chemical_refraction


























  1. This is not a snarky comment. I was once a tech, also an optician, also a front desk person, and now I am a doctor. The bullshit never ends. I always thought it would but it doesn't. The only question is are you paid enough for your own happiness (sounds like not)...so all you need to do is decide on going a whole new direction or same direction with better environment? Pay? Stress? Whatever you say is the issue is my point. But never...NEVER plan on them just handing it to you. You take it or leave it for somewhere new...that is it. Don't listen to anything else.

  2. First eye exam is 6mo to 1 year of age. Normally what ends up happening is first eye exam is around 5 years old when school gets into the picture. The fact that this patient didn't have an exam till 58 is surprising because even those folks usually come for their first eye exam around age 40 when accommodation starts to kick the bucket.

  3. My two cents: if they are a hyperope you can run into a situation where they won't adapt to the full amount vs undilated. Otherwise you can simply do a dry refraction if they need an RX check. I advise making sure the damp refraction is somewhat close to an autorefraction before the dilation in certain situations.

  4. I wish I had more info than the OCT but keep in your differentials: adult onset vitelliform dystrophy(early), solar/laser retinopathy, and CSR.

  5. Just trying to understand. What would lead you think of adult vitelliform as a possible form that oct ?

  6. If you look at the left side of the video as the OCT raster goes down the lesion appears to be round and lighter colored. The patient is the right age for adult onset vitelliform(which again wouldn't be my top differential with this info alone). And while I agree the OCT is not the classic look of this lesion, the early phase can present as some mild fluid before progression.

  7. That question doesn’t mean much to me. If it’s preflop I think they’re trying to see if they have the correct odds to call with a suited connector or something.

  8. Especially true on a draw. Had myself a nit the other night and I asked the question knowing full well he had a made hand. When they had less than an min buy behind I knew it was shove/gamble or just get out cheap. I chose to fold.

  9. I mean, Jenny was sexually assaulted by her father and numerous other men, and died of AIDS.

  10. That definitely was worth the read and opens the dynamics of the story up significantly, but how in the hell do people just have a link for a post made 10 years ago. Do people keep a repository with links similar to how some store memes?

  11. I don't have it saved, I just remember it from all those years ago. I find it fun to share any time a Jenny debate comes up.

  12. Best thing to do is have a cycloplegic refraction and probably some binocular vision testing. Either way for now I might just keep with the appointments for either the neuro/pediatric ophthalmologist as they should also be able to initially assess these things.

  13. How would I go about asking for that testing?

  14. It's doing the glasses prescription while your eyes are dilated from the drops. This ensures you are not overminused. You could bring these ideas to them but generally speaking these things will be checked anyway in addition to other concerns they will have while having all the information from previous exams.

  15. I'm surprised with something persistent no topical antibiotics were tried in conjunction with the keflex. Also what kind of warm compress are you using...a wash cloth with hot water is not going to get the job done compared to a heat mask that delivers consistent heat for 10-20 minutes. As far as drops are concerned try preservative free drops in case you are sensitive to preservatives in the normal bottles. I think you should get a second opinion from an office that is more medically/dry eye oriented.

  16. I asked the opto whether we need oral or topical and he advised oral would be much stronger. I use bruder mask heated in microwave. Is the any topical antibiotic drops that are preservative free? I couldn’t find any brand. I’m seeing an ophthalmologist soon, this inflammation is still persistent.

  17. Yes oral is better, but using both can be helpful. Persistent lesions sometimes need to be biopsied but that might not be the case right away. The mask you are using should be fine. I don't think you are having/going to have any issues with preservatives in your prescription drugs...just lubricants since they get used more often per day. I would just keep doing what you are doing until the ophthalmology appointment.

  18. This is just an example of how you can manipulate words to sound like what you mean and in the proper context aren't the same as the word you are using. Math is already "made up" in other words the rules are rules because we decided on the rules.

  19. What you are describing is likely just presbyopia. Happens to everyone as they approach their 40s. Got to the grocery store and get some +1.00 over the counter readers and see if the same issue persists. Keep using the drops. Then make an eye appointment.

  20. Normally you can monitor retinal holes, especially small ones, but as soon as fluid is getting into the hole retinal tears and detachment become a higher risk. You are going to the specialist and they are likely going to offer laser as a prophylactic measure to prevent that risk. Think of your retina as wallpaper, and the retinal hole as a small defect in that wallpaper. The fluid getting under the wallpaper causes more of the wall paper to fall down...which is not what you want. The laser is like putting tacks around the edge of the wallpaper with a defect. I recommend following your specialist's advice after they look at it.

  21. I appreciate your answer!! I’ve been so anxious about this, especially since the doctor I saw couldn’t answer any of my questions. I see the specialist in 3 weeks and plan on following whatever they suggest.

  22. Many. Sometimes it is in an area of thinning (lattice degeneration) and sometimes it is because the jelly in the eye (vitreous) has been tugging on the retina, finally causing a hole...and sometimes it's just a shoulder-shrug and no one know why it happened.

  23. From the photo alone it appears to be a localised subconjunctival haemorrhage. It’s the equivalent of a bruise on your body. It can happen spontaneously and causes are almost always idiopathic. Look closely in the mirror and check to see it is not crossing the limbus. Lubricating eye drops can be used for comfort and you should notice an improvement in 72hrs with it fully healed within 2 weeks. You should have no pain, light sensitivity, visual changes or history of recent trauma. Some patients are more prone to these than others. Tell your optometrist is these are reoccurring or other symptoms are experienced.

  24. It's not a subconj heme, it's sectoral episcleritis, or just to put it more plainly a section of the bulbar conj which is irritated. Plenty of reasons it can happen, again not super concerning as it can also resolve on its own...but if it is irritating enough she should go see her eye doc for a mild steroid and an evaluation for any causes that may be present.

  25. The drops that make your pupils big have a secondary effect called cycloplegia. This means the lens in the eye is temporarily paralyzed and won't allow you to see up close. Just as an FYI what you experienced with the drops is what you will experience into your 40s and beyond and which is why older people have bifocal glasses. It should wear off and the bigger the +plus prescription you have the more difficulty you will have seeing up close without the glasses, and with the glasses will only help a little until the cycloplegia wears off.

  26. I don’t understand the relevance of the 2nd question nor have I ever thought about it or known that to be the case?

  27. Since we both know a lens doesn't magically dry out more in a particular gaze I think it is easy to equate the words dry out = feel the lens more, which is probably a fancy way to say either their lids catch the edge of the lens in a particular gaze or maybe edge fluting in said gaze. That would be my interpretation in any case.

  28. For my own education, how can you tell just by looking that the dilation is due to a chemical?

  29. First I'll say that it is not an all or none situation. You can't really know the right answer the same way you can answer a multiple choice question on an exam. But I can tell you from experience how I know or at least feel "scared vs not scared" for the patient.

  30. Do the scop. patches that dilate the eye still make up close vision appear blurry ?

  31. Yes all anticholinergics cause cycloplegia (paralysis of the accommodative lens). The one that optos use most is Tropicamide since it wears off in a couple hours rather than scopolamine which lasts much longer; 24-72 hrs.

  32. This is true as it's a farm team, but we have no other pro sports within ~2.5hrs so it is our best local sports team we have. Although if you did this at their choice of college football stadium the same fans would be on the turf mauling refs

  33. I still think you are describing an actual community. Without getting into the mud of politics I can tell you most people don't find their "neighbors" their actual neighbor. They are simply a person living near them. Smaller communities rely on each other more and therefore bonds actually form to at least describe "etiquette" and "hey I gotta see these guys tomorrow too"...as opposed to a major city event where everyone are strangers by another name.

  34. Farm team is the term for MLB minor league team... My city is still ~500k people metro area

  35. I'm horrified by this picture, and yet I can't look away.

  36. https://www.dailymail.co.uk/news/article-12689081/amp/Ohio-social-worker-Payton-Shires-24-accused-having-sex-13-year-old-boy-counseling-wedding-planning-fianc-new-mother-backed-DEATH-PENALTY-pedophiles.html

  37. To add to this, almost 99% of the time the contact was indeed removed and the feeling my patient had was a small ulcer or abrasion...OP should definitely get it checked.

  38. Is there like a “mildly upset upvote” sub because I’m not mad but also not happy haha

  39. But I’m not angry I’m just mildly upset haha. I know that sub and was referencing that but I want a less angry one

  40. Angry I think is overstated and it's meant more to mean "groan" or "reluctant".

  41. Probably a nevus or melanosis, nothing to be overly worried about. Check old pictures, they likely were present before.

  42. I was going to say it's probably an axenfold loop. But before and after pics are still useful.

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