Here's another post really geared to my OD (or future OD) readership. One of my largest learning curves since graduation from optometry school has been in the nuances of contact lens fitting.  There are no hard and fast rules that work every time, but here are some tips that I have picked up (sometimes the hard way) in contact lens fitting.

• BIOFINITY:  This is my go to lens for patients wearing monthlies.  I also like Air Optix Aqua, so if Biofinity doesn't work that is my next choice.  One tip about Biofinity lenses: the aspheric design allows for really superb vision.  Due to this you can often cut -0.25  from your Rx (so if you would usually pull a -3.00 for a patient consider a -2.75).

• AIR OPTIX FOR ASTIGMATISM: This is my go to toric contact lens.  Again, the Biofinity toric also works just as well, but if you have a higher prescription I really prefer the Air Optix for stabilization.  Both have the same base curve and the same diameter, but the Air Optix material tends to really hug the cornea creating better stabilization in those high power astigmats.  

For all of those times I hear mothers lament how video games are likely destroying their children's vision, new studies are finding that video games may actually improve visual acuity! These studies were specifically geared toward individuals with amblyopia, a condition where one eye has reduced vision despite the best possible pair of glasses.  Amblyopia (or a lazy eye as it is sometimes called) is the result of a high prescription that has been left uncorrected, or an eye turn causing a poor visual signal to reach the brain.  As a child is growing, a poor or blurry visual signal will cause the eye-brain connection to fail to develop properly, resulting in permanent visual decrease.  In the past it has been commonly accepted that ambylopes have no chance of regaining sharp vision to their "lazy" eye past the age of 8 (because by then the eye to brain connections have fully developed).  Children were typically treated by patching their good eye to force them to use their lazy eye in an attempt to develop these visual connections.  Newer studies, however, have shown that visual improvement may be possible past this critical period of 8 years of age!

Most children are happy playing video games, despite the face this one is making!

The other difficult part of treating amblyopia is that children (no surprise) don't exactly like having their good eye patched.  And you can't just put the patch on and let them go take a nap, or eat ice cream or something.  They traditionally had to perform at least 2 hours of near activities like reading or word searches or puzzles, etc.  These activities have high visual demand, and can be quite frustrating when you are looking through a blurry eye.  Two new studies are showing that playing video games for one to two hours with the good eye patched (an activity that won't exactly be hard to entice children or adults for that matter to perform) can also be effective, however!  One study showed a 30% improvement in visual acuity in patients with amblyopia between the ages of 15 to 61 (well past the critical 8 years of age that was traditionally set as the limit).  This improvement in vision was after just 40 hours of video game play.  It took 120 hours of traditional "near" activities to get the same 30% improvement in the control group.  A second study of 10-18 year olds showed similar notable improvement in vision versus a control group when video game therapy was employed for 1 hour a day.

What do these studies mean?  One, getting someone to participate in vision therapy activities is very taxing (and usually not that fun) when it involves forcing them to use an eye they can barely see out of.  When you temper that with an activity that is inherently enjoyable and doesn't seem like work, the compliance with treatment is going to be much better.  Do I believe that video games make the brain more plastic than traditional reading activities? Probably not.  But I'm quite sure that more therapy is getting done when the patient finds it enjoyable.

Traditional patching with near work.  He sure looks like he is having fun.  Photo courtesy National Eye Institute

Take home points: video games are not going to destroy your children's vision, but I would recommend they take breaks to play outside.  Video games can actually be useful as vision therapy because they have the advantage of improving hand-eye coordination and developing important visual skills like figure ground differentiation.  Will you create superhuman vision or stop needing glasses if you play enough video games?  Of course not.  But the good news is that people who are suffering from vision loss due to an amblyopic eye can see improvement through doing an activity that they enjoy!

Amblyopia is another reason why it is so important to have your child's vision checked, even if they are not complaining about blur.  If one eye is seeing clearly, no one will know the other eye is not working unless they develop a tell-tale eye turn (or strabismus).  Children as young as 6 months of age can be screened for signs of amblyopia, so please bring them to an eye doctor to make sure they have all the visual skills they need to learn to read and succeed at school!

I had the pleasure of speaking to a group of optometry students from my alma mater, the Southern College of Optometry earlier this week, and ever since then I have been thinking about the transition from student to practicing doctor.  It was not too long ago that I was in the classroom learning the techniques and skills that I utilize every day in diagnosing and treating my patients.  For all of those optometry school students out there, the rest of this blog post is for you!

My Graduating Class from SCO!

Best Advice for new (or soon to be new) grads:

• Take a deep breath; you are more than prepared to see your own patients!  By the time you get to the end of your fourth year of optometry school you have logged so many hours in patient care that you will have seen an example of almost every case that walks through your door.  And you have the advantage that all of this experience both from externships and classroom time being fresh in your memory.  If you are concerned about your diagnosis, you can always triage with a fellow optometrist (whether they are at your practice, mentors from school, or fellow peers from your optometry school days) or refer to a local ophthalmologist that specializes in that area of eye care. 
• Use your youth to your advantage.  Most new graduates are in their late twenties, and your patients are going to notice your relative young age.  Some more kindly than others.  For as many times that I have had patients ask me: "just how old are you?", I have had someone else (or sometimes even that same person by the end of the exam!) compliment me on how thorough I was.  Patients appreciate a new doctor's willingness to explain and patience with their questions of concern or during the refraction.  As one of my patients recently put it, "I can tell you aren't jaded yet, and I appreciate that!"
• Trying to build a reputation (and a good patient base)? Two ideas that can win you a lot of patient loyalty:
• 1) Always send a thorough referral letter or examination report to other doctors that you are triaging care.  The patient also appreciates it when you take time to send their primary care doctors a thorough report if you are following ocular manifestations of systemic conditions.
• 2) Call back your patients to follow up!  Have a red eye?  Call your patients in a day or two to make sure they are doing better.  You won't believe the positive response you get from this simple act!

You know you have thought about it. Compare the prices at different websites to what you see inside any optical, and the price difference is usually staggering.  And people order their contact lenses off the internet all of the time, right?  Ordering glasses from internet providers is a growing trend, but as its popularity rises so do the number of complaints.  Here is an honest look at some of the pros and cons of ordering glasses off the internet:

Pros:

• PRICE.  Some websites even offer designer frames for incredible discounts.  And the costs of lenses are much less expensive as well.  It is possible to save near a hundred dollars off typical optical costs.
• EASE.  Well nothing can be easier than shopping from your seat.  You just pick your frame and enter your prescription, and then swipe your card. No trip outside of your living room necessary (as long as you already have a copy of your Rx).
• SELECTION.  Let's face it, optical displays can be overwhelming.  And different offices offer differ frames and designer lines.  With the internet you can narrow your search immediately by brand or color or material, streamlining the selection process if you know your likes and dislikes. No more searching for frames on towering racks or drawers.  

This is how a progressive lens is worked up to get proper alignment in an optical lab, as you can see  a few millimeters of measurement in one direction or another can cause major disruptions because of all of the factors at play.

Remember those friends you had that never, ever had to wear glasses or contact lenses.  They were just blessed with perfect vision and never even entered the door of an optometrist's office growing up.  They went through life knowing how lucky they were and thinking how awful it was for those poor glasses wearing people. 

Presbyopia: the closer the reading material, the harder it is to see

The lens functions just like a lens on a camera, adjusting shape to focus images near and far.  Picture courtesy sciencedaily.com

Time for another fashion update, and coming off recent attendance at an eyewear expo, I can deliver news straight from the optical world's leaders!  According to designers, this seasons biggest trends are:

Kensie Frames

Lafant frames -- not a color combo for me, but the trend is for surprising and unexpected designs and color pairings

D+G in Red Crystal Lace

Jill Stuart: just one of the designers drawing on vintage for inspiration