Understanding LASIK First Hand

I had LASIK yesterday. As an Optometrist I have been around, recommended and participated in this procedure for many years. I just had never got around to having it myself. I think my motivation for having LASIK was probably different than most. It wasn't that I hated my glasses and want to get rid of them, I actually liked them in most situations. It wasn't that I was blind. I could see alright without glasses, It bothered me some to drive, watch sporting events or movies without glasses but otherwise I did pretty well. I did it for two reasons;

1. My wife was always saying I should. I think she was just tired of me asking what the score was in the game I was watching on TV.

2. I thought it would be a great educational opportunity. Here I am telling patients they should do this(LASIK) and here is what to expect when I truely did not know.

So at my wifes urging I called Danyelle Madrid at Hoopes Vision( Sandy, UT) a week ago and said lets do it. Danyelle is the co-management co-ordinator extrodinair for Hoopes Vision. She said great I'm having LASIK on Monday, want to be my surgery buddy? Well there is no time like the present so I did it. This blog will be a log of my experience and I hope will be educational and insightful.

Surgery Day:

I probably had less butterflies than most patients. This was not my first rodeo as the saying goes but I was surprised by my concern about whether I was making a good choice for me. Even though I have held many hands as people approached surgery, I still needed a little hand holding and reassurance myself as surgery approached. If I needed it, others for whom it is not as common place certainly will and I need to make sure I provide that.

The procedure itself held some suprises. Dr. Phillip Hoopes Sr. was great and made me feel relaxed through the whole procedure. I have always told people it does not hurt at all. Well that is 95% true. I did experience small amount of pain during the Intralase procedure( laser flap creation). It was not great, probably more accurately described as pressure, but it was there so don't be surprised. The visual sensations I experienced were interesting. My vision going black when the suction ring induced pressure during the Intralase procedure was expected, just how blurry my vision was following the flap creation was not. The coolest thing was having the tissue flap lifted and my vision totally blur out and then having it laid back down and it immediately clearing again. I don't think I experienced the dramatic change in vision that most experienced upon sitting up. Once again my prescription was not huge to begin with and the residual haze from the surgery cancelled out any noticable improvement in my vision. I was 20/20 in each eye however even through the haze.

I was planning on going back to my office and seeing patients following surgery. I figured I'm a tough guy and I can handle it. I think we did everybody a great service by moving my patients however. Take my advice, stop by In and Out in Draper, grab a burger and fries, go home and close your eyes after surgery. My vision was not great and my eyes needed the rest.

My eyes felt great aside from a little dryness the first night. The haze cleared after a couple hours and while sitting home watching Monday Night Football I had my first I can see that moment. I could actually see the score and time left in the game. My wife finally had a night of peace without me asking her the score or time left. Both of us were happy. The only residual effect I still had was halos around lights. I imagine if this persisted long term it could become a problem but this night it was just cool. My christmas tree never looked more beautiful with each light appearing like a bright star burst. I imagine people pay good money for recreational substances to achieve the same effect.I anticipated wearing the eye shields at night would be a pain. Besides looking goofy they did not bother me at all.

Day 1:

I woke up the next morning and did something else I had not been able to do. See the clock across the room. Another fun I can see that moment. Eyes felt great, no pain and no dryness. The sticky residue from the tape that held the eye shields in place was hard to remove when you are trying to be gentle around your eyes. Put in my drops and lets go. Full day of work seeing patients and my eyes felt great all day. Vision is good, 20/15 in the right eye and 20/20- in the left when Blanine Bird O.D. checked my eyes. I wanted my right eye to be perfect without glasses and my left to be just slightly near sighted to help with near vision and delay for a few years the need for reading glasses. Nailed it perfectly. Towards the end of the day my eyes felt a little tired and maybe slightly dry but nothing that a quick dose of artificial tears did not handle. Still some haloing around lights on my drive home but that just adds to the Christmas spirit and should disappear about the time the holidays are over so no problem. Worst part of the whole deal so far is that the steroid and anti-biotic drops taste horrible.

Day 2:

Eyes feel fine. Still hard to get all the sticky residue from the tape off my face. Vision is great however. Still some halos but my vision is remarably sharp and crisp. Mountains are vivid as I drive to work. I am use to seeing this much detail with my glasses but it just looks better, more defined, each snow covered tree is visible. Cool again. As I go throughout the day I notice my eyes get tired if I miss my hourly dose of artificial tears.

Day 3:

Suprisingly my eye have been more tired today than any day previous. This may be due to the fact it has been so easy to forget about the drops. I am trying to keep on my drop schedule but when my eyes feel great I just keep working. It is only when I feel them get tired I remember to drop them. Vision is fine. Halos are still present but they should be. I now can see the eye chart as I am working with patients much better. In the past when I have been in the exam room I have not worn my glasses. Today I was working with my patients when I noticed how much dust was on the projector slide for my eye chart. There were little dust spots every where on my chart. I'm sure they have been there for a long time, I just did not see well enough to notice them. I have heard similar stories from ladies in their 70's and 80's who have had cataract surgery and then are embarassed to go home and find out that their kitchens are not as clean as they thought they were. Now I understand.

Eyecare For Infants

The importance of eye care for infants was brought to our communities attention in May of 2007 when 10 month old Tatum Fisher, the daughter of then Utah Jazz Guard Derek Fisher, was diagnosed with retinoblastoma. Retinoblastoma is a form of cancer which most often affects children and infants. It starts in the eye and can cause death but with early diagnosis and treatment most children affected live long and happy lives. I think the whole state watched and prayed for this family as this drama played out and Tatum was one of the lucky ones.

I am grateful that in 10 years of examining peoples I have never had to tell parents that there child is facing such a situation but these conditions do happen and need to be caught early. I see individuals every week whose vision and lives would be better if the would have had eye care at an early age. Eye conditions such as hyperopia(see article in this blog), amblyopia and astigmatism while not life threatening can limit vision and learning and cause eyes to turn or become lazy. If not caught early these conditions and there visual consequences can be permanent.

To help ensure that eye care is received at an early age the American Optometric Association(AOA) has started a program to provide infants between the ages of 6-12 months with eye exams at no cost. The program is called Infantsee and there are thousands of participating optometrists across the nation. In an Infantsee exam babies are checked to make sure that their eyes are healthy and that there are no conditions which will limit there vision or learning potential. We at Advanced Family Eyecare are thrilled to be participating in this program and hope that all parents will take advantage of this opportunity to make sure their infants eyes are ready for life.

Reduce Your Risk For Macular Degeration

As an eye doctor I have learned that the two words that seem to be the most terrifying to my more mature patients are Macular Degeneration. These words strike fear into these patients because they have seen friends, family members and spouses lose vision and independence to this disease. I am always asked the question, "How can I prevent it?" I have never had really a great answer. Don't smoke is the best way but beyond that we had very little to offer. Eat right and protect your eyes from UV rays were things we thought were helpful but we did not have proof. The Age-Related Eye Disease Study(AREDS), which was concluded in October 2001, gave use guidance on what could help those who already had the disease but we had very little that guided us in how to prevent it.

The Woman's Antioxidant and Folic Acid Cardiovascular Study provides us with great information which changes that. In an article released in the February 23, 2009 edition of the Archives of Internal Medicine, results from that study found that daily supplementation with folic acid, vitamin B6 and vitamin B12, over a seven year period, reduced the risk of having visually significant macular degeneration(visual loss from macular degeneration) by 41%. While this study involved only women it will most likely hold true for men as well. USA Today also produced a nice article on this topic. This study was well designed and will significantly impact how I advise my patients in the future.

Ed Hardy Sunglasses Are Here

When we went to the Vision Expo in Las Vegas last fall, right in the center of the exibit hall was a huge display with people just literally lined up all the way around it. As we were standing there a woman walked by us wearing an amazing pair of sunglasses. As she passed I noticed how all eye were on her. Megan informed me she was a Kim Kardashian. To be honest, I still don't know who she. Her sunglasses were stunning however. She walked into the display and I then figured out she was there to sign autographs. The booth was for Ed Hardy Eyewear. I learned then that this stuff is a big deal in the world of high fashion.

We have them. The hottest thing in high fashion sunwear. What all the big names are wearing. They really are beautiful. I was truely impressed when I saw them. My wife loves them. We are excited about them and would love you to come see them. Through the month of May we will be offering them at 20% off so you can get great fashion at a great value. We will also be featuring them at the What Women Want show in May where we will have the entire line. Come see them at our office or at the show.

Go FYSH

We at Advanced Family Eyecare are excited to announce the introduction of two new frame lines in our office, FYSH an edgy fun line offering european styling in great colors and KLiiK a Danish designed line in smaller sizes that teenagers and those who are young at heart just love. This is truely exciting stuff. My staff loves them because of the great styling and the energy they bring to our optical. My wife thinks that they look incredibly cute on everybody. I have had a pair of FYSH for about 2 months now and have loved them. I am more about function and feel in my frames and these work awesome. We work hard to find frames that meet our stringent standards for fit, finish and durability and these do. As always they carry our exclusive two year, unconditional, no excuses warranty. Come on in and see how good a frame can look and feel.

NEWS: Why does Health Care Keep Getting More Expensive?

As reported in the Review of Optometry, January 15, 2009 issue, the Nachimson Advisors, a health information consulting firm, just one of the incoming regulatory changes in the works for medicine is set to cost the average small practice like ours $83,290. Mid size practices (10 docs) will spend $285,195 on the upgrade, and large practices (100 docs) will spend an estimated $2.7 million.

At issue is medical coding. Currently, we use ICD-9 codes which define and describe a doctor's findings which are then linked to the procedure/office visit codes that get billed to your insurance company. In short, ICD-9 codes supply the "reason" for testing and office time for which the doctor is trying to get reimbursed. The problem, according to the Department of Health and Human Services (HHS), is that sometime next year, they will run out of codes in the ICD-9 set.

So the HHS is getting ready to adopt a new coding system, the ICD-10 set. The goal is to have it in place by October 2011. Insider analysts think implementing the new ICD-10 coding will be the most costly event medical practices will ever experience.

Here is how it pencils out for us. Rough calculations that figure our current costs and average revenue-per-patient collected indicate that our practice would have to see our next 757 patients just to pay for the switch to ICD-10. Of course, like any business, medical practices will need to recoup the added cost of this new mandate to stay solvent. But unlike the regular market place, medical practices can't just increase the rates they charge insurance companies for their service and expect the insurance companies to pay the increase. They will have to make up the difference with their private pay patients, or eliminate other overhead or services which may reduce the quality of care you receive.

ICD-10 coding for diagnoses is just one of the oncoming challenges we have to prepare for. The procedure codes we have to use that describe the time and testing we do in order to get paid is also getting more complicated by orders of magnitude (which is its own subject for another time.) We now have level 2 procedure codes and PQRI codes (quality assurance coding) to include when we bill, just so we can get paid without penalty.

Sometimes I wonder if the increased complexities in coding and billing are just a calculated effort on the part of payers to trim costs by virtue of our reduced compliance as we struggle to figure out and pay for the new programme. Understanding the current system is already so complex that keeping payments coming properly is a non-stop battle. We feel like we have evolved our processes to the point that it works fairly well, and we follow the rules to the "T."
Patients already get frustrated as they try to understand why we code and bill as we do. I fear the new regulations will add more layers of confusion between doctors and consumers of medical care, further separating the two from the normal market forces that control buyer/seller relationships in other market settings.

Dr. Gooch

What The Heck is Hyperopia?

One of the most difficult things I have to explain to patients and parents of patients is hyperopia or near sightedness. I must thank my good friend Paul Gooch O.D. for this description of this condition and the difficulties it presents for both patient and practitioner.

Hyperopia (Farsightedness) Explained
After examining a two-year old nephew this week, I attempted to explain what it means to be farsighted to his worried mother. I've been in practice for nearly 12 years and I still struggle to explain hyperopia in lay terms. Its not that Hyperopia is complicated, but it is not as intuitively tidy as Myopia, or nearsightedness (where near things are clear and far things are blurry). Patients often exclaim, "Ah, Farsighted... so things far away are clear and things up close are blurry?" Well, sort of. Therein lies the problem with understanding Hyperopia. We collectively miss-apply the logic that so nicely fits nearsightedness, to farsightedness. And people often confuse presbyopia, or bifocal vision with farsightedness. Even a quick google search on the subject reveals very little for the lay person that isn't slightly off colored just enough to leave an element of confusion. This post is for you, Sis, so you'll grasp how your young son sees; and for me, as I work to conjure a solid explanation of Hyperopia.

The Normal Eye
First, to understand Hyperopia, you must understand how the normal eye functions. When viewing things in the distance (20 feet and beyond are optically equal), the normal eye is relaxed and focused. The light rays entering the eye are parallel, and the relaxed eye converges those parallel rays, bringing them into focus on the retina. When the eye shifts its gaze to anything inside 20 feet, the rays of light begin to diverge, or open up, which pushes the focal point to somewhere behind the normal relaxed eye. The eye then has to accommodate, or shift focus, to keep the near object in focus. This happens when an internal muscle called the cilliary body activates and changes the shape of the crystalline lens that sits behind your pupil. This accommodation [Photo]pulls the long-focused rays back into focus on the retina. And it all happens faster, and more fluidly than you can perceive, without conscious effort on your part. The normal eye uses about 2.50 diopters of accommodative power to see things at the normal reading distance (approx 16 inches).



Hyperopia(Farsightedness)
Hyperopia is the condition where the natural relaxed eye focuses the normal parallel rays from the distance behind the eye. How the farsighted person sees is based on the complex interaction between the amount of farsightedness, the natural strength of the accommodative mechanism, the person's age, and the visual system's alignment mechanisms which keep the eyes on target (they happen to be tied to the focusing system). A young person with small to moderate amounts of Hyperopia can use their close focusing power to pull the distance into focus on the retina and see clearly. Near objects take an additional 2.50 diopters in focus power, and if they have the ability to do it, they can see close as well. Here are some examples of a small and a large amount of Hyperopia:A person with +1.00 diopter Hyperopia needs 1.00 diopter of their close-focus power to see in the distance. Add another 2.50 of accommodation for close vision and they end up needing a total of 3.50 in close focusing power to see clearly at the reading distance.A person with +7.50 diopters of Hyperopia needs 7.50 diopters of help to correct the distance (usually they can't contribute that much by themselves unless they are very young) and they need another 2.50 for near for a total of 10.00 diopters of focusing power.Since the eye's close focusing power was not designed to remain constantly activated, just like your arms weren't designed to hold a bucket of water outstretched for long periods of time, uncorrected Hyperopes can get extra fatigued with the full time, extra-duty use of their close focusing power. Depending on the factors mentioned above, Hyperopes experience a range of symptoms from mild, imperceptible strain, to extreme fatigue, double vision, and completely blurry distance and near vision.
Correction
Hyperopia can be corrected with glasses, contacts, or surgery, using PLUS dioptric power. Unlike Myopic (nearsighted) corrections which are very exact and simple to derive, Hyperopic corrections depend on the practitioner's ability to measure the amount of Hyperopia and then integrate all the other complex factors involved like age, accommodative strength, eye alignment, and lifestyle needs. Generally, correcting Hyperopia relaxes the farsighted eye for focusing in the distance the way it was designed, so the eye can use the normal amount of close focusing power for reading.Because Hyperopic eyes can contribute accommodation to the vision-equation, finding the amount of correction that makes his/her eyes comfortable can be a challenge, and that equation changes over time as the aging eye loses its natural accommodative ability. The older you get, the easier it becomes to find the right amount of correction because your accommodation interferes less. Sometimes younger eyes won't relax and accept plus powered lenses. Large amounts of Hyperopia are easier to correct because the visual benefit is so dramatic. Small to moderate amounts are tougher because the benefit is the delayed gratification of reduced fatigue--which benefit often comes at the end of the day, the end of the week, the end of the school year, etc. For the younger Hyperope, we don't always correct the full amount, but instead, the amount that makes the eyes most comfortable--especially for close work.

Children and Hyperopia
Hyperopia is the most missed eye condition at school and pediatrician screenings because small to moderate amounts don't usually blur the child's vision. Children's symptoms increase with age and amount of Hyperopia, but they often don't know that the discomfort they feel is abnormal and they get numb to it. Often, it plays out as near-task avoidance. If reading is uncomfortable or tiresome after extended periods, the child usually develops avoidance patterns, which can turn into habits, attitudes, labels, and a self perception that can often be difficult to correct as the child gets older. As a parent, you can watch for these avoidance patterns, afternoon headaches, or strange visual behavior like squinting, sideways looking, or looking closer than normal at books, TV, etc.Some eye doctors use a blanket approach to correcting a child's hyperopia--relying strictly on numbers. It is very important to find a practitioner who is committed to using the more sophisticated approach of finding the correction that makes the farsighted child comfortable for near tasks (whether that amount is none, or something different from their full correction). If correction is needed, sometimes single vision lenses suffice, or sometimes it is more convenient to put it in the form of bifocals. These are all complexities that take time to sort through and you will do well to expect your doctor to explain and recommend what is best for your child.Having your child examined before the age of two is the best way to make certain that problems aren't missed which can lead to poor school performance and delayed visual development. You did a wonderful service for your son by bringing him in early, Sis.