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.

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The Stigma of Astigmatism

Dear Diary,

I’m giving up.

I can’t take it anymore.

For as long as I can remember I’ve been misunderstood.  I get blamed for things that aren’t my fault, most people don’t know anything about me, and I’m never spoken of in a positive light.

I mean, for starters, most people seem to think that I can cause irreparable damage to their vision, and that’s a dirty lie!  If only they knew how prevalent I am and all of the different types of vision correction that can make me pretty much unnoticeable.  Glasses, contacts, laser surgery.  And yet they still say that I have an effect on their vision!  Dude, your LASIK surgeon obliterated me when you had your procedure – if you still can’t see clearly, then it’s not me, it’s you.  Maybe you need laser BRAIN surgery HAHAHA.

I’m sorry Diary, that was crude.

But darnit, it’s just so FRUSTRATING.  I’ve never purposefully done anything to hurt anybody.  I mean I guess there was that one guy in Minnesota who slid off the road because he couldn’t clearly see the patch of ice ahead of him.  Or the lady from San Francisco who was injured in that car accident because she was squinting to see a billboard.  But that’s not MY fault.  I mean it is, but it isn’t.  I don’t deserve this.

Two foci are better than one!

To make things worse, all those eye doctors explain what I am in the same way.  It’s always “your eye is like a football not a baseball.”  What the heck is that supposed to mean?  Personally I’ve never seen a person in side-profile whose eye jutted out from their head like the cone of Madonna’s bra.  A football?  Really?  Let’s call a spade a spade:  all I am is a difference in the steepness of the cornea; that’s it.  Kind of like if you held a balloon and gently squashed it between your hands – in one direction the curvature of the balloon would be steeper than in the other direction.

But NooOOooOOoo, I’m a football.  Most people are pear-shaped or apple-shaped, but I’m a pigskin.

SPORTS EQUIPMENT PROPAGANDA

And then there are those people that say they can FEEL me.  Really?  I’m a microscopic change in steepness in your cornea and you can FEEL me?  Maybe your eyes are dry, or you have allergies, or you have some other foreign body in your eye, but your astigmatism is not something you can feel!  Does anyone ever think about how I FEEL?  It’s depressing to be thought of as a blinding eye disease when all that’s really needed are glasses.

Diary, I know I’m complaining a lot today.  I guess I should just be thankful that so many people know me.  What I need is a good PR campaign to put a positive spin on things.  Like a catchy slogan or something.  Let’s do some brainstorming, Diary.

Astigmatism:  It’ll Make You A Sandwich.

Astigmatism:  It Won’t Get Mad When Your Dog Poops on the Sidewalk.

Astigmatism:  At Least It’s Not Dysentery.

Astigmatism:  It Doesn’t Think Twilight is the Epitome of Fiction, But It Won’t Judge You if You Do.

Astigmatism:  It’s a Party in Your Eye!

Any other ideas?

Tyrannosaurus Rx

Ever looked at your eyeglasses or contact lens prescription?  If you’ve ordered eyewear online you certainly have.  To those uninitiated in the science of refraction, that prescription probably just looks like a big jumble of nonsensical numbers and plus/minus signs.  Well, for those of you who want to know, this post is for you!  Your very own post!  If we’re lucky we might even get to the bottom of that pesky PD thing.

What language is this written in? Sanskrit?

So let’s start with the bare-bones basics:  abbreviations.  Your prescription probably has the letters “OD” and “OS” somewhere on it, and I would imagine that you’ve used the POWER OF LOGIC to determine that these refer to your right and left eye.  More specifically though, OD is short for oculus dexter, which in Latin translates to “the eye of an HBO serial killer series.”  Either that or “right eye.”  By process of elimination, OS is short for oculus sinister, which of course is Latin for “evil eye.”

You might also see the abbreviations SPH and CYL on your prescription.  These refer to the shape of the lenses:  SPH stands for sphere (a spherical lens), while CYL is for cylinder (a cylindrical lens).  If you are near-sighted (myopic) or far-sighted (hyperopic) you will see a number in the SPH column; if you’re myopic it’ll be a negative number, and if you’re hyperopic it’ll be positive.  If there is a number in the CYL column, it means you have astigmatism.  This number indicates how many days you have left, so live them well.

Just being completely serious kidding.  Astigmatism is not a life-threatening condition, and it’s actually a condition that the majority of humanity suffers from.  That’s right; most people have some amount of astigmatism.  Makes you feel less special, doesn’t it?  In addition to the CYL value, you’ll also see a number under a column marked AXIS; this is because a cylindrical lens must be specified at a particular orientation, or axis (measured in degrees, and falling between 1 and 180), in order for your astigmatism to be corrected.

Alternatively, SPH is the sound you make when someone tells you an outrageous lie, and CYL is the part of the window where your cat sunbathes.  I never said optometry makes any sense.

This is my favorite cyl.

Speaking of astigmatism, there are contact lenses available that correct it.  However, they can be somewhat limited in the amount and orientation of astigmatic correction that they offer; usually your optometrist can ballpark it so that you can still see clearly.  That being said, sometimes your vision may fluctuate if the contact lens rotates when you blink; unlike glasses, contacts are free to rotate on the eye.  You would look pretty goofy if your glasses spun around on your face.  Like a nerd-copter.

Depending on your age, you may also see a number in a section marked ADD; this is the power of your bifocal.  Here’s a little trick regarding this number:  if you wear contacts that correct your distance vision but require a bifocal in your glasses, you can use the ADD number to buy a pair of over-the-counter reading glasses to wear on top of your contacts to improve your near vision.  Don’t say I never gave you anything.

And last but not least, the revered PD.  This is the limiting factor that most patients curse when they’re trying to order glasses online.  It can be elusive – I would imagine that most optometric offices don’t include it on the prescription form.  PD stands for pupillary distance, and this is an important measurement because it determines where the optical centers of your spectacle lenses reside – if it’s measured incorrectly, you may experience unnecessary distortions through your glasses.  This may lead to nausea and explosive vomiting.

So in a nutshell, that’s how your RX works.  And outside of a nutshell, that’s also how it works.  Questions?

3-2-1 Contact (Part 2)

Announcer:  Welcome back!  Today’s episode of CL Jeopardy is brought to you by Dr. Hougland’s Twitter account, MakeEyeContact.  For the latest updates in fascinating eye-related news and assorted tidbits on a variety of other topics, Follow Dr. Hougland on Twitter.  You probably won’t regret it!  Now, here’s Alexandra.

Alexandra:  Thanks once again Announcer.  That Dr. Hougland sounds like a stand-up guy.  Usually at this point in the game we’d announce the scores, but since no money is being offered as a prize today, we’ll just say that the playing field is even, with a three-way tie between Contestant 1, Contestant 2, and Goat.  Once again, our categories are:

WE’VE GOT A SOLUTION

SOFT OR HARD

YOUR WEAR-TIME IS WHAT?

FLYING THE RED EYE

HYDRACLEAR

Alexandra:  I don’t remember whose turn it is, so Contestant 2, you’re up.

Contestant 2:  Um, I’ll take Flying the Red Eye, Alexandra.

Alexandra:  “When your eyes turn red and become painful, these are the medicated drops you should use.”

Contestant 1:  What are antibiotics?

Alexandra:  Well, here’s the thing:  you might be right.  A red eye can be caused by an almost infinite number of factors; it could be bacterial, viral, allergic, autoimmune, inflammatory, or even just dryness.  Just because you have a spare bottle of leftover, expired antibiotic drops that you used for your dog’s last eye infection doesn’t mean you should start drowning your face in them when you notice a little ocular redness.  Some eyedrops, such as steroids, while helpful in some cases, may actually be harmful in other cases.  For instance, did you know you can actually have a herpes infection of the eye?

Contestant 1:  Ewwww!

Alexandra:  It’s true!  And putting steroid drops on an eye infected with herpes is NOT a good idea.  Therefore, if you ever develop a red eye, the best course of action is to pay a visit to your friendly neighborhood eye doctor.

I'm not sure what this will do but I think I'll put it in my eye.

Goat:  Baaaah!

Alexandra:  Very astute observation.  Contestant 1, since you were sort of correct, choose again.

Contestant 1:  I’ll take Your Wear Time is What?

Alexandra:  This brand of contact lenses can be worn continuously for months at a time without removing them from your eyes.

Contestant 2:  What is Acuvue?

Alexandra:  No, I’m sorry.  Contestant 1?

Contestant 1:  What is…Night and Day?

Alexandra:  Also incorrect.  Goat?

Goat:  ……..

Alexandra:  Actually, the goat is correct!  There is currently no FDA-approved contact lens that is supposed to be worn without removal for months at a time.  There are contacts that are approved for overnight wear, but even those generally have a monthly replacement schedule.  If you wouldn’t wear the same pair of underwear for months at a time, why would you do the same to your eyes?

Contestant 2:  What’s wrong with wearing the same underwear for months?

Contestant 1:  …gross.

Alexandra:  Aaaaaaand with that, let’s go to Final CL Jeopardy!  I’ll present one final category, and our contestants will have the chance to wager all that they have on their answer!  Now you might be wondering “Alexandra, if there is no monetary compensation for answering questions correctly on this show, then how do the contestants wager anything?”  Well viewer, you obviously haven’t been paying attention.  Our contestants will be wagering their knowledge of contact lenses – that is, if you answer the final category incorrectly, you’ll be receiving a selective frontal lobotomy!

Audience:  OooooOOOOoooooo.

Alexandra:  Today’s Final CL Jeopardy category is

CONTACT LENSES

Alexandra:  Well that’s vague.  Make your wagers now!

Contestant 2:  Um, Alexandra, I didn’t sign up for a frontal lobotomy.

Contestant 1:  Yeah, me either.

Goat:  Baaaaaah!

Alexandra:  Actually, it’s a selective frontal lobotomy, meaning we’ll only remove the portion of your frontal lobe containing the amount of contact lens knowledge that you wager.  And possibly some adjacent tissue.  The answer is:  “Toric contact lenses provide correction for this type of refractive error.”  Aaaaaand…go!

*CL Jeopardy music plays in the background.*

Alexandra:  Time’s up!  Let’s see who’s going home a few milligrams lighter.  Contestant 1, what say you?

Contestant 1:  Oh God I’m so scared.

Alexandra:  I’m sorry! That’s incorrect!  And it looks like you wagered 50% of your contact lens knowledge; say goodbye to that!

Contestant 1:  Noooooooooooooooo

Alexandra:  Contestant 2, don’t let me down.

Contestant 2:  What is……ummm……What is…….What is glaucoma?

Alexandra:  Also incorrect!  Bid adieu to 65% of your contact lens knowledge, and possibly also your ability to ride a bicycle.

Contestant 2:  Well darn.

Alexandra:  You’re up, goat!

Goat:  What is astigmatism?

Alexandra:  We have a winner!  Toric contacts correct astigmatism, whereas non-toric, or spherical, contacts only correct myopia (nearsightedness) or hyperopia (farsightedness).  Today’s winner will be going home with our first two contestants’ partial frontal lobes!  We’ll see you next time on CL Jeopardy!

***LEGAL DISCLAIMER:  No animals were harmed in the filming of CL Jeopardy.  However, Contestant 1 no longer remembers his name and Contestant 2 can’t walk in a straight line anymore.  Don’t take signing up for game shows lightly!***