Occasionally I can’t help myself when met with dreadful customer service. Today was one of those days. When chatting with a friend the topic of yellow page advertising came up. Last year they had left his address off of his ad but insisted the phone number was the important thing. This year they had substituted the photo he supplied, altered the layout, and added a tag line without supplying a proof.

In my optometrist listing, I was contacted several days before closing by DEX and told there was not time to provide me with a proof. (This was by an out of state rep even though we do have a local office).  I provided copy and explicit directions on what I wanted. I was assured they could take care of it. The changes involved a name change vital to my strategy in the eye care business.  When my friend pulled out the new yellow pages, lo and behold I found last years ad instead of the changes I requested. Since this is not the first time DEX has made mistakes in my listing I know what to expect. There was no proof to check so  I fully expect them to say sorry but it was my fault (please note I supplied them with one and explicit directions).  They probably will be unwilling to adjust their fees based on the mistakes.

DEX removed the one good rep I had a few years back. Apparently it is a policy to discourage reps from building up client relationships-maybe to try to keep churning accounts? Who knows. This is a company that in my experience has never shown an inkling of desire to provide customer service. In eyecare and any medical or health care setting it can have severe consequences when patients can’t find their providers in an emergency.

DEX even has a contract that is open ended allowing them to keep charging you for an ad past a year until the next phone book comes out. While no one can be sure, I have had the impression they have delayed phone book releases in years when the economy was suffering and people were going to cut back their ads.

Maybe I will be surprised this week and meet with a strong, customer service department that doesn’t even charge me for the year since my ad was totally wrong. I really don’t expect that.

When customer service falls to the level they have provided me it is time to find better ways to communicate with eye and contact lens patients in a reliable medium. Join me in sending a message to DEX in 2011. We’re not going to pay for incompetency.  Ditto for DC.

Visibility from an automobile is a major factor in safety while driving. It is a somewhat complex science that is  unfortunately often short changed for appearance. Cars typically have two posts (referred to as pillars)  supporting the roof, the A posts are located on either side of the window shield and the B posts are between the front and back seats. The angle of the window shield has a large bearing on the blind spots creating in front.  While a vertical A post provides the least obstructions to vision, the poor aerodynamics reduce gas mileage from the air resistance.  A sharply angled widow shield, while reducing air friction, greatly decreases the filed of vision.  The difference is analogous to a large bulky pair of eyeglasses compared to contact lenses.  The small triangle window sometimes added to the side window can also block vision for shorter drivers. The B post (or pillar), can also leave a blind spot and interfere with eyesight.  It seems that the best location for The B post to protect from side impacts is more of an obstruction to vision.  Also, the studier pillars that are offer much more protection are inevitably thicker and more of an obstacle to seeing objects on your side. While head rotation can help, other technology is in development.

The Volvo concept car uses special front A pillars the have areas you can see through. The B pillars can be curved in towards the top to open up the visual field, especially useful to taller drivers.  The next time you are considering purchasing a car carefully examine the limitations on sight while sitting in the drivers seat and compare a few cars. If more than one family member will be driving, everyone should compare how well they can see, since height differences can cause radical changes in blind spots.

After you purchase the car,  remember all of that effort will be wasted if your vision is suboptimal. See your eye doctor for the best corrective eyeglasses or contact lenses you can wear.  Accidents are common at night due to the reduced capacity of the retinal rod cells compared to the cone cells used in daylight. Anti-reflection coating on eye glass lenses are very effective today and add almost 10% more visibility.  Polarized lenses are essential for safe driving at dawn or dusk when driving head on into the sun. And of course, if you are looking at your cell phone, you won’t see anything regardless of how well designed the automobile is made. The 2009 tragic loss of a nine year old girl in in Fort Collins community brought home that point.

Alcohol, drugs, and fatigue all not only impair motor skills and judgement but also can interfere with vision and focusing.

Finally, remember it is illegal and not acceptable for the community to drive without automobile insurance.  Make sure your insurance agent is providing you and everyone involved with the type of protection they need for the hazards of driving. In Fort Collins, longtime resident ballroom teacher extraordinaire Andre Volosov is particularly good at helping you understand the type of automobile insurance you need to protect your family.

Eyeballing  a new way to help the stimulus package work? A new pair of special eyeglasses and a small contribution to Panasonic this spring will provide you with 3D television viewing at home. The VT25 HD television uses technology to alternately blank out the image of one eye at a speed rapid enough to avoid detection by the human eye. At the same time, an offset image is presented to each eye producing the 3D effect. Microsoft is reportedly working on technology that does not require special glasses so you may want to wait a few more years.

Sony, Samsung, LG, Toshiba and Vizio all announced 3D-compatible HDTVs at this year’s CES, but Panasonic has made the most noise about the technology. The company began touting an extra dimension at last year’s CES, and this year it has finally announced a shipping date for its first 3D plasma TV. Dubbed the VT25 series, it’s expected to be released in the spring. It will be among the first 3D-capable flat-panel HDTVs available for sale in the U.S.

The set will include one pair of 3D glasses–every other 3D set announced at the show, save Sony’s XBR-LX900 series, lacks included glasses. Also, like all other makers, Panasonic will employ an active LC shutter system. The right and left lens in the glasses alternately darkens and lightens, too quickly to perceive, while the TV synchronously displays the corresponding right- and left-eye-specific images. The result is a stereoscopic 3D effect that, in the case of the VT25 mated to full-resolution 3D content, preserves all 1,920×1,080 (1080p) pixels for each eye–hence Panasonic’s term “Full HD 3D.”

Many eye doctors office claim they provide specialty contact lenses or are contact lens experts. We know the frustration you feel when it turns out they are really only interested in simple cases they can shuffle in and out the door in a hurry.

Don’t call us if you have special contact lens challenges that you want solved in an hour.  We don’t want to waste your time.

Please do call us if you want your contact lens problems solved and are willing to dedicate the time needed.

Specialty Contact Lenses We Provide Include:

• Kerataconus-This is an eye disease where the clear corneal tissue on the front of the eye thins develops a very steep curvature with an irregular curvature. A cone shaped protrusion forms on the cornea. Many different special contact lens designs are used to compensate for this shape including soft contact lenses, gas permeable lenses such as the Rose-K designs, hybrid lenses with soft lens material on the outer edges and RGP rigid gas permeable materials on the inside, piggyback lenses that combine a gas permeable lens on top of a soft lens, and scleral lenses that extend over the white tissues on the eye. Kerataconus contact lens fitting is still very much an art form with no exact science.
• Cosmetic Lenses For Eye Damaged by Trauma: The colored part of the eye, the iris may be mishaped from birth or by trauma leaving an oddly shaped pupil. Specialty Colored Contact Lenses can be used to restore a normal pupil appearance and cut down on glare and discomfort from a malformed pupil.
• CRT or Orthokeratology Contact Lenses: Gas permeable lenses can be used in some cases to reshape the corneal tissue on the front of the eye and reduce nearsightedness (myopia). This is often done by wearing a lens overnight so the eye is prescription free during the day.
• Large Amounts of Astigmatism: New advances in contact lens technology allow for large degrees of astigmatism to be corrected by contact lenses. Usually the comfort of soft contact lenses can be  used in a disposable contact lens for health and comfort.
• Contact Lenses After LASIK Laser Eye Surgery: LASIK doesn’t always work and the eyes may be left with a very irregular surface. They may also be left with residual corrections and change with time. These issues can be solved with specialty contact lenses, when glasses may not provide a good correction due to irregularities in the astigmatism.
• Color Vision Defects: While contact lenses cannot restore normal color vision they can make it easier for some patients to discern differences.
• Nystagmus or Eye Tremors: In some cases, rigid contact lenses can supply feedback to the brain about these uncontrolled eye movements and help dampen the eye movements to some degree.
• Contact Lenses For 40+ Year Old Eyes Needing Bifocals: If your arms are getting too short too read, don’t despair-bifocal and mutlifocal lenses are available in many different designs in soft and gas permeable contact lenses. Expect to spend some time being fit.

Patients frequently ask me how long their pupils will remain dilated after the eye exam. Eye Doctors use different drops,different strengths, and different dosages when dilating your pupils. If you are having light flashes or symptoms that could indicated retina problems two different drops may be used in higher concentration and several doses. A routine exam may only require less dilation and milder drops.

Eye color effects the duration of dilation. Since brown pigment in the iris is essentially the only eye pigment, blue eyes lack significant color and gain their blue shade from light reflecting in the iris. Pigment binds the dilating drops and require higher doses but blue eyes react faster and more to dilation drops.

Different drops are often used for children’s eye exams and occasionally for adults that have inflammation in the eye from contact lens injuries, eye trauma, or autoimmune diseases and they may keep eye dilated for several days.

Finally, there are individuals with idiosyncratic reactions to the prescription eyedrops used to dilate your eyes. Basically, that means the optometrist is an idiot and has no idea why one out of hundreds of eyes are extremely sensitive to dilation drops and stay dilated for 24 hours or more. (The meaning of idiosyncratic is a well kept secret by all types of Doctors so please don’t reveal me as the source of explanation). If you have this type of reaction you can try and request a little known secret we use-simply diluting the drop!

The final answer is your eyes will usually stay dilated for several hours but it could be up to several days. Good luck and remember, after the first time you will probably have a fairly good idea of what to expect in the future.

Have you ever felt concern over prescription eye drops or dilation drops used by your eye doctor?

The most common eye drop is rated category c as outlined below. Nursing can be a higher risk period than pregnancy due to drugs being secreted directly through the milk. In our Fort Collins Optometry Practice we usually don’t dilate pupils during these critical time periods unless their are other potential eye problems;  like retina changes from diabetes or high blood pressure caused by the pregnancy. Fortunately, there is very little absorption of eye drops into the blood stream and by applying lite pressure to the drainage ducts even this small amount can be largely eliminated. And information about side effects is in process to greatly improve our knowledge.

Currently prescription medications including eye drops are rated by the Federal Drug Administration for safety during pregnancy and nursing. The FDA uses the five following categories:
Pregnancy Category A: Adequate and well-controlled studies have failed to demonstrate a risk to the fetus in the first trimester of pregnancy (and there is no evidence of risk in later trimesters).
Pregnancy Category B: Animal reproduction studies have failed to demonstrate a risk to the fetus and there are no adequate and well-controlled studies in pregnant women OR Animal studies have shown an adverse effect, but adequate and well-controlled studies in pregnant women have failed to demonstrate a risk to the fetus in any trimester.
Pregnancy Category C: Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.
Pregnancy Category D: There is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.
Pregnancy Category X: Studies in animals or humans have demonstrated fetal abnormalities and/or there is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience, and the risks involved in use of the drug in pregnant women clearly outweigh potential benefits.

While this database has been limited due the unethical nature of testing on humans a new research program called the Medication Exposure in Pregnancy Risk Evaluation Program (MEPREP) should help fill in some of the current gaps. The FDA will study mothers and their children born 2001-2007.  This will cover  almost one million births at eleven participating centers. Since a large number of these women took some prescription medication during their pregnancy it should greatly to our limited knowledge base in the current rating system.

While eye drops are usually low risk due their minute quantities and limited absorption,  these studies should help you rest more comfortably at the eye doctors office and with any other prescription. Of course, when contact lenses used to deliver prescription drugs are introduced in the next year or two they will need to be added to future research like this.

Being a fan of the new venue of three D movies I have to  say the Fourth Final Destination movie has it’s high spots but should remain -THE FINAL DESTINATION MOVIE. The special effects were the typical  spectacular variety of REALID but the plot  left me with eyestrain and headaches. The new release, Avatars looks very interesting in the trailers.

Since the movie is using circullarly polarized light a question remains how many people with binocular vision problems ( eyes with problems maintaining  alignment together) really do have headaches and eyestrain from 3D movies. Presumably a significant number of people do, probably at least 5%.  Forunatly, people who have a long standing eye turned out or in can still watch the new REALID movies, they just don’t see the 3D effect.

Swine Flu (H1N1) is starting to creep back into the news and will probably reach TV hysteria by September. I believe it will be a mild version and not have a large impact in the U.S. Even so, we are planning to continue serving your eye care and eye doctor needs if it should become a severe pandemic.

The first thing to consider is isolation as the number one, proven method to stop the spread of flu. During the Spanish Flu Epidemic of 1918 Western Samoa was devastated with 90% of the population infected and high mortality rates. American Samoa was barricaded closed and was flu free. Here in  Gunnison, Colorado the train station was closed with similar results.

Isolation works. Flu cycles typically occur for about 6 weeks, returning after months for a few more cycles. That means planning on restricting activities for about 6 weeks. If needed, we have plans to extend refill times on prescriptions and mail glasses or contact lenses directly to your house. For office visits we plan on scheduling every visit, even pick ups, adjustments, or any type of office visit. By reducing the number of people in the office at the same time as you we can greatly reduce exposure. We can also perform more limited exams during the 6 week cycle. We will request you come in alone if at all possible to reduce exposure to our employees. By scheduling all visits we can reduce the number of employees in the office at any given time reducing exposure.

Obviously, if you feel like you might have the flu we would request rescheduling your appointment. While we do have some face masks, there are still questions if they have any effect on preventing transmission. As you might know, most masks are manufactured overseas and difficult to obtain. We may request patients to wear them instead of us to extend the supply we do have.  As you may have heard there will be a shortage of vaccine. Unfortunately, in years past most production was moved offshore. The last several years there has been a move to correct this but only 40 million vacines are expected from initial production in October.

Additional measures will be placing hand washing stations by the doors for everyone entering the office, and requesting keeping a three foot distance away from anyone else.

Pinkeye is not a common complication of the H1N1 Flu and there are reports of a number of cases with low or no fevers.

Again, I personally so not expect this to be a serious problem in the U.S. and don’t expect we will need to change our normal procedures, but we are prepared to if needed.  Less developed parts of the world have the potential to face a much more grim prospect due to crowding, hygiene, and lack of health care. Probably the worst thing we can expect is the possibility of being stuck at home with kids when the internet or cable goes down!

Stay Well

Dr David Kisling, Optometrist

The National Eye Institute

The Department of Health and Human Services (HHS) is the United States government’s principal agency for protecting the health of all Americans and providing essential human services. The National Institute of Health falls under HHS and the National Eye Institute (NEI)  is part of the National Institute of Health. It was established by Congress in 1968. That’s the alphabet soup for the day.

The National Eye Institute supports research into understanding eye diseases and disorders of the vision system.  The NEI awarded about 1600 research grants and training awards  to scientists last year including several hundred medical centers and numerous  researchers around the country. The NEI also has its own facility in Bethesda, Maryland where it conducts patient research.

NEI research has contributed to numerous advances in areas such as

• Diabetic retinopathy
• Amblyopia.
• Age-related macular degeneration (AMD).
• Glaucoma.Retinopathy of prematurity.
• Corneal stromal keratitis.
• Cytomegalovirus (CMV) retinitis.
• Uveitis.
• Retinitis pigmentosa.
• Leber’s congenital amaurosis.
• Lasers for treatment of AMD, glaucoma, and myopia (nearsightedness).

Another function of the  NEI mission is to develop public and professional education programs that help prevent blindness, reduce visual impairment, and increase awareness of services and devices that are available for people with low vision.

Current projects cast insight into future treatments. NEI programs are working on transplanting cells into diseased retinas for eye diseases like macular degeneration. They are also working on genetic treatments for inherited eye diseases and new methods of glaucoma treatment involving protection of the optic nerve fibers.

• NEI-supported scientists are working toward transplanting healthy cells into diseased retinas. This research may lead to new treatments for people with blinding retinal diseases, including AMD and retinitis pigmentosa.
• Researchers are exploring gene-based treatments for a variety of inherited eye diseases.
• NEI-supported scientists are developing “neuroprotection” methods that will prevent or slow glaucoma cell damage and promote the survival of retinal cells damaged by glaucoma.

The National Eye Institute is on of National Treasures of Health Care Assets that deserves support for future advances in eye care.