# Ask the Doctor of Optometry \[formerly student\] **URL:** \ **Category:** In My Humble Opinion\ **Created:** [December 26, 2010, 7:35pm UTC](https://boards.straightdope.com/t/ask-the-doctor-of-optometry-formerly-student/565447 "2010-12-26T19:35:51Z")\ **Posts on this page:** 20\ **Page:** 3
**Author:** ![Ferret\_Herder](https://avatars.discourse-cdn.com/v4/letter/f/e47774/32.png) [@Ferret\_Herder](https://boards.straightdope.com/u/Ferret_Herder)\ **Post date:** [January 6, 2011, 11:45am UTC](https://boards.straightdope.com/t/ask-the-doctor-of-optometry-formerly-student/565447/41 "2011-01-06T11:45:46Z")
It sounds like you had fundus photography done. The fundus is the inside back surface of the eye. An “artifact” in this case almost surely just means a little error caused by the photography method, a missing pixel or something like that. They like to use photos from previous years as comparisons, so if photos are done at your next visit, that will help show if there’s anything real about that white dot. ---
**Author:** ![BobLibDem](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/boblibdem/32/3149_2.png) [@BobLibDem](https://boards.straightdope.com/u/BobLibDem)\ **Post date:** [January 6, 2011, 12:40pm UTC](https://boards.straightdope.com/t/ask-the-doctor-of-optometry-formerly-student/565447/42 "2011-01-06T12:40:46Z")
How good was the best vision you ever saw in a patient? You know, like the cartoon bit where the patient is told to read the chart on the wall and says “Acme Eye Chart Company, Walla Walla Washington” and the doctor’s eyes bug out as he checks the fine print on the chart with a magnifying glass. ---
**Author:** ![cromulent](https://avatars.discourse-cdn.com/v4/letter/c/b4bc9f/32.png) [@cromulent](https://boards.straightdope.com/u/cromulent)\ **Post date:** [January 8, 2011, 7:51pm UTC](https://boards.straightdope.com/t/ask-the-doctor-of-optometry-formerly-student/565447/43 "2011-01-08T19:51:59Z")
**Tony** posted: > [@](#): > > I read quite a lot about how near-sighted people tend to have more floaters, but no explanation as to why this is. Should I be careful about working out or playing tennis because my near-sighted eyes might be more prone to damage? How about a dental drill shaking my skull? If you have degenerative myopia (a particular diagnosis based on retinal appearance) or have had a prior tear or retinal detachment, you may be told to avoid contact sports or anything that increases the risk of head trauma. The risk of retinal detachment is low enough for most average nearsighted people that they shouldn’t go out of their way to avoid head trauma (or at least, no more so than they would anyway). > [@](#): > > I can live with my floaters but I’m afraid that I’ll get one (or more) that isn’t annoying but disabling and then I’ll be told to live with it. Is this possible? And since I notice that I only tend to see the floaters when I’m looking at a bright screen, is it possible to diminish the strength of the floaters by wearing dark or tinted glasses, thereby minimizing the shadow? Some people are quite irritated by floaters. Sometimes a posterior vitreous detachment can cause a articular type of dense floater that may interfere with vision. While there are some ophthalmologists who treat floaters with lasers, it’s not done much and it doesn’t have a great track record. We mostly counsel patients that after the formation of a floater, they will find it easier to “tune it out,” and that dense ones might dissipate somewhat and that can lessen the effect on vision. Even those generally don’t cause a significant decrease in visual acuity. A dense vitreous opacity (as can be caused by blood in the vitreous) can be removed via vitrectomy, or removal of the vitreous humor. This generally occurs due to some other problem in the back of the eye (such as proliferative diabetic retinopathy, or some other issue causing growth of blood vessels). That’s the only example of disabling (as opposed to simply annoying) floaters that I can think of. Tinted lenses can certainly help with minimizing the effects of the floaters. > [@](#): > > By the way, what’s the latest on those contacts you wear at night that shape your cornea so you can see lenses-free throughout the day? I like my eyeglasses but I find this technology interesting. It’s called orthokeratology, and involves using rigid gasp-permeable lenses to re-shape the cornea. It works pretty well on a relatively narrow range of refractive errors (I think up to -4 or so, and less than about 2 diopters of cylinder, but I’m not sure about the exact ranges, and like LASIK and PRK it also depends on the practitioner. ) However the results are not permanent, are generally less stable than refractive surgery, and require a bit more effort on the part of the patient – so people who just want some kind of refractive correction without having to wear glasses and contacts full time may well be better off with LASIK/PRK. I think orthokeratology is best for people who don’t want, or can’t have, refractive surgery. **palacheck** posted: > [@](#): > > What do they call those eye mapping machines? They have a hole you stick each eye up to and the doc moves your head around a bit and out pops a detailed picture of your inner eye. That’s a very technical description I know. **Ferret Herder** is right that this is fundus photography. It sounds like a particular type of fundus photography called Optomap or Optos, which takes a very wide-field view of the retina. Most retinal cameras don’t require you to stick your eye up right to the hole and move your head around. > [@](#): > > Are “artifacts” common? What are they? While examining the picture up on the computer screen, the doctor saw a white speck in or near a capillary that she suspected could be either cholesterol or an “artifact” and she would consult with the main doc and call me if anything serious turned up. I never got a call back. I should have taken initiative and called the office later that day, but I really just kind of forgot. I don’t have cholesterol issues and my vision hasn’t worsened noticeably in the year since then. Yup, they can be very common. One of the skills in analysis of retinal photography is to be able to distinguish artifacts from actual stuff on the back of the eye. I think they’re related to the camera optics, may involve stray light from the camera flash, or might even be small smudges on the lens – it depends on the fundus photography system. **BobLibDem** posted: > [@](#): > > How good was the best vision you ever saw in a patient? You know, like the cartoon bit where the patient is told to read the chart on the wall and says “Acme Eye Chart Company, Walla Walla Washington” and the doctor’s eyes bug out as he checks the fine print on the chart with a magnifying glass. It’s kind of hard to answer this question because the eye charts used at school only go down to 20/13, and the charts we use at the low vision center only go to 20/20 (although they’re moveable and we could potentially test lower visual acuity by moving the chart farther away – but as you might imagine, being a low vision center, this rarely is an issue.) But young people can often test to 20/13 or better. Actually people who are very farsighted will often get better than 20/20 acuity with correction because of the magnifying effects of positive lenses. ---
**Author:** ![lisalan](https://avatars.discourse-cdn.com/v4/letter/l/0ea827/32.png) [@lisalan](https://boards.straightdope.com/u/lisalan)\ **Post date:** [January 8, 2011, 8:02pm UTC](https://boards.straightdope.com/t/ask-the-doctor-of-optometry-formerly-student/565447/44 "2011-01-08T20:02:30Z")
> [@lisalan](#): > > So then I take it there is nothing remarkable about me being able to read microprint when others need to read it using a magnifying glass??? > Darn…and here I was ready to use my powers for good not evil. No reply? ---
**Author:** ![cromulent](https://avatars.discourse-cdn.com/v4/letter/c/b4bc9f/32.png) [@cromulent](https://boards.straightdope.com/u/cromulent)\ **Post date:** [January 8, 2011, 8:13pm UTC](https://boards.straightdope.com/t/ask-the-doctor-of-optometry-formerly-student/565447/45 "2011-01-08T20:13:38Z")
Sorry **Lisalan**! Nope, there is nothing remarkable about your amazing powers – it just basically means your eyes have what amounts built-in magnification ability, with a dioptric power equal to your refractive error (but opposite in sign.) ---
**Author:** ![dmatsch](https://avatars.discourse-cdn.com/v4/letter/d/3be4f8/32.png) [@dmatsch](https://boards.straightdope.com/u/dmatsch)\ **Post date:** [January 12, 2011, 8:17pm UTC](https://boards.straightdope.com/t/ask-the-doctor-of-optometry-formerly-student/565447/46 "2011-01-12T20:17:10Z")
My uncle was an optometrist. His career was cut tragically short when he fell into the lens grinder and made a spectacle out of himself. ---
**Author:** ![Allecher](https://avatars.discourse-cdn.com/v4/letter/a/a6a055/32.png) [@Allecher](https://boards.straightdope.com/u/Allecher)\ **Post date:** [January 13, 2011, 1:23am UTC](https://boards.straightdope.com/t/ask-the-doctor-of-optometry-formerly-student/565447/47 "2011-01-13T01:23:59Z")
I have a question but I don’t think that optometry nor ophthalmology is the perfect answer. Maybe you can steer me in the right direction, though. My upper eyelids have a lot of excess skin. My friend calls it “bedroom eyes” but I call it a pain when all my photographs show my eyes closed or make me look drunk. What type of doctor would help with that? Eye doctor? Plastic surgeon? ---
**Author:** ![cromulent](https://avatars.discourse-cdn.com/v4/letter/c/b4bc9f/32.png) [@cromulent](https://boards.straightdope.com/u/cromulent)\ **Post date:** [January 14, 2011, 11:11pm UTC](https://boards.straightdope.com/t/ask-the-doctor-of-optometry-formerly-student/565447/48 "2011-01-14T23:11:44Z")
> [@Allecher](#): > > I have a question but I don’t think that optometry nor ophthalmology is the perfect answer. Maybe you can steer me in the right direction, though. > > My upper eyelids have a lot of excess skin. My friend calls it “bedroom eyes” but I call it a pain when all my photographs show my eyes closed or make me look drunk. What type of doctor would help with that? Eye doctor? Plastic surgeon? You should see an\*\* oculoplastic surgeon\*\*, generally a type of ophthalmologist sub-specialist, although it’s possible there are plastic surgeons trained to do this too. ---
**Author:** ![purplehorseshoe](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/purplehorseshoe/32/2996_2.png) [@purplehorseshoe](https://boards.straightdope.com/u/purplehorseshoe)\ **Post date:** [January 14, 2011, 11:59pm UTC](https://boards.straightdope.com/t/ask-the-doctor-of-optometry-formerly-student/565447/49 "2011-01-14T23:59:40Z")
Is the eye-puff test on its way out? I went to the eye dr. for the first time in years (no insurance after losing my job) and was dreading that part. I HATEHATEHATE the eye puff. He didn’t do it. Yay! What he did do, that I’ve never experienced before, was putting some drops into my eyes that, according to the doc, glow under a blacklight. They also made me feel like I’d just come off a four-hour crying jag. But I didn’t catch his explanation of what he was doing - I was mostly nervous because his hands were shaking when he was putting the drops in. Sooo … 1) is the eye puff test becoming obsolete? and 2) what was that stuff he put in my eyes, why did it make them feel _exactly_ like I’d been crying, and what was he testing for? Please, please tell me they’re doing away with the eye puff. (Can you tell how much I hate that thing yet?) ---
**Author:** ![Ferret\_Herder](https://avatars.discourse-cdn.com/v4/letter/f/e47774/32.png) [@Ferret\_Herder](https://boards.straightdope.com/u/Ferret_Herder)\ **Post date:** [January 15, 2011, 1:02am UTC](https://boards.straightdope.com/t/ask-the-doctor-of-optometry-formerly-student/565447/50 "2011-01-15T01:02:06Z")
> [@purplehorseshoe](#): > > Is the eye-puff test on its way out? I went to the eye dr. for the first time in years (no insurance after losing my job) and was dreading that part. I HATEHATEHATE the eye puff. > > He didn’t do it. Yay! > > What he did do, that I’ve never experienced before, was putting some drops into my eyes that, according to the doc, glow under a blacklight. They also made me feel like I’d just come off a four-hour crying jag. But I didn’t catch his explanation of what he was doing - I was mostly nervous because his hands were shaking when he was putting the drops in. > > Sooo … 1) is the eye puff test becoming obsolete? and 2) what was that stuff he put in my eyes, why did it make them feel _exactly_ like I’d been crying, and what was he testing for? > > Please, please tell me they’re doing away with the eye puff. (Can you tell how much I hate that thing yet?) Going to snipe this one again. 😃 **cromulent** can follow up with if the “air puff” is still being used and if there are other common methods. Where I work, we use two methods. The first, what you almost surely had, is Goldmann applanation tonometry. The drop put in your eye is a fluorescing dye (the glowy part) combined with a topical anesthetic (aka “numbing drop”), typically under the brand names Flurox or Fluress. Numbing drops usually make your eyes feel all dried out and funny anyway; I don’t know if that dye adds to the effect or not. The dye temporarily stains the surface of the eye and helps show any damage (abrasions, severe dry eye, etc.). The numbing drop lets a little blue light-emitting cone (built into the “chin rest” part of the equipment) gently touch the surface of the eye without bothering your eye, so the pressure can be measured. The other method we use is called a [Tonopen](http://www.proceduresconsult.com/medical-procedures/measurement-of-intraocular-pressure-tono-pen-technique-EM-procedure.aspx). It looks an awful lot like an in-ear thermometer; it’s a plastic hand-held device with a button and digital display on the barrel, and a metal tip. A little condom-like rubber cover is slipped over the metal tip. That tip has a little flat end that depresses easily. We put a numbing drop (no dye in this one) in the eye, and then tap gently a few times on the surface of the eyeball to measure the pressure. ---
**Author:** ![cromulent](https://avatars.discourse-cdn.com/v4/letter/c/b4bc9f/32.png) [@cromulent](https://boards.straightdope.com/u/cromulent)\ **Post date:** [January 16, 2011, 3:47am UTC](https://boards.straightdope.com/t/ask-the-doctor-of-optometry-formerly-student/565447/51 "2011-01-16T03:47:53Z")
> [@purplehorseshoe](#): > > Is the eye-puff test on its way out? I went to the eye dr. for the first time in years (no insurance after losing my job) and was dreading that part. I HATEHATEHATE the eye puff. > > He didn’t do it. Yay! > > What he did do, that I’ve never experienced before, was putting some drops into my eyes that, according to the doc, glow under a blacklight. They also made me feel like I’d just come off a four-hour crying jag. But I didn’t catch his explanation of what he was doing - I was mostly nervous because his hands were shaking when he was putting the drops in. > > Sooo … 1) is the eye puff test becoming obsolete? and 2) what was that stuff he put in my eyes, why did it make them feel _exactly_ like I’d been crying, and what was he testing for? > Please, please tell me they’re doing away with the eye puff. (Can you tell how much I hate that thing yet?) **Ferret Herder** is right that what you had was Goldmann applanation tonometry. Another method that is basically the same thing, but involves a hand-held device and not something attached to a table, is the “Perkins” tonometer. The air-puff test, aka non-contact tonometry (NCT), is still commonly used. It’s generally less accurate than the Goldmann test, although recent NCTs are increasingly accurate. At my school’s clinic, we preferentially use Goldmann, but if someone is going to be inserting contact lenses during the exam or right after, or if a patient doesn’t want eye drops for whatever reason, we do NCT. The dye that’s used in the Fluress eyedrops **Ferret Herder** mentioned can stain contact lenses. In general, NCT is perfectly fine as a screening test, but if your eye pressure is high or there is suspicion that it might be, or you need more accurate monitoring of eye pressure (such as if you’re a glaucoma patient, or a glaucoma suspect) then Goldmann is the “gold standard,” no pun intended! ---
**Author:** ![Autolycus](https://avatars.discourse-cdn.com/v4/letter/a/22d042/32.png) [@Autolycus](https://boards.straightdope.com/u/Autolycus)\ **Post date:** [January 18, 2011, 1:20am UTC](https://boards.straightdope.com/t/ask-the-doctor-of-optometry-formerly-student/565447/52 "2011-01-18T01:20:11Z")
> [@cromulent](#): > > It’s called orthokeratology, and involves using rigid gasp-permeable lenses to re-shape the cornea. Do these lenses have to be worn every single day to achieve the desired effect? I ask this because I can see myself really liking this, however as an irresponsible young adult I sometimes forget my pre-sleep rituals. Leaving contacts in every now and then was no huge deal, but I imagine this might be quite different. ---
**Author:** ![cromulent](https://avatars.discourse-cdn.com/v4/letter/c/b4bc9f/32.png) [@cromulent](https://boards.straightdope.com/u/cromulent)\ **Post date:** [January 19, 2011, 1:21am UTC](https://boards.straightdope.com/t/ask-the-doctor-of-optometry-formerly-student/565447/53 "2011-01-19T01:21:00Z")
> [@Autolycus](#): > > Do these lenses have to be worn every single day to achieve the desired effect? I ask this because I can see myself really liking this, however as an irresponsible young adult I sometimes forget my pre-sleep rituals. Leaving contacts in every now and then was no huge deal, but I imagine this might be quite different. Well, most patients undergoing orthokeratology wear the contact lenses while sleeping, so if you left the lenses in while sleeping, you’d actually be following directions. 😛 As far as forgetting to put them in at night – to my understanding, once your prescription has stabilized with orthokeratology (i.e. past the initial period, the duration of which is dependent on your starting prescription) you may be able to occasionally skip a night of contact lens wear. I haven’t worked with orthokeratology at all, so I couldn’t tell you how common that is. Remember that one of the points of orthokeratology is that it’s reversible – if you stop wearing the lenses, your eyes will eventually return to their starting prescription. That’s either a benefit or a drawback depending on your point of view. ---
**Author:** ![cromulent](https://avatars.discourse-cdn.com/v4/letter/c/b4bc9f/32.png) [@cromulent](https://boards.straightdope.com/u/cromulent)\ **Post date:** [June 6, 2011, 2:27am UTC](https://boards.straightdope.com/t/ask-the-doctor-of-optometry-formerly-student/565447/54 "2011-06-06T02:27:42Z")
So, this thread is still open for questions… But as of today, I can change the title to “Ask the Doctor of Optometry.”😃 ---
**Author:** ![congodwarf](https://avatars.discourse-cdn.com/v4/letter/c/e36b37/32.png) [@congodwarf](https://boards.straightdope.com/u/congodwarf)\ **Post date:** [June 6, 2011, 2:59am UTC](https://boards.straightdope.com/t/ask-the-doctor-of-optometry-formerly-student/565447/55 "2011-06-06T02:59:17Z")
Congratulations!!! ---
**Author:** ![BigT](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/bigt/32/12044_2.png) [@BigT](https://boards.straightdope.com/u/BigT)\ **Post date:** [June 6, 2011, 6:11am UTC](https://boards.straightdope.com/t/ask-the-doctor-of-optometry-formerly-student/565447/56 "2011-06-06T06:11:49Z")
> [@cromulent](#): > > So, this thread is still open for questions… But as of today, I can change the title to “Ask the Doctor of Optometry.”😃 Congrats! Go for it. Report your thread. It’d be cool. ---
**Author:** ![needscoffee](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/needscoffee/32/1076_2.png) [@needscoffee](https://boards.straightdope.com/u/needscoffee)\ **Post date:** [June 6, 2011, 7:36am UTC](https://boards.straightdope.com/t/ask-the-doctor-of-optometry-formerly-student/565447/57 "2011-06-06T07:36:36Z")
Congratulations! So now we can ask the really hard questions? When I got my eyes examined the last week, the optometrist didn’t dilate my pupils, or use that fluorescent strip in my eye. Did I get gypped? ---
**Author:** ![Ellen\_Cherry](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/ellen_cherry/32/3600_2.png) [@Ellen\_Cherry](https://boards.straightdope.com/u/Ellen_Cherry)\ **Post date:** [June 6, 2011, 12:49pm UTC](https://boards.straightdope.com/t/ask-the-doctor-of-optometry-formerly-student/565447/58 "2011-06-06T12:49:22Z")
Congrats, Crom! I’ll _see_ if I can change the title. 🙂 ---
**Author:** ![Khadaji](https://avatars.discourse-cdn.com/v4/letter/k/9e8a1a/32.png) [@Khadaji](https://boards.straightdope.com/u/Khadaji)\ **Post date:** [June 6, 2011, 2:09pm UTC](https://boards.straightdope.com/t/ask-the-doctor-of-optometry-formerly-student/565447/59 "2011-06-06T14:09:47Z")
Congrats **cromulent!** Wishing you luck and joy in your new career! ---
**Author:** ![cromulent](https://avatars.discourse-cdn.com/v4/letter/c/b4bc9f/32.png) [@cromulent](https://boards.straightdope.com/u/cromulent)\ **Post date:** [June 7, 2011, 1:03am UTC](https://boards.straightdope.com/t/ask-the-doctor-of-optometry-formerly-student/565447/60 "2011-06-07T01:03:30Z")
Thanks for the congrats, everyone! > [@needscoffee](#): > > Congratulations! > > So now we can ask the really hard questions? > > When I got my eyes examined the last week, the optometrist didn’t dilate my pupils, or use that fluorescent strip in my eye. Did I get gypped? It sorta depends. If you’re young with no symptoms/risk factors or ocular pathology, you don’t really need to get dilated every year. My school’s clinic is more conservative than most (in terms of dilating basically everyone) and even we tell people between the ages of about 10 to 65 with no obvious risk factors that they only need to be dilated every other year. But I still offer it to all my patients, even if it isn’t specifically indicated. As far as the fluorescent strip, so long as you had some form of eye pressure test (such as the air puff) you’re probably good to go. There are situations where the Goldmann test, involving fluorescein and a topical anesthetic, is necessary, since it’s generally more accurate. But the air puff test is fine for screening. There are also situations where the dye is used on its own to assess corneal integrity, but unless there’s a specific reason to do this (such as trauma to the eye, foreign body sensation, or eye pain) your doctor can reasonably skip this test. [Previous page](https://boards.straightdope.com/t/ask-the-doctor-of-optometry-formerly-student/565447.md?page=2) [Next page](https://boards.straightdope.com/t/ask-the-doctor-of-optometry-formerly-student/565447.md?page=4)