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.