When you hear hoofbeats, sometimes it IS a zebra!

From Dr. Robert Levy

There's an old saying in medicine and healthcare: "If you hear hoofbeats, think horses, not zebras." What that means, is that when you listen to a patient's symptoms and complaints, you should think of the most obvious and common things it could be, and not the unusual or rare things that it could be.

But yesterday, I saw a zebra!

I had a 94-year-old patient who one week ago presented to the emergency room with a complaint of an extremely painful right eye. The emergency room doctor told her she probably got soap in her eye, and flushed it out, and recommended that she see an eye doctor the next day, and gave her the name of a well-regarded opthalmologist in her area. She went to that doctor the next day, still in pain, and he diagnosed a corneal erosion; the sloughing off of the top layer of the cornea. He bandaged the cornea with a bandage contact lens, gave her several drops to use (lubricants for comfort, and an antibiotic to prevent infection) and saw her back the next day. He told her she was significantly better the next day, and scheduled a follow-up for one week later. She came to see me two days before that scheduled one-week follow up, still in pain. I took a look at her cornea, and it was clean as a whistle! No sign of any abrasion or erosion, and nothing visibly wrong with the eye. But she was in so much pain she was literally crying. Further probing of her symptoms revealed that her teeth and jaws hurt when she ate, or chewed, or brushed her teeth, and she had pain in her forehead, and radiating back to her ear. At this point, I knew it was more than just her eye, and diagnosed trigeminal neuralgia.

The trigeminal nerves are one of the twelve pairs of cranial nerves that leave the brain and go directly to parts of the body; this one is called the "trigeminal nerve" because it has three branches - one that goes to the eye, one that goes to the upper jaw, and one that goes to the lower jaw. When she related her eating, chewing, and brushing complaints, I knew it had to be that. "Neuralgia" means nerve pain, and that is what she had. I referred her to a neurologist who will be able to treat her symptoms and finally give her some relief.

So the point of this story is not to pat myself on the back for coming up with a less-than-usual diagnosis, but to advise people to tell doctors ALL your symptoms, even if you don't think they're relevant. If she had mentioned the jaw and teeth involvement a week ago at the ER, or the next day in the corneal specialist's office, they may have been able to come up with the same diagnosis as well. But because she was going to "an eye doctor", she didn't think the teeth and jaw symptoms were important, and she only brought up the eye pain.

Today's optometrists are trained to diagnose far more than eye problems, as long as there is some ocular involvement that brings the patient into our office to begin with!

I look forward to receiving the neurologist's report, and to seeing the patient back when the neurologist discharges her, hopefully finally free of pain!

Dr. Levy's Jeapardy episode is fun to watch!

Dr. Levy claims that his buzzer wasn't working correctly during the first part of the Jeapardy episode. He was clicking 'too fast', and he was told during the commercial break that he actually had to wait before clicking in order for the computer to register his click! Perhaps that is true, or was it just rigged? Well, after he learned the secret, Dr. Levy raises his meager score of 0 to 7600, tying the champion! It gets more exciting, though, during Final Jeapardy, when the two contestants are tied and they battle the last question... For the first time in over 14 years, there is an unusual outcome to the game!

View the episode on youtube: http://www.youtube.com/watch?v=yVEMvybyhb8&NR=1

The myths and facts about Ted Williams' vision

From Dr. Robert Levy:

So Dr. Paull's recent entry about our 20/10 patient reminded me of the late great Red Sox player, Ted Williams, one of the greatest baseball hitters of all time. Williams was rumored to be able to see 20/3 (able to see from 20 feet away what a normal-sighted patient can see from three feet away); rumored to be able to see the seams on a baseball as they approached him at 90-100 miles-per-hour and tell by the spin of the seams whether the ball was going to be a fastball (straight pitch) or a breaking ball (curve ball or the like); was rumored to be able to read the label on a 78rpm record as it spun (records are what we had before compact discs and mp3s, for you young-uns).

While these make for amusing stories, Williams himself admitted that none of them were true. He DID in fact have 20/10 acuity, same as our star patient from the last blog entry, meaning he could see from 20 feet away what normal-sighted people could see from 10 feet away - but the other myths and legends were just that, myths and legends. Although as he entered the Marines as a pilot in World War 2, the ophthalmologist performing Williams' entry examination said his vision was on the order of a "1 in 100,000 occurrence."

Still, this remarkable vision was one contributing factor to his being one of the best hitters of all time, and to date, the last player to hit over .400 for an entire season. His lifetime batting average ranks among the best of all-time as well.

So he may not have been able to see the seams on a spinning baseball, or read the label on a spinning 78rpm record, but his actual visual acuity is still legendary.

Lions Club Helps Save Eyesight

The Lions Club of Brandermill-Midlothian-Woodlake has many fun-loving volunteers who serve the community. Besides helping to provide free eye exams and glasses for needy individuals, they help raise money for the blind and provide services for the hearing impaired. Taking time from their day, they enthusiastically serve the needs of our community with little or no recognition.


Bob and Alan (pictured above) are local Lions members who helped check the distance and near visual acuities in one station of the vision screening.

On Thursday, January 20th, 5 volunteers from the Lions Club assisted Dr. Paull in screening 41 home-schooled children for vision disorders. Although most children passed with good results, there were several children who needed additional attention. For example, one 7-year old boy was found to have normal 20/20 vision in his left eye, but 20/100 vision in his right eye. His mother had never known that he had much blurrier vision in his right eye because he had always compensated for it when both eyes were open. Thinking back, she did remember that he would often rub his right eye only when they were reading, but she never knew it was due to a vision disorder. Thankfully, his condition was caught early, during the critical period of vision development. He can receive correction for his right eye now so that he can develop the proper brain connections between his right and left eyes and develop proper 3-D vision.


Many thanks are given to the Lions Club volunteers for their tireless efforts to promote better vision health for both our community and others throughout the world. Did you know that over 12 million children have been screened by international Lions Club members? If you would like more information about joining a community club, please visit http://www.lionsclubs.org/EN/becoming-a-lion/index.php. You may also join a 'cyber club', whose participants meet online! Joining a club is not only great fun and fellowship for each member, but it helps many others in the community and abroad.

King of Vision

Congratulations to Greg L. - he is the King of Vision for our optometric practice! He even beats Dr. Paull and all the associates in the practice.

Greg told Dr. Paull that he had always had super vision with his contact lenses (he wears Air Optix Night & Day lenses). Dr. Paull looked at his high prescription (-8.00), and she knew that his uncorrected visual acuities were so bad that he couldn't even read the 20/400 "Big E". She did not really believe that he could have an 'eagle eye', due to his high nearsightedness. It is harder for him to see small letters because images are made even smaller with higher prescriptions for nearsightedness.

However, Greg surprised Dr. Paull by reading all 5 letters on the 20/10 line without a problem! Erynn, the optometric technician, was brought into the room to confirm that Greg could actually read a perfect 20/10. That means that what the average person could read 10 feet away, Greg can see it 20 feet away. That is almost impossible, because most people have distortions in the cornea, lens, and other media that the lightwaves pass through in order to be seen by the retina. Additionally, the neurological cells that are stimulated by the lightwaves must be small enough to distinguish the wavelengths from the small letters. Science has shown that if the eye was 'perfect' and if all the media was completely clear, then the best theoretically possible vision would be 20/8 because of the limit of the cells based on their size. Greg is one of the few in the world that has this near-perfect vision. Right now, there is no officially documented "Guinness Book of World Records" holder or best vision, but perhaps Greg should hold that title!

We will be checking our patients carefully this year, to see if anyone can come close to Greg's vision. If not, he will reign as King of Vision indefinitely!

Red eyes? Don't go grabbing just any eyedrop!

If you have red, irritated eyes, you may be tempted to grab the nearest bottle of Visine "Get the Red Out". These eyedrops contain a special ingredient which temporarily constricst the blood vessels, helping the eyes to whiten in most cases. However, there is a 'rebound reaction', and the blood vessels can return. Sometimes people become dependent on them, and if you read the small print on the bottle label, it might say "Overuse may cause more redness". Great!

Eye redness may be due to multiple factors. Sometimes staring at a computer screen all day can dry out the eye and cause redness. Eye fatigue, dryness, irritation, allergies, infection and contact lenses can all contribute to mild redness. It is best to have a thorough exam where your tear film can be evaluated and we can determine the cause and extent of your redness.

Some mild dry eye and redness problems can be solved with over-the-counter eyedrops. I have a few favorites, but it depends on each person as to which one works best for them. Some are formulated better for allergies, some are for severe dry eye, and some are for mild dry eye. There are also several prescription eye drops which help relieve more persistent cases of redness or dry eye.

If you have trouble with dry, irritated or red eyes, please do not settle for an eyedrop that might make things worse! Come in and see us for a thorough, personal exam to determine the best treatment for you!

You are what you see...

What do you see to the left? A young lady or an old woman?

I see the back of a young lady, but if you look closely enough, you will notice that it could also be a picture of an old woman. Turn the young lady's ear into a wrinkled eye, and turn the young chin into a crooked nose of an old woman.

This optical illusion is a reminder that there is often more than one way to 'see' any situation. If we undergo a hardship in life, it may look like an 'old woman' when in reality it is a 'young lady' full of life and promise.

What is your 'old woman' that needs to be turned into a 'young lady'? I am reminded of a patient who came to our office for an exam because his labrador puppy had chewed up his expensive glasses. He was so mad at that puppy! However, because of the exam and the retinal photos that were taken, it was found that he had early stages of an eye disease. It turns out the puppy may have saved his vision because his condition was managed at an early stage and will not progress to vision loss.

I believe that any, and I mean any negative situation can be turned around for good. Look at it in a positive light and it will become a positive experience. We are what we see... Let's see the good in any situation!

If you have a story you'd like to share to help encourage the rest of us, don't be shy! Feel free to leave your story below.

Struggling in school? How to check for hidden vision disorders

Did you know that 80% of learning depends on vision? Make sure your child does not have a hidden vision disorder that may contribute to poor learning in school. They may not even know they have a problem because they think everyone else sees the blurriness that they see!

The American Public Health Association recommends eye exams at the ages of 6 months, 2 years, and 4 years. After age 5, they recommend exams at least every 1-2 years, depending on the needs of the individual.

Common vision disorders are:

Nearsightedness (Myopia): Objects at near are in focus, but objects at a distance are blurry.

Farsightedness (Hyperopia): Objects far away may be in focus, but objects up close may be blurry or require additional work in order to keep clear. Sometimes people with high amounts of farsightedness have blurry vision even at a distance.

Astigmatism: Objects such as letters are blurry, distorted, or may seem double. This may be noticeable both at distance and near.

Rare, but more serious conditions include:

Lazy eye (Amblyopia): Objects are out of focus usually only in one eye due to poor development of the visual system or a problem with the visual pathway. This may or may not be associated with an eye turn (strabismus).

Convergence insufficiency: The eyes have difficulty turning inwards while focusing to read. This may cause double vision or a decreased ability to concentrate while reading.

What to check for in children or adults:

• Squinting
• Holding a book very close to the eyes
• Frequent eye rubbing
• Closing one eye
• Headaches
• Blurry or double vision
• Tilting the head
• Short attention span
• Avoiding near work

A thorough exam is necessary to determine what treatments could help. Some conditions are simply treated with glasses, whereas other cases may require vision therapy or specialized treatment plans. The gift of clear vision enables a person to perform to their highest potential both at school and socially. During the critical period of development and as a child or teenager grows, it is even more important that they have regular eye examinations to make sure they are performing their best!

If you know of a child or teenager who is struggling in school or exhibiting any of the above symptoms, an eye exam may help. Appointments can be made at 272-0848, or online at www.RichmondOptometry.com. Check yearly, see clearly!

Can contact lenses be TOO comfortable?

The latest advances in technology have created contact lenses that are very breathable and even approved for overnight wear. I do not recommend overnight wear of soft contacts on a general basis. Recent studies have shown that sleeping in soft contact lenses can increase your risk of a bacterial infection by 8-10 times. However, some patients have accidently overworn their lenses without even knowing it!

Dr. Levy had an experience that he describes:

"A middle aged father came in for an exam complaining that his one eye had been blurry for a month. I took a look at him behind the biomicroscope, and asked him how long this badly coated and deposited contact lens had been on. "What are you talking about?" he asked; "I don't wear contacts!" "Sir," I replied, "I guarantee you that I am looking at a contact lens on your eye, and it is badly coated with deposits." "But I don't wear contacts," he protested; "I only borrowed a pair from my son for a race about a month ago." "And how long has that eye been blurry?" I asked. "About... a ... month..." came the sheepish reply. I just smiled, didn't say a word, and he took the dirty lens out."

A month? In someone else's dirty contacts? He was very fortunate that his 'tough' eyes did not experience more severe consequences, such as infection, blisters, or severe dryness.

We will take advantage of the excellent new comfortable contact lens technology, but we will use this responsibly to provide the best vision and eye health. Just remember to take your lenses out and clean them daily, and to NEVER borrow someone elses contacts!

Please don't let this happen to you!

Giant papillary conjunctivitis (GPC) can arise from contact lens abuse, such as not taking them out daily, or not throwing them way at the recommended time period prescribed by the doctor. The overwear of contacts may cause a patient to develop small little 'blisters' underneath the eyelid, such as those shown in this picture. Think of how painful a blister on your foot can be - well a blister in your eye can be quite painful! Please wear your contacts safely and responsibly!

Slightly Nerdy but Helpful Bed Spectacles

Not the prettiest glasses in the world. I use these "Bed Spectacles" while lying flat on my back on my couch. However, even though I am looking straight up at the ceiling, I am actually viewing my computer laptop on my lap. These glasses allow you to lie flat on your back and look up, but you actually see something about 90 degrees below, such as a computer, a book, or TV. Do you know of anyone confined to a bed and is sick of looking at the ceiling? How about using them to peek around corners and spy? Maybe I could bring them to the dentist next time and see what he is really doing!


PROS: A person can watch TV or do computer work while lying flat on their back and looking straight up.


CONS: Due to gravity, they kept sliding onto my face and hitting my eyelashes so that I couldn't blink. The secret to wearing them is to put the temples outside of your ears to hold them off your face a little so they don't slide into you.

I also noticed my eyes would dry out after a while because I was holding them open so wide looking up at the ceiling. It was better when I took the glasses off and tilted my head at an angle and my eyes were slightly closed. However, some people may not be able to tilt their head if they are in a neck brace, etc.




Even though I am lying flat on my back and you have a great view of my chin, you can see my eyeballs peeking through the glasses.

There are actually different types of these glasses, and I do not endorse any particular brand. I have yet to find one that is adjustable so that you can alter the angle from 90 degrees to any any degree. Let me know if you find one!

These sell at for $27.25 from Amazon at: http://www.amazon.com/Reizen-Prism-Bed-Spectacles/dp/B003I7HOF6/ref=pd_sbs_hpc_1