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.

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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.

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.

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.