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 Problem is the Solution

One of my earliest memories regarding contact lenses dates way back to grade school when I played on the basketball team (yes, I am mildly athletic).  This was long before I had any aspirations of being an eye doctor; believe it or not I did not exit the womb holding an ophthalmoscope (and my mother thanks me everyday for that).  We were in the middle of a game against a neighboring town when one of the better players on my team froze and covered his right eye with his hand.

“I lost my contact!” I heard him shout to the referee, resulting in an ear-splitting blow of the whistle.

Somebody either lost a contact or there is something VERY interesting on the floor.

The rest of the players on the court froze and all six parents in attendance went dead silent while the half-blinded boy knelt down to look for his lost lens.  It didn’t take long for him to find it, and what he did next is forever frozen in my mind (now that I know better) as one of the most cringe-inducing thoughts in my optometric mind.  You can probably guess what he did with that lens.

Like it was a piece of bubble gum or Pez, he popped it in his mouth and ran to the sidelines while our coach substituted a replacement player.  And after sucking the dirt off that contact lens…yes, he re-inserted it.  In his eye.  Let’s take a time-out while I stop shuddering.

Okay, time-in.

It’s amazing what some people will put in their eyes.  Most of the offenders use questionable methods for cleaning their contacts before inserting them – I’ve actually read stories online of people using Coca-Cola as a solution.  Let’s pause while I think of a good joke for this.

Putting your contacts in Coke: almost as bad as putting them on Lady Gaga.

However, incomprehensible behavior aside, a lot of well-meaning contact lens wearers simply do not know that there is a difference between all of those cleaning/storing/multipurpose/peroxide/no-rub/miracle solutions that they come across in the pharmacy aisle.  I can attest to this fact because I was once among them.  It’s a confusing world out there and I can’t even decide on what to make for dinner, let alone decide between the green box versus the blue one for my contacts.

Let’s look at some of the big players.  There’s Opti-Free (and its many variations including Replenish, Express, and PureMoist), Renu (which also has a couple variations), Complete, Clear Care, Revitalens, Biotrue, and those are just the ones I can think of because I have them in the cabinet down the hall.

To put it bluntly, there’s really only one solution I feel comfortable recommending for ALL patients, and that solution is Clear Care.  I say this because Clear Care is hydrogen peroxide…and that’s it.  No preservatives that may irritate your eyes, no other chemicals that may cause issues, just peroxide.  The only real downfall is that your contact lenses have to soak in it for a MINIMUM of 6 hours, and if you ever make the terrible mistake of putting it directly in your eyes, get ready to mimic Macaulay Culkin in Home Alone…AHHHHHHHHHHHHHH!

Not there’s anything wrong with the other solutions; most of the others will work well for most people.  The only solution I will not recommend is generic, and the primary reason for that is because it’s never the same from year to year; companies basically take bids and the cheapest one wins the generic solution contract for that time period.  It’s like the mystery meat of contact lens solutions – you don’t even know what you’re putting in your eyes.

Do you know what you’re putting in your eyes?

Although I guess that still beats the heck out of using Diet Coke.

Edit from the (relative) future:  Since I’ve written the main text above, apparently there’s been an uproar about the safety of using Clear Care.  One of the things I stress to every single patient I dispense a sample to is that you CANNOT put it directly in your eye.  I demonstrate the red ring on the top of the bottle as well as the red tip and repeat that you CANNOT put it directly in your eye.  As long as you follow instructions, Cleare Care will not burn your eyes.

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!***

3-2-1 Contact (Part 1)

Announcer:  Get ready everyone!  It’s time for America’s favorite game show about contact lenses, where the answer is a question is the answer!  That’s right, it’s CL Jeopardy!  Now, here’s your host, Alexandra Trebek!

Bad Paint job.

Alexandra:  Thanks Announcer!  Welcome to CL Jeopardy, the only game show that rewards you for your knowledge of contact lenses, and when I say reward I of course mean that you’ve already rewarded yourself by learning about contact lenses!  There are no monetary prizes, and each of our contestants have had their legs chained to their podium because they didn’t have knowledge of this until now!  Speaking of our contestants, let’s meet our lucky and now probably unwilling competitors.  First we have Contestant 1, who I’m told is an avid stamp collector.  Is that right?

Contestant 1:  Actually Alexandra, I’m a collect stamper.  Any time you call someone and ask for them to accept the charges, it starts a trickle-down of paperwork that eventually leads to me.  If the charges were accepted by the receiver, I put the final stamp on the paperwork and file it away.

Alexandra:  How…interesting.  Our second contestant today is Contestant 2.  My notes say that you once killed a man.

Contestant 2:  WHAT?

Alexandra:  Oh I’m sorry, that second L is actually a T.  So you kilted a man.

Contestant 2:  Phew!  You had me worried there for a second Alexandra.  But yes, my family hails from Scotland, and when my husband and I were married I convinced him to wear the traditional kilt to the ceremony.

Alexandra:  At your wedding eh?  I hope he didn’t get cold knees!

Contestant 2:  …huh?

Alexandra:  You know, cold feet like at a wedding, and he was wearing a kilt so…Nevermind.  Our third contestant is a goat who eats garbage.

Goat:  Baaaaaaah.

Alexandra:  Now that we’ve met our three players (and after far too long of a lame comedic setup), let’s check out today’s CL Jeopardy categories!  Those categories are:

WE’VE GOT A SOLUTION

SOFT OR HARD

YOUR WEAR-TIME IS WHAT?

FLYING THE RED EYE

HYDRACLEAR

Alexandra:  Contestant 1, you drew the short straw backstage so you get to choose first.

Contestant 1:  I’ll take Soft or Hard for $200.

Alexandra:  “These contacts are prescribed for overnight wear and reshape the cornea to neutralize the patient’s prescription during daytime hours.”

Contestant 1:  What is soft?!?

Alexandra:  No, I’m sorry.

Contestant 2:  What is hard?!

Alexandra:  Yes!  The process of using rigid gas-permeable (or hard) lenses to reshape the cornea overnight is known as orthokeratology!  Contestant 2, you choose next.

Contestant 2:  Hydraclear for $100, Alexandra.

Alexandra:  “This is the technology that makes Hydraclear such a wonderful product.”

Contestant 2:  What is…um…uhhhh…

Alexandra:  I’m sorry Contestant 2, but you’re out of time.

Contestant 1:  What is…what is…

Alexandra:  Once again out of time.

Goat:  Baaaaaahhh.

Alexandra:  Insightful, but no.  This is a difficult question to answer; the folks at Acuvue market the heck out of their contacts, Oasys for example, and tout Hydraclear as the reason for those lenses being so great.  Through the miracle of mass marketing, your ordinary Joe Myope is led to believe that Hydraclear is what he needs to remedy all of his contact lens problems and so he asks for the contacts with Hydraclear at his next eye exam.  However, if you were to question Joe about why he needs Hydraclear or even what Hydraclear is, he wouldn’t be able to tell you.  Capitalism and marketing at its finest, and since I’m a stand-in for the author (Editorial note:  wink wink), I’ll leave it at that.  Contestant 2, it’s still your board.

Apparently Hydraclear is what you get when you mix curly fries with chains of Jesus fish.

Contestant 2:  I’ll take We’ve Got A Solution for $850.

Alexandra:  “This contact lens solution is superior to pure saline in regards to disinfecting contact lenses.”

Contestant 1:  What is Opti-Free?

Alexandra:  That is corr-

Contestant 2:  No!  What is Clear Care?!

Alexandra:  Actually, that is also corr-

Goat:  Baaaaaaaaaaaah.

Alexandra:  You are all correct, except for the goat.  We also would have accepted BioTrue, Revitalens, or Renu.  Each of these contact lens solutions are superior to saline, which does not effectively disinfect contacts.  With the exception of Clear Care, all of these are classified as Multi-Purpose Disinfecting Solutions, or MPDS’s.  Clear Care is regaular old hydrogen peroxide, which should never be put directly in your eye unless you’re a masochist, and even then, unless you’re a really dedicated masochist.  And on that note, we’re due for our first commercial break; get ready for a 50% increase in volume and we’ll see you back on Contact Lens Jeopardy in a bit.