The Daily Eyeball Report

It was a busy and somewhat hectic day at the Alamo Heights Vision Source yesterday.  Our Officemate electronic medical record software was inaccessible and we had to resort to writing everything down on paper.  Paper!  It was like it was 2004 or something!  It doesn’t seem that long ago when everything was written on paper, and honestly with a good paper chart I can move just a little more efficiently through the exam.  As opposed to clicking dozens of times with our software, I often joke with patients that it’s a good thing we don’t charge you per click.

So this along with a couple of team members calling in sick, really made for a day that was more tense than normal.  Thankfully, the patients didn’t seem to pick up on it.  But we were running behind schedule and it was a day for apologizing to every patient.

A lot of contact lens wearers.  It seemed like prescriptions got higher and higher as the day went on starting with a -1.25 and heading all the way up to -8.50.

Patients included a couple of very nice local physicians (1  pediatrician and 1 family practice) and I shared a couple of pointers on using an ophthalmoscope.  My biggest tip was to ditch the traditional one and pick up a Welch Allyn Panoptic ophthalmoscope for a much improved view.  We swapped chairs and I let them look in to my eyes and sure enough, they were impressed.  I should be a sales rep for that company maybe.welch allyn panoptic alamo heights deviney vision source los patios

I guess that’s about it.  Hopefully when I’m back to Alamo Heights on Monday, the software will be working again.  Probably just about the time that they all get used to using paper again.

I hope you have a great Friday and a great weekend!

Posted in Alamo Heights, Contact Lenses, Los Patios, Olmos Park, Practice Management, Vision Source | Tagged , , , , | Leave a comment

Bifocal Contact Lenses vs. Monovision

It’s a battle that’s been “raging” since the mid-1980s when soft bifocal contact lenses were first introduced.  Vistakon got in to the game early with the Acuvue Bifocal and CibaVision followed shortly thereafter with their Focus Progressives.  Both were better than nothing, but I was never really impressed with either, and monovision often won out.

alamo heights vision source los patios bifocal multifocal contact lensIf you’re not familiar with monovision, it’s a contact lens option that lets one eye have a prescription for seeing far away and the other is prescribed a lens to see near.  As I tell my patients, it’s a “prescribed compromise” to reduce your dependency on reading glasses.  Because of the slight visual imbalance it creates, this tends to work best for those people who do a little bit of everything during their day.  But it doesn’t tend to work as well for those who may be in front of the computer constantly, drive a lot, or who spend a lot of time in dim lighting.

Historically, I’ve probably fit close to 75% of my patients in monovision (vs. bifocals) over the years since I started practicing 12 years ago, because it just seemed to give patients better vision than the multifocal contacts that I had available.

But the tide has turned with the introduction of Coopervision‘s Biofinity Multifocal and CibaVision’s Air Optix Multifocal.  These designs have actually made it easier to deliver clearer, more functional vision to each patient.  They work on a design principle known as “simultaneous vision”.  Since you can’t look through the top or bottom half of a contact lens, the reading power is normally placed in the middle of the contact lens like a bullseye.  You are therefore required to look through both powers at the same time.  It’s kind of like looking through the screen on a window.  You can look at the screen or ignore it and focus through to a farther distance.  See below for the design idea and click the pictures to make them larger.

air optix multifocal ciba bifocal deviney vision source

coopervision deviney biofinity multifocal vision source san antonio alamo heights los patios

Neither design is perfect.  And a good pair of progressive lenses should give you superior vision.  But it’s as good as we’ve ever had it in soft contact lenses.  I now recommend multifocal contact lenses before monovision, probably almost 70% in favor of multifocals.

Expectations are a key to success.  I make sure to go over the basic design of the lenses.  And I always mention that you should get better vision in good lighting and poorer vision in dim lighting.  If you have astigmatism, it will limit our overall success with these designs.  But Coopervision has a Proclear Multifocal Toric that does a decent job.

So this may not answer all your questions about multifocal contact lenses, but this post addresses most of the things that I talk about with my patients.  If you’ve been curious about them, feel free to schedule an appointment.  I see patients at the Alamo Heights Vision Source on Mondays and Thursdays.  And I am at the Los Patios Vision Source on Wednesdays, Fridays and Saturdays.

Click this link: http://www.allaboutvision.com/contacts/bifocals.htm to find out more information about bifocal contact lenses.

Thanks for reading and feel free to send me questions!

Posted in Alamo Heights, binocular vision, Contact Lenses, Los Patios, Multifocal Contacts, Olmos Park, Vision Source | Tagged , , | Leave a comment

The daily eyeball report.

Today I was thinking about my friends in Keene, NH. Talked to them today as a matter of fact (fantasy football-related).  When we would go over to visit my good friends Kristin and Eric, one of them would always ask me how the eyeballs were that day.  “Much better now”, I would jokingly say.  So in thinking about that, I thought it would be fun to do a daily eyeball report to share what I had learned during each day.  Easy way to update the blog more often, right?

So here goes:

Tango.  Zebra.  Edward.  Victor.  Charlie.  Lima.

sapoa vision source san antonio eyedocdevineyMusic to my ears when I’m at our Los Patios Vision Source office off of N.E. Loop 410 and Starcrest.  That tells me that a San Antonio police officer has read the 20/20 line (TZVECL) and should have great vision with his or her new prescription.  In 12-plus years of helping people with their vision, I’ve never seen a better group of folks.  I might have thought that police officers might be too high-strung to relax when they come in, but they and their families are some of the most polite and respectful group of patients I’ve ever seen.  It’s a pleasure to help them.

They come to see us for two reasons.  One is that the San Antonio Police Officer’s Assocation is located within our building.  And two is that Dr. Mervyn Bloom treats all of them like family.  It’s been great.

Today was a busy day of eye exams, with a foreign body removal and an eye infection sprinkled in.

I’m having more and more success with the Air Optix Multifocals.  I wrote one of my first blog posts back in 2010 http://eyedocdeviney.com/?s=air+optix as it was just coming out and we’ve learned more tricks to get them to work well. We can fit most prescriptions with trial lenses the Air Optix multifocal vision source san antonio bifocal contactssame day. But if you have a little astigmatism, your chances of success does go down a little.

Currently, we are having a promotion with Ciba contacts. When combined with a purchase of new glasses, patients can save up to $200 combined. Details vary depending on the type of contacts and glasses purchased.

Otherwise back to school eye exams are going to keep us busy for at least the next two weeks as students and teachers come in to prepare for the academic year.  I would love to help you get your vision ready.  Currently, I see patients at the Los Patios office on Wednesdays, Fridays and Saturdays and I see patients at the Alamo Heights Vision Source on Mondays and Thursdays.  Hope to see you soon!

Posted in Alamo Heights, Contact Lenses, Los Patios, Multifocal Contacts, Olmos Park, Vision Source, Vision Therapy | Tagged , , , , | Leave a comment

Glad to be back in Texas

 

It’s good to be back and it seems like I’m reminded of something every day.  Here’s a short list in no particular order:

1.  Warm water to swim in.  I grew up swimming in water that was 85-90 degrees, mostly in Lake Corpus Christi where I spent this past weekend with my family.  Water temperatures this time of year in New England may not top 70 degrees and York Beach on the coast of Maine averages 64 degrees this time of year.  Frigid.

2.  The cooing of doves and the sounds of locusts in the distance.  It even reminds Jillian of being at my parents’ lake house the same way it takes me back to my childhood.

3.  Shiner Bock.  I’ll admit I’m a light beer drinker, and thankfully Shiner has put out a good one.  A true Texas beer.

4.  I can watch the Astros as often as I want.  But I don’t, because they stink.  I’ll give them a few years when they should be relevant again.

5.  Mexican food.  Carne guisada or chorizo for breakfast, lunch or dinner.

6.  BBQ.  BBQ.  BBQ.

7.  And the chance to catch up with family and old friends with Shiner brews and some BBQ!

Did I forget anything?

 

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Ten Things I’ll Miss in Keene, NH

eyeworks deviney vision source alamo

My general route from NH to TX.

This Friday morning I hit the road for San Antonio, Texas.  Our family’s new home.  It’s estimated to take 3 1/2 days including a visit with my brother and family in Bartlett, TN.  I am happy about the decision to move back to Texas, but I’m saddened because of the people and the life I’ll leave in Keene after 3 years of living here.

It was May 31, 2009 when my family flew in to Manchester and drove to Keene.  We beat the moving truck by 2 or 3 days, so we stayed in three different hotels our first three nights.  I remember not being prepared for 35 degree weather on the morning of June 1st.  I only packed shorts!  It was June 1st!  It’s hard to believe that 3 years have passed by so quickly.

And I’ve been reflecting on the things what I will miss most about living in this area…

10.  Small town life.  No rush to get anywhere, because you’ll be there in no time anyway.  Slow and steady suits me pretty well.

9.   Mountains and streams.  Even though we’re moving to the beautiful Hill Country of Texas, I will miss the green mountains, dark lakes, and flowing rivers that are so commonly seen here.  I only fished one river and climbed one mountain, but I always stare at them in wonder for an extra moment as I drive past them up here.  Disappointed I never saw a moose either.

8.  Real winters, to a certain extent.  Shoveling snow got old after the third scoop.  I enjoy cold weather but I don’t like being cold.  And I’ll miss watching Jillian make snow angels and hand-held snow pies in the front yard.

keene nh jason deviney eyeworks san antonio vision source alamo heights

Central Square in Keene, NH.

But a crisp winter when the sun is shining and it’s 28 degrees is really beautiful.  And we could very well be wearing shorts on Christmas Day in Texas.

7.  New England beaches.  But not the frigid water.  Give me 88 degree water any day.

6.  Ice cream stands.  Only open in the warm times of the year and I probably frequented them a little too often.  But I know of nothing like them in Texas.

5.  The classic New England charm.  Cobblestone streets of Nantucket, colorful houses and traffic circles.  History comes alive in most places here in ways that are uniquely different from Texas.

4.  Downtown Keene.  Beautiful and walkable.  Good chance you’ll see someone you know as you walk up one side and down the other.  Lots of classic downtowns in the towns of New England.

3.  My patients.  I didn’t get a chance to say goodbye to most of my patients.  I want all of you to know that my replacement, Dr. Bart Higley is going to be a superstar of a doctor.  We were able to work together for several weeks here before he graduated, and he impressed me every day.  And being that he and his wife are from this area means that he won’t get homesick and should be here for years and years to come.  Check out the beginnings of his blog at http://letstalkvision.blogspot.com/

deviney jason eyeworks keene nh san antonio vision source alamo heights

One of the best eye care practices you’ll ever find.

2. Dr. McMahon and the team at EyeWorks.  This practice was the reason I moved here in the first place.  I honestly didn’t expect to get homesick, but I did.  But I’d take this staff anywhere with me because of their dedication to eye care and the patient experience.  Dr. McMahon’s passion for optometry will carry this practice in to the future.  If you’ve been here before, you’ve probably commented on the difference here.  We continuously strive to make the experience better every time and you’d have to drive a long way to find any better eye care technology.  I became a better eye doctor during my time here and will always be grateful for that.

1.  And last but not least, my incredible friends.  I won’t mention any by name, because you know who you are.  A circle of friends who were always there for each other and always knew how to have a good time.  Words cannot explain how much I will miss you.

So mostly, this was a therapeutic post and thank you if you’ve read this far.  I will continue this blog in San Antonio, TX but will need to change the title up top.  Any suggestions?

Posted in Community, EyeWorks, University of Houston College of Optometry, Vision Therapy | Tagged , | 4 Comments

Concerned moms have similar vision questions about Accommodative Esotropia

Courtesy of Pediatric Ophthalmic Consultants

Yesterday, I had three interesting and completely separate inquiries in to an eye condition that is often detected at home (usually by mom) at a very young age.  My first question came from Kim, an elementary school classmate that I had connected with on Facebook after many years.  She is concerned because she is noticing that her three-year old daughter’s left eye has been crossing lately.  Kim’s also noted her running in to things and seeming clumsy.  A good eye exam will help gain a better understanding of why it’s happening.

The next interaction was with Adelyne,another young girl that had been in for her first eye exam after having trouble at a school vision screening.  She could tell that one eye was worse than the other and sure enough her left eye was twice as bad as her right.   She had been having difficulty with reading and headaches and I prescribed her glasses to correct the varied amount of farsightedness in her eyes.   Today’s visit was a six-week follow-up to see how she was doing and to see if patching her good eye would be helpful.  We decided to start patching therapy and see her back in three months to check her progress.  I recommended “active” activities such as iTouch games, Word Finds and drawing/coloring as opposed to “passive” activities such as sitting around and watching television.

I had my last encounter when I was going to pick up my daughter at a friend’s house as the day was winding down.  After a quick hello, mom expressed concern over noticing that one of little brother’s eyes seems to be turning in excessively when he’s looking at his food.  In addition to that, he’s closing that same eye at times while reading.  Following a discussion on what I think could be happening, I recommended that it was time for him to have an eye exam too.

Although these cases weren’t exactly alike, they all point to symptoms experienced when one eye is much stronger (or weaker) than the other.  A common diagnosis when we see this is accommodative esotropia.

Courtesy of MarinEyes.com

This condition is an inward turning of an eye as one is trying focus up-close or “accommodate” on a near target of some kind.  As the child is trying to overcome the farsightedness, he or she loses binocular control of the muscles that keep our eyes aligned.  At that point, one eye over-converges or crosses.  This condition can often be corrected with glasses alone, but sometimes requires patching and perhaps vision therapy.

There is a very good blog for parents of children diagnosed with similar eye conditions called littlefoureyes.com.  Ann Z. has done a great job of creating a community for those with little ones wearing glasses.  Always an interesting, fun read!

Kudos to the moms for reaching out to me for help.  I hope they get a good accurate diagnosis soon!

In other EyeWorks news, we have our first video testimonial from one of our first patients at the VisualEyes Therapy Center.  Click here to watch the video.  Let me know if you have any questions!

Posted in binocular vision, Headaches, Los Patios, Olmos Park, Vision Source, Vision Therapy, VisualEyes | Tagged , , , , , , , , , | 1 Comment

VisualEyes Therapy Center @ EyeWorks

eyeworks keene nh vision therapy occupational deviney mcmahon higleyBehold!  The new logo for EyeWorks’s vision therapy center!  Thank you again to Heather for the design.  And thank you to our staff for helping us come up with the name.  We’ve been seeing and helping patients in our therapy center since October of last year but we decided a name was necessary.

Almost 2 years ago, I wrote an article that I called If you build it, will they come? which introduced our new Sports Vision program.  Well, nobody really came.  We tried promotions and free screenings, but it just never took off.  One of the missing key ingredients was finding a therapist who could implement the necessary treatment for each patient.  

It wasn’t until the virtual death of the sports vision program that I was approached by a local occupational therapist, Krista, who was interested in helping patients with eye coordination difficulties.  After a few meetings in the fall we enrolled our first three patients.  One of our first patient (9 years old) has graduated and she is now free from motion sickness and headaches.  Two more young ladies (9 and 14) are about to graduate and now enjoy reading and can get through their homework in no time at all.  And the best part…no medication required.

We’ve taken a unique approach with the integration of occupational therapy and vision therapy.  A brief explanation of the combination is found on the Eyeworks.com website.  So far, the approach has worked better than I could have ever hoped for.  I will write more about it as we go and sometime next week we should have some video testimonials from two of our patients and their mothers.

I hope you can follow along with the VisualEyes success stories.  Chances are, you may know someone who we might be able to help and along the way we may see the rebirth of the sports vision program.  Stay tuned and Happy Thursday!

Posted in binocular vision, EyeWorks, Sports Vision, Vision Therapy, VisualEyes | Tagged , , , , | Leave a comment

For the dog lovers.

Did you know in some areas that there are veterinary ophthalmologists?  I’m pretty sure they don’t prescribe eyeglasses and I can guarantee you they don’t believe in the effectiveness of vision therapy.  But I’m sure they deal with their share of glaucoma, cataracts and dry eyes just like we humans have to deal with.

I’ve treated or co-managed three doggie eye injuries since I’ve been here and have yet to refer one to a vet ophthalmologist.  Not that most veterinarians can’t handle the run of the mill eye scratches that many dogs deal with.  The nearest I could find was 55 miles away in Harvard, MA.  Good to know.

For today’s post, I found an article titled “What a dog’s eyes can tell you about its health” written by Denise Maher from vetstreet.com.

Condolences to Steph who lost her dog Betsy this week. I hope you’re doing okay.

So take a look and email me if you have any questions. The weekend is in sight!

Posted in EyeWorks, Glaucoma, Uncategorized, Vision Therapy, VisualEyes | Tagged , , , , , , , | Leave a comment

Vision therapy at EyeWorks

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We’ve been helping patients with vision therapy since October, but it was only this week that we’ve come up with a name for that center.  Here you see three examples, but I’ve turned it over to our design specialist, Heather to make it look professional.

Be on the lookout for some success stories coming your way!

Posted in binocular vision, EyeWorks, Headaches, Sports Vision, Vision Therapy, VisualEyes | Tagged | 2 Comments

EyeWorks introduces the iProfiler plus from Carl Zeiss.

The iProfiler plus is full featured 3 in 1 system that incorporates corneal topography, a wavefront aberrometer, and autorefractor.  We scan every patient and it offers a variety of diagnostic capabilities that are invaluable tools in a variety of clinical applications: evaluating the complete refractive status of the eye, including low and high-order wavefront aberrations; fitting soft and rigid contact lenses; monitoring ocular diseases; and and managing or co-managing surgical procedures such as lasik.

We can use the measurements from the iProfiler plus to produce a more customized prescription for the unique features of your eyes

Call us at (603) 352-7803 to take advantage of this advanced technology!

Posted in EyeWorks, High definition vision, Izon lens | Tagged | Leave a comment