March 3, 2011

It’s a complicated thing…

Vision, that is.  I realize it more and more every day with my own eyes and the patients that come in seeking help for their eyes.  Oh sure, it can be simplified and over-simplified.  Many people, including eye doctors do it all the time.  ”My vision is perfect…I can see 20/15!”  Well that’s great if you’re going to be a professional eye chart reader, but I’ve never seen that listed as one of the more high demand jobs on Monster.com.  And on days like today when I have a couple of gaps in the schedule, I get the chance to really reflect on this and come up with a new blog entry.

After doing this for 10 years, I feel like I’ve become quite an expert in fitting contact lenses for all sorts of needs, treating medical eye problems that do not require surgery, and helping patients see well with their eye glasses.  But I wonder sometimes if I can call myself an expert in understanding vision?  Especially after 10 years.  I guess it depends on how one defines expert.  Dictionary.com defines expert as “a person who has special skill or knowledge in some particular field; a specialist; an authority.”   Actually after reading this definition, I guess I can call myself an expert on vision because this definition isn’t really all that impressive.

So why am I being so hard on myself?  Here’s an example of why:  I had a really sweet little 10 year old girl yesterday who was having all sorts of underachievement issues academically.  She had undergone extensive testing at school and problems were ruled out and suspected problems were suggested, including vision-related deficiencies.  She had become labelled and it was deemed that she qualified for special education considerations.  She had some symptoms related to vision, so that’s what I needed to look closely for.  But after a half hour of testing, I couldn’t put my finger on any specific problems related to her ability to focus near or far or any problems related to the ability of her eyes to work together.  I explained this to her mother, who thanked me for my time and they left somewhat relieved that I didn’t find a major problem.  But I still suspected there was a problem related to vision, I was just disappointed that I couldn’t find it.

So I couldn’t find a vision problem, what’s the big deal???  I should be content with that.  Well, honestly I think I couldn’t find it because of my lack of complete understanding of the “complications” of vision.  What part of the visual processing was fouled up in this little girl?  Why did she reverse her letters?  Well, because she might have dyslexia…Well, why does she have dyslexia?!?!?  Open can of worms now..

So in a continued effort to become more of an expert on vision and its complications, I decided several months ago to do something I swore I’d never do.  Study and go through a very lengthy testing process to earn a Fellowship in the College of Optometrists in Vision Development, a group of eye doctors and therapists specializing in vision care services that can develop and enhance visual abilities and correct many vision problems in infants, children, and adults.  The trouble with this plan is, I’m not much of a reader (and never have been) because of my own recently discovered vision complications.

Here’s why I swore I’d never do this:  I got through grade school and 10 years of college because I had at least a half a brain, but it wasn’t until I made it through school and started working with the public that I really started to flourish in this career.  Reflecting back, you probably know someone just like me… One of the smartest kids in the class through the fifth grade, the best speller in ALL of Schallert Elementary.  But on to middle school…and book reports and other longer reading assignments dropped me down a few notches.  Their was less memorization and more reading comprehension and math word problems.  Like many before me and after, I adapted, and was still looked at as one of the smartest in the class.  But it was almost as if I felt like I wasn’t as smart as I used to be, because it was getting harder to remember and comprehend all the additional stuff.  Before I became an eye doctor, I figured it was due to distractions like girls and sports.  We didn’t text or surf the internet in the 70s or 80s, so for me there didn’t seem to be any other excuses.

Fast forward to only two years ago and I discover that my eyes don’t aim together well without a decent amount of effort…they’d rather rest pointing away from each other horizontally and one higher than the other.  So I think back and wonder if that’s why my perception of the difficulty of school changed.  Is that why I never hit much better than .200 in baseball?  I didn’t make up the phrase you can’t hit what you can’t see.  Is that why my high school coach moved me to first base so that I would stop over running fly balls in center field.  Is that why I had to work so hard to catch a football while on the run (or standing still for that matter)?  Think about it…our eyes tell us where every thing is positioned in the world around us.  If my eyes told my brain to tell my arms that the ball was an inch away from where I thought it was…swoosh…swing and a miss or football on the ground.  And those of you without these issues, have no concept.  But I hope, especially that it makes sense if you have or once had “perfect vision.”

I may continue on with this topic tomorrow.  The gaps in my schedule filled in after I started this, plus this post is getting too long anyway.  I could go on and on and on…

Did I make it complicated enough for ya yet?

  • Lots of info at the EyeWorks website (eyeworks.com)

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    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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