Optometry blog

It seems like yesterday I was grilling up meat at a bbq for the class of 2013, and really it seemed like yesterday (2 years ago) when I was being served BBQ for my class of 2012. But today, there was another annual orientation BBQ. The SCCO class of 2014 was out with their bright eyes and youthful enthusiasm,

It’s fun to watch orientation 3 months after May when the seniors graduated.

Not optometry related as much business related.

Last weekend I went to Las Vegas, and in particular ate at a Restaurant called Bouchon‘s in the Venetian hotel. It was awesome, except pricey, but price isn’t the biggest factor when picking a restaurant in Vegas.

My friend Elaine orders a dish, but she ends up not liking it too much. The waitress notices immediately that she doesn’t like it and without prompting suggests that Elaine pick something else. Elaine doesn’t mind it so much and says no thanks.

Without us even asking, they take the entire dish off the bill. And Elaine gets free dessert.

Also, besides the fact that they had people watching the table nonstop to refill our waters when the glasses were even half empty, get this.

I went up to use the restroom and throw my cloth napkin without even thinking about it on the table. When I come back the waitress apparently had stopped by, and folded it into a neat pretty fan-looking thing! Wow I was impressed.

They say you can only win two of these three categories of price, quality, and service when running a business. Most private optometric practices will never win the price war, so don’t fight it. But if you can “wow” someone in the other 2 categories, they’ll keep coming back.

What are you supposed to be doing 1 hour before your last final of the quarter? STUDYING. But what did I do instead?

I decided to meet successful optometrists and network.

On campus today at noon, the professional eye care resource co-operative invited students to join them for lunch. This was the second time I joined the group for lunch, and they’ve always been an incredibly friendly group of people. PERC is an optometric co-opt comprised of individual practitioners who all gross over 1 million dollars annually.

Right now there are over 100 optometrists in the group, with the majority of them in Southern California. I talked a bit to one of the founders, Howard Stein, who is the actual benefactor of the Stein Family Cornea and Contact lens clinic here at SCCO! He was incredibly nice, and invited Dave and I to visit his practice in Manhattan Beach. Definitely going to take him up on that offer, I’d love to see more of how a successful practice is run, not just how our clinic is run.

Again, it boggles my mind that successful optometrists WANT to meet students, are incredibly friendly, offer delicious lunch food, yet out of 115 students on campus or so, only Dave and I show up. I guarantee 5 months from now I won’t know that focus-execute is a critical component of visual attention, but I will remember meeting nice doctors and being able to visit their practices.

There is evidence that the prevalence of myopia is increasing significantly over just the past few decades.

Rate of myopia increasing rapidly.

Looks like decent future job security for optometrists in the United States. The article (written in 2009 by Susan Vitale) states that 1999-2004 rates were 41% versus 25% when done in 1971-1972.

Interesting indeed!

Beginning July 26 optometrists can see Medi-Cal patients once more.

Check it out here

This is the first of many optometry clinical encounters where I learned something.

1. Very first patient ever in my life. (I don’t count seeing classmates/friends as first time experiences). 62 year old male contact lens patient who wants multifocals CLs. But he’s doing a modified monovision of sorts where he has a multifocal in one eye and a distance toric lens in the other. I fit him with the CIBA Air Optix Aqua Multifocals in his non-dominant eye and the CIBA Air Optix Toric Lens distance contact lens in his dominant. He LOVES the vision, reads happily and can see distance great and the over-refraction (loose lens in multifocal eye, and the distance I did a sphero- cyl OR through the phoropter) was about plano-ish in both eyes.

The clinical pearl is that I’m doing phorometry (Von Graefe, with no contact lens on), and he sees one (cross of letters) no matter what I do to increase/decrease the prism starting from 12 BI OD, 6 BU OS. It dawned on me after 30 seconds of fiddling with the prism amounts that the guy is probably suppressing.

“Blink a few times for me, sir” (followed by me occluding and then unoccluding what I think to be the “seeing” eye).

“Oh now I see 2″

*nice!*

Clinical pearl #1 is something I knew but in the heat of the moment forgot. Monovision type of patients are more apt to suppress an eye when doing near work than your ordinary patients.

2. Very first primary care patient ever in my life . 87-year old Spanish speaking only patient comes in with one eye barely open. Chief complaint from his son (translator) is that his left eye is always nearly closed. 20/30 in his open (OD) eye, and light perception only (OS) in the eye that he barely keeps open.

Turns out he has a full-blown retinal detachment secondary to diabetic retinopathy that my partner Chad and I spot which Dr. Lee confirms and congratulates us on. So what about the eyelids closing? The patient was able to lift that eye when he desired.

The retinal disparity caused by the retinal detachment between each eye made him voluntarily (and then just out of habit), close his non-seeing eye. When he just came in we were thinking “uh oh, ptosis of some sort,” but it was not the case.

3. Second contact lens patient ever. Female keratoconus in her 20s who has lost one gas permeable lens and needs a new one. Chad and I are at it again. Getting a crazy cover test of 20 exotropia in entrance testing. Dr. Tran comments when we first meet with him with this clinical pearl:

“Haha, don’t do a binocular test on an essentially monocular patient” (at this point she had just one CL on, and she can see hand motion only in the eye without the RGP)

Oops haha.

Other clinical pearls was the patient was getting inferior dimple veiling on the cornea. To fix this we steepened the lens. You might be thinking

“What!?” don’t you want to flatten it out???”

We steepened it to allow for better centration so that the lens would not slide down and we also reduced the optic zone diameter to decrease chances of air bubbles.

That’s it for now!

A classmate of mine made this video. It highlights some of the more lighthearted aspects of being an optometry student at SCCO. This was also shown at our spring open house for interested SCCO students.

I’m flattered that my blog is receiving so much attention that other websites have started to copy and paste word-for-word my more popular posts and then call it their own. It’s a weird phenomenon. If you go to “prlog” they’ve lifted a few of my popular posts and then attributed them to an optometrist in Costa Mesa’s website – this is the link

The optometrist seems like a successful nice guy, but I bet he is paying for outside help for his website and they are creating links to his site as much as they can.

I guess the message I have at the bottom of my website that it is copyrighted doesn’t mean much! I sent them a message that if they’re going to use my work, at least give me credit! It posts my blog posts and then at the end to go to HIS website for more information. Maybe I’ll run into him at an Orange County Optometric Society meeting and ask him about it =).

Screenshots of plagiarism (click to enlarge):

My AOSA Trustee Dave sold me on going to optometry’s  meeting, so I went last week to the AOA optometry’s meeting in Orlando and boy was it an event. The Gaylord Hotel was enormous with multiple pools, bars, and a large convention center. There’s just something about a huge auditorium with two big screens showing the speaker and powerpoint presentation that is just cool in my opinion.

Highlights:

- Optometry super bowl (hosted by Essilor) . Oh my gosh, insane. It was like a sporting event, people were chanting and screaming for 2 hours for their representative to show everyone who was the biggest nerd of all in a knowledge bowl optometry trivia match. Unfortunately, our guy Andy didn’t make it past first round. Dr. Kevin Alexander, our president, was there and told us if we won the bowl he’d give the winner a full-ride scholarship – so I’m going to go for it next year!

- Went to a seminar by John Rumpakis, and A. Kabat about day to day dilemmas. It was similar to my case analysis classes and there were probably 500+ students in attendance. Being uber nerds, Val and I were the only students to walk up to the presenter A. Kabat after the lecture to get his opinion on why he used Azasite for something in conjunction with oral doxycycline – though I forget what the condition was (ocular rosacea?).

- John Rumpakis and Ryan Parker had a presentation on private practice and the transition from student to doctor. They did something really ingenius idea to get participation by putting up their cell phone numbers for us to text questions and while the other person was talking they would read the text messages and answer the questions. They might have answered 20-30 in total and 2 of them were mine! I asked them who they thought would win, Lakers or Celtics, before the actual game and they were split. I also was confused at how Dr. Parker got his practice breaking even 2.5 months after starting cold without stealing patients from his former partner – he kind of shyly answered the question but Dr. Rumpakis called him on it and said he basically stole the patients lol. I guess in optometry, you gotta do what you gotta do.

- The receptions were a ton of fun. I met a bunch of other students from Berkeley to SUNY and thought everyone I met was super nice and easy to talk to. The future of the profession looks bright, I know this because nice people finish first in my opinion =). Got in touch with former bruinlifer Mark from Berkeley, he seems to be doing well.

- Go Lakers! We were in a hostile east coast environment, but Karen was able to lay some good karma on the Lakers by furiously cursing Paul Pierce throughout. =)

- Practicing optometrists at the AOA convention love the profession and think it has a bright future. I kept hearing from the young and older docs “Congratulations! You joined a fantastic profession.” To be honest, it makes me feel great to hear such things.

- Some believe optometry  is oversaturated. “Get out of California, come to my neck of the woods.” Others (some of the hotshot consultants) think saturation is no big issue.

From optometric management

Clink on the link above to read an article about bringing a new grad into an established practice.

In psychology there is something called the self-serving bias. To quote from Wikipedia:

“A self-serving bias occurs when people attribute their successes to internal or personal factors but attribute their failures to situational factors beyond their control.” (wikipedia)

Not my fault, the DOG ate my homework!

This is prevalent in optometry school and no doubt with many other professional/graduate  schools. When it comes to test-taking, it seems to happen on every other test that there is a question that students miss yet inevitably blame the instructor for writing a poor test question.

I am guilty of this myself, it sort of shows how “a little knowledge can be a dangerous thing” that Dr. Gordon said in my previous post. You start to think you’re hot stuff, and refuse to listen and learn when you’re wrong. At my friend’s work, she laments often about coworkers who EVERYONE knows is at fault for a particular problem, yet they are too dense or prideful to admit they made a mistake and the politics of the matter makes life difficult to get things done.

So what’s the point of this post? It’s really just to say “don’t take yourself so seriously.” At SCCO they try to teach confidence in the clinic, to make a decision and stick to your guns. I plan on doing that this summer but to remember to let things go when I make a mistake.

One short anecdote I forgot to mention at the RAM.  My friend Denh was talking to Dr. Gordon, a staff doctor over at OCLA about ocular disease. It went something like this:

“Dr. Gordon! How much disease do you see at OCLA?!”

“Oh we see quite a bit, I guarantee you’ll learn a lot if you come here”

“Awesome! The more disease the better. We just learned about Trachoma in class yesterday, about ARLT’s line it was fun!”

:Chuckling: “A little knowledge can be a dangerous thing.”

I thought it was interesting what Dr. Gordon said, but he is right on the money. How many times do I expect to see Trachoma in the United States in my lifetime. Let me see. Probably… roughly… about ZERO times ever. It essentially should never be on my list of differentials. Inclusion bodies from Chlamydia, definitely possible, but never Trachoma. So why do we learn it?

Some will fault optometry school, saying what’s the point of teaching all this “junk” information. Or mention that in a private practices someone shadowed, they never do phorometry on every single patient – so they’re mad that opt schools make us waste our time.

My opinion is that the point of optometry school is to learn every single thing possible so that if I ever run across it, I can make the call and not just refer out. Definitely, it would be financial suicide to do 2 hour exams on all our patients when we graduate, but for now it is academic suicide to not practice all the skills we’ve been taught and to do a thorough (this is the emphasis, not speed) exam.