hawaiimomdoc

I am an ophthalmologist and co-owner of Honolulu Eye Clinic. At Honolulu Eye Clinic, we strive to bring total eye care for the entire family - from our ohana to yours. We have specialists for all of your eye care needs - our cataract surgeon, Dr. Jeff Wong, my husband and the amazing Dr. Jenifer Bossert, our contact lens specialist.

 

I’m sure there are tons of articles and posts out there about keratoconus.  But, in the past month, I have diagnosed 3 kids with keratoconus – two of whom were previously misdiagnosed by another eye doctor, so I thought it might be good to get something out there focusing on this disease in kids.

First, what is keratoconus?  Let’s go back to our diagram of the eyeball I drew a while ago.

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The cornea is the very front part of the eye.  It’s the clear, circular dome shaped outer most part of the eye.  The colored part, or iris, is flat right underneath it.Wong(Opt)Shoot39

Now, lots of people have astigmatism.  Astigmatism is when the cornea is not perfectly round.  I usually tell patients and their parents int he exam room, that most corneas look spherical, like a basketball.

 

Screen Shot 2016-02-11 at 10.17.11 PMCorneas with astigmatism or more egg or football shaped.

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One axis of the circle is a little longer than the other.

But, people with keratoconus, don’t just have regular astigmatism.  They have irregular astigmatism.  It’s common, occurring 50 people per 100,000.  And, unlike regular astigmatism, which usually stays pretty stable throughout life, keratoconus is progressive.  The center part of the cornea starts to become thinner and bulges.  This usually worsens during puberty, which is why many people are first diagnosed in their teens.

Since their corneas are thin, patients shouldn’t be playing contact sports.  One of the hardest things I had to do was tell a 15 year old, up and coming MMA fighter that he couldn’t fight anymore.

This is a topography, or map of the cornea in a normal eye.  There’s a nice symmetric, red bow-tie in the middle.  This patient has regular astigmatism.

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And, here’s  a kid with keratoconus.  See how it has circles of red at the bottom of both eyes?  That means the cornea is really steep there.

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In the past, we would just advise teenage patients to stop all contact-sports and offer contact lenses to improve their vision.  But, now, there is a new FDA approved treatment to stabilize progressive keratoconus.  It consists us using UV light to stiffen the collagen in the cornea, along with riboflavin eye drops.

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Cross-linking-600x185                                                                                                Drawing of Collagen Before Cross Linking            Collagen After Cross Linking (stronger and thicker)

The patient above actually traveled from Hawaii to Seattle to get the treatment, but now, one of the Cornea doctors on the island can perform this procedures.  It is ideal in younger patients, since it does not reverse damage that has already occurred.  Unfortunately, it’s not a cure.  But, it stabilizes their keratoconus thinning, so if we catch kids early enough, then we can offer treatment which can truly change their ocular health.  Of course, all surgery has risks, and this article nicely discusses them, but I think it’s wonderful that it’s finally FDA approved in this country.  We’re hoping that insurance companies will realize this procedure prevents potential future blindness and disability and start covering it.

Severe cases of keratoconus require treatment with a corneal transplant or INTACS, which I will save for a later post.

Two of the kids who I saw in the office were initially misdiagnosed as having “amblyopia”.  Amblyopia simply means poor vision in one eye.  This can be  typically caused by an unequal refractive error between two eyes, misaligned eyes, or strabismus, and something obstructing vision in the eye.  There should be always be a REASON for the poor vision.  And, in these two children’s cases, there was a reason – keratoconus.  One patient was only 9 years old and the other 13 year old, which is definitely on the young side.  But, the fantastic thing is that now there is something that can be done to prevent keratoconus from getting worse.

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I thought I’d do a year end wrap up of our most popular frames for 2016.  2016 saw the resurgence of the round frame and I think we’ll see more of that in 2017.  We also saw more matte frames as well.  Though of course, classic frames likes aviators always do well.  So, in no particular order…

1.   Silhouette

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This is Kevin, our wacky optician.  He lives in these frames and you can just barely even see them on his face. These frames are so light you’ll hardly feel them on your face.  There’s a reason that half my family wears these.

2.  Ray Ban Aviators

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These classic suns will just never go out of style.

 

 

3.  Red Tomato

These are new kids frames that we just started carrying in 2016.  I noticed a patient of mine had them on and they were so cute and just had a great built up nose bridge for little ones.  They don’t smash on to the face the way Miraflex does.  They are very well made and come in cute colors.

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Red Tomato glasses on the bottom. An adult sized frame on top of the blocks for reference to judge how small these glasses can get!

4.  Tom Ford

We started carrying these back in 2015 and they have continued to gain in popularity.  I love the beautiful, neutral colors that complement any skin color.  Plus, James Bond wore them, so what’s not to love about Daniel Craig?

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5. Maui Jim

We live in Hawaii, so it’s no surprise that Maui Jim frames are some of our best sellers. Their polarized lenses are excellent.

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6.  Crocs

These are also new kid frames and they are just so cute and well made and come in a variety of fun colors.

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7.  Roberto Cavalli

For those of you who like bling, bling, these frames are for you!  I love that the sides are AMAZING, but they don’t look ostentations from the front.

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8.  Dragon Vantage

These frames are truly perfect for the Hawaii lifestyle.  It’s a FLOATABLE frame built for “aquatic action”.  The lenses are made of polycarbonate, so if your surfboard tips up when you’re catching a wave, your eyes are protected.  So, all you surfers our there who say you can’t wear sunglasses, these are perfect.

 

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9.  Zenka

One of my patients was actually wearing these frames and I complimented her on them and her friend happened to be the rep. I love them.  They are French and incredibly boutique.  If you want something different than what everyone else buys from Costco, Lenscrafters, then these are your frames.  These really awesome part about these frames is that you can buy these clips that attach to the front, to change up the look.

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And, here I am modeling three different clips that go on the clear frame.

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And, here’s Ronnie, my clinic manager, selfie-taker expert, who is teaching me what I need to do.  She had me cracking up!

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10.  Oakley

Another kind of no-brainer for Hawaii.  Well made, well-constructed.  Nothing more needs to be said.  They make specialty frames for each and every different kind of sport.  I love my hot pink ones for running.

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I hope everyone had a wonderful holiday season.  Here’s one of our Christmas photos from this year.

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As I prepare to return to work tomorrow, I am trying to institute some change for myself for 2017.  I don’t want to call them resolutions exactly, because it’s not a goal that I’ll achieve and be done with.  Instead, it’ll be an ever-changing process as I evaluate what works for our family and what doesn’t.

My 7 year old son (oldest) wrote this letter to Santa.

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It created all sorts of working Mom guilt.  Does he realize how stressed I am trying to juggle everything is making me?  Was my frantic pace to juggle it all – work, family and friends affecting him?  Should I stop working?  It gives me so much meaning to be a physician, but is it detrimental to my kids?

When I want some special time with him, I’ll take him out for boba tea.  It’s a treat and it encourages one on one time.  Our younger two kids (ages 5 and 3) are so fiesty, that some times my oldest does not get as much attention since he doesn’t demand it in the way the other two do.  Anyone with kids probably knows what I’m talking about.

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So, I asked this sweet boy, pictured above, “Do you want Mommy not to work?”  He thought about it long and hard.  And, he said “I like that you work because you help people.  But, I like when you don’t work too, because you pick me up from school and I get to spend time with you and I love you”.  Cue the water works.  I’m not really a very emotional person, but man, did I feel proud and touched by this little guy’s answer.

So, this year I endeavor to be more intentional in my time with the kids.  I’ve had this discussion with many of my friends who work part time – sometimes it’s the best of both worlds – home and work, and sometimes it’s the worst.  I feel guilty when I’m away from the office, but I also feel guilty when I’m away from the kids.  And  being out of the office, doesn’t mean I’m off duty.  Since I am the managing partner for the office, I feel the need to be ever available to my staff.  So, on my days “off” I’m still fielding at least 3-4 phone calls with the staff, writing blog posts, emailing  our accountant, HR provider, doing Quickbooks, etc.  So, there is a tendency real fast, for work to creep into all aspects of my “time off”.  I’m checking my phone when I’m with the kids on the playground, calling patients back when we are at the aquarium.  Part of this is the price for being able to work from home 2 days a week.  But,I am hoping for 2017 that I can find a better balance.  I may not be available to my children at all hours, but I want to make the time that I with them count.  Quality, not quantity.

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With that in mind, I am trying to create these intentional moments with my children.  Carving out time for just them and only them.  Right now, my oldest son and I are working on an art project for our master bedroom.  His art teacher at school told me she was very impressed with his painting skills and I have always loved art.  Obviously, growing up in a pretty traditional Indian household, academics was always prized above the creative arts, however, now that I have my own time, I thought this was something perfect I could share with my son.

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We are doing our own version of this painting we spotted on minted (but are too cheap to shell out $2K for).  Plus, the trips to Ben Franklin, the time it takes us to construct this piece together, is worth so much more.  And, in the end, I’ll have art in my house which is meaningful to me and something that my husband and I can agree upon (we have vastly differing art styles!).

For my baby girl, she is a girly girl who loves the water and is extremely fearless.

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Climbing too high for me.

Since my husband was an all-American water polo player in high school and college, I let him handle the swim excursions with her. But, she and I have our special time when I give her little manicures.  Some might think 3 years old is too young for nail polish (as my husband says) and I agree, but I have given in on this front.  I do only use these awesome VOC-free nail polishes that I found at Nordstrom.  She has quickly commandeered all of the bright pink shades.

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For my middle, he loves reading with me and getting massages (yeah, I know, I’m spoiling him for my future daughter-in-law, sorry!) and what he calls “date night” with me.

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Usually we just go to coffee bean and I’ll get him a strawberry milk and he tells me about his day.  It’s nice to have separate time with each child, when you have more than 2, some times I feel like I’ve spent the whole day with the kids, but have not been an active participant in their playing or their activities.  It’s all about running them to ballet, soccer, piano, etc.  So, I’m hopeful that creating some intentional moments with them will benefit all of us for 2017.  As my friend said “All moms have guilt”, whether you’re working full time, part time or SAHM.  But my mom (a child psychiatrist) once advised a friend of mine “The fact that you are having guilt about these things means you are a good Mom.  Bad Moms don’t even give these decisions a second thought.”

 

**All photographs courtesy of Daphne Hargrove Photography.  She is amazing!  She does family pics, birthday parties, senior portraits, and even boudoir photos**

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This is a topic I’ve been wanting to address on our blog for a while, since it’s so applicable for kids in Hawaii.  Adults often forget what it’s like for young kids, who have a strong prescription in their glasses, what it must be like to swim and snorkel without their glasses.  My kids don’t wear glasses (yet!), though we use them as our glasses models, like below, but if they start to become as nearsighted as some of their relatives, I will certainly look at prescription goggles for them._mg_8748-2jpg

 

I do not recommend prescription goggles for every child.  The majority of children can see well enough without their glasses that the extra expense is not necessary.  But, for a small subset of my patients, they truly can barely function without their glasses and improving their experience in the water, when you’re swimming at least once or twice a week year round like you do in Hawaii, is worth it.

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Since I always send these patient to my Optical shop, since I don’t really know much about the specifics of prescription goggles, I thought it best to consult my optician, Kevin for this post.  Kevin has over 30 years experience working with children and is a certified and licensed optician.  Take it away Kevin.

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Hi everyone, Kevin, friendly neighborhood optician here.  For kids and adults who wear glasses, swimming in the pool or exploring the ocean can be a frustratingly blurry experience. Did you know our optical shop can make prescription swim goggles and scuba masks?

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Even children as young as two years old can enjoy clear vision underwater — while simultaneously being protected from water-borne diseases and parasites, chlorine and saltwater!

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How’s it done?

 

Our optical shop offers two different lens options designed to accommodate virtually any prescription. How?

Similar to over-the-counter reading glasses, we can offer swim goggles inexpensively for those with a lower prescription or one that does not require astigmatic correction. This is accomplished with ready-made spherical prescription lenses which fit into a swim goggle or scuba mask. Since eye doctors do not recommend contact lens use underwater, swim goggles provide premium visual performance and maximum protection.

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For those who require a higher prescription, or prescriptions where astigmatism correction is needed, our swim goggles and scuba masks can be custom-made to fit your individual needs. Add an anti-fog treatment and Transition lenses for superior performance in and out of the water!

We are blessed in Hawaii with lovely weather year-round. Don’t let poor vision keep you from enjoying our island’s underwater beauty.

Consult our optical staff about pricing and availability.

 

As a pediatric ophthalmologist, this question is one of the most common ones I get.   Parents bring their adorable baby in with huge, beautiful blue or green eyes and they themselves have brown eyes.  They want to know if the light colored eyes will “stay.”

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The part of the eye which gives it color is called the iris.  Melanocytes are cells which contain melanin, present in the iris.  The number of melanosomes doesn’t differ between people with different eye colors.  Individuals with brown eyes simply have more melanin in their melanosomes in the irises than individuals with blue eyes.

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My oldest son, with his big brown eyes.

We used to think that eye color was controlled by just one gene and blue eyes were recessive and brown eyes were dominant.  And, that 2 parents with blue eyes could only have a blue eyed baby.  But, that’s not quite true, though uncommon, a brown eyed kid can have 2 blue eyed parents. The inheritance of eye color is much more complicated than previously thought. There are actually 16 different genes responsible for eye color, but the main two sit next to each other on chromosome 15.  These 2 genes control the amount and quality of melanin produced.  When babies are born, the melanocytes do not produce very much melanin.  That’s why a large number of babies have light eyes.  Even my 3 kids have grayish/lighter eyes when they were born.

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My son when he was a couple weeks old, note the lightness of his eyes compared to the previous photo

With time, usually when babies are between 6 months-3 years,  the melanin production increases and then stabilizes.  The melanin in your iris is not affected the way the way the melanin in your skin is (otherwise, everyone’s eyes would become brown when they are in the sun for a prolonged period of time).  After age 3, very little change occurs in the color of eyes.

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My nephew, at six months old who has one lighter eye and one darker eye. Also note his lighter eyes, even though both his parents have brown eyes.

 

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My nephew, now 10 years old. Note how both of his eyes have darkened to a more hazel color.

There are many disorders which can cause a change in iris color later in life.  Some of these are vision threatening, conditions such as albinism, or  and if you notice any change in your child’s eye color past the age of 3, please see your ophthalmologist.

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This young boy was born with one brown eye and one green eye

There are many causes for heterochromia, some of which require urgent evaluation and management, such as possible tumors in the brain or chest (Horner’s syndrome), inflammation of the eye (Fuchs heterochromic iridocyclitis) or even a type of glaucoma.   Some glaucoma medications can also change hazel or green eyes to darken, as can Latisse, the eyelash growth medication (which is based on a glaucoma drop).  Tumors, nevus (moles) of the iris can cause a darkening of the iris, as can a foreign body, This article is an excellent summary of the many causes for different or changing eye colors.  If you notice a difference in color between the 2 eyes, called heterochromia, please also see your pediatric ophthalmologist.

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First, sorry, I’ve been MIA for a while.  I was on my nice posting schedule and I got hit with the flu back in April when I was attending our national pediatric ophthalmology conference in Vancouver.  It seems as if every time I attend a conference, I get sick – 2 years ago, I had to be ambulanced out of the conference because of what turned out to be kidney stones.  That was a little embarrassing.

Anyway, I don’t usually get sick and I’m pretty sure I had mono.  It was supposed to be a nice time to hang out with my friends from Boston Children’s Hospital, enjoy Vancouver and spend some child-free time with my husband.  Instead, I was in bed with high fevers and a box of tissue. And, though everyone keep telling us how lucky we were because it was so warm in Vancouver, let me tell, 50’s and 60’s does NOT feel warm to a girl who is used to Hawaii sun. Being a physician, of course, I couldn’t actually go get the mono test, but just relied on my skills of self-diagnosis.

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However, the conference was great. I really think it’s important that physicians in Hawaii attend the national conferences.  Jeff and I try to make it a point to do one or two a year.  We’re so isolated out here in the middle of the Pacific Ocean, that I truly think it’s worthwhile to make the trip to the mainland to stay cutting edge in terms of research and surgery.  And, to be honest, I don’t learn the most from the conferences themselves, but I actually learn the most when I’m with a group of senior peds ophthalmologist and I can get their take one of my difficult cases.  I’m not ashamed to ask someone’s advice who has more experience than I do!

Dr. Carolyn Wu on my left and Dr. Alexa Elliott on my right.  Two of my attending when I was a fellow.

Dr. Carolyn Wu on my left and Dr. Alexa Elliott on my right. Two of my attending when I was a fellow.

We had a dinner of all the fellowship alumni from Boston Children’s, which was terrific.  Two former alumni are Chairmen of Peds Ophtho Departments one at Childrens Hospital Philadelphia, and the other at D.C. Children’s, so I was really surrounded by the best and brightest in my field.

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The other neat thing was meeting former fellows who graduated after me.  At least 3 of them immediately recognized me and said “you’re the one with the blocked tear duct blog and video”.  That was kind of cool – though I wish in retrospect that I had taken more effort with filming it.  I am literally holding my iPhone in one hand as I perform the Crigler massage on my squirmy 4 month old son with the other!

Though I spent most of my time in bed at the hotel, recuperating, I did force myself to get out of bed to go biking around Stanley Park with Jeff and then I coughed for like 6 hours straight (it was worth it though). Vancouver is beautiful, I’m hoping the next time I visit, I’ll be in good health!

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So, mono set me back about a month. And, then I’ve literally been scrambling for the past 4 months to catch up.  But, I’m back now, and should resume my regularly scheduled posts.  I’m really aiming for once a week now so keep checking back!

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I’m definitely of the mind set that the more prepared you can make your child for doctor’s appointments, the better they turn out.  So, I thought I’d post about the details of what I do all day, in the hopes that maybe this will help calm the fears of our littlest patients.  I’ve had some parents tell me that they show their kids picture of my Honolulu magazine cover before the appointment and just that simple thing, makes my patients much more comfortable with me.

First up in an any eye exam is to check vision.  Vision should be checked with an actual eye chart for any kid over the age of 3.  Your pediatrician (or his/her nurse) should be doing this at the well child visit.  They may either use an old fashioned wall chart or any one of the number of new vision screeners out there that pediatricians are currently using. I’ve actually found that the Plus Optix screener that couple pediatricians use in the area is very accurate.  When your child comes into our office, we try to immediately escort them into our pediatric waiting room. IMG_6963This way they don’t have to feel antsy about sitting in a grown up chairs in an adult waiting room.  Here, they can play and read until they are called for their appointment.  Then, they are called into the exam room by one of technicians.  The child will sit in the chair (on a parent’s lap if necessary) and we will check vision. We have the children wear special glasses that have a hole on one side to check vision.  We have a pair which has the hole on the other side to check the other eye.Wong(Opt)Shoot42Older kids can check vision like adults, using the paddle.

Then we use a vision testing system which is a computer program.  It’s nice because we can isolate the chart to a single letter and can change the letters on any given line (for any of you guys who try to memorize the chart!).  It also has the advantage of having different types of tests to use based on the age of the kid.  This is why we can usually test any child older than 3 years of age.  Sometimes, we’ve even been able to do 2.5 year olds!

IMG_9161 And, if the kids are too young to know their letters, then we do these shapes or the HOTV letters.

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Some pediatricians still use the chart below to test kids who don’t know their letters.  They are called Allen symbols, but most pediatric ophthalmologists don’t like them because each picture is so unique in shape, that they’re easy to guess.

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Which kid now a days knows that that is a picture of a telephone? I had one patient call it a hot dog! I figured, close enough.

Then, we use special polarized glasses to do a test of 3D vision.

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“Grab the wings of the butterfly”

Then, if the child is older than 12 or 13 years old, I will refract them – that means checking to see if they need a glasses prescription.  That’s the whole “1 or 2 ” test.

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“What’s better – 1 or 2?”

If the kids are younger than 12 years old, then I don’t do this for them.  It’s tough enough for most adults to figure out which is clearer – 1 or 2.  For some reason, this simple question seems to provoke a lot of anxiety.  I check the glasses prescription for younger kids only after dilating their eyes.  Click here to read more about how I can figure out if babies need glasses.

If a child is old enough (at least 4 years old), I will try to examine the front part of the eye at the slit lamp biomicroscope. You’ve probably had this done if you’ve gone to the optometrist or ophthalmologist.  This basically gives me a closer look at the eyelids, conjunctiva, cornea, iris and lens.

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Then, on to the dilating drops.  This is probably what gives children the most anxiety.  I try to minimize this by combing all of the various drops into one spray bottle.  This way, the child doesn’t need to have 3 different drops (even though they may need 3 doses even of the spray).  And, the convenience of the spray is that I can apply it to the child’s eyelashes when their eyes are closed and if I really soak them, then whey they open their eyes, the drops get into their eyes.

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It’s actually quite rare for kids to scream and cry for the drops.  OK, maybe rare is an overstatement – my own oldest son cried when I put drops in his eyes to do his eye exam and that was me putting them in.  This is when the teachers at his preschool kept insisting that he needed glasses because he tilted his head to the side when watching TV or thinking.  And, they knew I was a pediatric ophthalmologist!  “Yeah, I’m pretty sure I’ve checked my son”, I condescendingly thought.  However, add 2 more kids to the crazy mix of our life and I will abashedly admit that I’ve never checked their eyes.  So I guess it wasn’t totally out of the range of possibility that I could miss my kid’s need for glasses.  But, that’s a tangent.

Once the eyes are dilated, I use this crazy thing on my head, called the indirect ophthalmoscope to examine the inside of the eye.  For young kids, I use toys to distract them so I can get a good view inside.  For older kids, I have movies playing to hold their attention (best money I have ever spent when setting up my practice!)

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For the young kids, this is when I check the refraction.  I do this both with an automatic machine (pictured below) and then I double check everything by using a retinoscope as well.

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And, that’s about it.  Of course, they get to choose a toy from our treasure chest on their way out.  I have a lot of kids who don’t want to leave our office.  We have the nicest techs and they are just wonderful with children.  We try to make the experience as pleasant as possible!

FullSizeRenderAnd, no I don’t usually have a professional photographer following me around the clinic.  Almost all of these pictures were taken a freshman in college, right before he graduated from college.  His pics are amazing, for any local moms who want to use him when he comes home for summers and breaks.

 

 

 

The holiday season is always a super busy time in our house, but this year it has been even more so.  For Thanksgiving last week, we actually had both sides of our family in town, which was really wonderful, but a little chaotic!  My brother and his family, as well as my parents flew in from the mainland.  And, my husband has 3 older sisters – his oldest lives just down the street, but the other 2 live in the Bay Area.  They also flew in for the holiday.  My kids had such a blast with all their cousins.  Even Arya, who is only 2, was running around with everyone.  I thought it would be great to get family pics done since everyone was in one place.  But, since my brother was leaving Friday morning and Jeff’s side wasn’t getting in until late Wed night, that meant 2 separate photo shoots.  My husband was less than thrilled with this prospect, since he really doesn’t like posing for pictures, though he is always super glad that we did them after the fact.

So, on Wednesday, my good friend Daphne Hargrove, an amazingly talented photographer came over to shoot my side of the family.  I’ll start with our “after picture”.  Pretty much everything that could go wrong, did.  We just took the pics in our backyard and of course it rained.  Then my oldest son got stung by a bee on his foot.  Then, my middle son fell over backwards after standing on the chair we were using for the pics.  We bribed everyone with candy/chocolate which pretty much showed up in each picture.  I posted this on FB and everyone wanted me to use this as our Christmas card, so we did!

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But, despite all of that, we did get some cute ones of the kids.

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Arya with her cousin, Kiran. She looks like she’s barely tolerating his sweet kiss.

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And then a group shot of Jeff’s side of the family.  I’m so short and everyone in his family is so nice and tall, so I had to wear really tall heels so that I wouldn’t look a foot shorter than everyone else.
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And then a fun one with Jeff’s side of the family.  I saw this idea on pinterest so I cut these signs last year and everyone wrote their names on it.

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Have you ever wondered what you would look like wearing new model frames you see online? If you are interested in Silhouette frames, well, you can after with Silhouette iMirror, you can experience how Silhouette eyewear would look on your face- anywhere and any time you like. Due to the advanced Augmented Reality video technology you are free to move around like you are in front of a real mirror, while wearing a pair of Silhouette frames, hence, the name “Silhouette iMirror.” If you are using a mobile device such as phone or tablet with a front facing camera, it is the perfect tool for this task.  There is a large selection of rimless and sunglass frames to choose from.  Sihouette frames are one of our most popular frames in our Optical shop.  Several of my relatives wear them and love their lightweight comfort.  My brother-in-law even told me that he settled in for an 18 hour flight and took a nap with his Silhouette glasses on and they were so light, when he woke up, he forgot he even had them on and wondered why he could see!

 

Here is how to use the app:

  1. You can find the app in your app store such as iTunes under Silhouette iMirror. Download the app.  It should be free.

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  1. Take a picture of your face.

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  1. Three labels with appear, match your right, left eye and ear with the crosses.

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  1. A default frame will appear, click change frame on the bottom of the screen

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  1. A board of frames will appear on the right side of the screen; from there you can select any frame you like to try on. Also on the side of the screen, there is a menu of colors and various lens shapes.

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After you are done trying on the different styles, you can save your picture in your album or share on social media.

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It’s the best way to preselect a frame before going to an optician to order them. As soon as you find the perfect Silhouette frame with the app, come on down to our optical and our opticians will  help you find the matching shape of the picture.

Pictures source: https://itunes.apple.com/us/app/silhouette-imirror/id337239568?mt=8

 

 

 

 

 

There are so many advantages to living in Hawaii – the sun, the outdoor sports, the sense of ohana.

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October in Hawaii! And, just a few blocks from our house on a public access beach – can’t beat that!

 

But, one thing which is not better here than on the mainland is the ALLERGIES!  I have lived in many places – North Carolina, Boston, New York – and my allergies are the absolute worst here in Hawaii.  This year seems to have hit allergy sufferers particularly hard – you may recognize the signs of hay fever – runny nose, clogged sinuses, headaches, coughing and sneezing. One-third of individuals who suffer from allergies also have ocular allergies – dry, itchy and red eyes. Allergic conjunctivitis occurs when the clear layer of tissue lining the eyelids and the white covering of the eyes, becomes inflamed. This causes tearing, discharge (makapiapia), itching, and redness. The most common cause of these symptoms is pollen during hay fever season, however, there are many allergens which can trigger symptoms year round. Cockroaches, dust mites, and animal fur or hair are just a few examples of triggers for sensitive individuals.

Symptoms of allergic conjunctivitis

  • tearing
  • discharge
  • itching 
  • redness

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A severe type of allergic conjunctivitis is called vernal conjunctivitis.  On the mainland, this usually only happens during summer and spring, but here in Hawaii, I see it year round.  So, these poor kids not only suffer from the redness, tearing, itching of typical allergy sufferers, but additional complaints.

Symptoms of vernal conjunctivitis

  • light sensitivity
  • thick pus like discharge
  • bumpy growths on the clear part of the eye or underneath the eyelid
Bumps on the pink part of the lower lid (conjunctiva), also known as papillae

Bumps on the pink part of the lower lid (conjunctiva), also known as papillae

I had one child from Maui who came in because her eye doctor that she needed eyelid surgery for a droopy eyelid.  I could barely examine the poor girl.  She was so light sensitive, she kept her right eye shut constantly and her vision was also terrible in that eye.

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Once I actually was able to flip her upper lid, I saw this.

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Huge bumps underneath her eyelid, just like in vernal conjunctivitis.

So, we started her on treatment.  The most common treatment for vernal conjunctivitis is:

  • Oral antihistamines (Claritin, Zyrtec)
  • Antihistamine drops (Pazeo, Padatay, Lastacaft)
  • Steroid drops to reduce swelling and redness (lotemax, prednisolone acetate, durezol)
  • Cold compresses
  • Avoidance of the allergen

She was also tested for allergies.  Turns out that she was allergic to dogs and cats and she had been visiting her grandmother’s farm every weekend which had tons of animals.  We reduced her visits to the farm, gave her Pataday and lotemax and several weeks later…

Screen Shot 2015-11-03 at 12.55.37 PMHer vision improved to a perfect 20/20 and she was able to open the eye again.   No surgery needed to elevate that upper lid. This was the only dog she could have now – but at least she could see!

Though classic teaching regarding vernal is that it mainly occurs during spring and summer months, I do see it year round here in Hawaii.  And, I can tell when allergens getting bad because all of my patients with vernal conjunctivitis will flare and make appointments in the same few weeks!  The most common allergens in Hawaii are dust mites, mold and cockroaches.  I lived in NYC for 8 years, I thought I was cool with roaches.  But, I tell you, NYC has nothing on Hawaii in terms of the sizes of our cockroach.  It was one of the deals I made with my husband before I moved here – he had to kill all of the roaches.  He gets super annoyed when I wake him up at midnight to tackle yet another flying roach (and I swear our house is clean!).  But a deal is a deal!

 

 

 

 

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