Vertical Eye Problems

Many times a patient will will be able to see clearly out of each eye separately but has trouble using both eyes together.

One problem that could be causing this is the eye's being out of alignment in the vertical direction.  If the eyes are the least bit out of alignment vertically, straining to see or double vision could occur.  This finding is often not measured during the course of an examination.

Also, when an individual has a very significant difference in prescription between the two eyes, especially with bifocal wearers, the patient can feel this same strain.  Regarding this particular situation, prism might need to be added to the prescription  to help compensate for this difference between the two eyes.

Glaucma Certification

I am currently going through continuing education coursework  to become certified in prescribing for patients who have glaucoma.  I anticipate completing the courses by mid-March, 2013. 

This is a significatnt expansion of the scope of care that I can provide.  One of the factors I so love about optometry is that nothing is static.  There is constant change within the profession.  I feel so fortunate that I picked such a profession to make my career. 

I am also able to share this with individuals either in optometry school or students who are trying to decide what career path to follow.

Mastermind Group

Most Thursday evenings at my office at 7:00 P.M., we have a Mastermind Group meeting.  In these meetings which usually last about one and one half hours, we discuss the tenets of Jim Rohn.  He writes on everything from economic gains, physical well being, business, networking and even spirituality.  Our next two meetings, are November 29 and December 6.

I so enjoy these meetings.  I get a great feeling after their conclusion.  If you're interested in attending, please give me a call at (951) 206-1747.  I think you'll find it very fulfilling.

Just a reminder.  My office is located at 7211-A Haven Ave. in Rancho Cucamonga in the Ralph's Shopping Center.  Our office has the sign "optometry" in front of

Continuing Education

Optometry is such an expansive field.  When I go to continuing education seminars, it amazes me the developments that are occurring within the eye and vision fields.  New contact lenses and lenses for glasses have come a long way over the last few years.

Medical advanements in refractive surgery (lasik for example), cataract surgery and being able to treat macular degeneration  has also grown by leaps and bounds.  It's great to be witness to the patients receiving the benefits of these developments.

Also, the fact that almost everyone is in front of a hand-held device, tablet or monitor will help insure the needs for my services will only grow. The effects of viewing extensive close up work, for some, affects one's vision. To be honest, this area alone is a very exciting area for me.

Attention To Detail

I was recently at a Chamber of Commerce function last week.  One of my patients came up to be me and was very happy about her glasses.  She said it was the first time she was able to read comfortably then look up and see clearly with her bifocal.

The patient had problems previously because she had a very significant difference between her two eyes.  This meant that when she looked down to read, she was struggling from seeing double vision.  A lot of times, consideration for this is overlooked.  We prescribed what's called "slab-off" prism to help with the situation.  It made a significant difference for the patient.

Mastermind Group

On a weekly basis, a group of about ten indiviuals have been getting together weekly at my office studying the tenets of Jim Rohn and his pillars of success.  This has been of great value to the participants and myself.  We share in a discussion group areas of life pertaining to networking, spirituality, physical well being and other areas of life.

Our meetings are usually on Thursday at 7 P.M. on a weekly basis.  The feedback of guests who have attended has been really positive.  We'd like to see our group grow.  If you'd like to attend, please cally my cell at (951) 206-1747.

I came across the term"mastermind group" in Napolean Hill's great book, "Think and Grow Rich."  If you haven't read this book, you should.  If you haven't read it in a while, you should.

HOPE TO SEE YOU.

Refractive Surgery and Age Consideration

People usually ask me if they're a candidate for refractive surgery.  Most surgeons usually want the patient to be at least 21 years old although I have seen some surgeons perform surgery with the patient at 18 years old.

A prime consideration for performing surgery at any age is if the eyes are changing.  If they are, usually the surgeon will not perform surgery no matter what the age is.

A third and very important consideration are the ages between 35 and 42.  This is a critical age because around this time the focusing system of the eyes is changing.  Let's say you perform a surgery at 39 years of age.  The patient should be able to see both distance and near.  However, as the patient gets into the early 40's, the patient will not be able to see as well close up and will probably need reading glasses.

If the patient is in their mid 40's or older, they already know they can't focus through the distance prescription .  In this case they'll either have surgery where one eye's for reading and one eye's for distance or they'll need reading glasses for up close if both eyes are corrected for distance.

The above surgeries only pertains to corneal surgery.  If the older patient elects, they can have surgery where a multifocal lens is implanted into the eye and they can see far and near.

Keen Observation By Teacher

A seven-year- old patient came into my office.  Her complaints included headaches.  The mom remarked that the teacher indicated that the patient had trouble focusing from the book to the board.  The patient had 20/20 vision in each eye without any distant prescription. 

The patient held everything close up within 4 inches to read.  When I put the reading prescription in front of her, she was able to see it more easily and she was able to hold the book around 10--12 inches away.

The reading prescription would blur the distance so we gave her a bifocal with no prescritpion on top and the reading prescription on the bottom.  I have done this often for kids who just need correction for reading and it has made a real positive difference.

Those Mobile Devices

I was doing an examination on a five year old boy yesterday.  Not only was the mom looking at her device, but her two year old son was also. 

Over the last several decades, increased near work has attributed to the increase of near-sightedness in the population.  When I went to optometry school over 30 years ago, the average population was far-sighted while the average population in the optometry school was near-sighted.

It's hard to predict how the tremendous amount of close up work everyone is doing, especially very young children, will haveon one's vision.  There definitely won't be a shortage of patients.

A Little Prescription Goes A Long Way

I had a nine-year-old boy come in last week for an examination.  The mom related he was going to be tested for educational deficiencies.  The child basically couldn't see any of the letters on the distant chart and had to hold print exceedingly close to read it. 

When I examined the boy, I found he had a very low prescription.  With this he was able to see the distant chart.  More importantly, when I put the lenses in front of the boy while reading, the mom marveled at how he had never read this fluidly before.  He was also reading at a normal distance.

In rare circumstances, a youngster's focusing system will spasm, both causing headaches and blurred vision at distance and near.  A mild prescription in some of these cases makes all the difference in the world.  It certainly did with this individual.

"Hopeless" Case

A few days ago, a patient who suffered a stroke came in.  Even though the patient was capable of 20/20 sight in each eye, he almost functioned like a blind person.  This was because he lost the right side of his vision in each eye as a result of the stroke.  He actually used a cane to help guide him in his walking.

The patient's eyes were healthy.  He was told there was nothing further that could be done for him.  The patient was similar to others whom I've seen who have a visual field defect.  I prescribed prisms which help shift the image up, down, left or right, depending how they're placed in the glasses.  This appeared to have a dramatic effect on the patient.  His walking was a lot better.  His confidence exuded.  He was also way less sensitive to light.

I love these type of cases.  The change seen in these patients is priceless.

Community

It's really neat to live and work within the same community.  I have now been practicing in Rancho Cucamonga, CA for over 23 years.  I live 1/2 mile from my office.  I see many of my patients in the stores, the gym and other local hangouts.  It's really great.  I also belong to four chambers of commerce:  Rancho Cucamonga, Fontana, Upland and Ontario.  In addition to business, these organizations have been a great source of friendships.  I feel really fortunate in being in this situation.

Understading Your Visual Condition

One of the factors I most enjoy about optometry is being able to demonstrate to a patient what their problem is and in most cases, what it's going to take to remedy it.  It's easy to show a patient what you're prescribing in the form of glasses and contact lenses before they receive them.  It's really good to show a patient how they've changed from their old prescritpion.

As far as disease or injury to the eye, it's easy to go online and show a patient what their condition looks like.  Patients could get an appreciation of what's going  on with their own condition.

Also, when we do talks to audiences, it's very interesting to demonstrate to an audience member what effects certain visual conditions have on performance, especially at school, work or play.

If you, your organization, or business would like to have a seminar, please let us know.  We could be reached at (909) 980-3535 or e-mail us at ranchooptometric@verizon.net.

Contact Lenses and the Over 40 Set

One of the biggest challenges fitting contact lenses is when a patient is over 40 and wants contacts. If you fit just the far away situation, more likely than not the patient will have problems close up. There are three ways to deal with this. The first and by far the easiest is to fit both eyes for distance and then have the patient wear a pair of reading glasses over the contacts for near. The second way is to fit one eye for reading and one eye for distance. This has been shown to work in most but not all cases. The third and most challenging way is to fit multifocal contact lenses. These lenses are geting better all the time and many different companies manuafacture them. However, they don't work on everybody. The only way to fit them is to put them on the patient and see how they adapt. More times than not, you have to try multiple pairs on the patient until one pair works. Sometimes the patient can't adapt to any of the multifocals. Then the patient has to decide if they want one eye for reading and one eye for distance or if they want both eyes for distance and reading glasses over them. I had a patient today who wants to ride a bicycle and be able to see his speedometer. He's around 50. On the third pair of contacts we tried, the patient seemed fairly content with his far and near vision. In a number of cases when the over 40 patient can wear contact lenses, they're a lot more content as compared to their glasses. This is because when successfully fitted with contacts, there is no zone of vision that the patient can't see out of.

Feel Good Experience

Optometry,for me, is a real rewarding experience. On June 9, I had a patient scheduled. During the exam she related to me that the two daughters whom we saw previously, are doing really well. We had prescribed glasses for them. She told me that each one had a very significant increase in reading level just a few weeks after receiving the glasses. The second patient came in with a red eye with pain and discharge. We were able to prescribe both drops and an oral antibiotic ointment. Within two days, the infection had significantly improved and the patient was in total comfort. It's really neat, the wide areas of conditions that we could treat and the effects we actually have an people's lives.

Seminar for Lewis Homes

I had the pleasure of conducting a seminar on different aspects of vision for local residents in Rancho Cucamonga last week.  There were 53 individuals from kids to senior citizens there.  I really had a good time.  We discussed everything from contact lenses to eye disease.  We also discussed the effects of prolonged viewing of a monitors as well as the effects of one's vision on learning. 

The interest showed by the attendees was most rewarding for me.  If you'd like a seminar on vision for your group, please call us (909) 980-3535.

20/20 Isn't Everything

Many individuals feel as long as they're seeing 20/20, they don't need to have their eyes checked.  Your child could have 20/20 sight and still have a visually related learning problem.  This could include inability to read without losing one's place or not being able to read for long periods of time without headaches or fatigue.  Also you cannot rule out your child having some form of eye disease that could only be detected with an examination.

Regarding adults, they too could also have 20/20 both at distance and reading and still have problems.   Sitting in front of a terminal, smart phone or for that matter, any hand-held device, for hours on end for some patients is a very arduous task possibly causing eye, hand, back or shoulder strain.  Also the chances for developing eye disease increases with age.  We have also referred patients with peripheral vision problems in both eyes for neurological work-ups.  In some patients, tumors, strokes or aneurysms have been diagnosed.  A number of diseases in the body are first diagnosed after an eye examination.

This is just a few of the reasons to have regular eye examinations.

Networking

I've been in my own practice for 23 years in Rancho Cucamonga.  Part of the success of the practice lies in networking.  For years, I've belonged to four different chambers of commerce in the area.  In addition to the friendships made, it has definitely had a strong positive effect on my practice.  Over the last few years, online networking is having an increasing effect on the practice.  Among my website (www.wehelpuc.com), blogs, tweets, posts on Linkedin and videos, I feel I have been able to convey information about my practice to a lot more individuals and businesses.

Local Lecture on Vision

I conducted  a lecture covering different areas of vision for local residents. The lecture covered everything from contact lenses to eye disease.  Topics also included the effects of viewing monitors for a prolonged period as well as visually related learning problems.

There were 53 individuals there ranging from very young kids to senior citizens. The lecture was enjoyable for me and I believe enjoyable for the attendees.  I want to thank Lewis Homes for helping me put it together.   If  you'd like a seminar for your group or business, please contact me at (909) 980-3535.

Vision and Productivity

In addition to seeing clearly, there are certain visual skills that are necessary for us to be productive.  For example in sports, being able to aim and focus your eyes from one distance to another is important.  Depth perception and peripheral vision  are critical skills.  How could you hit a baseball or shoot a basketball without them?

At work, being able to view a monitor or read text (or both) for hours on end requires a visual sytem that sees clearly and doesn't fatigue with time.  In addition to glasses and contacts, certain training of the eyes can aid with this.

The last topic to be discussed is visin and learning.  In addition to seeing clearly, what is it worth to a student not to lose one's place or being able to improve one's comprehension? 

For more information, Please visit our website, www.wehelpuc.com for more information.

Sports Vision

Performing well in sports requires more than just seeing clearly.  It requires good depth perception, especially when both you are moving and the target is moving.  Performance also hinges on being able to focus quickly from near to distance.  Peripheral awareness is also important.  When we're under stress, peripheral vision generally becomes more tunneled.  This has a significant effect on performance.  One last item I want to touch upon is glare recovery.  When exposed to a bright light, how quickly can you recover normal vision?

What's interesting is most if not all of these areas of vision are improvable through vision training.  With this, one's performance in their sport could very much improve.

Gas Permeable Lenses

Soft contact lenses have now benn around since the early 1970's. They're generally comfortable and can correct most vision conditions. Why would anybody want to wear hard lenses (gas permeable). There are various reasons.

1) If there is a distorted front surface (the cornea) of the eye, gas permeables correct the vision better.

2) Some older individuals have always worn gas permeables and cannot switch to soft lenses and see clearly.

3) They're smaller in size and for various visual conditions, that's bettefor the eye as compared to the larger soft contact lenses.

Periphery Revisited

Peripheral vision is so important. What's it worth to a person who rides a bicycle to notice objects (or cars) in the periphery? What's interesting is that the better your observance of periphery, the better balance you have. Peripheral vision is so important in many professions. One that comes to mind is law enforcement. What's interesting is that when some of us are in stressful situations, our periphery tunnels down.

Sometimes through vision training, we could improve one's periphery.

The above situations are what I call functional. In other words when these patients are given a peripheral vision test within the office, their findings are normal. Of course, we have to rule out peripheral vision defects due to pathology in the eye or the brain. These are permanent and don't respond to training.

Thanks To My Staff

I am really thankful that I have what I feel is a wonderful relationship with my staff. It's such a pleasure going into the office, They actually set out the plans for the development of our new office. They were so instrumental for the organization and actual move from the old office to the new.

A more important factor is how well my staff works with the patients. My patients constantly comment to me how they so enjoy coming into the office and they comment how fortunate I am to have the staff that I do. Just as important is that they have such a compassion and respect for each other.

I really thank my staff for making my office the way it is.

A Thankful Patient

March 9, 2012

Dr. Robert Rothbard
7211-A Haven Avenue
Rancho Cucamonga, CA 91701

Subject: Letter of Appreciation

Some time ago I was faced with a serious dilemma related to my prospective employment with the City of Los Angeles. I was turned down for a position with the City having failed the extensive pre-employment medical exam that was required for the job title of plant equipment operator. According to the City's medical department I failed to pass the vision portion of the medical exam due to the amblyopia condition I have had in my left eye since early childhood. The City's position was that this condition was affecting my depth perception and that such an impairment could present a safety hazard for myself and others in performing the duties required of the job.

Having been a patient of yours I contacted you regarding my concern over the City's decision and expressing that I did not believe my condition was a sufficient impairment to prevent me from performing the duties required for that position. I was seeking your opinion on whether or not my amblyopia condition would actually affect my ability to perform the job that I had applied for and if so whether there might be an optometric solution to this problem.

Subsequently you asked me to provide you with a copy of the job description for the position as depicted in the City's job announcement. From that and with some additional vision testing performed by you it was your conclusion that my vision, and most notably my depth perception, was not sufficiently impaired to prevent me from performing normally in the working environment to which I would be exposed. You also offered to provide any documentation that might be needed by the City to convey your conclusions on this matter. Subsequently you addressed a letter on my behalf to the City which outlined your analysis and subsequent conclusion as to my ability to perform normally for the position I had applied. From a medical standpoint the information provided in that letter was quite convincing. From that I made a formal appeal to the City to have my medical hold released and was successful in the City's medical department reversing their decision as to my medical profile. Shortly thereafter I was successfully hired by the City for the position I had originally applied.

I wish to thank you for your efforts on my behalf and for the persuasiveness of the arguments you set forth in the letter forwarded to the City. Most assuredly I would not have been successful in being hired by the City without those efforts.

Sincerely,
T.

One Picture Is Worth A Thousand Words

One of my opticians came in asking me about her aunt's vision condition. She stated to me that she has lost her vision in one eye and is starting to lose it in the other. She stated her aunt is diabetic and hypertensive. I could make an educated guess as to what her visual condition was. I was guessing there was diabetic retoinopathy with macula involvement. What was neat was that I now have a computer in my exam room and I was able to pull up a picture of what I thought her aunt's condition was. It showed bleeding, deposits and neovascularization (new blood vessel formation). I was able to tell her what the treatment of this condition was and why.

The convenience of this computer in the exam room is tremendous. This is especially true in showing patients how their glasses or contact lens prescription will affect their ability to view a computer monitor at their desired distance.

Going To Bat For A Patient

I recently examined one of my long time patients. Of course, I thanked him for returning. He stated that when he first came in years ago, he was applying for a job. One of the problems was that he had amblopia in one of his eyes. This means that even with glasses or contacts, the patient is not capable of clear vision. However, the patient had good peripheral vision in both eyes.

Origionally, the patient told me his application was being denied due to his vision. I had written a letter on his behalf stating that I didn't feel his vision problem would compromise his performance or safety at work. They reconsidered his situation and he has been in their employment for several years

now.

Marksman

I had a patient come into the office a couple of days ago. His chief complaint was that when he shoots, he closes one eye. At 52 years of age, he was unable to focus from the sight on the gun to the target. Bifocal glasses would not help because of the demands of having to look at a straight lline from the sight to the target without moving the eye below or above the line of the bifocal.

I tried fitting the patient with a bifocal contact lens. The configuration of a bifocal contact lens is the distance is location within the center of the contact while the near vision is through the periphery. This solution seemed to work well with the patient. He was able to see the sight and the target without moving his head.

New Office

We are in our new office now. We were in our previous office for 23 years. What an update. The office is about 50% more spacious and most aesthetically pleasing. But what makes the office great are the staff and the doctor. As stated in previous blogs, I am most fortunate to have the staff I have. They're very knowledgeable and personable. I always felt I picked the profesion most suited for me. If I had to do it all over again, I'd do it in a heartbeat. I believe I have even more passion for the profession than when I started. I feel very fortunate for the patients whom we've seen through the years. Some of the patients we saw many years ago as kids are now bringing in their own kids.

Visual Field Defect

A patient came into the office complaining of blurred vision. He had a history of diabetes and multiple sclerosis. The patient, with glasses, saw pretty clearly. There weren't any signs of disease when I looked at the back of his eye. When I performed visual fields on the patient, the lower right quadrant of his field of vision was gone. this condition existed in both eyes. This could be diagnosed as a right field quadrantopsia.

When a field defect appears in the same area for both eyes, it's generally not a problem with the eyes but a problem with the brain. A stroke or a tumor could cause such a problem. I referred the patient back to his neurologist to make him aware of the situation. I could not diagnose what exactly caused the defect in the fields.

Periphery Makes A Difference

Most people feel that as long as they see clearly at distance, everything's OK with their vision. You could see detail clearly and still have problems with your vision. If you have poor peripheral vision, you can have a lot of trouble functioning. Imagine driving and not being able to see the cars at your side. Imagine being a quarterback and not being able to see a lineman coming at you from the side.

There are two types of peripheral vision problems. There are those patients who have lost their periphery due to diseases such as glaucoma or stroke. Then there are those patients who test well on peripheral vision tests in the office but when they're under stress, their vision becomes tunneled. This type of loss of peripheral vision is functional in nature and could be trained.

One last item. Legally blind can be defined as not having correctable vision (with glasses or contacts) past 20/200 or have very tunneled vision.

Our New Office Progression

The Sum Is Greater Than The Parts

My practice has now been in its current location for almost 23 years. Due to a bank wanting our location, we will be moving across the parking lot to a new, larger and more state of the art location. The move was made a lot easier by both my office staff and our landlord, Lewis Homes. My staff was most instrumental in developing the design of the office. This included the lighting, cabinetry, displays and furnishings. I must say that the office looks fantastic.

I certainly feel that we will be better able to meet the needs of our patient. I am certainly looking forward to the opening. It should occur in about two to three weeks.

When Small Prescriptions Make Big Differences

Optometry is such an interesting profession. One reason is the human element. Some patients can tolerate a lot of blur and be happy while others want everything very sharp. Then there are patients who complain if what they see looks too sharp.

I have found over the years that when a small change in prescription makes a big difference in perceived vision, the patient may have other vision problems. One of these is motion sickness, particularly in the back seat of a car as compared to when the person is actually the driver. Other symptomology may include sensitivity to fluorescent lights or having to hold reading material very closely (even when the patient can see clearly at distance).

Very Sensitive Patient

I examined a patient this morning. Her complaint was blur at night as well as blur reading. What is interesting about the patient is that the prescription that made a difference to her for far away was extremely small. I checked her in all lighting conditions and with sunglasses and the prescription made a very significant improvement in her vision.

I have found over the years that when a small prescription makes a big difference in vision, there are generally some other problems the patient notices. One of which is motion sickness in a car. What's interesting is that the motion sickness is worst when sitting in the back seat, less when a passenger is in the front seat, and least when driving. I have some theories as to why its this way.

Mentoring Students

I got to attend an optometric society meeting last night. In a addition to an interesting continuing education meeting, I got to talk to a few optometry school student who will be graduating this year or next. I'm glad to say they appeared quite passionate about their future profession. I was able to convey to them certain aspects of patient care they hadn't come across.

After 30 years of practicing, I was glad I was able to exhibit my own enthusiasm in sharing different concepts of patient care they hadn't come across yet. Their sincere interest in what I had to say was quite rewarding.

New Office Status

We're getting close to moving into our new office. We should be in there by the second or third week of February. We're just moving across the parking lot within the same center at Baseline and Haven. The office is a lot more spacious and comfortable. I am particularly thankful to my staff for helping in the design of it. Our phone number will still be the same. We're certainly looking forward to the opening.

Metal in the Eye

I have had patients come into the office who are working around metal who have gotten small pieces embedded in the cornea (the front surface). Many times these could be removed fairly easily. Sometimes a rust ring forms around the metal particle and has to be either picked out with a needle of removed with a bur. Generally, as long as the particle doesn't embed in the line of sight, no loss of vision occurs. If however it does embed centrally. A possible scar could result, possibly leading to a disturbance of vision..

If the impact of the metal is high it could possibly penetrate through the front surface. More heroic measures are necessary to remove the particle and a significant loss of vision could occur.

It is so important that when working in any area where paticles could even remotely have a chance of entering the eye, safety glasses must be worn.