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.

I had a patient yesterday who was in the eighth grade. The mom's complaint was that his studies were faltering. The patient was 20/20 at both reading and distance. The eyes also appeared healthy. I did note that there was a problem with the patient coordinating his eyes together. I prescribed a weak power reading prescription which seemed to make a significant difference in his reading comfort.

There are a couple of things I look for during the examination when evaluating kids for learning problems which are visually related. One questions I ask if the patient gets motion sickness, particularly in the back seat of the car as compared to the front seat. Also, I note if the patient has to bring the reading material either very close or far away to read. These findings usually indicate a visual problem that could cause a learning problem.

I had a college age student in my office yesterday. She had two complaints. Her vision was blurred at night. Also, her eyes were bothering her on the computer. Her distant vision was a little less than 20/20. Even though her vision was pretty good, her complaints were significant for her.

In her case, I had to prescribe for both the distance blur as well as for her complaints concerning working with the computer. This required two different small prescriptions. I have seen this type of case quite often. If I were to prescribed for her just the distance prescription, this could actually make the up close vision worse.

Every patient is different. Sometimes the prescription for distance and near is the same and sometimes it's not. The findings are determined during the examination and demonstrating its results to the patient.

Contact lens wearers. should always have a pair of back-up glasses. Most do. I have seen contact lens patients who have extremely poor vision, uncorrected, who don't have any glasses. I had a patient come into the office yesterday with an irritated eye. There was a small bleb on the front surface of the eye which meant she could not wear her contact lenses. She had no glasses. She did wind up getting glasses immediately. Contact lens wearers should always make sure they carry their back-up glasses with them in case their eyes are irritated and they have to remove them at once. Sometimes wearing a contact lens that irritates the eye for a period of time could cause significant infection.

We are now coming to a close of another year. I have now been practicing optometry for 28 years. I've been established here in my own practice in Rancho Cucamonga for over 20 years. I completely enjoy it. There are so many reasons why. For one, it's a people profession. Through my patient base as well as my networking through the community and the chambers of commerce, I have met many interesting people as well as making good friendships. Also, optometry is exciting for me. The patient could almost immediately realize the benefit of what you've done for them. I could also say that there are those who we have definitely changed their lives for the better as a result of out service. Also, there are a few who we could say we possibly have saved their sight or possibly their lives as a result of our services. Finally, looking back over the last 28 years, I am proud to be part of a profession that has advanced so dramatically over the years.