Dr. Mai's Optometry Blog

In case you did not realize it, optometry is quickly expanding its role in primary care as a healthcare profession. I’ve seen it in action at the IHS hospital and Veteran’s Affairs clinic I’ve worked at and patients are definitely better off because of it. Strange asymmetric optic nerve cupping, CRVO’s, suspected ocular ischemic syndrome have all been reasons for referrals on our part for carotid ultrasounds.

Recently I stumbled across this article in review of optometric business by Dr. Kathleen Andersen. (you’ll have to create an account to read the article but I think it’s very worthwhile to read some of the other great articles on that website). Dr. Andersen has introduced vascular health screenings along with her comprehensive eye examinations and I think it’s fantastic. By evaluating the carotid intima media thickness, optometrists can get a good indication on an individual’s vascular health.

Myself, I’ve recently started working with HeartSmart’s EyeCare division. Basically our goal is to expand optometry’s role as a primary health care provider by offering patients vascular health screenings. Millions of eye exams are conducted each year. In fact many Americans go see their optometrist more often than even their primary care physician!

If you think optometrists should play a bigger role in keeping patients healthy, like us at http://www.facebook.com/HeartSmartEyeCare

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.

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!