I have recently started relying upon my glasses a little more.  My prescription is pretty small and I have only noticed in the past year or so, after I hit 40.    I usually choose the same type of rectangular frame and my prescription hasn’t changed in the past 2 years.  Just look at my collection – other than the difference in color, basically the same shape.

I usually wear my glasses for about an hour or two a week.  Not too often in the past, but, lately, more than that.  My usual go-to pair was this pair of Ray Ban above or the Fendi below. Same rectangular shape.

So, our clinic is upgrading our lenses to the new Zeiss lens and I chose a new pair of glasses to go with the new lens.  I got the pair back and it was SO clear.  Like viewing in HDTV clear when I had been watching an old cathode ray tube TV.  I loved them.

Then I decided I was tired of getting the same shape frame over and over, so I decided to try something totally different – round.  And, when those glasses came back a week later, I just didn’t like my vision in them.

Until I experienced this, I think I never truly understood what a patient meant when they said their vision was “too clear”.  But, that’s exactly what I felt.  I couldn’t quite put my finger on it, but it just wasn’t the same as the other pair I had just gotten.  Same prescription, same lab making the lens.  Only thing that was different was the shape of my glasses.  So, I asked my optician her thoughts and the first question she asked me

  1.  Are you switching back and forth between your two different pairs?

    Well, yeah, of course.  Turns, out that’s the wrong thing to do.  Being a newbie to wearing glasses, I had not given myself time to adapt to the new frame, so I asked our optician to give some advice about adapting to new lenses.

 

Hi, I’m the Optician for Honolulu Eye Clinic.

So you’ve finished the eye exam, and for the first time in your life, the doctor says you need to wear prescription eye glasses. You’ve never worn glasses before so you talk about lens options with the local optician, select a gorgeous new frame and finalize the order details. The optician calls you two weeks later when the glasses are ready. You try them on and your eyes widen in awe as you look around and suddenly see everything in sharp detail and crystal clarity. But after a few seconds of looking around, you start to feel a little funny. Objects almost look too sharp and after looking around and around through the lenses, you start to feel a little dizzy and feel a headache coming on. You look up at the optician in alarm and say, I cant wear these!!!

 

STOP. Take a deep breath.

 

This is a NORMAL experience, referred to as the adaptation period. Nearly all first-time glasses wearers experience initial dizziness and a sort of “off-balance” feeling. This is the time when the brain needs a chance to get adjusted to what the eyes are now seeing in crystal clarity. This is very common, and sometimes it takes a few minutes, a few days, or even a few weeks, before you can fully enjoy your new glasses. So don’t be discouraged! Take breaks when you experience dizziness, but do your best to put them back on and wear them as much as you can.

 

HEC Tips:

WEAR YOUR GLASSES. This seems like a no-brainer, but wearing the glasses every day for one or two weeks will give you the best chance at getting used to the new prescription. If dizziness or the “off-balance” feeling is the issue, practice wearing them in a safe environment, such as when you get home and are doing chores or watching TV. Be extra careful if you are wearing them while driving and walking down flights of stairs.  

 

KEEP YOUR HEAD MOVEMENTS NATURAL. Often times, first time wearers stop moving their head as they normally would and move their eyes only. Let your eyes and head work together, turning your head towards something you want to look at rather than just moving your eyes. This will usually help to reduce headaches and dizziness.

 

CLEAN YOUR LENSES. Smudges on the lenses are distracting to anyone wearing glasses, but especially to a first-time wearer who is adjusting to a new prescription. Keep your lenses clean with a small drop of liquid soap and water, and wipe the lenses dry with your Honolulu Eye Clinic microfiber cleaning cloth.

 

Even patients who have been wearing glasses for years can go through an adaptation period. Changes in prescription, slight changes in the inner curves of the lens, or even changing into a different frame style can create the need for an adaptation period. If this happens to you, TRY NOT TO WEAR YOUR OLD GLASSES. Resist the urge to switch to an older pair during the adaptation period. We understand that you may feel more comfortable wearing the old prescription, but wearing the old glasses will not give you a chance to adjust to the new pair. Even switching back and forth from old to new can prolong the adaptation period.

 

Wearing your glasses full-time for one or two weeks is typically the best way to adapt to your new prescription, however, if after that time you still experience headaches and dizziness, call your eye doctor  to schedule an appointment. It may be possible that a correction to your lenses or the prescription may need to be made. 

 

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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red aloha rupa sig

 

I didn’t grow up wearing glasses.  I always wanted glasses when I was young, but I didn’t need them.  And, I used to always hate the feel of sunglassses on my face.  They felt heavy, so, of course, I never wore them like I should have.  Nowadays, I adore my sunglasses – one day I’ll take a picture of the many pairs of sunglasses I’ve accumulated after 7 years of owning my own optical shop.  Yet, I still never truly know what type of frame is best on my face.  So, I asked Kristel, one of our opticians for help.

Kristel, our optician, performing measurements on a young patient.

Kristel, our optician, performing measurements on a young patient.

After having an eye exam, your doctor gives you a prescription for eyeglasses and you head to an optical. Once you are at the optical shop, you see many frames to choose from and don’t know where to start. Knowing your face shape is the best tool in selecting the right frames. You want a frame that compliments your features as well as looks good on your face.  Knowing your face shape helps choose your hair cut, make-up and accessories (including glasses).  Read here and here to determine your face shape.

Face Shapes:

Circle:

Round faces are about curves. Cheeks are fuller, with a wide forehead and round chin. The face is proportional in width and length and has no angles. Try angular narrow frames to lengthen the face, a clear bridge that widens the eyes and frames that are wider than deep like a rectangular shape. The angular shape will make the face appear longer and thinner. Rounds also go well with a slight angle on the corners to show off cheeks and bring attention to the eyes. Stay away from round shapes.

 

These circular frames on Kauis circular face do no balance her round face shape

These circular frames on Kauis circular face do no balance her round face shape

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These geometric frames add distinct, sharp lines to balance the round features of her face

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Oval:

Oval faces are considered the ideal shape because of its balanced proportions, with a gently curved jaw line that is slightly narrower than the forehead. The cheekbones are in general high and length is about 1.5 times the width. This shape is versatile with features that fit an assortment of frames. Try square and rectangular frames to add contrast to the curved lines on the face. One downfall is the size of the frame; it can either be too small or too large and can throw off the balance of the face. Avoid frames that are too large or can cover half of your face. A large frame that covers up your face will be overpowering and not as flattering. Colors are essential, you want to find frames that match your eyes and hair and will get the most compliments.

 

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Aubreys oversize frame overpowers her oval face. In addition, the circle shape does not enhance her features.

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The rectangular frames are better suited for her oval face.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Square:

Square faces have a broad forehead, strong jaw line and the width and length are the same proportions. Try frames that highlight the brow line with shape and color to balance the jaw line.  Also try frames that have more width than depth, narrow ovals to soften the angles and look longer. Oval and round frames are perfect for this shape.

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Though very cute, these Dior frames accentuate Dr. Bosserts square face and seem severe for her.

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These rounder Valentino frames soften Dr. Bosserts face and are the perfect fit.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Heart:

Heart shaped faces are broader at the forehead and narrow at the jaw line and chin. The face can be round or long, the forehead is wide and gradually narrows down to a pointed chin. Try to find shapes that balance the varying widths of the face. Since the face is narrow at the bottom, a bottom heavy frame makes the face appear more balanced. Frames with low-set temples focus attention downward to minimize the forehead. Oval-shaped frames take the attention away from your chin and focus more towards your eyes.

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The paler shade of the bottom of these frames do not balance this heart shaped structure of this patients face.

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This heavier frame balance the heart shape.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The purpose of your glasses is not only to improve your sight and protect your eyes; it should also accentuate your facial features.  As long as you know your face shape, choosing a frame should be easy. If you have any questions on color or choosing between what frames look good on you, our opticians are more than happy to help you.

 

 

 

 

 

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.

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“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.

 

As many of you know, I have 3 children.

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We found out we were pregnant with my oldest son the first weekend we moved to Honolulu.  We had just taken over Honolulu Eye Clinic, and out of nowhere, I came up with the idea to have a nursery in our office.  My husband thought I was crazy, but I figured, we are the owners, we can do what we want!  And, I also predicted (correctly, as it turns out), that Hawaii is so family centric, so focused on ohana, that I didn’t think patients would mind.  Plus, since I am a pediatric ophthalmologist, there were going to be kids crying from dilating drops anyway, what’s one more kid?

At the back end of the office, there was this room which Dr. Edwards was just using as a storage space.  I told Jeff I thought this would be the perfect nursery.  He didn’t have the vision I did and had a hard time imagining it.  He said “We’re going to put our first born in a storage closet?”.

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It was definitely a bit of a mess.  The 2 nice things about the space was that it was pretty large and that it was right across the hall from the pediatric waiting room. (which we stayed up until midnight before our first day putting together).

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Pediatric waiting room at Honolulu Eye Clinic

 

So, after craig’s listing everything in the room and reorganizing it all, we had a blank slate.  The room is actually bigger than the nursery we have at home. I kept everything pretty simple.  Just some paint on the walls and I found a comfy chair to nurse in off of craig’s list.  I was given a second hand pack and play which fit better in the room than a crib.  Then off to Target for a couple rugs and a changing table.

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Hard to believe it’s the same room ,right? I made some green curtains from fabric from Walmart to hide all the storage we still needed to keep in the room.DSC_0178I cut the top off cardboard letters and filled them with fake flowers from Ben Franklin.

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Lots of books from garage sales! You can never have too many books

It was so wonderful to have my kids close by when I was nursing.  It really helped me go back to work sooner, because I wasn’t worried about who was watching my children.  We were so blessed to find a wonderful nanny, Gabi.  And, I just scheduled a block in my schedule mid-morning and mid-afternoon to breastfeed.  It was ideal.  I never had to pump or worry about not producing enough milk.  Though the downside was that none of my 3 kids ever learned to take a bottle, they were very spoiled!  Our nanny would take the kids for walks, and when they were older to activities like Wee Play, Ohana Music Together, Children’s Discover Center, Aquarium, Hawaii State Library, Honolulu Zoo.  Queen’s is so well centered, that a lot of things were walking distance.  So, as the babies got older, they weren’t actually in the office nursery for that long, but they would come back for lunch and nap, and just seeing them at those times was wonderful too.  Gabi moved to the mainland when Nikhil was a little over a year old, and we were blessed again with another amazing nanny, Shawna.  She truly loved our kids as if they were her own.

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The other plus side of having a nursery in our office was that my children grew up with the wonderful girls we have on staff.  They call them their “Clinic Aunties”.  Again, another reason they could have been a little spoiled.  My kids love coming to the office because not only do they see us, but they adore seeing their aunties too!

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And, that’s what is truly wonderful about Hawaii – my patients loved seeing my kids, they wanted to see the nursery and be updated on how they were doing.  I have one patient who even made her appointment times with me around my baby’s nap schedule so she could see him!

My youngest child juststarted preschool last week – hard to believe!  So we will no longer need the nursery in the office and the plan is to turn it into an exam room next month.  I know, kids growing up is all a part of life, but clearing out this nursery definitely tugs at my heart strings.  And, no, we’re are 100% not having any more children!

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And for any other DIYers out there, here are some pics of our nursery at home.  It’s the same room, just decorated differently.  For Taj’s nursery below, my mom made the crochet airplane mobile with sewed in musical buttons.  I painted the canvas with Taj’s name in Tamil and his Chinese name as well.

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Taj’s cultural/travel themed nursery.

When we had Arya, we moved Taj to another room and I really DIY’ed everything from the crib bedding (thanks Mom!), to the felt mermaid crib mobile (made that while sitting in the doctor’s office during my pregnancy), hand stenciled curtains for Arya’s room with a coral paisley (absolutely never again – want to get back pain? then hand stencil curtains when you’re 36 weeks pregnant and then sew them with black out liner), paint stick mirror, gallery wall from old frames that I got for free from Pictures Plus and spray painted gold.  For some reason, I really love designing and decorating kids spaces.  I think they’re just so much fun and are meant to be creative spaces for your little one to grow.  It’s my stress relief from work!

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Arya’s gold glam mermaid nursery

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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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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 haven’t been blogging lately because we are doing a website overhaul and I didn’t want to keep adding too much content for the company to have to pull over to our new site.  For the new website, I wanted to add some additional photographs of our patients and staff.  I always feel like it’s much easier for someone to take that jump into having cataract or strabismus surgery if they can actually see pictures of patients who have the same procedures.

Through my friend, I found a great high school senior who is in the Photography club.  He has been taking pictures of my kids for the past year and I thought it would be great to hire him to do shots for our website.  He’s great – extremely reliable, easy to work with and turns the pictures around in 3 days.

Here’s a sneak peak.

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Our optician, Joel, performing pupil measurements on a patient.

This is our newest licensed optician, Joel Babb.  He’s a wonderfully experienced optician who is skilled at matching the exact lens type to fit the patient’s lifestyle.  He is also extremely personable and filled with aloha spirit.  We are really lucky to have found him.  He joins our stellar optical team of Rachel Rolison and Kristel Rabago, who have been doing an awesome job helping our patients.

We have 3 full time opticians and all are uniquely trained to assist with fitting glasses for kids.  Our selection of glasses is also one of the largest for kids.  We carry Roxy, Hello Kitty, Adidas, Disney, Flexon, Liberty sports goggles and Miraflex to name a few. We have kids as young as 10 months old in glasses.

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Our optician, Rachel, marking the pupils to make new glasses for a pediatric patient.

Here’s Dr. Bossert teaching a patient how to insert and remove contact lenses.  Our contact lens technicians are also specially educated at providing one on one contact lens training sessions for all patients – from pre-teens getting their first pair of contacts to adults who previously thought they could never wear bifocal contacts. With the range of different types of contact lenses now available, we can fit even the most complicated patients. Our staff review correct wearing schedules, proper lens hygiene, insertion and removal techniques, and contact lens care systems with every patient, making it the ideal place for patients new to contact lenses. We fit spherical, toric, multifocal, scleral, and rigid gas permeable lenses, to name just a few.

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We have an awesome surgical counselor, Ronnie who makes herself available to patients 24-7.  She answers emails, texts, and phone calls at all hours.  She obsesses constantly to make sure everything is complete and finalized for every patient.  And, she is able to reassure patients as they navigate the entire surgical process from booking the initial consultation to the post-operative visits.  In addition, she is also my assistant in the operating room for strabismus patients.  Patients love seeing a familiar face in the operating room.  Here she is reviewing an upcoming surgery with a patient.

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Of course, I do exams on children and most of them are so interested in every aspect of the exam.  They love getting examined at the slit lamp.  Often times, my pediatric patients can hold more still than my adult patients!

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Here’s our staff hard at work.  We’ve transitioned to a new Ipad based electronic medical record, from Modernizing Medicine, so you’ll often see us on both the tablet and PC.  It’s a really new system.  I believe I am the first private practice pediatric ophthalmologist to use it, and Dr. Bossert is one of the first optometrists to use it, so we’re helping them work out the kinks.

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And, finally, Aubrey, our front desk receptionist, getting some make-up done before her close-up.  Look for her beautiful smiling face when you come in for your next appointment.

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Keep checking our website for the new updates!

 

It will definitely take me another month to get used to writing 2013 as I sign charts in the office.  Unbelievable how fast 2012 went by.  And, a lot was accomplished in 2012 at Honolulu Eye Clinic.  Here’s a little recap of our favorite moments/accomplishments of 2012!

1. Our office renovation was begun and completed (though almost wasn’t completed!).  Amidst a contractor who declared bankruptcy mid-way through our project and the fact that I was coordinating everything while on maternity leave, somehow our renovation was finished.  Click here to see our fist blog about demolition (I was so excited and naive to think things would be completed without a hitch!).  And, click here for the post about the progress.  If you haven’t been in yet for your annual eye exam, here’s a look at the finished office.

2.  Jeff and I made the Best Doctors in Hawaii list and were featured on the cover of Honolulu magazine.  Click here to read about the photoshoot.

3.  We had 2 glasses trunk shows (Gucci/Dior and Fendi/Valentino).  Below are pics from the latest trunk show.

 

4. We were featured in Midweek twice – in the Business Roundtable section and the Doctor in the House section.

5. Taj (my second son), turned one !

6.  We added some amazing staff members to our HEC ohana (Summer, Amalis, Amber, Michelle, Jocelyn, Lauren, and Sam join verteran HEC staff – Lia and Grace).  See how we’ve grown over the past 4 years!

September 2009 (one year)

August 2010 (two years)

 

April 2011 (2.5 years)

April 2012 (3.5 years)

 

November 2012 (4.25 years!)

 7.  I published my first textbook on strabismus surgery.

8.  We had 4 cosmetic open house events, including the very successful Mommy Makeover event.  Below are pics from our last one in December – Gold Medal Glam – Beauty for Athletes.

 

9.  421 likes on Facebook.

10.  Judged the Miss Chinatown competition this past fall and met some amazing young leaders in our community.

Thanks to all of our patients, friends and family for your support throughout the year!

 

Our renovation is almost over – thankfully!  Thanks to all of our patients who have endured the chaos, mess and cramped temporary reception area as we have renovated over the past 2 months.  Our HEC patients are so great – they tolerated sitting on the ground, their charts being misplaced and all sorts of blunders as we tried to cope with seeing patients while renovating.

Of course, the reno was supposed to be done on Feb 1, by the time I returned from maternity leave.  And, of course, that didn’t happen.  Demolition only began on January 23, so there was no way that it was getting done in a week.  We have never renovated anything before and this was certainly a learning experience.  Lots of delays, items that we had to make sure were done properly.  But, we are getting very excited – the new space will certainly now be large enough to accommodate all of our patients.  Below is a sneak peek at the office.  We have started using the reception area even though we are still waiting for the granite to be installed and there’s a laundry list of items that still need to be completed.  The end is in sight!  Anyone out there survived a recent renovation of your home or office?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Even baby Taj is helping clean the new shelves!

© 2011 Honolulu Eye Doctor & Mom Suffusion theme by Sayontan Sinha