One area that's often overlooked in an athlete's ability to perform is their vision. There is more to vision than just seeing clearly. Peripheral awareness, depth perception, ability to focus one's eyes quickly from distance to near and back to distance are all important skills which could have a significant impact on an athlete's success. What's important is that these skills are measurable and more importantly, can be improved upon.

I received a call from one of my patients this morning at 3:30 A.M. (I am on 24 hour call.) He stated that his eye was in pain and tearing. He told me he was surprised I answered I the cell, I told him I would see him at the office in 15 minutes. (I live 1/2 mile from the office.) I treated him with drops and told him to return in about 5 hours. The pain and tearing subsided and the eye looked less angry (red). The relief that the patient experienced was extremely gratifying to me as a doctor. Anyway, after I saw the patient at 4:00 A.M., I wound up going to the gym and working out.

A 54 year old patient came in this morning with a history of a cataract in his left eye for his entire life. His best corrected vision in that eye with glasses was about 20/100. The other eye was corrected to 20/20. I noticed during the examination that his eyes were not aligned vertically. He stated that he had trouble with depth perception. I put in a prism to help compensate
for this misalignment. He noted everything was brighter, closer and clearer. He stated that no doctor had measured him for this before. I do not know at this time whether the lack of vision in the left eye was due to the cataract, the misalignment of the two eyes or a combination of the two problems. I'll be anxious to see him after he receives and wears his glasses.

I've been practicing optometry for over 29 years. I enjoy practicing more now than ever. The advances in the field have been tremendous. I so have enjoyed the interaction with patients and their families over the years. I've had patients whom I've seen as five and six year olds who have brought their own kids in. Also, what's neat is seeing the impact on some of our patients' lives after they've been treated. I can't think of another health care profession where you get such immediate feedback after the conclusion of treatment.

There have been patients who have come into the office with a very high prescription. When these individuals start to look for glasses, they have a lot or problems telling what the frames they're choosing look like. In these cases we offer to put contact lenses into the patients' eyes so they could tell. A lot of times, the patient has never tried a contact lens. They are surprised at the comfort and the clarity of vision. Some of these patients are in their 50's or above and have never been offered contact lenses. I have patients who were glad they had this experience and wind up as a contact lens wearers.

One of the more rewarding experiences I've enjoyed is mentoring a student who is interested in making optometry a career. The individual has been able to shadow me as I examine my patients as well as seeing what's involved in running a practice. It makes me even more proud and passionate about my chosen profession.

One of the most challenging situations dealing with my patients is dry eye. It could be due to a number of conditions. Such conditions include overwearing of contact lenses, age related, autoimmune disease, allergies, certain dysfunctions of glands within the eyes and a host of other causes. Remedies may include artificial tears., anti-allergy drops, steroids and plugs, Restasis, or a combination of the above. Sometimes there is a quick response to treatment and other times it takes a long time for the condition to resolve.

Vision has a profound effect on one's ability to perform in sports. In addition to seeing clearly, peripheral awareness and the efficiency for the eyes to be able to aim and focus together are skills that are necessary to be able to perform effectively. It's quite obvious how important depth perception is in most sports.

What's interesting is that a lot of the above vision skills can be enhanced with training. There are a few eye doctors who specialize in this area. Enhancing vision skills is often overlooked as a means to improving one's performance in a particular sport.

One of the most challenging but rewarding types of contact lenses to fit are the bifocal contact lenses. When they work, they really are great. You don't have to adjust your head in order to see things above you as you do with normal bifocal glasses. There are various manufacturers and and styles of bifocal lenses available. The patient and the doctor sometime have to spend a lot of time in getting the appropriate lenses fit. I have had some patients come back several times in order to arrive at the optimal contact lenses.

Sometimes, the older way of fitting the over 40 contact lens wearer is the best. The patient would wear one contact lens for reading and one for distance. The third modality is having the patient wear two single vision contact lenses for distance and then wearing reading glasses over them.

Prescribing contacts for a mildly nearsighted individual around 40 can be a challenge. Most of these patients take their glasses off when they read. It has to be pointed out to the patient that if you prescribe contact lenses for distance, they might have trouble focusing up close. I, as an optometrist, have to discuss this issue with the patient. The remedy may include reading glasses over the contacts, monovision (one eye for reading and one eye for distance) or bifocal contact lenses. This particular patient opted out of contacts completely but was appreciative that I pointed this out first.

I was talking to an individual who is a photographer who wears glasses. I noted that her glasses did not have an antireflective coating. I told her the benefits of it including cosmetic as well as seeing better particularly at night or on a computer. She stated that her husband use to wear them and they smeared. I told her that the coatings now are a lot better and the problems of smearing or the coating coming off have been greatly minimized.

I had a patient about 30 years old come into the office today. He told me his vision was changing. The patient was found to have astigmatism and nearsightedness. The first question out of the patient was whether his vision problem was caused by aging. I told him it was probably due to the type of close-up work he was doing.

Usually, aging problems equate with not being able to see clearly with the same prescription for reading and distance. This usually starts in the late 30's to early 40's.

I am so grateful to be in private practice. Granted, this is not for every optometrist. I've been in my own practice now for over 21 years. I literally enjoy coming into work daily. Some of the patients whom I've seen as kids bring their own kids in now. The office takes on a a real family feeling, both among the employees and the patients. Also, I have been able to network very effectively with the business community, belonging to three local chambers of commerce.

I was sitting in my exam room with an adult patient when I noticed that her four year old was being entertained by a video on a cell phone. Over the last few years there has been an explosion of hand held devices with video capability. It will be interesting to see the effects of viewing such detail at such a close distance over an extended period of time. I truly believe that the incidence of nearsightedness and possibly astigmatism can only increase with this.

I could only imagine with time these devices are going to act as "pacifiers" to kids even younger than the one just mentioned.

I mentioned in earlier posts about the effects of nearwork on vision, especially with young people. One of the more dramatic changes I have seen was with a ten year old boy. He was basically 20/20 last year. Over the last 12 months his vision has dropped to about 20/200. He can achieve 20/20 with glasses. Part of this may be genetic. However, the father states his son is constantly doing a lot of hand held video games. Think how close the device is to the boy's eyes and how small the text is. I am confident that among texting, video games and normal computer viewing, the changes in vision I will see among my patients will be very significant.

I recently had a teenage patient who had suffered an eye injury playing soccer. He was not wearing any eyewear protection. The ball hit him in the eye and he immediately noticed blurred vision. He visited the ophthalmologist. There was scarring in the back of the eye (retina). If the scarring were 2mm superior, the patient would have lost most of his central vision in that eye, and nothing would have been able to restore it. The sad part about this patient is that he is still hesitant in wearing protective eyewear due to vanity reasons.

I asked one of my high school patients what percentage of students text. He answered, "100%." when I started practicing almost 30 years ago the pc was coming on the scene. I saw changes of vision in my patients who were staring at screens at work all day. That hasn't changed much. When you text, the phone is a lot closer. It will be interesting to see if this added amount of close-up viewing will affect one's distant vision.

I had a patient whom I hadn't seen for over 10 years. Upon his eye examination, he commented to me that because we observed possible changes in the retina due to hypertension, I had referred him to his primary care physician. Indeed there was hypertension. His physician also ordered for him at that time a psa and subsequently found out the patient had prostate cancer. His doctor stated that if he would have gone six months longer, he may not have survived.

I had a patient come in this morning for an eye examination. He had lasik eye surgery to correct his distant vision. He was capable of clear vision at distance and needed reading glasses for up close. One of his main complaints was that he could not read the greens when he was putting while wearing his sunglasses. So he did not use them playing golf. The problem is that his lenses were polarized. Normally polarization helps with the sun particularly when you're on the water. However, some golfers do have problems with polarized lenses, particularly around the greens. The second thing about his sunglasses was that they were made with glass lenses. I had a patient who was struck around the eye with a golf ball while playing. Fortunately, he was wearing lenses made of polycarbonate. The lenses did not shatter. I feel that glasss lenses possilbly would have shattered and done injury to the eyes. Also, by not wearing sunglases while golfing over a long period of time, the patient was exposing himself to increase risks of cataracts and macular degeneration.

I was hearing that the increase in texting has led to individuals developing carpal tunnel syndrome. In fact there are young individuals who text 100 times, per day. Viewing a screen that close for that duration could very well affect one's vision. This is especially true in that many of the prolific texters are young. For information regarding extreme close up work over a period of time, go to our website at www.wehelpuc.com.

I had the pleasure of attending the International Congress of Behavioral Optometry last week. Even though I was only able to attend one day of the Congress, the information I learned was wonderful. A lot of the information dealt with how we process information, visually. There were speakers from all around the world. I learned about a new lens that specifically for the over 40 set who work on a computer. I am anxious to try it on myself. Also I saw professors who
I had 30 years ago. I really enjoyed everything.

An issue often overlooked with children is eye safety. Particularly if the child doesn't need a prescription to see clearly. I have seen kids (and for that matter adults) who play various sports including soccer, tennis baseball, football and other sports who have suffered eye injuries from being hit by a ball, person or racket. These injuries sometimes are sight threatening. We recommend that anyone participating in sports should wear a sports goggle with impact resistant lenses for protection. If the individual wears glasses normally, they should be a special frame that will withstand substantial impact. It could make all the difference in the world.

I had a new patient come into the office with a very red eye. He was a contact lens wearer who had just used a different solution than what he was using previously. I am currently treating him. I am not sure whether he had an allergic reaction or the bottle he used was contaminated. Either way, when using contact lens solutions, try to stay with the same brand in order to avoid possible problems.

My office staff and I visited the Vision Expo in NYC last week. We plan on making a few additions to the office. The advances in contact lenses, lenses for spectacles and diagnostic imagery is fantastic. It is very important to realize also that there is a person behind the eyeballs.

We have now celebrated our 21st year in my practice here in Rancho Cucamonga, CA. I so enjoy being in private practice. Optometry for me has been a most rewarding career. I have seen many of my patients grow from childhood to adulthood. It is most gratifying when patients have confidence in the practice to refer their family and friends. I am quite involved with the happenings in the surrounding area. I'm involved with three different chambers of commerce. Interesting enough, I am one of the only health care professionals that is active in the functions of the chambers. I thoroughly enjoy both the direct networking and social networking (electronic) aspects of my business.

If I had to do it all over again, I would certainly pick the same profession.

Sometimes when you prescribe an individual over forty years of age glasses for distance and they don't want a bifocal, there can be discomfort. I had a patient who was in her fifties whom we prescribed distance glasses for ( she normally takes her glasses off for reading). She stated the distance was great but she got dizzy looking at her dashboard while driving as well as looking at the ground. I had to weaken the prescription slightly so she could view up close more easily while not disturbing the distance vision significantly. the outcome was good.

A patient was in the office today discussing with me about an optometrist who worked in her facility. The facility deals with injured and neurologically compromised individuals. The optometrist worked with patients who had either brain injuries or strokes. He dealt with rehabilitative care of these individuals which could involve prisms or actual vision training. The results of this could be quite profound.

I had an interesting patient that I have been working with over the last couple of months. The patient was a male in his 20s. He noticed a sudden blurring of his right eye. I was unable to correct it with glasses or contacts. I looked in the eye and I could see the central part of the back of the eye was abnormal (maculopathy). I immediately had him referred to a retinal specialist. There is an eye condition which does affect young males who are under stress this way.

Fortunately, I just saw the patient yesterday. His best corrected vision with glasses was 20/20 in the affected eye. The condition as followed by the retinal specialist resolved on its own. In other words no surgery or medication was administered. I did note that there was residual scarring of the macula. This did not seem to affect the patient's vision significantly.

Diabetes is one of the leading causes of blindness. I just examined a 43 year old who has a 20 year history of diabetes. He stated that his sugar has not been under the best of control and has not his eyes checked for about five years. The patient did have a small amount of diabetic change in the back of the eye for which we referred. Diabetics should have their eyes examined no less than once per year and more if eye problems are discovered. It could make the difference of possibly saving one's vision.

I recently had follow-up information on a patient whom I treated several years ago. This was an individual who after brain surgery could not walk straight and would walk into walls. She now works for a friend (who is the patient relating the information to me yesterday), has a drivers license and is in a wonderful state of mind. Before we helped to remedy the situation with glasses, she wasn't able to work, couldn't drive and was depressed. It's cases like this why I enjoy practicing so much.

There are often various symptoms of vision problems. Over my years of practice, I've come across a certain type of patient who has trouble using their eyes together. In addition to having problems with reading including loss of place, fatigue and headaches, the is one more symptom. They have motion sickness when sitting in the back seat of a car. What's interesting is that there's often significantly less motion sickness when driving in the front seat of a car and almost no problem when driving. I equate this to that there's more visual processing in the back seat where you see things off to the side, things two feet away and things at distance. In the front seat you only notice basically things in front of you far away and when driving, you have tactual back up (with holding the steering wheel) to the vision.

Refractive surgery has now been around for almost thirty years. The advances in technology over the period has been astounding. An area of vision that is being given considerable attention deals with patients who have lost the ability to focus up close. Various surgical strategies dealing with both the cornea and lens of the eye are helping individuals over forty see both distance and near. Depending on the individual and the type of near work being performed, a particular surgery and device will be used. It is important to know that at this time there are limitations as to having the patient be able to see perfectly at all distances. However, these surgeries are a great advancement compared to what was available to patients just a few years ago.

A topic I want to discuss is prescribing bifocals for kids. If a kid needs reading glasses, chances are the prescription will blur the distance. Even if the child has perfect distance vision we might want to prescribe a bifocal so the child can look up from their book and still have clear vision. Sometimes, however, the bifocal could be counterproductive in the child is gazing at a desktop (eye level) computer.

Quite often, when a child complains of distance vision, the child is prescribed glasses for distance. Sometimes the prescription for distance will be the same as it is for near. Sometimes, though, it is not. In fact, sometimes the prescription for distance could make reading worse.

Of course there are ways to actually measure this. It could have a significant effect on a child's ability to perform in school.

I had a patient referred to me from a corneal specialist. The patient has a history of a corneal transplant in the right eye and some corneal dystrophy in the left eye. The transplant looked great. There was a significant difference in prescription between the two eyes. She was already wearing rigid gas permeable lenses. They worked well. The patient needed a back-up pair of glasses. It's fortunate the patient is able to wear glasses. Sometimes when there is a significant difference in prescription between the two eyes, the patient can't function well with glasses. This is due to a difference in image size between the two eyes generated by the glasses. This generally does not occur with contact lenses. This is a situation when contact lenses are a lot better solution than glasses.