This Blog Will Cure Your Blindness

“I was legally blind before I had LASIK.”

“I can see ten miles away with my glasses on, but without them I’m legally blind.”

“My vision is great; I don’t need glasses or contacts. But you should see my wife’s thick glasses; she must be legally blind!”

NO.

NO NO NO.

Now, I don’t want to sound belligerent, but we really need to have a dialogue about the definition of “legal blindness.” Its misuse is something that really shouldn’t make me angry, but lately it’s been grinding my gears a little bit. I know, I know; there are better things to be miffed about – the Middle East is still in turmoil, unemployment numbers in the U.S. are still not great, they took away the McRib again – but gosh darn it, the record needs to be set straight. So I’m sorry for my ill-masked disgruntledness. Hopefully by the end of this post I’ll feel more gruntled.

Before we get into the real educational portion of this post, let me first attempt to justify or at least explain my anger (which by the way isn’t really anger, but more like anger’s little brother; I’d like to think that I never get truly angry about anything, except maybe when contestants on Wheel of Fortune buy vowels when they obviously already know that the vowel they’re buying is in the place they expect it to be – like “Well Pat, that word is three letters and starts with a T and an H, I’d like to buy an E.” Those vowels cost you money, dummy! I don’t care if there might be other E’s in the puzzle; it’s the principle of the thing.).

Anyway, my mini-anger. It’s just that I have yet to hear a single person in casual conversation use the term “legal blindness” correctly. Heck, I probably did the same thing before I went to optometry school. But now that I have a blog and a few people actually read it, I’m going to use this chance to give people the knowledge that I never received as a youngster. Frankly, I’m tired of cringing every time I hear one of the statements that I put at the beginning of this post. I guess you could call it a pet peeve. If you’re a patient of mine and you’re guilty of this and have said it in front of me, I hope I concealed my inner pain well enough (just kidding; you know I love you).

On to the definition. The United States government defines “legal blindness” as a visual acuity of 20/200 or worse in the better seeing eye, with best correction, or less than 20 degrees of visual field irrespective of visual acuity. If you need a refresher on how visual acuity works, click here.

Let’s break this down.

Possibly the most important phrase in that definition is “with best correction.” What does this mean? Glasses and contact lenses qualify as vision correction, so your best vision with your glasses or contacts would be your “best correction.” Thus, the statement “I’m legally blind without my glasses” makes no sense, because in order to meet the definition of legal blindness, you have to have poor vision (i.e. worse than 20/200) WITH YOUR GLASSES OR CONTACTS.

To use myself as an example, with my glasses on, I can see 20/20 on a standard visual acuity chart. Without my glasses, I can see about 20/800 (essentially I can see blobs of color. For reference, look at a Monet painting). Despite my awful vision without my glasses on, I am not legally blind. If you have a driver’s license, you are not legally blind.

That’s the long and short of it. If you feel absolutely inclined to portray to another individual just how poor your eyesight is, may I suggest the phrase “figuratively blind?” It may not roll off the tongue as nicely, but it’s much more accurate.

Thanks for reading! I’d continue, but I have an anger management class to attend.

Sharknado 2: Electric Boogaloo: Discovery Channel’s Behind-the-Scenes Docudrama

Tsk tsk, Discovery Channel.

With the recent airing of its Megalodon “documentary,” one of our few remaining “educational” (SCARE QUOTES!) television stations has temporarily, if not indefinitely, blown its credibility. The public outcry against such a deception should ensure that the higher-ups at DC will think twice before once again producing programming which presents false information as scientific fact, while providing only the tiniest of disclaimers to the contrary in its closing credit scroll. Viewers were tricked. Ratings were high. Is this a Bad Thing?

Before I jump into my reasoning for why it’s not, here’s a little more background for those who either don’t have cable, don’t like sharks, or don’t enjoy controversy. Every year around this part of the summer, the Discovery Channel (home to Mythbusters, Dirty Jobs, and…Amish Mafia?) devotes an entire week of scheduled programming to the glory that is the shark. Don’t ask me why, but this has become one of the most beloved traditions of cable television viewers over the past few years. Shark Week consists of a mishmash of documentaries, true life encounters, and other reality-type shows that revolve around (figuratively) dissecting this member of the elasmobranch subclass. These programs are generally touted as informational or educational or AT LEAST nonfictional; like the History Channel or Science Channel, Discovery has generally maintained an air of academic legitimacy in comparison to most other cable television wastelands (but Amish Mafia??). However, a recent and accelerating trend appears to be that these once revered outposts of EDUTAINMENT have been nosediving toward a bullseye with Honey Boo Boo’s face painted in the center. And it’s this decline in informational integrity that is at the core of this latest fish story. During Shark Week 2013, DC aired a documentary detailing the continued existence of the Megalodon, a 60-foot long prehistoric beast with 7-inch long teeth that mysteriously went extinct long ago. This documentary presented evidence from experts (read: not scientists) who built a case around the idea that Megalodon survives to this day, but it turns out that REAL experts (read: scientists) have come out since the airing of this show and refuted pretty much all claims that DC’s talking heads made; that is, there is no real scientific evidence that Megalodon swims with the fishes (or DOESN’T swim with the fishes? Maybe this is the wrong phrase to use here).

So, you can see where the outrage has come from: you’d be angry too after being punk’d by a cable channel. What’s worse perhaps is that polls were taken after the airing of “Megalodon” and a large majority of its viewers now believe that it may still exist.

When I first heard about this hubbub, I was torn as to how I felt about it. Given, I did not see it upon its initial airing, so maybe my opinion is disqualified. However, the more I think about, the more I like the way things turned out. I like it because once the news came out that the documentary was bunk, it reminded people (or SHOULD have reminded people) that the number one goal of television is not to educate. Sure, TV shows can be educational, and oftentimes channels like Discovery or History or Science do produce such programming. However, this aspect of television is a by-product of television’s real aim: to entertain. TV executives need you to be entertained enough by their programming that you don’t think to change the channel and thus continue to boost their ratings. Entertaining the viewer is a means to an end, and we all are aware of this. This goes for all television stations, whether they claim to be educational or not.

This is the reason I like the way things turned out with DC’s shark debacle. It reminds us what television is, and what it is not. What it is: a method of passively absorbing information that requires no real work on the part of the viewer, and as such it is one of the simplest ways to, as a viewer/consumer, obtain information (factual or not). What it is not: a reliable source of facts, scientific or otherwise, and in fact, it is a medium that actually favors the bending of facts towards the fantastical in order to entice interest and continued viewing. If you break it down, television provides ease, but not accuracy. It seems that the more dry or boring the reference material is, the more likely it is reliable as fact; while this is by no means always true, it seems to be a decent enough measuring stick by which to judge a piece of information’s authenticity. If you have to work for the knowledge you seek, not only are you more likely to be rewarded with truth, but you’ll also feel a greater sense of fulfillment in your work paying off. Holy crow, is this a self-help blog now?

Keep in mind, too, that even the most academically researched documentaries usually have an agenda. If you can decipher that agenda during viewing, it may help you to parse what’s scientifically true or un. Just because television shows are developed as a passive medium doesn’t mean that you can’t actively engage with them.

Unfortunately, assuming a Pandora’s box point-of-view, DC may be headed further away from infotainment and more towards sensationalist pseudoscience. In other words, watch carefully. The next documentary you see may star Tara Reid and Ian Ziering.

Doctor, Doctor, Give Me the News; I’ve Got a Bad Case of Listening to You

Dear Dr. Google,

First of all I want to apologize for sending such an impersonal correspondence. Usually I’m the type that enjoys writing a physical letter, putting the pen to paper and practicing the skills I learned in First Grade; however, it seems that the only way to reach you is electronically. I guess in this day and age, what do I expect?

I suppose it’s apropos, since all of our interaction up to this point has been through those underground pipes known as the Internet. Speaking of our interaction, the reason I’m typing to you today is because I want to discuss our relationship. As in any such discussion, there are positives and negatives I want to cover, so I guess think of this correspondence as a kind of Interpersonal Duracell.

Let’s start with the good stuff. Since I first found out about your near-limitless expertise, you’ve been the first entity to which I turn when things go pear-shaped. In a sense you’ve been my safety-net, my blanky. When I had chest pains, you diagnosed me with Primary Spontaneous Pneumothorax (PSP). When I got dizzy upon standing, you confirmed my case of Orthostatic Hypotension. In short, you’ve always had answers. You’ve always saved me a trip to the local urgent care.

You’re ALWAYS there. A wealth of information, a plethora of ideas. It was from you that I learned about Polycystic Ovary Syndrome (PCOS) – granted, I don’t own ovaries, but it’s good to know what it would be like if they were to go Krang on me. Likewise, you schooled me on Systemic Lupus Erythematosus (SLE) and how any site-specific pain I’m feeling at any given time just might be lupus. You’ve taught me so many acronyms! Oh, and don’t even get me started on fibromyalgia.

So now that I’ve covered the chocolate crunchy portion of the Dairy Queen ice cream cake, let’s get to the disappointing vanilla section. Ya see, endless information, especially health-related information, is an infinitely sharp and autoincisive double-edged sword. I won’t mention the time you made me think I had a metastatic colon polyp when it turned out to just be gas. Nor will I rub in your face your misdiagnosis of a sinus headache as an aggressive and strangely springtime-linked brain tumor. Not to mention the nagging stress caused by these missteps that was run through your medical processors and doctoral prestidigitation and spit back at me in a differential list that included ventricular arrhythmia, chronic asthma, and Sudden Infant Death Syndrome (SIDS).

I’ve come to realize that having all the world’s medical knowledge at my fingertips is a wonderful and dangerous thing, like a lawn dart. In the hand of an untrained professional (I do eyes; the other 99% of the human body is only a soft fleshy carrier for the eyes), unfiltered information is a one-way train to Worryville. And I’m the mayor of Worryville (I may have rigged the election).

The point, Dr. Google, is this: I’m switching my care to a different provider. I don’t want a doctor who is going to scare the flapjacks out of me with the possibility of muscular dystrophy or Marfan’s or gouty arthritis. While I will forever appreciate your penchant for being totally transparent, I need a caregiver who obfuscates the ugly truth. I need someone who sugarcoats things. I need Dr. Feelgood.

So, until the next time I have shoulder pain or cough up blood, we’re through.

No longer yours,

Apertis Oculis

Tips for Healthy Eyes in 2013

Well, we’re not all dead, so it looks like we’ll have to endure another year.  2012 gave us many things to remember, although I can’t really remember any of them right now.  With that in mind, let’s look forward to 2013 and the best ways to keep your eyes healthy in the year to come.

1.  Vitamins A, C, and E (the antioxidants) are good for your eyes.  Vitamin Q, however, is not.  NEVER take vitamin Q.

2.  Despite popular knowledge, wearing someone else’s glasses will not cause your vision to deteriorate.  Although wearing them might turn you into that person.

3.  Avoid staring into the sun.  This can cause damage to the eye known as solar maculopathy.  That being said, this damage generally only occurs after prolonged viewing of the sun; if you just want to glance at it, that’s fine.  The sun is pretty.

4.  Flashes of light or an increase in floaters in your vision may signal a retinal detachment, which requires prompt detection and treatment.  These symptoms may also be caused by attending a rave; if you hear a thumping bass beat, you probably don’t have a retinal detachment.

5.  Double vision, or diplopia, is a bad thing.  If ever you should see double, get yourself to an eye doctor immediately.  You may have an aneurysm.  You may also have a drink in your hand; if you have a drink in your hand, the diplopia is probably not as urgent, although you should get to an eye doctor soon anyway, just in case.  Put the drink down first though.

6.  Call your mother; she wants to hear from you.  This has nothing to do with eyes, but it’s just good advice in general.

7.  When your optometrist offers to dilate your pupils, go along with it.  Yes, your near vision will be blown to smithereens for a couple hours.  Yes, the sun will seem so bright that it’s as if the star around which our little planet revolves has a personal vendetta against you.  Yes, your eyes will look as though you just indulged in an illicit mind-altering substance.  However, with dilation, your optometrist can detect not only ocular abnormalities, but many, many other systemic diseases that may have as yet gone undiagnosed by your primary care physician.

Even Mario hates being dilated.

8.  If your eyes burn, they’re probably dry – use artificial tears.  If your eyes water, they’re probably dry – use artificial tears.  If your eyes feel “tired,” they’re probably dry – use artificial tears.  If artificial tears, they’re probably artificial tears, use artificial tears.

9.  Take your contact lenses out of your eyes.  Unless you’re not wearing contact lenses.  Overwearing your contact lenses can lead to the following:  vision-threatening eye infections, corneal neovascularization, giant papillary conjunctivitis, corneal edema, and jelly bumps.  Yes, jelly bumps.  You may ask, “What are jelly bumps?”  Wear your contacts for too long, and you’ll find out.

10.  If you’re staring at a computer screen right now, take a break!  Every 20 minutes look away from the screen for 20 seconds.  Computer vision syndrome exists and is becoming an epidemic; you can avoid it entirely by just looking away. Go ahead, look away.  You’re not looking away.

Look away.

Do it.

You’re not going to miss anything.

I promise.

Really, at this point I’m just trying to be facetious.

Have you looked away yet?

So those are 10 tips for protecting your eyes for the new year.  2013 looks like it’s shaping up to be a good one, and I think we owe it to ourselves to make it count since we survived 12/21/12.  Be happy, be safe, and I’ll see you at the party after we all survive 13/21/13.

The League of Extraordinary Newscasters

*****The following excerpt has been taken from an email released by Anderson Cooper’s public relations administrator.  It is being reposted here in the hope that the background behind this story reaches the general public and garners Mr. Cooper more recognition for his efforts above and beyond those required of his chosen profession as a television show host.*****

Ladies and gentlemen of the press:

First and foremost I’d like to dispel the rumor that has been circulating since the story of Mr. Cooper’s temporary blindness originally hit the wires:  the rumor that Mr. Cooper experienced any sort of heightening of his remaining senses as a consequence of his loss of vision is completely unfounded and purely based on speculation.

As most of you know, Mr. Cooper was stricken by a painful and alarming condition called “photokeratitis,” or so I’m told by our staff optometrist.  This condition is apparently caused by prolonged exposure to ultraviolet light, either direct or reflected, which essentially degrades the surface layer of the anterior surface of the eye, or cornea.  While this condition is temporary, it usually causes moderate to severe discomfort as well as blurry vision.

That being said, and although I am happy to say that Mr. Cooper has made a full recovery, we here at the CNN camp find it reprehensible, given the recent events involving the disappearance of Mr. Cooper’s on-air correspondent, Ms. Isha Sesay, that the rumor of Mr. Cooper’s so-called “superhuman abilities” has gained such a foothold in the popular media.

And before I continue with just how ridiculous these claims are, I’d like to also put to rest the following allegations regarding Mr. Cooper’s behavior of late:

• He has not destroyed every pair of sunglasses he owns.
• He has not been staring at the sun’s reflection in the water of Long Island Sound.
• He has not been practicing judo while blindfolded.

I have come to understand that the above allegations have gained popularity due to the temptation of portraying Mr. Cooper as a real-world superhero; i.e. the belief that he obtained a heightened sense of hearing, smell, and touch as a result of his loss of vision.  While I cannot account for the lack of an alibi regarding Mr. Cooper’s whereabouts upon the onset of this photokeratitis, I want to assure the press that he was NOT, as the parlance goes, “fighting crime.”

Furthermore, the above allegations have been made with the thought that Mr. Cooper is attempting to regain his super-abilities through submitting himself to a second episode of photokeratitis with the intention of using these powers to locate the missing Ms. Sesay and bring her captors to justice.  While I cannot 100% deny this claim, I invite the press to consider just how outrageous it sounds.

Now, I can sympathize with the temptation to portray Mr. Cooper as a so-called “superhero,” given his strong jawline, silver-fox hair color, and desire to bring wrongdoers to task (“keeping them honest,” so to speak).  I can honestly say that in the times in which we live, such a person is absolutely warranted.  Mr. Cooper is just not that person, despite my own personal experience in his presence post-blindness in which I witnessed him identifying one Mr. Matt Lauer, who was having a casual conversation with an acquaintance on the sidewalk outside of the Anderson Cooper 360 studio while Mr. Cooper himself was actually inside said studio.  This is not an indication of super-hearing, but merely a coincidence.

Nevertheless, Mr. Cooper, since his recovery, has carried on with the taping of his television news program, and refuses to acknowledge any of the above allegations.  I know what you more hopeful member of the press will say:  He is only denying these claims in order to protect his identity as a crimefighter.  To you folks, I have no rational refutation.

In summary, and putting it bluntly, Anderson Cooper does not have superpowers, is not a superhero.  Please stop perpetuating these rumors.  Because even if he is, and you truly want him to be, his efforts will only be harmed by your continued coverage.  Just let him be the superhero that he is.  Or is not.

Thank you for reading.  And please pray for the return of our beloved Ms. Sesay.  We hope that Mr. Cooper can bring her to safety.

Rod and Cone S01E02

*Back from commercial, the setting is a dimly lit restaurant where Cone is meeting his date, Photon.  The camera zooms in on a table at which a male and female sit, talking and laughing.  The man, Cone, is dressed in a bright red three-piece suit, while the woman, Photon, is dressed all in white with a string of pearls around her neck.*

Cone:  “So then I said, ‘well it’s not Tony Danza under that sheet!’

*Both Cone and Photon laugh loudly, as does the audience.*

Photon:  “Oh James.  Your stories are so outrageous and nonsensical.  You have such a sharp wit!”

Cone:  “Well thanks babe.  You should tell that to my roommate, Rod.  He doesn’t laugh at any of my jokes; always looking on the dark side of things.”

Photon:  “Well, that’s his job, isn’t it?”

*The audience chuckles, but an uncertain air engulfs the studio simultaneously.*

Cone:  “I’m not sure I catch your meaning.”

Photon:  “Allow me to shed some light on the issue.  It’s sort of what I do.  Surely you know that you and Rod, and myself for that matter, are players in a much larger game.”

Cone:  “Well of course, my dear, the game of life is much bigger than us all.  But I’m not sure – ”

Photon:  “No no no, James.  What I mean is that we are, the three of us, representations of a larger construct.”

*Cone, the smile fading from his face, slowly leans forward within whispering distance of his date.  The audience is dead silent.*

Cone:  (whispering) “What are you doing?  We’re not supposed to acknowledge the audience.  The first rule of sitcoms is that you’re not allowed to acknowledge that you’re in a sitcom.”

Photon:  “Oh don’t be silly.  And, you’re still thinking too small.  The audience of which you speak is part of the show of which I speak.  There is another audience for whom the audience of which you are aware is the entertainment.  And we, my friend, are a part of the same entertainment.”

Cone:  “…okay.  Well don’t keep me in the dark then.  What do we represent?  Who is watching us?”

*The audience begins to turn its collective head 180 degrees.*

Photon:  “Let’s start with the basics.  Your name is James Cone, whereas your roommate’s name is Rod Johnson.  Rod and Cone.  Ring a bell?”

Cone:  “You’re losing me.”

Photon:  “Oh come on.  If there’s one part of ocular anatomy everybody knows, it’s rods and cones.  Photoreceptors?  The cells of the eye that make it possible to absorb light and essentially facilitate vision as we know it?”

Cone:  “Sounds familiar.”

Photon:  “Boy, for the character that represents the photoreceptor cell most responsible for sharp, distinctive, detail-oriented vision, you are not very bright.  Maybe a better plot would have been one in which I went on a date with Rod; at least it would make sense that he was left in the dark, given that he represents the photoreceptor cell that allows for good night vision, peripheral vision, and detection of motion.”

Cone:  “Oh…”

Photon:  “Also, as we speak, I’m fulfilling my obligation as a character named for a light particle.  I’m illuminating things for you, no?”

Cone:  “Well, yeah, I guess.”

*Nothing can be heard throughout the studio audience at this point except for a random cough or sniffle.*

Photon:  “I suppose I’ve said too much.  To summarize, we are characters who are being used to illustrate a concept to an audience; we are the tools of education.”

Cone:  “I think I get it now.  But where does the circle close?  If there is an audience that can see this audience, how does the audience twice-removed know that it is not being watched?”

*Photon and Cone smile and look at each other across the table, then turn their heads and make eye contact with you.  Cue commercial break.*

Rod and Cone

*The following episode was taped before a live studio audience.*

{Setting:  The interior of a well-decorated urban apartment, as seen in most television sitcoms post-1990.  A pale green overstuffed sofa serves as the centerpiece of the main living area, which also includes a large window looking out at the surrounding cityscape.  Bookshelves line the side wall adjacent to the large window, and said shelves are adorned with various personality-describing bric-a-brac, such as sports trophies and portraits of family  members, not to mention a gaudy neon-pink stuffed penguin.}

{Audience applauds as one of our main characters, James Cone, enters the apartment carrying a briefcase.  He throws his bright blue overcoat on a nearby chair and places his briefcase gingerly on a round table next to the chair.  He takes a step back and eyeballs the briefcase, then gently turns it about 15 degrees clockwise before taking another step back.  He nods and smiles.  The audience laughs and applauds.}

Cone: “Rod!  You home?”

{Cue more audience applause as our other main character, Rod Johnson, groggily walks into the living room from a side doorway.  He yawns and shuffles to the couch, wearing gray pajama pants and a black bathrobe.  His dark hair resembles a bird’s nest.}

Rod:  “Home already, Cone?  Did you have a half-day today or something?”

Cone:  “Rod, it’s 6:00 in the evening.”

{Audience laughter.}

Rod:  “Oh.  Sooo, what’s for dinner?”

Cone:  “I’ll tell you what’s for dinner.  For you, either Chinese takeout or pizza.  I have a date and thus will be eating out tonight.”

{Audiences makes the “OOOOOOOooooOOOOOOoooooo” sound.}

Rod:  “A date?  Who wants to go on a date with you?  Was she drawn in by all your garish colored suits?”

Cone:  “For your information, she’s a highly discerning individual, like me.  We met on a sunny day downtown after work a few weeks ago and have had lunch several times.  Her name is Photon.”

Rod:  “Like the couch?”

Cone:  “That’s a futon; her name is Photon.  I think her parents were hippies.”

{Audience laughs.}

Rod:  “Well that’s just delightful.  You’re going out and galavanting about town while I’m left to sit here in this hole of an apartment in my dark bedroom.”

Cone:  “But you like the dark.”

Rod:  “That’s beside the point!  The point is, you seem to get all the Photons.  I’m lucky if a girl glimpses me in her periphery, let alone shoots me a full-on glance.”

{Audience “awwwwwwww’s”.}

Cone:  “But Rod, that’s your own fault!  How do you expect to be seen when you hang out on the fringe all the time; you need to be in the center of things, like me!”

Rod:  “Well thank you for the advice, Mr. Sunny Disposition.  I’ll meditate on your words while I’m sitting here alone.”

{Rod gets up from the couch and enters the adjoining kitchen area.  He opens the refrigerator and removes a brown generic-looking bottle of beer.  He slams the top of the bottle on the side of the kitchen table, causing the cap to flip off the bottle and into the air, and which he catches as the audience applauds his parlor trick.}

Cone:  “You are so melodramatic.  I’ll tell you what…If you come out with me tonight I’ll let you borrow one of my suits to wear to the club.  I know you don’t have any nice clothes of your own.”

Rod:  “Yeah right!  Your suits crimp my style; way too bright and colorful.  I’ll stick with traditional black and white for the times I choose to go out, thank you.  As for the club, I’ll pass.  Too many people jumping around; I’m too motion sensitive for all that.”

Cone:  “Suit yourself.  Or rather, I’ll suit myself.  I need to get changed for tonight.  Enjoy your lonesome beer!”

{Cone turns his back to the adjoining bedroom door before moonwalking off-camera.  Rod flops back down on the overstuffed sofa and drains the entire beer, before belching loud enough to wake the dead; the audience laughs.}

Rod:  “Photons…I could get a Photon if I wanted to…”

{Cue sitcom jingle as we head to commercial.}

Re:

In answer to my last post regarding writing letters, I have prepared the following as a response to the sample patient letter I composed.  Fellow optometrists, I encourage you to have a stack of these handy so that you’re prepared when a patient hands you the previously typed letter.  I do accept monetary donations.

Dear [patient name],

I appreciate your forethought in preparing the letter you have given me, which outlines your concerns about your eyes.  It takes a person with a large amount of [intelligence, kindness, good looks] to come up with such a well-worded document.  Anyway, let’s talk about your eyes.

You may take this as an indication of your age, but I recommend a [bifocal, trifocal, prosthetic eye].  I know this kind of thing is not good for your vanity, but I’m an optometrist, not Tim Gunn.  We have many different choices in spectacle frames, however, and I’m sure you can find something that makes you look [distinguished, flirty, other adjective]; that is, until your glasses inevitably get [lost, broken, eaten by the dog or vice versa].  In which case it’s probably a good idea to go ahead and buy a second pair as well.  Hey, seeing well and looking good ain’t cheap.

All health-related aspects regarding your eyes look good, although your ocular surface looks a little dry; I recommend [Restasis, artificial tears, looking up when it rains].  Your eyes don’t feel dry, you say?  They actually water all the time and are the exact opposite of dry?  Well, believe it or not, it’s possible that your eyes water because they are dry – this is a common occurence in people with dry eye syndrome; basically the tears your eyes are producing are [not of good quality, not coating your eye properly, crocodile tears].

I did not see any signs of serious ocular diseases such as glaucoma or macular degeneration, although you do you have very early cataracts forming.  Not to worry, as these are generally very slowly progressive and at worst will only cause you to have trouble with [reading, glare, thinking your spouse is attractive (kind of like nature’s beer goggles)].  When the time is right and you feel like your vision is no longer acceptable to the point that you can no longer perform everyday tasks, then we can talk about referring you to the local ophthalmologist’s [office, clinic, van] for cataract extraction.

Oh, I can see as you’re reading this that you have to hold the paper pretty far out from your face; either you are presbyopic or the paper just smells really bad.  If it’s the former, the bifocals I prescribed earlier will help; if it’s the latter, it’s probably because our paper is made from [recycled products, card stock, Soylent Green] kind of like those old Weekly Readers from grade school.  Remember those?  God did those things reek.

In summary, you should be good to go until your next annual eye exam, and I do mean annual, rather than the decade-long gap since the last time you were here.  Speaking of which, you should probably dispose of the trial pair of contact lenses that we gave you at that last visit; they’re probably a little [protein-deposited, worn out, nah nevermind they’re fine].  Call me if you need anything, otherwise I’ll SEE you then!  Haha, eye doctor humor!

Sincerely,

[Doctor’s name]

Aaaaaaaand scene!

To all of you optometrists out there who read this, see if you can get me an honorary Fellowship in the Academy for this great service I have provided you; writing case reports is so overdone.  And besides, what good does yet another case report do?  Either it reinforces previously known treatment protocol or it presents such a rare variation that no one will ever see such a thing again.  (What you’ve just witnessed is me justifying the fact that I’m writing on a blog rather than writing case reports.)

Like any doctor-patient relationship, communication is key.  And nothing communicates how much you care about your patient like a letter typed by a stranger on the internet.  So until next time, keep it real.

Know Your Letters

I’m a big fan of referral letters.  I write letters to other doctors all the time as a service to my patients who have systemic disease which may manifest in their eyes.  I think it’s a good way to keep other healthcare providers in the loop.  I always appreciate reading a progress letter about a referred patient that lets me know how they’re doing.

And then I thought to myself, what if a patient were to write me a letter.  What would it look like?  In that line of thinking, I figured I’d go ahead and whip up a template for all future patients.  I’ve left some fields alterable so you can fill in the blanks as necessary.  Think of it as a healthcare Mad Lib.  Your eye doctor (whether it’s me or not) will (possibly) thank you.

Dear Dr. [optometrist’s surname],

I am concerned that I might have [astigmatism, the glaucoma, hypochondria].  I’ve also been told that I have [migraines, cataracts, carpal tunnel].  During my eye exam today, I would appreciate it if you would address all of these problems including the ones that I will tell you about when the exam is over.

I would also like to renew my contact lenses.  I’m not sure what I’ve been wearing, but I mean who really knows what they put in their eyes, right?  My contacts are supposed to be replaced every [two weeks, month, Olympics], but I’m pretty bad about sticking to a schedule.  I was also wondering about contact lens solutions; I generally use [Opti-Free, something generic, breast milk], is that okay?

Oh, are you going to dilate my pupils today?  The last time I had that done it made me [nauseous, dizzy, dance on the ceiling].  If we could skip that today I’d really appreciate it; I have to [drive, go to work, make a list of excuses to not be dilated], and having my pupils dilated would really make that difficult.  I mean, I’ve heard that the side effects of those dilating drops can include [light sensitivity, impaired near vision, erectile dysfunction] and I really don’t need that right now.

In the event that my glasses don’t work, I hope you have a [return policy, cash-back guarantee, forgiving temperament].  That whole test with the “which is better, one or two” stuff was really tough and I hope you knew what you were doing because my eyes can be really [dry, sensitive, indecisive].  Also, can you show me ‘number 2’ again?  I think you tricked me the first time and that’s the one I’d actually like in my [glasses, contacts, actually nevermind I’d like ‘number 1’].

Anyway, thanks for your time and for helping me to see better.  Oh by the way, I think I forgot to mention that I have [diabetes, sickle-cell anemia, leprosy], but I figured that since you’re only an eye doctor you wouldn’t need to know that. Thanks again and see you in a year!

Sincerely,

[Patient’s name]

Me again.

Hopefully that didn’t seem too snarky.  Basically all you have to do is print this out and circle the pertinent answers; then when you go to your next eye examination just hand it to your optometrist.  Trust me, it’ll save some time and result in a more accurate prescription.

For my optometrist subscribers, I’ll post the appropriate response letter in the weeks to come.  Expect equilateral snark.

Glaucoma: Putting the Pieces Together

Disclaimer:  I’ve retooled this post because it’s being published in the local newspaper – thus I’ve toned down the goofball humor; I know, I’m a sell-out.

Ask someone to name an eye disease and one of the answers you’ll hear the most is “glaucoma.”  Everyone’s heard of it, but not many are familiar with the complexity of the disease.  It used to be simple:  if you had an eye pressure above a specified reading, then you had glaucoma, end of story.  Those were the old days of eyecare, and in this age of evidence-based medicine, glaucoma has become more of a chimera than a pitbull.  Nowadays there are many more factors to consider when the diagnosis of glaucoma is explored; so, how exactly is it diagnosed?

First, eye pressure still plays a significant role, and that is why measuring eye pressure is an integral part of any routine eye examination.  Many people associate the feared “air-puff test” with measuring ocular pressure, but today there are a number of different ways to obtain this important reading.  And though ocular pressure is a large part of diagnosing glaucoma, it is not a definitive measure any longer.  That being said, it is unfortunately still the only factor that is treatable.

There was me, that is Alex, and my three droogs, that is Pete, Georgey, and Dr. Smith.

Also of consideration in diagnosing glaucoma is the appearance of the optic nerve.  After all, this is a disease which causes peripheral vision loss secondary to the destruction of nerve fibers.  If enough of these fibers are eliminated, observable changes will be exhibited in the optic nerve itself, which is sort of a bundle of all the nerve fibers of the eye.  Viewing the optic nerve after dilating the eyes  is another significant portion of an eye examination.

Looks like glaucoma is sticking its tongue out at you.

Yet a third piece of the glaucoma puzzle is an evaluation of a patient’s visual fields.  Optometrists and ophthalmologists utilize visual field analyzing technology to essentially map out what a person sees when they are viewing the world.  In glaucoma, telltale defects may appear in the visual field which are indicative that functional changes are occurring due to optic nerve damage.  Usually the results of the visual field test are correlated with the appearance of the optic nerve and thus a diagnosis of glaucoma can be made.

Example of a visual field test printout. And not a normal one.

Recently, more technological advances in eyecare have led to retinal imaging devices which can provide even more information as to changes in the nerve fiber layer of the eye.  Many times these imaging studies can detect glaucoma sooner than it takes for visual field defects to show up, making imaging an invaluable tool in the arsenal of eye doctors.  Once again, the results of this sort of testing must be compared with other findings of the eye examination to properly diagnose the disease.

If there is any good news about glaucoma, it’s that the disease is one of slow progression.  If diagnosed with glaucoma, you will not lose your vision overnight; however, it is likely you will be placed on medication indefinitely since the disease is not curable.  Topical pressure-lowering eyedrops are the mainstay of glaucoma treatment and can drastically slow the destruction of ocular nerve fibers.  Due to its insidious nature, glaucoma is a disease that makes it important for all people to have a regular eye examination.  With early detection, vision loss can be minimized.

End local newspaper section.

I hope that wasn’t too boring.  I find it hard to believe that anyone would read something like that in a newspaper.  Heck, does anyone read the newspaper, period?  I doubt it.  You know what newspapers lack?  Explosions.  People like explosions – like Arnold Schwarzenegger-style explosions.  If your newspaper was called The BOOM Gazette, I’d read it.