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.

 

 

 

 

 

I thought I’d devote a post to those common myths you always hear about the eyes.  I get questions about one of these at least once a week.  It’s hard to do something contrary to the old wives tales you grew up hearing, and sometimes I even have to stop myself from believing something which I know is not true!  My oldest son loves the show Mythbusters and I have to admit, it’s pretty cool, hence the Mythbuster approach to eye myths (without any of the experimentation!).

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So, let’s get started.  Common Eye Myths – which ones are true and which ones are not!

1.  It’s bad to read in the dark.

This is how my son loves to read at night.  All the lights in the room are off and he uses this little bedside Ikea light.

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It actually is not dangerous to read in the dark.  It doesn’t make you need glasses sooner.  It doesn’t tire the eyes out.  There was one study which showed that reading in the dark for adults did affect their comprehension and reading times.  So, it stands to reason, for young readers, it’s best to use high contrast reading material to make it easier for them to read faster and understand what they’re reading.  But, again, not unsafe for they eyes.

MYTH BUSTED

2.  Babies will outgrow cross eyes.

Very rarely, babies can have wandering or crossed eyes when they are born.  Just like they are learning how to use their arms and legs, they have to develop their eye muscles and vision.  However, by the time babies are 4-6 months old, they should be able to use their eyes to focus on faces and toys up close with straight eyes.  It’s actually common for babies younger than 6 months old to have eyes that wander out.  The problem that often happens, is that many babies have real crossed eyes, which do not improve with time, as in my patient below who needed surgery.

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Sometimes, the parents, and even the pediatricians, falsely reassure the parents that this kind of eye crossing will improve.  So, they wait to come to see a pediatric ophthalmologist. This kind of eye crossing, esotropia or strabismus, does not improve with time.  And, actually when babies have esotropia, it is best to operate sooner rather than later.  The sooner your perform surgery, the better the child’s change to maintain or restore their depth perception. Strabismus surgery in infants is not a cosmetic procedure.  There is a lot of misinformation about strabismus surgery.  I remember I was operating on the little baby above (she was 7 months old) and even the Harvard employed anesthesiologist at Boston Children’s was questioning the mom as to why she was having surgery at such a young age!  Thankfully, the mom was extremely well educated on the topic and could set the anesthesiologist straight.

MYTH CONFIRMED (with a caveat)

3.   Sitting too close to the TV is bad for the eyes

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Maybe about once a week, I get a parent in my office who hopefully asks “It’s bad to sit close to the TV, right?” looking meaningfully at Little John in the exam chair.  Except, that it really isn’t.  So, I truthfully answer that sitting close to the TV is not harmful to the eyes or the vision.  No studies have found that it makes kids need glasses faster.  But, your child might be sitting close to the TV because they cannot see it.  It might, in fact, be a sign of nearsightedness in a child.  Your children’s eyes have the ability to focus much better than an adult, so for them, sitting (or standing) close to the TV is comfortable.  I do always add that the American Academy of Pediatrics does recommend restricting screen time (TV, iPad, iPhone, etc) to a maximum of 2 hours a day and only for children older than 2 years of age.

MYTH: BUSTED

4.  A cataract needs to be “ripe” before it can be operated upon.

Using words like “ripe” is an old school way of describing the severity of the cataracts.  Older ophthalmologists wouldn’t operate on a cataract until the cataract was large enough.  But, bear in mind, this was back when you had to be admitted to the hospital for cataract surgery and use sand bags to immobilize your head post-operatively.  Cataract surgery was a big deal.  Nowadays, no one uses that terminology, because with lasers an new intraocular lenses, cataract surgery doesn’t carry the same risks as it did 30 or 40 years ago.  So, really, it comes down to if your cataracts are interfering with your ability to do things you love – drive at night, reading, painting, etc.  If so, then it might be time for you to talk to your ophthalmologist about cataract surgery.   There’s no hard and fast line about when your cataracts are ready to be removed.  It’s all about how they affect your activities of daily living.

MYTH: BUSTED

5.  Wearing glasses will make your eyes dependent on them.

This is the one I am currently struggling with.  As I approach 40, I find it hard to read my iPhone in low lighting conditions.  I have a pair of very low prescription reading glasses (+0.50 sphere).  But, even though they make my quickbooks accounting much easier, I am hesitant to wear them.  Why you may ask?  I love the look of them – in fact, growing up not needing glasses ever, I always wanted glasses.  I adore my Fendis.  But, it’s for the simple fact that even if it’s way deep down, I still succumb to the notion that if I start to wear the reading glasses more regularly, my vision will deteriorate.  That is just not true.  My need for reading glasses will increase every year whether or not I wear glasses now.  Same is true for kids. A lot of parents worry about this dependency as well.  Children’s need for glasses has nothing to do with whether or not they were their glasses.  Genetics, anatomy of the eye are what’s important.

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I don’t like taking selfies

 

MYTH: BUSTED

6.  Crossing your eyes make them stay that way.

An oldie, but a goodie.

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Nope – crossing your eyes will not make them stay that way.  So, kids, cross away to your heart’s content.  Esotropia, or eye crossing, has many different causes.  People can be born with it (congenital esotropia), it can be secondary to being really farsighted (accommodative esotropia), from a blind eye (sensory esotropia), or even from a nerve palsy.  But, not because you do it over and over again.

MYTH: BUSTED

7.  Carrots help prevent you from needing glasses.

I love carrots.  I ate a ton of them growing up.  It was my after school snack with French salad dressing.  And, I don’t wear glasses (well I didn’t for the first 39 years of my life).  But, though carrots are rich in Vitamin A, that doesn’t help you from being nearsighted, farsighted or having astigmatism.

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It is always a good idea to eat a diet rich in vitamins and antioxidants for the overall health of your eyes.  Click here for my blog post about anti-oxidants and your eyes (with recipes)

MYTH: BUSTED

 

Hope you enjoyed our fun mythbusters post!

 

 

 

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!

 

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.

 

I know it’s been a while since I posted on the blog – the holidays were wonderful, hectic and crazy.  I did my usually DIY projects around the house to decorate and bring in the Christmas cheer.

I made these stockings last year, they took forever because though I’m a patient sewer when I am sewing eye muscles, I am a bit a impatient when sewing fabric!

 

I tried to take a little more time off this year to spend with the kids when they were home on break.

Taj at his Christmas show

Nikhil singing Christmas carols around his elementary school

 

 

 

 

 

 

 

 

 

 

 

 

We worked on little projects together, such as making “Reindeer Chow” together to give my middle’s son’s preschool classmates.  Got the idea from this blog.

Making 20 of something is always more time consuming  than I expect it to be.   I thought making it in bulk would be easier, but the packaging took up time.  And, yes I know – are these 3 year olds really reading these labels?  Probably not.  Am I doing this for myself? Possibly.  But, I’m sure any Moms out there understand – there is this pressure to keep raising the bar with these kind of things and not in a good way.  But, I will say, the reindeer chow was darn tasty and even though I was trying to be low carb, I convinced myself this somehow fulfilled that criteria!

My older son is in kindergarten and the room moms asked for locally made presents for his two teachers.  I am ADDICTED to the Magnolia Mom blog and they had this great tutorial on making gingerbread cookie Christmas ornaments.  I actually found this modeling clay at Ben Franklin that was non-toxic so my son could help roll out the dough and cut out the shapes.

And the finished product.

We spent so much wonderful time with my in-laws family.  My husband has 3 older sisters – one of them lives just six houses down from us, but the other 2 live in California.  They traveled to Hawaii for their annual vacation.  That means 9 adults and 10 children!  We found this great high school senior who is an awesome photographer.  We’ve been hiring him lately to take our family photos.  Check out his website here.  I saw the idea for the signs on pinterest and though I was for about half a second contemplating buying wood, sanding, staining and then painting with chalkboard paint to make the signs as in the original idea, better sense actually prevailed for once and I went with simple posterboard and a chalkboard pen.

The entire Wong side of the family

 

We did a lot of things that I’ve just never had the time to do here in Hawaii, even though I’ve lived here for over 6 years!  When we first moved to Hawaii, we were so overwhelmed with getting on insurance plans, learning how to manage a practice, build our patient base that we never had much of a chance for me to truly explore Hawaii.  My husband grew up here and his family has been here for generations, but I am an East Coast girl and hadn’t even been to Hawaii before we got engaged here!  So, it was wonderful to take the time to do these things with our family.

Hking Diamond Head with the kids

Koko Head Stairs with my in-laws on New Year's Day (my first time!)

I think that was the most important lesson from this past holiday season – even though I’m busy with work, I really think it’s about creating intentional time and moments with your kids.  Quality, not just quantity, right?

And, then last week, we went to Maui for the annual Hawaiian Eye Meeting.  The meeting conferences were from 6:30-1pm, so it left plenty of time to hit the pool and hang out with the kids.  So, we decided to take the children with us.  Here are we are the beautiful resort – look closely because this was the last 5 minutes that all kids were healthy.

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Yup, that’s right – the flu that’s been going around Oahu hit all of the children.  The first 3 days of the conference, our oldest son had it, then the baby for the next 2 days and then the middle child for the last 2 days.  They weren’t even sick at the same time.  And, if you can imagine – 5 of us crammed into one hotel room, cleaning up vomit off the beds, floor, etc.  Not exactly the vacation we were planning.  So, after this meeting we immediately decided to cancel our plan to attend another meeting in San Diego in April.  Just too hard.  I’m sure parents out there can relate – you come home from a vacation, needing a vacation from your vacation!  And, that was with just a 30 minute plane right.  As Arya gets older (she’s now 16 months old), it just gets tougher to travel!  But, when we moved out here, my husband knew we would need to do a lot of traveling to the mainland, since all of my family is there.  Before we were married, Jeff and I used to try to take one international trip a year.  We scrimped and saved as residents and fellows – lots of ramen, walking instead of paying the $1.50 to take the bus somewhere, you know all those things to save money .  My hope is that we will resume international traveling in the way of medical mission trips and I’d love to take the kids.  I think it’s so important for the children to see how life is in the developing world.  However, the thought of being outnumbered on a plane trip lasting over 15 hours with 3 kids scares my husband to death.  I think it’s just about adjusting expectations – you realize it won’t be pretty and it’s not the same as traveling without kids, but you’ll live through the plane ride and the end result will be to create memories that are amazing.  But, that was a bit of a tangent.

I’ll be back to a more regular posting schedule with an ophtho post about strabismus surgery next week.

 

It’s been a while since I’ve posted – mainly because of the holidays.  Everything just snuck up on me this year.  I still don’t know where the time between Thanksgiving and now went!  Some of my patients might not know this, but I love decorating and entertaining.  I’m obsessed with pinterest (as is every woman in America) and I love searching through there to find ideas for everything.  So, I thought I’d share what I’ve been doing for the last month (instead of blogging).

I had a potluck the week before Thanksgiving.  I scoured pinterest and came up with a chalkboard/burlap theme.  I love entertaining, but with 3 kids, I have to keep things somewhat simple and I don’t like spending tons of money on decor. Here’s the invite I designed.

I usually go super overboard with decorations, but I kept it simple.  I bought black Kraft paper from Etsy and used chalk markers to label the dishes.  

I read on a blog that you should put the napkins and cutlery at the END of the buffet line because why make your guests pick it up in the beginning and have to balance it with their plates.  So simple, yet GENIUS!  I saw this cute way to assemble napkins/cutlery together in a clear bag on pinterest (of course) and had to do it.  I purchased the eco-friendly cutlery on amazon and the clear bags from Ben Franklin.

For the table, I just spray painted some mini pumpkins in blue and white and placed them in a bowl with some votives I bought on sale at Soha ($1.60 each!).  I was going for a coastal Thanksgiving theme.

To be eco-friendly, I placed chalkboard labels on mason jars for glasses for guests.

For the kids table, my 5 year old son helped decorate by writing “Give Thanks” on the black Kraft paper which we put on small tables I bought at Costco to serve as a tablecloth.  Easy and a fun thing to keep the kids occupied while waiting for food!

And last, a super simple banner that I made from burlap, blue card stock and  left over ribbon.

Lots of simple ideas for a rustic potluck for tho holidays!  Hope you can use some of them!

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