Unique as the Doctor you Chose

http://www.equinoxi.com/internationalforwarding.htm

Yesterday was my first day as an official doctor!  Besides entering the room and referring to myself as doctor (which I must say was a little weird) everything seemed pretty much the same.  I was a little nervous, but the patients were nice and I was able to get in and perform the exam as efficiently as possible and still have time to chat a bit about their lives.  I believe that is one of the most important parts of my job.  Getting to know the whole person and what they have going on in their lives allows me to better treat the individual patient.  Lets face it, everyone is unique.  If you don't believe me look on somebodies Facebook.  It is funny how people seem to reveal more about themselves on Facebook than they do in person.  Maybe it is because people simply don't have enough time to show who they really are.  On FB one can reveal their hobbies, profession, friends, family, likes, dislikes, political views, religious views, romantic relationships, what they are feeling emotionally at the moment, and to top it all off they can provide a picture for every occasion.

As for my profession, I get all of 15-20 minutes a year to be somebodies best friend.  I need to know their eye health history, vision history, systemic health, medications, family systemic and eye health history, occupation, hobbies, what they need to see, if they have any abnormal symptoms, and (now thanks to the government) I need to know their preferred language, race, and ethnicity.  I need to know all of that while evaluating the health of the eye and their vision.  As you can see that is a lot to know about the individual.  This wasn't meant to reveal how difficult our jobs can be, we have many systems in place in order to gather all of that information and interpret it, but it was meant to show you how unique everybody can be.  Each and every patient has their own set of eyes with their own set of needs.  Each of us are unique and we all want to be treated as unique.  Think about a pair of glasses.  Each pair of glasses are specifically customized to the patient wearing them.  We take a series of specific measurements in the office and ask each patient questions like; how do you prefer to wear your glasses? Do you golf? Do you like outdoor activities? Do you play music? What is your profession?  What are your other hobbies?  Are you indoors or outdoors more often? Do you have glare issues?  Do you have light sensitivity issues?  Do you read?  Do you use computers?  Do you have a smart phone?...and the list goes on.  We take all of that information and combine it with the multitude of measurements we have taken in the office to provide a pair of glasses that are completely customized for your unique self!  And that is just glasses, think of the customized approach we need to take in order to individualize your eye health exam and treatment.  So next time you visit your eye doctor, remember that you are unique and they view you as unique.  Spend some time to talk to them about who you really are, or maybe you can just befriend them on Facebook!  See your best!

Last day as an intern

This is my last day as an optometric intern! These are the most amazing cupcakes that Stephanie from the EyeWorks staff baked for me. They are brownie cupcakes!

"Developmentally Delayed" Child or Vision Problems?

http://peopleplacespast.blogspot.com/

The following article talks about a child that was diagnosed with "unspecified delays" when she was 9 months old because she could not maintain eye contact or didn't grab for toys.  It turns out that she was a genius with an IQ of 159, one point below Stephen Hawking's!  She just needed glasses and some vision therapy in order to take care of some vision problems.  After that, she took an intelligence test and is now the youngest member of the high IQ Society Mensa at 2 years old.  Check it out!

Your Eyes are the Windows to Your Health

http://stuff4restaurants.com/

I was reading an article today in a magazine on age-related macular degeneration.  This disease can cause severe blindness and, unfortunately, is on a path of increasing incidence in the United States, like seemingly everything else.  This particular article was outlining a well respected theory of how this disease occurs and its connection with cardiovascular health.  I started thinking about the relationship between our eyes and our bodies.

The incidence of age related macular degeneration in the United States is increasing, but so is heart disease, obesity, diabetes, and cancer.  In fact, it has been predicted that half of Americans will either be diabetic or pre-diabetic by 2020.  Half?!!!  That's a lot of syringes, people.  Is there a common connection to all of our increasing ailments?  Maybe its our diets, pollution, or our stressful lifestyle (I never did get into yoga, and a cheeseburger with beer is so much more satisfying after a long day).

So what is the connection between our general health and our eyes?  Actually there is a large connection between our general health and our eyes:

-Did you know there is a condition with the eyes that seems to have a correlation with stress?  Central serous choroidopathy seems to occur in young men with type A personality?  That was the mantra we all had to remember in optometry school.  And for somebody who is, oh I don't know, exactly that, it was quite nerve racking to learn about it.  If I didn't already have have it, I was going to get it just by knowing what it was.  It causes swelling in the area of your 20/20 vision.  Luckily it has a good prognosis.

-When you go to the beach do you remember the sun block for your skin?  What about the sun block for your eyes (aka sunglasses)?  Sun exposure can cause cataracts and macular degeneration among other problems. 

-Cigarrette smoking can actually help cause blindness (and you thought it was only going to cause lung cancer.)  You have a significant risk of getting macular degeneration if you are a smoker. 

-When you get older, and especially if your cardiovascular health isn't up to par, then your blood flow is weak.  Less blood flow means less oxygen and nutrition being supplied to your eyes.  This has been shown to have a strong correlation with glaucoma, certain types of retinopathy, and macular degeneration.  High blood pressure can lead to conditions that could take away your ability to see.

-Also, remember our little friend diabetes (you know, the disease that one half of us are going to get)?  It can actually cause bleeding inside the eyes, not to mention blindness.

http://www.nandyala.org

Now lets talk about nutrition (and, no, eating tons of carrots isn't going to save your eyes).  Omega 3 fatty acid (EPA/DHA) is constantly being shown to help with various areas of our bodies such as cardiovascular health, brain function, and, you betcha, eye health.  It has powerful anti-inflammatory properties to keep your eyes feeling and seeing their best!  Antioxidants, such as vitamin E and C, regular exercise, eating green leafy vegetables, and control of mental stress have all been suggested to be beneficial as well (or maybe we should all just eat bugs like the chickens!).

As you can see our eyes are simply just an extension of our body's overall health.  If our bodies are having problems, chances are our eyes are having problems as well, both of which need special attention.  Your eyes provide an excellent window to your health.  When was your last eye exam?

Our new vision therapy department!

Thoughts? We have been playing around with some ideas of what the logo could look like. Vision therapy is a customized program designed to help patients with visual complaints that cannot be treated with glasses alone. Ie. Vision related headaches from reading, double vision, eye strain, eye fatigue...stay tuned for more!

What's your genetic risk?

                                           http://www.teenjury.com/can-a-company-patent-your-genes/

Genetic research is one of the most exciting aspects of health care.  New discoveries are constantly being made that link the individuality of our genes to the general health of our bodies.  Some lead to better forms of treatment, and some are just bad news.  While no discovery, in my opinion, is a bad one, there are certain genetic diseases that simply just don’t have good forms of treatment.  However, I’m here to talk about an eye condition that has a treament.

There is a very small area in our eyes called the macula that is dedicated to vision involving fine detail.  It is one of the most important areas because it allows us to see the 20/20 line of letters.  Specific changes to that area could lead to something called macular degeneration.  This is a condition that leads to progressive loss of 20/20 vision.  Macular degeneration is the leading cause of blindness among adults over the age of 55.  High blood pressure, a history of smoking, poor diet, sun light exposure to the eye, and having a relative with macular degeneration all put you at a higher risk for developing the disease.  There are different types of macular degeneration, and for simplicity’s sake, I will break them up into two categories; the “not-so-bad form” and the “bad form”.  The difference is the “bad form” leads to severe vision loss, while the “not-so-bad” form usually does not. 

http://www.nei.nih.gov/health/maculardegen/armd_facts.asp

   How a person potentially sees when suffering 

     from a very severe form of macular degeneration .

Our genetic make up is one of the biggest risk factors for this condition.  In fact, it has been argued that if we eliminated all of the genetic risk factors, the disease would not exist in 70% of the population!  Now lets move on to the good news.  Recently, a genetic test has been developed to determine your risk of developing the “bad form” of the disease.  With the use of this test, we can now identify which patients we need to monitor more frequently versus which patients we only have to see on an annual basis.  More frequent monitoring for patients has the potential to identify early changes related to the “bad form” of the disease that should be treated before severe vision loss occurs.  There have been studies that have shown more frequent monitoring and early treatment for higher risk patients lead to a much better visual outcome. 

http://www.revoptom.com/continuing_education/tabviewtest/lessonid/107647/

     A view of your relative risk of getting the "bad form" of macular 

degeneration.  Level 1 represents the lowest amount of risk while Level 5 

would represent the highest. 

If we identify early changes to the area of the macula at EyeWorks, we will schedule you back for an office visit. During the office visit we will take a three dimensional scan of the macula and gather your genetic information in the form of a cheek swab.  This allows us to get an in-depth view of that important part of your eye and further determine your risk level so that we may initiate an appropriate treatment protocol.  Macular degeneration is a serious vision-threatening disease that can be managed.  It is so important to determine your risk level so that we may help preserve your vision during your long and happy life.  Do you know your risk level?   

Wordless Wednesdays!

http://euforus.blogspot.com/2008_10_01_archive.html 

Through the eyes of a chicken...

                                                                              http://greenmnts.blogspot.com

                                               

Sunday, March 18th was an absolutely beautiful day in New Hampshire.  The temperature hovered around the mid 70’s, the sun was shining in all directions, and there wasn’t a cloud in the sky!  I could see cars driving by with kayaks strapped to their roves, people enjoying a mid-day walk, and it seemed like just about everybody was outside inventing outdoor home-improvement projects.  So, the good son that I am, (or maybe it was just because I couldn’t bear to waste the sunshine) I decided to help my parents with their little house projects…on their farm.  Yes, for the day I decided to be farmer Bart.  And as I was scooping out chicken poop while the wonderful sent of nitrogen rich air entered my lungs, I noticed a hen peck at a seemingly absent morsel and devour it whole.  I wasn’t about to figure out what that morsel actually was--in fact it was probably better that I didn’t--but I thought to myself how could she have possibly seen that?  That’s when I decided to learn more about a chicken’s visual system!  I came across some interesting facts. 

                You may already know how the human eye works, but humor me while I go into detail.  The human eye contains cells called rods and cones that receive light and are part of a complex pathway that is responsible for delivering a visual message to the brain.  Simply put, rods are designed for night-vision and detecting motion, while cones are designed for daytime vision and discriminating fine detail.  Another benefit of cones is that they are used as part of our color vision.  Our eyes have three different cones that are the most sensitive to three colors; red, blue, and green.  You may ask, “Why can we see many different colors when we only have three light absorbing cells?” (or something to that effect).   Well, our eyes are structured in such a way that we have the ability to turn on and off specific color channels.  These channels will combine to form other colors.  Think of it as if our eyes were painting a picture using only three key colors. 

A picture of rods and cones in the human retina magnified 

2,000x their original size.  The smaller cells are cones.

                                                               http://www.sciencephoto.com/media/308755/enlarge

                 Now let’s talk about the chicken.  Instead of 3 different cones, chickens have 5 different cones in their eyes!  One cone is actually a violet/ultra violet light absorbing cone.  The cones are arranged in such a complex pattern around the eye that color and fine-detail discrimination are extremely easy for the chicken.  Additionally, human eyes have a spot in the retina the size of a pin-point where the largest numbers of cones are clumped together.  This spot is called the fovea, and is the only area of our eye we use for 20/20 vision.  In the chicken it is a strip, instead of a spot, allowing for more cones to be bunched together and more surface area for a greater amount of light absorption.  In fact, some birds actually have 2 areas where this occurs!  The arrangement of these fine-detail, color discriminating, daytime vision cells leaves very little area for the night-vision rods to dwell in.  This is why chickens have a very difficult time seeing at night.  They usually run to their coops before the sun goes down.  This made me wonder if chickens have a hard time seeing motion due to the lack of rods in their eyes.   But, as I read on I came across a section that stated the 5^th cone that was discovered in a chickens eyes, called the “double-cone”, may be used as a motion detector in place of the low concentration of rods.  To summarize, chickens, and birds in general for that matter, have better color vision and sharper detailed vision than us humans.  So if you see a chicken, just remember its staring back at you! 

Beyond the Average Contact Lens

http://www.healthhype.com/what-are-contact-lenses.html

Why do people wear contact lenses?  It seems like a simple reason.  You visit your eye doctor's office and mention how you would like to be free of glasses.  You tell him or her that you want to go out to dinner without having to worry about glasses or you want your wedding pictures to be glasses-free. Perhaps you have worn them in the past and you just like the vision they produce.  Whatever the reason, more often than not it is usually a life-style choice.  The doctor calculates a few numbers, grabs some trial lenses, takes a look at the fit, and then sends you off with a fresh pair of contacts to order.  It seems like a pretty seamless process, right?  For a majority of the population it usually is.  However, have you ever thought about contact lenses as being a medical necessity rather than a "life-style choice"?  Some people actually require contact lenses not only to see, but also to see comfortably.  A high amount of astigmatism, large differences in prescriptions between the two eyes, certain post-surgical patients, and certain degenerative corneal diseases are a handful of issues that actually require contact lenses.  These patients have difficulty wearing glasses due to either the discomfort created from wearing glasses or the inability to see with glasses.  Another potential benefit of wearing contact lenses for these specific patients is to maintain the health of the cornea.

http://www.synergeyes.com/duette.htm

Unfortunately, a lot of these patients have little success with traditional forms of correction.  These are very special eyes that require special customized lenses using a complicated fitting process.  For post surgical patients something called a scleral lens is a very viable option.  The sclera is the white part of your eyes.  The lens gained its name from the idea that it rests on the sclera rather than the clear cornea of the eye.  This allows the cornea to be bathed in the eye's natural tears, providing excellent vision and health.  For high astigmatism patients, I recommend the Duette lens from Synergeyes.  Patients also find this to be very comfortable and vision is much better than any astigmatism lens available.  There are no problems with lens "rotation" which causes those annoying moments of temporary blur.  

So ask your eye doctor if you are a candidate for these specialty lenses and special fitting procedures, especially if you have had very little success with traditional glasses, contact lenses, or are not a candidate for vision correction surgery.  Have a great week, and I hope you see your best!