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.

Trail of Tears

Are all artificial tears created equal?

This is a question that I imagine many people must ask themselves when they walk down the eyecare aisle at Wal-Mart, or Target, or Jewell-Osco, or Costco (I actually don’t know if Costco has an eyecare aisle, but if they do I like to picture 10-gallon drums of Opti-Free).  I admit, until recently, I couldn’t recall the last time I had ventured down the eyecare aisle; as an eye doctor, I benefit from freebies at work.  But now that I’ve taken the time to wander down that aisle flanked by multicolored boxes of artificial tears and contact lens solutions, I can understand why people feel a little overwhelmed.  It’s a veritable Rainbow of Uncertainty.

It’s a similar experience to those times when the wife tells me to buy her some shampoo; all the bottles look the same to me, so I pick the cheapest one.  Honey, I’m sorry you ended up looking like James Carville.

Did that say “Pantene” or “Paint Thinner?”

So when your eyes are feeling dry and you just want a little relief, how do you pick which artificial tears to use if they all look the same and promise the same things?  Maybe you heard Ben Stein say on TV that Clear Eyes will help.  Or maybe you have a co-worker who swears by Systane.  Or perhaps you read an article online about a woman who poisoned her boyfriend with Visine.  Stay away from Visine.

Luckily for you, you have me.  I’ll admit, I don’t have a strong opinion on a lot of things, but boy-howdy do I have one when it comes to artificial tears.  Stop laughing at me.

First and foremost, I’m a big proponent of looking at ingredients.  Whether I’m buying artificial tears or artficial sweetner, I want to know what’s going in my body.  With eyedrops, the active ingredient you’re mostly likely going to see is the lubricant itself, such as glycerin, polyethylene glycol,  or carboxymethylcellulose.  You may also see a preservative, such as polyquaternium or benzalkonium chloride, listed.  Preservatives can be sort of a mixed bag; they’re good in that they keep bacteria from contaminating the bottle, but they may also be responsible for causing ocular toxicity if used too much, thus defeating the whole purpose of an artificial tear in the first place.  For this reason, I generally prefer a preservative-free drop, such as Theratears, for those times when frequent dosing is necessary.

Exciting stuff, right?

YES THAT IS EXCITING

Another thing to consider, after ingredients, is the specific application of different types of artificial tear.  Some claim to be better for certain types of dry eye, some are better for night time, some give you X-ray vision.  You don’t want to buy the wrong drop at the wrong time.  That is, if you were to pick up some Genteal ocular ointment and put that stuff in while you’re at work, have fun looking at life like it’s a dream sequence for the next 15 minutes – you might as well smear vaseline on your face.  So be careful about the indications on certain products; if there’s a moon and stars on the box, it’s probably not indicated for high noon.

“Okay almighty optometrist,” I can hear you saying to your monitor, “so which artificial tears do you recommend, specifically?”

Well, for your everyday run-of-the-mill mild dryness, I use a lot of Systane Ultra and OptiveSystane Gel and Blink Gel are both good if you like a thicker drop.  For dosing more than four times a day, I use Theratears.  If overnight lubrication is needed, an ointment like Genteal is great.  I try to stay away from Clear Eyes and Visine if possible (and it’s usually possible).

Now you know, and knowing is half the battle.  “What’s the other half of the battle?” you ask?  I…I’m not really sure.  G.I. Joe only ever gave me 50% of the formula for winning the battle.  Let’s say the other half involves artificial tears.  Aaaaaaand we have closure.

The End.

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?