Prescribing contacts for a mildly nearsighted individual around 40 can be a challenge. Most of these patients take their glasses off when they read. It has to be pointed out to the patient that if you prescribe contact lenses for distance, they might have trouble focusing up close. I, as an optometrist, have to discuss this issue with the patient. The remedy may include reading glasses over the contacts, monovision (one eye for reading and one eye for distance) or bifocal contact lenses. This particular patient opted out of contacts completely but was appreciative that I pointed this out first.

I was talking to an individual who is a photographer who wears glasses. I noted that her glasses did not have an antireflective coating. I told her the benefits of it including cosmetic as well as seeing better particularly at night or on a computer. She stated that her husband use to wear them and they smeared. I told her that the coatings now are a lot better and the problems of smearing or the coating coming off have been greatly minimized.

I had a patient about 30 years old come into the office today. He told me his vision was changing. The patient was found to have astigmatism and nearsightedness. The first question out of the patient was whether his vision problem was caused by aging. I told him it was probably due to the type of close-up work he was doing.

Usually, aging problems equate with not being able to see clearly with the same prescription for reading and distance. This usually starts in the late 30's to early 40's.

I am so grateful to be in private practice. Granted, this is not for every optometrist. I've been in my own practice now for over 21 years. I literally enjoy coming into work daily. Some of the patients whom I've seen as kids bring their own kids in now. The office takes on a a real family feeling, both among the employees and the patients. Also, I have been able to network very effectively with the business community, belonging to three local chambers of commerce.

I was sitting in my exam room with an adult patient when I noticed that her four year old was being entertained by a video on a cell phone. Over the last few years there has been an explosion of hand held devices with video capability. It will be interesting to see the effects of viewing such detail at such a close distance over an extended period of time. I truly believe that the incidence of nearsightedness and possibly astigmatism can only increase with this.

I could only imagine with time these devices are going to act as "pacifiers" to kids even younger than the one just mentioned.

I mentioned in earlier posts about the effects of nearwork on vision, especially with young people. One of the more dramatic changes I have seen was with a ten year old boy. He was basically 20/20 last year. Over the last 12 months his vision has dropped to about 20/200. He can achieve 20/20 with glasses. Part of this may be genetic. However, the father states his son is constantly doing a lot of hand held video games. Think how close the device is to the boy's eyes and how small the text is. I am confident that among texting, video games and normal computer viewing, the changes in vision I will see among my patients will be very significant.

I recently had a teenage patient who had suffered an eye injury playing soccer. He was not wearing any eyewear protection. The ball hit him in the eye and he immediately noticed blurred vision. He visited the ophthalmologist. There was scarring in the back of the eye (retina). If the scarring were 2mm superior, the patient would have lost most of his central vision in that eye, and nothing would have been able to restore it. The sad part about this patient is that he is still hesitant in wearing protective eyewear due to vanity reasons.