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.

memegen

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.

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.

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.