Dr. Mai's Optometry Blog

I have the pleasure of working at the Children’s Hospital of Orange County on Fridays. We do pediatric examinations for underprivileged children in the area. It’s a great overall experience. The kids come in a little shy but we generally have them smiling (except when we put in the dreaded eye drops) at the end of the day.

During my time there I get to work with Dr. Monique Nguyen, a residency trained doctor who owns a private practice in Ladera Ranch. It’s refreshing to talk to her about vision therapy and how she runs her private practice.

Working at CHOC is an awesome reminder of why I joined this profession. You have these children who are struggling in school because of significant myopia but cannot afford glasses. And many children rarely complain, quietly struggling through academics for years just because they have poor vision and can’t see what the teacher is working on in front of the classroom.

So it’s rewarding to break ground and give them their first pair of glasses. One patient (not at CHOC) but who I am following at the Eye Care Center who has a +9.50 DS Rx in both eyes proudly yelled at my last amblyopia continuing evaluation.

“I LOVE MY GLASSES!!”

Awesome.

Besides blog.drmai.info I am also a featured guest blogger for the AOSA and have also been asked to contribute to optometrystudents.com

In case you did not realize, the AOSA and AOA both have blogs where leaders post their thoughts and experiences. Here is my first blog as an AOSA blogger. I think I am the only non-former AOSA trustee or cabinet member to be invited to blog so I feel very honored!

How to refract like an OD and not a student. I realize that many optometry students and optometrists are masters at refraction, but hopefully some of my insights can help!

I decided to make this it’s own post from the comments section. This is a comment from a reader concerning career success (slightly edited).

From Joe M. – An engineer and father of an optometrist

I would like to state that I am not a Doctor of any kind and the father of a Optometry student and a son that is a DC. I have a engineering EE /ME back gound and more importantly business owner and CEO for over 35 years. First let me say that success is not simple to achieve and or maintain. And most believe that a degree entitles you to instant success and or big $$$ , well you are dead wrong. Trust me when i say I’ll take Lucky over Smart any and every day but we have to help your own luck by working longer, harder and smarter. If anyone expects the make 150- 200K plus to start working 40hrs a week on your first job you better have come from a very wealthy family and buy into a business or joining a family business or rethink your plan and get real. The system has provided you access to the tools of your craft , that is optometry, now it is up to you to use them to achieve a successful life.

I will tell you most times that success takes longer and is harder then planed and will not be in the same form as envisioned at the beginning.. . Get a second job to generate your play money or saving for the future. And some day you will not need the second income. BTW did you ever study about the 80 -20 rule? if not google it , if so then you know that 20% of the OD make 80% of the MONEY. What do you want to be… a 20 % guy or a 80% guy? I also will tell you yourself will be the only source of your failure in any thing you do. Keep working at your goal, always stay positive, and GOOD LUCK along the way.

I received this email yesterday from a distraught 4th year optometry student (I left out the name):

” I came across your blog for optometry residencies. I have matched a program for next year already. They accepted me even though I had not passed Part 1 boards. I re-took them in March and failed again. Can they take my residency spot away? Please let me know if you have any advice.”

You need to pass all parts of NBEO to practice optometry. If her residency programs begins in July, and the soonest she can retake her boards is in August (with scores released a couple of months afterwards), I told her to contact her residency program, to keep her head up, and best wishes.

In all things, begin with the end in mind. This allows you to focus on the big picture when a world of minutiae tends to get people hung up.

That’s also my buzz word (and enemy) of the quarter: Minutiae. There are many ways to study for a big test, but I believe firmly that the worse way is to feel like you must know EVERY thing. I have been telling classmates that if you try learning everything, you miss important concepts or at least fail to reinforce them.

There is a principle called the Pareto principle (aka the 80/20 law) that about 80% of the effects come from 20% of the causes. For instance, Pareto was growing peas and found out that 80% of his peas were being grown from only 20% of his plants.

Which means that 80% of his plants, which he had to care for and watch over just as closely as his 20%, weren’t doing much good in the big picture. The same is true with studying for a boards exam. When I look at a new drug/disease/any concept, I like to do the following:

What are 2-3 things I will take away from this (sort of like, which plant out of these five will give me the greatest return of intellectual investment)? And then I move on. If I can nail those 2-3 IMPORTANT concepts, then knowing anymore than that is just gravy (but unnecessary)

This is not an excuse to be lazy. I will spend the SAME amount of time studying, but just ensuring I hit big ticket items first always.

http://www.lrc.ky.gov/record/11rs/sb110.htm

Kentucky has followed in Oklahoma’s footsteps to pass a bill allowing optometrists to perform laser surgery. (SLT, LPI etc)

Here is a video of optometrists and ophthalmologists arguing whether or not optometrists should be allowed to train for laser procedures.

http://www.ket.org/cgi-bin/cheetah/w…tdir=&template

The KOA president, Ben Gaddie, has been to SCCO multiple times to discuss practice management. It was great to see him representing the profession.

Is Fall quarter of 3rd year. In case anyone wanted to know. =)

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!

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). 66 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 modified monovision can be an excellent option for patients with a little bit of astigmatism (he had 1.25 D of cyl.) Especially if the patient loves the feel of a particular contact lens multifocal but a toric multifocal option isn’t available.

2. Very first primary care patient ever in my life . 83-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 our staff doctor 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. This was not a case of ptosis.

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. our staff doctor comments when we first meet with him with this clinical pearl:

“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.

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

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.

From optometric management

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