Sunday, July 23, 2006

Eye Problem and Finally Got An Eye Exam

My eyes were giving me problems the last few weeks. They were itchy, red, red when i rub them, and always producing discharges (that gooy stuff, and have made opening my eyes in the morning literally hard.) When my eyes began to be very teary, and almost constant, I decided to see my general PCP doctor. They were able to see me the same day I called, and he said it's bacterial infection, and that it's very contagious. He gave me a prescription for an antibiotic ointment to use for several days, and said that i should see an ophthalmologist to get my eyes thoroughly examined (plus, he seemed very concerned when i answered to him that i saw an optometerist 7 years ago.)
After a few days later, I called an eye doctor. Choosing the eye doctor was difficult. The guy my PCP suggested was a single practice, and my insurance wouldnt cover it. So, I looked at my health insurance's website to see which doctors accept my insurance plan. I decided to go with an eye doctor that has several physicians working in the practice. I also looked for location, education, residency fellowships to get the best doc. (Another source was to ask friends and collegues; but most saw optometrists.) --I wanted to see an ophthalmologist; since I feel more comfortable with someone (a MD) who has had more specialized training (plus general medicine training) than an OD. Both can diagnose vision problems and eye diseases, prescribe eye glasses and contact lenses, and prescribe drugs to treat eye problems. However, if there was a problem that requires surgery, only the MD can do this. Degree wise...OD school is 4 years, and after graduation, they take written and clinical state boards. Then, usually at least a 2 year clinical residency for those wanting to specialize in certain areas of optometry, such as contact lenses, family practice, geriatric, hospital-based, ocular disease, vision therapy. The MD ophthalmologist attend 4 years medical school, complete 1 year internship and 3 years residency, and then they can enroll in specialized training, such as corneal disease, retina/vitreous disease, glaucoma, pediatric eye problems, plastic surgery. Surprisingly, the practice that I chose has 5 MD's, 2 OD's, opthalmic technician, and opticians.

My exam was scheduled in the morning. Ideally, I wanted a late afternoon appointment so that i can leave work early and go home afterwards (especially since most MD's perform dilated eye exams.) Did you know: If you wear glasses or contacts, the eye professionals recommend having your eyes checked at least every 2 years. (if you dont wear glasses or contacts, age between 20-29, you should have eyes checked once; twice between 30-39, and every 2-4 years between 40-65; thereafter, every 1-2 years; And, if there's any family history of eye disease or you notice a problem, they recommend you see eye doctor asap, and regularly.) I have contacts and glasses, and as I mentioned earlier, am very long-overdue for a complete eye exam and prescription check. While I'm okay with my current contacts and glasses, at times I do feel I could use a slight increase in prescription to see things abit clearer. (So, I knew that my prescription probably needs an increase of .25 or .50 in prescription. I just delayed it because I never thought of it as problematic.) Well, my eye exam was very different since my last visit with an optometrist 7 years ago. The whole thing was shorter than what I thought it would be. I arrived a few minutes early than my scheduled time. There was only another patient there; and the office did not have a waiting room. It was open to chairs in the middle, a side room with vision acuity machines; another side room where their optician and eyeglasses store was; and a hallway with few patient rooms. When I was called by the technician, we introduced ourselves and she began by having me sit in front of a machine. "Put your chin in the chin-rest, and your forehead against the support, and keep still and eyes open. Try not to blink." I dont know how many times I was told to do this during that hour. The machine was dark and I didnt know where to look at. "Just look straight into the machine, keeping your head and face still, and dont blink." I tried to do that; mind you, my eyes were somewhat teary and itchy. After a few seconds of seeing darkness and hearing something from the machine, I saw a picture of a long street in a desert with a tiny scarecrow standing in the center, kind of far away, with a background of that looked fuzzy. Within a millisecond or so, it was focused. This was repeated in my left eye. An autorefractor, was used; it provided her with my refraction measurements instantly. She also measured the strengths of my lenses (to my glasses and contacts). Afterwards, she had me sit down in the exam room with the lights dimmed, and gave me the standard Snellen eye chart test with contacts/glasses off. She also had me read a card at arms distance away to test my near vision. To make a better prescription, she used the photopter-- the mask that goes over my face and eyes with tons of lenses, and asked "is 1 better than 2", "is 2 better than 3", and so forth. I hate this part because it's too subjective and I felt that most were about the same or no difference. And this was repeated with the other eye. She wrote down the new lenses and positions, and said that my vision is relatively okay, with just a minor correction in both eyes. That was good to hear. (just like what I thought). Next, she tested my eye movements, my eye's response to light and dark, and their ability to converge on a fixed point. She had me sit in front of another machine, with the chin on the rest and the head on the forehead support, and tested my peripheral vision with the computer. I was told to stare at the center point, which was very easy. Whenever I saw a tiny light flash within my field of view, I pressed a button. It was like playing war games; without moving the eyes. This took a minute. When finished, she had me sit again on the exam chair, and then placed yellow drops into my eyes that made me see kind of yellow glares in the dimmed-light room. She placed about 2 drops into each eye, since my eyes blinked really quick as the drops were dropping from bottle. The blinking-reflex is fascinating; the body doesn't like drops of anything being splashed into the opened eyes. And, you can imagine my head moved slightly to try to avoid the drops. But, she managed to get drops in. I wiped some excess liquid with a tissue and the tissue was orange. She placed the slit-lamp binocularscope towards me and sat in front of me. She shined light individually to my eyes. It was a general exam of the exterior of the eye. As I was told to stare toward a corner of room, my eyes started feeling kind of heavy, full and tired. It was wierd...they were getting numbed! Plus, the light in the dimmed room was very bright. The reason for the numbing of the eyes was to actually to perform the "golden standard" exam in eye medicine: measure pressure of the eye to determine the risk of glaucoma using applanation tonometry

(plus it gives a better of the internal eye structures and getting a "wet" refraction test, to see how my vision acuity is without accomodation. A probe, connected to the slit-lamp, was aligned to my eye by the technician and shined a blue-light. She positioned the probe by also making sure none of my eye lashes get in the way. Once it touched my cornea, it measured the intraoccular pressure (IOP) or the force required to flatten the cornea apex. I only felt the probe touching my eyelashes or the perimeter of my eye. ALso, the tech had to hold my eye open with 1 hand while aligning the probe with the other. So, maybe a slight pressure touch on eye; but, not bad; probably due to numbness of eye. This was repeated with the other eye. This was definitely much better than the non-contact tonometer used on my eyes by optometrist (7yrs ago). The small puff of air that gets blown on my cornea was definitely "felt" by me; and that scary, direct-air wind on eye made it feel dry. Usually after the first eye gets air blown in, I occassionally move my whole head away from the machine for the next eye. It usually takes several attempts by the eye doctor/technician to get the air in my 2nd eye; since I then knew what to expect. Maybe this is why MD's in the office use applanation technique with eyes numbed. Moreover, it is considered more accurate. She said the pressure was normal in both eyes. She also had me sit in front of another machine that takes many measurements of my cornea and provided a detailed colored map of the contour and shape of my cornea, by using a keratometry measurer.Topcon KR-8000PA Auto Refractor/Keratometer/Topographer

They had a corneal topographer, which is used for fitting contact lenses and mapping the curvatures of the cornea for astigmatism, corneal disease, or irregular shapes.

I do remember getting another set of eye drops; eye drops for dilation. She then discussed with me my eyes, and said based on the prior tests, my prescription will only be 50 stronger in each eye and less stronger cylindrical lens. No astigmatism. She said the eye doctor will be with me in about 10 minutes. So, I was sitting in a partially dimmed-lit room waiting for the eye doctor. My eyes felt normal, but the full/heavy feeling of eyes was still around. After the eye doctor came in and we discussed my medical and eye history, she performed slit-lamp eye exam where she examines the interior of my eye in more detail...and took a digital picture of both eyes. All I remembered was that the light was much more intense than when the eye technician was looking at my eyes. (This is because there was ample time for the dilating eye drops to fully open-wide my eyes and made my pupils very large.) The doc said numerous times to try to keep my chin and head in place, and keep the eyes open. I said that the light was too bright and bothering me. She said it's normal; but it's necessary for accurate exam and to see what's causing your eye problems. The doc spent more time looking at my left eye than my right eye. Look to the far right, far left, up, down, corners, straight out. She repeated the same thing with my left eye. (This was my first eye exam where my eyes were numbed and dilated.) I remember that 7 years ago at the optometrist, I had an option to get a dilated exam for "a comprehensive eye exam". I declined because the office charged an extra $30 or $35 and it would not be covered by my health insurance plan at the time. Since my current health insurance plan covered the ophthalmologist's visit as a new patient doctor's visit (referred also from my PCP), I got the full works of a comprehensive eye exam. Another thing I noticed differently this time: this doctor's office takes digital pictures of patients' eyes, and keeps digital records from all of the various exam procedures. The slit-lamp scope had a digital camera. She took a few photos of both eyes. She said the slit-lamp pictures, the interior retinal photos (aka dilated fundus photographs) Topcon TRC-NW200 Non-Mydriatic Retinal Camera, along with the cornea topography, visual field, tonometry assessments, and refraction measurements will become a permanent record of my eye health. She also discussed her findings. Besides a slight adjustment to my corrective lenses, I have bacterial conjuctivitis and dry eyes. She gave me a prescription for a stronger antibacterial ointment to put in the lower eyelids twice a day for several days. In addition, she said i should do warm compressions to the left and right eyes with a cloth, to break up and remove the discharges. (she said try to do it 4x's a day.) Also, i should take some lubricating eye drops, such as TheraTears or Systain, without preservatives, 3x's a day to keep the eye well balanced. Of course, a follow-up visit was required. And, she said always get your eyes checked once every 2 years for good health. I said ok. Then, paid my $20 copay. The receptionist gave me these cheap shades that slide over my glasses. When I went outside, which was bright and sunny! Boy was it really sunny with them off! I went in my car and saw my eyes! I never saw my eyes so dark! Those mydriatic agents (dilation drops) really work on my pupils! When I looked in a mirror, my eyes were very large... the black spot was big, roundy. I followed-up 2 weeks later, and much better condition of eyes. No dilation needed! After a month later, I got new glasses from an online company; all you have to enter is the details from the prescription, selection of glasses and lens, and then pay and wait in the mail. It costed much less than if i went to Lenscrafter, Pearle Express, Walmart, Target, or local optician.product shot

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