MY EYE POD

Dead Blog?

noreply@blogger.com (Michael Prince, O.D.) — Sun, 15 Dec 2019 19:15:00 +0000

Apologies for the lack of new posts. I started this blog in 2006 - over 13 years ago. I have to admit I'm bored with it. I have other interests now. I guess I won't delete the whole thing, since it's still getting hits. The information is still good! I am just not motivated to add to it anymore. I got a new job in Aug 2019 and I'm more busy at work now, which is when I'd usually post. And my theatre hobby and playwriting etc have pushed this blog aside.

Thanks for reading! I may add to it later if I think of something I want to add.

Lens thickness and frame selection

noreply@blogger.com (Michael Prince, O.D.) — Sun, 11 Aug 2019 21:29:00 +0000

The following is a reply I sent to a post on reddit complaining of thick lenses (ordered online) ,despite paying extra for high index:

"Actually the *single biggest* factor in whether your lenses are "thick" or "stick out" is fame selection. Yes Rx matters of course. Yes high index lenses are thinner.

You need to try to make your "frame PD" be the same as your actual PD or as close as humanly possible.

For example: your PD is 62. The ideal frame for you would be a 44-18. A 50-20 is going to produce thick lenses on the outside because of decentration. It's my experience that when left to their own devices MANY people will pick a frame that is too wide for their face.

A 69 PD needs a 52-17 or as close as you can get. There are other factors like squeezing your head or temples that are too long for you etc etc but your main goal if you're nearsighted and worried about lens thickness should be frame selection IMO"

1970 Buick Riviera update

noreply@blogger.com (Michael Prince, O.D.) — Wed, 12 Jun 2019 20:07:00 +0000

Did the front shocks myself! Easy. Also have done all kids of other little stuff: some wiring for the brake lights, a whole bunch of new bulbs, fixed the hook attachment of the right wheel skirt. paid to have the front end alignment done. Flipped those whitewalls IN ... hate whitewalls, always have. Fixed the right door jamb switch for the courtesy lights. It needs a/c. The nearly 50 year old compressor and regulator are shot. I have a guy who can fix it (don't think I can do that myself!) but we're waiting on parts. Meanwhile we had our first 100 degree weather day last week (beginning of June) and it's rather unpleasant to drive a black car in those circumstances. I did it this morning anyway, tho! Bc it's just so cool to drive. Wherever I go people talk to me about it and ask questions. It's a very unique ride!

Dear Alleycat

noreply@blogger.com (Michael Prince, O.D.) — Wed, 12 Jun 2019 19:56:00 +0000

I wrote a play. It's a one-act, the title of which is above. It got picked up by Theatre Workshop of Owensboro (KY) and is going to be performed in their annual "Summer Shorts" program. Not gonna lie, I'm pretty excited about it. Excited and nervous. Like probably anyone in this situation, I have nightmares of it flopping epically. I hope not! I hope it gets a good reception, obviously.

I've seen the list of plays for the Summer Shorts along with their estimated run times. Mine is the longest, coming in at just under 30min. Can't decide if that's a good thing or a bad thing.

Before Dear Alleycat got picked up by T.W.O., I also submitted it for one other one-act contest, this one much closer to me in Lockhart, TX. Waiting to see if it advances to the final round of plays that will be performed there as well.

"What's it about?" is the question everyone asks. Well of course an author/playwright has a difficult time boiling things down to a two sentence summary. It's about a lot of things, but mostly it's about family relations and the tragedy of cancer. It's a drama and it is admittedly quite sad. A "tear-jerker", someone who read it told me. This person is a theatre professor at a renowned liberal arts college who offered some constructive criticism. She of course pointed out some areas that could be better, but overall gave it a good review and told me I should be proud of it. I am!

If it gets a good reception in the next few months I would like to look into publishing it. I would love for it to be on "the list" of one-acts that can be performed in high school one act competitions, etc.

It's called "Dear Alleycat" because "Allison" or "Ally/Alley" is the main character, and her mother writes letters to her using the pet nickname "Alleycat". There are no felines in the production. Well, none written into the script, anyway!

Haven't Blogged in Awhile

noreply@blogger.com (Michael Prince, O.D.) — Tue, 26 Mar 2019 16:10:00 +0000

Haven't blogged in awhile. I'm sure this happens to a lot of bloggers. Don't know who reads this, or if I'm just talking into the abyss. Have had a lot going on: been in a bunch of plays. Pretty much solid for a year now. End one, start another one. It brings me joy. Collecting vinyl. Kind of quit playing guitar...it doesn't bring me as much joy anymore. Quit the praise band at church. Quit writing my book. Maybe I'll pick it up again sometime. Been working on my car slowly, the 1970 Buick Riviera. Love driving it. Wrote a play that got picked up by a theatre in Kentucky of all places to be performed in their annual one-act contest! So that's fun! Probably going to go out there to see in it July. It'll be surreal seeing actors onstage portraying my characters and saying lines that I wrote. Just plugging along. Anything else? Got questions? Anyone reading this? haha

Bought a Classic Car - 1970 Buick Riviera

noreply@blogger.com (Michael Prince, O.D.) — Tue, 20 Nov 2018 16:17:00 +0000

I always said I wanted a "muscle car". Big American V8. My first car was a maroon 1974 Dodge Dart. I loved that car. Twin brother wrecked it.

Found a black 1970 Buick Riviera a few weeks ago on Facebook Marketplace for sale an hour away from me and, being of middle age and with some disposable income finally, I picked it up. Here she is:

I always envisioned buying a 1970's sports car: a Mustang Mach 1 or something. I also liked the 1969 Ford Galaxie Fastback. What I ended up buying is technically known as a "personal luxury vehicle", not a "muscle car". But the 1970 Buick Riviera had the biggest, most powerful engine Buick ever made: a 455 cubic inch displacement, 370 horsepower, V8 "big block". It had more horsepower (370) than the Buick sports car at the time, the GS-455 (360). Let me tell you it hauls. My daily driver is a Prius-C (that I bought in 2013 when gas was $3.85 in Texas and I was commuting 55 miles each way to work), so driving "the Rivie", as I call it, is a huge difference. I think I hurt my neck at a stoplight recently.

The 1970 Riviera is unique in multiple ways: it was the only year that featured the wheel skirts (the rear wheels are partially covered), and the first year that the headlights were not retractable. As mentioned above, no Buick engine was ever bigger or more powerful. 1970 was the first year of the "big block" and they only got smaller from there. It's a hard top coupe.

It needs some work: most notably I need new brakes. Getting those this week. Radio needs work, needs a new blower motor. But the engine runs great and the interior is in decent shape. I'll probably eventually have it reupholstered, but not all of this at once. I don't have *that much* middle age disposable income! Plus it gets a whopping 9.1 mpg, so a fill-up of super gets pricey real quick!

SightGlass Myopia Control Study

noreply@blogger.com (Michael Prince, O.D.) — Wed, 26 Sep 2018 17:17:00 +0000

People are always asking me "what can I do to stop my child's nearsightedness from continually worsening? Well this group (SightGlass) has a great idea that may revolutionize the way we treat young myopes. They're doing a clinical study right now and need participants in CA, FL, KS, LA, MO, NY, TN, TX, and UT

https://www.kidsvision.info/the-trials

What Optometry is Like - Advice to Potential Optometry Students

noreply@blogger.com (Michael Prince, O.D.) — Mon, 20 Aug 2018 14:40:00 +0000

I recently answered a question on Reddit r/optometry. The poster was a potential optometry school student with excellent grades, but hated chemistry lab. He was worried that he would hate optometry school and being an optometrist if it was anything like chemistry lab.

Day to day optometry is literally all people skills and problem solving. It is nothing like any academic anything. Nothing like chemistry lab, or chemistry class. Or any class, for that matter.

I went to school at SUNY Optometry with some of the best and brightest, who made literally over 4.0's in undergrad (which should be impossible, but that's a rant for another day). Some of these people just aced the first two years of optometry school, then reality hit them when we started seeing patients. They were terrible at it. They could not communicate with or relate to patients at all. They could not cut through a lengthy case history to determine what information was useful and what was superfluous, and they could not understand patients with thick accents who used different terminology, etc. Well that was bad bc that's what they're going to be doing for the rest of their lives. No more acing chemistry exams, now you have to understand people, which was really hard for some of them.

So basically here's my advice to potential optometry school students: you'd better like people and be good at relating to them, or at least learn to. If you're not a "people person", I don't think you'll like optometry very much. Go be a surgeon or a researcher instead.

Acuvue Oasys with Transistions

noreply@blogger.com (Michael Prince, O.D.) — Fri, 13 Jul 2018 14:20:00 +0000

Yes you read correctly: contact lenses that change colors when exposed to sunlight. "Sunglasses" in contact lens form. They're coming soon. We'll have them - we're a big Acuvue practice. An interesting development, for sure! As for how dark they get and how well they work...we'll see!

https://www.acuvue.com/acuvue-oasys-transition-contact-lenses

GREENE EYES IS RENOVATING!

noreply@blogger.com (Michael Prince, O.D.) — Mon, 25 Jun 2018 14:21:00 +0000

GREENE EYES IS RENOVATING!

We will be closed the following days to make our office cleaner, nicer and just plain more awesome:

Closing early Friday June 29 (3:30pm) 

Closed all day Saturday June 30

Opening late Monday July 2 (10am)

Closing early Tuesday July 3 (12:30pm)

Closed all day Wednesday July 4

Closed all day Thursday July 5

Closed all day Friday July 6

Closed all day Saturday July 7

Closed all day Monday July 9

REOPENING NORMAL BUSINESS HOURS TUESDAY JULY 10

Apologies for the inconvenience, as we're trying to make our office better for you!

Lumify Redness Relieving Eye Drops

noreply@blogger.com (Michael Prince, O.D.) — Sun, 22 Apr 2018 15:54:00 +0000

This is actually pretty significant news. Lumify is the 1st new and different "redness reliever" (vasoconstrictor) since the 1970's. Since it works in a different way than currently-available naphazoline and tetrahydrozoline, it is much, much safer both short term and long term. I'm so glad to be able to recommend something for cosmetic red eyes, because I cannot in good conscience recommend Visine and Clear Eyes. Actually many professionals including myself have used a homemade version of this formula for years, and now it's going to be available for everyone!

http://www.lumifydrops.com/

Bausch & Lomb Ultra for Astigmatism

noreply@blogger.com (Michael Prince, O.D.) — Tue, 20 Feb 2018 15:41:00 +0000

B&L has stepped up their game. I was already a big fan of the Ultra Multifocal, as I think it has a superior optics design. A few weeks ago we received our fitting set of the new toric (astigmatism) lens and I have been using it quite a bit. The initial feedback has been excellent. Good vision, good comfort...and when I examine the lenses on the eye it seems very stable. It's nearly always in position and doesn't rotate much on blinking.

I'm a big fan and will be prescribing the heck out of it.

Floaters - When it's an Emergency and When it's Not

noreply@blogger.com (Michael Prince, O.D.) — Fri, 22 Dec 2017 20:28:00 +0000

Vitreous floaters or muscae volitantes are benign, normal entoptic phenomena. I always say that everybody over about 30 has them, and if they don't...well they do, they just aren't astute enough to have noticed them. With today being Dec 22, we and every eye doctor's office will inevitably get some emergency calls on Christmas Eve and Christmas Day about floaters. That's because when you google "eye floaters" there are a lot of scary things to read about, namely retinal detachment. So let's just run down real quick when it could be an emergency and when it's probably not:

PROBABLY NOT AN EMERGENCY IF:

- it occurs in both eyes equally
- small dots or squiggles
- less than say 10 floaters per eye
- floaters are not always present
- no flashes of light
- still see well out of affected eye

Whenever someone calls the office about floaters I have my staff ask them: "one eye or both eyes?" If it's both, it is almost never an emergency. All the really bad stuff happens in one eye. Things that happen in both eyes are almost always benign. If its a few new small dots or squiggles that come and go, and no flashes of light, and you still see well, then just make an appointment for the 1st day the doc is back in the office after the holiday. For the record all floaters need to be investigated, just some sooner than others.

COULD BE AN EMERGENCY IF:

- one eye only
- large, very blurry, black, gray or red masses
- a *lot* of new floaters
- floaters always present
- flashes of light
- see poorly from that eye like something is "blocking" all or a portion of your vision

If any combo of that last list is true, it's time to call your eye doc's emergency number and have them see you today. It could be a retinal problem like a hole, tear, detachment, or hemorrhage that may need immediate intervention. Almost no retinal problem is painful, which is why sometimes people don't come in. They figure if it doesn't hurt, how bad could it be? Well the answer is: bad. Retinal problems don't feel like anything. They don't hurt or itch or burn...they have no feeling at all. Okay so in summary: HAVE A VERY MERRY CHRISTMAS and if you feel like you fall into the second list, call your eye doctor right now! If you fit solely in the first category, wait til the doc is back in the office, no biggie.

Zeiss i.Terminal Mobile

noreply@blogger.com (Michael Prince, O.D.) — Fri, 15 Dec 2017 16:18:00 +0000

We just purchased the brand new Zeiss i.Terminal Mobile. It was installed last week and we trained on it yesterday. We already had an i-Terminal 2, so we are familiar with the technology. There is not a more accurate or precise method for measuring progressive lenses. You haven't owned a good pair of progressives unless you've been measured with the i.Terminal, that is how strongly I feel about this technology. I won't ever go back to the old methods myself, and I don't recommend anyone buy progressives without using this system. I can't say enough about it - it's far and away the best technology out there for glasses. As far as I know we're one of the only practices in the Brazos Valley who use this system. When the information is digitally sent to the Zeiss ophthalmic labs, it seamlessly integrates with their progressive lens products, which have been specifically designed for use with this system. It's not only cool, but also super, uber precise. Okay I'll stop ranting about it. Suffice it to say: Greene Eyes is the place to go in the Brazos Valley for the best possible progressive lenses!

Tips on Reducing Digital Eyestrain from Handheld Devices

noreply@blogger.com (Michael Prince, O.D.) — Fri, 27 Oct 2017 16:00:00 +0000

For many of us, phones, tablets & phablets are the norm. Many of us work all day at a laptop or a computer, but almost all of us also use handheld smartphones or the like, both for work and at home. If you're like me, the tiny little white screen can actually be uncomfortable to look at, especially in low lighting. Here are some tips to help:

1) Enable Night Light (Android) or Night Shift (Apple). This feature changes your screen to allow less "blue light", which is annoying, causes eyestrain, interferes with sleep patterns, and may even be harmful to your eye. It turns your screen amber or "redder" during times of low light. You set your own custom timer. I have my Night Light set to be on from 7pm-7am. If your OS doesn't have this feature, you can download f.lux.

2) Reduce your screen brightness. This one is easy. Use the slider in settings. I find that "auto screen brightness" is not bright enough outdoors and too bright to reduce eyestrain in low lighting

3) Download an extension for your browser that allows for "night mode", which is a black background with white text. This is much easier to view in low lighting, and may even be higher contrast. I use an extension called "Night Mode Pro" for Opera and Yandex browsers, but Google Chrome and Apple Safari both have night mode extensions, just search for them and install.

4) Raise the ambient room lighting in your environment. Don't view your device in total room darkness. It won't damage your eyes to do so, but it will make everything more difficult to view on your device.

5) Remove point light sources from your view. Your device is back-lit, it does not need a lamp beside you or in front of you. Having a light bulb be visible in your view also won't harm you, but isn't conducive to comfortable viewing.

6) Consider a "blue blocking" filter on your next pair of glasses. Results are mixed as to whether this helps in practice, but the science is sound and it couldn't hurt. I have it on my glasses (came with my anti-reflection coating with no charge) and generally it's not a terrible idea to do for yourself what the eye doctor does for himself/herself.

7) Stop using your device and stop your children from using their devices 30min before bedtime. This one is difficult, even for me, but studies show that "overstimulation" of retinal receptors just before bedtime, especially with blue light, can hinder your falling asleep and reduce the quality of sleep.

Your Primary Care Provider Does Not Know About Eyes/Vision

noreply@blogger.com (Michael Prince, O.D.) — Tue, 10 Oct 2017 16:10:00 +0000

I'm sorry, but they don't. They don't know whether you have pink eye or not (probably not) and they don't know whether you are 20/20 or not. This is not a knock on them, they have a lot to worry about.

I just had a patient who I saw last year and Rx'd glasses to, glasses that she is perfectly happy with, wears 18+ hours/day, and sees well out of to her knowledge. Until, that is, she had her vision tested at her annual PCP visit. The nurse told her at that visit that her vision was "20/60" with her glasses on and that she was not seeing well at all and needed to get to the eye doctor right away. Well This was news to her bc she had no symptoms of blur, and was just seen last Sept, when I told her she saw great and everything was fine. So she came in today for an eye exam and...she still sees great and everything is still fine. Her Rx is unchanged. She is 20/20 through her glasses, she is absolutely not "20/60".

So how did this happen? Here's my speculation: this patient wears progressives. The standard non-eye-doctor way to check vision is to cover one eye with a plastic paddle and read a chart. Well everyone...everyone presses too hard with the paddle. The people not wearing glasses press too hard and literally smash their covered/closed eye, making acuity on the second eye awful bc of a deformed cornea, and the people wearing glasses press too hard and shove their glasses way closer and way higher than they normal wear them, which totally skews the vision in all glasses, especially progressives.

So we're back to something I've blogged about before: people generally do not understand how to check vision. It's not all that easy. So basically if your PCP or the DMV or the school nurse or whomever tells you to go to the eye doctor, do it. It's great advice. But please don't panic or make any decisions about your eyes/glasses/vision until you see the optometrist, bc a lot of times the info you've been given from those places is not accurate.

Want to Know Why Drugs Are So Expensive?

noreply@blogger.com (Michael Prince, O.D.) — Fri, 08 Sep 2017 21:46:00 +0000

Because of stuff like this. Drug companies will do WHATEVER IT TAKES to prevent their drug from going generic. This is shady as all get out, and I will probably not Rx Restasis anymore because of this. I like Xiidra (competitor) better, anyway:

https://www.aao.org/headline/allergan-uses-unorthodox-maneuver-to-protect-resta

SEP 08, 2017

Allergan uses an unorthodox maneuver to protect Restasis’ patents

sold the patents for Restasis to an Indian tribe in an effort to protect their top-selling dry eye drug from generic competition.

The Saint Regis Mohawk Tribe, a recognized sovereign tribal government in upstate New York, now owns the rights to Restasis and has granted Allergan exclusive licenses on the product. Under the terms of the agreement, Allergan will pay the tribe $13.75 million in initial payments and an additional $15 million in annual royalties.

According to the press release, Saint Regis will file to dismiss any patent challenges "based on their sovereign immunity from IPR (inter partes review) challenges". Three companies—Teva Pharmaceutical Industries, Mylan NV and Akorn Inc.—have filed IPR challenges related to Restasis.

Allergan's Chief Legal Officer Bob Bailey said that Saint Regis was the one who approached the company with the strategy. The decision to proceed was based on 2 previous cases involving universities that were successful in using their sovereign status to dismiss IPR proceedings.

Sales of Restasis (cyclosporine ophthalmic emulsion, 0.05%) generated $1.4 billion in revenue last year, and its patents are expected to expire in August 2024.

"This is a viable and sound opportunity for the Saint Regis Mohawk Tribe to enter into the patent, technology and research sector as part of our overall economic diversification strategy,” the Saint Regis Mohawk Tribal Council said. “We realize that we cannot depend solely on casino revenues and, in order for us to be self-reliant, we must enter into diverse business sectors to address the chronically unmet needs of the Akwesasne community; such as housing, employment, education, healthcare, cultural and language preservation."

The deal comes at an interesting time, as congress recently passed a funding mechanism that could help speed the generic drug approval process. The FDA has also been working on a fast-track process that could reduce the approval timelines to as few as 8 months.

Amblyopia - Sometimes the Answer is "Don't Treat"

noreply@blogger.com (Michael Prince, O.D.) — Thu, 31 Aug 2017 17:08:00 +0000

Here's a common scenario that I estimate happens 2-3/mo in our practice, it just happened again 6min ago: 13 year old girl comes in. She has been in glasses her whole life, literally starting at age 3. One eye is prescriptionless and 20/15 acuity. Other eye is +3.50-1.00x010 with BCVA (best corrected visual acuity) 20/50. That means that with her glasses *ON* she still can't see any better than 20/50. Here's the kicker tho: her uncorrected vision without glasses on in the bad eye is... also 20/50. So the right eye is awesome and doesn't need glasses, and the left eye is 20/50 with the glasses off and 20/50 with the glasses on. Wearing the glasses does not make her see any better in either eye, not even the "bad" left eye. So guess what I did? Nothing. I told her she didn't have to wear glasses. She was very happy! Mother was flabbergasted. See she's been told every year by every optometrist ever that her daughter MUST wear glasses at ALL TIMES, and if she doesn't wear glasses at all times her left eye will "go blind" (which is untrue, but I digress). Eye care professionals mostly agree that the "critical period" of visual development stops at around age 8. Basically an amblyopic ("lazy") eye probably can't get very much worse or better after that. So before they're 8 we are prescribing these kids glasses and making them "patch" their good eye, etc etc etc. But when they reach 10 or so and they're still 20/50...and putting the perfect Rx in front of their bad eye DOES NOT IMPROVE THE ACUITY AT ALL...well then IMO a strong case can be made for *not* prescribing those kids glasses anymore. The mother later told me that the child "doesn't wear the glasses anyway". Yeah, not surprising at all. You know why? BECAUSE WEARING THE GLASSES DOES NOT INCREASE THE ACUITY. She puts the glasses on and sees EXACTLY THE SAME. And then she tries to play volleyball and be on the Jr High cheerleading squad etc etc with glasses on that literally just get in the way and don't help at all. Exactly what is the point of that? Nothing, I say. Now obviously I am not saying give up on all amblyopes or anything like that, but I am saying that sometimes the correct answer is "don't do anything".

Android Nougat "Night Light"

noreply@blogger.com (Michael Prince, O.D.) — Thu, 13 Jul 2017 14:53:00 +0000

I recently purchased a new phone, the ZTE Axon 7. It's the flagship phone for ZTE, supposed to be comparable to the Samsung Galaxy S8 and iPhone 7. It is. It's a great phone. With it comes the Android Nougat OS and a function that I really like: Night Light. Basically Night Light is a blue blocker. It turns the screen amber at night. You can set up a custom schedule, which I encourage you to do if you have a phone with Nougat. Blue light causes eyestrain, especially in low lighting, and may even be bad for your retinal health. It can also interfere with melatonin levels and impede sleep patterns! Basically I think everyone should do this, especially children. Set up a time so that the Night Light comes on an hour before bedtime so that the last thing your child looks at before they retire for the day is not a super bright BLUE LIGHT screen. If you don't have Nougat OS you can download the Twilight app, which I've blogged about before. It has similar functionality.

Myopia Control - It's Still Not the Tablet!

noreply@blogger.com (Michael Prince, O.D.) — Fri, 07 Jul 2017 15:55:00 +0000

Almost everyone believes a few eye myths: "carrots improve vision" (they don't), "all red eyes are bacterial pink eye" (not even close), and "tablet use worsens your vision". I have already heard the following twice this week: "DR PRINCE - TELL MY SON/DAUGHTER THAT TOO MUCH COMPUTER USE IS CAUSING HIS/HER EYES TO GET WORSE! TELL HIM/HER THAT THEY NEED TO STOP SPENDING SO MUCH TIME ON THEIR TABLET/PHONE!" No, I will not tell your son/daughter that because it's not true. Time spent on devices may contribute to eyestrain and headaches, but they will not cause myopia nor will they worsen existing myopia. Everyone, and I mean everyone thinks it does, but it doesn't. That is not a thing. I know you "always heard" it was a thing, but it's not. Myopia is almost always GENETIC. Read more about myopia and myopia control here: http://myopiaprevention.org/

Foster Grant Mulifocus Reading/Computer Glasses

noreply@blogger.com (Michael Prince, O.D.) — Thu, 06 Jul 2017 18:22:00 +0000

Saw these in Kroger again yesterday. I've seen them before and read about them before. On paper a decent idea: an inexpensive OTC solution for those of us over about 45 who work at a desktop computer all day and also need to be able to read small print. A "progressive" for the people. $35 instead of $400. I can understand the appeal. I tried them. They were horrible; I knew they would be. I have some amount of astigmatism and that's not going to work in the FG's. But would they work for someone? Do they work for the average user? The answer is: "kind of". If you are happy with your uncorrected distance vision (far away vision w/o any glasses on) and you have an "average" pupillary distance, then they'll probably work fairly well for you. Granted (Foster Granted?) they will not work for driving or anything far away, even looking across the office farther than 20 ft. The website describes 3 different viewing "areas": reading, computer, and "interacting". I presume the interacting portion is say 1/4 of the reading power, the computer portion is 1/2 the reading power, and the reading is the full reading power. Factors that may keep you from being able to happily use these: a pupillary distance of anything other than average, a sensitivity to the poor optical quality of polycarbonate, astigmatism, a need for any distance vision correction, or very high acuity demand.

This is Community Theatre

noreply@blogger.com (Michael Prince, O.D.) — Mon, 26 Jun 2017 16:01:00 +0000

So I just finished playing Sam Byck in the Sondheim musical "Assassins". I was also Major Rizzolli in "Passion", as our theatre (The Theatre Company of Bryan/College Station) did a never-before-attempted double billing of those 2 shows. I'm pretty sure no one will ever attempt this again. The same 15 person cast performed both 1-act musicals in their entirety back-to-back with an intermission inbetween. It was both awesome and brutal. It absolutely wore me out, and we had difficulty keeping the run time under 3.5 hrs, which is really long for an audience. Anyway that's what I've been doing for the last 10 weeks or so instead of blogging. Here's a humourous anecdote from running Passion as Major Rizzolli:

So every night in Passion (the musical) the Italian soldiers played pool and sang. We'd roll the table on with all the balls while singing, then proceed to attempt playing an actual game of pool. My 1st line in the song was calling my shot by saying "4 ball in the side". As we rolled the table on, I'd place the cue and 4 in position where I could feasibly call and make that shot. Making the shot was important bc my next line was calling the shot "6 ball in the corner". So if I missed the shot or scratched or whatever, then the next line didn't make much sense bc it wouldn't be my turn anymore. In a perfect world I'd sink the 4 ball and set up a makeable 2nd shot on the 6. Well the pool table sucked haha. The stage is uneven and the balls rolled hilariously slanted. The bumpers were wood and didn't bounce AT ALL. Bank shots were not an option. Plus even after I "set" the 4 and 6 and cue, other balls would inevitably roll in the way of my shots bc of said uneven stage. There were also large wrinkles in the green felt top. The whole thing was a comical exercise in futility that the soldiers had a really, really fun time doing. We constantly joked about it, and it will be a running joke for a long time. When you saw us laughing on stage it was not really acting, we were *actually* laughing at the situation every performance. I thought it made for some pretty realistic and humorous theatre. Another actor had the line "GOOD SHOT!" right after I shot the 4 ball. If I made it he'd exclaim his line with raised eyebrows like he was impressed. When I missed (which was often bc of aforementioned hindrances) he'd very sarcastically say the line, which would break me every time. Then they'd all have to stand there and watch helplessly while I called and attempted the next shot after digging the cue ball out of the pocket or whatever haha. One performance I missed the 4 ball and scratched on the 1st shot, dug the cue out of the pocket, called the 6 ball and promptly sank the 8 instead. It was a big old bag of fail and I'm pretty sure all of the soldiers were laughing aloud. I was. I'll laugh about it for years!

Keratoconus Caused by Eye-Rubbing?

noreply@blogger.com (Michael Prince, O.D.) — Tue, 30 May 2017 18:22:00 +0000

Short version? NO. There is a significant genetic component.

Longer version: I recently read that KC is probably way more prevalent than we once thought. The newest studies show it's probably more like 1-in-400 patients instead of the previously-stated 1-in-12,000 or so. I was happy to hear this because prior to that I was seeing a LOT more KC patients than 1-in-12000. I just assumed it was our patient population (heavily Hispanic), but no, it was longstanding bad data. Then over the weekend I read this article by an MD who hypothesizes that KC is caused by eye-rubbing, which I personally very much disagree with. Eye rubbing is known to exacerbate KC and progress the corneal thinning and steepening of existing KC patients, but there is a LOT of data that shows it is genetic/inherited. The article isn't a study and doesn't present any real data to support the hypothesis. It's more of a "what if this were true - wouldn't that be a game changer!?" type of article. I know this is just anecdotal but MANY of my KC patients claim to never rub their eyes, before or after diagnosis. So then how did they get it? I don't have to present a lot of data in this blog post, it's already been presented for me over many, many years of journal articles and studies. It is widely accepted that KC is an inherited corneal ectasia. The author admits that his hypothesis is out of line with traditional thinking, and that it's not possible to prove his theory. The crux of his argument is that KC is poorly understood (that's true) so basically his theory is "possible". Kind of a Devil's advocate kind of presentation. Well OK there is a place for that in medicine, but I disagree that KC is "caused" by eye-rubbing. The vast majority of professionals agree that KC is a genetic/inherited corneal ectasia.

The 45 Year old Myope Contact Lens Wearer

noreply@blogger.com (Michael Prince, O.D.) — Mon, 17 Apr 2017 15:40:00 +0000

We get these all the time. Every week. These folks have been nearsighted for 35 years so they think they know all about vision and glasses and contacts bc they're very "experienced". Here's how it usually goes:
patient: "I'm starting to get blurry vision and a lot of eyestrain when I read my tablet or computer. I think I just need a little more power in my contacts, you know?"
me: "Well you're 45 so it's probably not that you need more powerful lens. You might even need less powerful, and you almost certainly need reading correction, You know - bifocals.
patient: "BIFOCALS!? Aren't those for old people?"
me: "Most people need them by 45. But the easier thing is to just wear over the counter reading glasses over your contacts."
patient: "No I see fine up close. I'M NEARSIGHTED (usually enunciated very slowly and deliberately, to make sure we understand what their condition is, is if we somehow don't understand myopia). I can read a book in bed all night without my contacts on, no problem."
me: "Yes I understand you're nearsighted. But now you have a new and different problem called PRESBYOPIA. It means with your contacts ON you'll need reading correction for up close work like reading or computer."
patient with very skeptical facial expression: "Are you sure? I've never had this problem before."
me: "Very sure, and you've never had this before because you're never been 45 before."
patient: "Can't you just make the contacts a little stronger?"
me: "Stronger won't work. That's going to make the near vision even harder."
patient with even more skeptical facial expression: "Usually I know when I need a new contact lens prescription because everything gets a little blurry and the optometrist just prescribes me a little more power and it clears right up!"
me: "Yes I understand that. But now this new problem is going to have to be treated differently."
patient: So what are my options here? Can I just get LASIK?"
me: "LASIK will not work for this. You could use reading glasses over your contacts as we discussed before..."
patient interrupting: "NO. I don't like glasses."
me: "Well we could make one lens a little weaker so that it sees better up close, then you'd have one eye to see well far away and the other to see well up close."
patient: "Doesn't that mess with your vision!? And give you a headache!? No, I don't think would work for me."
me: " Ok there are multifocal contacts, but the big downside there is that they will actually make you see slightly more blurry far away than traditional contacts."
patient: "OH NO I HAVE TO SEE! I can't have it be blurry far away!"
me: "Well unfortunately you're going to have to make some sacrifice in your vision."
That almost exact conversation happens 2-3x/week in our office (once or twice per doctor). It's a little frustrating because IMO a lot of myopes are "conditioned" to believe that a) stronger is always better and b) since they have always seen well up close uncorrected, they are very confused by a scenario where up close vision would be blurry. In their mind distance vision has always been the big problem for them (which is true) but their 30+ years of experience at the eye doctor hasn't prepared them for a near-vision-blur scenario. They've been to the optometrist 30+ times and this is the first they are hearing of this new problem, and a lot of them become very skeptical as if the doctor doesn't really know what they're doing or there is some kind of scam at play. I'm serious! We are of course very understanding of this scenario, we OD's do have quite a bit of experience with it. We are as patient as we can be and yet a lot of patients end up being a little put off by it anyway. Probably some combo of the aforementioned skepticism and a mild denial scenario in which they don't believe they are old enough for bifocals and reading glasses. Hopefully if you're nearsighted and 45 you'll read this and then you'll know, and knowing is half the battle!

Astigmatism/Toric Contact Lens Failure Rates

noreply@blogger.com (Michael Prince, O.D.) — Fri, 07 Apr 2017 14:33:00 +0000

I don't know if there are a lot of published numbers about what I'm going to talk about. I know we hear all the time about why contact lenses fail and the big one is "dry eye", or at least dryness in contact lenses, if not a clinical diagnosis of dry eye. But in my opinion one of the biggest contact lens failure rates is among people who have a low to moderate amount of astigmatism and not much else going on. I'm talking about low mixed astigmats, low simple myopic astigmats, and low compound myopic astigmats who have more cyl than sphere. These people are usually 20/25 or 20/30 without any correction, and they are 20/15+ with their glasses on. At some point they have the same idea as every other glasses wearer: "I sure with I could see clearly w/o these clunky glasses because sometimes they get in the way", which is of course true. But in my estimation these cases have a really high failure rate. I personally believe it to be over 50%, and the reason will surprise you: they're "not bad enough.". What I mean is that there is no "wow" factor when they put their contacts on. They usually go from their uncorrected 20/25 or 20/30 to a messy 20/20- with strain while wearing low-astigmatism soft toric contacts, and it's nothing like the crystal clear 20/15+ they get in their glasses, and they're disappointed. Not only that but they assume we've done something wrong and somehow haven't got their Rx right yet. This is especially true if they have a myopic friend who constantly wears and loves soft contacts who tells them how great contacts are and how much better they see than when they wear glasses. Those are apples and oranges, however. What they don't know is a lot of those high myopes who *love* their soft lenses can only reach 20/25 or so in their contacts, which they think is amazing and a vast improvement over their uncorrected vision. They're going from AWFUL to normal. But the low astigmats in question aren't doing that; they're going from almost normal 20/25 vision to superhuman vision in their glasses and they expect that same "wow factor" in soft, disposable, low-cyl, toric contacts and it's just an unrealistic expectation. So they come back and talk to me some more and I explain all of this again (because I have already warned them at the initial fitting about my low expectations), and some of them are okay with it and some of them still think I'm somehow not trying hard enough or haven't made the lenses "strong" enough or whatever. Just because a -0.25-0.75x020 toric lens is manufactured doesn't mean it's going to work. The folks who have that Rx in glasses we already know something about them: they're pretty high acuity demand. They're pretty "picky" about their vision. If they weren't, they'd just be perfectly fine with going w/o glasses and walking around with 20/25 acuity all the time. The fact that they are in glasses at all tells me they want to see AWESOME, and when they ask about soft contacts I already know "awesome" is a pipe dream and so I'm immediately skeptical of their success in contacts. Then add in the feel of torics, the "dry eye" or dryness issue mentioned at the beginning as the #1 culprit of contact lens failure, and you can see how I come up with such a low estimated success rate in these types of prescriptions.