Tuesday, November 26, 2013

The difference between Ophthalmologist and Optometrist's

Recently I went with one of my dearest friends as she took her 6 year old to the optometrist who also specialized in Vision therapy. Another dear friend referred her to this optometrist .  I'm interested in the subject immensely of course,  so she allowed me to go along.

If I hadn't been through so much with my own eyes, I would have never batted an eye at this subject. This optometrist was excellent....But I knew... She is still not a medical doctor.

The optometrist was very kind and very seemingly very smart.
The clinic had all sorts of high tech equipment.
We were in a smaller town in central MN.  I am used to going to the Mayo Clinic in Rochester and this little clinic had equipment that appeared to be of higher tech than the revered Mayo...

This appointment was very important as my little friend Lane, seems to be struggling to learn sometimes in school.  We wanted to make sure his eyes were not contributing to his struggles.  Turns out, yes! He needs a new prescription.  He favors one eye affecting his depth perception etc.  but as I looked at the perscription I found it odd that the child needed equal prisms in each eye and now bifocals at age 6.  I was a little worried about how hard it might be for a child to adjust to bifocals when it is sometimes quite difficult for adults to adjust to them.  I was worried he'd be just frustrated and take the glasses off altogether.

Optometrist, as I understand it, have not gone to medical school. They go to four years of optometry school.
Ophthalmologist, have gone to 8 years of medical school. And some have gone on to 2-3 years of subspecialty training.

Optometrist, specialize in eye exams, vision changes, managing already diagnosed eye issues and they can refer you to an ophthalmologist.
Ophthalmologist, specialize in comprehensive eye health, they can see the 'larger picture' of overall health, in regards to cause and effect and treatment options of various issues.  After an issue has been diagnosed, and optometrist can be quite capable of monitoring a condition.

I like to think of it as the optometrist is the ophthalmologist right hand man in caring for patients.

Apparently, this is a hotly debated item in eye world, especially in the USA.

As far as the fancy equipment.... well, come to find out.  Sometimes the best equipment is the doctors knowledge.  Sometimes simply doing something like dilating the eye is much more accurate than snapping a picture of the back of the eye.  Although, I'd like to add the machine is more comfortable.    That being said.  Nothing can out shine the human brain.

We followed up with a second opinion to the local Pediatric Ophthalmologist specializing in Strabismsus in our own town to learn that Lane's eyes were actually good! Very Good. He had better convergence than most his age. He just had a small stigmatism .  He did not need vision therapy and really could see good with out his glasses.  When all was said and done. Lane's eyes were not the cause of his class room issues.  It was more behavioral.  Can you imagine if we had gone down the road of prisms and bifocals?
Turns out Lane's mom had a hunch his eyes were working fine together ( converging well) He is excellent at sports.  Never misses a ball.  So how could his depth perception be that far off?
In this case the Optometrist was way far off.  We're so glad we got a second opinion before proceeding to put Lane through even greater frustration with learning.

 Please take the time to read the link noted here.
It makes a difference.  If you get well intended, but incorrect eye care, especially at 6 years old.  It will affect your whole life.

Do your home work... See the right Doctor at the right time! If you're 6, it could mean your future.

Friday, January 25, 2013

Punctal Plugs

Yesterday, I went to see my local eye doctor to see what we could do about how dry my eyes have progressively become.
They didn't seem too dry of course on the day I actually go to the doctor. But yes, indeed, they were so dry ( especially my right eye which has had more trouble) my normally 20/15 vision they now rated 20/25 which still is good, but I was alarmed as I truly couldn't make out one letter with my right eye on the exam.
After examining my eyes thoroughly, my doctor recommended temporary punctal plugs to be inserted in my lower tear ducts. This is to keep the fluids on my eye from quickly draining off,  ( and yes, I can still cry- my coworkers were wondering this today)
They simply putting some lovely numbing drops in your eyes, (that felt a bit like isopropyl alcohol) so I wouldn't be uncomfortable at all.
I simply had to look up to the ceiling as she used what I imagined were very precise instruments to insert this tiny little plugs deep into my tear ducts.  I felt the pressure etc. of what she was doing.  It really was no big deal.  However, I've had many eye procedures this was again, not a big deal.

However, I am happy to report that already this morning I can tell a nice difference.  It didn't hurt to blink and my eye lids didn't stick to my eye ball.  Must say, it was much nicer to wake up like that!

You can't see the temporary plugs at all in my case. She chose the temporary punctal plug because it had a greater chance of staying in for the full 4-6 months.  I agreed to this as I did have a permanent plug put in some time ago that popped out after 3 weeks.  The doctor figured I itched it out of my eye during allergy season.  See, the permanent punctal plugs have the tiniest little white dot that sits just above the tear duct. I must have worked that plug right out of my eye with my allergy to ragweed that summer.

Anyway, I'm very excited to find a bit of relief from these dry, burning, blurry eyes.

Also, it was lots of fun to hear how excited this doctor was when reviewing my strab. measurements.  She just couldn't get over what a difference I am now compared to before surgery.  It really is a miracle!

Friday, April 6, 2012

Tables turn

Quite interesting to accompany a friend as she went and had surgery with the same doctor I had down at the Mayo Clinc in Rochester this past week.
Very nice, I must say to NOT be the patient!  My friend did great.  But the doctor did even better.  He hit a home run! Amazing!  He put an adjustable suture, on EACH eye. But when he went to adjust them about 5 or 6 hrs later, they were pretty much 'spot on' , no double!  So he just had to tie the sutures off and clip them.  Amazing!
Immediate success!  Very cool to see such results!
Also, Very interesting to see them do the adjustable sutures after having had them done to myself 4 different times.  I concluded after seeing it all, it's not so much the act of surgery that is amazing, it is all about getting the math correct and knowing where to land those crazy muscles on the eye ball in the first place.  As the surgeon said, " the adjustable suture gives you the ability to be as aggressive as you need to be" meaning  a surgeon can fine tune and get it exactly right all because when the patient is awake they, by way of feed back and tests the dr does while adjusting the sutures, can make sure the muscles are exactly where they need to be.
I crudely would compare it to adjusting your headlights in your car... You would put your new headlights in, then sit in the drivers seat and see if it's correct, get out adjust them if need be etc.
Very educational this week was.
I'm gaining even greater appreciation for this science.  So fun to watch someone do this, plus, all the while he was teaching others the whole time.  That was pretty neat too...  So interesting to come this full circle and now be able to see someone else go through it.  Another eye miracle -- Poof!

Saturday, February 12, 2011

Ophthalmology vs Vision Therapy

I am breaking my promise here not to write anymore. However this is for a good cause.  
There are so few blogs about adult Strabismus that I fear people are getting only one side of the story on surgery vs. vision therapy. I edited this post on May 1, 2011.  Sorry it is long, but my hope is that it's worth the time it takes you to read...

My purpose in writing this is to encourage people to be as in formed as possible when it comes to weighing the options of surgery vs. vision therapy.   If you choose to search the web lean towards the sites that are .org's or .govs.  These have more credulity. Reading personal experiences on blogs are nice but, including mine, they are PERSONAL experiences.  You will have your own.  Just make sure you are educated by people who really know the science behind this eye disorder.

I have only heard about VT this past year - after all my surgeries.(4 surgeries - 8 procedures and FIVE cortisone trochlear  injections) Frankly, I was afraid I took the easy way out in having some one else fix it and someone else pay for it. ( although my deductible is HUGE) It made me question whether I was just lazy and didn't want to do the hard work to "fix myself" with therapy.  Was it my fault? Was I just a weak person for choosing surgery? I just didn't want to work hard to fix my problem?  That's what led me to ask this orthoptist questions about VT.

One blog mentions the authors opinions that Ophthalmologists do surgery for cosmetic reasons.  That is one view point.  Just because it is on the internet does not now make it a fact. That would make an ophthalmologist a cosmetic surgeon.  Which they are not.  From my personal experience how I look is the least of my problems. Surgery for me was critical. I knew I was soon to loose all single vision.  I had an inferior oblique that was too long. (we only learned that IN surgery)   No amount of exercise could change that fact.  I had a head tilt all of my life.  With one 3 hour 'nap' (surgery) I wake up and my head tilt nearly gone.  My neck pain is gone.  That is NOT cosmetic.  I woke up with depth perception.  That is not a cosmetic result.  That's a functional result.  Least of all, I don't see double anymore.

Vision therapy (VT) verses Surgery is one hot topic apparently in the 'eye profession'.  Keep a clear head when talking to Dr.'s and therapists.  Does it feel like a sales pitch?  Does one profession completely put the others down?  Maybe you'll agree, when a person is truly in the right, there is no need for putting others down.  You should clearly understand YOUR eye problem first.  Questions to ask; "Do I have a muscle weakness, or do all my eye muscles work equally? I personally, had a 4th Cranial nerve that wasn't working correctly, so no amount of exercise could bring back the nerve to functioning correctly.  What is YOUR situation?  If you do not clearly understand what your problem is how can you understand how to treat it?  Really good Doctors let you ask any and all your dumb questions and they would never think you dumb for asking them.
According to one orthoptist there are two types of Strabismus.
1):  there is NO obvious muscle weakness; the eyes move normally in all directions, they just don't work together normally. Usually this type develops in early childhood and is NOT associated with double vision. Some unfortunate souls develop double and it can be tricky to treat.
2): There IS a muscle weakness (various causes, various types and combinations of muscle weakness) and the eyes do NOT move normally in all directions. When you have this type (as I did) the muscle imbalance needs to be addressed in order to get the eyes to work together normally again - this involves either i) repositioning the eye muscles themselves or, ii) moving the double image using prism glasses so that it can be "fused" by the brain with the 'real' image (not possible in ALL types of double).

Something I learned this past two weeks:

Where VT (vision therapy) comes in: VT mostly tries to re-train the brain in how it processes what is seen. Occasionally it will claim to strengthen the muscles themselves, but i think even the most outspoken VT proponents wouldn't claim to be able to re-charge a weak/underacting nerve!
Now, if you have normally moving eyes that are out of balance the whole idea of VT has slightly more credibility than if you have non-normally moving eyes. As far as I understand it, no amount of VT in the world will make a weak / paralyzed nerve / muscle suddenly start moving / acting normally again.
SO, in my case the eyes needed to be mechanically re-balanced so that the images from each eye would line up with each other and your brain could then stand a chance at fusing them into  one 3-d image. (Prisms can work to optically relocate the double image but this does NOT work if you see a twisted / tilted image (which I did have) ... surgery is the main treatment option in that case)

Questions to ask your doctor's and therapists;  Well, there are endless questions if you are me, just ask my poor eye doctors.  I never stop asking questions.  But if you are considering vision therapy or surgery, why not ask each professional, why do you feel your approach would be superior to this other approach?  For instance in talking to a surgeon: " why do you feel VT would not work in my case?"  In talking to a VTherapist maybe ask them; " Why do you feel surgery is not the answer?" Go home and think about it.  Does their explanation make sense to you?

It is a valid question why insurance would cover surgery and not vision therapy.  It should raise a red flag or at least a yellow one that says "Proceed with caution"  Do your own research and not on Wikipedia.  My last surgery was complicated and cost $21000. or so.  So I don't think they are taking the cheap way out.

Insurance companies must feel surgery is a more stable, predictable out come.  Also consider, will vision therapy UN- suppress some suppression you've been having? Great!  Maybe it can.  But what is the alternative?  Both eyes working but not necessarily together?  When that happens you have double vision.  I'll tell ya from experience.  Double vision isn't necessarily better than suppression.  Much more upsetting.  There are no guarantees that you will move past double vision into single vision, and how long might that take?  Make sure you are not trading one problem for another. Some times the solution can be worse than the problem. This is a huge concern that surgeons have with VT.

Depth perception is not someone with misaligned eyes enjoys.  Will you get that back?  I hope you do.  But I don't know if I would put all my chips on the table just for that.  Why do I say that?  Because I didn't have it for 36 yrs. and you know what?  I got along just fine.   I didn't feel like I was 'suffering'  because I wasn't.  Now I think I have it back but you know what after the first two months you forget you have it back.  (until you get in front of a 3-d movie -and it is really really fun-  but that's like 3 times a year- you can have a full life with out seeing all aspects of a movie)

Maybe this is cold and harsh reasoning.  But I am genuinely afraid of people not using BOTH eye doctors and therapists.  Why can't every one play together nicely?

My blog is simply to log my journey's ups and downs of this amazing experience. Writing is like therapy for me, so If you can learn something from my experience, great.  However, it is not my intent to teach something here.  I just want to encourage ones to do their own research from legitimate sources.  Stick to the .org's or .gov. websites you'll fare much better.  I wish for everyone to have the success I found.  I lost my hope for many years and now have it back. Best wishes to you!

3/31/13 found this. Might be worth a readhttp://quackwatch.org/01QuackeryRelatedTopics/eyequack.htmlhttp://quackwatch.org/01QuackeryRelatedTopics/eyequack.html