Where is W?

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Jul 262013

July has been a pretty productive month so far!  Volunteering at the eye clinic here in Florida has been great and has proven to keep me busy and on my toes!  I saw numerous eye conditions this month, many of which I have never seen before.  One patient in particular was a young male who has keratoconus.  Keratoconus is an eye condition involving the cornea.  Unlike the normal round shape of the cornea, patients with keratoconus have a cone shaped cornea.  I remembered learning about this in one of my first year classes, but this was the first time I had seen a patient with this condition in a clinical setting.  Many patients with this condition are prescribed hard contact lenses, which allow the structure of the cornea to maintain a more rounded shape and help to prevent the cornea from progressing in steepness.  These lenses are also prescribed to help correct the patient’s refractive error.

While the doctors at this clinic had a few pairs of trial lenses, they did not have a lens that was steep enough to fit this patient’s eye.  In order to find a lens that would create a comfortable fit, the doctors had to order a trial fitting set, which contained various hard lenses with different radii of curvature.  Each lens therefore was designed to fit a specifically shaped cornea with a specific steepness.  When the fitting kit finally arrived (they are very expensive and the doctors at this clinic had to borrow it from another clinic), the patient was asked to try a variety of lenses, each with a different shape, to see which one was the most comfortable.  Due to these lenses typically being larger (to compensate for the steepness in its design), finding a comfortable fit is not very easy.  The doctors at the clinic told me that many patients who wear these lenses later present with sores and sites of irritation on their eyelids, resulting from the edges of the lenses rubbing against the skin.  After a few hours of trying on lenses, the patient and doctors came to an agreement on one of the lenses.  The lens was ordered and the patient was eventually fitted with the lens.  This was an excellent learning experience for me, as I have learned about this condition, but never had seen it before.  Being able to interact with the patient and hear about how this condition has affected him as well as his vision gave me great insight into how some of the smallest structures in the eye can result in big changes in a person’s life.

Aside from working in the clinic this month, I took a little vacation and traveled back to Rochester, New York, to visit my family.  Of course it felt like everyone and anyone asked me questions about their eyes, and I had to pull the “I haven’t had that course yet” excuse!  A few days before I went home, my sister had taken my 22-month old niece to the optometrist for an exam, as she was presenting with symptoms of pink eye (conjunctivitis).  While at the optometrist, I was told my niece was very talkative and when asked to recite the letters on the chart, she did very well.  She has just started to learn her letters and apparently has a new found obsession with the letter “w” (which she calls “dubee”).  As we all know, in traditional Snellen eye charts, only 10 letters are used (C, D, E, F, L, N, O, P, T, Z).  This was not okay with my niece because she could not find “dubee!”  She was very distraught over this observation and proceeded to look all over the room for “dubee” while saying “uh oh, dubee, oh no!”  After leaving the exam room and finally finding a “W” to ease her worries, she was prescribed an antibiotic eye drop.  I came home right in the nick of time to be deemed the one who was to administer these drops at home, and boy was that fun (actually it was really difficult, but between my sister and myself, we were able to use the birds and planes in the sky as a distraction for her to look up while we snuck the eye drops in!).  This story and experience of helping with the eye drops has made me extremely excited for the pediatrics courses I will be taking over the next couple of years at NECO!  You never know how the patient (especially children) will react and that type of challenge (and finding ways to overcome it) is just what I am looking forward to!


Where has this summer gone?  As I sit here and write this blog, I ask myself, what have I done with my time this past month?  At first, I have the embarrassing thought of “I have done absolutely nothing!”  But after I think about it for a few seconds, I reassure myself that I have been quite productive.

After school was finished for the year, I traveled down to Pensacola, FL, where I have been volunteering in an optometry office.  This has been a great experience so far, as I have had the chance to see many things that I have never seen before!  During first year, I was able to see patients during screenings.  The patients were usually not much older than 8 or 9 years old.   Thus, my first time seeing a patient in this office, I was not really sure what to expect.  Many of the patients here are elderly, and have various ocular conditions.  Part of my responsibility is to help “work up” these patients by completing entrance tests and other tests including OCT, visual fields, and fundus photos.  I learned about these tests in school, but never had the chance to actually perform them.  When I heard that I would be able to do these tests, I was really excited.

One of the first patients that I performed a visual field test on was an elderly man with glaucoma.  While in lab, I only performed visual fields on fellow students and fortunately had never come across any field defects.  Looking at this patient’s previous tests, I knew that I could expect some loss in his peripheral field of view.  I knew that this loss was not a good sign, but I was eager to see what his test results would be to see if I could pinpoint any patterns that I learned while in class.  After dialing all of his information into the machine, I had to calculate the lens to put in front of his eye so that he could see the lights during the test.  I never had to put a lens in place in a visual field machine before, and I learned very quickly that it was not as easy as it looked.  I put the lens in the holder multiple times, and each time when I asked the patient to put his head forward, the lens would fall out and I would have to do it all again.  Luckily, the patient was really friendly and he just kept making jokes about the lens situation!  I finally was able to get the lens in place and was able to start the test.  As the test progressed, I could see field loss become evident and it looked very similar to what I had predicted.  It was a very rewarding experience to understand what I was looking at and to have a good idea of what to be looking out for while reading the test results.  After working this patient up, I presented him to the doctor and she confirmed that his glaucomatous field loss was progressing.

In addition to performing entrance tests on patients, I had the opportunity to observe a LASEK surgery at the ophthalmologist’s office located next door to the practice I work in.  I was not expecting to see a LASEK surgery that day, but when asked if I wanted to observe, there was no hesitation.  The ophthalmologist just received a grant that enabled him to use a brand new machine to perform the procedure and I was allowed to observe his last procedure of the day.  I didn’t really know what to expect, as again, I only learned briefly about the procedure in class, but had never seen it performed in person.  After being suited up in scrubs and a face mask, I went into the OR and was introduced to all of the instruments being used.  I didn’t realize that LASEK involved multiple machines and lasers, so it was really cool to see everything performed all at once.  First, the doctors calculated the patient’s Rx as well as the thickness of the cornea.  This was to ensure that the flaps being cut and the layer being reduced would not result in the eye being too thin and unhealthy.  After the calculations were complete, the first laser (I was not completely sure if this was an actual laser or if they just called it one) was used to cut the flap, and it did so by using bubbles that created a “Velcro” like surface.  This roughened surfaced allowed the flap to be easily lifted by the surgeon.  After the flap was removed, the laser was put into place, and the procedure was performed.  It took a total of 13 seconds per eye, an astonishingly small number that I did not expect!  I found it really intriguing to see how the setup of the room and machines was crucial for the procedure to be performed safely and smoothly.  The surgeon sat in a chair with wheels on the bottom to allow him to move from machine to machine, and the patient was in a supine position in a moveable chair that was controlled by the surgeon.  When the surgeon needed to use a machine, he would just wheel over to it and position the patient’s chair to where he needed it.  Everything went so smoothly and I was surprised at how quickly the entire procedure lasted.

So far, summer has been great!  It has been awesome to apply things from school to what I am seeing in the clinic.  Can’t wait for more great experiences to come, and I will be sure to write about them next month!


As the recovery period from finals is beginning to slow down, and things are starting to return to normal, I can’t help but wonder, “Wow, how is my first year of Optometry school already done with?”  It seems like just yesterday I was moving into my new apartment, finding myself caught up in all of the hustle and bustle of college move in day.  The U-Haul trucks were lining the streets and people were covering the sidewalks (and were accompanied by mattresses, couches, and all sorts of other furniture that eager students were hoping to cram into their small, city apartments).  It was my first time living in a large city and, to be honest, I had no idea what I was getting myself into!

The first day of school was unlike any other “first day” I had experienced.  Everyone was so nice and helpful and we all joked that we felt like we were in Hogwarts from Harry Potter.  We were the innocent “first years” who had no idea where we were and we were overwhelmed by just trying to find our way to our classroom.  Each stairway seemed like a new obstacle (and we were convinced that they would start moving at any moment), with excitement hiding behind each door.  It took me about two full weeks to finally navigate my way through the school without getting lost more than twice a day!

As I look back and reflect on that first day, I realize how much I have learned and have grown since then.  I didn’t know that there were so many opportunities in the eye care field and I had no idea how complicated, yet interesting, the eye really is!  Coming into optometry school with a background in engineering, I was nervous that I would struggle with some of the natural science courses required to learn about the eye.  I had never taken a formal anatomy class and my background in cell biology consisted of one small introductory course.  As soon as the first lecture was over for both of those classes, though, I realized that I was in the right place, and that the professors and fellow students at NECO would make learning anything a possibility.  After week one of classes was over, things began to fly by.  Before I knew it, midterms were here and then a short few weeks later, finals for the first semester were over and I was on Christmas vacation!

After Christmas vacation, second semester jumped into action as fast as first semester did, and it was over with even faster.  Some weeks seemed to go by slowly, with everyone stressing over lab practices and proficiencies, but before we knew it, we were stressing over finals and then celebrating the completion of year one.  I don’t know how it went by so quickly, but I am so happy with how it went.  Before starting optometry school, I would tell people that optometrists were the people who looked at your eyes and gave you glasses or contacts.  Now, if someone were to ask me that same question, I would probably have them sit down as I explained all of the different aspects of optometry to them.  Optometry is not just about prescribing glasses.  And if I had to say what the most important thing that I learned this year was, it would be that optometrists have a very important role in overall healthcare.  From being the first person to possibly detect micro-vascular diseases in a patient, to ruling in or out a potentially life threatening neurological disorder, I have concluded that optometry is one of the coolest and most interesting careers out there.  What is cooler than looking at the only nerve (on a daily basis) in the human body visible without incision?

The list goes on and on.  I have learned so much, but I know there is still so much more to be learned.  This summer I am volunteering in an optometry office in Florida and even though I have only been there for one day, I feel that all of my training from first year has really paid off.  I thought that I would be following/shadowing the techs and doctors during my first week, but as soon as I arrived, they told me to jump right in!  I have been able to start working with patients and to complete their entrance tests right away.  Because I saw many patients during screenings and other opportunities offered to me during my first year, I am very comfortable doing this.  As the summer keeps rolling by, I am sure I will have many more opportunities to work with and learn from these patients as well as the doctors in the office.


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