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).