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Who else agrees with Jacob?

1800 Congame

The “Contact Lens Rule,” implements the Fairness to Contact Lens Consumers Act, codified at 15 U.S.C. 7601–7610, which requires that rules be issued to address the release, verification, and sale of contact lens prescriptions. Here is one part that I have a huge issue with.

(c) Verification events. A prescription is verified under paragraph (a)(2) of this section only if one of the following occurs:

(1) The prescriber confirms the prescription is accurate by direct communication with the seller;

(2) The prescriber informs the seller through direct communication that the prescription is inaccurate and provides the accurate prescription; or

(3) The prescriber fails to communicate with the seller within eight (8) business hours after receiving from the seller the information described in paragraph (b) of this section. During these eight (8) business hours, the seller shall provide a reasonable opportunity for the prescriber to communicate with the seller concerning the verification request.

Just because nobody replied back, doesn’t mean the Rx is ok….certainly not ok to send the order! This bothers me tremendously. Patients can by pass health checks for years, simply by giving bogus doctors info. I had a patient publicly call me out on the crookedness of online contact lens vendors. The sad part, is that its perfectly legal for the vendors to sell contacts to without actually verifying if the Rx is actually correct through a time constraint loophole. Basically, if they do not get verification wihtin 8 hours, they fill the order. The work around is simply. All one does is submit a name of a random doctor and hope that doctor does not tell the vendor that they are not a patient there. There is a drop down list of doctors names. I just picked the first one and the order went trhough with out an issue. Let me make this very clear:

I was able to order contacts that are not even close to the right power, size, shape or material for my eye. Dangerous! I was able to choose a doctor whom I never heard of from a convenient drop down list.

I’m guessing the Dr. Edward Smith doesn’t exist, didn’t see the verification, or didn’t care enough to let 1800 know that I was not a patient of his.  It is absolutely crazy to think that if the vendor hears nothing back from the doctor, they assume everything is fine and ship you the contacts!!!!!! That assumption is dangerous. A better solution is to have the patient email/fax a physical copy of the Rx that has the doctor’s name, signature, expiration date and contact info. A camera phone can easily take a pic and email it in. It would also free up the doctor’s office from having to do the verification process. The current system is a joke and easily gamed. Its a very dangerous game to play. You only have 1 set of eyes people, take care of them!

The Rub

It was really clever marketing to call it “No Rub”. Everyone and their mom thinks all you do is take your contacts out, put them in the empty case and fill it up with solution. That is not the way to do it!

Contacts have a bunch of crap on them from being on your eyes all day. If you hold them up to the light you can see it. You have to get this stuff off or it will be as if you are rubbing sandpaper on your eyes. You have 2 options.

The first is to high pressure wash them with the solution by blasting them for 10 seconds, making sure to get both sides. This means you will go through a bottle of solution in less than a month.
Nobody has ever told me they run through solution this frequently so NOBODY is cleaning their contacts correctly with the rinse only method. Is it effective? Well Dr. Peter Rozanec thinks “No-rub contact solution works as well as no-brush toothpaste.” Nice one doc. I agree! Another friend reminds me, “Its sort of like running your dishes under the faucet and then eating off them again. And a 20-second rinse is a ton of solution! Ineffective and expensive.”

The second thing you can do is take them out and add a few drops of solution then rub them for 5-10  seconds, flip it and rub it for 5-10 seconds. Finish with a quick squirt to wash it away. This will get most of the buildup off. Look at it. Its pretty clean now. The rubbing does the best job of getting it clean.

Whatever way you clean them, remember they are still germy and dry so they need to be soaked in multi-purpose solution overnight. This is where it is disinfected and re-hydrated. So it will come out clean, disinfected and hydrated. That will keep things clear and comfortable. It will also give your eyes the best chance at staying healthy.

As always, a fresh clean contact everyday is the best. If you can wear a daily disposables, wear them!

Say Hi to Park Slope Eye’s new doc! Introducing Dr. Lisa DeClemente!

Lisa DeClemente, O.D., F.A.A.O.
Park Slope Eye is excited to introduce the newest member of our team – Dr. Lisa DeClemente!  Like Dr. Bazan, Dr. DeClemente is one of the friendliest most helpful eye docs around! She is experienced in all aspects of primary eye health and vision care.  After graduating with a B.S. in Biochemistry from Bucknell University, Dr. DeClemente went on to graduate from SUNY State College of Optometry in 2003.  She then went on to complete a residency in Primary Eye Care.  While entering into private practice after her residency, Dr. DeClemente continued her research and was inducted as a Fellow of the American Academy of Optometry.  This distinction was bestowed after her demonstrated research and case work in several aspects of ocular health including dry eye and contact lens use.  “Dr. D” is excited to join the practice and continue to deliver the quality eye care that Park Slope Eye is known for. She will always welcome your comments, concerns or questions. Just drop her a line at Dr.DeClemente@ParkSlopeEye.com

I Don’t Have Allergies But…..

Doc asks, do you have any allergies?

You reply, I don’t normally have allergies BUT….

It starts off like that but then they proceed to list every symptom written on the bottle of  Zyrtec they are eating like candy. And their eyes? Well remember how Rocky looked after fighting Apollo creed? Yea, it’s that bad!

So what do you do for your eyes?
Oh the Zyrtec, yea it looks like that stuff is really helping! Just kidding, don’t worry, I have something better for them.
Right now the tree pollen in Park Slope is out of control. It looks like its snowing out there.  It’s so thick my throat is coated with it and I sound like Marge Simpson.  That is also why my contacts feel like a scratchy little puppy tongue is licking my eyeball when I blink. Yea, it’s that bad!
Or how about this:
Have you been crying ma’am?
No? Oh, its just your allergies!
Looking to self medicate? Well the allergy med row is ridiculous. How do u choose? Honestly it’s always best to work with a doc but I know what it’s like to just want relief and how convenient it is to just choose one. I’ve “had good luck with”….is what I hear all the time.

But these are your eyeballs. They are sensitive and precious. They are complicated and often wearing a super spongy allergen loving layer of a contact lens. A  ton of people are just going to grab the Visine A, or the bottle of the brand the know from an ad.  Will it work? Possibly. Is it the best solution? Probably not. If it’s used as directed, read the label, and it gets you happy then stop reading. Great work, you chose and spent wisely. If you’re lucky enough to be reading this before hand, even better.
If your still wanting to rip your eyeballs out and dunk them in a bucket of ice water, then read on to find out how your eye doc can help.

1. We know what type of med is best. Not all itchy eyes are the same. When we look we can see signs that will help us prescribe the most effective drop for the job.
2. We can optimize the associated factors. Maybe it’s helping you get your cls cleaner. Maybe it’s helping you get a better type of cl. Maybe it’s just a great resetting drop to get u comfortable. Maybe its time to just give your eyes a little break and where glasses until things get under control. The point is, we got options and we can help you.
3. Those better meds are most likely covered with your medical (not vision) copayment.
4.  Maybe it’s not just an allergy! Happens all the time. Ok, it’s what I call the allergy plus.  This means that there is an underlying allergy but also something else going on. It’s usually this https://parkslopeeye.wordpress.com/2007/08/04/89/ and u know what? That OTC drop ain’t gonna cut it when its that bad!
I know what it’s like out there. I know what an eye doc can do to help. Please just keep them in mind the next time you have to sit on your hands in order for you to stop rubbing you eyes!

Laser scan

Transverse view of the retina with an OCT, image courtesy of Russell Neches

Occasionally I send patients to another clinic to get a laser scan of the back of their eye.  What is this test, and why do we do it?

The official name of this procedure is called an “optical coherence tomography” scan or “OCT” for short.  The machine emits a very short wavelength (~100 nm) laser beam that hits certain structures in the retina.  The onboard processor is able to translate the information that the laser records into a topographical profile of whatever structure the doctor wants to see.  This affords him the ability to notice any disruptions below the retinal surface.

I take retinal pictures of every single patient in order to examine key anatomical and functional components of the eye.  Retinal photos are a brilliant form of technology that allows me to see very detailed things.  Occasionally I also utilize special lenses to determine if a problem is present.  However, these two techniques are sometimes not detailed enough to examine key hidden structures.

Instead of thinking about the retina, let’s use an apple analogy for a moment.  If you take a picture of the side of an apple, you could see that it is red. You could see the outline and perhaps infer that it curves outward towards you.  You wouldn’t be able to tell how deep the apple was or what the insides look like.  Taking an OCT of the apple would be like cutting it in half and observing a cross section.  You would now be able to see that red color is actually a very thin skin.  You could also measure the depth of the apple, see that the majority of it’s volume is composed of a fibrous network, and notice a small cavity in the center that’s filled with seeds.  If the seeds were displaced to the side, a traditional camera picture wouldn’t notice anything out of the ordinary since the external appearance is untouched.  However, an OCT would be able to tell that they are not in their proper position.  For almost every patient, a retinal photo is way above the standard of care that’s required to examine their eyes.  However, some patients’ eyes either present with abnormalities or have a suspicious appearance.  Those patients require the detailed level of imaging and analysis that an OCT can provide.

It’s important to clarify a few misconceptions about getting an OCT:

-Does it hurt?

It doesn’t hurt at all.  It’s actually slightly more gentle than a camera flash

-Will it fix my problem.

No.  There are many types of lasers that doctors use on the eye.  An OCT does diagnostic imaging only.  That means that it shows the doctor what is the issue and does not fix it.

-Why didn’t my doctor see what the laser saw?

A doctor only orders an OCT when a known or suspected problem lies in an area of the retina that’s not visible to human eyes and traditional machines.  Unless your doctor has x-ray vision, he won’t be able to see the deep hidden retinal layers.

-Come on doc.  Is this really important?

Absolutely!  With many retinal pathologies the OCT reading is how the doctor determines what treatment or monitoring protocols he will use.  Additionally, he now has a snapshot of the retina at a given time and can track it’s evolution in the future.

-Why doesn’t my doctor have an OCT?

Most patients don’t require such a scan.  Typically I will see only 1 patient who needs an OCT each week.  Although I can perform the scan and interpret the results with ease, I prefer my patients to be scanned by a doctor who does 10 a day and specializes in that type of care.

-You’re sending me to a disease specialist?  I must have something really bad.

Needing an OCT does not mean that you have a serious disease.  It does mean that your eyes present slightly atypically and an extra scan is the prudent thing to do.  Frequently the doctor who does my scanning will say, “It looks okay.  We’ll just monitor it.  Go see Dr. Ritenour in a year.”  Some patients I know are healthy, but have an elevated risk for developing a problem in the future.  In theses cases, the OCT scan is a baseline “snapshot” that we can always compare back to in the future.

Leave a comment or email me if you have any questions or concerns.

Spencer Ritenour, O.D.