Optometrist Perspective by Harvey Yamamoto, OD

Harvey Yamamoto, ODI’m a bit late on writing about my reflections of the previous year. 2011 was a very special year for me. For one thing, the year went too quickly. Working on 3 exciting seminars at the same time does take a lot of my personal time but whenever I see the finished product it makes me feel somewhat accomplished. We will be having 3 more fabulous seminars in Southern California hosted at the Doubletree hotel in Orange. In fact we will be having one this month on the 20th. Hopefully many of my readers can make this one.

Our staff has listened to our attending colleagues and we are doing our best to provide at least 6 hours a year on glaucoma. I believe that 2012 will have closer to 12 hrs on glaucoma. Unlike most other states, California received permission to begin allowing optometrists to become glaucoma certified via the new rules. Attendance at both Berkeley and SCCO has been at an all time high in attendance. I was fortunate to have completed all my requirements at SCCO with my final class completed in September.

Many of my close colleagues have decided to forgo the certification process.  I can’t say that I really blame them for their decision. For those, like me who have gone through the process of certification it is gratifying once the long process is complete. It has given me another level of responsibility and service that we can provide to our patients.

OCT: Our practice has been utilizing the OCT since 2003 the first unit was difficult to master and it was a time-domain unit. It wasn’t until 2009 that we took the newer model for a test run. The choice was pretty obvious, it was a much faster and simpler to use which made it a no brainer to upgrade.

A week does not go by that I will be confronted by a patient who does not see 20/20.  You all have those kinds of patients more often than we would like to admit.  It is primarily these kinds of patients that I like to perform the OCT. In many occasions, the images are very revealing.  We have found so many diabetic macular edemas that can be vision threatening with the OCT that would have been missed otherwise. Pretty scary thought, huh? Yes. Yes, it is. All of these patients were extremely grateful for us uncovering the mystery as to why their vision has been rapidly digressing. Getting these patients to the retinal specialists as quickly as possible has reversed these conditions with restoration of vision. These patients become our patients for life.  Referrals begin to come at a faster clip from these patients who go out of their way to make referrals.

Several of our colleagues have approached us during 2011, to see if they could send their patients to us for OCT imaging. Purchasing an OCT is a big investment and it makes sense to refer questionable patients to a local O.D. who has an OCT. Today, we have regular calls from colleague’s calling for that service

During 2011, I have had the privilege of being a consultant to GP Specialists in conducting numerous R&D on several products under development.  Since the beginning of this year, I decided to focus more of my energy in attracting new patients for contact lenses.  Primarily the more difficult to fit cases are attractive to me.  I’m also very much aware that not all patients are good candidates for contact lenses so I use great care in the selection of the patients that are most likely to succeed.

Multifocals: How many of you have been frustrated in fitting presbyopic patients with multifocal lenses? My first choice is gas perm lenses.  Having said that… I find that many of our patients prefer soft lenses.  We do our best to consult with our patients on the best choice for their particular condition.  After hearing our explanation the patient might still be interested in soft lenses but we will most certainly do our best to accommodate them.

During the last quarter of 2011, GP Specialists began to manufacture soft multifocal contact lenses.  I was fortunate to have become a beta testing sight on their behalf.  I’m also pleased to announce that we began with patients whom we had failed to fit with the “out of the box” multifocals.  There is much to be said about custom made multifocal lenses. I myself prefer the aspheric multifocal where the near power resides in the center of the lens. We have also many patients who prefer having the distance Rx in the center of their lenses. GP Specialists were able to manufacture these lenses for our patients needs.

50/50: To this date, we have found that 50% of our patients like the near center while the other 50% likes the distance center design. We found that to be very interesting. When you have time, I would encourage my readers to try their soft multifocals and take a reading in their lensometer to check the power. You will be as surprised as we were. We found that most of the box multifocals power readings were not what was printed on the label. That explained to us why we had failed to satisfy so many of our patients. Once we began to refit these so-called failures, we were able to satisfy over 90% of them with custom made hydrogel multifocals.  That certainly added to our bottom line but most importantly, we now have many more happy multifocal patients.

Phase #2 began in the fitting of numerous patients whom we had previously fitted with boxed lenses. These were all post-refractive grumpy patients. Many had RK surgery, PK, AK, Lasik, etc.  It really did not matter. What did matter was that they wanted to be fitted with soft contact lenses. Yes, the cookie cutter boxed lenses did work but not all the time. Why? The answer was found in the corneal topography maps. Their corneas were flatter (surprise) with some as flat as 32 diopters. Yes, the cookie cutter specials out of the box did fit but eventually they would wrinkle within a short wearing time due to the irregular and flatter K’s giving rise to poor acuity.

Once again, GP Specialists came to our rescue. They made our patient’s various base curves that I requested. Most were in the toric design. The question was with the extreme flattened corneas, would these custom designed lenses stay in position? My answers did not take long.  Working closely with their consultants, Mark Cosgrove and Matt Pogue, the lenses began to fit like a glove on these patients. I call them “Happy people” as they send us gifts and nice cards of appreciation.

Now that I know that GP Specialists are capable of making our patients anything that I can dream of they have become our “go to” custom lab. Now our goal in making 2012 “The year of contact lenses” is no longer a dream.  I would like to applaud our patients who never gave up on us.

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