Test Driving a Cataract

Gratefully, I have not yet reached the point of requiring or even thinking about requiring cataract surgery. Most of us (human beings) will need to have the cataract conversation with our optometrist sometime in our early to mid seventies; and, well, let’s just say I still have an 8-month-old baby at home. Recently, however, I had an experience that gave me a brief and unsettling glimpse at what may lay ahead for me in a few decades.

With my family out of town, I decided to head up to the mountains for some late-season skiing. Although recent snows made for a great day on the slopes, they also contributed to some slushy driving on the way up.

Unfortunately, I did not check that my windshield wiper fluid was up to an adequate level; and with all the muck being thrown onto my windshield from fellow cars, I soon found that my wiper fluid ran out completely. I did my best to wipe the windshield immediately, while the muddy water was still wet; but I was soon left with a frighteningly opaque film that made it difficult to navigate the road, especially when hit with glare from the sun.

As soon as I could, I pulled over in a safe area to grab some snow that I could use to wipe off the mud. Although this got me back down to ground zero, within minutes of returning to the road I was back in the same predicament, and I knew there would be no stopping until I got to the next town. Obviously I’m here to tell the tale, so all’s well that ends well, but I can tell you it was not a comfortable experience at the time.

By now you’re probably asking yourself what in the world this has to do with cataracts. Well, on pretty much a daily basis, I use the analogy of a dirty windshield to describe cataracts. If that windshield is dirty, it doesn’t matter how good your prescription is – you can’t see as well as you should. Glare definitely becomes an issue. And because that windshield (cataract) gets worse bit by bit, sometimes it seems like you’re doing fine, and all of a sudden you realize you’re in trouble.

I didn’t realize just how apt this windshield analogy was until I lived through it myself. If you or a loved one has ever been told they have cataracts, an annual comprehensive eye exam is vitally important to ensure that vision hasn’t gotten worse than you think!

 

Why Buy Brand Name Contact Lens Solution?

I recently read an article extolling the virtues and explaining the science of Clear Care contact lens solution.  Within the article, its authors made the point that store brand (generic) versions of solutions are not and should not be considered interchangeable for  name brands.

Growing up, I was always taught that generic medications were the same as their brand-name counterpart, and I think a lot of people believe this to be true.  In the world of eyes, at least, such is not always the case.  Following are three reasons to buy brand name contact lens solution:

1) Inactive ingredients often vary between brand name and generic solutions, and these variations may result not only in decreased eye comfort (more irritating preservatives, etc) but also decreased efficacy for the intended task (not as effective for disinfection, etc).  One comparison would be to drink a glass of apple juice and assume you’re getting all the nutrition that you would receive from an apple – the main ingredients are the same, but sometimes the little details make a big difference!

2) Often overlooked in contact lens care is the importance of regularly changing your lens case.  Almost without fail, whenever a widespread problem with contact-lens related eye infections develops, it is found that a ridiculously high percentage of affected individuals had cases that were many months or even years old.  Brand name solutions typically give a new case with each bottle of solution, whereas many store brands do not.

3) With brand name solutions, you always know what you’re getting.  The formula doesn’t arbitrarily change, so if it works for you now, it should work for you next year (assuming you’re using it properly!).  Store brand solutions don’t have this reliability – if the company selling the solution finds a different manufacturer that they prefer for whatever reason (probably cost), they can switch whenever they want and you’ll never know.  But you may wonder why the solution all of a sudden stopped working well for you…

For more information about proper use of contact lens solution, read my previous post on the subject.

What’s in a frame: How to choose the right glasses for you

Over the years, I have come to realize that I am a lot pickier than about 98% of the general population – including opticians and other eye care professionals – when it comes to picking out the right pair of eyeglass frames.  Following are a few of my cardinal rules for finding a great fit for you.

1) Size matters!  Sometimes height (you don’t want to cut off the reading power of your bifocals), but always width.  Many of today’s trendy styles are rectangular, and I feel like I’m always fighting to get my patients into frames that aren’t wider than their face.  A frame that’s too wide will put undue pressure on the bridge of your nose and the tops of your ears, even when adjusted as well as possible.  Additionally, especially if you have a stronger nearsighted prescription, choosing a frame that’s too wide for your face will result in really thick edges on your lenses.  Not only are thick lenses cosmetically unappealing, but they can also result in more dizziness or distortion when looking through your new glasses.

2) Adjustability can matter.  I love the look of chunky plastic frames as much as the next person (and I had a couple pairs before my LASIK surgery), but keep in mind that the thick plastic arms and lack of nosepads severely limit the extent to which these frames can be adjusted to fit your face.  Does this mean you shouldn’t consider plastic frames?  Absolutely not, but you’d better make sure they fit really well to begin with, as opposed to expecting that you’ll be able to adjust away a poor fit.

3) Weight can matter.  If you’ve never experienced problems with glasses becoming uncomfortable on your face, you can disregard this section.  If you HAVE had problems, or in general don’t like having glasses on your face, go for as light a pair of glasses as you can.  Rimless is great but can be expensive and is not available in all opticals.  Half-rim glasses are a good compromise, as are plastic frames or some of the newer titanium frames.  If you know you’re really hard on your glasses, titanium and/or some of the newer styles with flexible bridge and arms would be advisable, especially over a half-rim or rimless design.

Hopefully that helps get you started!  Obviously certain other styling elements should be considered, like fair-featured individuals generally not going for fat, black frames, but I won’t get into that here.  In a future blog, I will plan to go over considerations for which bells and whistles to choose for your lenses once you get the right frame; until then, happy shopping 🙂

 

 

Related articles

• Choosing the best eyeglasses for your face shape (fashionflu.com)

Help me help you

Every so often, a patient returns to my office within just a few months of their comprehensive eye exam, complaining of blurry or uncomfortable vision with their new glasses.  Of course I am happy to double check my measurements and see if some change is in order, but I often find that the situation could have been prevented a couple of different ways.

First and foremost, whenever you have an eye exam, bring as much information as possible regarding your current and/or preferred vision correction.  As an optometrist, my goal is not only to give you the clearest vision possible, but also to make it as easy as possible for you to adapt to your new glasses.  If I have no idea what correction you’ve been using, I also have no idea if I’m making a big enough change to give you a headache.  I have known people who almost seem to hold back information – because they don’t want to feel like the doctor is simply copying a previous prescription – but that sort of thinking can come back to bite you in the end.

If you do ever find yourself in the 2-4% of patients who have problems with their new glasses, my recommendation is first to stop by the optical department before ever seeing the doctor.  I would venture to say that at least 50% of glasses re-checks I see involve problems that could have been solved by the optical department through measuring or adjusting the glasses.  Especially if you are wearing a bifocal or progressive lens, stop by the optical first.

At the end of the day, prescriptions are variable, and mistakes can be made.  If your eyes were quite dry or irritated the day of your exam, your vision may change once your eyes are feeling better.  If your doctor saw 20 other people for exams the same day as you, statistics would suggest that at least one number on one person’s prescription was slightly off.  I definitely subscribe to the theory of “measure twice, cut once,” but no one is perfect.  If you can’t wear your new glasses that you paid good money for, please come in and let us help you!  The last thing we want is for those beautiful glasses to go in a desk drawer until next year.

LASIK Misconceptions

Having had LASIK myself, I try to bring up this option for vision correction with any and all patients who seem like good candidates.  After many such LASIK conversations, I’ve become aware of several widely held misconceptions or misunderstandings about the procedure.

1) Current-technology LASIK is completely blade free!  Many people are walking around swearing they’ll never have LASIK, simply because they saw a video ten years ago showing a little blade creating the flap for the procedure.  It’s all done with a laser now.

2) Not all LASIK is created equal.  Notice how above I said “current-technology” LASIK.  You know that radio commercial that advertised LASIK for $299 per eye?  I can almost assure you that’s for outdated technology – old lasers, still using the blade for the flap, etc.  These discount centers also often have many hidden costs, charging more for higher prescriptions than lower, charging more to upgrade to current technology, etc.  When comparing similar procedures and benefits between centers, the “discount” LASIK often doesn’t save much if any money.

3) 20/20 guarantees may do more harm than good.  We all want to feel like we “got our money’s worth” and have the best possible vision from our LASIK, but keep in mind that the possibility of developing complications increases every time you have another surgery.  If your surgery center has made a legally binding guarantee for 20/20 vision, they will be more likely to perform additional surgery where it is not truly warranted, thereby putting you at unnecessary risk.  Everyone heals differently, so even though statistics show that quality LASIK centers are able to give 20/20 vision to probably 95% of their patients, guarantees don’t really make sense.  Go with a great surgeon using the latest technology, and you’ll have the best chance of a fantastic outcome.

4) LASIK is designed to give great far vision, not so much close vision.  If you already have fantastic far vision and need help up close, you’re a better candidate for glasses or contacts.

That’s about it for now – feel free to post with any questions you may have about LASIK, or check out my prior post about refractive surgery.

Give your eyes a break!

For better or worse, as an eye doctor I am not immune to eye problems (shock!).  In fact, much of my initial interest in the field was due to the fact that I’d worn glasses and contacts since I was ten years old.  To this day, many of my opinions on different eye treatments or products come from my own personal experience treating my own eye issues!

 

During a recent family ski trip, I experienced some pretty significant eye irritation (above picture is not me, btw).  Wind blowing through my ski goggles, swimming every day with the boys, and waking up at night to deal with a fussy baby all conspired to give me red, dry eyes.  Although I was able to get the symptoms more or less under control with a mix of drops I’d brought along, I knew the underlying problem was still present.

 

This eye irritation continued even after arriving home, up until a couple of days later, when it magically seemed to stop.  Having not used any eye drops the previous couple of days, I reflected on potential sources of improvement, and I realized the answer was pretty simple: between a couple of short naps over the weekend and a great night’s sleep the previous night, I was better slept than I had been for several weeks!

 

Exposure-induced dry eyes are a major issue these days, especially with the high rate of computer and smartphone use, and especially here in the dry Mountain West.  Studies have shown that our blink rate decreases to 1/2 or even 1/3 of normal when we’re staring at a computer screen, and that leaves our eyes exposed to the dry air.  Although we live in a society that seems to want to treat all medical issues with medicine or surgery (soapbox alert) – as opposed to lifestyle changes – often there truly is nothing like a good night’s sleep to give our eyes the protection and the break they need!

 

Costco Glasses: to buy, or not to buy?

Not infrequently, my patients ask me how I feel about the quality of glasses that are produced by the Costco Optical, which is located approximately 8 feet from the entrance to my office.  I believe the unspoken question  underlying this query is something to the effect of, “How can Costco possibly provide a high quality product when it costs so much LESS than most nearby opticals?”  Glad you asked 🙂

As a disclaimer, I am not personally employed BY Costco or the Costco Optical – I lease space inside of Costco and operate as an independent Doctor of Optometry.  As such, I am not privy to the inner workings of Costco, including but not limited to figures such as costs and margins.  However, I am generally familiar with principles of optical management, macroeconomics, and Costco’s promise to keep margins low.  Upon this knowledge shall I base the rest of this post.

Here’s my short answer to the aforementioned patient question: Costco Optical is fantastic, they have been ranked #1 by Consumer Reports for overall customer satisfaction, and I’m convinced many of my patients really only come to see ME because they want to go to Costco Optical.

As for my answer to the underlying question of “How do they do it?” here’s my take on it.  Everything that Costco Optical makes is great quality, but they do have a limited selection of available products.  Whereas many independent opticals may choose from 10 or 20 different progressive lens designs, Costco uses maybe two or three.  Where some opticals may offer sunglasses in any number of materials and designs, to my knowledge Costco has just polarized polycarbonate (maybe in two different colors?).  Where some opticals have thousands of frames on their boards, Costco has…less than thousands – I actually have no idea how many frames they keep on hand.

The point I’m going for here is that Costco doesn’t have as wide of a selection as some independent optical shops, but the products they do offer are top quality at a fraction of the price of most independents.  Why such a price difference?  Partly due to economies of scale (lower material and production costs when in bulk; and with fewer products to order, each order is bulkier) and partly because Costco’s model is to keep low margins, whereas the standard mark-up at many independent optical shops is in the neighborhood of 2.5 times (as in 250%).

Again, I have no knowledge of Costco’s margins or costs, but assuming an $80 wholesale cost of a Flexon Nike frame, an independent optical may easily mark it up 2.5 times to a retail cost of about $200.  Costco obviously doesn’t go for 200% margins, but maybe something closer to 20% (I completely made up that figure for argument’s sake), which would give a price around $100.  Same frame, very different price.

I’ve already written about the insane price difference between Costco and most independent eye care providers for an annual supply of contact lenses.  Again, economies of scale.

Am I saying there’s no value to independent opticals?  Absolutely not.  If you value a wider selection of more designer frames or want to make sure you’re always getting the latest and greatest lens material or design, you may be better served by an independent optical shop.  But you’ll pay for it.  Through the nose. As a very small example, the premium non-glare treatment that Costco Optical includes on all of its lenses at no additional charge would be a $100 upgrade at most independent opticals.  I’m just saying…

Read These Posts!

For the first time in a LONG time, I browsed through my blog and came across a stats sheet displaying the most and least popular posts.  I was surprised to see that some of my favorite posts had garnered some of the least attention, and I determined to make things right!

In a reaching attempt to provide continuity between the picture above (3 medals) and my list below (3 posts), here’s are a few neglected and – if I do say so myself – pretty excellent posts that I really think you should check out.  Even if you’ve read them before, I’ve made a couple updates here and there (especially on the dailies post), so take a moment to re-educate yourself on your eyes 🙂

1) Allergy Season is Here!

2) Why I love the Optomap (and you should, too!)

3) Why you should consider daily disposable soft contacts

There’s a Rebate for that!

Contact Lens Annual Supply

Many – but I’m sure not all – contact lenses wearers are aware of the benefits of ordering a full annual supply of contacts at the time of your exam.  Not only are you less likely to cause eye irritation by over wearing your lenses because you’re worried you’ll run out, but you can also save some serious dollars through instant or mail-in rebates!

Here’s the short story on contact lens rebates: they generally only apply to buying a full year’s worth of lenses, although some brands offer a lesser rebate for a smaller supply.  Rebates are also generally limited to the newest lens brands from the lens manufacturers, who try to encourage patients to upgrade to the newest technology.  Besides, the older lenses usually cost less in the first place.

Because rebates are generally only available for newer lens brands, this also means that sometimes your total cost for an annual supply of newer lenses isn’t much more than for older lenses, after you factor in the rebate.

Lastly, more expensive lenses often have more substantial rebates.  Specialty lenses like multifocal and toric lenses sometimes have a larger rebate than standard soft lenses, and daily disposables definitely have the largest rebates of any lens.  My most-prescribed daily disposable has an ongoing $100 rebate if you buy them through the Costco optical ($85 rebate) and get the coupon from our office at your exam ($15 rebate).  When using this rebate and factoring in the cost of contact solutions that you DON’T have to buy with dailies (on average, $80-100 for the year), your total cost of ownership for the year is almost identical with dailies as with a standard reusable lens!

Bottom line: if you can afford to put out a little extra money initially to buy the full year’s worth of contacts at once, it will benefit you both financially and health-wise in the long run.  At your next exam, be sure to ask if your brand of contacts offers a rebate for an annual supply, and make sure you walk out of our office with a coupon if applicable.

Local Allergy Forecast

Check out the above link – very cool!  And for more information regarding eye allergies, read my recent post on the subject.

Related articles

• Allergy Season is Here! (costcoeyeexam.wordpress.com)

LASIK Thoughts ...

Here is a great website for all of the allergy suffers out there.

Easy to use – select your state, choose your city and get the 4 day allergy forecast for your area.

http://www.pollen.com/allergy-weather-forecast.asp

View original post