEO of the nationwide franchise.  We tried more products than we ultimately purchased, but we had a great array of diagnostic instruments in that practice too.

Then I found Dr. McMahon at EyeWorks.  I think it’s safe to say he’s a bit of a gadget guru like I am and always on the look out for the next best diagnostic instrument to help our patients with their vision.

So I thought I’d write a little about the instruments we have and what I like about them over the next few posts.

In the picture above, you see a printout from our Z-View Aberrometer.  In essence, it measures how light focuses through every surface in each eye from the tear film on the surface to the photoreceptors in the back of the eye.  And then it quantifies these imperfections in to the printout above.  FYI, click on the picture to get a larger version.  I’ll explain it in the next post.

Now, stay with me here.  I promise not to go in to a highly detailed and overly technical description of this instrument.  That’s not my style!

So over the years, all optometrists have performed eye exams on patients who just couldn’t be refracted (the better 1 or 2 test) to a crisp, clear endpoint at 20/20.  And when this happens, there are different types of abnormalities to look for from the front to the back of the eye that can be pointed to as the reason…anything from dry eyes to cataracts to macular degeneration.  Oh, and my newest emphasis…binocular vision problems.

But what if I don’t find any of these and I still have a patient unsatisfied with their vision correction?  In the past, I’d probably end up having them come in for a prescription re-check and ultimately end up saying that’s the best we could do.  But the Z-View Aberrometer has changed all of that…

I sense this post getting too long.  Stay tuned to learn more about the Z-View aberrometer in the next couple of days…

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July 28, 2010

The EyeWorks Difference

One of the reasons I decided to start this blog was to hopefully give people some insight in to some behind the scenes aspects of our practice.  EyeWorks is not exactly one of a kind, but our type of practice is few and far between.  And for me, it was worth moving halfway across the country for.  So through the blog,  I’d like to share with you some things you may not have known about our practice.

First and foremost, we take no discount vision plans.  Why?  Well, though many patients perceive their vision plan as a great benefit, they don’t realize that because of the discounted payments to the doctor, that office usually has to see 3 times as many patients in order to still pay the bills and the staff.  That often can lead to a staff that’s very frazzled and confused by the complexities of all the different vision plans.  What follows is spotty customer service and patients that may feel like all their needs have not been met.

In the practice I left in Houston, I was along side very hard-working doctors, management, and staff that tried their best to deliver superior customer service and patient care, but I saw how the busy busy nature of the practice could wear on each and every one of us.  All too often customer service would go up and down like a roller coaster.

Despite their best efforts, customer service (but not patient care) would suffer.  But that seems to be the nature of big city practices…with nearby large companies who all have vision plans and optometrists having to cram their schedules to make up the difference.

Vision plans often leave eye care offices with one hand tied behind their backs.  We are required to use their labs to save you money, even though our quality control is better.  We are required to sell their preferred frames to save you money, even if it’s a lesser quality frame.

So a few years ago, EyeWorks decided to no longer accept vision plans.  We found that there are plenty of patients who have eye exam coverage through their health plans or could use their flex or cafeteria spending plans.  And because we don’t have to schedule so many patients, we can spend extra time trying to dig deeper in to our patients’ vision problems or simply get to know them better.

And it’s worked, thanks to the hard work of Dr. McMahon, office manager Scott Thielen, and the rest of the EyeWorks team.  I like to think I’ve taken an outstanding practice and made it even better.  I invite you to come in and visit with the doctors and staff to experience the difference!

Quick edit:  My reference in Houston is to a large practice with multiple eye docs.  I know that many smaller 1 or 2 doc practices can deliver outstanding care to their patients without all the headaches that I experienced.  I also know that they wouldn’t take any vision plans if they didn’t feel like they had to.

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June 25, 2010

If you build it, will they come??

So we’ve finalized a name and logo (thank you again, Heather) and we’ve officially opened our Sports Vision Center for business.  To promote this new service we’ve done radio and print ads offering free sports vision screenings during June and we will probably extend that in to July.

Up until yesterday, our only patients were staff and family members.  To the left, you see my daughter Jillian using the saccadic fixator to work on eye-hand coordination.  She loves coming up to the office to work/play with the instruments we have.  Secretly, I’m hoping it will rekindle her interest in sports after having a rough season in baseball.  So I invite her up to the office when I have time between patients, and she enjoys the challenges of each test.  We’ll see what happens there.

Our first real screening was yesterday afternoon.  The patient was a 16 year old female going in to her junior year of high school.  She had never had an eye exam, but her mom had heard my ad on the radio and decided to bring her in for a screening.  Although she was almost 6 feet tall, she had always been considered klutzy and never enjoyed any success in sports.  But her goal is to try to make the high school volleyball team in the fall.

A simple vision check on the eye chart revealed a lot.  She was able to read 20/20 with her left eye, but struggled to read 20/40 letters with the right eye.  So there goes depth perception and the ability to accurately judge and track a fast moving ball.  And they wondered why she was so much better at catching soccer balls with her nose instead of her hands when she tried to play goalie!

Additional testing showed that her eyes tended to turn together too far inward when fixating on both near and far objects, which can make the brain think that objects are closer than they actually are.  Indeed she said that she often didn’t pull the car up far enough in to parking spaces.  And of course she always backs up the car by looking over her left shoulder instead of the right, because the right eye can’t see very well.

So both mom and daughter learned a lot about the importance of clear binocular vision by the time we were finished.  They scheduled a full exam and hopefully we can get a contact lens on to that blurry right eye and balance out her vision.  That should definitely improve a lot.

Since she’s getting a relatively late start on athletics, I’m really hoping they will consider getting some additional sports vision training in an effort to accelerate her progress.  Training with us could help her see the whole court better and make quicker decisions.

And then there’s my daughter, Jillian.  She’ll never be almost 6 feet tall, but you never know where this could take her!

Have a great weekend!

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