Tuesday, July 12, 2016

Another Reason Why it’s Great to be an Optometrist

I’m going to start this entry by freely admitting that I was never a model student when I was going through my low vision rotations with Dr. Feinbloom many years ago. I actually remember getting yelled at by him several times during my rotation for not totally getting it! Guess this is why I gravitated to primary care! Well, with that said, I’ve come to realize the importance of low vision work over the years, and the great benefit it brings to millions of patients. 

Thus, my story:

I was honored to be introduced to a 91-year-old World War II Navy veteran who is the father of one of my graduate school instructors.  Knowing my history in the Navy, my instructor asked if I would take the time to talk to his dad about the Navy and share some stories. Well, his dad and I quickly struck up a friendship over the phone where he shared some of the experiences he had on a Navy destroyer during the war in the Pacific. His stories were an amazing documentary of bravery, adventure, and modesty. During the course of our discussions (and I’m not really sure how we got to this) he mentioned that he had age-related macular degeneration and had not read a newspaper in a couple of years; watching television was becoming increasingly more difficult. I asked if he was being seen by anyone and he told me that he was seeing an ophthalmologist and optometrist, both of whom had told him that there was nothing more that could be done to help. At that point I thought, “how can that be?”, with all the great low vision aids and interventions that are out there today. He didn’t have any advanced optical aids nor was he aware that they existed. So, with the help of our staff at the Feinbloom Center at The Eye Institute, I was able to connect him with a Salus graduate who happened to be a low vision specialist working in the VA center near his home. 
At last week's Harvard Program


Let me fast forward a few weeks to when I was recently attending my graduate program at Harvard. When I ran into my instructor, instead of greeting me with just a traditional hello, he grabbed my hand and almost hugged me saying that we had changed his dad’s life! Because of the interventions he received from our former student, his dad, a huge NY Times fan, was able to read the newspaper for the first time in two years! It turns out that our former student evaluated him at the VA and he arranged for him to receive a CRT and other associated low vision aids. Additionally, my instructor told me that the doctor told him to replace his dad’s outdated 27-inch TV with a modern LCD flat screen. It turns out he was quite a sports fan and couldn’t enjoy the games on TV. Now that has also changed.


These are relatively simple fixes that significantly improved the quality of life of a person who, without our intervention, would not have realized these improvements. So, once again, it’s great to be an optometrist – even if I didn’t exactly excel in low vision when I was a student! Positively affecting the lives of those we care for is the centerpiece of what we all do as clinicians. I’m glad this worked out so well.

Tuesday, June 14, 2016

Why it’s Great to be an Optometrist




This is one of those “there I was” stories that makes me feel very proud to be in the optometric profession.

So, there I was (actually my wife and I and about 10 of my Navy buddies and their spouses) happily rafting down the Colorado River with another 20 or so individuals for a fun-filled week of relaxation, hiking, sightseeing and catching up. On the fourth day of our trip while taking a lunch break after hiking halfway up a canyon wall, one of the physicians came up to me and asked me if he could, “ask me an eye question?” Generally when this happens, people are curious about refractive surgery or contact lenses. This inquiry was clearly very different. The physician explained he had noticed a “C” shaped shadow in his vision in one eye the night before and it didn’t get any better over the course of the day. He also told me he had a history of ocular migraines. The previous evening he checked with one of the other doctors on the trip who advised him to wait and see what it was like in the morning due to his past migraine history. I immediately was suspect as ocular migraines are usually bilateral and generally present much differently. Well, that morning, since nothing apparently changed, the physician opted to go on a rather arduous group hike up about 800 feet over rocks and through streams in fairly severe heat. Needless to say, it required a great deal of effort for all of us. My wife and I opted out of the full route because of the heat and level of effort to traverse back down the steep path.

As soon as he finished telling me his story, I asked if he had seen any flashes of light and if he was a high myopic (very nearsighted), knowing both should be considered when diagnosing a retinal detachment (I do remember something from my days in clinical practice). He told me he thought he might have seen some flashes last night and he was a relatively high myopic. As a result, I did a quick confrontation visual field that revealed about 120 degrees of an inferior defect in the affected eye. He also mentioned he thought he saw some “red” in his vision in that eye! Well, from my perspective, that pretty much confirmed the likelihood of a superior retinal detachment or pretty good size tear in the affected eye.

The most impressive part of the story was when we notified the guides who were leading our trip; they immediately used their satellite phone to request a medevac. Remember, we’re on the Colorado River at the base of the Grand Canyon – no roads, no cell phones, etc. It was pretty rustic. After being told there were two other medevacs in progress – lots of tourists navigating the canyon this time of year – we received assistance within 45 minutes. Since we were on a small beach right off of the river (see the bottom photo), our guides organized all 30 of us into a bucket brigade to wet down a helicopter landing space so sand wouldn’t fly up and blind the pilot. It was very impressive to see the innate teamwork and organization that occurred within a few minutes. Everyone was calm and focused on the task at hand. As soon as we were done wetting down the beach, we could hear the National Park Service helicopter in the distance. Once it landed on a small patch of beach, the pilot and an EMT emerged to check out our patient. Within about 10 minutes they whisked him and his wife off to Flagstaff, AZ for a full ophthalmological evaluation.

A few hours later we found out the physician did, in fact have a fairly large retinal tear that required a scleral buckle and other procedures. In the end, he had to be transferred to a more specialized center for definitive treatment. The tear resulted in a 75-85% loss of his central vision but he retained good peripheral vision and of course, full vision in the unaffected eye. Based on the fact that the initial thought was ocular migraine as opposed to a retinal detachment, it appears it was a good thing I was there to help move it along more quickly. My only regret is he didn’t talk to me prior to taking that hike!



So, it’s great to be an optometrist, especially when you’re the only eye specialist within hundreds of miles and someone in your group experiences a retinal detachment. Kudos go out to the guides who were with us and the National Park Service for the quick and professional response to this emergency.  It’s nice to know they are accessible when necessary.


Tuesday, March 22, 2016

Upon reading the news of the terrorist attacks in Belgium this morning I was extremely saddened by the loss of life and number of injuries reported. Life is special and fragile. You have all chosen professions that instill hope, confidence and faith in people.

Unfortunately, we are living in unpredictable, crazy times. Just watch the presidential debates! What keeps me grounded is when I walk around the University and see the energy our students, faculty and staff exhibit directed to learning skills necessary to make others’ lives better. Every day when I see the excitement and confidence on our students’ faces, and the professionalism of our faculty and staff, I am reminded that everything else going on around us serves as a type of background noise, designed to distract us from what we really need to be concentrating on: each other and the goals we have all set out to accomplish. These goals, which are all focused on improving others’ lives.

Many individuals attempt to derail these thoughts and ideas but frankly, as Americans and even more so as healthcare providers or soon to be providers, our focus needs to remain on education and improving the quality of those lives that are entrusted to us.

So as you read this, please keep in your thoughts and prayers those families who have lost loved ones and those who have been injured in these cowardly attacks. While doing so, also give thanks for the freedom we have to learn and ultimately practice our professions in a free and safe environment.

Tuesday, March 1, 2016

More than Meets the Eye

It’s been a while since I’ve blogged – so it’s time! 


I just got back from Atlanta where I attended the Southern Educational Congress of Optometry (known to most optometrists as SECO) where I had the honor and privilege of delivering the opening lecture of the conference – and it was A BLAST! I was part of a special session entitled, “More than Meets the Eye” where I was asked to provide my view on the future of optometry as well as optometric education. I was followed by amazing lectures from Drs. Mike Gallaway, Clark Chang, both Salus affiliates, Vicky Vandervort from Omaha, NE, and Christina Master from the Children’s Hospital of Philadelphia. I had the opportunity to help set the tone and introduce the topics the other four doctors presented which included convergence insufficiency, visual training, closed head trauma and keratoconus. It was extremely well-received.



The best part of all is that I had people coming up to me throughout the meeting thanking me for being such a great spokesman for Salus/PCO and optometry. They were fired up about increasing our scope of practice, especially as we as confront a nationwide shortage of primary care providers through 2025. I think what’s most important about this talk is that it helps to set the stage for Salus/PCO to once again take the lead on moving the optometric profession forward while at the same time putting some pressure on our national organizations to begin marketing our great optometric profession to qualified applicants nationwide. One of the points I made, in addition to why it’s absolutely necessary to expand optometric scope of practice to include the diagnosis and management of metabolic disorders such as diabetes, hypertension and hyperlipidemia, was that optometric national organizations, such as the American Optometric Association and the American Academy of Optometry need to actively market the profession. Much like the nursing profession has done, they need to actively market in order to reverse the decreasing applicant pool we have been experiencing over the past decade. I see this as one of the most important challenges confronting the profession; ensuring we maintain a cohort of qualified applicants to fill the 1700+ seats we currently have nationally. If we don’t do this we risk having an applicant pool that does not provide enough qualified people to fill the seats of our 23 optometry schools. 

So here we go – I’d like to take this talk nationally as I believe expanding the optometric scope of practice as well as addressing a decreasing applicant pool are burning platforms Salus needs to take the lead in addressing! We’ve got a history of taking the lead on these types of issues; after all, we wouldn’t have diagnostic and therapeutic privileges today if it weren’t for the visionary leadership of those who came before us at PCO. I welcome your comments and support as we move this initiative forward. 


Have a great week!

Wednesday, December 23, 2015

Happy Holidays to All!

'Twas the day before Christmas when all throughout Salus not a student was stirring, not even in labs;

The faculty hung around, but by the end of the day, hoped to get home to catch some last minute shopping or football plays;

The staff settled in and then headed home to bed while visions of construction danced in their heads;

The library, the lab, and others quite near, are all on the docket to be improved next year,

All of our specialties are prepped for next year – waiting for the students to all re-appear,

As we close out this chapter in our history, we wish all a great holiday with peace and prosperity.


Happy Holidays to All! 





Sunday, November 29, 2015

A Reflective Holiday Season

It's amazing to me how quickly time passes. It seems like just yesterday we planned for and enjoyed the Pope's visit to Philadelphia, Veterans Day and this weekend we celebrated Thanksgiving. We now set our sights on Christmas, Chanukah, Kwanza and New Years! Yikes, 2015 is almost gone and 2016 is right around the corner. With all the hubbub around all of the holidays I think it's become increasingly crucial to focus on what's really important and not just all the trappings of this time of the year. With time passing so quickly, I absolutely believe we need to make the effort to focus on the reasons many of us have made the decision to become healthcare providers and educators. Corporate America would have us all believe the most important thing to do this time of the year is to shop 'till we drop or our fingers get tired of surfing the net. I disagree. While difficult at times, it's extremely important to direct our attention and energy towards family, friends and those patients and clients we care for on a daily basis. As I've alluded to earlier, time flies by much too quickly to take any of these relationships for granted. Before you know it, family members and friends are gone off to school, jobs, etc. and our patients and clients can fall through the cracks.  

I think this is a good time of the year to reaffirm our commitment to those closest to us. Do something special for those around you - tell them how much they mean to you. Review your office or teaching procedures to ensure you're providing/teaching the most up-to-date information, update your databases with current addresses and phone numbers and most importantly, take a few extra minutes with each patient, client or others to let them know how much you really care about them. In today's busy world we seem to have forgotten about the human touch necessary to convey our feelings and thoughts. To save time, we default to texting, focusing on the electronic health record entry while in the office or email. We're forgetting how to really communicate. As time passes we will have nothing concrete to look back upon other than a record of our texts, emails and EHR entries. So, what I am saying is let's commit ourselves to a renewal in communication and caring for those around us. Life is too short to let all those wonderful relationships we have the opportunity to be part of slip through time oh too quickly. It will take some work, but the outcome will be well worth the effort in the long run!

Wishing everyone a reflective holiday season.

Tuesday, November 10, 2015

Veterans Day

Today marks the 240th birthday of the United States Marine Corps. Here in Philadelphia, on November 10, 1775, the Second Continental Congress passed a resolution establishing the Continental Marines. Since that time, Marines have distinguished themselves defending our freedoms. During my 33-year Navy career I had the privilege of serving with the Marine Corps for almost one-third of that time. Tomorrow we also recognize all of our veterans as we celebrate Veterans Day.  World War I – known at the time as “The Great War” - officially ended when the Treaty of Versailles was signed on June 28, 1919, in the Palace of Versailles outside the town of Versailles, France. However, fighting ceased seven months earlier when an armistice between the Allied nations and Germany went into effect on the eleventh hour of the eleventh day of the eleventh month. For that reason, November 11, 1918, is generally regarded as the end of World War I.  Originally designated Armistice Day by President Wilson, November 11 commemorates the armistice that began that day. In 1954 Congress changed the name to Veterans Day to recognize all veterans. 

While I was on active duty I paid little attention to the observance of the Navy and Marine Corps birthdays and Veterans Day other than to enjoy a nice social event and a day off. Now, as a retired Navy veteran I find myself thinking of these days a bit differently. I have been reflecting on how lucky we all are to have men and women who, everyday make sacrifices to ensure we continue to enjoy the freedoms we have. They do this while being held to the highest of standards, both professionally and morally. Their core values of honor, courage and commitment have been the moral and ethical compass that has guided them for 240 years. 

As healthcare professionals we have much in common with those who serve in our armed forces.  We too have made a commitment to devote our time and energies to serve others.  Most importantly, though, as healthcare professionals we also must be guided by an ethical and moral compass – one that emulates that of our Navy and Marine Corps – that of honor, courage and commitment. 

So, as we celebrate the Marine Corps Birthday today and take time to honor our veterans tomorrow (and I hope every day) I also hope that we reflect on how we can leverage our own commitment to always conduct ourselves with honor and have the courage to always do what’s right for our patients. 

If you see someone in uniform or if you know someone who is a veteran, please take the time to thank them for their service while I thank you for your service and commitment to helping others! Semper Fi!