ask me about eyes

[slim]

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slim,

any thoughts on ortho k?

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Yes.....horrible. You will very likely become progressively farsighted.

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can you tell me more about this? my wife is slightly nearsighted (she wears glasses at dusk and in the evening when she's driving, but otherwise, no problems) and is seriously considering ortho k.

thanks,

-poin

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OOPS....I'm really sorry....I made a mistake. I thought you were talking about RK which is completely a different procedure.

Ortho -Keratology is quite safe although there are reported cases of Acanthomeoba which is a serious eye infecting that can lead to corneal transplant. Even though it is safe, I don't practice it because it makes no sense to me why anyone would benefit from it. Your wife only wears glasses at dusk for driving, so why would she go through the hassle, discomfort and expense of wearing hard contact lenses at night to sleep just so she doesnt have to wear glasses to drive at dusk? The cost of the procedure and contacts usually is close to the cost of having lasik. But in your wife's case, I would probably not even recommend lasik bc her vision seems quite good. It's all risk vs reward. I was blind as a bat so my reward was high and my risk was low when I had lasik. Your wife on the other hand would be low reward low risk....not worth it in my opinion for both lasik and ortho K.

[slim]

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should you get percription sunglasses or get normal sun glasses and wear your contacts?

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As long as your sunglasses have 100% UV protection, it doesn't matter although it would make more sense to wear normal sunglasses and contacts bc they are nicer and when you go indoors, you would need to take your prescription sunglasses off and then you wouldnt be able to see clearly.

[slim]

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are you an md? i always get confused to whos who in the eye business.

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No...I'm an OD. Everybody gets us confused. Think of it this way

The amount of schooling required for an OD, MD,DDS,DC are all the same. However, to work as a family doctor you require another 2 years (I believe) but you are an MD even without the 2 years.

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What the [censored]?? This thread totally blows. I went to school for 27 years (including Kindergarten) After college I did ten.

Optometrists treat eye disease in many states because they have a very powerful lobby and create increased scope of practice by legislative fiat.

The "MD" Makes a Difference....

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Wow Dr Steve, I just noticed that you posted your clinic website info here. "I fix retinas to pay taxes for my poker winnings"...LOL. You really are a cocky bastard. Who the hell posts personal information on a public forum like this? Even your screen name has to have "doc" in it so that everyone knows you are a DOCTOR! Holy fk you need some serious mental help. You got self esteem isssues. Too much VEGF going on in your massive brain...get out the Avastin. [img]/images/graemlins/grin.gif[/img]

[renodoc]

Slim,

What is with the quasi-ad hominem attacks? I have my business website on my profile. This makes me an a-hole and a cocky bastard??

Here's the first thing that popped up on LASIK complications-- these are the ones you claim don't exist:

Endopthalmitis post LASIK



Retinal Detachment Post-LASIK

From the American Academy of Ophthalmology:

Scope of Practice
The Academy, along with many other physician specialty organizations, continues to faces increasing challenges to its scope of practice on both the state and federal levels. To protect patient safety and ensure the highest level of quality eye care, the Academy is engaged in an ongoing battle against non-physicians who do not have the education or training to diagnose eye diseases or perform eye surgery.

As problems emerge in states across the country, the frontline for defending ophthalmology’s scope of practice remains in Oklahoma, where the Academy is on the offensive to reverse a rule recently passed that allows optometrist to perform over 100 surgical procedures with a scalpel.

On the federal level, non-physicians are using various federal agencies in an attempt to expand their scope of practice. Last year, the Academy successfully overcame a threat by optometrists to expand their practice within the Department of Veterans Affairs (VA). Following efforts by the Veterans Eye Treatment Safety Coalition and congressional leaders, the VA rescinded a directive that allowed optometrists to perform laser eye surgery on our nation’s veterans and Surgery by Surgery was reinstated throughout the VA. While this battle was won, the Academy continues to monitor and work with other federal agencies, including the Indian Health Service and the Department of Defense, to ensure the highest level of quality eye care is maintained for every patient.

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Calling yourself the "family doctor" for eyes is misleading. Optometrists are not trained to treat the vast majority of eye diseases. You have been brainwashed by your lobby to think of yourself as "the first line of defense" for eye diseases. Perhaps in the great socialist North it is different, but here, no patient is turned away for lack of a referral. They may at times be triaged to an appropriate specialist, or perhaps even to an optometrist. In the few states where you can perform "minor surgery" you have accomplished this by legislation, not by obtaining further training (i.e. going to medical school) which would qualify you to be a surgeon.

You state that the purpose of this thread would be to answer 2+2ers general ophthalmic questions. Why not handle just the optometric/refractive ones which you seem more than capable to do? The posters with sudden loss of vision, sudden onset of floaters, and decrease vision in the face of diabetes all need examinations by Medical Doctors , which would be someone who did 4 years of medical school, 1 year of internship, 3-4 years of residency, and then maybe 1-2 years of fellowship.

Finally, you SHOUT YOUR IGNORANCE with regard to Avastin as it has now changed the entire landscape for proliferative retinopathies. The vast majority of patients show improvement of their vision which has previously been unknown in age related macular degeneration. Additionally, this stuff makes abnormal vessels in diabetics melt away. The fact is, you don't know about it, its very important, and you should probably be content to spin those dials instead of mismanaging serious eye disease.

I submit that you have violated OOT Policies by being an OP in an "ask me " thread where you really aren't an expert, and by flaming me for no good reason. Perhaps you will catch NT in a good mood.

[Toro]

I wear progressive lenses because I need one rx for far another for medium and another for close. Does this mean Lasik would be useless for me?

[Fast Food Knight]

Slim,

My whole life I have had this weird ability to, at will, have my right eye drift all the way to the right while my left stays straight. At this point I see horizontal double vision, moving towards the left (which is weird, since my right eye is moving to the right). I think it may be the result of relaxing a muscle, because it sometimes happens when I'm tired. WTF is this? I've always been so curious.

BTW, Renodoc, you're a dick.

[7ontheline]

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I wear progressive lenses because I need one rx for far another for medium and another for close. Does this mean Lasik would be useless for me?

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Depends on what you want out of it. LASIK isn't going to magically return your eyes' ability to accomodate (focus on closer things) but could eliminate your need for glasses at distance. You are presbyopic (unable to focus on close things) becasue you are older (50s, IRC) and that is permanent. LASIK would be able to put your eyes at a different focal length so things far would be clear with one eye and things somewhat close could be clear with the other eye but it wouldn't perform miracles. Likely you would still need glasses.

[7ontheline]

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Slim,

My whole life I have had this weird ability to, at will, have my right eye drift all the way to the right while my left stays straight. At this point I see horizontal double vision, moving towards the left (which is weird, since my right eye is moving to the right). I think it may be the result of relaxing a muscle, because it sometimes happens when I'm tired. WTF is this? I've always been so curious.

BTW, Renodoc, you're a dick.

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You probably have a phoria / intermittent exotropia, similar to a previous poster in the thread. Basically, when you are alert and stimulated and using both eyes your eyes are focused and straight. When you are tired or not focusing actively your eye drifts outward. This is not bad by itself although the natural progression of things is for this to worsen with time. Sometimes your eye starts to drift out even when you're not tired, it may become more difficult to re-straighten, etc. It may eventually need surgery. Hard to predict whether it will get bad enough to really bother you though, you just have to wait and see.

[7ontheline]

As for the whole MD vs. OD thing. . .

For people who are not aware, optometrists (OD) go to school for 4 years after college and then can open up shop. Some go a residency for further training, which is generally 1 year. Normally the main scope of the optometric practice involves refractions, glasses, contact lenses and the like. Optometrists are licensed to prescribe a limited set of medications (most eye medications) in most states. It is not as hard to get into optometric school as it is to get into medical school by far.

Ophthalmologists (MD) go to medical school for 4 years after college to become a physician with all other MDs. They then go to a 1 year internship for more general medical training as a doctor and then 3 more years specialized only in ophthalmology to learn to treat the eye. After this they may do a 1-2 year fellowship for further training, usually in a specific subset of eye surgery/disease. Ophthalmologists tend to have been among the top students in their medical schools, as it is a selective and competitive specialty. Over all, MDs will have seen many more patients than ODs during their training and MDs are the only doctors trained to perform surgery on the eye, which includes LASIK and other procedures.

As an MD, I have mixed feelings about ODs. They are well trained within their defined range of focus. As for the issue of being a "primary care eye doctor" I would say this varies. I have been around very capable ODs who I would definitely trust with basic eye care. I have also seen referrals from ODs that have seemingly no clue what they are doing. This has been in many aspects of ophthalmology, whether it be management of chronic diseases like glaucoma or in acute eye injuries. I feel that some ODs (not all) have over-reached and are attempting to get more privileges than they are trained for. There are states in which they are fighting the laser/surgical privileges, or perhaps the right to prescribe a broader range of medications. Given the inconsistent level of training within the optometric community I think this is really deplorable. In the states where they are trying to get surgical rights (Oklahoma in particular) they are not doing it by showing a need for more surgeons but by trying to do a legislative end-around that gives optometric boards the right to determine which optometrists can do surgery. A little bit of the blind leading the blind, if you will.

Wow, long-winded post.

Cliff notes: ODs have less training than MDs. Not all are truly capable of being a "primary eye doctor" although some definitely are. Personally, I would go to an MD with any eye problem more significant than refractive/glasses/contact lens issues. MDs have better general medical training as well.

[7ontheline]

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can you explain what fluribuprofen does?
Tobramycin?
Atropine?
Prednisilone Acetate?
All of these are in opthalmic solution form, just a few off the top of my head.

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Meatball, do you really want to know or are you testing the OP?