Desktop or Laptop?

For years, when examining patients, I would be concerned whether they were working on a computer. This always presented unique challenges in prescribing glasses for those older than 40. The reason for this was the computer was usually stationed a lot higher than normal reading material. Also, the viewing distance for the computer was usually at a different distance than normal text. At times we'd have to prescribe a separate pair for the computer depending on the factors of its height as well as distance.

More recently, individuals are working with laptops. The good news is that the laptop is usually at the same height and distance as normal reading or perhaps a bit further. Again, special consideration needs to be given. Then you have the office worker who is working with both laptop and desktop computers simultaneously. The unique working demands of the patient need to be met with unique methods of prescribing.

Contact Lenses for the Over 40 Year Olds

Patients who are over 40 who want contact lenses present interesting challenges. The main challenge for these patients is being able to read and see distance through the contact lenses. There are generally three options. The easiest one is to fit the contact lenses for distance and fit reading glasses over them for reading. The second option is to fit one eye for reading and the other eye for distance. Surprisingly, this works quite well for many patients but not everyone. However, there are some limitations in fitting a patient this way. Limitations may include blur at night or the eyes feel strained when doing a lot of reading. Sometimes we fit glasses over the contacts at times to help compensate for the blur. The third way of fitting patients in this age group is multifocal contact lenses. When they work, they really work. If you're a bifocal wearer, you notice that when you're viewing something closeup with glasses that is at eye level or above. you have to tilt your head back. This does not occur with bifocal contacts. However, bifocal contacts don't work for everyone. There is sometimes a reported blur and reading or distance no matter what lens you fit. I've worked with patients who I have fit the first time they came in; others who were fit on the second or third time and others who couldn't be fit at all with the multifocal lenses. What's great is that the technology of the lenses is improving all the time.

30th Reunion

It's hard to believe it's been 30 years since I graduated from optometry school. I attended my 30th reunion in Forest Grove Oregon this past weekend. It was nice meeting with 29 of my fellow graduates from Pacific University, College of Optometry, Class of 1981. The school and curriculum has expanded greatly. I took four hours of continuing education. One of the courses in sports vision went into the topic of 3D. The university opened a clinic specifically dealing with this area. As discussed earlier, there are a significant amount of patients who would have trouble viewing 3D items such as movies and seminars. Also the ability to perceive depth is so important in areas of life such as driving and sports performance. This area of vision can be enhanced through appropriate contact lenses or glasses and also vision training.

One of My Most Interesting Cases

Several years ago a patient was referred to me by a friend of hers. The patient had brain surgery and afterwards, started walking into walls. In other words, she couldn't walk in a straight line. During my examination, the patient had clear sight at distance and near. Also, the eyes appeared to be healthy. There was one finding that was terribly abnormal. That was the patient's peripheral vision. With the right eye closed, the patient couldn't see anything on the right side. With the left eye closed, the patient wasn't able to seen anything on the right side. This condition is called a right field hemianopsia. Apparently, the surgery interfered with the visual fibers going back to the part of the brain that deals with vision.

One of the problems was that the patient did not realize she had a vision problem of any type. Also, according to the patient, the doctor who performed the surgery thought she was faking her condition.

Fortunately, she responded to a treatment that I have yet to use since I was in optometry school. I placed prisms in front of both eyes and shifted the world to the side. Immediately the patient was able to walk straight. This had profound effects on her life. She immediately was able to read better. She subsequently went back to work. Most importantly, her outlook on life was tremendously improved as she was no longer depressed.

A Life Possibly Saved

Last year, a patient came in complaining of headaches and blurred vision. These are not uncommon symptoms for many of the patients whom I see. The patient was relatively young, 41 years old.

When I examined her, I noted that the optic nerve of the left eye appeared abnormal. Also the best vision the patient was able to obtain in that eye with glasses was about 20/40. The right eye was correctable to 20/20 with glasses.

When I checked the patient's peripheral vision, both eyes showed a defect. With both eyes showing an identical defect, the problem probably lied somewhere within the brain.

We referred the patient immediately. Unfortunately it took two weeks for the patient to see the specialist. Once the specialist saw the patient, he immediately ordered imaging of the eyes and brain to help determine the etiology of the problem.

Many times when a visual field problem in both eyes is found, you think of a tumor. This was not the case. Instead, an aneurysm was found, a very large one at that.

Surgery was performed on the patient.

The patient came back to my office relating the above story several months after I originally referred her to the specialist She did lose sight in the left eye. She stated she almost died on the operating table. She also relayed what her surgeon said: "You should hug the eye doctor who referred you. If you waited any longer, the aneurysm would have probably ruptured and you would have died."

You can see the patient's brief letter in the "testimonial" section of the website, www.wehelpuc.com. I've been practicing optometry for 30 years and I am more passionate now about the profession than ever.

Continuing Education Seminar

I attended a tremendous continuing education seminar in Pasadena this weekend. It covered areas of retinal disease and surgery, cataract surgery and even areas of visual processing. The lecturers were top notch.

New Office

Construction on our new office should start within the next two weeks. We're really looking forward to our new office which should open right after the new year.