Tag Archives: gee eye care

You….lazy…..blinker!

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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 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???

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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…

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…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

Lash extensions…tanning salons…

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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

 

Everyone was very friendly and helpful…Janet J.

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Everyone was very friendly and helpful. Dr. Gee does a thorough exam. He gives you opportunity to ask questions to have a better understanding of your eyes and the importance of eye care. He also has a very nice smile. Thanks

Oct 11, 2012