Tag Archives: Dr. Kevin Gee

Let’s talk Myopia with Dr. Thuria Younis!

Posted on by
Reply

MYOPIA CONTROL

http://www.GeeEyeCare.com

Myopia, or near-sightedness, is one of the most prevalent conditions we encounter as eye doctors. For years, parents have dawned upon us the question of “how can I prevent my child’s eyesight from getting worse?” Scientists have been trying to answer this questions for decades and current research is highly motivated on giving us the answers. While there are multiple factors to consider, the great news is that we DO have treatment options available. 

 

There are 1.5 BILLION people in the world with myopia. Along with that, every 1 in 2 people has myopia and that trend has been growing at a steady rate. Myopia is either due to an elongated eye (increased axial length) or due to a steeper than average curvature of the cornea, the clear structure at the front of the eye. When either of these factors increases, so does the myopia. While myopia is non-reversible, we are able to implement the correct treatment type dependent on the child in order to slow it down.

 

There is not a “one size fits all” treatment when it comes to treating myopia. We have to consider the child’s age, refractive error (prescription), as well as the anatomy of the eye. What we DO know, is that ALL children with myopia CAN and SHOULD be treated! 

 

Soft Contact Lenses

Peripheral defocus soft contact lenses are worn by the child like any other contact lens. The lens has different areas of focus similar to a bull’s eye appearance – the center that corrects distance vision like a traditional contact would, and an outer area which creates peripheral defocus, essentially blurring the child’s peripheral vision, which has been linked to slowing down potential eye growth. This leads to a decreasing rate at which myopia progresses. There are many different options to consider. In order to determine the right contact lens appropriate for your child, it is imperative to have a thorough consultation. We are happy to be able to provide the only FDA approved soft contact lens for treating myopia control at this office – the MiSight 1 Day contact lens.

 

Orthokeratology

Orthokeratology, also known as Ortho-K, is a method of using a hard contact lens as the child sleeps, or rigid gas permeable lens (RGP) to reshape the cornea in order to correct blurred vision throughout the day without the need for contacts or glasses. The lens works by flattening the cornea as the child is asleep. Most orthokeratology treatments take about 1-2 weeks at most to achieve optimal results in the child not requiring glasses throughout the day and having “20/20” vision. The vision is only improved for a short period of time, however, so the child is required to wear the lenses nightly in order to keep the crisp and clear vision as they go about their day. Once the child stops ortho-K, the cornea will resume its normal shape and the myopia will still be present. However, the key is to remember that all of these treatments slow or provide some reduction in slowing myopia and do not correct it all together. We commonly treat with the first FDA approved Ortho-K lens, Paragon Corneal Refractive Therapy (CRT), as well as Euclid lens at our office. 

 

Atropine Drops

Atropine, when given in low-doses nightly, has been linked to slow the progression of myopia, likely from preventing axial elongation. There is emerging research that is contradictory to this statement, however, so this leads us for the need of more research on this specific topic. 

 

Time Outdoors

Researchers have always recommended at least 2 hours of outdoor time per day for children. This outdoor time has been linked to preventing the onset of myopia as well as slowing down the shift in refractive error. It was not effective, however, in slowing down the progression in eyes that are already myopic. 

 

All children with myopia have the potential to be treated. This will not only reduce the likelihood of the prescription increasing, but also reduce the likelihood of early cataracts, glaucoma, maculopathy, retinal detachments, and countless of other ocular conditions. This will also not discount them from any future career opportunities and keep them ideal candidates for potential refractive surgery such as LASIK should they decide to proceed in the future. We are happy to consult with you and your child on their ideal treatment options!

5-Star Reviews, “Perfect”…

Posted on by
Reply

Have you seen our reviews lately? 210 consistent 5-Star reviews? One might say that that is “perfect,” but hang on a minute. While it’s wild to think about the consistency of these reviews and it really makes you feel like you are doing something right–we are not perfect by any means.

Just a few things about our reviews. All of our reviews are organic. A simple invitation is sent out after a patient visits our office. There is no incentive nor even a mention of it when the patient is in the office. We are just trying to perform to the best of our abilities, not trying to earn a star or a rating, just taking care of patients, taking care of people.

It’s easy to let these reviews go to your head but we stay grounded here, trying to do our best for each person. Our services are not for everyone and we don’t try to be all things to all people. That said, if someone decides to provide us a positive review lauding our service, we graciously accept it and congratulate anyone mentioned or everyone that came into contact with that patient. The same goes for a less than stellar review, we re-evaluate the situation and try and do better. We welcome the feedback.

We are here to humbly serve. Make no mistake about it….despite the reviews…we are not perfect.

#SiennaEyeDoc

You….lazy…..blinker!

Posted on by
Reply

Lazy Blink – Not Always the Patient’s Fault 

It has been quite some time now, that eye care professionals (ECP) have been encouraging patients to blink fully and frequently to continually renew the ocular surface to a smooth and pristine state in order to maintain clarity and consistency of vision.  With the use of technology, ECPs are now able to analyze blink rates, blink quality and more specifically, the mechanism of the blink.  

I discovered an interesting phenomenon with one of my patients during a recent visit.  She had mild meibomian gland truncation, so I brought her back for computerized blink analysis using the LipiView II (Johnson & Johnson).  The LipiView II allows us to quantify a patient’s lipid layer thickness and analyze how many blinks are produced over a 20 second interval.  Even more revealing is whether those blinks are partial or complete—do the upper and lower lids touch in an effort to naturally express the meibomian glands?  The video capture can be further broken down into a frame-by-frame analysis and shown to the patient for educational purposes.  While I have traditionally blamed incomplete blinks on “lazy” blinking, I have come to discover this sometimes also occurs as a result of a mild ectropion of the lower lid during the blink itself (see figures 1a and b).  If such technology is unavailable in a practice, this phenomenon also can be visualized via sodium fluorescien pooling in the tear meniscus upon blinking and enhanced with the use of slit lamp video capture. 

This particular type of ‘blink ectropion’ may be caused by the development of lower lid laxity due to age or mechanisms related to years of RGP removal and make-up use etc.1  My intrigue in this area caused me to investigate radio frequency thermal treatment (RFTT).  The basic premise is that RFTT helps strengthen collagen bonds of the periorbital skin which brings the lower lid into better apposition to create a more full and forceful blink.2  An added benefit is that patients also enjoy a non-invasive approach to reducing under-eye bags, and fine lines and wrinkles.3  The treatment is simple, non-invasive, and takes about 10-15 minutes per eye.  It can be conducted by the doctor or a well-trained technician.  Ultrasound gel is applied generously around the periorbital area and a stylus-like probe is massaged in a circular fashion around the orbital rim while the temperature is slowly increased to 105°F. Boney prominences and the globe itself are avoided and there are no restrictions following the procedure.

in the image above the arrows point toward the reflection of the tears and space between the lid and eye

in the image above the arrows point to just one frame later as the upper lid starts to come down and the area between the lower lid and the eye starts to widen (seen in the reflection of the tears)

We received a warning this time, so let’s do something about it….

Posted on by
Reply

When schools were abruptly shut down due to COVID-19 in March it caught all of us by surprise.  Who would have ever thought that we were going to have to go from “home schooling” to now “virtual schooling?”  No one was really prepared for this turn of events last time.  We, as eye care providers were no different.  I have fielded a number of questions regarding screen time and blue light exposure since we reopened and schools shut down.  As we face the start of the school year in the fall we know it is going to be virtual.  While there are still some questions about what is going to happen and the logistics, one thing is certain, our school aged children will be spending an enormous amount of time in front of computer screens, tablets and various devices.  Let’s get these eyes prepared with a “Back to (virtual) School Kit” for the eyes!

First off, some rules of thumb, for every 20 minutes of screen time the child should take a 20 second break to look at an object at a distance.  Secondly, we all need to make a conscious effort to make complete blinks and make them frequently.  This is something we should all incorporate into our daily routine as computer/device users.

As part of our “Back to (vitural) School Kit” I am recommending a warm compress called the Bruder mask.  The way a Bruder masks works and benefits device users is that it helps warm up and heat the glands of the eyes named meibomian glands.  These glands contain a component of tears that help prevent the evaporation of tears that ultimately leads to dry eye syndrome.  By using this mask you help keep these glands open and restore essential components of the tear film.  I recommend using this nightly before going to bed.

The second part of the “Back to (virtual) School Kit” is a pair of computer glasses.  These glasses will provide relief from hours of staring at a computer screen.  They will have a minimal power in them to ease the accommodative stress (focusing at near) that is required for the working distance between the student and the screen.  The glasses may be worn alone, over contact lenses or the power may be incorporated into an existing glasses prescription if the student currently wears glasses.  In addition to helping ease the strain, these computer glasses will have a blue light treatment on them to help protect the student from the harmful blue light that is emitted from computer screens and devices.  I recommend using these glasses when there is dedicated time in front of a computer screen.

 I truly believe every student would benefit from this and we are pleased to provide this benefit for only $110.  The glasses and mask would normally cost around $250.  No appointment is needed.  Feel free to contact us for a “Back to (virtual) School Kit.”  You can also purchase it on our web store at http://www.gee-eye-care.square.site/s/shop.

#SiennaEyeDoc

We don’t have to dilate you…..

Aside

…well, maybe.

A dilated fundus examination (DFE) remains the standard of care for the detection, management and treatment of retinal disease.  Although this can often times be inconvenient, uncomfortable and laborious it still remains as one of the most traditional methods for the examination of the back of the eye.  Things have changed but it took a number of years to get there.  I remember my first encounter with an instrument that claimed to be able to negate the need for a dilation, I was an intern in my final year of optometry school.  I don’t want to date or age myself but that was in 2001 and that instrumentation has improved (17 years later) but it still produces an image like the one below:

This image has always bothered me because it is not how the back of the eye appears.  There is no green whatsoever in the physical examination of the retina.  Even the diagrams/cartoons we study in textbooks and are easily searched on the internet to show no green and those lashes at the bottom could sometimes hide a valuable finding:

Screen Shot 2018-10-07 at 6.57.50 PM

So, the question has always lingered, what is that prior image representing?  Is it a true representation of the retina or simply a shortcut to see more patients by not having to wait to dilate the patients?  While charging patients for an image that may not be truly representative of how the eye appears for the sake of convienence?

I am not here to judge what others do.  I am here to justify why Gee Eye Care has finally now decided to employ the use of ultra wide-field (UWF) imaging and what I have decided to do.  First off, an undilated view of the retina with traditional methods (ie. direct ophthalmoscopy, slit lamp with an auxiliary lens like a superfield or digital wide field lens) usually only yields, at maximum, a field of view of 30-60 degrees.  A dilated view or a traditional image with dilation may yield a view at 100 degrees or more (depending on skill level).  An image very similar to the one below:

Screen Shot 2018-10-07 at 7.00.45 PM

The time has come where we can now produce an image to at least 200 degrees in true color!  I have been waiting on this day since 2001.  Some have questioned why I still dilated eyes at Gee Eye Care.  Truth be told, I was not comfortable with any other technology that would properly be able to replace a dilated view with my own eyes and I was not going to compromise your eye health for a shortcut.  Now I finally can show you why because we didn’t have the technology to show you before and you just had to take my word for it!  I now feel confident in the image I am able to obtain in order to reliably depict the actual retina. It took some time and yes, further investment but I am so excited to present to you the following images taken by me on an undilated patient:

Screen Shot 2018-10-07 at 7.10.27 PM

Starting on October 8th we will be presenting patients with the opportunity to defer dilation and choose this imaging.  However, some patients will be required to be dilated:

  • all new patients
  • children (in order to best determine refractive error changes)
  • certain patients with known or suspected disease that may affect the retina (to name a few):
    • diabetes
    • hypertension
    • acute peripheral retinal degeneration
  • certain patients at Dr. Gee’s discretion

This imaging is available to all, even if dilated, for documentation purposes.  When appropriate, it may be billed to your insurance but the cost will be $30 out of pocket for both eyes.  This option will be presented to you before the examination and you will be given the choice to choose prior to beginning your examination (note, Dr. Gee may need to still dilate your pupils if something is noticed upon obtaining the image).  These images will be reviewed by Dr. Gee and shared with you during the examination.  If you would like them digitally sent to you, please ask and they will be emailed immediately.

Welcome to the new age of eye care.  Dr. Gee and Gee Eye Care has always been proud of being on the forefront of eye care technology and this is no different!

Click here to set up your appointment for the “no puff,” “non-dilated,” “no 1’s or 2’s” eye and health examination!

#SiennaEyeDoc

https://www.mayoclinic.org/tests-procedures/eye-exam/expert-answers/eye-dilation/faq-20057882

https://www.reviewofoptometry.com/article/pointcounterpoint-ultrawidefield-imaging-vs-dilated-funduscopy

Notes:

  • Image #1: reference and link to OptoMap Daytona, taken directly from their website
  • Image #2: diagram taken from Cirrus OCT poster
  • Image #3: photo captured by Dr. Gee
  • Images #4 & #5: photo captured by Dr. Gee on an undilated patient

The office is Closed! Why???

Posted on by
2

In life there are experiences that can’t be replaced, replicated or overlooked. That being said, the office has been closed a few days the past two weeks as a result of the World Series. I wanted to write an open letter explaining why and apologize for any inconvenience I may have caused.

Imagine a young boy growing up playing baseball, fond memories with his dad playing catch & trying to improve his game. Some memories that many would tell about him throwing a ball before he even remembered and shortly after learning to walk at a young age. Life, career choices took him a different direction but the love of the “game” has always been there. Now grown and making a living that same boy, a young professional, vowed he would purchase season tickets at the first chance he had to afford them, starting with only one in the outfield on a mini-season and then two behind the dugout a few years later—so that that father of his could experience the “game” with him. At one time attending every home game played, all 81.

Privileged to go to Spring Training with his father and mother, this tradition continues to this day, every year in March for 1 week. Privileged to visit every ballpark in all of Major League Baseball—31 (+1 new Yankee Stadium also). Privileged to see a miracle World Series run in 2005 only to be swept by the other team. Privileged to attend two Hall of Fame Induction ceremonies again all with his mother and father. Privileged to be associated with and serve the team he grew up cheering for as a member of the Astros’ Buddies.

That’s me. Your doctor by day but son, and now father, by night. I don’t get too personal about stuff in the public but I felt compelled to make a statement because I’m not just closing the doors for a few days of leisure (frankly it’s a lot of work) but I’m closing for the experience to do this with my mother and father, wife and son. I want my son to have these memories recited to him when he grows up.

This World Series run is emotional and much like the “game” it has its ups and downs. I wish I could have predicted that we would be where we are now (actually not really because it wouldn’t be the same) as to not have to reschedule and inconvenience patients but an opportunity like this doesn’t come around very often. Thank you for understanding and Go Astros!

We will be closed Tuesday, October 31st through Thursday, November 2nd as we travel to Los Angeles and reopen on Friday to regular business hours. You can reach Dr. Gee anytime via email or text.  DrGee@GeeEyeCare.com or 281.778.9912 (feel free to text)

I was wrong, I’m sorry…

Posted on by
Reply

…I don’t ‘sponsor,’ I ‘support’

If I was ever wrong, then I stand corrected especially now. If I ever said that I ‘sponsored’ an event—I was wrong, evidently. My efforts in the community are to ‘support,’ events, organizations, individuals, in anything I put pen to check.

I want to make it very clear that the efforts that I contribute to are because I believe in them and what they stand for, NOT for marketing/advertising. As a matter of fact we have a hashtag (#CommunityMatters) in the office and that’s what it is all about.

As a business person it’s a fine line on how this is viewed, both by myself and by the public. Those that are out there working hard to get sponsorship money from other establishments may take heed of this, for me it is not about ROI (return on investment) but merely just giving back. You know it’s not always about business. I have to make the right decisions based on financials but I budget for the major schools in our community and it’s usually flexible but the thought, “what am I going to get out of this?” rarely ever crosses my mind.  Rather, whether it fits in the budget, who is asking (whether a patient or just a cold call) and of course value (how is the money going to be used) all are considered more heavily.

I opened the office in 2007 and also dropped a stake in the ground in Waters Lake of Sienna Plantation to build a home. I wanted a place to call home, not just a house. I wanted to be a part of the community. As a result, I’ve been around to see two elementary schools develop, a high school and soon to be another middle school. I’ve supported all of them and intend to do the same for the up and coming. I remember when Ridge Point, in its infancy came to ask for assistance with their band and athletics programs. I’m honored that I was asked and even more honored to be able to participate. I am honored that many have remembered that and continue to give me the opportunity. Fast forward to 2017, 10 years later, we were fortunate enough to be able to move the office to an updated and larger location. One thing for sure, #CommunityMatters is even more important and I will not back down from supporting community efforts.

So, while I’ve probably been using the incorrect word all these years, I stand corrected, the intent has ALWAYS been to support the community that I live and am a part of.

 

#SiennaEyeDoc

Just for “face value,” not this doctor

Posted on by
Reply

I received a pretty interesting email this weekend regarding an online contact lens company that many of you have probably seen pop up on your Facebook feed (according to their email you will soon see them in mainstream media as well) they are called Hubble.  I found it interesting and I thought I would share with you my email (the sender’s name has been blacked out) because I need my patients to know and be aware of what these schemes are all about.  See the email below:

hubble-would-like-to-refer-our-missouri-city-patients-to-your-office

A snippet from the email is shown below.  This is being completely transparent with you and how much these lenses could potentially cost you and how much we could make off selling them.  WE are, however, concentrated on the health of the eyes that have been entrusted to us–not making a buck here.

screen-shot-2017-01-30-at-11-47-47-am

At face value, one might look at this and say, “Wow that’s a cheaper lens,” not me! Immediately, I recognized the material, being that I have been prescribing contact lenses for 15+ years it rang a bell that I decided to dig a little deeper.  Check out the facts below (credit http://www.CooperVision.com):

screen-shot-2017-01-30-at-11-40-51-am

And then a simple Google search of “Vertex Contact Lenses” found:

screen-shot-2017-01-30-at-1-57-14-pm

So, what is the deal here?  I’m not going to sit here and implicate but I am going to state facts.  It was well known and documented by doctors that private label contact lenses exist.  Many lenses are the same and relabeled due to negotiations from corporate buying groups and such.  The best thing to ever happen to contact lenses is UPP which stands for Universal Pricing Policy and most contact lens manufacturers are going toward that.  What UPP has done is bring everything to same price point and protect patients from getting unauthorized, uncertified contact lenses for the sake of saving a few dollars.  On the flip side, some of these online retailers are not obtaining their lenses from the manufacturer and you could be receiving rebranded, inaccurate contact lenses.  Contact lens manufacturers like Alcon are now providing a Gold Seal of Authenticity to assure you are receiving the correct lenses for an authorized source.

If you have questions, please feel free to reach out to us!

#SiennaEyeDoc

 

Why I do what I do….

Image

Reply

This is an early entry to the blog, as far as mornings go, but fresh on my mind and near to my heart I thought I would share a quick note/experience from last night’s patient care.  This is why I do what I do, who could ever orchestrate the events that I detail following?

A mother set out to seek my opinion (as a second one based off a prior visit with another eye doctor) regarding her son’s vision.  He plays sports and recently noticed that the vision in one of his eyes was compromised.  He was evaluated by another doctor previously and we started our visit with the customary preparation of the patient, taking his vision, asking how long the vision had been like that, if he had noticed worsening with time, etc.  It was during this conversation that it was revealed to me that the young man’s father was affected with a condition called keratoconus.  This is a chronic, progressive deformity of the cornea that is usually passed down through generations and has some very strong hereditary connections.  It is not a terribly common but also not something I would see even on a monthly basis.  Upon preliminary evaluation of his visual acuities, it certainly appeared that he was not seeing well in his right eye, and with our technology the initial scan of his prescription surely pointed toward a diagnosis of keratoconus.  I immediately ordered a scan of his corneal curvature, called a topography, to verify my initial suspicion.  Yes, the scan came back as a classic presentation of keratoconus.

screen-shot-2017-01-10-at-8-21-48-am

Here’s where things get very interesting.  I just happened to have just finished seeing an adult patient who traveled all the way from out of state for me to evaluate his condition a few weeks back.  I diagnosed him with keratoconus and suggested a treatment option for him which he accepted and we were finalizing his treatment 10 minutes before I saw the younger patient in the room next door.  How does this happen?  An existing patient that travels from out of state for me to take care of his condition hanging out after the visit whilst I am examining a new patient (about to deliver the news of a lifelong, progressive, chronic condition) and they happen to have the vision issues–again, how does this happen?  Divine intervention? Chance?  We were able to get them to connect in the office, have a conversation about the condition and bring a sense of comfort about the new diagnosis.  After reflecting on it, doing what I do with passion, integrity and what I was called to do, I believe….

I am forever grateful for the opportunities that this profession has provided me.  Not just to take care and spare vision for patients to but to invest and take care of people.  I look forward to experiences to touch lives daily, thank you for everyone who has trusted me with their eyes and my clinical judgement.

#SiennaEyeDoc

Lash extensions…tanning salons…

Posted on by
Reply

I decided I would start 2017 off with a blog post on lash extensions only because in 2016 not a week went by without someone asking me about them.  I have decided to share publicly what I have been sharing in the examination room to make everyone aware.  First off, I am not one to judge, vanity or not, this post is about; 1. the question that everyone has been asking (some may be afraid to ask) and 2. my responsibility as an eye care provider to protect and maintain ocular health.  With that, let’s get this started.

I predict that lash extensions are going to be the latest fad, much like tanning salons, to disappear over the next 3-4 years.  I have seen the improvements made over the years, we even have one next door to us at the existing office, they look more natural, they are very becoming on most people and the adhesive being used is better than ever before.  However, I have difficulty believing, mainly because I have seen it first hand, that the adhesive is coming off before a reapplication (or a fill) is being performed.  As with anything that builds up over time this is not healthy.  Once again, my job & responsibility is to make sure that the lashes are healthy after all is said and done and that you don’t look back in 5 years and say, “why did I ever do that, now I don’t have any lashes at all?”  What I have come to see is that the adhesive (which again is very gentle & the reason why you have to go in every 6 weeks to keep up with these extensions) is not being removed prior to reapplying new extensions, which may cause you to lose your natural lashes.  I have had discussions with all the surrounding lash studios about this.  They have a responsibility to inspect that prior to reapplying a new “fill.”

I suggest that, for the health of your natural lashes, that a gentle procedure that I have been providing for the past 3 years called BlephEx be performed periodically to clean the lashes from the adhesive.  This treatment takes about 10 minutes in the chair, you can drive home and the sensation is merely a tickle to the eyelids/eyelashes.  You come away with clean lashes and lids, not like the ones pictured below, and this helps to maintain the health and integrity of them.  Finally, there is a pharmaceutical agent available called Latisse that helps lashes grown longer and fuller.  This also an option for most.

If you have questions, feel free to contact me at DrGee@GeeEyeCare.com or comment below.  Happy New Year!

Dr. Gee