a Pediatric Ophthalmologist/Working Mom/Administrator.

As a working Mom, I wear many hats, just as many of my colleagues do.  So, for today’s post, I decided to chart down what I did for a full day from the time I woke up to coming home.  People always ask me how I can manage working with 3 kids and it’s a juggling act.  We’re also super blessed with terrific babysitters who we can really depend upon when we have late days.

5:45 am: Arya is awake.  She likes to reach over from her crib and turn the light on and then calls to us “Mommeeee, Daddeeee”.  Her brother, Taj, who is a very light sleeper, will wake up then and run into her room “I’m coming Arya!”.  It’s very sweet.

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Then, get ready, make my bed (I read somewhere it’s part of starting the day right).  Man, I need some coffee.  I look longingly at my Nespresso.

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Since it’s a surgery day, I don’t drink caffeine, just to make sure I don’t have any jitters when operating.  But, I miss the routine of my coffee.  Gotta remember to buy some decaf pods.  Help get the kids ready for school, etc.  Show the nanny where the stuff for dinner is, so she can prepare it (tacos for kids tonight)

6:45 am: Leave the house.  

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Jeff usually drives and I take care of admin emails.  It gives me time to eat my yogurt.  It’s nice having a chauffeur !

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My chauffeur, Jeff, does not like being photographed.

 

7:05 am: Drop Jeff off at the office and I drive over to the Eye Surgery Center.

7:15 am:  Arrive at Eye Surgery Center, greeted by friendly smiling nurses.  I love this place.

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One of the pre-op nurses at the Surgical Center.

 

7:20 am: Say hello to my patient, mark above his eye with a large S (don’t want to operate on the wrong eye! – don’t worry, I always print a large photo of the patient and place it on the wall in the operating room to remind which muscles I am operating upon), and sign the necessary paperwork.

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Change into my scrubs  and head into the operating room.

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My scrub nurse, Jackie, enjoys 80’s Pop music in the OR just like I do!

 

8:45 am : Surgery is finished.  My second surgery canceled at the last minute, so there was no time to move up another patient.  So, now it’s coffee time! Yes!  I always go to Padovani’s.  It’s a cute little shop 2 doors down from the surgical center in Dole.  They have wonderful hand made gourmet chocolates, delicious cappuccinos and fresh muffins (my favorites are the pineapple and and mango)

Phillipe Padovani, owner and chef.

Phillipe Padovani, owner and chef.

Now, I usually wait about 45 minutes to an hour for the patient to be awake enough to perform suture adjustment on him.  So, I grab my usual bench and get to finalizing some charts on our electronic medical record system, EMA.  Paper charts are still way faster than electronic charting, but at least I don’t have to carry 25 charts with me in my bag.  It’s all on the iPad.  I am WAY behind, as usual

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9:45am-10: Perform suture adjustment.  I’ll do a separate post on this next month, but this is basically when I can fine tune the eye muscle surgery to make sure the eye is aligned exactly where I want it to be post-operatively.  My surgical coordinator in the office, Ronnie, is my scrub assistant in the OR when I operate at Eye Surgery Center and she is fantastic.  A real joy to work alongside.  And, the patients adore her as well.  She assists me with the suture adjustment as well.  I am lucky to have her as part of our team!

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Ronnie, surgical coordinator, scrub assistant and all around awesome girl!

I change and drive Ronnie and I back to the office.

10:30-12 pm.  All the fun, sexy stuff that goes into being a physician and administrator (that’s sarcasm, in case you can’t read into that).  Finish my charting, sign all the paperwork for the company 401K, talk to our financial adviser at Morgan Stanley about the conversion from Nationwide to Mass Mutual, decide upon profit sharing contributions.  Fun, fun, fun!

12-12:45 pm: Reconcile bank statement for July.  Try to locate a missing payroll report from that time period. Did I mention how much fun this stuff is?  Oops – forgot to bring leftovers from dinner to eat.  Thank goodness, one of my staff, Brandi, was kind enough to grab food for me so I can eat while at my desk.  I have the best staff.  But, quickbooks is still not working and syncing with my bank, even after spending 1 hour 38 minutes with them on the phone on my day off.  I’m not in a good mood.

Yes, this is my desk - 2 monitors, an iPad and tons of bank statements.  With a spicy poke!

Yes, this is my desk – 2 monitors, an iPad and tons of bank statements. With a spicy poke!

I’m a very neat person, but my desk at the office is always cluttered.  I think I’m just mid-project all the time.  I remember when they were filming the Hawaii National Bank commercial and they wanted to shoot an action shot of me working at my desk.  I started cleaning my desk and they said “No, no, keep it.  It’s more authentic”.  OK, so now, it’s out there, I have a messy desk.

12:45: First patient is ready for me to see. Steady stream of patients until 3:45.

3:45 pm: My gorgeous girlfriend, Amelia, arrives for our cosmetic event we are having that, yikes, starts in 15 minutes!  We’re having a high tea party with stations for colored contact lenses, Botox, and hair/make-up by Amelia.  And, I have to help get everything set up pronto, though my office manager, Sara, has already done a ton.  I kind of fell into doing Botox about 7 years ago.  I was meeting with Thomas, the rep for Botox to ask about purchasing Botox for medical purposes (strabismus surgery) and he asked if I considered doing cosmetic Botox.  My training in cosmetic Botox was injecting my attendings with the leftover  Botox that we had used for medical reasons (since it has to be thrown away anyway).  And, I do enjoy it – I don’t ever want to be a primary cosmetic surgeon, but it does help people feel happier with how they look.  Most of my patients, are moms of the kids I examine for their eyes!

4-6 pm: Cosmetic event.  It’s a great turnout and all of the guests have a blast.

 

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My friend, Amelia, performing a mini-makeover. Who wouldn’t want to look like this girl?

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Our optician, Joel, doubles as a personal butler.

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Dr. Bossert explains the technology behind the new colored contact lenses

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My friend and I, with our hair styled by Amelia.

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6:10 pm:  Yowser, I was supposed to leave 10 minutes ago for my son’s 1st grade orientation, which got rescheduled at the last minute.  I stuff some sandwiches on a plate and eat while I drive.

6:30-7:10: 1st Grade Orientation.  I’m an hour late.  It started at 5:30, but at least my husband made it there on time.  The kids each drew a picture for us.  Here’s my son’s.

Saturday, September 19, 2015 00001

 

“Do not feel bad if you come late ”  Uggh.  The guilt of being a working Mom!

7:30 pm: Back at home.  My oldest and youngest are asleep.  But, my middle child takes forever to fall asleep.  He comes out when we get home and asks for a massage.  He’s such a high energy boy, so I started doing nightly massages with essential oil to help calm him down.  Now, he expects it and chooses his scent.  Sorry, future daughter-in-law!

8:00 pm: All kids asleep! I settle in on the couch to do some Netflix binge watching while I do, what else?, finish charts!

 

 

 

I can’t believe it’s been 2 months since I posted last.  Now that  all of the kids are in school, I can get back to a regular posting schedule. This past weekend, we invited all of our patients to a talk entitled “Advances in Cataract Surgery” at our office.  I went to my new favorite place – fiver.com to find a graphic designer to help design the invitation.

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The hard part was convincing my husband, Dr. Jeff Wong to actually give the talk.  You may have noticed that I tend to be the one to do all the videos and talks for our practice.  I enjoy it and don’t mind being in front of an audience or a camera (guess I can credit my days as a pageant queen for that).  But, Jeff is another story.  He is actually very well spoken and gives wonderful, insightful presentations, but he is more reserved and doesn’t like being front and center.  However, I was surprised that he was actually up for giving this talk.  As he said at the beginning of the talk on Saturday “I love doing cataract surgery and I love talking to my patients about cataract surgery, so that they have all of the information they need to make an informed decision”

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We had a continental breakfast for guests.  The poi malasadas went fast!

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And, our 2 surgical coordinators, Ronnie and Kaui were on hand to help answer questions as well about the surgical scheduling process.

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We had a great turnout – it was just the perfect number of people to provide an intimate forum for everyone to ask their questions.  Joel, our optician even went around and cleaned all of the guests’ eyeglasses – now that’s service!

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My husband gave basic information first – what is a cataract?

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He then discussed laser cataract surgery, which most people have heard about.  We’re lucky that we’re part of the Eye Surgery Center of Hawaii.  They have a laser cataract surgery machine and my husband is able to offer this option to all of his patients   As much as we love operating at Queen’s Medical Center, Queen’s doesn’t have a laser cataract machine, so for the past few years, we’ve been doing all of our adult cataract surgery at the Eye Surgery Center.  Click here to see my previous post about laser cataract surgery

catalys2He then answered specific questions about all of the various types of intraocular lenses which can be inserted into the eye. At the end, we also received really wonderful feedback, so I think we will try to do this roundtable talk very few months.  Keeping it small really allowed for everyone to feel comfortable interrupting my husband if they didn’t understand something.

At the conclusion of the talk, all guests received little gift bags chock full of educational information about cataract surgery.

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And, the nice part was, even though we did the talk on a Saturday, we just brought the kids in with us (just like old times!)

Here are 2 hard workers heading home.

IMG_8042Come join us for our next talk.  We’ll post invites and updates on our social media – facebook, instagram and twitter.

 

I see a lot of styes in my practice as a pediatric ophthalmologist.  Adults and kids get them and they can be slightly painful, tender and look terrible.  Most patients are concerned that styes are an infection (which they are not) and want quick treatment for them.  Usually our adult patients come in for an appointment, having researched online (I admit it, I consult Dr. Google as well), and want the stye cut out.  Sometimes, that’s not am immediate option.

A stye is a term that people use to describe two different medical conditions interchangeably.  Sometimes, people are referring to a hordeolum.  And, sometimes, they mean a chalazion.  What’s the difference?  And, what is a stye anyway?  A chalazion is simply a blocked meibomian gland.  The meibomian glands are these tiny glands that secrete oil for your tears.  The oil is necessary for the proper composition of tears in your eyes and prevents your natural tears from evaporating too quickly.  You have about 40-50 meibomian glands along the upper and lower lids, right on the inside aspect of the lid, located next to the lashes.

Meibomian gland picture jpeg(Side note: you may have noticed that I have black and white diagrams for most of images now.  That’s because I hand draw all of the pictures for the blog so that I am sure I am not mistakenly using any copyrighted images.  So, please do not reproduce these images without my consent)

When the meibomian glands are blocked as in the picture below, people get symptoms of dryness, redness, inflammation, foreign body sensation, burning, itching and stinging.  You can see the oil squeezing out of the glands while the examiner is compressing the eyelid.  I’m going to warn you the next 2 pictures are a little graphic, you might not want to view these if you are eating right now.
The easiest way to unblock these oil glands is by performing hot compresses for 5 minutes twice a day.

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meibomian gland zoom jpeg

 

When a gland gets really obstructed and acutely inflamed, then it is a hordeolum.  It’s red, tender and slightly painful.  Again, it’s not an infection, but think of it almost like a pimple.  When the lid is still hot and red appearing like this, surgical excision should not be performed.  That’s because you can get scarring if it’s operated upon when the eye is inflamed.  Here this little boy who I saw a few months ago with a really large hordeolum on the left upper lid.

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Treatment for this includes hot compresses for 15 minutes three times a day.  Some kids (and adults) dislike doing hot compresses with hot water because of the wetness and the fact that it doesn’t stay hot for the full 15 minutes and must be continuously rewet.  So, often I will recommend  preparing the hot compress by using a clean athletic sock and filling it with one cup of uncooked rice.  You can also add flax seed which takes longer to heat than rice, but is also smoother and stays warmer longer.  Don’t pack it in tightly; leave some room for the grains to move around so that it will more easily conform to the area to be treated.  Use a thick athletic sock so that the grain will not poke through the sock.  Use a rubber band to close the top or if you are using a tube sock, you can knot it.  Place it in the microwave for 30-60 seconds.  Check the temperature on the back of your hand before placing it on your eye.  It should be warm, but not uncomfortably hot.  Place it on your closed eye for 15 minutes three times a day.

I have about 3 of these socks lying around – I use them whenever I feel the earliest start of a stye forming.

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If started early enough, hot compresses will be sufficient to resolve the hordeolum by opening up the oil gland.  Below is a picture of the head of the hordeolum.  Note the beefy red bump on the inner aspect of the lower lid.  The goal is for this to drain with the hot compresses.IMG_7518

 

Sometimes, a combination antibiotic/steroid drop (Tobradex, Maxitrol, Nepolydex) will be started at the same time as the hot compresses.  The steroid helps decrease the amount of inflammation surrounding the blocked oil gland.  The antibiotic helps to combat the bacterial infection of the oil gland.  If these treatments are not sufficient, then the hordeoleum can sometimes progress into a chalazion.  A chalazion is a granuloma – basically when the body has begun to wall off the infection.  Therefore, drops are not as effective in treating chalazion.  Often times, I will recommend omega three supplements or flaxseed oil for multiple chalazion.  And, there has also been some data that reducing milk in your diet may help decrease the incidence of chalazion as well.

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If none of these modalities are effective, then the only treatment left is surgery.  Basically, the chalazion is incised and drained after injecting local anesthetic along the eyelid for pain.  The clamp (pictured below) is used to evert the eyelid to gain better access to the chalazion.

Chalazion clamp applied to lower lid

For adults, this can be an in an office procedure.  For kids, I always do this in the operating room under general anesthesia.  Oral antibiotics are not necessary after the procedure, I only prescribe antibiotic ointment post-operatively.  Usually sutures are also not necessary, since typically the incision is made on the underside of the skin.  If a skin incision needs to be made, then sutures will probably be placed.

 

There you have it – styes and what to do to hopefully prevent them from requiring surgery.

 

 

 

 

I love what I do.  Sometimes, it’s challenging, but it is always rewarding.  Most patients don’t really understand what it is I do, or my training.  I’d say 90% of the people out there don’t even know exactly what an ophthalmologist is!

So, here is summary – I am specialty trained in pediatric ophthalmology and adult strabismus.  This means, I am an eye surgeon as well as an eye doctor.  After medical school, my husband and I both did internships and then proceeded on to our residencies in ophthalmology for 3 years where we learned how to perform eye surgery.  I then went on to finish a fellowship in Boston in pediatric ophthalmology and adult strabismus.  These two are linked together since children often have strabismus, or misaligned eyes (eyes that point in different directions) and the training covers how to address this condition in both kids and adults, as well as other childhood eye diseases – glaucoma, congenital cataracts, blocked tear ducts.  When I was on at Boston Children’s Hospital, I did more pediatric surgeries since there were several senior members of the department who who were expert in adult strabismus (which tends to be more complicated).  However, when I moved to Hawaii, my surgical practice shifted and I started doing more of the more difficult adult strabismus cases.  Both types of rewarding and below is a testimonial from an amazing patient who I had the privilege to meet when he was visiting Hawaii to take care of his sister.  He is a firefighter from NY and hearing his NY accent definitely made me miss the 8 years I spent there.  Crazy to think I’ve been living in Hawaii now almost as long as I lived in Manhattan!

Anyway, here’s a before/after picture of Ed:

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Before strabismus surgery

 

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After strabismus surgery

 

One thing to note is that the procedure is NOT cosmetic surgery.  It is covered by health insurance because it causes double vision in adults or poor vision in children.  Even people who are blind in one eye and it’s wandering out – it is still covered under insurance.  I’m so surprised when patients come to me and say “Doc, I’ve been going to an eye doctor for 30 years and they said nothing could be done for this”  or “My eye doctor told me that medical insurance won’t pay for this surgery”  If you take away one thing from this post, please let it be that strabismus surgery is not a cosmetic procedure and is covered!

Forgive the editing of the video below – it was my first attempt at using iMovie.  And, the music that I dubbed in is actually Jeff, my husband, playing slack key guitar (he’s self-taught, very amazing!)

Strabismus surgery involves tightening or weakening the eye muscles to better align the eyes.  I did the adjustable suture form of strabismus surgery for him.  I do that for all of my adult patients.  Basically, it allows me to fine tune the surgery after the patient has woken up from the general anesthesia.  I can actually pull on long stitches connected to the eye muscle when the patient is awake and adjust the surgery further.  Since pa.  Strabismus surgery is a whole another post that I will get to next week, with some cool pictures!

It was a real honor and privilege that Ed trusted me enough to perform surgery on him when he was out here visiting Hawaii.  I truly enjoyed working with him and I’m so glad he finally had the surgery done.

 

For this week’s post, we have Dr. Jenifer Bossert, Optometrist and Director of Contact Lens Services at Honolulu Eye Clinic.  She recently appeared on KITV news to discuss serious dangers of improper contact lens storage which could be putting your eyes at risk.

 

In addition to disposing of your contact lenses in a  timely manner, here are a few other things you could consider:

When was the last time you really looked at your contact lens case?

When was the last time you actually replaced your contact lens case?

Did you even know you were supposed to replace it?

Several studies have confirmed that 70% to 82% of cases show contamination from overuse.  And only 26% of patients replace their cases periodically, 48% once per year, and the remainder, never!  Median frequency for cleaning cases was 2-3 times per week and one third cleaned only once per month!

Lens cases are hotbeds for bacteria and fungal colony growth…despite the addition of the Multi-Purpose Solution (MPS) contact lens solutions.  Cases are made from porous plastics.  Over time a “biofilm” coats the inner surface of the case.   This serves as a breeding ground for bacteria.  These bacteria become embedded in the pores of the case itself.  Even IF you properly follow contact lens cleaning and rinsing instructions, these nasty bacteria still find a way to grow.

When present, they can attach themselves to the micropores in the contact lens, multiply, and form this undetectable film on the contact lens, which is then transferred to the eye upon insertion.  These deposits irritate the cornea–the soft clear tissue on the front of the eye—causing the wearer to rub the eye and the eye to appear red.  The back and forth pressure from rubbing makes microscopic scratches on the surface of the eye. These small breaks in the tissue act as open pathways for the bacteria to invade the eye, thereby, increasing your risk for a bacterial infection and/or corneal ulcer.

Recent corneal infection in contact lens wearer at Honolulu Eye Clinic

Your best line of defense is following these instructions EVERY day:

  •  NEVER “top off” and reuse the solution in your case for a second day.
  •  After removing contact lenses, empty the case,  and rinse it with fresh MPS (not water).
  •  Turn it over (to keep the dust out) and let it air dry.
  •  REPLACE the case every 3 months.

Following these simple rules will reduce your risk of case and contact lens contamination.  Please remember that not all contact lens solutions are MPS (i.e. disinfecting) solutions so it is important to read the labels.  Saline is NOT a disinfecting solution.  If you have any questions regarding the proper solutions to use with your particular contact lenses, don’t hesitate to call and ask your doctor or the staff here at the Honolulu Eye Clinic!  We would love to hear from you!

 

I was trying to think of a good title for this blog post and I was reminded of FB posts I see and thought of : “This boy bought his Halloween contact lenses online and you wouldn’t believe what it did to his eyes!”  (He didn’t really, this is our Optician who purchased the lenses through our clinic).  But, that title was a bit too sensational for me, so I just thought a nice, simple title would suffice, though the dangers are very real.  I lived in Manhattan for 8 years and the Halloween parade down in the Village is legendary.  You see the best costumes and everyone gets dressed up.  That was the first time I saw someone in a costume contact lens – it was a cat eye and I thought it was cool.  I was an ophthalmology resident at the time, and I asked the girl where she got them “Oh, from the costume shop down on 14th Street”, she answered.  Yowser!  I couldn’t believe someone would put something in their eye that they bought at a pop up Halloween store!  That was about 8 years ago and now people can buy contact lenses online, which makes the dangers even more widespread.

Of course, we all want to have the best costumes for Halloween.  And, the cosmetic contacts add a little something extra – Walking Dead zombie with the crazy eyes; vampire with red rimmed iris, or cat eyes – all make for an exceptional outfit.

Our technician, Brandi, modeling our Halloween contacts

 The problem is that people do not realize that these kind of lenses require the same fitting and care as a regular contact lens.  People mistakenly believe that because it’s just for one night, that somehow these contacts do not need to be as safe, or fit as well, which is far from the truth.  Ten hours is more than enough time for bacteria to grow and for a serious, vision threatening infection to occur.  And, just because you can buy them online or in a novelty shop does not mean that they are.  Remember, all contact lenses are medical devices and should be approved by the FDA.  In fact, shops which sell non-FDA approved lenses or do so without requiring a prescription from your eye doctor are conducting business illegally can receive stiff fines, of up to $11,000.  Any place that sells contact lenses should ask you for a prescription.   The lenses pictured above are sold in our clinic and are FDA approved material.    The FDA has issued warnings in the past about the dangers of wearing Halloween contacts.

Dr. Jenifer Bossert, Director of Contact Lens Services at Honolulu Eye Clinic, offers this advice: “In our practice, I tell patients daily that contact lenses aren’t a “one size fits all”.  Just like everyone has a different size foot, everyone has a different size eye…and if your contact lenses aren’t fit to your eye, you run the risk of corneal ulcers, distortions, discomfort, and yes, even the potential for blindness as a result from a significant bacterial infection.  Halloween is such a fun time…and we want our costumes to be awesome…so think ahead, call your eye doctor early, and “treat” your eyes well!

 

Tips for a Safe Halloween with your costume lenses:

1.  Have your eyes examined by  a licensed eye care professional.  They can measure your eyes appropriately and discuss proper care of contacts.  This is especially important  for those of us (like me) who don’t wear glasses or contacts regularly.  We are just not as skilled at inserting or removing contact lenses and that is important at preventing scratches on the cornea.

2. Get a valid contact lens prescription which includes power, brand type, base curve measurements and expiration date

3.  Buy lenses from an eye care professional or vendor who requires a prescription.  We do offer the following contact lenses for sale.  The bottom ones are also available with prescription.  Today is the last day to order in time for Halloween.  Though, based upon their availability, there is a small chance that the lenses might not arrive in time since we live out in the middle of the ocean.  However, these lenses are available year round if you want to buy them early for next year for any upcoming  costume parties!

4.  Follow directions for proper cleaning and care of contact lenses.

5.  Never share your contact lenses.  This was the worst case I saw in NYC.  A 14 year old girl shared contacts with her friend and developed a terrible corneal ulcer and became blind in one eye from it.  It seems innocouus, but it is not just another part of your costume!

6.  Maintain proper follow-up appointments with your eye doctor.

Following these simple guidelines, should allow you to have a safe and fun Halloween!

 

 

 

This is probably one of the most common questions I get.  Even though my husband and I are ophthalmologists (eye surgeons), we still do a large number of glasses and contact lens prescriptions.

Here’s my son, Taj performing his first refraction with the phoropter when he was 1.5 years old. This picture was taken at the Children’s Discovery Center, our equipment in our office is much newer than this!

Taj adjusting the phoropter

Refraction is the term used to describe that process of fine tuning your glasses prescription when you sit behind the phoropter. Everyone gets so nervous when we ask “Better 1 or 2”.  They don’t want to get the answer wrong.  And, the thing is there is no wrong answer.  Your glasses prescription is individualized to suit your needs.  And, most optical shops (like ours) can always redo the lenses for free for three months if you end up getting the glasses and they just don’t seem to work for you, even after giving them a couple weeks.  So, that should take the pressure off.

So, you did it – finished the dreaded “1 or 2” test and your doctor hands you a prescription.  It’s like an ancient language – what does it all mean??? OD, OS, Sphere, Cylinder, Axis, Add??

 

OD and OS

First, OD and OS.  OD stands for oculus dextrous, for those of you who took Latin in high school, which means right eye.  OS stands for oculus sinister, for left eye and OU stands for oculus unitas or both eyes

 

Sphere (Sph)

This refers to the spherical lens necessary to sharpen your vision to 20/20 (if possible for you).  The number is the amount, measured in diopters, needed to correct nearsightedness or farsightedness.  In this example, this patient has a minus in front of the number because he is myopic or nearsighted.  This patient can see near, but not far. Whether the number is plus or minus, the higher the number, the stronger the prescription.

This patient’s eye is a little longer than normal, so the light focuses in front of the retina instead of on it.

Myopic eye diagram

 

A minus spherical lens, or a concave lens, helps focus it onto the retina.

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Here’s another prescription with a plus number in the sphere column, meaning this patient is hyperopic, or farsighted.  That means this person can see far away, but not up close (that’s only for adults).  Though, that’s not entirely accurate – most kids are hyperopic.  As their eyeball elongates, they outgrow this farsightedness – but, their vision is never affected by it because their eye is so flexible it’s able to focus past the farsightedness, giving them 20/20 vision.

This patient is a child and her eye is a little shorter than is normal, so light comes to focus behind the retina.

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A plus spherical lens, or convex lens, helps focus the light onto the retina.

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Cylinder (Cyl)

There are two types of lenses in glasses prescriptions – sphere and cylinder.  Cylindrical lenses are used for correcting astigmatism.  Sometimes new patients come to me and say, “I have…..ASTIGMATISM” (que the scary music).  It’s almost as if it’s a terrible disease (which it’s not).  Astigmatism just means the front of your eye, or the cornea, is shaped more like an egg or football, instead of being perfectly spherical like a ball.

Most people have some astigmatism.  For people with astigmatism, it means that images are slightly stretched horizontally or vertically, like a fun house mirror.  This number can be minus or plus, but practices tend to stick to one sign.  In our office, all our prescriptions are written using minus cylinder.  If you don’t have a number in this column, it means you don’t have any astigmatism.

Axis

Axis refers to the direction or position in which the cylindrical lens is pointed to correct the astigmatism.  It’s measured in degrees.  If your prescription doesn’t have a cylinder number, then it won’t have an axis number either.  Remember high school geometry?  That’s what the axis refers to, just like your old protractor.  Do they still use protractors in high school?  Probably not, I bet there’s some app for that now.

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Add

This number is also measured in Diopters and refers to the extra magnifying power needed to help you see up close if you are presbyopic.  Presbyopia is the condition which affects most individuals over the age of 40.  You probably know the signs if you fall into this age group – reading, using your phone, all starts to get a little harder and you have to hold things far away for them to be clear.  That’ presbyopia. If you wear bifocals or progressive glasses, then there will be a number in this column.  Add power is always a plus number and it can range from as low as +0.75 to +4.00 (in rare cases), though the normal add powers are between +1.25-+3.00.

Prism

My patients will have a number in this column.  This is for correcting eye misalignments (strabismus) and reducing double vision.  Depending upon the type of strabismus (eye drift up, out, in or down), the prism will be oriented in different directions to counter the eye misalignment.  Most people do not need prism in their glasses.

And, we’ll close with my favorite pic from the Cat in the Hat – it’s actually very accurate!

 
Honolulu Eye Clinic is so so excited to be one of the first clinics on the island to carry the new AirOptix Colors Contact lenses.

I’ll admit it – when I was young, there was nothing I wanted more than green eyes.  There was an auntie I used to babysit for down the street.  She was Indian with these gorgeous silver/green eyes and I used to tell my parents – “When I’m 18, I’m going to get colored contact lenses” . I wanted to look like the famous Indian actress (and former Miss Universe), Aishwarya Rai.  That’s her real eye color.

Fast forward to 2008 when we took over Honolulu Eye Clinic.  Finally, I thought, colored contact lenses.  The only option was the Fresh Look colors and alas, try as hard as I could, I could not get those contacts on to my eyes.  I thought it was just my inexperience wearing contact lenses, since I don’t wear glasses and have never needed contacts.  But, even when I had our stellar staff put them on for me, they were incredibly uncomfortable and moved all over the place on my eye.  On top of that, they blurred my vision.  I finally checked my corneal measurements and realized that my corneas were too flat for the standard size that the Fresh Look colors come in.  So, I resigned myself to having brown eyes (OK, I’m being a bit melodramatic).

But, just last month, Alcon introduced AirOptix Colors and it’s a contact lens I can actually wear!  The fit is comfortable – much less movement and drying than the previous iterations.  The Dk constant (which is just a measurement of how much oxygen the lens transmits) for the AirOptix is 6 times more than the Fresh Look Colors.

And, the colors are so much more natural.  My husband does not care for the fake, artificial colors of Fresh Look and these new AirOptix ones just make your eyes pop but in a subtle manner.  They have a 3 in 1 color technology, which enhances your natural eye color (instead of just covering it).  The outer ring defines and intensifes your eyes.  The primary color enhances your eye color and the inner ring adds depth and natural richness.  The colors are are on both surfaces of the contact lenses, which makes the color more life-like.

Here a pic of me wearing the green (subtle).

Air Optix Colors in Green

 

 

AirOptix in Gray

 

I hate taking selfies.

And, last one of me wearing just one green contact lens.

Green contact in right eye and normal in left eye

Here’s some of my staff. Sam has beautiful blue eyes.  But, she likes to change it up,so she’s wearing a hazel contact lens in her right eye.

 

Sofie is wearing hazel on the left side.  Wouldn’t you just kill for those lashes?

And, last our optician, Becca who has beautiful brown eyes, but likes to play with the gray contact lenses.


The Air Optix website has a fun virtual studio, but nothing is as good as actually trying on the contacts on your eyes.  Please call us if you would like to try the new Air Optix colors.  They are monthly lenses and currently come in plano (no power in the lens) and minus powers (nearsighted).  The plus powers are supposed to come out by the end of the year, though they are not yet available.

 

We all do it – use make-up even when a nagging feeling tells you that you should probably toss it.  I know, it hurts to throw away your $30 tube of mascara, just because it’s been three months.  What’s the harm?  And, I’m pretty pake (that’s cheap for any readers who aren’t from Hawaii), so I think back in med school, I’d use the same mascara for a year.  But,now I know better.  Microbial organisms are present on your lashes and they can flourish in tubes and bottles when given the chance. Serious eye infections can occur, so I’m listing some guidelines to follow with eye make-up.

1. Toss your mascara every three months

You’ve probably read this in your beauty magazine or blog, but where did this magic 3 month number come from?  A study done almost 40 years ago in a very reputable ophthalmology journal showed that bacterial and fungal growth was found in 36% of mascara tubes after 3 months.  So, now ophthalmologists make the recommendation to discard your mascara after 3 months.

Like I said, I know this one is painful.  A little tube of Diorshow costs over $28 (I used to love this mascara) and I totally didn’t used to do what I knew in my heart was the right thing to do – throw it away after 3 months.  Think about it, you double dip your mascara wand and there are numerous normal bacteria on your lashes.  Once you apply your mascara, you’re putting that cespool of bacteria back into a liquid/gel bottle and sealing it tight.  That means staph and strep are growing and replicating inside your mascara tube.  Convinced now?  If not, here’s another great little fact – one study found that almost 80% of mascara samples contained Staph aureus and 13% contained Pseudomonas.  Pseudomonas is a terrible bacteria that is responsible for this below:

OK, so, I don’t think there’s ever been a reported case of Pseudomonas infection from mascara, however, that picture will probably convince you to dispose of your mascara in a timely fashion!

Once the mascara starts to smell funny, change in consistency and become clumpy or dry, then you know it’s time to dispose of it.  There are a lot of less expensive mascaras out there which work really well.  And, then you won’t feel so bad to throw it away.  Also, be conscious of the expiration date.  Before I wrote this blog post, I didn’t even realize mascaras had expiration dates – but here it is.  This is from the back of my Fiberwig mascara.

If you look closely, it actually states 6 months, but don’t do it – stick to the 3 month guideline to be safe.

 

2.  Don’t share mascara or eyeliner

Anything that it’s in gel/liquid form can harbor bacteria more than powder form.  Therefore, don’t share!  If I get my make-up done by a make-up artist, I always bring my own gel liner and mascara.  Perhaps that’s being too careful, but I have no idea how long that tube has been open, even if they use a clean, disposable applicator each time.   Honestly, probably the best thing to do is to avoid the samples at make-up counters all together.

3.  Dispose of eye make-up after an eye infection

If you get conjunctivitis (pink eye), even if it resolves with antibiotic drops, you must throw away your eye make-up, at the very least your mascara.  Adenovirus particles can live on the surfaces of inanimate objects for upwards of one month .  And, you likely had the infection even before you started manifesting symptoms.  So it’s not good enough to just stop using the products when you have the conjunctivitis and the resume use once the pink eye improves.

One question I get asked often is if a patient can wear make-up if they have blepharitis.  Blepharitis is not an eye infection.  It’s inflammation of the eyelids, so technically, you can continue using your make-up with blepharitis.  However, there are certain types of make-up which are non-clogging and may be better tolerated by people with blepharitis.   Cosmetics may say “non-comedogenic” but that doesn’t necessarily mean they are oil-free.   AND, blepharitis can be caused by staph – remember, there’s a lot of staph just hanging out on your skin and lashes.   So, if you have the severe form of blepharitis – staph marginal disease – then check with your ophthalmologist regarding make-up use.

4.  Eye shadows (powder form) are good for 1-2 years, but don’t forget to clean your brushes

I have a bit of an eyeshadow addiction.  It started when I moved here to Hawaii.  I would get my make-up done at the MAC counter before our photos for our Honolulu magazine ad and have to buy $50 worth of makeup.  There’s just something so pretty about all the colors.  Anyway, here is the embarassing picture of the contents of my make-up drawer.  I own one eyeliner, one blush and a million pots of shadow.

Thankfully, since most eye shadows are powders, they carry much less risk of bacterial infection.  So, I’m safe to indulge my eye shadow addiction.  Though, now that I pulled out all my eye shadows, I see some in this pile from my days in NYC, which was 8 years ago!  Guess those are going in the trash now.  Another thing is even if eye shadow is safe for 2 years,  people often neglect to clean their make-up brushes and these can harbor bacteria.  I clean my brushes with MAC cleaner.  I’ll also use baby shampoo for a real deep clean as well.

5.  Remove make-up before sleeping (even if you have lash extensions).

This is a great time to review some standard eyelid cleaning techniques.  I see a lot of blepharitis in my adult patients, especially in women who wear lash extensions.  They have the extensions and then wear make-up, but they are so worried about losing their precious extensions, that they don’t clean their eyelids properly.  This almost always results in blepharitis.  Washing your eyebrows and eyelids with antibacterial shampoo (Johnson & Johnson’s baby shampoo is what I prefer) can help control blepharitis.  Put a small bit of dilute baby shampoo on your ring finger and suds right on to the lid margin for 30 seconds on each eye.

 

 

Why do my child’s glasses keep getting stronger? This is one of the most common questions I encounter in my practice.  I see a patient after they have failed their vision screening exam at their pediatrician’s office and diagnose them with nearsightedness.  The following year, their myopia is worse and the glasses prescription has to be increased.  The year after, same thing happens.  I always reassure parents,”‘This is normal.  Expect the prescription to increase every year until they hit college age”.  But, of course, as a parent, it’s worrisome.   Parents always ask me about TV/video games/foods they can eat, anything that could help “strengthen” their children’s eyes.  Before, I would have to tell them that nothing could be done, it was just genetics.  But, not so anymore!

But, first, let’s just review what is myopia?  Myopia is what most people often call nearsightedness  – you can see up close, but not far away.

 

Myopia is the most common refractive error in kids, and it’s on the rise. My son is obsessed with asking if my husband is nearsighted or farsighted after we read this page in the Cat in the Hat book at bedtime.

 

For myopes, the light rays from the outside world are focused just in front of the retina.  It can be because the eye is a little longer than usual (axial myopia), sometimes for adults, it’s because there is a cataract refracting the light differently.  But, let’s stick to the kids for this discussion.

Myopic eye diagram

So, it makes sense if one parent is myopic, then the child has a good chance of becoming myopic as well.  Eye size is inherited just as hair color, height, etc.  My boys don’t wear glasses for real (though they are modeling them in the picture above), but I should qualify this as a YET.  I am not nearsighted, nor is anyone in my immediate family, however, my husband’s side is a different story.  So, there certainly is a good chance that they may require glasses in the future.

Now, here’s a little throwback to high school physics.  For nearsighted individuals, the lens shape (concave) helps to focus the light on to the retina.

Screen Shot 2015-03-17 at 12.56.21 PM

Now, to the good stuff?  What can be done?  Two new studies have come out which have had some very promising results in terms of decreasing the progression of nearsightedness in kids.

1.  Increase Time Outdoors

One study examined 2000 children in Australia and specifically looked at the type of activities children were doing.  They then followed-up the kids 5- 6 years later to figure out which activities seemed to make a child more nearsighted.

  • Time spent indoors
  • Time spent doing near work (reading, homework, iphone, etc).
  • Family history of nearsightedness

So, what does this mean.  Being outdoors in the sunlight, is protective.  Kids who spent 1-2 hours/day outdoors, were on average a whole diopter less nearsighted than their peers who did not.  That would mean -3.00 prescription instead of a -4.00 prescription. And, the more time kids spent indoors on devices made their myopia worse.

But time spent doing near work, in and of itself, did not cause nearsightedness.  So, the belief that too much time spent on the iPad/iphone will cause a child to need glasses is incorrect.  I am asked this leading question at least daily by parents “Using the iPhone or playing video games is bad for the eyes, right?”  .  They look at me hopefully, expecting me to dispense a lecture to the kids of the dangers of said devices.  But, unfortunately, it’s just not true.  Now, what I do tell them, is that first and foremost, too much time spent on these devices is not great for their brain.  A policy statement issued  by the American Academy of Pediatrics warned about the dangers of attention problems, sleep difficulties and obesity from too much time spent on media devices.  However, there have been no conclusive studies which link media devices with eye or vision problems.  BUT, when kids are playing on these devices, it does make it more difficult to get them outdoors, in the protective UV light and that can make them more nearsighted. So, is it the bright light or the UV light that’s protective?  Well, studies in animals seem to indicate that it might just be bright light which is helpful, though it’s still too early to draw conclusions.  However, I still recommend that kids should always wear protective hats, sunglasses and clothing when outdoors, especially here in Hawaii.

Being myopic is not just a pain for children to wear glasses, it can also have serious consequences in terms of the health of a child’s eye.  People who are myopic have longer eyes than individuals who are not.  That predisposes them to having retinal tears and detachments if their prescription is higher than -6.00 D.   It’s basically because the same amount of retina is being stretched more in a myopic eye than in a normal eye.  This can leads to areas of thinning or tears which can cause retinal detachments.

 

2.  Atropine 0.01%

Another important study assessed the effectiveness of a dilute version of a dilating drop – atropine – in delaying the progression of nearsightedness.  Studies have been done with different strengths of this drop in the past, but as you may know from going to the ophthalmologist, even when dilute, dilating drops can cause side effects, like blurry vision and sensitivity to sunlight.  But, this study looked atropine 0.01%, which is 1/100th the strength we use in the clinic.  When administered daily to kids, it slowed their nearsightedness and also decreased the elongation of their eyeball.  Therefore, they were less at risk for those dangerous retinal tears or detachments.  I now offer these drops to a high select group of patients who have nearsightedness which is worsening quickly.

Schools in China are already applying the outdoor time in an effort to decrease their incidence of nearsightedness.  And, for those kids for whom this preventative treatment is not enough, then there is hope with the atropine drop.  As more studies come out, the research will be even better in helping us slow nearsightedness in our kids.

 

Jan 2018 Update:

I have now been prescribing low dose atropine for the past 3 years.  I have about 10 patients who have completed treatment and another 40 or so who are currently undergoing treatment.  I have been impressed with its limited side effects and the its efficacy.  However, it’s a difficult treatment – simply because it requires putting an eye drop in a kid’s eye ever single day.  If you have kids, then you know, that can be quite a challenge.  It’s just adding one more thing to the list of things that needs to be done.  But, I do think it’s worth it, so talk to your pediatric ophthalmologist about it and see if your child is a good candidate.

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