At this point, every passing basketball game brings us one step closer to a horrible finality: the end of NBA post-game fashion!  I have gotten so addicted to the post-game interview glasses display, I don't know what I am going to do with my late nights when the playoffs are over.  Not to mention, well there will be no more basketball to watch too.  Both are depressing thoughts.

But until then, let's delve into the incredible eyewear fashion of the Finals thus far:

GAME 1


Russel Westbrook's facial expression just goes so well with his ensemble in this screencap--I couldn't resist.  Honestly, these glasses fit him a bit better than usual, so I would say this is a step in the right direction.  His eyes are finally centered in the frame!
Kevin Durant looking daper in a suit, tie, and great fitting zyl frames.  These frames look stylish and appropriately sized.  I'm so used to seeing these guys wear hugely oversized frames, this almost looks small!  Dark plastics are one of the biggest wearable trends in eyewear, so if you are shopping for glasses,  I would use these frames as a good guide.

via fearthesword.com

I ask the same questions to every contact lens wearer in my practice:  Are your lenses comfortable?  Do you sleep in them?  How often do you throw them away?  What solution do you use to clean the lenses?
Nobody bats an eye by the first few questions.  We all know that overwearing your contact lenses is a main source of discomfort, not to mention a dangerous health risk to the corneal tissue beneath your contact lens (see this post for more details).  But when was the last time you stopped to think about how your contact lens solution made your contact lenses feel?  Believe me, it can make all the difference in the world.

Not everyone can comfortably use the same multipurpose contact lens solutions
Contact lens solutions are chemical cleaners designed to kill bacteria and remove protein and lipid debris from the surface of the lens.  No surprise, not everyone reacts to these chemicals in the same way.  I have patients that love generic solutions and never have a problem. I have patients that use the same solution every day for years, and then all of a sudden develop an allergy to the preservatives.  It happens.  The important thing is finding the solution that works with the chemistry of your natural eye and with that of your contact lens, and this is why talking with your doctor about any comfort issues can help find the solution that works bet for you.

Why I steer clear of generics
I prescribe generic medications all of the time, but I never recommend generic contact lens solutions as the best option for comfort. The reason?  Generics are older formula concentrations that are high in preservative count and low in moisturizers.  They will kill bacteria, so generics are not a health risk to your contact lenses.   Preservatives are great at killing microorganisms, but they also are very toxic to your cornea.  The higher the preservative count, the more drying, toxic chemical load your lenses are being coated in.  Obviously not the most ideal for comfort.

Contact lens solution hypersensitivity classically looks like this.  Your doctor will put a dye in the eye to visualize the patches of damaged corneal cells on the surface of the eye.   It can take several days to weeks without contact lens wear and frequent lubricating drops to return the cornea to normal after a case like this.

If you are having problems with lens comfort
Classic signs of a contact lens solution sensitivity are burning or stinging when the lens touches your eye, blurry vision after rinsing the lenses, and general dryness, itching, or discomfort when wearing contact lenses. Your doctor will be able to evaluate if the solution, your contact lenses, or both are causing the problems with your comfort.

There are a number of great new products that I have been having a lot of success with, so if you are having dryness with your contact lenses I recommend trying:

Opti-Free PureMoist (more moisturizers, less preservatives)
          -Brand new solution, but so far it has appeared to aid the transition for patients from a heavily moisturized 2 week lens to a more oxygen permeable monthly lens.  If you are switching from a 2 week lens like Acuvue to a monthly product, I definitely recommend using a highly moisturizing, low preservative count contact lens solution.

Biotrue (specifically formulated to match the natural pH of the eye for less stinging).  Great with the Synergeyes Duette products!

And my favorite contact lens solution for people with sensitive eyes:

Clearcare (just don't put the solution straight into your eyes!)
        Clearcare works great for people with seasonal allergies, heavy depositing, and anyone with preservative sensitivity because it is preservative free!

Optometry is such a small world.  No really, I feel like once you really start talking to an optometrist you realize that they know or have worked with at least 5 other optometrists that you also worked with at some point or another.   There is such a strong since of community, and this is just one of the many reasons that optometry is such a great career.

The Southern College of Optometry currently they are expanding their classrooms  to accommodate larger class sizes!

Currently there are 19 accredited colleges of optometry in the United States, with 4 new schools awaiting accreditation.  With the latest news out of Virginia, let's make that five.  Traditionally optometrists in the Southeast have attended regional schools that include the Southern College of Optometry (Memphis, TN), Pennsylvania College Of Optometry (Philadelphia, PA), and the University of Alabama at Birmingham School of Optometry (Birmingham, AL). See this link for an extensive list of all optometry schools. As an NC native, those three schools all had "regional" seats for North Carolina students wanting to pursue their optometry degree.  Now a new school in Grundy, Virginia (dubbed the Appalachian College of Optometry) is seeking accreditation for classes beginning in the Fall of 2014.  A class size of 48 is the goal for the college's inaugural class.  Apparently quite a few people are interested because Appalachian State University's website already has a disclaimer stating "We are NOT the Appalachian College of Optometry that is opening in Virginia." 

With more and more optometry schools opening around the nation, I know many doctors are concerned that too many graduates will cause an over-population of optometrists in their community.  I work in a highly populated area, and I will be the first to admit that finding the ideal practice situation to walk into as a new grad is next to impossible.  But the truth is, patients are needing more access to primary medical care providers like optometrists than ever.   The medical landscape is quickly changing over the past 20 years, and optometrists are now comprehensively educated to handle treatment and care of a number of acute and chronic ocular conditions and diseases.  We are on the cutting edge of technology being offered in contact lenses, and providing unique services like vision therapy and low vision.  There has never been a more exciting time in eyecare; as an optometrist you can offer general comprehensive family care or be a sole provider of specialty services in your areas of expertise and interest.  To all of those new grads or students considering optometry as a career, you have made a great decision and there are plenty of patients out there who are going to need your  care!

I attended a CE earlier this week and came away with knowledge of a great new service for optometrists and their patients.  Age Related Macular Degeneration is a potentially blinding condition that typically affects central vision in patients over the age of 60.  There is a large hereditary component (in addition to environmental factors), and since the conclusion of the Human Genome project, we now know a number of genes directly linked to the severe forms of the disease. Before I go into more detail I would like to add a disclaimer that I have not yet used this service, and I am in no way affiliated with them.  I do plan on possibly offering this genetic testing to my patients in the future; the results are actually very inspiring!

No blood tests needed, just a quick, easy cheek swab.

The Process
As an optometrist, all you need to do is sign up with the Macula Risk company (at no cost of course) and you will be sent packaging and sterile swabs to perform a cheek swipe for DNA sampling.  For any patient you want to genetically test, you would swab the inside of the cheek, package the swab in the provided sterile container, and FedEx the swab to the testing center in a prepaid envelope.  In 2 to 4 weeks, the company will have the DNA samples analyzed and sent you a full report as to the patient's risk factors.  You can schedule a 1-2 month follow-up visit after your initial sampling to discuss these results with the patient and set a plan for future management.  Like I said, I haven't tried this yet, but the process seems simple, easy, and free to the doctor and patient (as long as they have medical insurance).

What genes are being tested?
Age Related Macular degeneration can be linked to genes that control numerous ocular pathways.  Genes that control the Complement Cascade inflammatory response (CFH and Y402H genes specifically), genes that control cellular response to oxidative damage (like the ARMS2 gene), and genes found in mitochondrial DNA are all found to be linked to ARMD incidence at various rates.

ARMD is found in 10% of the population over age 60 and 25% of the population over age 75, so there are more and more patients being diagnosed with this disease every day with our aging baby boomer population.     The good news?  80% of patients diagnosed with early or dry ARMD will never have advanced vision loss. But that leaves 20% of patients that will develop devastating central vision destruction for the disease, and doctors have had few ways to predict which patients will belong to that 20%.  Unfortunately, the majority of these 20% of patients with severe or wet ARMD will not go to a doctor for treatment until they already have  permanent vision damage.  The goal of the Macula Risk genetic testing is to red flag that 20% of the ARMD population that will develop advanced disease when they still have great vision based on their genetic markers for the disease!

DRY ARMD photo courtest avclinic.com

WET ARMD photo rustoneye.com

The company sends you a print out of the patient's "Macula Risk score" based on their genetic profiles.  I'm not sure of the details, but if the patient's risk number is between 3 and 5 (with 5 being the highest) they are much more likely to develop advanced ARMD.  This signals the doctor to follow the patient more closely than just yearly exams, and the patient is also more educated to pursue lifestyle changes that can improve their ocular health (such as quitting smoking, eating more green leafy vegetables or adding vitamin anti-oxidant supplementation).  If the patient knows they are at a high risk, they are going to be much more likely to be compliant with regular exams and the disease processes can be caught earlier before vision is irreparably damaged.

Ocular Vitamins can be even more strongly recommended in younger patients  with drusen changes if their  genetic testing reveals higher risk factors.  Interestingly, even the presence of peripheral drusen has been found to genetically link to ARMD progression.

When would a genetic test for ARMD be warranted?


While we would all like to be able to do a screening of all patients with known family history, at this time the company can file medically with diagnoses of ARMD or retinal drusen (peripheral and macular drusen are both billable).  The company files to the patient's medical insurance directly for coverage, so the doctor does no billing and the patients will not be getting a bill.  At this time, there is no copay for the procedure.

I'm really looking forward to possibly implenting this genetic testing into my practice.  Please let me know if you have any opinions: if you have used this product before and if you would find it beneficial as a patient!

This blog has a lot of posts dedicated to sunglasses trends, but as an optometrist, wearing sunglasses means more than just a fashion statement.  Yes, I recommend sunglasses for ocular protection to my patients.  And yes, I truly believe that sun protection is beneficial.  If you are still on the fence about why your doctor is recommending sunglasses, here are the top reasons that your eyes do need UV protection!

Macular Degeneration photo courtesy spectoreye.com

Early basal cell carcinoma photo courtesy willseye.org

polarized lenses reduce horizontal surface reflections photo courtesy findingsun.wordpress.com

Wrapped Oakley frames--great for outdoor  sports due to their full coverage protection

I never suspected my most popular post on Eyedolatry all time would be a short segment on NBA players wearing glasses.  (Click here to access the post that sparked my realization of the original eyewear obsession).  Fortunately (or unfortunately in some player's cases) the trend for the NBA's top players to sport the latest eyewear fashions is rolling full steam ahead.  Here's the latest look at some of the top eyewear sported in this year's playoffs so far:

Paul Pierce


The Celtics star gave a post-game interview in these large rimmed zyl frames.  My verdict: these frames are much too large.  Look at all of the excess space between the side of Pierce's head and the outer rim of the frame.  If you see more air than face, this is a big indicator that your frames are too large.  Even when purchasing oversized frames for the "geek" eyewear trend, it is still best to get a deep frame (which will give you that oversize look) that actually fits your face for a tailored appearance. For more information on properly fitting  oversize "geek chic" frames to your face, please visit this post.

LeBron James
James has been photographed in glasses so many times, but honestly, there's a reason he is the poster-child of this trend.  He knows how to wear these glasses.  His frames fit his face; his eyes are perfectly centered in the lenses both horizontally and vertically, and there is no excessive air visible between the line of his face and the edge of the rim.  Somehow he gets it right every time!

Kevin Durant
Durant (pictured here on the right) actually does a great job with his glasses as well.  Let's ignore his less fortunately styled teammate to the left for a moment, and focus on the fit of Durant's frames.  They are sized appropriately, and  they appear to be well-centered even when we are viewing him from this angle.  The color of the frame is a little washed out, but clear and caramel colored plastics are having a major moment right now, despite being very difficult to wear.  Overall a good job.

Russell Westbrook
Let me start with this photo from Westbrook's own facebook page.  I admire his willingness to take fashion risks (and what is fashion but one risk after another anyway?) but these frames are really not helping anything.  Again, they are WAY too large, his eyes are positioned very high in the frames giving too much excess lens inferiorly, and with his round face shape, a round rimmed frame is never going to be the best choice.  (See this post for more information on better options for round faces)

Does Westbrook (or any of these NBA players) actually need glasses?  Definitely not in Westbrook's case at least.  Here is an excerpt from a "Daily Thunder" interview (courtesy http://blogs.thescore.com/tbj/2012/05/15/russell-westbrook-talks-fashion-ive-been-knowing-how-to-dress-for-a-while/)

Reporter: Your wardrobe last night drew national attention. I loved the glasses. Where’d you come up with that style? 

Westbrook: I’ve been wearing glasses all season. I think last night was probably just the night they finally seen it.

Reporter: Now why no lenses in the frames? 

Westbrook: I see better without ‘em.

Reporter: So why wear ‘em at all then? Just a fashion statement? 

Westbrook: There you go. 

Reporter: Where’d you get the idea? 

Westbrook: I’ve been knowing how to dress for a while.

Well, I think that last comment has sparked quite a bit of internet debate, but I am definitely not qualified to judge overall fashion statements.  Let me stick to glasses.


Compare Westbrook's (right) to Durant's frames here.  These frames aren't terrible, but again, too round for his face.  A frame like Durant's that is slightly more rectangular in shape would be much more flattering.  Conversely, Durant's face shape is much longer and he could wear a round frame like Westbrook's more easily.  Just some nuances of the glasses world.


And to the right we have Westbrook's now infamous "Gone Fishing" ensemble.  I'm not going to give any serious critiques here because that would be positively ridiculous.  I am still a big fan of red frames in case anyone is wondering.  The point that I respect about Westbrook's glasses choices is that he is obviously just trying to have fun.  And I think any celebrity encouraging the world that glasses are fun and stylish is a great thing to do!

So in my first year of practicing, insurance billing has been the biggest learning curve I have faced.  They try to prepare you in school.  They try to prepare you at your externships.  But the problem is that billing and coding seem to be changing every couple months.  Here is a review of the latest coding conundrum I have faced:

Insurances for Medically Necessary Contact Lenses
First off, not all insurances are going to offer any coverage for contact lenses.  With time and experience, you will learn which insurances reimburse anything.  So far I have successfully filed to VSP, Eyemed, and Superior Vision for visual conditions that require contact lens correction.  Medical insurances like Blue Cross are not going to cover anything for vision correction.   Medicaid (at least in NC) will offer some base level of reimbursement if filed correctly.  On the contrary, if you have a corneal abrasion or another condition where a bandage contact lens is appropriate, medical insurances like Blue Cross WILL offer coverage and vision insurances will not.

Medically necessary contact lenses for post-RK

Not all vision insurances cover medical contact lenses for vision correction to the same amount of reimbursement. Some insurances will reimburse cost of lenses and evaluation fee.  Some will only give a certain amount of dollars to be applied toward eval or lenses.  Just remember, if you are going to try to bill for contact lenses, do NOT use the patient's insurance benefits towards glasses.  Once the insurance has been used, they won't provide for anything else.

What Conditions Typically are Covered
Again, different insurances have different guidelines, but here are the most commonly accepted reasons for medically necessary lenses:

• Keratoconus, pellucid marginal degeneration, or a corneal degenerative condition where vision improves in contact lenses versus glasses
• High anisometropia (usually there are guidelines about how much, typically between 3D and 5D minimum)
• Condition where best corrected vision improves by at least 2 lines with use of contact lenses versus glasses (this includes high refractive error conditions)
• Bandage contact lenses for treatment of ocular surface conditions (this is typically with a medical office visit code and is billable to medical insurances, unlike the previous items)

Synergeyes ClearKone lens is a great option for medically necessary keratoconus correction