Just this morning, I stood in front of the SCCO amphitheater and finally became a doctor! Finally after 4 years of hard work, sacrifice, and more stress than you can think of, I attained the dream that I have been looking forward to when the idea of optometry school first came into mind during my college years. I look back at some of the blog posts and it reminds me of how much we all have been through, all the way back to day one (it's pretty surreal looking back at those old posts!). I am thankful to God, my family, friends, classmates, and especially my soon-to-be wife in two weeks for all their support! I also have a special thank you to all of you who have followed me in this journey in this blog...I would have never thought that I would have taken this website this far! It was always interesting to see people come to school and say, "hey, you're the guy with the website!" and hear back about how OptStudent.com has helped them get through the pre-optometry process. As far as what's next for this blog and website...well I won't be posting as often as I did previously but I sure will give you all some updates here and there, especially with updates on my residency and adventures as an Army Optometrist! Thanks again for following this blog and wish you all the best in your own paths in becoming an optometrist yourself!]]>Eventshttp://optstudent.com/nucleus/index.php?itemid=177Fri, 21 May 2010 18:56:01 -0700Last day as an intern!
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4th Year Rotationshttp://optstudent.com/nucleus/index.php?itemid=176Wed, 12 May 2010 20:56:00 -0700Scleral depression
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scleral depression. Basically what happens is that a small blunt ended instrument - usually a thin metal rod, or a even a cotton-tipped applicator - is pressed onto the eye either directly onto the globe or indirectly against the outer skin of the eyelid. What happens is that the tip applies pressure onto the retina from the outside and creates a greyish bump as you view inside the eye with the BIO.So what is the point of this? Scleral depression is indicated for patients that have suspicious looking holes in the retina. Before I discuss the mechanics, one should understand how retinal holes work. Holes can be caused by different reasons, including idiopathic causes (in other words, no obvious cause), or they can be caused by the vitreous (the gel in the eye) tugging on a spot on the retina, eventually pulling a piece off and creating a hole. To make it simple, take a look at the picture I made below. The retina is the reddish brown layer at the top, and the retinal pigment epithelium and choroid are combined as the second (red) layer. On the bottom left picture, note the gap in the reddish brown upper layer - that is the retinal hole.
When you push onto the outside of the eye with the depressor (indicated as the grey rod above), any holes in the depressed area can do one of two things: either they can stay flat or the edges of the hole sort of "flap up". The ideal situation is that the edges of the hole should stay flat, and this indicates that fluid is not likely leaking into the hole. Earlier I mentioned that a hole can look "suspicious." When there is a white cuff around the hole, this means that there can be leakage since the edges of the hole are lifted. This is demonstrated in the picture on the bottom right, where fluid can fill underneath the retina as indicated by the arrows. This is a dangerous situation because if fluid continues to build up under the retina, a retinal detachment can follow and that can make for a bad day for the patient.
As I mentioned earlier, a scleral depressor is applied either directly onto the eyeball or on the eyelid. You can use the lids when you are doing inferior or superior views, but when you are doing lateral views then you must apply the depressor directly onto the globe since there is little to no skin to place the depressor on. Scleral depression requires a lot of dexterity since you often have to juggle between holding the patient's lid open, holding the depressor at the precise location, and aiming the the BIO light perfectly onto the lens and aligned with the small opening of the pupil that's oriented off to the side. Just as it sounds, this is a pretty advanced technique and most optometrists do not perform it; scleral depression is usually left to the ophthalmologists.
We at SCCO were taught this briefly before, and I was able to do it once through the eyelid then, but this time I performed it on a patient directly on the globe...that was pretty intense! Of course, before you apply the depressor it's important to give the patient some anesthetic on the eye. My patient did not feel uncomfortable so it was a great opportunity for me to practice, and I even had the opportunity for the staff doctor walk me through the procedure as I was depressing the patient's eye. I didn't get to depress the hole directly but I did get to see the greyish bump move around inside after a few minutes of struggling to get the the perfect alignment - scleral depression is super tough!!!
Ultimately all optometrists should refer any hole that has a risk of further damage to an ophthalmologist. Holes can be a serious matter; remember that this blog should not be used for any kind of medical advice. If you ever see a hole, you should always use your best judgement and consider what is taught from your professors and textbooks as to when you should refer or not.]]>4th Year Rotationshttp://optstudent.com/nucleus/index.php?itemid=175Fri, 23 Apr 2010 11:30:07 -0700NBEO III: How it went down
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18 different optometric techniques. I took the exam in Fullerton, at our school which was the best bet for any SCCO student of course, since we were already familiar with the equipment in the clinic there. We entered into the main lecture hall building to meet up for a brief orientation. Prior to entering the building, we were required to remove or cover up anything that identifies our names or what school we attend - including anything on our lab coats and equipment. We were also presented with a list of required equipment to bring since there are certain items that will not be provided. We were also given a label that has our candidate ID number and it also has what order we will proceed with each station (out of the 4 stations). We were then given an orientation that talked about the logistics of the exam, etc. Afterwards we entered the clinic and proceeded with testing.Each station is timed for 30 minutes, and a very loud, shrill whistle was blown at the start and end. We had five minutes to go between stations and have our things prepared prior to starting. As I started the exam, I was of course a bit nervous and my first station was BIO and fundus lens, so my hand was a little shaky. However, I built my confidence quickly and had steady views for the most part. The grading criteria is very detailed and picky, so I knew that there would be points here and there that I would miss. The best part about the grading though is that there are plenty of points with procedures, not necessarily your results or findings; in other words, even though you may have poor retinoscopy findings, you can still gain many points from following the procedure as listed in the grading sheet (which was of course provided to us way in advance so we can study it).
I was aware that I did some errors here and there, and I also know that I did the worst with accommodative testing (I lost count with some numbers, oh well) so I am hoping that the tallied errors will not be enough to make me fail! Of course there will always be some points that I did not know that I missed, especially with the objective type tests like lensometry, and that makes things a bit more uneasy for me as far as knowing if I passed or not. I know that our school has historically had very high pass rates on this exam (something like 98-99% but don't quote me) but regardless, I have always been the type of person to expect the worst. The hardest part of this test is not the techniques themselves - they are actually quite doable - it is how you perform while being closely watched and under stress, with a time constraint (although I must say I finished early in every single station). I cannot say how well I did but I will keep you all posted...unfortunately, the results are supposedly not going to be up until around June! What a long time to wait considering it will be a couple weeks after my graduation on May 21st!!!]]>Academicshttp://optstudent.com/nucleus/index.php?itemid=174Mon, 12 Apr 2010 13:39:20 -0700NBEO III coming up soon
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here).
Pretty much all of the skills on this exam are techniques that we have been doing since we started working in the clinic, so the techniques are not really that difficult. However, the challenging part of this exam is the fact that we are not doing the techniques in the order we are used to, and we have to be able to tell our findings at certain points and in a certain way. Overall though, students at SCCO has been very successful in passing Part III - we've historically had something like a 98-99% pass rate (don't quote me on this). I'm not surprised with this because the techniques we learned has been drilled in our heads repeatedly, and also we had the mother of all proficiencies (aka 12 Station - see past blogs). So proficiencies are second nature to us! However, I've been practicing the procedures (especially in the manner in which we are tested) just to make sure I won't be that 1%...! Once the exam is done, I'll make sure to update you all on how it goes down.
Oh and one more thing - Happy Easter everyone!]]>4th Year Rotationshttp://optstudent.com/nucleus/index.php?itemid=173Sun, 4 Apr 2010 00:39:32 -0700Clinical case: retinal detachment?
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looked like a detachment but given the size of the area, it would have likely resulted in at least some symptoms of flashing lights. My staff doctor then took a look at it with a 3-mirror lens (which allows better views of the ora serrata, which is the most peripheral area of the retina). Underlying the whitish area, he saw some lattice degeneration, which is a typical peripheral retinal degeneration that is often benign. My staff doctor then started to think that it was just an area of vitreous condensation, which is a benign occurrence with the fluid inside the eye. Strangely, however, he said that it moved around just like a retinal detachment. To make sure, he then asked me to summon one of the ophthalmologists to take a look.
The ophthalmologist agreed that it looks like a detachment initially, but it was actually not and the whitish area was an area of vitreous condensation with a very distinct border. The reason why it was not a detachment is that, as she stated, there were retinal vessels underlying the whitish area, thus confirming that the retina was flat and attached in that area. A true retinal detachment would have whitish tissue floating about but with the retinal vessels on it. Also, many (but not all) retinal detachments would result in symptoms of flashes of light or multiple floaters. The video below shows exactly how a detachment looks like (however this one reaches all the way to the posterior pole); go to 0:59 to see how the vessels are on the floating, detached retina:
The patient was in the clear at the time, but given the lattice degeneration and the associated vitreous condensation, he is at a higher risk for detachment since the vitreous can have an adhesion to the lattice area and can tug the retina with it, resulting in a retinal detachment. I'm no pro at retinal detachments, but a key thing to keep in mind is that if you're ever in doubt, it is definitely a good idea to ask for a second opinion, especially for serious ocular diseases like retinal detachments!]]>4th Year Rotationshttp://optstudent.com/nucleus/index.php?itemid=172Sat, 27 Mar 2010 21:54:26 -0700Turf wars and optometry licensing
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This topic has been a hotly debated issue between ODs and OMDs and it has become something like a "turf war" where one profession loses ground and another fights to gain it back. One prime example is the recent legislation in California that allows optometrists to treat and manage glaucoma, among other ocular diseases. Previously, California ODs were permitted to treat it only if they underwent a pretty rigorous process that only very few gained certification in. Now, that limitation has been lifted but it only happened because of the efforts of its state association. Traditionally, OMDs were the only practitioners that were permitted to treat glaucoma but now more and more states are gaining this in the OD scope since it is a disease that has been thoroughly taught in optometry school.
Since each state has its own laws for the scope of optometry, there are also different requirements for licensing. I'm going through this process right now myself. This gets really confusing because depending on the state, you may be required to complete among the following to obtain a license:
- An application (all states require this of course)
- Fingerprints/background checks
- An optometric laws exam - this can be electronic or written
- Transcripts (in addition to optometry school, some states even require College and High School transcripts)
- CPR certification
- Many other possible requirements, e.g. Oklahoma requires you to take an anterior segment laser course
Since each state has different laws, you cannot practice optometry in any state other than where you are licensed. What makes matters worse is if you decide to move to a different state to become licensed there, you must have recent NBEO scores ready to hand over in order to become licensed there. In other words, your NBEO scores will not be honored after a certain amount of time e.g. five years or something like that. That means you have to take all parts of the NBEO all over again if you want to move to another state if you're past the time limit! Thankfully there are some states that accept a reciprocation of license where you can use your current license to obtain a license in another state without having to go through the national boards again. Hopefully one day, there will be something like regional or even national licensing where you can move between states without having to worry about that huge hassle. Then again, given the huge steps our profession has taken (e.g. something like 35-40 years ago, we were not even allowed to dilate patients!), it won't be surprising to see some changes with licensure requirements in the years to come.]]>Generalhttp://optstudent.com/nucleus/index.php?itemid=171Sat, 20 Mar 2010 23:33:31 -0700Clinical Case: Solar retinopathy
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SourceI couldn't quite figure it out because it looked like a macular hole but not quite. Soon after, my staff doctor came in, took a quick peek at the patient's maculas and asked him if he had a history of staring at the sun. As it turns out, the patient used to actually look out to the sun! Immediately after that I realized that this patient has Solar Retinopathy (or Solar Maculopathy).
Solar retinopathy is a result of the sun's powerful rays damaging the central part of our vision (the macula). Initially the patient would experience a photopsia, also known as an "after-image" which appears as a flashing spot in the center of their vision. Their acuity would be decreased, and if the patient has stared long enough, it would stay reduced permanently. But if the gazing was only brief, the acuity would only be only mildly affected, just like the patient in this case. There is unfortunately no treatment for solar retinopathy because the damage is permanent.
Another interesting tidbit is that there are actually people out there that practice sungazing as a spiritual and/or health practice! One particular website struck me as shocking is the Solar Healing Center. It is a website based on the practices of a man from India named Hira Ratan Manek, who since 1995 up to this day has supposedly lived off only water and the sun! This practice is definitely something that anyone should NOT recommend...I don't know if this man realizes it but we are not plants!!! ]]>4th Year Rotationshttp://optstudent.com/nucleus/index.php?itemid=170Sun, 7 Mar 2010 23:21:48 -0700Residency
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ORMS (Optometry Residency Matching Service) website and fill out an application during the middle of their fourth year. Then, you select your top choices, which are thrown into a pool and you eventually "match" to a residency, which basically means the residency site selects you. There are many different types of residencies out there, including Low Vision, Contact Lenses, Ocular Disease, Vision Therapy/Pediatric Optometry, and Primary Care. Most optometry students tend not to complete a residency but I heard that the the number of applicants this year has grown. Here are some of the reasons for applying to a residency:
- Expand your knowledge in a certain specialty
- Broaden future possibilities e.g. teaching or research
- Increase job marketability (but this can be debatable)
- No job lined up upon graduation (not often the sole reason but especially in this economic climate it's definitely true)
- Points towards a Fellowship in the Academy of Optometry (I'll have to write a separate blog about this one)
- Points towards taking the Board Certification exam
Since I am in the Army, I didn't go through ORMS; instead I applied through a different way other than ORMS for the SAMMC residency. By the way, the Army has two accredited residency programs, the one aforementioned in San Antonio and another in the U.S. Military Academy aka West Point in New York. The SAMMC residency has a lot to offer:
- Treatment and co-management of glaucoma and ocular disease at the pathology/glaucoma clinic
- Management of low vision and Traumatic Brain Injury patients
- Several lectures (both attending and providing)
- Medical contact lens fits including keratoconus, post-PK, aphakia - I was told there is a LOT of this done at SAMMC
- Training on various special testing: culture/sensitivity, shadowing neuroradiology specialists (for MRI/CT interpretation), training on establishing venous lines and fluorescein angiography
- Ophthalmology work-ups and co-management
- Attend ophthalmology resident lectures and weekly grand rounds
- Precepting for optometry interns
- Sick call at the Troop Medical Clinic: treat acute ocular injuries and infections
- Orbital and facial dissection course
- Army Humanitarian mission to Central/South America
- Anterior Segment Laser Course in NSU Oklahoma - yes, I will be doing surgery on live patients (not including LASIK though)!
As you can see, there's a lot in store for me in the coming year and I'm super excited!
...and stay posted for updates on my new rotation at the VA Los Angeles Ambulatory Care Center!]]>4th Year Rotationshttp://optstudent.com/nucleus/index.php?itemid=169Wed, 17 Feb 2010 23:07:42 -0700A few updates
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Next week will be the beginning of my last rotation...it's been a long journey so far and graduation is coming up super fast! I just ordered my diploma frame and looking at the picture of the sample diploma (and how my own will be framed in the near future) was pretty surreal! This year is very monumental for me since on top of graduation, I'll be getting married, getting promoted as an Army Captain, moving to who knows where (still waiting to find out), and starting off my career/adventure in the Army. What a whirlwind of events!!!]]>4th Year Rotationshttp://optstudent.com/nucleus/index.php?itemid=168Thu, 11 Feb 2010 13:34:46 -0700
